In one session, the procedure is carried out three to four times bilaterally down the back on either side of the spine with six to eight circular contusions resulting. Massage and manipulation is performed by elders and others with knowledge of healing techniques. Traditional Lao medicines are available in America, with some of these found or grown locally. Gathering such substances includes prayer and other prescribed means of respectfully taking them from the earth or elsewhere. Most such medicines are imported from Thailand, Laos, or elsewhere in Southeast Asia.
Chinese medicine is widely available from both stores and individuals.
Commercial preparations from Asia and elsewhere are also used by many Laotians. Spiritual or spirit-based practices are related to Phram beliefs rather than Buddhism, but many of these practices will occur in the context of Buddhism. The metal is inscribed with Pali prayers called To Dham . These are not viewed as decorative jewelry, but as potent and sacred talismans which are made by monks or holy men. Buddha or boddhisatva images are worn on a chain around the neck by some Laotians.