Ayurveda Research Papers (CCA Student papers)

The selected papers published on our website have been written by students of the California College of Ayurveda as a part of their required work toward graduation.

An Ayurvedic Approach to the Treatment of Secondary Amenorrhea By: Zoe Middlebrooks

AN AYURVEDIC APPROACH TO AMENORRHEA 

Overview of Women’s Reproductive Cycle

The glands of the endocrine system that regulate a women’s menstrual cycle are the hypothalamus, pituitary gland, and the ovaries. The hypothalamus is the master gland of the system; it secretes Luteinizing Hormone Releasing Hormones (LHRH) and stimulates the pituitary gland to release Luteinizing Hormone (LH) and Follicle-­‐Stimulating Hormone (FSH). As the pituitary gland secretes LH and FSH, these hormones act on the follicle in the ovary and stimulate its maturation. At the ovary, estrogen and progesterone are released. As the follicle matures, estrogen affects the development of a woman’s body and maturing egg. At the same time, progesterone affects the development of the endometrium and the breast tissue. The hormonal flow between the three glands is a negative feedback system; if the body has enough estrogen then no LHRH is produced, however, if estrogen levels are running low, than the hypothalamus secretes LHRH. A healthy menstrual cycle is dependent on functioning of the endocrine system.1
 
Every month an egg matures and a woman’s body and uterus prepare for pregnancy. If pregnancy does not occur, than the endometrial lining is released. Following menstruation, the endometrial lining of the uterus builds again as the uterus prepares for a fertilized egg. During this time there is an increase in arterial and venous blood flow. This is called the proliferative phase of the  uterine (menstrual) cycle. Then, during the secretory phase, the tissue leftover after the egg is released, known as the corpus luteum, secretes estrogen and progesterone to act on the uterus and body. At this point in the cycle, if fertilization has occurred, estrogen and progesterone remain high and there is no need for the hypothalamus to secrete LHRH. However, if the egg was not fertilized then production of estrogen and progesterone drops, triggering the shedding of the endometrium-­‐ the start of another menstrual cycle.2  This monthly release is the motion of apana vayu. The subdosha of vata associated with downward movement.
 

  • 1  

    Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012)


    2  

    American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up-­‐to-­‐the-­‐Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.213

Menarche & Menstruation

The onset of menses in a young woman is called menarche, according to the American Medical Women’s Association, this occurs “between the ages of 10 and 14, when the ovaries begin producing the hormone estrogen.  This causes the hips to widen, breasts to develop, and body hair to grow.  It also triggers menstruation, the monthly cycle of bleeding that is a key part of a woman’s fertility.”3  On average, menstruation lasts 3-­‐5 days.   Women’s menstrual cycles can range in length from 21 to 35.  A 28-­‐day cycle is the average and is thought to be the healthiest length for a woman.  Health complications become more common the farther away from 28 days a women’s cycle gets.
 
The classical Ayurvedic description of menses was more specific; according to the Astanga Hrdayamis, “in women, the rajas (menstrual blood) which is the product of rasa (the first dhatu), flows out of the body for three days, every month, after the age of twelve years and undergoes diminision by the age of fifty years.”4
 
There are many Sanskrit terms that refer to the menstrual cycle. In Sanskrit, “the menstrual cycle of a woman is called rajodarshana. The root raja means ‘blood’ while dharshana means ‘to see.’ Thus rajodharshana is the ‘seeing of blood.’”5  Other Sanskrit terms include rutukala, or “woman’s season,”6 arajaska from the Charaka Samhita.7
 
Amenorrhea
 
Amenorrhea is a condition in which there is an absence of menstruation. “This absence is normal before puberty, after menopause, and during pregnancy [& lactation].”8  Amenorrhea can be a primary or secondary condition. “Primary amenorrhea occurs when a woman reaches the age of 18 and has never had a period. It is usually caused by a problem in the endocrine system that regulates hormones.”9  Reasons a woman could experience primary amenorrhea include “ovarian failure,” “problems in the nervous system or the pituitary gland in the endocrine system that affect maturation at
 
  • Ibid. p.210

    4 Astanga Hrdayam 1:360

    5 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐4 6 Ibid.

    7 Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series), Volume 5 p.155, XXX:17

    8 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up-­‐to-­‐the-­‐Minute Medical

    Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232

    9 Ibid.

puberty,” or “birth defects in which the reproductive structures do not develop properly.”10 The Sanskrit term for amenorrhea from the Charaka Samhita is and nashta-­‐rakta with nashta meaning lost, destroyed or missing, and rakta meaning blood.11
 
“Secondary amenorrhea is an absence of menstruation for greater than or equal to three months.”12  Secondary amenorrhea can be triggered by “problems that affect estrogen levels, such as stress, weight loss, exercise, or illness;” “problems affecting the pituitary, thyroid, or adrenal gland;” or “ovarian tumors or surgical removal of the ovaries.”13  Stress, whether physical or emotional, “causes   low levels of FSH and LH along with low estrogen levels.”14  Another common cause is coming off of birth control. According to Rosemary Gladstar, “many women have waited for months, even years, for their menstrual cycle to return after having been on birth control pills for an extended period of time.”15
 
A woman experiencing Amenorrhea should consult a western doctor or other diagnostician in order to identify any obvious reasons for her lack of menses. Common diagnostic tools are blood tests for thyroid function, female and male hormone, and possible ultrasound imaging to view the reproductive organs.16  This paper will focus on the pathology and treatment of secondary amenorrhea.
 
Pathology of Amenorrhea
 
According to Charaka, “a woman never suffers from gynecic diseases except as a result of affliction by the aggravated vayu. Therefore, first of all, the aggravated vayu should be alleviated, and only thereafter, therapies should be administered for the alleviation of other doshas.”17  Dr. Frawley has  a similar claim, stating that “as a long-­‐term or frequent condition [amenorrhea] is mainly a deficiency disease due to Vata. But other doshas can cause it as well.”18  While both pitta and vata can play a role in amenorrhea they are uncommon, and in most cases, vata is the primary vitiated dosha. The nidana, or etiology of this condition is caused by vata-­‐provoking lifestyle regimens that lead to depletion. The
 
  • 10 Ibid.

    11 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐100      12 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐100      13 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up-­‐to-­‐the-­‐Minute Medical

    Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232

    14 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐100

    15 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993)

    p.122

    16 Mayo Clinic, Mayo Clinic Staff, Amenorrhea, http://www.mayoclinic.com/health/amenorrhea/DS00581

    17 Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda

    Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series) Volume 5 p.159, XXX:114.5-­‐116.5

    18 Frawley, Ayurvedic Healing: A Comprehensive Guide 2nd Ed. (Twin Lakes, WI: Lotus Press 2000) p.248

 

consumption of old, dry and light foods that lead to malnourishment is a very important contributing factor. So too is excessive motion such as a fast paced lifestyle filled with travel, stress and overwhelm. Physically, excessive exercise provokes vata.
 
Symptoms accompanying amenorrhea can include other symptoms of depletion and dryness including “constipation, dry skin, dry hair, weight loss, worry and anxiety.”19  As all these symptoms are those of vata dosha, the samprapti of amenorrhea will be primarily vata associated. In Dr. Halpern’s Clinical Ayurvedic Medicine, he concisely describes the six stages of disease of amenorrhea as the vitiation of vata travels through accumulation, aggravation, overflow, relocation, manifestation, and diversification.
 
  • “Vata accumulates and becomes aggravated in the purishavaha srota. It overflows to the rasa and rakta vaha srotas and relocates deeper into the rasa dhatu as well as into the medas and shukra dhatus. Relocation to the rasa dhatu leads to dryness throughout the body and a decrease in the production of menstrual fluid. Relocation to the medas dhatu results in weight loss and further drying of the body. Relocation to the shukra dhatu inhibits ovulation. Relocation to the mind results in anxiety and overwhelm  along with other vata emotions. “ 20
In addition, after accumulation and aggravation in the purishavaha srota, apana vayu could relocate in the purishavaha srota with a decrease in rasa dhatu leading to a possible and likely symptom of constipation.
 
Western Approach to Treatment
 
According to the Mayo Clinic staff, depending on the nidana of the amenorrhea, treatments include contraceptive pills to jumpstart the menstrual cycle, medications to treat possible thyroid or pituitary disorders or surgery in the case of tumors or structural blockages. In addition, they also mention “lifestyle and home remedies” a woman can work with, including a recommendation to “strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life.”21  The American Medical Women’s Association notes that patients are often asked to record their basal body
 
temperatures in order to help detect whether or not a woman is ovulating.22  Taking ones basal body temperature daily is also useful in bringing awareness and mindfulness to a woman’s monthly cycle and accompanying  patterns.
 
Ayurvedic  Treatment
 
As a holistic health, in treating an absence of menses ayurvedically, a practitioner would treat the patient through their mind, body, and spirit. Their treatment plan would include dietary and lifestyle changes in addition to herbal and five sense therapies.
 
Dietary Recommendations
 
As a condition of vata vitiation, women with amenorrhea will likely experience an increase in the qualities of dry, cold, light and mobile. To counteract these qualities they should alter their diet to concentrate on warm, moist and heavy foods. The most beneficial tastes for them at this time are sweet, in addition to salty and sour. The spicing of foods with dipanas is important to ensure that samana and apana vayu are functioning, as absorption and elimination of nutrients is key. Classical Ayurvedic  dietary recommendations from the Susruta Samhita include taking “fish, Kulattha pulse, Masa pulse, Kanjika (fermented sour gruel etc.), Tila, wine (Sura), cow’s urine, whey, half diluted Takra, curd and Sukta.”23  These suggestions include the sweet, sour and salty tastes as well as heavy and oily foods to nourish vata. A woman with amenorrhea should increase her consumption of whole grains, root vegetables, nuts, dairy and oil. The addition of oils to the diet will be very nourishing and help to keep moisture in the body. It is also important to consider a woman’s daily caloric intake and make sure that it is adequate especially in cases of amenorrhea and vata vitiation due to anorexia nervosa or excessive exercise.
 
For some women, taking daily supplements will help them to get any vitamins or minerals that their diet is lacking.  According to the University of Maryland Medical Center, for women lacking menstruation, it may be beneficial to supplement the diet with calcium, magnesium, vitamin D, vitamin K, boron, Vitamin B-­‐6, and essential fatty oils.  “Women who don’t have periods are at higher risk of
 

  • 22 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up-­‐to-­‐the-­‐Minute Medical

    Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232/233

    23 Bhishagratna, Susruta Samhita(Varanasi: Chowkhamba Sanskrit Series 2002) p. 146, II:22-­‐23

osteoporosis”, calcium, magnesium, vitamin D, vitamin K, and boron “may help keep bones strong.”24 Vitamin B-­‐6 is recommended because it may help reduce high prolactin levels.  “Prolactin is a hormone released by the pituitary gland, and women with amenorrhea often have higher levels of prolactin.”25 Essential fatty acids are important to supplement into the diet, as the human body is not able to synthesize these fats.  A couple examples of oils containing omega 3 and 6 fatty acids are flaxseed oil and cod liver oil.
 
Herbs for Amenorrhea
 
Herbal treatments for amenorrhea can be very effective when taken in addition to dietary and lifestyle changes. The suggested herbal treatment for amenorrhea in the Charaka Samhita is to “drink  the blood of deer, goat, sheep and pig mixed with yoghurt, juice of sour fruits and ghee. She may also  take the milk boiled with drugs belonging to Jivaniya group (jivaka, rasabhaka, meda, maha-­‐meda, kakoli, ksira-­‐kakoli, mudga-­‐parni, masa-­‐parni, jivanti and madhuka).”26  Only some of these classical recommendations can be utilized in the twenty-­‐first century as few women will agree to drinking the blood of animals and many of the suggested herbs are no longer available. “The first six herbs listed in Jivaniya are listed in a group of herbs known as Ashtvarga-­‐ eight herbs. These eight herbs became  extinct 500 years ago.”27  Bhavamisra the author of Bhavaprakasa Nighantu has made some suggested substitutions for the extinct herbs; these include replacing meda and mahameda with shatavari, and jivaka and rasabhaka with vidari kand.28
 
In Dr. Halpern’s text he writes “herbs that are nutritive tonics should be taken along with spices to improve digestion. Most nutritive female reproductive tonics are demulcents and build the rasa dhatu supporting the production of menstrual flow.”29 Therefore, reproductive tonics, demulcents, nervine tonics, and tonifying emmenogogues are herbal categories that should be concentrated on. Most herbal treatments must be continued for several months before the menses returns as rebuilding the health    and tone of the reproductive system takes time. While a woman may be tempted to work with
 
  • 24 University of Maryland Medical Center, http://umm.edu/health/medical/altmed/condition/amenorrhea 25 Ibid.

    26 Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series) Volume 5 p.155, XXX:101.5-­‐102.5

    27 Skudder, Vitalizing Herbs-­‐Jivaniya, http://www.atreya.com/ayurveda/Vitalizing-­‐Herbs-­‐Jivaniya.html 28 Ibid.

    29 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐101

emmenogogues, “purifying emmenogogues…while stimulating menstrual bleeding, should not be taken as they are drying to the body and lead to greater depletion.”30
 
The Jivaniya herbal substitutes of shatavari and vidari kand in addition to wild yam are nutritive female reproductive tonics that will benefit women with amenorrhea. These are the reproductive tonics are also recommended in the Dr. Halpern’s Clinical Ayurvedic Medicine text. Dong quai is another suggested herb because of its actions as a tonifying emmenogogue. The roots of these four herbs are the part of the plant used medicinally as tonics. All of them are considered to have a sweet rasa (taste). The sweet taste in Ayurveda is composed of the earth and water elements. According to Michael Tierra “it is cooling, nutritive, pleasant and softening…the essence of nourishment.”31
 
Shatavari
 
Asparagus racemosus is the variety of asparagus root used medicinally in Ayurveda, known as Shatavari. The translation of Shatavari is one “’who possesses a hundred husbands,’ as its tonic and rejuvenative action on the female reproductive organs is said to give the capacity to have a hundred husbands”32  Shatavari is an heavy and oily tonic used often in Ayurveda “for gynecological purposes and to strengthen female hormones.”33  Its demulcent quality helps to nurture the mucous membranes. “It both nourishes and cleanses the blood and the female reproductive organs.”34
 
Vidari Kand
 
Vidari Kand, or Ipomea digitati, falls into the herbal categories of rasayana and demulcent, as well as many others. This sweet root is related to the sweet potato. Studies have shown that vidari kand has “significant oestrogenic and progesteronogenic activities with no toxicity.“35  In addition, patients have responded positively when taking vidari kand as a replacement for routine hormonal therapies.36
 

  • 30 Ibid.

    31 Tierra, Plantetary Herbology: An Integration of Western Herbs into the Traditional Chinese and Ayurvedic Systems

    (Twin Lakes, WI: Lotus Press 1988) p.41

    32 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Ed. (Twin Lakes, WI: Lotus Press, 2008) p.183

    33 Tierra, Plantetary Herbology: An Integration of Western Herbs into the Traditional Chinese and Ayurvedic Systems

    (Twin Lakes, WI: Lotus Press 1988) p.321

    34 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Ed. (Twin Lakes, WI: Lotus Press, 2008) p.184

    35 Puri, Rasayana: Ayurvedic Herbs for Longevity and Rejuvenation (Traditional Herbal Medicines for Modern

    Times)(London: Taylor & Francis 2002) p.306

    36 Ibid.

Wild Yam

Deioscorea villosa also known as wild yam is a sweet herb that “contains hormones and is an effective tonic for the female reproductive system.”37  The phytoprogesterones contained in wild yam help “to regulate the ratio of progesterone to estrogen in the system,” making wild yam beneficial to both the herbal and scientific communities.38   When treating disorders of the women’s reproductive system it is important to consider the liver. The liver is a detoxifier, filtering toxins from the bloodstream. It also plays a major role in the balance of hormones.39  When there is stagnation in the liver, these processes slow. Wild yam is a recommended herb to use in this case, in addition to working on the reproductive system. Wild yam is a great liver tonic, as it “activates and stimulates liver activity.”40
 
Dong quai
 
Dong quai, or Angelica sinensis is another sweet root that “can be used to treat almost every gynecological imbalance because of its strengthening and building qualities…Though dong quai has no specific hormonal action, it exerts a regulating and normalizing influence on hormonal production through its positive action on the liver and endocrine system.”41  It can be used in all complaints of the female reproductive system. In addition, don quai is also a mild nervine tonic, helping to lower stress by calming and relaxing the nervous system.
 
Dipanas
 
Shatavari, vidari kand, wild yam, and dong quai are all heavy and cooling herbs, therefore they turmeric. Cinnamon (Cinnamomum cassia) is a good choice because of its demulcent and stimulating properties. Dried ginger (Zingiberis officinale) would be a useful carrier herb in a formula because it is also considered an emmenogogue. Turmeric (Curcumae longa) is less stimulating than cinnamon and ginger, but it helps to regulate menses by decongesting the liver.42
 

  • 37 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Ed. (Twin Lakes, WI: Lotus Press, 2008) p.186

    38 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993) p.258

    39 Ibid. p.78-­‐79 40 Ibid. p.259  41 Ibid. p.241

    42 Ibid. p.244-­‐245, 274

Anupanas

When considering the appropriate anupana for these herbs in pacifying vata, it would be best to cook a formulation of these herbs into a medicated ghee or oil. A teaspoon of this ghee would be taken an hour away from food in the morning and evening. As long as there are appropriate dipanas in the medicated ghee then it could be melted into warm milk, another option is to take it with ginger tea. This treatment will need to be continued for several months in order to give the uterus and reproductive system time to rebuild itself.
 
Chyawanprash
 
Chyawanprash is another beneficial herbal supplement, recommended for its nutritional value and general tonifying effects.  In Parle & Bansal’s review of the herbal formula it is said that it “streamlines menstrual cycles in females.”43    Comprised of around fifty herbs, Chyawanprash is a comprehensive tonic, great for maintaining homeostasis.  As the carrier, the honey in formula helps drive the herbs deep into the body’s tissues.44   In the case of amenorrhea this is useful for the honey’s action of driving the tonifying herbs into the tissues of the uterus.  It is also commonly used in the reduction of stress.  As a daily tonic, a woman can take 1-­‐2 teaspoons of Chyawanprash morning and evening; taking it with warm milk will enhance the tonifying effect.45
 
Rejuvenative  Therapies
 
Women with amenorrhea should consider treating themselves to a series of Ayurvedic body therapies. A Bliss therapy consisting of abhyanga, shirodhara, and svedana treatments would be beneficial as these treatments are pacifying to vata and very nourishing to the system. In addition to the Bliss therapy, anuvasana and uttara bastis would help to encourage healthy downward movement and svadhisthana basti would localize energy and release to the 2nd chakra. These treatments would be most helpful if the woman repeated them every month several times until menstruation returned.46
 

  • 43 Parle, & Bansal, “Traditional medicinal formulation, Chyawanprash-­‐ A Review,” Indian Journal of Traditional Knowledge 5(4)(October 2006)487

    44 Ibid. p.484

    45 Frawley, Ayurvedic Healing: A Comprehensive Guide 2nd Ed. (Twin Lakes, WI: Lotus Press 2000) p.116    46 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5-­‐101

Lifestyle Changes

Lifestyle and yoga therapies are very important for women experiencing amenorrhea. They need to partake in vata pacifying behaviors and therapies. Most importantly this includes rest and minimizing the amount of things or stressors that are apart of their everyday lives. In addition, women can look toward the support of other women, Yoga Nidra, daily movement, and releasing pranayama practices.
 
Sharing  Pheromones
 
In Herbal Healing for Women it is recommended for women experiencing amenorrhea to spend extra time surrounded by menstruating women. She states, “menstruating women secrete a chemical called pheromone. This enzyme triggers a hormonal reaction in other women which can stimulate the menstrual cycle.”47  In 1998 at the University of Chicago a study was done that demonstrates “the existence of human pheromones and identify[ing] a potential pheromonal mechanism for menstrual synchrony, as well as for other forms of social regulation of ovulation.”48
 
Yoga Nidra
 
A six-­‐month trial study with women experiencing menstrual disorders suggested, “in patients with menstrual irregularities, Yoga Nidra not only has utility as a possible therapeutic strategy, but also may be a method for improving headache, giddiness, nervousness and irritability.49  In the study, amenorrhea was included in the various menstrual symptoms whose changes were tracked in both the intervention (Yoga Nidra & medication) and control (medication only) groups. In the group of women that experienced Yoga Nidra for 35 minutes five days a week for six months there was a larger decrease in the occurrence of amenorrhea than in the control group. 50
 
Daily Movement
 
When excessive exercise is not the cause of amenorrhea, it is recommended to incorporate 30 minutes of movement daily. This exercise should be gentle and can include walking in nature or a
 

  • 47 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993)

    p.123

    48 Stern & McClintock, “Regulation of ovulation by human pheromones,” Nature 392 (March 1998) 177-­‐179

    49 Rani, Tiwar, Singh, Agrawai, “Six-­‐month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform

    symptoms,” Industrial Psychiatry Journal 20(2) (July-­‐December 2011) 97-­‐102

    50 Ibid.

restorative yoga asana practice and should only be preformed if the woman is strong enough. Yoga is beneficial when trying to bring back the menstrual cycle because when done consistently it to reduce stress and brings balance to the endocrine system. A balanced practice would include a full range of motion, focusing on inversions, twists, and backbends. “Inversions increase blood circulation, and balance your endocrine system, backbends tone your liver, and twists massage your internal organs.”51 A suggested sequence for healthy menstruation could include supta baddha konasana, adho mukha virasana, jahu sirsasana, triang mukhaikapada paschimottanasana, paschimottanasana, upavistha konasana I, parsva upavistha konasana, upavistha konasana II, viparita dandasana, setu bandha sarvangasana,  savasana.52
 
Conclusion
 
Western medicine and Ayurveda both offer options for the treatment of amenorrhea. In most cases, Western medicine encourages the return of menses through the use of artificial hormone therapy. Ayuveda offers more options and avenues for treatment that allow women to bring awareness to their own cycles and lives. Taking charge of their own treatment by making positive lifestyle changes and utilizing the natural but effective medicine of herbs.
 

  • 51 Sparrowe & Walden, Yoga for a healthy menstrual cycle (Boston: Shambhala Publications, Inc 2004) p.29

  • 52 Ibid. p.11


Sources Cited

  • American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up-­‐to-­‐the-­‐ Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995)
  • Bhishagratna, Susruta Samhita(Varanasi: Chowkhamba Sanskrit Series 2002)
  • Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series)
  • de la Foret, Herbal Remedies Advice, Female Reproductive System,  http://www.herbalremediesadvice.org/female-­‐reproductive-­‐system.html
  • Frawley, Ayurvedic Healing: A Comprehensive Guide 2nd Ed. (Twin Lakes, WI: Lotus Press 2000)
  • Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Ed. (Twin Lakes, WI: Lotus Press, 2008)
  • Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993)
  • Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012)
  • Mayo Clinic, Mayo Clinic Staff, Amenorrhea,  http://www.mayoclinic.com/health/amenorrhea/DS00581
  • Parle, & Bansal, “Traditional medicinal formulation, Chyawanprash-­‐ A Review,” Indian Journal of Traditional Knowledge 5(4)(October 2006)484-­‐488
 
ABSTRACT
 
Pheromones are airborne chemical signals that are released by an individual into the environment and which affect the physiology or behaviour of other members of the same species1. The idea that humans produce pheromones has excited the imagination of scientists and the public, leading to widespread claims for their existence, which, however, has remained unproven. Here we investigate whether humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours (thereby fulfilling the classic definition of a pheromone). We found that odourless compounds from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing-­‐hormone surge of the recipients and lengthened their menstrual cycles. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones.
  • Puri, Rasayana: Ayurvedic Herbs for Longevity and Rejuvenation (Traditional Herbal Medicines for Modern Times)(London: Taylor & Francis 2002)
  • Rani, Tiwar, Singh, Agrawai, “Six-­‐month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform symptoms,” Industrial Psychiatry Journal 20(2) (July-­‐December 2011) 97-­‐102
 
ABSTRACT
 
Background:
Emotional insecurity, stress, depressive or/and anxiety symptoms are common with variable severity among patients with menstrual disorder. Yogic relaxation therapy (Yoga Nidra) leads to conscious and subconscious recognition of these underlying psychological factors and helps releasing of suppressed conflicts.
Objective:
To evaluate the effect of Yoga Nidra on anxiety and depressive symptoms in patients with menstrual  disorders.
Materials and Methods:
Subjects were recruited from the Department of Obstetrics and Gynecology, C.S.M. Medical University (erstwhile KGMU), Lucknow Uttar Pradesh, India. The subjects were randomly divided in to two groups: Intervention group (with yogic intervention) and control group (without yogic intervention). Assessments of all subjects were carried out by administering Hamilton anxiety scale (HAM-­‐A) and Hamilton rating scale for depression (HAM-­‐D) at baseline and after six months.
Results:
The mean age with S.D of the intervention group was 27.67 ± 7.85 years, and for control group was 26.58 ± 6.87 years (among completed intervention group nn = 65 and control group nn = 61). There was significant reduction of scores in HAM-­‐A (P<0.003) and HAM-­‐D (P<0.02) respectively in subjects with mild to moderate anxiety and depressive symptoms after six months of yoga therapy (Yoga Nidra) in intervention group in comparison to control group.
Conclusion:
The patients with mild to moderate anxiety and depressive symptoms improve significantly with ‘Yoga Nidra’ intervention. There is no significant improvement in the patients with severe anxiety and depressive symptoms.
 
ABSTRACT
 
Pheromones are airborne chemical signals that are released by an individual into the environment and which affect the physiology or behaviour of other members of the same species1. The idea that humans produce pheromones has excited the imagination of scientists and the public, leading to widespread claims for their existence, which, however, has remained unproven. Here we investigate whether humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours (thereby fulfilling the classic definition of a pheromone). We found that odourless compounds from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing-­‐hormone surge of the recipients and lengthened their menstrual cycles. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones.
 

BUILDING OJAS: The road back to health from Chemotherapy By: Jill Talve

 Introduction

Cancer is characterized by the spread of abnormal cells in the body. Mutated cell growth is often uncontrollable and can cause death in the individual by eventually compromising the body’s vital functions. The existence of cancer and its manifestations go back thousands of years as described in the classical texts of Ayurveda. While modern research has linked numerous causes to the proliferation of cancer cells within the body, malignant cancer cells are produced in all bodies. The general difference between a detectable cancer and that which does not develop further is the body’s immune system and its many functions. From an ayurvedic perspective, Ojas, a Vedic concept that contains the body’s defense against such pathogens , is disempowered at a time when cancer cells begin to populate. In today’s world, the abundant use of chemotherapy to eradicate many cancers can leave the body in a severely weakened state. The success of chemotherapy is often a matter of ridding the body of more malignant cells before too many healthy cells are compromised. When the body has reached this point and the chemotherapy has ceased, the body’s immune system, already  compromised as evidenced by the high volume of cancer cells, is further impaired. In order for the body to continue to survive, immunity must be restored. In Ayurveda, the practice of restoring immunity is referred to as building Ojas. The cultivation of Soma, Rasayana or Rejuvenation therapies, including physical, mental , and spiritual practices must all be employed so that the body can fully recover and defend itself against future assaults.
 

Cancer and the use of Chemotherapy

Chemotherapy is the use of certain chemicals that are introduced to the body for the purpose of destroying disease. Antineoplastic (anti-cancer) therapy and Cytotoxic (cell-killing) therapy are specific to treating cancer.   In the article Chemotherapy and the war on cancer, a historical account of the development of chemotherapy  explains that during WWII an event causing exposure to mustard gas led to a decrease in white blood cells among those who were in contact with the gas. Continued research in the 1940’s led to the experimental treatment of non-hodgkins lymphoma with nitrogen mustard. The mustard gas derivative caused a temporary regression of the mediastinal and lymphatic masses. By the late 1940’s, compounds identified as antifolates were the first drugs to induce remission in cases of acute lymphoblastic leukemia. More stabilized versions of these drugs diminished tumors successfully in Breast, ovarian, bladder, and head and neck cancers. Clinical trials continued through the 1950’s and 60’s as natural and synthetic compounds were combined and tested on tumor cells at various stages. Chemotherapy was considered as constructive adjuvant therapy following the surgical removal of tumors. Although there has been tremendous support for the development of chemotherapy since the early stages of research, there exists a parallel concern around the “Acute and long-term toxicities of chemotherapies, which affects virtually every organ in the body”.  Oncologists have accepted this fact as the price for controlling such a fatal disease. In patients who are treated yearly with chemotherapy, approximately 20% are cured and another 20% experience a significant extension of life.  The remaining 60% of patients experience minimum benefit from cytostatic treatment and suffer from the effects. Common side effects resulting from the administration of chemotherapy drugs include: Decrease in blood cell counts, hair loss (reversible), confusion, nausea, vomiting, ringing in ears, hearing loss, kidney damage, bladder damage, fertility impairment, lung and heart damage, mouth ulcers, decreased appetite, liver damage, photosensitivity, skin rash, seizures, loss of reflexes, and weakness.  As several rounds of treatment are often dispensed over a period of time, the patient can develop psychological disturbances in anticipation of subsequent rounds. Although many of these conditions subside once the chemotherapy is over; the long-term effects force the patients to discontinue treatments and leave the person in a deeply weakened state with low quality of life.
 

Ayurveda and Cancer 

Cancer is described in the classical texts as inflammatory or non-inflammatory swelling and described as Granthi (minor neoplasm) or Arbuda (major neoplasm).  Granthi is the term most commonly used to describe benign tumors and is visible from the surface. Arbuda is the term that specifies a malignancy.  Other terms from the texts include Gulma, which describes any palpable mass in the abdominal area; and Dwirarbuda, which refers to the spread of the malignant cells from its origin throughout the body.  Malignant tumors (Tridosaja) are the result of all three doshas deeply out of balance and unable to inhibit tissue damage.   According to the sushruta samhita, it is the vitiation of all three doshas that ultimately lead to the manifestation of tumors.  Dr. Marc Halpern  explains the evolution of a tumor to be a function of Vata ( faulty division of cells) pushing Kapha (tissue growth) and the excess of pitta creates malignancy making it sannipatika in nature . Cancer manifests differently in each individual according to their distinct exposure to pathogens and their unique constitutional makeup.  Not only is the spread of cancer due to the vitiation of the Vata, Pitta and Kapha doshas, but disturbances deeply rooted in the Rakta, Mamsa and Medas dhatus.
 

Ayurveda and Chemotherapy

Visha Dravya is a Sanskrit  term that refers to poisonous drugs. Chemotherapeutic agents belong in this classification, as they all possess a hot potency. While working to destroy cancerous cells, they inadvertently destroy healthy cells within the GI tract, mucous membrane, skin, hair root, and other organs. Chemotherapy drugs embody properties that directly oppose the Rasa, Kapha and Ojas in an individual, thereby creating vitiation in the vata and pitta doshas while depleting the Kapha dosha, leading to the depletion of the rasa and Rakta dhatus and resulting in the depletion of Ojas.
 

Life after Chemo

When the round(s) of chemotherapy end(s), many of the acute symptoms end too. However there are long-term effects that are now a part of a persons’ physical landscape. Common long –term (1 year and beyond) complaints include fatigue, anemia, neuropathy or numbness (due to injured nerves), lymphedema (arm or leg swelling), dry mouth, teeth problems, loss of taste, painful mouth and gums, jaw stiffness or jawbone changes, weight gain, weight loss, trouble swallowing, hormone depletion and lack of libido. Many of these conditions can develop months or years after the treatment has ended.   There is also a large psychological component , where the entire paradigm of a healthy life is transformed. Even if the cancer is in remission, a cancer survivor can experience deep fear from the possibility of recurrence and as a result have difficulty making life decisions, such as career path or marriage. Values and goals may be altered, reflecting deeper inquiry into spiritual and existential  concerns over death and dying. The psychological path of a cancer patient is constantly changing, with transitions being particularly stressful, such as the “Transition from treatment to long-term follow up.” 
 

The Heart of Healing: Ojas

“Disease always forces us to confront our attachments. All attachments are temporary and are dissolved by Nature when She feels it is time to broaden our personalities. Disease is always an opportunity to learn from our mistakes, an opportunity that nature provides us out of Her maternal magnanimity. She hopes  we will learn enough so we will never be sick. She can even teach us how to overcome death ….Rejuvenation is the first step in the direction of immortality”.   –Dr. Robert Svoboda
 
To understand the ayurvedic concept of Rasayana and its protocols, it is necessary to understand the concept of Ojas . It is defined poetically in verse from the Caraka Samhita:
Ojas:
It maintains the living beings by its saturation;
Without ojas no life of creatures exists,
It is the initial essence of embryo and also the essence of the embryo’s nourishing material,
It enters into the cardiac cycle first,
If it is destroyed, it leads to destruction of that person,
It is the sustainer
It is located in the heart,
It is the cream of the nutrient fluid in the body,
It is where vital factors are established,
It is the fruit of them or they produce various types of fruits. 
 In the Astanga Hrdayam, Ojas is seated in the hrdaya (Heart); although it is the essence of all the dhatus. It is what regulates the body and even has a texture( viscous) and color (reddish yellow). The loss of ojas leads to a loss of life.  According to Dr. Robert Svoboda , the definition of Ojas is “A hormone –like substance which is derived from Shukra. Ojas produces the aura, transmits energy from mind to body, and controls immunity.”  Dr. David Frawley contends that Ojas is the is the foundation of the development of all other faculties: “ The internalized essence of digested food,water,air, impressions and thought, the basis for patience, control of the senses and mental endurance.”  Many causes of the loss of Ojas are listed in the classical text and in the notes given by Professor K.R.Srikantha Murthy, who  references  many additional factors from other classical sources including Abhisanga (assault by evil spirits; micro-organisms such as bacteria, virus, etc.) and Visa, ingestion of poisonous substances. Dr. Marc Halpern cites in The Principles of Ayurvedic Medicine that Ojas can be defined as  the “force of contentment and stability.”  Dr. Halpern connects the condition of low ojas with the presence of cancer in the affected tissue; and as the disease progresses, for the systemic Ojas to become lower and lower.  In order for long term healing to occur, one’s Ojas needs to be rebuilt. The Astanga Hrdayam plainly states that the increase of Ojas creates “Contentment, nourishment of the body and increase of strength”.  
 

An Ayurvedic Solution

“Ayurvedic Herbology reaches its culmination in the science of rejuvenation .Aimed at the renewal of both body and mind, Ayurvedic herbology does not seek simply longevity, but moves towards a life of pure awareness, natural creativity, spontaneous delight.” –Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs
 
Rasayana, or Rejuvenation therapy, provides multi-dimensional relief to the many residual issues imposed on a person who has undergone chemotherapy. The general effects of rasayana therapy include Vayahsthapana (anti-aging), Balya (restoring power),  and Jeevaniya (improving vitality).   Rasayana literally means “The path of Rasa.” This implies a journey back to health. Dr. Svoboda impresses the importance of the health of the Rasa dhatu, which is the substance by which other dhatus are formed. He continues to describe healthy Rasa as the primary element in creating healthy shukra, where ojas are produced.  Bri Maya Tiwari describes rasa as “The mother essence of healing.”  She continues to define Rasa as the taste we have for all things, not only with our mouths to taste food, but through sensory impressions as well. The path to healing includes all forms of Rasa, and in choosing the appropriate foods and rituals (sadhanas) in one’s daily life, one can engage in the inherent intelligence of acting in accord with their surroundings, thereby forging a clear path to health.   Nourishing the Rasa requires the physical consumption of the sweet taste. Made up of the elements water and earth, it is the perfect foil to the hot, sharp qualities of Chemotherapy. Dr. Svoboda defines honey and its origins, pollen , which is referred to as the sperm of plants, as plant shukra, which increases human shukra and thereby nourishing Rasa.  In this way honey is a primary food in rasayana therapy. The Sanskrit term for honey, Madhu , appears in numerous classical rejuvanative formulas. One such formula that is very popular is Chyavanprash, a spicy sweet  amla based jam consisting of 5 of the 6 tastes(excludes salty). Other foods which provide the sweet taste include Whole Grains, root vegetables, fruits and milk. Foods that have the sweet taste have a cool potency(virya) and a sweet  post digestive effect (vipaka). Each dhatu benefits from the sweet taste; Foods that increase the Rasa Dhatu include some dairy products, fruits and oils; Molasses, black grapes, carrots and beets enrich the rakta dhatu; Meat, grains and nuts build mamsa dhatu; Oils, dairy, wheat and nuts replenish the medas dhatu; Bone soups will aid the Asthi dhatu; Ghee , butter and nuts protect the majja dhatu;  Milk, ghee, almonds and sesame seeds enliven the shukra dhatu.  A balanced amount of sweet taste in accordance with one’s constitution will help the recovering patient to rebuild healthy tissue. It is also essential to eat seasonally and locally. In Maya Tiwari’s Living Ahimsa Diet, she makes a strong case for the effectiveness of honoring the cycles of nature. The presence of foods as they appear in order out of the ground is not coincidence; but rather an ancient agreement between all living things to feed and be fed at the appropriate time. Since us as humans are created from the same elements that have created the seasons, we share this inherent rhythm with nature. “Only the rhythms of the seasons have the power to fully restore our vital tissues and their innate memories that guide their form and function to perfect health”.  Another important component of restoring health to a body ravaged by cancer and its treatments are the plant-based medicines utilized in Rasayana therapy. In the article published by AYU :An international Quarterly Journal of Research in Ayurveda,  A trial involving a total of 36 cancer patients were divided into two control groups where one group received chemotherapy and radiotherapy and another group received the same cancer treatments along with an ayurvedic formulation Rasayana Avaleha. The results showed a clear indication that the formula helped to protect patients from the adverse effects while going through treatment.  The herbs used in this formula are ones that are used in many classical rejuvenative formulas and continue to be the subject of many clinical studies.  The formula contains Amalaki, Ashwaganda, Gaduchi, Yastimadhu, Jivanti, Tulasi and Pippali. Amalaki (Emblica Officinialis)or Dhatri(the nurse) is one of the strongest rejuvenatives in ayurveda. It is a premium source of vitamin C, rebuilds and retains new tissues and increases red blood cell count, and is also a major component in the rejuvanative  Chyavanprash .  Ashwaganda (Withania Somnifera)  is considered among one of the best rejuvenative herbs  for the muscles, marrow , semen and vata constitution, especially in cases where tissues are debilitated as a result of chronic disease.  Guduchi (Tinospora Cordifolia) is a potent anti-inflammatory and excellent tonic for the immune system.  Yashtimadhu(Glycirrhiza glabra) Otherwise known as Licorice, is an effective expectorant, demulcent, emetic, Kapha-cleansing agent, laxative, restorative, rejuvenative agent. , Jivanti (Leptadinia reticulate) is a natural source of Quercitin.   Tulasi (Ocimum sanctum)or Holy Basil, is the most sacred plant in India, as it opens the heart and mind, clears the aura and strengthens immunity.  Pippali (piper Longum), also known as long pepper is a stimulant ,expectorant  and revives weakened organic functions.  Flavonids as potent antioxidants are vital for protection against disease and are present in Guduchi, Ashwaganda, Amalaki, Pippali, and Tulasi.  Many of these herbs have a sweet rasa, cool virya and sweet vipaka, which aid in nourishing Kapha dosha, depleted by cytotoxic chemicals. As a result these herbs serve to offset the cancer anorexia-cahexia syndrome, a source of malnutrition in cancer patients. Gaduchi, Ashwaganda and Jivanti are also known adaptogens, correcting imbalances without negative side-effects.  To combat the psychological conditions that occur post-treatment, Dr. David Frawley, In his book Ayurveda and the Mind, highlights key rejuvenating herbs for the mind. Calamus,(acorus calamus)  is a rejuvenative for the brain and nervous system, and used by the ancient Vedic seers. Calamus is currently restricted for internal use by the FDA.   Gotu Kola (Centella asiatica),is a rejuvenative that increases intelligence and memory, as well as fortifies the immune system;   And  Shanka pushpi (Canscora desuccata).  Brahmi, or Mandukaparni, (Hydrocotyle asiatica, Umbellifera, Bacopa monniera, Scrophulariaceae) is considered one of the most important nervine herbs in Ayurveda. In The Yoga of Herbs by Drs. David Frawley and Vasant Lad, Brahmi is a great rejuvenative when combined with ghee, as it revitalizes brain cells and purifies the nervous system.  The Caraka Samhita has many Rasayana formulas containing the aforementioned herbs. One such formula promises that if used every day for three years a person will live a vital 100 years disease-free, will be physically strong and solid and untouchable by poison. It begins with the herbs haritaki, amalaka, bibhitaka, haridra, salaparni, bala, vidanga, guduchi, sunthi, madhuka, pippali and katphala cooked into ghee; then amalaka powder (which has been impregnated 100 times with amalaka juice) mixed with ¼ quantity of iron powder(iron Bhasma) , combined with the herbal ghee mixture and some extra honey and sugar. 10gm of the formulation is to be taken every morning and a diet of Sali and swastika rice with ghee along with green gram or milk taken at night.   If required, rasayana herbs can add bulk and increase tissue where need, but more importantly these substances will add quality tissue to the body, thereby promoting longevity and the quality of life. 
 

Yoga

According to David Frawley in his book “Ayurveda and the Mind”, Dr. Frawley defines Yoga  as a means to gain awareness around the “original impetus of life”. It is the human experience to move towards integration, consciously or unconsciously, with universal wholeness and peace. This greater system of yoga can reverse  psychological distress by reuniting the mind back into pure consciousness, which “resides in perfect peace.”   Where the protocols of Ayurveda heal the body in a physical and subtle way, it also prepares the body for Yoga, an inner pathway that ultimately merges the mind which the “Cyclical nature of the cosmos”. Embodied in the classical eight limbs of yoga lie a treasure of healing practices for the cancer survivor.  The use of asana, pranayama, mantra and meditation are invaluable tools to aid in the whole Ayurvedic  healing process. Asana includes all postures, either seated of moving, that when done correctly with the right intention, can open up and loosen stagnant energies that may have played a part in causing illness.  Pranayama is a method that develops and expands the energy of the life-force (prana) beyond its ordinary limitations . Conclusions to a pilot study showed that pranayama may improve sleep disturbance, anxiety and other chemotherapy associated symptoms.  According to Dr. David Frawley, Mantra is the most important healing sound therapy in Ayurveda. The word mantra is a word that combines Trayati, that which saves, and Manas, the mind. He explains that mantra can heal emotional patterns by re-patterning them where counseling or analysis cannot. The more repetition of the mantra, the more effective it is for the individual.  Dr. Vasant Lad instructs that mantra should first be spoken aloud so that the sound is heard by the heart. Ultimately the vibrations of the mantra infiltrate the heart and no external sound is necessary, allowing the deepest resonance within, creating a powerful healing energy. Each person chooses their own mantra; as it is as unique as one’s own constitution.  Meditation is another powerful self-healing tool.  A controlled study of ninety cancer patients showed a significant decrease in those who did mindfulness meditation for 7 weeks.  31% had fewer symptoms of stress and 65% had fewer episodes of mood disturbance than those who did not meditate.    According to the American Cancer society, Some studies have also suggested that more meditation improves the chance of a positive outcome.  Deepak Chopra describes the effectiveness of meditation and healing as follows: ”  Rather than considering it a relaxation response, consider it as a heightened awareness or a restful alertness response. We meditate to experience an inner wakefulness, an inner knowingness that gives us a sense of control over the processes inside our body, as well as over our life experiences. In the silence of meditation there is alertness, flexibility, creativity, sensitivity, freshness, aliveness and renewal. There is pure consciousness, no contamination of experiences in the past, by memories or by cravings---awareness remain pure, full of energy, full of clarity.”  Additional holistic therapies that will help an individual back to health and strengthen ojas include aromatherapy and Chromotherapy . Aromatherapy enlists the sense of smell to take in the environment . Certain plants provide energetics through their oils that are extracted from the various parts, depending on the plant. If the scent is in accordance with one’s nature, the effects can be extremely beneficial to the mind, body and consciousness.  Chromotherapy, or the use of color to improve overall health, is a broad field that covers  everything from decorating the home in a color scheme that is according to one’s prakriti to using colored lights to treat different parts of the body. Understanding the elemental quality of color and how it relates to nature is another way of bringing a sense of harmony to one’s environment, setting the stage for effective healing.
 

Soma and the quality of Life

For a cancer survivor, mortality is no longer a distant concept. Many survivors do not consider themselves healthy; There is always a chance of recurrence of the disease. However, many survivors find that their life takes on new meaning after cancer. Life and living take on greater value. This attitude often leads the survivor to a more thoughtful position on spirituality.  As with any crisis, a space is created where new paradigms are forged in seeking  the greater meaning to life. According to David Frawley in his book Soma in yoga and ayurveda,  greater longevity is only a benefit if we connect to meaning, consciousness and creativity, and doing so requires” An ability to connect with the immortal essence of our being.”  This is only one aspect of Soma. Dr. Frawley interprets, through his lifelong study of the Vedic texts, a vast concept that encompasses physical and non-physical , inner and outer manifestations of lasting bliss, resulting in the infinite quest for immortality. Soma, both material and otherwise, is rooted in the field of rejuvenation. Through traditional ayurveda therapies, diet and lifestyle , internal soma will unfold, revealing the potential for “immortality of spirit”. In exploring this inner immortality, the physical body is no longer the object of greater longevity, but rather a desire to achieve a “Greater existence in consciousness itself” provides a true prolonged existence.
 

Conclusion

In Maya Tiwari’s The path of Practice, an autobiographical account of her victory over incurable ovarian cancer, she is summoned into healing through spiritual reckoning, after being told that nothing else could be done to save her. Her journey back to perfect health is a testament to the value of the wisdom of Ayurveda and its protocols. Along with her devotion to her daily practices(sadhanas), Tiwari simultaneously engaged deeply into an agreement with the sea of souls before her;  And to connect to the supreme consciousness that provides an everlasting awareness, or pure love.  For the cancer survivor, it is a long road back to health.  With the use of proper diet, herbs, sensory therapies and lifestyle choices, Ojas can be strengthened. However, if the person continues to explore the relationship between their own receptivity to the healing practices and the healing practices themselves, and they make their journey about this, with an open mind and an open heart…Oja s can be restored.
 
  Bruce A. Chabner and Thomas G. Roberts. (2005). Chemotherapy and the war on cancer. Nature Reviews Cancer. doi:10.1038/nrc1529
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  The Medical and Psychological Concerns of Cancer Survivors After Treatment ." From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press, 2005 .
  Premalatha balachandran, Rajgopal Govindarajan, Cancer-an ayurvedic perspective.http://www.elsevier.com
  Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 1995-2012) Appendix C: Managing Cancer pg.A-33.
  Premalatha balachandran, Rajgopal Govindarajan, Cancer-an ayurvedic  perspective. http://www.elsevier.com
  Bhishagratha KL. Sushruta samhita (Varanasi:choukhamba Orientalia,1991)
  Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 1995-2012) Appendix C: Managing Cancer pg.A-33.
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  Premalatha balachandran, Rajgopal Govindarajan, Cancer-an ayurvedic  perspective. http://www.elsevier.com
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  The Medical and Psychological Concerns of Cancer Survivors After Treatment ." From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press, 2005 .
  Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161.
  Sharma PV, Caraka Samhita ,(Varanasi: Chaukhambha Orientalia;1981) Su30#9-11
    Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi  2011.) 
 
  Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98) 197-198.
 
  Dr. David Frawley, Ayurvedic Healing For Healthcare Professionals (California College of Ayurveda, Copyright 1988-2011)pg.264.
  Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi  2011.) p.163-164.
  Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.238.
  Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 1995-2012) Appendix C: Managing Cancer pg.A-34.
  Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi  2011.) p.164.
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161.
  Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)p. 274.
  Ibid.
  Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161.
  Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.277.
  Maya Tiwari, Living Ahimsa Diet,(Mother Om Media,2011) p.80-81
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
 
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.161
    Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes,   WI: Lotus Press 2001)p.242,243
  Ibid,p.127-128
 
   Pal A, Sharma PP, Pandya TN, Acharya R, Patel BR, Shukla VJ, Ravishankar B.
 Phyto-chemical evaluation of dried aqueous extract of Jivanti [Leptadenia reticulata (Retz.) Wt. et Arn].
Ayu. 2012 Oct;33(4):557-60. doi: 10.4103/0974-8520.110525.
 
 
   Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.102,103
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.180
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy inreducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy inreducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.106,107
 
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes,   WI: Lotus Press 2001)p.171
  Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)pg.199
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes,   WI: Lotus Press 2001)p.240-241
  Sharma PV, Caraka Samhita ,(Varanasi: Chaukhambha Orientalia;1981) Ci 1.1 #77
  Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes,   WI: Lotus Press 2001)p.72
  Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)p.259
  Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)p. 72.
  Dr. Vasant Lad, Ayurveda: the science of Self-healing, A practical guide ( twin Lakes, WI: Lotus Press 2004)p.113
  Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)p271
  Anand Dhruva,MD,Christine Miaskowski,PhD, Donald Abrams, MD, Michael Acree PhD, Bruce Cooper, PhD, Steffanie goodman,MPH, and Freerick M Hecht,MD, Yoga Breathing for Cancer Chemotherapy-Associated Symptoms and Quality of Life: Results of a Pilot Randomized Controlled Trial (The journal of Alternative and Complementary medicine, Volume 18, Number 5,2012) pp473-479
    Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)
  Dr. Vasant Lad, Ayurveda: the science of Self-healing, A practical guide ( twin Lakes, WI: Lotus Press 2004)p.125
  Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62:613-622.
  www.AmericanCancer society.com
  Transcribed from an interview with Deepak Chopra, the Oprah Winfrey show, 2013
  Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.325.
  Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.332-334.
  David Frawley, Soma in Yoga and Ayurveda: The power of rejuvenation (Twin Lakes, WI: Lotus Press 2012)  Author’s Preface.
  Ibid.
  Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)
 
 
 

 

Brahmi: “Herb of Grace”

Abstract

   The uses of alternative medicines have increased significantly around the world. The search for effective and safe medicines is always on as well as new uses of old medicines are being looked into. Brahmi is an Ayurvedic medicinal herb which has been used for centuries. Certain neurological disorders have limited therapeutic options in Western medicine and hospitals and research institutes across the globe are increasingly looking into Ayurvedic science for effective and safer alternatives. Brahmi is a well-known nootropic herb and its uses in neurological and psychiatric disorders are well recognized. Its efficacy and safety is supported by research and thousands of years of knowledge and experience. Despite being such an old medicine, its new benefits are constantly being studied. Brahmi is one of the most sattvic herbs known in Ayurvedic pharmacopeia since Vedic times. Here, we will delve deep into the Brahmi plant, its science, its Ayurvedic uses and much more. 

Introduction 

   In recent times, the use of herbal products has increased significantly in the western world as well as in the developing countries. Brahmi is an important medicinal plant that has been widely used therapeutically in the orient and is becoming increasingly popular in the west 6. Brahmi is a Sanskrit word derived from “Lord Brahma” or “Brahman”. Lord Brahma is the divinity responsible for all of the creative forces in the world and Brahman is the Hindu name given to the universal consciousness. Brahmi literally means the energy (or “Shakti”) of Brahma 8, 9, 10. Thus, Brahmi has a lot to offer to the medical world 9.

   The ancient Ayurvedic sages, who were also great physicians, revealed Brahmi’s role in promoting Medhya (intellect), Ayushya (longevity), Rasayana (rejuvenation), Prajnasaktivardhana (intellectual power), Hrdaya (Heart), Majjadhaty Rasayana (nervous system rejuvenation), Balya (strength, especially mind), Jivaniya (life energy), Nidrajanana (sleep), Dhana (wealth), Svara (voice), Varna (complexion) and Anuloma (redirecting the flow of vata downwards). Over the centuries, the role of Brahmi in the treatment of Kustha (leprosy/skin disorder), Pandu (anemia), Meha (diabetes), Asra Vikara (blood disorders), Kasa (cough), Visa (poison), Sopha (edema), Jwara (fever), Vatahara (vata), Unmadahara (mental illness), Unmada (insanity), Alaksmi (inauspiciousness), Apasmara (epilepsy), Papa (evil deeds), Krtya (black magic), Ruk (pain) and Manasavikara (mental disorders) has been well described 3, 5, 9, 19.

   Scientifically, Brahmi is known as Bacopa Monnieri L. Pennell; some of the other names it is also known as are Bacopa monniera, Indian Pennywort L. Pennell, Bramia monnieri L. Pennell, Gratiola monnieria L, Herpestes monnieria L. Kunth, Herpestis fauriei H. Lev, Herpestis monniera, Herpestris monnieria, Lysimachia monnieri L. and Moniera euneifolia 4. The herb comes from the family of Plantaginaceae; it can also be placed under families of Scrophulariaceae, Gratiolaceae, or Veronicaceae 2, 4. It commonly grows in marshy areas throughout India, Nepal, Sri Lanka, Pakistan, China, Taiwan, Vietnam & USA. In the USA, it is grown in Florida, Hawaii and other southern states 4. It is widely distributed across most regions of the world including China, India, Canada, USA, Brazil, Australia, Argentina, Nigeria, South Africa, etc. 2

   Due to Brahmi’s widespread availability across the globe, it is often recognized by different names in different regions and languages. In Sanskrit, it is called Saraswati (Goddess of learning, knowledge and wisdom or the essence of the self), Somavati (containing soma or nectar), Indravalli (energy of Lord Indra), Brahmi (knowledge of Brahma or supreme reality), Adha-birni 2, Jala-Brahmi, or Svetakamini 7. In Hindi, it is known as Brambhi, Safed kami (white Lord) 7, Brahmi, Jaributi (herb), Nirbrahmi, or Jalneem. In Gujarati, it is known as Jalanevari or Kadavi luni (the better herb). In English, it is called herb-of-grace, Bacopa, Thyme leaved Gratiola, or Waterhyssop. It is known as Farfakh (the hottest tree) in Arabic, Jia ma chi xian in Chinese, Kleines Fettblatt, or Wasserysop in German, Medha giree (mountain of wisdom) in Nepalese, Litet tjockblad in Swedish and many more 2, 7. 

The plant

   Brahmi is a small creeping perennial with numerous branches and small, oblong, relatively thick leaves which are arranged opposite to each other on the stem. Flowers are small and light purple or white with four to five petals. It can grow naturally in wetland, shallow water, damp and muddy shores. Its ability to grow in water makes it a popular aquarium plant; it can also grow in slightly brackish conditions 4, 11. What makes Brahmi a unique plant is that even though it is an aquatic plant, it can easily be cultivated in pots, in a garden under a shade or even under full sun when provided ample water 13. 

   The whole plant can be used for medicinal purposes. It has bitter and sweet taste (Rasa), cooling energy (Virya) and sweet post-digestive effect (Vipaka). It normalizes all three Doshas and all Dhatus (tissues), especially nerve, blood and plasma. It has an effect on numerous Srotas (system); like circulatory, digestive, nervous, excretory, muscular and reproductive 8, 9.

Mandukaparni and Brahmi

   Since the 3rd century, ancient Ayurvedic authors like Charaka, Sushruta and Vagbhatta treated Brahmi and Mandukaparni as two different herbs 15. Later, confusion was created in the 16th century when Bhavaprakasha and Hemadri equated Brahmi with Mandukaparni 4, 15. Since then, Centella Asiatica (Gotu Kola or Mandukaparni) has been known as Brahmi, particularly in North India and Kerala 4. However, according to The Ayurvedic Formulary of India, Bacopa monnieri is Brahmi and Centella Asiatica is Mandukaparni 9. A critical study of comparative photochemistry, pharmacology and therapeutic properties of these two drugs has proven that they are distinct 15. Brahmi was used specifically in mental diseases like insanity and epilepsy, while Mandukaparni was used as a general brain tonic. Another study published in 2012 proved that these two herbs exhibited significant differences in their antioxidant values too. The study concludes that regular use of Brahmi as a supplement could be more helpful compared to Gotu Kola in the treatment of neurological disorders caused by free radical damage 14. Brahmi promotes fertility and sustains implantation; while Mandukaparni is abortifacient. Both are used for skin diseases but their therapeutic effects are different 15. Also, unlike Brahmi, Mandukaparni is a stronger diuretic 8.  Hence, these two are entirely different herbs.

Brahmi and Ayurveda

   In India, Brahmi is largely treasured as a revitalizing herb used by Ayurvedic medical practitioners for almost 3000 years. The herb has been mentioned in several Ayurvedic treatises including Charaka Samhita and Sushruta Samhita in the 3rd century AD 11. In addition to being a well-known Nootropic herb for centuries, it has also been used as an antispasmodic, alterative, astringent, cardio tonic, diuretic, anticonvulsant, anti-inflammatory, analgesic, antipyretic and antiepileptic agent 8, 9, 10.

   Brahmi is one of the best herbs for balancing and rejuvenating Pitta, while at the same time strongly reducing Kapha 8. It enhances the quality of Sadhaka pitta which directly influences the nature of consciousness 9. It can balance Vata if taken in proper doses or with other anti-vata herbs 8. It aids in the recovery from exhaustion, stress, debility and aggravation of vata. It helps in all conditions with a deficient Majja dhatu; hence it is used in Parkinson’s disease, Alzheimer’s disease, dementia, ADHD, Asperger’s syndrome, autism, insomnia and depression 9. It reveals its sattvic quality by helping to give up bad habits and all types of addictions. It aids in recovery from alcoholism or drug abuse, and also helps to kick the sugar habit. For this reason it is added to many Ayurvedic formulas as a nervine agent 8. As a purifier, it is a first rate herb to cleanse the system by eliminating all sorts of poisons. It is therefore very useful in leprosy, syphilitic and scrofulous ulceration, obstinate eczema, cutaneous affections and psoriasis 12. According to Bhavaprakasha, Brahmi is useful in skin conditions with underlying nervous imbalance. In addition to a blood purifier, it strengthens the immune system, allays excess sexual desire, and is beneficial in venereal diseases, including AIDS. It also cleanses the kidneys, while calming and soothing the liver. It calms the heart and helps guard against heart attacks 8. It is beneficial in relieving tension throughout the system and helps to ease constipation from stress, relaxes muscles and alleviates menstrual pain and disorders. It has a cooling effect on Mutravaha srota (urinary system) and it cools the heat of cystitis and pain of dysuria by guiding pitta out of the system 9. 

Brahmi Rasayana

   Ancient Ayurvedic texts describe a remedy called Brahmi Rasayana which is a molecular nutrient and nutrition enhancing agent. According to Acharya Charaka, Rasayana therapy improves the nutritional status of the body, leading to the formation of better qualities of cells and tissues which can sustain aging and stress 18. Sage Sushruta explains Brahmi Rasayana as an elixir and remedial agent which improves memory and invigorate mental faculties, as well as increasing the duration of human life. After proper cleansing of the body, Sushruta describes the treatment with fresh juice of Brahmi and an extremely light diet at a specific time of the day for 21 days. It improves memory and intellectual power every week of the treatment. The complete 21-day treatment removes all inauspicious features of the body and the mind. The Goddess of learning appears in an embodied form in the mind of the user and the mind gains different kinds of knowledge. It also enables the person to live for five hundred years 17. As a heart rejuvenator, it is recommended in the treatment of heart diseases 30. Acharya Charaka also used Brahmi as one of the herbs in preparation of Aindra Rasayana to treat Svitra (leucoderma), kustha (skin diseases including leprosy), Jathara (abdominal diseases including ascites), Gulma (phantom tumor), Purana pliha (chronic splenic disorders), Visama jvara (irregular fever); and in Indrokta Rasayana to improve longevity, youth, voice, complexion, nourishment, intellect, memory and strength and be disease free 5. 

   The Rasayana specific to the brain called Medhya Rasayana slows the brain aging process and helps in regeneration of neural tissues besides producing anti-stress, adaptable and memory enhancing effects 18. The soothing effects on the nervous system as well as its mind enhancing capability are legendary. According to Dr. Frawely, it is the most important Nervine herb used in Ayurvedic medicine; it improves memory and aids in concentration. It revitalizes the brain cells by removing toxins and blockages within the nervous system, while at the same time having a nurturing effect. Brahmi, which grows in the Himalayas, is an important food for yogis practicing meditation. A small amount of its fresh leaves are eaten daily for rejuvenating the mind and to improve meditation. Brahmi helps awaken the crown chakra (Sahastrara; the seventh spiritual chakra in head) and balances the right and left hemispheres of the brain 8, 9. Brahmi has been used as Medhya Rasayana since Vedic times and it is still well-researched in today’s medical world.

Usage forms

   The Ayurvedic pharmacopoeia of India mentions important formulas of Brahmi as Sarasvataristha, Brahmi Ghrita, Ratnagiri Rasa, Brahmi Vati, Sarasvata Curna and Smrtisagara Rasa 19. The herb can be taken as ghrita (medicated Ghee), medicated oil, churna (powder), svarasa (fresh juice), infusion, decoction, tincture (fermented beverage), syrup, tea, lepa (paste), pill or eaten fresh (leaves).  As a milk decoction, Brahmi is a good brain tonic, particularly if combined with Aswagandha 8. Sarasvataristha is a fermented beverage (tincture) in which Brahmi is the major constituent, used in the treatment of infertility, epilepsy and mental disorders 20. As a medicated oil, it helps relieve joint pain, headache and to clear the mind. When massaged on the skull, it works as a brain tonic to strengthen memory and encourage hair growth 9. Brahmi paste applied to the neck is very useful in cough and pneumonia, especially in children 12. Topical use also treats diaper rash in infants 30. Brahmi lepa (paste) helps to reduce swellings. A poultice made of boiled plant is placed on the chest in acute bronchitis and other coughs in children. Its leaves are fried in ghee (purified butter) and consumed to relieve hoarseness. Juice of its leaves is given to relieve diarrhea in children. Brahmi juice mixed with petroleum can improve symptoms when applied in rheumatism 7. As neti, Brahmi is one of the best herbs to normalize the absorption of prana through the sinus 30. A cup of fresh Brahmi tea taken with honey before meditation is also a great aid in its practice 8. 

   When combined with ghee (purified butter) or milk, Brahmi has a tonifying, nerve nourishing and pitta cooling effect 9. Brahmi Ghrita or Ghrta (Brahmi medicated ghee) is a popular formula referenced in classical Ayurvedic texts. Charaka described the recipe of Brahmi Ghrita as one part old cow’s ghee cooked with four parts Brahmi juice and 1/4th part in total of the paste of vaca, kustha and sankhapuspi. This medicated ghee cures insanity, inauspiciousness, epilepsy and effects of evil deeds 5. In Astanga Hrdayam, Brahmi Ghrta is mentioned with herbs like vyosa, syama, trivit, danti, sankhapuspi, nrpadruma, saptala and krmihara for the treatment of insanity, leprosy and epilepsy, and to improve speech, voice, memory, intelligence and to bestow sons to barren women 6. Classical texts also mention the use of Brahmi along with other herbs in the preparation of other Ghrtas. For example: Maha paisacika Ghrta to treat insanity 6 and Tryusanadya Ghrta to cure fever, gulma (phantom tumor), anorexia, splenic disorders, headache, chest and cardiac pain, jaundice, piles, vatika type of asthila (hard tumor), phthisis and tuberculosis 5. Brahmi Ghrita can be applied as nasya in doses of five drops per nostril in the treatment of mental disorders. Brahmi Ghrita prepared with sesame or coconut oil can be massaged on the feet, large joints and ears before sleep in the treatment of anxiety and depression 20. According to Dr. Frawely, “Brahmi Ghrita is the best rejuvenative for the mind and the heart which should be kept in every home” 8.

With other herbs

   When Brahmi is combined with other herbs, its medicated qualities are expanded even further. Taken with basil and a little black pepper, Brahmi is good for all kinds of fevers 8. When used with neem, manjishtha and turmeric, it helps in skin conditions with pitta imbalance 9. According to Dr. Halpern, a popular remedy for acne is to combine Brahmi and turmeric in equal amounts, add 1 tsp. (4oz.) of warm cow milk and ½ tsp. of ghee and taken twice a day for several months. This remedy reduces Bhrajaka pitta on the skin (acne) and makes the skin lustrous 30. Brahmi and vacha stimulate the mind with a high kapha condition, whereas; gotu kola, jatamansi and tagarah bring out its sedative effect. Brahmi combined with aswagandha, kushta, kappikacchu, shankhapushpi and bala works as a nerve tonic. Brahmi Rasayana, with ten parts Brahmi, forty parts sugar, two parts clove and one part each of cardamom and pippali, works as an anti-inflammatory and nerve tonic agent. When combined with digestive stimulants like ginger and cardamom, it suppresses the appetite; with cumin, fennel and ajwan it relaxes the intestines 9.  

Kaya Kalpa

   Swami Sivananda described a very remarkable treatment called Brahmi Kalpa treatment in his book – ‘The Practice of Ayurveda’. It is a treatment of ‘Kaya Kalpa’, where ‘Kaya’ means the body and ‘Kalpa’ means transformation or rejuvenation. After going through pancha karma, he explains Kaya Kalpa treatment with fresh Brahmi leaves’ juice and fresh cow milk for 45 days. The treatment restores the aged and debilitated body to its pristine youth and vigor, re-establishes the full potential of the senses and imparts good health. It prolongs as well as improves the quality of life. It restores the natural balance of all three doshas, brings the function of sapta (seven) dhatus to a normal condition and cures many incurable diseases 12.

Brahmi and Science

   Over the last few decades, Brahmi has been researched extensively for its chemical constitution and identification of its therapeutic role. Compounds responsible for the pharmacologic effects of Brahmi include alkaloids, saponins, and sterols 21. Detailed investigation first reported the isolation of the alkaloid ‘brahmine’ from Brahmi 11. Later, numerous compounds have been isolated including nicotine, herpestine, betulic acid, stigmastarol, beta-sitosterol, as well as numerous bacosides and bacopasaponins 21. Extensive investigation on the plant extract and isolated bacosides, especially bacosides A and B, confirm their nootropic (Medhya Rasayana) action 23. Brahmi enhances the three basic components of mind: power of learning (Dhi), power of retention (Dhuti) and power of recall (Smriti) 21. 

   Since 1993, Central Drug Research of India has been doing extensive research with Brahmi on human volunteers 13. Triterpenoid saponins and their bacosides are responsible for Brahmi’s ability to enhance nerve impulse transmission. The bacosides aid in repair of damaged neurons by enhancing kinase activity, neuronal synthesis, and restoration of synaptic activity, and ultimately nerve impulse transmission 22. A research on adults indicated that Brahmi had a significant effect upon retention of new information; improved the speed of visual information processing, learning rate and memory consolidation within 12 weeks of treatment 20. A 2012 research study on the elderly clearly demonstrated that B. monnieri suppresses AChE activity resulting in enhanced cholinergic function, which in turn enhances attention and memory processing and increases working memory 24. In children, a 12 week Brahmi treatment revealed significant benefits with improvement in sentence repetition, logical memory, and paired associate learning tasks 22.

   Brahmi helps in coping with combined hypoxic, hypothermic and immobilization stress that could lead to the onslaught of ‘free radicals’ (highly reactive oxygen species). Brahmi extract exhibits interesting antioxidant properties, expressed by its capacity to scavenge superoxide anion and hydroxyl radical, and to reduce H2O2 induced cytotoxicity and DNA damage in human fibroblast cells. An animal study showed its antioxidant activity in the hippocampus, frontal cortex and striatum. Brahmi extract has shown neuroprotective effect against aluminum-induced oxidative stress in rat brain; and reduced nicotine-induced lipid peroxidation and geno protection in mice. It reduces amyloid levels and can be used in the therapy of Alzheimer’s disease 11. Since mild cognitive impairment (MCI) and early phase Alzheimer's disease occur due to cholinergic degeneration and oxidative stress, Brahmi extract provides a benefit in terms of decreasing memory impairment in these two diseases and even in attention deficit disorder 24. A study has shown a protective role of bacoside A against chronic cigarette-induced oxidative damage in rat brain 11. In the management of stress related study, Brahmi extract was found not only to induce the expression of heat shock protein (HSP 70) but also of CYP 450 enzymes in all regions of the brain. Brahmi primes the brain for stress by stockpiling and modulating the activities of useful enzymes like HSP 70, CYP 450 and SOD even before the onset of the stressful condition 11. In paranoid schizophrenia, adding Brahmi to olanzapine resulted in improvement in psychopathology as evidenced by reduction in PANSS and BPRS scores, without any treatment associated adverse effects 25. 

   Brahmi extract has been found comparable to standard anti-depressant drug imipramine in anti-depressant activity in rodent animals. The same study has postulated its role on serotonin and GABA (gamma amino butyric acid) receptors in the mechanism of action for its anti-depressant and anti-anxiety activity 11. Early research in India demonstrated that hersaponin (an active constituent of Brahmi) exhibited protection against seizures in mice; whereas another study examined the anticonvulsant properties of Brahmi extract at higher doses by its mechanism on GABA receptors 11. 

   Animal and human studies have investigated the effect of Brahmi extract on the gastrointestinal tract. An in-vitro study has demonstrated its direct spasmolytic activity on intestinal smooth muscles, via inhibition of calcium influx across cell membrane channels; suggesting its benefit in intestinal spasm such as irritable bowel syndrome. Brahmi also has a protective and curative effect on gastric ulcer. A study showed that Brahmi extract significantly healed penetrating ulcers induced by acetic acid, significantly strengthened the mucosal barrier and decreased mucosal exfoliation. A methanolic extract of Brahmi given for 5 days demonstrated a dose-dependent anti-ulcerogenic on various gastric ulcer models induced by ethanol, aspirin, two hour cold stress and four hour pylorus ligation 20. The extract also alleviated stress-induced ulcers as observed by significant reduction in LPO in rat gastric mucosa 11. Diethyl ether and ethyl acetate extract of Brahmi have slight anti-fungal activity but have a broad spectrum of antibacterial activity 10. Another in vitro study demonstrated its specific anti-microbial activity against Helicobacter pylori, a bacterium associated with chronic gastric ulcers 11. 

   A recent 2013 study revealed Brahmi’s wound healing properties. Brahmi showed antimicrobial activity against skin pathogens, enhanced wound breaking strength, rate of contraction, skin collagen tissue formation, and early epithelization period with low scar area by decreasing myeloperoxidase and free radical generated tissue damage 32.  Brahmi possesses anti-inflammatory activity that has shown 82% edema inhibition when compared to indomethacin. It also significantly inhibited 5-lipoxygenase (5-LOX), 15-LOX and cyclooxygenase-2 (COX-2) activity. Another paper supported its anti-inflammatory activity via inhibition of prostaglandin synthesis and lysosomal membrane stabilization 10, 11. 

   Brahmi extract has the potential usefulness in bronchoconstrictive and allergic conditions. Animal studies have demonstrated that it has a relaxant effect on chemically-induced bronchoconstriction, probably via inhibition of calcium influx into cell membranes. In vitro research using rabbit and pig aortas and pulmonary arteries has demonstrated that Brahmi exerts a vasodilatory effect on calcium chloride-induced contraction in both tissues via interference with calcium channel flux in tissue cells. Nearly all of the Brahmi extract subfractions inhibited carbachol-induced bronchoconstriction, hypotension and bradycardia in this animal model. Another study demonstrated that a methanol extract of Brahmi possessed potent mast cell stabilizing activity comparable to disodium cromoglycate, a commonly used allergy medication 11.

   Recently, some studies have demonstrated Brahmi’s anti-cancer activity. A study on rats found that Brahmi extract promotes antioxidant status, reduces the rate of lipid peroxidation and markers of tumor progression in fibro sarcoma 10. The anticancer effect of Brahmi extracts may be due to inhibition of DNA replication in cancer cell lines 11. A study on rats revealed that pretreatment of bacoside A prevents the elevation of lipid peroxidase activity of serum marker enzymes and maintains the antioxidant system and thus protects the rats from Diethyl nitrosamine-induced hepatocellular carcinoma 10. Brahmi protects human lymphocytes against various clastogens with its high anti-oxidant activity since clastogens are known to induce their clastogenic effects via the production of oxidative radicals 10. More research is needed to support Brahmi’s anticancer ability.

   A study on rats showed Brahmi’s protective effect against morphine-induced liver and kidney toxicity 10. Simultaneous administration of morphine and alcohol extract of Brahmi significantly decreased lipid peroxidation and increased liver antioxidant enzyme level, thereby protecting the liver against morphine 28. In mice, Brahmi administration with phenytoin reversed phenytoin-induced cognitive impairment, and improved acquisition and retention of memory 22. 

   An animal study showed that high doses of Brahmi extract increased the thyroid hormone, T4. However, T3 levels remained unchanged. Based on this study, Brahmi may have a potential use in hypothyroidism, however, the doses used in this study were very high and this effect has not yet been studied in humans 26. The antifertility potential of Brahmi was studied in male mice. According to a 2009 study, Brahmi caused reversible suppression of spermatogenesis and fertility, without producing apparent toxic effects; and 56 days after treatment cessation, the parameters returned to baseline 27. According to classical texts, Brahmi can safely be used during pregnancy to help both the mother and the fetus to be strong and sattvic. Also following delivery, the child may be given a honey-sweetened confection prepared with Brahmi to promote intellect 30. 

   In addition to its beneficial effect on humans and animals, Brahmi has a favorable effect on the environment. Brahmi is a known hyper accumulator of cadmium, chromium, lead and mercury and can be used for phytoremediation 10. A 2011study reported that substantial amount of arsenate were found accumulated in the Brahmi plant, thus aiding in phytoremediation 29. 

   Brahmi growing in contaminated areas may be toxic to health when consumed by humans 29. According to Swami Sivananda, Brahmi should not be collected from impure and unholy places; instead it should be collected from clean places with "fresh airy regions" 12.

A Final Thought

   Brahmi is one of the rare Ayurvedic herbs which can be grown almost anywhere when provided ample hydration and is widely available. It has been used for centuries in various forms and its advantages are supported by a vast body of literature and experience. Interestingly, the whole plant can be used for medicinal purposes. Ayurveda is the complete knowledge of life. Brahmi helps to achieve the primary goal of Ayurveda which is to prevent and treat illnesses and enhance lifespan by maintaining proper balance between the body, mind and the soul. Its therapeutic range is wide, and can be used in prevention as well as cure of a variety of disorders. It is a sattvic herb which comes from the same root as Brahman whose nature is Sat-Chit-Ananda 16. Its sattvic quality can help build strong ojas and reduce bad habits and treat addictions. It balances all doshas, dhatus and has an effect on almost all the Srotas of the human system and, based on the studies, animals, too. Being a nervine agent, it is beneficial in many neurologic and psychiatric disorders. This unusual herb has tonic, sedative and at the same time stimulant nervine effects. As a purifier, it is helpful in debilitating skin conditions. It strengthens the immune system and improves nutritional status, memory, intellect and longevity. It can help to achieve higher consciousness and improve meditation skills. By helping to open the crown chakra, it helps to achieve the highest goal of human life which is self-realization. Its ability to be used in different forms as well as in combination with other herbs makes it a popular medicinal plant. Finally, we have to agree with Swami Sivananda, “Rarely is it possible to come across an herb of such great worth.” 

References

1. USDA, plants profile: ‘Bacopa Monnieri (L.) Pennell http://plants.usda.gov/java/profile?symbol=BAMO
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20. Caldecott, T. "Brahmi". Ayurveda: The Divine Science of Life. Elsevier / Mosby. ISBN 0-7234-3410-7. http://www.toddcaldecott.com/index.php/herbs/learning-herbs/384-brahmi
21. Wendy Weissner, article: “Brahmi and Cognition: Nature’s Brainpower Enhancer”               http://ayurveda-nama.org/pdf/resources/NAMA_Brahmi_Weissner.pdf
22. Monograph: Bacopa monnieri. Alternative Medicine Review, Vol 9 (1), 2004, pp. 79-85                http://www.thorne.com/altmedrev/.fulltext/9/1/79.pdf
23. Russo A, Borrelli F., “Bacopa monniera, a reputed nootropic plant: an overview,” Phytomedicine. 2005 Apr; 12(4):305-17. 
24. Tatimah Peth-Nui, Jintanaporn Wattanathorn, Supaporn Muchimapura, Terdthai Tong-Un, Nawanant Piyavhatkul, Poonsri Rangseekajee, Kornkanok Ingkaninan, Sakchai Vittaya-areekul, “Effects of 12-Week Bacopa monnieri Consumption on Attention, Cognitive Processing, Working Memory, and Functions of Both Cholinergic and Monoaminergic Systems in Healthy Elderly Volunteers,” Evid Based Complement Alternat Med. 2012: 606424, doi: 10.1155/2012/606424, PMCID: PMC3537209
25. Sukanto Sarkar, Biswa Ranjan Mishra, Samir Kumar Praharaj, S. Haque Nizamie, “Add-on effect of Brahmi in the management of schizophrenia,” J Ayurveda Integr Med. 2012 Oct-Dec; 3(4): 223–225. doi: 10.4103/0975-9476.104448, PMCID: PMC3545244
26. Kar A, Panda S, Bharti S., “Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice,” J Ethnopharmacol. 2002 Jul; 81(2):281-5.
27. Singh, A., Singh, S. K. (2009). "Evaluation of antifertility potential of Brahmi in male mouse". Contraception 79 (1): 71–79. doi:10.1016/j.contraception.2008.07.023. PMID 19041444
28. Sumathy T, Subramanian S, Govindasamy S, Balakrishna K, Veluchamy G., “Protective role of Bacopa monniera on morphine induced hepatotoxicity in rats,” Phytother Res. 2001 Nov;15(7):643-5.
29. Mishra S, Srivastava S, Dwivedi S, Tripathi RD., “Investigation of biochemical responses of Bacopa monnieri L. upon exposure to arsenate,” Environ Toxicol. 2013 Aug; 28(8):419-30. doi: 10.1002/tox.20733. Epub 2011 Jun 7.
30. Dr. Marc Halpern, Clinical Ayurvedic Medicine. California College of Ayurveda, sixth edition, September 2012, pp. 2-47; 5-25, 33,88
31. Dr. Marc Halpern, Principles of Ayurvedic Medicine. California College of Ayurveda, tenth edition, September 2010, pp. 295
32. Murthy S, Gautam MK, Goel S, Purohit V, Sharma H, Goel RK. “Evaluation of In Vivo Wound Healing Activity of Bacopa monniera on Different Wound Model in Rats,” Biomed Res Int. 2013; 2013:972028. doi: 10.1155/2013/972028. Epub 2013 Jul 29.

 

The Magical Moringa By: Vanita Agarwal

Introduction

Growing up in India this humble tree grew in our backyard and it never caught my attention, though I always loved the vegetable that grew on it. As I  entered into the world of Ayurveda I learnt about  this most  nutritious  tree  in the world called Moringa  only to realize that this tree was a childhood friend that I had loved and this world famous Moringa was my backyard fried the drumstick tree or Sajana as we used to call it.

In this paper I will attempt to cover:

  • 1. What is Moringa?
  • 2. The Nutritional value of Moringa
  • 3. Johns Hopkins University research on Moringa
  • 4. Health benefits of Moringa
  • 5. The qualities of Moringa from an Ayurvedic perspective

1. What is Moringa?

According to Wikipedia Moringa, a native to parts of Africa and Asia, is the sole genus in the flowering plant family Moringaceae. The name is derived from the Tamil word Murungai (முருங்கை) [1]. 

It contains 13 species from tropical and subtropical climates that range in size from tiny herbs to massive trees. The most widely cultivated species is Moringa oleifera, a multipurpose tree native to the foothills of the Himalayas in northwestern India and cultivated throughout the tropics. M. stenopetala, an African species, is also widely grown, but to a much lesser extent than M. oleifera.

As Moringa spread from India to other tropical and subtropical areas, it adapted to local conditions. Over time, these thirteen distinct species of Moringa developed.

Scientific Classification of Moringa [1]:

Kingdom:         Plantae
(un-ranked): Angiosperms
(un-ranked): Eudicots
(un-ranked): Rosids
Order: Brassicales
Family: Moringaceae
Genus: Moringa

Scientific Names of the 13 different species of Moringa found in the world today [1] 

1. M. oleifera (Northwestern India)
2. M. arborea (Kenya)
3. M. borziana
4. M. concanensis
5. M. drouhardii (Southwestern Madagascar)
6. M. hildebrandtii
7. M. longituba
8. M. ovalifolia
9. M. peregrine
10. M. pygmaea
11. M. rivae
12. M. ruspoliana
13. M. stenopetala

Common Names of Moringa:

While native to the Indian sub-continent, Moringa has spread throughout the tropical and sub-tropical regions of the world. There are over 400 names of Moringa around different parts of the world. Here are some of the many common names of Moringa: [3]

English Drumstick tree, Horseradish tree, Mother's Best Friend, Radish tree, West Indian ben
French Bèn ailé, Benzolive, Moringa, Ben oléifère, Arbre radis du cheval
German Behenbaum, Behenussbaum, Flügelsaniger Bennussbaum, Pferderettichbaum
Italian Sàndalo ceruleo
Portuguese Acácia branca, Cedra (Brazil), Marungo, Moringuiero, Muringa
Spanish  Árbol del ben, Ben, Morango, Moringa

Africa

Benin: Patima, Ewé ilé
Burkina Faso: Argentiga
Cameroon: Paizlava, Djihiré
Chad: Kag n’dongue
Ethiopia: Aleko, Haleko
Ghana: Yevu-ti, Zingerindende
Kenya: Mronge
Malawi: Cham’mwanba
Mali: Névrédé
Niger: Zôgla gandi
Nigeria: Ewe ile, Bagaruwar maka
Senegal: Neverday, Sap-Sap
Somalia: Dangap
Sudan: Ruwag
Tanzania: Mlonge
Togo: Baganlua, Yovovoti
Zimbabwe: Mupulanga

Asia

Bangladesh: Sajina
Burma: Dandalonbin
Cambodia: Ben ailé
India: Sahjan, Murunga, Moonga; 
Hindi: Sahijan, Munaga, Sajana, 
Sindhi: Swanjera
Tamil: Murungai, Murunkak-kai, Morunga
Telegu: Tella-Munaga, Mulaga, Sajana
Kannada: Nugge mara, Nugge kayi; 
Oriya: Munigha, Sajina
Punjabi: Sanjina, Soanjana
Rajasthani: Lal Sahinjano
Sanskrit: Sigru Shobhanjan, Sobhan jana, Shobanjana
Konkani/Goa: Moosing, Mosing
Malayalam: Sigru, Moringa, Muringa, Murinna, Morunna
Marathi: Sujna, Shevga, Shivga

Indonesia: Kalor

Pakistan: Suhanjna
Philippines: Mulangai
Sri Lanka: Murunga
Taiwan: La Mu
Thailand: Marum
Vietnam: Chùm Ngây

South and Central America, Caribbean

Brazil: Cedro
Colombia: Angela
Costa Rica: Marango
Cuba: Palo Jeringa
Dominican Republic: Palo de aceiti
El Salvador: Teberinto
French Guiana: Saijhan
Guadeloupe: Moloko
Guatemala: Perlas
Haiti: Benzolive
Honduras: Maranga calalu
Nicaragua: Marango
Panama: Jacinto
Puerto Rico: Resada
Suriname: Kelor
Trinidad: Saijan

Oceania

Fiji: Sajina
Guam: Katdes
Palau: Malungkai

2. The Nutritional value of Moringa

The tree is often referred to as "The Miracle Tree" and "Mother’s Best Friend", which is understandable when you learn that Moringa contains a unique combination of vitamins, minerals and amino acids that make it one of the most nutritious plants ever discovered. Much of the plant is edible by humans or by farm animals.

Moringa leaves
Moringa leaves are exceptionally nutritious. When fresh, they are rich in vitamin C. When carefully dried, gram for gram Moringa leaves contain 24 times the iron of spinach, 16 times the calcium of milk, 9 times the vitamin A of carrots, many times the potassium of bananas, and every essential amino acid your body needs.
The leaves are rich in protein, vitamin A, vitamin B, vitamin C and minerals [4]. 100g of fresh Moringa leaves have 8.3 g protein, 434 mg calcium, 404 mg potassium, 738 μg vitamin A, and 164 mg vitamin C [5].
 
Antioxidants
Moringa contains 46 powerful antioxidants - compounds that protect the body against the destructive effects of free radicals by neutralizing them before they can cause cellular damage and disease [6].
 
Vitamins
Vitamin A (Alpha & Beta-Carotene), B, B1, B2, B3, B5, B6, B12, C, D, E, K, Folate (Folic Acid), Biotin [6]
 
Minerals
Calcium, Chromium, Copper, Fluorine, Iron, Manganese, Magnesium, Molybdenum, Phosphorus, Potassium, Sodium, Selenium, Sulphur, Zinc [6] .
 
Essential Amino acids
Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine [6]. 
 
Non-essential Amino Acids
Alanine, Arginine, Aspartic Acid, Cystine, Glutamine, Gl ycine, Histidine, Proline, Serine, Tyrosine [6]

Vitamin & Mineral Content of Moringa: [9]

All values are per 100 grams of edible portion.

  Fresh Leaves Dried Leaves
Carotene (Vit. A)* 6.78 mg  18.9 mg
Thiamin (B1) 0.06 mg 2.64 mg
Riboflavin (B2) 0.05 mg 20.5 mg 
Niacin (B3) 0.8 mg  8.2 mg
Vitamin C  220 mg 17.3 mg
Calcium  440 mg 2,003 mg
Calories  92 cal 205 cal
Carbohydrates  12.5 g  38.2 g
Copper 0.07 mg 0.57 mg
Fat   1.70 g  2.3 g
Fiber  0.90 g 19.2 g
Iron  0.85 mg 28.2 mg
Magnesium 42 mg  368 mg
Phosphorus  70 mg 204 mg
Potassium  259 mg 1,324 mg
Protein  6.70 g 27.1g
Zinc  0.16 mg  3.29 mg

Amino Acid Content of Moringa [9]:

All values are per 100 grams of edible portion.

  Fresh Leaves Dried Leaves
Arginine  406.6 mg  1,325 mg
Histidine  149.8 mg 613 mg
Isoleucine  299.6 mg  825 mg
Leucine  492.2 mg  1,950 mg
Lysine  342.4 mg  1,325 mg
Methionine  117.7 mg 350 mg
Phenylalinine  310.3 mg 1,388 mg
Threonine  117.7 mg  1,188 mg
Tryptophan  107 mg  425 mg
Valine  374.5 mg 1,063 mg

3. Johns Hopkins University research on Moringa [10] :

Jed W. Fahey, Sc.D. , Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences produced a very important research paper titled: “Moringa oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1.” In this seminal work, they began the process of sifting through the scientific work on Moringa, as well as the traditional, as well as anecdotal evidence for Moringa’s nutritional, therapeutic and prophylactic. In doing this, they found that much of the scientific evidence is beginning to support much of the traditional and anecdotal information.

4. Health Benefits of Moringa

Moringa preparations have been cited in the scientific literature as having antibiotic, antitrypanosomal, hypotensive, antispasmodic, antiulcer, anti-inflammatory, hypo-cholesterolemic, and hypoglycemic activities, as well as having considerable efficacy in water purification by flocculation, sedimentation, antibiosis and even reduction of Schistosome cercariae titer. 

Antibiotic Activity: This is clearly the area in which the preponderance evidence—both classical scientific and extensive anecdotal evidence—is overwhelming. The scientific evidence has now been available for over 50 years, although much of it is completely unknown to western scientists [10].

Phytochemicals and 6 Carbon Sugar Rhamnose: An examination of the phytochemicals of Moringa species affords the opportunity to examine a range of fairly unique compounds. In particular, this plant family is rich in compounds containing the simple sugar, rhamnose, and it is rich in a fairly unique group of compounds called glucosinolates and isothiocyanates. For example, specific components of Moringa preparations that have been reported to have hypotensive, anticancer, and antibacterial activity [10].

Antibacterial and Antifungal:

Subsequent elegant and very thorough work, published in 1964 as a PhD thesis by Bennie Badgett (a student of the well-known chemist Martin Ettlinger), identified a number of glycosylated derivatives of benzyl isothiocyanate [5] (e.g. compounds containing the 6-carbon simple sugar, rhamnose) (8). The identity of these compounds was not available in the refereed scientific literature until “re-discovered” 15 years later by Kjaer and co-workers (73). Seminal reports on the antibiotic activity of the primary rhamnosylated compound then followed, from U Eilert and colleagues in Braunschweig, Germany (33, 34). They re-isolated and confirmed the identity of 4-(α-L-rhamnopy-ranosyloxy)benzyl glucosinolate [6] and its cognate isothiocyanate [2] and verified the activity of the latter compound against a wide range of bacteria and fungi. (Jed W. Fahey, 2005) This is clearly the area in which the preponderance of evidence—both classical scientific and extensive anecdotal evidence—is overwhelming. The scientific evidence has now been available for over 50 years, although much of it is completely unknown to western scientists [10].

ANTIBACTERIAL PROPERTIES OF MORINGA STENOPETALA [12] 

The main objective of this study was to isolate compounds from root wood of Moringa stenopetala and evaluate antibacterial activities of the isolated compounds. Three of the compounds namely cholest-5-en-3-ol, palmitic acid and oleic acid showed highest activity against E. coli. The observed antibacterial activities of the crude extract and the isolated compounds could justify the traditional use of the plant for the treatment of different bacterial infections [12].

H. pylori is an omnipresent pathogen of human beings in medically underserved areas of the world, and amongst the poorest of poor populations worldwide. It is a major cause of gastritis, and of gastric and duodenal ulcers, and it is a major risk factor for gastric cancer (having been classified as a carcinogen by the W.H.O. in 1993). Cultures of H. pylori, it turned out, were extraordinarily susceptible to [2], and to a number of other isothiocyanates (37, 60). These compounds had antibiotic activity against H. pylori at concentrations up to 1000-fold lower than those which had been used in earlier studies against a wide range of bacteria and fungi. The extension of this finding to human H. pylori infection is now being pursued in the clinic, and the prototypical isothiocyanate has already demonstrated some efficacy in pilot studies [10].

Cancer Prevention:

Since Moringa species have long been recognized by folk medicine practitioners as having value in tumor therapy, we examined compounds for their cancer preventive potential. Recently, these compounds were shown to be potent inhibitors of phorbol ester (TPA)-induced Epstein-Barr virus early antigen activation in lymphoblastoid (Burkitt’s lymphoma) cells [10].

In one of these studies, they also inhibited tumor promotion in a mouse two-stage DMBA-TPA tumor model. In an even more recent study, Bharali and colleagues have examined skin tumor prevention following ingestion of drumstick (Moringa seedpod) extracts. In this mouse model, which included appropriate positive and negative controls, a dramatic reduction in skin papillomas was demonstrated. Thus, traditional practice has long suggested that cancer prevention and therapy may be achievable with native plants.

Role of Moringa on Gastric Ulcer and its use as Antacid

  • A study on Moringa leaf extract to determine its effect on experimental gastric ulceration concluded that the leaf extract can be beneficially used in the management of gastric ulcer in contrast to the classical antacid, antihistamine or surgical treatment [13].
  • Two weeks of treatment with Moringa Oleifera healed gastric ulcer damage [14].

Role of Moringa on Muscle cramps and Sleep

  • • Moringa is found to significantly reduces muscle cramps, decreases body temperature, and enhances sleep [15].

Benefits to Heart, Cholesterol, Triglycerides, Atherosclerotic Plaques:

  • Moringa has been found to have significant benefits to heart [16]. Water extract of Moringa Oleifera leaves possesses strong antioxidant activities. The prevention of artherosclerotic plaque formation in artery as well as the lipid lowering activity of the extract has been shown in rabbit fed with high cholesterol diet. M. Oleifera has high therapeutic potential for the prevention of cardiovascular diseases.
  • It works as well as Simvastatin in decreasing cholesterol, triglycerides, and inhibiting the formation of atherosclerotic plaques. [17]
  • Moringa strengthens heart function : Prevented structural damage and prevented increases in lipid peroxidation in the myocardium [8]

Anti-fungal 

  • • Moringa seeds have shown anti-fungal ability and effectiveness against athlete’s foot [18].

Prevention of Kidney stone 

  • • Moringa water extract has shown to prevent kidney stone formation and dissolve already performed stones [19]. 

Liver fibrosis 

Oral administration of Moringa seed extract in rats reduced liver damage as well as symptoms of liver fibrosis. Moringa seed extract can act against CCl(4)-induced liver injury and fibrosis in rats by a mechanism related to its antioxidant properties, anti-inflammatory effect and its ability to attenuate the hepatic stellate cells activation. [20]

Cancer/Chemo preventative property of Moringa 

  • • A study was conducted to find out the Chemomodulatory effect of hydro-alcoholic extract of Moringa oleifera, Lam, on hepatic carcinogen metabolizing enzymes, antioxidant parameters and skin papillomagenesis in mice. The findings are suggestive of a possible chemo preventive potential of Moringa oliefera drumstick extract against chemical carcinogenesis [21]

Blood glucose level and Diabetes

  • • Variable doses of M. oleifera leaves aqueous extract administered orally to test the glycemic control, haemoglobin, total protein, urine sugar, urine protein and body weight. The dose of 200 mg kg(-1) decreases blood glucose level (BGL) of normal animals by 26.7 and 29.9% during FBG and OGTT studies respectively. In sub and mild diabetic animals the same dose produced a maximum fall of 31.1 and 32.8% respectively, during OGTT. In case of severely diabetic animals FBG and PPG levels were reduced by 69.2 and 51.2% whereas, total protein, body weight and haemoglobin were increased by 11.3, 10.5 and 10.9% respectively after 21 days of treatment. Significant reduction was found in urine sugar and urine protein levels from +4 and +2 to nil and trace, respectively. The test result concluded that the study validates scientifically the widely claimed use of M. oleifera as an ethnomedicine to treat diabetes mellitus. [22]

5.  Ayurvedic Perspective on Moringa 

According to Vaidya Mishra [23] , an Ayurvedic expert from the Shankha Vamsa lineage, Moringa is  both a  detoxifier as well as a tonic. Whenever we detox we also use a tonic, Moringa does both. It purifies and nourishes the blood and muscle tissues, the bone marrow and the fat tissues of any toxins at the same time nourishing it.

Ayurvedic Properties/Guna of Moringa

Taste (rasa) Pungent/katu, tikta/bitter 
Virya Heating/ushna 
Post  Digestive metabolic state (vipak): pungent/katu 
Guna Light/laghu, dry/ruksha, sharp/tikshana, fluid/sara
Prabhava Liver cleanser (yakrit sodhana)
Purifies Blood (rakta sodhaka)
enhances spleen/pliha 
Removes worms (krmi), acidic toxins from the blood (amavishagni)
Relieves from tumor (gulma)
Strengthens heart/ hridya, fat metabolism and weight loss/Medovishahara and regulates cholesterol. 

In Bhava Prakash (16 Century canonical textbook of Ayurveda), part one, authored by Bhav Mishra and Rajnigantu, Moringa is called sigru, or “it moves like an arrow” in the body because it rapidly penetrates the tissues and has deep absorption and detoxification ability, making its effect on the deep bone marrow tissue swift and effective. 

The Nature and Qualities of Moringa: 

  • Hot and sharp, but also bitter and pungent 
  • Pacifies vata and kapha (vatakaphapaha) 
  • Pacifies kledaka kapha and increases appetite 
  • Reduces stiffness in the jaw, relaxes the jaw and thus helps in opening the mouth (mukhajadyahar) 
  • It is appetizing (rucyo) 
  • Increases digestive flame (dipano)
  • It cleans and clears the ulcers (vranadosanut). Vrana means ulcer.
  • Bitter (Sigrustiktah) 
  • Pungent and heating (Katuscosnah) 
  • Reduces kapha-predominant swelling and water retention, which can also lead to vata imbalance. Swollen ankles are a common complication of excess weight. Three-four drumstick pods per meal begin to reintroduce the intelligence so the body does not accumulate toxins in the lower extremities. Over time, little by little, the swelling will go down and not return. (Kaphasophasamirajit) 
  • Creates an unfriendly environment for the growth of tumors 
  • Destroys krimi and amavisha (Krgyamvisa) 
  • By binding the toxins in the blood, and cleaning the blood (due to its hot potency and pungent taste and post digestive taste), it relieves long term burning in the skin and stomach. 
  • Prevents and rids the tumors. When the clean blood circulates, growth of tumors are prevented and also if tumors are present, gets rid of the tumors (gulmanut). 
  • The Ayurvedic verse on Moringa by Bhav prakash of Bhav Mishra cites Moringa as removing acidic toxins from the blood, cleansing the blood. This in turn lowers bad cholesterol and improves cholesterol metabolism. This correlates the power of Moringa in lowering bad cholesterol and improving cholesterol metabolism. 
  • Kidney Stones: Ushna/hot and thikshana/pungent quality of Moringa stimulates the kidneys, dysuria, increases quantity of urine, removes excess acidity in urine and calculi. 

Dr. JV Hebbar, summarizes several interesting facts about Moringa in his blog [24].

Sanskrit Synonyms:

  • Shobhanjana – Very auspicious tree
  • Shigru – has strong, piercing qualities
  • Teekshnagandha – Strong and pungent odor
  • Aksheeva – relieves intoxication
  • Mochaka – helps to cure diseases

Classical categorization:

  • According to Charaka Samhita – 
  • Krimighna – group of herbs that are used to treat worm infestation.
  • Svedopaga – group of herbs that are used in Svedana (preparatory procedure for Panchakarma)
  • Shirovirechanopaga – group of herbs that are used in Nasya Panchakarma treatment
  • Katuka Skandha – group of herbs that have pungent taste.
  • According to Sushruta and Vagbhata – Varunadi Group of herbs. (Hence it is an ingredient of a famous Ayurvedic medicine – Varanadi kashayam)

Medicinal Qualities of drumstick tree:

  • Rasa(taste) – Katu (Pungent), Tikta (bitter)
  • Guna(qualities) – Laghu (light to digest), Rooksha (dryness), Teekshna (strong, piercing)
  • Vipaka – katu (Moringa undergoes pungent taste conversion after digestion.)
  • Veerya – Ushna – hot potency.
  • Effect on Tridosha – Balances Kapha and Vata

Varieties of Moringa:

There are three varieties of Moringa explained in Ayurvedic text books.

1. Shyama – black variety
2. Shveta – white variety and
3. Rakta – red variety. It is also called as Madhu shigru.

Black variety of drumstick tree is the most common. Its qualities are:

Katu – pungent,
Teekshna – piercing, sharp, strong
Ushna – hot in potency
Madhura – slightly sweetish
Laghu – light to digest
Deepana – improves digestion
Rochana – Improves taste,
Rooksha – dry
Kshara – Has alkaline properties
Tikta – Bitter
Vidaahakrit – causes burning sensation
Sangrahi – Useful to check diarrhoea
Shukrala – Improves semen quantity and sperm count
Hrudya – Good for heart. Cardiac tonic
Pittarakta prakopana: Increases Pitta and vitiates blood. Hence, drumstick should not be consumed during bleeding disorders, duriner menstruation and for people with pimples and Pitta related skin diseases.
Chakshushya – Improves vision, good for eyes.
Kaphavataghna – Decreases imbalanced Kapha and Vata
Vidradhi – Useful in abscess. It helps in quick wound healing of abscess, upon oral intake and external application as paste.
Shvayathu – It is a good anti inflammatory herb.
Krimi – useful in worm infestation in stomach and in wounds.
Meda – helpful to decrease fat and obesity.
Apachi – Useful in relieving carbuncles.
Visha – Anti toxic. Has detoxifying action.
Pleeha – Useful in spleen related diseases
Gulma – Useful in abdominal bloating and tumors
Ganda Vrana – Useful in lymphadenitis

White variety Moringa Properties: It is quite similar to the black variety.

Dahakrut – causes burning sensation
pleehaanaam vidradhim hanti – useful in splenic abscess
VraNaghna – helps in quick wound healing
Pittaraktakrut – Increases Pitta and vitiates blood.
 
The Red Variety, called as Madhushigru 
Deepana – Increases digestion power.
Sara – promotes proper bowel movements.

Moringa Leaves and Bark

The juice extract of drumstick leaves and bark are very useful in relieving pain. They act as natural analgesic. They are used both for oral intake and also for external application as paste.

In Indian household, the leaves are used to prepare Chutney and Sambar (a south-indian soup).

Moringa seeds uses: Moringa seeds are called as Shweta Maricha
Chakshushya – good for eyes
Vishanashana – anti toxic
Avrushya – do not have aphrodisiac qualities
Nasyena Shiro Artinut – When used for Nasya (in the form of powder or oil), it helps to relieve headache.
 

Moringa for Headaches:

Moringa leaves paste applied externally, or used as vegetable helps to relieve headache.
Its seed powder, in the form of nasya treatment cures headache.
 

Moringa for Diabetes: Many studies have been conducted to prove the anti-diabetic and anti-oxidant effect of Moringa.

Oil prepared with Moringa is useful to relieve headache, pungent, useful in skin diseases and diabetes.

Moringa flowers are useful in intestinal worms. It balances Pitta and kapha.

Moringa Side Effects:

As explained above, it causes increase in burning sensation and is pungent. Hence, people with gastritis or sensitive stomach should use this vegetable carefully.
It is not ideal to be taken during periods, since it increases Pitta and vitiates blood.
It is also not ideal to be taken during bleeding disorders.
 

Moringa during pregnancy and lactation:

Moringa fruit is rich in protein, vitamins, minerals and anti-oxidants. Hence it can be used during pregnancy. But Moringa leaves, root bark and flowers are not indicated during pregnancy.
 

Conclusion:

Thus we can see that this humble tree is loaded with wonderful qualities that can be used for healing by an Ayurvedic practitioner. Several scientific studies have documented its great properties of healing like anti-bacterial, anti-cancer, anti-inflammatory, anti-fungal etc. and has been used successfully for hundreds of years. 
 

Bibliography/References:

1. Moringa, Wikipedia. http://en.wikipedia.org/wiki/Moringa.
3. Trees for Life International, Moringa Tree. http://www.treesforlife.org/our-work/our-initiatives/Moringa.
4. Janick, Jules, Robert E. Paull, The Encyclopedia of Fruit & Nuts. (CABI, 2008): 509-510.
5. Food and Agriculture Organization of the United Nations, Barbara Stadlmayr, U Ruth Charrondiere, et. al, West African Food Composition Table,   http://www.fao.org/docrep/015/i2698b/i2698b00.pdf
6. Moringa Tree Foundation, Seeds of Hope, www.Moringatreefoundation.org 
7. Trees for Life International, Moringa Tree. http://www.treesforlife.org/our-work/our-initiatives/Moringa
8. Fuglie LJ, The Miracle Tree: Moringa oleifera: Natural Nutrition for the Tropics (Church World Service, Dakar 1999),   68.; revised in 2001 and published as The Miracle Tree: The Multiple Attributes of Moringa,  172
9. All Things Moringa, H. Hiawatha Bey, www.allthingsmoringa.com
10. Jed W. Fahey, S., “Moringa Oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1.” (Vols. Copyright: ©2005 Jed W. Fahey. Baltimore, Maryland: Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences, Lewis B. and Dorothy Cullman Cancer Chemoprotection Center, 725 N. Wolfe Street, 406 WBSB, Baltimore, Maryland, USA 21205-2185.]
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19. Karadi, R. V., Gadge, N. B., Alagawadi, K. R., & Savadi, R. V., “Effect of Moringa oleifera Lam. root-wood on ethylene glycol induced urolithiasis in rats.” J Enthnopharmacol, 105(1-2), (2006): 306-311. 
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The Skinny: Western and Ayurvedic Treatment Approach To Anorexia Nervosa. By: Leah Kaplan

   Anorexia Nervosa, the mental disorder in which individuals consciously starve themselves, remains one of the most complicated mental illnesses present today. From its first appearance in Medieval Europe to its current form, anorexia nervosa continues to baffle those who study it and destroy the lives of those stricken with it. It remains so elusive for a few reasons. One, there is no reliable source as to what causes the disease. Research shows some genetic link, and trauma seems to be involved somehow, but evidence remains loose as to how exactly those factors affect the development. The public is inclined to lay blame on the media and current ideals of female thinness, but if this were the cause the entire population would be struggling, as we are all exposed to those images and messages. Secondly, while the three medical criteria discussed in this paper, a body weight of 85% below the ideal, an intense fear of gaining weight, and amenorrhea, are consistent amongst anorexic patients, all other symptoms and signs are variable. Some patients will present with depression and apathy, while others will struggle with excessive exercise and OCD behaviors. One woman might show signs of developing osteoporosis, while another has no symptoms of this at all. As many individuals as contract anorexia, that is how many expressions of the disease there will be. This fact lends itself to Ayurveda, India’s ancient system of wellness, which views each individual as completely unique and in need of a unique healing recommendation to match. Finally, while anorexia is very much a mental disorder, the physical symptoms cannot be ignored or put on the back-burner while the mental body is attended to because of the dangerous nature of the disease. It is the most deadly amongst mental disorders and must be handled with a level of seriousness to match. For this reason, Western medical science, with its abundance of research, seems more trustworthy and capable of handling treatment. By examining what both Western medicine and Ayurveda have to offer, one can develop strategies across modalities to increase healing and well-being for these patients and form a more complete picture of all that is needed to take care of an anorexic patient. 

   Anorexia Nervosa (AN) is defined in the DSM-V, the American Psychiatric Association’s (APA) classification and diagnostic manual, as having three criteria:

  • 1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health; 2. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight; 3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.  

   As one can discern from this lengthy and somewhat objective criteria, anorexia nervosa is a complex and complicated disease, both to diagnose and to treat. This becomes even clearer when one considers that the origin of this disease is psychological in nature, but unlike other common psychological disorders, becomes visible primarily because of physical habits and changes. These physical changes then perpetuate the psychological changes. In their guide, Eating Disorders: Everything You Need to Know, Jim Kirkpatrick and Paul Caldwell sum up this vicious cycle, “the psychological and emotional changes initiate the physical ones, but then the physical changes reinforce the negative psychological changes.”  The complexity of this cannot be overstated. From a treatment perspective, the question then becomes which do you consider first? Whatever therapies are administered to heal physical ailments as a result of starvation must also concern themselves with their psychological effects on the anoretic. And although the disease needs to be eradicated at the level of the mind, the physical body needs to be re-fed in a most literal way, as soon as possible; according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), “20% of people suffering from anorexia nervosa will prematurely die from complications relating to their eating disorder,” making eating disorders the most fatal of any mental disorder.   But treatments that might prove extremely effective for the physical symptoms of anorexia nervosa (such as severe weight loss and amenorrhea) might be useless here due to non-compliance on the part of the anoretic. Physical treatments cannot wait for the slower, more gradual process of psychological rehabilitation, which can take years, however: the re-feeding process must occur simultaneously to the psychological treatment for both bodily and mental health. As this paper proceeds to examine the Western and Ayurvedic treatments for the three medical criteria necessary for a diagnosis, this point of view will be considered for all possible therapies. 

   Classical Ayurveda does not mention anorexia nervosa, as we understand it today, as a disease condition. The origins of anorexia nervosa can be traced back to religious fasting in Medieval Europe and the reported starvation of female saints, the most famous being Catherine of Siena (1347-1380), who “claimed to be incapable of eating normal earthly fare.”  And the first medical reports of anorexia nervosa did not appear until 1689 in Thomas Morton’s “Wasting Disease of Nervous Origins.”  Considering that the Classical Ayurvedic texts were written between 500 and 1500 BC,  it becomes obvious why it was never mentioned: it probably did not exist. Anorexia nervosa seems to appear only after food becomes abundant and eating becomes less about survival and more about a social obligation or sensory pleasure. As Joan Jacobs Brumberg, the author of Fasting Girls: A History of Anorexia Nervosa comments in a New York Times article entitled “Anorexia: It’s Not a New Disease,”  “Anorexia nervosa emerges in cultures that are food-abundant…You don’t have anorexia nervosa in the third world: what you don’t eat, someone else will.”  While the specific disease anorexia nervosa is not mentioned in the Classical Ayurvedic texts, anorexia nervosa would be classified as manasika arocaka or “loss of appetite due to factors of the mind”  and for management of anorexia due to psychic origin, the Cakradatta recommends that “the patient is managed with pleasing and agreeable items.”  It is important to note the significant difference between anorexia, meaning loss of appetite, and anorexia nervosa, the disease described above. While this paper will address loss of appetite as it appears as a symptom in advanced stages of anorexia nervosa, it is a deep misunderstanding to think that the anoretic has lost her appetite or does not desire to eat. “Individuals with anorexia nervosa may eventually develop a true lack of appetite, but for the most part it is not a loss of appetite but rather a strong desire to control it that is a cardinal feature. Rather than lose their desire to eat, anorexics, while suffering from the disorder, deny their bodies even when driven by hunger pangs…”  writes Carolyn Costin in her reference manual, The Eating Disorder Sourcebook. Thus, loss of appetite will be considered as a late-stage symptom and not a causative factor. 

   In fact, the etiology of anorexia nervosa is still very much debated. It is beyond the scope of this paper to thoroughly investigate this topic, but trauma, genetics, a perfectionistic, self-critical personality, the influence of the media, and participation in competitive activities that have an ideal weight have all been found to be contributing factors.  Due to the size and scope of this paper, descriptions and treatments will focus only on post-menarche females, who account for 85-95% of all cases.  This is not to suggest that anorexia nervosa does not also affect males and older women. Additionally, there are as many symptoms and expressions of AN as there are patients. While this paper will only focus on three of them, it is worth noting that other symptoms will be present and can frequently include: dry skin and hair, the development of lanugo (fine hairs on the body to conserve heat), insomnia, fluid retention, decreased ability to concentrate, dullness in the mind, depression, social withdrawal, and apathy.   

   The first medical criteria required for a diagnosis of AN, as determined by the APA, is a “refusal to maintain body weight at or above a minimally normal weight for age and height…leading to body weight less than 85% of that expected.”  It is reasonable to say that all other symptoms are a cascade that originate from this one source. The refusal to maintain body weight is not due to lack of hunger, as previously noted, “but, rather, due to strict denial of that most basic of body instincts: hunger.”  So, while symptomatic relief is available and will be discussed for other medical complications, to treat the physical root of anorexia nervosa is to begin a process known as re-feeding. Re-feeding can happen either through working with a nutritionist and team of doctors while the patient lives at home or at an in-patient clinic, either at a private institution or in the psychiatric wing of a hospital. Throughout this process, Western treatment places primary importance on the calorie level and number of exchanges (measures of carbohydrate, fat, and protein content) present in the patient’s diet. A 2013 study conducted by the University of California, San Francisco, examined caloric intakes for adolescent anoretics: “Current recommendations for re-feeding in anorexia nervosa (AN) are conservative, beginning around 1,200 calories to avoid re-feeding syndrome.”  Re-feeding syndrome is “the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally).”  So one can see that there is a standardized caloric starting point for all anorexic patients. As Erin Naimi, R.D., eating disorders specialist and nutrition therapist commented in an interview for this paper, “things are pretty non-individualized in terms of how much [food]” is given to anorexic patients in treatment. This recent study completed by UCSF concluded that higher calorie diets with phosphate supplementation actually reduced hospital stays and resulted in faster weight gain with no incidents of refeeding syndrome.  This is very much against the current model of refeeding at Western treatment centers, who use “the strategy called ‘start low, advance slow.’”  Calorie increases from the baseline are dependent upon how quickly the anoretic gains weight. In a hospital setting, “there is a baseline meal plan which is the same…someone who needs to gain more weight would increase to a more rigorous meal plan,” says Ms. Naimi. But while immediately beginning with a higher calorie level might have physical benefits, like faster weight gain, there are psychological factors to consider; in the New York Times article, “Protocol to Treat Anorexia Is Faulted,” a patient who underwent rapid weight gain during her first hospital stay was so traumatized by it that she immediately lost all the weight as soon as she got out. When she was re-hospitalized two years later, she stayed for a longer period with slower weight gain and no such ramifications in the future.  Complicating matters further, anorexics will frequently experience hypermetabolism during the refeeding process. A 2012 study found consistent “evidence of a hypermetabolic state in patients with AN during refeeding which cannot be attributed to increased body mass alone…This is a phenomenon which appears to be unique to AN patients.”  This phenomenon requires caloric levels to increase rapidly and dramatically if the patient is to keep gaining weight. Increase levels too fast, however, and patients may experience “digestive disorders like constipation, diarrhea, and reflux disease. They may vomit involuntarily because the stomach and digestive capacity is diminished.”  The refeeding process shows exactly why treating AN remains a delicate matter; quantity of food must be balanced with rate of weight gain and digestive capability in equal measure, with the focus also being shared by the mental health of the patient. 

   Food choices in an inpatient program will vary from program to program, Ms. Naimi, the eating disorders specialist in Los Angeles, reports, but generally are not seen as important as caloric levels. In a strict hospital setting, the food provided for eating disorder patients is of the same quality as the food provided for all the other patients in the hospital. This usually means conventionally grown, highly processed, low quality ingredients. Foods are simple, bland, and dense, with the emphasis on the quantity of calories and number of exchanges rather than the specific foods used to deliver those measures. The strictest eating disorder programs will not even make accommodations for food allergies or vegetarianism. Other privately-run programs offer patients “up to three likes or dislikes, but draw the line around veganism, generally,” says Ms. Naimi. The ability to select foods from a menu is sometimes given as a privilege after the patient has gained a certain amount of weight and can be trusted to make her own meal choices. Upon arrival to an in-patient program, the anoretic does not possess the mental capacity to choose foods that are healthful for her and even more than that, cannot be trusted to make food choices that are not the direct result of the disease. This is the thinking behind stripping away any and all “preferences,” which might just be a thin veil for her disorder to control her food choices.  More than anything, the lack of information available on this specific subtopic speaks volumes as to how little attention is paid to food choices for the recovering anoretic. 

   In terms of food habits, the recovering anoretic’s entire day is structured around mealtimes and snack times. Interestingly, routine is of primary importance; breakfast, lunch and dinner are served at the same time everyday in in-patient programs. In Ms. Naimi’s experience, meals are timed so that patients finish their meals in a “normal” amount of time, with consequences if they are unable to do so. This usually means 30 minutes for each meal and 15 minutes for each snack. Ms. Naimi has never encountered a program that incorporates spiritual practices such as prayer into their mealtime routines, especially at larger, hospital in-patient centers. She says that smaller, private institutions will offer more spiritual practices, but not necessarily around mealtimes. The patients will always be monitored during meals and snacks, either by a nursing staff or by their own private therapists. These practices vary from program to program. The idea is two-fold: one, anoretics, especially at the beginning, are essentially at the mercy of their disease and will try anything to not eat, so monitoring prevents them from getting out of eating; and two, especially with a therapist, the mealtime becomes a sort of therapy session, where the doctor can see the patient interact with her meal and help her deal with the thoughts and behaviors surrounding it as they arise. Following mealtime, patients will typically have some form of therapy to help them process anything that came up during the meal or quiet time to relax, journal and practice stillness after eating.  

   From an Ayurvedic perspective, as explained in the Astanga Hrdayam, “consuming of insufficient quantity of food does not help improvement of strength, growth, and vigour, it becomes a cause for all diseases of vata origin.”  Thus, the first symptom of AN, weight loss resulting in a body weight of 85% of the ideal, is an invitation for vata vitiation, and treatment would therefore be centered around vata pacification: 

  • The treatment of (increased) vata are – oleation (internal and external), sudation (diaphoresis), mild purifactory therapies (emesis and purgation), ingestion of foods which are of sweet, sour, and salt taste; warm-oil bath massage of the body, wrapping the body with cloth, threatning (frightening), bath (pouring of medicinal decoctions, water, etc on the body), wine prepared from cornflour and jaggery (molasses), enema therapy with fat (oil), and drugs of hot potency, adherence to regimen of enema therapy, comfortable activities, medicated fats of different kinds (sources) prepared with drugs causing increase of hunger and improving digestion; especially anuvasana basti (oleation enema) prepared from the juice of fatty meat and oil.

   We have concluded that weight loss due to insufficient food qualifies as a vata imbalance and as noted above, the Astanga Hrdayama indicates the sweet, sour, and salty tastes as best for pacifying vata. So, a diet rich in these three tastes should be best for the recovering anoretic. Other qualities known to pacify vata are heavy, moist, oily, and warm foods. Refeeding according to Ayurveda follows samsarjana karma and recommends that the anoretic begins eating “the heaviest food that is well digested.”   In stark contrast to the non-individualized Western treatment approach, Ayurveda begins by tailoring the amount of food taken in to the specific digestive ability of the patient. If the patient is found to have deficient digestion, the Cakradatta recommends taking “hot rice-scum mixed with hingu and sauvarcala. By this the irregular fire becomes regular and the mild one is intensified. The rice-scum has eight properties – it increases appetite, cleans urinary bladder, gives energy, promotes blood, alleviates fever and pacifies kapha, pitta, and vata.”  Other foods like rice water, thin rice gruel, and rice porridge are also recommended as starting points to assess digestion by. Ghee and oils are added in small amounts to the food, beginning when the patient can properly digest rice, and then increased as digestion can tolerate.  Warming dipanas and appetite increasers, like Ginger, Pippali, Amalaki, and Chitrak should be taken with all meals, as well.  Ginger is especially recommended for low agni in the Cakradatta, “(In case of mildness of fire) taking pieces of fresh ginger with salt in the beginning of the meal is always wholsome [sic]. It stimulates digestive fire, cleanses tongue and throat and is pleasant.” In addition to dipanas, herbs can be used to help increase weight and improve appetite, while improving the psychiatric condition of the patient. Dr. A. A. Mundewadi, Chief Ayurvedic Physician at Mundewadi Ayurvedic Clinic in Maharashtra, India, recommends Ashwagandha, Shatavari, Samudrashosh, Jayphal, and Khurasani Ova for this purpose.  In addition, he, along with other sources, recommends the jam Chyawanprash to help with weight gain. No references to specific caloric levels can be found in modern Ayurvedic treatment plans for AN, an indication that the health of the digestion and pacification of vata are to be given more attention than the caloric level. While the goal of treatment is the same (weight gain), Ayurveda seems to prioritize healthy digestion above the speed with which weight is put on.

   Following principles of Ayurveda, more important than even the choice of foods that the anoretic is eating would be the way in which they are prepared and the way in which she is eating them. In the context of AN, these food habits become even more critical to counteract the anxiety that peaks with mealtimes. According to the Charaka Samhita, “food should be taken mindfully…food should not be taken when afflicted with grief, anxiety, confusion, fear, anger, passion or greed…Food should be taken under conducive and pleasant environment. The individual should be relaxed and happy.”  Ayurvedic treatment would extend off the plate and into the very room in which meals are being held, encouraging the use of all five senses to make eating a more pleasant experience. Aromatherapy may be administered before a meal, to stimulate digestion, during a meal to calm anxiety, and after a meal to promote relaxation in the mind and reduce digestive upset. Ginger, Mandarin, and Lavender, respectively, are all indicated. Color therapy on the walls of the dining-room or as a light source can also be recruited to aid the healing process. Sattvic colors like gold, green, and blue are all indicated. In addition to these recommendations, “food should be taken when hunger is felt and not delayed or taken in a hurry or very slow.”  While hunger cues are guaranteed to be distrusted at the beginning, meals can certainly not be taken in a hurry or very slowly. This seems particularly applicable to anoretics who will want to rush mealtimes to get them over with or draw them out to avoid eating. Taking an appropriate amount of time encourages mindfulness and connection of the mind to the body. 

   In addition to maintaining a body weight that is less than 85% of the ideal, a patient must display an “intense fear of gaining weight or becoming fat…and a disturbance in the way one’s body weight or shape are experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.”  This symptom moves the disease from the physical body into the deeper layers of the mental and emotional bodies, what would be considered the manomaya kosha and vijnanamaya kosha in Ayurveda. Western treatment for this fear, anxiety, and misperception incorporates psychotherapy and, to a lesser extent, medications. The use of medications is solely focused on symptomatic relief of psychological symptoms, such as anxiety, and not on the root cause of the disease. As reported by the Mayo Clinic, “there are no medications specifically designed to treat anorexia because they haven’t been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental disorders you may also have, such as depression or anxiety.”  The most common medications used to treat mental symptoms stemming from AN are anti-depressants, specifically Selective Serotonin Reuptake Inhibitors and anti-anxiety medications, like benzodiazepines. Research shows that the time of administration significantly alters the effectiveness of SSRI’s. Fluoxetine (Prozac), an SSRI, for example, has been shown to prevent relapse in anoretics, but only when given after weight restoration.  Benzodiazepines, on the other hand, are best administered “when therapeutic efforts are made to counteract the pursuit of thinness and ritualistic behaviours [sic] around eating,”  it was reported in a study published in The Journal of Psychiatry and Neuroscience. Further, from the same study, “despite their merits in the acute treatment of anorexia nervosa, benzodiazepines are used sparingly in clinical settings. This may be because psychotherapy, accompanied by nutritional and behavioural approaches to healthy eating and weight gain, is considered the most promising treatment.” We can conclude, therefore, that while appropriately administered drugs can be helpful in reducing relapse, the initial healing is not accomplished through pharmaceuticals. Nutritional and behavioral approaches are administered in the form of therapy, both personal and group, and through nutrition therapy and education. As far as therapeutic approaches go, cognitive behavioral therapy has been found to be most effective, generally, and even more effective than nutrition counseling. A 2003 study published in The American Journal of Psychiatry found that “cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse.”  This can be attributed to the fact that it is not lack of knowledge about nutrition that is causing the anoretic to starve (on the contrary, eating disorder patients frequently display an encyclopedic knowledge of caloric contents and dietary facts), but the mental disturbances caused by the disease. 

   Fear and anxiety like the kind displayed by anoretics would, from an Ayurvedic perspective, fall squarely under the category of vata vitiation. Specifically, prana, vyana, and samana vayu would all be vitiated in the manovaha srota. To treat this vitiation in the mind, Ayurveda provides a great variety of body therapies, lifestyle practices and herbs. As cited earlier in the Astanga Hrdayam, both external and internal oleation are strongly indicated to pacify vata in the body, as well as in the mind. In his text, Ayurvedic Healing, Dr. David Frawley recommends sesame oil massage for anorexia, with emphasis on the head and feet of the patient, as well as the administration of sandalwood oil to the head.  Even though he is referring to anorexia meaning loss of appetite, the remedies are applicable, as they are designed to pacify vata. This external oleation will pacify vyana vayu as well as slow the rate of absorption of prana vayu, decreasing the speed at which thought flows through the mind and thus calming anxiety. In addition to this therapy, shirodhara, known for its effectiveness in reducing anxiety, insomnia, and nervousness would be of huge benefit to the anoretic, too. This external oleation would be best complemented by internal oleation as well, however, this brings up some of the complexities that are inherent in this most complicated disease. Firstly, agni in the advanced stage will be low, perhaps too low to digest oils without creating ama (as explored previously in this paper). Secondly, the anoretic is almost guaranteed to strongly resist taking in pure oil, which she sees as pure fat, to the point that it creates more anxiety than it is worth. Anuvasana basti, as previously recommended in the Astanga Hrdayama, would be an excellent way to apply oil internally in order to pacify vata at its root, the colon. And because it would not need to be ingested through the mouth, this internal oil application might be easier for the anoretic to swallow, as well as being of excellent benefit. Additionally, lifestyle practices that would be recommended include yoga, meditation, and time in nature. Yoga is of particular importance for several reasons. As Patricia Walden, yoga teacher, writes in the book The Woman’s Book of Yoga and Health, “besides offering emotional and spiritual support, yoga provides physiological help to reverse or minimize the long-lasting effects of starving.”  Physically, yoga postures can balance the endocrine system and blood pressure, calm the adrenal glands, and even jumpstart menstruation.  Almost more importantly, though, yoga can arrest the sympathetic nervous system response, a fight-or-flight mechanism that will frequently kick in for an anoretic during and right after mealtimes, when anxiety is highest. Gentle, slow, flowing sequences that are designed to pacify vata by including lots of poses that encourage compression of the solar plexus will have the additional benefit of providing a new habit that, hopefully, in time, will replace the old starvation patterns. A 2010 study completed by the Department of Adolescent Medicine at Seattle Children’s Hospital shows very promising results; the authors of the study concluded that individualized yoga sessions decreased Eating Disorder Examination scores after 12 weeks of practice and also significantly reduced food preoccupation immediately after the practice.  Finally, herbal remedies are available to treat anxiety; nervine sedatives will calm vata in the mind, while nervine tonics will build the strength of the nervous system. Dr. A. A. Mundewadi recommends “Jatamansi, Shankpushpi, Vacha, Kushmand, Brahmi, and Sarpagandgha [to treat the psychological component of anorexia nervosa].”  

   The final symptom that will be examined in this paper is amenorrhea. This criteria was recently removed from the DSM-V, the most recent version of the APA’s manual, but because of the large number of anoretics who experience amenorrhea and because of the seriousness of such a symptom, I have chosen to include it in this report. Amenorrhea is defined by the Mayo Clinic as “the absence of menstruation – one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea.”  “From a traditional Western medical perspective, the loss of menses due to AN is viewed as a result of low hormone levels, specifically a lack of luteinizing hormone and follicular-stimulating hormone precipitated by inadequate body fat or low weight which causes corticotropin-releasing hormone to be suppressed.  But, recent studies, like the one from the Department of Pediatrics at the Schneider Children’s Hospital at the Long Island Jewish Medical Center are finding that “resumption of menses require[s] restoration of hypothalamic-pituitary-ovarian function, which [does] not depend on the amount of body fat.”  And a 2006 study by the University Tor Vergata in Rome, Italy, found that “an adequate body composition and a well represented fat mass are certainly a necessary but not sufficient condition for the return of the menstrual cycle.”  Very few studies have been conducted around treating the hypothalamic disturbance that seems to be at the root of the persistent amenorrhea. A 1976 study entitled “Amenorrhea in Anorexia Nervosa: Assessment and Treatment with Clomiphene Citrate” concludes that in patients who were still amenorrhoeic following the finding of normal LH levels, “that they have a persistent hypothalamic disorder whereby the normal midcycle peak of LH secretion does not occur. A hypothalamic disturbance has long been postulated as the cause of pituitary hypofunction in anorexia nervosa, but definite evidence has been lacking.”  Due to this lack of research, Western medical treatment focuses on hormone replacement as the answer to amenorrhea, if menses has not resumed following adequate weight gain. It is recommended that patients who present with amenorrhea be placed on oral contraceptives for the health of their bones, which are already under duress from malnutrition. Osteoporosis is one of the major health concerns facing anoretics because bone density loss is believed to be irreversible and amenorrhea is seen as a major causative factor in osteoporosis. Thus it is of primary importance to replace the hormones artificially to protect the health of the bones. The common treatment plan is to keep the patient on oral contraceptives until weight is restored and then observe if menses returns. If it does not, then the patient would be placed back on oral contraceptives. As the lack of research in this area shows, the priority for AN patients is to get hormones back into the body as quickly as possible to protect the stability of the bones; amenorrhea is really only viewed as an issue if the woman wants to get pregnant, at which time they will provide medications to stimulate ovulation. 

   Following in line with all the other symptoms before it, from an Ayurvedic perspective, secondary amenorrhea of this sort is considered a vitiation of vata in the rasa and shukra dhatus of the artavavaha srota. The shukra dhatu is the deepest dhatu of the body, so nutrition must be digested first by all six other dhatus before it can reach and nourish the shukra dhatu. Thus the treatment of amenorrhea begins with the treatment of dhatu agnis and regulation of the digestive system of a patient. Ayurveda understands that even if adequate nutrition is being taken in, the tissue being produced could be of low quality if there is disturbance in the dhatu agnis. The Cakradatta suggests a “suppository made of iksvaku (seeds), danti, pippali, jaggery, madana, yeast, madhuyasti and snuhi latex and kept in vagina” to induce menstruation.   If not this, then another alternative remedy is suggested, “Japa flower mixed with sour gruel or jyotismati leaves, both fried, and rice-cake of durva – woman taking any of these gains menstruation.”  As Dr. Frawley notes for treatment of amenorrhea, “an anti-vata or tonifying diet is primarily indicated using dairy, nuts, oils, whole grains and other nourishing foods.”  This is right in line with the diet discussed previously to restore the weight of the anoretic. Dipana herbs to regulate any digestive disturbances would also be indicated here. Herbs may also be used to promote menstruation, if necessary. Reproductive tonics like Shatavari, Ashwagandha, Vidari Kand, and Wild Yam are all indicated. Chyawanprash, as mentioned before, would be an excellent herbal supplement for amenorrhea. Ayurveda also recognizes the role that stress plays in amenorrhea. “Excessive motion such as a fast-paced lifestyle filled with travel, stress and overwhelm is a key contributing factor [to amenorrhea],” as is excessive exercise.  Other vata-pacifying therapies like abhyangha, shirodhara, and appropriate yoga (as previously discussed) would also come into play as treatments for stress-related amenorrhea. Restorative yoga as well as Yoga Nidra would be the preferred types of yoga. Even sleeping during the day should be considered as a remedy, as suggested in the Cakradatta, “sleeping during the day is recommended in the following conditions – those who are exhausted by exercise…patients suffering from diarrhea [sic], abdominal pain, dyspnea, thirst, hiccough, and vatika disorders; those who are emaciated…”  The other aspect of amenorrhea that cannot be denied is in the mind of the patient. If the eating disorder serves the function of keeping maturation and adulthood at bay, then the patient will actually desire to lose her menses. This must be dealt with on a psychological and spiritual level through therapy and self-study.

   In summary, I believe that neither Western nor Ayurvedic remedies provide the entire answer to this mysterious and dangerous illness. Rather, it seems that a treatment plan which encompasses the best of Western science along with the holistic, individualized healing therapies of Ayurveda would provide the most well-rounded and complete approach with the best possible chances of achieving recovery. Due to the severity of advanced cases of anorexia, it would be irresponsible to depend purely on Ayurveda as a healing modality; there is much more evidenced-based research around a Western refeeding model to support its use in providing nutrition to malnourished individuals safely. But for healing not just the body, but also the mind and the spirit, Ayurveda can absolutely supplement Western prescriptions. Since medications have been found so ineffective in treating AN, perhaps both providers and patients will feel more open to alternatives like herbal treatments and body therapies. And as the trend towards more conscious eating keep moving forward, one can only hope that eating disorder programs will pay more attention to not just how much, but what they are feeding their patients. Ayurveda, I believe, can be especially helpful in the treatment of amenorrhea, since the condition seems to still baffle Western medicine and appears to have so much to do with lifestyle and stress reduction. Imagine a hospital program that offered regular yoga instruction, had a meditation space, offered abhyanga and shirodhara, and encouraged reverence, rather than rigidity, around mealtimes: such a place would encourage not only the healing of bodily tissues, but the mending of the very soul itself, which can be just as starved for attention as the body it inhabits. Ms. Naimi has already seen a trend towards bringing in spiritual practices in smaller, private residential treatment centers and in private practices, so maybe the larger inpatient centers will follow suit. This would require a rethinking of the anoretic as an individual with a disease, rather than as a disease that has taken over an individual. And that can only result in deeper levels of healing and understanding of this still elusive and devastating disorder.

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The Use of Sound in Healing—An Ayurvedic and Western Perspective By Parthena Rodriguez

Abstract 

It has long been noted that particular sounds have a direct effect on the body’s ability to heal from various disharmonious states or dis-ease.  From imbalances associated with anxiety to nerve disorders and cancer, recent advances in western medicine show how sound affects us on the cellular level and can have broad, physiological healing results.  Modalities shown to have beneficial effects include listening to music, toning, humming, chanting and giving one’s attention to the sounds of various instruments.

This paper compares recent advances in western medicine’s ability to analyze what the ancient rishis knew long ago:  that we are part of a common vibratory experience which begins with what has been known as The Word (Om) and that unhealthy or negative patterns in the body could be eliminated and health restored or helped by repeating mantra, listening to music or patterned sound, and/or becoming attuned to various rhythms or harmonies, external as well as internal.  Though this knowledge is inherent and was passed down through the millennia, recent examples of specific healing effects from sound therapies are studied and documented by scientists, doctors, physicists, musicians, and modern day yogis. 

As western attitudes broaden, eastern teachings are being integrated and are seen as complementary, leading to a convergence of the ancient and the modern methods of healing, mind, and spirit.

The Use of Sound in Healing—An Ayurvedic and Western Perspective By Parthena Rodriguez

“In the beginning was the Word and the Word was with God,” is stated in St. John’s Gospel. Johannes Kepler, the great German mathematician and astrologer writes in his Music of the Spheres,   “The earth hums a tune,” and the ancient rishis uttered secret syllables before administering life saving treatments and medicine.    Edgar Cayce, the great modern day mystic called sound ‘The Medicine of the Future’ and the benefits of ultrasound in modern medicine are duly noted for a number of things, including the use in healing muscles that are affected by pain.  

Actually, the word heal, in old English, means “to return to a sound state”’   

to “make whole, sound and well. “ 

The Sanskrit word svanah, meaning sound or tone, generally refers to a type of synchronization.   

There is no doubt that human beings along with all sentient beings are a part of  a vibratory experience which began with creation, ever permeating prakruti and that sound, being  of that experience,  plays a vital role in our emotional, physical, mental,  and spiritual existence and  well being.   Assuming that the reader understands that sounds or vibratory patterns have an effect, this paper will delve into some of the physics of what sound is, cite examples of Western studies and Ayurvedic views as related to sound used in healing, and explore the Om sound and its vibratory significance on humankind’s fit in this universe.

Sound   

All sounds are waves and are produced by the vibrations of material objects.      These vibrations are transmitted through air or other mediums such as solid, liquid, gas or plasma.   When vibrations reach the ear they are converted to electrical impulses in the brain, which we interpret as sound.  However, lower frequency vibrations can also be felt by the body.   Sound also has a speed at which it travels and is dependent on subtle atmospheric changes like temperature and humidity.    

Because sound travels in waves, it can move over very large distances.   However, the linear concept of how sound travels can go quite beyond that sounds are simply waves.   Paul in his book, The Yoga of Sound states that “sound is infused with intelligence—an organizing principle that shapes the forms we perceive [even] through our eyes. “    That organizing principle has been shown to affect everything down to our DNA, permeating every cell within our bodies.  In other words, sound effects form, as it was proposed that sound came first, before form.  This connection of sound to form was summed up when Plato said that ‘a stone is frozen music’.   

It is interesting to note that sound waves bend and take little energy to produce.  The conceptual physicist Paul Hewitt states that “10,000,000 people talking at the same time would produce sound energy equal only to the energy of an ordinary incandescent lamp. “  Yet our sense of hearing is subtle and we are only able to hear because of our ears’ remarkable sensitivity.     Medical science has even proven that our ears are “the first organ to develop in the fetus and the last organ to stop function during the process of death.”     

Sound has loudness which depends on the amplitude of the wave.   We gauge loudness in decibels which measure common noise levels found in our environment and are registered by the human ear beginning at about 10 decibels with painful sounds beginning at about 125 db.  The frequency of sound is measured in Hz, or cycles per second.  Humans can hear from around 20 Hz to 20,000 Hz.     However, it has also been suggested that “music or audible sounds could modulate physiological and pathophysiological processes” and that “cell types other than auditory hair cells could respond to audible sound [as] vibrotactile sensations… in the chest and throat.”  

Sounds, simply, have waves, patterns, and frequencies; yet, affect us in ways that are both subtle and remarkable.

Pitch and quality are also ways to describe frequency and sound characteristics.  For example, low pitch notes have a lower frequency of vibration than high notes--the higher the pitch, the faster the vibration and the lower the pitch, the slower.   A musically pure note is one frequency, though most sounds that we experience have many different frequencies combined. 

Resonance is an important factor when examining sound and its quality because “when the frequency of forced vibrations on a body matches the body’s natural frequency, a dramatic increase in amplitude occurs.”    This brings in the idea of a principle called prime resonance.  This means that our organs and systems have their own innate frequencies.  These frequencies determine how the cells and systems absorb sound or to what extent they can be re-harmonized by various outside healing frequencies.  And we know that our cells, organs, and systems are susceptible to a variety of environmental and emotional traumas which can de-harmonize them and vice versa.  For example, long term exposure to noise can contribute to the dis-harmony of the cells and systems in our bodies.    Studies conclude that each organ as well as each cell vibrates its own frequency since cells emit sounds as a part of their metabolic processes as they interact with the frequencies in their environment.    

Rhythm

We know that before birth, the fetus is not only encompassed in the mother’s rhythms, but is also able to hear noises outside of the womb as early as four months.      Caraka notes that around the third or fourth months, the fetus begins to manifest consciousness.  This is when ether or akasha, the most subtle of the five elements, becomes evident.  Ether, according to Ayurveda, is responsible or associated with the sound of hearing.   And from birth on, we are surrounded by rhythms and sounds that make up the vibratory experience of pattern all around us.  These rhythms are noted in our immediate environment—in the seasons and in the passing of different times of day, the cycles of the moon and our patterned breathing.  Even the rhythmic beats of our hearts are mirrored in great poetry and in Shakespearean plays in the form of iambic pentameter.      This makes us an obvious reflection of these patterned rhythmic experiences of which even our “Milky Way Galaxy turns like a Ferris wheel” every 10 million years.    Nothing in the universe escapes movement and rhythmic patterns.   So sound has to be a part of a rhythmic structure that affects the cadence of our experience.  The more we are in tune with waves of varying worth may determine the quality of our bodily existence in the greater scheme of life’s rhythms.  

Western studies and stories on the effects of sound on healing

Not surprisingly, there have been numerous studies on the effects of sound on health.

In Masaru Emoto’s book on water crystal healing, he is able to show how organized sound in the form of music affects the formation of patterns in water crystals which are frozen in Petri dishes under a light microscope.  Through photographs, he demonstrates how water takes on expressions of sound.   He also likens our body’s systems to a symphony that is healthy when it is harmoniously vibrating.  As with all energy, sound moves in waves outwards, though they may affect patterns beyond ‘normal’ perception. 

Emoto reveals how one vibration influences another as in prime resonance.  First, he shows that diseases have a measurable wave or vibration.  That vibration is something termed hado and is measured using a device called a Magnetic Resonance Analyzer.  The MRA measures the characteristic of the wave produced by the vibration inherent in the diseased organ.    He then shows how music formulates patterned crystals when exposed to various classical musical pieces.  Dr. Emoto claims that upon drinking the water that was exposed to healing music prescriptive to that patient and his disease that healing and balancing is able to take effect, correcting the energy disturbance.    

From analysis of each piece of music’s hado, he is able to suggest that by listening to various melodic pieces, one can be relieved from a variety of imbalances which include irritability, suppression of emotions, relationship problems, stuck thought patterns, self- pity, hopelessness, deep sorrow, stubbornness, and depression. 

In The Mozart Effect, Campbell, a classically trained musician, begins by telling how he healed himself from a potentially deadly blood clot in the brain through internal visualization and by humming a sound which he felt helped his cells resonate a healthy pattern throughout his system.  

In humming a tone, I sensed the power of a sound that had warmth, brightness, and clarity.  I envisioned the sound as a vibrating hand coming into my skull on the right side, simply holding the energy within.  I imagined a vowel sound coming into my left hand, traveling through my heart and body, up to my right hand, and then back into my head, heart, and down through my feet.  Each tone made a circuit through my body.   

Undergoing a series of medical tests three weeks later, the results showed that the clot had decreased from more than an inch to less than an eighth of an inch, astounding the doctor who pronounced him out of mortal danger.   

Most people would agree that ‘music masks unpleasant sounds and feelings’, but music, patterned sound, is also demonstrated to slow down and equalize brain waves.    Campbell reminds us that varying states of consciousness are associated with different types of waves such as beta, delta, and theta and it has been proven that the slower the brain waves, the more relaxed and peaceful we feel.

Respiration, heartbeat, pulse rate, as well as blood pressure have all been proven to be affected by various types of music.   Campbell cites a study by researchers at Temple University who found that when our heart rates are increased, our resistance to disease is decreased.  They also found that rock music increased the heart rate more than other types of music and that some forms of rock music were responsible for reducing skin resistance to stimuli.   

Campbell, inspired by his own healing with the help of sound, was able to show how attributes of various types of music resulted in specifically desired effects.  As with prime resonance, how the listener responded to various patterned sound or music was important, so the healing effects varied “according to the composition, the performer, the listener, the posture assumed in listening, and other factors.”      

It is interesting to note how various musical genres have a range of effects on most listeners, again this is due to individual perception and experience.   For example, chants were noted to create a sense of relaxed spaciousness, classical music with improved concentration and memory, jazz can elicit feelings that inspire and uplift, and salsa may simultaneously soothe and awaken the senses.  Even heavy metal, “with its dynamic and disturbing consequence of exciting the nervous system, can help modern day adolescents release their inner rage and turmoil.”   

In Empower for Your Health magazine, Dr. Mark Harrell, an endocrinologist, after explaining how our biology demands rhythm, discusses how music therapy can help stroke victims and patients with Parkinson’s disease.  

Scientists believe that music triggers undamaged networks of nerve cells that allow translation of the beat into organized body movement.  Dr. Concetta Tomaino, co-founder of the New York City Institute for Music and Neurologic Function, notes that ‘someone who is frozen (from Parkinson’s or stroke) can immediately release and begin walking.  They can co-ordinate their steps to synchronize with the music.’ 

Music affects health as it influences digestion, endurance, productivity, and feelings of romance.   Used along with other healing modalities, mainstream or otherwise, certain types of music are seen as helpful and prescriptive sources.  

In one single-blind controlled scientific study, patients who had experienced cerebral artery strokes were shown as benefiting simply from listening to music for two months. 

Fifty-four patients completed the study.  Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused moods than the control group. 

Those findings also demonstrate “that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood.”  

Using just sound waves themselves have been shown to have an effect on the human body.  An example is proven in yet another single-blind study done in Finland several years ago involving forty-nine volunteers in two senior citizen centers.  The effect of low-frequency sound wave therapy was shown to have a positive effect on blood pressure, mobility, as well as bone density on frail elderly subjects.   

In one researcher’s postlude, there are numerous examples given of people who have helped to heal or soothe themselves from varying degrees of dis-harmony.   For example humming helped minor abrasions, listening to Mozart helped to relieve acute pain, enjoying grounding music with strong beats helped folks with anxiety, and the harp helped to relieve back pain.  Music may be one of the keys to “transcending the pains of the moment…from Zen monasteries to intensive care units, accounts abound of [those] who experienced the remission of a disease or disorder as the result of some sound or melody.”     

Toning and humming

The book Toning: The Creative Power of the Voice, Laurel Elizabeth Keys articulates stories about people who were healed with toning or relaxing into their voices.  “Toning can release psychological stress before surgery, lower the blood pressure and respiratory rate of cardiac patients, and reduce tension in those undergoing MRIs and CAT scans.”   Sounds seem to trigger endorphin release, thus masking pain which may help the body to heal more effectively.    

In Campbell’s book he, as a listening therapist, was able to detect through a patient’s voice, long dormant emotions.  A forty-seven year old woman had a cyst on the right side of her right breast and Campbell heard a break in her voice when he stood on her right side.  After she was able to express a long held repressed memory, she was then able to release the memory through humming.    The woman’s cyst had completely disappeared within three months.   

Campbell also noted that humming was more helpful than singing in helping schizophrenia patients positively modify their behavior. 

Some people, with guidance, are able to find their own sound or resonance in order to help release unresolved emotions and pain.  

There is also evidence that toning and humming helped to alleviate various ailments including headaches and menopausal hot flashes.  

In essence, every person is seen to have a tune, a song, a hum, a string of syllables or rhythmic sounds that “resonates with his or her essence” creating “harmonious thoughts and feelings.”    

Jack Kornfield in his book, A Path with Heart, reminds us of the story of Siddhartha, finding his song as he sits alone by the river, taking everything in as Himself.  During deep contemplation is where “we [can] experience more deeply both the beauty and the sorrow of life [listening] deeply, the great song moves through each of our lives.”    

Tibetan singing bowls

Dr. Mitchell L. Gaynor in his book Sounds of Healing discusses his discovery of Tibetan singing bowls in helping cancer patients.  As a scientist, he communicates the importance of vibrational healing through sound and how “we can order our molecular structure though sound and heal physical and emotional imbalances.”    He gives one example of a woman with a tumor in her thymus gland and how singing bowls helped her to relax and reflect upon internal stresses that were the cause of the blockages in her body.   By listening to “the vibration of the crystal bowl and visualizing the shape of her fears” she was able to see where the fear was stuck in her physical body, in this case, the throat.    He points out that her story is not unique as most people are in so much of a rush that they don’t stop to consider what is important or missing in life, getting ‘out of tune’ with the world around them.  This dis-harmony is usually reflected in disease or imbalance.  Getting ‘back in tune’ helps us to release tensions that we are many times not even aware of.  

Entrainment

How sound can affect us can be explained by what is termed as entrainment.  Entrainment is defined as the process by which the powerful rhythmic vibrations of one object with a similar frequency causes an object to vibrate in resonance with the first object.     We are not, of course, referring to our bodies as inanimate objects since human beings possess amazing complexity that complements their ability to harmonize and to adapt to the environment.   Entrainment is based in rhythm and when a vibration is perceived through the auditory senses, then the combined synergy creates profound synchronicity.   

It has been studied then postulated that everything rhythmical is subject to entrainment, and that even people’s bodies respond to the talk of another.  Dr. William S. Condon from the Boston University School of Medicine closely observed the body language of people as they listened to another person speak.    “Listeners were observed to move in precise shared synchrony with a speaker’s speech.”    He also noted that there was “no discernible lag even at 1/48 of a second.”  An analysis of this data shows the power of entrainment works whether or not we are conscious of it.    

The idea that “the human organism is not only constructed according to harmonic principles, but also functions within them” is suggested by physiologist Gunther Hildebrandt.    He helps us to understand the notion of entrainment since everything vibrates in a certain resonance with what is around it and that we are deeply entrenched in a great synchronized scheme.  

Ayurvedic examples on effects of sound.

The Rishis

Ayurveda, or the knowledge of the ancient rishis, is deeply rooted in the idea of entrainment and of the greater vibratory experience for which we are all striving.   The rishis were also attuned to the primordial sounds and understood that everything was held together by things that we could not see.   Deepak Chopra explains that “Ayurveda tells us to apply a specifically chosen primordial sound like a mold or template slipped over the disturbed cells pushing them back into line, not physically, but by repairing the sequence of sound at the heart of every cell.”  

In the Vedas, sound was understood to have a healing effect on its listener and, not surprisingly, various instruments were used to enable particular vibrations of sounds to prevent increases in particular doshas.

On Healing Sounds of Ayurveda site, a musician offers a variety of melodies played by specific instruments in order to pacify doshic imbalances.  The melodies attributed to these instruments’ sounds seem to counterbalance the effects of an imbalance.

For example, the instrumental sounds of the bamboo flute are thought to prevent the increase of vata.  The bamboo flute emits soft notes and has a soothing effect on its listener.  This is also the flute from which Lord Krishna played his soulful calming melodies alone on a calm river. 

Pitta needs a strong quality to catch its attention and the sitar is believed to possess that with its nasal overtones and rich sound.

The sarod is a classical Indian lute-like instrument and, with its deep and ‘awakening’ sound and clear tones, is said to help balance and enliven the kapha dosha.  The sarod is not as sweet as the sitar, nor as soothing as the bamboo flute.   

Nadis, chanting, and mantra  

In The Yoga of Sound, Paul states that sound essentially “works with the transformation, restoration, and reconstitution of the energies of the soul through channels known as nadis…subtle channels of the chakra system related to the soul’s infrastructure.”   In other words   “sound optimizes the performance of energy vortexes or chakras which govern our emotional, psychic and spiritual states of consciousness.”  

Mantras, or hymns, became interwoven with all actions related to healing.  Mantras, as sacred sounds, are known to affect our vibratory being and consciousness as the word mantra itself means both protection and instrument.   

In the Ashtanga Samgraha, chants are noted as playing a vital role in the overall healing process.    From the very start of life, chants are indicated.  For example, the attendant present at the birth of a child is instructed to chant a hymn into the baby’s ear right away.  

Mantras are also alleged to have the power to rid a child of evil demons.   It was seen important that those evil spirits are won over by the chanting of certain sacred sounds or hymns.   

The Vedas themselves are a series of mantras, as both words and sounds awaken memory and the deep knowledge encoded in our DNA and cells. This deep encoding is linked to the primordial sound of creation and to the source from which we emanate and are deeply a part.   However, it also understood that the emanator of the sound must, as stated in the Ashtanga Samgraha, be fully conscious in order to achieve the highest level of effect.   As Paul reminds us, “The vibratory effects of our tones…find their way into the psyche. Let us be mindful about these tones and use our voices to heal.”  

The experience of mantra and chanting are best when accompanied by ritual.  Ritual, in the very way that it is performed --the same time each day, also mirrors the rhythmic quality of mantra or the universe’s ebbs and flows.  Paul states that without sound encompassed in ritual that it is difficult to “release the accumulation of psychic toxicity in our spiritual system.”    It also “allows us to experience the deep and the high, much like sound.”   

In a translation of the Yoga aphorisms of Patanjali, it is noted that the “repetition of sacred words or mantras is…an invaluable aid to spiritual progress.”    Tapping in to our true nature, the definition of health being not forgetting who we are, is where true health lies.   Any disengagement from our spiritual nature is a disconnection from the source; and overall good health is more possible when we are encompassed by our connection and in tune with our greater nature, all of which is helped by sacred sound.

The rishis in Ayurveda also addressed other ways to fall ill besides disconnecting with one’s true nature.  Poison is a reality of our world and the ancients understood that being poisoned or otherwise harmed by the external environment posed a very real harm to the human body.  Toxins from snakes, animals and plants were believed to have possessed a fire that would severely harm one’s well-being.   One of the suggested antidotes to poison was the use of sound.  The Ashtanga Samgraha states that “Poison is full of tejas…it does not get warded off by the administration of drugs as quickly as by the use of mantras, full of satya, brahmacarya and tapas of the priest.”   The physician would have to be proficient with the hymn, however  as part of ‘sacred hymn’ therapy in helping the patient.   

Interestingly, in Traveling the Sacred Sound Current, Debroah Van Dyke notes that “sound is [also] fire…the agent of purification.”  Sound, therefore has “an inherent role in the transformation of our consciousness because it is the very vibrational nature of our soul.”   The creative organizing force of sound on our biology cannot be denied as sound’s power is evidenced to organize matter itself.   

An interpretation of the Yoga Sutras notes a sort of transcending effect of sound, one that goes beyond simply healing the body.  “By making samyama [when the true nature of an object is known] on the sound of a word, one’s perception of its meaning and one’s reaction to it…one obtains understanding of all sounds uttered by living beings.” This understanding translates into one being able to “attain supernatural powers of hearing” and achieving various levels of samadhi, complete absorption.  

Chakras and bija mantras

Chakras, the energy wheels in our subtle body, are also directed by sound.   Chakras represent their own dimension as they act as a “superhighway system in which our energies travel.”  Roadblocks through this highway system can be unblocked not only by visualization and physical exercises, but also by using sounds, specifically mantras, something that was known during the Vedic era.  

Chanting bija mantras or what are known as ‘seed sounds’ increase the rotation or the frequency of prana moving through a chakra. If the function of a chakra increases, then there is heightened awareness and change in the chakra, with the quality of that dependent upon intent and the level of the practitioner.  

Mantras in themselves have long been a part of Hindu cosmology.  The intelligence inherent in each syllable, vowel or consonant when uttered, has very specific connections to our total spiritual being.

The following is a breakdown of how bija mantras work within the body, utilizing all five elements.

The bija mantra of the first chakra, Lam, helps to increase the earth element in the body.  The second chakra’s bija mantra, Vam, helps to increase the water element in the body.  The third, Ram, is believed to increase the fire element in both the body and the mind as the fourth chakra, Yam, increases the air element in both the body and mind.  The fifth bija mantra for the throat is Ham and influences the either element, again working with the mind and body.   The bija mantra Ksham influences the ether element, but goes beyond the physical and affects the astral body as well.  And the crown chakra’s bija mantra, Om, influences the physical, subtle, as well as the causal body.   

One may also note the consonant and vowel sounds in each of these mantras, as their vibratory effects are connected back to the source of the universe and well as to the duality inherent in our current state of being.

The M in each of these sounds is said to represent the maternal and material aspect of the universe.  The A sound in turn represents the Father, the nonmaterial, the action of the Alpha.  L (lam, earth) is a heavy, closing sound, while H in HAM (ether) is light, airy, ethereal sound, and R (ram, fire) is an energetic, fiery sound.   Typically, consonants have come to reflect the hard, material aspects of the world, while vowels represent the spiritual or etheric aspects.    

Paul states that the movement of various appropriate tones for the individual using Vedic mantras helps to “sustain the wavelength of sound frequencies generated by our brain [and] streamlines our mental processes toward the intention of the mantra.”   Focus lends itself to practice of the seventh limb in yoga, dhyana, and is the precursor to the ultimate state of consciousness, samadhi.

OM

One of the most interesting aspects of the Vedic mantra Om is that its uttering and meditating upon it connects us to a higher vibratory rate, linking us to the origin of Prakruti.

It is, in other words, “the sound of all sounds together.”  

If we are to assume that the ancients were in resonance with the creation of the universe itself, then we must examine some of the theories of creation.

One of those theories is that the universe was created by the ‘big bang.’  

The word ‘bang’ connotes loud sound.  Interestingly enough, scientists theorize that the big bang wasn’t an explosion at all.  Stephen Hawking in his book The Universe in a Nutshell puts forth a multiple of theories by great physicists, most notably, Einstein.   Space, so it seems, originated as a point of density when “density would have been very large.”   

Through Einstein’s theories and the invention of the modern telescope, Hawkins reveals that galaxies are spreading apart and that the universe “is not a cosmological constant.”  

The ‘primeval atom’ or big bang points to the scientific fact that our universe is expanding and that both space and time had a beginning.   The expansion of the universe can be likened to our ever expanding consciousness.  And the sound of Om is in resonance with this expansion as well as our consciousness which is ever changing and growing.

The sound of the big bang was mathematically construed by University of Washington physicist John G. Cramer. One can listen to the sound of this expansion on audio.   It is of interest to compare a modern day scientist’s rendition of ‘the big bang’ to the rishis mantra Om. The listener will notice that the ‘big bang’ is actually a hum, and is very much “what the ancient Rishis perceived in their deepest meditations. “   This hums signals an expansion, not just in matter, but also in consciousness itself. 

The ancients harmonized in resonance with the expansion of what we perceive as time and space as Om can be said to mirror the space time continuum.  

“Om is the single most important sound that can, by itself, configure the human body optimally for maximum resonance and is noted to have the ability to generate overtones or additional frequencies that occur over and above a tone.”    Paul quotes a passage from the Upanishads which helps us to contemplate the depth of Om’s meaning.

There are two ways of contemplation of Brahman:  in sound and in silence.  By sound we go to silence.  The sound of Brahman is Om. With Om we go to the End; the silence of Brahman.  The End is immortality, union, and peace.  

Even as a spider reaches the liberty of space by means of its own thread, the [person] of contemplation by means of Om reaches freedom. 

In other words Om “represents… the totality of all that is and all that is not.”   And chanting it connects us to the Divine expansion, offering us the awareness that we are a part of everything that is and was.   This glimpse of wholeness and of both surpassing and encompassing duality is offered if we simply tune into it.

Summary

Through these examples we can see that the Ayurvedic understanding of sound is ancient and intuitive, with deep involvement in our spiritual being and the bodies we occupy.  The western interpretation includes analytical understanding of the physical nature of sound.  But as the effects of sound on the body and psyche are steadily investigated, the convergence of western and Ayurvedic perspectives become more integrated. 

The good news is that western medicine and what we once called ‘alternative medicine’ are beginning to work together.  The science of the spirit is becoming more understood as we progress on the path of the best ways to get well, stay well, and feel connected. Therefore, healing modalities become complementary, eliminating the need for isolation. 

Fewer and fewer western medical doctors are separating their practices from what is becoming more and more evident—that we are energetic beings and not simply made up of parts.  And much is being scientifically noted about how stress and outside influences affect our well-being and can even be the cause of dis-ease in the body.   The connection to what we hear, as well as see, has a lot to do with how we feel.  Any wellness professional, who is truly into his patient feeling whole, connected, and empowered, will be able to address that in his or her practice.

At the beginning of last century, Edgar Cayce called sound “The Medicine of the Future.”  Perhaps this is the future to which he was referring.

  Ashtanga Samgraha: Prof. KR Srikanta Murthy, Chowkumbha Orientalia, Varanasi, India   (Vol 1, xiii).  

  Mayo Clinic, Mayo Clinic Staff, Myofascial pain syndrome. http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042/DSECTION=treatments-and-drugs

  Don Campbell, The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit (New York: Avon Books, 1997), 10. 

  Online Etymology Dictionary, health. http://www.etymonline.com/index.php?term=heal.

  Ibid.

 .Paul G. Hewitt, Conceptual Physics—A New Introduction to Your Environment (Boston: Little, Brown and Company, 1977), 288.

  Ibid 291

  Russill Paul, The Yoga of Sound: Tapping the Hidden Power of Music and Chant (Novato California: New World Library, 2004), 12.

  Ibid, 11.  

  Ibid. 5, 293.

  Ibid, 14.

  Ibid 5, 302.

  Masaru Emoto, Water Crystal Healing: Music & Images To Restore Your Well-Being (New York: Atria Books, 2006), vii.  

  Lestard Nd, Valente RC, Lopes AG, Capells MA. Direct effects of music in non-auditory cells in culture. Noise Health 2013; 15:307-14.

  Ibid 2, 32.

  Ibid 5, 293.

  Cymascope, Sound Made Visible. http://cymascope.com/cyma_research/soundhealinghtml.

  Ibid.

  Mayo Clinic, Mayo Clinic staff, Pregnancy week by week. http://www.mayoclinic.com/health/fetal-development/PR00113.

  Ibid. 2, 68.   

  Jack Kornfield, A Path with Heart—A Guide Through the Perils and Promises of Spiritual Life (New York: Bantam Books, 1993),  323.  

  Ibid 13,vii- xii.

  Ibid 13, x, xi.

  Ibid 13, 2-50.

  Ibid 2, 7.

  Ibid 2, 65.

  Ibid 2, 67.

  Ibid 2, 221.

  Ibid 2, 80.

  Empower Your Health Magazine, Mack Harrell, MD, FACP, FACE,ECNU, Music For Your Health. http://www.empoweryourhealth.org/magazine/vol2_issue3/music-for-your-health.

  Teppo Sarkamo, et al., “Music Listening Enhances Cognitive Recovery and Mood After Middle Cerebral Artery Stroke,” Brain (2008) 131 (3): 866-876.  http://brain.oxfordjournals.org/content/131/3/866.full.

  Ibid 32.

  Zheng A. et al., “Effects of a Low-frequency Sound Wave Therapy Programme on Functional Capacity, Blood Circulation and Bone Metabolism in Frail Old Men and Women.” Clinical Rehabilitation, 2009 Oct; 23 (10): 897-908.  http://www.ncbi.nlm.nih.gov/pubmed/19717506.

  Ibid 2, 64.

  Ibid 2, 92-94.

  Ibid 2, 99.

  Ibid 2, 272.

  Ibid 2, 221- 283.

  Mitchell L. Gaynor, M.D., Sounds of Healing: A Physician Reveals the Therapeutic Power of Sound, Voice, and Music (New York: Random House, Inc., 1993), 19.  

  Ibid 20, 322.

  Ibid 33, 19.

  Ibid 33, 46 47.     

  Ibid 33, 64).  

  Ibid 7, Paul 135.

  Anodea Judith, Wheels of Life—A User’s Guide to the Chakra System (St Paul, Minnesota: Llewellyn Publications, 1998),  287.  

  Ibid 33,  68.   

  Ibid 2, 158.

  Healing Sounds of Ayurveda, Markus Frerichs.  http://www.ayurveda-music.com

  Ibid 7, Paul 24.

  Ibid 40, 279.

  Ibid 1, 258.

  Ashtanga Samgraha: Prof. KR Srikanta Murthy, Chowkumbha Orientalia, Varanasi, India   (Vol 3, 2).  

  Ibid, 58 – 61.

  Ibid 48, 80

  Ibid 7, 68- 79.

  Ibid 7, 111.

  Swami Prabhavananda and Christopher Isherwood, How to Know God: The Yoga Aphorisms of Patanjali (Hollywood CA: Vedanta Press, 1981), 203.

  Ibid 48, 371.

 Ibid 48, 451.

  Ibid 48, 371

  Deborah Van Dyke, Travelling the Sacred Sound Current: Keys for Conscious Evolution (Brown Island B.C. Canada: Sound Current Music), 21.

  Ibid, 23.

  Ibid 52, 182.    

  Ibid 40, 16.    

  Marc Halpern, Principles of Ayurvedic Medicine10th ed. (California College of Ayurveda, 2010),  218.  

  Ibid 58, 218-232.    

  Ibid 40.

  Ibid 7, 79.  

  Ibid 40.

  Stephen Hawking, The Universe in a Nutshell: A Brief History of Time, Black Holes and Baby Universes and Other Essays (New York: Bantam Books, 2001), 22.

  Ibid, 21 – 23. 

  John G. Cramer, “Sound of the Big Bang,” November 10, 2003, http://faculty.washington.edu/jcramer/BBSound.html

  Ibid. 

  Ibid 7, 73

  Ibid 7, 175.  

  Ibid 7, 219.

  Ibid 7, 179- 181.

 
 
 

A Perspective of the Ayurvedic Application to HIV (By Lance Roehrig)

Abstract

   The role of traditional, complimentary and alternative health care is rapidly changing in the world climate. A greater emphasis on complimentary and alternative health care, and its practitioners, is developing in the wake of economic downturns. Healthcare and Health Insurance prioritized as a moneymaking industry rather than the greater seva, act of service, to heal and promote longevity is unsustainable. Although the care received in hospitals and by Doctors is beneficial for the most part; when the bottom line speaks louder than the individual that lies ill, great tides of change can and must occur. Communities have taken into their own hands the motto, “I am my primary care physician.” By integrating alternative health care practitioners as a tool in educated themselves in preventative and natural care, individuals empower themselves to take their health into their own hands, thus creating a truly holistic approach to health which is the very core of Ayurveda.

   The goal of this paper is not to prove viability of one herb, approach or method as a viable healing agent of HIV. Rather, the goal of this paper, like Ayurveda, is to show the extensive tools available to the HIV individual and in fact all individuals managing chronic disease. The important term here is managing. The goal of this paper is to show that with the use of an Ayurvedic framework; or roadmap, one can use allopathic technology in addition to the abundant tools available, thus taking back the power of healing from the healthcare industry and its beneficiaries and placing it back into the hands of each and every one of us.

Introduction to Ayurveda

“Forgetting our true nature as spirit is the primordial cause of disease.” – Dr. Marc Halpern

   Ayurveda is the ancient science of life and the world’s oldest holistic medical system.  It is said to be as old as humanity itself, but scholars place the age between five and 10,000 years.[1]   The term Ayurveda is derived from the two sanskrit root words “Ayus” meaning life and “veda,” meaning knowledge, “The science of life.”  Ayurveda takes its origins from the spiritual texts of India known as the Vedas. The Vedas are the oldest known written text with subjects as vast as grammar, phonetics, astrology, ritual, etymology and prosody (metric verse). [2] There are four Vedas, The Rig Veda, Atharva Veda, Yajur Veda and Sama Veda. Ayurveda is a gathering of knowledge from all four texts.
Vedic knowledge was perceived by merging ones consciousness with the subject of inquiry. Tajjayat Prajnalokah, “By the mastery of [one pointed focus and meditation] comes the light of knowledge.” [3] From this practice true wisdom was received as gifts from the Devas (Gods). Dr. David Frawley writes in his book Ayurveda – Natures Medicine, “[Ayurveda] is not merely a kind of antiquated folk medicine as it is sometimes considered to be.”  [4] Many discoveries in modern sciences and technology can often be linked with parallel wisdom in the Vedas.  “Today, quantum physicists have become the torchbearers in the realm of the ‘tinier than tiny.’ Ten million to one hundred million times smaller than the sub- atom lies the level of the quanta, the new frontier of min-body research. The source of this quantum level is a field of pure energy, which serves as the underlying intelligence and glue of the entire universe. 65 years ago, quantum physicists labeled this the Unified Field. Nearly six millennia ago, Ayuvedic sages called it the Cosmic Life Force or Field of Pure Consciousness. While modern science is only beginning to understand implications of this discovery, Ayurveda has been steeped in quantum theory for a millennia.” [5]
   Unlike our modern age where our focused intent is outward, ancient Rishis chose to place their eye on the internal universe and in doing so they discovered this Unified Field as modern scientist call it; “[Is a,] field of consciousness, which connects every thought, wave pattern and particle of our being.” [6] It is here where we discover infinite potentiality as well as the understanding that what is in the microcosm is in the macrocosm and what is in the macrocosm is in the microcosm. Our ability to heal can be attained by simply watching the rhythms of the universe … or better yet, our own backyard.
   The philosophies, principles and techniques in Ayurveda, the Vedas, Tantra, Yoga; these are all part of an ancient wisdom known as Sanatana Dharma (now known as Hinduism) roughly translated as the eternal truth.  As the same sun is called by different names in different countries at different times, these truths are universal and cannot be defined by time nor are written by, or for; the benefit of one man, one nation or one race. These truths have been written and passed chest –chest for the benefit of humanity.
   “… great rishis sat together on the slopes of the Himalayan Mountain. They discussed the occurrence of great diseases that had arisen and how to deal with them … They decided that they should ask the Gods how to stay well and avoid disease as well as how to heal those who are sick … (The rishi ) Bharadvaja was selected … as he was best suited for the mission. Bowing before Indra, he explained the reason he needed an audience before such a great God. Bharadvaja was successful and Indra taught him the knowledge of Ayurveda…” [7]
   Bharadvaja went on to teach many great rishis and sages the science of Ayurveda. One of the great sages was Atreya, who passed on the knowledge to Agnivesa. Agnivesa later wrote the Agnivesa Tantra, which became the Caraka Samhita after Caraka revised it. [8] The Caraka Samhita is one of the primary Ayurvedic text that many practitioners gather their information from. In it myth and history are woven revealing the secrets of Ayurveda.
   “Forgetting our true nature as spirit is the primordial cause of disease.” Writes Dr. Halpern. When we forget our true nature as spirit we become dominated by the ego. We are wrapped up and consumed in vrittis, the dramas of everyday life. Yogas citta-vritti-nirodah, Yoga is the cessation of the mind or settling of the mind into silence. [9] When we connect our physiology with the dramas of everyday life, time seems to increase and our reality becomes further attached to maya, illusion. By connecting to our ego; my car, my house, my job, my safety, my money, my family, my society, my government; and defining these transient things as I, simply, we forget. We forget our true and timeless nature is here in this infinitesimal moment of the now. It is here where the deepest secrets unravel and one can capture a glimpse into the internal pharmacy where anything is possible.
Ayurveda uses the language of nature to describe the rhythms and cycles of the macrocosm and shows the similarities within the microcosm. It relates and shows how the five elements of earth, water, fire, air and ether are intrinsically connected in this beautiful lila or cosmic play, in the outer world, and how they are part of the body - and the internal world. It uses the language of 10 sets of opposite characteristics: hot/cold, moist/ dry, heavy/ light, gross/ subtle, dull/ sharp, soft/ hard, smooth/ rough, cloudy/clear… to further describe and relate the harmony and the imbalance in the individual.  These principles are used to describe the body, the disease and ultimately the path of healing. For example, if one were to present constipation (cold/ dry) Ayurveda recommends opposite therapy, so in said example one would employ warm, moist and nourishing qualities as an anecdote.
    The three causes of disease in Ayurveda outlined in the Caraka Samhita, are: 1) The unwholesome conjunction of the senses with the objects of their affection (“Having forgotten its true nature as spirit, mankind understands itself to exist only as its senses, its body and its mind … the meaning of life becomes the simple pursuit of pleasure.” 2)Intellectual blasphemy, the failure of the intellect or crimes against wisdom (“When we listen deeply inside ourselves, we find that we know how to act in ways that would bring us toward health … Yet, we often do not follow what we know to be true.”) 3)Transformation or decay due to time and motion. (There are two kinds of time: Linear time, which is static. Then there is biological time, which changes in response to motion. The faster our pace of life, biological time increases, gross motions such as air and automobile travel exacerbate this. More important than gross motions is the motion of the mind. The faster the rate of our thoughts time seems to increase and so does our biology. When the mind slows down such as in meditation or yogasana the biology also slows down.) [10]
   When we look at the three causes of disease we can see how the nidana or cause of HIV falls into the first two categories and the treatment and rate of action on the body falls into this third cause. Hope lies in reconnecting the individual to the eternal. We are more than our senses perceive. The path of healing lies in the ability to turn on the innate intelligence that resides within.  Understanding that how we move through life and that how we perceive to move through life are two very different things and can be altered.

The History of HIV

“Due to funding constraints AVERT is unfortunately not able to fund any new projects, or accept project proposals until at least April 2012. Please do not send in any applications for funding until that date.” [11]

   1981 was the year AIDS was first reported in the U.S. Scientists scrambled through much confusion in the first few years surrounding the illness, attempting to pin down transmission of the virus and treatment of those infected. Advancements in the 1990s with new classifications of drugs have greatly changed the landscape of treatments. [12]
   The genetic research places the origins of HIV in West-central Africa. The Mayo Clinic states, “Scientists believe a virus similar to HIV first occurred in some populations of chimps and monkeys in Africa, where they’re hunted for food. Contact with an infected monkey’s blood during butchering or cooking may have allowed the virus to cross into humans and become HIV”[13]

Before 1970s
1    HIV (the virus that causes AIDS) probably transfers to humans in Africa between 1884 and 1924.
2    HIV probably enters Haiti around 1966.
1970s
1    HIV probably enters the United States around 1970.
2    African doctors see a rise in opportunistic infections and wasting.
3    Western scientists and doctors remain ignorant of the growing epidemic.
1981
1    AIDS is detected in California and New York.
2    The first cases are among gay men, then injecting drug users.
1982
1    AIDS is reported among haemophiliacs and Haitians in the USA.
2    AIDS is reported in several European countries.
3    The name “AIDS” – Acquired Immune Deficiency Syndrome – is created.
4    Community organisations in the UK and USA promote safer sex among gay men.
1983
1    AIDS is reported among non-drug using women and children.
2    Experts become more confident that the cause of AIDS is infectious.
3    Three thousand AIDS cases have been reported in the USA; one thousand have died.
1984
1    Scientists identify HIV (initially called HTLV-III or LAV) as the cause of AIDS.
2    Western scientists become aware that AIDS is widespread in parts of Africa
3    The world's first needle exchange program is set up in Amsterdam, the Netherlands.
1985
1    An HIV test is licensed for screening blood supplies.
2    AIDS is found in China, and has therefore been seen in all regions of the world.
1986
1    More than 38,000 cases of AIDS have been reported from 85 countries.
2    Uganda begins promoting sexual behaviour change in response to AIDS.
1987
1    AZT is the first drug approved for treating AIDS.
2    The UK and other countries act to raise awareness of AIDS.

1988
1    The American government conducts a national AIDS education campaign.
2    Health ministers meet to discuss AIDS and establish a World Aids Day
1990
1    Around 8 million people are living with HIV worldwide, according to estimates made later.
1991
1    Thailand launches Asia’s most extensive HIV prevention program.
1993
1    AZT is shown to be of no benefit to those in the early stages of HIV infection.
1994
1    AZT is shown to reduce the risk of Mother to child transmission.
2    Infant HIV infections begin to fall in developed countries, due to use of AZT.
1995
1    The Joint United Nations Programme on AIDS (UNAIDS) is established.
1996
1     Combination antiretroviral therapy shown to be highly effective against HIV.
1    In developed countries, many people begin taking the new treatment.
2    Annual global spending on AIDS in low- and middle-income countries is $300 million.
1997
1    AIDS deaths begin to decline in developed countries, due to the new drugs.
2    Brazil is the first developing country to begin providing free combination treatment.
3    In other developing countries, only a tiny minority can access treatment for HIV.
4    Around 22 million people are living with HIV worldwide, according to estimates made later.
2000
1    President Thabo Mbeki of South Africa voices support for Aids dissidents
2001
1    At a UN Special Session, world leaders set long-term targets on HIV/AIDS.
2002
1    The Global Fund established to boost the response to AIDS, TB and malaria.
2    Botswana begins Africa’s first national AIDS treatment programme.
2003
1    AIDS drugs become more affordable for developing countries.
2    The “3 by 5” campaign is launched to widen access to AIDS treatments.
3    The first HIV vaccine candidate to undergo a major trial is found to be ineffective.
2004
1    America launches a major initiative called PEPFAR to combat AIDS worldwide.
2    After much hesitancy, South Africa begins to provide free antiretroviral treatment.
2006
1      Circumcision is shown to reduce HIV infection among heterosexual men.
1    28% of people in developing countries who need treatment for HIV are receiving it.
2    Annual global spending on AIDS in low- and middle-income countries is $8.9 billion.
3    It is estimated that $14.9 billion would be needed for a truly effective response.
2007
1    Around 33 million people are living with HIV, according to revised estimates.
2    Another major HIV vaccine trial is halted after preliminary results show no benefit.
2008
1    A controversial Swiss study claims people adhering to ARVs have a "negligibly small" risk of transmitting HIV through unprotected sex.
2    PEPFAR is reauthorized, committing $48 billion for the next five years.
3    Michel Sidibé is named as new head of UNAIDS as Peter Piot steps down.
2009
1    President Obama announces the removal of the travel ban that prevents HIV-positive people from entering the US.
2    4 million people in developing and transitional countries are receiving treatment for HIV; 9.5 million are still in immediate need of treatment.
2010
1    The United States, South Korea, China and Namibia lift their travel bans for people living with HIV.
2    The CAPRISA 004 microbicide trial is hailed a success after results show the gel reduced the risk of HIV infection by 40%.
3    Results from the iPrEx trial show a reduction in HIV acquisition among men who have sex with men taking PREP [14]

What is HIV?

Western Interpretation

Definition

   HIV (Human immunodeficiency virus): A disease of the human immune system that attacks white blood cells reducing the body’s ability to fight off illness. This condition progressively reduces the effectiveness of the immune system. Left untreated individuals become susceptible to opportunistic infections or tumors that usually are handled by a strong immune system. At this stage HIV has manifested into AIDS (Acquired immunodeficiency syndrome). [15]

Etiology

   HIV is transmitted with direct contact with a mucous membrane or bloodstream with a body fluid containing the virus such as infected blood, semen, vaginal secretions, preseminal fluid and breast milk. Infection cannot take place via hugging, kissing, dancing or shaking hands. HIV is temperamental and cannot live long outside of the body. It cannot be transmitted by air, insect bite or water. [16]

Signs and Symptoms

    Initially there is brief flu like systems presented two to four weeks after infection that dissipate and generally go away. Symptoms are fever, headache, sore throat, swollen glands and rash. Years later as the condition progresses some may develop mild infections or chronic conditions such as swollen lymph nodes (often a first sign) diarrhea, weight loss, fever, cough and shortness of breath. If the condition progresses and the HIV infection is not treated the disease typically progresses to AIDS. At this stage the symptoms include: soaking night sweats, shaking chills or fever, cough and shortness of breath, persistent white spots and unusual lesions on the tongue or in the mouth, headache, persistent fatigue, blurred and distorted vision, weight loss, skin rashes. [17]

Complications

   Complications can be as individual as the person infected with HIV. From the Avert website here is a partial list of some of the most common: “Bacterial diseases such as tuberculosis, bacterial pneumonia and septicaemia (blood poisoning) Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis.  Fungal diseases such as PCP, candidiasis, cryptococcosis and penicilliosis. Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus.  HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.”
   Complications also arise in the treatment of HIV with the side effects from the antiretroviral therapies. Some common side effects are: Hepatoxicity (liver damage), Hyperglycemia (elevated blood sugar), lipodystrophy (fat redistribution) and skin rash. [8]

Test and Diagnosis

   The ELISA (enzyme-linked immunoabsorbant) is the most common test for routine diagnosis of HIV among adults. There is however a window period after HIV infection from weeks up to 6 months where the antibodies are not produced after infection.  During this time an antibody test can give a false negative. To avoid a false negative it is recommended that a second test be done three months after possible exposure. [19]

Blood Tests and Treatments

   An HIV positive result will result with the patient being referred to an Infectious Disease Specialist (I.D. Dr.). This specialist will work with the patient and come up with a selection of drugs to treat the virus. In some cases with the advancement in research only 1 pill, once day that is a cocktail of multiple drugs is used, such as Atripla. It is imperative that the patient takes the medication as directed to curb side effects as well as drug resistance.  The Mayo Clinic lists on their website the classifications of drugs for the treatment of HIV:
        “Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
        Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
        Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
        Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
        Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, protein that HIV uses to insert its genetic material into CD4 cells.” [20]

    Some of the blood tests that the I.D. Dr. will use to determine which medication to use as well as its effectiveness and the management of possible side effects are: CBC (Complete Blood Count), this will tell the I.D. Dr. the kinds and numbers red and white blood cells along with platelets; Liver Function panel to assess the function of the liver and avoid toxicity; CD4 (T- Cell) count tells the I.D. Dr. how the immune system is functioning – with the standard range being between 290-2077 and Viral Load. This Test measures how many counts of HIV are in the blood. Today, with increasingly newer technology, an undetectable viral load is becoming more common. [21]

Ayurvedic Interpretation

“Remember that no disease can harm you if agni is balance, ojas is strong and you are living a sattvic lifestyle.” – Dr. Marc Halpern

   No, disease can harm you if agni is balance and ojas is strong. These words written in an email by Dr. Halpern inspired the approach of this paper. How does one address Ayurveda’s message to HIV? - Hope.
   Underlying the message of Ayurveda is a deeper wisdom of spiritual connection that can get lost in the interpretation of Ayurveda. As western-minded individuals it is easy to struggle with the tendency to take Ayurveda out of its context and westernize its procedures and treatments, thus losing the very heart that differentiates Ayurveda from allopathic medicine.  By simply treating the symptoms and not uprooting the entire tree of dis-harmony we lose the opportunity Ayurveda presents to create a deeper change within. It is the deeper meanings beyond what we see with our eyes that Ayurveda has so eloquently conveyed. Yogi Baba Prem wrote, “…one must learn to look at eastern teachings through eastern eyes. The literalist tradition, common in the west and relevant in the east, does not afford much opportunity to unlock the vast secrets held within the eastern traditions and the more familiar system of yoga.” [22] We must understand this in order to facilitate a deeper awareness within ourselves when we venture into these ancient traditions for healing. When we blend the modern treatments of western allopathic medicine with the wisdom from the east we truly discover a holistic approach to healing. “Whether animal, herb or pharmaceutical everything is medicine when given to the right person, at the right time, for the right reason. Whether animal, herb or pharmaceutical everything is poison when given to the wrong person, at the wrong time, for the wrong reason.” [23] It is by accessing these internal secrets that each one of us is gifted with; will we have the capability to surpass great odds and learn great lessons.
   When we step into an Ayurvedic mind, we realize that Ayurveda includes all forms of medicine as treatment and the need to battle or pit one group against another just isn’t there. Shanti, Peace. In the fullness of a harmonious and global, community mind - adversity does not have a place to function. What we discover is that this subtle wisdom is the very philosophy that is capable of powerful treatment in chronic disease. When the mind, body and spirit create a harmonious community within, adversity melts and naturally the route of healing and the ability to access the internal pharmacy becomes alive. And, even in the face of chronic conditions such as HIV, one can find Shanti.

*    *    *

    According to Ayurveda, HIV can be correlated to Ksaya  or  OjaKsaya, the loss and consumption of vital energy. “Ksaya,” is most commonly associated with tuberculosis, it is characterized as an end stage respiratory condition with all three doshas vitiated. Any disease that is not properly treated can result in this condition and is considered, rajayaksmadi, “king of diseases.” [24] In The Ayurvedic Encyclopedia, Swami Sadashiva Tirtha writes,” In an ancient Ayurvedic text, Madhava Nidan, written around 700 A.D., the author, Madhavakara foretells a disease that will come to India. From its description, we know it as HIV/ AIDS. Its cure was said to be shilajit.” [26]

Nidana (Cause)

   HIV is a tridoshic viral infection affecting the strength and ability of the immune system to function.  It causes a deficiency in life-sap, ojas.  When ojas is strong the HIV virus cannot develop. Ojas is lost or diminished by excess sex, improper food, improper routine, worry and insomnia.  The HIV virus uses the body’s immune cells to replicate itself.  Much like a ghost, this virus does not have a body of its own and uses its host’s cells and body to function and survive. Dr. Marc Halpern, director of the California College of Ayurveda wrote on Ksaya “A lifestyle that reduces ojas leads to individual susceptibility to the condition. A lifestyle that results in a loss of shukra (vital fluid) is considered to increase the risk of developing the condition. In addition, a person is weakened by the suppression of natural urges and the intake of foods and drinks that are disharmonious.” [26]

Purva Rupa (Premonitory Symptoms)

   According to the Ashtanga Hrydayam, the following is a list of premonitory symptoms that often precede the onset of the disease. [27]

•    Nasal catarrh
•    Increased salivation
•    Sweet taste in the mouth
•    Weak agni
•    Increased desire for sex and wine
•    Swelling of the feet and face
•    Dreams of being defeated by animals
•    Visions of dirt in foods
•    Denial of emaciation

Rupa (Symptoms)

   Vata and Pitta are primary factors, however Kapha may present symptoms of congestion and lung disorders as the virus manifests. Fever, chills, headaches, tiredness, enlarged lymph nodes and general flu like symptoms in the first stages of infection. Symptoms of vata vitiation include: Fatigue, nerve disorders, cough, pain, change in voice and emaciation. Pitta symptoms include:  fever, low energy-burnout, yellow, green or red foul smelling sputum. Symptoms due to kapha vitiation are loss of appetite, congestion, oral candida, vomiting and dyspnea. [28]

Samprapti (Pathogenesis)

   The symptoms that develop from HIV have one major factor in common – movement. The symptoms seem to manifest throughout the various dhatus and strotas (tissues and channels) throughout the entire body, affecting all dhatus. Because HIV affects the white blood cells, the actual infection is located in the rasa dhatu of the rasavaha strota. Dr. Marc Halpern of the California College of Ayurveda states, “It is a constituent of rasa. (lymph)”   According to the Madhava Nidanam, Vata then becomes the primary vitiated dosha in the pathogenesis. Vata vitiation then leads to pushing pitta and kapha. From this we can see the condition is sannipattika (tridoshic) with vata at the root, overflowing into the rasa dhatu and the rasavaha strota and relocating to various sites through out the body creating the classic symptoms of early HIV infection as well as later stages. [29]

Stage Evidence Dosha Subdosha Dhatu Incr/Decr Srota Herb Categories Herb Examples
rmd HIV Infection/ low ojas/ reduced immuntiy V vyana Rasa decr Rasa-vaha Strota Rasayana Chywanprash
AshwagandhaShatvari
Shillajit
rmd Ema-ciation V apana

Medas
Mam-sa
 

decr Medo-vaha Strota Fat tonics
Muscle tonics
Shatavari, licorice
Amalaki ashwagandha
rmd anxiety V prana n/a decr Mano-vaha Strota Nervine sedadtive
Nervine tonic
Jatamamsi/ shankha pushpi
Brahmi
ashwagandha
rmd Fatigue V vyana rakta decr Rakta-vaha Strota Blood tonics Amalaki/ turmeric
rmd HIV Infection / Fever
 
P n/a rakta decr Rakt-vaha Strota Anti-microbials Turmeric/ neem/ goldenseal
rmd Fatigue P n/a rakta decr Rakta-vaha Strota Blood Tonics Amalaki/ Turmeric
rmd HIV Infection
Swollen lymph nodes
K n/a rasa incr Rasa-vaha Strota Channel clearing
Anti-Microbial
Turmeric/ Garlic
rmd Loss of appetite K kledaka rasa incr Anna-vaha Strota dipana Trikatu/ Ginger
rmd Oral candida K Bodhaka rasa incr Anna-vaha Strota Anti-Microbials
Anthelmintic
Musta, Pau d’arco
Asofatida
vidanga
rmd Depression K tarpaka n/a incr Mano-vaha Strota Nervine stimulant Brahmi/ Calamus

Chikitsa (Treatment)

   Ayurveda gives the patient the framework to lead a harmonious life and build ojas. This is key in preventing the infection form further manifesting as well as managing the possible side affects associated with the pharmaceuticals employed to treat HIV.  Along with numerous others, all HIV allopathic medications list possible digestive imbalances and anxiety/ depression, as common side affects that may subside as treatment continues. Little is known as to whether the psychological disturbances are caused by the disease, the medication, the outlook of the patient or a combination.  These side affects in treating HIV from an Ayurvedic perspective will be taken into account below.

   Because Vata vitiation is of concern, a treatment for general vata imbalance is employed. Nourishing foods that are vata pacifying are consumed being aware that vata in HIV individuals can very quickly push pitta and kapha out of balance. (As HIV is tridoshic in nature. See samprapti above.) The diet will often need to be adjusted to compensate. It is interesting to note specifically the use of goat meat in soups as well as fried in ghee in Caraka Samhita.  Many recipes included goat milk along with all the recipes employ ghee, cows milk, sugar and honey for their nourishing nature on vata and rasa dhatu (lymph). [30] Because HIV affects the nourishment of the tissues, regulating samana vayu ( the ability to absorb nutrients) is considered a primary focus when it comes to nutrition as well as daily routines. The annamaya kosha (food sheath or physical body) is nourished by the right foods at the right time, thus creating ojas, immunity. The daily routines are vital in treatment of HIV, keeping patterns and routine grounds samana vayu. Daily routines consist of regular bowel movements, self-abhyanga (daily oil massage), yoga, pranayama, and the routines around meals such as prayer and the routines around sleep. Tongue scraping and neti, nasal irrigation, help remove toxins and dead cellular debris from the tongue and sinus cavity. Abhyanga increases lymphatic flow from the heat it generates and can promote the detoxification of pharmaceuticals as well as the removal of the virus from the body.

   Considering what sort of mental impressions are being digested is a factor in healing and creating strength in the mind, nerves and musculoskeletal system. On the lecture Ayurvedic Psychology, Dr. David Frawley, comments how “…we let people into our minds that we wouldn’t let into our houses.” [31] Allowing the junk impressions into the mind is akin to eating junk food. Ojas is depleted and the body, mind and spirit must digest these junk impressions. Therefore it is paramount for the psychology and treatment of majjavaha strota and manovaha strota or the mind and nervous systems, to begin to build and nourish the environment from which one lives and functions.

   Auditing ones life and evaluating how nourishing each situation is within the home, career and self is extremely beneficial. How nourishing is the quality of the mind and heart? Systematically moving through each segment of the day one can audit and discover how nourishing and ojas building is each segment of the day is.  Break these segments into drying, heating, cooling, astringent etc. and one can begin to see the picture and quality of the course of the day. What aspects can be nourished?  Meditation can significantly effect the quality of these segments as the more one meditates and reconnects to Self, the more the various circumstance seem less important or less attachment is placed on them.  Color therapies play an important role in this segment. Gold is the most healing and nourishing, an abundance of this color in the form of flowers can uplift and tonify any environment.

   The use of herbal Anti-microbial herbs to treat the infection and rasayana (longevity/ ojas building therapies), to increase immunity is the corner stone of the treatment for HIV. Nervine sedatives and tonics help treat anxiety while fat and muscle tonics help in weight loss. Blood tonics are used for fatigue and oil massage and nasya with herbs like ashwagandha and brahmi. The gold ash formula, Survana Vasant Malti  is revered as being excellent for all immune disorders. [32]

   Essential oils are the rasa of the trees and plant kingdom. They prove very effective in healing and rebuilding the rasa of the human organism. Vata pacifying essential oils are highly effective in treating vata imbalance as they can be applied via Abhyanga.  They are applied through the pathways of the skin, nasal passages, lungs and gastro-intestinal tract. Once absorbed, essential oils quickly penetrate into the rasa and rakta (lymphatic and blood systems). As the oils circulate through the circulatory system, tissues and organs may choose any portion of the essential oil it wishes to use in the metabolic process, receiving the stimulating, sedating or beneficial property of the oil. [33] Essential oils are diluted in base oils that are constitutionally appropriate. A general accepted ratio of essential oil to base oil is about 25ml (12-13) drops: 1oz base oil. See the table below for doshic appropriate base oils. [34] Essential oils can be applied to the main marma point that balances each dosha: Vata, third eye; Pitta, Heart chakra; Kapha, between the navel and pubic bone.

Vata……………………...Sesame
Pitta…………Coconut/Sunflower
Kapha …………Canola/ Mustard

   Essential oils can be used as misting bottles with either healing oils or anti-microbial/ anti-viral/ anti-bacterial oils which are great for the rooms, bedding and the space in which the HIV patient resides. The general rule is one drop per 2 oz of water. [35] Shirodhara is effective in calming the mind, relaxing the nerves and immune system, providing individuals with a profound state of rest. Deep-seated stressors can be released via this treatment. [36]
   Mantra is sacred sound. On an esoteric level it is the sound or vibration pattern behind the universe itself. [37] Connecting to this sound vibration puts one in harmony with the universe and unlimited potentiality. It connects the individual with the sound vibrations available to awaken the internal pharmacy of healing. On a practical level it has gained wide recognition for its use in affirmations of healing. “According to the researchers, … repeating a mantram may help HIV-positive individuals examine stressful situations in a more nonjudgmental and accepting way…” [38]
   Gemstones can also be used as they speak to the body via outside the realm of the five senses. Stones are grounding representing the earth element however; gemstones like all of nature are composed of all of the five elements.  When wearing the gemstone the qualities of the gemstone interact with the qualities of the person. Gem infusions are made by soaking the gem in a glass of water in the moon or sunlight. [39] Time moves slower as mass increases; so time moves faster in the atmosphere above earth than it does on earth. This can be noted that by large structures such as mountains and even the great pyramids in Egypt, its hypothesized time moves at an infinitesimally slower rate. [40] Pondering this opens the attitude that there is more to life than what can be understood by the five senses.

Ayurvedic Treatments for HIV

Pancha Karma

   Pancha Karma is the process of removing ama and excess doshas from the body and mind and then rebuilding the internal strength and ojas, immunity. The state of ojas is important to determine whether or not the individual is ready for pancha karma.  Birmhana Chikitsa , tonification therapy may need to be performed prior to beginning a pancha karma routine. During the first stage, Purva Karma, a palliative doshic appropriate diet is indicated. During this time the built up toxins in the body from medications as well as viral debris can be thought of as moving towards the organs of elimination. Abhyanga  is performed as well as color, mantra, and pranayama. The duration for this initial phase is determined by doshic imbalance. As HIV is primarly vata, then tridhoshic, balancing vata and taking care not to cause vata imbalance is key to the success of the treatment.
   Pancha Karma literally means the five actions. Vamana (Therapeutic vomiting), Virechana (Purgation), Basti (Enema), Nasya ( Nasal Purgation), Rakta Mokshana (Bloodletting). Therapies like anuvasana basti, tonifying enema, are employed to heal and calm vata at its root site. These therapies performed by a skilled Pancha Karma specialist help to alleviate excess doshas and bring balance to the HIV individual as well as prepare the body to receive the tonification therapies of the third step, Praschat Karma.  These therapies are the tonifying and rasayana portion of the treatment and is the key in building immunity, ojas, as well as strengthen agni, the fire of digestion. The fire of agni is key in the overall health of the HIV individual. If the fire of agni burns to low, ama is left behind; if the fire of agni burns to hot, it smokes and burns and metabolizes the individual. When in balance agni burns clean and clear with no residues left. This is the goal of Pancha Karma.[41]

Amalaki

   The amalaki fruit is also known as Dhatri, the nurse, as it is like a nurse or mother in its healing properties.  It has a sweet, sour, astringent, pungent and bitter rasa, a cool virya, and sweet vipaka. It is part of the revered preparations, Chyawanprash and Triphala.  It is one of the best herbs for pitta and considered a rasayana for pitta type vitiation. The amla fruit contains the equivalent of nine oranges of vitamin C, as well as studies confirmed the bioavailability of the vitamin C in amla is better than that from synthetic ascorbic acid. It has anti-microbial properties and was shown to have inhibitory effects on HIV. [42] Increased cholesterol is a common side effect in many HIV medications. Studies have shown it to reduce cholesterol. Amalaki shows anti-oxidant properties against oxidative stressors. [43] It is considered the best among rasayana as well as it clears all three doshas from the body. When vitality is low amla with ashwagandha, ghee and honey is restorative and invigorating. [44], [45], [46]

Ashwagandha *

   Ashwagandha has a sweet, astringent and bitter rasa, warm virya and sweet vipaka. Its qualities are light and oily. is used in general debility and is the best rejuvenation herb for muscle, marrow and semen and for Vata constitution. [47] It is adaptagenic and increases the bodies ability to handle stressors. It is used in weakness, consumption and debility.  [48] It is a nervine sedative and nervine tonic and is known to treat anxiety, arthritis, insomnia and stress as well as an antioxidant. [49] Because Vata vitiation is paramount in the treatment of HIV Ashwagandha becomes an herbal ally in treating the stressors on the nervous system from the virus and/or the medications. Ashwagandha has been shown to increase body weight and total protein content.  It has been shown to have anti-cancerous activity and has shown to be effective against hepatotoxicity, chemical driven liver damage. [50]  (*See Appendix I For related research)

Shilajit

   A unique ayurvedic panacea or cure all.  Its rasa is pungent, bitter, and salty. It’s Virya is warm and its vipaka  is pungent. It is not actually an herb but a mineral pitch.  “It is an exudate that oozes out from ceratain rocks in the Himalayas, as they become warm.” [51] “Shilajit is renowned as a rejuvinative tonic with specific action on the urinary, reproductive, and endocrine systems. According to Caraka, almost all diseases can be controlled or cured with the use of this substance.” [52] In a comparative study of shilajit and 2 other herbs and AZT in 2006, shilajit performed 80%-90% effective against an enzyme found in HIV necessary for its multiplication. AZT was 70% effective. [53]

Turmeric*

   “When a virus replicates the ‘long terminal repeat’(LTR) sequence is activated. Without this activation there can be no replication of a virus like HIV. Published laboratory tests, completed by researchers at Harvard Medical School in 1993, indicated three inhibitors of HIV LTR. Curcumin is one of them…”  [54] Curcumin is what gives turmeric its yellow color. Turmeric works on all the tissues of the body. It has a bitter rasa warm virya and pungent vipaka. It is an anti-microbial, good for indigestion, poor circulation, cough, skin disorders, diabetes, arthritis, anemia, wounds and bruises. It helps to improve intestinal flora and is good antibacterial for those chronically weak or ill. It purifies the blood and warms and stimulates the formation of new blood tissue. It helps in digestion of protein as well as promotes proper metabolism in the body, correcting both excess and deficiencies. On an energetic level it gives the Shakti of the Divine Mother and is effective in cleansing the chakras (nadi-shodhana)  purification of the channels of the subtle body. [55] It seems to be slightly controversial as to whether or not Turmeric is Vata/ Pitta aggravating or tridoshic. As a satvic herb Tumeric has the ability to clear the intensity, anger and heat in the blood from excess Pitta. According to Prashanti de Jager, Turmeric is tridoshic because of its herbal actions and high carbohydrate percentage (70%) – the sweet taste. [56] (*See Appendix I For related research)

Triphala*

   Triphala, perhaps the most famous combination of herbs in the Ayurveda, Triphala is made of the three herbs amalaki, bibhitaki and haritaki. Considered a panacea for digestive disorders and is useful in almost every condition of the intestines. Triphala tones the intestinal muscles, creates regularity and dispels gas.  “Triphala’s actions extend beyond the digestive system. Each herb in Triphala is itself a rasayana for one dosha… Hence, this formulation builds internal strength and ojas.”  [57] Unlike over-the-counter laxative and laxatives in general Triphala is not dependency forming; in fact it is a remedy for this sort of dependency. Triphala becomes and ally in the treatment of digestive imbalance occurring form the virus as well as the pharmaceuticals employed to treat HIV. The individual’s ability to digest and absorb foods properly increases when the doshas are brought into balance and removed when in excess from their sites of origin. (*See Appendix I For related research)

Chyawanprash*

   This famed rasayana is considered the supreme rasayana of Ayurveda. It is a tasty dietary supplement that strengthens the organs under the ribs. It is very effective in the convalescence of the weak. It is made from amalaki (see below) and is the premier builder of ojas. It is heavy, sweet, sour and pungent in taste. Its vipaka is sweet.  It is said to dispel drowsiness, fatigue and preserve the harmony of all three doshas. It inhibits aging, rejuvenates depleted bodies, increases all dhatus and builds ojas. Chyawanprash becomes a strong ally in the treatment of individuals with HIV in maintain tissue strength and tone and helps bring balance into Vata dosha. Note that some are heating and others are more tridoshic as well as it is heavy. Those who have ama should undergo purifaction by Pancha Karma for its most beneficial effects.
    Legend has it that the sage Chayavan was an old man. He was destined to marry a very young woman from his village. Fearing that he could not satisfy this young woman and produce healthy progeny, he sought the counsel of the Gods. In meditation, he was instructed in the preparation of the now famous confection. Upon eating it, he became young and virile again. Hence, chywanprash is used by those who wish to remain young for many years.  [58] (*See Appendix I For related research)

Gemstomes

   Gemstones can be worn as jewelry such as a ring or pendant. The effect is greatest when the setting is designed for allowing contact to the skin. Gold is warming and tonifying as well as tridoshic and is best for Vata. Silver is cooling and purifying and is best for Pitta. Infusions can be made by soaking the gem in water in the sunlight for Vata and Kapha, and the moonlight for Pitta. Emerald/ Jade builds ojas is a nervine sedative and is good for degenerative diseases such as HIV. Pearl/ Moonstone, increases ojas is a tonic and is calming. It reduces hyperacidity  and ails the liver and kidney. Yellow Sapphire/ Yellow Topaz/ Citrine, increases ojas as well as discrimination, tejas. Reduces fear, nervousness and anxiety and is good in wasting conditions and regulates the hormonal system. [59]

Aromatherapy

   Aromatherapy speaks to the subtle channels as well as the mind. The mind has the ability to choose to attach to healing or sorrow, in this regard Aromatics become useful in the overall well being and healing of the individual. Rose increases love, compassion, has a prabhava of reducing anger and increasing immunity. It is a anti-microbial and cools the eyes (what the body digests via the eyes.) In this manner it is used as rose water. Rose increases ojas. Sandalwood is calming to the mind, is a nervine sedative and tonic and is useful in nourishing the heart. It increases ojas and has a prabhava for reducing anxiety and fear. Lotus is tonifying on the immune system and helps build ojas. Saffron increases faith which is the antidote for Vata. It is a rasayana, builds ojas, and is considered useful in cancer and HIV. [60]

Mantra

   Utilizing the Sanskrit language mantra is a powerful tool for healing. The Sanskrit alphabet is based on the cosmic sounds of creation and as such resonates deep within our beings. On a subtle level each letter resonates in the petals of different chakras, wheels of energy. When we use healing mantras they resonate on our physical, psychological and spiritual selves. However mantra does not need to be specifically in Sanskrit, although powerful; affirmations in ones own language can and should be considered equally as healing. In an article that Yogi Baba Prem, wrote,

“Within the Atharva Veda, one can find teachings of modern day visualization and affirmation tools; with such quotes as, ‘My mind stands against disease.’ Or from the Yajur Veda (Sukla version).



Preserve my life.


Assist/Preserve my prana (life-force).


Assist/preserve my vyana (circulating life-force).
Assist/preserve my sight.


Assist/preserve my ears [hearing].


Assist/preserve my speech, let it abound.


Be active in my mind.


Keep my soul.

[Keep] my light pure. 


Yajur Veda XIV.17



This is a powerful affirmation for health and wellness.” [61]
   Maha Mritunjaya Mantra is found in the Rig Veda. It is dedicated to Shiva and is considered the Death- Conquering mantra. Along with the Gayatri Mantra it is hailed as the heart of the Vedas. It is used for contemplation and meditation and is considered a nourishing mantra.  Swami Satyananda Saraswati of the Devi Mandir (www.shreemaa.org) says that by reciting this mantra 108 times one receives the blessings of Lord Shiva.

OM. Tryambakam yajamahe
Sugandhim pushtivardhanam
Urvarukamiva bandhanan
Mrityor mukshiya mamritat

We worship the Father of the three worlds, of excellent fame, grantor of increase. As a cucumber is released from bondage to the stem, so may we be freed from death to dewll in immortality.  (www.shreemaa.org)

   The practice of mantra should be approached with care in the HIV positive individual as to fully integrate the healing benefits and to not cause undue stress and imbalance. Intense emotions, tiredness or fatigue are signs of pressing too hard into the practice of mantra.  Creating routine and allowing the practice to unfold is the key to the success of mantra japa. So-Hum mantra is a wonderful mantra to begin with, as it is the natural mantra of the breath. With each inhalation and each exhalation the breath naturally repeats this powerful mantra. In the text supplement to the California College of Ayurveda, Dr. Marc Halpern guides the so-hum meditation in this fashion: “Allow your mind to become completely present. Bring your awareness within and follow the flow of your breath as it moves in and out of your body. (Pause) Do not control your breath, just be the witness as it moves in and out. (Pause) And now, with each inhalation I want you to listen within the breath for the sounds soooooo as you inhale and huuuuuuuum as you exhale. Let your breath and your mantra be your point of focus. If, at any time, your mind begins to wander, gently bring it back to your breath and your mantra.”  This is the secret in this meditation, find the mantra naturally within the breath rather than verbally repeating “So-Hum.”  Another mantra practice is reciting the Sanskrit name of the herbs that are being consumed. The names themselves are mantras and often times are broken into stories and legends that give keys into how they are used and employed as well as the energetics behind them. The act of story in this fashion speaks to the more subtle nature of the individual and works on the subconscious to heal from within.

Meditation

   In 2008 UCLA did a study on mindfulness meditation and its effect on the CD4 count of the individual. “This study provides the first indication that mindfulness meditation stress-management training can have a direct impact on slowing HIV disease progression," said lead study author David Creswell, a research scientist at the Cousins Center for Psychoneuroimmunology at UCLA. [62] The benefits of meditation on the immune system and stress are numerous. When given the opportunity to quiet the mind and let go of the attachments of the day - the mind, body and spirit are afforded an opportunity to heal. Meditation however is a challenging prospect for many and “to get there” is often a struggle. One must first understand that meditation cannot be taught. Meditation must be experienced. Only the technique to experience meditation can be taught. Some of the techniques noted above in the mantra section are useful as well as the use of breathing techniques such as alternate nostril breathing and observing the movement of the breath. Trataka, gazing at the flame of a lit candle or ghee lamp is another technique employed to help with meditation. One observes the candle without blinking and allows the initial tears to come and pass. Upon closing the eyes, the flame will still be able to be seen. Keep the gaze at this point until it is no longer there.  In Oshos translation of the Vigyam Bhairav Tantra, he writes, “Shiva proposes one hundred and twelve methods (for meditation). These are all the methods possible. … these one hundred and twelve methods are for the whole of humanity – for all the ages that have passed and for all the ages that have yet to come. In no time has there ever been a single man, and there will never be one, who can not say ‘ These one hundred twelve methods are all useless for me.’”  [63]
   When one is guided with a few techniques the inner light turns on and the remaining journey is lead from within. In the Yoga Sutras, sutra 1:4-6 refers to the waves and motions of the mind.  In any given 24 hour period the mind is attached and wrapped up within five states: right knowledge, wrong knowledge, memory, sleep and the stories that we imagine due to something we see, hear, smell etc [64] When one quiets the mind beyond these five states equilibrium is created; a certain detachment is cultivated and a deep awareness and connection with spirit is rekindled. In the practice of meditation one has the opportunity to connect with Self, consciousness or God. Experiencing this aspect of the divine instills faith, the most healing emotion to vata dosha and HIV.

Hatha Yoga

   Hatha Yoga, here referred as the general asana, posture, practice that all the styles in the west branch from. Since yogasana can increase the effectiveness of the immune system it has the potential to limit the damage the HIV virus can create. “The practice of yoga appears to improve the immune function in part by lowering levels of the stress hormone cortisol and yoga asana may boost immunity by improving the circulation of lymph, a fluid rich in disease-fighting white blood cells like lymphocytes.” When in states of secondary disease or fatigue long restorative postures such as child’s pose and savasana during a practice is very therapeutic. Grounding poses such as those were both feet are firmly on the ground help ground vata, in addition to hip compression and forward folds. Side lateral extensions and twists move the lymph and reduce pitta dosha. Back bends clear kapha and should be approached with care as they invigorate the nervous system. To stimulate the thymus, Pandit Rajmani Tigunait, PhD. Recommends two pranayama, breath techniques: Ujjayi and Bhramari. He also suggests meditating on the hollow of the throat.
   When one steps onto a yoga mat it is a different moment each and every time, those living with HIV need to pay particular attention to their bodies and ask “How am I feeling in this posture today?” Those that are feeling good are encouraged to do a normal, energetic yoganasana practiced balanced with plenty of restorative work. Iyengar methodology for HIV insists that one not strain during any pose or practice as well as supported inversions and restorative postures are prescribed.  [65]


Conclusion

   In the article, “Conversations With My Virus,” Shana Cozad writes a heroic journey of acceptance of her virus and how she transforms and spiritualizes her journey. “This disease is simply remarkable at bringing out the raw and emotional and scariest aspects of Life, or Death, and often at the same time. Our culture doesn't prepare us how to deal with death very well, and as far as I am concerned, our culture has haphazard way of preparing us for life anyway.” [66]
    Ayurveda guides one on the journey toward equanimity and harmony. The two goals of Ayurveda are: to keep the body in a state of health and free from disease, and, To show us how to use health as a basis of, or as a part of, the path to enlightenment. [67] As noted earlier Sanskrit, the language of the Vedas, has the uncanny ability, like modern URL’s, to guide us further and deeper into stories and secrets. Ayus = life. Veda = knowledge. Ayurveda - the knowledge of life. But when one meditates on this further, the question arises; what sort of knowledge? And what and how is life defined?  The knowledge gifted to us by Ayurveda asks us to look deep within and find the Sadguru, the teacher within; to spiritualize our circumstances and to learn from them. When, as Shana Cozad demonstrates so heroically, we transform ill fortuned circumstances and diseases like HIV into spiritual teachers, we can then see the knowledge Ayurveda may be hoping to impart.

Hatha Yoga Prayer

I offer this practice to the Sadguru, the Teacher within all things,
The Teacher that is the Prana (life) from which my body emerged,
The Teacher that sustains and nourishes me with each breath,
The Teacher whose lessons are in every life experience – even pain and death.
May this practice open me to the wisdom of the Sadguru,
That my mind may know peace,
That my heart may know compassion
And my life may offer peace and compassion to all beings.
Om Shanti, Om Peace
- Darren Main[68]

Appendix I

Related Studies on the Effects of Herbs in Anti-Viral Therapies

   The role of traditional, complimentary and alternative health care is rapidly changing in the world climate. A greater emphasis on complimentary and alternative health care, and its practitioners, is developing in the wake of economic downturns. Healthcare and Health Insurance prioritized as a moneymaking industry rather than the greater seva, act of service, to heal and promote longevity is unsustainable. Although the care received in hospitals and by Doctors is beneficial for the most part; when the bottom line speaks louder than the individual that lies ill, great tides of change can and must occur. Communities have taken into their own hands the motto, “I am my primary care physician.” By integrating alternative health care practitioners as a tool in educated themselves in preventative and natural care, individuals empower themselves to take their health into their own hands, thus creating a truly holistic approach to health which is the very core of Ayurveda.

   “Traditional, complementary and alternative medicine (TCAM), drawn from indigenous medical and/or healing knowledge systems from around the world, has for the last 30 years been recognized by the World Health Organization (WHO) as providing culturally acceptable, affordable and sustainable primary healthcare. TCAM knowledge has been known for some time to assist with birthing practices, acute injuries, infectious diseases and parasites.” “Specific examples include the use of TCAM practitioners for HIV/AIDS prevention awareness and direct treatment of AIDS-related symptoms; the use of TCAM herbs for the treatment of malaria and the use of home herbal gardens for health maintenance.”  (69)

   Below is a listing of articles and abstracts that contributed to the research of this paper.

Bombay Hospital Journal
   
    Dr. A.A. Mundewadi has been practicing Ayurvedic medicine for 25 years and has several published clinical works including one study on HIV. The results of his study showed Ayurveda to be effective anti-viral and immuno-stimulant as well as safe for long-term use. (70)    (www.ayurvedaphysician.com/)

   This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating disease of the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since several months. After being given Ayurvedic treatment for about 11/2 months he became alert, and could speak clearly, albeit temporarily, for 1 week. Another patient with Nephrotic syndrome resulting in long-standing generalized oedema (2 years) had complete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patient with suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, he started putting on weight. This patient later underwent a CT-guided FNAC, the results of which are awaited. Another patient with history suggestive of HIV Encephalopathy was semi-conscious at presentation. He was passively fed on liquid diet and a combination of both modern drugs and Ayurvedic treatment. This patient became ambulatory within 2 weeks, and after 2 months of treatment he is faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedic medicines may have multi-faceted properties and need further evaluation.
Conclusion
   The retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 to November 2004 proved the Ayurvedic medicines to be considerably effective as anti-viral and immuno-stimulant,and safe on long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regular counselling support appears to be an ideal combination in the management of HIV/ AIDS patients.
Acknowledgement
   The medicines used in this study were purchased from Chaitanya Pharmaceuticals, Nasik and Nahar Pharmaceuticals, Gujarat.
References
1    UNAIDS. Global Summary of the AIDS Epidemic. Update. December 2004.
2    UNAIDS. Epidemiological Fact Sheets on HIV/AIDS. India. Page 2. 1/9/2004.
3    Foundation for Integrative AIDS Research. Potential Anti-HIV Herbs. 15/9/2002.
4    Sharma PV. Vegetable Drugs. IV Edition. Chaukhamba Publications.1978:2.
5    Dahanukar S A, Kulkarni RA, Rege NN. Pharmacology of Medicinal Plants and Natural Products. Indian J Pharmacology 2000; 32 : S81 - S118.
 

*Ayurvedic Physician, T.M.C. Office Bldg., 1st Floor, Mumbra, Thane 400612.
(71)

 

 

 

 

Allopathic and Ayurvedic Approaches to Hypothalamic Amenorrhea (by Sharyn Galindo A.H.P)

See PDF document.

Allopathic and Ayurvedic Approaches to Leucoderma (by Rama D. Napolitani C.A.S)

Introduction

Leucoderma, also known as vitiligo is a skin disorder that affects nearly 2% of the world population. [1] Allopathy, the system of medicine in widespread practice today offers palliative measures, but no cure. By contrast, the Charaka Samhita , a two thousand-year-old Indian Ayurvedic text [2] , provides a description of leucoderma with recommendations for treatment . In this paper, the modern medical understanding and treatment of leucoderma will be discussed. Then, a detailed Ayurvedic analysis and approach to management will be presented.

Modern Medicine and Leucoderma

Leucoderma, a Latin word, meaning ‘white skin' is caused by the destruction of melanocytes; the cells responsible for skin color. There are many theories as to what may be responsible for causing leucoderma. Researchers have suggested an auto-immunological, neurological or auto-cytotoxic origin. None of these have been proven definitive. [3] The disorder is said to affect all races and genders equally and in 95% of cases, leucoderma manifests before age 40. [4] As for a possible hereditary link, approximately one third of cases report a family history. The most commonly afflicted areas of the body are the sun-exposed tops of hands and faces, and hyper-pigmented areas of the body, such as the groin, nipples, genitalia and axilla. [5] The disorder is not infectious, nor does it cause pathological harm. However, leucoderma does leave the skin aesthetically disfigured, often causing psychological and emotional stress.

In consideration of no known medical cure, allopathic treatment of leucoderma offers two approaches to the management of this disorder: protection of depigmented patches and repigmentation therapies. Due to the absence of melanocytes in depigmented skin, the body is unable to provide adequate UV light shielding from the harmful rays of the sun; thus protection of depigmented patches is of paramount importance. To minimize exposure to UV concentrated light, protective measures are encouraged, such as the application of Sunscreen 15-30 SPF or the use of protective clothing. 5 In addition to protecting leucodermic patches, many cosmetic products are available that act to camouflage the affected skin.

The second approach to the management of leucoderma focuses on repigmentation therapies. Common therapies are of three types: The topical application of potent corticosteroids, (PUVA) psoralen photochemotherapy and surgical therapies. Of these interventions PUVA is considered the most effective treatment available in the United States, however the treatments are time-consuming, side effects can be severe, 4 and complete repigmentation only occurs in 15-20%. 5 Interestingly, psoralens used with photochemotherapy are obtained from the ancient Ayurvedic herb known as Vakuchi (psoralea corylifolia). [6]

Ayurveda and Leucoderma

Ayurveda, a Sanskrit term meaning ‘science of life', is said to be the most ancient system of medicine in widespread practice today. In fact, the archeological findings of the ‘Bower Manuscripts' support the notion that Ayurveda has been in continuous practice for more than two millennia. [7] The practice of Ayurveda finds its roots in a body of knowledge and principles that were systematized in the Charaka Samhita , a treatise written more than two thousand years ago. In this ancient text a description and treatment for leucoderma is discussed. However, the basic theory, principles and objectives of Ayurveda will first be presented.

Ayurveda, an ancient healing system and a medical science, first seeks to restore, then maintain Svastha of the body and mind. S vastha, meaning health in English, has a definition in Ayurveda that, when fully understood, sheds much light on the objective of this system of medicine. Health is defined “as physical and mental well-being; freedom from disease, pain, or defect; normalcy of physical and mental functions; soundness.” [8] Ayurveda, defines Svastha in Sanskrit as:

“sama dosah samagnis ca sama dhatu mala kriyah prasannatmendriya manah svastha ityabhihiyate (Sushruta Samhita, 15.38)

One who is established in Self, who has balanced doshas, balanced agni, properly formed dhatus, proper elimination of malas, well functioning bodily processes, and whose mind, soul, and senses are full of bliss, is called a healthy person .” [9]

In this Ayurvedic definition of health, not only is the western concept of health encompassed, but there are other layers, that of the doshas, agni, dhatus, and malas. Hence, Ayurveda views health as a balance of the doshas which are vata, pitta, kapha (in consideration of one's prakruti), properly formed/functioning dhatus (seven tissues of the body), and proper elimination of malas (waste products). Thus, when Ayurveda looks at a disease such as leucoderma, invariably, these aforementioned factors are taken into account and discussed. Unique to Ayurveda, is its understanding and articulation of disease.

In western medicine when a disease or a group of symptoms is examined, analyzed, then given a name, the disease has been ‘diagnosed'. In contrast, the Ayurvedic approach to disease diagnosis seeks first to define its' root, or its' roganam mulakaranani; [10] it is considered as important to define the root of a disease as it is to name a disease.

In Ayurvedic medicine, the process by which a disease is understood and diagnosed is called s arvaroga nidanam and is composed of five parts: nidanam (causative factors or etiology), purvarupa (earliest signs/symptoms), rupa (clinical signs/symptoms), samprapti (pathogenesis of the condition), and upasaya (diagnostic tests). [11] Traditionally, when a disease is being discussed, the five parts of the sarvaroga nidanam will be presented. Indeed, the ancient Ayurvedic text, Charaka Samhita , presents skin disease (kustha) following this format.

Classical Ayurveda and Svitra

In Ayurvedic classical literature, such as the Charaka Samhita , leucoderma also known as ‘white leprosy‘ is called svitra or kilasa. [12] It is within volume III, chapter VII of this aforementioned text where “ kustha (obstinate skin diseases) and leucoderma are discussed. The sarvaroga nidanam of kustha and svitra share many common threads as will now be presented. [13]

Nidanam

The development of leucoderma in an individual is said to be caused by the incorporation of the following unwholesome regimes into their life:

• “Intake of mutually contradictory food, and drinks which are liquid, unctuous and heavy;

• Suppression of natural urges;

• Performance of physical exercise in excessive heat and after taking very heavy meals;

• Transgression of the prescribed order of the intake of food and with reference to heat and cold, as well as fasting;

• Use of cold water immediately after exposure to scorching sun, exertion, or exposure to frightening situations;

• Intake of uncooked food and/or intake of food, before the previous meal is digested;

• Excessive intake of food prepared of freshly harvested grains, curd, fish, salt, and sour substances.

• Untruthfulness, ungratefulness…insult of preceptors, sinful acts… misdeeds of past lives.

Purvarupa (earliest signs/symptoms)

• Excessive or absence of perspiration;

• Discoloration of patches on the skin;

• Horripilation, itching, pricking pain, physical exhaustion, mental fatigue

Rupa (clinical signs/symptoms)

• Daruna- when dosha (chiefly) vitiates the rakta or the blood, the patches will be red in color.

• Caruna- when dosha (chiefly) vitiates the mamsa or the muscle tissue, the patches will be coppery in color.

• Kilasa- when dosha (chiefly) vitiates the medas or the fat, the patches will be white in color.” [This is the most common rupa (clinical presentation) of svitra hence leucoderma is often called kilas]

Samprapti (pathogenesis of the condition)

In the Charaka it says the three vitiated dosha mix with the dhatus, namely the rasa, rakta, mamsa, medas, and result in the white patches. “Ayurveda maintains that leucoderma is caused by some morbidity of the liver” which is a vitiation of pitta. [14]

Below in table 1, is the authors' rendition of a samprapti for leucoderma. The format used for presentation was designed and created by Dr. M. Halpern as a tool to articulate a disease process.

Table 1 :     Samprapti and Herbal Chikitsa Summary –Vata-Pitta type Leucoderma

{vata pushing pitta, or primary pitta vitiation}

 

Stage

Evidence

Dosha

Sub-dosha

Dhatu

Srota

Category

A/A

Possible constipation and gas

Vata

Apana

Rasa

Purishavaha srota

Laxatives

Demulcents

Carminative

O

Mild, transient systemic dryness

Vata

Vyana

Rasa

Rasavaha srota

Demulcents

O

Mild transient feeling of cold

Vata

Vyana

Rakta

Raktavaha srota

Circulatory Stimulants

RMD

White skin patches with irregular edges, asymmetry

Vata

N/A

Rasa, Rakta, Mamsa, Medas,

Rasa, Rakta, Mamsa and Medo vaha srota

Skin tonics,

Liver tonics

RMD

Decreased Sweat

Vata

Vyana

Rasa

Rasavaha srota

Svedavaha srota

Demulcents

RMD

Worry/anxiety

Vata

Vyana

N/a

Manovaha srota

Nervine Tonics

Nervine sedatives

A/A

Possible loose stool, burning indigestion

Pitta

Pachaka

Rasa

Annavaha srota

Demulcents

Cool dipanas

O

Transient mild burning mucus membranes

Pitta

N/A

Rasa

Rasavaha srota

Demulcents

O

Transient mild feelings of warmth

Pitta

Ranjaka

Rakta

Raktavaha srota

Alteratives

RMD

White symmetrical skin patches

Pitta

Bhrajaka

Rasa

Mamsavaha srota, medovaha srota

Liver tonics,

Skin tonics

RMD

Excessive sweating

Pitta

N/A

Rasa

Rasavaha srota

Svedavaha srota

Alteratives

RMD

Anger, criticism

Pitta

Sadhaka

N/A

Manovaha srota

Nervine Tonics

Nervine sedatives

In the above samprapti, it is indicated that vata dosha accumulates in the purishvaha srota resulting in poor elimination, then overflows into the rasa and rakta dhatu. When vata relocates to the rasa and rakta dhatu it results in deficient flow through the rasa and raktavaha srota. Coupled with pitta vitiation, in due course, an altered functioning of the liver¹ 6 occurs, which in turn contributes to impaired elimination/management of impurities in the body. It is understood in Ayurveda, that deficient flow through the raktavaha srota vitiates posaka rakta (the building blocks of the mamsa dhatu). [15] Since the mamsa dhatu is responsible for healthy skin, it stands to reason that an impairment of the skin may result. In essence, an accumulation of vata and pitta dosha and ama (toxins) in the srotas and dhatus is resulting in impaired function, as well as inferior production, of tissue. Consequently, one can understand why the Charaka says, “The patient of svitra should (first) be cleansed by the administration of elimination therapies and thereafter” [16] employ other measures. Thus it is essential that ama and excess dosha be expelled from the body, only then can the restoration of healthy tissue commence. Next, Ayurvedic treatments (chikitsa) for leucoderma will be discussed.

Chikitsa (Overview)

An Ayurvedic treatment plan starts with measures to arrest the ongoing aggravation of dosha in the body. The digestive track is targeted first with the implementation of a dosha appropriate diet. For example, if pitta-dosha aggravation were present, then a pitta pacifying diet would be implemented. Salt intake should be minimized and restricted to rock salt only, as this will further expedite recovery from kilas. [17] Concomitantly, lifestyle would be closely evaluated for possible nidanam (causative factors), and these would be corrected. Once all correctable causative factors such as lifestyle and diet have been addressed, proper eliminative measure would be taken to facilitate the removal of ama (toxins) and excess dosha from the body. Eliminative measures must initially be employed, taking into consideration a patients' agni and level of ojas, then might herbal remedies prove effective. Purification kriyas such as oleation (application of oil), svedana (fomentation or heat therapy) and vrechana (purgation) are employed to (1) “loosen and liquefy ama” and excess dosha from the various sites of accumulation in the tissue, (2) mobilize ama and excess dosha, (3) facilitate removal of ama and excess dosha from the body. [18] An additional manner of purification often mentioned with leucoderma is called rakatamoksha (therapeutic bloodletting). In this treatment, excess pitta dosha in the rakta dhatu is being removed via one of the following methods:

• Removal of 300cc of blood via venipuncture (performed following oleation and svedana) [19]

• Topical application of leeches to affected areas.

A case study published in 2004 demonstrated complete resolution of vitiligo in a six year old boy whom had incorporated raktamoksha (per topical application of leeches) in his Ayurvedic treatment plan, “There was a marked difference in the skin color after the first (application). The skin started to appear pink. After a period of 2 ½ weeks leeches were applied again, the client continued with herbs and the local application of Bakuchi oil. Gradually the skin started getting back it's brownish hue, the hair on the scalp that had turned white at the patch started turning black again…patches regained their color fully after a period of two months” [20] With proper elimination of excess dosha and ama, then herbal remedies may prove effective.

Herbal Chikitsa

An abundance of herbs are mentioned in the Ayurvedic texts, many of which are readily available today. Several of these herbs have been studied in Indian laboratories. Interestingly, properties identified in the lab often support the Ayurvedically identified properties. For example, Khadira (acacia catechu), as a decoction, is recommended for treatment of leucoderma.¹ 6 The rasa of Khadira is bitter and astringent. Its' virya is cold, and its vipaka is pungent. It is said to balance both Pitta and kapha dosha. Laboratory studies have identified constituents shown to regenerate liver cells, as well as providing anti-fungal and anti-inflammatory effects. [21] A decoction of khadira and amla is recommended as a two-ounce dose every morning.¹ 7

Another herb, Vernonia anthelmintica (somaraja/kattu-shiragam/purple fleabane), is also reported to be an effective remedy for vitiligo. The rasa is bitter, virya is warm and the vipaka is pungent. In the Indian Materia Medica a few remedies with this herb are mentioned: (1) The powdered seeds of this herb taken with a decoction of emblic myrobalans (amalaki or nellikkai) and catechu. (2) The powdered seeds taken alone (1 tsp.) (3) The powdered seeds taken with black pepper or black sesame seeds in equal parts, daily in the morning, with warm water, just after perspiring. It is indicated that if one of the above methods is followed for one year, resolution of vitiligo will occur. [22]

However, the one herb most often mentioned with leucodermic treatment is Vakuchi (psoralea corylifolia Linn). This herb is recognized as being helpful for treatment by all the major medical disciplines, Ayurvedic, Chinese, Unani, as well as Western medicine. Vakuchi, also called Bakuchi or karpkarishi has a pungent and bitter rasa, a warm virya, and a pungent vipaka. [23] Most sources suggest taking vakuchi internally as well as topically. The seeds, as a powder (churna), are recommended for internal use. The parts of the plant used for topical applications are the essential oil extracted from the seeds, or a medicated oil prepared from the seeds. As a diluted essential oil, when topically applied to white depigmented patches, it is reported to act “on both the Rouget's cells and the melanoblastic cells of the skin…stimulation (of these cells) by the oil leads them to form and exude pigment which gradually diffuses into the decolorized areas.” [24] Other methods of preparation and administration of this herb are as follows:

• The paste of the seeds made with milk is rubbed into the affected parts of the skin. However if continuous application irritates the skin, the treatment should be discontinued for some time.² 5

• Equal parts of the seeds of Vakuchi, seeds of chakramarda (cassia tora), and the wood of Mahanimba (melia azdarach or persian lilac) made into a paste with rose water is applied over the white patches. The persian lilac can be substituted with Nimba (Indian lilac or neem) berries. [25]

• Another formulation including vakuchi, Pancha-nimba gutica or Pancha-amrita is recommended in daily doses of 4 drachms (this is equal 1 tablespoon). To prepare, take the five different portions of the neem tree, namely the flowers, fruits, leaves, bark, and roots 15 parts each powdered to 1 part each of the following substances: iron oxide, chebulic myrobalans, seeds of cassia tora, triphala, fruit of Semecarpus anacardium, embelia ribes, sugar, emblic seeds, curcuma longa, long pepper, black pepper, dry ginger, seeds of psoralea corylifolia, pods of cassia fistula and tribulus terrestris all powdered. Mix all together and make into paste in the juice of eclipta erecta. Then mix with the decoction (1 in 8) of the bark of acacia catechu. [26]

A final area of treatment comes into focus when considering the last nidanam (causative factor) of this disorder which is, “untruthfulness, ungratefulness…insult of preceptors, sinful acts… misdeeds of past lives.” This nidanam has its' roots in the concept of karma. The law of cause and effect can be seen manifesting in many diseases afflicting our society. A person smoking daily for the past 30 years, who is discovered to have lung cancer, illustrates the concept of karma in action. Lung cancer is the effect. Smoking a known carcinogen, daily for 30 years, is the cause. This is a simplified example of karma. A more complex example is the all too often 60-year-old obese male with elevated cholesterol complaining of severe sudden chest pain. After presenting to the hospital with elevated troponin levels and tombstone t-wave elevations per EKG, he is informed he is having a massive heart attack. When cardiac cathaterization reveals that some of the arteries leading to his heart are severely occluded, he is told that the cause of his heart attack is the severe arterial sclerosis, which was caused by his elevated cholesterol. He might then be told that the poor diet and absence of exercise that he reports caused his elevated cholesterol. In essence this is karma in action. The cause is a life long poor diet, coupled with the absence of exercise, resulting in elevated lipid levels, ultimately leading to the massive heart attack. While many behaviors are clear causes of disease, others are much subtler. Ayurveda encourages a regular practice of self-introspection such as meditation, by which an awareness and clarity of judgement develops. People shower and brush their teeth often to maintain cleanliness of body and mouth. A regular practice of meditation can provide a similar cleansing, of the mind and thoughts. Clarity of mind produces balanced judgment and right decisions which in turn promote right actions, hence healthy results.

“Character is nurtured midst the tempests of the world" -Goethe

Having once been rough and jagged, the weather worn surface of an ocean cliff is only now smooth and beautiful due to the indiscriminant sculpturing of powerful ocean waves. So too do the trials and tribulations of life have mysterious ways of sculpting beauty out of humanity. Perhaps disease is a method nature uses to sculpt and refine creation. Vitiligo like any other ailment affecting humanity is a manifestation of disease. In this paper its roots have been articulated, and Ayurvedic remedies presented. In Western medicine, reduction of symptoms alone is all too often the result. However, leucoderma stubbornly refuses to be cured by allopathic methods. On the other hand, many cases of leucoderma have been resolved with Ayurveda. The key to successfully treating disease is a comprehensive approach. Ayurveda offers this. The key to resolving Disease is to treat the root. Ayurveda offers this. Finally, the key to restoring health is to address the individual as a WHOLE. Ayurveda achi

References

[1] Zhang XJ, Liu JB, Gui JP, et al. Characteristics of genetic epidemiology and genetic model for vitiligo. J Am Acad Dermatol.2004, 51 (3): 383-90.

[2] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 192.

[3] Yu, Dr. Hsin-Su. Melanocyte Destruction and Repigmentation in Vitiligo: A Model for Nerve Cell Damage and Regrowth, J Biomedical Science 2002;9:564

[4] Moshell, Alan. Et al. National Institute of Health Pub No. 01-4909. May 2001

[5] Dr Su, R. Handbook of Dermatology & Venereology 2 nd Edition: www.hkmj.org.hk/skin/vitiligo/html

[6] Electronic Textbook of Dermatology—Botanical Dermatology, Phytophotodermatitis, www.telemedicine.org/botanica/bot5.htm . 01/06: pg. 1

[7] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 186-92.

[8] Webster's New World Dictionary, Simon & Schuster, Inc. 1988 3 rd College Edition: pg. 621

[9] Lad, Vasant D. Text Book of Ayurveda, The Ayurvedic Press 2002 1 st Edition: pg. 279

[10] Athavale, Dr. V.B. Pathogenesis in Ayurveda, Chaukhamba Sanskrit Pratishthan, Delhi , 2001, 2 nd Edition: pg. 141

[11] Halpern, Dr. Marc. Clinical Ayurvedic Medicine , California College of Ayurveda, 2005, 4 th Edition: pg. viii

[12] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pp. 359-63.

[13] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pg. 318-63

[14] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 94

[15] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 3.19-20

[16] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pg. 359-363

[17] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 95

[18] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 8.19, 8-28, 8.39-41

[19] Ranade, Dr.Subhash, Natural Healing Through Ayurveda, Motilal Banarsidass, Delhi , 1999: pg.159

[20] Kelkar, Dr. Rucha: Vitiligo and Blood Letting- A Novel Approach: Compilation of Papers Presented at the National Ayurvedic Medical Association Conference 10/21-24, 2004: pp. 63-65

[21] Williamson, E. Major Herbs of Ayurveda, Churchill Livingstone 2002: pp. 13-15.

[22] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 1269

[23] Gogte, Vaidya V.M. Ayurvedic Pharmacology & Therapeutic Uses of Medicinal Plants (Dravyagunavignyan), Bhavan's Book University 2000: pp.436.

[24] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Vol. 1: pg. 1021

[25] Dastur,J.F. Everybody's Guide to Ayurvedic Medicine- a Repository of Therapeutic Prescriptions Based on the Indigenous Systems of India, Taraporevala Sons & CO. Bombay-1, 1960: Pg. 209

[26] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 783

[1] Zhang XJ, Liu JB, Gui JP, et al. Characteristics of genetic epidemiology and genetic model for vitiligo. J Am Acad Dermatol.2004, 51 (3): 383-90.

[2] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 192.

[3] Yu, Dr. Hsin-Su. Melanocyte Destruction and Repigmentation in Vitiligo: A Model for Nerve Cell Damage and Regrowth, J Biomedical Science 2002;9:564

[4] Moshell, Alan. Et al. National Institute of Health Pub No. 01-4909. May 2001

[5] Dr Su, R. Handbook of Dermatology & Venereology 2 nd Edition: www.hkmj.org.hk/skin/vitiligo/html

[6] Electronic Textbook of Dermatology—Botanical Dermatology, Phytophotodermatitis, www.telemedicine.org/botanica/bot5.htm . 01/06: pg. 1

[7] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 186-92.

[8] Webster's New World Dictionary, Simon & Schuster, Inc. 1988 3 rd College Edition: pg. 621

[9] Lad, Vasant D. Text Book of Ayurveda, The Ayurvedic Press 2002 1 st Edition: pg. 279

[10] Athavale, Dr. V.B. Pathogenesis in Ayurveda, Chaukhamba Sanskrit Pratishthan, Delhi , 2001, 2 nd Edition: pg. 141

[11] Halpern, Dr. Marc. Clinical Ayurvedic Medicine , California College of Ayurveda, 2005, 4 th Edition: pg. viii

[12] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pp. 359-63.

[13] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pg. 318-63

[14] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 94

[15] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 3.19-20

[16] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi-1, 2003: Vol. III, pg. 359-363

[17] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 95

[18] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 8.19, 8-28, 8.39-41

[19] Ranade, Dr.Subhash, Natural Healing Through Ayurveda, Motilal Banarsidass, Delhi , 1999: pg.159

[20] Kelkar, Dr. Rucha: Vitiligo and Blood Letting- A Novel Approach: Compilation of Papers Presented at the National Ayurvedic Medical Association Conference 10/21-24 , 2004: pp. 63-65

[21] Williamson, E. Major Herbs of Ayurveda, Churchill Livingstone 2002: pp. 13-15.

[22] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 1269

[23] Gogte, Vaidya V.M. Ayurvedic Pharmacology & Therapeutic Uses of Medicinal Plants (Dravyagunavignyan), Bhavan's Book University 2000: pp.436.

[24] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Vol. 1: pg. 1021

[25] Dastur,J.F. Everybody's Guide to Ayurvedic Medicine- a Repository of Therapeutic Prescriptions Based on the Indigenous Systems of India, Taraporevala Sons & CO. Bombay-1, 1960: Pg. 209

[26] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 783

Applying The Knowledge of Ayurveda to Appraise the US Nutritional Paradigm

By Mrunalini R. Patel, BSc.

Ayurveda and the Treatment of Attention Deficit Dissorder: (By Ryan Strong)

     Ayurveda  is the worlds oldest and most complete holistic healing modality.  Although Ayurveda appears in the Rig Veda, dating back over 3000 years, it is widely believed to be  thousands of years older.  Ayurveda in relative terms is ancient, yet it is not a relic of the past.  Rooted deep in timeless wisdom, Ayurveda is ageless.  It has been continually practiced for millennium, passed down from generation to generation,  Ayurvedic medicine remains alive, enlightening and healing.

     Ayurveda recognizes life as one unified spirit that contains and connects the energy of the universe to the individual soul.  Ayurveda sees every life form as a unique combination of matter, spirit and mind.  It approaches healing by balancing the elemental forces that make up the physical and spiritual construct of our universe.  Ayurveda is the knowledge of how to live, this knowledge brings awareness of our situation here on earth, it is very practical and yet it is profound.   Awareness and understanding of our true selves, the environment, and how the two interact.  Ayurveda looks at the qualities inherent in all matter, to the energy that pulses through all life.

     According Ayurvedic theory, there are three main constitutions make up the body.  These constitutions are often referred to as doshas or humors.  Every person has a unique dosha, with different combinations of ether, air, fire, water, and  earth.  These elements combine to make up Vata, Pitta, and Kapha.  Vata dosha having more air and ether, with pitta being more so fire.   Earth and water make up Kapha dosha.  Ayurvedic medicine seeks to recognize the dosha in each person in order to understand any imbalances that may cause disease.  By examining the doshic qualities of modern diseases, Ayurveda can balance and heal them.

     One such ailment that widely affects people today is Attention Deficit Disorder (ADD).  This disorder was known and treated by Ayurvedic doctors in ancient times, and continues to be treated by Ayurvedic doctors today.  By looking at modern and classical Ayurvedic writings to shed light on the causes, we can learn holistic treatments that   can heal this disorder. This disorder considered benign by some, is very serious. Millions of people struggle with ADD, and the numbers continue to rise.

     ADD is defined by the Diagnostic and Statical Manual of Mental Disorders  as “ inattention, compulsive behavior, and hyperactivity.”[1]  According to the Attention Deficit Disorder  Association www.adda.org , over eight million adults, and two million children have a form of this disorder.[2]  People who suffer from ADD will have varying degrees of symptom intensity.  ADD may also be referred to as ADHA (Attention Deficit /Hyperactivity Disorder).  ADHD presents with more hyperactivity.   ADD is further classified as Adult ADD or Child ADD. This only indicates the age of the person who has ADD and is not a differential diagnosis.  ADD was recognized but not defined by the psychiatric world until the mid 1970's.  Up until the last couple years, some children diagnosed with ADD were thought to grow out of the condition as they got older.  It is now thought that children whose ADD symptoms disappeared as they grew up, were in fact wrongly diagnosed.  It is now believed by western medicine that ADD is a life long affliction.

     Most people can relate to feeling unfocused, and we all have made impulsive decisions. Certainly most people at one time or another have felt hyper.  So, what are the differences between common experiences, and what is experienced by people who have Attention Deficit Disorder?  This question makes it hard for doctors to diagnose ADD.   ADD is defined as having one or more of  three main symptoms; inattention, compulsive behavior, and hyperactivity.  In addition, there are nine defining secondary symptoms associated with ADD used to diagnose the condition.  The most common are insomnia, learning disabilities, and delayed language development.  The majority of people with ADD have two if not three of these secondary symptoms.

     A person suffering from this ailment will find it hard to complete tasks, meet deadlines, and manage their time.  Dr. Thomas Brown author of Attention Deficit Disorder, suggests ADD effects the executive functions of the brain, “ getting started, shifting focus, making an effort, being persistent, being organized, managing time, managing frustration, and retrieving things from memory”, can all be compromised when suffering from ADD.[3]    According to Dr. Russell Barkley www.russellbarkley.org, people who suffer from ADD have “impaired response, impulse control, poor sustained attention, remembering to do things, delayed development of language, poor rule following, and regulation of emotion.”[4]

     Any one symptom of ADD can pose a problem, but combined, these symptoms can create real life challenges to work, school, relationships, and just about every facet of life.   People who suffer from ADD will be plagued with many difficulties.  Dr. Russell Barkley lists that ,  “up to 36% of people with ADD will drop out of high school,  up to 40% suffer from low self-esteem, up 25% will suffer from clinical depression, and up to 25% will suffer from long term addiction to drugs and or alcohol.”[5]

     According to Kenneth Appelbaum in The American Journal of psychiatry, up to 45% percent of American inmates may suffer from ADD.[6]   Although there has never been a widespread study on  American inmates, a study published by the  Norwegian  University of Science and Technology, suggests that ADD is very prevalent in the inmate population in Norway.[7]   The Suicide and Mental Health Association International, http://suicedandmentalhealthassociationinternational.org, website, Lists higher rates of  “failed marriages, motor vehicle accidents, teen pregnancy, and increased rates of suicide by ADHD sufferers.”[8]   In the book Driven To Distraction by Dr. Edward M. Hallowell and  Dr. John J. Rately, they suggest that men and women who have ADD will seek out stimulation, negative or positive, from drugs, sex, and  excess eating.  A study published by the a Nutritional Disorder Clinic in Toronto Canada, suggests a link between obesity and ADD.[9]  It suggests  that  treating ADD may became an affective tool in fighting obesity.

     ADD can damage the health of the person who has it.  The inability to focus and to be able manage ones time, actions, and thoughts can create real hardships in all aspects of life.  Failure can strongly weigh upon a person with ADD, when they are unable to meet goals necessary to move forward in life.  This syndrome does not just effect the individual, but also affects the society as a whole.

     Author and Psychologist Dr. Edward M. Hallowell states that,” ADD is almost always accompanying problems such as a learning disabilities and or low self-esteem,” and that if left untreated, “it leaves millions of children and adults misunderstood and unnecessarily floundering and even incapacitated.”[10]

     Western medicine does not know the cause of ADD.  There are several theories that underline possible causes of ADD, but nothing has been proven.  Some believe exposure to environmental toxins while in the womb may have caused ADD.   Others blame sensitivities to sugar, and synthetic food additives.  The increased exposure to television and the internet is a popular theory.  Many authors will site the combination of all three of these.  However, there is no consensus, or solid evidence supporting  them.  Currently the most accepted theory is that ADD is a genetic disorder, and that is hereditary.

     Scientists have compared brain function and activity of  a person with ADD to that of a person without it, using various tests that take images of the brain.  According to the Dana Foundation www.dana.org, an organization dedicated to the study of brain science,  “people with ADHD have differences in brain structure and function, especially in chemical regulation of dopamine and norepinephrine.”[11] , suggesting that lower levels of these neurotransmitters may cause ADD symptoms.  Dopamine and norepinephrine have critically important roles in our brains, both are key for stimulating many different areas of the brain in order for us to function properly, and especially in stimulating our brains in order for us to focus.  Current research indicates the frontal lobe, basal ganglia, caudate nucleus, cerebellum, as well as other area of the brain, play a significant role in ADHD (ADD) because they are involved in complex process that regulate behavior.”[12]  The role of dopamine and norepinephrine regulation in patients with ADD is considered the most important in treatment, from a western science view point.

      The treatment for ADD consists of medication, counseling, and cognitive  behavioral therapies, with the main focus being pharmaceutical medications.  The most commonly prescribed medications are central nervous system stimulants like Ritalin and Adderal.  Both theses medication speed up the release of dopamine and norepinephine,  increasing brain function.  Anti depressant drugs and other non-stimulant drugs are also used.  It is thought that anti depressant medications will increase up take and absorption of neurotransmitters in the brain, thus increasing brain activity.

     Both types of medication are prescribed to children and adults. These medications do not cure ADD.  The symptoms associated with ADD cease only for the time the medication is active within the body.  When the medication wears off, the symptoms return.  A patient taking these medications are to continue taking them throughout their life.

     In order for an  Ayurvedic treatment of ADD, the disorder must be seen from a Ayurvedic perspective. The doshic imbalances that cause the symptoms of ADD must be recognized in order to balance them.  Looking for references in the Caraka Samhita in regards to ADD, we can interpret what ADD would have been classified by Ayurvedic doctors during ancient times.  Although the western classification will not be identical, the symptom picture will remain the same. We can find passages in the Caraka Samhita that sight symptoms associated with inattention, hyperactivity and compulsive behavior.

     The inability to keep a steady thought stream or focus, is described in the Caraka Samhita as one of twenty main blocks of Vata in the body.  In chapter  XXVIII  verse 198, The Caraka Samhita states, “ If vyana-vayu is occluded by prana-vayu, then there will be loss of all the senses, and there will loss of memory as well as strength.”

     The Vata dosha is a combination of ether and air.  The qualities of Vata are light, cold, rough, and subtle. Because of these qualities, it is the most changeable and moveable. Being that it is the most moveable, it can easily become imbalanced, and cause imbalances in the other doshas, Kapha, and Pitta.  Vata plays many roles within our bodies and minds.  Vata dosha being in balance is vital to the health of our bodies and mind.  Vata, although one dosha, is divided up into five sub-categories, classifying the different actions and movements of Vata into and out of our body.

     The two sub-categories referred to in the cited quote from the Caraka Samhita refer to Prana and Vyana.  Prana Vata is responsible for bringing in  all of the sensory perceptions of the environment outside of us.  Prana Vata relays information we experience from the world around us to the mind through the nervous system.   According to Ayurveda the nervous system and Prana Vata are intricately connected.  Proper function of Prana Vata is key for proper neurological function.

     Vyana is the circulation and movement of the Prana once it is in the body and mind.  Because of the world around us, the Prana we take in may in a sense become toxic.  These sensory impressions may be considered toxic for the following reasons: they may not be harmonious, they may be become too much, and over load or overwhelm the neurological system.  Prana can obstruct Vyana, and because of this, Vata dosha in the mind and body may become disturbed.  This disturbance is an over stimulation of Prana Vata.  According to Ayurveda too much stimulation can increase the prana of the mind.  This excessive movement of the mind due to an over stimulation of the neurological system deranges the mind, and upsets the balance of our bodily system as a whole. The high Vata in the mind will not only cause emotional and behavioral symptoms but will also manifest as bodily distress as well.  Vata can cause numerous symptoms that include weight loss, weight gain, constipation, hyperactivity, insomnia, disorientation, confused speech, light headed, confusion and depression.  Dr. David Frawely states that, “ Vata is aggravated by excess and wasteful mental activity like worry and too much calculation about things,” he goes on to say that, “ Vata people should not read too many newspapers or magazines, or watch several television programs at the same time, as these agitate Vata and the mind.”[14]

     To look at another cause of ADD we may examine the description of mental illness in the Caraka Samhita,  Ch IX, verse [6-7], it describes that “unmada (mental illness) is a wandering mind, intellect, consciousness, knowledge, memory, inclination, manners, activities and conduct.”[15]   Describing the possible causes for imbalances, it says that any one or all of the three doshas, Vata, Kapha, Pitta, may cause mental illness, or mental illness may be due to outside factors.

     The outside factors that may cause, what Ayurveda deems “a wandering mind”, may be  the environmental pollutions of the modern world.  An exogenous factor causing ADD may be the vast  amount of  information we are exposed to through our eyes and ears. With the inventions of modern transportation, film, TV, internet, cell phones, video games, and so forth.  These images may be too much for some brains to process.  They may disturb the flow of Vata, and damage the nervous system.  Not only is the mind subjected to fast moving images and sounds, but it has to deal with the consequence of  their qualities.  Many images are in fact negative, and can also cause disturbances in Vata.  Mass media may be considered to be harmful because of it's over stimulation.  This over stimulation  is also often accompanied by negative subtle forms of advertising, that among many things: subjugates women, propagandizes violence, war, and greed.   According to the Nielson report, a company that tracks advertising and programing, “the average person is exposed to 1600 advertising messages a day,  has their TV on for 7.5 hours and watches about 4.5 hours daily.”[16]

     Prana is not just the images we see, but it is also the smells, textures, tastes and sounds.  It is the food and water we consume.  Exposure to harmful toxins in our food and water may be other exogenous factors.  Fluoride, a chemical found to lower cavities, is added to the water supplies across the United States.  In fact, according to a study done in Brazil at the University Federal de Parana, fluoride even in small quantities may cause “memory impairment” and is considered harmful to neurological function.[17] Other factors may include the standard American diet.   According to the American Heart Association,  “The average American consumes 22 teaspoons of sugar a day.”[18] Many people eat processed foods that contain additives like MSG and caffeine.  The outer environment for many humans is harmful, sometimes deadly.  Many cities and towns are polluted exposing humans to harmful pathogens, chemicals, and air pollutants.

     Attention Deficit Disorder may be a result of too much exposure to the harmful substances in our environments, of too much Prana flowing into our nervous systems. The over stimulation of our  day to day lives, may increases the flow of Prana Vata until it is too much for the body to handle.  Vedic scholar  Dr. David Frawely describes it as  ''Vata (high air) is damaged by too many stimulating impressions, particularly those of an artificial nature.”[19]

     Vata is a combination of air and ether.  According to Dr. Marc Halpern a leading Ayurvedic healer and educator, “ In the case of hyperactivity and attention deficit disorder there is an excess in the qualities of air and ether and deficiency in the qualities of earth.  Hence, from the perspective of Ayurveda, ADD and ADHD are conditions of increased expansive and creative energies and decreased in stability.”[20]  To treat the symptoms of ADD,  Ayurveda seeks to counterbalance the unstable elemental forces of ether and air by increasing the grounding element of earth.

     In treating ADD, Ayurveda approaches the symptoms and the underlying causes by working with many treatments, including diet and lifestyle changes and specific herbs that  improve cognitive function.  These treatments include cleansing possible toxins known in Sanskrit as Ama, that have built up in the body and even the mind.  To treat ADD,  Ayurveda looks at each individual case, and does not prescribe one treatment, nor does it view any one protocol to be appropriate for any one person.  Everyone has a unique make up of doshic qualities, with varying degrees of elemental make up.  Each person has a different level of strength, or vital energy.  Vital energy in Ayurveda is known as Ojas.  Determining the level of the ojas is key in any treatment plan of ADD.  If  the cause of the doshic imbalance is deemed that of exogenous factors, treatment may include cleansing toxins from the body and mind.  However, if the ojas in the individual is low, cleansing is contraindicated, because cleansing may increase depletion of Ojas.    

     ADD is a Vata disorder, that has increased elements of air and ether, this causing too much movement in the mind and body.  To balance Vata, actions, food, and herbs of apposing qualities of ether and air are administered.  The increased Prana causes agitation to the nervous system. This flow must be slowed, grounded and stabilized.  Herbal medicines, routines, and foods that are slow, heavy and sweet have the elemental qualities of earth. They generally build tissues and ojas, which will nourish and calm Vata. 

     To fully treat ADD Ayurveda seeks to reverse the cause of the imbalance.  This is paramount and must be looked at and dealt with for healing inattention, compulsive behavior, and hyperactivity.  To reverse the cause of ADD, a lifestyle that is first and foremost regular must be experienced.  Regularity of sleep patterns, eating patterns, and avoiding anything that disrupts, or over stimulates the senses.  Steady routines stabilize Vata and negate the ill effects that irregularity causes. Individuals with ADD also must limit activities like TV, internet, and travel. They must avoid stimulants like refined sugar and caffeine.  The relief an individual may experience by using stimulates to see through the fog of inattention is momentary.  The use of stimulants will increase the disturbance to Vata, and will  weaken the nervous system, and lower ojas.  Over stimulation of any kind must be completely avoided, and is vital for successful long term treatment.  Building Ojas is key to having and maintaining healthy minds, nervous systems, and bodies.  Healthy levels of Ojas will help stabilize the mind and counter the symptoms of inattention, compulsive behavior, and hyperactivity. Ojas will also protect people from substances or environmental factors that cause Vata disturbances.   Creating consistent patterns in our life, avoiding mass media, building Ojas, and clearing Ama in the the mind and body will heal ADD.

     Ayurveda utilizes a large spectrum of herbal remedies to address neurological disorders caused by doshic imbalances.  Holistic Ayurvedic herbal medicine seeks to bring balance to the entire body system. For example, if a person is suffering from symptoms like inattention, hyperactivity, or compulsive behavior, Ayurvedic medicine will employ herbal remedies that both seek to give symptomatic relief, and repair and rebuild healthy tissues in the entire body.

     Rasayana therapies that include herbal preparations are useful tools in treating the nervous system and mind of a person suffering from ADD.  Rasayana is defined as rejuvenation.  Ayurvedic rejuvenation therapies that will treat both the Vata in the mind and nervous system, according to The Ayurvedic Encyclopedia are, “oil and ghee therapies are given to remove block.”[21] The Ayurvedic Encyclopedia also includes “abhyanga, ingestion of ghee to stimulate the mind, intellect, memory, and consciousness.”[22] The Ayurvedic Encyclopedia also sites the use of the herb Brahmi with ghee.[23]

     In the case of ADD a herbal medicine prepared with the herb Bramhi (bacopa monniera) would be administered.  A study done in Australia by the Brain Sciences Institute at Swinborne University in Victoria, studied the effects of Bramhi on people. The study revealed to modern scientists what Ayurveda has known for centuries,    noting; “cognitive enhancing effects in healthy humans after 90 day administration of the bocapa monniera extract.”   Other therapies to improve the mind and nervous system include nasya, mana shuddi, and pratyahara.

     Nasya is medicated oil administered into sinuses through the noise. Nasya medicated with herbs that ground Vata, and clear the mind will be very helpful in the treatment of  Vata symptoms associated with  ADD.  According Vedic scholar Dr. David Frawley, “ Nasya and neti are important treatments of Vata conditions in the nervous system and mind”... “They help restore the organic equilibrium of the mind and body and hormonal secretions that hormonal secretions that are ruled by Prana.”[25]

     Mana Shuddi is mental cleansing. This can be achieved by pratyahara, which is fasting from one or more of the senses.  Resting our senses by withdrawing from hearing, seeing, touch, tastes and smell, we rest the nervous system and also cleanse the mind. Both of these practices help build Ojas and increase the stability of the mind. According to The Ayurvedic Encyclopedia the yoga posture Shavasana, also known as corpse pose is a good way to practice Pratyahara.[26]

     The Ayurvedic approach is to balance elemental qualities by determining the underlying doshic imbalance, state of ojas, and toxin (ama) build up.  Attention Deficit Disorder can be fully treated by Ayurveda.  The combination of symptoms may be the result of a combination of causative factors.  Regardless of the causes western medicine may discover for ADD, be it genetic, environmental, dietary, or a combination of all three, the Ayurvedic treatments will remain the same, and stand the test of time. The treatment will remain as effective today as it was 3000 years ago.  However it is clear from the research that ADD is serious, for the individual suffering from it, and the effects on the society as a whole. The modern day world is over stimulating  to the senses, and toxic to the mind and body. To combat ADD and to reverse the causes, we must reduce the speed and volume of modern life.  We must live in the natural rhythms of day and night.  The food we eat need to be appropriate for our needs, organic and fresh. The air we breath must be clean, and the water we drink and give to our children must be pure.

     Vata is the most sensitive dosha, exhibiting symptoms of imbalances much Quicker than the other doshas.  Perhaps it might be wise to view ADD, as an early warning.  Maybe those suffering from these Vata imbalances or “ADD”, are the metaphoric canary in the mines.  An alarm, warning us of the deeper issues that may come to manifest.  The rising ADD population may represent pending issues the world faces.  The human species is living out of balance from nature and because of that, the planet as a whole is suffering.   Using Ayurveda as a lens to perceive the world, we can both heal much of what has been done, and we can see the causes for the issues.  Ayurveda works both to minimize and end suffering, but more importantly, it seeks to reverse the cause.   Ayurs is the root sanskrit word meaning “to align”.  It is this aim of aligning with spirit, mind and body that Ayurveda seeks to attain.  It is the truth of our reality that we must align ourselves with, to live in, and to abide in.  The pure radiance of health and happiness is our birth right.  Living in balance and harmony is not some idealistic dream,  but a life style we can fully realize.  It is not a foreign science we must adopt, but is the unnatural lifestyle of most modern cultures we must un-adopt.  Living in balance is moving through  life with our hearts fully open, and hearing life by listening to our soul.  Only then can we live in alignment, to be in tune with our higher self.  From our higher-self we know and make right choices. This is what it means to live righteously.  To make the right choices, from the foods we choice to eat, from  how we eat them, and for all the other millions of decisions we make. In ayurs, in alignment we simply  live right.  This is Ayurveda, this is knowledge of life.

 

References 

1.  The American Psychiatric Association, The Diagnostics and Statistical Manual of Mental Disorders 4th Edition: (Washington D.C.: The American Psychiatric Association, 1994) 85.
2.  The Attention Deficit Disorder Association.  Www.add.org.mc/page?citepageid=92501eorgid=atdda. “Over eight million people”  (1996-2009)  11/25/09
3.  Brown, E. Thomas,  The Unfocused Mind in Children and Adults: (New York: Integrated Publishing Solutions, 2005) 21.
4.  Russel, A. Barkley PhD. D. The Official Site www.russelbarkley.org/adhd.fucthtm.  “Up to 36% of people with ADD.” (2006) 11/15/09  “Getting started, shifting focus.”  (2009)  11/15/09
5.  Russel, A. Barkley PhD. D. The Official Site www.russelbarkley.org/adhd.fucthtm.  “Up to 36% of people with ADD.” (2006) 11/15/09  “Getting started, shifting focus.”  (2009)  11/15/09
6.  Kenneth L. Appellbaum, M.D., “Assessment and treatment of correctional inmate with ADHD,” The American Journal of Psychiatry 165( December 2008):1520 
11/25/09  Http://ajp.psychiatryonline.org
7.  U.S. National Library of Medicine.  Www.pubmed.gov.ncbi.nlm.nih.gov/sites/entrez.  “prison ADD”  Rassmusen K. Alvmikr. J am acad psychiatry law. (2001) Pmid 29 (2) : 186-93. 11/25/09
8.  The Suicide and Mental Health Association International.  Www.suicideandmentalhealthassociationinternational.org/adhsui.html.  “Failed marriages, motor vehicle accidents”  (2004-2006)  11/25/09
9.  Fleming, Levy.  Nutritional Disorder Clinic.  Http://www.ncbi.nih.gov/pubmed//9223848?itool
“Obesity and ADD.”  Pmid: 19223848 : Canada (2009) 11/25/09
10.  Hallowell, M. Edward; Ratey, J. John, Driven to Distraction : (New York:  Simon and Shuster, 1995)Preface xi.
11.  The Dana Foundation.  Www.dana.org/news/brainnews/detail.aspx?id=10398.  “People with ADHD have differences in brain.”  Mchann, Guy MD.  (2007) 11/25/09
12.  The Dana Foundation.  Www.dana.org/news/brainnews/detail.aspx?id=10398.  “People with ADHD have differences in brain.”  Mchann, Guy MD.  (2007) 11/25/09
13.  Sharman P. V. , Charaka Samhita : (Varanasi: Chaukambha Orientalia, 2003) 481.
14.  David Frawely, AYURVEDIC HEALING FOR HEALTHCARE PROFESSIONALS PART IV :(New Mexico:NorthAmerican Institute for Vedic Studies, 2006)66.                                        
15.  Sharman P. V., Charaka Samhita : (Varanasi: Chaukambha Orientalia, 2003)160.
16.  The Neilson Company.  Http://blogneilson.com/neilsonwire/online-mobile/americans.  “The average person is exposed to.”  (2009) 11/25/09
17.  U.S National Library of Medicine.  Www.ncbi.nlm.nih.gov/pubmed/19957215?itool.  “Memory impairment”  Pereira Dombrowski.  Sector de ciencias biologicals. Brazil. Pmid: 19957215 (2009) 11/25/09
18.  American Heart Association.  Www.circ.ahajurnals.org.  “The average American consumes.”  R.K.
Johnson  (2002)  11/25/09
19.  David Frawley, Ayurvedic Healing for Healthcare Professionals Part IV : (New Mexico: North American Institute for Vedic Studies,2006)62.
20.  California College of Ayurveda.  Www.ayurvedacollege.com/articles/drhalpern/clinic/hyperactivity-add.  “In the case of hyperactivity and attention deficit.”  (2009)  11/25/09
21.  Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)466. 
22. Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)467.
23.  Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)468.
24.  U.S. National Library of Medicine.  Www.ncbi.nlm.nih.gov/pubmed/18683852?itool.  “Cognitive enhancing effects in healthy.”  Stough C. Downy: Brain and Science Institute. Australia. Pmid: 18683852.  (2008)  11/25/09
25.  David Frawley, Neti, Healing Secrets of Yoga and Ayurveda: (Wisconsin: Lotus Press,2005)54.
26.  Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)280.

 

Ayurveda – An ancient healing system’s gifts to the Modern Woman

Ayurvedic Approach to Age-Associated Macular Degeneration (by Rammohan V Rao PhD,C.A.S)

Abstract

Macular degeneration also called as Age related macular degeneration (ARMD) is an age
associated chronic eye disease and is a very common cause of reduced vision among
older individuals over the age of55 years. The condition is characterized by degeneration
of light-sensing cells of the central region of the retina - the rnacula which malfunction
and eventually die, resuhing in a gradual decline and loss of central vision, while
peripheral vision is retained. MD is the main cause of blindness in the United States and
accounts for blindness in approximately 80 percent of people who are 75 or older. The
condition affects more than 10 million Americans and this number is predicted to
increase as the ''baby boomers" age.

Eyes, Vision and Macular Degeneration

The retina, which is situated at the back of the eye, contains an extraordinary
photosensitive array ofcells that line the back ofthe eye. The light fulling onto these cells
in the retina is transfurmed into electrical signals which arc transmitted to the brain
centers !bat process and interpret them. The retina has two main parts - the macula and
the peripheral retina 1-3.
The rnacula is the part of the retina that is responsible fur seeing line detail (see fig
below), such as reading, seeing fueial features and interpreting different colors. The
macula is made up of densely packed light-sensitive cells called cones and rods. These
cells, particularly the cones, are essential for central vision. The cones are responsible for
color vision, and the rods enable the individual to see shades ofgray 1-3

The choroid is an underlying layer of blood vessels that noutishes the cones and rods of
the retina. A layer of tissue furming the outermost surfuce of the retina is callcd the
retinal pigment epithelium (RPE). The RPE is a eritical passageway fur nutrients from the
choroid to the rerina and helps remove waste products from the retina to the choroid. It is
this part of the retina that is affected by age-related macular degeneration and results in
debilitating loss ofvital central or detail vision 1-3.

Types of Macular Degeneration

Read Full Article

Ayurvedic Approach to Down Syndrome (by Vidya Venkatesh A.H.P.)

See PDF document.

Ayurvedic Approach to Stress (by Jeff Mortlock C.A.S)

See PDF document

Ayurvedic and Allopathic Approaches to Migraine Headaches (by Patricia J. Brinkmann B.S., A.H.P)

See PDF document

A Survey of Marmani Chikitsa By: Emily Laine Levoy

Introduction

   Ayurveda, the knowledge of life, is India’s most ancient system of healing.  Its fundamental aim is to bring each and every one of us into alignment with our true nature as Spirit, and thus allow us to be our best, healthiest, Selves.  Through the application of myriad therapies using herbs, colors, aromas, foods, breath, movement, meditation, oil, massage and more, Ayurveda prescribes a unique program to balance the unique constitution of each unique individual that exists in the world. 
 
   Ayurveda’s origins are in Samkhya philosophy, which teaches that in the beginning there existed only Purusha, the potential for pure consciousness, and Prakriti, the potential for pure matter.  Purusha desired to know itself and merged with Prakriti in the act that was the beginning of the world as we know it.  From this merging the cosmic vibration of Aum emerged, the qualities of Sattva (clarity or mind), Rajas (motion or life), and Tamas (inertia or matter) were produced, and the five basic elements of earth, water, fire, air, and ether were created.  The elements are the building blocks for all that exists, and their physical and subtle forms are the basis for Vata (physical air and ether), Pitta (physical fire and water), and Kapha (physical water and earth), and for Prana (subtle air and ether), Tejas (subtle fire and water), and Ojas (subtle water and earth).  It is with these six elemental combinations that Ayurveda diagnoses and treats it’s patients.   
 
   Under the umbrella of Ayurvedic treatments falls Marma Therapy, also called Marmani Chikitsa, which involves the stimulation of sensitive points to promote healing in the physical, mental, and energetic planes by affecting the flow of prana.  Marma points can be found all over the body from the hands and feet to the trunk and head, and when manipulated via massage, pranic healing, oil and herb application, heat, or pressure, can “alter both the organic functions and structural conditions of the body” (Muley).  Since all was created from Purusha and Prakriti, all matter is fundamentally the same.  While it may be difficult to perceive this oneness of all, marma points provide a super sensitive entry point into these more subtle realms of the physical-energetic connection that resides in all of us.  In the words of Dr. Vasant Lad, “Like quantum mechanics, Ayurveda holds that a human being is not a solid, stable material structure but an ever-changing, dynamic collection of energy and intelligence in the larger field of energy and intelligence that is the universe.” (Lad, 19)   Marma points are vortexes of prana, the life force that can be used as a gateway into this dynamic field.
 
   The purpose of this exposition is to provide a general overview of the origins and classical uses of marma, as well as a survey of the application of marma therapy in the modern age.  For in depth information on any specific marma point, therapy, or Ayurvedic concept please refer to the copious information available in the sources cited at the end of this paper.

History and Evolution:

   The aim of marma therapy in the modern day is to promote healing, however as vital points of life marma have also been used for harm.  In his course on marma therapy, Dr. Marc Halpern said, “any area of the body that can be harmed with a forceful blow can be healed with a therapeutic touch,” and it is this dichotomy that can be seen in the history and evolution of marma.  An important part of Ayurveda, Yoga, and the martial arts of Southern India, marma originated in the most ancient of Indian civilizations known as the Indus-Sarasvati culture (3500 - 1700 BCE) which was located in the north of India and evolved along with other Vedic disciplines from this time.2 Emphasized as a means to inflict injury on an opponent, as guidelines for healing wounds,4 and as a map for the use of body armor in combat, marma points were an integral part of South Indian martial arts and “the path of the warrior who learned to master his Prana for both defensive and offensive purposes”(Frawley, 8).  Wartime surgeons in classical times were versed in the energetics of marma points in order to provide the best possible care on the battlefield.8  References to marma points can be found in a wide variety of ancient texts including the Rig Veda, Mahabharata, Charaka Samhita, Sushruta Samhita, and classical yogic texts where marmas are incorporated with asana, pranayama, and the nadis.2
 
   A noted Ayurvedic surgeon, Sushruta is recognized as the leading contributor to the classical study of marma.  His text, the Sushruta Samhita, defines marma as fatal spots8 and contains details for manipulating marmas through surgical techniques and in the treatments of acute conditions.  In the section of his text on anatomy there exists documentation on the location and effects of each marma point (detailed below) and this knowledge has evolved with each generation of practitioner.4 
 
   Interestingly, in his commentary of the Sushruta Samhita, Prof K.R. Krikantha Murthy specifically comments on the use of marma for therapeutic effect as is common in modern day.  “
  • A recent trend among some Ayurveda scholars is an attempt to equate and correlate knowledge of Marma with the ancient Chinese method of treatment known as Acupuncture.  Though recognition of special spots on the body is common to both, the aim of approach of each one is thoroughly opposite of the other.  While Ayurveda describes the ‘Marma’ as seats of prana… the descriptions are mainly intended to warn the surgeon not to cause injury [where as] Acupuncture… spots are considered centers of ‘vital energy’ that when stimulated by sharp needles… brings about cure of many diseases.  Nowhere in Ayurvedic texts is there any suggestion of meddling with the Marma for either relief of pain or for cure of diseases” (Murthy, 115). 
   Dr. Frank Ros, however, states that errors were made in earlier translations of the Sushruta Samhita, and upon further review, “evidence was found showing that the marmas correspond precisely with traditional acupuncture points used to treat the vital organs in the flow of qi” (Frawley, 215).  The terms dhamanis and siras were previously misinterpreted to mean arteries and veins, when actually they correspond to the channels, which control the flow of prana (or qi).  Many prominent Ayurvedic scholars agree with Dr. Ros’s statement, including Dr. Vasant Lad whose entire book, Marma Points of Ayurveda, is a comparison of Marma and Acupuncture 
Whether marma were classically used for healing or not, it is nonetheless now commonly used as such in Ayurvedic clinics and schools around the world.

Locations, and Categorizations:

   According to Sushruta and Dr. David Frawley there are 107 marma, though others including Vagbhata and Dr. Vasant Lad indicate there to be 116 or 117.  Vagbhata says that “structures which show irregular pulsation and where the pain on pressure persists can be labeled as Marmasthana” (Muley).  Sushruta categorizes marma according to the following tissue types: Mamsa (Muscular) Marma, Sira (Venous) Marma, Snayu (Ligament) Marma, Asthi (Bony) Marma, and Sandhi (Joint) Marma.8   Some say marma may contain all five tissue types, and some may contain only two.  Marma can be measured by the unit angula, which are defined as “the width of the patient’s middle finger measured across the proximal interphalangeal joint” (Lad, 316).  
   
   The following table and diagram of marma points with their location and size is composed of the 107 marma according to Sushruta.  While there are descriptions available as to the locations of marma points on the physical body, every body is different, thus is may take a trained marma therapist to locate the specific points.
 
Marma Location Size Number of Points
Adhipati Crown Chakra ½ angula 1
Amsa Shoulder ½ angula 2
Amsaphalaka Shoulder blade ½ angula 2
Ani Lower region of upper arm and upper leg ½ angula 4
Apalapa Armpits ½ angula 2
Apanga Outer corner of each eye ½ angula 2
Apastamba Medial and inferior to nipples on abdomen ½ angula 2
Avarta Midpoint above each eyebrow ½ angula 2
Bhavi Inside of upper arm 1 angula 2
Basti Lower abdomen/ bladder 4 angula 1
Brihati Broad region of upper back ½ angula 2
Guda Rectum 4 angula 1
Gulpha Ankle 2 angula 2
Hrdaya Heart 4 angula 1
Indrabasti Center of forearm and lower leg ½ angula 4
Janu Knee 3 angula 2
Kakshadhara Coracoid Process 1 angula 2
Katika Taruna Hip joint ½ angula 2
Krikatika Neck joint ½ angula 2
Kshipra Between thumb and index finger and between big toe and second toe ½ angula 4
Kukundara Sides of the lower iliac spine ½ angula 2
Kupara Elbow joint 3 angula 2
Kurcha Bottom of thumb and big toe 4 angula 4
Kurchashira Base of thumb joint and base of big toe joint 1 angula 4
Lohitaksha Lower frontal end of shoulder and hip joint ½ angula 4
Manibandha Wrist 2 angula 2
Manya Side of the neck 4 angula 2
Nabhi Naval 4 angula 1
Nila Base of the throat 4 angula 2
Nitamba Upper buttock ½ angula 2
Parshva Sandhi Upper hip ½ angula 2
Phana Side of each nostril ½ angula 2
Shankha Temple ½ angula 2
Shringataka Just below each cheek bone 4 angula 4
Simanta Sagittal Suture of skull 4 angula 5
Sira Matrika Base of the neck 4 angula 8
Stanamula Nipples 2 angula 2
Stanarohita Superior and medial to nipples ½ angula 2
Sthapani Third eye center ½ angula 1
Talahrdaya Center of palm of hand and sole of foot ½ angula 4
Utkshepa Above ears ½ angula 2
Urvi Mid-region of upper thigh 1 angula 2
Vidhura Behind and below ears ½ angula 2
Vitapa Perineum 1 angula 2
 
   As their origins lie in combat, five types according to the result of injury additionally categorize marma points.  The following information comes from Prof K.R. Krikantha Murthy’s translation of the Sushruta Samhita:
  • Sadya Pranahara:  Immediately causing death
  • The marma of this type are Shringataka (four points), Adhipati (one point), Shankha (two points), Kanthasira/ matrika (eight points), Guda (one point), Hrdaya (one point), Basti (one point), Kshipra (four points), and Nabhi (one point).  According to Sushruta, Sadya Pranahara points have the qualities of fire, and this is why they quickly cause death.  Some classical physicians said that Sadya Pranahara points are those containing all five tissue types (Mamsa, Sira, Snayu, Asthi, and Sandhi).  Sushruta disagrees and says that all five tissue types are present in the below four types of marma.
  • Kalantara Pranahara: Causing death after some time
  • Kalantara Pranahara have the qualities of water and fire, thus with their hot/fiery qualities kill debilitated people quickly, and with their cold/watery qualities kill others after some time.  Sushruta designates the following marma as Kalantara Pranahara:  Stanamula (two points), Stanarohita (two points), Apalapa (two points), Apastamba (two points), Simanta (five points), Tala (four points), Indrabasti (four points), Katika Taruna (two points), Brihati (two points), and Nitamba (two points).  
  • Visalya Pranahara:  Fatal if pierced
  • Visalya Pranahara points have the quality of air, thus are fatal if the air residing in the marma is disturbed.  If pierced, the air will remain undisturbed if the foreign object is not removed, but upon removal of the foreign object air will be allowed to escape from the marma and thus cause death.  Marma of this type are Utkshepa (two points) and Sthapani (one point).
  • Vaikalyakara:  Disability causing
  • Sushruta describes Vaikalyakara marma as “possessing qualities of the moon/water” and explains that the corresponding stable and cold qualities help with the sustenance of life when these points are injured.  Thus, only disability is caused.  Points of Vaikalyakara nature are Lohitaksha (four points), Ani (four points), Janu (two points), Urvi (four points), Kurcha (four points), Vitapa (two points), Kupara (two points), Kukundara (two points), Kakshadhara (two points), Vidhura (two points), Krikatika (two points), Amsa (two points), Amsaphalaka (two points), Apanga (two points), Nila (two points), Manya (two points), Phana (two points), and Avarta (two points).
  • Rujakara:  Pain causing
  • o The final categorization of marma point is Rujakara, which designates points composed of the qualities of fire and air, which produce pain.  These marma are Gulpha (two points), Manibandha (two points), and Kurcha Sira (four points).  
 

Relations to Ayurveda & Diagnosis

   Ayurveda bases its diagnoses on the fundamentals of the three doshas:  Vata, Pitta, and Kapha.  As already explained, each dosha is a combination of two elements, and it is the qualities of these elemental combinations that provide clues as to the nature of a given imbalance.  Treatment is then accomplished using the opposite qualities to those of the condition .  Conditions of Vata nature will present with qualities such as cold or dry, and they may have decreased tissues, energy, pain, or insomnia.  Sensitivity upon light pressure of a marma would be indicative of Vata.  Pitta conditions will display warm or hot qualities such as fever, anger, or bleeding, and would be indicated by sensitivity to moderate pressure on a marma.  Kapha conditions will be those of heaviness such as water retention, excess weight, tissue, mucus or swelling.  Heavy pressure causing sensitivity would indicate a Kapha imbalance at the site of a marma.  Any of the qualities of a specific dosha can be observed at the site of a marma to provide clues to determine the best course of treatment.  
   
   Different marma points also relate specifically to different doshas and body systems, and can be used both to indicate an imbalance, and in the treatment.  These relationships are detailed in the tables below:
 
Relationship of Doshas, Subdoshas, and Marma Points
Vata
                                      Pitta                                   Kapha
Prana Vayu Adhipati Sadhaka Pitta Adhipati Tarpaka Kapha Adhipati
  Sthapani   Simanta   Simanta
  Phana   Hrdaya   Hrdaya
  Vidhura Alochaka Pitta Kurcha   Shringataka
  Kshipra   Kurchashira   Krikatika
  Talahrdaya   Sthapani Bodhaka Kapha Shringataka
Udana Vayu Nila   Apanga   Manya
  Manya Bhrajaka Pitta Nila   Phana
  Krikatika   Manya Avalambaka Kapha Hrdaya
  Amsa   Talahrdaya   Stanamula
Vyana Vayu Hrdaya   Amsa   Talahrdaya
  Brihati   Katika Taruna Kledaka Kapha Nabhi
  Amsaphalaka Pachaka Pitta Nabhi   Apastamba
  Talahrdaya   Apastamba   Kurchashira
  Kshipra   Kurchashira Sleshaka Kapha Janu
Samana Vayu Nabhi   Indrabasti   Kupara
  Apastamba Ranjaka Pitta Nabhi   Manibandha
  Kurchashira   Kupara   Gulpha
Apana     Basti   Janu   Katika Taruna
  Guda   Kukundara    
  Vitapa        
  Talahrdaya (feet)        
  Lohitaksha (Legs)        
  Utkshepa        
 
Relationship of Body Systems and Marma Points
Circulatory System Hrdaya, Nabhi, Kupara, Brihati, Janu, Lohitaksha, Sira Matrika
Digestive System Nabhi, Indrabasti, Kurchashira, Parshvasandhi, Shankha
Female Reproductive Guda, Vitapa, Gulpha, Basti
Lymphatic System Hrdaya, Kshipra, Stanamula, Lohitaksha, Amsaphalaka, Nila
Muscular System Kurchashira, Kakshadhara, Stanamula, Stanarohita, Guda
Nervous System Adhipati, Simanta, Sthapani, Apalapa, Apastambha, Shringataka
Respiratory System Talahridaya, Kshipra, Hridaya, Phana, Sthapani
Skeletal System Kukundara, Katikataruna, Janu, Manibandha, Simanta
Urinary System Basti, Guda, Kukundara
 

Methods of healing through Marma

There are many methods through which healing such as massage, oils, heat, herbs, and pranic healing which a trained therapist whilst interacting with marma points may employ.  There are other therapies such as yoga postures and meditation, which a person can use to independently affect their marma points and with the right knowledge affect the flow of their own prana.  Below some of these techniques are described. 
 
Massage/ Therapeutic Touch
   One of the most basic treatments in Ayurvedic Medicine is Abhyanga, the Ayurvedic Oil Massage.  A rejuvenating therapy with strokes coordinated with the five Vayus, or directions of Vata dosha, Abhyanga affects marma points through therapeutic touch, and through the healing qualities of the oils and any herbs or aromas that are used.  Specific attention to marma points may be included in the massage, but marma points are affected simply through the flow of Abhyanga strokes without specific concentration,
   
   Acupressure (also called Mardana by Dr. Frawley) is another form of therapeutic touch where firm pressure is held on a specific marma or collection of marmas until associated tension or pain is reduced or released.  The pressure used should be quite firm for Kapha conditions, moderate for conditions of Pitta, and light for those of Vata nature.

Herbs

   Ayurveda uses a vast breadth of herbs and formulations for internal and external healing.  The topical application of herbal medicated oils, pastes, and powders may be used to elicit a desired effect from a specific marma.  Dr. Frawley recommends Guggul as the most well rounded herb for marma therapy, citing it’s clearing properties and it’s affinity for reducing pain and promoting the flow of energy.  For healing of a specific condition an herbal formula with properties specifically targeted toward the desired result should be used. 

Oleation
   Most commonly used as part of the Abhyanga massage, the application of oils is deeply therapeutic most especially for conditions of Vata nature but can be therapeutic for imbalances of all doshas.  Warm sesame oil is best for the treatment of Vata, and the essential oil of sandalwood, calamus, or cinnamon can be added.  For pitta coconut or sunflower oils are best, potentially mixed with the essential oils of sandalwood or rose.  For Kapha, oil is generally contraindicated however sesame and mustard oil mixed together with the essential oils of camphor, menthol, or wintergreen would be balancing.2

 
   Another technique would be applying oil locally to the specific marma points that are being used for healing, rather than applying oil to the whole body as in Abhyanga,
 
Pranic Healing
   Pranic Healing involves transmitting energy from the healer to the client and can be accomplished by placing one’s hands above the specific area of the body (or in this case the marma point) that is the target of the healing.  In Ayurvedic terms marma points are part of the Majja dhatu, or nervous system, which is governed by prana.  Pranic healing can assist in the harmonious interaction of prana vayu (the flow of cellular intelligence), sadhaka pitta (present especially in the gray matter of the brain) and tarpaka kapha (the white matter covering the brain), to promote greater healing in the physical, mental, and emotional bodies. 
When contemplating the manipulation of the emotions, energetic body, or physical points remote to a specific marma it is interesting to note the correlation with modern superstring theory which considers all particles to be made of “infinitesimally small vibrating strings”5 which are the foundation of all energy. 
  • The oneness of mindbody and how it may be bundled as vibrating energy that is interconnected to everything else in the universe, is the basis of what may be called the "Cosmic Connection". Furthermore, vibrating bundles of energy (i.e., vibrating strings of mutual harmonic resonance that have coalesced to form an electromagnetic field operating at a given frequency -- not unlike a frequency for a radio station, for instance) create fields of influence around their physical selves.  A physical manifestation of the energy of thoughts is the instincts and/or emotions as they elicit as a response to a specific stimulus.7
   Since all matter, all emotions, and all thoughts are considered to be energy, and since all energy is thought to be made up of the same fundamental component, it becomes clear how the manipulation of certain points on the body could promote healing elsewhere.  According to Dr. Deepak Chopra, “Once you strip off its physical mask, a cell is really a junction point between matter and consciousness, a station where the quantum mechanical body and the outside world intersect.” (Chopra, 178) 

Yoga Asana
   Yoga is known to increase general pranic levels  and also directly affects marma points through compression in certain poses.11  For example, Janu Sirsasana (seated forehead to knee pose) compresses Nabhi, Janu, and Sthapani marma as the third eye connects with the knee, and the abdomen is contracted.  Sirsasana (headstand) stimulates Adhipati through the connection of the crown chakra with the earth.  Halasana (shoulder stand) affects Hrdaya, Nila, and Nabhi as the frontal plane of the body is contracted and may also affect Brihati and Krikatika on the posterior plane.  With a thorough knowledge of marma points and yoga postures, a great variety of therapeutic applications may be derived. 

Meditation 
   Healing may be brought on by meditation upon a specific marma point, or set of points, to promote the free flow of prana independently of a therapist.  Simply concentrating one’s energy on the specific point(s), or by following the flow of energy within the body to or from a specific point, or by performing a complete rotation of consciousness around all the marma points of the body, awareness and healing may be achieved. 
   

Conclusion

The subject of Marma Therapy is vast and complex, with varying opinions from many prominent Ayurvedic physicians and scholars.  All seem to agree on at least one thing:  that marma points are regions on the body powerful enough that they can be used for harm or healing.  The experience of the author in the realm of using marma points for healing has been quite potent, through meditation, yoga postures, massage, and pranic healing techniques used on her self and in the use of therapeutic touch and pranic healing transmitted to others, and this experience was her motivation for embarking upon this research.
 

Bibliography:

1.    Bhishagratna, Kaviraj Kunja Lal.  An English Translation of the Sushruta Samhita.  Calcutta:  Published by Author, 1911
2.    Frawley, Dr. David.  Ayurveda and Marma Therapy.  Wisconsin: Lotus Press, 2003
3.    Halpern, Marc, The Importance of Marma Therapy in Ayurvedic Practice:  http://www.ayurvedacollege.com/importance-marma-therapy-ayurvedic-practice
4.    Lad, Vasant.  Marma Points of Ayurveda.  Albequerque: The Ayurvedic Press, 2008
5.    Smith, William L.  The Human Electromagnetic Energy Field:  It’s Relationship to Interpersonal Communication:  http://www.journaloftheoretics.com/articles/4-2/Smith.htm
6.    Swami Vivekananda Yoga Anusamdana Samsthana, Bangalore, India, Effects Of Yoga Practice on Acumeridian Energies: Variance Reduction Implies Benefits for Regulation: http://www.ncbi.nlm.nih.gov/pubmed/23439630
7.    Halpern, Marc. Ayurvedic Marma Therapy.  Course Supplement, 2004 - 2012.
8.    Murthy, Prof. K. R. Srikantha. Illustrated Sushruta Samhita, Vol 1,2,3.  Varanasi, Uttar Pradesh, India: Chaukhambha Orientalia, 2010.
9.    Chopra, Deepak. Perfect Health. New York: Three Rivers Press, 1991
10.    Muley, SK, Associate Professor and Head, Department of Sharira Rachana, Government Ayurved College, Nanded, Maharashtra, India, Study of Vaikalyakara Marma with special reference to Kurpara Marma: http://www.ncbi.nlm.nih.gov/pubmed/22661839
11.    Niharika Nagilla, Swami Vivekananda Yoga Anusamdana Samsthana (S-VYASA), Bangalore, India, Effects of yoga practice on acumeridian energies: Variance reduction implies benefits for regulation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573545.
12.    Caraka.  Caraka Samhita.  R.K. Sharma and Bhagwan Dash translation.  Varanasi, India:  Chowkhamba Sanskrit Series Office, 1976.
 
 

Ayurveda, Death & Dying by Renee Traub

 Introduction:

The intent of this research paper is to look at death and dying from an Ayurvedic perspective, specifically to assist those in the hospice and end­of­life caregiving field in learning to spiritualize the death process for themselves, their patients and patient families.  This paper will utilize Ayurvedic principles and introduce practices that caregivers, professionals and families can implement with patients in the process of dying.  My intention is to expand Ayurvedic practice into a field where it can be used to open the door to mindful, aware and compassionate dying. My interest in this topic stems from my professional experience as a neonatal ICU nurse for 28
years and a hospice nurse for 3 years, as well as my experience last year around my mother’s passing.  Oftentimes I have felt like a midwife to the soul.  I have experienced the sacredness of death and this is what I would like to share with the public. Research sources include ancient and modern Ayurvedic texts, allopathic medical journals, and alternative and complementary
texts relating to the topic.  To echo the work of Dr. Mits Aoki, I would like to “make death a work of art, a great achievement for the patient and a time of growth, understanding and closeness for family members.1 ”

Principles of Ayurveda

Ayurveda is a traditional Indian medical system with a scientific basis. It incorporates mind, body, and spirit in its understanding of the human being. Ayurvedic medicine complements Western medicine by focusing more on root causes rather than symptomatic treatment. Self­care practices are foundational for a healthy life. Examples of Ayurvedic practices are meditation and breathing techniques. Preventative medicine is emphasized as it is easier to put into effect than treating disease that has already manifested. Prevention means empowering patients to make positive lifestyle changes and behavior changes by educating and incorporating diet, spirituality, psychology, herbal medicine, and detoxification (known as pancha karma). Ayurveda reminds us that our true nature as human beings is spirit, and to connect to something greater than ourselves.
 
Ayurveda means “science of life.” It is a science because it contains systematically applied knowledge that has been proven in its effectiveness over thousands of years of continual application.  Ayurveda supports balance in all aspects of life ­ physical, mental and spiritual.  In the words of doctor and author Vivek Shanbhag, Ayurveda “respects the uniqueness of the individual, considers all the levels of the individual, emphasizes prevention, [and] empowers everyone to take responsibility for their own well­being.2 ”
  • 1 Aoki, Dr. Mitsuo.  www.livingyourdying.com “Helping Others Live with Dying.”
  • 2 Shanbhag, Vivek. A Beginner’s Introduction to Ayurvedic Medicine: The Science of Natural Healing and Prevention Through Individualized Therapies. Keats Publishing, Inc: CN, 1994. p. 9
According to Ayurveda, doshas are forces of nature that combine into the tapestry of life.  The human body is composed of the three doshas and operates based on their functioning,  If the doshas are out of balance with one another, there will be a disturbance in the function of the body and/or mind.  Often health or disease is discussed in terms of the balance existing
between the three doshas.  The three doshas are vata, pitta, and kapha.  On a cosmic level, one can say that vata relates to wind, pitta relates to the sun, and kapha relates to the moon and the earth.3 In short, doshas are forces that govern the physiology of the human being.4
 
Ayurveda “recognizes that each person is made up of a unique body type and a unique psychological personality.5 ”  We all have our own individual doshic combination from the moment of conception, and this is what accounts for our differences as people.  Vata dosha represents the forces of movement.  Vata is active and dynamic, like the wind.  Vata makes things happen in the body and mind, and is responsible for all movement, including the breath, the circulation, and movement of thoughts.  People who have a lot of vata can be energetic, vivacious social butterflies.  They can be very vibrant, enthusiastic and creative.  Every dosha has its balanced side, as well as its out of balance side.  When vata is out of balance, a person may be flighty, fickle, fearful and insecure.  Excess vata can manifest in worrying, a fragile nervous system, anxiety and exhaustion.  In order to heal, patients with vata imbalances will need a lot of hand holding, support, nurturing and a deep sense of connection with others.
 
The force of vata dosha is inherently dry, cold and light.  It is the dosha that governs depletion, destruction, decay, necrosis, debility, dissolution, and the process of wasting away and shutting down.  For these reasons it is especially correlated with the active dying process.  Signs of impending death such as a change in smell, bodily organs shutting down, core temperature instability, gurgling breathing (death rattle) and the mottling of the skin are all vata symptoms.
Terminal agitation, a dying patient’s behavior of responding unpredictably, is also linked to vata, and may include speaking to those who have already passed on, being spaced out or not present, non­responsiveness, outbursts of tears or yelling, and other behaviors displaying the movement and rapid dynamism of vata.  Vata dosha benefits especially from therapies involving calming, grounding and peaceful touch and sound.
 
Pitta dosha represents the forces of transformation and metabolism in the body and mind.  It is very active in the digestive system, the liver, eyes, and the rational aspect of the intellect.  Pitta dosha allows food to transform into energy and experiences to transform into opinions, analysis and evaluations.  Pitta is hot and fiery, and has rough, sharp, and clear qualities.  Individuals with a lot of pitta in their unique doshic combination can often be confident, organized, driven, bright, passionate and disciplined.  However, like fire, pitta can easily become uncontained.  This creates an excess of heat in body and mind, expressing itself in outbursts, anger, tantrums, criticism, resentment, jealousy and rage.
  • 3 Heyn, Birgit. Ayurvedic Medicine: The Gentle Strength of Indian Healing. Thorsons Publishing Group: Vermont, 1987. p. 13.
  • 4 Halpern, Dr. Marc. Principles of Ayurvedic Medicine. California College of Ayurveda: California, 1995. p. 53
  • 5 Shanbhag. p. 10.
 The process of dying is neither controlled nor precise.  This can be a challenge for pitta individuals who can be over­controlling and demanding, especially in times of stress. Strong­willed people who are used to being leaders and making things happen find that they have no control over the dying process, and this is difficult for pitta.  Sometimes pitta patients and/or family members are very direct and intense, and communicate in a way that is explosive and sharp due to their feelings of helplessness and powerlessness.  Strategies to support pitta patients and families in the dying process include cooling, relaxing and stress­diffusing forms of aromatherapy, breathing practices, yoga nidra and guided meditation.
 
Kapha dosha represents the forces of stability and structure in the body and mind.  It is the container for vata and pitta doshas.  Kapha dosha provides the physical form and material structure of the body.  Linked with the qualities of earth and water, kapha is wet, dense, heavy, slow and steady.  In the mind, kapha dosha describes qualities of gentleness, calm, consistency, and dependability.  Individuals with a lot of kapha in their unique doshic combination can often be nurturing, affectionate, compassionate and loyal.  However, when kapha is out of balance, these same qualities can become stubbornness, lethargy, withdrawal, depression, and issues of attachment and possessiveness.  Kaphic individuals, unlike vata and pitta, are slow to change, but once change is implemented, they are steady and enduring in new habits.
 
When working with kapha individuals in the death and dying journey, it is important to understand that they may experience a longer grieving process. Watery emotions such as tears may be present. Kaphas can also internalize emotions and not show them, even though they feel very deeply.  Honoring relationships is very important, as is self­care for caregivers and families who have created deep attachments to individuals who have passed on. 
 
In order to understand Ayurvedic psycho­spiritual healing, one must also understand the concept of gunas. Guna is a Sanskrit word meaning attribute or quality.6 It describes a person’s state of mind or state of consciousness.  The three gunas are sattva, rajas and tamas.  Sattva guna describes a state of consciousness that is peaceful, calm and balanced.  Rajas guna describes a state of mind that is full of movement and activity, constantly creating turbulence and drama. Tamas guna describes a state of consciousness that is inactive, dull and stuck.  A colleague has beautifully put this in terms that are understandable:
  • “A person who is a vegetarian, practices yoga daily, meditates daily, is emotionally stable and has a good work/life balance could be described as sattvic; a person working in the corporate field who is highly committed and driven, spends most of their waking hours at work, works hard and plays hard, is a competitive sportsperson, and eats meat every day could be described as rajasic; and a person who sits at home all day every day watching TV, eating microwaved food, and not exercising could be described as tamasic7 ”
  • 6 Klutznick, Karen.  http://www.kkayurveda.com/ayurvedabasics/thegunas.html 
The concept of chakras is important to understand when considering health from a mind/body/spirit perspective.  Chakras are energy centers in the body that “show how the life force...directs and guides the physical body through the nervous system.”8 Chakras are composed of energy that ranges from being more open, flowing and functioning to more closed and blocked.  Because chakras are not in the physical body, they can be worked with through energetic techniques such as meditation, mantra, color therapy and visualization. The seven major chakras correspond with the movement of energy through the spinal cord.
 
This paper will introduce two more concepts in Ayurveda that connect to the subject of death and dying.  These concepts are prana and ojas.  Prana is the lifeforce behind all creation that each person is linked to through the breath.  The process of breathing brings prana into the body. Individuals with healthy prana radiate a strong sense of aliveness, vibrancy, and sparkle.  They are full of life.
 
Ojas relates to the strength of the immune system.  Strong ojas creates physical and mental endurance and the capacity to get things done despite stress.  Individuals with strong ojas are centered and grounded, and less reactive than those with weak ojas.  Weak ojas creates hypersensitivity to the environment, as well as sensory overload and decreased immune system function.  Individuals with depleted ojas are often exhausted physically and emotionally.

Introduction to Hospice

Hospice is a care model that provides palliative care to individuals who are in the process of dying.  Hospice is a way to deal realistically and honestly with terminal disease.  It offers hope of dignity and comfort for patients and families.9 This model of care, focused on palliation rather than curative therapies, neither hastens nor prolongs death, allowing nature to take its course.10 Hospice care can take place at a dedicated hospice facility, nursing home, hospital, or at the patient’s home.  Patients are generally put on hospice towards the very end of life, generally no longer than six months.  The current model of hospice care centers around making the patient comfortable, managing patient pain, educating family members on the death and dying process, and helping the family organize and prepare for their loved one’s death.  Hospice describes an interdisciplinary team which may include doctors, nurses, social workers, assistants, chaplains and grief counselors.
Individuals in the process of dying undergo many changes physically, mentally and spiritually. Often they become drawn inward, sleeping more and showing disinterest in food, guests and other activities.  The body weakens, and the mind may become agitated and confused.  Fear and sadness may arise, as well as feelings of not wanting to be a burden.  The patient may wish to talk about the past and review her/his life.  Elizabeth Kubler­Ross, pioneer in the field of near­death studies, identified five stages of grieving for the imminent loss of one’s life: denial, anger, bargaining, depression and acceptance,11 The process of death has been studied forthousands of years, and is described in ancient texts in similar terms as today:
  • While approaching death, the process of destruction is initiated in the body.  Functions of various limbs and organs of the body get disturbed….drainage of strength from limbs, cessation of movement, destruction of sensory/tactile, impairment of consciousness, restlessness in the mind, affliction of the mind with fear, deprivation of memory and intellect….radical change in the conduct...wasting of muscle tissue and blood….morbid changes in the smell of the body...discoloration of the body, dryness in the orifices of the body.12
In my experience, hospice is all about being present with what is.  The practice of being unconditionally present and just listening, without having one’s own agenda, can be incredibly profound.  Caring for the dying can be a deep spiritual calling where one is open to whatever comes up, and willing to give whatever is needed.  In the words of spiritual teacher Ram Dass:
  • Whenever I tried to impose my model of a good death on a situation, or been attached to a particular outcome, it has backfired.  But when I meet the person with love, without wanting anything, I become a safe haven.  When I could remain conscious, aware of my own thoughts and feelings, waves of sadness or pity, aversion or fear, as well as my own temptation to react, I could bring soul quietness and a feeling that what was happening was alright.  This inner calm seemed rock­like it its stability.13
Hospice creates an attitude of service to the body, mind and spirit of the patient. Hospice has really made a difference in the lives and deaths of those it has touched, and by adding complementary Ayurvedic practices, opportunities are created to deepen compassion, mindfulness and integration.

Timeline of Hospice Care14

1948: The term hospice, from the same linguistic root as hospitality, is first applied to specialized care for dying patients by physician Dame Cicely Saunders of the UK.
1963: The concept of hospice is introduced to the medical community of the US by Saunders.
1967: Saunders opens the first modern dedicated hospice facility in the UK.
  • 11 Kubler-Ross, Elizabeth. On Death and Dying. Scribner: New York, 1969.
  • 12 Caraka Samhita. Vol 2. Chapter 5. v. 90-91.
  • 13 Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. p. 178.
  • 14 timeline information courtesy of National Hospice and Palliative Care Organization, Alexandria, VA.
1969: Elizabeth Kubler­Ross publishes On Death and Dying, a controversial book which sparks widespread public conversation on death and dying care in the US.
1974: Florence Wald of Yale University opens first hospice care facility in the US.
1982: Medicare begins to cover hospice benefits.
1984: Standardized hospice accreditation is initiated through the Joint Commission on Accreditation of Healthcare Organizations.
1986: Medicare hospice benefits are expanded and made permanent by US Congress.
2002: Department of Veterans Affairs launches program expanding hospice services to veterans and also providing continuing education in hospice and palliative care to clinicians.
2006: American Board of Medical Specialties recognizes hospice and palliative medicine as a medical specialty.
 
In recent years, research and policy work has been done in areas of hospice for HIV/AIDS patients in sub­Saharan Africa, pediatric hospice, expansion of hospice services for veterans and provision of hospice to individuals who are incarcerated.

Ayurvedic Aromatherapy

Aromatherapy is the use of the sense of smell for healing.  High quality essential oils distilled from plant sources can affect moods, balance the nervous system, and help calm and refresh the body and mind.  Aromatherapy works powerfully on the mind, and helps create sattva, allowing for greater peace and serenity in the final stages of life.15 The sense of smell is perceived through the evolutionarily oldest part of the brain, the limbic system, which responds to stimuli instantly, without thought.16  Scents have the ability to penetrate deeply into the brain, and chemically alter the functioning of the nervous and endocrine systems.  Studies have found that aromatherapy massage decreases anxiety, promotes relaxation, and stimulates autonomic nervous system function, especially in instances of palliative care.17
 
The application of aromatherapy in a hospice care setting can take many forms, all of which are user­friendly.  Essential oils can be purchased in health food stores or online, and many of the oils suggested here are inexpensive.  It is important that essential oils are pure and of good quality. “Fragrance oils” aren’t true essential oils ­ be aware of synthetic and adulterated oils used in the cosmetic and food industry. They do not have the therapeutic value of natural oils.18 Essential oils can be added to a tub of warm water for a foot or hand soak, added to a massage oil, or dripped into a spray bottle full of water.  Bear in mind that essential oils should generally not be placed directly on the skin.  One drop of an oil can be placed on a cotton ball to scent a room.  A spray bottle of rose water hydrosol can be used instead of rose essential oil, which is more cost effective.19
  • 15 Sushruta Samhita. Section 8, verse 10.
  • 16 Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998. p. 12.
  • 17 American Journal of Hospice and Palliative Care. “The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.” Downey et al. Aug/Sep 2009. 
 Excellent oils for reducing anxiety, stress and worry are lavender, chamomile, clary sage, lemon balm, rose geranium, rosemary and sandalwood.  Lavender creates a calm and positive attitude and stimulates brain secretions of serotonin, as well as calming and soothing the nervous system.20 21  Lemon balm, also known as melissa, is an excellent restorative of the nervous system.22 Rosemary is known to ease emotional tension.23 Sandalwood is known to relieve irritability that stems from anxiety.24 Chamomile is a nervine sedative specific to anxiety and stress.25 Clary sage is useful in cases of despair stemming from anxiety and stress.26 Feel free to make your own oil blends and remember that one drop goes a long way; only a few drops are needed in a foot bath or 4 oz spray bottle.
 
Many oils are helpful in aiding relaxation and supporting restful sleep.  This allows patients to respond to the stresses of living and dying from a more peaceful place.  Oils specific to this purpose are lavender, chamomile, frankincense, jatamamsi, lily, nutmeg, rose and sandalwood. Lily soothes the nerves and relieves irritability.27 Many of the oils listed in for anxiety, stress and worry are also helpful with stress relief and relaxation.
 
Anger and resentment can arise at different stages of the dying process, especially in patients with high pitta.  Resistance to the dying process, asking “why me?”, loss of control over the body and one’s life, and family­ related dramas that come up during difficult times can all cause pitta to rise.  Spearmint, lemongrass, fir and cedar can all rebalance the body and cool hot feelings.28 Lavender, rose and sandalwood are excellent oils for relaxing and purifying a heated pitta mind. Rose increases love and compassion.29 Sandalwood deeply nourishes the heart.30 Jasmine is great for releasing anger, and purifying the mind and emotions.31 32 Lily calms the heart and soothes the nerves, reducing irritability and increasing faith and devotion.33
  • 18 Wall, Carly. p. 16.
  • 19 Edgar Cayce Rosewater is highly recommended and inexpensive.  Reputable brands of essential are Floracopeia, Simplers, Mountain Rose, Young Living and Doterra.
  • 20 Wall, Carly. Setting the Mood With: Aromatherapy.  
  • 21 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 22 Wall, Carly. Setting the Mood With: Aromatherapy.
  • 23 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 24 Ibid.
  • 25 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
  • 26 Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996.
  • 27 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 28 Wall, Carly. Setting the Mood With: Aromatherapy.
  • 29 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 30 Ibid.
 Loss, sadness, depression and grief are often present in the dying process.  Patients may have regrets from the past, sadness at not being able to accomplish things they want to, and grief at saying goodbye to loved ones.  Gently uplifting oils can be beneficial in shifting the mind and increasing movement towards acceptance.  Coriander, pine and helichrysum are great for softening the grief process.34 Rose is a wonderful soothing oil for the mind and an anti­depressant, allowing for greater experience of love and increased self esteem.35 Rosemary, tulsi (holy basil), patchouli, cardamom and wintergreen also help alleviate depression.36 37 Citrus oils such as bergamot, lemon and orange are very uplifting.38 break through despondency.39 Cypress and eucalyptus can help break through despondency.39
 
Aromatherapy can bring about a sattvic state of consciousness, spiritualizing the death process and awakening higher awareness.  Scent has the power to bring us back into alignment with our authentic self.  Oils that have this property have been used in many of the world’s spiritual traditions.  Frankincense creates a space of purity in which higher virtues can come forth.40 Sandalwood and rose are other herbs that possess this sacred quality.  Essential oils can be selected for their therapeutic purposes and used not only in aromatherapy, but also in touch therapy or massage.

Massage and Gentle Touch

Massage has a long history as an integrative part of many healing traditions, including Ayurveda. Ayurvedic massage can feed the senses and nourish the body and mind through the application of therapeutic touch. It supports restful sleep and a calm, happy mind.41 A recent study of complementary practices in a hospice setting found that massage was not only beneficial to patient care, but reported by patients themselves as the most beneficial treatment they received. 42 Sharing massage with a patient or loved one can be a deep expression of love, care and compassion.  Especially while caring for those in hospice, it is important to maintain a sattvic touch, which is light, mild, gentle, balancing, harmonizing, warm, pleasant, sweet and nourishing.43 When massage is done with love, care, gentleness and sensitivity, it will increase sattva in the patient.  The massager must also have a sattvic quality in their attitude and manner of application.44 Healing benefits of massage and application of oils build up over time, and are also immediately beneficial to skin, muscles and the nervous system.45
  • 31 Halpern, Dr. Marc. p. 324.
  • 32 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 33 Ibid.
  • 34 Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991.
  • 35 Wall, Carly. Setting the Mood With: Aromatherapy.
  • 36 Halpern, Dr. Marc.. p. 324.
  • 37 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 38 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
  • 39 Young, Gary. Aromatherapy: The Essential Beginnings.
  • 40 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
  • 41 Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998. p. 60.
  • 42 American Journal of Hospice and Palliative Care. “Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” Downey, et al. Aug 2009.
 Massage is recommended for patients with high vata, pain and hypersensitivity, as well as any disturbance of the mind, emotions and nerves.46 Sesame oil and almond oil are recommended as they are softening to the tissues of the body.  Mild and sweet essential oils such as sandalwood, rose and lavender can be added.47 Incorporating aromatherapy into massage helps the mind and body prepare for a deeper opening.  Gentle massage of patients is recommended three times a week, or even daily.  Frequency of this practice allows oils and herbs to penetrate deep into the skin, creating permanent changes.48
 
Techniques and supplies for this practice are very simple.  Purchase cold pressed, organic sesame or almond oil at a health food store.  Pour some oil into a bottle and store the rest in a cool, dark place.  Add essential oils according to patient needs. Warm oil prior to application in a hot water bath in a sink or a pan.  Test temperature on wrist before use.  Pour oil in hand liberally, and use both hands to spread oil along body part.  Use long strokes for long parts, such as arms, legs, and torso, and use circular strokes around joints.  Rub the oil in and allow the body to soak it up.  Maximum absorption is important and may take 20 minutes or more.  Stress reducing or mindfulness practices such as meditation may be done while the oil is absorbing. After absorption, pat off excess with a cloth, and if necessary, some warm water.  Removing oil with soap is not recommended.49
 
If massaging the whole body is not available, a simple foot and scalp massage will have many of the same therapeutic benefits, and will assist in relieving sleeplessness and fatigue.50 Head massage can relax the entire body by relaxing the nervous system and relieving mental strain and stress.51 and scalp.52 Brahmi oil, available online, is especially recommended for the soles of the feet and scalp. 52

Altars and Color Therapy

  • 43 Frawley, David. p. 502.
  • 44 Ibid.
  • 45 Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 167.
  • 46 Sushruta Samhita. Section 5, verses 90-91
  • 47 Frawley, David. p. 506
  • 48  Ibid.
  • 49 massage technique from Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 168.
  • 50 Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996. p. 4-5.
  • 51 Charaka Samhita.Vol 1. Section 5, verse 81-83.
  • 52 Lad, Vasant.p. 260.
The visual images that we take in through our sense of sight can bring pleasure or pain. The sense of sight can trigger memories, feelings and thoughts that are sattvic, rajasic or tamasic. The skillful use of color can add psychological harmony and peace of mind, and contribute positively to a patient’s emotional well­being during the dying process.53 This happens on a very subtle level and the psychological effects of color are not always consciously apparent to the viewer.  Color is vibrational energy that enters the eye and goes directly to the brain and mind.54
 
Color therapy can be applied in many ways.  Various methods include surrounding ourselves in therapeutic color choices through clothing, linens, window coverings, paint choices, colored light bulbs, flowers, candles, artwork and nature imagery.  Soft lights can be used instead of fluorescent or neon, and full spectrum light bulbs can be used in winter.55 Choosing decor with awareness of the specific effects of different colors can calm the mind and increase sattva.
 
The color gold is especially powerful in harmonizing the mind, strengthening the heart, and supporting ojas and immune and endocrine system health.56 Gold also provides stability, relieves anxiety, uplifts the spirit, and supports greater awareness and transformation of consciousness.57 For these reasons, gold is highly beneficial in hospice care settings.
 
The colors white and blue can also be used therapeutically.  White invokes purity, virtue and spirituality, and calms the heart, mind, nerves and emotions.58 It promotes meditation and spiritual awareness, and supports a state of mind that is expansive, flowing, clear and effortless. 59 Although these aspects are beneficial, white can increase vata and is not recommended in
excess.  Blue spiritualizes anger, antidotes the critical mind and reduces attachment and pitta, however, blue is very cold, light and dry and in excess, can increase vata.60
 
Another way to experience color is through creating an altar.  An altar creates a physical and tangible sacred space to facilitate mental and spiritual peace.61 Co­creating an altar with a patient allows for intimacy, connection, grounding and creativity.  Any objects can be used that have meaning and provide inspiration.

Mantras, Music and Affirmations

  • 53 Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998. p. 319.
  • 54 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. p. 126.
  • 55 Tirtha, Swami Sadashiva. p. 319.
  • 56 Ibid. p. 320.
  • 57 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126.
  • 58 Tirtha, Swami Sadashiva. p. 321.
  • 59 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126.
  • 60 Ibid.
  • 61 Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999. p. 24.
The sense of hearing, like the sense of sight, can be used in ways that create harmony and peace, or in ways that agitate and disrupt the mind and body.  Hearing is the first sense that develops in utero.  The fetus reacts to its mother’s voice and external sounds as early as 4 ½ months.62  Hearing is the last sense to go as people transition into death.  Even unresponsive patients can often hear what is said to them.  Relaxing music, uplifting mantras such as ‘om,’ and affirmations are all sattvic tools that can be incorporated into patient care.
 
An affirmation is a positive, personally inspiring phrase that is a powerful tool to focus positive intention and counteract previous negative conditioning.63 Affirmations can be used to shift awareness and belief.  They can be played in the background, repeated aloud by patient or caregiver, written and placed around the space, or repeatedly mentally.  Patients and caregivers can develop their own affirmations, or use existing ones such as: May I be free from suffering, May I be at peace, May my heart flower.64 Other helpful affirmations are: I am at peace in this moment.  I release control; I embrace the unknown.65 Repeating affirmations creates the openness in mind and heart to receive what is longed for. If possible, repeat affirmations, or have them playing in the background, throughout the day.
 
Mantras are sound forms that create a shift in consciousness. Like affirmations, they can be chanted aloud or internally, or listened to in music.  To pacify vata, and create sattva, mantras need to be soft, warm, soothing, and calming.66 Patients should only chant out loud briefly, if at all, as this can deplete energy.  The mantra ‘om’ (rhymes with ‘home’) balances mind, body and spirit, promotes awareness, harmonizes the nervous system and clears the energy.67 The mantra ‘lum’ (rhymes with ‘chewing gum’) can be used to stabilize, ground, calm, and bring joy, happiness and contentment, and is especially useful when vata is high.68 Mantras resonate with the chakras and help to spiritualize the awareness on a subtle level.
 
Music can support the dying process in ways ranging from stress relief, to bedside support, to grief recovery.  Because music reaches a deep, non­rational part of the mind, it is ideally suited to shift feelings such as grief, fear, anxiety, sadness and anger that create rajas in the mind. Music can release blocked or painful feelings and can stimulate positive ones such as hope, love and gratitude. Sharing music together can lead to sharing of the emotions that the music brings up.69 70
  • 62 Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999. p. 23
  • 63 Simpson, Liz. p. 138.
  • 64 Levine, Stephan. Healing Into Life and Death.  Doubleday: New York, 1987. p. 23-24.
  • 65 Ibid. p. 27.
  • 66 Tirtha, Swami Sadashiva. p. 314.
  • 67 Ibid. p. 312.
  • 68 Ibid. p. 313.
  • 69 Levine, Stephan.. p. 25.
  • 70 http://www.growthhouse.org/music.html This website streams music that is intended to support the death process and patients in hospice and palliative care settings.
 Sound is a nutrient for the spirit as well as for the body.71 When the moment of transition into death arises, chants can be used to say goodbye. Stephan Levine suggests: Go in beauty. Peace be with you.  Til we meet again in the light.72 Another chant, made famous in Kundalini Yoga circles, that can be used comes from a popular song from the 1960s:
 
May the longtime sun shine upon you, May all love surround you,
And the pure light within you guide your way home.73

Meditation Practices for Hospice and Palliative Care

Meditation is a journey to the center of our own being.74 Meditation can be done anywhere, at any time, sitting, lying down, or walking.75 One can meditate with a mantra, a thought or feeling, by looking at nature, thinking about God, feeling pure love, or with any technique that doesn’t cause strain, anger or worry that one is not doing it properly.76  There are countless techniques for meditation, and they are all valid.  The technique introduced here is simple to learn and to practice.  Any other techniques can also be used.  The most important aspects to practice are devotion and sincerity.77
 
Meditation is an art of bringing harmony to body, mind and consciousness.78 It has been shown to be clinically beneficial in healing body and mind.79 It gives us a respite from the pressures of life.  As we relax, the heart beats more slowly and the blood pressure lowers. Meditation helps retrain response mechanisms so we don’t react as strongly or as negatively to adverse situations. It gives us the ability to be more centered, and more in control of our reactions.80 Meditation allows the mind to be healthy and sattvic, alert, positive and calm.81 When we meditate, we release rajasic mental states such as fear, worry and anger and replace them with positive attitudes.82 By practicing meditation as regularly as possible, we gradually gain control over the flow of our emotions and movement of our minds.  This allows us to turn awareness inward.83
  • 71 Levine, Stephan.. p. 25.
  • 72 Ibid. p. 27.
  • 73 lyrics written by Incredible String Band.
  • 74 Novak, John. Ananda Course in Self-Realization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997. p. 13.
  • 75 Tirtha, Swami Sadashiva.. p. 595.
  • 76 Ibid.
  • 77 Ibid.
  • 78 Lad, Vasant..p. 76.
  • 79 International Journal of Palliative Nursing. “Mindfulness Based Cognitive Therapy.” Kabat-Zinn, Dr. Jon. June 2001.
  • 80 Novak, John. p. 15.
  • 81 Ibid.
  • 82 Ibid. p. 16.
  • 83 Ibid.
 One advantage of the form of meditation outlined below as a treatment method is that it is very safe, has no side effects, and is easy to teach and share.84 This form of practice creates the ability to look within and contact the deeper aspects of consciousness. In So Hum meditation we sit quietly and watch our breath.85 Patients can be in supine position or seated.  Keeping the spine straight is helpful. Patients can be supported with pillows to suit their comfort. Begin by allowing the mind to be present. Let go of stories in the mind and thoughts about what’s going on elsewhere.  Relax and be comfortable.  Take a few deep breaths in, if possible.  Inhale and
exhale through the nose, if possible.  As you inhale, mentally think ‘so’ (rhymes with ‘no’).  As you exhale, mentally think ‘hum’ (rhymes with ‘chewing gum’).  Continue this pattern of repeating ‘so­hum’ with the breath.  The syllable ‘so’ represents the life force entering the body through inhalation, and the syllable ‘hum’ represents the release of limitations through the exhalation.86 If the mind starts to wander, just bring it back to focus on the mantra and the breath.87 Breathe through whatever comes up.  In this practice, for most people, the breath naturally deepens.  You will very likely become distracted, just bring the mind back to focus on the breath and mantra, be gentle with yourself, and keep going.  When beginning this practice, 2­3 minutes of practice is suggested.  Practicing consistently brings benefit.  After the practice is finished, allow a few moments to bring the mind back to normal awareness.88
 
Another practice that supports deep relaxation and spiritualizing one’s awareness is yoga nidra. Yoga nidra begins with the patient in a supine position, supported with pillows for comfort.  This practice is guided by a soothing voice, and many good recordings are available.89 Yoga nidra takes the body through a total relaxation process, calms the mind and releases tension and stress.  Yoga nidra brings the mind to focus on different parts of the body, feeling them distinctly, and then fully relaxing.  It brings the mind to focus and creates intention.  Although it is not intended to cause one to fall asleep, one will receive benefit even if one is asleep.  If possible, keep the mind alert and focused.  When practiced effectively, this technique is as restorative as sleep.90

Breathing Practices for Hospice and Palliative Care

The breath is the primordial life force governing mental and physical function.  One’s breath is the essence of one’s life.  The first breath is taken shortly after arriving in the world, even before the umbilical cord is cut.  The breath continues, unbroken, until death. Breathing does not require conscious attention, but by choosing to bring awareness to the breath, one can influence the body and mind. Mindful breathing clears the mind, brings calm and allows individuals to connect their personal energy with the universal energy.91 
  • 84 Frawley, David. p. 517.
  • 85 Lad, Vasant..p. 79.
  • 86 Ibid.
  • 87 Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004. p. 90-91.
  • 88 For different meditation techniques, consult the many books of Pema Chodron, as well as titles by Stephan Levine Who Dies? and Healing into Life and Death.
  • 89 Yoga nidra recordings are widely available on CD, iTunes and YouTube.  The recording of Dr. Marc Halpern guiding Yoga nidra is recommended.
  • 90 Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999. p. 61.

To practice mindful breathing, sit or lie in a comfortable position.  Relax the shoulders.  Breathe deeply and slowly, allowing the breath to come from the abdomen.  Imagine that the belly is breathing, rather than the chest.  If possible, have the entire breathing movement come from the diaphragm.   After a few minutes, observe the effects of this practice on the body and mind.

Support for Caregivers

Caregivers for the dying often become distressed, depressed and drained of energy.  They often become the second patient.93 In times of stress it is easy to focus one’s attention outward, and forget one’s own needs.  There may seem to be no time for caregivers to focus on their own needs such as nourishing and healthy food, sleep, quiet time or meditation and time to unwind in nature or with loved ones.  For those who devote their time to caring for the ill and dying, it is especially important to prioritize self­care, ask for help and delegate responsibility to others.
Studies have shown that caregivers experience a rise in anxiety, depression and salivary cortisol, and that regular practice of yoga and meditation reduces all three of these symptoms.94 Caregivers can use all five of their senses to create harmony, peace and balance.95 The recommendations outlined in this paper can also apply to caregivers.  Massage nourishes the sense of touch, aromatherapy can influence the mind through the sense of smell, relaxing music and healing mantras can serve as sound therapy and color therapy can be applied through flowers and pleasant visual impressions.  Caregivers need to bring their attention to keeping ojas high, therefore, ojas building foods are recommended, such as nourishing soups, dates, almonds, and hearty grains such as basmati rice, quinoa and oatmeal with warming spices.
Helping others have a peaceful and dignified death, either as a professional or familial caregiver, is heart­centered work.  Caregivers in hospice situations extend themselves above and beyond usual boundaries.  Having a “good death” is important to people, and contributing to that end is a deep calling and not something that everyone is called to do.96 In order to be able to continue to give, one must avoid draining one’s self.  Ayurveda has profound wisdom to offer in this capacity.
 
Conclusion
  • 91 Chopra, Deepak and David Simon. p. 99-104
  • 92 Ibid.
  • 93 Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996. p. 34.
  • 94 Evidence Based Complementary and Alternative Medicine. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Danucalov et al. April 2013.
  • 95 Sushruta Samhita. Section 8, verse 10.
  • 96 Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013.
Ayurveda is an ancient system that can be used to offer ease and comfort to patients in hospice care settings, as well as their family and caregivers.  Techniques explored in this paper help support relaxation, manage stress and anxiety, and create feelings of peacefulness and upliftment.  These practices assist all who are involved in experiencing and being present to the sacredness of dying.  Through Ayurveda, we can explore the dimension of spirituality within us, unlocking greater capacity to love, care and be compassionate.

Bibliography

Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996.
Charaka Samhita.
Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004.
Danucalov et al. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Evidence Based Complementary and Alternative Medicine. April 2013.
Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. Downey, et al.“Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” American Journal of Hospice and Palliative Care. Aug 2009.
Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999.
Frawley, David. Ayurvedic Healing for Healthcare Professionals. California College of Ayurveda: Nevada City, CA, 1988.
Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999.
Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. Halpern, Dr. Marc. Principles of Ayurvedic Medicine. California College of Ayurveda: California, 1995. Heyn, Birgit. Ayurvedic Medicine: The Gentle Strength of Indian Healing. Thorsons Publishing Group: Vermont, 1987.
initiateayurveda.blogspot.com
Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996.
Kabat­ Zinn.  “Mindfulness Based Cognitive Therapy.” International Journal of Palliative Nursing. June 2001.
Kubler­Ross, Elizabeth. On Death and Dying. Scribner: New York, 1969.
Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998.
Levine, Stephan. Healing Into Life and Death.  Doubleday: New York, 1987 livingyourdying.com
Novak, John. Ananda Course in Self­Realization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
Shanbhag, Vivek. A Beginner’s Introduction to Ayurvedic Medicine: The Science of Natural Healing and Prevention Through Individualized Therapies. Keats Publishing, Inc: CN, 1994.
Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999.
Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013. Sushruta Samhita.
Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998.
Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998.
What Hospice Is, What Hospice is Not. Patient education pamphlet distributed by Vitas Innovative Hospice Care.
Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991.
Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996.
 

Abstracts

from Contemp Nurse. 2013 Aug 4.
Home is where I want to die: Kelly's Journey.
Sneesby L, Mater C.
 
Abstract
The definition of a "good death" is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack & Seymour, 2011) 70% of Australians express the desire to spend their last days at home. In reality only 16 % of people die at home (Preferred place of death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care.
 
from­Evid Based Complement Alternat Med. 2013 Apr 18.
 
A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.
Danucalov MA, Kozasa EH, Ribas KT, Galduróz JC, Garcia MC, Verreschi IT, Oliveira KC, Romani de Oliveira L, Leite JR.
 
Abstract
Familial caregivers of patients with Alzheimer's disease exhibit reduced quality of life and increased stress levels. The aim of this study was to investigate the effects of an 8­week yoga and compassion meditation program on the perceived stress, anxiety, depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a stress­reduction program for a 2­month period (yoga and compassion meditation program­YCMP group) (n = 25) or an untreated group for the same period of time (control group) (n = 21). The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after intervention. The groups were initially homogeneous; however, after intervention, the groups diverged significantly. The YCMP group exhibited a reduction of the stress (P < 0.05), anxiety (P < 0.000001), and depression (P < 0.00001) levels, as well as a reduction in the concentration of salivary cortisol (P < 0.05). Our study suggests that an 8­week yoga and compassion meditation program may offer an effective intervention for reducing perceived stress, anxiety, depression, and salivary cortisol in familial caregivers.
 
from Am J Hosp Palliat Care. 2009 Aug­Sep
 
Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.
Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE.
 
Abstract
Improving end­of­life care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates' assessment of patients' benefit from the study intervention, suggested significant gains from massage­the treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard end­of­life care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for end­of­life studies.
 
from Am J Hosp Palliat Care. 2009 Aug­Sep
 
Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.
Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE.
 
Abstract
Research suggests that aromatherapy massage (AM) is increasingly being used by cancer patients, especially in the palliative care setting, although few studies have assessed its effectiveness. I wanted to find out whether AM reduces anxiety in patients with a primary malignant brain tumour attending their first follow­up appointment after radiotherapy. Eight patients were recruited to the study, which comprised three methods of data collection: the measurement of physical parameters; the completion of Hospital Anxiety and Depression Scales (HADS); and semi­structured interviews. The results from HADS did not show any psychological benefit from AM. However, there was a statistically significant reduction in all four physical parameters, which suggests that AM affects the autonomic nervous system, inducing relaxation. This finding was supported by the patients themselves, all of whom stated during interview that they felt 'relaxed' after AM. Since these patients are faced with limited treatment options and a poor prognosis, this intervention appears to be a good way of offering support and improving quality of life.
 
from Int J Palliat Nurs. 2001 Jun;
 
The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.
 
Abstract
 
Mindfulness is a lifetime engagement­­not to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.Mindfulness is a lifetime engagement­­not to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.

 

The Use of Herbs as Part of an Ayurvedic Treatment Approach to Diabetes Mellitus and Blood Glucose Imbalances By: Airlie Ellsworth

Introduction
The average American consumes 22.7 teaspoons of sugar per day. With this constant overdose of both refined and natural sugar it’s no surprise that 347 million people worldwide have diabetes mellitus – a figure that has climbed from 153 million just 35 years ago1. What’s even more alarming is that greater than 35% of Americans have pre-diabetes2, which puts them at increased risk for conditions such as hypertension and heart disease, Alzheimer’s, cancer, polycystic ovarian syndrome, anxiety, depression, and sleep disorders; as well as inflammation, male pattern baldness, food cravings and mood swings, poor circulation, high cholesterol, and high levels of stress hormones3.

Luckily, making small changes to our diet and lifestyle can make big improvements in our health and wellness. In this paper I will briefly review the body’s physiology as it pertains to maintaining stable blood glucose levels; the various diseases associated with imbalanced blood glucose levels: hypoglycemia, pre-diabetes, and types 1 and 2 diabetes mellitus; review and discuss several herbs which are commonly used to treat these diseases: gurmar, cinnamon, fenugreek, aloe vera, shallijit, and jambu; then consider diet and lifestyle recommendations that are beneficial in their management.
Physiology of blood sugar
Our bodies have a complex and intelligent way of maintaining homeostasis. To sustain healthy blood glucose levels, glucagon and insulin are released via a negative feedback loop as follows: the onset of hypoglycemia (a drop in blood glucose levels) stimulates the release of glucagon from alpha cells in the pancreas. The glucagon then acts on hepatocytes (liver cells) to promote the formation of glucose from lactic acid and amino acids (a process called gluconeogenesis) and accelerate the conversion of glycogen into glucose (a process called glycogenolysis).  These reactions cause hepatocytes to release glucose into the blood stream more quickly, which raises the blood glucose level. If blood glucose continues to rise, hyperglycemia (high blood glucose levels) inhibits the release of glucagon and stimulates the secretion of insulin by beta cells in the pancreas. Insulin has a variety of effects: it acts on specific cells in the body to increase facilitated diffusion of glucose into cells, it speeds up the conversion of glucose into glycogen (glycogenesis) and the synthesis of fatty acids (lipogensis), it slows glycogenolysis and gluconeogenesis, and it increases the uptake of amino acids by cells. All of these reactions cause blood glucose levels to fall. If blood glucose levels drop back into hypoglycemic range, the release of insulin is inhibited, which stimulates the release of glucagon, and the cycle repeats to right itself4.

When sugars and simple carbohydrates are ingested, the pancreas is forced to produce and secrete excess insulin to help move the sugars from the blood stream into the cells. A diet high in sugar forces insulin levels to spike more frequently than the body can handle. This fatigues the pancreas and causes the cells to become resistant to allowing in any more glucose. As a result of this excess glucose in the blood, levels remain unnaturally high. Insulin then stores this lingering glucose as fat, causing weight gain and an increase in unhealthy cholesterol5.

If hypoglycemia is ‘below-normal’ blood glucose levels and hyperglycemia is ‘above-normal’ blood glucose levels, what then are considered ‘normal’ blood-glucose levels? Nancy Klobassa Davidson, a registered nurse who specializes in diabetes, recommends a normal fasting blood glucose target range of 70-100mg/dL6, with ‘fasting blood glucose’ being the blood sugar level first thing in the morning before eating breakfast7. While this seems like a fairly broad-ranging safety zone, studies have found that the risk of cardiovascular and degenerative diseases increases significantly when fasting blood glucose levels rise above 85mg/dL. One such study, published in Diabetes Care Journal in 1999, tracked the fasting blood glucose level of 1,998 non-diabetic men over a 22-year period. This research showed that men whose fasting blood glucose level rose above 85mg/dL were 40% more likely to die of cardiovascular concerns8.
 
Conditions associated with blood glucose levels
 
Hypoglycemia
 
The Merck Manual Home Health Handbook defines Hypoglycemia as “abnormally low levels of sugar (glucose) in the blood”9. Besides being a side effect of the treatment of diabetes mellitus, there are two other types of hypoglycemia that occur due to abnormal endocrine functions: in reactive hypoglycemia blood glucose levels drop within a few hours of eating; in fasting hypoglycemia one experiences incredibly low blood glucose levels in the morning or if meals are skipped10. Symptoms of hypoglycemia generally include sweating, shaking, faintness, nervousness, hunger, palpitation, weakness, an inability to concentrate, headache, and general anxiety. If no known cause for the hypoglycemia can be detected, such as a tumor in the pancreas, a reaction to drugs, or some other disease11, then this condition can be treated Ayurvedically as a vata vitiation. When pitta is vitiated as well as vata, anger and irritability may also be exhibited12.

Pre-Diabetes
When blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes a person is considered pre-diabetic. People have prediabetes if their fasting blood glucose level is between 101 mg/dL and 126 mg/dL13.

Diabetes Mellitus – Type 1 & Type 2
Diabetes mellitus is “caused by an inability to produce or use insulin”14. As discussed in the previous section, insulin is responsible for helping usher glucose from the blood into the cells via facilitated diffusion. Without sufficient insulin, blood glucose levels remain abnormally high while levels in the cells become deficient. These two imbalances combine to produce the symptoms of diabetes mellitus15.

There are two types of diabetes mellitus. Type I, previously known as insulin-dependent diabetes mellitus, occurs when a person’s immune system destroys the pancreatic beta cells. As a result little or no insulin gets produced. Without insulin there is no means by which glucose can be carried into cells, so the cells signal to the brain that they need energy. Appetite increases and fat cells begin to break down. In order to maintain balanced blood glucose levels, patients with this condition require insulin injections. Of the two types of diabetes, type I accounts for only 10% of cases; most people with type 1 diabetes develop the condition by the age of 3016.

Madhu meha, literally ‘sweet or honey like urine’ is the Sanskrit name for type 1 diabetes mellitus.  Ayurveda attributes madhu meha to a vitiation of vata dosha17 . Though the Dravyaguna Vijnana translates madhu meha to ‘diabetes’ in general18, here we use it to mean the vataja type 1 diabetes.

The majority–90%–of cases of diabetes mellitus is type 2 diabetes.  In type 2, formerly known as ‘non-insulin-dependent diabetes mellitus’, the pancreas continues to produce insulin, but the body develops a resistance to it19. When sugar enters the bloodstream, insulin also rises to help carry the glucose into cells. If a diet is high in sugar, then over time more and more insulin is needed to complete this transfer. Dr. John Douillard writes on LifeSpa.com: “Normally just one unit of insulin is needed to deliver 10 mg of glucose into the cell, but as the blood sugars stay chronically high, it can eventually take 10 units of insulin to deliver the same 10 mg of glucose into the cell.”20
Iksu meha translates from Sanskrit as ‘sugar urine’. It is so named for the extra sweet nature of the urine, caused by the excess glucose being flushed from the body. This is the classical Ayurvedic description of type 2 diabetes, which is seen as a vitiation of kapha dosha21.

One of the hallmark symptoms of both madhu meha and iksu meha is prameha (polyuria). Dr. Preeti Kishore on MerckManuals.com explains: “When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine”22. This causes the kidneys to excrete additional water to dilute the large amount of glucose. As a result of this excessive urination, abnormal thirst is also a symptom of diabetes mellitus. Other indications include weight loss, excessive hunger, blurred vision, nausea, drowsiness, and decreased endurance23.

Disease management using herbs
The primary long-term effects of poor blood glucose regulation are the result of impaired circulation caused by vascular blockages. Diminished circulation may lead to kidney failure, blindness and neuropathy24. Because madhu meha is an auto-immune disease and classified as a vata vitiation, and iksu meha is caused by obesity and classically seen as a kapha vitiation, they are managed differently. There are similarities however, and so both benefit from taking herbs that help tone the endocrine system (endocrine tonics), reduce blood glucose (hypoglycemic), and increase circulation (circulatory stimulants).  Bitter and astringent herbs are also important in treating iksu meha. The following are some herbs that have been used to help regulate blood glucose level and aid in the management of hypoglycemia, madhu meha and iksu meha.

Gurmar
Gurmar (gymnena sylvestre), specifically the leaf, has an astringent quality and is one of the primary herbs used in Ayurvedic medicine to treat blood glucose imbalances such as madhu meha, especially during the initial onset of the disease, and to prevent it from worsening. It’s also proven useful in swaying sugar dependency, thus helping to reduce excessive blood glucose levels. Its Sanskrit name, madhunashini, translates to “what destroys the sweet taste”25. In their book ‘The Yoga of Herbs’, Doctors David Frawley and Vasant Lad explain that gurmar “counters our cravings for sugar, dulling the taste buds, and soothing the nerves. It helps control the appetite and reduce sugar cravings. It calms and soothes the liver and pancreas.”26  

This herb has an active component called gymnemic acid that has been found to successfully decrease glucose absorption, thus aiding in weight loss. There are also elements of this herb that prevent the accumulation of triglycerides in the liver and muscles, and help to decrease the accumulation of fatty acid in the circulatory system27. While these are beneficial side effects that help reduce the accumulation of kapha dosha associated with iksu meha, the other effects of the herb–dulling of the taste buds, reduction of sugar cravings–diminish the amount of sugar ingested, thus decreasing its tax on the body in a pre-emptive way.  

Cinnamon
Dr. John Douillard reports that “according to the US Department of Agriculture, cinnamon helped reduce risk factors associated with diabetes and heart disease”28. Despite this claim, cinnamon (cinnamomum zeylanicum), an easily accessible and popular circulatory stimulant and alterative, has yielded mixed results when tested in its efficacy to balance blood glucose levels.

In 2013 a meta-analysis was done to address these conflicting results of past research. (The primary focus of the experiments and research reviewed had been on iksu meha patients.) This meta-analysis, which included a total of 543 participants who had been administered varying doses of cinnamon, concluded that the ingestion of cinnamon lead to significant statistical decreases in fasting blood glucose levels29.

Two such studies support these findings.

In 2003, 30 men and 30 women with iksu meha were divided randomly, some given cinnamon, the others a placebo. After 40 days, those in the placebo group showed no change in their blood glucose levels while the cinnamon showed to have reduced fasting blood glucose levels–as well as reduced triglyceride levels, LDL cholesterol and total cholesterol–in the treatment group. This study concluded that the inclusion of cinnamon in the diet of those suffering from iksu meha would help reduce the risk factors associated with this disease30.

A similar study was performed in 2012 with 44 participants and the results were on par; after eight weeks of taking three grams of cinnamon per day, fasting blood glucose levels in those in the placebo group were unaffected while those in the treatment group showed a significant reduction31.

In 2011 a group of researchers at Mahidol University in Bangkok did a similar meta-analysis that yielded different results than those in the 2013 review. After identifying and statistically comparing nine randomized placebo-controlled trials with almost 500 participants total, they found no evidence that cinnamon helped control blood glucose levels. Their calculations did, however, substantiate that fenugreek may prove effective in doing so32.

Fenugreek
Fenugreek (trigonella foenum-graecum) has been cited in both Ayurvedic and Traditional Chinese Medicine texts as being useful in the treatment of madhu meha and iksu meha.  The seeds in particular have an affinity for regulating insulin33. Meta-analysis of 10 western clinical trials moderately supports this therapy, though the researchers report that a more “well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.”34
It is the bitter nature of fenugreek that is beneficial, as bitter herbs are useful in reducing fat and regulating glucose metabolism. In this way fenugreek is helpful in such conditions as diabetes35.

Aloe Vera
Another bitter tonic that has been shown in clinical trials to be valuable in the regulation of blood glucose levels in iksu meha is aloe vera. Aloe regulates sugar and fat metabolism36. A study completed in Iran analyzed the results of 85 studies (18 human and 67 animal) that measured the efficacy of glucose lowering abilities of medicinal plants. The findings placed aloe vera at the top of the list37.

Shallijit
Shallijit is described in The Yoga of Herbs as “one of the wonder medicines of Ayurveda… It is not an herb, but a kind of natural mineral pitch from the Himalayas and carries the healing power of these great mountains… [It] possess great curative powers and is considered capable of treating many diseases…including diabetes…”38 As an endocrine tonic, shallijit supports the pancreas in insulin secretion and so is beneficial in treating both madhu meha and iksu meha.

Jambu
Though less common in the west, jambu (syzygium cumini) is cited in the Dravyaguna Vijnana as being, “an esteemed drug for diabetes mellitus...one of the important anti-diabetic drugs studied”39. The fruit is sometimes used, however, it’s the seeds that really prove an effective hypoglycemic agent. They are recommended to be taken orally in powder form as a single drug or as part of an herbal anti-diabetic formula. In either form of administration, the seeds’ power is useful to reduce blood and urine sugar in diabetes40.

Herbal anti-diabetic and blood glucose stabilizing formulas can easily be found at reputable herbal pharmacies or can be created at home using well-sourced herbs. One such formula, designed and sold by Dr. John Douillard includes gurmar (leaf), fenugreek (seed), cinnamon (bark) and shallijit, each of which have been discussed here as valuable herbs in the treatment of blood glucose related diseases.    

Diet & Lifestyle
Besides the use of ‘plant drugs’, the Caraka Samhita stresses dietary regulation in the treatment of these diseases. It also prescribes baths and physical exercise in their management41. More so than in herbal treatment, madhu meha and iksu meha differ in how they’re managed using diet and lifestyle.  

It’s important when treating madhu meha Ayurvedically that the patient also be working with a western medical doctor to receive insulin injections. As it is a vata-type disease, a vata reducing diet and lifestyle should be strictly maintained. Western doctors encourage the same, suggesting adherence to routines, especially around eating. The Mayo Clinic maintains, “Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too”42. It is recommended that patients follow a traditional diabetic diet, eating the right mix of vegetables, fruits, proteins, fats and starches at each meal, and to be extra mindful of taking in the same amount of carbohydrates at every meal and snack because of its effects on blood glucose levels. Small meals at regular intervals are the best way to keep blood glucose levels in check. If there’s weight loss, tonifying foods such as nuts, bone marrow, whole grains and meat should be emphasized43.

Exercise can help because of the way it improves the body’s response to insulin44, though caution should be taken to avoid anything too strenuous; gentle or restorative yoga is optimal. Meditation and yoga nidra are also recommended because of their grounding, stabilizing and rejuvenative power. Mantra can be used as a form of meditation, reciting the bija sounds of  ‘lam’ (Muladhara chakra) and ‘vam’ (Svadhisthana chakra) to reduce the light, mobile quality of vata and increase the denser, heavier qualities of earth and water. Oil therapies such as abhyanga and shirodhara are worthwhile as they reduce stress and build ojas. Vata-pacifying aromas such as sandalwood, cinnamon, rose and lavender can be added to the oil for potency.  

People suffering from iksu meha can benefit greatly from Ayurvedic treatments. As it is a kapha vitiation, diet should be light and should emphasize the bitter and astringent tastes so as to support weight loss45. A nutritious balance to any meal is 50% vegetables, 25% protein, and 25% whole grain or healthy starches46. Fruit, though full of important vitamins, is high in sugar and so should be eaten minimally, especially dried fruit as the drying process concentrates the sugar content47. Along with the bitter herbs discussed in the last section, pungent spices such as ginger, oregano, turmeric and basil can be added to food.  If possible, patients should complete a Pancha Karma treatment to purify their tissue and remove the toxins that block the glucose from entering the cells.

Besides weight loss, vigorous exercise is a wonderful way to reduce blood glucose levels as it makes cells more receptive of glucose; glucose passes more readily through the cell membrane when we exercise. The more strenuous the activity, the longer the effects last48. Invigorating pranayama practices like surya bhedana and kapalabhati are valuable because of their capacity to increase circulation. Abhyanga can be productive, though dry powders should be used to increase stimulation. Both circulation and stimulation are also enhanced by spicy scents such as clove, patchouli, cedar and eucalyptus.

Conclusion
Maintaining homeostasis of blood glucose levels is a complex process involving the release and use of insulin to carry glucose out of the blood stream and into cells. Imbalance and disease occur when the pancreas is unable to produce enough insulin to support the movement of glucose from the blood to the cells, when the body builds up a resistance to insulin, or when the cell receptor sites become blocked and no longer allow glucose to pass through. Hypoglycemia, madhu meha (type 1 diabetes mellitus) and iksu meha (type 2 diabetes mellitus) are conditions associated with the imbalance of blood glucose levels.

Herbs have proven to be effectual in the management and stabilization of blood glucose levels as well as in treatment of madhu meha and iksu meha. This paper highlighted a select sample of those that have garnered attention for their usefulness in this therapy.  

Though cinnamon is a widely accepted ‘plant drug’ used to regulate blood glucose levels, statistical findings are rather inconclusive in its efficacy as it pertains to these two diseases. It does, however, hold enough character to be regarded as beneficial in stabilizing blood glucose in those prone to episodes of hypoglycemia. While doing research for this paper, clinical trial reports and meta-analytical reviews on herbal treatments for hypoglycemia were not found to be as prevalent in the public databases.

Because madhu meha is an auto-immune disease, herbs act more as a support to western treatment than as a treatment in an of themselves. Fenugreek shows to aid in insulin regulation, and shallijit supports the pancreas by its endocrine tonifying tendencies.

With regards to the herbs discussed in this paper, iksu meha is more versatile in its response to herbal remedies. Gurmar is favourable because it counters sugar cravings and decreases glucose absorption. Fenugreek is a successful medicine because of its ability to metabolize fat. Similarly, aloe metabolizes fat and also regulates sugar.  

Shallijit’s ability to support the pancreas benefits those who suffer from iksu meha as well as madhu meha. Though no reported research on jambu was reviewed, it has long been esteemed for its hypoglycemic action and so is useful in reducing blood glucose in those who either cannot produce enough insulin naturally or for those who have build up a tolerance to it.

Scientific measurement proves that herbs can successfully assist in the treatment of these diseases, but changing dietary and lifestyle habits are paramount. By reducing and/or eliminating those physical, mental and emotional behaviours, as well as addressing the mental, emotional and spiritual beliefs that lead to an imbalance in the first place, herbs become a complementary support to a greater Ayurvedic treatment plan that affects wellness and healing on every level of our being.

End Note References

[1] John Douillard’s LifeSpa, John Douillard, DC, The Not-So-Sweet History of Sugar Part II. http://www.lifespa.com/not-so-sweet-history-sugar-part-ii.html

[2] Center for Disease Control and Prevention, CDC Staff, 2011 National Diabetes FactSheet. http://www.cdc.gov//diabetes/pubs/estimates11.htm

[3] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 6.

[4] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 709.

[5] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 5.

[6] Mayo Clinic, Nancy Klobassa Davidson, RN, Know Your Blood Glucose Target Range. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/blood...

[7] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 11.

[8] VJ Bjornholt, G Erikssen, E Aaser, et al. “Fasting Blood Glucose: An Underestimated Risk Factor for Cardiovascular Death. Results from a 22-Year Follow-Up of Healthy Nondiabetic Men.” Diabetes Care (January 1999): 45-49

Abstract: Because of the available conflicting epidemiological data, we investigated the possible impact of fasting blood glucose as a risk factor for cardiovascular death in nondiabetic men. This study reports the results from a 22-year prospective study on fasting blood glucose as a predictor of cardiovascular death.  Of the 1,998 apparently healthy nondiabetic men (aged 40-59 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were included in the study in which also a number of conventional risk factors were measured at baseline.  After 22 years of follow-up, 483 men had died, 53% from cardiovascular diseases. After dividing men into quartiles of fasting blood glucose level, it was found that men in the highest glucose quartile (fasting blood glucose > 85 mg/dl) had a significantly higher mortality rate from cardiovascular diseases compared with those in the three lowest quartiles. Even after adjusting for age, smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s, and physical fitness (Cox model), the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8). Noncardiovascular deaths were unrelated to fasting blood glucose level.
Fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middle-aged men.

[9] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[10] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3.57-58.
[11] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[12] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-60.

[13] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[14] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721.

[15] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[16] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[17] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-40.

[18] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 910.

[19] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721.

[20] John Douillard’s LifeSpa, John Douillard, DC, Western Docs Are Not Prescribing This Critical Test! http://www.lifespa.com/western-docs-are-not-prescribing-this-critical-te...

[21] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-39.

[22] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[23] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[24] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-42.

[25] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243.

[26] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243.
[27] R Pothuraju, RK Sharma, J Chaggalamari, et al. “A Systemic Review of Gymnema Sylvester in Obesity and Diabetes Management.” Journal of the Science of Food and Agriculture (March 2014): 834-840.
Abstract: The prevalence of obesity is associated with many health-related problems. Currently, more than 300 million people are considered to be obese. According to the World Health Organization (WHO), by 2030, 87 and 439 million people will be affected in India and the world, respectively. Today, herbal medicines are gaining interest in the treatment of obesity and diabetes, because of their minimal side effects. Gymnemic acid - an active component isolated from Gymnema sylvestre - has anti-obesity and antidiabetic properties, decreases body weight and also inhibits glucose absorption. Several components extracted from Gymnema prevent the accumulation of triglycerides in muscle and liver, and also decrease fatty acid accumulation in the circulation. In this paper, an attempt has been made to review the effects of various extracts from Gymnema sylvestre in the regulation of carbohydrate and lipid metabolism in both animal and clinical studies.
[28] John Douillard’s Life Spa, Jouhn Douillard, DC, Have a Cinnamon Holiday Season! http://lifespa.com/have-a-cinnamon-holiday-season.html
[29] RW Allen, E Schwartzman, WL Baker, et al. “Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis”. The Annals of Family Medicine (September/October 2013): 452-459
Abstract: Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemic-lowering effects, but studies have been small and show conflicting results. A prior meta-analysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and meta-analysis of RCTs evaluating cinnamon’s effect on glycemia and lipid levels.  MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A1c), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using random-effects models.  In a meta-analysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (−24.59 mg/dL; 95% CI, −40.52 to −8.67 mg/dL), total cholesterol (−15.60 mg/dL; 95% CI, −29.76 to −1.44 mg/dL), LDL-C (−9.42 mg/dL; 95% CI, −17.21 to −1.63 mg/dL), and triglycerides (−29.59 mg/dL; 95% CI, −48.27 to −10.91 mg/dL). Cinnamon also increased levels of HDL-C (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A1c levels (−0.16%; 95%, CI −0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDL-C (I2 ranging from 66.5% to 94.72%).  The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear.
[30] A Khan, M Safdar, MMA Khan, et al. “Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes”. Diabetes Care Journal (December 2003) 3215-3218.
Abstract: The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes.  A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 ± 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20-day washout period.  After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol (12–26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant.  The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.
[31] M Vafa, F Mohammadi, F Shidfar, et al. “Effects of Cinnamon Consumption on Glycemic Status, Lipid Profile and Body Composition in Type 2 Diabetic Patients”. International Journal of Preventative Medicine (August 2012): 531-536.
Abstract: Type 2 diabetes is the most common metabolic disorder worldwide. Traditional herbs and spices can be used to control blood glucose concentrations. The objective of this study was to evaluate the effects of the daily intake of three grams cinnamon over eight weeks on glycemic status, lipid profiles and body composition in type 2 diabetic patients.  A double blind, randomized, placebo controlled clinical trial was conducted on 44 patients with type 2 diabetes. Participants were randomly assigned to take either a three g/ day cinnamon supplement (n=22) or a placebo (n=22) for eight weeks. Weight, height, body fat mass and systolic and diastolic blood pressure were measured at baseline and after intervention. The fasting blood glucose, insulin, HbA1c, total cholesterol, LDL C, HDL C, Apo lipoprotein A I and B were measured at baseline and endpoint.  From 44 subjects participated in this study 37 completed the study. There were no significant differences in baseline characteristics, dietary intake and physical activity between groups. In the treatment group, the levels of fasting blood glucose, HbA1c, triglyceride, weight, BMI and body fat mass decreased significantly compared to baseline, but not in placebo group. No significant differences were observed in glycemic status indicators, lipid profile and anthropometric indicators between the groups at the end of intervention.  These data suggest that cinnamon may have a moderate effect in improving glycemic status indicators.
[32] N Suksomboon, N Poolsup, S Boonkaew, et al. “Meta-Analysis of the Effect of Herbal Supplement on Glycemic Control in Type 2 Diabetes.” Journal of Ethnopharmacology (October 2011): 1328-1333.

Abstract: A variety of herbs have been used in traditional medicine for the treatment of diabetes. However, evidence is limited regarding the efficacy of individual herbs for glycemic control. We performed a systematic review and meta-analysis to evaluate the effect of herbal supplement on glycemic control in type 2 diabetes.  Randomized controlled trials were identified through electronic searches (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) up until February 2011, historical searches of relevant articles and personal contact with experts in the area. Studies were included in the meta-analysis if they were (1) randomized placebo-controlled trial of single herb aimed at assessing glycemic control in type 2 diabetes, (2) of at least 8 weeks duration, and (3) reporting HbA(1c). Treatment effect was estimated with mean difference in the final value of HbA(1c) and FBG between the treatment and the placebo groups.  Nine randomized, placebo-controlled trials (n = 487 patients) were identified. Ipomoea batatas, Silybum marianum and Trigonella foenum-graecum significantly improved glycemic control, whereas Cinnamomum cassia did not. The pooled mean differences in HbA(1c) were -0.30% (95% CI -0.04% to -0.57%; P = 0.02), -1.92% (95% CI -0.51% to -3.32%; P = 0.008), and -1.13% (95% CI -0.11% to -2.14%; P = 0.03), respectively, for Ipomoea batatas, Silybum marianum, and Trigonella foenum-graecum. The corresponding values for FBG were -10.20mg/dL (95% CI -5.32 mg/dL to -15.08 mg/dL; P<0.0001) and -38.05 mg/dL (95% CI -9.54 mg/dL to -66.57 mg/dL; P = 0.009), respectively, for Ipomoea batatas and Silybum marianum.  The current evidence suggests that supplementation with Ipomoea batatas, Silybum marianum, and Trigonella foenum-graecum may improve glycemic control in type 2 diabetes. Such effect was not observed with Cinnamomum cassia. Given the limitations of the available studies and high heterogeneity of the study results for milk thistle and fenugreek, further high quality, large controlled trials using standardized preparation are warranted to better elucidate the effects of these herbs on glycemic control in type 2 diabetes patients.

[33] M Tierra, CA, ND, Planetary Herbology (Lotus Press, 1988) 301-302.

[34] N Neelakantan, M Narayanan, RJ de Souza, et al. “Effect of Fenugreek (Trigonella foenum-graecum L.) Intake on Glycemia: A Meta-Analysis of Clinical Trials.” Nutrition Journal (January 2014): 13-17.

Abstract: Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the long-term effect on glycemia remains uncertain.  We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis. PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using random-effects models.  A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by -0.96 mmol/l (95% CI: -1.52, -0.40; I² = 80%; 10 trials), 2 hour postload glucose by -2.19 mmol/l (95% CI: -3.19, -1.19; I² = 71%; 7 trials) and HbA1c by -0.85% (95% CI: -1.49%, -0.22%; I² = 0%; 3 trials) as compared with control interventions.  The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality.  Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.

[35] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 56.

[36] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 100.

[37] AA Rashidi, SM Mirhashemi, M Taghizadeh, et al. “Iranian Medicinal Plants For Diabetes Mellitus: A Systemic Review.” Pakistan Journal of Biological Science (May 2013): 401-411.
Abstract: In the Iranian traditional medicine a significant usage of herbs is promoted for their anti-diabetic activity. The aim of this review to assess the efficacy of glucose lowering effects of medicinal plants cultivated in Iran. An electronic literature search of MEDLINE, Science Direct, EMBASE, Scopus, Web of Science, Cochrane Library Database, Ebsco and Google Scholar from database inception conducted up to May 2012. A total of 85 studies (18 humans and 67 animals) examining 62 plants were reviewed. The quality of Randomized Controlled Trials (RCTs) assessed by using the Jadad scale. Among the RCTs studies, the best results in glycemic control was found in Aloe vera, Citrullus colocynthus, Plantago ovata, Silybum marianum, Rheum ribes and Urtica dioica. The majority of plants that have been studied for antidiabetic activity showed promising results.

[38] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 250-251.

[39] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826.

[40] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826.

[41] PV Sharma, Caraka Samhita, Vol II (Chaukhamba Orientalia, 1983), 118.

[42] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...

[43] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-44.

[44] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...

[45] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-46.

[46] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 9.

[47] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 20.

[48] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...
 
 
 
 
 

Cultivation of Sattva Guna Through Ayurveda and Yoga as the basis of Stress Reduction

By: Jolanda Davies

Stress - “...a state of mental, emotional or other strain”
   Concise Oxford English Dictionary, Eleventh Edition
“...any factor that threatens the health of the body or has an adverse effect on its functioning....the existence of one form of stress tends to diminish resistance to other forms. Constant stress brings about changes in the balance of hormones in the body”
- Oxford Concise Medical Dictionary, Seventh Edition
   The word stress has been used in physics for hundreds of years; however seven decades ago it was redefined by Hans Selye, a brilliant Canadian stress researcher, as “the non-specific response of the body to a demand for change.” [28] p. iv. The word stress was part of vernacular speech and became a buzzword that signified different things to different people. Some used it to refer to an annoying or distressful situation, while for others it was the resultant unpleasant emotional or physical symptoms that were experienced [28]. Paul J. Rosch, the President of The American Institute of Stress, says their clinical and experimental research confirms that stress is all about the level of control one feels they have which is determined by perceptions and expectations, “many times we create our own stress due to faulty perceptions.” [28] p x.
   “Too much stress hurts. It hurts relationships and work performance. It hurts health and quality of life. It hurts the enjoyment of yourself, others and life” [28] p. 2. In this paper I will discuss how developing the qualities of Sattva through the ancient sciences of Ayurveda and Yoga will benefit the body and the mind for the management of stress, developing control in day to day life, or indeed how to change ones perceptions and expectations.

The Effects of Stress

   “Stress is a normal physical response to events that make you feel threatened or upset your balance in some way” [22] When you sense danger, Dr. Palmer says the body's defences kick into high gear in a rapid, automatic process known as the „fight or flight‟ reaction, or the „stress response‟. “The stress response is the body‟s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. The stress response also helps you rise to meet challenges” [22]. “Stress switches on brain circuits and hormones that prepare the body to protect itself in dangerous situations.” [28] p. 5
   As people grow older they lose the emotional flexibility, to release and let go, therefore stress accumulates [28]. “Your mind and brain hold onto past fears and disappointments and project future ones. Your emotions stay drained, and your nervous system stays strained. You get trapped in your stresses. When this happens, your heart feels dismayed and your spirit feels constricted.” [28] p. 3.    Childre and Rozman discuss the body chemistry when stress is experienced. “A cascade of 1,400 different biochemicals is released by the body as soon as it senses stress. These hormones and neurotransmitters affect how you perceive and feel. High stress keeps your system bathed in stress hormones, which speeds up your biochemical aging clock, draining emotional buoyancy and physical vitality. Stress makes you feel like you are living to survive instead of to enjoy life. Your perceptions and feelings signal your body to release stress hormones into your system, depressing your mood and decreasing your ability to face the day‟s challenges.” [28] p. 85
   The stress response also includes the activity of the adrenal, pituitary and thyroid glands of the endocrine system. The adrenal medullas produce adrenaline which is released into the blood supply. Adrenaline increases both the heart rate, and the pressure at which the blood leaves the heart; dilates bronchial passages and dilates coronary arteries; skin blood vessels constrict and there is an increase in metabolic rate. Also gastrointestinal system activity reduces which leads to a sensation of butterflies in the stomach. [22]. “Strong emotions, like anger or fear, release a lot of adrenaline into your system, but adrenaline doesn‟t stay in the bloodstream for long. This is why anger or fear can give you a surge of energy and a temporary high but leave you feeling drained afterward. Too much adrenaline, too many ups and downs, can lead to high blood pressure and burnout.” [28] p. 85
   In a stressful situation, the anterior hypothalamus activates the pituitary gland to release adrenocorticotrophic hormone (ACTH) into the blood which then activates the adrenal cortex to synthesise cortisol. In Dr. Palmer‟s description of the physiology of the stress response, he discusses the effects of cortisol. “Cortisol is an important hormone in the body. It has been termed „the stress hormone‟ because it is secreted in higher levels during the body‟s response to stress, and is responsible for several stress-related changes in the body.”[23]. While cortisol is an important hormone, “when you chronically produce more than you need, it can lead to a host of problems.
   Over time excessive levels of cortisol can cause sleeplessness, loss of bone mass and osteoporosis, allergies, asthma, acid reflux, ulcers, low sperm count, redistribution of fat to the waist and hips, and fat build up in the arteries, which can lead to heart disease and numerous other diseases (McCarty, Barrios-Choplin, et al. 1998). All of these are the bodys efforts to protect itself.” [28] p. 86. Negative emotions fuel higher cortisol levels. This means “that every time you are anxious or angry, or even rehash a stressful situation, your brain signals your adrenal glands to pump more cortisol into your system. Excessive amounts of cortisol linger in the bloodstream for hours, which can tend to increase feelings of anxiety.” [28] p. 86. Too much cortisol also depresses the immune system, opening the door to infection and other diseases. [22]
   As a result the adrenal gland may malfunction which can result in tiredness with the muscles feeling weak; digestive difficulties with a craving for sweet, starchy food; dizziness; and disturbances of sleep [22]. “Chronic stress can lead to excessive secretions of these hormones that can lead to both serious psychological effects (depression) and physiological effects (malaise and susceptibility to infections).” [6] p. 287
   “Precipitating events or „stressful‟ life events can lead to depression in some people and discouragement in others. One is an illness and the other is a natural response to misfortune.” De Paulo says the answer to the question whether stressful life events cause depression is how the brain responds to environmental influences.
   He says medical researchers who follow the teaching of the great psychologist Walter B. Cannon understand stress to mean the nervous systems hormonal and behavioural responses to intensively unpleasant conditions. However, he does point out that depression can lead to stress, “a person may already be depressed and not know it, and because of the depression will have excessive anxiety”, especially he says, in somewhere like the work place and may not be able to perform due to the anxiety which in turn leads to stress. [2] p. 65-66
   Tortora and Grabowski discuss how stress can lead to certain diseases by temporarily inhibiting certain compounds of the immune system, and that people under stress are at a greater risk of developing chronic disease or dying prematurely. As an example they discuss Interleukin-1 (IL-1), a cytokine secreted by macrophages of the immune system, as an important link between stress and the immunity: “In response to infection, inflammation and other stressors, IL-1 stimulates the production of immune substances by the liver, increases the number of circulating white blood cells that are phagocytes, activates cells that participate in immunity, and induces fever. All these responses result in powerful immune response.” However, they go on to explain that “IL-1 also stimulates the secretion of ACTH (adrenocorticotrophic hormone) which stimulates the production of cortisol, which not only provides resistance to stress and inflammation, but also suppresses further production of IL-1.” [3] p. 545
   The American psychological Association say when you feel like you are losing control or feel overwhelmed, that you should pay attention to the body‟s warning signs,(as listed below). They say these are just some of the ways that your body tells you it needs maintenance and extra care. [4]

  •  Headaches, muscle tension, neck or back pain
  •  Upset stomach
  •  Dry mouth
  •  Chest pains, rapid heart beat
  •  Difficulty falling or staying asleep
  •  Fatigue
  •  Loss of appetite or overeating „comfort foods‟
  •  Increased frequency of colds
  •  Lack of concentration or focus
  •  Memory problems or forgetfulness
  •  Jitters
  •  Irritability
  •  Short temper
  •  Anxiety [4]

   The Mayo Clinic agrees also, saying “when you recognise common stress symptoms you can take steps to manage them.” They have divided the effects of stress into three categories; effects of stress on your body, effects of stress on your thoughts and feelings and the effects of stress on your behaviour. [5]. Table 1 lists these effects in each category as laid out by the Mayo Clinic staff.

Table1: Effects of stress by Mayo Clinic staff

Effects of stress on your body

Effects of stress on your thoughts and feelings Effects of stress on your behaviour
Headache Anxiety Overeating
Back pain Restlessness Under eating
Chest pain Worrying Angry outbursts
Heart disease Irritability Drug or alcohol abuse
Heart palpitations Depression Increased smoking
High blood pressure Sadness Social withdrawal
Decreased immunity Anger Crying spells
Stomach upset Feeling insecure Relationship conflicts
Sleep problems Lack of focus  
  Burnout  
  Forgetfulness  

 Gunas

   The Sanskrit word guna means “quality or attribute - one of three qualities of Nature (Prakruti): sattva, rajas, tamas” [9] p. 10.6. Dr. David Frawley describes the relationship between Primal Nature or Prakruti and the three gunas, “Primal Nature, Prakruti, is not a homogenous substance but the seed ground of multiplicity....Prakruti holds in herself all the forms of creation which manifest through her three main qualities, the gunas of sattva, rajas, and tamas.” [8] p. 27. All forms of creation include the human being and all its levels of existence. When Prakriti manifests creation “the three qualities differentiate, with sattva giving rise to the mind, rajas generating the life-force, and tamas creating form and substance through which the physical body comes into being.” [8] p. 28. Before manifestation, Prakruti, the seed potential for creation, “holds these three qualities in equilibrium, in which rajas and tamas are merged into sattva,” [8] p. 28 because, “sattva is the balance of rajas and tamas, combining the energy of rajas with the stability of tamas.” [7] p. 34. Dr Frawley says that all objects in the universe consist of various combinations of the three gunas and that they are the most subtle qualities of Nature that underlie matter, life and mind and help us to understand our mental and spiritual nature and how it functions. [7] p. 30
   Within Nature Rajas “is the active, stimulating or positive force that initiates change, disturbing the old equilibrium. Tamas is the obstructing or negative force which sustains previous activity. Sattva is the neutral or balancing force, harmonising the positive and the negative, which oversees and observes.” [8] p. 27. Dr Frawley says that all forces are necessary for ordinary activity.
   However, these forces also have spiritual implications “which can either expand us into wisdom or contract us into ignorance.” [7] p. 29. “Sattva is the quality of light, love and life, the higher or spiritual force that allows us to evolve in consciousness.” When cultivating this force, Sattva, we attain dharmic (true to our Nature) virtues of faith, honesty, self-control, modesty and truthfulness [8] p. 27. “Rajas is the quality of twilight, passion, and agitation, the intermediate or vital force, which lacks stability or consistency” [8] p.28. Cultivating rajas, David Frawley says “gives rise to emotional fluctuations of attraction and repulsion, fear and desire, love and hate.” [8] p. 28 Whereas Tamas is the quality or force of “darkness, non-feeling and death, the lower or material force” David Frawley says Tamas “drags us down into ignorance and attachment....causing dullness, inertia, heaviness, emotional clinging and stagnation.” [8] p. 28
   These qualities of nature, in terms of the mind “make it possible to determine the general state of a person‟s consciousness.” [14] p. 254. Dr David Frawley in his book about the healing of consciousness says “for any real healing of the mind to be possible, we must understand these forces (the gunas) and learn how to work with them as they exist, not only in the world, but also in our own psyche.” [7] p. 30. Although the state of the gunas are present within the consciousness, they are, Dr Halpern says “reflected in the mind” and “the dominant guna is a reflection of the evolution of the soul as it grows from ignorance to awareness and from awareness to transcendence.” [14] p. 254. “Sattwa is known as mind. It controls the body by conjunction with the self. Psyche is of three types according to strength – superior, medium and inferior. Accordingly the persons are also (of three types) having superior, medium and inferior psyche. Amongst them, those having superior psyche are, in fact, sattwasara (with sattwa as essence). They are seen unmoved even in severe afflictions – innate or exogenous – due to predominance of sattwa quality.” [27] Vimanasthanam, Chap. III, verse 119, p. 382
Dr. Halpern uses the analogy of a lake to liken sattva guna to the mind. “Imagine a still lake early in the morning before the sun has risen. There is no wind and the lake looks like a sheet of glass or a mirror.” [14] p. 254. Ayurvedic theory describes the primordial cause of disease as “forgetting our True Nature as Spirit.” Dr. Halpern says once we have forgotten our True Nature as Spirit, we become dominated by the ego and we live our life as sensory beings, in constant pursuit of sensory pleasure. He says through this pursuit we tend to overindulge and this leads to a host of energetic and physical imbalances which lead to disease. A sattvic individual is “unattached to the physical world.....their minds are at peace and they appear happy and content....through clarity of the mind, the sattvic person sees nothing to be angry about, nothing to be sad about and nothing to fear. There is only unconditional love and absolute faith.” [14] p. 254. Just like the lake “when it is clear, pure and still, the light of the stars and the moon are reflected off it” so too is our True Nature as Spirit revealed, “when our mind is clear, pure and still, the light of God is reflected through it.” [14] p. 254. “It is the principle of clarity, wideness and peace, the force of love that unites all things together.” [7] p. 31
   Manas prakruti is a term that defines the mental constitution and is described in terms of the three gunas (sattva, rajas and tamas). “Sattva qualities of the mind are clarity, alertness, attentiveness, understanding, purity, compassion and co-operation. Rajas qualities include ambition, self-centeredness, selfishness and restlessness. Tamas qualities express in the mind as dullness, gloominess, sadness, depression and laziness” [17] 174. To be freed from this material world of rajas and tamas, Vasant Lad says there needs to be release from tamas and rajas by controlling desire, temptation, agitation and lethargy. “The mind should be pure, which is sattva. Sattva will bring clarity, purity and insight.” [17] p. 175. However, Lad goes on to explain “to create balance, sattva, rajas and tamas must be balanced which means having a balanced diet, moderate amount of sleep (tamas), moderate levels of activity (rajas) and moderate meditation (sattva)” [17] p. 176. Rajas is responsible for movement, but we should have Sattvic movement, which is good conduct. Tamas is inertia, but we need Sattvic inertia, which is sound sleep. Samadhi or absorption is a state of balance between the gunas. A state which is beyond these qualities because the three gunas are so balanced that they merge into prakruti, which merges into Purusha (realisation of the True Nature as spirit). Manas prakruti is therefore the mental constitution when the gunas are balanced and in a state of nirguna. [17]

   Dr. Halpern comments on the lack of clarity (sattva) within the mind. He says rajas and tamas are the true causes of mental disease and hence disease begins when a person forgets their true nature as Spirit. This causes imbalances, which are perceived in the mind as disturbing emotions. These emotions are disturbances in prana1, tejas2 and ojas3 and they ultimately lead to imbalances in the physical body via vata4, pitta5 and kapha6. Dr. Halpern says that healing is through the cultivation of sattva to make the mind clear and pure so the memory of one‟s true nature is restored and a person is empowered to act harmoniously. [14] The process of cultivating sattva occurs through all five senses through proper lifestyle.
   Manas vikruti is the unbalanced mental state. Dr. Vasant Lad lists five main causes of manas vikruti:
1. Inappropriate diet
2. Inappropriate lifestyle
3. Lack of clarity in relationships
4. Repressed emotions
5. Stress [17]
   Dr. Vasant Lad says psychological stress is caused by not being in the present moment as it is. Instead “in the present moment we see „what is‟ and immediately we create stress by seeing the opposite of this which is „what should be,‟ „could be‟ and „would be‟ ” [17] p. 184. However, he says these are mere emotions and „what is‟ is reality and „what should be‟ is illusion, yet, he says, we always run after the illusion and this is a cause of manas vikruti. “manas prakruti is the now, the present...‟should be,‟ „could be‟ and „would be‟ are the shadows of manas vikruti.” [17] p. 184. He says we have to surrender to the eternal present. Vasant Lad also talks of emotional stress which is “a reaction from the past to the perception and sensation of the present.” [17] p. 184. When the past meets the present it is bound to cause a reaction in the form of emotion. The past is gone and dead, whereas the present is now, fresh and alive. “If we are not happy with the present, the past suddenly creates what „should be,‟ „could be‟ and „would be,‟ trying to overlay the present, “this is how human beings live in the past” [17] p. 184 which as Vasant Lad says causes stress.
   To cultivate sattva guna, to move from manas vikruti to manas prakruti, Dr Frawley says that Yoga and Ayurveda emphasise its development. Yoga practice he says has two stages: the development of sattva guna (purification of mind and body) and transcendence of sattva (going beyond the body and mind to our True Self – comes from higher meditation practices). He quotes that “sattva body and mind are less likely to suffer from disease and more able to continue in a state of balance.” [8] p. 30.” Sattva guna is the key to Ayurvedic healing and is developed through right diet, physical purification, control of the senses, control of the mind, mantra and devotion.” David Frawley says that disease is a tamasic state and brings about the accumulation of negative thoughts and emotions on a psychological level, as well as toxins and wastes on a physical level. “Health is a Sattvic state of balance and adaptation which prevents any excess from occurring.” [8] p. 30.
   Dr. David Frawley discusses the functions of the mind and “understanding the gunas of the mind and changing them from tamas to sattva is the key to mental health.” [7] p. 138. He lists how sattva manifests in the layers of the mind as shown in Table 2.

Table 2

Function of the mind

Sattva

Consciousnesses (chitta) Inner peace, selfless love, faith, joy, devotion, compassion, receptivity, clarity, good intuition, deep understanding, detachment, fearlessness, inner silence, clear memory, calm sleep, right relationships
Intelligence (Buddhi) Discrimination between the eternal and the transient, clear perceptions, strong ethics, tolerance, non0violence, truthfulness, honesty, clarity, cleanliness
Mind (Manas) Good self-control, control of senses, control of sexual desire, ability to endure pain, ability to withstand the elements (heat & cold), detachment from the body, does what one says
Ego (Ahamkara) Spiritual idea of self, selflessness, surrender, devotion, self-knowledge, concern for others, respect for all creatures, compassion

Ayurveda

   Ayurveda is a system of healing that has its roots in ancient India. It is thought by many scholars to be the oldest healing system extant on the planet. Knowledge of Ayurveda originates in the Sanskrit language and the term Ayurveda comes from the roots „Ayus’ and „Veda’ – ayus meaning life and veda meaning knowledge, hence Ayurveda is the Knowledge of life. Dr. Vasant Lad states that the knowledge contained in Ayurveda deals with the nature, scope and purpose of life, and includes its metaphysical and physical aspects – health and disease, happiness and sorrow, pain and pleasure. He says “Ayurveda defines life as the conjunction of body, mind and spirit, found in Cosmic Consciousness and embracing all of creation.” [15] p. 1. Hence, there is no part of our existence that Ayurveda does not address. “Mind, self and body – these three make a tripod on which the living word stands. That (living body) is Purusa (person), sentinent and location of this Veda (Ayurveda). For him alone this Veda is brought to light.” [27] Sutrasthana, Ch. I, verse 46-47, p. 6. The knowledge of Ayurveda was revealed through the hearts of the enlightened rishis (seers), “it is not a creation made by the mind of man but rather a revelation from the hearts of meditative sages.” [15] p. 3. Students came to study with them, and the rishis imparted knowledge as they experienced it in deep states of meditation.
   The term „knowledge of life‟ is not simply the understanding of the facts of life but it is a deep knowing of Truth, “to know something means to become one with the knowledge” [16] p. 3. To have health means to become one with the knowledge of the self. In Sanskrit, the word for perfect health is svastha. The term comes from the root sva meaning self and stha meaning established, therefore the term svastha, for perfect health, means established in the self. [16] p. 4, Being established in the Self is to have a deep knowing of the Truth of the Self which brings about svastha.
   “Health is the natural end result of living in harmony. Disease is the natural end result of living out of harmony. Healing is the process of returning to harmony.” [16] p. 2. “In Ayurveda sattva guna is the state of balance that makes healing happen.” [8] p. 29. In order to have perfect health sattva guna must be developed, it is “the key to Ayurvedic healing” and can be developed “through right diet, physical purification, control of the senses, control of the mind, mantra and devotion.” [8] p. 30. By cultivating sattva guna “a person grows and evolves, awareness increases....further growth and evolution (of the soul) leads to higher states of awareness and realisation of God. This is sattva.” [16] p. 258.
   In his definition of disease Dr. Halpern says understanding what health is, disease can be understood as its opposite. “Disease is anything less than perfect health...Any disturbance of a person‟s peace of mind and well-being, no matter how slight, implies disease.” [16] p. 5. The Caraka Samhita quotes, “perverted, negative, and excessive use of time, intelligence and sense objects is the threefold cause of both psychic and somatic disorders.” [27] Sutrasthana, Ch. I, verse 54, p. 7. Ayurvedic concepts define disease not only as physical, but as subtle and spiritual also. It states the primordial cause of disease as “forgetting our true nature as spirit” [16] p. 6. Dr Halpern explains this loss of awareness is forgetting that a part of God resides within each of us. He says this piece of God is the principle of atman7 in Sankhya8 philosophy, “it is our spirit or soul.” [16] p. 6. Dr. Halpern says once we forget our true nature as spirit, we understand ourselves only as body and mind, and become wrapped up in the stories and dramas of the physical world which results in disturbances of the mind and mental tranquillity. These disturbances cause challenging emotions to rise and upset the biological energies that control the body which results in physical disease. [16] p. 6. The Caraka Samhita quotes “the object (of Ayurveda) is to protect the health of the healthy and to alleviate disorders of the diseased.” [27] Sutrasthana, ch. XXX, verse 26, p. 240.
   Achieving perfect health through Ayurveda is “related almost directly and proportionally to proper lifestyle and state of mind” [16] p. 1. This proper lifestyle “is an art of daily living that has evolved from practical, philosophical and spiritual illumination rooted in the understanding of Creation” [15] p. 1. “As health improves, with proper lifestyle and a peaceful state of mind, life expands with equal tenacity.”[16] p. 1. Ayurveda provides the insight for each person to create a way of life that is in harmony both with the world of nature and our higher Self. [8] p. 4. Ayurveda considers proper lifestyle to surround the three pillars of life and through this sattva is cultivated. [14] p. 332.
The three pillars of life are; proper management of food and digestion, proper management of sleep and proper management of sexual energy. “Through proper digestion our bodies are able to distract, from the food, all of the nutrients present as well as the life energy (prana1). The end result of proper digestion is ojas3, a subtle energy that protects the body and mind from disease.” [16] p. 54. Proper digestion is achieved by eating the ideal food choices for each individual‟s unique constitution9 and consuming it following the Ayurvedic guidelines of healthy eating.

   Sleep, the second pillar, is essential for the well-being of any person. The body uses sleep as an opportunity to use its energy for healing and repairing any damage to the body that accumulated during the waking hours. If the body does not receive enough sleep it cannot repair the damage caused by stress and strain. Too little sleep results in weakening of the body tissues, while too much sleep results in tissues that become excessive, stagnant, lethargic and immobile. [16]
   The third pillar, the management of sexual energy is important because sexual release is understood to reduce the energy available for supporting the healing of the body and mind. Excessive sexual indulgence can leave a person in a weakened and exhausted state. Sexual energy called shukra is needed to build ojas3, the energy that provides stability to the body and mind and underlies the strength of the immune system. When shukra is depleted, ojas3 becomes depleted as well. [16] p. 54-55. “diet, sleep and celibacy, if these three are observed properly and thus the body is supported well by these pillars, it continues well endowed with strength, complexion and development till the completion of lifespan.” [27] Sutrasthana, Ch XI, verse 35, p. 75.
   Creating balance by structure in life helps reduce the effects of stress says Robert Svoboda [1] p. 123. He says that stress, or rather an improper reaction to stress can cause disease and it impairs the ability of the immune system. Stress occurs every time you have to adapt to a new situation. Every time your environment, physical, mental, emotional, social and spiritual surroundings change, you must change along with it and develop a new equilibrium with it. Your resilience, your ability to cope with the change, is your immune system, and as stress increases, strain on the immune system grows. When the strain becomes too great the immune protection fails, this is due fundamentally to a weakness of ojas3. [1]. Ojas3 is a substance that can be produced, collected and stored and is the “foundation of your physical immunity, and produces your aura8. Your aura8 is your first line of defence from the outside. It is a buffer against all the negativity which is consciously and unconsciously projected against us each day...The weaker your aura8, the less stress you can simply shrug off and ignore.” [1] p. 125. “Ayurveda believes that routine discipline, for body and mind, actively strengthens immunity” [1] p. 99. Dr. Halpern discusses the importance of daily routines, habits and rhythms saying they are the single most important determinant of well-being. Healthy habits create a healthy life; unhealthy habits create an unhealthy life. “It is here in the lifestyle that the causative factor of disease is identified. Thus healing occurs by correcting the habits that are causing ill-health and adopts habits that bring about harmony and healing.” [14] p. 448. “He who constantly thinks of (reviews, examines) how his day and night are passing (and adopts the right way only) will never become a victim of sorrow.” [26] Sutrasthana, Chp. II, verse 47, p. 31.
   Ayurvedic concepts describe the physiology of the body being governed by three main forces, which are commonly known as the three doshas. “Although dosha literally means faulty or to cause harm, they only do so when they are functioning abnormally. When functioning normally, they maintain the good health of the body and guide all the normal bodily processes.” [16] p. 69. The three doshas are vata4, pitta5 and kapha6 and the “human constitution9 or prakruti, is the inherent ideal balance of the three doshas within the individual.” [16] p. 71. Dr. Halpern says this ideal balance is determined at conception and does not change throughout a person‟s lifetime. Vikruti is the nature of the imbalance, “anything other than balance, present at the moment of conception, creates disease, vikruti defines the nature of the disease and healing is the process of returning the vikruti to the state of prakruti.” [16] p. 100.
   Ayurveda and Yoga emphasise a pure vegetarian or what is called a sattvic diet – a diet to encourage the development of sattva, the higher qualities of peace, love and awareness. Ayurveda emphasises right diet as the foundation of all healing therapies, it is the first and most important form of medicine. Ayurveda recommends Sattvic food because sattva creates balance, eliminates harmful factors and helps reduce all the doshas. [8] David Frawley says, with ahimsa (non-harming) being the basis of sattva “a sattvic diet is first of all vegetarian, avoiding any products that involve killing or harming of animals, Sattvic diet emphasises natural foods, foods grown in harmony with nature, on good soils, ripened naturally, cooked in the right manner and with the right attitude of love. Such foods are carriers of prana1 and consciousness.” [8] p. 168. Ayurveda prescribes dietary regimens for the different doshas. [8]. “Strength and life depend on diet.” [27] Vimanasthanam, Chp III, verse 120, p. 382
   Herbs are used to nourish and repair the body and the mind. “Nervines are herbs that strengthen the functional activity of the nervous system. They may be stimulants or sedatives and can be used to correct excesses or deficiencies of nervous function. They have a strong action on the mind and are useful in promoting mental health and clarity as well as aiding in the treatment of psychological imbalances and mental diseases.” [25] p. 66. Many of these herbs are fragrant because “aromatic herbs work directly on prana1, the prime energy of the nervous system......they open the mind and senses, clear the channels, relieve congestion, stop pain and restore the smooth flow of energy in the mind-body system” [25] p. 67. Frawley and Lad comment that vata4 emotions, experienced with stress, like fear and anxiety damage the nerves and cause insomnia, mental instability, nerve pain, cramping and numbness which may lead eventually to the wasting away of nerve tissue. “Most nervines particularly those that are aromatic move vata4 and so help remove the obstructed vata4 or life energy behind these disorders.” [25] p. 67. However, they also point out that vata4 nervous conditions require nutritive herbs when there is deficiency of nerve tissues and therefore the use of nerve tonics are appropriate.
   They go on to talk of the pitta5 type emotions, which are experienced during stress, such as anger, hatred, envy, which heat up the blood, liver and heart, “they can cause hypertension, insomnia, irritability and other nervous and mental imbalances. They can also burn out the nerves, a condition of high pitta5, aggressive, „business executives‟ life style.” [25] p. 68. Frawley and Lad mention that often these pitta5 conditions can be treated with bitter tonics or purgatives, but most of the herbs that act upon the mind are cooling in energy, “this is because the mind is unbalanced largely by negative emotions, which are like pitta5, and create heat. A calm and clear mind is usually a cool mind.” [25] p.68.
   Kapha6 nervous conditions are more a matter of dullness, lethargy and hypoactivity of the nervous system, suffering from greed, desire and attachment, clinging to the past. In terms of the mind and nerves kapha6 requires stimulation. Frawley and Lad recommend nervines that are aromatic, stimulating and decongesting. [25].
   “Oil massage (Abhyanga) is an important Ayurvedic therapy, not only for physical but for psychological conditions. Oil massage is calming to the mind, nurturing to the heart, and strengthening to the bones and nerves.” [7] p. 201. Dr. John Douillard comments on the goals of Ayurvedic massage, “to prepare the koshas12 to facilitate the flow of consciousness and shakti13 through each of these fields.” [29] p. 24. He says “when the subtle bodies are balanced, then each sheath or kosha – including all aspects of mind, body, spirit and emotions – can function up to its full harmonious potential.” [29] p. 24. Dr Douillard discusses the benefits of Shirodhara as one of the most powerful treatments to relieve vata4 in the mind. “When vata4 is in excess the mind can easily become over stimulated. Preoccupied with swarming thoughts, the mind has a difficult time slowing down. This can lead to an inability to handle stress, creating nervousness, anxiety, depression, insomnia, fatigue, psychological disorders and more. Shirodhara is the specific treatment for these disorders and any other disorder that is stress related. Shirodhara works mainly in the manomaya kosha, or mental sheath. It is here that the mind holds onto past impressions that create imbalanced desires (vasanas) and habitual patterns of behaviour (samskaras). As oil is poured on the forehead, the nervous system is deeply stilled.” [29] p. 271.
   Pancha Karma is the main Ayurvedic method of physical purification. “Owing to the subtle nature of its processes, it penetrates deep into the nervous system. It is useful for psychological problems caused by excess of the three doshas. Yet it can also be helpful for psychological problems caused by internal factors, emotions and karma.” [7] p. 203. Ayurveda also utilises subtle therapies such as colours, gems and aromas to alter sensory input so to control the mental and emotional condition. [7]

Yoga

   Dr. David Frawley describes Yoga as one of the most extraordinary spiritual sciences that mankind has ever discovered. “It is like a gem of great proportions, containing many facets whose light can illumine the whole of our lives with great meaning” [8] p. 3. It dates back over five thousand years and Frawley says “it is one of the few spiritual traditions that has maintained an unbroken development throughout history.” [8] p. 3. It covers and comprehends the whole of the human existence, “from the physical, sensory, emotional, mental and spiritual to the highest Self-realisation.” [8] p. 3. The methods used are “physical postures, ethical disciplines, breath control, sensory methods, affirmations and visualisations, prayer and mantra, and complex meditative disciplines.” [8] p. 4
   Within his Yoga Sutras Patanjali Maharishi compiled these methods into „The Eight Limbs of Yoga‟ or „Ashtanga Yoga.‟ These eight limbs form the systematic path of Raja Yoga. [9].Dr. Frawley describes as follows:
1. Yama – Rules of Social Conduct
2. Niyama – Rules of personal Behaviour
3. Asana – Physical Postures
4. Pranayama – Control of the Vital Force
5. Pratyahara – Control of the Senses
6. Dharana – Right attention or Control of the Mind
7. Dhyana - Meditation
8. Samadhi - Absorption

Yama and Niyama

Dr. Frawley says the Yamas and Niyamas are the dharmic (natural/true law that governs the universe) foundation of Yoga and Ayurveda. [8] p. 51 He lists the yamas or dharmic principles of social behaviour as follows:

  •  Ahimsa (non-violence)
  •  Satya (truthfulness)
  •  Asteya (non-stealing)
  •  Brahmacharya (control of sexual energy)
  •  Anabhinivesha (non-clinging) [8] p. 51

   Swami Sivananda, in his commentaries on the Yoga Sutras of Patanjali, does not mention anabhinivesha but comments on Aparigraha (non-coveting), as does B.K.S Iyengar in his Light on Yoga. “Aparigraha is freedom from greed or covetousness. One should not try to keep or try to get in possession anything beyond the very necessaries of life.” [11] p.31. Dr. Frawley states that right social behaviour is important for health, psychological well-being and spiritual development. “If we follow these observances, we will have no harmful impact upon the world and not get entangled in external complications of wrong relationships or wrong possessions.”[8] p. 51. The niyamas or dharmic principles of personal behaviour, as listed by Frawley, are as follows:

  •  Saucha (purity)
  •  Santosa (contentment)
  •  Tapas (self-discipline)
  •  Svadhyaya (study of the Self)
  •  Isvara Pranidhana (surrender to God) [8] p. 51

   “These are the lifestyle principles necessary to establish a personal yogic practice in life. They are also the basis of Ayurvedic life regimens for constitution9 balancing....Yama and Niyama constitute the dharmic or ethical foundation for all right living......These two sets of principles go together. Unless we have integrity in our social interactions, we cannot have it in our personal behaviour and vice versa.” [8] p. 52. In the Astanga Hrdayam it cites a verse that too discusses moral behaviour, “compassion with all living beings, granting of gifts, controlling the activities of the body, speech and mind, feeling of selfishness in the interests of others (looking after the interests of others as his own) these are sufficient rules of good conduct (moral behaviour)” [26] Sutrasthana, Chp. II, verse 46, p. 31.

Asana (posture)

   “By practicing them one develops agility, balance, endurance and great vitality. Asanas have been evolved over the centuries so as to exercise every muscle, nerve and gland in the body.......and they keep the body free from disease. They reduce fatigue and soothe the nerves. But their real importance lies in the way they train and discipline the mind.” [10] p. 20. Backing up his comment Iyengar goes on to talk of the health that is gained from the practice of asana. “It is a state of complete equilibrium, of body, mind and spirit.” “Purity of mind is not possible without purity of the body in which it dwells.” [9] p. 2.25.
   Focusing on asana for health and awareness Dr. David Frawley says “asanas keep the body in the best possible health” and “release tension at a deep level from the tissues, organs and joints.” [8] p. 205. He says that asanas provide specific positions and movements to strengthen and stretch the musculature to effectively move the body away from small pains and illnesses back to perfect and normal balance. [8] p. 205. “While asana can be a discipline in its own right, asana as exercise or as therapy should not be confused with the role of asana in classical yoga......Asana is mainly meant to help reduce rajas or the quality of turbulence that disturbs the mind” [8] p. 206 and perhaps most importantly “they begin a systematic cleansing of the tissues” [8] p. 205. Emotional tension is always reflected somewhere in the body, “every mental knot has a corresponding physical knot and vice versa. The aim of asana is to release these knots. Asanas release mental tension by dealing with them on a physical level.” [20] p.11.
   To understand how asanas can be of benefit to reducing symptoms of stress one must be aware of the mind body connection. Frawley talks about asana creating a free flow of energy in order to help direct our attention within, but he also says that this flow of energy can be focused on the body to treat its ailments. “Our physical posture affects our health, vitality and awareness. The mind-body complex consists of various interrelated channels – from those which carry food to those which carry thoughts. These channels are held together on a physical level by the musculoskeletal system, the shape of which is determined by our posture.” [8] p. 208. This is important for the healthy functioning of the mind and the body as “wrong posture creates various stresses, causing contractions that impair or block the proper flow through the channels. It inhibits the circulation of energy and nutrients while allowing toxins and waste materials to accumulate....As mind and body are interconnected, physical blockages intertwine with mental and emotional blockages and hold various addictions, compulsions and attachments.” [8] p. 208
   “Ayurveda recommends asanas as its most important lifestyle recommendation....it also prescribes asanas as an important treatment measure for various diseases.” [8] p. 207. Dr. Halpern states that Ayurveda approaches asana from an understanding of individuality. “Asanas are categorised for their effects on vata4, pitta5 and kapha6 and takes into consideration the type of asana, as well as the flow and the speed in which it is practiced.” [14] p. 453. On discussing vata4 asanas Dr. Halpern says the important mobility quality of vata4 needs to be balanced and therefore asanas for vata4 imbalance should be practiced slowly with great attention to focus and detail. Proper practice helps bring focus to the vata4 mind. He goes on to say that standing poses emphasise stability and sitting poses are calming to the mind reducing anxiety. With Pitta5 asanas care should be taken not to overheat the body whereas kapha6 imbalances benefit from flow sequences with greater speed. [14]. As with all imbalances “asanas bring harmony and balance to the physical body, particularly the musculoskeletal system that is the support of the body. Asana is part of the Ayurvedic treatment system for the physical body. Postures can be used to increase vitality or to balance the doshas. They can be adjusted to target certain organs or weak spots in the body.” [8] p. 52

Pranayama (control and expansion of vital energy)

   “Prana1 means breath, respiration, life, vitality, wind, energy or strength....Ayama means length, expansion, stretching or restraint. Pranayama thus connotes extension of breath and its control.” [10] p. 22. Iyengar talks of the yogi‟s life being measured by the number of breaths rather than the number of days and therefore the yogi will follow proper rhythmic patterns of slow deep breathing. “These rhythmic patterns strengthen the respiratory system, soothe the nervous system and reduce cravings.” [10] p. 22. These cravings are the mind displaying impurity. Iyengar says the mind is two-fold – pure and impure. “It is pure when it is completely free from desires and impure when it is in union with desires.” [10] p.23. Therefore from the practice of pranayama “desires and cravings diminish and the mind is set free” [10] p. 23. The benefits are physical too and Iyengar mentions a quotation that was often said by the seventeenth-century mystic Kariba Esken: “if you would foster a calm spirit, first regulate your breathing, for when that is under control, the heart will be at peace; but when breathing is spasmodic, then it will be troubled. Therefore, before attempting anything, first regulate your breathing on which your temper will be softened, your spirit calmed.” [10] p. 23 Sivananda teachers training manual discusses how prana1 connects the body and the mind, “the highest and most subtle manifestation of prana1 is thought. The grossest manifestation of prana1 in the human body is in the motion of the lungs. If the motion of the lungs is stopped, all other energy and movements in the body will stop automatically. In order to control subtle prana1, i.e. the thoughts, the yogi begins by controlling the breath.” [9] p. 2.25
   Pranayama includes all ways of energising the vital force (prana1) through the body, senses and mind by developing and expanding the energy of the life force. Dr. Frawley says that prana1 is our energy and if we do not have sufficient energy we cannot do anything in life. “Pranayama provides this needed energy for both body and mind.” [7] p. 271 The various types of pranayama lead to a condition of energised relaxation, “when the breath is at peace, the life force is calmed and the senses, emotions and mind are put to rest. The disturbed movements of our vital urges cease to trouble us with their desires and fears.” [7] p. 272.
   A number of research and clinical studies have pointed to the need for patent, well functioning nostrils to support mental and physical health. Swami Niranjanananda Saraswati, in his discussion on nasal obstruction research, discovered the incidence of various ailments were greater in patients suffering from one sided nasal obstruction. [19] “The breath alternates cyclically from one nostril to the other approximately every ninety minutes. There is a period of three to four minutes in each ninety minute cycle when the breath crosses over from one side to the other” [19] p. 104. This is important because during this crossing over the breath flows equally through both nostrils, “and this is the period traditionally advocated for successful and spontaneous meditation.” [19] p. 105. Since meditation, in the broadest sense, involves “placing the mind in a calm and concentrated state” [8] p. 286. The breath must therefore be regular and relaxed to “induce relaxation, regularity, and integration of the body‟s rhythms and processes so that they work in harmony together.” [19] p. 101. If the breathing is irregular and tense this can lead to “disordered, mental activity and chaotic thinking pattern, as well as physical emotional and mental disease.” [19] p. 101.
   There is a harmonising influence on the brain and the autonomic nervous system by the practices of pranayama. “The right side of the brain is activated when the left nostril is flowing, the left side of the brain is activated when the right nostril is flowing and whenever both nostrils flow equally, “every faculty of the human brain is functioning in an optimal and integrated manner.” [19] p. 106. “It is believed that during inhalation, the flow of air in each nostril stimulates specific unilateral autonomic nerve centres lying within and beneath the mucous membranes (in the nose). These specific stimuli subsequently influence the autonomic processes of respiration, circulation, digestion and so on.” [19] p. 107. Swami Niranjanananda suggests that the “autonomic nervous system, and its two complimentary components – the excitatory sympathetic nervous system (pingala nadi10) and the relaxatory parasympathetic nervous system (ida nadi11) – can be activated from the nasal mucous membrane region.” [19] p. 107. In this light, he says, we can begin to anticipate the far-reaching effects of yogic practices such as pranayama upon the whole autonomic nervous system, and hence upon the endocrine and physiological functions. [19]
   The subtle body is a field of energy. Through it, flows prana1 within subtle channels called nadis12. These channels permeate the entire subtle body. Dr. Halpern says the mind cannot function without the nadis and the nadis cannot exist without the mind, “the mind can be understood to be the sum total of all the nadis....the mind is the field and the nadis are the channels through which pranic energy flows.” [14] p. 275. The nadis energise the subtle body in a manner similar to the way the nervous system energises the physical body and “when the nadis are functioning properly, the mind is clear and vibrant.” [14] 275. Dr. Halpern continues to discuss the relationship between the mind and flow through the nadis, “mind is the initiator of pranic movement....altered flow through the nadis will also affect the mind.” “When flow is normal, a person is emotionally stable.” [14] p. 275. Any imbalance of the doshas within the mind thus alters the flow through the nadis. This alters a person‟s enthusiasm, clarity, peacefulness and bliss. To restore balance pranayama methods are used for working with the subtle energies of the body (prana1, tejas2 and ojas3) and influencing the flow of prana1 through the nadis. [14]
   Dr. David Frawley says pranayama, specifically alternate nostril breathing (nadi shodhana or anuloma viloma), is an important key to physical and mental health because it keeps the nadis clear and maintains a balanced flow between Ida11and Pingala.10 He says the “left nostril is lunar or kapha13 predominant, promoting the breath through it increases bodily tissues, Ojas3 (basis of the immune system) and gives nourishment to the outer mind.” [7] p. 276. He lists some of the effects of stress that are counteracted from left nostril breathing; insomnia, anxiety, anger and agitation (restlessness). The right nostril is solar and promoting the breath through it “increases courage and motivation...and counters poor digestion, depression and laziness.” [7] p. 227.
   “Therefore pranayama should be done daily with a sattwic state of mind so that the impurities are driven out of Sushumna nadi and purification occurs”
Hatha Yoga Pradipika, chapter 2, verse 6

Pratyahara (control of the senses)

   If there is rhythmic control of the breath through pranayama one will be able to prevent the senses from running after external objects of desire, this is done through the fifth stage of Yoga, control of the senses. To have purity of mind is not simply closing off the senses but to have right management of them and the ability to go beyond them, “it is not suppression of the senses but their right application, which includes the ability to put them to rest.” [8] p. 53 A Sattvic mind is one that is pure, when all desires and fears are annihilated, but there is impurity when the mind is in bondage with objects of desires. Iyengar says “the yogi knows that the path towards satisfaction of the senses by sensual desires is broad, but that it leads to destruction” [10] p. 25. In his book about the healing of consciousness, Dr. Frawley more accurately describes pratyahara as a “withdrawal from distraction,” rather than a withdrawal of the senses, which means detaching the mind from the impulses deriving from the senses, without this control the mind becomes fragmented and we have no internal stability. [7] p. 280. Pratyahara restores the proper relationship between the mind and the external world and cuts off the reception of negative influences and in turn opens up the reception of positive influences from within. [7] p. 283.
   Control of the senses is keeping the mind aloof from the senses and in control of their input. [7]. One of the three main causes of disease in Ayurveda is „the unwholesome conjunction of the senses with the objects of their affection‟. “Our senses are the vehicles through which we relate to the world around us.” [16] p. 7 Dr. Halpern describes the senses as “portals, or gateways, into our body, our mind and our consciousness.” [16] p. 7. The constant intake of energetic and physical impressions are either “harmonious or disharmonious in relation to a person‟s constitution9 and thus can take a person toward harmony and health or toward disharmony and disease.” [16] p. 7. Dr. David Frawley says wrong use of the senses may be excessive, deficient or improper and how we use our senses determines the kind of energy we take in from the external world. [7]. Ayurveda uses the five sense therapies to bring about healing through the senses; “taste therapy in the form of diet and herbs, touch therapy in the form of massage, visual therapy in the form of colours, sound therapy in the form of mantra and smell therapy in the form of aromatherapy.” [16] p. 7 Ayurveda also prescribes „spending more time in nature‟, “this allows for peaceful harmonious impressions to enter consciousness through all five senses. In nature the fresh wind caresses the skin, the smells of flowers and trees caress the nose, the sights of mountains, streams, trees, flowers and ocean caress the eyes and the sounds of birds, wind and water caress the ears.” [14] p. 333
   Intellectual blasphemy (the failure of the intellect or crimes against wisdom) is another cause of disease outlined in the Caraka Samhita. This is failure to follow what we know to be true to bring health and peace of mind. Dr. Halpern gives examples of staying up too late, eating too much, eating the wrong food. The intellect is connected to both the senses and the soul, the senses lead it astray while the soul leads it to harmony, however, “the whispers of the soul are hard to hear over the ruckus of the senses, hence we usually follow our senses desires. Ayurveda uses Yoga to train the intellect to listen deeply and hear the voice of the soul, when the voice is heard there is awareness of the connection to God” [16] p. 8 Dr Halpern says this connection fills the listener with spiritual energy that empowers them to overcome the temptations of the senses. [16]
   The Caraka Samhita cites a short quote which sums up the importance of controlling the senses, “the cause of happiness (health) is only one – balanced use (of the senses)” [27] Sarirasthanam, Ch. I, verse 129, p. 408.

Dharana (control of the mind)

   The sixth stage is reached “when the body has been tempered by asanas, when the mind has been refined by the fire of pranayama and when the senses have been brought under control by pratyahara.” [10] p. 27. David Frawley explains this as right attention, the capacity to bring all our mental energy, at will, to whatever we need to examine. Therefore dharana involves developing and extending our power of attention [8] p. 53. In the second Yoga sutra Patanjali, says what Yoga is, „Yogas chitta-vrtti-nirodhah’ – “Yoga is restraining the activities of the mind.” [12] p. 140. In order to achieve the true peace of Union (uniting the individual with the Universal Soul [12] p. 140 .i.e. realising True Nature) it is the mind and nothing else, that must be corralled and controlled. When the peace of Union is achieved the state of mind is unruffled and calm in all situations. [12] p. 140. “The quality of our attention in life determines our state of mind.” [7] p. 283. Dr. Frawley says the methods used some are the same as those in pratyahara, but pratyahara gathers the energy of the mind; then dharana focuses it. [7]
Dhyana (Meditation)
   David Frawley explains that meditation is not actually a technique, in-fact meditation techniques more properly belong to pratyahara or dharana. “True meditation is the natural state of awareness, not a method. But this requires some preparation to reach, indicated by the other limbs of yoga” [8] p. 54 Therefore meditation is a state that is reached through techniques involved in pratyahara and dharana. Dharana sets our intention on a particular object and dhyana holds it there, as Frawley says “sustained dharana in time becomes dhyana.” [7] p. 289. Therefore sustained attention or “a continuous flow of perception (or thought) is Dhyana.” [11] p. 154. To get to this stage, Sivananda explains, “there must be a gradual ascent in the stages of Yoga.” [11] p. 155. Dr. Frawley agrees with this saying “true meditation cannot be achieved by a restless or emotionally disturbed mind. It requires properly developed concentration, which itself rests on control of the body, senses, vital force and mind.” [7] p. 290 Thus it is necessary to practice all the stages of Yoga as laid out by Patanjali.
   The tools or techniques that are generally used to begin meditation, Frawley says, are prayer, mantra, pranayama or visualisation, from this, formless meditation can proceed, like sitting in silence, practicing self-inquiry, or performing devotional meditation. [8] p. 289. Meditation with form employs the same techniques as pratyahara and dharana, holding the mind on a particular object, but sustained over a longer period and that any object which draws the mind can be used, he gives examples of a form in nature, a deity2, a guru, yantra3 or a mantra. [7] p. 289. Formless meditation involves sustained awareness on truth principles such as „all is the Self‟ or on the Void which transcends all objectivity. [7] p. 289. Whatever the „object‟ B.K.S. Iyengar says “the mind when it contemplates an object is transformed into the shape of that object.” [10] p. 30. Thus contemplation on Pure Consciousness (True Nature) “there is no other feeling except a state of SUPREME BLISS.....He sees the light that shines in his own heart.” [10] p. 30
   This all depends on the predominance of sattva guna within our entire nature otherwise, “to simply try not to think is to put ourselves into a blank state, in which our consciousness is not transformed but merely put to sleep.” [7] p. 290. For this reason, we must first purify our life and mind. David Frawley goes on to discuss the importance of meditation for the maintenance of stress. He says that much of what is referred to as meditation today is more properly pratyahara (like visualisation) or dharana (concentration techniques) and such techniques are useful for calming the mind, “stress is an accumulation of tension in the mind. Meditation, expanding the mental field, relieves it.” [7] p. 291. Ayurveda prescribes meditation as a way of increasing sattva as a principle of treating mental disease. “Most forms of meditation create greater stillness in the mind and deeper awareness. In stillness, a person cannot help but see past the illusions of creation and connect more deeply with spirit.” [14] p.333
Samadhi (absorption)
   “At the peak of his meditation he passes into the state of Samadhi, where his body and senses are at rest as if he is asleep, his faculties of mind and reason, are alert as if he is awake, yet he has gone beyond consciousness. The person in a state of Samadhi is fully conscious and alert.” [10] p. 31. “Samadhi is our capacity to merge with things in consciousness that shows our joy and fulfilment in life.” [8] p. 54

Conclusion
   “To have sattva predominant in our nature is the key to health, creativity and spirituality. Sattvic people possess a harmonious and adaptable nature which gives the greatest freedom from disease, both physical and mental. They strive toward balance and have peace of mind that cuts off the psychological root of disease. They are considerate of others and take care of themselves.” [7] p. 34. Sattva creates balance, eliminates harmful factors and helps reduce all the doshas and as Dr Halpern mentions, anything other than balance of the doshas, creates disease. [16]. As described, stress has many potentially harmful effects on the body, mind, emotions and behaviour, which effectively speaking in Ayurvedic terms, is an imbalance of one, two or all three doshas.
   Vasant Lads comment, discussed on page 9, stress can be caused by not living in the present moment as it is, backs up Paul J. Rosch‟s experiments, (as discussed on page 2), which demonstrated stress is all about the level of control one feels they have which is based on their perceptions and expectations. Not being happy in the present moment is only a result of perceptions and expectations of what the present moment „should be‟.
   Creating sattva through Yoga and leading an Ayurvedic lifestyle brings about awareness of the Self. To get here there must be perfect health. Perfect health or svastha, is achieved by being established in the Self, being established in the self is having a deep knowing of the Truth of the Self, knowing the Truth of the Self is realising that a part of God or atman7 resides within us. This level of clarity can only be obtained with a Sattvic body and mind; “unless the mind is calm and clear, we cannot perceive anything properly. Sattva creates clarity, through which we perceive the truth of things.” [7] p. 32. To be able to perceive the truth of things has been declared to take away all the miseries and pain of life. [9]. Practicing the techniques of Yoga and Ayurveda allows the mind to be calm, the senses to be brought under control and the body, mind and spirit to be purified, the body in this state of svastha is not attached to the illusions of „what should be‟ or „what could be‟ but instead accepts „what is‟ as the truth of the present moment is clear.
   “Yoga and Ayurveda emphasise the development of sattva.” [8] p. 29.

 

 

Excessive use of the sweet taste: Effects on the body and mind (by Debi Mueller C.A.S)

Abstract

The role of the six (6) tastes as related to the health of body and mind was documented in the ancient text as the Rishis note their impact on the body and mind. The sweet taste in particular was observed to be of significance due to the percentage of this taste in the human diet in general. In a review of the literature from the classical Ayurvedic texts to current Ayurvedic writers, as well as recent scientific evaluations, the affects of overuse of any taste has been shown to have serious negative outcomes. This paper will review that information which focused on the overuse of the sweet taste. One suggested process which leads to over indulgence of the sweet taste will be described, and a recital of the problems caused from this use in both the physical body and the mind will be provided.

List of Terms

Sanskrit

English interpretation or equivalent

ap

water

prthvi

earth

agni

fire

vayu

wind (or air)

akasa

ether

mahabhuta

great element

rasa

taste

dhatus

tejas

tissues

fire

dosa or dosha

constitution or humor

priya

delicious

hita

wholesome

Vata, Pitta, Kapha

the 3 constitutions (air, fire, water)

ahamkara

ego

prameha

condition of excessive urination, diabetes

The Role of Taste in Nutrition

According to the Caraka Samhita as translated by R. K. Sharma and Bhagwan Dash , "There are six rasas (tastes), viz. sweet, sour, saline, pungent, bitter and astringent. When employed properly, they maintain the body and their incorrect utilization results in the vitiation of the dosas ." [1] Further, it is noted, "Measurement of food is, in fact, of two types, viz. food as a whole and of its different ingredients having different tastes like sweet, sour, etc. If food as a whole is taken according to the prescribed measurement but its ingredients having different tastes like sweet, sour, etc. are not in prescribed ratio, the equilibrium of dhatus and dosas gets definitely disturbed due to imbalance in the ratio of the composing rasa s (tastes). Consequently the timely digestion of food as a whole will also be affected." [2]

In the current body of literature, Dr. Marc Halpern writes, "The ancient Rishis of India who developed the Ayurvedic system of living did not know about proteins, carbohydrates, and fats. Rather, they approached nutrition from an energetic perspective. They learned that if the qualities of a human being were understood and the qualities of a food source were understood, then it could be predicted what effect would occur when they were mixed together." [3]

The focus of developing a healthy diet began with the energetic, or elemental make up of the foods as it compared to and supported an individual's constitutional make up. This elemental combination was observed by the ancients as they came to understand the building blocks of a healthy diet. Caraka wrote, "Rasa or taste is the object of gustatory sense organ, as distinct from the objects of the other sense organs. Primarily ap is the substratum of rasa. Besides, prthvi also indirectly serves as a substratum thereof.

"The qualities of preceding basic elements ( akasa, vayu, agni, ap and prthvi ) are included in the succeeding ones; so the qualities of ap is automatically included in prthvi. To sum up, ap and prthvi are the substrata for the manifestation of taste ( rasa). That is to say, taste (rasa) can manifest itself only through ap and prthvi. These two mahabhutas , (in addition to the remaining three) are also responsible for the manifestation of specific rasas like sweet, etc. For example, taste is sweet when there is predominance of the qualities of ap and it is sour when the qualities of prthvi and tejas are predominant." [4]

Therefore, identifying and understanding the elemental nature of the tastes within food serves as the basis for defining good nutrition.

The Role of the Sweet Taste

Of the six (6) tastes, the sweet taste is found to be highly significant. The classical literature notes, "Sweet, sour, saline, pungent, bitter and astringent" this is the sixfold collection of tastes "In this classification, sweet taste occupies the first position inasmuch as it plays an important role in the diets of all living things" [5]

Current day Ayurvedic experts acknowledge the first position of the sweet taste as well. In his writings, David Frawley states, "In terms of nutrition, sweet is most important generally for everyone, as it possesses the highest nutritive value." [6]

There is agreement of the value and necessity of the sweet taste prevailing in the diet. It has been found to be the predominate taste with most foods containing the elements of ap (water) and prthvi (earth) as their key constituents. The energetics of these elements as provided by the sweet taste are necessary for the health of all living things.

Frawley goes on to describe the positive affect of the sweet taste as he writes, "Each taste has its specific therapeutic actions. Sweet taste is building and strengthening to all body tissues. It harmonizes the mind and promotes a sense of contentment. It is demulcent (soothing to the mucous membranes), expectorant and mildly laxative. It counters burning sensations." [7] All of these aspects of sweet are supportive of the digestive processes. Digestion being at the root of all health or disease, it is essential to have an abundance of supportive intake. In concert with Subhash Ranade, Frawley further points out, "Sweet taste has the same nature as the body, increasing bodily tissues including plasma, blood, muscle, fat, bone, nerve and reproductive. It prolongs life, nourishes the sense organs, imparts vigor and improves the complexion. It has a lubricating effect on skin, hair and voice and promotes strength. Psychologically, it promotes cheerfulness, energy and happiness, containing the energy of love." [8]

In support of the importance of the role of the sweet taste, John Douillard writes, "The sweet taste, when taken in its natural form (such as rice, bread, or pasta) along with the other tastes, provides a "satisfaction factor." Without it, most people will leave the table feeling unsatisfied, although unable to pinpoint why" [9] Most people would agree that a meal which is satisfying is most desirable. Feeling satiated allows one to move into the flow and expectations of life more easily. The sweet taste provides a key element of making food not only wholesome, but delicious. These two critical fundamentals of our diet were addressed by Caraka as follows, "the food should be delicious ( priya) and wholesome ( hita ). If the food is only delicious but not wholesome, then this does not contribute to the sustenance of the body and nourishment of the sense organs and their objects, namely smell, taste, vision, touch and sound in the body. Similarly, if the food is only wholesome, but not delicious, then this does not provide nourishment to the senses and their objects in the body instantaneously. Therefore, the food should be both delicious and wholesome." [10]

Elements of the Sweet Taste and Foods Predominately of Sweet Rasa

The sweet taste is made of the elements of water and earth. Water provides the very essence of taste. It is through the moisture that the sensory organ of taste is able to operate. As noted previously, sweet is the predominant taste. Most foods include in their make up the sweet rasa , often with one or more of the other rasas.

In evaluating the rasa of specific foods, Dr. Vasant Lad has identified all meat as having a sweet rasa, frequently in addition to an astringent rasa; dairy products, with the exception of yogurt, have a sweet rasa; oils carry a sweet rasa , except for white mustard oil; all sweetners, legumes, grains, nuts, seeds, and fruits have sweet rasas; most vegetables also have sweet rasas, with the notable exceptions of cauliflower, celery, leafy lettuce, onion and radish. Of the main food substances, only herbs and spices are found frequently not to carry sweet rasas, nevertheless, even some of these are known to have a sweet rasa . [11]

As you can see from this list, it would be very rare to consume a reasonable meal without ingesting a high percentage of the sweet taste. It is essential that our diet predominates in the sweet taste as both classical authors and current writers have noted the positive role of sweet in our diet. Frawley, however, points out "everyone needs a certain amount of each of the six tastes. The relative proportion differs according to the constitution or humor of the individual. Too much of any taste can become harmful to any constitution type, as can too little." [12] Taking into consideration the constitutional make up of an individual, judgment should be used to provide a higher degree of sweet for Pitta individuals, a moderate amount for Vata, and less for Kapha , ingesting only as much as is necessary for healthy tissue manufacture. [13]

With all of the positives provided by the sweet taste for the health of the body, it is necessary to have a clear picture of what can happen that causes an individual to overuse the sweet taste and the resulting negative consequences.

How Overuse of the Sweet Taste May Develop

As we assimilate all of the information presented above, it becomes key for a practitioner or follower of Ayurvedic principles to understand what may be at the root of developing a habit of overusing the sweet taste. Douillard sets groundwork for understanding this issue when he writes, "The problem doesn't originate with the sweets. If we are not nourishing our minds, bodies and emotions properly with all six tastes in each meal, we will become emotionally susceptible. The nutritional foundation needed to support balance in times of stress simply won't be there. As a result, wherever we have a weak link, whether emotional or physical, we will break down." [14]

In our society, with its fast-paced and aggressive nature, it becomes a perpetually increasing situation that we do not nourish our bodies, minds or emotions. Douillard additionally notes, "The sweet taste of food (often in the form of junk food) is frequently abused in the attempt to make up for the lack of satisfaction in one's life. Sweets are then inappropriately tried and found guilty for causing a multitude of food and sugar addictions." [15] From this we can draw the conclusion that sweets, especially in the form of simple sugars or non-complex carbohydrates, i.e., junk food, can provide a temporary consolation for the lack of satisfaction in our life. This is supported by Dr. Robert Svoboda as he writes, "All addictions are fundamentally addictions to the Sweet Taste, the Taste that creates satisfaction in ahamkara" Addiction to sugar is a good example of how addictions develop. If you search for satisfaction primarily in your food instead of in your life you may well become addicted to sweets. If you are not careful to select healthful Sweet foods like fruit and whole grains, you will probably fall prey to sugar-filled junk foods like doughnuts for your Sweet fix. When you eat too much white sugar for too long it will exhaust your system's ability to digest it. This will make you hypersensitive to it, which will aggravate Vata" [16]

In numerous medical research studies, as reported in multiple journals including "Pharmacological Biochemical Behavior","Obesity Research," and "Neuroreport," scientists have shown that when rats had high levels of simple sugars introduced into their diet, intake of healthy chow diminished. Of significance are the following findings:

• When allowed liberal access to a 20% sucrose solution in addition to their normal diet, even after introducing a drug to block pain, the rats increased their sucrose consumption and steadily decreased consumption of normal chow. [17]

• After being food deprived for 12 hours daily, rats were offered 25% glucose as well as the standard chow; after being deprived of the glucose and chow, they showed signs such as teeth chattering, tremors and head shaking typically associated with signs of opioid withdrawal; indicating sugar dependency. [18]

• Rats given 25% glucose solution with chow for 12 hours and then deprived of food for 12 hours doubled their glucose intake in 10 days and developed a pattern of excessive intake in the first hour of daily access. [19]

In interpreting the information provided by the Ayurvedic writers as well as that of the medical researchers, it appears that when one attempts to find fulfillment of body, mind and spirit through the overuse of the sweet taste, a strong potential exists to move toward the most immediate form of sweet digestible. That includes processed sugars and alcohol. [20] Frawley notes that it is the stronger pure forms that aggravate the doshas . First it will impact the one it typically aggravates, but after excessive use even the dosha(s) it typically alleviates will become deranged. For the sweet taste the pure form is sugar, any form of pure sugar. [21]

Affects of Overuse on the Body

The literature reports a plethora of negative impacts of overuse of the sweet taste on the body. Beginning with the Caraka Samhita it was identified that overindulgence or addiction to habits and foods that aggravate kapha are responsible for the causation of prameha . [22] This is a condition of excessive urination and has come to be known as diabetes mellitus. Current Ayurvedic scholars report, "Too much sweet damages the spleen (pancreas) [23] ; "Sweet taste creates heaviness that obstructs the channels" [24] ; "(it) increases kapha and decreases pitta and vata. It is cold, damp and heavy for digestion, reducing agni. Excess use of the sweet taste produces such kapha disorders as obesity, lethargy, heaviness, loss of appetite, edema, dyspnea, cough, cold, constipation and vomiting." [25] Many of these same symptoms are echoed by Dr. Lad and he adds diabetes and abnormal growth of muscles. [26]

In the medical science community a myriad of studies have been conducted to determine the impact of certain variables within the diet. These experiments go far in supporting the Ayurvedic knowledge with empirical data.

In the "British Journal of Nutrition" it was reported that ingestion of pure carbohydrate or pure protein resulted in lower overall cognitive performance. Their findings supported the need for a balanced glucose metabolism. [27] Another statement of the concept of using all six tastes in appropriate balance.

A study done by the Department of Food Science and Human Nutrition at Michigan State University looked at diet quality and risk factors for cardiovascular disease in U. S. adults. Of interest in this study was the finding that a managed carbohydrate diet actually decreases the risk of cardiovascular disease. However, both the source and amount of intake of carbohydrates are important. When carbohydrates were ingested as simple sugars it was shown that there was "a greater effect on raising triglyceride and total cholesterol than starch and a substantial effect on lowering HDL-cholesterol." [28]

This study went on to report that "the highest quintile of carbohydrate intake (>57.5% in men and >59.1% in women) was associated with higher concentration of serum triglyceride and lower HDL-cholesterol "it was predicted that the more insulin-resistant an individual, the greater would be the negative metabolic effects of high-carbohydrate, low-fat diets." [29] A study conducted in Argentina fed rats on a sucrose rich diet and found significant evidence that it "induces hypertriglyceridemia and insulin resistance." [30]

A study reported in the "Journal of Obesity Related Metabolic Disorders" indicated that "when offered a choice of foods, rats typically prefer high-fat and/or high-sugar food items over their nutritionally balanced chow diet. In addition, they may increase their total energy intake by 20-40% and consequently develop mild to moderate obesity." [31]

Numerous other studies have found evidence of:

• sugar-induced hypertension [32]
• suppression of neuronal survival signals by hyperglycemia resulting in transient forebrain ischemia (stroke) [33]
• development of kidney stones from sucrose intake [34]
• increased risk factors for lung cancer due to high dietary sugars [35]
• increased susceptibility to neurotoxins with excessive dietary intake of sugars [36]

These symptoms primarily define kapha type disorders. These findings therefore support the understanding and wisdom of both the ancient and current acknowledged teachers of Ayurveda with regard to the physical body.

Affects of Overuse on the Mind

When attempting to understand the impact of overuse of any of the tastes, it is important to evaluate the doshic balance of the individual. To comprehend the impact of abuse of the sweet taste on the mind, it is important to distinguish it from the body. Frawley writes, "Nature has many ways of making human beings and every possible variety must be manifested. Moreover, the energetics between the outer and inner aspects of our nature are not always of simple correspondence "we must not treat psychological conditions simplistically according to the physical Dosha . The physical body may not simply reflect the mental nature, but may try to balance or compensate for it." [37] Therefore, the mental constitution of an individual must be taken into account when evaluating the amount of any of the tastes that will support health.

Ayurvedic philosophy identifies the mind as existing in the subtle or astral body. Frawley describes it as "being the most subtle form of matter." [38] He goes on to point out that "the mind can be easily affected and disturbed, easily excited, depressed or distracted. It can overreact to momentary impressions" Indeed there is nothing more difficult to control than the mind. Inability to control the mind causes sorrow and is behind the disease process." [39]

In assessing the impact of the sweet taste then, it is essential to understand both the physical and mental constitution as well as understanding that the mind is the more difficult to balance. Therefore, once out of balance, it will cause numerous physical and emotional conditions. It is unhealthy sensory habits that results in the vitiation of prana vayu leading to addiction. As noted by Marc Halpern, "the largest amount of prana or prana vayu enters the body through our mouth and our nose "when prana vayu is disturbed within the mind, it creates excessive thought and most importantly fear, worry, nervousness and anxiety." [40]

In the Caraka Samhita, the Principle of Psychopathogensis states, "The sense faculties, together with the mind get vitiated by excessive utilisation, non-utilisation and wrong utilisation of the objects concerned. This causes an impediment to the respective sense perceptions" The sense faculties get vitiated due to the excessive utilisation, non-utilisation, wrong utilisation of their respective objects. The vitiated sense faculties, in their turn, also vitiate the mind." [41] Frawley and Ranade note that when derangement to the senses occurs, as through overuse of any taste, there will be impairment to the mind. [42]

As quoted earlier, Svoboda states clearly that "all addictions are fundamentally addictions to the Sweet Taste, the Taste that creates satisfaction in ahamkara" [43] In the Yoga Sutras Patanjali, it is stated, "In subtle form, these obstacles can be destroyed by resolving them back into their primal cause [the ego]" [44] It follows that overuse of the sweet taste plays a serious role in the vitiation of the mind which impacts perception, the ability to think and function clearly, and maintenance of mental and emotional stability in life.

Conclusion

Diet and nutrition are at the core of the Ayurvedic philosophy of health and balance. This essential fact is made obvious when evaluating the most basic of dietary concepts: tastes. As I reviewed the literature, classical and current, as well as notable empirical evidence, it became clear that excessive intake of the sweet taste can lead the mind, and then the body, to a condition of imbalance and possible addiction. The evidence points to the move from healthy amounts and types of sweet substances to the ingestion of high volumes of the purest form of sugar. The physical maladies resultant from this excessive intake will continue to increase until it is acknowledged that the mind and emotions must be addressed at the root of the problem.

Ayurveda provides the solutions to both physical and mental vitiation. In dealing with any physical disease, it will be necessary to address mental states to see overall improvement and for balance to be reestablished.

As Caraka noted, when the sages desired healthy, long life, they turned to Ayurveda, "the immortal and sacred (science of life)." [45] The translators, Sharma and Dash, comment "They (the sages) found in this science various prescriptions dealing with the avoidance of the unwholesome habits and acceptance of wholesome ones and thereby attained inexhaustibly long life and well being devoid of all miseries." [46]


[1] R. K. Sharma and Bhagwan Dash, trans., Caraka Samhita . Vol II, 1:4 ( India : Chowkhamba Sanskrit Series Office, 2000), 113.

[2] Ibid., Vol I, 5:4, 106.

[3] Marc Halpern, Principles of Ayurvedic Medicine . 4 th ed. ( Grass Valley : California College of Ayurveda, 2002). 6:3.

[4] Sharma. and Dash, trans., Caraka Samhita . Vol I, 1:64, 45-46.

[5] Ibid., 1:65, 46.

[6] David Frawley, Ayurvedic Healing , (Salt Lake City, UT: Passage Press, 1989), 16.

[7] Ibid., 16.

[8] David Frawley, and Subhash Ranade, Ayurveda, Nature's Medicine , ( Twin Lakes , WI : Lotus Press, 2001), 134.

[9] John Douillard, Body, Mind and Sport , rev. ed. (New York: Three Rivers Press, 1995), 91

[10] Sharma, and Dash, trans., Caraka Samhita . Vol IV, 15:12 , 8.

[11] Vasant Lad, Ayurveda The Science of Self-Healing , 2 nd ed., (Wilmot, WI: Lotus Press, 1985), 92 " 99B.

[12] Frawley, Ayurvedic Healing , 16.

[13] Ibid., 16.

[14] Douillard, Body Mind and Sport , 91.

[15] Ibid., 91.

[16] Robert E. Svoboda, Prakriti Your Ayurvedic Constitution , Rev. Enl. 2 nd ed., (Bellingham, WA: Sadhana Publications, 1998), 68.

[17] G. M. Schoenbaum, R. J. Martin, D. S. Roane, "Relationships between sustained sucrose-feeding and opioid tolerance and withdrawal." in Pharmacological Biochemical Behavior abstract Vol 34(4): 911-4. Dec, 1989. Available from the World Wide Web @ http://www.ncbi.ilm.nigh.gov search 2623045.

[18] C. Colatuoni, et al., "Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence." in Obesity Research abstract Vol 10(6): 478-88. June, 2002. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 12055324.

[19] C. Colatuoni, et al., "Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain." in Neuroreport abstract Vol 12(16): 3549-52. Nov, 2001. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 11733709.

[20] Svoboda, Prakriti Your Ayurvedic Constitution , 68.

[21] Frawley, Ayurvedic Healing , 18.

[22] .Sharma and Dash, trans. Caraka Samhita Vol III 6:4, 298.

[23] Frawley, Ayurvedic Healing , 19.

[24] Frawley and Ranade, Ayurveda Nature's Medicine , 138.

[25] Ibid., 134.

[26] Lad, Ayurveda The Science of Self-Healing 2 nd ed., 90.

[27] K. Fischer, et al., "Cognitive performance and its relationship with postprandial metabolic changes after ingestion of different macronutrients in the morning." in British Journal of Nutrition abstract Vol 85(3): 393-405, March 2001. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 11299085.

[28] Eun Ju Yang, et al., "Carbohydrate Intake is Associated with Diet Quality and Risk Factors for Cardiovascular Disease in U. S. Adults: NHANES III." in Journal of the American College of Nutrition, Vol 22, No. 1, 71-79. 2003. On-line journal available from the World Wide Web @ http://www.jacn.org/cgi/content/full/22/1/71.

[29] Ibid..

[30] A. Chicco, et al., "Muscle lipid metabolism and insulin secretion are altered in insulin-resistant rats fed a high sucrose diet." in Journal of Nutrition abstract Vol 133(1): 127-33. Jan, 2003. Available from the World Wide Web @ http://nchi.nlm.nih.gov search 12514279.

[31] A. Sclafani, "Psychobiology of food preferences." in Journal of Obesity Related Metabolic Disorders abstract Vol 25 Suppl 5:S13-6. Dec, 2001. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 11840208.

[32] H. G. Preuss, et al., "Sugar-induced blood pressure elevations over the lifespan of three substrains of Wistar rats." in Journal of the American College of Nutrition abstract Vol 17(1):36-47. Feb, 1998. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 9477388.

[33] Q. He, K. Csiszar, and P.A. Li, "Transient forebrain ischemia induced phosphorylation of cAMP-responsive element-binding protein is suppressed by hyperglycemia." in Neurobiological Disorders abstract Vol 12(1):25-34. Feb, 2003. Available from the World Wide Web @ http://www.nchi.nlm.nih.gov search 12609486.

[34] N. J. Blacklock, "Sucrose and idiopathic renal stone." in Nutrition and Health abstract Vol 5(1-2):9-17. 1987. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 3313140.

[35] E. De Stefani, et al., "Dietary sugar and lung cancer: a case-control study in Uruguay." in Nutrition and Cancer abstract Vol 31(2):132-7. 1998. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 9770725.

[36] K. Olivier, et al., "Glucose feeding exacerbates parathion-induced neurotoxicity." in Journal of Toxicology and Environmental Health abstract Vol 22;63(4):253-71. June, 2001. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 11437059.

[37] David Frawley, America Institute of Vedic Studies Ayurvedic Healing Correspondence Course For Health Care Professionals Part II. (Santa Fe, NM: American Institute of Vedic Studies, 1999). 27.

[38] Ibid., 101.

[39] Ibid.

[40] Halpern, Principles of Ayurvedic Medicine., 2:19 .

[41] Sharma and Dash, trans., Caraka Samhita , Vol 1 8:15 , 169-170.

[42] Frawley and Ranade, Ayurveda: Nature's Medicine ., 258.

[43] Svoboda, Prakriti, Your Ayurvedic Constitution ., 68

[44] Sri Swami Satchidananda, trans., The Yoga Sutras of Patanjali. (Yogaville, VA: Integral Yoga Publications, 1999), 93.

[45] Sharma and Dash, trans., Caraka Samhita , Vol 1 1:24 , 21.

[46] Ibid., 1:27-29, 23.

Ghee: An Ayurvedic and Biochemical Treatise By: Catherine Robbins

Irritable Bowel Syndrome (IBS) - An Ayurvedic Approach (by Branislava Petric C.A.S)

See PDF document

Kaya Kalpa and the Alchemical Tradition in Ayurveda and Siddha Medicine (by Ione Linker C.A.S)

See PDF document

Male Pattern Baldness (by Scott Ryals C.A.S)

Allopathic Perspective on Androgenetic Alopecia

Hair Structure

Hair is composed of strong structural protein called keratin. This is the same kind of protein that makes up the nails and the outer layer of skin.

Each strand of hair consists of three layers.
1. An innermost layer or medulla, which is only present in large thick hairs.
2. The middle layer known as the cortex. The cortex provides strength and both the color and the texture of hair.
3. The outermost layer is known as the cuticle. The cuticle is thin and colorless and serves as a protector of the cortex.

Structure of the hair root

Below the surface of the skin is the hair root, which is enclosed within a hair follicle. At the base of the hair follicle is the dermal papilla. The dermal papilla is fed by the bloodstream which carries nourishment to produce new hair. The dermal papilla is a structure very important to hair growth because it contains receptors for male hormones and androgens. Androgens regulate hair growth and in scalp hair androgens may cause the hair follicle to get progressively smaller and the hairs to become finer in individuals who are genetically predisposed to this type of hair loss. [1]

What Causes Androgenetic Alopecia?

“ The hair follicle is a structure that encases the lower part of the hair shaft. Each follicle contains blood vessels that nurture new hair growth. All of our hair follicles are present at birth, and throughout our lifetime each follicle grows and sheds single hairs in a repetitive cycle. The growth phase for a single new hair lasts two to three years. At the end of this time, growth ceases and the follicle enters a resting phase. After three to four months in the resting phase, the hair is shed and the next growth cycle begins. On a normal scalp, approximately 80 to 90 percent of follicles are growing at any time. And each day, about 75 follicles shed their hair and the same number enter a new growth phase.
Men and women experience Androgenetic Alopecia with equal frequency, although it may be camouflaged better in women. People who experience this type of hair loss have some hair follicles with a shorter than normal growth phase and produce hair shafts that are abnormally short and thin. These follicles are said to be "miniaturized." They develop because of hormonal changes that occur in the hair follicle itself, although men with male pattern balding also may have higher levels of dihydrotestosterone (a byproduct of testosterone) in the blood.

Khalitya1

What areas of the scalp are most affected?

In men, Androgenetic Alopecia is characterized by gradual hair thinning that most often affects the crown and frontal areas of the scalp. In many men, the hairline around the temples regresses. As it moves back to the mid-scalp, an M-shaped hair pattern develops. The hair in areas affected by hair loss may be of various lengths and thickness, and the presence of uneven lengths and texture is a classic sign of male pattern balding. Women may have similar patterns of hair loss, although typically the hair loss is a little more diffuse than in men, and women rarely experience loss of all their hair.” [2]

How is male pattern balding diagnosed?

“Androgenetic Alopecia can usually be readily diagnosed in men based on visual inspection of the scalp. A family history of similar hair loss also is suggestive of Androgenetic Alopecia.
The diagnosis of Androgenetic Alopecia in women is similarly based on the history and visual inspection of the scalp. The scalp should be inspected carefully, however, for signs of hair disease such as scarring or follicular plugging. In addition, other causes of hair loss should be considered, including certain illnesses (such as hyperthyroidism, hypothyroidism, or iron deficiency) or medication side effects (such as anticoagulants, anticonvulsants, beta blockers, and antidepressants).
Women may rarely experience hair loss due to an excess of male hormones (androgens). Typically these women have other signs of androgen excess, such as menstrual irregularities, acne, and excess hair growth in other areas. However, given the frequency with which Androgenetic Alopecia occurs in women, no extensive testing is necessary unless one of these other signs of androgen excess is present.

Can male pattern balding be treated?

Two medications, Minoxidil and Finasteride, are available to treat male pattern balding in men; only Minoxidil is used in women. A medication called Spironolactone is also sometimes used in women. Surgical options may also be considered in some cases.” [3]

Minoxidil (Rogaine)

“Minoxidil promotes hair growth by lengthening the growth phase of hair follicles and causing more follicles to produce hair. The hairs that are produced tend to be larger and thicker. Minoxidil is a liquid preparation that is applied directly to the scalp. It is available in both 2 and 5 percent solutions, although the 5 percent solution has been shown to be more effective in men and is probably also more effective in women. It can be purchased over-the-counter without a prescription

Administration

Minoxidil is a scalp treatment, not a hair treatment. One milliliter of the solution should be applied twice a day to the affected areas of the scalp using a dropper or pump spray device. The solution should be lightly spread over the affected area with a finger, and does not need to be massaged into the scalp. People using Minoxidil must have a normal, healthy scalp since cuts or openings can allow the solution to be absorbed into the bloodstream.

Results

Minoxidil must be used twice a day for at least four months before the initial response to treatment can be gauged. When it is effective, people usually begin to shed less hair within two months after the start of treatment, and by four to eight months hair begins to grow. The effects of Minoxidil usually stabilize after 12 to 18 months of use.
Treatment must be continued indefinitely. If Minoxidil is discontinued, any hair that has been maintained or re-grown as a result of the medication will be lost.” [4]

“Not all people benefit from Minoxidil. Best results are obtained when baldness has been present for less than 5 years, when it affects the crown of the head (the vertex), and when it is less than 10 centimeters in diameter. Studies have shown that up to one-half of men and women with vertex hair loss experience cosmetically significant results with Minoxidil.

Side effects

Minoxidil causes few side effects. Occasionally, the skin may become irritated. Systemic side effects are possible if Minoxidil is absorbed through cracks or cuts in the scalp. Patients with a history of heart disease, in particular, should watch for systemic side effects such as an increased heart rate, edema or swelling (for example in the hands or feet), or weight gain. Women treated with 5 percent Minoxidil may occasionally develop increased facial hair.

Finasteride

Finasteride decreases dihydrotestosterone levels, resulting in an increased amount of hair covering more of the scalp. It cannot be used in women of reproductive age because of concerns regarding abnormal genitalia development in male fetuses. One study that evaluated the use of Finasteride in postmenopausal women with Androgenetic Alopecia found that finasteride did not improve hair loss. Thus, Finasteride is not currently recommended for women at any age.
Finasteride is taken orally in men at a dose of 1 milligram (mg) per day. Higher doses of Finasteride (such as those used to treat some prostate conditions) can cause side effects including sexual dysfunction and decreased sex drive. However, such side effects are rarely seen with the 1 mg dose used to treat hair loss.” [5]

“A small study suggested that Finasteride worked better than 2 percent Minoxidil and there may also have been a benefit with combination therapy. Studies comparing Finasteride and 5 percent Minoxidil have not been performed. However, clinical observations suggest that Finasteride is easier to use. Because of this, men may be more apt to take it consistently and it may yield better outcomes.

Spironolactone

Spironolactone blocks the action of the hormone Aldosterone. Women with Androgenetic Alopecia who do not respond to Minoxidil may benefit from the addition of Spironolactone. A typical dose would be 100 to 200 mg per day.

Surgery

For some patients, surgery may be a preferred form of treatment. Surgical options include hair transplantation, in which healthy follicles from other parts of the scalp are transplanted to areas affected by baldness. Scalp reduction is another procedure sometimes performed. In scalp reduction, bald patches of the scalp are removed and the remaining skin is sutured together.” [6]
 
Beth G Goldstein, MD
University of North Carolina at Chapel Hill
Adam O Goldstein, MD, MPH
University of North Carolina at Chapel Hill
Retin-A / Tretinoin

” Retin was originally used in the treatment of acne and other skin disorders. However studies have shown that Retin-A alone or in combination with Minoxidil can result in moderate to good hair growth in individuals with Androgenetic Alopecia and Alopecia Areata. Many dermatologist recommend using Tretinoin in combination with Minoxidil to increase the effects of both these products. Side effects of Retin-A include blistering, altered pigmentation and increased sensitivity to light. If a gel is used it is suggested that Minoxidil be applied in the morning and Retin-A gel in the evening to reduce the problems caused by sunlight.

Zinc

Some vitamins have been shown to inhibit the activity of 5-alpha reductase and the subsequent production of (DHT) dihydrotestosterone. These vitamins therefore may be of great benefit in the treatment of Androgenetic Alopecia or pattern baldness. There have been studies in which Zinc is shown to inhibit 5 alpha reductase activity and it has therefore been concluded than Zinc is beneficial in disease and disorders related to an excess in dihydrotestosterone (DHT). There have also been studies which have shown that vitamin B6, Zinc and Azelaic Acid combined together even at very low concentrations produced a 90% inhibition of 5 alpha reductase activity.

Skinoren / Azelaic Acid

Azelaic Acid like Retin-A is more commonly used in the treatment of acne and other skin conditions. Recently the potential effect of using Azelaic Acid in the treatment of Androgenetic Alopecia has been looked at and discussed.” [7]
 
“Studies carried out in France in the late 80's were to assess the effects of Zinc Sulphate, a Azelaic Acid on the human skin. The result of these studies demonstrated that at high concentrations Zinc could completely inhibit the activity of 5 alpha reductase. Azelaic Acid was also shown to be a potent inhibitor of 5 alpha reductase. Inhibition was detectable at concentrations as low as 0.2mmol/l and was complete at 3mmol/l. When Zinc, Vitamin B6 and Azelaic Acid where added together at very low concentrations which had been ineffective alone, 90% inhibition of 5 alpha reductase was achieved.

Saw Palmetto Extract

Studies have shown that Saw Palmetto is an effective anti-androgen. It acts in a similar way that Propecia does. Firstly it lowers levels of DHT in the body by blocking 5 alpha-reductase. Secondly Saw Palmetto block receptor sites on cell membranes required for cells to absorb DHT. Although no studies have been carried out on Saw Palmetto and its relation to hair growth. Studies have been performed on the use of Saw palmetto in the treatment of benign prostatic disease, which similar to Androgenetic Alopecia, also depends on the production of dihydrotestosterone. All of the studies that have been performed to date show that Saw Palmetto is an effective anti-androgen and has shown conclusively to be effective in the treatment of benign prostatic disease.

One may assume from this that since Saw Palmetto is an effective anti-androgen and is used in the treatment of prostatic disease then it may also be effective in the treatment of Androgenetic Alopecia.” [8]

Ayurvedic Approach to Alopecia

Pathogenesis Of baldness and Premature Graying of Hair

“The tejas (heat) of the body in association with vayu and other dosas, scorches up the hair-root (scalp) giving instantaneous rise to Alopecia in men.” [9]
 

Line of treatment

“In Khalitya (Alopecia), the patient should, in the beginning, be given elimination therapies (emetis, purgation, etc.), and thereafter, be given nasya (inhilation therapy with medicated oil, and application of paste of drugs over the head.” [10]
 

Recipe of medicated oil, etc.

"Medicated oil should be prepared by cooking with vidari-gandha (sala-parni), prsni-parni, brhati, kantari and gokshura, or with Jivaniya group of drugs, viz., jivaka, rsabhaka, meda, maha-meda, kakoli, mudga-parni and masa-parni.
Inhalation therapy with these medicated oils or with Anu-taila cures Alopecia and graying of the hair” [11]
 

Recipe for Restoration of Hair

Application of three paste of tila, amalaki, kiñjalaka, madhuka and honey over the head restores the colour of the hair, and promotes hair growth.” [12]

Khalitya2
Amalaki
Terminalia Chebula

Khalitya3
Brhati, Solanum Indicum

Khalitya4
Kantari,
Solanum Xanthocarpum

Khalitya5
Madhuca Esculenta,
Madhuka

Khalitya6
Gokshura,
Tribulus Terrestris

Khalitya8
Vidari-Gandha,
Pueraria Tuberosa

Khalitya9
Karanj kiñjalaka,
Pongamia Glabra

Khalitya11
Prsni-Parni,
Desmodium Gangeticum

Khalitya13
Bhringaraj,
Eclipta Alba

 
 

Current Ayurvedic Treatment

“In Ayurveda, hair is considered to be a byproduct of bone formation.
The tissues responsible for building bones are also responsible for the growth of hair.
Ayurveda doctors believe that early hair loss is related to body type and the balance of the mind-body constitution (doshas) and those who have excess pitta in their system, are likely to lose their hair early in life, or have prematurely thin or gray hair.
Excess pitta in the sebaceous gland, at the root of the hair, or folliculitis can make the person start losing hair. Hair loss is treated in Ayurveda with a combination of diet, herbs, oil massage, meditation, aromatherapy, breathing and yoga.
To reduce pitta and preserve the health of hair, drink 1/3 cup aloe vera juice. Alternately, you can take 1 tablespoon aloe vera gel with a pinch of cumin 3 times a day for about 3 months.
Baldness is treated by bleeding from the forehead after treatment with oils and sweating, followed by lotions and pastes of manahsila, kuttannata, devadaru, gunja, malati, karavira, citraka, naktamala, blue and green vitriol, and black pepper.
 

Ayurvedic Oil Massage   

To pacify pitta, rub some coconut oil on your scalp and on the soles of your feet at bedtime. Massage your scalp with Brahmi oil or Bhringaraj oil at bedtime to help prevent hair loss. Massage the hair with vitamin E oil. This also may prevent or slow down the hair loss.” [13]

Ayurvedic Diet for Hair

“Eat a handful of white sesame seeds every morning. One handful of these small seeds contains about 1,200 mg. of calcium and magnesium. Take some yogurt everyday (unless you are allergic to milk).
 

Ayurvedic Herbs For hair loss

Use the following herbal combination:
Dashmula 5 parts Bhringaraj 4 parts Jatamamsi 3 parts Add 1/2 teaspoon of this mixture to 1 cup of goat's milk. Heat to boiling, and drink at bedtime.” [14]

Conclusion

The process of doing this research has been very enlightening and has presented some surprises for me. To understand that “hair Loss” is actually a misnomer, since the hair follicle actually goes dormant and has the ability to be reactivated with proper diet, lifestyle and herbal treatment.
It also is very clear that the herbs recommended for treating an enlarged prostate and the herbs recommended for treating Androgenetic Alopecia are often exactly the same.
As one who has Androgenetic Alopecia, I have started some of the treatments suggested, out of curiosity and a belief that it is possible to regenerate cells (far more often then I was lead to believe).
Time and my ability to adhere to a consistent therapeutic regimen will determine my success.

Bibliography

Caraka Samhita Text in Sanskrit with a New English Translation & Critical notes based on Cakrapanis Ayurvedadiplka Dr. R. K. Sharma & Dr. Bhagwan Dash
http://www.follicle.com/section2/2.html
http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877  
http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm
 

Image Credits

http://www.unyamaneegarden.com/
http://www.holistic-online.com/
http://uwadmnweb.uwyo.edu
http://biotech.tipo.gov.tw
http://www.eco-planet.com/
[1] http://www.follicle.com/hair-structure-life-cycle.html
[2] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877
[3] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877
[4] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877
[5] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877
[6] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html
http://patients.uptodate.com/topic.asp?file=gen_hlth/2877
[7] http://www.follicle.com/section2/2.html
[8] http://www.follicle.com/section2/2.html
[9] Caraka-Samhita VOL IV Chapter XXVI Page 509 and 510
[10] Caraka-Samhita VOL IV Chapter XXVI Page 540 and 541
[11] Caraka-Samhita VOL IV Chapter XXVI Page 540 and 541
[12] Caraka-Samhita VOL IV Chapter XXVI Page 543
[13] http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm
[14] http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm

Care of Non Ulcer Dyspepsia (by John Sekerka C.A.S)

Table of Contents 

Introduction

Upset stomach or occasional heartburn may not be due to excess stomach acid but there are several OTC medications available to reduce stomach acid and apparently solve the problem. What are the options a person has when they have an upset stomach or NUD (non-ulcer dyspepsia) due to eating? Is there one problem or many? Should the treatment be the same for each person or should it depend upon the person? Are medications ever necessary? With the heavy promotion of antacids and many other medications for heartburn and indigestion, many people may not know that there are other choices for these very common problems. First a look at the problem from the Western point of view, both mainstream and non-drug approach and then the Ayurvedic view.

NUD is upper abdominal pain without an ulcer, which is twice as common as an ulcer and may lead to one. In half of the cases of NUD or indigestion no cause is found, but medication is commonly used to control symptoms. Allopathic medicine is focused on organic damage and may over look function of the GI tract. The gastrointestinal tract is a very integrated system via nervous and hormonal regulation, and all medications have side effects of disruption or turning off some of the GI function. There is poor understanding of NUD and consequently no specific care from standard medical treatment. NUD can resemble GERD, ulcers, gastritis, or hiatal hernia but if there is no cause or damage found it is called NUD or functional dyspepsia, or just plain indigestion with no apparent treatment. The symptoms are similar for each condition: dull ache, uncomfortable fullness, or static stomach, distention, overt pain or burning or both with or without nausea. Excess stomach acid is not thought to be the problem, more likely inadequate protection of the stomach from the acid. The symptoms may also be due to slower gastric motility or to increased gut sensitivity.

Psychological issues also affect NUD. Stressful events produce responses in the gut, but people with NUD do not seem to have more stress in their lives than those without NUD. Do those with NUD react more strongly to stress leading to symptoms? Relaxation techniques have been shown to reduce gastric acid secretions in hyperchlorhydric patients. Balancing digestive function by reducing stress maybe partially attributed to a global nervous system shift from a sympathetic to a parasympathetic tone (1).

Diet involvement in NUD is important but not well defined. Certain foods and other substances are known to increase symptoms; spicy, acidic, and high fat foods, alcohol, tobacco, coffee, analgesics and other medications. These are reduced or eliminated to help with symptoms.

In a functional approach to health and nutrition diet and eating habits play a more important role than the standard allopathic model. The following is a functional view of digestion.

Digestion begins with the cephalic phase in which any sensory stimulus or even thoughts can provoke a digestive related response in the body. These include thermodynamic, salivary, cardiac, mesenteric blood flow, diuretic, digestive enzyme secretion, altered gastric acid secretion, altered intestinal motility, release of GI hormones and other intestinal process changes (2). Impulses travel via the vagus nerve to the stomach where acetylcholine stimulates mucus, acid, and pepsinogen secretion in the body and gastrin release in the antrum. The response is greater to foods that the person likes and is less in bland foods, an important fact with an anorectic client (3). To fully support digestion eating in a calm manner and chewing properly are necessary. For some this may be more helpful than relying on digestive enzymes, glandulars, bitters, or other digestive aids.

In the mouth or lingual phase adequate salivary output is necessary for proper digestion. Besides enzymes like alpha amylase the saliva also contains other important substances such as mucopolysacirides, ion containing fluids, and transcobalamin III necessary for vitamin B12 absorption. The digestion of fats is initiated in the month by lingual lipase from glands at the base of the tongue. Lingual lipase hydrolysis short chain and medium chain triglycerides more readily than it does long chain triglycerides. This is also true of gastric lipase. Both lipases are resistant to the proteolytic enzymes and the acid environment of the stomach,so that the digestion of the short and medium chain triglycerides continues in the stomach, but the main digestion of fats is done in the small intestine. Dehydration can reduce salivary output as can old age and thus reduce the digestive response.

Digestion in the stomach results from proper coordination of hydrochloric acid and pepsin along with other substances. Gastrin and intrinsic factor are the other two compounds that are exclusively produces in the stomach. In the gastric phase stimulation of secretions is by direct contact with food, a rise in ph, and by distention or mechanoreceptors. Besides the main job of digesting protein foods, appropriate amount of hydrochloric acid is necessary for:

The absorption of minerals.
Acid-base balance.
To kill microorganisms.
Converts pepsinogen to pepsin (at ~ ph of 2).
Inhibits the secretion of gastrin.
And stimulates the secretion of secretin.

Gastrin stimulates the secretion of acid and pepsinogen, increases gastric blood flow, circular muscle contractions in the stomach, and growth of the mucosa of the stomach and small intestine. Thus there are not only many coordinated responses to food for adequate secretions and proper digestion, but also feedback systems to down regulate the secretions when they are no longer needed. Mixing of the stomach contents is from the middle of the stomach toward the duodenum. This mixing, with downward pressure from the upper part of the stomach, help to empty the contents. The time required to empty the stomach depends on several factors. Solids, lipids, and solutions of high osmotic pressure empty more slowly than solutions that are isotonic. Solids empty more slowly than liquids. There are receptors in the duodenum that respond to lipid content, acidity, and osmotic pressure of the chyme. Some of the factors involved in the emptying are gastrointestinal hormones and neurological reflexes. The enterogastric reflex inhibits peristalsis in the antrum, which is next to the duodenum, because of high or low osmotic pressure, or when acidity is high in the duodenum. Particle size, viscosity of the chyme, and volume of the gastric contents also affects emptying time (4). Emotional stress affects motility through the autonomic nervous system.

Hypochlorhydria – inadequate secretion of gastric acid by the parietal cells in the stomach wall is a component of poor digestion. A diet of excess protein increases acid production and high fat diet encourages over secretion of acid. Medications to reduce acid, H2 histamine receptor blockers and proton pump inhibitors are now available OTC so that diet induced hyper acidity becomes medication induced hypoacidity in many U.S. adults with causes of indigestion not explored. Research suggests that low gastric acidity may influence the development of diseases such as:

  • Rheumatoid arthritis
  • Acne rosacea
  • Celiac disease
  • Diabetes mellitus
  • Eczema
  • Hepatitis
  • Asthma and others (5).

The ability to produce acid decreases with age and over half the population over 60 has insufficient secretory ability. Common sign and symptoms of low gastric acidity are:

  • Bloating, belching, burning, and flatulence immediately after meals
  • A sense of fullness after meals
  • Indigestion, diarrhea, or constipation
  • Mild food allergies
  • Undigested food in the stool
  • Post adolescent acne
  • Nausea after taking supplements
  • And other sysmptoms
  • Chronic reduction of gastric acid secretion invites bacterial over growth in the stomach

(Heliobacter pylori) and the small intestine which compromises nutrient digestion and absorption especially B vitamins , iron, and calcium. H. pylori does not appear to cause ulcers but let untreated may lead to atrophic gastritis (6). I f gastritis progresses to an ulcer then H. pylori has to be addressed usually with acid controlling medication and antibiotics.

In the treatment of NUD it is recognized in allopathic medicine that there is no reason for medication but it is often given because of its placebo effect and the drugs are considered safe. Though excess acid may not be the problem in the short term some people feel better with medication to reduce acid or to increase the rate of stomach emptying (7). Treatment also requires dietary and lifestyle changes to reduce symptoms. First a look at the medications then the diet and other changes.

Drugs that were developed for ulcer treatment are now being used for any problem that manifests itself as acid indigestion even if there is no known ulcer. The following are the drugs commonly used:

  • Antacids are used to neutralize acid: Those with aluminum can cause constipation, those with magnesium can cause diarrhea, prelief (calcium glycerophosphate) is taken at meals to reduce stomach acid. H2 histamine receptor blockers to reduce acid secretion from the parietal cells, via histamine release stimulated by the vagus nerve. This includes Tagamet, Pepsid, Axid, and Zantac.
  • The proton pump inhibitors: Previcid, Prilosec, Nexium, Aciphex, and Protonix that are so heavily advertised today, and are in use more now than the H2 histamine receptor blockers.
  • Motility agents that speed up gastric emptying and increase lower esophageal sphincter (LES) pressure. Reglan, and Propulsid.
  • And protective type drugs: Cytotec, Arthrotec, and Carafate (8).

In the case of an infection or apparent infection of H. pylori the common medication of Pepto-Bismol has been shown to be affective with a usual four times a day dosage over two weeks with less side effects than the typical drug and antibiotic therapy (9). The possible side effects of these medications are numerous, as listed below (10).

that turn off stomach acid secretions, like Prilosec and Prevacid: Diarrhea, abdominal pain, nausea, vomiting, heartburn, liver necrosis, pancreatitis, Headaches, back pain, anemia, infections, and others.

Gastric motility drugs like Propulsid and Reglan: Ventricular tachycardia, and fibrillation, headache, diarrhea, abdominal pain, nausea, constipation, joint aches.

Cytoprotective agents like Cytotec that increase bicarbonate and mucus production: Nausea, vomiting, gas, heartburn, diarrhea, constipation, abdominal pain, abortion, Menstrual irregularities, headaches, depression, impotence, chest pain, arrythmia, High blood pressure, blood clots, GI bleed, liver malfunction and others.

Stomach coating medication for protection from acid like Carafate: Diarrhea, nausea, vomiting, dry mouth, turns off pepsin , and contains Aluminum, which has possible links to Alzheimer's disease and bone loss.

H2 blockers – Tagamet, Zantec, Pepcid, Axid, Mylanta – which turn down acid production: Impair liver detoxification processes thus increase the side effects of other drugs and environmental chemicals that use the same detoxification pathways. Arrthymias, Hypertension, headaches, liver malfunction, hair loss, anemia, arthritis, blockage of Nerve conduction in the heart, and others.

The above medications are intended to reduce the symptoms of NUD and reduce any pain associated with it, but end up causing more GI problems and further cover up the causes of the indigestion.

There are several supplements and medications, listed below, that can worsen the symptoms of GERD and may also negatively effect NUD (11).

  • Large doses of vitamin C
  • Potassium supplements
  • White willow bark
  • Calcium channel blockers for high blood pressure
  • Certain antibiotics
  • Red yeast rice
  • Fosamax
  • NSAIDS (Motrin, Aleve, Nuprin, Orudis)
  • Theophylline
  • Glucosamine
  • Fish oil capsules
  • Aspirin, which can also affect the stomach lining directly.

The health and proper function of the stomach is dependant on the balance of the defensive factors (mucin secretion, cellular mucus, bicarbonate secretion, mucosal blood flow, and cell turnover), and the aggressive factors (hydrochloric acid, pepsin, H. pylori, bile salts) (12). The role of the defensive factors is gaining importance over simply reducing the aggressive factors. With more evidence of adverse effects of the various drugs more research is being done with herbs to find new compounds to aid in ulcer treatment without the side effects, which may also prove beneficial in treating NUD. In a review of anti-ulcer drugs of Ayurveda, authors R.K. Goel and K. Sairam listed the commonly used herbs of Ayurveda and the studies with various herbal extracts and their use in ulcer treatment. The extracts used were fresh juice, water decoction, ethanolic ,methanolic , hot water, acetone, chloroform, and petroleum ether extracts. For the following herbs they were extracted from one of the first five methods: ashwaganda, shatavari, licorice root, brahmi (Bacopa monniera), gotu kola (Centella asiatica), and amla. Aswaganda showed anti-stress activity which wasn't specified. The other herbs had no effect on the acid-pepsin secretion but an increase in the defensive factors of mucin secretion and the life span of the mucosal cells. Shilajit had a per se effect of both reducing acid-pepsin secretion and increase in mucin secretion (13). Several anti-ulcer compounds have been isolated from ginger and studies have shown that ginger increases gastrointestinal propulsion (14). In the conclusion of the review the emphasis was on standardized active constituents of the herbs and not use of the whole herb.

In a non-medication approach to better digestion there are several herbs, juices, and other compounds used to heal the stomach, or aid in digestion. Common ones are DGL – deglycyrrhizinated licorice, sulfate mucin, aloe juice, ginger tea, chamomile tea, fresh vegetable juices (cabbage, carrot, cucumber, beet), digestive enzymes, baking soda, and even Pepto-Bismol. DGL is licorice with the compound that is responsible for hypertension removed. It is known to normalize LES (lower esophageal ) pressure, increase the protective factors of the stomach, increase immunity by increase in secretin, and is antinflamatory and antioxidant (15). Of the vegetables juices cabbage is recommended more than any other to help heal the stomach lining. There are also various combinations of digestive enzymes and gladulars for those with poor digestion. Chinese and Ayurvedic herbal formulas for digestion are available through supplement suppliers with only general guidelines on their use.

In the Western view whether mainstream allopathic or a natural approach certain dietary and lifestyle changes have to be made if a person with NUD is to have an improvement in symptoms and better digestion. It is well recognized that digestion is improved if a person eats in a calm and relaxing environment. Some health care practitioners emphasize this much more than others. This and proper chewing is the beginning of proper digestion. Appropriate sized meals are important since large meals take longer to digest, distend the stomach and increase acid production, and expose the stomach longer to the aggressive factors of digestion. There is the need to eliminate or reduce offending foods such as orange juice, tomato products, other acid foods or ingredients, radishes, spicy foods, fatty foods, excessive protein, dry beans, or any other foods an individual may have symptoms with. Substances to avoid if causing problems are alcohol, tobacco, coffee, caffeineated tea, colas, Ibuprofen and other NSAIDS, aspirin, or any other medication that causes symptoms of NUD. Some healer also emphasize proper food combining or simplifying meals for easier digestion. Others are adamant about cutting out all processed foods from the diet and eliminating any foods with additives or preservatives. There is also the possibility of a food allergy in which case the offending foods will have to be identified and eliminated. This could be a lengthy and difficult process and would not usually be done unless all other changes proved unfruitful.

Food combining deserves further expounding since it is commonly referred to for digestive ailments in natural health and nutrition literature. The principal is fairly simple, don't eat foods together that don't digest well together. This won't overtax the digestive enzymes and compromise digestion. Food combining can be somewhat to very restrictive even though there is little scientific evidence that certain foods inhibit the secretion of digestive enzymes. This is not to say there has not been success to varying degrees with food combining. The most common rule is not to eat fruit, or sweets, with meals. Fruits digest sooner than other foods and they can be fermented by microorganisms before the heavier foods are digested. The resulting gas can distend the gut and cause bloating and indigestion. The gas is also toxic to the nerves and tissues, causing an inflammatory reaction that impairs normal peristaltic action (16). Also milk dose not combine well with any foods and is best eaten alone. A person would make their meals as simple as necessary to have good digestion, starting with mono meals if necessary. Other foods can be added one at a time as all previous foods are well tolerated. A person then builds a history of what they can and cannot eat and what foods they tolerate together.

In the Caraka-Samhita chapter – xv treatment of grahani dosa the digestion function, dysfunction, and treatment are discussed. This is the classical Ayurvedic approach which will be summarized, then the modern interpretation will follow. That which has an influence on the stomach and thus important in the care of NUD will be noted. All digestion is dependant upon proper functioning of the digestive fire or agni. Jatharagni (enzymes in the GI tract), bhutagnis (the elemental agnis – enzymes to transform heterogenous elements into homologous ones) dhatuagnis (enzymes for the synthesis of the seven categories of tissues) make up the 13 agnis of which jatharagni is the most important for the other depend upon its proper functioning, and is considered to be the most important sustaining factor of living beings (17). Since it resides in the GI tract it will be referred to as agni in this report.

Ingested food needs to be both delicious and wholesome to nourish the senses, the sense organs, and the rest of the body. Once ingested the food is mixed with dravas (liquids) of saliva and other fluids of the GI tract that contain the enzymes or agni . Samana vayu in its normal state will stimulate agni appropriately. Too little samana vayu and agni is low and digestion is inadequate. Too much and agni is too hot and digestion too fast which may deplete the kapha in the stomach making it more suseptable to symptoms of NUD or eventually to an ulcer. During the first stage of digestion in the mouth and stomach, or the kapha stage, the sweet taste is digested. Once the semidigested (vidagdha) food mass leaves the stomach it is sour. This sour stuff stimulates the production of pitta (bile), and since pitta is sour it gets stimulated by sour food matter (18). Thus the appropriate amount of pitta or acid needs to be produced in the stomach for proper digestion or agni there before leaving the stomach and continuing to stimulate normal pitta and agni for optimal digestion.

Ajirna or indigestion is caused by the vitiation of agni. This is caused by the following:

  • Eating too fast, over eating , or irregular eating.
  • Intake of unwholesome, heavy, cold, un-unctuous, or contaminated food.
  • Improper use of purgation, emetic, and oelation therapy.
  • Emaciation as a result of disease.
  • Living in improper country, or seasons.
  • Suppression of natural urges.

The vitiated agni is then abnormally sour and works like poison or can be the beginning of several diseases (19). When pitta is excessive it is Amla pitta or acid gastritis a type of grahani disorder. The seat of agni is in the grahani or small intestine and stomach, which may not be used exactly the same way as in modern anatomy and physiology. The signs and symptoms of amla pitta are indigestion, mental fatigue, nausea, sour and bitter belching, and heartburn. Other pitta symptoms in the digestive system and elsewhere are yellow tongue coating, red tongue, loose stools, and anger. High vata will have less acid and burning and will have a more static or nervous stomach. Other high vata symptoms in the digestive system are gas or belching, bloating, constipation, erratic appetite, a brownish and dry tongue coating, and nervousness or anxiety. There will also be pain with both conditions. High kapha will have sluggish digestion in the stomach but not likely to suffer from NUD as much as high pitta and high vata so only pitta and vata out of balance will be considered.

Agni has four different states: normal, irregular, sharp or high, and low. In the normal state a person would eat the right quality and quantity of food and there would be proper digestion, metabolism, and tissue development. This is helped with a balanced samana vayu. With any of the abnormal agnis digestion and tissue development is compromised. Sharp agni can cause depletion of tissues if not enough food is eaten. Irregular agni usually results in an under nourished individual with an under developed body as in a typical vata type person. Low agni is associated with excessive development of poorer quality tissue as in a kapha type person. Grahani (small intestine) is the site of agni and grahani and agni can be used interchangably because agni restrains (grhnati) the downward movement of undigested food and retains it until it is fully digested in the region above the unbilicus (20). Likewise food is also retained in the stomach until it is fully digested. When agni is weak food is only partly digested and there is some undigested food in the stools. Vatika grahani (caused by vitiated vata) is caused by intake of pungent, bitter, astringent, cold dry foods, not enough food, over exertion, suppression of natural urges, and excessive sexual intercourse. Vayu gets aggravated, suppresses agni, and food is not easily digested. In paittika grahani pitta is aggravated by foods that are pungent, heavy (ajirna), vidahi (cause burning sensation), sour, alkaline, etc. This aggravated pitta supresses agni. A person has foul smelling and sour belching, heartburn, anorexia, thirst, and loose stools (21). When ama becomes manifest because of the aggravated dosa in the grahani, and food is not fully digested, then emetic therapy should be given. After the amasaya (stomach including small intestine) is cleased of the ama by purgation and fasting the patient should be given a light diet and herbs that stimulate digestion (22). If pitta is aggravated then digestive stimulants that are bitter should be given along with sweet ingredients. If vata is aggravated then digestive stimulants mixed with ghee, salty, and sour items are helpful. Samana vayu in particular is regulated with medicated ghee and promotes the proper functioning of the gastric fire. If the gastric fire gets suppressed because of urdhva-vata (upward movement of vata) the patient should be given niruha and anuvasana medicated enemas (23). In the Ayurvedic view digestion in the stomach cannot be completely separated from digestion in the small intestine since the seat of agni lies mainly in the small intestine but also in the lower part of the stomach. Digestion is a continuum and the stomach and small intestine and the whole GI tract is interdependent.

Indigestion or NUD begins with eating habits and improper food choices, but most digestive disorders begin in the stomach or are first noticed there (24). The digestive problems may then continue into the rest of the GI tract. From indigestion comes ama which disrupts not only the digestive system but also the immune system and results in low energy. The two sub doshas of most concern are pachaka pitta and samana vayu. When pachaka pitta is high there is excess gastric acid and the typical symptoms of heartburn, sour belching, and other pitta symptoms in the GI tract and mind. With high samana vayu there is nervous stomach and variable appetite, digestion, and peristalsis (25). There could also be other vata symptoms in the rest of the GI tract and mind. So hyperacidity could also occur with vata and a weak digestion where the food stays too long in the stomach which is then exposed to acid after the food can no longer buffer the acid. Apana vayu could also be involved. If it is not properly flowing downward, with possible gas and constipation, then this could slow or alter digestion further up in the GI tract and indirectly affect stomach functioning and emptying. Or apana vayu could rise upward due to nervous system vata stress and negatively effect digestion (26). Low kapha may accompany high vata and there is not adequate protection for the stomach lining from the acid even if the acid is not in excess. The eating habits that lead to excess pitta and hyperacidity are eating too much, or eating foods that are too sour, spicy, or fatty, too many sweets which can also be fatty, too much alcohol, tea, or coffee, poor food combining, and too much salty foods. Eating habits that would throw vata out of balance and lead to NUD would be eating irregular meals, eating too much, eating cold, dry, or raw foods, eating too much variety at a meal, or eating foods that are hard to digest. Other eating habits that could cause NUD with anyone are eating when not hungry, eating poorly prepared or cooked foods, eating too much processed foods instead of freshly prepared foods, and eating leftovers.

In the Ayurvedic view food, eating habits, and herbs make up the treatment for NUD. For a vata person with NUD meals may have to be smaller and more frequent, regular, and generally cooked foods. A pitta person can eat three regular meals a day, more raw food, and more variety in a meal than a vata person. A vata person needs rich and moderately spicy food , while a pitta person needs less richness and spice. Each person should also take those foods that digest easily for their constitution, or pacifying for the high dosha. Skipping a meal until the appetite comes back may be needed.

To avoid digestive difficulties the first step would be to follow Upayogasamatha - the general guidelines for healthy eating according Ayurveda (27). To begin eat in a proper place or setting. The main point is that it is calm and peaceful. The mind should also be peaceful when eating, prepared by saying grace. This is done with awareness of the sacredness of the experience and acknowledges the spirit of the food. The food should be prepared in a loving way or in a sattvic state of mind. The food is then eaten with no distractions and a calm mind including confidence that what a person is eating is perfectly fine so there is no anxiety about eating. Time is taken to chew the food properly or to an even consistency and to fully taste and enjoy the meal. The food should be warm, and moist with some richness, which stimulates digestion, is more easily digested, and is more nourishing than dry food. It could also be said that food should be freshly prepared and cooked since it would also be warm and moist and best for digestion. Foods of opposite potencies should not be eaten in equal amounts so that they cancel each other out and end up with a neutral potency that does not promote digestion. A small amount of cool spices may be included in a dal for instance but the overall spice mix would be warm for a vata digestion. Only enough liquids to aid in eating should be taken with a meal. The more liquid the meal the less other liquid is needed, and it should not be cold. A person is best eating until about 75% full, to room for the stomach to mix and digest the food. One should feel satisfied but not full. Eating in a calm manner, chewing appropriately, taking the time to eat, and being aware of eating without distractions will give one the opportunity to sense when they are satisfied but not full. It is best to rest and not do any intense mental or physical activities after eating for up to an hour if possible. If work or other strenuous activities cannot be avoided then a smaller or lighter meal might be in order. Once the meal is finished one should not eat again until they are hungry, or the previous meal is fully digested. This is usually three hours or more. If it is sooner the person may want to or need to eat larger meals. If too long a time has past the person may have eaten too large a meal or need to strengthen their agni. Eating before the previous meal is fully digested will mix ahara rasa with the new food and vitiate all three doshas (28). This will disrupt proper digestion.

Following the Upayogasamaatha will for most people alleviate their NUD or indigestion. If that is not sufficient then each person needs to follow a diet plan for their dosha as outlined above and specifically avoid foods that aggravate them. A general diet plan for vata and pitta follows (29). A diet for vata types would include fruits except dry fruits, unless well soaked, apples, pears, and melons. A large variety of vegetables can be tolerated if properly cooked and spiced if needed or with ghee. The cruciferous vegetables may not be tolerated but some may depending on the individual. Other common vegetables that may cause some indigestion are artichokes, asparagus, cucumber, green beans, potatoes, spinach, tomatoes, turnips, and zucchini. It is more important to avoid too much raw vegetables and eat cooked vegetables, and avoid mushrooms and lettuce. For grains stick to wheat, rice, and oats. For beans only mung usually. All nuts, seeds, and oils are acceptable, as is dairy except ice cream because it is too cold. Condiments are fine and can help to pique the appetite. Sweeteners should be used in moderation and best not to use refined sugar. Animal foods are nourishing and grounding for vata but consideration should be given to the karmic consequences of eating when there is no necessity to do so. For pitta types generally avoid sour, pungent, and salty foods when there is any imbalance or tendency to get out of balance. For fruits eat sweet and astringent ones like apples, dates, figs, mango, grapes, melons, pears, persimmons, and plums. Certain fruits may cause problems – citrus, strawberries, cherries, bananas, and any sour tasting or under ripe fruit. Vegetables to avoid are hot peppers, onion, garlic, radishes, etc. Others that may be a problem are beets, carrots, spinach, chard, tomatoes, and parsley. For grains basmati rice, oats, wheat, and corn are recommended. Most dry beans can be digested well except lentils. Nuts are limited for use, best are coconut and sunflower seeds. For oils coconut, sunflower, ghee, olive, and corn. For dairy, sour products – yogurt, buttermilk, aged cheeses - limit or avoid. For sweeteners all are ok except honey and molasses. No condiments are good because of the salt and or vinegar. For animal foods egg whites and white chicken meat are good (30). This is a general list to help someone dominated by a vata or pitta constitution but is not all inclusive. Each person must also be aware when they eat if a particular food or combination of foods aggravates their digestion if they are to learn to improve their digestion and health. If a person is a duel dosha, vata – pitta, then they would have to take in foods acceptable to both doshas and avoid or limit those foods that aggravate both doshas or strongly do so to either dosha. Or if one dosha is predominately out of balance then that one would take precedence over the other dosha and the secondary dosha may not need to be addressed at that time.

If a person still has NUD after following the above guidelines then digestion may be weak and proper food combining would be appropriate. The summary of proper food combining follows: (31)

Bitter green salads should be eaten at the end of the meal not the beginning since bitter taste reduces agni.

Astringent foods or tea should be taken at the end of the meal or between meals because astringent taste reduces the secretion of digestion enzymes.

Sweets are best eaten at the beginning of the meal because they are preferentially digested and will interfere with digestion if eaten later in the meal by stopping digestion at that point to digest the sweets. Sweets can also be eaten separately between meals.

When digestion is very challenged eat only one carbohydrate and only one protein at a meal, in general simplify the meal as much as needed to improve digestion.

Avoid any difficult to digest foods such as cruciferous vegetables, raw onions, fried foods especially breaded and fried foods, heavy sweets that have high fat content, and dried beans.

For NUD there is also herbal treatment for the dosha out of balance. For a high pachaka pitta cool and demulcent herbs are used. The bitter and sweet taste predominate with a cooling effect to reduce acid and also cool the liver, small intestine, and pancreas. Typical herbs are aloe gel, amalaki, barberry, cilantro, coriander, gentian, licorice, marshmallow, shatavari, and Avipattikar churna. Other spices that can be used unless pitta is very high are cumin, fennel, mint, and turmeric. Avipattikar churna is taken after meals to reduce acidity. Bitters can also be taken before meals to counter high pitta (32). Avipattikar churna : trikatu, triphala, cyperus, vidanga, cardamom, cinnamon leaf, cloves, trivit, raw sugar. Take 1-4 grams 2-3 times a day after meals with warm water.

For high vata or high samana vayu in the stomach and digestive system the types of herbs given are carminatives to calm the system and help balance digestion. Commonly used herbs are fresh ginger, cardamom, basil, fennel, cloves, and camomile. Spices are best taken with food or something sweet or demulcent to counter the dryness of the spices. Vata in the stomach is also likely to dry out the stomach lining and a demulcent would be beneficial. Since the site of accumulation for vata is in the colon, herbs for the colon may also need to be given to help reduce vata in the stomach. In that case the formula Asafoetida 8 is appropriate, to counter gas, bloating, and constipation. Triphala would also be used for constipation since it is the chief laxative in Ayurveda (33).

Another approach is to treat NUD by increasing the agni or by alleviating the indigestion. The following are modern Ayurvedic remedies (34). To rekindle agni use:

Before a meal - Fresh ginger with a little lime juice and a pinch of salt, or ginger tea.

  • Garlic pwd. ¼ tsp., ½ tsp. trikatu, and a pinch of rock salt.
  • One clove fresh garlic chopped with ¼ tsp. cumin pwd. a pinch of rock salt, a pinch of trikatu, and a tsp. of lime juice.
  • Ayurvedic herbal wine, Draksha. Use 2 to 4 tbs with equal amount of water.
  • A tea of ginger, brahmi, and chamomile (equal parts) for emotional causes

After a meal a tea of bay leaves with a pinch of cardamom may help to improve agni.

For indigestion there are several options:

  • Fresh pineapple juice with pinch of ginger and black pepper, and ½ tsp. sugar.
  • Onion juice, fresh ¼ cup, with ½ tsp. honey, and ½ tsp. black pepper.
  • Fresh garlic one clove chopped with a pinch of salt and a pinch of baking soda.
  • Juice of ¼ of a lime in one cup of water, add ½ tsp. baking soda and drink right away.
  • This drink is for acute indigestion.
  • For chronic indigestion : trikatu 1 part, chitrak 2 parts, kutki 1 part. Take ¼ tsp. before meals, with a little honey and fresh ginger juice.
  • Cumin pwd. 1/3 tsp., a pinch of asafetida, and a pinch of rock salt. Take with warm water.
  • Chew Ajwan seed ½ tsp. with ¼ tsp. baking soda and take with warm water.
  • Chew a mixture of roasted fennel, cumin, and coriander seeds ½ tsp.
  • Or a tea of the above three seeds, equal amounts of each ½ tsp. per cup of water.
  • Or a tea of angelica, chamomile, and comfrey equal amounts, ½ tsp. per cup.

The approach to nutrition is similar in the natural western and the Ayurvedic viewpoints, and there

are some differences. Both emphasis eating wholesome unprocessed foods, organic when possible, healthy eating habits, and appropriate amounts of food for normal healthy digestion. But Ayurveda has Upayogasamaatha, the guidelines for healthy eating that acknowledges all levels of our being that need nourishment and can be practiced by anyone regardless of their spiritual outlook.

In the care of NUD a western medicine approach, a natural health or nutritional approach, and an Ayurveda approach to healing have much in common but there are also some differences. The typical allopathic practitioner, usually an M.D., has extensive knowledge of human anatomy and physiology. They are trained to diagnose illness or diseases and when there is no manifest disease then there is often no protocol to follow in the care of the patient. Signs and symptoms maybe ignored assuming they will naturally abate, while not looking further for the causes. The patient maybe pacified with medication and the M.D. may feel it can do no harm. This is a narrow version of allopathic health care but it is typical of acute care medicine with the administration of only standardized pharmacological medications for any ailment the standard. At the other end of the spectrum M.D. and natural care practitioners are practicing medicine without medicine, using only supplements, herbals, extracts, enzymes, and an increasing number of what are considered natural products with little or no side effects. More time and care is taken with the patient to discover the underlying cause of the problem the patient presents with and not just focusing on symptoms. In acute care medicine bodily systems are separated while in a holistic view the body is integrated, and the approach to health is preventative or even to optimize health. Ayurveda's goal is to keep the body and mind healthy and to guide one on their path in life. It can touch every aspect of a person's life, and is intended to as a person is ready to let Ayurveda into their body, mind, and inner life. Comparing just the physical health aspect of each approach Ayurveda is similar to the holistic form of health care that treats each individual as an individual, with natural healing methods in assessment, diagnosis, nutrition, herbs and supplements, and other therapies. Ayurveda differs in that it is a fully integrated system consistent throughout the care of the client. The principals and therapies are in harmony with each other and support each other in the healing of the patient. In holistic care of NUD a less specific approach is used. Though a person is treated as an individual some may be given similar care of NUD though their constitutions are different. Though there is the attempt to treat the whole person and as an individual there is still a temptation to treat the symptoms or the disorder and not the imbalance that caused the symptoms. Holistic care has the benefits of extensive knowledge of the human body from medical school and research, a vast array of newer diagnostic tests that are useful in discovering underlying causes of GI symptoms, and a large choice of supplements, herbs, probiotics, natural foods, etc. for their clients. The holistic or natural or functional medicine care still has some of the analytical approach that is the hallmark of modern science and western medicine. Though the amount of knowledge and wisdom is enormous the modern systems are not completely integrated; in philosophy, principals, and practice as Ayurveda is. It might be seen as the difference of nature and science. Our bodies and minds are a part of nature and Ayurveda is natures medicine. Science is descriptive of nature and can be very knowledgeable of nature but is still separated from nature. Using science to help us heal can be very beneficial but it is still putting science first and not allowing direct communication from nature to teach and to heal directly.

References

1,2,5. Clinical Nutrition; A Functional Approach. The Institute for Functional Medicine. Gig Harbor , WA . Bland JS, et al.

3,4. Zeman FJ, Clinical Nutrition and Dietetics. Macmillian Publishing Company, 2cd Ed. 1991.

6,9,10, 15, 16. Rogers SA. No More Heartburn. New York : Kensington Publishing Company, 2000.

7.Frishman RG. The Sensitive Gut. Boston : Harvard Medical School Health Publications Group, 1996.

8, 11. Bonci L. American Dietetic Association Guide to Better Digestion. New Jersey , John Wiley & Sons, Inc. 2003.

12, 13, 14. Gael RK, Sairam K. Anti-Ulcer Drugs From Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale. Indian Jr. Pharm 2002; 34:100110.

17, 18-23. Caraka Samhita: R.K. Sharma, Bhagwan Dash. Varanasi India . Chaukhamba Sanskrit Series, 1992.

24, 25, 29, 30, 32, 33. Frawley D. American Institute of Vedic Studies Ayurvedic Healing Corresponding Course for Health Care Professionals, Parts III and IV. Santa Fe NM . American Institute of Vedic Studies, 2002.

27, 28, 31. Halpern M. Principals of Ayurvedic Medicine, 5 th Ed. California College of Ayurveda. Grass Valley , CA. 2003.

26. Douillard J. Ayurvedic Specific Condition Review: Peptic Ulcer. John Douillard Lifespa: Rejuvenation Through Ayurveda.

34. Lad V. The Complete Book of Ayurvedic Home Remedies. New York , Three Rivers Press 1998.

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Musculoskeletal Injuries: A Comparison of Western Allopathic and Ayurvedic Treatments ( By: Anna Holden)

   The human body is a wonder.  The structure of our skeleton, combined with the fluid strength of our muscles and the tendons and ligaments that connect muscles and bones together, makes the human body a bio-mechanic masterpiece.  It is able to move through several planes of motion by the grace of our spine, which can move in four different directions, allowing us perform a multitude of physical activities.  For example, we are capable of flowing through sun salutations, propelling ourselves forward to walk or run, and find dynamic stability and balance while surfing or skiing.  When anatomical principles are followed, including proper alignment and attention to proper range of motion, our bodies can function with ease.  If, however, we continuously practice activities with improper alignment, or we are pushed out of alignment by some outside and unseen event, our bodies can experience pain and injury.  Sometimes, pain can arise without any acute episode.  The Western Medical model has a fairly succinct system for managing both acute and chronic injury, and is only starting to look towards ancient healing systems like Ayurveda for healing injury.  Traditional Ayurvedic treatment of injury includes some Western allopathic methods, but moves beyond them to include healing of the mind, body and spirit.  This paper will explore the Western allopathic and Ayurvedic treatments for both acute and chronic injury and/or pain.

   For the purposes of this paper, injuries will be divided into two categories: acute and chronic.  Acute injuries are those with a sudden and severe onset of pain, possible swelling and the inability to place weight on the area, abnormal ranges of movement, weakness and tenderness.  Chronic injuries may start out as acute injuries but continue to persist in the body.  One way to gauge whether an injury has become chronic is when pain is experienced during participation in physical activity or exercise after the acute injury has been healed, a dull ache occurs during rest, or when there is persistent swelling .  Chronic injury can also be defined as pain lasting greater than three months . 

Acute Injury

   Some of the most common acute injuries are sprains and strains.  Sprains occur on ligaments and strains affect muscles and tendons.  Ligaments are bands of connective tissue that connect bone to bone and hold joints, like the shoulder, together.  Tendons are bands of connective tissue that connect muscles to bones.  A sprain is a stretched or torn ligament, while a strain is a stretched or torn muscle or tendon.  Sprains and strains share some similar symptoms, which include pain and swelling.  With a sprain, however, there may also be bruising, inability to move the affected joint and a popping or tearing sound.  The symptoms of a strain may also include muscle weakness, muscle spasm and trouble moving the affected muscle .    

Western Treatments of Acute Injury

   The most commonly recommended Western allopathic treatment of sprains and strains is to use the R.I.C.E. method: Rest, Ice, Compression and Elevation.  Following this method, at the onset of injury the activity should be discontinued and the injured area of the body should be rested.  Next, an ice pack should be applied to reduce swelling and inflammation.  An Ace bandage or other clean wrap can be used to compress the injury, keeping swelling at bay.  Finally, the injured area should be rested in a position elevated above the heart.

   Other Western allopathic treatments of sprains and strains includes the use of NSAID pain relievers, immobilization of the injury, and rehabilitation exercises to restore proper range of motion.  Also, a program of strengthening and stretching the affected area should be followed so that scar tissue will not build, which could increase the possibility of re-injury.  Additional Western modalities of injury treatment include electrical stimulation, alternating cold and hot packs, ultrasound and massage .  In certain conditions, including tearing of ligaments, tendons or muscles, the patient may require surgery to repair the damaged tissue.

   As the above methods point out, treating acute injury involves managing symptoms and resting the injured area.  In addition to symptom management, some literature points to taking preventative measures to reduce the likelihood of experiencing injury or re-injury.  Preventative measures are different based on where in the body injury is more prone to occur, but all preventative measures have the same basic principles of stretching what is tight, strengthening what is weak and improving range of motion in all directions   .  Less commonly focused on in the Western allopathic literature of acute injury recovery and prevention is proper diet, however, one article suggests that athletes experiencing acute injury should follow a diet high in vitamins and minerals obtained from healthy sources like fresh vegetables. It also suggests athletes eat “balanced protein,” and to avoid overeating so as not to gain weight while injured .  

Ayurvedic Treatment of Acute Injury

   Ayurvedic treatment of acute injury takes a more holistic approach.  While Ayurvedic treatment follows the same general course as Western allopathic treatment in that it aims to reduce inflammation and swelling and to restore the muscle, tendon or ligament to its proper healthy function, Ayurvedic knowledge allows for identification and treatment of the many subtleties within injuries.  These include noticing the different types of inflammation and swelling, observing different forces at work within the injury and addressing them individually, and keeping in mind the unique constitution of the individual so that the healing program can be as unique as they are.  In addition, Ayurveda acknowledges at the energetics of an illness or injury, takes into consideration the amount of toxins or ama a patient may have in their body, and assesses how well prana, the life-force energy responsible for all movement in the body, is flowing in the injury itself and in the patient’s body in general.

   In order to understand Ayurvedic treatment, it is important to understand the basics of Ayurveda itself.  Ayurveda is a holistic system of health that utilizes the five-element theory, which underlies all life on the planet.  The five elements – earth, water, fire, air and ether – combine to create the three doshas.  Doshas are the forces within nature and our bodies that are responsible for all action and inaction, including the formation of our tissues, the metabolism of thought and food, and all movement in the body including nutrients in and out of cells, breath in and out of the lungs, creative flow from our minds out our hands as well as speech and muscle movement.  The definition of dosha is “fault” or “imperfection,” which explains how these forces can move to excess through improper diet or lifestyle and create a state of dis-ease in the body.  In the case of acute injury, vitiation of the doshas usually occurs from outside factors like unexpected events.

   In Ayurveda, both the treatment and management of disease is based on the qualities of imbalances found in the body.  Ayurveda relates every state in nature, and thus in our bodies, back to their most basic building blocks – the elements and qualities that they are made of.  Once the basic qualities of an imbalance are understood, we are able to provide treatments that balance the disease or injury.  The most primary principle of Ayurvedic treatment is that “like increases like, and opposites reduce each other .”  In Ayurveda, dry is treated with moist, cold is treated with heat, heavy is treated with light and so forth .

   The Ayurvedic author M.S. Valiathan, who translated the ancient Ayurvedic text the Susruta Samhita, does not talk about injury management specifically, but he does talk about the treatment of swelling and inflammation that occur from traumas like “excessive jolting…” .   These types of “generalized swellings,” as he calls them, can be attributed to either vata, pitta, kapha or all three doshas (sannipata).  Vata swelling appears red or black in color and includes prickling, soft, fleeting pain.  Pitta swelling has a yellow or red coloring to it, is soft and hot to the touch and spreads quickly.  Kapha swelling is pale or white in color, feels cold and smooth, spreads slowly and may itch.

   In general, Valiathan recommends that anyone with swelling, regardless of the cause, should avoid sour and salty foods, and heavy foods such as milk, sugar and ghee .  This is because most generalized swelling is due to increased water retention in that area, caused by Kapha dosha, and because the water element in the body (i.e. swelling) is increased by the intake of the aforementioned foods. Based on the type of swelling and inflammation, mentioned in the previous paragraph, Ayurvedic treatment can include herbal formulas containing properties to treat the imbalance with its opposing qualities.  Some of the herbs Valiathan recommends to treat swelling include vidanga, trikatu, haritaki, guggulu, fresh ginger, punarnava and pippali .

   The classical Ayurvedic text the Ashtanga Hridayam, by Vagbhata, does not talk about muscle injuries specifically, but does talk about the healing of traumatic injuries, which he defines as those “wounds which occur suddenly.”   Vagbhata also recommends treating with opposites.  He recommends treating inflammation in acute traumatic injury with a topical herbal application, called a lepa, using herbs with a cold potency, sweet taste and unctuous properties .  These three qualities – cold, sweet, and unctuous – help to reduce inflammation and heat.

   Most modern Ayurvedic sources encourage the use of external herbal compounds, like lepas, for treating acute injury.  Lepas are medicinal herbs made into a paste with oil, aloe, or another liquid, then applied to the skin. An article in Yoga Journal Magazine recommends the use of herbal compounds to improve the circulation of prana, or life force energy, and blood around the injury.  The article states that, if applied correctly, the active ingredients in the herbs will be absorbed by the skin, thereby reducing pain and swelling and improving circulation.  The article also suggests the use of herbs such as Salai guggul, kapitthaparvi, and bola, both internally and externally to reduce pain, strengthen bones and joints, and cleanse the blood of toxins .  Additionally, white willow bark – the herb that inspired Westerners to create Asprin – is recommended as an analgesic and anti-inflammatory.  This article also recommends that the patient rest and ice the injury.

   An article by Alakananda Ma, an Ayurvedic Practitioner, recommends reducing pitta-type pain and inflammation through the use of pitta reducing herbs that have an affinity for joints and muscles.  These include guduchi, tulsi, turmeric, licorice and the formula Kaishore guggulu, all taken internally.  Additionally, the patient could drink anti-inflammatory teas like ginger or tulsi-turmeric-ginger.  For localized healing, the author recommends the use of anti-inflammatory oils like castor and mahanarayan to be massaged into the affected area, and then rinsed off in a hot shower.  Once inflammation is gone, the patient could massage the area with one of the aforementioned oils, and then follow with a ginger or baking soda bath.

   For muscle tendon injuries where there is no inflammation present, Ma also recommends Patrapinda Sveda therapy.  Patra means “the leaves of medicinal plants,” pinda means, “bolus,” and sveda means fomentation or heat therapy .  Therefore, Patrapinda Sveda is the application of medicinal leaves fried in ghee or oil, and wrapped in a muslin cloth to form a bolus.  The bolus is then massaged into the injured area, where the medicinal properties of the plant will absorb into the skin and provide pain relief via softening of the tissues.  Additionally, Ma recommends that once an acute injury has healed past any inflammation, a yoga therapy program should be started that addresses any pain, under-use, loss of conditioning and join laxity.  Finally, muscles should be slowly conditioned to sustain maximum functional capacity.

   The treatments that Ayurveda offers to heal acute injury can be summed up by the treatments offered at a clinic in Kerala, India, which specializes in Ayurvedic sports medicine.  The treatments utilized by Ayurveda to heal acute injury are: internal medicines (like herbs and diet), external medicines (like lepas and patrapinda sveda), varma chikitsa (procedures to increase joint mobility and function and decrease pain), pancha karma (removing toxins and cleansing the body), and traditional physiotherapy. With this holistic approach, Ayurvedic treatment of injury can be a good route to healing and even an alternative to surgery .

Chronic Injury

   As stated above, chronic injury can be described as injury lasting more than three months, or twelve weeks.  The original cause of chronic musculoskeletal pain may have been an infection, injury, or wear and tear from incorrect movement over an extended period of time.  Chronic pain or injury are often difficult to manage because many times the cause is unknown , and sometimes pain occurs in the body for no apparent orthopedic reason, with no acute episode of injury.  Both Western medicine and Ayurveda offer treatments for chronic injury.

Western Allopathic Treatments of Chronic Injury and Pain

   For the most part, Western treatment of chronic injury includes following the plan laid out for acute injury, and then adding a recovery and maintenance phase of healing.  In the recovery phase, the American Academy of Physical Medicine and Rehabilitation recommends building strength and flexibility around the injured area to repair normal function and range of motion.  Then, they suggest a maintenance phase during which the patient minimizes the chances of injury recurrence by engaging in a supervised, total-body fitness program .

   Chronic injury, however, can have more of an effect on the body than just the area of injury and surrounding tissues.  Long-term chronic injury and/or pain can have psychological effects also.  Often, pain can change the regular patterns of a person’s life, their relationships to others and the way they function in everyday life.  Reduced coordination or strength in an area of a body can make a person less independent than they once were, and create a need for them to rely more on others. These changes due to pain, when left untreated, can lead to psychological problems and even more pain .  The Mayo Clinic conducted a study on pain and depression. They describe the link between pain and depression like a cycle:

   Pain and depression are closely related.  Depression can cause pain – and pain can cause depression.  Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain .

   Therefore, not only does pain affect the physical body, it also affects how a person thinks and feels.  When thoughts and emotions are particularly negative, they can increase the pain that the person experiences .  There are some Western techniques for addressing the emotional/psychological component to pain.  They include occupational therapy, and psychotherapy or counseling.

   Occupational therapy helps people manage both the physical and psychological effects of pain.  Occupational therapists teach people to manage their daily activities and lifestyle in accordance with their pain or injury through several methods. They teach people how to identify behaviors that increase pain and then offer alternative methods instead, and methods for decreasing the frequency or intensity of pain.  They teach patients new ways for using their bodies to decrease pain during everyday tasks.  Occupational therapists also help the patient by collaborating with their team of health care professionals to keep a clear path of treatment .

   Psychotherapy or counseling can help patients by guiding them to reduce stress and tension, and to make lifestyle changes when necessary.  Because of the aforementioned link between pain and depression, it can often be difficult to tell which came first if there was no acute injury to musculoskeletal tissue.  In these cases, psychotherapy can be quite effective at getting to the bottom of what is causing the pain and/or depression – whether it be a stressful job, a negative living situation, or an unsupportive relationship.  Patients may be guided through counseling to change the situations that may be aggravating their chronic pain or injury .

Ayurvedic Treatment of Chronic Injury and Pain

   Similar to Western Allopathic treatments of chronic injury, Ayurvedic treatment of chronic injury and pain will firstly follow their same treatments for acute injury, and also include phases in treatment for maintenance and prevention.  All of the aforementioned Ayurvedic treatments would continue to be applied as needed for pain and healing of tissues.  Also similar to Western medicine, Ayurveda treats chronic injury and pain with both physical application and psychotherapy – specifically, Ayurvedic psychology, which differs from Western.  Ayurveda always includes treatment of the mind, body and spirit, and believes that health and healing must address each of these aspects of our being.  In addition, because it believes that every physical manifestation had first a subtler component, complete Ayurvedic treatment will provide treatment for pain and injury through subtle body anatomy, including the nadis, chakras and auric field.

   Beginning with treatment for the physical aspects of chronic injury, Ayurvedic body therapies for chronic pain would include those listed above – internal medicine, external medicine , varma chikitsa, Pancha Karma and physiotherapy – but would be adjusted as necessary as vitiated doshas come into balance.  Next, a patient would be treated using Ayurvedic psychology, which teaches the patient about who they are as an incarnated soul and the specific growth and challenges that they may face in the this life.  From this understanding of soul development, the patient can gain an understanding of their pain or injury in the context of their life journey. This can help a patient understand the lesson behind the pain, which can change the perception of pain from something that occurred outside “to” the patient to a signal from the body to create change within the patient’s life.  Additionally, while Western psychology focuses on revisiting the past in order to understand how a current situation manifested, Ayurvedic psychology emphasizes taking stock of the current situation and making positive changes to transcend the situation and create the life that is wanted. 

   To begin to address chronic musculoskeletal pain and injury through Ayurvedic psychology, the practitioner may look at the tissues affected and their related psychological function.  Musculoskeletal injuries, by definition, are those that affect the muscle tissue, tendons and ligaments, and bone tissue.  Ayurveda calls muscle tissue and ligaments mamsa dhatu, and the related psychological function is courage, fortitude and self-confidence.  Symptoms of deficient mamsa dhatu can result in muscle wasting, loose ligament (which often cause many chronic injuries in athletes), and fear, worry, low self-confidence and low self-esteem.  The Ayurvedic term for bone tissue is asthi dhatu, and its related psychological function is stature and the ability to stand tall.  Deficient asthi dhatu can result in osteoporosis and other weak-bone disorders, as well as arthritis. 

   Using the above information as a guide, the patient should be guided to recognize what in their life is causing them to feel a lack of confidence and support, and be guided toward building confidence and self-esteem so that they can stand tall and have no doubt that they can support themselves. In order to do this, we must understand all aspects of the Self – moving past the physical body and into the subtle and causal aspects of our existence. Ayurvedic philosophy states that all physical reality had a subtler component that preceded it, so only addressing the physical component is not necessarily addressing the root cause.  For mind-body-spirit healing, Ayurveda will of necessity address the subtle components of pain – the underlying thoughts, behaviors or attitudes that may keep the body in distress.

   Looking at the bodily tissue associated with the injury is just one way to treat the underlying psychological issue.  Additionally, chronic pain can be assessed based on where it is in the body and how that relates to the subtle or astral body and the chakra system that energizes it.  The subtle body is an energetic copy or template of the physical body and is projected by the seven chakras, which are the energetic templates of the nerve plexuses of the body. Our chakras serve two basic purposes – first as pumps that run energy through our bodies via the nadis, or energetic channels that run along the spine, and second as determinants of our experience.  Chakras can run two types of energy – ordinary subtle energy, which is necessary for everyday experience and function; and heightened subtle energy, which changes our perceptions and allows our consciousness to be raised.  When energy in a chakra is partially blocked or moving too slowly, dis-ease in the physical body may manifest.  Until the underlying issue has been addressed at the chakra level – which usually includes self-reflection and work in underlying values, beliefs, and emotional attachments – the physical pain will persist.  Much research has been conducted and written about the different chakras and the life lessons they provide.  Therefore, the location of the chronic injury or pain as it relates to the nearest chakra can give the practitioner more information about the cause and purpose of the pain and how to treat it.

   There are several healers in the alternative medicine field who work with this principle.  Some do not fall fully into either the Western allopathic model or the Ayurvedic model, but I will include them here because they utilize the ancient wisdom of the subtle body system, which originated from the same source as Ayurveda.  Carolynn Myss, in her book “Anatomy of the Spirit,” describes in detail the seven chakras and the common injuries, diseases, and afflictions that occur because energy in that chakra is stagnant or blocked.  Her first principle of whole body healing is that our subtle biography becomes our physical biology. She says:

   As our lives unfold, our biological health becomes a living, breathing biographical statement that conveys our strengths, weaknesses, hopes and fears. . . . All our thoughts, regardless of their content, first enter our systems as energy. Those that carry emotional, mental, psychological, or spiritual energy produce biological responses that are then stored in our cellular memory.  In this way our biographies are woven into our biological systems, gradually, slowly, every day. 

   This is very similar to the Ayurvedic principle that every physical manifestation first had subtler origin.  In her book “Women’s Power to Heal Through Inner Medicine,” Ayurvedic author Maya Tiwari emphasizes this principle when she says, “Our bodies are made of consciousness and spirit . . . . In order to heal, we need to appease vital tissue memory and nourish and nurture the whole self.   What Tiwari and Myss are saying is that what we believe about our world, and especially how we think and act on those beliefs will affect our biological health.  People with chronic pain, then, are receiving constant signals from the body that something is not right and that there are beliefs, thoughts, values, lifestyle choices or relationships that are continuing to create disharmony in the subtle body system.

   Myss’ second principle for subtle body health is that personal power is a necessity for health.  This relates directly to what was stated above, that in Ayurveda, people with chronic musculoskeletal injuries must be treated for the psychological conditions of lack of confidence, self-esteem, and ability to stand up and support one’s self.  Tiwari’s writings support this with an entire chapter entitled, “Your Own Energy is Your Best Medicine .”  Both Myss and Tiwari argue that our attitude can cause us to either keep healthy personal power and self-esteem, or cause us to lose power.  Myss uses the example of a woman who came to her with chronic pain.  She had no acute episode responsible for her pain or exhaustion, however, she believed she was inadequate and constantly criticized her children in order to make them dependent on her and give her a sense of purpose.  Because she believed she was inadequate, she consistently gave away her power to this belief, which left her with no personal power with which to heal herself .  Only a change in her beliefs and attitudes about herself could change the flow of energy through her chakras and keep her subtle body energy at a healthy level.

   Myss’s third principle of healing – that you alone can help yourself heal  - also closely follows the Ayurvedic understanding that we carry within us the innate ability to heal ourselves, and that real healing comes from the inside, through self-inquiry, self-acceptance, and understanding of our true nature as spirit.  The Western allopathic model is set up in such a way that we give up our power to self heal and instead turn our physical bodies over to someone with more “credentials” for healing.  This model leaves us with a great sense of helplessness and defeat when it comes to pain and injury.  Instead, the philosophy laid out by Ayurveda and Myss – that each of us has within us the power to heal – teaches us that not only are we responsible for our health, but we are also responsible, at some level, for creating the injury or pain.  Embracing this can give us the power needed to heal, because it allows us to recognize that by participating in our healing, we are healing our mind, body and spirit as one – not turning the physical body over to someone else for partial healing.

   Similarly, in “You Can Heal Your Life,” Louise Hay guides readers toward healing dis-ease, including chronic pain and injury, in the body. She believes in principles that closely follow Ayurvedic philosophy:

We are each responsible for all of our experiences. 

Every thought we think is creating our future. 

The bottom line for everyone is, “I’m not good enough.” 

It’s only a thought, and it can be changed. 

We create every so-called illness in our body. 

We must be willing to begin to learn to love ourselves. 

Self-approval and self-acceptance in the now are the keys to positive changes.  

When we really love ourselves, everything in our life works.

   Hay affirms that the path to healing all disease, including chronic pain or injury, is through releasing the negative emotional patterns (subtle body anatomy) that create pain in the physical body by learning to love the self.  She relates physical injury to the subtle body cause behind it – our attitudes and beliefs about our world and ourselves.  Then, she guides readers step-by-step through a series of positive affirmations designed to change negative thought patterns.

   Ayurvedic treatments for chronic injury and pain on the subtle body level to address chakra or energy imbalance could include self-inquiry, meditation, pranayama, sound therapy (both listening to music and chanting), and repeating affirmations or Sanskrit chants.  Because chronic injury or pain is signal that there is a long-term imbalance in the body, subtle body healing is critical in addressing the underlying cause of discomfort and eliminating it from the body.

   Both Western medicine and Ayurveda treat chronic injury and pain through both physical modalities and psychotherapy (the body and mind).  However, because Ayurveda believes in the connection of the mind, body and spirit, it is able to take a healing a step further with its utilization of subtle body anatomy to aid in understanding and releasing the underlying causes behind chronic injury and pain that Western medicine often misses.

Conclusion

   Both Western Medicine and Ayurveda offer options for healing acute and chronic injury.  When working with acute injury, Western medicine generally utilizes a one-size-fits-all approach that generally helps people recover; however, through its doshic theory, Ayurveda has a more intricate healing method and can offer more individualized healing.  For chronic injury, Western medicine has recognized that both the body and the mind must be treated in order to realize healing.  However, Ayurveda’s knowledge of the subtle body system make it an excellent choice for patients ready to take charge of their own healing path and realize healing of the entire mind, body and spirit.  

Author’s Notes

   I have personally experienced chronic, low back injury and pain for most of my life, but more extensively the past three years.  I have experienced severe ligament laxity (hyper mobility) of the sacral iliac joint and pelvis, resulting in near constant pain and discomfort.  I originally tried a Western approach that included ice, heat, NSAID pain relievers, rest and physical therapy.  I did not heal.  I turned to an alternative approach to healing which included Yoga, meditation, yoga-based physical therapy, visceral manipulation therapy and an Ayurvedic diet and lifestyle.   All of these modalities helped the physical manifestation of my injury, but did not provide complete healing. I was only able to fully heal when I learned about the subtle body connection and dove into figuring out what negative beliefs and attitudes I held about myself.  Then, I came to recognize how my current lifestyle and relationship was constantly and consistently reinforcing those negative beliefs.  For me, the changes necessary to bring about healing required that I learn to find the courage to let go of fear and have faith that if I love myself, and I follow the path of self-love and Spirit, I would be taken care of.  It was through the lesson of chronic injury and pain that I was able to learn the lesson of self-love and realize full-body healing.

References 

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Easty-to-Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d

National Institute of Neurological Disorders and Stroke (NINDS), NINDS Staff, NINDS Back Pain Information Page,  http://www.ninds.nih.gov/disorders/backpain/backpain.htm

Medline Plus, Medline Plus Staff, Sprains and Strains, http://www.nlm.nih.gov/medlineplus/sprainsandstrains.html

Medline Plus, Medline Plus Staff, Sprains and Strains, http://www.nlm.nih.gov/medlineplus/sprainsandstrains.html

Mayo Clinic, Mayo Clinic Staff, Hamstring injury, http://www.mayoclinic.com/health/hamstring-injury/DS01183/METHOD=print

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Easty-to-Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Easty-to-Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d

American Academy of Physical Medicine and Rehabilitation (AAPM&R), AAPM&R Staff, Overview of Neck Pain, http://www.aapmr.org/patients/conditions/msk/spine/Pages/Overview-of-Neck-Pain.aspx

Active.com, Nancy Clark, Injury, Diet and Recovery: Guidelines for Nutrition and Healing. http://www.active.com/nutrition/Articles/Injury__diet_and_recovery__Guidelines_for_nutrition_and_healing.htm

Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 59.

Charaka. Edited by Bagriel Van Loon. Charaka Samhita: Handbook on Ayurveda, Volume 1.  (P.V. Sharma & Chaukhambha Orientalia). Su10#6.

Valiathan, M.S. The Legacy of Susruta.  (Orient Longeman Private Limited, 2007), 346.

Valiathan, M.S. The Legacy of Susruta.  (Orient Longeman Private Limited, 2007), 346.

Valiathan, M.S. The Legacy of Susruta.  (Orient Longeman Private Limited, 2007), 347.

Valiathan, M.S. The Legacy of Susruta.  (Orient Longeman Private Limited, 2007), 347.

Vagbhata. Translated by Prof. K.R. Srikantha Murthy.  Vagbhata’s Astanga Hrdayam. (Chowkhamba Press, Varanasi, Fifth Edition, 2009), 247. Chapter 26, Verse 1.

Vagbhata. Translated by Prof. K.R. Srikantha Murthy.  Vagbhata’s Astanga Hrdayam. (Chowkhamba Press, Varanasi, Fifth Edition, 2009), 248. Chapter 26, Verse 7.

Yoga Journal, James Bailey, L.A.c, M.P.H. Damage Control. http://www.yogajournal.com/health/550

Banyan Botanicals. Alakananda Ma. Rotator Cuff Injuries in Your Ayurvedic Practice. http://www.banyanbotanicals.com/bv/rotatorcuff

All About Ayurveda. Dr. Rayhuram Y.S. Patra Pinda Sweda…Herbal rejuvenation of back and spine..in back pain severe. http://drraghuramys.wordpress.com/2009/11/10/patra-pinda-sweda-herbal-rejuvenation-of-back-and-spine-in-back-pain-severe/

Kottathil Ayurveda Hospital.  Hospital Staff. Ayurvedic Sports Medicine. http://www.kottathilayurveda.com/ayurvedic-sports-medicine.html

Chronic Pain.  National Institute of Neurological Disorders and Stroke staff. http://www.nlm.nih.gov/medlineplus/chronicpain.html

American Academy of Physical Medicine and Rehabilitation (AAPM&R). AAPM&R Staff.  Overview of Neck Pain. http://www.aapmr.org/patients/conditions/msk/spine/Pages/Overview-of-Neck-Pain.aspx

The American Occupational Therapy Association, Inc. (AOTA). AOTA Staff.  Managing Chronic Pain. http://www.aota.org/Consumers/consumers/Health-and-Wellness/Pain/35137.aspx

The Mayo Clinic.  Mayo Clinic Staff.  Pain and Depression: Is there a link? http://www.mayoclinic.com/health/pain-and-depression/AN01449/METHOD=print

Medline Plus. Medline Plus Staff.  Low back pain – chronic. http://www.nlm.nih.gov/medlineplus/ency/article/007422.htm

The American Occupational Therapy Association, Inc. (AOTA). AOTA Staff.  Managing Chronic Pain. http://www.aota.org/Consumers/consumers/Health-and-Wellness/Pain/35137.aspx

Medline Plus. Medline Plus Staff.  Low back pain – chronic. http://www.nlm.nih.gov/medlineplus/ency/article/007422.htm

Charaka. Edited by Bagriel Van Loon. Charaka Samhita: Handbook on Ayurveda, Volume 1.  (P.V. Sharma & Chaukhambha Orientalia). Su11#55.

Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 181.

Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 198, 199.

Myss, C.  Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 40.

Tiwari, Maya. Women’s Power to Heal Through Inner Medicine. (Mother Om Media, 2007). 91.

Tiwari, Maya. Women’s Power to Heal Through Inner Medicine. (Mother Om Media, 2007). 91.

Myss, C.  Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 44,45.

Myss, C.  Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 47.

Hay, Louise L. You Can Heal Your Life. (Hay House, Inc. 2004). Xiii

 

 

POPULATION HEALTH THROUGH SENSORY EXPERIENCES: LIFESTYLE AND CULTURAL INFLUENCE ON THE SENSES

By: Elana Berman

Introduction

   The impressions of the five senses are experienced differently throughout life based on a variety of factors. Through the examination of geographical differences and community development in various cultures, it is clear that disease precedence differs. The following essay examines and identifies trends in each population segment.  Every culture, living environment and financial status impacts the way of life in various regions throughout the world. This study addresses life in developed and in developing countries. Some locations utilized in the Western world include Los Angeles, California and France. Examples from the eastern world and of developing countries include urban and rural locations in India.

   Disease affecting factors differ greatly between the eastern developing and western developed world. One factor, which Ayurveda considers the root of physical disease, is food, diet and digestion. Ayurveda teaches that most disease and doshic imbalance first occurs in the mahavaha srota, also known as the digestive tract.9 Through the development of unplanned cities and the corresponding population increase, the availability of sustainable natural foods decreases. Many of India’s metropolitan cities have developed without planning. Unplanned cities lack consideration for projected population growth and all of the necessities that an exponentially growing population requires for survival. On the opposite side of the spectrum, this essay looks at life in planned western cities. I compare and contrast the variety of sensory experiences that humans perceive while living in unplanned versus planned cities and rural versus urban environments. Disease exists throughout the world’s populations. I attempt to identify causes and trends for disease occurrence through a comparison of use of the senses. 

The Causes of Disease

   In Ayurveda, the “science of long life” there are three causes of disease according to its oldest text Charaka Samhita. First is disharmonious use of the senses, which occurs when the senses, also viewed as gateways into our body, mind and consciousness are used primarily for the pursuit of pleasure for the physical body. This disharmonious use occurs as a result of forgetting the existence of our higher selves or the existence of any divine form. Essentially, this disharmony results in conjunction with the primary cause of disease, which is forgetting our true nature as spirit.6

   The second cause of disease is called prajnaparadha, which translates from Sanskrit as failure of the intellect. This intellectual blasphemy results when we hear the voice of the intellect louder than the voice of the soul. This failure of the intellect also results from the primary cause of disease, when we forget our connection to the divine. The practice of disharmonious behaviors despite the fact that we know they are disharmonious causes decision making based on the lower self. The lower self speaks to us through sensory or physical desires.10

   Parinama is the third cause of disease, which means transformation or decay due to time. Time can be further defined as the act of living life. As we live and have experiences the elements of the world stress our bodies. The very act of living causes a natural degradation of the body. After all, we are not placed in this world to live forever. Rather we are here, Sankhya philosophy says, to fulfill our karma and samskaras in order to experience life and then return to our un-manifested home in the divine form. The nature of life is to move, exist, think and participate as time moves forward. Technological advances such as flying and driving accelerate this transformation through hastened means of movement.11

   The movement of the mind is at the forefront of this cause of disease. Our state of mind, in the present or future and active or distracted, directly correlates to the movement of biological time. When we live outside of the present moment, it is impossible to have single-pointed concentration also known in the realm of Yoga philosophy as dharana. With the practice of dharana, parinama slows down and harmonious use of the senses prevails. This discipline leads to slower aging and reduced impact of stressors on the body.7

How Ayurveda Heals with the Senses

   In this 5000-year-old eastern medicine lineage, the five senses of sight, smell, touch, taste and sound are used to reduce doshic and elemental imbalances in an effort to create harmony. Ayurveda aims to achieve this homeostatic state by optimizing an individual’s surroundings based on individual needs. An individual’s needs are determined by a combination of factors. An individual’s elemental constitution at the time of conception, called Prakruti, and an individual’s current state of imbalance, called Vikruti. With these two factors, Ayurveda treats with customized sensory therapies to bring a person to optimal health.

   Each of our physical experiences in the gross body affects the deeper bodies and subtler senses. Our physical sensory intake impresses the astral senses through its effect on the chakras, which are subtle energy centers in the body. The astral body is also affected by the flow of prana, or energy, through nadis, which are energy channels in the body. These astral experiences then affect the subtlest of all bodies, the causal body. This body lies beyond the physical world. Karma and samskaras cause a soul to physically manifest in the cycle of reincarnation.12

Introduction to the Five Senses

   Ayurveda uses a variety of approaches to integrate holistic sensory therapy into healing the 3 different bodies: physical, subtle and astral. The sense of smell, while experienced in most actions in life, can be treated through the use of aromatherapy. The sense of vision can be modified through color therapy. The sense of touch can be affected through body therapies. The sense of hearing can be impacted through the use of chanting, japa and bija mantras. The sense of taste is affected everyday by diet and herbs.3

   None of these senses exist independently as they each affect the sensory lens through which all other senses and experiences are perceived. It is in this context that the practice of pratyahara is a useful tool. Pratyahara is one of the 8 limbs of yoga and is the discipline of withdrawal of the senses. Through this practice we become aware of extrasensory perceptions and singular sensory experiences further emphasizing the practice of dharana with single pointed focus.4

Case Study of Sensory Experiences in a Developing Urban Area

   One of the most important resources in life is food. It represents one of the three pillars of life according to Ayurveda.13 India’s urban obesity rate was 24.8% in 2006.5 While this disease prevalence is common in most urban environments, it is often due to a variety of increasingly sedentary lifestyle factors. In urban India it presents for some unique reasons associated with the lack urban planning, which affects the population’s food resources.

   A large proportion of urban India is unplanned cities and the growing disease rates and obesity epidemic statistics demonstrate some of the consequences of improper planning. In New Delhi, the availability of sustainable food and nutrition shadows in comparison to the today’s population. In order to feed the exponentially growing population of Indian cities, food must be imported from outside the region. Fertile lands are being destroyed in order to provide space for the increasing housing requirements of a growing population.15 A lack of planning causes inconsideration for the fact that these new inhabitants may well have a roof over their heads but will not have access to fresh and local foods. As food undergoes longer transport time before it reaches consumers, it has to contain more preservatives. These additives affect the digestion and level of sattwa in consumers. Additionally, the longer time that passes between the time that food is taken from its source, for example plucked off a tree or harvested, the lower the level of prana and nutrition in the foods. According to Ayurveda, a high prana diet containing all of the 6 tastes and rich in fresh foods is one key component to maintaining health.9

   Aside from the sense of taste and foods consumed, the lifestyle in India’s unplanned cities provides a plethora of interesting sensory experience. Some of these experiences are wholesome, for instance holy sites and spiritual enclaves within the daily routine. However, many of these sensory experiences are unwholesome. New Delhi is a good example. Moving through any space all the senses are stimulated, however movement through space in Delhi overwhelms the senses with unwholesome experiences. These disharmonious experiences add to disharmonious use of the senses and may arguably contribute to India’s growing obesity rates.14 

   Pollution generation is increasing from construction projects, transportation emissions due to automobiles and waste quantities. The smell of diesel permeates streets. The sound of begging homeless and insistent shop keepers fight to be heard of roaring motor bikes and revving rickshaws. Pedestrians feel gusts of sweltering hot air polluted by the dust of nearby construction sites. The sight of dirt and trash amongst hurrying people moving rapidly through their day pollute the visual senses. The senses are stimulated if not over stimulated by the pungency of life in New Delhi. All of these experiences are primarily rajasic and tamasic, causing unsettling of the mind. Disease starts in the subtler body before manifesting in the physical body and relocating to deeper srotas. It is therefore arguable that these unwholesome sensory experiences contribute to physical disease.16

Case Study of Sensory Experiences in a Developing Rural Area

   As history demonstrates, people settle in areas where life is viable. Some of the earliest traces of civilization in the Mesopotamia Era near the Nile River demonstrate that. People gather near rich soil and water sources where one of their three basic needs of life, is most easily sustained. Rural towns and villages have a produce output that mirrors or in the case of agriculture towns exceeds, the needs of local people. As a result, locals have access to fresh, unpreserved and natural food sources thereby promoting healthier diet and digestion. With Ayurveda teaching that the root cause of disease is in digestion, arguably rural inhabitants would have less disease as a result of the availability of healthier foods.

   Examining the obesity and obesity risk rates in metropolitan and rural areas of India demonstrates a drop in incidence in rural populations. A 2001 study concluded that obesity rates in urban Indian slums is growing and in need of timely addressing and public education.1 Likewise the incidence of coronary artery disease, hypertension, and Diabetes Mellitus Type 2, all of which are commonly associated with excess body weight, are significantly more prevalent in urban areas. This increased prevalence is stated to be a result of sedentary lifestyle and higher fat intake.2 It is reasonable to conclude that while growing in incidence, the obesity rates in rural India shadow in comparison to that of metropolitan India. The unique question is what causes that increased fat intake and sedentary lifestyle from an Ayurvedic Perspective.

Comparison of Rural and Urban Sensory Experiences

   When considering the other sensory experiences of rural India, they tend to be more harmonious than that of urban areas. The eyes are exposed to plentiful natural images of trees, plants, the Himalayan mountain range, and other life forms living in their natural habitats. Witnessing the way other organisms live harmoniously in their environments and being surrounded by so many organic life forms, influences the way in which humans live and reinforces that humans thrive in natural environments too. When in a metropolitan city, people lack this experience and live mostly in between concrete and constructed walls, inorganic surroundings. Their eyes are often tired and dry due to the Vata and Pitta doshas prevalent in an urban environment and then lack the nourishing tarpana therapies needed to rejuvenate.8 This causes the metropolitan population to lose touch with nature and consequently, their true nature as spirit.

   In rural environments, the sense of smell is less synthetically influenced and more from natural sources. The surrounding flowers and plants prevail as well as the daily work performed in livestock, farming and agriculture industries. The rural population is more commonly immersed in plants, animals and produce, all naturally produced products. While the majority of people may consider not all of these smells pleasant, they are all naturally derived smells, which bring people closer to our true nature as spirit. Adversely, in an industrialized urban environment, the smells that prevail are those of city life and work including print cartridges, automobile emissions, mostly artificial and pollutant smells.

   The sense of hearing in rural India is permeated by animal sounds of nearby cattle and shepherds passing through. The natural sounds of wind and leaves outweigh the motorbikes, rickshaws and buses passing through. In a metropolitan city the opposite is true. While planned cities present parks and opportunities to be immersed in planned natural settings, even so, the sound of transportation and business supersedes.

   The sense of touch differs in the way people move, interact, and live. The work of rural versus metropolitan Indians differs and results in more harmonious experiences with nature in the rural environment. In cities, people do not touch each other and interact physically. In smaller towns and villages, people are friendlier, more intimate and more often physically interact. It is fair to generalize that the rural population experiences more physical intimate contact than the metropolitan population.

A Comparison of Sensory Experiences in France and Los Angeles

   In France, architecture and planning prevail. French culture relishes aesthetic beauty and takes every opportunity to optimize sensory experiences. Once of France’s best-known strengths is cuisine. French food contains high quality fresh ingredients. One French ideology is to enjoy and indulge in each experience that we have. Despite the use of whole milk, full cream and rich chocolate ingredients, France has a lower obesity rate compared to America. 

   One different factor is mode of transportation. In cities like Paris, Lyon and Marseille, the three largest cities of France, the majority of the population use public transport for their daily commutes. These cities have planned networks and bus services that cover the entire metropolitan areas creating links between all suburbs and housing areas with most places of employment. Shops and outdoor markets are planned along the way, which many residents reach via walking on their route. By taking the metro, buses and walking to and from work and to achieve most of life’s daily needs, the sensory experience of the French differs greatly from that of Americans.

   In Los Angeles, the majority of the population travels through town in a car since public transportation is limited, leaving patches of unconnected areas. By creating a sprawling city with limited transport services, the population is additionally forced to sit in traffic in their cars. In the following comparison, we will use a car with closed windows, as that is the most common method of use for modern vehicles.

   These modes of transportation impact the amount of physical activity required by populations. Sitting in a car as compared to walking to the metro, riding the metro and walking out of the metro deliver very different sensory experiences. Walking provides movement of the body through space allowing nature’s elements like wind, rain and temperature to be felt. Being in a car allows a controlled environment and climate in which nature’s changes are not as greatly experienced due to the protective nature of the vehicle. 

   Additionally, walking through a French city provides an opportunity to smell the plants and trees on the street, wafts of baking baguettes and croissants from boulangeries and dog feces which sprinkle the ground by day’s end. Comparatively, a car will provide a concentrated smell of body odor and possibly car emissions. There is a limited exchange between the natural world and constructed city to the interior of a car than when an individual walks down the road.

Conclusion

   The very nature of our lives makes us susceptible to an ever-changing variety of sensory experiences, which affect our elemental make-up, every millisecond. It is within our reasonable control to choose our surroundings. An Ayurvedic lens helps us to decipher what is complementary to our natures. At the same time, some circumstances and situations are more challenging to change. Both the harmonious and disharmonious sensory experiences in our lives affect the incidence of health and disease.

   Urban planning has the ability to affect disease incidence as a result of the sensory experiences it addresses, creates and alleviates. From waste management and transportation to lifestyle and food sources, urban planning helps provide more harmonious environments. That said, rural life helps even more. Rural living keeps people closer to nature than any urban environment can possibly try. Being in harmony with nature keeps us in sync with our true nature as spirit. When we supersede the sensory distractions that can get in the way of harmonious living life, disease has the ability to disappear. Whether unplanned or planned, rich or poor, rural or urban, the sensory experiences that surround our lives are arguably within our control. If urban environments explored ways to integrate rural lifestyle qualities into its planning and construction, the prevalence of disease would diminish in urban areas. 

   That is not to say that when urban diseases diminish no disease will exist. In the cycle of life and karma we each have lessons to learn and pain and disease to experience as our teachers. By cutting through the disharmonious lifestyles of an urban environment, people may have the opportunity to be even closer to their samskaras and deal with them directly. Though it is also arguable that the disease and disharmonious experiences of an urban environment may be the perfect medicine for some people. As after all, we are all exactly where we need to be and learning the right lessons that we need to learn at any given phase of life. Wherever you live, if you live consciously with awareness for your surrounding and sensory experiences, you can accept the rajas, which will transform, if conscious, into sattwa. If we take the research, the facts and the stories, and bring it into the now, we can live in the present.

Bibliography

1. Misra A, Pandey, RM, Devi JR, Sharma R, Vikram NK, Khanna N of The Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, “High prevalence of diabetes, obesity and dyslipidemia in urban slum population in northern India.” International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity (2001, 25(11):1722-9) http://ukpmc.ac.uk/abstract/MED/11753596/reload=0;jsessionid=BE09C556E9D20A03D3038054C94B1B03

2. “Prevalence of type 2 diabetes mellitus and risk of hypertension and coronary artery disease in rural and urban population with low rates of obesity” by Ram B Singh, Sarita Bajaj, Mohammad A Niaz, Shanti S Fastogl, M Moshiri in The International Journal of Cardiology (September 1, 1998). http://www.sciencedirect.com/science/article/pii/S0167527398001417

3. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Page 325.

4. Yoga Sutras of Patanjali. Sutras 2.54 – 2.55 Pratyahara or Sense of Withdrawal

http://swamij.com/yoga-sutras-25455.htm

5. Page 3 Chart PPT by Anoop Misra Director, and Head Department of Diabetes and Metabolic Diseases Fortis Hospitals, New Delhi. www.sph.umn.edu/img/assets/25422/Anoop_Misra.pdf.

6. R.K. Sharkma, Bhagwan Dash. Volume 1, Charaka Samhita I:56, Page 41

7. Yoga Sutras of Patanjali. Sutras: 3.1-3.33: Dharana, Dhyana, Samamdhi

http://swamij.com/yoga-sutras-30103.htm

8. Vagbhata’s Astanga Hrdayam. Volume 1, I-3.5, Page 283

9. R.K. Sharkma, Bhagwan Dash. Volume 1, Charaka Samhita V:1-V:13, Page 105-111

10.  Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Pages 5 - 6.

11. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Pages 6 -7.

12. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Pages 199 – 202.

13. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Pages 41-43.

14. Malhotra, Shriya, “Population Health Through Inclusive Urban Planning: Healthier Communities and Sustainable Urban Development in Indian Cities” in Sustainable Development in the Urban Environment (2010).

15. Malhotra, Shriya, “Population Health Through Inclusive Urban Planning: Healthier Communities and Sustainable Urban Development in Indian Cities” in Sustainable Development in the Urban Environment (2010). Page 6.

16. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010).  Pages 240 – 245.

 

 
 
 
 
 

 

Prolactinoma and Ayurveda By: Tesia Love

Promoting the Health of Mother & Baby during Pregnancy using Ayurveda (by Christine Visco)

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Pulse Diagnosis: How do we read the heart beat? (by Noah Volz C.A.S)

Introduction

Ayurvedic Medicine has been using the pulse as a form of diagnosis since it was created 5000 years ago. Those who are familiar with modern Ayurvedic medicine think of the scenario where an Indian doctor takes your pulse and looks at your tongue and then can tell you what you've eaten for dinner the night before. Although many intuitive doctors have this capability this paper is more concerned with the methodology of the pulse. What are these doctors looking for? How do they interpret their findings? What can the pulse offer us as health care practitioners? What can be identified as fact by being repeatable with adequate practice? This will become more clear to us as we begin to understand what the pulse is and what it has to teach us. To do this we will look at the methodology and lineages of Dr. John Douilliard, Dr. Vasant Lad, and Dr. Smita Naram. Then we will compare and contrast these doctors' methods and ideas.

The goal of this analysis is not to determine the efficacy of the pulse as a diagnosis method, but to understand the methodology of the pulse more clearly as a diagnostic tool. In Ayurvedic medicine the pulse is used in conjunction with Darshana (pure observation and inspection), and Prashna (questioning). It is all three of these that must be employed to reach a complete diagnosis. Pulse diagnosis is best understood through the teachings of those who have been practicing and teaching it the longest. We will begin the journey of understanding the pulse through the three most revered methods in the West. An assessment of their similarities and differences will follow. Concluding with the relevance pulse diagnosis has to emerging practitioners here in the west. Let us begin by holding the threads that weave Ayurveda and the pulse together.

The overall method of taking the pulse begins with the placement of the fingers. The index finger is placed below the radial styloid. The radial styloid is the protruding wrist bone on the thumb side of the hand of the pulse recipient. The middle finger and ring finger are placed next to the index finger. The pulse taking fingers are adjusted along the underside of the arm to find where the pulse is the strongest.

The pulse is the beating of blood through the arteries as it moves outward from the heart. The blood carries nutrients to each cell in the body, just as thought is transferred through chemical reactions in the cells simultaneously, intelligence is found in the blood in the information it carries to each cell. In Ayurveda this information carried by the blood is made of the 5 elements: earth, water, fire, air and ether. These are the scientific building blocks of Ayurveda. The 5 elements are used to explain in simple terms what science has determined through complex experiments. These elements combine in three distinct ways in the physical form. These are the Doshas , psycho-physiological functional principles of the body. The three Doshas are Vata which combines the elements of air and ether. Pitta is fire and an aspect of water. Kapha is water and earth. We can find the Doshas in the qualities and textures that can be felt in the pulse.

The Doshas have concrete qualities that are made when their respective elements are combined. Doshas being combinations of elements are not only found in the body, but also in the environment. As we look at the natural world we can see the dominance of air and ether in the dry barren plains of the high mountain desert of central Arizona . Vata is seen in the rough and rugged change of season characterized by Fall in the northern hemisphere. Pitta is characterized by summer heat, hard work, and intensity. Kapha is embodies the spring moisture of the Northwestern states of Washington and Oregon . This is when the qualities of earth and water are the most noticeable. Like the environment, Doshas can be supportive or destructive to our total well being.

Doshas and their qualities are also found in the pulse. Think of the pulse like a cardiograph: a computer readout graphically recording the physical or functional aspect of the heart. Like the graph being sketched across the screen of the computer the pulse has its own rate, crest, wave, amplitude, and cessation. These individual characteristics define the overall movement, quality, and rhythm of the pulse. In these broader categories the Doshas of Vata , Pitta , and Kapha can be distinguished based on the smaller movements sketched graphically by a cardiograph.

In pulse diagnosis our fingers become the receptors that transfer the information of the heart beat graphically into a more concrete image. The Gati (movement) is best defined by the natural world. A snake as it swiftly slithers out of danger or attentively rests on a warm rock when felt characterizes Vata. The elements that make up Vata are air and ether and they are swift and light as they slither through the fingers. A frog on land bounds powerfully, a frog in water pumps its legs and arms in strong fluid motions. The elements of fire and an aspect of water characterize Pitta bounding into the fingers, strong and forceful, but without the sharp quality of the snakes bite. A swimming swan methodically bobs its head as it gracefully moves across the water. The elements of earth and water in Kapha glide into the fingers. The Gati is considered the most important part of the pulse as it makes up the crest and wave of our computerized image or the movement of an animal. Vata has the quality of a snake. Pitta is a frog. Kapha is a swimming swan.

In Western diagnostics it is only the rate of the pulse that is taken. The rate is dependant on the dominance of the Doshas in Ayurveda. Vata is 80-90 beats per minute. Pitta is 70-80 bpm. Kapha is 60-70 bpm. The rhythm of the pulse can be irregular or regular. An irregular pulse has no distinguishable pattern. Its intensity and rhythm fluctuates wildly. Vata is irregular. A regular pulse in consistent, it pumps in the same rhythm and amplitude. Its crest and wave are even. Pitta is regularly irregular, meaning that if it skips a beat it always skips that beat, and thus the pattern repeats itself. The amplitude of the pulse is the force or strength with which the beat moves into the fingers. Pitta's intensity is high, Kapha's consistency is moderate, and Vata's variability is low. Overall the characteristics of each dosha are: Vata is feeble and light as it slithers into the fingers. Pitta bounds into the fingers strongly and clearly. Kapha slides into the fingers slow and cloudlike. These are elaborated on in the graph below.

VATA

PITTA

KAPHA

Characteristics

Fast, feeble, cold, light, thin, disappears on pressure

Prominent, strong, high amplitude, hot, forceful, lifts palpating finger

deep, slow, broad, wavy, thick, cool or warm, regular

Location

Index

Middle

Ring

Gati

Sarpa (Cobra)

Manduka (Frog)

Hamsa (Swimming Swan)

Vega (Rate)

80-95

70-80

50-60

Tala (Rhythm)

Irregular

Regular

Regular

Bala (Force)

Low +

High +++

Moderate ++

Akruti (Tension and Volume)

Low

High

Moderate

Tapamana (Temperature)

Cold

Hot

Warm to cool

Kathinya ( vessel wall)

Rough, hard

Elastic, flexible

Soft thickening

(Lad, 14)

Anyone can recognize that there are differences between their pulse and that of others. What these diff