Journal of Thai Traditional and Alternative Medicine

Monograph of Select Thai Material Medica: (..)

Subcommittee on the Preparation of Monographs of Selected Thai Materia Medica — 2025-08-29

N/A

Dictionary of Traditional Chinese Medicine Volume 2 (Chinese-Thai-English) (21)

Tawat Buranatawonsom — 2025-08-29

N/A

Effect of Boesenbergia rotunda ethanolic extract on CYP3A4, CYP2C9 and CYP2E1 activities

Nattaporn Polsan — 2025-08-29

Introduction and Objectives: Fingerroot (Boesenbergia rotunda), a traditional Thai herb, has long been used in both culinary and medicinal applications within traditional Thai medicine. Recent studies have shown that ethanol extracts of B. rotunda, commonly referred to as B. rotunda liquor, exhibit various pharmacological activities with potential applications in drug development or as herbal health products, including antiviral activity against SARS-CoV-2. However, the use of B. rotunda extract products alongside conventional medications raises concerns regarding potential herb–drug interactions. These interactions may be due to the modulation of cytochrome P450 (CYP) enzymes by herbal constituents. This study aimed to investigate the effects of B. rotunda extract and its major constituents on the activities of CYP3A4, CYP2C9, and CYP2E1. These isoenzymes were selected based on their clinical significance: CYP3A4 metabolizes over 50% of marketed drugs; CYP2C9 metabolizes warfarin, a drug with a narrow therapeutic index; and CYP2E1 is involved in the metabolism of ethanol, which is widely consumed.

Methods: B. rotunda rhizomes were extracted by maceration in 95% ethanol for 72 hours, repeated three times. The chemical composition and content of active compounds in the extract were analyzed using ultra-performance liquid chromatography (UPLC). The inhibitory effects of the extract on CYP3A4, CYP2C9, and CYP2E1 enzymes were evaluated by measuring the fluorescence of metabolites formed during enzyme-substrate reactions. Inhibitory activities of both the crude extract and its major constituents were compared to a negative control (0.25% DMSO) and known positive CYP inhibitors: ketoconazole (CYP3A4), sulfaphenazole (CYP2C9), and tranylcypromine (CYP2E1). The results were presented as percentage inhibition (% inhibition) and IC₅₀values. Statistical analyses were performed to assess the significance of differences observed.

Results: The major active compounds identified in the ethanol extract of B. rotunda were pinocembrin and pinostrobin, with contents of 6.0% and 12.0% w/w of the dried extract, respectively. The concentrations of pinocembrin and pinostrobin in the tested extract were 11.71 µM and 22.20 µM, respectively. The ethanol extract demonstrated inhibitory activity against CYP3A4 and CYP2C9 but not against CYP2E1. Among the individual constituents, pinocembrin significantly inhibited CYP3A4 (p = 0.037) at the concentration found in the extract, whereas pinostrobin showed no such effect. Neither compound inhibited CYP2C9 or CYP2E1 activity.

Discussion: The inhibitory effect of the ethanol extract on CYP3A4 activity was concentration-dependent and attributed, at least in part, to the presence of pinocembrin. Pinostrobin did not contribute to this inhibition. The observed inhibition of CYP2C9 by the extract is likely due to other constituents besides pinocembrin and pinostrobin. No significant inhibition of CYP2E1 activity was observed for either the extract or its major constituents.

Conclusion and Recommendations: The ethanol extract of B. rotunda inhibits CYP3A4 activity, with pinocembrin being a contributing factor. The inhibition of CYP2C9 activity by the extract does not appear to involve either pinocembrin or pinostrobin. No inhibitory effects on CYP2E1 were observed for the extract or its major compounds. Further research is recommended to elucidate the specific mechanisms of enzyme inhibition and to conduct clinical studies to evaluate potential herb–drug interactions.

Evaluating Thai Traditional Medicine Health Promotion Program, Lampang Province: 3S Anti-Aging

Wanna Damnoensawat — 2025-08-29

Introduction and Objectives: This research aimed to evaluate of the 3S Anti-Aging (Style-Smile-Smart Lampang Anti-Aging Program) implementation, a health promotion initiative utilized Thai traditional medicine for pre-elderly and elderly populations in Lampang Province. The evaluation employed the CIPP Model (Context, Input, Process, Product) as a conceptual framework to examine the relevance of the program’s context, inputs, effectiveness of implementation process, and achieved outcomes.

Methods: The study employed mixed methods to collect data from two sample groups: 26 multidisciplinary professionals who participated in the program and 130 individuals who joined the activities organized by these professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through content analysis.

Results: The study findings revealed that the program aligned well with the context and needs of the local community, promoted holistic health through Thai traditional medicine, and integrated seamlessly with the existing activities of senior citizen clubs in the area. The multidisciplinary professionals who underwent training were able to effectively transfer their knowledge to the community. Despite certain limitations—such as insufficient personnel, high workloads, coordination issues, and budget constraints—the program maintained continuous operations. Following the training, the multidisciplinary group successfully established 60 anti-aging centers in the area, organized 57 activities over two fiscal years, and engaged more than 5,640 participants. The most popular activities included nine-square step exercises, facial massages, resistance band exercises, herbal food, and herbal skincare. These centers played a critical role in providing accessible health services through the integration of health promotion with Thai traditional medicine. This approach sparked interest among participants in utilizing Thai traditional medicine for their health care needs, potentially reducing dependency on hospital-based care. However, the study did not observe clear impacts on the volume of services provided by Thai traditional medicine practitioners.

Discussion: This project employed a strategy to enhance health literacy in Thai traditional medicine among multidisciplinary professionals, aiming to develop an integrated and sustainable model for health promotion. Recommendations for improvement included increasing personnel, leveraging technology to support activities, allocating appropriate budgets and resources, enhancing the suitability of activity venues, providing flexibility in scheduling, and strengthening coordination among involved agencies.

Conclusion and Recommendation: The 3S Anti-Aging Program reflected a successful integration of Thai traditional medicine with holistic health promotion and served as a model for scaling up to other areas to sustainably improve the quality of life for the population.

Outcome of Kae Lom Kae Sen for Pain Relief in Patients with low back pain: An observational study

Sasipong Tipratchadaporn — 2025-08-29

Introduction and Objective: Kae Lom Kae Sen has the properties of relieving muscle pain, fatigue, muscle stiffness, and numbness, serving as a traditional Thai herbal medicine formula making it one of the top 3 most used cannabis formula in Thailand medical cannabis clinics. However, there has been no study on its clinical outcome and side effect methodically. This study aims to evaluate the outcome and adverse drug reaction of using Kae Lom Kae Sen in outpatients with low back pain symptoms at the Hang-Ka-Rok Clinic, Pra Arjan Phan Arjaro Hospital.

Methods: The study was conducted through a prospective observational study on outpatients receiving treatment for low back pain. A total of 60 patients were included between June 2020 and May 2021. The sample group received Kae Lom Kae Sen, packaged in sachets of 2 g each, to be taken once a day, 1 sachet mixed with honey, Citrus anrantium juice, or warm boiled water, taken twice a day before meals, morning and evening, continuously for 4 weeks. The sample group was scheduled for follow-up to assess treatment outcomes, including pain intensity scores (Visual Analogue Scale: VAS), adverse events from medication, and overall treatment satisfaction.

Results: 93.33% of the sample group experienced improved lowback pain symptoms after completing one week of treatment, with statistically significant reductions in average pain intensity scores before and after completing 4 weeks of Kae Lom Kae Sen treatment, from 7.57 ± 1.24 points to 3.18 ± 1.14 points, respectively. The most common adverse events from drug were heartburn (16.67%), dry mouth, feel dry (5.00%), and dizziness (1.67%). The average overall treatment satisfaction score for Kae-Lom-Kae-Sen treatment was 4.51 ± 0.62 points.

Discussion: Kae Lom Kae Sen can reduce the pain score. This may be a result of the pharmacological effects of important herbal substances in the formula that have analgesic effects and anti-inflammatory. The main flavor ot the recipe is very hot. Let the blood flow to various organ and increase body warmth.

Conclusionand Recommendation: The research results indicate that Kae Lom Kae Sen can effectively alleviate muscle pain symptoms in the sample group, as assessed by reduced pain intensity scores, along with safety among the sample group using the medicine continuously for one month.

A Clinical Study on the Effects of Acupressure Combined with Herbal Poultice in the Treatment of Knee Osteoarthritis: Clinical Outcomes and Patient Satisfaction

Bodin Chatawatee — 2025-08-29

Introduction and Objectives: Osteoarthritis is a physiological and anatomical disorder of the articular cartilage, leading to structural changes and inflammatory processes within the knee joint. The severity of the disease correlates with pain levels and joint functionality, which limits joint mobility and affects daily activities. According to traditional Thai medicine theory, knee osteoarthritis is believed to result from a blockage of wind energy in the knee joint, causing stiffness and pain, and eventually leading to dysfunction of the earth element. Therefore, traditional Thai medicine treatments focus on relieving the blockage of wind energy in the knee area to reduce pain and improve joint function. This study aims to evaluate the clinical outcomes and patient satisfaction of a treatment combining knee acupressure and knee herbal poultice for patients with knee osteoarthritis.

Methods: This quasi-experimental clinical study was conducted with 36 knee osteoarthritis patients diagnosed by physician at Thepha Hospital, Thepa district, Songkhla province. All patients received knee acupressure combined with knee herbal poultice; knee acupressure at seven points (2 minutes per point for a total of 14 minutes) including signal points 1, 2, 3 of knee, signal point 4 of outer knee, 2 inches above the inner knee joint, signal point 4 of inner knee, and 2 inches below the knee joint. Knee herbal poultice for 30 minutes; the herbal formula, developed by the Traditional Thai Medicine Hospital, Prince of Songkla University, contained Plai (Zingiber cassumunar Roxb.), Dong-dueng (Gloriosa superba L.), Ya-dam (dried resin of Aloe vera (L.) Burm.f.), and camphor. The treatment was administered once daily for three consecutive days. The clinical outcomes were measured pre- and post-treatment. Pain levels were measured using a numerical pain rating scale, and clinical outcomes were assessed with the Thai version of the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which includes 3 questions on pain, stiffness, and functional ability. Patient satisfaction was also evaluated. Data were analyzed using frequency and percentage for pain changes and satisfaction, while paired t-tests were used for clinical outcome comparisons pre- and post-treatment, with a statistical significance level set at 0.05.

Result: After 3 consecutive days of treatment, 55.56% of patients experienced a reduction in pain from moderate to mild levels. Statistical analysis of the modified WOMAC results showed significant improvements in pain, stiffness, and functional ability (p < 0.001). Additionally, patients reported an average satisfaction score of 4.47 ± 0.65, with 55.55% expressing the highest level of satisfaction with the treatment outcomes.

Discussion: Knee acupressure combined with knee herbal poultice effectively reduced pain and improved patient’s clinical outcomes. The 7 knee acupressure points used in this study, based on Thai massage principles and anatomical locations, stimulated blood, and wind circulation around the knee, leading to muscle relaxation and improved joint functionality. The knee herbal poultice formula, containing active ingredients such as terpinene-4-ol, a compound with anti-inflammatory effects, and camphor, which enhance the skin’s absorption of active ingredients. These properties may support the deeper penetration of therapeutic compounds in the knee herbal poultice, contributing to the observed clinical improvements. The effects may also be linked to the gate control theory of pain, which inhibits pain signals from the spinal cord to the brain and stimulates the release of β-endorphins, promoting vasodilation and pain relief.

Conclusion and recommendations: Knee acupressure combined with knee herbal poultice, administered once daily for three consecutive days, significantly reduces pain, stiffness, and improves knee joint function in osteoarthritis patients. This approach can be effectively applied in managing osteoarthritis care.

Development of Tetrahydrocannabinol Content Analysis by HPLC and Physicochemical Properties of Cannabis Female Inflorescences and Leaves

Puritat Rattanasiri — 2025-08-29

Introduction and Objectives: Due to the absence of standard specification for the quality control of cannabis female inflorescences and leaves, this study aimed to evaluate their physicochemical properties, establish chemical profiles, develop quantitative analytical methods and validate these methods. The findings will support the formulation of monographs of cannabis female inflorescences and cannabis leaves for the Thai Herbal Pharmacopoeia.

Methods: A total of 23 cannabis female inflorescences samples and 16 cannabis leaf samples were analyzed. Chemical identity was assessed using tetrahydrocannabinol (THC) and cannabidiol (CBD) as reference standards. Physicochemical properties were evaluated, and a high performance liquid chromatography (HPLC) method was developed and validated for quantifying THC content.

Results: Colorimetric reactions revealed the presence of cannabinoids and terpenoids. Thin layer chromatography confirmed the presence of THC and CBD.For female inflorescences, the mean ± standard deviation values for moisture, total ash, acid-insoluble ash, water extractive, ethanol extractive and THC contents were 8.00 ± 0.68, 12.94 ± 2.03, 1.96 ± 0.96, 18.51 ± 3.33, 17.64 ± 2.59 and 1.95 ±1 .51 %w/w, respectively. For leaves, the corresponding values were 7.83 ± 0.74,17.38 ± 3.07, 2.48 ± 1.70, 26.04 ± 2.54,14.88 ± 3.39 and 0.39 ± 0.23 %w/w, respectively. The developed HPLC method demonstrated high specificity and linearity across the concentration range of 2 to 10 µg/mL (R²=0.9998). Recovery rates ranged form 97.71% to 103.15%, precision (%RSD) from 0.08% to 0.36%, with LOD and LOQ values of 0.08 and 0.25 µg/mL, respectively.

Discussion: Our study on the chemical profile of female cannabis inflorescences and leaves showed varying levels of THC and CBD, while CBD was detected in only a few samples. This variation may be due to differences in strain, cultivation location, and harvesting time. Within the same cultivation site, the female inflorescences contained more THC than the leaves, aligning with previous findings that female inflorescences are the primary site of cannabinoid accumulation in cannabis plants. Chemical profiling using HPLC enabled the separation of eight standard compounds. Physicochemical quality assessment can serve as a guideline for quality control of medicinal cannabis. Moreover, the development of an HPLC method to quantify THC in female inflorescences and leaves showed high specificity, with excellent linearity, recovery, and precision, meeting accepted pharmaceutical analysis standards. The use of a gradient HPLC system also significantly reduced analysis time.

Conclusion: The physicochemical specifications and the analytical method developed in this study can be used to help establish national standard specification for cannabis female inflorescences and leaves in the Thai Herbal Pharmacopoeia.

The Role of Benjakul in Knee Osteoarthritis Treatment: A Perspective Through the Influence of Body Innate Elements

Chitrada Kongkum — 2025-08-29

Introduction and Objective: Benjakul (BJK), a traditional Thai remedy, shows potential in treating knee osteoarthritis particularly in the elderly due to its anti-inflammatory, analgesic, and circulation-boosting properties. In Thai traditional medicine, disease is believed to result from imbalances among the four Innate Body Elements (IBE): earth, water, wind, and fire, which influence both symptoms and treatment response. However, limited research has explored the link between IBE types and treatment outcomes in osteoarthritis. This study aims to compare the efficacy of BJK in relieving knee pain among osteoarthritis patients, grouped according to their dominant IBE type.

Methods: A multicenter clinical trial was conducted at four Thai hospitals with 170 participants aged 50–80 years diagnosed with knee osteoarthritis (Kellgren and Lawrence grade 1–3) by orthopedists, pain score ≥ 3 and BMI ≤ 32 kg/m². Participants received 100 mg BJK extract capsules three times daily after meals for 28 days, along with omeprazole for gastric protection. The extract was prepared according to the Thai Herbal Pharmacopoeia and contained equal parts Piper retrofractum, Piper sarmentosum, Piper interruptum, Plumbago indica, and Zingiber officinale, extracted with 95% ethanol and encapsulated under quality control. The 500 mg capsules each contain 100 mg of the BJK extract. The results were assessed using the Visual Analogue Scale (VAS), the 40m Fast-Paced Walk Test (40mFPWT), the Timed Up and Go Test (TUG), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the assessment of global improvement in efficacy. Liver and kidney function tests were also performed for safety testing. Participants were categorized into four IBE types based on their date of birth. Descriptive statistics summarized the characteristics of the sample, while chi-square tests analyzed categorical data. One-way analysis of variance (ANOVA) for normally distributed data was used for between-group comparisons, and paired-samples t-tests were used for within-group comparisons. Statistical significance was defined as p < 0.05.

Results: Of the 151 participants who completed the study, 23.8% were assigned to the element of fire, 33.8% to the element of wind, and 21.2% each to the elements of water and earth. After taking BJK extract capsules for 28 days together with omeprazole, all groups showed a significant reduction in VAS pain scores (p < 0.001). The 40m Fast-Paced Walk Test showed a slight improvement, with significance only in the earth group (p < 0.001). TUG times improved significantly in the fire, wind and earth groups (p < 0.001) and moderately in the water group (p < 0.05). KOOS scores improved in several dimensions: The fire, wind and water groups improved in all domains (p < 0.05), while the earth group improved in daily activities, sports/recreation, and quality of life (p < 0.05). The overall efficacy was 87.5% in the fire, wind and water group and 75% in the earth group, with the wind group showing the highest efficacy. At the end of the study, 43% rated their condition as moderately better, with the water group having the highest mean score (2.69/4), followed by the wind group (2.31/4). No adverse changes in liver or kidney function were observed.

Discussion: Most participants were classified as wind element, followed by fire element. This is consistent with Thai traditional medicine’s view that knee osteoarthritis (Lom-Chap-Pong-Haeng-Khou) is caused by an imbalance of wind (Lom). The warming properties of BJK help to dispel wind, stimulate fire, improve circulation and restore element balance, resulting in reduced pain, inflammation and improved joint function. The mechanism, supported by previous studies, involves the activation of heat-sensitive receptors that desensitise pain pathways while modulating inflammatory responses — particularly effective in people suffering from wind elements. Post-treatment results showed significant improvements in pain, mobility and balance (as indicated by the TUG test and KOOS scores) attributable to BJK’s anti-inflammatory agents, including piperine, 6-gingerol, 6-shogaol and plumbagin. The warming properties of the BJK extract effectively relieved wind-induced blockages in knee osteoarthritis, resulting in pain relief and improved joint function. The earth element group showed a lower response to treatment, possibly due to a higher BMI, which is consistent with the traditional theory that earth element individuals tend to have a larger physique and higher weight factors that contribute to osteoarthritis. BJK was well tolerated and had no adverse effects on liver or kidney function.

Conclusions and Recommendation: BJK extract (100 mg, three times daily with omeprazole) is effective in relieving the pain of knee osteoarthritis and is safe to use. Although the differences between the IBE groups were minimal, the wind and water groups showed slightly better results than the earth group. The improved efficacy of treatment outcomes may be important information for considering the use of hot herbal medicine formulas for pain relief based on the theory of wind element disease in traditional Thai medicine. Controlling weight and incorporating knee exercises, which are part of the treatment for knee osteoarthritis, may improve treatment efficacy and adherence. Further studies with larger samples and standard drug comparisons are recommended.

Effectiveness of Court-type Thai Traditional Massage Combined with Herbal Compress on Pain Intensity and Shoulder Range of Motion in Patients with Frozen Shoulder

Pathikhom Phasawang — 2025-08-31

Introduction and Objective: Frozen shoulder (adhesive capsulitis) is caused by chronic inflammation of the synovial membrane and thickening of the joint capsule, which leads to the narrowing of the joint cavity. This results in shoulder stiffness and limited movement. In Thai therapeutic massage (TTM), this disease is known as “Hua Lai Tit” and is divided into two types: acute frozen shoulder and chronic frozen shoulder. Previous studies have reported the effectiveness of court-type Thai traditional massage (CTTM) combined with Thai herbal compresses (THC) in significantly reducing pain levels and improving the range of motion in the neck and knee joints. However, evidence regarding its effectiveness in patients with frozen shoulder remains limited. Therefore, the objective of this study was to investigate the effectiveness of CTTM combined with THC in patients with chronic frozen shoulder. This preliminary quasi-experimental study employed a single-group design with pre- and post-intervention assessments. The protocol was approved by the Human Research Ethics Committee of Mahasarakham University (Ref. no. 319-317/2566).

Methods: This study aims to evaluate the effectiveness of CTTM combined with THC on pain scores using visual analog scale (VAS) and shoulder range of motion (SROM) in all directions: flexion, extension, abduction, adduction, internal rotation, and external rotation. Thirty participants with frozen shoulder were recruited. Participants were given 8 sessions of CTTM+THC treatment (2 sessions per week) during a four-week period. The assessments of pain scores and SROM were performed prior to the treatment (baseline), at the end of treatment period (4^th week), and two weeks after the treatment ended (6^th week). Data were statistically analyzed using paired samples t-test.

Results: Most of research participants were female, aged 50–69, and had right-sided frozen shoulder. The study found a statistically significant decrease (p < 0.05) in the average shoulder pain score. The mean VAS scores before treatment, after 4 weeks, and after 6 weeks were 4.47 ± 0.33, 2.61 ± 0.45, and 2.40 ± 0.44, respectively. In addition, the average shoulder range of motion also increased in all directions, with a statistically significant improvement (p < 0.05). The average SROM values before treatment, after 4 weeks, and after 6 weeks for each movement were as follows: Flexion (raising the arm forward): 105.8 3 ± 6.24, 119.50 ± 5.55, 121.2 ± 6.88 degrees; Extension (raising the arm backward): 29.30 ± 5.56, 39.70 ± 5.01, 41.20 ± 3.66 degrees; Abduction (raising the arm out to the side): 80.06 ± 5.49, 93.63 ± 5.36, 92.90 ± 6.09 degrees; Adduction (lowering the arm to the side): 15.64 ± 4.12, 24.11 ± 5.26, 23.77 ± 4.96 degrees; Internal rotation (rotating the shoulder inward): 29.30 ± 4.92, 37.73 ± 4.78, 37.10 ± 4.42 degrees; and External rotation (rotating the shoulder outward): 27.36 ± 5.05, 37.16 ± 5.68, 36.20 ± 5.55 degrees.

Discussion: CTTM combined with THC is a recognized and effective treatment option within Thailand's healthcare system for musculoskeletal disorders. This therapy is known to improve blood and lymphatic circulation, enhance relaxation, reduce tissue tension, and decrease pain levels. As demonstrated in this study, the integrated therapy of CTTM and THC effectively reduced pain, alleviated chronic shoulder inflammation, and improved the shoulder's range of motion in all directions. These positive outcomes were observed after a course of eight treatments, administered twice per week over a period of four weeks.

Conclusion and recommendation: The combination of court-type Thai traditional massage and Thai herbal compresses is shown to be effective in reducing pain intensity and enhancing SROM in all directions. Future research should compare the combined therapy of massage and herbal compresses with a standard conventional medical treatment, while also increasing the number of research participants.

The Wisdoms of “Toh Bidae” for Reproductive Healthcare among Women in Pattani Province, Thailand

Onchuda Chaitam — 2025-08-29

Introduction and Objectives: In the southern border provinces of Thailand, there exists traditional wisdom from local healers that has been passed down through families. This wisdom, known in the local Malay language as "Toh Bidae", plays an important role in these provinces due to the healers ‘expertise in caring for women from early pregnancy through postpartum. It also encompasses knowledge in treating infertility and maintaining women's health. This study aims to examine the wisdom of Toh Bidae in caring for the reproductive health of women in the Pattani province, with the goal of using this knowledge to further public health initiatives and improve community healthcare.

Methodology: This qualitative research explores the knowledge of Toh Bidae in Pattani province with a sample group of 17 participants through in-depth interviews. The research tool is an interview recording form. Data were verified by the informants and analyzed using thematic analysis. The duration of the study is from October 2023 to March 2024.

Results: The sample group consisted of 17 individuals, and the data are divided into five key points: (1) The inheritance of Toh Bidae Wisdom, which involves both studying from textbook and gaining knowledge through supernatural means. (2) Infertility treatment, where Toh Bidae practices are considered an alternative approach to treating infertility. (3) Healthcare for pregnant women, where Muslim women, especially those from families with elderly such as grandmother and mother, have strong beliefs in prenatal care provided by Toh Bidae. (4) Postpartum healthcare, where Toh Bidae typically provide postpartum care for 15 to 30 days, starting from three days postpartum or following a cesarean section once the surgical wound has healed. (5) Participation in public health system, where some hospitals allow Toh Bidae to assist in pregnancy and postpartum care. The study results suggest the potential for developing integrated approaches between traditional medicine and public health system.

Discussion: Toh Bidae in Pattani province have inherited knowledge passed down through generations. Their care practices can be divided into pregnancy preparation period, the pregnancy period, and the postpartum period. It was evident that direct birth care is no longer practiced, as there is currently a campaign promoting hospital births for the safety of mothers and children. Moreover, integrating Toh Bidae care with health services can reduce challenges and increase access to hospital service, lowering the risks associated with not receiving prenatal care in hospital.

Conclusion: Toh Bidae in the southern border provinces continue to play role in caring for the reproductive health of women in the area. Compiling and summarizing the wisdom of Toh Bidae can help in developing guidelines for integrate on of this traditional knowledge with public health initiatives, benefiting the community.

The Clinical efficacy and safety of Thai traditional medicine remedy call “Kae Lom Kae Sen” for upper back pain: A Double- Blinded Randomized Controlled Trial.

Piyatas Jaiyen — 2025-08-29

Introduction and Objectives: The prevalence of musculoskeletal disorders has increased in recent years, particularly among the working-age population, primarily due to overuse of muscles and poor posture. This has led to a growing burden on the healthcare system and increased reliance on imported modern medicines. In 2020, Thailand’s importation cost for musculoskeletal drugs reached approximately 7.07 billion baht. Meanwhile, interest in traditional Thai medicine and herbal treatments has been growing. However, the use of herbal remedies remains limited due to the lack of strong scientific evidence. In response, the Ministry of Public Health has promoted the use of herbal medicines by including 97 items in the National List of Essential Herbal Medicines in 2023. In addition, under the medical cannabis policy, several traditional Thai formulations containing cannabis were introduced in public healthcare settings. One such remedy, Kae Lom Kae Sen remedy, comprises seven herbs: white cumin, black cumin, fennel, ginger, plumbago, cannabis leaves, and black pepper. This remedy has been listed in the national herbal drug list and is believed to be effective in muscle pain relief. This study aimed to compare the efficacy and safety of Kae Lom Kae Sen remedy with placebo in relieving upper back muscle pain.

Methods: This study was a double-blind randomized controlled trial conducted among individuals with upper back muscle pain lasting between 2 to 30 days. A total of 60 participants were randomly assigned using computer-generated simple randomization into two groups of 30 each. The intervention group received the Thai herbal formula Kae Lom Kae Sen, composed of seven herbs: Cuminum cyminum, Nigella sativa, Foeniculum vulgare, Zingiber officinale, Plumbago indica, Cannabis sativa leaves, and Piper nigrum, encapsulated in 500 mg capsules. The control group received a placebo identical in appearance. Participants were instructed to take four capsules per day, two capsules in the morning and two in the evening—for seven consecutive days. Efficacy outcomes were assessed using the NRS (numerical rating scale) for pain, the CROM (cervical range of motion) device for neck and shoulder mobility, and an algometer for pressure pain threshold. Follow-up evaluations were conducted on days 3 and 7. Safety was assessed via laboratory investigations, including complete blood count (CBC), renal function tests, and liver function tests. Data were analyzed using descriptive statistics and appropriate inferential tests (Independent t-test, Mann–Whitney U test, Paired t-test, and Wilcoxon Signed Rank Test), with a significance level set at p < 0.05.

Results: All 60 participants completed the study, with > 80% adherence to the intervention. Baseline characteristics such as age, gender, body weight, height, blood pressure, pain duration, and work posture were not significantly different between groups (p > 0.05). Regarding efficacy, the intervention group exhibited a statistically significant reduction in muscle pain scores on days 3 and 7 (from 5.70 to 1.86, p < 0.001), compared to the placebo group (from 5.33 to 4.10, p < 0.001). Cervical and shoulder mobility significantly improved in the herbal group by 8–14 degrees (p < 0.001), while the placebo group showed less consistent improvements. Pressure pain threshold increased in both groups, with greater average improvement in the herbal group, although between-group differences were not statistically significant. Overall treatment assessment revealed that 46.7% of participants in the herbal group reported "very much better," and 6.7% reported "complete recovery," compared to only 3.3% in the placebo group reporting "very much better" and none reporting complete recovery (p < 0.001). Safety outcomes showed no significant differences in CBC, renal, or liver function between groups (p > 0.05), and all values remained within clinical reference ranges. Minor adverse effects such as dry mouth and drowsiness were reported only in the herbal group.

Discussion: The Kae Lom Kae Sen remedy demonstrated greater efficacy than placebo in relieving muscle pain and tendon stiffness, improving range of motion, and enhancing pressure pain tolerance from as early as Day 3 of treatment. These improvements were also consistent with the normative range of cervical and shoulder joint mobility in the general population. Although muscle pain can resolve spontaneously, the findings suggest that this herbal formulation significantly accelerates recovery. Its superior effect may be attributed to the pharmacological properties of its key herbal components, particularly black pepper (Piper nigrum), which contains piperine a compound known for its anti-inflammatory effects through COX-2 enzyme inhibition and suppression of pain-related cytokines and neurotransmitters. Additionally, cannabinoids such as THC and CBD derived from cannabis leaves contribute to reduced pain sensitivity by activating CB1 and CB2 receptors, improving both mobility and pressure pain thresholds. These biomedical mechanisms are in alignment with Thai traditional medicine, which attributes muscle pain to imbalances in the elements, particularly Lom (wind) and Fai (fire). The use of herbs with "hot" properties, such as Kae Lom Kae Sen remedy, helps restore balance by dispersing accumulated wind, alleviating muscle tension, and stimulating blood circulation. Nevertheless, the use of this herbal medicine should be under the supervision of a licensed Thai traditional medicine practitioner or qualified healthcare professional. This is to ensure proper dosage adjustments and to minimize potential adverse effects associated with prolonged use, thereby ensuring patient safety during treatment.

Conclusion and Recommendations: The Kae Lom Kae Sen remedy demonstrated superior efficacy to placebo in relieving upper back muscle pain, improving pain scores, increasing cervical mobility, and enhancing muscle pain pressure tolerance, with a favorable safety profile. Further studies are recommended to explore its active compounds, pharmacodynamics, and long-term safety.

Policy and Ethics

Vichai Chokevivat — 2025-08-31

N/A

Vichai Chokevivat — 2025-08-29

N/A

Editor's Note