saccng prathormakan is caused by blood. (See pp. 49, 51 , 58,
59-61, and 66.) KPC II; 114, 115 (see p. 61) mentions the effects of eating food 'which is strange and new to the four elements' contributing to the symptoms of CbirthD saang. The elements are not discussed in any of the passages on minor saang} la3 la-ong3 and
lom3 apart from KPC III, 5; 163, 164 (see p. 74) which gives internal heat as the cause of saang khaao plueak; and the use of the name of one of the
wind elements, lorn utthangkhamaawaat for the name of a disease otherwise called lom utthonwaat (see pp. 56, note 1; 57 , note 2).
There are a few other short passages introducing the elements as the cause of saang3 taan saang3 khamao, or particular kinds of saang included in KPC II, 1; 85-88 (see pp. 37-39).
In the above examples, we find a pattern of diagnosis which attempts to integrate Ayurvedic with indigenous theory.
Otherwise, as might be expected, considering the nature of the theory of the elements, and the causes of disease, birth saang has no equivalent in this Indian influenced system of medicine. Some of the miscellaneous passages from other texts, which constitute Book VI, refer to the body elements, but this system does not permit the identification of large numbers of individual diseases. It does the reverse: all diseases are reduced to the effects of an increase or decrease in the quality or an abnormality in one of the tridosa, wind, bile, and mucus, and sometimes blood. These represent three of
the four main groups of body elements, wind, fire and water. When the element earth becomes involved, the patient's condition is graved KPC VI discusses the breakdown of the tridosa and the earth element,
leading to death.
Whereas the theory of diagnosis discussed on pp. 86-92
relates all diseases of children to the day of birth, the theory, based on Ayurveda, in its strictest form, relates all diseases of children to the birth element. The following quotations explain this method of diagnosis of children’s diseases.
KFC VI; 219-222.
... When a life has been conceived in the mother's womb, the element appropriate to the season of conception is the birth element Cliterally, the element of that child!.
If a woman becomes pregnant in the 5th, 6th or 7th month,1 the baby has the characteristics of the element fire. When the foetus has the five branches Csee p. 31, note 23 and the 32 parts complete,2 the element fire is the birth element which combines with the mother's elements.
If a woman becomes pregnant in the 8th, 9th or 10th month... the element wind is the birth element...
If a woman becomes pregnant in the 11th, 12th or 1st month... the element water is the birth element...
If a woman becomes pregnant in the 2nd, 3rd or 4th month... the element earth is the birth element, which
combines with the mother's elements. Finally, whichever season it is, and whichever is the birth element, this season and this element will be the primary causes of disease of that child up to the time of birth, and from birth up to five or six years of age. Then, at five or six years, when taan saang is finished, taan chon occurs...
Symptoms of the abnormal fire element: the baby has flatulence, distension of the abdomen, nausea, difficulty in breathing, constriction in the chest, swollen hands and feet, and constant cough. If it cannot be cured, the child will die in eight days...
Symptoms of the abnormal wind element: deafness, offensive discharge from the ears, blurred vision. When pressure is applied to the inner corner of the eye, the patient cannot see any light. Muscular pains in the hands, feet, and legs, like”~an adult, causing cramps and backache; and bruises all over the body, giving the appearance of abscesses in the tendons. Vomiting, sometimes dry retching,
1 The first month, according to the Thai calendar, begins about December. New Year starts in mid-April.
The substantial parts - 20 elements of earth, and twelve of water.
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but the baby still has gastric pain, flatulence, vomiting, and so on, even though it does not eat.
This is because of the disorders of the element wind... Symptoms of the abnormal water element:
diarrhoea, epigastric pain, cold hands and feet; the intestines coil up tightly into a lump in the abdomen; sometimes constipation; difficulty in micturition; discomfort in the pubic area; sometimes the child passes mucus and blood in the stools; colic or a stabbing pain around the sides. This occurs on the left side in a female, and the right side in a male. It is very difficult to cure...
Symptoms of the abnormal earth element:
abdominal pain, flatulence, the child cannot eat, ^ distension of the abdomen, like an adult with ritseeduang, thin and yellow, backache. This may change to ongkhasuut,2 causing rectal and urethral bleeding with pus. If it does not respond to treatment within five days, the baby will die. There is no place here for birth saang, minor saang, la, la-ong, and the lorn associated with birth saang. Here we have a pattern of diagnosis of children’s diseases rigidly following the Ayurvedic derived system of the elements on which the principles of Thai traditional
medicine are based. This is quite unadulterated by any effort to accommodate to the birth saang theory, which must be a very ancient, local system still found to be of value diagnostically after the adoption of Ayurveda. Thus the traditional Thai doctor may follow either system or a combination of the two, in his diagnosis of children's diseases.
But there are still other patterns of thought woven into the text, suggesting different causes of saang.
There are the spirits, whether mae sue, saphan or various kinds of paksee (see pp. 38, 40, and 41); the physical form of the infant, sometimes in association with paksee or the elements (see pp. 39, 40); there are the normal changes which take place in a child's development, 1 ritseeduang ? Arlene usually refers to a condition in
which lumps occur; for example, haemorrhoids. There are many kinds. A c h a m Chalerm Phongsanit, personal communication, Bangkok, 25th September, 1978.
given as a perfectly straightforward explanation of fact (see p. 36); and a second version of these changes brought about by the weather, in one case, assisted by unfamiliar diet, in another, by
two of the
tridosa
(see p. 37); and there is the quality of the mother's breast milk (see pp. 36 and A3).Concerning the last point, the text has quite a lot to say about the characteristics and character of the nursing mother or wet nurse and their effects on the quality of her milk and
consequently, whether the baby will be easy or difficult to rear, that is, whether it will be a healthy or sickly child.
(KPC
I, 3; 71; I, A; 76-83; II, 1; 86; I, A; 97). The way the baby isdelivered - face up, face down, or on its side - and the amount of the mother's blood swallowed in the process, are also deemed to have a direct effect on how it thrives
(KPC
I, 2; 63, 6A).Traditional Thai paediatrics offers the doctor many diagnostic alternatives. Just as the Thai patient has a wide choice in his selection of a doctor, so has the traditional doctor a wide choice in his method of diagnosis. In
KPC
we find yet another indication of the versatile Thai mind, which shows great tolerance andadaptability to contrasting points of view.
We have now surveyed the patterns of diagnosis of children's diseases. In the next four chapters we will look at the treatment of these diseases.
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CHAPTER 8
THE TREATMENT OF CHILDREN'S DISEASES: THE PRESCRIPTIONS