The management of disease in Ayurvedic medicine

The following articles were written by Dr. Marc Halpern. 

Asthma and Ayurveda

From the Ayurvedic medical viewpoint, asthma does not begin in the lungs but in the digestive system according to Marc Halpern, D.C., C.A.S., P.K.S. Dr. Halpern, a licensed chiropractor and now an expert in Ayurvedic medicine, directs the California College of Ayurveda (instruction) and Ayurveda Healthcare Center (treatment), both in California. Dr. Halpern relates the case of Isabel, 44, who came to him with symptoms of severe asthma. Isabel complained of wheezing, shortness of breath, weight loss, dry cough, sleeping difficulties, dry skin, scanty appetite, and frequent constipation. In consultation with Isabel, Dr. Halpern learned that her asthma was sufficiently serious to require the daily use of an inhaler and the frequent use of cortisone during an asthma attack. Her recent weight loss from 120 to 108 pounds had left her gaunt and even "emaciated," observed Dr. Halpern. She drank a great deal of coffee and had a rapid, thin pulse. Isabel said food settled in her stomach "like a rock." Coffee, as a stimulant, "makes everything more faster," and is not helpful to a person with a predominating vata condition in which, in effect, there is already too much movement, says Dr. Halpern. Isabel's "emotional landscape" was dominated with fear, worry, anxiety, and a deep-set concern about suffocating; her mind was flighty, "like a bee, moving very fast" unable to focus and settle for long on one topic and constantly waffling and changing direction. These factors, and Isabel's light thin skeletal structure, were classic indicators of a basic constitutional type called vata, one of three types described by Ayurvedic medicine, says Dr. Halpern. In Ayurvedic medical thinking, the internal "fire" or basic life force is Isabel's system was suppressed, leading to digestive difficulties, and mal-absorption of nutrients. "It's like putting a big log on a campfire with a tiny flame; most likely, the log will not catch fire but only smolder," says Dr. Halpern. From Isabel's digestive system, the imbalance then spread upward to her lungs, he adds. "Dry' asthma, as in Isabel's dry cough without mucus, begins in the intestines while 'wet' asthma, with mucus on coughing, starts in the stomach." This is why Dr. Halpern began his treatment program by addressing what foods Isabel put in her stomach. The goal was to use foods to introduce warmth into Isabel's digestive system and to stimulate the digestive fire. Dr. Halpern put her on a limited diet for five days consisting of 1/8 teaspoon of nutmeg mixed with ½ cup of buttermilk (diluted 50% with water), to be taken three times daily. Buttermilk, because it is fermented, provides warmth to the stomach (compared to regular milk, which is a "cold" food and thereby harder to digest), while nutmeg increases nutrient absorption. Dr. Halpern also recommended Basmati rice mixed with cumin, fennel, and ginger; these hot spices would "increase the fire" in Isabel's digestive system and enhance absorption. She ate these foods with a traditional Indian product called ghee, made from clarified butter, to help regulate the digestive forces, or "fire." After the five days, Isabel's digestion was noticeably better, so Dr. Halpern began to gradually increase her food intake by adding selected cooked vegetables, not raw, as well as warm milk mixed with ginger. His approach was to increase Isabel's food consumption in proportion to the improvements in her digestion. "That's the key because if you increase the foods too rapidly, the digestion will be upset." Dr. Halpern also sought to reduce the overbearing influence of vata in Isabel's system by prescribing foods to "pacify" its effects. Dr. Halpern introduced a series of tonic herbs to increase Isabel's internal strength, including Shatavari, Bala, licorice, and Ashwaghanda. She took these in capsule form three times daily, then gradually increased the dosage to nine capsules daily. Dr. Halpern gave her Triphala, a common Ayurvedic herbal flaxative formula for the colon to normalize bowel movements; she took ¼ teaspoon of Triphala powder three times daily, Hingwastika, another traditional Ayurvedic formula, was also given (1 capsule, 3 times daily) to stimulate digestive function. Here is the goal was to "work more systematically on Isabel's internal energy as it encompasses the function of all her organs and systems," says Dr. Halpern. Only one month after starting Dr. Halpern's program, Isabel reported that her asthma was gone, her breathing capacity had returned to normal, and that she had discontinued the cortisone. Bear in mind that Isabel had suffered from asthma for a full year before Dr. Halpern and that for the final three months she had endured the severest symptoms and used the inhaler every night. Even so, Dr. Halpern wanted to fine-tune Isabel's recovery from asthma, so he drew upon other facets of Ayurvedic practice. He prescribed special breathing exercises, called pranayama, to help free up her lungs, giver her more control over her breathing, and again, to stimulate her digestion. Dr. Halpern suggested that Isabel apply a small amount of sesame oil into her nasal passages to help normalize the breathing. Isabel started using more of the hot spices (mentioned above) in her foods to reduce the formation of mucus throughout her body and she started having broths made from stewing meat and bones, then draining off the stock. The intention here was to help Isabel regain her lost weight; in about two weeks, she had put on three pounds. Next, Dr. Halpern added "heavier" foods to her diet,, meaning ones harder to digest, such as almonds and sunflower seeds, and he suggested she eat five small meals every day. During a holiday dinner, Isabel binged on foods outside the strict Ayurvedic prescription, and had a three-day flare-up of her asthma symptoms. Specifically, she ate some vegetables, such as broccoli, cauliflower, kale, and cabbage, which for her system at that point, were to taxing to easily digest. Even so, her system was strong enough to require the use of an inhaler only once; after the three days, the asthma symptoms disappeared again. Dr. Halpern introduced another Ayurvedic specialty preparation called kitcheree to help normalize digestion. Kitcheree, which consists of split mung beans and Basmati rice cooked with spices and ghee, became a mealtime regular for Isabel in the third month of her program. "We also started paying attention to all the habits that surrounded her eating," comments Dr. Halpern. He suggested that she eat slowly in a quiet environment, that she chew her food thoroughly, and generally create a positive atmosphere for eating, adding prayer, grace, or brief meditation, if she wished. "In Ayurveda, we say it's more important how you eat rather than what you eat, that even good food eaten the wrong way will create digestive problems." Isabel broke her diet again, this time with yams, butter, and turkey, and quickly saw how it led to a transient return of the milder of her previous asthmatic symptoms. To regulate her system again, Dr. Halpern re-instituted the earlier stages in her diet, of, first, nutmeg, buttermilk, kitcheree, and Basmati rice for three days, followed by the nuts as well as the various herbs already prescribed. To strengthen her lungs, Dr. Halpern added an herbal formula in jelly form called chavanprash, made from the amla fruit, mixed with spices and herbs. Four months after starting treatment with Dr. Halpern, Isabel's asthma "had totally subsided, as though it never existed," he reports. After one more month, her weight had climbed from 113 to 117 and she had experienced no further episodes of asthma. Dr. Halpern emphasizes that while the program produced excellent results for Isabel, it was precisely tailored to her temperament and physiology. Not every case of asthma is treated this way. There are many other asthma treatments for different types of people." Ayurveda is the traditional medicine of India, based on many centuries of empirical use. Its name means " Ayu = (Life) + Veda (Knowledge)", implying that a holistic medicine may be founded on spiritual principals. Ayurveda describes three metabolic, constitutional, and body types (doshas), in association with the basic elements of Nature in combination. These are vata (air and ether, rooted in the large intestine), pitta (fire and water/small intestine), and kapha (water and carth/stomach). Ayurvedic physicians use these categories (which also have psychological aspects) as the basis for prescribing individualized formulas of herbs, diet, massage, breathing, meditation, exercise and yoga postures, and detoxification techniques.

Ayurveda And The Treatment of Digestive Disease

On the physical level, Ayurveda teaches us that the health of the digestive system is the single most important long term determinant of your health and well – being. Healthy digestion leads to a healthy life. Unhealthy digestion leads to an unhealthy life. Its often that simple.

Healthy digestion assures that all of the nutrients taken in through eating are assimilated in a healthy manor into the cells that become you. In other words, you are what you digest! If your digestion is healthy, your body can produce healthy tissues (dhatus). When digestion is weak, the tissues of your body such as muscle, blood and nerve become weak susceptible to disease.

The cause (Nidanam) of digestive disease lies in our actions. By indulging our sense of taste in an unhealthy manor we upset the balance of the bodily doshas. Vata is upset by cold, dry and light foods such as raw vegetables. Pitta is upset by warm, oily, light foods such as deep fried vegetables and Kapha is upset by cold, heavy, moist foods such as cold ice cream and yogurt. In addition, taking foods in an improper manor can be even more harmful than choosing inappropriate foods. Healthy food taken in the wrong way will still cause digestive disease.

The symptoms of poor digestion include excessive gas, constipation, diarrhea, burping, burning, vomiting, indigestion, bloating and pain. In various forms, Western medicine has given them names such as irritable bowel syndrome, ulcers, colitis and pancreatitis among many others. Through the eyes of Ayurveda, the practitioner comes to an understanding of the cause through examining one’s lifestyle. Faulty eating practices are the number one culprit, poor food choices and poor food combing are next in line. Together they make up the major causes of digestive disease.

The Ayurvedic Specialist examines the patient and also comes to an understanding the pathogenesis (Samprapti) of the disease or how the disease unfolded within the body of the patient. By understanding the pathogenesis, the Clinician can develop a treatment plan to reserve the condition. This treatment plan includes both constitutional treatments to address the patients lifestyle and direct treatment to target the compromised area of the body.

The key players in the Ayurvedic pathogenesis of digestive disease are as follows. The nature of their imbalance and how they are interacting determines the presentation of the disease.

Jatharagni: This is the digestive fire that governs the catabolism (breakdown) of the food into smaller molecules for digestion. When it is healthy, the body is capable of proper assimilation. When it is too weak the initial digestion of food is compromised and either malabsorption will take place or ama will form. When it is too strong, burning results.

Samana Vayu: This is a subdosha or type of Vata which governs the absorption of nutrients into the body. Assuming they were broken down properly, samana vayu can guide their absorption. Not only does samana vayu govern absorption but it also directly affects agni as would wind when it blows upon a fire. If the wind is strong, the fire is strong. If the wind is weak, the fire burns low. If the wind fluctuates so does the fire. Faulty samana vay can lead to gas, diarrhea and malabsorption.

Apana Vayu: This type of Vata governs the downward motion. Particularly the excretion of toxins and feces. When it is healthy, elimination is normal, the bowel movements are solid but soft. When apana vayu is faulty, a variety of problems can manifest including both constipation and diarrhea.

Kledak Kapha: This type of Kapha governs the protective mucous lining of the digestive system. Particularly that of the stomach. When healthy it is in equilibrium and agni and vayu protecting the membranes from too which heat or dryness. When excessive, mucous forms and nausea results. When diminished, the membranes become susceptible to the irritating effects of agni and the drying effects of vayu. In addition, an increase in the solid nature of Kapha can block the digestive tract and cause constipation.

Packak Pitta: This type of pitta contains the agni. This is called Pachak agni. This aspect of Jatharagni is responsible for the breakdown of food. Its role is essentially that of Jatharagni. However, since Pitta is fire and water in combination, it is possible to have high pitta and low agni. A metaphor often used to explain this is how water can put out a fire. If fire and water increase together, eventually it is possible that the water will put out the fire. This ist he case in chronic pitta digestive disturbances. This results burning as well as ama formation due to poor digestion.

Ama Dosha: Ama is the end result of poorly digested food. It has sticky qualities which adhere to the channels (srotas) of the body obstructing flow. It is a toxin which accumulates in the digestive system and is later deposited into the organs and tissues of the body where it contributes to disease. Ama leads to foul odors in the breath and body as well as foul smelling gas.

Constitutional Treatments

Constitutional treatments include all habits that support healthy digestion. It is in fact more important how you eat than what you eat! While it sounds absurd, it is better to eat a greasy hamburger properly than basmatti rice improperly!

1. Meals should begin with grace in order to create a quiet, calm and respectful environment.
2. Food should be eating in quiet without distraction such as television, reading, reading or excessive conversation.
3. Food should be chewed well.
4. Food should be taken warm.
5. Food should be taken with only a small amount of water.
6. One should rest at the completion of the meal to allow food to digest.
7. The largest meal should be taken near the noon hour when the sun is high and the agni (digestive fire) strongest.
8. One should never overeat.

Proper eating means that one begins to look at food intake as a sacred experience. In fact, as a form of meditation. This spiritual perspective on food (Sadhana) elevates eating to a holy experience where by the eater connects to all things past, present and future knowing that they are taking into their bodies the primal substance of all matter. In this regard, eating is more than satisfying hunger or indulging the sense of taste, it is a time where we take in the prana and substrate that will become ourselves. With this realization, a person can be successful meditating their eating.

Following the proper guidelines above for healthy eating will correct many digestive problems. Failure to follow them will most certainly cause most. In addition to the healthy intake of food, proper food combining assists with proper digestion. From an Ayurvedic perspective, eating bitters such as salad after a meal is better than doing so before. The bitter taste is cold and weakens agni. Taken at the beginning of a meal it can diminish the digestion of all that follows. Likewise, sweets are digested first. Deserts are best eaten before a meal or as between meal snack. Taken immediately after a meal it may upset digestion. Mixing foods of opposite potencies (vira) can sometimes be problem. Milk which is cool should not be mixed with yogurt which is warm even though both are dairy. Other rules of food combining are good to follow as well such as avoiding mixing dairy and meat.

Making the proper food choices is another piece of the Ayurvedic puzzle to creating optimal digestion. Ones food choices should be based on their constitution. This is the unique balance of energy in a persons body and is defined by the balance of the three doshas, Vata, Pitta, and Kapha. Seeing an Ayurvedic physician or Clinical Ayurvedic Specialist is important to ascertain your constitution (prakruti) as well as the energetic basis of the imbalance (Vikruti). Based upon these determinations a food and lifestyle program can be prescribed which is in harmony with your nature and which leads to optimal digestion.

Direct Treatment

Proper treatment of digestive disease utilizes herbs to target he affected subdoshas, agni and ama. Herbs have constitutional effects based upon their taste (Rasa), Energy (Virya) and Post Digestive Effect (Vipaka). As well as specific effects based upon the medicinal aspect of the herb (Prabhava). By understanding the nature of the herb, the Clinical Ayurvedic Specialist is able to match up the herbal treatment to the prakruti (constitution) and vikruti (imbalance) of the patient.

Treatment of Agni

In digestive disease, agni may have to be strenthened, diminished or simply stabilized. Increasing agni improves digestion and rids the body of ama. Decreasing agni can be helpful in burning indigestion and ulcers. There are many herbs from around the world that the Ayurvedic Specialist can choose from. Traditionally, herbs can increase agni are called Dipanas and include Chitrak, Clove, Asafetida and the Ayurvedic formula Trikatu which contains two types of pepper and ginger. These herbs are particularly effective which agni is low as in diseases of Kapha nature. In this way they diminish nausea and heaviness after eating. In addition, they alleviate gas prodcued by weak digestion. Other herbs have a stabilizing effect on agni via their effect upon samana vayu. They can also increase agni without aggravating pitta in the process. These include cumin, coriander and fennel. They improve digestion without any risk of causing the burning symptoms of gastritis. When burning indigestion is dominant and the agni is high, bitter herbs are used which lower agni such as dandelion or gentian as well as the Ayurvedic herb Kutki. The ayurvedic preparation of red coral, pravel pishti is also directly anacid in nature.

Treatment of Samana Yayu

Samana vayu is best treated using carminative herbs which aid the absorption of nutrients. These herbs include nutmeg, fennel, cumin and coriander. While each has its own prabhava (special medicinal usage in different diseases), they all regulate samana. Samana vayu is also balanced by adopting regular routines in our lives. Samana vayu is known as the stabilizing air. When our lives are stable and our routines strong, samana stays in balance. This is important to good health because as the balancing air, its role is the stabilization of the other aspects of Vata as well as agni. Hence, once out of balance, the other energies in the body quickly suffer.

Treatment of Apana Vayu

Apana Vayu is the downward moving air which eliminates waste. In the colon it governs the evacuation of feces. Imbalances can lead to either constipation or diarrhea. When the motion is too great, it can be slowed in a variety of ways depending upon the state of the other doshas. Nutmeg for instance, best taken in Takra (Yogurt mixed with water) reduces diarrhea when the origin is Vata. Apana can combine with Pitta as well and when it does bitter / astringent herbs work best such as red raspberry as well as small amounts of psyllium which absorbs water creating bulk.

Vitiation of apana can also lead to dry stools and subsequent constipation. Oily herbs and foods help this condition. Herbs such as licorice or shatavari can be effective. The ayurvedic formula Triphala is commonly used with success as is the Western herb Cascara Sagrada. When the heat of the Pitta is to blame for the dryness and consequent vitiation of the apana, moist cool herbs such as shatavari and Cholegogues such as dandelion can be used. When apana is blocked by kapha, stronger purgatives are needed such as senna, castor oil or the Ayurvedic herb trivit.

Treatment of Kledaka Kapha

Kledaka Kapha is the subdosha governing the protective secretions which line mucous membranes. When healthy, digestive secretions are sufficient to protect the stomach lining called the epithelium against acids. When the secretions are diminished as occurs when kledaka is low, burning indigestion occurs. Kledak may be diminished for several different reasons. First, the influence of Vata disturbance can dry up the secretions. This occurs for instance as a result of stress and worry as well as inappropriate diet. In addition, the secretions can dry up due to excess heat as in pitta conditions such as intensity and anger as well as too much hot pungent foods. When Kledak is low, cool, moist demulcent herbs are used such as licorice or slippery elm which re-hydrate the membranes and increase protection.

Kledaka Kapha can also be too high. When this occurs it suppresses the agni resulting in slow digestion and possible nausea. This condition results from too many heavy, sweet foods and is best treated with the category of herbs called dipanas which increase agni and diminish kledaka. This includes the Indian herbs chitrak and the Ayurvedic formula trikatu as well as common pungents such as ginger and cayenne pepper. While herbal therapy is important, following a light diet or fasting for several days will often correct the imbalance.

These principles above can be applied to the understanding of all digestive disease and leads the practitioner to a sound treatment protocol in the examination of ulcers and irritable bowel syndrome we shall she how this works.

Treatment of Ama

When ama is present, it must eventually be eliminated. Ama complicates disease because its effects are systemic and it can inhibit the effectiveness of herbs and other medicaments. The problem with treating ama lies in the clinical management of the patient. Purification therapy called Pancha Karma is advised for removing ama. When the patient is strong Pancha Karma is advised. However, purification therapy is also depleting to the body and can cause weight loss. In the case of great weakness such as that which accompanies some chronic diseases, purification therapy is contraindicated or must be modified and applied with great care.

Purification begins with proper preparation. This process called Purva Karma involves properly oiling the body both internally and externally. The external portion is performed using body oils, which may be applied in a variety of ways including massage. The internal portion is performed using medicated ghee. This is a preparation of clarified butter with special herbs cooked in it. Triphala gee and brahmi gee are common preparations as well as bitter ghee prepared with multiple bitter herbs. Once oiled, the patients body is exposed to heat, again, from a variety of sources including steam, dry heat, or via a hose attached to a pressure cooker. This last variety is called Nadi Swedana. This combination of oil and heat loosens ama trapped in the tissues of the body and dilates the channels of the body allowing the ama to return to the digestive system for elimination. During this period special foods are taken, most commonly Kitcheree (Mong Dal and Basmatti Rice) as well as additional herbs as indicated.

The second phase of Pancha Karma are the elimination procedures. These include Niruha Basti (Herbal decoction enemas), virchana (purgation), nasya (Cleansing of the nasal passages and sinuses) and Vamana (Vomiting). Traditionally Blood letting may also be applied. One or more of these procedures may be administered depending upon the nature of the patient and the nature of the disease.

In the final phase of Pancha Karma procedures are administered which rekindle the agni and rebuild the patients strength. This process called rasayana is what leaves the patient stronger from the procedures than before they began. To rekindle the agni, dipanas are mentioned above are utilized such as Trikatu or Hingwastika. The diet is slowly increased in both variety and quantity to match the growing strength of the agni an dthe patient. This process is called Samsarjana Krama. When strength of the agni is sufficient, rejuvenative herbs or preparations are given. These include herbs such as Bala, Ashwagandha and Kappikacchu as well as formula Chyavanprash. Which specific formula is given depends upon the nature of the patient and the disease.

The first two phases of Pancha Karma can take from 7 – 28 days to administer in order to remove all the ama present in a person. As these programs are costly in both time and money, multiple shorter programs are often prescribed. Phase three, rejuvenation can take an additional month but is well worth the effort.

Approaching Two Common Digestive Diseases

Ulcers

Ulcers known as Grahani in Ayurvedic medicine can be cause by Vata, Pitta or by a combination of both. Agni is often disturbed and Ama may or may not present. When ama is present, it must be addressed either initially or later depending upon the strength of the patient.

Ulcers from a Western condition are sores in the mucosal surface of the stomach or small intestine. They cause burning, aching pain which may be mild or severe, constant or intermittent. Form an Ayurvedic perspective, ulcers are an advanced form of hyperacidity or Gastritis called Urdvarga Amplapitta.

In Vata type Grahani, Vata has caused a drying of the gastric protective secretion (Kledaka). Pitta may or may not be elevated. The loss of protection leaves the surface of the stomach exposed to normal, excess or even diminished acids, whichever are present. This exposure causes pain which can lead to ulceration and scarring. The primary subdosha of vata involved is samana vayu whose wind dries the surface of the affected region and may fan the flames of agni. In addition to a vata pacifying diet and improving the patients routines, herbal therapy focuses first on demulcents which assist healing such as licorice, shatavari or comfrey. These rebuild the protective secretions. Bitters may be added to the formula in small amounts of Pitta or agni are simultaneously vitiated to reduced the excess heat. Samana is pacified with herbs such as fennel and cumin. A sample formula based on this theoretical model would be 6 parts Licorice, 2 parts Shatavri, 2 part fennel, 1 part cumin. Dosage: 1-2 grams T.I.D.

In Pitta type Grahani, excesses in Pachak pitta are responsible for drying the mucous membranes as well as for creating a strong acid environment. Vata may still be vitiated as well complicating the pathogenesis and treatment. This condition results in bleeding in the stomach or small intestine in addition to the other symptoms. This Vata – Pitta condition is the most severe of all. In addition to the treatments mentioned above homeostatic herbs such as amalaki and the ayurvedic preparation of red coral called praval pishti are useful. A theoretical formula based upon this model is 4 parts amalaki 4 parts licorice, 2 parts praval pishti, 1 part fennel. Dosage 1-2 grams T.I.D.

Irritable Bowel Syndrome

Often called Spastic Colitis, Irritable Bowel Syndrome is disorder of the small and large intestines causing chronic intermittent constipation or diarrhea often associated with varying degrees of abdominal pain. This origin of this condition is not well understood in the West and is very difficult to treat.

Through ayurvedic eyes, the practitioner of Ayurveda comes to understand the nature of their patient physically, emotionally and spiritually. Upon doing so, each patient with irritable bowel syndrome will present with a wide variety of imbalances on all three levels. As each person is unique, so too will each presentation be unique. There are however many commonalties and from these, the practitioner can come to understand the nature of the disease and develop a plan for managing it.

This condition appears to occur most prevalently in those individuals with a Vata prakruti or vikruti. The severity of the condition is somewhat proportionate to the state of Ojas. When ojas is low, the condition is more severe.

Symptoms of vata type disease begins with a dull achy discomfort which becomes severe as the condition progresses. There is considerable gas and bloating as well as malabsorption in more severe cases. The pathology is complex. There is vitiation in samana vayu which leads to imbalances in apana and agni. What makes this condition more significant and difficult to treat than simpler bowel disease is that it is the end result of long standing inappropriate lifestyle habits and routines. Such routines are intertwined with vitiation of the mind or manovaha srota. Vitiation of the mind by Vata (prana and samana) leads to less stability in the mind and thus the mind further associates itself with the senses in an attempt to reestablish harmony. Due to disturbances of prana (the inward moving air governing what we take in through our senses), these association are often themselves disharmonious and lead to further imbalance. Thus faulty habits are devolved. The end result of long standing vata disturbance in the body and mind is the drying out of ojas (the essence which stabilizes and gives endurance to the body and mind). The patient becomes weak, and may lose weight and often presents with anxiety or depression.

Treatment of this condition requires addressing the imbalances both psycho – spiritually and physically. The physical component requires nourishing therapy to rebuild ojas. This first requires pacifying samana and apana vayu and normalizing agni. This can be done with spices of mild to moderate pungency such as fresh ginger and cool spices such as fennel and cumin. Takra, a mixture of yogurt and water can be taken to enhance digestion and absorption. Putting the Ayurvedic formula hingwastika or other spices into the takra can be beneficial. Nutmeg and small amounts of psyllium can be added if diarrhea is profound. If constipation is dominant cascara sagrada or high doses of triphala can be taken. In the long term, tonic therapy specific to the intestines should be administered. The preparation of triphala called Shita Skhaya (Soak one tsp. Of triphala in 8 oz. Of room temperature water for 12 hours and then drink the water without the triphala) is most beneficial as a tonic. Once agni is normalized, generalized tonic therapy can be begun. This includes a more nourishing diet as well as herbs such as ashwaganda, shatavari and bala.

Managing the psycho-spiritual component of the disease is the most difficult aspect to manage. While herbal therapy is supportive, deepening the patient’s connection to God is imperative. This connection empowers the patient to act in a more harmonious manor and moves the mind attention away from the senses and toward the spirit. While most any spiritual path can be sufficient. Ayurveda typically employs Yoga and its associated principles in this process.

Herbal therapies for the mind which pacify prana and bring about stability include ashwaganda and brahmi. In combination they appear most effective.

Pitta imbalance can combine with Vata in irritable bowel syndrome. When it does the symptoms present with diarrhea accompanied by rectal burning. Diarrhea may be more predominant and when it is malabsoption is more pronounced and weight loss more rapid. While the pathogenesis of the condition is similar to Vata type, vitiation of pachak pitta in the anna vaha srota (stomach and small intestine) accompanies the involvement of the other subdoshas. In addition the emotional component takes on a more heated quality as sadhak pitta is vitiated creating greater anger and resentments. Herbal treatment is modified in these conditions to account for the additional components of the pathogenesis. Cooler digestive herbs are used and formulas should emphasize fennel, coriander and cumin. In the mind chrysanthemum and skull cap may be used in combination with brahmi. Severe diarrhea may have to stopped to prevent continued wasting with herbs such as bayberry, red raspberry and alum root. Takra can also be prepared with 2 parts amalaki 2 parts licorice, 12 part nutmeg 1 part psyllium Dosage 1 tsp.

Kapha imbalance can combine with Vata in irritable bowel syndrome. When this occurs, mucous will present in the stools and periods of nausea will occur. Constipation is more common but periods of diarrhea can occur. In addition to the vata pathology of this condition, Kledaka Kapha is vitiated and is responsible for the mucous and nausea. Agni is typically low and significant ama is likely to be present. Emotionally there may be greater depression. While the vata nature of this disease is still dominant herbal modifications should be made to account for the additional pathology. Stronger dipanas such as dry ginger and cayenne pepper or ayurvedic formula trikatu should be added to formulas. In addition a light simple diet should be followed for several days to alleviate the Kapha and ama aspects of the disease. When ama and excess Kapha are alleviated a more nourishing diet to rebuild ojas can be implemented.

Case Management

Regardless of the disease, case management is essential and is usually the difference between success and failure. Case management entails the understanding of upasaya and anupasaya or viewing treatment as the process of gaining additional information in the nature of the disease. Treatment which gives comfort supports the diagnosis and the understanding of the disease. Treatment which gives discomfort while not desirable still yields useful diagnostic information. Hence, the practitioner must follow up their patients progress and make adjustments to their programs as indicated. These adjustments may include altering the dosage or the herbal formulas, modifying the formulas and coaching the patient to make additional lifestyle changes.

Guiding a patient back toward health is a process. The Ayurvedic practioners role should not be looked at as a one of finding the newest or latest magic herb to heal their patients. It is a treatment approach based in a set of principles which guides the practitioner to understand the nature of the patient, the nature of the disease and the nature of the direction of therapy.

References:

Caraka Samhita: Translated by Bhagwan Dash and R.K. Sharma; 3rd ed.; published 1992.
Sushrut Samhita: Translated by K.L. Bhishagratna; Published 1994
Ashtang Hrdayam: Translated by Prof. K.R. Srikantha Murthy; Published 1992
Ayurvedic Healing: By Dr. David Frawley Published 1989.
Cakradatta: Translated by P.V. Sharma; Published 1994

Ayurveda and the Understanding and Management of Respiratory Disease Part I: Kasa - The Understanding of Cough

Introduction

Respiratory Disease will afflict every human being at some time in their life. Whether it’s a cough associated with the common cold or respiratory distress associated with allergies and asthma, respiratory challenges are a constant source of irritation and misery for the afflicted.

Classical Ayurvedic Medicine categorizes respiratory challenges into two main categories. These are Kasa (cough) and Swasa ( dyspnea or difficulty breathing). From an understanding of ayurvedic knowledge, common conditions such as the common cold, asthma and bronchitis can be understood and managed. This article address the condition of kasa (cough).

Kasa (Cough)

In the West, coughs are understood to be the result of either infection or irritation of the bronchial tissue and are known as bronchitis. Infectious bronchitis commonly accompanies the common cold but may occur separately and may or may not be associated with fever. Coughs may be dry or productive. Irritative bronchitis is usually the result of pollutants, smoke, or chemicals and may have an allergic component.

Samprapti (Pathology)

Kasa occurs when apana vayu is obstructed resulting in an increase in upward motion. Vitiation of udana vayu propels the air upward and out of the body. Vata may however lodge in the chest, back, or head resulting in pain and repeated coughing.

All disease has its physicial origins in the digestive system. This is the site of accumulation and aggrevation of the doshas. Kasa begins with vitiation of apana vayu in the purishavaha srota (large intestine). Vata eventually overflows into circulation (raktavaha srota) and relocates to the pranavaha srota (respiratory system.) Additional doshas may mix with vata or become dominant in the pathology.

Purvarupa (Prodomal symptoms)

Coughs are often preceeded by symptoms of the common cold such as a sore throat, and a decrease in appetite. Proper early management of the prodromal symptoms can prevent the onset of bronchitis.

Types of Kasa

Kasa (cough) is of five types; vata, pitta, kapha, ksataja and ksaya. Those of a vata, pitta and kapha nature represent different doshic manifestations of a cough. Ksataja type are due to chest injuries while ksaya type is due to disease that results in wasting of the bodily tissues such as tuberculosis.

Rupa (symptoms)

Coughs due to vitiation of vata are called “vataja kasa”. They present as a dry cough with little mucous production. While small amounts of hard mucous may occasionally accompany a cough, the condition is for the most part dry. Examination of the mucous reveals it to be gray in color and ununctuous (not very sticky). The cough may be accompanied by a loss of voice and severe chest pain. The frequency of the cough is episodic and may occur in fits.

Coughs due to pitta vitiation are called “pittaja kasa”. They present with a greater amount of mucous. Examination of the mucous reveals a yellow color and possible blood within the mucous giving it a “rusty” appearance. This latter appearance indicates that the infection has penetrated deeper in the respiratory system as is seen in pneumonia. Pittaja kasa is accompanied by fever. The cough is more continuous than that of vata type.

Coughs due to kapha vitiation are called “kaphaja kasa.” They present with the greatest amount of mucous. Examination of the mucous reveals a cloudy, white color and the mucous is thick and sticky. The condition is often accompanied by a runny nose, nausea, and vomiting. Actual pain in the chest and head is mild. Kaphaja kasa is not associated with fever. Coughing is continuous. Comparative Rupa (symptomatology) of Vataja, Pittaja and Kaphaja Kasa

Vataja Pittaja Kaphaja
Minimal mucous, hard mucous, grey in color Moderate mucous, sticky, yellow in color Large amounts of mucous, sticky, cloudy and white in color

Coughs due to trauma, called “ksataja kasa” reveal a combination of symptoms related to vata and pitta types. Sputum may be red, yellow or black indicating infection and bleeding. While the mucous is abundant, it is ununctuous. Fever is probable and there may be joint pains as well. Due to trauma, blood may simulatanously appear in the urine. Coughs due to trauma are described as resembling the cooing of a pigeon.

Coughs due to ksaya occur with wasting disease such as tuberculosis. Tuberculosis is called “rajayaksmadi” literally the “kind of diseases” in the Ayurvedic literature. The condition results in a drying up and loss of tissue (ksaya). While vata dosha plays the most important role in this condition, the condition is sannipattika in nature (due to the vitiation of all three doshas).

Chikitsa: Treatment and Management

The management of kasa (cough) requires an understanding of the state of the patients agni, ama, and ojas as well as an appreciation of the doshic pathology present. In addition to treatment at the site of relocation in the pranavaha srota (respiratory system), treatment should also be directed toward the mahavaha srota (digestive system) as this is the physical root of the condition and the raktavaha srota (circulatory system) as the pathway of overflow.

Management of Vataja Kasa
The management of vataja kasa, at the site of relocation focuses on the application of oils and heat to the pranavaha srota (respiratory system). Sesame oil massaged into the chest followed by fomentation is recommended. Fomentation may be performed simply using hot water bottles, a heating pad or locally applied steam as in nadi svedana. Popular cough relieving herbs from India include kantakari (solanum xanthocarpum; VK-P+) and vamsa rochana (bamboo manna; VP-K+) . These are commonly used and may be prepared as ghrita (medicated ghee). Popular herbs used in the West include licorice (glycyrrhiza glabra; VP-K+) and wild cherry bark (prunis virginiana, prunia serotina; VP-K+).

Care of the digestive system requires dietary modification and the use of anuvasana basti (oil enema) or niruha basti (decoction enema). The diet, though nourishing should be taken in small quantities at first until the agni becomes strong. Nourishing soups are most beneficial. Patients should receive plenty of rest.

For both vataja and pittaja kasa, the classical formulation, Sitopaladi churna is commonly used. It may also be prepared in warm water or with honey. Sitopaladi churna is a combination of many herbs and spices with vamsa rochana as the chief herb in the formulation.

Management of Pittaja Kasa
The management of pittaja kasa, at the site of relocation focuses on herbal therapies. Oil and heat are not recommended. Medicated ghrita (ghee) may be prepared with cough relieving, expectorant herbs such as vamsa rochana (bamboo manna; VP-K+) and vasa (adhatoda vasica; PK- V+). Western herbal alternatives include licorice (VP-K+), mullein (verbascum thapus; PK-V+) and wild cherry bark (prunis virginiana, prunia serotina; VP-K+). The classical Indian formulation, sitopaladi churna may also be used.

Virechana performed early in the condition is most beneficial to allieviate pitta at its root. The diet should emphasize a greater amount of the bitter taste as the bitter taste is cooling and purifies the rasa and rakta dhatu helping to destroy the infection. The diet should be light and and consist of easy to digest foods until improvement is noted. Stronger antimicrobial bitter herbs may be given to accompany the cooling, cough reducing herbs. These include kutki (Gentiana kuroo; PK- V+) and neem (Azadirachta indica; PK-V+) as well as well as Western alternatives such as goldenseal (Hydrastis Canadensis; PK-V+) and echinecea (Echinecea augustifolia, echinecea purpura; PK-V+). Patients should receive plenty of rest.

Management of Kaphaja Kasa
In the management of kaphaja kasa, treatment focuses on strong purification and may include vamana, virechana and niruha basti. Nasya is also recommended to purify the nasal passages and sinuses. An important herb from India is kantakari (solanum xanthocarpum; VK-P+). Kantakari alleviates cough and is a bronchodilator. Kantakari is one of the herbs in the famous ten roots formulation, dashmoola. Along with kantakari, additional herbs may be added to formulations such as vidanaga (embelia ribes; KV-P+) and chitrak (plumbago zeylancia; K-VP+). Dry, expectorant herbs may also be added to formulation or prepared for inhalation. Clove (caryophyllus aromatica) and bayberry (myrica nagi, myrica sapida, myrica cerifera) are commonly prepared in cigarette form or simply burned and inhaled. Western herbs that are beneficial include elecampane (inula helinum), eucalyptus (eucalyptus globulis) and black pepper (piper nigrum).

The diet of patients with kaphaja kasa should be very light and patients may fast for several days according to their strength. The diet emphasizes the pungent taste to support drying the lung tissues. Patients who are not experiencing great fatigue should remain active but should not overly exert themselves.

Comparative Chikitsa (treatment) of Vataja, Pittaja and Kaphaja Kasa

Vataja Kasa: Palliation therapies plus warm or moist expectorant herbs: Kantakari, vasa, licorice and wild cherry bark
Pittaja Kasa: Moderate purification plus cool expectorant herbs: Vamsa rochana, licorice, mullein. Antimicribial Herbs: Kutki, neem, echinecea, goldenseal.
Kaphaja Kasa: Strong purification plus dry or hot, expectorant herbs: bayberry, kantakari, clove, black pepper, elecampane and eucalyptus.

Managing coughs due to trauma requires referral to a medical specialist as the lung may be punctured. Until medical care can be administered, patients should take hemostatic herbs such as the Indian herbs manjishta and praval pisthi or the Western herb comfrey. Patients should also stay well hydrated.

Coughs associated with wasting disease are difficult to treat and careful management is required. Weak patients usually require tonification to combat weight loss and increase strength. Medicated ghees with demulcent herbs such as bala rejuvenate the body and support repair of respiratory tissues. The dosage of the herbs is dependent upon the state of the patient’s agni. Anuvasana basti should also be administered to improve strength and can be prepared with nourishing herbs such as bala and ashwaganda in a sesame oil base. The diet should be nourishing. Meat and bone soups may be required to prevent continued weight loss. Vegetarian patients may object, however they are strongly recommended if the patients life is in danger. The quantity of food taken should be proportional to the bodies ability to digest it. Hence, dipanas to strengthen agni are required.

Sadhyasadhyata (Prognosis)

Doshic disturbances resulting in kasa are relatively easy to treat with vataja considered the easiest and kaphaja the most difficult. Those of mixed dosha pathology such as ksataja type are more difficult. Ksaya kasa is the most difficult of all. Ayurvedic texts state that kasa of any kind, if not treated properly can progress to ksaya type.

Dr. Marc Halpern is the founder and director of the California College of Ayurveda located in Nevada City, California. He is a nationally known lecturer on the subjects of Ayurveda and Yoga and has written numerous articles in newspapers and magazines.

Ayurveda and the Understanding and Management of Respiratory Disease Part II: Svasa: The Understanding of Breathing Disorders and Asthma

Introduction

Disorders of the breath affect almost every human being at some time in their lifetime. Whether due to a common cold resulting in bronchitis or something more serious such as asthma or emphysema, the ability of people to simply breath is not always as easy as it seems.

Ayurveda refers to breathing disorders (dyspnea) as “swasa”. There are five basic types. They are characterized by the type of breath they create, rather than the doshic disturbances that create them. The five types are called: ksudra, tamaka, chinna, urdhva and mahan.

Descriptions

Ksudra svasa is the name for heavy breathing such as might occur after exercise. However, the condition can also arise from anything that taxes the respiratory system resulting in increased respiration, including heavy eating.

Tamaka svasa is the name for forceful respiration that leads to great distress. The condition is due primarily to kapha doshs vitiation and results in the eyes opening wide and gazing in an upward direction during an attack. The condition term is used synonymously with bronchial asthma. Ayurvedic folklore attributes Tamaka svasa to past life karma resulting from the indiscriminant killing of animals.

Chinna svasa is the name for interrupted breathing such as that which is seen in the terminal stages of illness. The term is used synonymously with “Cheyne – Stokes”, respiration which occurs somewhat near the time of death. When Chinna svasa occurs the eyes gaze downward and one eye often appears red. Chinna svasa often preceeds the onset of coma.

Urdhva svasa is the name for prolonged expiration and an inability to inhale. Like tamaka svasa, patients eyes gaze upward and the eye balls may even roll back. Often times the mouth is covered with mucous. It should not be surprising that the patient is described as being in great fear. Urdhva svasa does not directly correlate with any one specific syndrome noted in the West.

Mahan svasa means “The Great Dyspnea” as this is the most serious of all breath disorders. The condition occurs shortly before death. The breath is described as being similar to a bull in heat. There is a sound which accompanies the breath which is high pitched. Patients with mahan svasa are usually delusional, there urine and feces are often obstructed, and death is impending.

Purva Rupa (Prodromal Symptoms)

Common purva rupa of svasa include chest, heart and flank pain, headaches, and gas.

Nidana (etiology) and Rupa (symptoms):

The presentation of Tamaka svasa (asthma) varies according to the doshic dominance of the condition. Vata type asthma is precipitated by physical or emotional stress along with a diet that is light, dry and cold. Vata type asthma presents with a dry cough following the asthmatic episode. There may also be accompanying weight loss which can be quite profound. Additional signs of vata vitiation may be present in any system of the body.

Kapha type asthma is the most common. The condition is precipitated by an excess of cold, heavy, moist foods, and over-eating. Attacks present with a moist, productive cough following an asthmatic episode. Mucous appears cloudy and white in color. Patients may be overweight and additional signs of kapha vitiation may present in any system of the body.

Pitta vitation may combine with either a vata or kapha type asthma. Attacks are precipitated by exposure to allergens or microbes. Inflammation of the bronchial passages reduces airway patency. Coughing following an asthmatic attack may produce yellow or green mucous. Additional signs of pitta vitation may be present in any system of the body.

Samprapti (pathogenesis)

The breath is disturbed when vata is obstructed by kapha. Vitiation is classically stated to occur in the pranavaha srota (respiratory system), the ambuvaha srota (water metabolism system) and the annavaha srota (stomach). Kapha is given the greatest role in the pathology. Vitiation of kapha results in obstruction to the movement of air in and out of the respiratory system. This condition has its origin in the stomach, the site of kledaka kapha. Hence, kapha accumulates and becomes aggrevated in the stomach, overflows into circulation and relocates into the respiratory system where it obstructs the movement of vayu (air.)

Tamaka svasa, while classically dominated by kapha in the pathology also has a vata presentation. These patients present with weight loss and extreme sensitivities to the environment. These patients suffer not only from vata vitation but from low ojas. Hence, vata accumulates and becomes aggrevated in the purishavaha srota (large intestine) overflows to the rasa dhatu (plasma) and raktavaha srota (circulatory system) and relocates into the pranavaha srota (respiratory system)

Chikitsa (Treatment)

The classical management of tamaka svasa is the management of kapha dosha. Proper management requires an appreciation of the patients agni, ojas, and whether or not ama is present. Purification therapy should be performed in accordance with the patients strength. Following proper preparation, strong patients may undergo vamana, virechana, and niruha basti as well as nasya therapies. Agni can be improved with the use of dipana (pungent) herbs. These herbs allieviate kledaka kapha at the origin of the condition. Many pungent herbs also dry up excess mucous secretions in the pranavaha srota (respiratory system). Espeically effective are cloves and black pepper.

Weak patients require either tonification or palliation therapies. Tonification is required for the weakest patients whose ojas is depleted or where there is significant weight loss. Patients with moderate strength may undergo palliation therapy. All patients benefit by following the principles of samsarjana karma following any kind of purification.

Yogic Techniques for Managing the Breath

The practice of pranayama purifies the nadi. Depending upon the type of pranayama performed, the flow of pranic energy may be increased or decreased in either one or more of the major nadi: ida, pingala, or sushumna nadi. While Ayurveda understands the role of pranayama in regards to prana, tejas, and ojas and their corresponding effects on the mind, relaxation along with conscious breathing of almost any type will improve the functioning of the respiratory system. Simple diaphragmatic breathing increases the volume of air moving through the lungs on inhalation and exhalation. Experience with pranayama and meditation enables patients to take some control over autonomic function, offering the patient an opportunity to relax and dilate the bronchial passages at the onset of an asthmatic episode. This may also benefit patients with additional breathing challenges such as chronic bronchitis.

Common Herbs For Easing the Breath

Herbs that enhance the flow of breath come in two major categories; expectorants and bronchodilators. Expectorants soften or liquify accumulated mucous making it easier to expel. Bronchodilators expand the air passages allowing greater air flow. Bronchidilators are essential to the management of asthma and chronic bronchitis, which obstruct normal flow. Expectorants are beneficial for reducing mucous associated with colds and chronic bronchitis.

An important Indian herb in the management of kapha type respiratory complaints is Vasa (Adhatoda Vasica). Vasa is an important bronchodilator and expectorant, and has cool virya. Having a bitter and astringent rasa it is both rough and dry. These qualities make it best for pacifying pitta and kapha.

An additional herb of importance for those with vata type respiratory complaints is Bala (Sida Cordifolia). Bala is a respiratory tonic with a mild bronchodilating action. Bala has a sweet rasa, cool virya, and sweet vipaka. It has both oily and heavy qualities most suitable to vata. Bala has a multitude of additional actions making it one of the best rasayanas for people with a vata nature.

An important Chinese herb is Ma Huang (Ephedra Sinica, Ephedra Vulgaris). Ephedra is a strong bronchidilator and stimulant which dries up mucous secretions. It has a pungent, bitter and astringent rasa, warm virya, and pungent vikpaka. In additional to dilating the bronchial passageways it is a potent vasoconstrictor and cardiac stimulant. Hence, care must be used in its administration to patients at risk of cardiovascular disease and stroke. Ma Huang is best for those with kapha type respiratory disorders.

An important American herb is Mullein (Verbascum Thapu). Mullein is an effective astringent, expectorant and anti-inflammatory reducing the intensity of all mucousy conditions and respiratory allergies. With a bitter and astringent rasa, cool virya, and pungent vipaka, it is best for conditions of pitta and kapha nature. However, with a secondary sedative action, it will only aggrevate vata with long term use.

An important herb used in many parts of the world for kapha type respiratory conditions is Elecampane (Inula Helinum). Considered one of the best herbs for long term use, Elecampane is warming and dry and is an effective expectorant. Elecampane has the unique effect of strengthing respiratory tissue making them less susceptible to irritants of all kinds.

The common Indian spice, Long Pepper (Piper longum) is also important. With a pungent rasa, warm virya, and pungent vipaka, it is best for pacifying the kapha dosha. It also has a light, sharp, and surprisingly oily nature. Although best for kapha, it is also beneficial for pacifying vata. Long pepper is commonly used for preventing recurrent attacks of asthma. For this purpose, one peppercorn is taken on the first day of treatment. This is then followed each day for seven days by the administration of one additional peppercorn. (One peppercorn fills about two 00’ capsuls). Hence, by day seven, the patient is taking 14 capsules of peppercorn. The herbs are taken with hot water and the dose can be divided up during the day. This program continues for 6 more days as the patient reduces the dose by one peppercorn each day. Black pepper (Piper Nigrum) is less effective.

There are many additional beneficial herbs and spices to be considered by the practitioner. These include amalaki, ashwanganda, clove, cardamom and licorice.

Case Management

Management of asthma begins with the identification of the doshic disturbance. Proper management includes not only the direct care of the respiratory system but also the care of the digestive system as the digestive system is the physical root of the disorder. As many cases of asthma can be triggered by emotions, the care of the mind is equally important. As with all conditions, the patients lifestyle should be assessed and modified to reduce stress and bring about greater harmony. Lifestyle adjustments should address the patients interactions with the environment through all five of their senses. Because of the complexity of the condition and the lifestyle changes the patient is asked to make, it is important that the practitioner follow up with the patient on a regular basis to monitor progress, adjust herbal formulations, and support the patient on their journey to establish a healthier lifestyle.

Sadhyasadhyata (Prognosis)

Ksudra svasa is mild and is most often self limited. Tamaka svasa is more difficult to manage but correctable. Chinna, urdhva and mahan svasa are generally considered incurable by ordinary Ayurvedic methods. Hence, Ayurvedic health care focuses primarily on the management of tamaka svasa.

Dr. Marc Halpern is the founder and director of the California College of Ayurveda located in Nevada City, California. He is a nationally known lecturer on the subjects of Ayurveda and Yoga and has written numerous articles in newspapers and magazines.

Ayurveda, Hyperactivity and Attention Deficit Disorder

Ayurvedic Medicine approaches the subject of Hyperactivity and Attention Deficit Disorder from an elemental and doshic perspective. It is this understanding that leads to a complete model of management that is truly holistic and integrates the care of the body, mind, and spirit of the patient.

Reviewing the five elements, earth is the capacity for stability in the body and mind. Water is the capacity for flow and feeling. Fire is the capacity for discrimination and digestion. Air is the capacity for motion, both physical and the movement of thought. Ether is the capacity for expansiveness and creativity. In the case of hyperactivity and attention deficit disorder, there is an excess in the qualities of air and ether and a deficiency in the qualities of earth. Hence, from the perspective of Ayurveda, ADD and ADHD are conditions of increased expansive and creative energies and a decrease in stability. The end result is a person who can go into creative spaces that others can not enter and therefore thinks outside of the normal perceptive view of the general population. The loss of stability is required to enter the realm they are in. Increases in the qualities of the elements air and ether are called a “vata disturbance” by practitioners of Ayurveda. While the condition has its creative advantages, it can also reach a degree of disturbance in which it becomes difficult to function well in the world of common experience.

The Ayurvedic approach to the management of ADD and ADHD is the process of assisting the patient to build a stronger container to control the energy of expansion and creativity. The container ideally creates a state of control without creating suppression of the increased energies.

Managing any condition through Ayurveda requires care for the physical, mental and spiritual aspects of the patient. Patients with vata disturbances often experience physical conditions such as constipation and gas in the digestive system and dryness through out the body. There may also be of low body weight and poor muscular development. Patients often feel cold. Care of the physical body is essential to the care of the mind. Hence, a diet that is nourishing, oily and somewhat heavy is important as long as the patient does not become overweight. Overweight patients require a similar diet but with smaller portions. Nourishment is the key to increasing stability.

Spiritually, Ayurveda views all people as being in the physical world for the purpose of learning important lessons which ultimately aid the soul toward the attainment of enlightenment. Every difficult life circumstance is a lesson or opportunity for growth. What is to be learned is not often easy for another person to identify. Learning is an internal process of self–observation. While children find self-observation difficult, it is important that parents create a supportive environment for self–exploration at the child’s pace. This can include reading books with important morals and which demonstrate growing self awareness and planting subtle seeds of insight that might germinate in the child’s future. Child counselors can also play an important role through the variety of techniques they are trained in to affect a child’s consciousness.

On the mental level and emotional level, Ayurveda approaches the condition through the use of herbs. Ayurveda classifies herbs with a stabilizing effect on the mind as “medhya rasayanas”. These herbs promote the intellect and deeply nourish the neurological tissues. They are nervine tonics. Many such as Ashwaganda and Shankha Pushpi have a secondary mild sedative effect. Others like Calamus have a mild stimulating effect. The most well known herbs for the condition are Brahmi (Bacopa Monierra) and Gotu Kola (Centella Asiatica). Studies on Bacopa Monierra performed at Benaras Hindu University in Varanasi, India have revealed beneficial effects on children. Ayurveda favors the use of combinations of herbs that meet the specific needs of the patient as no two patients present exactly the same. Often, additional imbalances, mild or otherwise are present and complicate the condition.

In order to create a “container” for the creative and expansive energies, Ayurveda recommends consistent routines surrounding bed time and meals as well as the overall daily routine. Routines are essential to creating stability of the mind. The condition is exacerbated by irregular routines.

In summary, Ayurveda offers the patient with ADD and ADHD an alternative approach to the care of the psyche that respects their individuality and recognizes their gifts as well as their challenges. Care is systemic and holistic and emphasizes maximizing the potential of the patient without suppressing their natural gifts. Complete care includes lifestyle and diet as well as the application of herbs.

Conquering Headaches with Ayurveda

Published in the Union - February

Headaches are one of the most common health challenges. At one time or another, most people suffer from headaches. When suffering from a headache, most people reach for Asprin, Tylenol or Ibuprofen. While pain killers offer temporary relief, they do not address the cause and often headaches return. Ayurveda, the traditional medicine from India, is a holistic, natural approach to health and well being. Ayurveda, utilizes herbs to offer natural relief while striving to correct internal imbalances. More importantly, Ayurveda looks toward a person’s lifestyle as the primary cause of headaches.

Headaches fall into three major categories: Migraine headaches, cluster headaches and tension headaches.

Migraine headaches, known for causing great distress are throbbing headaches accompanied by sensitivity to lights, sounds and smells. They often occur along with nausea or vomiting. These severe headaches can last a few hours to a few days and affects more than 20 million Americans!

Cluster headaches can can also be quite severe. They last only a few minutes to a few hours but are reoccurring through out the day. These pulsating headaches are often accompanied by tearing or redness of the eye, sweating or the constriction of one pupil.

Tension headaches are the most common headaches. These headaches last from 30 minutes to a week. They tend to be mild to moderate and are constant. They are not usually accompanied by any other symptoms.

The cause of Migraines and Cluster headaches are poorly understood. Tension headaches however appear to have many causes including stress, toxins, difficulty sleeping and anxiety. What all of these headaches have in common is that in one way or another, something is out of balance in the patient.

The goal of Ayurveda is to restore balance and optimum function within the patient. This is accomplished through proper diet, herbs, exercise and stress reduction. Stress reduction includes meditation, yoga and the creation of a harmonious lifestyle.

It is the creation of a harmonious lifestyle that is the most challenging for patients. Caught in a cycle of crisis management and struggling to survive, many patients are just keeping their head above water. The busier we become, the more our lifestyle suffers and the more difficult it is to take proper care of ourselves. It is no wonder we get sick. If a plants needs are ignored, it wilts. If a cars needs are ignored, it breaks down. If a humans needs are ignored, we suffer and become ill.

A harmonious life is one that supports the body to function optimally. It is a lifestyle that is relaxed and at ease. This does not mean laziness or a lack of productivity. Just the opposite, a person living a harmonious life can be more productive as they are sick less and their mind and body are clear and able to focus.

Try these four simple practices to bring harmony and balance into your life and see if your headaches are improved.

Get up in the morning early enough to sit quietly and either meditate, pray or contemplate in silence. Get up before the kids and have a cup of tea and do some stretching. A regular practice of stretching, meditation and a quiet cup of tea will go a long way toward peace of mind and harmony.

Make sure that you are always eating sitting down in a calm and quiet environment. Create enough time to be present with your food. Avoid eating in the car or at your desk. Take a few breaths and relax before taking that first bite. A calm eating experience improves digestion and quiets the mind.

Let go of the toxins in your life. When you suffer from chronic headaches, you may be sensitive to environmental toxins. To purify your body, try giving up cigarettes, marijuana and alcohol and consume organic food to avoid pesticides and hormones.

Go to bed early so that you can get up early. Try to go to bed around 10:00. This leaves most people time to get a good night sleep and feel refreshed in the morning. When you’re well rested, your entire day goes better. Going to bed early is luxurious. Enjoy the soft comfort of your bed and snuggle under those warm blankets.

If you suffer from chronic headaches see a health care professional for a proper diagnosis. If no cause is found, try the above ideas or see a certified Clinical Ayurvedic Specialist for specific herbal and lifestyle recommendations.

Healing Ulcers with Ayurveda

Healing from any condition requires knowledge of cause (nidana) and pathology (samprapti). The cause of most ulcers lies in a mixture of vata and pitta provoking factors.

Vata type ulcers occur secondary to the stress of overwhelm and anxiety. This usually occurs in the presence of a vata vitiating lifestyle consisting of stressful life changes, a lack of routines and a diet of cold, dry and light foods such as salads and corn breads.

Vata type ulcers occurs secondary to dryness of the mucous membranes of the stomach and small intestine. Ayurveda describes this as vata entering the rasa dhatu of the annavaha srota. A dry membrane is unable to protect the underlying tissue from the normal or even low levels of acid present in the digestive system. The result is that the acids burn the tissue resulting first in hyperacidity (a poor term as there is no excess acid) and later in ulceration.

This condition is healed by rebuilding the mucous membrane lining the stomach and intestinal wall. Following a moist or oily diet is beneficial. Cooked foods and herbs with a demulcent quality help hydrate the rasa dhatu. Herbs such as licorice and slippery elm not only provide symptomatic relief but long term healing as well. Treatment of the whole person is always required and hence, the mind must be treated and a proper lifestyle restored.

Pitta type ulcers occur secondary to the stress of intensity. This usually occurs in the presence of a pitta vitiating lifestyle consisting of a highly focused intensity on goal achieving and a diet of hot, spicy foods.

Pitta type ulcers result from excess acid secretions. These secretions overwhelm the protective mucous secretions of the intestinal lining. The result begins as the burning of hyperacidity and later results in ulceration. This is a condition of pitta entering the rasa dhatu of the Annavaha srota.

This condition is healed by reducing the acid secretions as well as rebuilding the mucous lining. A cooling diet is one that reduces acid secretions. By avoiding hot spices and taking in foods with a sweet and bitter taste, acid secretions are minimized. In addition, the mucous membrane should be rebuilt utilizing moist, oily foods with a sweet taste. Hence, combinations of bitter and sweet herbs are most beneficial. The combination of dandelion and licorice roots is a personal favorite of mine. Bleeding if present can be managed with haemostatic herbs such as praval pishti or red raspberry. Praval pishti has the added benefit of being an antacid. As mung dal also has antacid properties and is relatively easy to digest, a diet of mung dal or kitcheree rapidly improves the situation.

The person with pitta vitiation should also be encouraged to relax more and adopt less competitive activities. Hence benefit is gained through treating them mind and adopting a healthy pitta pacifying lifestyle.

Many cases of ulcers are caused by a combination of vata and pitta factors. Hence, a combined approach is often most beneficial. This approach emphasizes the use of the cool and moist qualities such as those found in the sweet taste. Herbs such as licorice root and slippery elm pacify both doshas.

Ulcers and a related hyperacidity are relatively easy conditions for the Clinical Ayurvedic Specialist to manage. Through proper lifestyle and diet along with the right herbs, suffering is reduced and healing takes place.

Inflammatory Joint Disease (Rheumatic Conditions)

Rheumatic disease is a family of diseases that often affect the joints of the body with inflammation. Each disease presents with a unique cluster of typical symptoms. All of tend to include joint pain. Often, joint inflammation leads to joint destruction.

The root word “Rheum” means mucousy or watery. This most likely refers to the puffy, inflammatory nature of the condition. Rheumatism is an outdated term originally referring to either rheumatic fever or miscellaneous joint pains.

Joint damage caused by Rheumatic joint disease progresses along three basic stages. In the first stage, the synovial membrane becomes inflamed. In the second stage, the membrane thickens. In the third stage, the cells of the membrane secrete enzymes that digest the surrounding bone and cartilage resulting in joint deformity. The role of pitta is predominant in this condition resulting in joint inflammation (redness and heat around the joint) as well as the digestion of the surrounding structures. Vata also plays an important role as seen in the variable nature of the inflammation and joint pain and the tendency of the condition to migrate from joint to joint around the body.

Rheumatoid arthritis is the most common of the rheumatic joint diseases. Other diseases in the same family include include: Systemic Lupus Erythemetosis, Polymyositis, Dermatomyositis, Sjorgen's Sydrome, Scleroderma and Mixed Connective Tissue Disease.

Each of these conditions has a known or suspected autoimmune dysfunction as a part of its pathology. Autoimmune disease is a caused in by a combination of “tendency” and low ojas. Karma creates samskaras or tendencies within consciousness that are likely to manifest on psychological or physiological levels. Not all tendencies express themselves. Whether a tendency expresses itself of not depends upon both the strength of the tendency and the lifestyle of the person.

Rheumatoid Arthritis

Rheumatoid arthritis affects between 2-3 million Americans or about 1% of the adult population. It is 2-3X more common in women and usually begins between the ages of 20 and 50. There is a variant, called Juvenile Rheumatoid Arthritis (JRA) that affects approximately 50,000 children in the United States . JRA usually affects children below age 16. Rheumatoid arthritis tends to affect the hands and wrists most often but other joints in the body can be affected. Chronic inflammation leads to joint deformity. Secondary involvement of the connective tissues of the body leads to generalized stiffness which tends to be pronounced in the mornings.

Madhava Nidanam refers to acute rheumatism as “ambat”. Many other texts refer to the condition as “ amavata”. The two terms are the same with different spellings. The term ambat refers to air mixed with impure chyle. Hence, it is common to understand rheumatic arthritis as a condition of vata vitiation combined with ama.

The most common symptom of rheumatoid arthritis is joint pain. Common, possible secondary symptoms include fever, fatigue and loss of appetite.

Samprapti:

According to the Madhava Nidanam, the pathology is due to poor digestion resulting in ama formation in the stomach. Poor digestion results in poorly formed chyle (immature rasa ; a fluid produced by digestion in the intestines that is taken up by lymph vessels called lacteals and thus enters the lymph system). This poorly formed chyle is likened to mucilage and is stated to cause all of the varieties of this disease. All three doshas are vitiated in this condition. Deranged vata produces pain. Deranged pitta produces inflammation and heat. Deranged kapha produced rigidity.

Vata dosha is vitiated wherever there is pain in the body. Vata type pain tends to come and go. It may also migrate from place to place. When it mixes with pitta, there is inflammation. When the affected part itches, becomes rigid and feels like it is covered with a wet cloth, kapha is affected. Ama mixes with the doshas and settles into the joints.

In the joint, vyana vayu is responsible for joint motion. Apana vayu is responsible for the health of the bones. Thus, altered motion is a function of vyana vayu while joint damage is a reflection of apana vitiation. It is sleshaka kapha that is responsible for the synovial fluids. Vitiation of sleshaka results in excess fluid and swelling in the joint.

Chikitsa (Treatment)

It is always most important to normalize the function of the digestive system. By normalizing agni, ama is no longer produced. Ama that has been produced and is now stationed in the affected joints should be removed by purification programs such as pancha karma and the use of pachanas. Proper diet along with the appropriate use of dipanas assures that ama will not accumulate.

In the management of this condition herbs with the characteristics of being analgesics and anti-inflammatory are most important. The following are several important herbs in the management of rheumatic joint diseases.

Castor Oil (Eranda, Ricinus communis ): Castor oil has a sweet, pungent and astringent rasa , warm virya and pungent vipaka . It has heavy, oily and sharp qualities. Its actions include being a purgative and analgesic. It is best for treating vata . Regular use aggravates pitta and kapha . However, external use as a poultice may be used for all three doshas when combined with appropriate herbs. Poultices or oils may be applied directly to the painful joints. In arthritis, a small amount of castor oil may be taken daily for a few weeks. Long-term internal use is not recommended. Castor oil can aggravate inflammatory colon diseases ( pitta conditions) and is contraindicated in pregnancy.

Guggulu ( Commiphora mukul ). Guggul has a pungent and bitter rasa , warm virya and pungent vipaka . It is an anti-inflammatory, dipana and pachana . It is considered to be one of the best herbs for reducing ama from the joints and tissues of the body. It is considered excellent in the treatment of arthritis. It reduces vata and kapha but can aggravate pitta unless it is combined with cooler herbs such as gaduchi . Guggul is also renowned for reducing cholesterol levels, assisting in weight loss and acting as an anti-microbial.

Gaduchi ( Tinospora cordifolia ): Gaduchi has a bitter, slightly sweet and astringent rasa , warm virya and sweet vipaka . It is heavy and oily and it pacifies all three doshas . While having many uses, in the management of arthritis it is an effective anti-inflammatory and analgesic. This herb is often added to formulas with guggul in the treatment of pitta -type arthritis.

Nirgundi ( Vitex negundo ): Nirgundi has a bitter, astringent and pungent rasa , a warm virya and a pungent vipaka . It is light and rough. It is best for the kapha dosha but is also stated in some texts to pacify vata . It increases pitta . While having many uses, it is revered for its benefits in the treatment of rheumatic joint pains. It is a respected anti-inflammatory and analgesic, useful in arthritis, nerve pains and back pains.

Ginger ( Zingiber officinale ): Ginger has a pungent rasa , warm virya and sweet vipaka . It is light and oily and pacifies vata and kapha . While having many uses, in the management of arthritis, it is an effective analgesic and pachana . It may be applied to joints as a poultices or salve and taken internally to reduce ama . Research suggests that it inhibits prostaglandins and leukotriens, which are mediators of pain and inflammation. It has been well studied and found effective in reducing arthritic pain in 75% of those involved in the studies.

Turmeric ( Curcuma longa ): Turmeric ha a bitter rasa , warm virya and pungent vipaka . It is light and rough. While having many uses, in the treatment of arthritis, turmeric acts as an effective anti-inflammatory. As an alterative, it is beneficial in reducing impurities in the body. It may be applied topically or internally. Studies performed on turmeric show that it inhibits prostaglandin production and stimulates the production of cortisol. Both actions decrease inflammation. For vata and kapha -type arthritis, it works even more effectively when combined with cayenne pepper. Together, they have been found to reduce substance P from nerve endings. Substance P is a neurotransmitter involved in pain mediation.

Frankincense ( Boswellia serrata) : Boswellia has an astringent, bitter and sweet rasa with a slightly warm virya and pungent vipaka . This herb pacifies kapha and pitta but increases vata . The part used is a resin. While having many uses, in the management of arthritis it is an effective anti-inflammatory.

Portions of this article were adapted from Dr. textbook, Clinical Ayurvedic Medicine in which he recently added a section on the management of chronic diseases. For more information on this and many other conditions, please see the latest edition of this textbook or purchase the latest chapter (50 pages).

Parkinson's Disease (Kampavata): Understanding the Ayurvedic Approach

Introduction

Parkinson's disease, known in Ayurveda as "Kampa Vata," is a neurological disorder affecting 1% of the population over age 65 and is the fourth most common neurological degenerative disorder found in the elderly (1). Because this condition occurs more frequently in industrialized countries, some have speculated that this condition may be caused by environmental toxins (2). However, earlier references to this condition preceding industrialization are numerous. Western medical literature from the famous physician Galen, dating back to around 175 AD, gave one of the first descriptions of this condition under the name "Shaking Palsy." In 1817 the physician James Parkinson published a very detailed description of the condition and thus, as the tradition in the West, the disease was named after him (7). Direct reference to the Parkinson's disease in the ancient ayurvedic literature is sparse and refers only to related symptoms including tremors. Thus, the condition is referred to in the modern ayurvedic literature by various names for tremors: Kampavata (tremors due to vata), vepathu (shaking, as in being off track or out of alignment), prevepana (excessive shaking), sirakampa (head tremor), spandin (quivering), and kampana (tremors) (4,5,6,8). Parkinson's disease is most commonly called Kampavata.

Ayurvedic Etiology and Pathology (Nidana and Samprapti)

As we age, particularly into our later years, apana vayu accumulates (sanchaya) and may become aggravated (prakopa). This leads to the constipation so commonly seen in the elderly. When this is combined with a vata increasing lifestyle and constitutional tendencies, the stage is set for vata to overflow (prasara) into circulation. Overflow causes vyana vayu to become disturbed within the rasa dhatu. Systemic signs of vata disturbance occur, such as dryness of the membranes of the body. Vata may relocate (sthana samsraya) to any dhatus that are weak. When a preexisting weakness resides in the tissue of the brain, this becomes the site of relocation and thus we have a condition of vata (prana, samana and vyana) in the majja dhatu, damaging portions of the brain stem and causing altered coordination and tremors. Additional components of the pathology which are commonly present include vata (vyana) entering mamsa dhatu causing muscle rigidty and prana kshaya (diminished prana) in the manovaha srota causing depression. In addition, kapha appears to be diminished in the majja dhatu in these patients. An increase in vata dries out kapha (cellular structure) in the susceptible region of the majj dhatu (brain stem). This creates an open space inviting vata to become vitiated. While the condition has a predominantly vata pathology, pitta can also play an important role in the samprapti (pathology) as its heat can burn out the celluar structure causing kapha kshaya (diminished kapha) in the majja dhatu, creating the original weakness in the brain stem. Hence personalities based in fear (vata) and intensity (pitta) are most predisposed to this condition and those of kapha nature are the most naturally protected.

Medical Pathology

Medical research has determined the cause of the condition to be a loss of function of specialized cells in the brain stem which stimulate the production of the neurotransmitter, dopamine (9,1). The cause of the functional disturbance is not known. It is known that Parkinson's disease can occur secondarily to several known causes including the ingestion of anti-psychotic drugs such as reserpine. (Reserpine is a plant alkaloid derivative of the Indian herb Sarpagandha or Rauwolfia Serpentina (8).) These drugs block the action of dopamine on the brain even though normal levels are present. In addition, carbon monoxide and maganese poisoning can instigate the condition as well as other brain tissue abnormalities such as tumors and infarcts. Finally, drug abusers injecting N-MPTP or Meperidine (1-menthyl-4-phenyl-1,2,5,6-tetra hydropyridine (1,3,7).), can cause a form of the disease which has a sudden onset and is irreversible.

Signs and Symptoms (Rupa and Laksana)

The most common recognizable symptom of Parkinson's disease is known as a "pill rolling tremor." In this condition, the thumb and fingers move uncontrollably in a manner resembling the rolling of a pill between the fingers. Tremors most commonly appear in the hands, arms and legs, though other areas may be affected. Small movements of the hands and fingers may eventually be difficult. This condition called micrographia, can make ordinary daily activities such as buttoning a shirt very difficult. Another symptom is stambha (rigidity), in which movement becomes slow and difficult to initiate. Patients usually have to look at their feet to begin, shuffle forward to and occasionally, inadvertently break into a trot (festination). The arms do not swing in coordination with the usual stride. The face may appear without expression (mask face), dull or depressed, though no depression may be present. Reduced blinking is an early symptom. The voice becomes monotone and expressionless, further causing some to mistake this as depression. Fifty percent of patients will develop dementia- (1)Vishada (depression), can accompany the disease but the symptoms of mask face and monotone voice occur as a part of Parkinson's disease and should not be confused with depression. Upon examination, passive movements of the limbs, produces what is commonly called, "cogwheel rigidity." This is an unconscious resistance to passive motion causing the limb to move with irregular starts and stops or a ratchet type motion. Sensory examination and reflexes are usually normal. Other signs of autonomic nervous system dysfunction may or may not be present, including orthostatic hypotension, constipation and urinary hesitancy (1,9). The most common signs and symptoms of Parkinsons Disease * Tremors * Muscular Rigity * Mask Face/Staring * Festinating Gait

Nidanam (Diagnosis)

Diagnosis is based primarily on signs and symptoms. Resting tremors (tremors which occur when the body is at rest and there is no voluntary initiation of motion) along with rigidity, loss of facial expression or gait abnormalities strongly suggests the disease. As only 70% of patients exhibit tremors, the other 30% of the cases are more difficult to diagnose (1). This condition may be confused with other causes of tremors, depression and gait abnormalities.

Western Medical Treatment

Drugs supplying the brain with L -dopa have been the mainstay of allopathic Parkinson's treatments (1,9). The strongest effects of this chemical are seen in the reduction of gait abnormalities and rigidity (1). Additional drugs are given to prevent the catabolism (breakdown) of dopamine. L-dopa is often administered in combination with other drugs (1). Surgery to alter brain function and the use of fetal dopamine neurontransplantation are under study (1).

Ayurvedic Treatment (Chikitsa)

Ayurvedic treatment for this condition centers around the treatment of vata disturbance. Oleation and fomentation form the basis of the constitutional treatment (4). Oleation through massage (abhyanga) and enema (basti) are indicated as well as the ingestion of oils. Naturally, jathargni must be strong enough to support such as a heavy regiman. If the patient exhibits significant ama and is strong enough, gentle purification procedures should be administered first. Oils medicated with ashwagandha (withania somnifera) and bala (sida cordifolia) are commonly used to pacify vata and build ojas. They are known to be rejuvenative with a strong nourishing action on the nervous system. The herb atmagupta (Mucuna Pruriens - also known as Kappikacchu) has received a lot of attention historically and again in recent years. A study in 1978, published in the journal, Neurology (india), showed its effectiveness on 23 patients diagnosed with Parkinson's disease. This study used only the powdered seed of the plant. In 1990, Manyam published the results of his study in the Journal Movement Disorders in which he found that Mucuna Pruriens contains Levodopamine or L -dopa within its seeds. This confirmed the 1937 study by Damodaram and Ramaswamy published in the journal, Biochemistry (8,10). L-dopa is the precursor of dopamine, the neurotransmitter which is absent or decreased in Parkinson's disease. The findings of these studies were confirmed at the Southern Illinois University, School of Medicine published research which was performed in the department of biology at the University of Groningen, the Netherlands. A controlled trial using a derivative Mucuna Pruriens called HP 200 was found to be effective in treating Parkinson's disease. Ayurveda teaches that a holistic treatment regimen offers the greatest chance of success with Parkinson's patients. In addition to using Mucuna Pruiens (V-PK ++, sweet/bitter/cool/sweet), vata must be pacified at its site of origin in the colon, site of overflow in the rasa dhatu and at its site of relocation in the majja dhatu. Apana vayu disturbance may be treated with moist laxatives such as psyllium (Plantago Psyllium), flaxseed (Linum Usitatissimum), or the traditional formula, triphala. Vyana vayu in the rasa dhatu may be treated with demulcents, such as slippery elm (Ulmus fulva) or licorice (Glycyrrhiza Glabra). And, prana vayu in the majja dhatu may be treated with kappikacchu (Mucuna Pruriens, along with supportive herbs such as ashwagandha (Withania Somnifera). If vata has also entered the mamsa dhatu causing rigidity, herbs which are muscle relaxers and nervine sedatives may be of value. Jatamansi (Nardostachys Jatamansi) and Shank Pushpi (Canscora Dicussata) may be used. If vata has entered the manovaha srota and depression is present, Gotu Kola (Hydrocotyle Asiatica) and Saint John's Wort (Hypericum Perforatum) are examples of herbs which can be added to formulas or used separately. A vata pacifying diet and proper dietary habits are essential to long term success. Additional vata pacifying regimens including daily oil massage (applied by the patient or practitioner) and sensory therapies complete the treatment regimen. Finally, a supportive environment should be created which is not overly stimulating. Meditation and yogic practices are the cornerstone of all holistic ayurvedic programs, as they cultivate a sattvic mind and teach the patient how to manage their internal energies. This is essential for good health. When pitta is vitiated in addition to the primary vata disturbance, care should be taken that treatment and lifestyle do not overheat the mind or body. Herbs such as Gotu Kola (VPK-, bitter-cool-sweet) which are cool and tonify the mind and nervous system may be added to any formula and are essential if there is a distrubance of sadhaka pitta (symptoms of sadhaka pitta vitiation: Anger, overly critical, intense). Another good herb to add to the formula for a pitta-vitiated individual is Gaducci (Tinospora Cordifolia), and excellent bitter, nervine tonic and pitta rasayana.

Side Effects of Treatment

According to the Materia Medica of the Hindus, patients treated with Kappikacchu (Mucuna Pruriens) have shown mild side effects which include headache, dystonia (abnormal muscle tone), fatigue, tremors, syncope (fainting) and thirst (8,11). Allopathic administration of L-dopamine can cause abnormal movements of the face (tardive dyskinesia) and limbs (chorea) as well as abnormal muscle tone (dystonia) (1). Unfortunately, the drug appears to decrease in effectiveness over time. Some experts believe that taking L-dopa early in the disease increases the overall progression of the condition and choose to only use the drug later in its course (1). Other drugs include amantadine, which improves symptoms in 50% of patients though it is unclear how it works and may caused edema, confusion and liver reticularis. Bromocriptine and pergolide are additional drugs used. Ergot alkaloids may also be used; these activate dopamine receptors causing less dopamine to be more effective. Side effects of this drug include confusion, delirium and psychosis, among others. Additional drugs may be used such as selegiline, propranol, and anticholinergic drugs. These are used either alone or with L-dopa. They all cause a host of side effects and effectiveness is limited.

Discussion

Ayurvedic regimens have a lot to offer patients with Parkinson's disease. While the pharmocological actions of specific herbs such as Atmagupta (Mucuna Pruriens) are being found useful, complete treatment requires proper lifestyle and daily regiments which pacify the patients vikruti (imbalance) and in the long term, those which are in harmony with the patients constitution. Following a yogic model, patients should be encouraged to look within to discover the underlying psychological and spiritual components contributing to their condition. Since disease is the end result of living out of harmony with one's constitution, understanding where a person is out of o harmony on the physical, emotional and spiritual levels is the cornerstone of Ayurvedic and Yogic healing and the healing of our consciousness. With this understanding, a person can take the actions necessary to bring about harmony and healing. Ayurvedic philosophy teaches us that the harmonious individual with a purely sattvic nature, does not experience disease. Likewise, one who is sick, who cultivates a sattvic mind, brings rapid healing to their body. Hence, all patients should be encouraged to reduce stress and cultivate practices such as meditation, which bring about peace of mind. Future Western scientific exploration of Ayurvedic healing will have to go beyond the pharmocological actions of various herbs, and explore, the effects of ayurvedic lifestyles, regimens and Yogic practices applied as part of a treatment regimen in addition to herbs. While Mucuna Pruriens has a predictable allopathic effect which is easy to measure, outcome studies can be designed to look at complete treatment programs and not simply individual components. The effectiveness of ayurvedic treatment goes beyond the pharmocological and incorporates the behavioral, and ultimately depends upon the internal and subtle energies of our being. While these aspects are hard to isolate and scrutinize, they can be evaluated as a whole, and it is here that genuine ayurvedic research begins.

References

1. The Merck Manual, Seventeenth Edition, Merck Research Laboratories. 2. The role of environmental toxins in the etiology of Parkinson's Disease. Tanner, CM. TINS 1989; 12:49-54 3. Langston JW, Ballard P, Tetrud JW, Irvin I. Chronic Parkinsonism in humans due to a predouce of Meperidine. Analog synthesis. Science 1984; 219; 979-980 4. Caraka Samhita Vol. 1-4, Bhagwan Dash and R.K. Sharma, Chowkhumba Sanskrit Series, Varanasi, (General Reference used for concepts, not specific information) 5. Ashtanga Samgraha of Vagbhata Vol., 1-3 K.R. Srikantha Murthy, Chaukumbha Orientalia, Varanasi 1997 (General Reference used for concepts, not specific information.) 6. Madava Nidanam 7. Treatment of Parkinson's disease in Ayurveda: Journal of Royal Society of Medicine; M Gourie-Devi, M G Ramu and B S Venkatarum. Department of Neurology and Ayurvedic Research Unit, National Institute of Medical health and Neuroscience's, Bangalore, India. 1991 Page 491-492. 8. Paralysis Agitans and Levodopa in Ayurveda: Ancient Indian Medical Treatise, Bala V. Manyam, Division of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois. Movement disorders Vol. 5, No. 1, 1990. Page 47-48. 9. Principles of Internal Medicine: Harrison 10. Damodaran M, Ramaswamy R. Isolation of L-dopa from the seeds of Mucuna Pruriens. Biochemistry 1937;31:2149-51 11. Dutt VC. Materia Medica of Hindus. Varanasi: Chowkumbha Saraswalibhawan, 1980: 148-149 12. Treatment of Parkinson's Disease of Cowhage plant - mucuna pruriens. Vaidya AB, Rajagopalan, TG, Mankodi NA, Antakar DS, Tathed PS, Purohit AV, Wadia NH, Neurology (India) 1978; 171-6 13. Indian Materia Medica, A.K. Nadkarni, K.M. Nadkarni, Popular Prakashan 1976

Restless Leg Syndrome: An Ayurvedic and Personal Perspective

Restless leg syndrome is a neurological condition that is characterized by an uncontrollable desire to move the legs while resting or trying to fall asleep. The condition has no known cause and no known cure and often gets worse as a person ages. It is also not known how many people suffer from the condition though most Medical Doctors report having seen between 1-10 cases. As the condition has been receiving recent publicity, more patients can be expected to report symptoms to their doctors and practitioners.

The sensations reported vary from burning sensations to insects crawling on the leg and can very from irritating to painful and may be mild or severe. The most important symptom is an uncontrollable to desire to move the legs while falling asleep. Those suffering from the condition are often prescribed central nervous system depressant drugs in the opiate class as well as dopamine agonists (supporters) such as L-dopa, the drug commonly used for Parkinson's disease. Most patients are sent to see a neurologist, some are sent to sleep specialists and others to psychiatrists.

Many people who know my story of self-healing know that in 1997 I was crippled with an autoimmune disorder that affected many systems of my body. After healing from the acute crippling aspects of the condition, I suffered from Chronic Fatigue Syndrome for the next 8 years. What many people don't know is that during this period I developed a wide range of secondary symptoms including severe insomnia, allergies and Restless Leg Syndrome among others.

While I have, for the most part healed from the illness that crippled my body, I do still suffer from some occasional odd symptoms. One of those is Restless Leg Syndrome (RLS).

My experience of RLS is like this. I lay down at night and I feel an energy build up in my solar plexus. The energy travels from my solar plexus to my left leg most often. I feel the discomfort mostly in my leg and not in my solar plexus. But, during a particularly bad episode, my solar plexus become agitated as well. The energy begs me to move and impacts my breathing. At first, I shook my leg a lot but that did not help. I then found that if I stuck the ankle of the opposite leg under and into the thigh muscle while lying on my belly that the trigger point type massage I was giving my self alleviates some of the discomfort. When the condition was particularly bad, I found that putting pressure on my solar plexus also alleviated or interrupted the flow of energy and I felt a little better.

Still, the relief gained from contorting my body in bed was only minimal and temporary. For a long time the condition frustrated me. I did not know that it had a name. I just knew that it contributed to my insomnia and at times I feared going to bed. At times in the past, the condition could get so bad that I simply could not sleep. Sometimes, my insomnia kept me up till the early morning hours.

Eventually, I did learn one way of alleviating the symptom that would allow me to fall asleep. That method was through sexual release. I observed that sexual release allowed the energy building up in my solar plexus to flow down and out. Without the release, the energy remained trapped and agitated eventually traveling down to my legs. Sleep came easy. As you can imagine, sexual activity became a part of my falling to sleep ritual.

Of course, Ayurveda and Yoga teach that excessive sexual activity is not healthy. It depletes the shukra dhatu (sexual energy) and leads to low ojas (weak immune system). What's a yogi to do? I continued to observe the condition and found a few additional clues. First, I observed that the condition tended to come on if I stayed up later into the night. By going to bed before by 10:00 , more often than not, the experience would be less intense or would not occur at all. The next observation was that while sexual release decreased the symptom for the one night, the next night it was more likely to occur again. In other words, by engaging in sexual activity I actually made the condition worse over time. On the other hand, the discipline of abstinence while initially making the condition worse, dramatically improved the condition over time.

From an ayurvedic perspective, the pathology of the condition includes a disturbance of vata dosha in the majjavaha srota. Vata dosha is responsible for excessive motion and disturbances in the movement of prana. In my condition, it was clear from the agitation to the solar plexus that pitta also played an important role. Hence, it can be said that vata may be pushing pitta out of balance.

In considering treatment for the condition, the ayurvedic practitioner should consider a vata or vata-pitta pacifying program of diet, herbs and lifestyle. Herbs that may be beneficial are those with the following actions.

1. Nervine Sedatives: These help reduce the flow of prana through the nerves and nadi of the physical and subtle body. skull cap and jatamamsi are good examples of nervine sedatives.
2. Nervine Tonics: These herbs help to stabilize the flow of prana through the nerves and nadi of the physical and subtle body while improving the ability of the nervous system to manage stress. Ashwaganda and shankhapushpi are examples.
3. Rasayanas: These are herbs that restore the strength and endurance of the body. Many herbs are considered to be rasayanas including ashwaganda and amalaki.
4. Cool Dipanas: These herbs have a regulating action on agni and on the flow through the manipura chakra. Fennel, dill and aloe vera are examples.

Each patient has their own unique experience and each person's path toward healing is often equally unique. Below are additional suggestions on how to manage Restless Leg Syndrome. .These are based on both my own personal experience and my experience working with my patients.

1. The condition may improve if the patient goes to bed earlier, prior to the rise in pitta that naturally occurs after 10:00pm .
2. If the condition is active, consider having the patient get out of bed and perform yoga poses that work the thigh muscles and also those that flex and extend the solar plexus and pelvis. I have found that forward bends, backward bends and spinal twists are all beneficial as well as specific poses that contract the thighs such as the chair pose and the warrior pose series. I would not recommend any poses be performed in a manner that is too active. All poses should be performed very slowly with great attention to the body and breath.
3. Have the patient perform alternate nostril breathing before bed.
4. If your patient has found that sexual release alleviates the condition encourage a period of abstinence to build the shukra and the ojas.
5. Avoid the use of stimulants such as caffeine and nicotine
6. Avoid the use of white sugar

By living an Ayurvedic and Yogic lifestyle, the nervous system of the body becomes balanced and healthy. This type of lifestyle supports the healing of all disease. Through the proper use of the senses and by following the specific herbal and lifestyle suggestions above, I am confident that patients with Restless Leg Syndrome can recover and live and sleep normally. This is not to say that the journey is easy, it most certainly is not. We must always remember that even small changes toward harmony in our lifestyle can stimulate the healing process and make dramatic changes in our well being.

The Importance of Marma Therapy in Ayurvedic Practice

   Marma therapy is an ancient Indian practice whose focus is the manipulation of subtle energy (prana) in the body for the purposes of supporting the healing process. Marma therapy is based on the utilization of 107 points in the body which are considered to be access points to body, mind and consciousness. Knowledge of Marma allows the practitioner to influence the flow of prana through both the gross and subtle bodies for the purposes of restoring health and peace of mind. 

   Marma therapy is the original point system of healing in the body. As it spread out of India it influenced the development of Chinese acupuncture and even Kung fu. Its origins are South India within a martial arts tradition known as Kalari Payatu. The art of Kalari was utilized to defend kingdoms during times when expertise in hand-to-hand combat was the mark of a great warrior. These ancient warriors needed to understand subtle energy and they used their knowledge to disable or kill an opponent. “Marma” comes from the Sanskrit “Mru”, which means “To Kill”.  The 107 marma points are categories in terms of their effect on the vitality of the body. Some points, when injured, simply hurt. Others, when injured, become life threatening. While warriors had knowledge of these points for the purposes of defending a kingdom, it was the job of the physicians to utilize these same points for healing. The Marma master, sometimes called an “Aasan” or a “Marmani”, would also tend to the wounded. The master had the knowledge both of how to cause injury as well as how to use the knowledge and awareness of prana for healing.  The “Aasan” was a rare master who could both kill and heal a person with a touch.

   Knowledge of marma was not separate from Ayurveda.  Discussion of the marma points is found in most of the great texts of Ayurveda but the most famous text to explore the subject is the Sushruta Samhita.  Vaidya Sushruta described the locations of the marma points, as well as how they influence prana.  He stated that it was important for the surgeon to have knowledge of these points for the purposes of avoiding them, as to cut into them could result in a catastrophic outcome. 

   An important principle of marma therapy is quite simple. Where a strong blow can cause injury, a mild touch can cause healing. This is the most important principle of Marma massage. When the knowledge of marma is combined with an ability to both perceive and direct the flow of prana, marma chikitsa becomes a powerful tool for influencing the healing of every known condition.  While marma therapy is not well known or practiced except by a few practitioners in India, its practice is becoming more popular here in the United States. 

   I was introduced to the practice of Kalari Payatu and marma therapy in the mountains outside of Cochin, in Kerala in 1999. It was a brief but powerful experience and I have been fascinated with it ever since. My previous training included cultivating the ability to perceive subtle energy and I studied various point systems of the body. This made it easier to grasp. However, my knowledge of Marma came more from re-awakening than from formal teaching. Structure, however, is needed for awareness to flow. Toward the end, I always found Dr. Ranade’s and Dr. Frawley’s text on Marma to be very illuminating. The illustrations and summations of the knowledge are quite excellent. 

   The work I do today with marma therapy has its roots in Kalari, was nurtured by Sushruta, was cultivated by Dr. Frawley and Dr. Ranade and ripened by my own awareness and experiences. The six-day Marma Therapy Course and the five-day  Advanced Marma Therapy Course I teach at the College are the fruit of this knowledge. During the Basic Marma Therapy Course students learn to identify the 107 points on the body. They also learn to perceive the flow of prana and learn the basic technique for manipulating the flow of prana using awareness, intention, essential oils, light pressure massage and pranic healing.  This is then applied to learning a general full body healing protocol and then specific protocols to treat lower back and neck pain as well as shoulder and knee pain.  

   During the Advanced Marma Training Course students review the Basic Course and then spend several days learning new protocols including the management of the male and female reproductive systems, liver and splenic disease, conditions of the nervous system, the management of agni, the management of the heart and much more. The advanced course is more practice than theory.  

   Every Ayurvedic practitioner would benefit from learning Marma Therapy. It can be practiced on and off the body. It can be practiced with the clothes on or off. It is safe, simple, effective and it supports the counseling work of the practitioner, as well as the hands-on work of the Ayurvedic Massage and Body Therapist. 

Quotes from Students Who Have Taken the Course

“I loved this course.” — Michelle Magid 

“I loved the comprehensiveness, detailed explanations and the responses to questions.”— Abiola Ofachte 

“It was like a lifetime of knowledge came back in just one course.” — Clement Lam (Sankara)

“This training was one of the most complete trainings I have ever taken.” — Janice Craig

“One of the best programs I’ve attended.” — Wendy Boerger

“Probably my favorite workshop / class yet in the whole program!” — Jessica Hartley 

“I thought it was amazing and grew and learned so much. It was life changing.” — Jill Johnson

“I came to learn but had a deep personal transformation.” — Eleni Tsikrikas 

“It was absolutely beautiful.” – Maria Szarfac

“I had no idea that it could work to such a level. It’s not the program information, it’s the teacher.” — Bobby Thakar 

“Certainly one of the highlights of my first year at CCA!  Wonderful instruction, compassionate teaching.” — Heather Anthony 

“Wow!! It was my favorite workshop.” — Dena Jackson 

“The best workshop I’ve taken at CCA. Dr. Halpern brings 100% expert knowledge into the subject.” — Leslie Stewart 

“It was fabulous. It was deeply healing and transformative.”  – Laura Perlin

“ A great teacher who knows how to present information in an open and welcoming way using visual, verbal and tactile approaches.”— Angela Brown 

“The information was well put together, easy to follow and the result was such a positive one. Dr. Halpern is truly what made this course for me. His presence and ability to communicate to all of us was one that is rarely found.” — Totiana Lamberti

“I loved it. The material was so magic.” — Kara Lukowski

“I was very excited and surprised at how much we focused on energy and pranic healing. This knowledge is necessary and will never be forgotten. The experience was so gratifying and there is nothing else I would rather have been doing.” — Jaime Lefcovich

“As a full time bodyworker, I will use this information every day.” – Thomas Taylor

“It was perfect!”— Julie Wardell

“It’s been a while since anyone has been able to enlighten me and I am very excited about it.  Marc is the best teacher I have ever worked with.” — Gina Abeyts

“It’s very complete, very well prepared and very important.”— Lucs Tubio 

 “Dr. Halpern brings out information that cannot be drawn from a book.” — Glen Swindler 

“The guided marma meditation was great.” — Bernadette Mansori 

“It was an amazing learning and growth experience. I loved it.” — Jen Petullo

“Thank you for teaching by example.” — Becky Frazier