Effectiveness of Harag Herbal Poultice for Relieving Abdominal Pain as per Thai Traditional Medicine Practice Guidelines for End-stage Liver Cancer Patients at the Thai Traditional and Integrated Medicine Hospital, Bangkok

Main Article Content

Preecha Nootim
Amornrat Rachderm
Worawut Raksaithong


The majority of end stage liver cancer patients suffer from abdominal pain if an effective pain relief treatment is not given, probably affecting healing outcome and quality of life. This quasi-experimental study aimed to determine the effects of a harag (five-root) herbal poultice used for relieving abdominal pain in end stage liver cancer patients as per the Thai Traditional Medicine Practice Guidelines for End-Stage Liver Cancer Patients. The study participants were the patients with end stage of liver cancer at the Thai Traditional and Integrated Medicine Hospital in Bangkok. Sixty subjects who met the selection criteria were included in this study. Among them, the experimental group (n = 30) received a harag herbal poultice made up of five roots, 30 grams each, applied in the affected area of 10x15 cm, twice a day (morning and evening) for 3 days as per the aforementioned practice guidelines, while the control group (n = 30) did not receive any of such herbal poultice treatment. The five herbs were roots of Harrisonia perforata (Blanco) Merr., Capparis micracantha DC., Clerodendrum indicum (L.) Kuntze., Ficus racemosa L., Tiliacora triandra (Colebr.) Diels.  Data were collected retrospectively using (1) a Visual Analog Scale for pain levels as determined by the patients and (2) a patient satisfaction questionnaire, whose content had been validated by five experts and its content validity index was 1 and Cronbach’s alpha coefficient was 0.84. Dependent and independent t-tests were used for data analysis. The results revealed that the experimental group had significantly lower pain scores after receiving the herbal poultice than before. Additionally, the experimental group had a significantly lower pain score than the control group. Furthermore, patient satisfaction was reported as good. So, harag herbal poultice can be used for relieving abdominal pain in patients with end stage liver cancer as per the Thai traditional medicine practice guidelines for such patients, and it is a suitable medication for such a healing purpose.


Download data is not yet available.

Article Details

Original Articles


Turk DC, Feldman CS. Noninvasive approaches to pain control in terminal illness: the contribution of psychological variables. Hosp J. 1992;8(1-2):1-23.

Phosri T. Palliative care in the end of life patients: from hospital to home setting [Independent study]. Khon Kaen: Khon Kaen University; 2007. (in Thai)

The National Statistical Office Thailand. Crude rates of deaths (1:100000), Registered - In and Registered-Out by sex and region: 2002-2009. Office of the Permanent Secretary, Ministry of Public health. 2010. (in Thai)

The National Statistical Office Thailand. Crude rates of deaths (1:100000), Registered - In and Registered-Out by sex and region: 2002-2009 [Internet]. Office of the Permanent Secretary, Ministry of Public health. 2010 [cited 2018 May 11]. Available from: https://bps.moph.go.th/new_bps/sites/default/files/health_statistics2555.pdf. (in Thai)

Bureau of Non Communicable Diseases, Department of Diseases Control, Ministry of Public Health. Annual report 2015 [Internet]. Bangkok: WVO Officer of Printing Mill.; 2016 [cited 2018 May 12]. Available from: https://thaincd.com/document/file/download/paper-manual/Annual-report-2015.pdf. (in Thai)

Leelanantakit S. Clinical treatment guideline for End of life patients. Bangkok: The Agricultural Cooperative Federation of Thailand. Institute Of Geriatric Medicine, Department of Medical Services, Ministry of Public Health; 2004. (in Thai)

Steinman RH. The cancer patient with anxiety and chronic pain. Pain Clin Updates 2009;17(4):1-5.

School of health science, Sukhothaithammathirat Opent University. Thai traditional therapy I. Nonthaburi. The Office of the University Press Sukhothaithammathirat Opent University; 2012. (in Thai)

Reid N, McCormack P. Symptom management. In: Lugton J, Mcintyre R, editors. Palliative care: the nursing role 2nd. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 91-132.

Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 11th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.

Chokevivat V. Policies and directions for the development of Thai traditional medicine and alternative medicine in Thailand. 1st ed. Bangkok: The War Veterans Organization of Thailand Press; 2003. (in Thai)

Petrakard P, Limpananont J, Chantraket R, et al. The Report of situations and trends in The Indigenous medicine, Thai traditional and alternative medicine (2005-2007). Bangkok: Manasfilm; 2007. (in Thai)

Elimination of liver fluke and cancer of the bile duct in the public [Internet]. 2017 [cite 2017 November 5]. Available from: https://www.samatcha.org/nha/cms/files/menu_content_files/7/43/77/198/198_20150127061035.pdf. (in Thai)

Chiangthong A, Sawacharangkul N, Kerdtho S. Clinical practice guideline field Thai traditional medicine for the pilot Thai traditional medical hospital. Bangkok: Samcharoen Panich Printing; 2016. (in Thai)

National List of Essential Medicines B.E. 2558 (2015). Thailand B.E. 2558 (2015), Government Gazette, Vol. 132, Part 184 ngor. (10 Aug2015). (in Thai)

Gara G, Singer AG, Taira BR, Chohan J, Cardoz H, Chisena E, Thode HC Jr. Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patient. Academic Emergency Medicine. 2010;17(1):50-4.

National Comprehensive Cancer Network. Adult cancer pain. In: NCCN Clinical Practice Guidelines in Oncology. 2008.

Biegler KA, Chaoul MA, Cohen L. Cancer, cognitive impairment, and meditation. Acta Oncol. 2009;48(1):18-26.

Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: systematic review. J Adv Nurs. 2008;63(5):430-9.

Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.

Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL Jr, Slee CK, Wun T, Oliver JW, Lorig K, Franks P. Cancer health empowerment for living without pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain. 2011;152(7):1572-82.

Beck SL, Towsley GL, Berry PH, Lindau K, Field RB, Jensen S. Core aspects of satisfaction with pain management: cancer patients' perspectives. J Pain Symptom Manage 2010;39(1):100-15.