Thai Herbal Medicine: Traditional Recipes for Health and Harmony

CHAPTER 2. Thai Herbal Theory

The Elements

Thai Element theory has its roots in the Pāli Buddhist tradition. Like many other forms of traditional medicine in Europe and Asia, this tradition holds that all things are made of the Great Elements, and that it is the relative balance between these that is responsible for the variance of the universe. From urban asphalt to jungle leaves—even the character and the nature of our thoughts—everything is believed to be influenced by these basic Elements.

TTM holds that the body, too, is made up of Earth, Water, Fire, and Wind. (Though Thai healers primarily work with these Four Elements, they recognize a total of six: the standard four, plus Space and Consciousness.) While the underlying foundational system of TTM is similar to other traditions (such as Greek, Indian, and Arabic medicine), each culture has understood and explained the Elements in different ways. No one medical system can be simply substituted for another, and the Elements in Thai medicine must be understood within the Thai context.

The Elements refer not to physical substances but to qualities. For example, substances that are solid, hard, stable, and heavy can be said to have the qualities of the Earth Element. Substances that are cold, moist, fluid, and/or soft can be said to have the qualities of the Water Element. Knowing and understanding the attributes of each Element is vital to working with any aspect of TTM, and this is especially true in the case of herbal medicine.

According to the Four Element theory, the anatomy and physiology of the human body can be broken down into the following categories:


Anatomy / Physiology

Within The Body


All that is solid, providing structure and containment

1. Hair on the head

2. Hair on the body

3. Nails

4. Teeth

5. Skin

6. Muscles

7. Sên (“channels,” i.e., the tendons, ligaments, vessels, nerves)

8. Bones

9. Bone marrow

10. Kidneys

11. Heart

12. Liver/pancreas (in some TTM texts, these are considered one system)

13. Fascia (sometimes diaphragm, pleura)

14. Spleen

15. Lungs

16. Large intestine

17. Small intestine

18. Stomach (including recently eaten food and chyle)

19. Digested food and feces

20. Brain and central nervous system


All bodily fluids, providing viscosity and cohesion

1. Bile

2. Phlegm in the respiratory tract

3. Pus and lymph

4. Blood

5. Sweat

6. Fat

7. Tears

8. Oil

9. Saliva

10. Mucus in the nose and throat

11. Synovial fluid

12. Urine


Warmth, digestion, breaking things down, motivation

1. Fire that causes aging and decay of the body

2. Fire that provides warmth to the body

3. Fire that digests

4. Fire that causes emotion and fever


All movement, from physical movement to the movement of thoughts

The Wind Element is conventionally divided into six types of Winds, as is similar to the teachings found in Buddhist texts:

1. Wind that moves from the top of the head to the feet/abdomen, depending on text (Descending Wind)

2. Wind that moves from the feet to the head/or from the abdomen to the head (Ascending Wind)

3. Wind that is within the digestive tract

4. Wind that is within the abdomen but outside the digestive tract

5. Wind that circulates to all parts of the body

6. Wind that is inhaled and exhaled

Another common way of dividing up the Wind Element is to distinguish between Subtle Winds and Gross Winds. Subtle Winds include the movement of thoughts, emotions, ideas, impulses, urges, memories, habits, sense of self, and dreams. Gross Winds include all physical body movements, such as circulation, respiration, nervous impulses, peristalsis, running, writing, talking, lactation, urination, and osmosis.

The constant interaction of the Four Elements gives rise to the processes of the human body, and is the impetus behind physical life. It is therefore of vital importance to do one’s best to keep the Four Elements balanced. The Elements can become unbalanced due to a variety of reasons. Environmental factors can affect the body, for instance, when hot weather causes excitement of the Fire Element and weakening of the Water Element, or cold weather causes the Water Element to become amplified while weakening the Fire Element. Food can also affect the balance, as for instance when indulgence in spicy foods and alcohol causes excitement of the Fire Element, or indulgence in sweet and heavy foods causes excitement of the Water Element.

Elements can exist in various states, including:

•  BALANCED (s-m-dun สมดุล): A normal Element that is functioning in a manner that is healthy and balanced.

•  EXCITED (gam rêrp กำเริบ): An excited Element is functioning at a more intense level than is healthy. Other terms that convey this state include “amplified,” “intensified,” and “agitated.”

•  WEAKENED (yòn หย่อน): A weakened Element is functioning with less vitality than is healthy. Another term that conveys this state is “depleted.”

•  DISTORTED(p-gaan พิการ): A distorted Element is out of balance, or unstable, but not always clearly excited or weakened. It may fluctuate between the two.

•  BROKEN (dtaèk แตก): A broken Element is a very serious condition, possibly but not necessarily fatal, that requires professional medical attention.

•  DISAPPEARED (hăai bpai หายไป): Once any one Element is gone, the body is dying. We require all Elements to live.

While it is common for people to discuss the state of Elements in terms of “excessive” and “deficient,” the quantity of the Element does not change within us; it is more apt to say that the vibrancy or the potency of the Element is prone to fluctuation. For this reason, we prefer to use terms such as “excited” and “weakened,” or “amplified” and “subdued.”

During the normal course of life, the balance of intensity of each Element fluctuates with age, season, environment, and diet. These fluctuations are natural and do not require moderation unless they sway too far from a healthy state, or occur outside of the expected parameters created by natural changes. It is important to take these factors into consideration before embarking on Elemental diagnosis. (For example, a slight increase in Wind excitement during the rainy season, when it is an expected fluctuation, is less likely to indicate a problem than an increase in Wind excitement during the hot season.)

Causes of Change in Elemental Balance

According to Four Element theory, there are three causes of a shift in the state of Elemental balance: natural, unnatural, and karmic. (The Earth Element, being the most stable, is often omitted in the following factors).

1. The Thirteen Natural Causes of Elemental Imbalance

Elemental Fluctuations

Ongoing internal fluctuations of the Elements are natural. But, the relationship between the internal Elements is also affected by external factors, such as:

Wind: Agitates the Wind Element within us.

Heat: Agitates the Fire Element within us.

Dampness: Agitates the Water Element within us.

Cold: Can agitate Wind and Water within us.

Dryness: Agitates Wind within us.


Hot Season: Causes a natural excitement of the Fire Element.

Rainy Season: Causes excitement of the Wind Element. (This point frequently causes confusion, as people associate rain with Water. However, in TTM, rain is associated with Wind because rainstorms involve lots of motion of wind and water, and motion is the quality of the Wind Element.)

Cold Season: Causes excitement of the Water Element.


Wind is more vibrant from 2−6 a.m. (or the 4 hours preceding sunrise), and again from 2−6 p.m. (or the 4 hours preceding sunset)

Water is more vibrant from 6−10 a.m. (or the 4 hours post sunrise), and again from 6−10 p.m. (or the 4 hours post sunset)

Fire is more vibrant from 10 a.m.−2 p.m. (or the two hours before and after the sun’s zenith), and again from 10 p.m.−2 a.m. (or the two hours before and after midnight)


From birth to 8 years old: Water Element is strong. (This is why children show Watery characteristics such as soft skin, large eyes, strong emotions, and a tendency toward mucusy diseases.)

Age cont.

From 8–16 years old: Water is waning, and Fire is waxing. (The emergence of Fire can be seen in an increase in acne, rebellion, and sexuality as the individual enters adolescence.)

From 16–32 years old: Fire Element is strong (This is the peak of one’s motivation, drive, and intellect.)

From 32–64 years old: Fire is waning, while Wind is waxing.

From 64 years old until death: Wind Element is strong and continues waxing. (This is seen in the tendencies of aged people to have dry fragile skin, smaller eyes, insomnia, constipation, arthritis, and anxiety.)

Region, Climate, Geography

The relative dryness, coldness, humidity, heat, and dampness of a geographical area all affect our Elemental balance. (For instance, living in a hot, dry climate will tend to agitate Fire and Wind, while living in damp cool climate will tend to agitate Water.) Likewise, the features of the geography also influence Elemental balance. An example of this would be living by a large body of still water (agitating Water Element) or living in a subterranean environment, such as a basement or cave (increased connection to Earth Element).

Daily Routine

How we go about our day affects the Elements. Inconsistent patterns in sleeping and eating erratically, for example, will lead to agitated Wind, as will constant stress and rushing about. Conversely, consistency and slow pacing may strengthen Water. Repeated bold actions and driven behavior may be signs of a Fire Element that is already strong, but may also assist in creating stronger Fire Element.


What we eat has a direct effect upon our Elemental balance. For instance, habitual intake of cold, moist foods, such as iced drinks and ice cream, will excite the Water Element and weaken the Fire Element. Diet is one of the primary factors in Elemental diagnosis and treatment.


Poor posture causes Elemental imbalance and has a particular effect on Earth and Wind Elements. For example, sitting hunched over for extended periods of time causes bound muscles (Earth) and constricts movement (Wind).

Sleep Patterns

Getting the right amount of sleep, at the right time, maintains Elemental balance. Sleeping too much or too little, or sleeping during the daytime, may lead to agitations of the Water Element.

Exercise and Work

The kind of exercise or work we engage in, the intensity with which we engage in it, and even the time of day in which we engage in it will affect our Elemental balance. (For example, hard exercise outside at midday will excite Fire, while an excessive amount of cardiovascular exercise agitates Wind.)

Extremes in Temperature

Temperature extremes cause Elemental imbalance. For example, those who live in hot climates but work in extremely cold, air-conditioned buildings are constantly shifting back and forth between hot and cold in a way that is unnatural and unsettles the Fire Element.

Natural Urges

Suppression of natural urges, such as belching, defecating, urinating, coughing, etc., causes Elemental imbalance.


Indulgence in strong emotions (even excessive joy) will also cause Elemental

imbalance. (For example, dwelling in anger will excite Fire, while anxiety excites Wind.)

While the previous chart included primarily environmental and behavioral factors, the next two lists include a number of factors that are part of the Thai religious and spiritual worldview.

2. The Six Unnatural Causes of Elemental Imbalance


Ghosts and spirits can cause various Elemental imbalances but most often affect Wind. (Traditionally, Thais have a strong belief in ghosts and spirits, collectively known as pe ผี.)


Any Element may be affected (positively or negatively) by deities. Thai religion recognizes a great number of deities from the Buddhist and Hindu pantheon.


Like deities, magical causes of Elemental imbalance may affect any Element. For example, if hexed with obesity, one is hexed with a Water problem.


Weapons primarily affect Earth Element, as they break the skin, bones, organ structure, etc. This will, in turn, affect all other Elements.


Most of the time, accidents will be the same as weapons, in that Earth Element is the first affected.


Poison can also affect any Element. It depends on the particular effect of the substance ingested, inhaled, or touched.

3. The Two Karmic Causes of Elemental Imbalance

Past Karma

Past karma can predetermine one’s Elemental makeup during in-utero development and is the result of choices made in previous lifetimes.

Present Karma

Present karma is determined by our actions and reactions in this lifetime.

Element Diagnostics

Diagnosing disease according to the Elements is a crucial part of Thai herbal medicine. Diagnostic skills take many years to develop, and traditionally Thai apprentices studied under able teachers for decades before they were considered to be healers in their own right. Some basic guidelines can be outlined. However, for serious conditions an experienced medical doctor must be sought out.

In the charts below, the Elements are listed in the order in which they become disturbed. Wind is generally the first Element to become imbalanced, due to it being the lightest and therefore the most easily blown off course. Earth, on the other hand, being the heaviest Element, is generally the last affected in the progression of a disease. Once it is affected, however, this usually means a serious condition. (For example, in a liver disease, imbalances of Fire and Wind would refer to problems with the function of the organ, but once Earth is involved we are talking about the structure of the liver itself being compromised. Also, conditions such as an abundance of tumors and other abnormal growths, as seen with serious cancers, are a result of Earth Element being affected.) An exception to the progression of the Elements is the event of sudden trauma that directly impacts Earth body parts—such as injury to the tissue, bones, tendons, and ligaments.

Examples of Elemental Imbalances - Excited State





Anxiety, insomnia, restlessness, attention deficit disorder. In cases of extreme imbalance, Tourette’s Syndrome, obsessive-compulsive disorders, and insanity.

All symptoms of sharp pain, such as headaches, arthritis, and shooting pains. Conditions involving movement, such as restless leg syndrome, tics, hiccups, and other spasms. Constipation that results from excessive dryness, or diarrhea that results from too much downward Wind movement.


Tendency to anger and frustrate easily. Possibility of living “on overdrive,” driven to succeed to the point of ill health.

Symptoms of redness, such as rash, acne, and boils. Problems with the liver and gallbladder, food digesting too quickly, and fever.


Depression, lack of mental acuity, sadness

Lethargy, obesity, issues with reproductive and urinary systems. Mucus diseases, such as pneumonia, congestion, wet cough. Also, toxicity (Water is a heavy Element and tends to hold onto toxins).


Stubbornness, lack of mental acuity

Tumors, prolific growth of hair (especially in abnormal areas), bone spurs, extra bones and teeth, any overabundance of tissue.

Examples of Elemental Imbalances - Weakened State





Lack of mental acuity, lack of creativity and inspiration.

Any condition with impeded movement, such as paralysis, slow circulation, coma, frozen shoulder, food not moving through digestive system, certain types of constipation, or contracted muscles. Lethargy and exhaustion.


Lack of motivation, drive, mental acuity, sex drive, courage, or self-defense.

Poor digestion, lack of body heat, low blood pressure.


Lack of mental cohesion, ungrounded characteristics.

Dryness in the lungs or intestines, thinness of blood, dry skin, reproductive issues, brittleness, lack of vitality, failure to thrive physically.


Signs of imbalance are similar to Water Element characteristics, such as lack of mental stability, ungrounded characteristics, flightiness, but are more ingrained and less malleable.

Weak, broken, or compromised bones, nails, hair, teeth, skin, organ structures, etc.

Five Sense Diagnosis

Traditionally, Thai medicine practitioners would use all five of their senses in making a diagnosis. They would use hearing to listen to their patient’s complaints and needs. But, also to listen to how the patient speaks, their choice of words, their pacing and focus, as all these factors are clues to Elemental diagnosis. (For example, someone with overly excited Wind may speak quickly and have a hard time staying on topic.) Sight is used to examine the patient visually. The smell of a person’s sweat, breath, and urine gives rise to vast amounts of information, including the ability to detect infection. Touch is used to palpate muscles, bones, tendons, and other tissues, to determine the quality of skin hydration and to take pulse readings. And, while it is not done as much in modern times, traditionally, the sense of taste was employed in tasting a patient’s urine in order to gain further understanding of particular disease conditions. (In fact, the Thai name for what we call diabetes, translates to “Sweet urine disease.” Since urine is sterile, this practice was not as dangerous as some might think.) While you may choose to skip the use of the sense of taste, it remains important to use as many senses as possible for a thorough examination of a condition.

Further Diagnostic Tools

Specific diagnostic tools employed in TTM are outlined below. Of course, they too employ the use of the practitioner’s senses.

•  THAI PULSE DIAGNOSIS: With Thai pulse diagnosis, the practitioner feels the patient’s pulse, most often at the wrist, to determine Elemental balance and imbalance. It can take many years to become proficient at this diagnostic tool, but once mastered the practitioner can often determine exactly what is happening Elementally to each individual organ in the patient’s body as well as the systemic state of the Elements.

•  THAI TONGUE DIAGNOSIS: Tongue diagnosis in Thailand is used primarily to determine the state of the patient’s digestive system but can also show some systemic conditions. The therapist looks at the shape, color, coating, and texture of the patient’s tongue for diagnostic clues.

•  CUPPING AND SCRAPING: These are techniques that have the unique quality of being both therapeutic and diagnostic. When the body is cupped or scraped, the resulting colors that appear on the skin can be used diagnostically.

•  OBSERVATION: This is a very important diagnostic tool. Practitioners observe the patient’s behavior, body, eyes, tongue, feces, urine, skin, nails, and more in order to learn causes and conditions of illness.

•  QUESTIONING: In addition to the primary symptoms, a traditional medicine practitioner will generally want to know about the patient’s diet, lifestyle, digestion, sleep patterns, menstrual cycles, work, elimination, and spiritual life. The more complete a picture the therapist can get, the more likely they can make an accurate diagnosis. Of special importance is diet. Knowing what the patient eats, how it is digested, and the condition of the resulting waste tells a TTM practitioner great quantities of information.

The tools above can be used to acquire very specific information about conditions and diseases, not only narrowing down what Element/s is/are out of balance, but even identifying individual body parts that are affected. (For instance, a practitioner might determine that a patient has overly excited Water in their lower digestive tract, or weakened mental Fire.) A more general diagnosis may be made by a newer practitioner by determining simply which Element is out of balance and then determining if it is excited, weakened, or distorted. When an Element is distorted it can be harder to diagnose. The symptoms will fluctuate between those of excitement and weakness, and there may be a sense of confusion and elusiveness in the diagnostic process. (For example, feeling the Wind pulse on someone with distorted Wind, one experiences the pulse speeding up, then slowing down, then disappearing and reappearing.) Broken and disappeared Elements are beyond the capacity of the ordinary practitioner to address and require professional emergency treatment.

The newcomer to Thai herbal medicine should keep in mind the above points, but should also recognize that diagnostic skill can sometimes be an art rather than a science (this is true even in modern scientific medicine). Symptoms can often manifest with a mix of excited and weakened states, and can appear in more than one organ system. (For example, a patient with excited Fire Element may also exhibit weakened Wind. This individual could manifest with heart disease, high blood pressure, high cholesterol, short temper, reddish color in the face, and a voracious appetite—all symptoms of Fire Element excitement. At the same time, he or she could exhibit lethargy, boredom, and sluggishness—all of which relate to Wind.)


Once the affected Elemental imbalance has been pinpointed, and it has been determined whether the disease is a matter of excited, weakened, or distorted Elements, the Thai herbalist can prescribe dietary changes and herbal supplements to either strengthen or soothe this particular Element.

In traditional Thai herbal medicine, every ingestible substance is assigned a “Taste” classification. There are five different Taste systems found in TTM, named for the number of Tastes recognized in each:

1.  The Nine Taste system is used when utilizing individual medicinal herbs internally.

2.  The Eight Taste system is used when herbs are combined with a “vehicle,” a substance that assists the body to absorb the medicine and direct it to the proper place.

3.  The Six Taste system is used to understand herbs in everyday life, such as in foods.

4.  The Four Taste system is used when herbs are applied externally.

5.  The Three Taste system is used for herbal formulas that combine multiple herbs to be used medicinally internally.

The Six Taste system for everyday herbs will be elaborated upon in Chapter 3, and the Four Taste system for external herbs will be elaborated upon in Chapter 4. The others will be explained here.

Nine Taste System for Individual Herbs Used as Medicine

As mentioned above, the Nine Taste system is utilized when individual herbs are taken internally for medicinal purposes. (You will see that there are actually 10 categories listed here. This is still called the “Nine Taste System” because the 10th, “Tasteless,” is not considered an actual Taste but the lack thereof.)

The information in the chart below can be used to determine which Taste category would be given to a patient to help with a given condition. It should be noted that combining multiple herbs for multiple conditions is not recommended, as not all herbs are compatible with one another and the combining itself may produce an entirely different effect.

Overview of the Nine Taste System


Therapeutic Use



Absorbs wetness, heals wounds, treats diarrhea and dysentery. Dries mucus and stools. Binds the Elements, hence is good for external wounds, stopping bleeding, cleansing and healing.


Constipation, indigestion, distorted Fire Element, and diseases of Wind. Also contraindicated with presence of small, dry feces.


Permeates and builds the tissue (making it abundant and healthy), treats general malaise, and provides strength. Also an energy tonic.


Mucus, diabetes, jaundice, lymph issues, and wounds.


Treats poison and toxins in the body, including toxins arising from blood, and mucus. Treats poisonous animal and insect bites as well as parasites and skin conditions. Treats toxic fever.

Corrects poison

Diseases of heart, bile, and cough.


Lowers fever caused by blood or bile, increases appetite, helps with dehydration, treats blood problems, quenches excessive inner thirst. Bitter Taste is a tonic for the blood and bile.

Corrects blood

Diseases of the heart. Diseases in which Wind causes pain (e.g., bloating, intestinal gas, etc.).


(This Taste has a subcategory of Aromatic Pungentherbs, which are not necessarily spicy but have a warming effect, such as cinnamon and cardamom.)

Treats diseases of Wind, flatulence, gas pain, indigestion, and chest and abdominal tightness. Moves blocked Wind, moves the Wind in the intestines, removes stagnant blood in the uterus, tonifies the Elements, treats distorted Elements, and moves menstrual blood.

Corrects Wind

Diseases of Fire, high fevers, toxic fever (a traditional disease category that includes dangerous forms of fever and infectious diseases characterized by fever, such as dengue fever, scarlet fever, etc.).


Treats distortions in the sên (i.e., tendons, ligaments, nerves), lubricates joints, lubricates the body and allows smooth function of organs and tissue, supports the body heat, nourishes the bone marrow. Oily Taste is a tonic for tissue.

Corrects the sên

Distortion of the Water Element, jaundice, cough, difficulty breathing, dysentery, and fevers.


Fragrant/Cool is a tonic for the heart-mind (in TTM, the heart is connected both to the physical organ and to mental/emotional well-being). Eases stress, anxiety, mental fog. Relieves stress of the fetus. Tonic for the liver and the lungs. This is the primary Taste for supporting the Subtle Winds.


Diseases of the Gross Winds, gas pain, other pain in the body caused by Wind.


Permeates the skin and the mucus membrane, treats some skin diseases, preserves tissue (prevents putrefaction), removes mucus from the colon, and is beneficial for conditions with dry small feces.

Permeates the skin

Diseases that cause problems with elimination, diarrhea, internal bleeding, dysentery.


Treats diseases of mucus and cough, cleanses the blood, expels toxins, and is a purgative.

Cuts mucus

Problems of the lymph, wounds, loose stools, toxic fever, and diarrhea.


Calms diseases of Fire, acts as a diuretic, decreases mucus, treats mild fever, relieves dehydration and inner heat, helps support kidneys, treats fever and some kinds of toxic fever, absorbs poison, relieves dehydration and thirst.

Corrects Mucus

Low blood pressure.

Examples of the Nine Tastes from Traditional Thai Texts




Tea leaves

Pomegranate rind

Mangosteen rind

Tamarind leaves

Betel nut

Unripe banana

Safflower flowers

Licorice root

Annatto flower

Sugar cane

Palm fruit




Nux vomica

Candelabra bush


Pomegranate root


Python bones









Bitter melon

Gall bladder of various animals







Long pepper



Black pepper

Sesame seeds

Water chestnut

Many beans & nuts

Lotus seed

Coconut meat

Various animal milks (especially goat milk)

Various animal livers

Egg yolk

Costus root

Mung bean


Lotus root

Sichuan lovage root




Ylang ylang

Heartwood of white and red sandalwood





Lotus stamens


Onion leaf


Potassium nitrate



Potassium chloride

Cuttlefish bone

Oyster shell


Kaffir lime fruit

Lime fruit

Senna leaf






Pine wood


Morning glory

Lime tree root


Eight Taste System

The Eight Taste system relates to how tastes permeate to different parts of the body and is used primarily when herbs are combined with a vehicle. A vehicle is a substance that supports the herb by directing it to the right place (e.g., alcohol transports medicinal effects to the sên), or by boosting the herb’s effectiveness. The Eight Taste system uses the same tastes as the Nine Taste system, but with the omission of Toxic and Tasteless.


Permeates to the skin


Permeates to the tissue (muscle, fascia, fat)


Permeates to the sên (tendons, ligaments, nerves, circulatory vessels)


Permeates to the bone


Permeates to the large intestine


Permeates to the small intestine


Permeates to the heart


Permeates to the joints throughout the body

Three Taste System for Compound Medicinal Formulas

Once multiple herbs are combined into a medicinal formula, the Three Taste system is employed. Formulas will have either a warming, cooling, or neutral effect.

How the Tastes Affect the Elements

All ingested substances exert their medicinal effects on the body through the effects of the Tastes on the Elements. Each of the 13 Taste categories introduced above has a specific effect on the Elements. While TTM texts do not elaborate on exactly how each of these tastes treats each Element in all cases, in practice we can observe the following: