Using Ayurvedic Practices in the Treatment of Crohn’s Disease An Eastern Practice in the Western World By: Jocelyn Segal-Townsend

Western and eastern medicine have different but relatable approaches to healthcare and wellbeing. As the world develops, the ability to gather and share information has become more and more accessible. In the West, this has lead to a greater ability to understand complex diseases that have previously seen as mysterious or psychosomatic in nature, an example of that is Crohn’s disease.  

 

Western medicine classifies Crohn’s disease as an irritable bowel disease that consists of chronic inflammation in any part of the digestive track. This inflammation causes deep ulceration amongst the digestion track’s mucous and sometimes muscular layers. 

To quote: “Whatever the initiating factors in Crohn’s disease, excessive activation of mucosal T cells leads to transmural inflammation, which is amplified and perpetuated by the release of proinflammatory cytokines and soluble mediators.19”   As a result of inflammation and ulceration the subject may experience abdominal pain, fissures, diarrhea, gas, weight loss, fatigue, and malnutrition. Secondarily, to the main symptoms, if left untreated, patients may suffer from fever, eye disease, skin and joint inflammation20.

 

Though western science officiates that the cause of Crohn’s disease is still uncertain, many findings in western medicine and research, psychology and gastro-immunology speculates that a combination of psychological, genetic and bacterial infection play a key role in the onset of disease.  Gastroenterolgist, Dr. Drossman quotes,“I believe there is at least indirect evidence that psychosocial factors do affect disease susceptibility and activity. The most likely mechanism for this to occur would be through psycho immunological pathways3.”

Crohn’s disease, like many autoimmune related disease need both be triggered and have the genetic components for susceptibility. Professionals including Dr. Gabor Mate, Dr. Michael D. Gershon and his predecessor – Dr. J.N. Langley, believe that there is a correlation between stress, the nervous system and digestive health which triggers the onset of Crohn’s1,2,3. Dr. Gabor Mate, in his book, When the Body Says No, states that most unexplained digestive diseases and disorders root back autoimmune deficiencies created by the sympathetic nervous systems in its attempt to process hidden stress and/or trauma4.

 

In fact, research has been conducted across North America on the impact of mental health on digestive health. A study done by the University of Toronto found that 25% of irritable bowel related diseases first reported symptoms in relation to physical, emotional, or sexual abuse during childhood. Other patients reported high amount of interpersonal stress11,12. In the U.S.A, a study conducted by J Pediatr Gastroenterol Nutr., on 499 youth with irritable bowel disease between the ages of 9-12 from the years 2008-2012, found that 38.1% of patients struggled with clinically identified depression symptoms including negative thought patterns such as: rumination, and powerlessness. It has been hypothesized that the depressive mind-set is due to enduring circumstances outside of their control16. How stress is dealt with may be genetic. Studies that show that stress is a component that trigger the onset of Crohn’s disease. Although this has been researched, certain chromosonal markers need be in the genetic composition of a person in order to develop Crohn’s Disease19. 

 

With genetics in play, the psycho/gastro immunological issues seem to self perpetuate the continuation of Crohn’s disease flare ups. Studies done by the Centre for Digestive Disease concludes that, “In patients with Crohn’s Disease, the immune system seems to overreact to substances and bacteria in the intestine21.” They also believe that geneology in culmination with bacterial exposure and a hyperactive nervous system play a role in the causation of disease. To further this notion, Gabor Mate has found a continuity in his patients with Crohn’s disease, they’re all highly conscientious and thus internalize stress. Their temperaments seems to indicate characteristics of high sensitivity including but not limited to: perfectionism, self-critical behaviour and underlying anxiety3.  As western science has shown, there is a correlation between the nervous system and the gut. In fact, the gut plays a role in the wellbeing of two nervous system, the central nervous system and the enteric nervous system23.  Modern research in western medicine shows that the vagus nerve sends information from the gut to the brain. If there is an imbalance in gut flora, e.i. too little, there in an effect on the brain’s chemical synthesis, creating a  decreased flux of neurons such as serotonin which can lead to negative emotions. Even more so, just as the brain has neuron receptors, so does the gut. Hence, gastro imbalances directly impact a person’s mood22. Evidence suggest that those with Crohn’s disease struggle with two types of bacterial infection, having had a bout once in their lives with Salmonella and Adhesive-Invasive E Coli (AIEC). This, in culmination with childhood stress, and exposure to the bacterias would create a looped unit between mind, body and emotion that perpetuates bacterial growth and infection. In fact, a Danish population-based and follow-up study found that contraction of nontyphoid Salmonella or thermophilic Campylobacter increases the risk of developing any IBD24.  The difficulties in healing Crohn’s disease becomes complicated. Stress allows for the bacteria to continue to develop in the gut, causing ulceration and inflammation, however if the gut is unhealthy, the person experiences stress. Therefore it is understandable that Ayurvedic medicine would attribute one of there causes of digestive upsets such as Crohn’s disease to fear and grief, as it is only by treating the mind, body and emotions, from an Ayurvedic perspective,  can Crohn’s disease be put back into remission.  

Gabor Mate, M.D. writes: “It is my pleasure and a privilege to uphold, therefore bring in front of the reader the findings of modern science that are reaffirming the intuitions of age-old wisdom.” – When the body says no, A note to the reader1.

 

Though Gabor Mate M.D does not directly state that in part the intuitive wisdom he speaks of includes the teachings of Ayurvedic Medicine, the correlation between the research of western doctors is clearly comparable and affirms the statements made by Ayurvedic doctors and in classical texts.

 

It is challenging to talk about Crohn’s disease without addressing ulcerative colitis, as modern Ayurveda conglomerates them under the same classification: Grahani (Ulceration of the small intestine or duodenum),  which effects include atisara (diarrhea) and udara roga (Abdominal pain and cramping)6.  For a matter-of-fact, both the Caraka Samhita and the Astanga Hrdyam attest to the psycho-immunological nature of digestive disfunction7,9,10.

 

The classical text Vaghata’s Astanga Hrdyam, intestinal disease of this sort is said to be caused when atisara caused by grief (sojoka and bhayaja atisara) are left untreated to the point of progressing into Grahani26. This is seen both in ulcerative colitis and Crohn’s disease, hence why Ayurveda conjoins them in both pathology and treatment. 

 

In the Caraka Samhita, it is written that there are two types of diarrhea that arise due psychological factors. They are sokaja atisara- those caused by grief and sannipataja atisara- those caused by fear and anxiety25. Here, it is evident that in ancient India there was an understanding of mental health’s impact on digestive wellbeing, as two sources reinstate it.

 

In a discussion about Ulcerative Colitis, Vasant Lad explains “vata” the dosha that is also increased by stress “pushes pitta into the colon causing inflammation.5”. Gangadhara Roy, discusses this as well in the Caraka Samhita when he states that the psychosomatic nature of these two types of digestive disturbances then later associates as vata dosha27.  

 

To fully understand how the Ayurvedic perspective relates back to new western findings, one will have to look at the interconnectivity of the bodily systems including the Ayurvedic Principles of Disease. The Ayurvedic Principles of Disease explains how a specific disease spreads. From the perspective of the Caraka Samhita, there are three causes of disease they are: Prajnaparadha: intellectual blasphemy (misuse of knowledge or crimes against wisdom),  unwholesome conjunction of subjects with objects of affection (misuse of objects and substances), and parinama: transformation due to time or motion7,8.

 

In the case of Crohn’s disease, vata’s subdosha, prana vayu, is the first to be vitiated in the onset of Crohn’s disease. Prana vayu is aggravated by the over stimulation of external stimuli, this causes excessive movement of the mind, which relates back to parinama, as it is a transformation done over time and with excessive motion. Prana, then enters the body and circulates through the body as vyana vayu. Vyana vayu is the air that moves from the body’s centre to its’ peripheries. It often, and does in this case, move information through the majjavaha srota and effects the state of the majja dhatu , which is the eastern equivalent of the nervous system and nervous tissue7. When the information from the external world is too much, the nervous system becomes hyperactive or vata imbalanced. Understanding this connection between dhatu (tissue) and subdosha can help to clarify the current evolutions in western thinking.

 

The nervous system controls stress response. When stress is high from an increase of stimulation from prana, the first signs of the development of Crohn’s disease are seen. The subject, at this point, may experience early symptoms of digestive upsets such as gas and constipation, he or she may have mild systemic dryness and feel weak and/or cold. Many studies of Crohn’s disease and related digestive disorders have shown that the subjects have had symptoms of weak digestion and digestion disturbances far beyond the onset of disease, this relates back to the studies of childhood stress and previous bacterial infection playing a role in the causation of Crohn’s. At this point, there would be chronic digestive upsets similar to the symptoms in accumulation and aggravation of pitta and vata. As the disease continues, “ White blood cells invade the intestinal lining and produce inflammatory toxins causing chronic tissue swelling, injury and ulceration17”. As primary symptoms are often ignored due to external unremovable stressors, the majja dhatu becomes overwhelmed with vata, so the disease needs to relocate. Thus, as the vata relocates, it does so in the inner pathways also known as the digestive track, affecting what Ayurvedic science calls the mahavaha srota). 

 

In the small intestine of the digestive track, vata transmutes to samana vayu, the wind that stokes the fire7. Because there is an overload of vata in the body, the samana vayu vitiates the Agni and pachaka pitta throughout the digestive track. In the development of Crohn’s disease the stressful stimuli, does not get removed. This, in culmination with the over conscience personality already has high vata and pitta in their constitution, this is notable in their sensitivity and self-critical behaviour. Their data and pitta prakruti (natural constitution) makes them more susceptible to vata and pitta vikruti (state of imbalance). As vata pushes pitta throughout the digestive track and stimuli continues to increase vata and pitta, kapha becomes vitiated in attempts to protect the mucous lining and walls of the digestive track from dryness and acidity (vata and pitta imbalance). This makes Crohn’s disease a tridoshic disturbance, also known as, sannipatika (tridoshic gastric disturbance). Digestive symptoms, at this point of relocation, may appear as: bloating, weight loss, constipation, diarrhea, ulceration of the digestive track stemming beyond the small intestine, high gastric acidity, mucous in stools, and loose stools6.

 

If, as often does, Crohn’s disease persists without effective treatment, it will cause mood disturbances such as anxiety, depression, lethargy, and angst20.

 

In Ayurveda, it would be stated that in the samprapti, also known as the pathogenesis, that Vata, Pitta and Kapha would relocate in the manovaha srota. Vata in the Manovaha srota causes anxiety, pitta causes fever, angst or anger and kapha causes lethargy and depression30.       

In many cases, eye ulceration and reddening, as well as acne may be present as the body attempts to release toxin and acidity. Canker sores which are ulcerations in the mouth, are another symptom that is seen in patients with severe gastro intestinal disease20. In Ayurveda, this would be further relocation and manifestation of pitta dosha in the forms of alochaka pitta (the fire that digests light and visual impressions)7 in the Majja Dahtu (tissue of the nervous system), bhrajaka pitta in the mamsa dhatu; as for canker sores, they can be understood as a conjoined vata/pitta imbalance in the annavaha srota (upper digestive track) or as part of ulceration in the mahavaha srota6.

 

Like Gabor Mate has stated, understanding the wisdom of the East offers guidelines to further unfolding why the manifestation and relocation of perplexing autoimmune diseases, such as Crohn’s disease, develops the way that it does. By choosing to understand the bodily systems as channels, tissues and connected elements (with inherent qualities), we can commence comprehension of an illness that would otherwise seem arbitrary and only half explained by western science. As the eastern healthcare system offers a comprehension of the Crohn’s disease, by implementing their use of herbs, oils, diet, and exercise, we can effectively treat Crohn’s disease  by addressing the body as a whole. 

As we turn back to the ancient wisdom of Ayurveda for solutions to the management of Crohn’s disease, there are a few options on how to go about it. The best option for treatment depends on the severity of symptoms. Some patients may succeed from treating the root of the disease while simultaneously treating the primary symptoms;  for them, this will be enough to clear up secondary complaints. Other patients will need additional treatments for the secondary complaints. Despite the variability in approaches, in treating Crohn’s disease, all processes should address the primary complaints, balance the subtle body and healing the mahavaha srota from both ulceration and flora imbalances. The following paragraphs will discuss treatment for the cause and primary complaints of Crohn’s disease.

 

Firstly, in the case of Crohn’s disease, the patient often shows signs of emaciation, weakness and low energy. Palliative care, known as shamana chikitsa, is necessary as Ojas (mental and emotional stability) is low but ama is high. Palliative care is necessary in cases when dhatus need to be purified from ama (mucous and toxin) but also tonified. In classical Ayurveda’s Astanga Hrdayam treatment for grahani can be found to include treatment for both atisara and udara roga9,10. The first thing that the book suggests is the implementation of herbal decoctions and a change of diet. Making these changes address the primary complaint of the patient, by cleansing bacteria from the gut and helping to reestablish gut flora. The use of medicated oil, rest, scent and meditation are necessary to rebuild Ojas. Once internal balance is rekindled, lifestyle changes have proven effective to keep the vata/pitta prakruti common to Crohn’s disease in remission. Dr. Drossman has implemented the use of mindfulness practice in his treatment of IBDs after research conducted in 1985 at the University of Massachusetts Medical Center found mindfulness based practices beneficial for stress related diseases. These practices, of which are taken from eastern culture have shown to decrease cortisol levels which, when high, trigger the autoimmune system, leading to re-laps of disease18. Thus, once disease falls into remission, lifestyle management using mindfulness practices improves overall health.

The Ashtanga Hrdayam suggests that in the cases of atisara and grahani that the patient begin with a cleaning process to remove toxins. Therapy for atisara includes vomiting and purgation which may be helpful in removing the substance or bacteria that is obstructing the proper flow of the digestive track. As the patient is weak, appetite needs to be built. Fasting or eating lightly for a few days is helpful for both Atisara and Grahani. To reduce further vata imbalances. Fasting should include oleation with vata reducing medicated oils28. Other therapies, such as scent therapy and meditation can be used during this time. The fasting and cleansing period should last no longer than seven to ten days depending on the patients strength6. 

The Astanga Hrydayam suggests that water well cooked with the ayurvedic plants and minerals known as: Vaca and Prativisa, musta and parpata or hribera and nagara should be ingested. Only when hunger arises should the patient eat. The patient should consume small portions of food that aids digestion and quickly reenables taste and digestive capabilities. Food such Tarka (buttermilk), sour gruel and thin gruel, tarpana (a paste made of flour, ghee, milk and sugar), beer or madhu, fremented liquor prepared from honey are suggested to rebuild agni when hunger arises9.

 

The second stage of rehabilitation includes foods processed with water absorbents and carminatives for example: aparajita Khala acts as both, and eating tender fruits of, but not limited to, bilva, sathi, dhanya, hifiguvrksamla and dadima9.

When hunger is completely reestablished eating foods such as sali rice mess, vegetable soup and medicated ghee formulated with dadhi and dadima. This should be taken to when symptoms of vata are present, as the oils and warm watery content help to soften hard stools. As diarrhea is to soon be expected, it is also recommended in the Ashtanga Hrdayam, to have the gruel also prepared with tender leaves (kapittha, kacchura, phanji, yuthika ect.) which will help alleviate symptoms of pittaja when they arise.  If flatus is a consistent problem the Astanga Hrdayam regards the use of milk in large quantity straight from the utters of the cow, if possible9. 

 At this point in time modern Ayurveda that takes the knowledge we now know about Crohn’s disease and still suggests that the patient should introduce herbs to clear the intestines from pathogens. There are herbs with similar qualities to the ones mentioned in classical Ayurveda to which we might be more familiar. These are expressed in the following formula:

 

This formula should be taken throughout the fasting period in the amounts of 1/4tsp two to three times a day and can continue to be taken for one to two months5,6. 

 

As disturbances to the gut begin to clear the patient will benefit from a formula to heal ulceration throughout the mahavaha srota. Vulneraries and hemostats can be used for this. Note: all formulas containing comfrey should be used for only a limited period of time due to its’ harmful effect on the liver. For long term use, slippery elm can be supplemented for comfrey, however, the hemostatic properties will be lost29. The following formula can be used in mending ulceration and bleeding from colon, to intestine and muscular layer:

This formula can be in medicated ghee in the amount of 1/4 tsp 2 or 3 times a day.

 

Suggested oils to reduce vata include: castor oil, sesame oil and almond oil. Nervine sedatives and tonics such as Ashwaganda and shankha pushi should be added to the chosen oil. These oils sound be used for full abyanga. Abyanga targets both secondary symptoms effecting the skin and the manovaha srota7. When appetite is built, light, easily digestible meals, such as vegetable soup with well cooked rice with medicated ghee containing: carminatives, dipanas, and purgatives are recommended6,9,10.

Because Crohn’s disease roots back to a sensitivity towards stress and anxiety, ayurvedic treatments targeting vata and pitta in the digestive track have been suggested throughout time for treatment. More so, the evolvement of the western wellness community’s thinking, such as that conducted Gabor Mate and Dr. Drossman, has recognized the psychological tendencies experienced by the patients that perpetuates the autoimmune condition. These psychological tendencies were expressed in Ayurveda during the time the Astanga Hrydayam and Caraka Samhita were written as sokaja atisara and sannipataja atisara, suggesting the relevancy of ancient Ayurveda in a modern day world.