Squirming with pain, Som Vanna clenched his teeth and toes and stared hazily up at the ceiling.
His face distorted and he let out a defiant cry.
“It makes me feel better,” he cried.
“This doesn’t happen in the West,” the 62-year-old added.
Mr Vanna was referring to Kors Kyal, otherwise known as coining, a traditional form of medical treatment in Cambodia with origins dating back millennia to the time of the Roman Empire.
The procedure traditionally consists of forcefully scraping a brass coin over an oiled section of the skin’s surface until the blood cells underneath break down causing sever bruising and burst blood vessels.
And like many Cambodians, Mr Vanna said that whatever the problem—muscular pain, diarrhea, high fever or common cold—the painful coining has an immediate, almost magical healing effect.
“It hurts, but it is very effective in ridding my illness,” he said, as two matronly women furiously scraped his skin from head to toe with shiny metal coins at a small, shophouse without a sign in Daun Penh district.
“Whenever I have a problem with my health I come here,” Mr Vanna said with gritted teeth.
Nursing a high fever, Mr Vanna said that he was fed up with modern medication prescribed by doctors, exclaiming that Western medicine took too long to cure his illness.
Coining, on the other hand, is a flawless procedure that has never failed him, he said.
Despite Mr Vanna’s beliefs in the transformative healing power of coining, those trained in a more contemporary and scientifically based forms of medicine have their reservations, and some also believe that it is highly dangerous.
Gavin Scott, a British doctor based in Phnom Penh, said coining has built up its reputation from being carried out by an array of different populations throughout the world through several historical époques.
However, contrary to popular belief in Cambodia, he says that its effects are only temporary and in no way serve as a definitive cure.
“By scratching the skin that hard, the body naturally produces endorphins, which causes the amount of pain to reduce,” he said.
“It’s the equivalent of taking an Aspirin,” he said. “It’s not going to get rid of any symptoms except the pain.”
Nonetheless, Mr Scott admits that there is usually no real long-term damage caused by the procedure apart from lacerations of the skin that heal relatively quickly.
But Dr Kem Sam San, a general practitioner who received his medical training in Singapore, says that coining can actually cause severe damage.
He says that instead of relieving the pain caused by, for instance, muscular injuries or a fever, coining actually causes additional suffering.
“The process breaks down blood cells and can damage blood vessels,” he said.
Dr Sam San explained that he had seen patients with migraines ask for coining on their foreheads. They later fainted because of the excruciating pain.
“Maybe they believe that the toxins are being scraped out of them,” he said.
Moreover, if the patients ask to be scraped with intense force – a belief that is supposed to heighten the healing process – the rubbing can even cause burns to the skin. Coining can also cause the patient’s blood pressure to rise increasing the risks of stroke for elderly people.
Many of the patients who undergo the coining treatment interviewed for this article said they were having the procedure done on a weekly basis, a phenomenon that Yim So Botra, a psychiatrist at the Sunrise Mental Clinic in Phnom Penh said could be dangerous to a person’s health.
Mr So Botra said that the heightened release of endorphins into the blood stream caused by the intense rubbing against the skin could give the patient an immediate sense of pleasure that they often become addicted to.
“But one or two days later, they feel nervous, they feel dizziness and they want to start coining again,” he said. “This is called an anxiety disorder.”
Mr So Botra said that his center sees up to 80 people a day complaining of heart palpitations, breathing problems, insomnia and dizziness. Most of the cases, he says, concern patients that admit to undergoing coining treatment on a regular basis.
“Four to six weeks later if they stop coining they nearly always improve,” he said.
Despite the skepticism from specialists and doctors, coining is nonetheless inherently ingrained in the belief systems that belong to the cultural domain in Cambodian society.
Miech Ponn, an advisor to the Ministry of Cults and Religion and former advisor to the mores and customs commission at the Buddhist Institute, said that coining was a deeply important and “traditional way to be cured when you are sick.”
And “it works,” he explained, adding that his mother-in-law, who is now at the ripe old age of 90, is still going to the neak kors kyal, or coiner, for regular treatment.
Pev Chinda, a coiner from Phnom Penh who provides an hour long coining session for 10,000 riel, said she has about 20 people a day come to her house to receive the painful treatment.
“Afterwards you feel a bit dizzy. But whatever the illness you feel so much better,” she said.
Mrs Chinda explained how some clients ask for a similar technique known as chup.
Chup consists of drenching a tightly packed swab of cotton in alcohol and setting it alight then placing it on the skin until the skin is singed.
Another variation of chup is where the flame is briefly placed inside a small glass bowl that creates a vacuum, and the glass is then pressed down on the skin. The skin is sucked into the glass bowl by the vacuum, creating the same, burst-blood-vessel-like effect as Kors Kyal.
The chup process is usually performed at least 80 times – one crops of painful vacuum marks on the neck, back, legs and buttocks, and one on the stomach, chest and forehead.
For Mr Vanna, the man being kors kyaled, the chup practice of burning the skin has left him with permanent scars on his stomach from when he received the treatment 5 years ago.
“When I had a sore back the doctor burnt me here, making sure he followed the Cambodian tradition. I had severe burn wounds that took months to heal,” he said, adding that he was advised to let the resulting wounds to heal by themselves.
“We aren’t allowed to use medicine to help the healing process go faster. This is against the rules,” he said.
Like Mrs Chinda, Koy Sovanny, another traditional neak kors kyal, believes that coining has proven itself as an immediate cure to a whole range of illnesses, from sinusitis to chronic skin diseases like psoriasis.
“It’s a Cambodian habit. When I grew up I would see my grandma and mother doing it to other members of the family,” Mrs Sovanny said, explaining that she first had it performed on her at 12 years of age.
According to Mrs Sovanny, she carries out her coin-rubbing techniques on different parts of the body depending on what type of illness the patient is affected by.
For diarrhea she rubs the back; for a fever she rubs the chest and the back; and for food poisoning she rubs the stomach.
And the effects are sometimes gob smacking, she said.
By the end of Mr Vanna’s treatment he was covered in long deep red bruises running the full length of his neck, chest, stomach and legs.
“I just want to get rid of my fever,” he said only minutes before leaving with what he claimed was a reduced temperature.
But for Dr Scott, coining is at best a temporary solution designed to mask the fundamental symptoms of the illness.
“It’s the classic placebo effect,” he said.