Chronological development
The Kingdom of Thailand has its own system of traditional medicine called “Thai traditional medicine” (TTM) that was gradually developed throughout the country’s history as a means of health care for the Thai people.
Table 1: Chronological development of Thai traditional medicine
| Years | Historical milestones |
| Before Sukhothai period (before 1238 AD) | Stone inscriptions showed that as many as 102 “Arokayasala” (hospitals) were built during King Jayavarman VII (1181-1219) of Khmer, some were located in the northeast of Thailand. The names of some herbal materials used in Arokayasala were shown in the inscriptions. |
| Sukhothai period (1238-1583 AD) | Historical evidence suggested the use of herbal medicines for oral use in the form of decoction and plaster for external use. |
| Ayutthaya period (1350-1767 AD) | During the reign of King Trilokanat (1448-1488), directory of feudal status in terms of farmland for civil servants showed that there were departments of medical services, pharmacy, internal medicine, massage therapy, ophthalmology, and tuberculosis. Tamra Phra Osod Phra Narai (or King Narai Drug Formulary), the first official textbook of TTM compiling drug recipes used by 7 royal physicians in the royal court of King Narai the Great (1656-1688) and 2 private practitioners were compiled. Among the 7 royal physicians, 3 were foreigners (Chinese, Indian, and westerner). This very important document is transmitted to present. |
| Rattanakosin period (1782-present) | After the new capital was moved to Bangkok where the Rattanakosin period began in 1782, King Rama I (1782-1811), King Rama II (1809-1824) and King Rama III (1824-1851) played an important role in the revival of TTM that was lost or destroyed during the war, and in the provision of health education to Thai people. Over 1,000 drug recipes and the knowledge of TTM regarding the origin of diseases and their treatments, the principles of Thai traditional massage and stretch exercise called ruesi dadton were gathered and inscribed on marble tablets and placed on the walls of two temples, namely Wat Pho and Wat Raja Orasaram. |
| The reign of King Rama V (1868-1910) | The influence of Western medicine, which was introduced into Thailand by missionaries and Western physicians during the reign of King Rama III, gradually increased. |
| 1887 | Siriraj Hospital, the first Western-style hospital and medical school, was officially opened. Initially, both TTM and modern medicine services were provided and the medical school established later in 1889 taught both disciplines of medicine. |
| 1889 | Three volumes of medical textbook called Paetsart Songkroh covering both Thai traditional medicine and western medicine disciplines were published for use at the medical school. |
| 1907 | Textbook of medicine called Tamra Phaetsart Songkroh Chabap Luang regarded as the first Thai national formulary covering 10 scriptures of TTM was published in 2 volumes as well as another descriptive medicine textbook Tamra Vejjasart Wanna for the teaching of medical students. |
| 1908 | Tamra Phaetsart Sangkhep or Vejjasartsueksa, written by Phraya Phitsanuprasartvej (Moh Khong), were published in 3 volumes. They are still official textbooks of TTM recognized by the Thai Food and Drug Administration (FDA) for the registration of traditional medicines. Several drug formulae in this textbook were produced for sale by the government dispensary before World War II and are still in use nowadays as some were selected as traditional household remedies and in the current National List of Essential Medicines. |
| The reign of King Rama VI (1910-1925) | In 1916, the teaching of TTM at the medical school of Siriraj Hospital was discontinued as the two medical disciplines were considered incompatible. Later in 1918, the teaching of Thai traditional pharmacy (wicha ya Thai) in the pharmacy training curriculum (laksut phaetprungya) was also discontinued. |
| 1923 | The Medical Act B.E. 2466 (1923) was promulgated for controlling the practice of the art of healing led to the decline of the practice of TTM. |
| The reign of King Rama VII (1925-1934) | In 1929, Ministerial Regulation was issued categorizing the practitioners of the art of healing into modern and traditional medicines and defining TTM as the practice on the basis of observations and skills passed on through generations, or based on ancient textbooks, not on scientific principles. TTM was categorized into 4 branches (medicine, pharmacy, midwifery, and massage therapy). |
| 1932 | Traditional Medicine Practitioners Association was set up. |
| The reign of King Rama VIII (1934-1946) | The practice of the Art of Healing Act B.E. 2479 (1936) was enacted, repealing the Medical Act B.E. 2466. TTM was categorized into only 3 branches; i.e., Thai medicine, Thai pharmacy, and Thai obstetrics (no Thai massage branch). |
| 1942 | The Ministry of Public Health was established. |
| The reign of King Rama IX (1946-present) | In 1951, while visiting Wat Pho, the King suggested that a school teaching TTM should be established at Wat Pho as it was the center of TTM knowledge. As a result, “Traditional Medical School of Thailand” was established at Wat Pho offering training courses on Thai medicine, Thai pharmacy, and Thai manual therapy. In 1957 Wat Phra Chetuphon (Wat Pho) Traditional Medicine Association was established offering training courses on Thai medicine and Thai pharmacy, followed by Thai massage training in 1963. |
| 1980 | Professor Dr. Ouay Ketusingh established Thai Traditional Medicine Promotion Foundation under the Royal Patronage of HRH Princess Maha Chakri Sirindhorn and the Patronage of the Buddhist Supreme Patriarch. |
| 1982 | The foundation established Ayurved Vidhayalai School (Jevaka Komarapaj) for the teaching of applied Thai traditional medicine (3-year curriculum) and the clinic of applied TTM was opened at the school in 1984. |
| 1989 | Collaborating Center for the Development of Thai Traditional Medicine and Pharmacy was established by the Ministry of Public Heath. |
| 1993 | Institute of Thai Traditional Medicine (ITTM) was established under the Department of Medical Services by upgrading the above collaborating center to the institute level Federation of Thai Traditional Medicine Practitioners of Thailand was established comprising of 28 foundations, association and clubs working on TTM. |
| 1999 | The practice of the Art of Healing Act B.E. 2542 (1999) was enacted.Protection and Promotion of Thai Traditional Medicine Wisdom Act B.E. 2542 (1999) came into force on 27 May 2000. |
| 2002 | Establishment of the Department for Development of Thai Traditional and Alternative Medicine (DTAM) under the Ministry of Public Health. |
Current Practice
- Modern medicine is the main medical system in Thailand.
- Under the Practice of the Art of Healing Act B.E. 2542 (1999), the Ministry of Public Health officially recognizes 3 types of TM/CAM as branches of “the Art of Healing”; namely, Thai traditional medicine(TT), traditional Chinese medicine (TCM), and chiropractic.
- The “Department for the development of Thai Traditional and Alternative Medicine” (DTAM) was established on 3rd October 2002 under the Ministry of Public Health. DTAM is responsible for the development and management of TTM knowledge, scrutinizing TTM and CAM knowledge, integrating of TTM and selected CAM in the health care system, setting up the standard of TTM&CAM services, and enforcing the Protection and Promotion of Thai Traditional Medicine Knowledge Act. B.E 2542 (1999). As TTM and CAM as well as indigenous medicine involve various sectors; e.g., related government offices, universities, research institutions, private sector, civil society, practitioners and their foundations, etc.. DTAM has therefore collaborated with the above-mentioned allied network in order to develop quality TM/CAM that is safe and effective in the health care system.
Prevalence
- Nowadays Thai traditional medicines services are covered by all three health security systems of Thailand;namely,
- Welfare for the medical treatment of government officials (including their parents and children < 20 years of age, a total of about 5 million people),
- The social security system of Social Security Office for employees of private businesses (for about 9-10 million people (about 48 million). However, the benefit of TTM services covered by each system may vary.
- To promote the use of TTM and self-reliance on health care of the country, in 2007 the NHSO established the “Fund for the development of Thai Traditionally Medicine System” providing additional on-top funding for public health service facilities that provide TTM services in order to stimulate the provision of TTM services for out-patients, especially Thai traditional medicines and herbal medicines, Thai traditional massage for therapeutic and rehabilitative purpose as well as post-partum care. The on-top funding has gradually increased from 0.50 baht/capita in 2007 to 7.20Baht/capita in 2012.
- In 2011, the total number of times people received TTM treatment modalities in public health service facilities was 3,644,304 increasing from 2,725,896 in 2010 by 33.7%
- In 2011, there are 10,692 public health service facilities providing TTM services. Of these, 95 are regional or general hospitals, 733 are community hospitals, and 9,864 are tambon (sub-district) health promotion hospitals (previously health stations).
- In 2010, the data of healthcare service provided in public health service facilities indicated that 81.7% were for treatment and rehabilitation and 18.3% were for health promotion and disease prevention. Regarding services for therapeutic and rehabilitative purposes, 32.6% were Thai traditional massage, 23.5% were herbal steam baths, and 20.5% were traditional/ herbal medicines. For the coverage for the cost of services provided, 34.4% were by UC program, 23.7% were by welfare for government officials, 2.7% were by social security system, and 39.1% were paid out of patient’s own pocket
- Nowadays among Thai people who seek health care services in public health service facilities, about 10% receive TTM treatment modalities. To promote the use of herbal medicines and Thai traditional medicines in the health care system, in 2011, the list of herbal medicines in the National List of Essential Medicines was expanded from 19 items to 71 items as more licensed herbal medicinal products, traditional household remedies, and herbal hospitals formularies were selected into the list. Of those, 21 are single herbal medicine and 50 are Thai traditional medicine recipes.
Official Body
Department for Development of Thai Traditional and Alternative Medicine (DTAM)
Contact
Adress:
Deparment for the Development of Tahi Traditional and Alternative Medicine,
Ministry of Public Health,
Tiwanont Road, Muang District
Nonthaburi 11000
Thailand
Contact No: +66 2591 4409, +66 2591 7809, +66 2591 0319
Fax No : +66 2591 4409
Email : [email protected]
Webiste: http://www.dtam.moph.go.th
Main therapies
Under the National Health Security system, the types of TM/CAM services covered by the three health security system are as follows:
Thai traditional medicine
1. The treatment and diagnosis with
1.1 Thai traditional medicine
1.2 Applied Thai traditional medicine
2. The treatment and rehabilitation with
2.1Traditional herbal medicines or traditional recipes composed of medicinal plant materials
2.2 Therapeutic massage for treatment and rehabilitation
2.3 Herbal steam bath for therapeutic purpose
2.4 Hot herbal compress for therapeutic purpose
2.5 hot salt pot compress for post-partum care (not covered by the welfare for medical treatment of government officials)
Traditional Chinese medicine
- Acupuncture
Policy & Regulations
Policy
The national policy to promote the use of Thai traditional medicine, indigenous medicine, and alternative medicine in the health care system and in primary health care as stated in key related national plans; namely, the National Economic and Social and Development Plan, National health Development Plan developed in line with the former, National Health Act, Statue on National Health System, and National Strategic Plan on the Development of ‘Tai’ Wisdom, ‘Tai’ Healthy Lifestyle.
Guideline
Institute of Thai Traditional Medicine in cooperation with other networking organization have developed various tools and guidelines to facilitate the provision of Thai traditional medicine in health service facilities;
i.e,
Regulation
Acts related to TM/CAM and the regulatory bodies are;-
- Drug Act B.E. 2510- Food and Drug Administration, Ministry of Public Health. To comply with ASEAN harmonization of rules and regulations on product registration, production standards, and quality control of traditional medicinal products, Thai FDA recently issued Ministry of Public health Regulation and Submission for License and the Issuance of License for the Production, sale, or Import of Traditional Medicines into the kingdom B.E. 2555 ( 2012) that was published in the Royal Gazette on 4 July 2012. To enforce the above mentioned Ministerial Regulation, Ministerial Notification on GMP of Traditional Medicines is currently under consideration and formulation. Before the Ministerial Notification will be issued, manufacturers are required to follow the GMP guideline 2005.
- Practice of the Art of Healing Act B.E. 2542 (1999)- Profession Commission in the Branch of Thai Traditional Medicine, Profession Commission in the Branch of Applied Thai traditional Medicine, Profession Commission in the Branch of Traditional Chinese Medicine of which the Bureau of Sanatorium and Art of Practice, Department of Health Service Support served as the secretariat office
- Protection and promotion of Thai Traditional Medicine Knowledge B.E 2542 (1999)- Department for Development of Thai Traditional and Alternative Medicine by Protection of Thai Traditional Medicine Knowledge Division
- Plant Varieties Protection Act, B.E 2542 (1999)- department of Agriculture, Ministry of Agriculture and Cooperatives.
Facilities
As previously mentioned, in 2012, there are 10,692 public health service facilities providing TTM services. Of these, 95 are regional or general hospitals, 733 are community hospitals, and 9864 are tambon (sub-district) health promotion hospitals (previously health stations).
To strengthen TTM service in the health care system further, in 2011 there was an establishment of 9 pilot TTM hospitals under the Ministry of Public health and 4 hospitals under the Ministry of Education, and a Thai Traditional Medicine and Integrative medicine Hospital in Bangkok under the administration of DTAM. Lessons learned from the pilot TTM hospitals will help develop an appropriate model of TTM hospitals in the future.
Such TTM hospitals are:-
| Hospitals | Province |
| TTM Hospitals under the Ministry of Public Health | |
| Chophaya Abhaibhubejhr Hospital | Prachinburi |
| U-Thong Hospital | Suphanburi |
| Phrapokklao Hospital | Chanthaburi |
| Wangnamyen Hospital | Sra-Khaew |
| Wattananakorn Hospital | Sra-Khaew |
| Khunhan Hospital | Sri-sa-ket |
| Denchai Crown Prince Hospital | Prae |
| Tarongchang Hospital | Suratthani |
| Thoeng Hospital | Chiang Rai |
| TTM Hospitals under Ministry of Education | |
| Chiangrai Rajabhat University | Chiangrai |
| Rajamangala University of Technology, Isan (Sakonnakhon Campus) | Sakonnakhon |
| Prince of Songkla University | Songkla |
| Suan Sunandha Rajabhat University | Bangkok |
Insurance coverage
Not available
Research Institute/s
Some leading research institutes conducting research on TTM and medicinal plants are:-
- Institute of Thai Traditional Medicine (ITTM), Department for Development of Thai Traditional & Alternative Medicine
- Thai Traditional Medicine Research Institute, Department for Development of Thai Traditional & Alternative Medicine
- Medicinal Plant Research Institute, Department of Medical Sciences
- Thailand Institute of Scientific and Technological Research (TISTR)
- Research and Development Institute, The Government Pharmaceutical Organization (GPO)
- Faculty of Pharmacy, Mahidol University
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
- Faculty of Pharmaceutical Sciences, Chulalongkorn University
- Division of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University
- Natural Products Research and Development Center (NPRDC), Faculty of Pharmacy, Chiang Mai University
- Faculty of Pharmaceutical Sciences, Khon Kaen University
- Cosmetics and Natural Products Research Center, Faculty of Pharmaceutical Sciences, Naresuan University
- Phytomedicine and Pharmaceutical Biotechnology Research Center (PPBRC), Prince of Songkla University
In addition to the above mentioned institutes, other universities that offer four-year undergraduate and postgraduate courses in TTM or Applied TTM also conduct research on Thai traditional medicine and Thai indigenous medicine as a part of the curriculum in partial fulfillment of B.S., M.S, and Ph.D. Degrees of the students.
Training and Education
Thai traditional medicine
The educational systems of TTM can be divided into two major types based on the types of practitioners, namely: –
1. The systems producing “Thai traditional medicine practitioners”.
The education in this system can be either by ‘apprenticeship with an authorized licensed practitioner’ (original way of learning & teaching) or by ‘studying in a certified academic institution’.
Under the apprenticeship system, a person who would like to be registered and obtain license as a practitioner in the branch of Thai traditional medicine must have official document of apprenticeship approved by Profession Commission in the branch of Thai traditional medicine and Certificate of completion of training from an authorized TTM teacher (who is also licensed TTM practitioner) in an institute or clinic certified by the Profession Commission. The period of apprenticeship under an authorized teacher (of the same area of TTM) varies depending on the areas of TTM; namely: –
- Thai traditional medicine – not less than 3 years of apprenticeship
- Thai traditional pharmacy – not less than 2 years of apprenticeship
- Thai traditional midwifery – not less than 1 year of apprenticeship
- Thai traditional massage – not less than 2 years of apprenticeship
Regarding the study of Thai traditional medicine in a certified academic institution, as an interest in TTM and alternative medicine among Thai people greatly increased since the early 2000’s, increasing numbers of universities and academic institutions have responded by offering four-year Bachelor degree education in TTM. University graduates still have to take separate licensing examinations to become licensed traditional medicine practitioners in each of the four fields of TTM practice.
Training and education in Thai traditional massage or Nuad Thai
Under the Ministry of Public Health Notification issued on 1 February 2001, therapeutic Thai massage is regarded as a branch of TTM. As a result, the registration and licensing of TTM practitioners in the field of Thai massage, the conditions and the regulation of practice will be according to the Practice of the Art of Healing Act B.E. 2542. The Profession Commission in the branch of Thai traditional medicine developed the standard curriculum for the profession of TTM in the field of Thai massage requiring a total duration of training of not less than 2 years (800 hours curriculum) before being eligible for licensing examination. Thai massage training institutes must also be certified by the Profession Commission if their training curriculum complies with the standard curriculum.
Curriculum for Thai traditional medicine assistants
For the training of “Thai traditional medicine assistants” who are allowed to practice the certain task of TTM practitioners in health service facilities under the supervision of other licensed practitioners, the Profession Commission in the branch of TTM developed and officially announced the 330-hour training curriculum for TTM assistants in 2007, training in Thai massage is the main part of this curriculum.
2. The system producing “Applied Thai traditional medicine practitioners”.
This education system is given by certified academic educational institution only. The four-year curriculum includes some basic life science and basic medical clinical science knowledge, e.g. anatomy, physiology, biochemistry, pathology, pharmacology, and botany and pharmacognosy as prerequisite courses, together with the lectures and clinical training of Thai traditional medicine, pharmacy, midwifery, court-type Thai traditional therapeutic massage, and midwifery medicine. Licensed applied TTM practitioners can therefore practice in every field of Thai traditional medicine.
Teaching Institutions of Thai traditional medicine
As of October 2012, there are 21 universities of which the curricula were certified by Profession Commissions. Certified schools/universities are as follows: –
Universities offering Bachelor’ Degree in Applied Thai traditional medicine
- School of Health Science, Mae Fah Luang University
- Faculty of Medicine Siriraj Hospital, Mahidol University
- Division of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University (Rangsit Campus)
- Faculty of Abhaibhubejhr Thai Traditional Medicine, Burapha University
- Faculty of Public Health, Naresuan University
- Thai Traditional Medicine College, Rajamangala University of Technology, Thanyaburi (Pathumthanee Campus)
- Faculty of Medicine, Mahasarakham University
- Faculty of Science and Technology, Suan Sunandha Rajabhat University
Universities offering Bachelor’s Degree in Thai traditional medicine
- College of Thai Traditional and Alternative Medicine, Ubon Ratchathani Rajabhat University
- Faculty of Natural Resource, Rajamangala University of Technology, Isan (Sakonnakhon Campus)
- School of Traditional and Alternative Medicine, Chiangrai Rajabhat University
- Faculty of Traditional Thai Medicine, Prince of Songkla University
- Faculty of Oriental Medicine, Rangsit University
- Faculty of Science and Technology, Bansomdejchaopraya Rajabhat University
- Faculty of Science and Technology, Surindra Rajabhat University
- Institute of Health Science, Ramkhamhaeng University
- Sirindhorn College of Public Health Yala, Associate Institute of Yala Rajabhat University
- College for Muay Thai Study and Thai Traditional Medicine, Muban Chombueng Rajabhat University
- Faculty of Science and Technology, Phetchaburi Rajabhat University
- Sirindhorn College of Public Health Phitsanulok, Associate Institute of Rajamangala University of Technology, Isan (Sakonnakhon Campus)
- Kanjanapisek College of Medical and Public Health Technology, Associate Institute of Rajamangala University of Technology, Isan (Sakonnakhon Campus)
Universities offering postgraduate courses in Thai traditional medicine
- College of Public Health Science, Chulalongkorn University (M.S. & Ph.D.)
- Thammasat University (M.S.)
- Rangsit University (M.S.)
- Suan Sunandha Rajabhat University
Traditional Chinese Medicine (TCM)
The Ministry of Public Health by Bureau of Sanatorium and Art of Healing, Department of Health Service Support, which serves as the secretariat office of the Profession Commission of Traditional Chinese Medicine, is responsible for organizing TCM licensing examination once a year. As of September 2011, the Ministry of Public Health has issued license for the practice of TCM to 388 qualified persons. Among these, 309 are TCM doctors who learned TCM from their ancestors and lived in Thailand for more than 3 years, while 79 are TCM doctors who received Bachelor’s Degree in TCM from universities in Thailand or abroad.
Institutions that teach TCM – Currently, there are 3 universities and college that offer five-year Bachelor of Science degree in TCM curriculum and are certified by the Profession Commission in the Branch of Traditional Chinese Medicine; namely –
1. Faculty of Chinese Medicine, Huachiew Chalermprakiet University with technical support from Shanghai University of Traditional Chinese medicine
2. Alternative Medical College, Chandrakasem Rajabhat University with technical support from Xiamen University and Liaoning University of Traditional Chinese Medicine
3. Faculty of Science Program Traditional Chinese Medicine, Nakhonratchasima College with technical support from Chengdu University of Traditional Chinese Medicine
In addition, to TCM practitioners, modern medicine doctors or physicians who passed the three-month course on acupuncture certified by the Ministry of Public Health can also give acupuncture treatment for the patients in health service facilities. As of September 2011, there were 1,004 physicians who completed this three-month training course on acupuncture offered by the Southeast Asian Institute of Thai-Chinese, DTAM in collaboration with TCM universities in the People’s Republic of China.
Links
- Institute of Thai Traditional Medicine (DTAM)
- Institute of Thai Traditional Medicine (DTAM)
- Southeast Asian Institute of Thai-Chinese Medicine
- Bureau of Drug Control, Food and Drug Administration
- Bureau of Sanatorium and Art of Healing, Department of Health Service Support
- Institute of Thai Traditional Medicine (DTAM)
- Institute of Thai Traditional Medicine (DTAM)
- Southeast Asian Institute of Thai-Chinese Medicine
- Bureau of Drug Control, Food and Drug Administration
- Bureau of Sanatorium and Art of Healing, Department of Health Service Support
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