MetaphorandIllnessClassification inTraditionalThaiMedicine
SCOTTBAMBER Australian NationalUniversityCanberra,A.C.T.
INTRODUCTION^ I n an early article, the medical anthropologist
Arthur Kleinman referred
totheclassificationofillnessasbeingtheinitial therapeuticact (1973:
209).That is,theclassificationofillness alonemaymakea significant
contributiontothehealingprocess.Byclassificationismeanttheor-
dering ofparticulargroupsofsymptoms intotheentities whichwere-
cognizeasillnesses.Thepresentstudywillendeavortoshowhow,
withrespecttotraditional Thai medicine,thehypothesis that
classifica- tion plays an active part in therapy is supported by
the seemingly strange useofmetaphorin the naming ofillnesses.
Before embarking on an analysis ofmetaphor in Thai medicine it is
necessarytosay something more on the waysin whichtherapyand the
classificationofillnessmayberelated.TheanthropologistVictor Turner,
in reference to the symbolic aspects ofNdembu medicine, wrote that:
(Therapyis)partlyaprocessofmakinghiddenandsecretthings visibleand
thereby accessible, ifthey are harmful, to redressiveand remedial
action(1967: 302-303). That is, by providing an identity for the
affliction, a significantcontribu-
tionismadetothehealingprocess.The identitywhichisprovided
maybemadeintermsofspiritbeliefs,asTurnerdescribes,inwhich case it
satisfies an emphasis on revealingwhyan illness afflicts a person.
Alternativelyitmayexplainintheoreticaltermshowan illnessafflicts
someone, as inIndic medicineand scientific medicine,where the prob-
AsianFolkloreStudies, Vol. 46,1987: 179-195. 180SCOTTBAMBER lemis
elaboratedin terms ofbiologicalprocesses.Thai medicineem-
bodiesexplanationsforbothofthesequestionssince,althoughmany
aspectsare obviouslyIndic in origin, forexample the medical texts
and the theory,Thai medicinealsoacknowledges thatthereis
ananimistic - sidetoillness.Thi s
isoftenrevealedinthetreatmentofanillness.
ForexampleinnortheasternThailand whenmedicine is prepared,care
istakentopreventshadowsfallingacrossthepot,sinceitisbelieved that
sprits mayseize the advantage ofthe darknessto drain the mixture
ofitsgoodness.Whetheranexplanationresultsin,say,thepropitia- tion
ofspirits, or the administrationofValium, there is a high
likelihood
thathealingwilloccur.Asmanyasuccessfulmedicalpractitioneris
aware,aconfidentdiagnosis is often therapeutically ofbetter value
than to leavea patient in a state ofdoubt. I n the process
ofrendering the symptoms experienced by the patient into a form
whichcan be grasped intellectually,symbols, especially ver- bal
symbols, playan importantrole.One ofthe more striking illustra-
tions in the literature ofthe power ofsymbols to effect healing is
perhaps thatgivenbyLCvi-Strauss.HedescribesaritualusedbytheCuna
Indians ofSouth Americatofacilitateadifficultchildbirth.The phy-
sician is in this case a shaman, and his technique is to guide the
distressed womanonasymbolic journeyintoherwombtoseekthecauseofthe
difficulty.Oncetheimpedimentisidentified,birthoccursnormally. Thus,
by what LCvi-Straussterms a " psychologicalmanipulationofthe
sickorgan,"physiologicalchangesaremadepossible(1972:186-192).
Ofinterest in LCvi-Strauss'description is his use ofthe term " lan-
guage " toreferto the symbols providedbytheshaman forthe use of the
sickwoman.This in fact highlightsan importantdifferencein the
waythat verbalsymbols areusedinconnectionwith illness:theymay
occuraspartoftheordinarysymbolsoflanguage,asintheexample
above,wherethe individualwordsarepassivein function,alternatively
theindividualwordsmayplayamoreactiverole,beingcontextually
unusual.This type ofusageembraces the trope, ofwhich metaphoris,
from our pointofview, the most important kind(Fernandez 1974: 122).
Metaphorhasbeendefined simplyas the transferenceofaspectsofone
objecttoanother(Hawkes1972: 1)orasFernandezexpressedit,as " the
predicationofa sign-imageupon an inchoate subject " (Fernandez
1974: 120).I n the following discussionaratherwideinterpretationof
metaphor has beenadopted, more in keeping with the first ofthe
defini- tionsgivenabove.Anexampleofthistypeofusagemaybeseenin the
names accorded illnesses by the Ainupeopleofthe SakhalinIslands
nearJapan.AccordingtoOhnuki-Tierney,intheirclassificationof
headaches the Ainuhavesuchcategories as" bearclaw,"" woodpeck-
METAPHORANDILLNESSCLASSIFICATIONI NTHAILAND181 er,"" lamprey,"and"
dog,"whichare primarilydistinguishedonthe
basisoftheaudioortactilecharacteristicsoftheseanimals.Forex-
amplea" woodpeckerheadache"islikethesoundofawoodpecker
boringintoatreetrunk,a" dogheadache " likeadoggnawingona
bone,andthe" lamprey " typelike the persistent sucking ofa lamprey
(1981:51). A substantial amount ofresearch over recent years has
indicatedthe active role playedbymetaphor in cognitive arousal
(Fernandez 1972: 43 ; Paivio1979:
151-152)andproblemsolving(Ortony1979: 16;Black 1979:
37;Jackson1983: 138).Afurtherbodyofresearchpointsboth to links
between thoseareasofthe brainconcerned with the interpreta-
tionofspeechandthose responsiblefor themediationoftheemotions,
andthelatterandthebody'simmunesystem(BradyandNauta1972:
181-182;Steinetal.1980: 1963).Thus theremaywellbe anatomical and
physiological links which wouldenable the" movement " generated
bymetaphor(Fernandez1972: 43)toaffectthoseorgansofthebody
concernedwithhealingandimmunity.Thattheselinksdoindeed existis
borneout byrecentstudies whichshowthatpsycho-socialfac- tors,such
as stress or anxietycausedfor example bybereavement,may
resultinadepressionofhumoral andcell-mediatedimmunity,and may
influencetheincidenceofinfections,allergies,andauto-immunedis-
eases(Stein et al.1980: 1961-1962,1966; Moerman1979: 61).
Tosummarizethusfar,thereductionoftheillnessfromanun- known to a
known entity may be achievedby symbolism, of which meta- phor is an
important type.Rather than fulfilling this function passively,
metaphoractivatescognitive processes.Links betweenthepartofthe
brainwheretheseprocessesoccurandthebody'simmunesystemsug- gest that
metaphor may be capable ofinfluencing a person'ssusceptibili- ty to
illness, or the healing process.
ILLNESSCLASSIFICATIONINTRADITIONALTHAIMEDICINE Turning
nowtotheclassificationofillnessesinThaimedicine,a rep-
resentativecategoryfrom traditionalThai medicine will be examined
in ordertodeterminetheextentto whichthehypothesisadvancedabove
provides an explanation for the naming ofinternal illnesses.The
illness category which will be examined is krasai2 and is described
in the collec- tionoftraditionalmedical texts publishedbytheCollege
ofTraditional
MedicineatWatPh6inBangkok.Thesetexts,calledthePhiietsiit Songkhro,
are derived from the texts formerly usedby the Royal Physi-
ciansattheThaiCourt.3The followinganalysisisbasedononeof
thesetexts,thePhrakhamph? Krasai,andissupplementedbyinforma-
tiontranscribedfrom the wallplaquesat Wat PhG4 as wellasinforma-
182SCOTTBAMBER tionobtainedfrompractitionersoftraditionalThai
medicineandvil- lagers in central Thailand during interviews
conducted in 1984 and1986. The wordkrasai isderived from the
Sanskrit k~aya, which refers to the conditionofemaciation, that is,
to a symptom, ratherthan an illness category.Thedescriptions
ofkrasai inthetextdonotstressemacia- tionas a
salientfeature,ratherthe descriptions are ofarangeofsymp- toms
generally located in the lower abdominal area.These include such
categories recognizedin scientific medicine as hernia,
urino-genitalafflic-
tions,ulcers,andpossiblygallbladderillness.Thisisinagreement
withtheopinions ofcentral Thai villagerswhowerequestionedin this
studymostofwhomsaidkrasaireferredtokidneyafflictions(r6ktai).
Bradley'sThai dictionarywhichdates from the late nineteenthcentury
alsoemphasizesthe locationofsymptoms in thelowerabdomen (Brad-
ley:1873).However,despitethisevidence,twomajordictionaries
(McFarland's Thai-EnglishDictionaryandthe Photthaniinukrom chabap
Riichabanditsathzn) both define krasai as an illness
characterizedbyema- ciation. THENUMBERINGOFILLNESSCATEGORIES I tis
in the numberoftypes ofkrasai that wefirstencounter metaphor.
Villagersgenerallyonlyknowoffourorfive typesofkrasai,whichare
usuallygivenas" earth,"" fire,"" wind,"" water,"and" blood."
Oftenthenumberisgivensimplyas" onehundredandeight."The
numberonehundredandeightisofcoursemetaphoricalinthiscon-
text,andmeans" alot,"or" many."Its useisofIndicorigin,be- ing
verycommonin Hinduism andBuddhism. This
typeofnumbersymbolismisalsoveryevidentinthetext.
Astheaccompanyingtableshows(SeeTable1.)twenty-sixtypesof krasaiare
describedin the texts.Though this numberis ofnospecial
significance,thedescriptionsofkrasaiaresubdividedinthetextinto
twogroups,onecomprisingeightandtheothereighteentypes.Both
ofthesenumbersaresignificant.The numbereightoccurs elsewhere
inthetexts,beinggivenasthenumberoftypesofpuang,anillness affecting
the gastro-intestinaltract(PS : 1 : 47), and ofpradong,a catego-
ryofskin affiictions(PS: 2: 186-187).The numbereight isfrequently
encountered in Thai culture and its special significance appears to
be of Indic origin(Heinze1977: 98), the numberfiguring
prominentlyin the contextofBuddhistphilosphy,forexampleasthe"
NobleEight-Fold Path."Ayurvedic medicine recognizes eight divisions
ofillnesses which were adopted byBuddhism (Heinze 1977: 88;
Takakusu1896: 127-128). The numbereighteenonthe other handis
notcommonly foundin
theThaimedicaltexts,orelsewhereinThaiculture.Interestingly,
METAPHORANDILLNESSCLASSIFICATIONINTHAILAND183 Krasai Table
"Element"Krasai \ (unla belled)6: din("solid) nam("liquid)
phlueng("movement") lom("vine") thaw nam lom fai("heat")
.Ion("overflowing") 0. r2k("vomiting") 11. lek("iron") 12.
pO("crab") 13. Ehuk("colicky") 14. plalai("eel") 15. pla
m0("doctorfish") 16. pla duk("catfish") "Spontaneous"Knsai17.
pluak("termite") 18. lin knbl("buffa10tongue") 19.taw("turtle")
0.dan("lumpy") 1.thon("excessive") 2.siar("stabbing-pain") 3.
phloeng 4.nam 25.chu'ak("rope") 6.lom 1.The twenty-six types
ofkrasai described in the Phrakhamphi Krasai. however,the
numbereighteenoccurs in someSri Lankanmedical texts believedto be
derived from Malayalam texts originating in South India,
whereseveraloftheillnesscategoriesaredividedintoeighteentypes
(Obeyesekere1969 : 198-199). I
wouldsuggestthattheuseofnumericalsymbolisminthiscon- textis
anotherexample ofthe reductionofillness toa graspableentity: it is
important that the types ofkrasai befinite andclassifiable into the
specifiedcategories.Thatthisisnotalwayspossibleisborneoutby
thefactthatthereisconsiderablerepetitionorduplicationamongthe
184SCOTT BAMBER descriptionsofthedifferent types ofkrasai.Blocks
ofinformationap- peartobeincludedsimplyinorder tofillout
thecategoriesto thepre- determinednumber. The second encounter with
metaphor comes in the naming of the twenty- six
typesofkrasai.Itisconvenienttodescribetheseintwosections,
correspondingto the groups ofeightand eighteen specified in the
krasai text.Of the first group ofeight krasai, five types are
included in another
taxon,kl6n,withtheremainingthreebeingsubordinatedirectly tothe
krasai t a ~ o n . ~ SevenofthesetypesarenamedaccordingtoIndichu-
moral theory, that is, they are namedfor the four elements
ofwhichthe humanbodyisthoughttobecomposed:earth,wind,fireandwater.
Theseelementsmaybestbethoughtofasaclassificationofthebody
basedonmetaphor:ratherthanbeinginterpretedliterally,theyshould
betakenasrepresentingthequalities ofthethingsforwhichtheyare
named.Thus earthstandsforthatwhichissolid, jireforheat,wind
forthequalityofmovement,andwaterfor that whichis liquid. Illnesses
are namedaccording to whichofthese qualities is involved in a
particular case.For example " wind illness " may involve the body's
nervoussystem,suchasinParkinson'sDisease,paralysis,orepilepsy. The
partial facial paralysis suffered byKing Mongkut was thus described
as"windillness"bytheSiameseCourtphysicians.This wasmuch
tothedispleasureoftheAmericandoctorBradley,whotookthemeta-
phorliterally,thinkingthattheSiameseattributedtheafflictiontothe
entry ofwind into the body (Bradley1836). WithinIndic
theorythereisalsoaclassificationbasedonthreeof
theseelements:wind;heat,whichismanifestedasbile;andliquid,
whichismanifestedasmucus.Collectivelythesethreeelementsare
knownasthetridoja.6Whilenoexplicitreferencesaremadetothis
theoryinthePhrakhamphi Krasai,thetertiarytheorymayexplainthe
repetitionofthenamesoftheelementswithin the firstgroupofkrasai
illnesses,sincetherepeatednamescorrespondtothoseofthetridoja.
Thesethreeelementsalsooccurwithinthesecondgroupofeighteen krasai
illnesses.The remainingmemberofthefirstgroup,thatisthe
fifthtypeofklcn,krasaithaw,whichdoesnotbearthenameofan element,is
problematic.Iwouldsuggest its inclusionin this sectionis
forthepurposeofcompletingthefulleighttypes,sinceitsnameand
descriptionbearstrong similaritiesto taxaappearingin thesecondmain
groupofkrasai illnesses. Thesecondgroupofkrasaiillnessesaretermed"
spontaneous" afflictions in the text.Asidefrom the three types
correspondingtothe METAPHORANDILLNESSCLASSIFICATIONINTHAILAND185
tridofa,whichhavealreadybeendiscussed,thecategoriesinthissec-
tionbearnoresemblancetohumoraltheory,eitherinnameorsymp-
toms.Whileitis temptingtosuggestthattheserepresentindigenous
Thaicategories,itismorelikelythatthevariousnamesofillnesstaxa in
this sectionmaysimplyrepresentthe translationofIndic terms into
Thai.Ifso,thisinstanceissignificant,forelsewhereinThaimedi-
cine,eveninthe textsfromnorthernThailandwhichrepresentamore
folk-influencedtradition,Indicnamestendtoberetained.' The
taxainfactbearastrongresemblancetoothertypesofTaifolkclassification,whichasdescribedbyChamberlain(1977:
35-36) generallyutilize"
outstandingcharacteristicsoftheorganism'snatural
history."Theseclassificationsarecharacteristicallypolythetic,
thatis, thoughthemembersofaparticulartaxonomymayshare features from
arangeofattributes,orin thecase ofillness,symptoms, noneofthem
possessalltheseattributes.Thi sisgenerallytrueofkrasai,buta
stronger link is the emphasis on certain types ofsymbolism in the
actual symptomaticdescriptions.I tisnotproposedtoelaboratehereonthe
use ofsymbols in the diagnostic descriptionsofillnesses, apart from
say- ing that theychieflyinvolvespatial and
temporalconsiderations,among whichthelocationofsymptoms
withrespecttotheheadandfeet,and the phasesofthe moonare important.
Oftheeighteentypesofkrasai,thenamesofnineare metaphors. I
willconcentrate onanexaminationoftheseratherthantheothersix
whichbearsymptomatically-descriptivenamesandthethreewhichare
namedfor theelements.Ofthe ninewhichemploymetaphors,seven,
possiblyeight, are animal-related.Animalsare widelyusedas vehicles
formetaphor,and as Tambiah has indicated, theyfrequently embodya
complexofsymbolicassociationswhichareculture-specific(Tambiah 1969:
457).Thi s argues againstthe possible assumption oftheir selec-
tionbeingsimplyanarbitrarymeansofclassification.I n factthose
animalsusedin ,the classificationofkrasai dopossesscertainfeatures
in common,althoughtheseemergeonlyoncloseexamination.
Thesefeaturesareoftwotypes,whicharelinked:edibilityand
habitat.Firstly, regardingedibility,and bearinginmind that diet may
varymarkedlywithin culturesandevenbetweenhouseholds (Chamber-
lain1977: 30),all the categoriesare namedforanimalswhichmay form
partoftheThai diet.Withtheexceptionofthebuffalo-tongueand termite
types, theseareallwatercreatures (sat ndm).8This providesa
cluetotheseconddistinguishing feature, whichistheabilityofallthe
creatures namedto move betweentwo environments. I tis obviousthat
thecraband the turtle mayinhabit twoenviron-
ments,buttheothercreaturesusedinnamingofthesecategoriesalso
186SCOTTBAMBER havethispotential.The catfish(plEduk) mayleaveone
watersystem and wriggle to another (Davidson1975: 58).The eel (pla
lai) may bury itselfin mud to survive the drying out
ofwatercourses(Davidson1975:
89),andthedoctorfish(p1Emd)maysimilarlyleavethewater,having
beenknowntoclimbtrees(Davidson1975: 74).Withregardtothe
twocategories buffalo-tongue and termite, both ofthese also occupy
two environments.Thetongueoccupiesawetinternalmilieu,whichis
nevertheless liable to exposure and drying out.Termites inhabit
mounds whichtheybuildto preventtheir bodiesfromdessication.The
distin-
guishingcharacteristicmaythereforebedefinedintermsofabilityto
movebetweenan internalandan external, or a wet anddry milieu.
DescriptionselicitedfromCentralThaiinformantsemphasized
anothercharacteristic whichthesecreatureshaveincommon.This is
thequalityofkinesis.That is theypossessdistinctivetypesofmove-
ment,beitwalking,wriggling,orscuttlingalong.Eventhebuffalo- tongue
has a distinctivemuscularmovement. Taking all
thesecharacteristicstogether, that is the wetand dry, or
internal-external,dichotomy,theemphasis on movement,andthecom-
patibility withthebodybyvirtue ofedibility,an image is generatedof
illnesscharacterizedbytheinvasionofthebodybyacreaturecapable
ofmovementbetweentwo media.Ifthis is the case, that is that Thais
mayenvisagesome types ofillnessas theentry into the bodyofa crea-
tureofsomesort, thenit wouldbeanticipated that this wouldbe sup-
portedby the symptomatic descriptions i n the text.This is indeed
the case, and some types ofkrasai are described in terms consistent
with the presenceofan animal withintheabdomen.For example,
thedescrip- tionofkrasai plalai (eelkrasai)is givenasfollows: When
fully developed it causes symptoms by wriggling its tail, work-
ingits waydownto affectthelowerabdomen,aswellastheanus and urethra.
. . the body ofthe krasai winds its way upwards along the
intestines, the head risingup as far as the edgeofthe liver and
thestomach.Iffoodiseatenthekrasai willeatit,andiffoodis
noteaten,the krasai willbitetheedgeofthe liverandthespleen,
causinggreatpain,orsometimesaching,painin all the joints,and
ague,as in severe illness(PS: 2: 200). Anothercategory,krasai
plEm6(doctor-fishkrasai),is describedas fol- lows : Krasai
plEmdarisesintheintestines.Ifitdevelopsduringthe waxingmoonthe
krasai turns its headupwardstobiteat theedge
METAPHORANDILLNESSCLASSIFICATIONI NTHAILAND187
oftheliver,spleen,andlungs,causingcolickypains.Ifitarises
duringthewaningmoon,thekrasai turnsitsheaddownwardsto the lower
abdomen and the supra-pubicregion, causing obstruction to the
faeces and the urine,and the person to suffer great pain, cry- ing
and groaning(PS: 2: 201). The occurrenceof" animal categories "
isnotunique tothe taxon krasai.Other illnesses appearing in the
same set oftexts also take their names from animals.For example
sHng,or " children'sdiseases " have a"
cow"(wua,kh6)typeandanelephant(chHng)type(Mulholland 1982:
252).Puang(illnessesinvolvingthegastro-intestinaltract)has
eighttypes,includingsnake,monkey,andbabybird(PS: 1: 47)and
pradong(atypeofskincomplaint)alsohaseighttypes,includingant,
elephant, buffalo,cow, monkey,cat, and rhinoceros(PS: 2: 186-187).
In these other taxa, despite the resemblance to krasai throughbeing
namedafteranimals,theredoesnotappeartobeanemphasisonthe
descriptionoftheillnessasbehavinglikeananimal,withwhichsome
typesofkrasaiareaccredited.Therepetitionofcategorynamesand
thelackofdescriptivepassagessupporting them,tendtoargueagainst
anyfurthersimilarity withthe krasai categoriesbeyondthat ofbearing
animalnames.However,elsewhere,inTai languageandinspirit
belief,thereisstrongevidencetosupportthenotionthatillnesswas
conceivedbyThais as resemblingthe entry ofan animal into the body.
The general classifier for animals in Tai istua (Conklin1981: 130-
132;Tambiah1969: 457)whichwas,andstillis,despiteexcitingthe
displeasureofcertainmembersoftheliterati,usedbymanyThais to
classify illnesses (Sukprachl1984: 361).Tua is also takenas a
classifier formostobjectspossessinglegs,thusits
useinconnectionwithillness serves toemphasize the nature
ofillnessas a living entity, or something resemblingalivingentity.I
nthePhrakhamphfKrasaiforexample reference is made to the tua krasai
(PS : 2: 200), whichis consistent with the description ofthe
illnessin terms evocativeofanimal-likebehavior. Another word for
illness, phayHt, also serves to emphasise the notion
ofillnessasalivingentity.Phaydtis derivedfrom theSanskrit word
vyddhiwhichmeans" disease,ailment,sickness,orplague " (MMW
1984:1037).ThemeaningoftheTaiwordphaydtasitappearsin earlyTai
inscriptions isconsistentwiththeSanskrit,forexample: MayI
berebornwithwisdomandpropertyin eachreincarnation.
MayInothaveillness(phayztko yHmi kzekc (Khanakammakdn
phithHranHlaethat phimekasdnthdng prawatisdt:152 [Inscription 14
2:131). 188SCOTTBAMBER This
meaningappearstohavebeenretainedinnorthernTaimedical
texts,wherethemorecommoncentralTai wordforillnessingeneral, rdkdoes
notappear.g I ntheRoyalmedicaltexts,however,thoughphayatmayoccur
bearingthe generalmeaning of" illness,"l0its meaningisfor the most
partmorespecific,referringtoparasiticafflictions.llThis isalsothe
usualmeaningofthewordphayatinmodern(central)Tai,theword
byitselfreferringtoparasitesingeneral,ormorespecificallytotape-
worm,andwithamodifyingadjective denoting other types ofintestinal
parasites,such as phayztpakkhd(hookworm), phayattuaklom(round-
worm),andphayatsendzi (threadworm).I t wouldthereforeappear
likelythatincentralTai,withtheadoptionofthewordrdkasthe
generaltermforillness,themeaningoftheword phayatnarrowedto referin
the main to parasitic diseases. The
ideathatillnessmaybecausedbytheentry of' worms ' into
thebodymayalsobeseen elsewhere in Thai medicine,forexamplein
thecaseofdentalcaries,whereit wassaid(asitstill isinthespoken
language) that mzeng kin fan(literally 'insects eat the teeth')
(Mulholland 1970a: 90).This idea, still prevalenttoday in some
areas ofThailand,lZ has also been observed in other cultures, for
example that of the Malays,l3 as wellasoftheEnglishat the
timeofShakespeare.14The prevalence ofthisbeliefin
EnglandhasbeenattributedtotheinfluenceofArabic
medicine(Campbell1926: 1: 203-204).15I t islikelythatthebelief that
' worms ' cause dental caries arose from the observation that,
owing tothehardnessofthesurfaceenamelofteeth,advanceddecaymay
reveal only a ' pinpoint ' surface cavity,concealing the inner
destruction, similar in appearance to the way in which fruit may be
spoiled by insects. AnotherThaiillnesstaxon,sang('
children'sillnesses ')(Mulhol- land1982: 252)16 maybe cognate with
the ZhouChinese xiang,or yang. Yang(g,@),theusualmeaningofwhichis'
sickness ' (Karlgren 1957: 193, no. 732 g, i), may alsorefertoa
worm which was believedto " gnawat the heart " (Mathews1975 :
1084).The link betweenillness and the invasionofthe body bya living
entity maythereforebeofvery ancientoriginandpredatetheThai
arrivalin theMaeNam Valley. The useofthe word' worm ' as a general
termfor illness,andthe accompanying belief that illness is caused
by the entry ofworms into the
bodyisofcoursenotwithoutfoundation.Evidenceofparasiticinfes-
tations is often readily apparent in the faeces, and some
nematodes, such as the " guinea worm " may burrow beneath the
surface ofthe skin, and
bevisiblethroughsurfaceulcerations.17Acasewithsymptomscon-
sistentwiththoseofguineawormisdescribedinthenovelKhriiBzn
N6k:anelderlywomansuffersintermittentlyfromabominalpainand
METAPHORANDILLNESSCLASSIFICATIONI NTHAILAND189 generalaching ofthe
body,whichis originallydiagnosedbythe village
doctoraspzndong,whichisthenortheastern' raiwordforpradong
mentionedearlier.laLater,aftermuchdiscomfort,pain,andweight
loss,awormboresitswayoutfromherknee,whichtheteacherPiya extracts
and preserves to show his students (Khammaan 1980:109, 158).
Thaispirit belief,the secondofthe pointsmentioned above,lS also
maintainsthatcertaintypes ofspirits (phi) mayenterthehumanbody
andconsumetheorgans.Thusthephiphai,or' vampirespirit ' of
NorthernThailandandLaos,livesoffthebloodofan individualand saps
hisenergy(Halpern1963 : 194),20 and the phipiip, prevalentin the
sameregion,eatstheinternalorgans,especiallytheliver(Dore1979: 49;
~hi i r uwan(n.d.) : 112-1 13).The behavioraccreditedtothislatter
spirithasstrong affinitieswiththebehaviorofthe' doctorfish ' krasai
inthetext,which,itwillberecalled,isalsopartialto' bitingatthe
liver.' METAPHORANDTHETREATMENTOFILLNESS The
animalmetaphorisextendedfurtherintotherealmoftreatment.
Whileitisnotproposedtogointothesubjectoftreatmentinany detail
herethereareneverthelessafewobservationswhichshouldbe
madeinthiscontext.The firstoftheseisthatmedicinemayalsobe
referredtointermswhichsuggesta livingentity.Thus themedicine
maybecalledatuayz,thatisabodyofmedicine,anditsinteraction with the
krasai illness is described as beingits food.The krasai is said
tolike(chiipkin)certainmedicines,whicharethemosteffective.I n what
wouldappeartobea typeofsympathetic magicsome ofthepre- scriptions
involvethepreparationofacurrybasedonthecreaturefor whichthe
illnessis named.Thusforeelkrasai an eelcurry is oneof the
alternativemedicinesprescribed,incorporating,besidesoneeel,the
ingredientscommonlyfoundinordinarycurries,suchas blackpepper,
ginger,galangal,onions,and garlic(PS: 2: 201).Afteronecup ofthe
curryiseatenthekrasaiissaidtoseparateoutaslumps,likeclotsof blood.
The treatmentofsome ofthe other types of krasai is similar.The
curry for the treatment ofdoctorfishkrasai includes, in addition to
three doctorfish,aquantity ofa plantcalled" doctorfishgills."21Thi
s is an
indicationthatcertaintypesofsymbolichealingsuchassympathetic
magicmaystillplayan importantparti n theThaimateriamedica.
CONCLUSION I n summary,twoobservationsmaybemadeabouttheuseofanimal
categoriesinnamingthedifferenttypesofspontaneouskrasai.The
190SCOTTBAMBER firstoftheseis thatthenamesaredrawnfromthe
varietyofcreatures
inhabitingthefamiliarThaivillageenvironment.Thus,forthemost
part,theyrepresentcreatureswhichareactivelysoughtafterasfood,
andwhosehabitsarewellknown.Therefore, in the light ofwhat has
beensaid earlier it might be reasoned that in ascribing to the
illness such a name, the unknown and potentially life-threatening
is also incorporated into the realmofthe familiar. The second
observation follows from the first, and it is that, having named
the illnessfora creature,predictions mayalso be made about its
behavior.I n so-doinga link is establishedwithabodyofTaifolklore
whichseeks toprovideexplanations fortheonsetofillness,thatis the
beliefthat illness is due to the maligninfluenceof' spirits
'.Similarly,
certaintherapeuticpathwaysarealsoopened,whichwerebrieflycon-
sidered above.Both these observations would support Kleinman'scon-
tention,quotedat the beginningofthis paper,that the
identificationof an illnessis theinitialtherapeuticact, since in
bothcasesanattempt is made to provide explanations for what Thais,
at least in the time at which
thetextswerecompiled,regardedastwoequallyimportantaspectsof
illness: what is happening,and why.22 N O T E
S1.Amongthemanypeopletowhomtheauthorisindebtedfor theirassistance
andsuggestionsduringthepreparationofthispaper,hewouldinparticularliketo
expresshisgratitudetothefollowing:DrA.V.N.Diller,Dr.B.J.Terwiel,Mr
PreechaJuntanamalaga(alloftheFacultyofAsianStudies,
A.N.U.),MrsVacharin McFadden(ofthe NationalLibrary ofAustralia),and
Dr Jean Mulholland.
2.ThesystemoftransliterationofThaiwordsadoptedhereistheLibraryof
Congresssystem,exceptincaseswherethereisalready an
acceptedEnglishlanguage spelling. 3. These
textsare,atleastinpart,ofIndicorigin.They alsoreflectdifferent
schools ofIndic medicalthought:some, for example,show a similar
style to the Ayur-
vedictextofCaraka,whilstelsewhere,particularlyintheillustrationsatWatPhb,
and in thesouth atSongkhla,tantric medicalthought,probablyfrom
northeastIndia, isapparent.The textin
whichkvasaiisdescribedbearscertainfeatures whichindi- cate thatit
is ofSri Lankan orSouth Indian origin. There isalsoevidencethatthe
texts mayhavereachedSiam viaCambodia, since
manyofthetraditionaltextsoriginallyincludedsectionswritteninthekhdmscript.
Thoughthisdoesnotinitselfconstituteproofthatthecompletetextcamefromthe
Khmer,whencoupledwithcertainlinguisticfeaturessuchastheconsonantchanges
evident in some Sanskrit words,it providesa strong argumentforKhmer
influence.
Thereisalsostrongevidencethatthetextscontainmaterialfromanumberof
Thai sources, and that the form in which they now exist is the
result ofthe loss or addi- tion ofcertainsections.Partofthe
disorderedcondition ofthe krasaitextas wenow haveit,forexample its
inclusionofadditional prescriptions,wouldappeartobecon-
METAPHORANDILLNESSCLASSIFICATIONI NTHAILAND191
sistentwiththechangeswhichmighthaveresultedfrom
itsuseasaphysician'sref- erence or notebook,whereusefulnew
prescriptionswereaddedfrom time to time. That atextin
acollectionsuchas this shouldcontainsuchinconsistenciesisnot
entirely accounted for by the faithful reproductiongenerally
accorded to these respected
works.Apossibleexplanationisthat,atthetimeofthesackoftheoldcapitalof
AyutthayabytheBurmesein1767,
thetextsoftheRoyalLibrarywereburned,dis-
persed,orremovedtoBurma(Koenig1894:154).WhentheSiamesesoughttore-
establish the medicallibrary, theyhadtodraw uponcopiesoftheRoyal
texts keptin templelibrariesoutside the capital.Itislikely
thatthesecopies werenotmaintained in thesameconditionas the books
whichwerelost, and contained discrepancies,such
asthoseresultingfromtheireverydayuse,asmentionedabove,orastheresultof
deteriorationofthepalm leaves on which they were probably
written.Thus inorder togetadescriptionofkrasaisuitableforanalysis
ithasbeennecessarytoreconstruct much ofthe originalformat. 4.These
wereerected byRoyal decreeduring the Third Reign. 5.I n
modernTai,kl6nisusuallytakentorefertowhatwouldberecognised
inscientificmedicineasaninguinalhernia,generallywithscrota1
involvement.This
interpretationisconsistentwiththedescriptionprovidedinthePhrahhamphZKrasai
text,although
therangeofsymptomsincludedwithinthevarioustypesofkrasai de-
scribedinthatsourceismuchwider,indicatingthatanarrowingofmeaninghasoc-
curred. 6.For a detailed examination ofthe role playedbythe
tridosain traditionalThai medicine,see Mulholland(1979b). 7.See
PalmLeafTextStudies Program(1979) for example.
8.Wateranimalsprovidea veryimportant partofthe Thai diet.See
Tambiah 1969: 455. 9.See forexamplethetexttitledYci salorn
phaycit(' medicinesforillnesses ') (Palm LeafText Studies Program
1979: 28). 10.I n thefinalsection ofthePhrahhamphi
Krasai,forexample,there isapre- scriptionsaid to free the
personfromJhe " five hundred plzaycit" (PS: 2:220). 11.See
Phrahhamphi PrathomChindci (PS: 1: 198) for example.
12.Seeforexample,thearticle" ThedentistoftheSancimLuang" inThaiRat
,6th November,B.E.2526(1983). 13.According
toMcFarland(1944:700),thelatexoftheraktreewasbelieved bythe
Malaysto killthe worm thatcauses toothache. 14.In
MuchAdoAboutNothing(3:2:25),Leonsays:"Whereisbutahu- mour or a
worm?," a referenceto Benedick'stoothache which is both
metaphorical and literal.I
nVpponBartholome,StephenBatmansaysoftoothache:" Thecauseof
suchakingishumorsthatcomedownefromtheheade,. . .
Alsosometimeteethbe pearcedwithholes& sometime
bywormstheybechangedinto yellowcolour,greene, or black"(In
Humphreys1981:150). 15.According
topopularArabicmedicalbelief,wormswerealso believedtobe thecause
ofnymphomania:inThe BookoftheThousandNightsandaNightacase of
nymphomaniaistreatedbytheremovaloftwoworms,oneyellow,theotherblack,
fromthevaginabymeansofthevaporsfromasteamingpotfulof" virginvinegar
and apoundoftheherbpellitorycalled wound-wort" (Burton1885:
4:298-299). 16.Various types ofwhichwere mentionedabove.See
page183.
17.Thisistheafflictionknownasdracontiasis,infestationbythenematode
Dracunculusmedinensis (Maegraith 1980:103-108). 18.See page187.
192SCOTTBAMBER 19.See page187. 20.Similar types of phiare
recognizedby otherTai groups, for example the Red Tai ofLaoswho
believethatthe phi-pha,or phi-xan-phufeaston the bloodofinjured
people(Boutin1938: 77). 21.ngu'ak pl6md(McFarland 1944: 939).
22.AsMacleanpointsout, the emphasis given
thesevarieswidelybetweencul- turesand " the' real '
reasonsforillnessmaybedivinedratherthandefined " (1971 :
26-28);theobservationmadebyReidthattotheYolnguofCentralAustralia"
any
explanationofasicknessordeathwhichdoesnotidentifyaproximateorultimate
causeisincomplete "
illustratesthiswell(1983:55).Thecompatibilityofthetwo
aspectsfromatherapeuticpointofviewisalsoexemplifiedin
thecommentmadeby a young Yolngu womanin response to a questionas to
the best treatmentfor nephritis: " Go toamarrnggitjnol ngu'
healer'1tosee whatcauseditand thengotoa[west- ern]doctor for
medicine " (97). REFERENCESCITED BLACK,Max
1979Moreaboutmetaphor.AndrewOrtony, ed.,Metaphorandthought.Cam-
bridge:CambridgeUniversity Press, pp.1943.BOUTIN,M. 1938Croyances
et superstitionschez les Thay rouges,Bulletin des "Amis du Laos",
2: 2:65-79. BRADLEY,D. B. 1836unpublishedjournal,April 23rd.
1873DictionaryoftheSiameselanguage.Bangkok. BRADY,JosephV.,and
Walle J. H.NAUTA,eds. 1972Principles, practices,and
positionsinneuropsychiatric research.Oxford:Per- gamon Press.
BURTON,RichardF. 1885The bookofthethousandnightsandanight,17
vols.London:The Burton Club. CAMPBELL,Donald
1926Arabianmedicine.Amsterdam:Philo Press.(Reprinted1974)
CHAMBERLAIN,James Robert
1977AnintroductiontoProto-Taizoology.UniversityofMichigan,Ph.D.dis-
sertation. ~ HKRUWANThammawat [n.d.]Khat
ich6wbanIs6n[NortheasternThai folklore].Bangkok:Sarnnakphim
AksdnwatanH. CONKLIN,NancyFaires 1981The Semantics and syntax
ofnumerical classification in Tai and Austronesian, 2
vols.,University ofMichigan, Ph.D.dissertation. DAVIDSON,Alan
1975Fish andfish dishes ofLaos.Vientiane:Imprimerie Nationale.
DORE,Amphay
1979DelasymboliquehystkriqueLaohproposd'uncasdephipop,Ethnopsy-
chiatrica2 :1: 49-77. METAPHORANDILLNESSCLASSIFICATIONINTHAILAND193
FERNANDEZ,James W. 1972Persuasions and performances:Ofthe beast in
every body. . . and the met- aphors in every man, Daedalus101 :
39-60.
1974Themissionofmetaphorinexpressiveculture,Currentanthropology15:
119-146. HALPERN,Joel M. 1963Traditionalmedicine
andtheroleofthephiinLaos, Easternanthropologist 16: 191-200.
HAWKES,Terence 1972Metaphor.London:Methuen andCo. Ltd.
HEINZE,Ruth-Inge 1977The
natureandfunctionofsometherapeutictechniquesinThailand, Asian
folklorestudies36 : 2: 85-104. HUMPHREYS,A. R., ed.
1981MuchadoaboutnothingbyWilliam Shakespeare.London:Methuen.
JACKSON,Michael
1983Thinkingthroughthebody:Anessayonunderstandingmetaphor,Social
analysis, 14: 127-149. KARLGREN,Bernhard 1957Grammata
Sericarecensa, Bulletin no. 29.Stockholm:The Museum ofFar Eastern
Antiquities.(Reprinted1972)
KhanakammakHnphiEhlranllaeEhatphimekasinthgngprawatislt[Committee
for examination and printing ofhistorical documents]
1978PrachumsilEZhEru'k[Collectedinscriptions].Bangkok:Samnaklekhiithikfin
nayokratthamontri. KHAMMAANKhonkhai 1980KhrtibdnnGk[Country
teacher].Bangkok:Samnakphim bankid. KLEINMAN,Arthur
1973Medicines'symbolicreality:Onacentralprobleminthephilosophyof
medicine, Inquiry16 : 206-213. KOENIG,J. G. 1894Journal ofa voyage
fromIndia to Siam and Malacca in1779 (translated from
hismanuscriptsintheBritishMuseum), JournaloftheStraits Branchofthe
RoyalAsiaticSociety:58-201. LBvI-STRAUSS,Claude
1972Structuralanthropology.Harmondsworth:PenguinUniversity Books.
MACLEAN,Una 1971Magicalmedicine.Harmondsworth:Allen Lane, The
Penguin Press. MAEGRAITH,Brian
1980AdamsandMaegraith:Clinicaltropicaldiseases.Oxford:BlackwellSci-
entific Publications. MATHEWS,R. H.
1975Mathews'Chinese-Englishdictionary.RevisedAmericanEdition.Cam-
bridge:HarvardUniversity Press. MCFARLAND,George Bradley
1944Thai-English dictionary.Stanford:StanfordUniversity
Press.(Reprinted 1974) MMW.See Monier-Williams, Sir Monier.
MONIER-WILLIAMS,Sir Monier 1984ASanskrit-English
dictionary.Delhi:Motilal Banarsidass. 194SCOTT BAMBER
MOERMAN,DanielE.
1979Anthropologyofsymbolichealing,Currentanthropology, 20:59-80.
MULHOLLAND,J. 1979aThai traditionalmedicine:Ancientthoughtand
practiceinaThai context, Journalofthe Si am Society,67:80-115.
197913Thaitraditionalmedicine-thetreatmentofdiseasecausedbythetridosa,
South EastAsian review3: 2:29-38. 1982Contrasting diagnostic and
prescribing patterns in traditional Thai paediatrics,
AustralianNationalUniversity, Ph.D. thesis. OBEYESEKERE,Gananath
1969Theritualdramaofthesannidemons,Comparativestudiesinsocietyand
history, 11: 2:174-216. OHNUKI-TIERNEY,Emiko 1981Illness and
healing amongst the Sakhalin Ainu.Cambridge:Cambridge Uni- versity
Press. ORTONY,Andrew
1979Metaphorandthought.Cambridge:CambridgeUniversity Press.
PAIVIO,Allan 1979Psychological processes in the comprehension
ofmetaphor.Andrew Ortony,
ed.Metaphorandthought.Cambridge:CambridgeUniversityPress,pp.
150-171.
Palmleaftextstudiesprogram(AjointprojectbetweentheNationalMuseumof
Ethnology,Osaka,Japan,andtheSocialScienceResearchCenter,Faculty
ofSocial Sciences,Chiangmai University) 1979Tamrd
ydsamunphraiLCnnd[Texts ofLannaherbalmedicine],Chiangmai: Chiangmai
University.
PhotEhandnukromchabapRdchabanditsathdn[B.E.]2525[RoyalInstituteeditiondic-
tionary] 1982Bangkok:Samnakphim AksonEharBenthat. PSSee Samikhom
rBngrian phiet phien bBrHn. REID,Janice 1983Sorcerersandhealing
spirits.Canberra:A.N.U.Press. Samikhomr6ngrian~ h i e t phienbdr5.n
Wat PhraEhetuphon[The Wat Photraditional medicalcollege
association] 1961Phdetsdt songkhro[Texts on medicine],3
vols.Bangkok. STEIN,Marvin, Steven SCHLEIFER,and StevenKELLER
1980Comprehensive
textbookofpsychiatry3,HaroldI.Kaplan,AlfredM.Freed- man, and
BenjaminJ.Sadock, eds., 3 vols.Baltimore:Williams and Wilkins, 2:
1961-1972. SUKPRACHAWHEhanon 1984laksanandm. . . khraiwdmai
samkhan[Classifiers-whosaystheyarenot
important?]inPhdsdThaikapsangkhomThai [Thailanguageandsociety]
(nu'ang nai kdn chalGem chal6ng700 pildi sc'Thai )[In
commemorationof700 yearsofthe Thai writing system],[Bangkok]
:Samnakngin sbemsgng ekalak kh6ng chit samnaklekhithikin
nayokratthamontri. TAKAKUSU,Junjiro, trans. 1896A record ofthe
Buddhist religion as practisedi n India andthe Malay Archipelago
(A. D.671-6Q5), by ITsing.Taipei:Ch'enWen.(Reprinted1970)
TAMBIAH,S. J. 1969Animals are good to think and good to prohibit,
Ethnology8: 423-459. METAPHORANDILLNESSCLASSIFICATIONI NTHAILAND195
Thai Ratdaily newspaper, Bangkok. TURNER,Victor 1967The forest of
symbols.Ithaca:Cornell UniversityPress.
