អាគមផ្សំអាយុ …. akom psarm ayuk … “Speak of the devil and he will appear.”
If you wake up one day in the Cambodian countryside as an aged – and venerable, obviously – Khmer grandfather with an acute pain in your gut, your first inclination might be to head to the local health center in your commune. The large hospital in the provincial town is known to be incredibly expensive and you are on a farmer’s budget. Once one of your virile progeny has moto’d you there, the health center staff members – all of whom you will address as “doctor” although none of them are doctors and most of them have had very little formal training – will collect some basic information, fudge your temperature and blood pressure, ask trivial, polite questions about your abdominal pain which – although it may be anything from gas to an appendicitis – you and all the staff will describe as choke, a versatile word for discomfort akin to “putting a cork in a bottle.” You end up at the pharmacy counter where you will be given several paracetamol, antacids, perhaps some multivitamins, and have you had a small cold or sniffle lately? Here, take some benedryl for your trouble. Days go by and the pain hasn’t lessened despite taking the cocktail of drugs you brought home as the pharmacist ordered – eh, maybe, her instructions were mumbled in between mouthfuls of spring rolls – and drinking plenty of rain water, some modest sips of your own homebrewed rice wine, and gumming down your favorite pond snails. Finally fed up, tnam pet (“Western medicine”) having failed you, you resort to what you knew you really needed all along, what your parents and their parents before them would have demanded you seek: tnam Khmai. Traditional Khmer medicine.
Although most of ancient Khmer medical texts have been lost amid civil war chaos or French colonization, many traditional medical practices and beliefs prevail today in the Cambodian countryside, albeit predominantly as modern interpretations or approximations. The spiritual and supernatural still come in to play with highly respected traditional Cambodian healers (kruu Khmai) acting as the advisors, herbalists, and sometimes conduit between the corporeal and spectral. In the role of the ailing grandad, your limited general education certainly would not have included much anatomy or health-specific biology, and you might have attributed your pain to the same litany of causes that your grandmother might have invoked when you were a child: an excess of “bad wind” in your body, improper balance of “hot and cold” foods, a vengeful or neglected ancestor, a streak of impiety, or even just a stroke of poor luck. There exist countless traditional beliefs and practices which attempt to explain and alleviate the equally innumerable ways that beautiful Cambodia – scorching, lacking in sanitation, and teeming with tropical germs – makes one’s body a constant grievance.
The first and most common method of mitigating an ill-at-ease body are various forms of dermabrasion, namely gkaob khjal (“coining”) and jup khjal (“cupping”). In coining, the patient lays on their stomach or sits upright while the administer rubs the upper back, sometimes as well as the chest and upper arms, with tiger balm, herbal oils, or lotion. Then, the tiger balm lid often serves as the bespoke coin which the administer rakes across the recipient’s oiled skin in severe rows, multiple times as dark red welts of broken blood vessel form on the skin. The bright red is thought to show that the blood is flowing more forcefully than before and the heinous “bad wind” of your body has been expelled. Although little to no research has yielded concrete proof of the merits of coining, some medical professionals liken the extreme discomfort inflicted upon the patient as a method of pain-displacement which at least serves to temporarily distract the them from his or her enduring ailment. Additionally, this is merely one use for the almighty tiger balm, brenng kolaa, which is used for every ache from head to tooth to stomach to carsickness and anxiety attacks. Once I bore witness to a moto accident wherein a young woman was left bloodied and visibly shaken after her moto skidded for several meters after overturning. Another observer, an elderly woman, hopped off her husband’s moto and produced tiger balm from her purse. She rushed to vigorously spread under the young woman’s nose and chin before she hopped back on her husband’s moto without a word, leaving us all wincing in her icy menthol wake.
Cupping, although now characterized as a “pseudoscience” is becoming more contemporary in spheres of alternative Western medicine and has been famously promoted by some celebrities. This practice also serves to extract “bad wind” from the body by way of creating a small vacuum and eventual welt on the skin using glass (traditional) or plastic (modern, fancy) cups. With glass cups, a small ball of cotton is wrapped around the tip of a wand or stick, lit afire, swirled in and out of the cup very quickly to heat the glass and burn up the oxygen within, and quickly pressed to the skin where it adheres due to the vacuum left in the wake of the flame. My friend recently had his sister cup him using a fancy-shmancy cupping set that she brought back from her time working on a farm in Korea, complete with a hand-pump which extracts the internal air from the cup. My favorite variation of this is when people, namely my host-mother, will walk about with an empty tiger balm jar cupped to their forehead as if it isn’t the silliest thing in the entire world.
Khmer medicine borrows from the Chinese tradition of minding one’s internal balance of yin and yang, although in Cambodia it is described as one’s hot-cold balance. Many patients arrive at the health center with the chief complaint of having a “hot body,” although often no fever is present. A desirable balance is met through methods of both herbalism and diet as well as clothing. As an example, it is believed that while a woman is pregnant she is very hot which must be moderated with diet. This becomes tricky, however, because many grandmothers have their own idea about what “cold” foods should be recommended and some expectant mothers find there is very little they are permitted to eat when both her and her husband’s grandmother’s lists of taboos are taken into consideration. As soon as she delivers her baby she immediately enters into the very dangerous, “cold” phase of pregnancy and may die if not kept adequately warm. The practice of “roasting,” wherein a smoldering fire was built beneath the bed of a newborn for some hours after birth, was widely practiced in Cambodia until recent years when education efforts were made to warn of its danger. Now, many families will wrap the mother in multiple layers and serve her only hot (literal) food and beverages in the hours and days after birth as an ersatz roasting. I’ve been snapped at more than once for carelessly turning on a fan when I walked into the room of a sweating, wide-eyed mother and found the air deathly thick and still. Which foods are considered hot and which are cold is an elusive topic and seems sometimes to vary somewhat from family to family, causing many a row among neighbors and friends. A food’s designation as hot or cold is used more frequently than nutritional content as an indicator of when it should be eaten and by whom. My host-mom insists on “cold” coconut water and barely ripe oranges (just the juice, not the fiber, which is “hot”) when the body is “hot” from a common cold. And while some aunties claim my daily black coffee is “hot” and some swear it’s “cold,” they all agree that this habit of mine is a tragedy given that it will make me sterile.
Most herbal Khmer concoctions service a particular issue. Cambodians drink tisanes of countless different types of tree bark, seeds, and leaves, few of which anyone could actually identify for me. Beyond that there are poultices, types of tobacco and chewables. Both Vuth and my host-dad prefer gargling with a mixture of stunted palm branch, salt, and young eucalyptus bark to numb toothaches. Sieklin’s mom makes a famous mixture of raw green bananas, unripe oranges, and sugar/salt, the expressed liquid of which is mixed with a touch of water and rice wine to lower one’s blood cholesterol. Mothers of newborns can mixed crushed fresh turmeric with rice wine as a natural concoction to warm the skin and then mix that same rice wine with Khmer honey to help open up her blood vessels which have contracted during birth. My coworker shuns the famously nutritious leaves of the moringa tree for its seeds which, he swears, can be taken like any pill to control blood sugar for diabetics or crushed into a poultice for dermal tumors.
My friends dispersed throughout various medical fields would agree that there is nothing wrong with a good placebo to alleviate nerves or lessen pain, so long as it does not have any harmful side-effects. Vuth, a man too practical for his own good, however, openly encourages me and others not to dabble in Khmer medicine given how so much of it is unregulated and can so easily contain naturally occurring poisons. That, he says, and never accept rice wine from someone who’s brewing process you have not yet inspected yourself. He has been the only one to express something like suspicion in place of reverence when salesmen and women come to town with fresh batches of unidentifiable concoctions, especially the charlatan (implied) who rides his elephant from province to province with sacks of Khmer meds.
Betel nut chew, however, is a penchant of many elderly Khmer women which everyone seems to accept as par for the course, although it is considered slightly narcotic. The bright red nuts of the areca tree are sliced thin, dried, and often kneaded with limestone paste to create a bright magenta gum. When wrapped in the bright green leaves of the betel tree, the chew imparts a pleasant buzz to the granny gumming on it. At one time, women with teeth dyed dark red from the chew, as it is known to do, was once thought of as a sign of great beauty. Despite the fact that the grandmothers who are known to chew in our commune barely have a full set of teeth remaining between the lot of them, Cambodians maintain that the chew is protective of dental health. As a friend in the village once rationalized it to me, “Khmer women get told how to dress, who to marry, how many babies to have, not to drink, not to smoke, and all that… old women deserve something enjoyable in their lives.” Amen.
Finally, “preventive health” in Cambodia comes in the form of regular offerings for deceased ancestors who can both protect from malevolent spirits and also bring their own wrath if neglected. Such wrath is used to explain some of the imperceptible or internal diseases, especially psychological conditions and episodes as shown below. The shrines range from extravagant (made of painted stone or polished wood) to as simple as possible (a torn to-go container on a café counter). Every home and business will have a small shrine or two at which they will place offerings of fruit, small cups of liquor, coffee/tea, soda, and incense at least weekly if not daily. Once the spirits have been given first dibs, the family is welcome to eat the remains or give it to guests. As a further measure of protection and blessing, Cambodians trust in variations of yoan and yantra figures, complete with Pali letters and numbers. Both the kruu Khmai and monks can use the figures to…
“…call upon the five incarnations of the Buddha… and the ten baareamjy (from Pali parami), to engage the good deeds of the Buddhas. The representations of these Buddhas are often present in the drawings of yantra and in the five Pâli letters … These letters stand for the five Buddhas and also for the five parts of the human body: the head, two arms and two legs, which bud in embryological development (Bizot, 1988). As the kruu often call upon groups of the five incarnations of the Buddha, it appears that each incarnation has its own contribution to treatment…”
– Maurice Eisenbruch, The Ritual Space of Patients and Traditional Healers in Cambodia, 1992).
Flags displaying these figures can be hung in the home for protection and some go so far as to have them tattooed on the skin. Additionally, protective belts and necklaces containing protective Pali and Khmer scriptures written on long, thin scrolls of paper can be worn from ages 0 until death. Most babies will sport a small pouch around their necks while women often decorate their waists with expensive, silver chains (like Navy’s below) complete with small chambers in which the scriptures are kept.
Although I have never met them myself and my coworkers would likely never admit to having visited themselves, they assure me that the kruu Khmai in our commune are most skilled. In serious cases, the local monks can also be called upon for additional treatment of a more mystic nature, although theirs a role apart from the kruu. Ultimately, if you or your relatives are facing extended poor health without relief, you can seek a fortune teller who will help divine the cause.
“The monks are seen to be spiritual, the kruu medical healers. The monks are ordained in a specific monastic ceremony, the kruu are initiated in the course of a long apprenticeship; the monks study Buddhist texts, the kruu learn from palm leaf manuscripts and old masters; the monks follow the Vinaya code that forbids them owning to or showing their power; the kruu are known to have power and can use it publicly…”
– Maurice Eisenbruch, The Ritual Space of Patients and Traditional Healers in Cambodia, 1992
Grampa, I’m also going to ask you to eschew unfamiliar plant-parts and traditional healers you don’t trust and stick to you occasional jigger of Frangelico, for I have only ever known such a thing to heal the body. I’m off to continue begging the dehydrated, feverish elderly patients to please for the love of Buddha drink some water as they insist it will kill them by way of “frozen belly.”
Love you all the time,