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Ayurveda Articles In this section you can find several Ayurveda articles written by Dr. Marc Halpern, as well as numerous student research papers.
Important Herbs in Ayurvedic Medicine Ginger: An Ancient Panacea for Modern Times ( By Brenda Castro) INTRODUCTION Known as vishwabheshaja, “the universal medicine”, ginger (zingiber officinale) has been a panacea for digestive, respiratory, and circulatory disorders for thousands of years.1,2 Ginger’s versatility is found in ancient Ayurvedic texts, international cuisine, and a broad spectrum of home remedies. With today’s advent of scientific research, ginger’s therapeutic constituents are being isolated and tested against some of the most common diseases. Not only has it been scientifically proven to aid in digestion, ginger has also shown antiinflammatory, anticarcinogenic, and antioxidant properties. This paper gives a brief background of ginger, its traditional Ayurvedic use, and its effectiveness in clinical trials.
HISTORY Ginger is a perennial lily, indigenous to tropical Asia, though it has never been found growing in the wild. Even though its exact botanical origins are unknown, it plays a large role in the ancient traditions of Ayurveda, Unani, and Chinese Medicine. The flowering plant reaches heights “of 3 to 4 feet, *with+ leaves growing 6 to 12 inches long…[Its] flowers are white with purple streaks and grow in spikes.” 3 The medicinal portion used is the rhizome, or horizontal, underground stem. This fleshy, aromatic, firm, fibrous, and plump portion of the plant is how it propagates itself, through its many knobby portions, and not through its sterile flowers. Today it grows throughout the world in tropical Botanical Drawing of Zingiber officinale A Modern Herbal, Mrs. M. Grieve, Ginger. http://www.botanical.com/botanical/mgmh/g/ginger13.htm climates, its unique flavor finding its way into signature dishes worldwide. 4 ,5,6 http://www.ayurvedacollege.com/book/export/html/2
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Whereas Indian, Chinese, and other Asian cuisines have used ginger for thousands of years, its unique qualities made it attractive to Europeans more recently, as an important ingredient along the spice trade routes. Ginger ale was popular in 19th century pubs, while ginger’s use in everything from baked goods, to salad dressings, to exotic dishes continues in the western world.7,8 As KP Khalsa says, in the Way of Ayurvedic Herbs, “*g+inger is a multipurpose spice, equally delicious in both sweet and savory dishes.” He also mentions that, though “*h+erbs and spices are typically not significant sources of nutrients in the diet…ginger has [a] relatively high calcium and iron content.”9 Its addition to meals may therefore not only add flavor and medicinal properties, but valuable nutrients too.
AYURVEDIC INTERPRETATION In Ayurveda, ginger’s rasa (taste) is pungent and sweet, its virya (energy) heating, and its vipāka, (post digestive effect) sweet. Even though it has a pungent and heating, it is tonifying, as a sweet vipāka implies. As Pole explains in Ayurvedic Medicine, this sweet vipāka leaves a cooling, lasting effect. Through its warm virya, it subdues vāta and kāpha, while increasing pitta, though it is often found counterbalanced in pittareducing remedies. As the “universal medicine,” it affects all dhātus (tissues) and specifically the digestive, respiratory, and circulatory srotas (channels). 10,11,12, 13 The Ayurvedic actions of ginger, as described by Pole include: Āmanāśaka (Destroys toxins), Pācana (Digestive), Chardinigrahaṇa (Prevents nausea), Hikkānigrahaṇa (Stops hiccups), Agni dῑpana (Enkindles the digestive fire), Grāhῑ (Absorbs fluids from the intestines), Arśoghna (Removes piles), Śitapraśamana (Reduces feelings of cold), Rasāyana (Rejuvenative), Kāsaśvāsahara (Alleviates cough and breathing difficulties), and Vedanāsthāpana (Alleviates pain).14 Its therapeutic uses are also found throughout the Materia Medica of Ayurveda and the Sushrut Samhita, mostly in formulas treating varying complaints.
WESTERN INTERPRETATION In western herbal terminology, it is described as a stimulant, diaphoretic, expectorant, carminative, anti emetic, analgesic, sialagogue, appetizer, antiflatulent, antitussive, antimicrobial, hypolipidemic, antioxidant, antispasmodic, antiatherosclerotic, cardiotonic, circulatory stimulant, and emmenagogue. Its indications include digestive upset of all kinds, including nausea, indigestion, vomiting, belching, abdominal pain, gas, colic, and motion sickness. It can also be used for respiratory conditions, rheumatism, osteoporosis, gout, colds, flu, laryngitis, arthritis, hemorrhoids, headaches, heart disease, gas, “cramps in the abdomen, including menstrual cramps due to cold”15, migraines, lumbago, fever, and its fresh juice can even be used for burns. 16,17,18,19,20 With such a long list of actions and indications, it is no wonder it is referred to as “the universal medicine”.
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ĀRDRAKA & ŚUṆṬHI Ginger has many names across cultures, and even within Ayurveda. Most commonly, the fresh form is recognized as ārdraka (moist), and the dry rhizome as either śuṇṭhi or nagara, meaning “dry.” 21 Traditional Chinese Medicine also creates a distinction between these two forms of the rhizome, calling fresh ginger shen jiang and dry ginger gan jiang.22,23 Scientific research confirms the difference between the properties of fresh and dried ginger. As the “volatile and diaphoretic essential oils βsesquipphellandrene and zingiberene decompose on drying…*t+he warming gingerol principle transforms into shogoals…making it more centrally heating”. 24 “Gingerols have been reported to be responsible for the characteristic taste” of ginger. 25 “The gingerols have analgesic, sedative, antipyretic, antibacterial and gastrointestinal tract motility effects.26 As the most numerous chemical constituents of ginger, both gingerols and shogoals are some of the most researched compounds of ginger. In The Yoga of Herbs, authors Frawley and Lad mention that “*f+resh ginger is a better diaphoretic, better for colds, cough, vomiting and for deranged Vāta.”27 In both the Materia Medica of Ayurveda and the Sushrut Samhita, ārdraka is touted for promoting a “good voice,” curing vibandha (constipation), ānāha (obstruction to the movement of wind in the stomach), and śúla (colic pain). It is said to be an effective “appetizer, aphrodisiac and cardiac tonic.”28,29 It is also found as part of a treatment for acute conditions, such as earache. 30 Frawley and Lad also state that the drying action and increased heat of dry ginger makes it “a better stimulant and expectorant for reducing Kapha and increasing Agni.” Śunthi is found in many kaphareducing remedies throughout the Materia Medica, often combined with marica (black pepper) and pippalῑ (long pepper).31 Together the three herbs, combined into powder in equal portions, are commonly called Trikaṭu Cūrṇa, a heating, stimulating, and toxinreducing rasāyana for Kapha.32
APPLICATIONS & RESEARCH DIGESTIVE SYSTEM Ginger “warms the digestive system, [and] increases agni and the secretion of digestive enzymes. Fresh ginger especially benefits rasadhātvagni (agni of the rasa dhatu) while dry ginger clears āma and is better for kledaka kapha aggravations.”33 As Pole suggests, the two forms of ginger play different roles in digestion, but both help to warm and stimulate the process. Many randomized controlled trials (RCT) were performed on people to examine ginger’s effect on digestion. It is said that “*a+bout 40% of patients with functional dyspepsia have abnormally delayed gastric emptying.” 34 Therefore, two RCTs were done to “evaluate the effects of ginger on gastric motility and emptying, abdominal symptoms, and hormones that influence motility in dyspepsia”. 35 Patients who suffered from functional dyspepsia ingested either three ginger capsules totaling 1.2g, or a placebo. Gastric emptying was more rapid http://www.ayurvedacollege.com/book/export/html/2
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and antral contractions were more numerous in the experimental group, but the ginger “had no impact on gastrointestinal symptoms or gut peptides.” 36 The same study was done previously on healthy, asymptomatic volunteers to test the gastrointestinal effects of ginger. Again, the 1.2g of ginger accelerated gastric emptying while stimulating antral contractions. 37 In another RCT, adult respiratory distress syndrome (ARDS) patients, who were dependent on mechanical ventilation and fed via nasogastric tube, “showed that gastric feed supplementation with [120mg] ginger extract might reduce delayed gastric emptying and help reduce the incidence of ventilatorassociated pneumonia in ARDS.” 38 Pole also mentions ginger’s effectiveness in nausea for motion sickness, morning sickness in pregnancy, and postoperative nausea.39 Ginger as a remedy for motion sickness was evaluated in an RCT, where the experimental group was pretreated with ginger at 1g and 2g before being subject to circular vection. The study showed that “ginger reduces nausea, tachygastric activity, and vasopressin release induced by circular vection,” while delaying their onset and shortening the recovery time afterwards.40 Another RCT, evaluating the effectiveness of ginger on motion sickness, was performed on “eighty naval cadets, unaccustomed to sailing in heavy seas”. 1g of “ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo” and ingestion gave “remarkably fewer symptoms of nausea and vertigo,” though the latter “was not statistically significant.”41 One article explained that, “gingerols have been reported to be responsible for…many pharmacological activities including motion sickness”. They are thought to work directly “on the gastrointestinal tract rather than…on the central nervous system.”42 Studies show that ginger’s antiemetic properties can benefit patients in a variety of circumstances. In a guide for prenatal care from London, the authors referred to three RCTs that demonstrate the alleviation of nausea and vomiting in pregnancy with the use of ginger. After taking 250 mg of ginger, four times a day, pregnant women displayed less severe nausea and fewer instances of vomiting over those in the control group. In another RCT mentioned in the report, patients ingesting 1 tbsp. of ginger syrup in 4 to 8 fluid oz., four times a day, showed a relief in nausea and less vomiting than those in the placebo group. 43 Ginger was also found to be effective in a review of RCTs concerning postoperative nausea and vomiting. The analysis demonstrated “that a fixed dose *of+ at least 1 g of ginger is more effective than placebo for the prevention of [24hour] postoperative nausea and vomiting *PONV+.”44 In clinical trials for patients with Chemotherapyinduced nausea and vomiting (CINV), ginger again proved to be a valuable antiemetic. “Ginger root powder was effective in reducing severity of acute and delayed CINV as additional therapy to ondensetron and dexamethasone in patients receiving high emetogenic chemotherapy”. 45 Thus, the ancient tradition of using ginger to reduce nausea by stimulating digestion has been proven successful in clinical trials. In addition to aiding in the general digestive process, it exhibits cholagogic effects, with its chief pungent principles, [6]gingerol and [10]gingerol, being most responsible. 46 While ginger stimulates bile production, it is also hepatoprotective. A study using an aqueous ethanol extract of ginger concluded that it works either by preventing the decline of hepatic antioxidant status or due to its direct radical scavenging capacity.47 Another experiment compared the hepatoprotective property of 6gingerol against the standard drug silymarin, and found them to by comparable.48 Even though it is heating in virya, ginger has even been shown to be beneficial in the treatment of experimental ulcers. It stimulates defensive mucin (a constituent of mucous) production slightly more than the offensive acidpepsin secretions. The isolated compound 6 gingesulphonic acid proved more effective in anti ulcer activity than 6 gingerol and 6shogaol, perhaps due to weaker pungency.49 A study on ulcerinduced rats “clearly demonstrated that aqueous extract of ginger was able to protect the gastric mucosa from stressinduced mucosal lesions and inhibits gastric acid secretion probably by blocking H+, K+ATPase action, inhibiting growth of H. pylori and offering antioxidant protection against oxidative stressinduced gastric damage.” 50 Ginger also assists in the treatment of ulcers through antibacterial actions, as found by a Nigerian study: http://www.ayurvedacollege.com/book/export/html/2
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Ginger’s antibacterial ‘power' is effective against preventing numerous intestinal problems that take place as a result of the alteration of the intestinal flora. This is ideal to avoid the formation of ulcers by eliminating the Helicobacter pylori, a bacterium whose secretions of ammonia are responsible for many ulcers, especially those of the duodene, and for other stomach problems like gastritis, since the plant is able to neutralize the excess of gastric acid that is another of the causes that favours the formation of ulcers.51
ANTIMICROBIAL “Its gingerolrelated components have been reported to possess antimicrobial and antifungal properties, as well as several pharmaceutical properties.” 52 The aforementioned Nigerian study demonstrated the effectiveness of the antibacterial properties of ginger against digestive pathogens. Various extracts, ranging from ethanolic to raw juice, to hot and cold water, exhibited varying effectiveness at different concentrations. “*T+he coldwater extract of ginger inhibited both Escherichia coli and Salmonella typhi at all concentrations,” while the “ethanolic extract of ginger gave the widest zone of inhibition” against Salmonella typhi. In other studies referenced by the authors, “ginger extract and its pungent compounds demonstrated greater [than those of onion] antibacterial activity against a variety of bacterial species including Helicobacter pylori, Staphylococcus aureus, Pseudomonasaeruginosa and Escherichia coli, although mixed result is attributed to different ginger preparations and varying strength.”53 Pole confirms ginger’s antibacterial actions against Escherichia coli and adds its effectiveness against Shigella bacillus.54 Ginger’s antimicrobial actions go beyond digestive pathogens. As some bacteria grow resistant to pharmaceuticals, such as Acinetobacter baumannii (XDRAB) has, scientific studies turn to ginger as a potential aid. When combined with tetracycline, four components of ginger, [6] dehydrogingerdione, [10]gingerol, [6]shogaol and [6]gingerol, exhibited antibacterial actions against XDRAB, and modulated resistance to the drug. Results of the experiment also showed that antioxidants within the compounds aided the antimicrobial actions. 55A research article in Phytotherapy Research sought to explore the antibacterial actions of ginger, and its isolated components, on oral pathogens related to periodontitis. Ethanol and nhexane extracts of ginger showed anti bacterial actions, while the isolated constituents [10]gingerol and [12]gingerol, also inhibited the growth of, and killed the three strains of bacteria in the experiment.56
ANTIINFLAMMATORY Ginger is gaining more and more recognition for its antiinflammatory actions. While Ayurveda has long touted its benefits, contemporary research studies are now proving which constituents are most responsible, and how they work. From an Ayurvedic perspective, Pole states, “*d+ry ginger is used as an āmaclearing, śleṣaka kaphareducing, toxindigesting, antiinflammatory in arthritis (āmavāta) in many traditional ayurvedic formulas, e.g. triphala guggul, yograj guggul.” He goes on to mention that, “despite its ‘warm’ energy it also inhibits the activity of inflammatory prostaglandins.” 57 As a relative of turmeric, ginger shares many of its functions. One study found ginger’s active constituents to act much like turmeric’s in affecting inflammation, oxidative damage, and “fighting the ravages of aging and degenerative diseases.” It did so by influencing: some endocrine gland functions, and signal pathways involved to mediate their actions. With some systems and adipose tissue, ginger and turmeric exert their actions through some/all of the following signals or molecular mechanisms: (1) through reduction of high levels of some hormones (as: http://www.ayurvedacollege.com/book/export/html/2
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T4, leptin) or interaction with hormone receptors; (2) by inhibition of cytokines/adipokine expression; (3) acting as a potent inhibitor of reactive oxygen species (ROS) generating enzymes, which play an essential role between inflammation and progression of diseases; (4) mediation of their effects through the inhibition of signaling transcription factors; and/or (5) decrease the proliferative potent by downregulation of antiapoptotic genes, which may suppress tumor promotion by blocking signal transduction pathways in the target cells. 58 Today, scientists look to some of the key enzymes within the body to understand the mechanism behind ginger’s antiinflammatory properties. Actions from Cyclooxygenase1 (COX1) enzymes produce hormonelike prostaglandins that protect the digestive tract from acids and assist in essential blood clotting. COX2 enzymes play a direct role in the production of prostaglandins that protect the body after injury, creating inflammation. Nonsteroidal antiinflammatory drugs (NSAIDS), such as aspirin and ibuprofen, are often used to both reduce inflammation, and the associated pain. By acting on COX2 and often COX1 enzymes, NSAIDS reduce the prostaglandins produced, and “may irritate the stomach’s lining and cause digestive upset, peptic ulcers, and bleeding in the digestive tract.” 59 One research paper summarized research on ginger, and what the findings have meant for pharmacology: The original discovery of ginger's inhibitory effects on prostaglandin biosynthesis in the early 1970s has been repeatedly confirmed. This discovery identified ginger as an herbal medicinal product that shares pharmacological properties with nonsteroidal antiinflammatory drugs. Ginger suppresses prostaglandin synthesis through inhibition of cyclooxygenase 1 and cyclooxygenase2. An important extension of this early work was the observation that ginger also suppresses leukotriene biosynthesis by inhibiting 5lipoxygenase. This pharmacological property distinguishes ginger from nonsteroidal antiinflammatory drugs. This discovery preceded the observation that dual inhibitors of cyclooxygenase and 5 lipoxygenase may have a better therapeutic profile and have fewer side effects than nonsteroidal antiinflammatory drugs. The characterization of the pharmacological properties of ginger entered a new phase with the discovery that a ginger extract (EV.EXT.77) derived from Zingiber officinale (family Zingiberaceae) and Alpina galanga (family Zingiberaceae) inhibits the induction of several genes involved in the inflammatory response. These include genes encoding cytokines, chemokines, and the inducible enzyme cyclooxygenase2. This discovery provided the first evidence that ginger modulates biochemical pathways activated in chronic inflammation. Identification of the molecular targets of individual ginger constituents provides an opportunity to optimize and standardize ginger products with respect to their effects on specific biomarkers of inflammation.60 Many studies have since been done on the various components in ginger, examining the effectiveness on inflammation. In an invitro study of 6 shogaol, and 6, 8, and 10gingerols, the compounds were evaluated for their antioxidant and antiinflammatory efficacy. “6Shogaol has exhibited the most potent antioxidant and anti inflammatory properties which can be attributed to the presence of alpha,betaunsaturated ketone moiety. The carbon chain length has also played a significant role in making 10gingerol as the most potent among all the gingerols.”61 As some of the most studied components of ginger, shogaols and gingerols do not act alone. A scientific study compared a “crude dichloromethane ginger extract, which also contained essential oils and more polar compounds”, to a compound containing only gingerols and their derivatives. The crude extract had significantly more antiarthritic effects on arthritisinduced rats, reducing both joint inflammation and destruction. This research revealed that gingerols are more effective in treating arthritis when working synergistically with other components naturally found in ginger.62 http://www.ayurvedacollege.com/book/export/html/2
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Another scientific study used methanol extracts of ginger roots, to isolate the components, 10gingerol, 8 shogaol and 10shogaol. They inhibited cyclooxygenase2, COX2, but not COX1. The report reiterates that the “inhibition of COX1 is associated with gastrointestinal irritation,” and goes on to explain that “selective inhibition of COX2 should help minimize this side effect.” 63 Thus, ginger’s use over common NSAIDS may have less side effects in the digestive tract. The study involving the “standardized and highly concentrated extract of 2 ginger species, Zingiber officinale and Alpinia galanga (EV.EXT 77),” showed a “statistically significant” reduction of symptoms in patients with osteoarthritis (OA) of the knee. Since only “mild GI adverse events *occurred+ in the ginger extract group, it was concluded to have a “good safety profile.”64 In a smaller experiment, a limited number of patients used ginger compresses on their kidneys to manage the symptoms of osteoarthritis. They explained that “warmth penetrated through the entire self, activating deep relaxation, [and that] total relaxation of the self enabled release of tension and improved receptivity towards others. Additionally, interest in the outer world increased as the self felt more mobile and energized.” This alternative treatment to arthritis enabled them to overcome some of the other symptoms that many arthritis patients face, such as “psychological distress, social isolation and general inability to cope” as well as pain.65 In one study, 6shogaol expressed its usual anti inflammatory capabilities, but the study examined them within cells of the central nervous system. By mediating microglial activation, which results in neuronal cell death, “6shogaol is an effective therapeutic agent for treating *and possibly preventing+ neurodegenerative diseases.”66 Ginger exhibits actions across a widespread spectrum of inflammatory conditions.
RESPIRATORY SYSTEM Though not as many clinical research studies have examined ginger’s effects on the respiratory system, its use in Ayurveda for respiratory complaints is well known. As a kāsaśvāsahara, it is known for alleviating cough and breathing difficulties. As Pole also mentions, fresh ginger’s stimulating effects on peripheral circulation, vasodilation, and sweating may contribute to its ability to clear colds. As the āma clears from the rasa and rakta, kaphavāta coughs and colds are reduced. Combined with different herbs, ginger’s many actions can be tailored to the symptoms at hand. With cinnamon and lemongrass, it can induce sweating for a cold. For a high kaphavata cough, vasa and pippali may be more helpful. As part of trikatu, it can also aid kapha respiratory complaints while accelerating slugglish digestion. 67 According to the Merck Manual of Medical Information, asthma is becoming more common, more serious, and is even resulting in more deaths annually. As explained in the Manual, “airways narrow –usually reversibly—in response to certain stimuli”. While one muscle layer spasms, another becomes inflamed, leading to the excessive production of mucous, which may further lead to an obstruction of the airway. 68 Recurring attacks over a longperiod of time, may lead to airway remodeling, a “permanent narrowing of the bronchial tubes.”69 Ginger has been proven effective with asthma, as an antiinflammatory, antihypersecretory, and even helping to repair the body after attack. Using an aqueous methanolic crude extract of ginger, one study found it to inhibit airway contraction through its antiinflammatory properties.70 Perhaps it did this by reducing interleukin1 secretion, as a German research paper found it to do, in human bronchial epithelial cells. The authors went on to propose “that distinct ginger compounds could be used as antiinflammatory drugs in respiratory infections,” such as those in asthmatic patients.71 It can also repair the body after harmful inflammation. A Taiwanese study found that “inflammatory cytokines, which are produced by the bronchial epithelium after exposure to phthalate esters [ingredient in many plastics]…contribute to airway remodeling”. The research went on to demonstrate that “ginger reverses phthalate estermediated airway remodeling.”72 Research from South Korea proved [6] Gingerol’s anti hypersecretory abilities in relation to human airway epithelial cells.73 Thus, ginger can help reduce inflammation, secretions, and even longterm http://www.ayurvedacollege.com/book/export/html/2
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destruction related to asthma, and thus help in many stages of the disease.
ANTICARCINOGENIC In cultured cell studies and experiments with animals, ginger’s pungent principles (gingerols, shogaols, paradols, and zingerone) have proven to possess anticarcinogenic properties that may be both chemopreventive and chemotherapeutic. 74 These “cancer preventive activities are supposed to be mainly due to free radical scavenging, antioxidant pathways, alteration of gene expressions, and induction of apoptosis, all of which contribute towards decrease in tumor initiation, promotion, and progression.”75 6Gingerol assisted the apoptic pathway in gastric cancer cells by enhancing the TRAILinduced viability reduction of the cells. 6Shogaol damaged microtubules of the cancer cells, halting their reproduction and thus reducing their ability to reproduce. 76 In breast cancer cells, 6gingerol has been found to inhibit “cell adhesion, invasion, motility and activities”. The rate of inhibition was dosedependent, increasing as the concentration of ginger compounds increased.77 In an experiment from the National University of Singapore, the isolated constituents, 6, 8 and 10shogaol, were shown to “have an inhibitory effect on induced breast cancer cell invasion,” without creating cytotoxic conditions.78 One study explained the method by which ginger reduced the incidence of liver neoplasms and “the risk of subsequent carcinoma”. In liver cancer cells, NFκB is constitutively activated and…blocking NFκB activation with ginger resulted in suppressed production of *inflammatory markers+ NFκB and TNFα. This is in line with findings that many of the pathways that mediate adaptive survival strategies in cancer cells are under the transcriptional control of NFκB. Thus, the ginger extract may have a chemotherapeutic effect in the treatment of liver cancer. 79 Researchers from the University of Minnesota referenced many experiments comparing the effectiveness of gingerols and shogaols in cancer inhibition. As the two constituents are those most prevalent in ginger, they were predominantly examined, although other components were also evaluated. With effectiveness varying with the compound, the constituents were successful against a broad spectrum of cancer cells, including human lung, leukemia, skin, ovarian, and colon cancer cells, as well as mouse skin and lung cancer cells.80
CARDIOVASCULAR SYSTEM Ginger’s many actions show widespread potential in cardiovascular disease as well. In one study, ginger’s ability to increase body temperature was scientifically examined. It was found that gingerols and shogaols activated transient receptor potential vanilloid subtype 1 (TRPV1), which detects and regulates body temperature. The pungent constituents also increased adrenaline secretion, which heats the body.81 Describing it as a śitapraśamana, Ayurveda has known of its ability to reduce feelings of cold. Pole explains that, Ayurvedically, “*d+ry ginger may be of benefit in cardiac disorders due to increasing circulation and potential bloodthinning properties when used at a high dosage”.82 In combination with the herbs arjuna and guggulu, it treats congestive heart conditions and poor circulation.83 An article from the International Journal of Cardiology, explains, “*h+uman trials have been few and generally used a low dose with inconclusive results, however dosages of 5g or more demonstrated significant anti platelet activity…Should *more human trials+…prove positive, ginger has the potential to offer not only a cheaper natural alternative to conventional agents but one with significantly lower side effects.”84 In an invitro http://www.ayurvedacollege.com/book/export/html/2
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experiment comparing synthetic gingerols with aspirin, the gingerols and related analogues inhibited human platelet activation at the same potency, or greater than that of aspirin, depending on the analogue.85 Using an orallyadministered, aqueous extract of ginger with rats, high doses of the extract (500mg/kg) lowered prostaglandin, thromboxane (bloodclotting substances), and cholesterol levels. “These results suggest that ginger could be used as a cholesterollowering, antithrombotic and antiinflammatory agent.”86 In another study, test rabbits were fed cholesterol for 75 days, and thus were induced with atherosclerosis. After ingesting experimental doses of air dried ginger powder, at 0.1g/kg of body weight, for 75 days, atheroma was reduced by half. Evidence of anti oxidation was evident in decreased lipid peroxidation, and an increase in fibrinolytic activity meant that woundhealing capabilities also increased. “However, ginger did not lower blood lipids to any significant extent. This distinct protection from the development of atherosclerosis by ginger is probably because of its free radical scavenging, prostaglandin inhibitory and fibri properties.”87
DOSAGES Author or Research Study
Dosage
ARDS, Gastric Emptying RCT
120 mg, gastric feed supplementation with ginger extract88
Lad & Frawley
250 to 500mg powder89
Morning Sickness RCT
250mg, 4 times a day90,
Seasickness 1gm91 RCT Post Operative Nausea & Vomiting RCT
1gm92
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Circular Vection RCT
12gm 93
Lust
½ tsp., or about 2.2gm, powdered root, as tea94
Gastric Emptying, RCT
1.2gm total, in 3 capsules95
Pole
1.55gm per day (fresh) 12gm per day (dry)96
Khalsa
500mg per day, capsule, tea, juice or in food97 As desired, in food, or up to 3gm per day, in capsules 1tsp., chopped fresh root, as tea, 3 times per day98
Reid
38gm99
Tierra
39gm dried, 2 6 slices of fresh root as tea100
Landis
2 to 5 capsules per day, or about 1.5 to
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3.7gm101 Anti Platelet Studies
5gm or more102
CONCLUSION Ginger’s versatility expands in all directions. As a seasoning, it spans continents, finding its way through Thai, Indian, Chinese, and other Asian cuisines, and into western baked goods, ales, and sauces. As a supplement, it provides valuable minerals, bridging the gap between diet and medicine. Therapeutically, it works on many conditions, operating synergistically to bring balance through various modalities. Many of the Ayurvedic uses and terms associated with ginger are being proven in today’s laboratories and clinical trials. Its aid in digestion is widespread, working to initiate (agni dῑpana) and stimulate (pācana) the process, prevent nausea and vomiting (chardinigrahaṇa), treat ulcers, and inhibit harmful bacteria and fungi. It does all this while stimulating, and protecting the liver. It also simultaneously aids in inflammatory and cancerous conditions. By affecting hormone processes, and other biochemical pathways, harmful gene expression, reactive oxygen species, and freeradical scavenging (āmanāśaka), it reduces inflammation and carcinogenic activity at the same time. This simultaneously allows it to be a preventative, pain reliever (vedanāsthāpana), and rasāyana to damaged tissues. The remarkable thing about ginger is that these tissues can range from an arthritic and degenerated joint, to an obstructed airway, to an organ recovering from cancer. As if that was not enough, ginger also enhances cardiovascular health. In a modernday, mostly sedentary society, with more and more high cholesterol and heart related diseases, ginger’s assistance is more than welcome. As a food with a longhistory of use throughout the world, its harmful side effects are minimal, especially when compared to many pharmaceuticals. In a gavage safety assessment of ginger, rats were given excessive amounts of ginger, (2000mg/kg), but displayed no harmful abnormalities or mortalities, except for a slight decrease in weight of the testes.103 Though its dosage varies according to use, author, mode of extraction, and research study, it is still relatively safe, even if taken in excess. Thus, ginger has proven to be the vishwabheshaja, “the universal medicine”, not only through time in ancient medical systems, but also through modernday clinical and experimental research for some of today’s most common diseases.
ABSTRACTS OF ARTICLES CITED (in order of citation) R.K. Goel, and K. Sairam. “AntiUlcer Drugs from Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale,” Indian Journal of Pharmacology 34 (2002): 100110. http://www.ayurvedacollege.com/book/export/html/2
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Sula, Parinamasula and Amlapitta are clinical entities recognized by ayurveda, akin to peptic ulcer and functional dyspepsia. Many indigenous drugs have been advocated in ayurveda for treatment of dyspepsia. Our laboratory has been engaged in screening of various indigenous herbal and metallic drugs for their potential use in peptic ulcer diseases, taking lead from Ayurveda and have reported antiulcer and ulcerhealing properties of Tectona grandis (lapachol), Rhamnus procumbens (kaempferol), Rhamnus triquerta (emodin), Withania somnifera (acylsteryl glycoside), Shilajit (fulvic acid and carboxymethoxybiphenyl), Datura fastuosa (withafastuosin E), Fluggea microcarpa and Aegle marmelos (pyrano and iso coumarins) etc., along with their mechanism of action. The present article includes the detailed exploration of ulcer protective and healing effects of unripe plantain banana, tambrabhasma and Asparagus racemosus on various models of experimental gastroduodenal ulceration and patients with peptic ulcer. Their effects on mucin secretion, mucosal cell shedding, cell proliferation, antioxidant activity, glycoproteins, and PG synthesis have been reported. Clinical trials of these drugs for evaluating their potential ulcer healing effects in peptic ulcer patients have been done. Their potential ulcer protective effects both, experimental and clinical seemed to be due to their predominant effects on various mucosal defensive factors rather than on the offensive acidpepsin secretion. Thus, the above herbal / herbomineral drugs do have potential usefulness for treatment of peptic ulcer diseases. NC Azu, and RA Onyeagba, “Antimicrobial Properties Of Extracts Of Allium cepa (Onions) And Zingiber officinale (Ginger) On Escherichia coli, Salmonella typhi And Bacillus subtilis.” The Internet Journal of Tropical Medicine 3.2 (2007). http://www.ispub.com/journal/theinternetjournal oftropicalmedicine/v... number2/antimicrobialpropertiesofextractsofalliumcepaonionsandzingiberofficinalegingeron escherichiacoli salmonellatyphiandbacillussubtilis.html The antimicrobial properties of various extracts of Allium cepa (onions) and Zingiber officinale (ginger) against Escherichia coli, Salmonella typhi and Bacillus subtilis that are common cause of gastrointestinal tract infections were investigated using the cupplate diffusion method. The result obtained revealed that ethanolic extract of ginger gave the widest zone of inhibition against two out of the three test organisms at the concentration of 0.8gml1. However, Escherichia coli and Salmonella typhi were more sensitive to the extract of onion bulbs compared to Bacillus subtilis which was predominantly resistant. It was also observed that the solvent of extraction and its varying concentrations affected the sensitivity of two of the test organisms to the plant materials. The minimum inhibitory concentration (MIC) of ginger extracts on the test organisms ranged from 0.1gml1 0.2gml1, showing that ginger was more effective and produced remarkable inhibitory effect on the two out of the three test organisms when compared to the onion extracts. This investigation indicates that, though both plants had antimicrobial activities on the two gram negative test organisms but not effective on the gram positive test organism, ginger had more inhibitory effect thus confirming their use in folk medicine. SengKee Chuau, et.al, “Effect of Ginger on Gastric Motility and Symptoms of Functional Dyspepsia,” World Journal of Gastroenterology 17.1 (2011):105110. AIM: To evaluate the effects of ginger on gastric motility and emptying, abdominal symptoms, and hormones that influence motility in dyspepsia. METHODS: Eleven patients with functional dyspepsia were studied twice in a randomized doubleblind manner. After an 8h fast, the patients ingested three capsules that contained ginger (total 1.2 g) or placebo, followed after 1 h by 500 mL lownutrient soup. Antral area, fundus area and diameter, and the frequency of antral contractions were measured using ultrasound at frequent intervals, and the gastric halfemptying time was calculated from the change in antral area. Gastrointestinal sensations and appetite were scored using visual analog questionnaires, and blood was http://www.ayurvedacollege.com/book/export/html/2
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taken for measurement of plasma glucagonlike peptide1 (GLP1), motilin and ghrelin concentrations, at intervals throughout the study. RESULTS: Gastric emptying was more rapid after ginger than placebo [median (range) halfemptying time 12.3 (8.5 17.0) min after ginger, 16.1 (8.322.6) min after placebo, P ≤ 0.05+. There was a trend for more antral contractions (P = 0.06), but fundus dimensions and gastrointestinal symptoms did not differ, nor did serum concentrations of GLP1, motilin and ghrelin. CONCLUSION: Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia, but had no impact on gastrointestinal symptoms or gut peptides. SK Chuau, et al., “Effect of Ginger on Gastric Emptying and Motility in Healthy Humans,” European Journal of Gastroenterology and Hepatology 20.5 (2008):436440. OBJECTIVE: Ginger has been reported to improve upper gastrointestinal symptoms. Little information about the effects of ginger on gastric motor function, exists, however. Our aim was to investigate the effects of ginger on gastric emptying, antral motility, proximal gastric dimensions, and postprandial symptoms. METHODS: Twentyfour healthy volunteers were studied twice in a randomized doubleblind manner. After an 8 h fast, the volunteers ingested three ginger capsules (total 1200 mg) or placebo, followed after 1 h by 500 ml lownutrient soup. Antral area, fundus area and diameter, and the frequency of antral contractions were measured using ultrasound at frequent intervals over 90 min, and the gastric halfemptying time was calculated from the change in antral area. Gastrointestinal sensations and appetite were scored using visual analog questionnaires. Data are expressed in terms of mean+/standard error. RESULTS: Antral area decreased more rapidly (P<0.001) and the gastric halfemptying time was less after ginger than placebo ingestion (13.1+/1.1 vs. 26.7+/3.1 min, P<0.01), whereas the frequency of antral contractions was greater (P<0.005). Fundus dimensions did not differ, and there was no significant difference in any gastrointestinal symptoms. CONCLUSION: Ginger accelerates gastric emptying and stimulates antral contractions in healthy volunteers. These effects could potentially be beneficial in symptomatic patient groups. M. Mokhtari, et al., “Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients http://www.ayurvedacollege.com/book/export/html/2
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hospitalized in an intensive care unit,” Journal of Critical Care 25.4 (2010):647650. PURPOSE: The purpose of this study was to evaluate the effect of ginger extract on delayed gastric emptying, developing ventilatorassociated pneumonia, and clinical outcomes in adult respiratory distress syndrome (ARDS). MATERIALS AND METHODS: Thirtytwo ARDS patients who were dependent on mechanical ventilation and fed via nasogastric tube were studied. After enrollment, patients were randomized to 2 groups. The control group received 1 g of coconut oil as placebo, and the study group received 120 mg of ginger extract. The amount of feeding tolerated at the first 48 hours of feeding, amount of feeding tolerated during the entire study period, nosocomial pneumonia, number of intensive care unit (ICU)free days, number of ventilatorfree days, and mortality were evaluated during 21 days of intervention. RESULTS: There was a significant difference between the ginger group and the control group in the amount of feeding tolerated at the first 48 hours of enteral feeding (51% vs 57%, P < .005). There was a trend toward a decrease in pneumonia in the ginger group (P = .07). The overall inICU mortality was 15.6%, with no significant difference in the 2 groups. The number of ventilatorfree days and that of ICUfree days were lower in the control group compared with the ginger group (P = .04 and P = .02). CONCLUSION: This study showed that gastric feed supplementation with ginger extract might reduce delayed gastric emptying and help reduce the incidence of ventilatorassociated pneumonia in ARDS. Owyang Chung, et al., “Effects of ginger on motion sickness and gastric slowwave dysrhytmias induced by circular vection,” American Journal of Physiology 284.3 (2003):G481G489. Ginger has long been used as an alternative medication to prevent motion sickness. The mechanism of its action, however, is unknown. We hypothesize that ginger ameliorates the nausea associated with motion sickness by preventing the development of gastric dysrhythmias and the elevation of plasma vasopressin. Thirteen volunteers with a history of motion sickness underwent circular vection, during which nausea (scored 0– 3, i.e., none to severe), electrogastrographic recordings, and plasma vasopressin levels were assessed with or without ginger pretreatment in a crossoverdesign, doubleblind, randomized placebocontrolled study. Circular vection induced a maximal nausea score of 2.5 ± 0.2 and increased tachygastric activity and plasma vasopressin. Pretreatment with ginger (1,000 and 2,000 mg) reduced the nausea, tachygastria, and plasma vasopressin. Ginger also prolonged the latency before nausea onset and shortened the recovery time after vection cessation. Intravenous vasopressin infusion at 0.1 and 0.2 U/min induced nausea and increased bradygastric activity; ginger pretreatment (2,000 mg) affected neither. Ginger effectively reduces nausea, tachygastric activity, and vasopressin release induced by circular vection. In this manner, ginger may act as a novel http://www.ayurvedacollege.com/book/export/html/2
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agent in the prevention and treatment of motion sickness. Torben Brask, et al., “Ginger Root Against Seasickness: A Conctrolled Trial on the Open Sea,” Acta Oto laryngologica 105.12 (1988):4549. In a doubleblind randomized placebo trial, the effect of the powdered rhizome of ginger (Zingiber officinale) was tested on seasickness. Eighty naval cadets, unaccustomed to sailing in heavy seas reported during voyages on the high seas, symptoms of seasickness every hour for 4 consecutive hours after ingestion of 1 g of the drug or placebo. Ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo did (p<0.05). With regard to vomiting, a modified Protection Index (PI)=72% was calculated. Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant. For all symptom categories, PI=38% was calculated. N Chaiyakunapruk, et al., “The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta analysis,” American Journal of Obstetrics and Gynecology 194.1 (2006):9599. OBJECTIVE: The aim of this study was to specifically determine the impact of a fixed dose of ginger administration, compared with placebo, on the 24hour postoperative nausea and vomiting. STUDY DESIGN: The design was a systematic review and metaanalysis of trials revealed by searches. Randomized controlled trials comparing ginger with placebo to prevent postoperative nausea and vomiting and postoperative vomiting from Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles, contact of authors, and experts in the field. Two reviewers selected studies for inclusion and independently extracted data. RESULTS: Five randomized trials including a total of 363 patients were pooled for analysis of preventing postoperative nausea and vomiting and postoperative vomiting. The summary relative risks of ginger for postoperative nausea and vomiting and postoperative vomiting were 0.69 (95% confidence interval 0.54 to 0.89) and 0.61 (95% confidence interval 0.45 to 0.84), respectively. Only one side effect, abdominal discomfort, was reported. CONCLUSIONS: This metaanalysis demonstrates that a fixed dose at least 1 g of ginger is more effective than placebo for the prevention of postoperative nausea and vomiting and postoperative vomiting. Use of ginger is an effective means for reducing postoperative nausea and vomiting. Y.K. Gupta, et al., “Antiemetic effect of ginger powder versus placebo as an addon therapy in children and young adults receiving high emetogenic chemotherapy,” Pediatric Blood & Cancer 56.2 (2011):234238. PURPOSE: Chemotherapyinduced nausea and vomiting (CINV) are major adverse effects of chemotherapy. Ginger has been used in postoperative and pregnancyinduced nausea and vomiting. Data on its utility in reducing CINV in children and young adults are lacking. http://www.ayurvedacollege.com/book/export/html/2
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PATIENTS AND METHODS: Sixty chemotherapy cycles of cisplatin/doxorubicin in bone sarcoma patients were randomized to ginger root powder capsules or placebo capsules as an additional antiemetic to ondensetron and dexamethasone in a double blind design. Acute CINV was defined as nausea and vomiting occurring within 24 hr of start of chemotherapy (days 14) and delayed CINV as that occurring after 24 hr of completion of chemotherapy (days 5 10). CINV was evaluated as per Edmonton's Symptom Assessment Scale and National Cancer Institute criteria respectively. RESULTS: Acute moderate to severe nausea was observed in 28/30 (93.3%) cycles in control group as compared to 15/27 (55.6%) cycles in experimental group (P = 0.003). Acute moderate to severe vomiting was significantly more in the control group compared to the experimental group [23/30 (76.7%) vs. 9/27 (33.33%) respectively (P= 0.002)]. Delayed moderate to severe nausea was observed in 22/30 (73.3%) cycles in the control group as compared to 7/27 (25.9%) in the experimental group (P < 0.001). Delayed moderate to severe vomiting was significantly more in the control group compared to the experimental group [14/30 (46.67%) vs. 4/27 (14.81%) (P = 0.022)]. CONCLUSION: Ginger root powder was effective in reducing severity of acute and delayed CINV as additional therapy to ondensetron and dexamethasone in patients receiving high emetogenic chemotherapy. T Chisaka, et al., “Cholagogic effect of ginger and its active constituents,” Journal of ethnopharmacology 13.2 (1985):21725. The effect of bile secretion in rats was examined in order to clarify the stomachic action of ginger and also to investigate its active constituents. The results showed that mainly the acetone extracts of ginger, which contain essential oils and pungent principles, caused an increase in the bile secretion. Further analyses for the active constituents of the acetone extracts through column chromatography indicated that [6]gingerol and [10] gingerol, which are the pungent principles, are mainly responsible for the cholagogic effect of ginger. T.A. Ajith, et al., “Zingiber officinale Roscoe prevents acetaminopheninduced acute hepatotoxicity by enhancing hepatic antioxidant status,” Food and Chemical Toxicology 45.11 (2007): 22672272. A large number of xenobiotics are reported to be potentially hepatotoxic. Free radicals generated from the xenobiotic metabolism can induce lesions of the liver and react with the basic cellular constituents – proteins, lipids, RNA and DNA. Hepatoprotective activity of aqueous ethanol extract of Zingiber officinale was evaluated against single dose of acetaminopheninduced (3 g/kg, p.o.) acute hepatotoxicity in rat. Aqueous extract of Z. officinale significantly protected the hepatotoxicity as evident from the activities of serum transaminase and alkaline phosphatase (ALP). Serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT) and ALP activities were significantly (p < 0.01) elevated in the acetaminophen alone treated animals. Antioxidant status in liver such as activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase and glutathioneStransferase (GST), a phase II enzyme, and levels of reduced glutathione (GSH) were declined significantly (p < 0.01) in the acetaminophen alone treated animals (control group). Hepatic lipid peroxidation was enhanced significantly (p < http://www.ayurvedacollege.com/book/export/html/2
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0.01) in the control group. Administration of single dose of aqueous extract of Z. officinale (200 and 400 mg/kg, p.o.) prior to acetaminophen significantly declines the activities of serum transaminases and ALP. Further the hepatic antioxidant status was enhanced in the Z. officinale plus acetaminophen treated group than the control group. The results of the present study concluded that the hepatoprotective effect of aqueous ethanol extract of Z. officinale against acetaminopheninduced acute toxicity is mediated either by preventing the decline of hepatic antioxidant status or due to its direct radical scavenging capacity. Suresh Kumar, et al., “6gingerol, an active ingredient of ginger, protects acetaminopheninduced hepatotoxicity in mice,” Journal of Chinese integrative medicine 9.11 (2011):12641269. To investigate the hepatoprotective efficacy of 6gingerol against acetaminopheninduced hepatotoxicity in mice. Mice were injected with a single dose of acetaminophen (900 mg/kg) to induce hepatotoxicity, while 6gingerol (30 mg/kg) or the standard drug silymarin (25 mg/kg) was given 30 min after the acetaminophen administration. The mice were sacrificed 4 h after acetaminophen injection to determine the activities of liver marker enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP), total bilirubin in serum, and lipid peroxidation and antioxidant status (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, glutathione transferase and glutathione) in liver homogenate. The treatment of 6gingerol and silymarin to acetaminopheninduced hepatotoxicity showed significant hepatoprotective effect by lowering the hepatic marker enzymes (AST, ALT, and ALP) and total bilirubin in serum (P<0.05). In addition, 6 gingerol and silymarin treatment prevented the elevation of hepatic malondialdehyde formation and the depletion of antioxidant status in the liver of acetaminophenintoxicated mice (P<0.05). The results evidently demonstrate that 6gingerol has promising hepatoprotective effect which is comparable to the standard drug silymarin. Harish Nayaka Mysore Annaiah, et al., “Gastroprotective Effect of Ginger Rhizome (Zingiber Officinale) Extract: Role of Gallic Acid and Cinnamic Acid in H+, K+ATPase/H. pylori Inhibition and AntiOxidative Mechanism,” Evidence –Based Complementary and Alternative Medicine 2011. (2011): 249487. Zinger officinale has been used as a traditional source against gastric disturbances from time immemorial. The ulcerpreventive properties of aqueous extract of ginger rhizome (GRAE) belonging to the family Zingiberaceae is reported in the present study. GRAE at 200 mg kg−1 b.w. protected up to 86% and 77% for the swim stress/ethanol stressinduced ulcers with an ulcer index (UI) of 50 ± 4.0/46 ± 4.0, respectively, similar to that of lansoprazole (80%) at 30 mg kg−1 b.w. Increased H+, K+ATPase activity and thiobarbituric acid reactive substances (TBARS) were observed in ulcerinduced rats, while GRAE fed rats showed normalized levels and GRAE also normalized depleted/amplified antioxidant enzymes in swim stress and ethanol stressinduced animals. Gastric mucin damage was recovered up to 77% and 74% in swim stress and ethanol stress, respectively after GRAE treatment. GRAE also inhibited the growth of H. pylori with MIC of 300 ± 38 μg and also possessed reducing power, free radical −1 scavenging ability with an IC50 of 6.8 ± 0.4 μg mL gallic acid equivalent (GAE). DNA protection up to 90% at 0.4 μg was also observed. Toxicity studies indicated no lethal effects in rats fed up to 5 g kg−1 b.w. Compositional analysis favored by determination of the efficacy of individual phenolic acids towards their potential ulcerpreventive ability revealed that between cinnamic (50%) and gallic (46%) phenolic acids, cinnamic acid appear to contribute to better H+, K+ATPase and Helicobacter pylori inhibitory activity, while gallic acid contributes significantly to antioxidant activity. http://www.ayurvedacollege.com/book/export/html/2
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M Park, et al., “Antibacterial activity of *10+gingerol and [12]gingerol isolated from ginger rhizome against periodontal bacteria,” Phytotherapy Research 22. (2008): 1446–1449. Ginger (Zingiber officinale Roscoe) has been used widely as a food spice and an herbal medicine. In particular, its gingerolrelated components have been reported to possess antimicrobial and antifungal properties, as well as several pharmaceutical properties. However, the effective ginger constituents that inhibit the growth of oral bacteria associated with periodontitis in the human oral cavity have not been elucidated. This study revealed that the ethanol and nhexane extracts of ginger exhibited antibacterial activities against three anaerobic Gram negative bacteria, Porphyromonas gingivalis ATCC 53978, Porphyromonas endodontalis ATCC 35406 and Prevotella intermedia ATCC 25611, causing periodontal diseases. Thereafter, five ginger constituents were isolated by a preparative highperformance liquid chromatographic method from the active silicagel column chromatography fractions, elucidated their structures by nuclear magnetic resonance spectroscopy and electrospray ionization mass spectrometry and their antibacterial activity evaluated. In conclusion, two highly alkylated gingerols, [10]gingerol and [12]gingerol effectively inhibited the growth of these oral pathogens at a minimum inhibitory concentration (MIC) range of 6–30 µg/mL. These ginger compounds also killed the oral pathogens at a minimum bactericidal concentration (MBC) range of 4–20 µg/mL, but not the other ginger compounds 5acetoxy[6]gingerol, 3,5 diacetoxy[6]gingerdiol and galanolactone. CY Chen, et al., “Zingiber officinale (ginger) compounds have tetracyclineresistance modifying effects against clinical extensively drugresistant Acinetobacter baumannii,” Phytotherapy Research 24.12 (2010):1825 30. Extensively drugresistant Acinetobacter baumannii (XDRAB) is a growing and serious nosocomial infection worldwide, such that developing new agents against it is critical. The antimicrobial activities of the rhizomes from Zingiber officinale, known as ginger, have not been proven in clinical bacterial isolates with extensive drug resistance. This study aimed to investigate the effects of four known components of ginger, [6] dehydrogingerdione, [10]gingerol, [6]shogaol and [6]gingerol, against clinical XDRAB. All these compounds showed antibacterial effects against XDRAB. Combined with tetracycline, they showed good resistance modifying effects to modulate tetracycline resistance. Using the 1,1 diphenyl2picrylhydrazyl (DPPH) radical scavenging method, these four ginger compounds demonstrated antioxidant properties, which were inhibited by MnO₂, an oxidant without antibacterial effects. After the antioxidant property was blocked, their antimicrobial effects were abolished significantly. These results indicate that ginger compounds have antioxidant effects that partially contribute to their antimicrobial activity and are candidates for use in the treatment of infections with XDRAB. RA AlEssa RA, et al., “Physiological and therapeutical roles of ginger and turmeric on endocrine functions,” The American Journal of Chinese Medicine 39.2 (2011): 21531. The natural product ginger (Zingiber officinale) has active constituents gingerol, Shogaol and Zerumbone, while turmeric (Curcuma longa) contains three active major curcuminoids, namely, curcumin, demethoxycurcumin, and bisdemethoxycurcumin. They have the same scientific classification and are reported to have antiinflammatory and many therapeutic effects. This article reviews the physiological and therapeutic effects of ginger and turm eric on some endocrine gland functions, and signal pathways involved to mediate their actions. With some systems and adipose tissue, ginger and turmeric exert their actions through some/all of the following signals or molecular mechanisms: (1) through reduction of high levels of some hormones (as: T4, leptin) or interaction with hormone receptors; (2) by inhibition of cytokines/adipokine expression; (3) acting as a potent http://www.ayurvedacollege.com/book/export/html/2
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inhibitor of reactive oxygen species (ROS)generating enzymes, which play an essential role between inflammation and progression of diseases; (4) mediation of their effects through the inhibition of signaling transcription factors; and/or (5) decrease the proliferative potent by down regulation of antiapoptotic genes, which may suppress tumor promotion by blocking signal transduction pathways in the target cells. These multiple mechanisms of protection against inflammation and oxidative damage make ginger and curcumin particularly promising natural agents in fighting the ravages of aging and degenerative diseases, and need to be paid more attention by studies. Carmelita G. Frondoza, et al., “Ginger—An Herbal Medicinal Product with Broad AntiInflammatory Actions,” Journal of Medicinal Food 8.2 (2005):125132. The antiinflammatory properties of ginger have been known and valued for centuries. During the past 25 years, many laboratories have provided scientific support for the longheld belief that ginger contains constituents with antiinflammatory properties. The original discovery of ginger's inhibitory effects on prostaglandin biosynthesis in the early 1970s has been repeatedly confirmed. This discovery identified ginger as an herbal medicinal product that shares pharmacological properties with nonsteroidal antiinflammatory drugs. Ginger suppresses prostaglandin synthesis through inhibition of cyclooxygenase 1 and cyclooxygenase2. An important extension of this early work was the observation that ginger also suppresses leukotriene biosynthesis by inhibiting 5lipoxygenase. This pharmacological property distinguishes ginger from nonsteroidal anti inflammatory drugs. This discovery preceded the observation that dual inhibitors of cyclooxygenase and 5lipoxygenase may have a better therapeutic profile and have fewer side effects than nonsteroidal antiinflammatory drugs. The characterization of the pharmacological properties of ginger entered a new phase with the discovery that a ginger extract (EV.EXT.77) derived from Zingiber officinale (family Zingiberaceae) and Alpina galanga (family Zingiberaceae) inhibits the induction of several genes involved in the inflammatory response. These include genes encoding cytokines, chemokines, and the inducible enzyme cyclooxygenase2. This discovery provided the first evidence that ginger modulates biochemical pathways activated in chronic inflammation. Identification of the molecular targets of individual ginger constituents provides an opportunity to optimize and standardize ginger products with respect to their effects on specific biomarkers of inflammation. Such preparations will be useful for studies in experimental animals and humans. MK Balijepalli, et al., “Comparative antioxidant and antiinflammatory effects of [6]gingerol, [8]gingerol, [10] gingerol and [6]shogaol,” Journal of ethnopharmacology 127.2 (2010): 51520. ETHNOPHARMACOLOGICAL RELEVANCE: Zingiber officinale Rosc. (Zingiberaceae) has been traditionally used in Ayurvedic, Chinese and TibbUnani herbal medicines for the treatment of various illnesses that involve inflammation and which are caused by oxidative stress. Although gingerols and shogaols are the major bioactive compounds present in Zingiber officinale, their molecular mechanisms of actions and the relationship between their structural features and the activity have not been well studied. AIM OF THE STUDY: http://www.ayurvedacollege.com/book/export/html/2
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The aim of the present study was to examine and compare the antioxidant and antiinflammatory activities of gingerols and their natural analogues to determine their structureactivity relationship and molecular mechanisms. MATERIALS AND METHODS: The in vitro activities of the compounds [6]gingerol, [8]gingerol, [10]gingerol and [6]shogaol were evaluated for scavenging of 1,1diphenyl2 picyrlhydrazyl (DPPH), superoxide and hydroxyl radicals, inhibition of Nformyl methionylleucylphenylalanine (fMLP) induced reactive oxygen species (ROS) production in human polymorphonuclear neutrophils (PMN), inhibition of lipopolysaccharide induced nitrite and prostaglandin E(2) production in RAW 264.7 cells. RESULTS: In the antioxidant activity assay, [6]gingerol, [8]gingerol, [10]gingerol and [6]shogaol exhibited substantial scavenging activities with IC(50) values of 26.3, 19.47, 10.47 and 8.05 microM against DPPH radical, IC(50) values of 4.05, 2.5, 1.68 and 0.85 microM against superoxide radical and IC(50) values of 4.62, 1.97, 1.35 and 0.72 microM against hydroxyl radical, respectively. The free radical scavenging activity of these compounds also enhanced with increasing concentration (P<0.05). On the other hand, all the compounds at a concentration of 6 microM have significantly inhibited (P<0.05) fMLPstimulated oxidative burst in PMN. In addition, production of inflammatory mediators (NO and PGE(2)) has been inhibited significantly (P<0.05) and dosedependently. CONCLUSIONS: 6Shogaol has exhibited the most potent antioxidant and antiinflammatory properties which can be attributed to the presence of alpha,beta unsaturated ketone moiety. The carbon chain length has also played a significant role in making 10gingerol as the most potent among all the gingerols. This study justifies the use of dry ginger in traditional systems of medicine. Jennifer B. Frye, et al., “Comparative Effects of Two GingerolContaining Zingiber officinale Extracts on Experimental Rheumatoid Arthritis,” Journal of Natural Products 72.3 (2009): 403407. Ginger (Zingiber officinale) supplements are being promoted for arthritis treatment in western societies based on ginger’s traditional use as an anti inflammatory in Chinese and Ayurvedic medicine. However, scientific evidence of ginger’s antiarthritic effects is sparse, and its bioactive joint protective components have not been identified. Therefore, the ability of a wellcharacterized crude ginger extract to inhibit joint swelling in an animal model of rheumatoid arthritis, streptococcal cell wall (SCW)induced arthritis, was compared to that of a fraction containing only gingerols and their derivatives. Both extracts were efficacious in preventing joint inflammation. However, the crude dichloromethane extract, which also contained essential oils and more polar compounds, was more efficacious (when normalized to gingerol content) in preventing both joint inflammation and destruction. In conclusion, these data document a very significant jointprotective effect of these ginger samples, and suggest that nongingerol components are bioactive and can enhance the antiarthritic effects of the more widely studied gingerols. Wenkui Li, et al. “Cyclooxygenase2 inhibitors in ginger (Zingiber officinale),” Fitoterapia 82.1 (2011):3843. Ginger roots have been used to treat inflammation and have been reported to inhibit cyclooxygenase (COX). Ultrafiltration liquid chromatography http://www.ayurvedacollege.com/book/export/html/2
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mass spectrometry was used to screen a chloroform partition of a methanol extract of ginger roots for COX2 ligands, and 10gingerol, 12gingerol, 8shogaol, 10shogaol, 6gingerdione, 8 gingerdione, 10gingerdione, 6dehydro10gingerol, 6paradol, and 8paradol bound to the enzyme active site. Purified 10gingerol, 8shogaol and 10shogaol inhibited COX2 with IC50 values of 32 μM, 17.5 μM and 7.5 μM, respectively. No inhibition of COX1 was detected. Therefore, 10gingerol, 8shogaol and 10shogaol inhibit COX2 but not COX1, which can explain, in part, anti inflammatory properties of ginger. RD Altman, et al. “Effects of a ginger extract on knee pain in patients with osteoarthritis,” Arthritis and rheumatism 44.11 (2001): 25318. OBJECTIVE: To evaluate the efficacy and safety of a standardized and highly concentrated extract of 2 ginger species, Zingiber officinale and Alpinia galanga (EV.EXT 77), in patients with osteoarthritis (OA) of the knee. METHODS: Two hundred sixtyone patients with OA of the knee and moderatetosevere pain were enrolled in a randomized, doubleblind, placebocontrolled, multicenter, parallelgroup, 6week study. After washout, patients received ginger extract or placebo twice daily, with acetaminophen allowed as rescue medication. The primary efficacy variable was the proportion of responders experiencing a reduction in "knee pain on standing," using an intenttotreat analysis. A responder was defined by a reduction in pain of > or = 15 mm on a visual analog scale. RESULTS: In the 247 evaluable patients, the percentage of responders experiencing a reduction in knee pain on standing was superior in the ginger extract group compared with the control group (63% versus 50%; P = 0.048). Analysis of the secondary efficacy variables revealed a consistently greater response in the ginger extract group compared with the control group, when analyzing mean values: reduction in knee pain on standing (24.5 mm versus 16.4 mm; P = 0.005), reduction in knee pain after walking 50 feet (15.1 mm versus 8.7 mm; P = 0.016), and reduction in the Western Ontario and McMaster Universities osteoarthritis composite index (12.9 mm versus 9.0 mm; P = 0.087). Change in global status and reduction in intake of rescue medication were numerically greater in the ginger extract group. Change in quality of life was equal in the 2 groups. Patients receiving ginger extract experienced more gastrointestinal (GI) adverse events than did the placebo group (59 patients versus 21 patients). GI adverse events were mostly mild. CONCLUSION: A highly purified and standardized ginger extract had a statistically significant effect on reducing symptoms of OA of the knee. This effect was moderate. There was a good safety profile, with mostly mild GI adverse events in the ginger extract group. http://www.ayurvedacollege.com/book/export/html/2
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T. Therkleson, “Ginger compress therapy for adults with osteoarthritis,” Journal of Advanced Nursing 66. (2010): 2225–2233. AIM: This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis. BACKGROUND: Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non pharmacological strategies, including complementary therapies and pain relieving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms. METHOD: Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and followup interviews and telephone conversations were conducted. FINDINGS: Seven themes were identified in the data: (1) Meditativelike stillness and relaxation of thoughts; (2) Constant penetrating warmth throughout the body; (3) Positive change in outlook; (4) Increased energy and interest in the world; (5) Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others; (6) Increased suppleness within the body and (7) More comfortable, flexible joint mobility. The essential experience of ginger compresses exposed the unique qualities of heat, stimulation, antiinflammation and analgesia. CONCLUSION: Nurses could consider this therapy as part of a holistic treatment for people with osteoarthritis symptoms. Controlled research is needed with larger numbers of older people to explore further the effects of the ginger compress therapy. SY Kim, et al. “6Shogaol, a ginger product, modulates neuroinflammation: A new approach to neuroprotection,” Neuropharmacology 63.2 (2012): 21123. Inflammatory processes in the central nervous system play an important role in a number of neurodegenerative diseases mediated by microglial activation, which results in neuronal cell death. Microglia act in immune surveillance and host defense while resting. When activated, they can be deleterious to neurons, even resulting in neurodegeneration. Therefore, the inhibition of microglial activation is considered a useful strategy in searching for neuroprotective agents. In this study, we investigated the effects of 6shogaol, a pungent agent from Zingiber officinale Roscoe, on microglia activation in BV2 and primary microglial cell cultures. 6Shogaol significantly inhibited the release of nitric oxide (NO) and the expression of inducible nitric oxide synthase (iNOS) induced by lipopolysaccharide (LPS). The effect was better than that of 6gingerol, wogonin, or Nmonomethyllarginine, agents previously reported to inhibit nitric oxide. 6Shogaol exerted its antiinflammatory effects by inhibiting the http://www.ayurvedacollege.com/book/export/html/2
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production of prostaglandin E(2) (PGE(2)) and proinflammatory cytokines, such as interleukin1β (IL1β) and tumor necrosis factorα (TNFα), and by downregulating cyclooxygenase2 (COX2), p38 mitogenactivated protein kinase (MAPK), and nuclear factor kappa B (NFκB) expression. In addition, 6shogaol suppressed the microglial activation induced by LPS both in primary cortical neuronglia culture and in an in vivo neuroinflammatory model. Moreover, 6shogaol showed significant neuroprotective effects in vivo in transient global ischemia via the inhibition of microglia. These results suggest that 6shogaol is an effective therapeutic agent for treating neurodegenerative diseases. MN Ghayur, et al. “Ginger attenuates acetylcholineinduced contraction and Ca2+ signalling in murine airway smooth muscle cells,” Canadian Journal of Physiology and Pharmacology 86.5 (2008):26471. Asthma is a chronic disease characterized by inflammation and hypersensitivity of airway smooth muscle cells (ASMCs) to different spasmogens. The past decade has seen increased use of herbal treatments for many chronic illnesses. Ginger (Zingiber officinale) is a common food plant that has been used for centuries in treating respiratory illnesses. In this study, we report the effect of its 70% aqueous methanolic crude extract (Zo.Cr) on acetylcholine (ACh)induced airway contraction and Ca(2+) signalling in ASMCs using mouse lung slices. Airway contraction and Ca(2+) signalling, recorded via confocal microscopy, were induced with ACh, either alone or after pretreatment of slices with Zo.Cr and (or) verapamil, a standard Ca(2+) channel blocker. ACh (10 micromol/L) stimulated airway contraction, seen as decreased airway diameter, and also stimulated Ca(2+) transients (sharp rise in [Ca(2+)]i) and oscillations in ASMCs, seen as increased fluo4induced fluorescence intensity. When Zo.Cr (0.31.0 mg/mL) was given 30 min before ACh administration, the AChinduced airway contraction and Ca(2+) signalling were significantly reduced. Similarly, verapamil (1 micromol/L) also inhibited agonistinduced airway contraction and Ca(2+) signalling, indicating a similarity in the modes of action. When Zo.Cr (0.3 mg/mL) and verapamil (1 micromol/L) were given together before ACh, the degree of inhibition was the same as that observed when each of these blockers was given alone, indicating absence of any additional inhibitory mechanism in the extract. In Ca(2+) free solution, both Zo.Cr and verapamil, when given separately, inhibited Ca(2+) (10 mmol/L)induced increase in fluorescence and airway contraction. This shows that ginger inhibits airway contraction and associated Ca(2+) signalling, possibly via blockade of plasma membrane Ca(2+) channels, thus reiterating the effectiveness of this ageold herb in treating respiratory illnesses. JA Podlogar, and EJ Verspohl. “Antiinflammatory effects of ginger and some of its components in human bronchial epithelial (BEAS2B) cells,” Phytotherapy Research 26.3 (2012): 3336. The proinflammatory chemokine interleukin8 is increased in asthmatic patients. Traditionally, ginger is used as an antiinflammatory drug. An extract and several compounds of Zingiber officinale (ginger) were tested in human bronchial epithelial cells (BEAS2B cells) with respect to their effect on lipopolysaccharide (LPS)induced secretion of the proinflammatory chemokine interleukin 8 (IL8) and RANTES (regulated upon activation, normal Tcell expressed and secreted). An oily extract of ginger rhizome with > 25% total pungent compounds, ginger volatile oil, ar curcumene and αpinene reduced the LPSinduced IL8 secretion (measured by a specific enzymelinked immunosorbent assay), whereas a spissum extract, the pungents [6]gingerol and its metabolite [6]shogaol, and the terpenoids citral and βphellandrene showed no effect. The LPSinduced slight increase of RANTES was reduced by volatile oil, arcurcumene and αpinene. There was no effect of LPS on TNFα. Our results suggest that distinct ginger compounds could be used as antiinflammatory drugs in respiratory infections. MS Huang, et al. “Ginger suppresses phthalate esterinduced airway remodeling,” Journal of Agricultural and Food Chemistry 59.7 (2011) 3429 http://www.ayurvedacollege.com/book/export/html/2
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38. This study has two novel findings: it is not only the first to demonstrate inflammatory cytokines, which are produced by the bronchial epithelium after exposure to phthalate esters and contribute to airway remodeling by increasing human bronchial smooth muscle cells (BSMC) migration and proliferation, but it is also the first to reveal that ginger reverses phthalate estermediated airway remodeling. Human bronchial epithelial cell lines BEAS2B and HBE135E6E7 (HBE) were treated with butylbenzyl phthalate (BBP), bis(2ethylhexyl) phthalate (BEHP), dibutyl phthalate (DBP), and diethyl phthalate (DEP), and the conditioned medium (CM) was harvested and then added to BSMC. Cultures of BSMC with BBP, BEHP, DBP, and DEPBEAS2BCM and DEPHBECM increased BSMC proliferation and migration, which are major features in asthma remodeling. Exposure of BEAS2B and HBE to DBP caused epithelial cells to produce inflammatory cytokines IL8 and RANTES, which subsequently induced BSMC proliferation and migration. Depleting both IL8 and RANTES completely reversed the effect of DBPBEAS2BCM and DBP HBECMmediated BSMC proliferation and migration, suggesting this effect is a synergistic influence of IL 8 and RANTES. Moreover, [6] shogaol, [6]gingerol, [8]gingerol, and [10]gingerol, which are major bioactive compounds present in Zingiber officinale , suppress phthalate estermediated airway remodeling. This study suggests that ginger is capable of preventing phthalate esterassociated asthma. JH Bae, et al., “*6+Gingerol suppresses interleukin1 betainduced MUC5AC gene expression in human airway epithelial cells,” American Journal of Rhinology & Allergy 23.4 (2009): 38591. BACKGROUND: [6]Gingerol is a major active component of ginger and a natural polyphenol compound. The present study investigated whether [6]gingerol suppresses interleukin (IL)1 betainduced MUC5AC gene expression in human airway epithelial cells and, if so, examined whether the suppression of MUC5AC gene expression is mediated via the mitogenactivated protein kinase (MAPK) signal transduction pathway. METHODS: MUC5AC mRNA and protein were measured using reverse transcriptionpolymerase chain reaction (PCR), realtime PCR, and Western blot analysis in cultured NCIH292 human airway epithelial cells. Extracellular signalregulated kinase (ERK) and p38 MAPK protein levels were analyzed by Western blot. RESULTS: Expression of MUC5AC mRNA increased in NCIH292 cells upon treatment with 10 ng/mL of IL1 beta for 24 hours. When the cells were pretreated with 10 microM of [6]gingerol, expression of IL1 betainduced MUC5AC mRNA and protein was significantly suppressed. Suppression of IL1 betainduced MUC5AC mRNA was also observed in cells pretreated with ERK or p38 MAPKspecific inhibitors, suggesting that [6]gingerolmediated suppression of IL 1 betainduced MUC5AC mRNA operated via the ERK and p38 MAPKdependent pathways. CONCLUSIONS: http://www.ayurvedacollege.com/book/export/html/2
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[6]Gingerol suppresses IL1 beta induced MUC5AC gene expression in human airway epithelial cells via the ERK and p38 MAPKdependent pathways; therefore, [6]gingerol may be considered a possible antihypersecretory agent. JK Kundu, et al., “Gingerderived phenolic substances with cancer preventive and therapeutic potential,” Forum of Nutrition 61. (2009): 18292. Ginger, the rhizomes of Zingiber officinale Roscoe (Zingiberaceae), has widely been used as a spice and condiment in different societies. Besides its foodadditive functions, ginger has a long history of medicinal use for the treatment of a variety of human ailments including common colds, fever, rheumatic disorders, gastrointestinal complications, motion sickness, diabetes, cancer, etc. Ginger contains several nonvolatile pungent principles viz. gingerols, shogaols, paradols and zingerone, which account for many of its health beneficial effects. Studies conducted in cultured cells as well as in experimental animals revealed that these pungent phenolics possess anticarcinogenic properties. This chapter summarizes updated information on chemopreventive and chemotherapeutic effects of gingerderived phenolic substances and their underlying mechanisms. MS Baliga, et al., “Update on the chemopreventive effects of ginger and its phytochemicals,” Critical Reviews in Food Science and Nutrition 51.6 (2011): 499523. The rhizomes of Zingiber officinale Roscoe (Zingiberaceae), commonly known as ginger, is one of the most widely used spice and condiment. It is also an integral part of many traditional medicines and has been extensively used in Chinese, Ayurvedic, TibbUnani, Srilankan, Arabic, and African traditional medicines, since antiquity, for many unrelated human ailments including common colds, fever, sore throats, vomiting, motion sickness, gastrointestinal complications, indigestion, constipation, arthritis, rheumatism, sprains, muscular aches, pains, cramps, hypertension, dementia, fever, infectious diseases, and helminthiasis. The putative active compounds are nonvolatile pungent principles, namely gingerols, shogaols, paradols, and zingerone. These compounds are some of the extensively studied phytochemicals and account for the antioxidant, anti inflammatory, antiemetic, and gastroprotective activities. A number of preclinical investigations with a wide variety of assay systems and carcinogens have shown that ginger and its compounds possess chemopreventive and antineoplastic effects. A number of mechanisms have been observed to be involved in the chemopreventive effects of ginger. The cancer preventive activities of ginger are supposed to be mainly due to free radical scavenging, antioxidant pathways, alteration of gene expressions, and induction of apoptosis, all of which contribute towards decrease in tumor initiation, promotion, and progression. This review provides concise information from preclinical studies with both cell culture models and relevant animal studies by focusing on the mechanisms responsible for the chemopreventive action. The conclusion describes directions for future research to establish its activity and utility as a human cancer preventive and therapeutic drug. The abovementioned mechanisms of ginger seem to be promising for cancer prevention; however, further clinical studies are warranted to assess the efficacy and safety of ginger. T Ando, et al., “Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms,” Biochemical and Biophysical Chemical Research Communications 362.1 (2007):21823. Ginger has been used throughout the world as spice, food and traditional herb. We found that 6gingerol, a phenolic alkanone isolated from ginger, enhanced the TRAILinduced viability reduction of gastric cancer cells while 6gingerol alone affected viability only slightly. 6Gingerol facilitated TRAILinduced apoptosis by increasing TRAIL induced caspase3/7 activation. 6Gingerol was shown to downregulate the expression of cIAP1, which suppresses caspase3/7 activity, by inhibiting TRAILinduced NFkappaB activation. As 6shogaol has a chemical structure similar to 6 gingerol, we also assessed the effect of 6shogaol on the viability of gastric cancer cells. Unlike 6 gingerol, 6shogaol alone reduced the viability http://www.ayurvedacollege.com/book/export/html/2
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of gastric cancer cells. 6Shogaol was shown to damage microtubules and induce mitotic arrest. These findings indicate for the first time that in gastric cancer cells, 6 gingerol enhances TRAILinduced viability reduction by inhibiting TRAILinduced NFkappaB activation while 6 shogaol alone reduces viability by damaging microtubules. Nam E Kang, et al., “[6]Gingerol inhibits metastasis of MDAMB231 human breast cancer cells,” The Journal of Nutritional Biochemistry 19.5 (2008): 313319. Gingerol (Zingiber officinale Roscoe, Zingiberaceae) is one of the most frequently and heavily consumed dietary condiments throughout the world. The oleoresin from rhizomes of ginger contains [6]gingerol (1*4′hydroxy3′ methoxyphenyl]5hydroxy3decanone) and its homologs which are pungent ingredients that have been found to possess many interesting pharmacological and physiological activities, such as antiinflammatory, antihepatotoxic and cardiotonic effects. However, the effects of [6]gingerol on metastatic processes in breast cancer cells are not currently well known. Therefore, in this study, we examined the effects of [6]gingerol on adhesion, invasion, motility, activity and the amount of MMP2 or 9 in the MDAMB231 human breast cancer cell line. We cultured MDAMB231 cells in the presence of various concentrations of [6]gingerol (0, 2.5, 5 and 10 μM). *6+Gingerol had no effect on cell adhesion up to 5 μM, but resulted in a 16% reduction at 10 μM. Treatment of MDAMB231 cells with increasing concentrations of [6]gingerol led to a concentrationdependent decrease in cell migration and motility. The activities of MMP2 or MMP9 in MDAMB231 cells were decreased by treatment with [6]gingerol and occurred in a dosedependent manner. The amount of MMP2 protein was decreased in a dosedependent manner, although there was no change in the MMP9 protein levels following treatment with [6]gingerol. MMP2 and MMP9 mRNA expression were decreased by [6]gingerol treatment. In conclusion, we have shown that [6] gingerol inhibits cell adhesion, invasion, motility and activities of MMP2 and MMP9 in MDAMB231 human breast cancer cell lines. EH Chew, et al., "6Shogaol, an active constituent of ginger, inhibits breast cancer cell invasion by reducing matrix metalloproteinase9 expression via blockade of nuclear factorκB activation,” British Journal of Pharmacology 161.8 (2010):17631777. BACKGROUND AND PURPOSE Shogaols are reported to possess antiinflammatory and anticancer activities. However, the antimetastatic potential of shogaols remains unexplored. This study was performed to assess the effects of shogaols against breast cancer cell invasion and to investigate the underlying mechanisms. EXPERIMENTAL APPROACH The antiinvasive effect of a series of shogaols was initially evaluated on MDAMB231 breast cancer cells using the matrigel invasion assay. The suppressive effects of 6shogaol on phorbol 12myristate 13acetate (PMA)induced matrix metalloproteinase9 (MMP9) gelatinolytic activity and nuclear factorκB (NFκB) activation were further determined. KEY RESULTS Shogaols (6, 8 and 10shogaol) inhibited PMAstimulated MDAMB231 cell invasion with an accompanying decrease in MMP9 secretion. 6 Shogaol was identified to display the greatest antiinvasive effect in association with a dosedependent reduction in MMP9 gene activation, protein http://www.ayurvedacollege.com/book/export/html/2
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expression and secretion. The NFκB transcriptional activity was decreased by 6shogaol; an effect mediated by inhibition of IκB phosphorylation and degradation that subsequently led to suppression of NFκB p65 phosphorylation and nuclear translocation. In addition, 6shogaol was found to inhibit JNK activation with no resulting reduction in activator protein1 transcriptional activity. By using specific inhibitors, it was demonstrated that ERK and NFκB signalling, but not JNK and p38 signalling, were involved in PMAstimulated MMP9 activation. CONCLUSIONS AND IMPLICATIONS 6Shogaol is a potent inhibitor of MDAMB231 cell invasion, and the molecular mechanism involves at least in part the downregulation of MMP 9 transcription by targeting the NFκB activation cascade. This class of naturally occurring small molecules thus have potential for clinical use as antimetastatic treatments. Srijit Das, et al., “Ginger Extract (Zingiber Officinale) has AntiCancer and AntiInflammatory Effects on Ethionine Induced Hepatoma Rats,” Clinics 63.6 (2008):807813. OBJECTIVE To evaluate the effect of ginger extract on the expression of NFκB and TNFα in liver cancerinduced rats. METHODS Male Wistar rats were randomly divided into 5 groups based on diet: i) control (given normal rat chow), ii) olive oil, iii) ginger extract (100mg/kg body weight), iv) cholinedeficient diet + 0.1% ethionine to induce liver cancer and v) cholinedeficient diet + ginger extract (100mg/kg body weight). Tissue samples obtained at eight weeks were fixed with formalin and embedded in paraffin wax, followed by immunohistochemistry staining for NFκB and TNFα. RESULTS The expression of NFκB was detected in the cholinedeficient diet group, with 88.3 ± 1.83% of samples showing positive staining, while in the cholinedeficient diet supplemented with ginger group, the expression of NFκB was significantly reduced, to 32.35 ± 1.34% (p<0.05). In the cholinedeficient diet group, 83.3 ± 4.52% of samples showed positive staining of TNFα, which was significantly reduced to 7.94 ± 1.32% (p<0.05) when treated with ginger. There was a significant correlation demonstrated between NFκB and TNFα in the cholinedeficient diet group but not in the cholinedeficient diet treated with ginger extract group. CONCLUSION In conclusion, ginger extract significantly reduced the elevated expression of NFκB and TNFα in rats with liver cancer. Ginger may act as an anti cancer and antiinflammatory agent by inactivating NFκB through the suppression of the proinflammatory TNFα. Ann M. Bode, et al. “[6]Gingerol Suppresses Colon Cancer Growth by Targeting Leukotriene A4 Hydrolase,” Cancer Research 69.13 (2009):558491. http://www.ayurvedacollege.com/book/export/html/2
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[6]Gingerol, a natural component of ginger, exhibits antiinflammatory and antitumorigenic activities. Despite its potential efficacy in cancer, the mechanism by which [6]gingerol exerts its chemopreventive effects remains elusive. The leukotriene A4 hydrolase (LTA4H) protein is regarded as a relevant target for cancer therapy. Our in silico prediction using a reversedocking approach revealed that LTA4H might be a potential target of [6]gingerol. We supported our prediction by showing that [6]gingerol suppresses anchorageindependent cancer cell growth by inhibiting LTA4H activity in HCT116 colorectal cancer cells. We showed that [6]gingerol effectively suppressed tumor growth in vivo in nude mice, an effect that was mediated by inhibition of LTA4H activity. Collectively, these findings indicate a crucial role of LTA4H in cancer and also support the anticancer efficacy of [6]gingerol targeting of LTA4H for the prevention of colorectal cancer. K. Kobata, “A nonpungent component of steamed ginger[10]shogaolincreases adrenaline secretion via the activation of TRPV1,” Nutritional Neuroscience 9.34 (2006):16978. We investigated the components of ginger that are involved in increasing body temperature. Gingerols ([6,8,10] gingerols) and shogaols ([6,8,10] shogaols) having different alkyl carbon chain lengths were targeted. All the gingerols and shogaols increased intracellular calcium concentration in rat transient receptor potential vanilloid subtype 1 (TRPV1)expressing HEK293 cells via TRPV1. In this regard, the shogaols were more potent than the gingerols. Aversive responses were induced by [6], [10]gingerol, and [6]shogaol (5 mmol/l) in rats when these compounds were applied to the eye; however, no response was observed in response to [10]shogaol (5 and 10 mmol/l). [10]Shogaol induced nociceptive responses via TRPV1 in rats following its subcutaneous injection into the hindpaw; the pungent compound capsaicin (CAP) and [6]shogaol were observed to have similar effects. Moreover, adrenal catecholamine secretion, which influences energy consumption, was promoted in rats in response to [6] and [10]gingerols and [6] and [10]shogaols (1.6 micromol/kg, i.v.). [10]Shogaolinduced adrenaline secretion was inhibited by administration of capsazepine, a TRPV1 antagonist. In conclusion, gingerols and shogaols activated TRPV1 and increased adrenaline secretion. Interestingly, [10]shogaol is the only nonpungent compound among the gingerols and shogaols, suggesting its usefulness as a functional ingredient in food. MY Henein, and R. Nicoll, “Ginger (Zingiber officinale Roscoe): a hot remedy for cardiovascular disease?” International Journal of Cardiology 131.3 (2009):4089. Ginger is now exciting considerable interest for its potential to treat many aspects of cardiovascular disease. This letter reviews the more recent trials, which suggest that ginger shows considerable antiinflammatory, antioxidant, antiplatelet, hypotensive and hypolipidemic effect in in vitro and animal studies. Human trials have been few and generally used a low dose with inconclusive results, however dosages of 5 g or more demonstrated significant anti platelet activity. More human trials are needed using an appropriate dosage of a standardised extract. Should these prove positive, ginger has the potential to offer not only a cheaper natural alternative to conventional agents but one with significantly lower side effects. AJ Ammit, et al. “Gingerols and related analogues inhibit arachidonic acidinduced human platelet serotonin release and aggregation,” Thrombosis Research 103.5 (2001):38797. Gingerols, the active components of ginger (the rhizome of Zingiber officinale, Roscoe), represent a potential new class of platelet activation http://www.ayurvedacollege.com/book/export/html/2
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inhibitors. In this study, we examined the ability of a series of synthetic gingerols and related phenylalkanol analogues (G1G7) to inhibit human platelet activation, compared to aspirin, by measuring their effects on arachidonic acid (AA)induced platelet serotonin release and aggregation in vitro. The IC(50) for inhibition of AAinduced (at EC(50)=0.75 mM) serotonin release by aspirin was 23.4+/3.6 microM. Gingerols and related analogues (G1G7) inhibited the AAinduced platelet release reaction in a similar dose range as aspirin, with IC(50) values between 45.3 and 82.6 microM. G1G7 were also effective inhibitors of AAinduced human platelet aggregation. Maximum inhibitory (IC(max)) values of 10.5+/3.9 and 10.4+/3.2 microM for G3 and G4, respectively, were approximately 2fold greater than aspirin (IC(max)=6.0+/1.0 microM). The remaining gingerols and related analogues maximally inhibited AAinduced platelet aggregation at approximately 2025 microM. The mechanism underlying inhibition of the AAinduced platelet release reaction and aggregation by G1G7 may be via an effect on cyclooxygenase (COX) activity in platelets because representative gingerols and related analogues (G3 G6) potently inhibited COX activity in rat basophilic leukemia (RBL2H3) cells. These results provide a basis for the design of more potent synthetic gingerol analogues, with similar potencies to aspirin, as platelet activation inhibitors with potential value in cardiovascular disease. KK AlQattan, et al., “The use of ginger (Zingiber officinale Rosc.) as a potential antiinflammatory and antithrombotic agent,” Prostaglandins, Leukotrienes, and Essential Fatty Acids 67.6 (2002):4758. The effect of an aqueous extract of ginger (Zingiber officinale) on serum cholesterol and triglyceride levels as well as platelet thromboxaneB(2) and prostaglandinE(2) production was examined. A raw aqueous extract of ginger was administered daily for a period of 4 weeks, either orally or intraperitoneally (IP) to rats. Fasting blood serum was investigated for thromboxaneB(2), prostaglandinE(2), cholesterol and triglycerides. A low dose of ginger (50 mg/kg) administered either orally or IP did not produce any significant reduction in the serum thromboxaneB(2) levels when compared to salinetreated animals. However, ginger administered orally caused significant changes in the serum PGE(2) at this dose. High doses of ginger (500 mg/kg) were significantly effective in lowering serum PGE(2) when given either orally or IP. However, TXB(2) levels were significantly lower in rats given 500 mg/kg ginger orally but not IP. A significant reduction in serum cholesterol was observed when a higher dose of ginger (500 mg/kg) was administered. At a low dose of ginger (50 mg/kg), a significant reduction in the serum cholesterol was observed only when ginger was administered IP. No significant changes in serum triglyceride levels were observed upon administration of either the low or high dose of ginger. These results suggest that ginger could be used as an cholesterollowering, antithrombotic and antiinflammatory agent. A. Bordia, et al., “Protective effect of ginger, Zingiber officinale Rosc on experimental atherosclerosis in rabbits,” Indian Journal of Experimental Biology 42.7 (2004):7368. The effects of air dried ginger powder (0.1g/kg body weight, po, for 75 days) were studied on experimentally induced atherosclerosis in rabbits by cholesterol feeding (0.3g/kg body weight, po). Cholesterol feeding for 75 days lead to distinct development of atheroma in the aorta and coronary arteriesof the rabbits and this was significantly inhibited by about 50% following ginger administration. There was distinct decrease in lipid peroxidation and enhancement of fibrinolytic activity in ginger treated animals. However, ginger did not lower blood lipidsto any significant extent. This distinct protection from the development of atherosclerosis by ginger is probably because of its free radical scavanging, prostaglandin inhibitory and fibri properties. Yuhao Li, et al., “A 35day gavage safety assessment of ginger in rats.” Regulatory Toxicology and Pharmacology 54.2 (2009):118123. http://www.ayurvedacollege.com/book/export/html/2
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Ginger (Zingiber officinale Roscoe, Zingiberacae) is one of the most commonly used spices around the world and a traditional medicinal plant that has been widely used in Chinese, Ayurvedic and UnaniTibb medicines for several thousand years. However, there was still lack of systemic safety evaluation. We conducted a 35day toxicity study on ginger in rats. Both male and female rats were daily treated with ginger powder at the dosages of 500, 1000 and 2000 mg/kg body weight by a gavage method for 35 days. The results demonstrated that this chronic administration of ginger was not associated with any mortalities and abnormalities in general conditions, behavior, growth, and food and water consumption. Except for dose related decrease in serum lactate dehydrogenase activity in males, ginger treatment induced similar hematological and blood biochemical parameters to those of controlled animals. In general, ginger treatment caused no overt organ abnormality. Only at a very high dose (2000 mg/kg), ginger led to slightly reduced absolute and relative weights of testes (by 14.4% and 11.5%, respectively). This study provides a new understanding of the toxicological properties of ginger.
ENDNOTES 1 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 2 David Frawley, and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 122. 3 John Lust, The Herb Book (New York: Benedict Lust Publications, 2005) 205, 514. 4 Ibid, p205, 514. 5 Karta Purkh Singh Khalsa, and Michael Tierra The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 136, 138. 6 R.K. Goel and K. Sairam. “AntiUlcer Drugs from Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale,” Indian Journal of Pharmacology 34 (2002): 100 110. 7 Karta Purkh Singh Khalsa, and Michael Tierra The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 136, 138. 8 John Lust, The Herb Book (New York: Benedict Lust Publications, 2005) 514515. 9 Karta Purkh Singh Khalsa and Michael Tierra, The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 138. 10 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 11 David Frawley, and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 121. 12 Vaidya Bhagwan Dash, Materia Medica of Ayurveda (New Delhi: Concept Publishing, 1980) 35, ch.2, v.54. http://www.ayurvedacollege.com/book/export/html/2
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13Kaviraj Kunia Lal Bhishagratna, ed. The Sushruta Samhita. Vol.I (Calcutta, self, 1907) 510, ch. XLVI. 14 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 15 David Frawley, and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 122. 16 Karta Purkh Singh Khalsa and Michael Tierra, The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 136. 17 Michael Tierra, The Way of Herbs (Santa Cruz, CA: Unity Press, 1980) 70. 18 David Frawley and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 121122. 19 Daniel P. Reid, Chinese Herbal Medicine (Boston: Shambhala Publications, Inc., 1986) 116. 20 Victoria Zak, 20,000 Secrets of Tea (New York: Dell Publishing, 1999) 131132. 21 David Frawley and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 121. 22 Daniel P. Reid, Chinese Herbal Medicine (Boston: Shambhala Publications, Inc., 1986) 116. 23 David Frawley and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 121. 24 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 25 R.K. Goel and K. Sairam. “AntiUlcer Drugs from Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale,” Indian Journal of Pharmacology 34 (2002): 100 110. 26NC Azu and RA Onyeagba, “Antimicrobial Properties Of Extracts Of Allium cepa (Onions) And Zingiber officinale (Ginger) On Escherichia coli, Salmonella typhi And Bacillus subtilis.” The Internet Journal of Tropical Medicine 3.2 (2007). http://www.ispub.com/journal/theinternetjournaloftropicalmedicine/volume3number 2/antimicrobialpropertiesofextractsofalliumcepa onionsandzingiberofficinalegingeronescherichiacoli salmonellatyphiandbacillussubtilis.html 27 David Frawley and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 122. 28 Vaidya Bhagwan Dash, Materia Medica of Ayurveda (New Delhi: Concept Publishing, 1980) ch.2, v.54. 29 Kaviraj Kunia Lal Bhishagratna, ed. Sushruta Samhita, vol.II, 311, ch.V, verse 34. 30 Ibid, vol.II, 311, ch.V, verse 34. 31 Vaidya Bhagwan Dash, Materia Medica of Ayurveda (New Delhi: Concept Publishing, 1980) ch.2, v.63; ch.8, v.9; ch.27, v.1113. http://www.ayurvedacollege.com/book/export/html/2
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32 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 302. 33 Ibid p183. 34 SengKee Chuau, et.al, “Effect of Ginger on Gastric Motility and Symptoms of Functional Dyspepsia,” World Journal of Gastroenterology 17.1 (2011):105110. 35 Ibid p105110. 36 Ibid p105110. 37 SK Chuau, et al., “Effect of Ginger on Gastric Emptying and Motility in Healthy Humans,” European Journal of Gastroenterology and Hepatology 20.5 (2008):436440. 38 M. Mokhtari, et al., “Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit,” Journal of Critical Care 25.4 (2010):647650. 39 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 40 Owyang Chung, et al., “Effects of ginger on motion sickness and gastric slowwave dysrhytmias induced by circular vection,” American Journal of Physiology 284.3 (2003):G481G489. 41 Torben Brask, et al., “Ginger Root Against Seasickness: A Conctrolled Trial on the Open Sea,” Acta Oto laryngologica 105.12 (1988):4549. 42 R.K. Goel and K. Sairam. “AntiUlcer Drugs from Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale,” Indian Journal of Pharmacology 34 (2002): 100 110. 43“NICE Clinical Guidelines, No. 62,” Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: National Collaborating Centre for Women’s and Children’s Health (UK), RCOG Press, 2008. 44 N Chaiyakunapruk, et al., “The efficacy of ginger for the prevention of postoperative nausea and vomiting: a metaanalysis,” American Journal of Obstetrics and Gynecology 194.1 (2006):9599. 45 Y.K. Gupta, et al., “Antiemetic effect of ginger powder versus placebo as an addon therapy in children and young adults receiving high http://www.ayurvedacollege.com/book/export/html/2
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emetogenic chemotherapy,” Pediatric Blood & Cancer 56.2 (2011):234238. 46 T Chisaka, et al., “Cholagogic effect of ginger and its active constituents,” Journal of ethnopharmacology 13.2 (1985):21725. 47 T.A. Ajith, et al., “Zingiber officinale Roscoe prevents acetaminopheninduced acute hepatotoxicity by enhancing hepatic antioxidant status,” Food and Chemical Toxicology 45.11 (2007): 22672272. 48 Suresh Kumar, et al., “6gingerol, an active ingredient of ginger, protects acetaminopheninduced hepatotoxicity in mice,” Journal of Chinese integrative medicine 9.11 (2011):12641269. 49 R.K. Goel, and K. Sairam. “AntiUlcer Drugs from Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale,” Indian Journal of Pharmacology 34 (2002): 100 110. 50 Harish Nayaka Mysore Annaiah, et al., “Gastroprotective Effect of Ginger Rhizome (Zingiber Officinale) Extract: Role of Gallic Acid and Cinnamic Acid in H+, K+ATPase/H. pylori Inhibition and AntiOxidative Mechanism,” Evidence –Based Complementary and Alternative Medicine 2011. (2011): 249487. 51 NC Azu and RA Onyeagba, “Antimicrobial Properties Of Extracts Of Allium cepa (Onions) And Zingiber officinale (Ginger) On Escherichia coli, Salmonella typhi And Bacillus subtilis.” The Internet Journal of Tropical Medicine 3.2 (2007). http://www.ispub.com/journal/theinternetjournaloftropicalmedicine/volume3number 2/antimicrobialpropertiesofextractsofalliumcepa onionsandzingiberofficinalegingeronescherichiacoli salmonellatyphiandbacillussubtilis.html 52 M Park, et al., “Antibacterial activity of *10+gingerol and [12]gingerol isolated from ginger rhizome against periodontal bacteria,” Phytotherapy Research 22. (2008): 1446–1449. 53 NC Azu and RA Onyeagba, “Antimicrobial Properties Of Extracts Of Allium cepa (Onions) And Zingiber officinale (Ginger) On Escherichia coli, Salmonella typhi And Bacillus subtilis.” The Internet Journal of Tropical Medicine 3.2 (2007). http://www.ispub.com/journal/theinternetjournaloftropicalmedicine/volume3number 2/antimicrobialpropertiesofextractsofalliumcepa onionsandzingiberofficinalegingeronescherichiacoli salmonellatyphiandbacillussubtilis.html 54 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. http://www.ayurvedacollege.com/book/export/html/2
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55 CY Chen, et al., “Zingiber officinale (ginger) compounds have tetracyclineresistance modifying effects against clinical extensively drug resistant Acinetobacter baumannii,” Phytotherapy Research 24.12 (2010):182530. 56 M Park, et al., “Antibacterial activity of *10+gingerol and [12]gingerol isolated from ginger rhizome against periodontal bacteria,” Phytotherapy Research 22. (2008): 1446–1449. 57 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183184. 58 RA AlEssa, et al., “Physiological and therapeutical roles of ginger and turmeric on endocrine functions,” The American Journal of Chinese Medicine 39.2 (2011): 21531. 59 Mark H. Beers, ed., et al, The Merck Manual of Medical Information 2003. 2nd edition. (New York: Pocket Books, 2004) 408409. 60 Carmelita G. Frondoza, et al., “Ginger—An Herbal Medicinal Product with Broad AntiInflammatory Actions,” Journal of Medicinal Food 8.2 (2005):125132. 61MK Balijepalli, et al., “Comparative antioxidant and antiinflammatory effects of [6]gingerol, [8]gingerol, [10] gingerol and [6]shogaol,” Journal of ethnopharmacology 127.2 (2010): 51520. 62 Jennifer B. Frye, et al., “Comparative Effects of Two GingerolContaining Zingiber officinale Extracts on Experimental Rheumatoid Arthritis,” Journal of Natural Products 72.3 (2009): 403407. 63Wenkui Li, et al. “Cyclooxygenase2 inhibitors in ginger (Zingiber officinale),” Fitoterapia 82.1 (2011):3843. 64 RD Altman, et al. “Effects of a ginger extract on knee pain in patients with osteoarthritis,” Arthritis and rheumatism 44.11 (2001): 25318. 65T. Therkleson, “Ginger compress therapy for adults with osteoarthritis,” Journal of Advanced Nursing 66. (2010): 2225–2233. 66SY Kim, et al. “6Shogaol, a ginger product, modulates neuroinflammation: A new approach to neuroprotection,” Neuropharmacology 63.2 (2012): 21123. 67 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. http://www.ayurvedacollege.com/book/export/html/2
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68 Mark H. Beers, ed., et al, The Merck Manual of Medical Information 2003. 2nd edition. (New York: Pocket Books, 2004) 236. 69 Mayo Clinic, Mayo Clinic Staff, Asthma. http://www.mayoclinic.com/health/asthma/DS00021/DSECTION=complications 70 MN Ghayur, et al. “Ginger attenuates acetylcholineinduced contraction and Ca2+ signalling in murine airway smooth muscle cells,” Canadian Journal of Physiology and Pharmacology 86.5 (2008):26471. 71 JA Podlogar and EJ Verspohl. “Antiinflammatory effects of ginger and some of its components in human bronchial epithelial (BEAS2B) cells,” Phytotherapy Research 26.3 (2012): 3336. 72 MS Huang, et al. “Ginger suppresses phthalate esterinduced airway remodeling,” Journal of Agricultural and Food Chemistry 59.7 (2011) 342938. 73 JH Bae, et al., “*6+Gingerol suppresses interleukin1 betainduced MUC5AC gene expression in human airway epithelial cells,” American Journal of Rhinology & Allergy 23.4 (2009): 38591. 74 JK Kundu, et al., “Gingerderived phenolic substances with cancer preventive and therapeutic potential,” Forum of Nutrition 61. (2009): 18292. 75 MS Baliga, et al., “Update on the chemopreventive effects of ginger and its phytochemicals,” Critical Reviews in Food Science and Nutrition 51.6 (2011): 499523. 76 T Ando, et al., “Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms,” Biochemical and Biophysical Chemical Research Communications 362.1 (2007):21823. 77 Nam E Kang, et al., “[6]Gingerol inhibits metastasis of MDAMB231 human breast cancer cells,” The Journal of Nutritional Biochemistry 19.5 (2008): 313319. 78 EH Chew, et al., "6Shogaol, an active constituent of ginger, inhibits breast cancer cell invasion by reducing matrix metalloproteinase9 expression via blockade of nuclear factorκB activation,” British Journal of Pharmacology 161.8 (2010):17631777. 79Srijit Das, et al., “Ginger Extract (Zingiber Officinale) has AntiCancer and AntiInflammatory Effects on Ethionine Induced Hepatoma Rats,” Clinics 63.6 (2008):807813. http://www.ayurvedacollege.com/book/export/html/2
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80 Ann M. Bode, et al. “[6]Gingerol Suppresses Colon Cancer Growth by Targeting Leukotriene A Cancer Research 69.13 (2009):558491. Hydrolase,” 81K. Kobata, “A nonpungent component of steamed ginger[10]shogaolincreases adrenaline secretion via the activation of TRPV1,” Nutritional Neuroscience 9.34 (2006):16978. 82 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 183. 83 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 184. 84 MY Henein and R. Nicoll, “Ginger (Zingiber officinale Roscoe): a hot remedy for cardiovascular disease?” International Journal of Cardiology 131.3 (2009):4089. 85AJ Ammit, et al. “Gingerols and related analogues inhibit arachidonic acidinduced human platelet serotonin release and aggregation,” Thrombosis Research 103.5 (2001):38797. 86KK AlQattan, et al., “The use of ginger (Zingiber officinale Rosc.) as a potential antiinflammatory and antithrombotic agent,” Prostaglandins, Leukotrienes, and Essential Fatty Acids 67.6 (2002):4758. 87A. Bordia, et al., “Protective effect of ginger, Zingiber officinale Rosc on experimental atherosclerosis in rabbits,” Indian Journal of Experimental Biology 42.7 (2004):7368. 88 M. Mokhtari, et al., “Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit,” Journal of Critical Care 25.4 (2010):647650. 89 David Frawley and Vasant Lad, The Yoga of Herbs (Twin Lakes, WI: Lotus Press, 1992) 121. 90 “NICE Clinical Guidelines, No. 62,” Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: National Collaborating Centre for Women’s and Children’s Health (UK), RCOG Press, 2008. 91 Torben Brask, et al., “Ginger Root Against Seasickness: A Conctrolled Trial on the Open Sea,” Acta Oto laryngologica 105.12 (1988):4549. 92 N Chaiyakunapruk, et al., “The efficacy of ginger for the prevention of postoperative nausea and vomiting: a metaanalysis,” American Journal of Obstetrics and Gynecology 194.1 (2006):9599. 93 Owyang Chung, et al., “Effects of ginger on motion sickness and gastric slowwave dysrhytmias induced by circular vection,” American Journal of Physiology 284.3 (2003):G481G489. http://www.ayurvedacollege.com/book/export/html/2
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94 John Lust, The Herb Book (New York: Benedict Lust Publications, 2005) 206. 95 SK Chuau, et al., “Effect of Ginger on Gastric Emptying and Motility in Healthy Humans,” European Journal of Gastroenterology and Hepatology 20.5 (2008): 436440. 96 Sebastian Pole, Ayurvedic Medicine (Philadelphia, PA: Elsevier, 2006) 184. 97 Karta Purkh Singh Khalsa and Michael Tierra, The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 136. 98 Karta Purkh Singh Khalsa and Michael Tierra, The Way of Ayurvedic Herbs (Twin Lakes, WI: Lotus Press, 2008) 138. 99 Daniel P. Reid, Chinese Herbal Medicine (Boston: Shambhala Publications, Inc., 1986) 116. 100 Michael Tierra, Planetary Herbology (Santa Fe, NM: Lotus Press, 1988) 154, 244. 101 Robyn Landis with Karta Purkh Singh Khalsa, Herbal Defense (New York: Warner Books, 1997) 302. 102 MY Henein, and R. Nicoll, “Ginger (Zingiber officinale Roscoe): a hot remedy for cardiovascular disease?” International Journal of Cardiology 131.3 (2009):4089. 103 Yuhao Li, et al., “A 35day gavage safety assessment of ginger in rats.” Regulatory Toxicology and Pharmacology http://www.ayurvedacollege.com/book/export/html/2
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Coriander The Wealthy One (By Dr. Khaled Haidari DDS) 1. Introduction 2. Botanical description 3. Ayurvedic description 4. Uses 5. Herbal Combinations 6. Contraindications and interactions with drugs and minerals 7. Conclusion 8. End notes 9. Abstracts
1. Introduction Coriander is an amazing herb that is used for culinary and medicinal purposes. From the oldest times it is known in the Mediterranean region, Africa and the Middle East, central Asia, India and China.1 The old Greeks, Egyptians and Romans were familiar with it. Pliny (Plinius), the famous Roman historian, tells us that “the best coriander came from Egypt’”.2 It is also very popular in Latin America, and it is getting more appreciated in the West. It appears under many names because of its use in many places and times. From the old Sanskrit name kustambari, many modern versions are derived such as the Indonesian kutumbar and the Tamil kotamali. There is another reference from the Persian geshniz being the basis for the central Asian names. In Arabic it is known as kzbara. Most of the European names originate from the Latin coriandrum or the Greek corianon. In English coriander leaves are often referred to as cilantro and the fruits as coriander. The fruits are also known as seeds. Coriander is also found under the names Indian parsley or Chinese parsley because of the close resemblance to its cousin parsley.1 In India it is known as dhanya or dhanyaka, which means “the rich one”.3 It deserves its name because of its many culinary and medicinal uses. For culinary purposes, some regions prefer the fruit and others, the leaf. Most of the people like the taste of the fruit and would describe it as warm, nutty and spicy. Some even find an orangelike quality. The leaves are appreciated by almost everyone in Asia and Latin America, and they are described as fresh, green, tangy and even citrusy. Central and Northern Europeans are on average not very fond of the taste and would describe it as soapy, like burnt rubber, or even like crushed bed bugs. Coriander is very good in bringing together the aromas of different spices. That is the reason why it is found in spice mixes even in regions where it is not used separately.1 It is less known that a very deep knowledge was used in designing the curry and spice blends in which coriander is an important component. The intention was to balance and heal.4 Using food as medicine is an important idea of Ayurveda and other systems that developed from it. Another use is in preparing medicines for an amazing variety of health problems with studies confirming the old knowledge and opening new possibilities. The treasure of the “rich one” is immense, and it is http://www.ayurvedacollege.com/book/export/html/2
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very exciting to explore it.
2. Botanical description The botanical name is Coriandrum sativum. It is classified in the family Apiaeceae, formerly known as Umbeliferaeae.5 This family is also known as the carrot family and has many important members, such as anise, asafetida, caraway, celery, dill, fennel, and parsley.60 Parts used – Fruit and fresh leaves. Description: Coriander is an annual with erect stems, 13 feet high, slender and branched. The lowest leaves are stalked and pinnate, the leaflets roundish or oval, slightly lobed. The segments of the uppermost leaves are linear and more divided. The flowers are in shortlystalked umbels, five to ten rays, pale mauve, almost white, delicately pretty. The seed clusters are very symmetrical, and the seeds fall as soon as they are ripe. They are quite round like tiny balls. They lose their disagreeable scent on drying and become fragrant. The plant is bright green, shining, glabrous and intensely fetid. Gerard describes it as follows: “The common kind of Coriander is a very striking herb. It has a round stalk full of branches, two feet long. The leaves are almost like the leaves of the parsley, but later on become jagged, almost like the leaves of Fumitorie, but a great deal smaller and more tender. The flowers are white and grow in round tassels like Dill.” Cultivation: “Coriander likes a warm, dry, light soil, though it also does well in a somewhat heavy soil… It is sown in mild, dry weather in April, or in the wormer month of March.” “As the seeds ripen, about August, the disagreeable odor gives place to a pleasant aroma and the plant is then cut down with sickles and when dry the fruit is threshed out.” The parts used are: the fruit and sometimes the fresh leaves for salads and soups. The fruit (socalled seeds) are of globular form, beaked, finely ribbed, yellowish brown, 1/5 inch in diameter, with five longitudinal ridges, separable into two halves (the mericarps), each of which is concave internally and shows the broad, longitudinal oil cells (vittae). The seeds have an aromatic taste and when crushed, a characteristic odor.2 This plant is a native of the Mediterranean region and is intensively grown in India. It is cultivated in all the states and is an important subsidiary crop in the black cotton soils of the Deccan and south India and is also important in North India.6 “The coriander grown in Russia and central Europe (var. microparcum) has smaller fruits less, than 3 mm, and contains more essential oil than the oriental variety ( var.vulgare), which is greater than 3 mm and is cultivated for fruits and leaves.” 1 Constituents Coriander fruit contains about 1 percent of volatile oil, which is the active ingredient. It is pale yellow or colorless, and has the odor of Coriander and a mild aromatic taste.2 Terpene alcohols are the main component and up to 80 % goes to linalool. 7 Its essential oil consists of linalool called coriandrol (6070 %), geraniol and borneol .8 The volatile oil also has anethole, camphor and limonen. Coriander essential oil has flavonoids: rutin, quercetin, apigenin, coumarins: psoralen, angelcin, umbeliferone, phenolic acids and phtalides (Williamson 2003) 3. The fruit yields about 5 percent of ash and also contains malic acid, tannin and some fatty mater.”2 Some more components are Betasitosteral, Dmannital, http://www.ayurvedacollege.com/book/export/html/2
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flavonoid, glycosides, Lpinene, betaphellandrene, 1,8cineole,betacaryophyllene, aflatocsins B1 and B2.6
3. Ayurvedic description According to Drayaguna Vijnana, the Gana or classification of coriander according to Ayrveda is Shitprashmana (Refrigerant) and Trishnanigrheneya (Thirst depressant). Synonyms are Dhania (Hindi), Dhanya, Dhanyaka, Kustumburu, Vitnnaka (Sanskrit), Coriander (English). Habitat: it is found in India. Rasa (taste): madhura (sweet), katu (pungent), tikta (bitter) and kshaya (astringent). Guna (physical property) is laghu (light) and snigadha. Virya (potency) is ushana (hot). Vipaka (post digestion effect) is madhura (sweet). Pacifying Vata, Pitta and Kapha dosha. Karma (action) is trishnanigrhena (thirst depressant) It is used in fevers, loss of appetite and indegestion. Parts used are fruits and oil. Dose 13 g. 9 Formulations based on Dnayaka are Dhanyapanchaka kwatha and Dhanyakadi hima (Coriander water). (drayaguna vijnana). Dhanyapanchaka Kwatha churna, Satamolyadi Lauha, Ernada Paka, Dhanyadi Lima, Bhaskar Lavana Curna. 10 In the Indian Materia Medica we will find that “Dhanyaka is astringent, bitter and sweet in taste, cardiac tonic, digestive stimulant and carminative. It cures casa (coughing), trt (morbid thirst) and chardi (vomiting). It is useful for the eyes. Green kustumbari (dhanyaka), when used in different ways, imparts good taste, fragrance and cardiac tonic property to various excellent types of vegetables. The dried kustumbari is sweet in vipaka and unctuous. It cures trt (morbid thirst), daha (burning) and aggravated doshas. It is slightly pungent and bitter. It cleanses the channels of circulation.” 11 It belongs to the group of herbs known as Guducuyadi gana which according to Arogya cintamani also consists of guduci, nimba, padmaka and rakta candana. The Dravaguna Vijnana gives information from Susruta according to whom drugs belonging to this group cure trsna (morbid thirst), daha (burning syndrome), aruci (anorexia), chardi (vomiting) and jvara (fever). They also stimulate the power of digestion.12 It is also an alterative, diaphoretic, diuretic and carminative according to “The Yoga of Herbs” by Dr. Frawley and Dr. Lad.13 In Dr. Tierra’s “Planetary Herbology” the seeds of Coriander have a neutral energy, and the leaves are cooling. Benefitted organs are the bladder and stomach. It is carminative, aromatic and diuretic.8 According to Sebastian Pole, the virya (energy) is cooling (leaves) and warming (seed). Its Ayurvedic actions are dipana (appetite stimulant), amapacana (toxin digester), sulaprasamana (alleviates intestinal spasms), dahaghna (alleviates burning in the body), agmimandyanasaka (aleviates sluggish appetite), trshaghna (alleviates thirst), hrdaya (lifts the spirits), krmighna (warm killer), mutrala (diuretic), kusthaghna (alleviates hot skin conditions).3 Dr. Kurt Schaubelt states, “Because of the high linalool content, this oil is tonifying and strengthening. In addition, a series of coumarin compounds together with linalool provide a mild euphoric effect.” 7 http://www.ayurvedacollege.com/book/export/html/2
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4. Uses “Coriander seeds are a good household remedy for many pitta disorders, particularly those of the digestive tract or urinary system.” 13 They can be used together with burdock seeds, which have similar indications.14 “This popular Indian curry ingredient is also an invaluable medicine; it soothes an irritated digestive system and cools any burning sensations in the body. Its sweet aroma subtly lifts the spirits. Dhanyaka is a proper noun also meaning rich.” It is used in dosages 130 g/day or 315 ml/day of a 1: 3@45 % tincture. It is often used with sugar to increase the antipitta effect. 3 Digestion. Coriander seed is an excellent remedy for promoting Pitta digestion as it enkindles agni but does not aggravate acidity. It is safe to use when there is an inflammation in the digestive system and agni needs strengthening. It is prescribed in IBS (irritative bowel syndrome) and colic. Both the leaf and the seed are used to clear flatulence, gripping and bloating.3 For gas and indigestion a tea can be prepared: an infusion with the seeds.15 It is an effective digestive agent for Pitta conditions in which most spices are contraindicated or used with caution. Often used together with fennel and cumin which are related plants with similar properties for digestive disorders, mainly owing to high Pitta, and are also used together in various formulations to promote the assimilation of the other herbs.13 Coriander can be used roasted alone or with fennel and cumin, one teaspoon after meals for cramping and flatulence.16 For pitta type bloating where symptoms of high pitta such as hyperacidity, diarrhea, heartburn and irritability appear along with gas, cool carminatives among which is coriander should be combined with bitters (gentian, barberry, goldenseal, katuka). Coriander, fennel and cumin should be taken in equal parts, ¼ teaspoon before meals.17 It is also useful for vata and kapha because of its digestion enhancing quality, although in small amounts. It is useful for flatulence and indigestion.6 “ The curry powder characteristic of the Indian cooking was originally a therapeutic blend of spices. It included turmeric, cumin seed, coriander, ginger, asafetida and chili pepper along with garlic and onions sautéed in ghee (clarified butter).4 The basis of Indian curry is three important spices: cumin seed which is heating, carminative and with a strong spicy flavor; coriander seed which is cooler and has a milder spicy flavor and turmeric root, pleasantly bitter and only slightly spicy tasting, imparts a golden color to the food. It has liver detoxifying, blood moving and digestive properties. These three spices used together are balanced within themselves and are most important in promoting optimal digestion and assimilation of complex carbohydrates.”18 Urinary tract.For urinary tract infections, burning urethra and cystitis. It is a cooling diuretic.19 It combines well with fennel.16 It is specific for strengthening of the urinary tract. The seeds and the leaves can both be used as an infusion for infections of the urinary tract.8 http://www.ayurvedacollege.com/book/export/html/2
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A cold infusion of the seeds is used for draining heat out of the urinary system. Useful in cystitis, dysuria and cloudy urine (bhavaprakasa). 3 Warm infusion is also advised for burning on urination. This tea makes the urine more alkaline.15 One formula for urinary tract infections with burning urination is: coriander, pipsissewa, plantain, Marshmallow, lemon grass and gotu kola in equal parts, 12 teaspoons of cut and sifted herbs in 1 cup of hot water every few hours.20 Kidney flash procedure done after one day of fasting consists of drinking one or two quarts of water with a small amount of mild diuretic herbs, like coriander, parsley and lemon grass the following morning.21 Edema. Cilantro is used as a mild diuretic which is good in order not to over stimulate the kidneys.22 ”Excess moisture of the body is dried out by coriander.” 23 Used as a decoction, it is useful for treating the swelling during pregnancy starting from the fifth month.24 High blood pressure. Here, its property of being a good diuretic is used.53 Burns 13 Allergies, hay fever, skin rushes, urticaria. The fresh juice of the herb is effective internally, but it can also be used externally for itch and inflammation. One teaspoon three times a day.13 Skin rash is treated with an application of the pulp of cilantro leaf directly or by taking coriander tea, 1 tsp. to 1 cup of water.26 “Coriander may be used internally for allergic rhinitis of pitta origin (Frawley & Lad 1994).” 3 When used internally it helps purify the blood and externally relieves the burning sensation. It is also applied for dermatitis. 15 Coriander is used to increase digestive fire and regulate digestive function in pitta patients with allergies. 25 Food poisoning/radiation: In 1 cup of miso soup add 1 tsp. of ghee and ½ tsp each of coriander and cumin powder.27 A Romanian study shows coriander being an excellent antibacterial and antifungal, effective against staphylococcus, streptococcus, E. coli, salmonella and Candida albicans. The study suggests industrial use for coriander as a food preserver.54 Vomiting 11’12 Warm infusion of the seeds is used and also helps with nausea.15 Temporal headache: that indicates excess pitta in the stomach. That can be relieved by drinking a tea of cumin and coriander seeds, ½ tsp each in one cup of hot water. This goes with an application of sandalwood oil or paste to the temples.28 Poison bites and stings: drink cilantro juice.26 Parasites. The powder of the seed is used for worms in children. 3 A decoction of the seeds is used effectively.29 Eye infections. Eyes are rinsed with a cooled decoction of the seeds.24 http://www.ayurvedacollege.com/book/export/html/2
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Diabetes. Coriander is beneficial in the hot, pitta type diabetes (pittaja prameha).3 This herb has a hypoglycemic effect; it lowers the glucose level in the blood.43 Hot flashes 3 Respiratory system. It is used for sore throat 13. It is useful for coughs 11 when combined with licorice and pippali 3. Another way is ground coriander seeds mixed with honey in the 1:2 ratio. 24 For pittatype asthma coriander is applied in the antipitta diet. 31 Coriander helps clean mucus from the lungs with its antispasmodic and expectorant properties. (Paranpje 2001) 3 Detoxifying herb. Coriander helps to clean the body from the cell up 6. The leaf is used to facilitate the safe excretion of heavy metals and other environmental toxins such as lead, arsenic and mercury. It must be used in dropbydrop doses accompanied by chlorella, an intestinal heavy metal toxin agent.3 Fever. Resolves fevers. 23 The seeds are a mild diaphoretic and they can help alleviate a fever by allowing the displaced agni, pitta and ama to be released through the skin and urine. 3 It is also a cooling diuretic. 19’12 Measles.32 Small pox. It was used for treating of this horrible and now extant disease.33 Colds. Coriander is “particularly useful when a person has a cold.” 23 The essential oil applied externally helps alleviate the body aches.29 Morbid thirst. 11’12 A cold infusion is used with some honey.24 Anorexia. 12 Liver, hepatitis. Coriander is a mild spice that helps promote liver energy and improve the appetite when the liver is sluggish or congested. It is used as a spice for cooking or tea, before or after meals.34 During the treatment of hepatitis, after a mono diet of mung beans for 12 weeks, basmati rice can be added to make kicharee, along with coriander, turmeric and other liver cleansing spices. Mainly bitter herbs are indicated with bile clearing, blood cleansing and mild purgative action. Here aloe vera is used with small amounts of turmeric and coriander, 12 teaspoons before meals.35 For milder cases of gall stones, corn silk tea, 1 ounce per pint of water with 1 teaspoon of coriander, taken daily is effective. Most herbs for http://www.ayurvedacollege.com/book/export/html/2
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urinary stones help clear gall stones as well when combined with coriander to conduct the action to the liver area. One formula is coriander, turmeric, barberry, gravel root and corn silk in equal parts. 36 It has a hepatoprotective effect, reducing the liver weight and clearing the fat and necrosis. 55 Epistaxis or nose bleeds. Coriander tea is used in this case. 37 Also, a paste of green coriander leaves can be applied on the forehead, and the patient should inhale the aroma of fresh coriander leaves.38 Cleansing of the channels of circulation. 11 ”It opens the subtlest networks of the veins.” 23 Weakened immunity. Therapy for weakened immunity (according to Franchomme) starts with two days of intense treatment with essential oils containing phenol (oregano or thyme) and then starts with steadily decreasing them and introducing oils that contain terpene alcohol (coriander, eucalyptus, tea tree, thyme etc.) that are to be applied alternately.39 AIDS. Equal parts coriander, gotu kola, sarsaparilla, ashwaghandha, shatavari, gokshura and sandalwood.30 Increasing of the milk flow.23 Increasing of the menstrual flow.23 Excessive menstrual bleeding Take coriander with rice water and fresh cilantro leaves.24 Boldness, scalp problems and prevention of grey hair. The oil is used 23 or fresh juice made of the leaves.24 Insect repellant. The smoke of the burning seed is an effective insect repellant.23 Arthritis. Coriander is traditionally used for arthritis, and a study shows that its swellingdecreasing action is based on the antiinflammatory property.56 Linalool has an antiinflammatory action.40 The essential oil is applied by massaging the painful joint.29 If no oil is available, a decoction of crushed seeds is used to soak a cloth and place it on the joint. The cloth has to be warm. (anecdotal) Halitosis (bad breath). Chewing of a few seeds as needed takes care of the problem.24 Antifungal. A study on the effect of coriander essential oil on Candida albicans isolated from the oral bio film of patients with periodontal disease shows that it has a strong antifungal activity which gives it a good potential to be used in a new antifungal preparation. 57 ’54 Antianxiety. Its extract applied in certain doses on mice has an antianxiety effect comparable to diazepam, according to a study. 58 It is believed the effect is due to the linalool.40 Insomnia. A paste made of the green leaves is placed on the forehead or is taken orally as a juice of the leaves or by chewing the leaves.24 Linolool is proven to induce sleep.40 For this purpose in the Unani Tibb system the seeds are used as an infusion.41 http://www.ayurvedacollege.com/book/export/html/2
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Stress. It is relaxing because of the linalool component. 40 Promotes good memory. 29 Cholesterol and triglyceride lowering. It is proven by a study that coriander seeds significantly reduce the level of cholesterol and triglycerides after a diet high in fats. HDL is increased. It is believed that this is due to the enhanced hepatic bile acid synthesis and increased degradation of cholesterol to fecal bile acids and neutral sterols. 59 Diarrhea. Chewing coriander seeds is recommended. 42
6. Herbal Combinations With fennel, cumin and cardamom for digestive upsets 3 and with fennel for urinary problems. 19 Gokshura, manjishta and punarnava for urinary problems, especially stones and burning. 3 Sariva and pit shirisha for skin allergies. With vasa for respiratory allergies.3 Licorice and pippali for cough 3 Fresh ginger for fever. 3 Coriander seeds work well together with burdock seeds, which have similar indications. 14 Together with betel leaves, it is used to flavor food, as a purgative and to prevent gripping (with meals) 6
7. Contraindications and interactions with drugs and minerals According to Pole, “There are no known contraindications and drugherb interactions for Coriander. The herb is very safe.” 3. Dr. Schnaubelt also states that there are no known contraindications. 7 So coriander is considered to be a very safe herb, but there is some advice on avoiding the coriander essential oil in the first three months of pregnancy due to its mildly stimulating effect. 40 Many members of the Apiaecae family, formerly known as Umbelliferae (or the carrot family), are more prone than other species to causing allergic reactions. Among them is contact dermatitis due to handling or local application. This can sensitize to other members of the family. Aside from coriander, members of this family are anise seed (Pimpinella anisum), asafetida (Ferula spp.), caraway (Carum carvi), celery seeds, root or stalks (Apium graveolens), dill (Anethum graveolens), fennel (Foeniculum vulgare), parsley leaves (Petroselinum sativum) and Queen Anne’s lace (Daucus carota).44 In some cases there is interaction between vitamin supplements taken in high doses and drugs or minerals. That interaction can work in two ways. Drugs and minerals can lower the vitamin absorption and reduce its serum levels, or increase its metabolism and excretion. In those cases it is good using plants that contain the vitamin that is deficient.45 Another way of interaction is when the vitamin or mineral can raise the drug or mineral serum levels or reduce their effect. Many people take mineral supplements, and interactions with drugs are documented. Consumption of herb sources that contain the mineral is not going to cause the same effect, but it has the potential of exacerbating it (when a supplement is used). Herbs are an adequate source of minerals http://www.ayurvedacollege.com/book/export/html/2
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when high potency mineral supplements cannot be used due to drug interactions. Mineral elements have a toxic potential when used in excessive quantities. This is a point that goes in favor of using natural sources of mineral ingredients instead of high concentrations of mineral inorganic supplements. 46 Cilantro leaves are rich in calcium. 47 Calcium as carbonate has interactions with some drugs and minerals. Documented in human studies, cilantro lowers the serum level or effects of levothyroxine, and in the case of tetracycline leads to insufficiency. Drugs that lower the calcium serum level leading to insufficiency are corticosteroids, gentamicin, phenobarbital, phenolphthalein, phenytoin, tetracycline and viomycin. 48 The leaves of this beautiful herb are also rich in iron. 49 It is documented in human studies that iron lowers the serum level or effects of doxycycline, levodopa, methacycline, methyldopa, minocyclyne, oxytetracycline and thyroxine, causing an insufficient effect. It lowers trientine without causing insufficiency. Drugs that lower the serum iron levels leading to insufficiency are caffeine, calcium carbonate, chloramphenicol, tetracycline, trientine and vitamine E. 50 Cilantro leaves are rich with magnesium. Digoxin, gentamicin and viomycin lower the magnesium, causing insufficiency, as proven by studies in humans. 51 It is also a source of potassium. Acetazolamide, carbenicillin, carbenoxolone, cephalothin, clindamycin, gentamicin and penicillin lower its serum levels or efficiency, causing insufficiency. Spironolactone causes an increase to toxic levels.52 This herb has a hypoglycemic effect. It lowers the glucose level in the blood. Insulindependent diabetics (type I) who take coriander have to monitor their blood glucose level not only because of the need to prevent high glucose level, but also to be able to avoid hypoglycemic episodes. It is possible to have insulin shock as a result of the combined actions of the insulin and the hypoglycemic herb.43
8. Conclusion Coriander is a herb well known since ancient times in vast parts of the world from the Mediterranean basin to India and China. Both its dried fruits and the fresh leaves with the stem known as coriander and cilantro, respectively, are used for culinary and medicinal purposes. Even the culinary applications have a medicinal background. They were originally designed to balance the food and facilitate digestion. As part of the food, the herb is also useful for controlling bad breath and is a source of vitamin C, magnesium, potassium, calcium and iron. Different cultures have different preferences between the seeds and the leaf, and the number of applications is huge. The purely medicinal use is also very developed with a big variety of problems that are treated and many different formulas and ways of preparations. Corainder is considered to be very safe. The most widelyknown use is for digestive problems where it improves the digestion, stokes the agni (digestive fire) without aggravating pitta and increasing acidity. It is very useful for flatulence, gripping and bloating. Another well known use of coriander is for urinary tract problems that are connected with burning urination and infections. It is a mild diuretic, great for the task because it will not overwhelm the kidneys with excessive activity. It is also strengthening to the urinary system. Kidney stones are prevented with a kidney flush with coriander. Its diuretic property will be useful in treating edema and high blood pressure. Coriander has a detoxifying action for various toxins, which, interestingly, is used for poisoning with metals. It is also cleansing to the liver and cleans the fat and necrosis in it. Coriander is effective in simple cases of gall stones. Most herbs that act on urinary tract stones will have an effect on gall stones when coriander is used as a carrier to conduct their action to the liver. http://www.ayurvedacollege.com/book/export/html/2
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Studies are proving its great ability in treating bacterial and fungal infections and parasites. The traditional use is in eye infections, colds, food preserving and parasites in children. Coriander has hypoglycemic action (reducing blood glucose), which makes it very useful in diabetes. It is proven to lower the “bad” cholesterol and triglycerides. In the long list, coriander also helps with excessive or insufficient menstruation, allergies, skin problems, burns, baldness, measles, nose bleed, increasing blood flow, treating thirst and working as an insect repellant. When we consider coriander’s proven uses, the studies opening new avenues for applications, as well as its safety, the inevitable conclusion is that this formidable herb, coriander, rightfully deserves its name dhanyaka, which means “rich” or “wealthy”. It can also be said that we are immensely enriched by it.
9. End Notes 1. Gernot Katzer’s Spice Pages, Gernot Katzer, Coriander seeds and cilantro herb. http://www.uni graz.at/~katzer/engl/Cori_sat.html#disc 2. Botanical.com, M. Grieve, Coriander. http://www.botanical.com/botanical/mgmh/c/corian99.html 3. Sebastian Pole,: Ayurvedic Medicine, Principles of Traditional Practice (Philadelphia, Pa: Elsevier Ltd. 2006) 165 4. Michael Tierra, C.A., N.D.,O.M.D., Planetary Herbology, an Integration of Western Herbs Into The Traditional Chinese and Ayurvedic Systems (Twin Lakes, Wi: Lotus Press, 1988) 100 5. Francis Brinker, N.D.; Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 209,210 6. Charu Mahawar;Alka Agarwal,“Ayurveda Wonder FoodsSpices”,Light on Ayurveda Journal,Vol. VIII,Issue 1,(Fall 2009):39 7. Kurt Schaubelt, Ph.D.; Advanced Aromatherapy, The Science of Essential Oil Therapy (Rochester, Ve: Healing Arts Press, 1998) 66 8. Michael Tierra, C.A., N.D., O.M.D.; Planetary Herbology, an Integration of Western Herbs Into The Traditional Chinese and Ayurvedic systems (Twin Lakes, Wi: Lotus Press, 1988) 219 9. Dr. Amritpal Singh, Drayaguna Vijnana ( Delhi:Chaukhambha Orientalia, 2005) 115 10. Charu Mahawar;Alka Agarwal,“Ayurveda Wonder FoodsSpices”, Light on Ayurveda Journal, Vol. VIII, Issue 1,(Fall 2009)40 11. Vaidya Bhagwan Dash & Vaidya Lalitesh Kashyap, Materia Medica of Ayurveda Based on Ayurveda Saukham of Todarananda (New Delhi, Naurang Rai, Concept publishing company, 1979) 41,42 12. Vaidya Bhagwan Dash & Vaidya Lalitesh Kashyap, Materia Medica of Ayurveda Based on Ayurveda Saukham of Todarananda (New Delhi, Naurang Rai, Concept publishing company, 1979) 420 13. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986), 114 14. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986) 106 15. Dr. Vasant Lad, Ayurveda The Science of Self Healing (Twin Lakes, Wi: Lotus press, 1984) 134 16. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986), 117 17. Dr. David Frawley, Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 183,184 18. Michael Tierra, C.A., N.D., O.M.D., Planetary Herbology, an Integration of Western Herbs Into The Traditional Chinese and Ayurvedic Systems (Twin Lakes, Wi: Lotus Press, 1988)422 http://www.ayurvedacollege.com/book/export/html/2
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19. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986) 61 20. Dr. David Frawley, Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 233 21. Dr. David Frawley, Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 229 22. Dr. David Frawley, Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 232 23. Shaykh Hakim Moinuddin Chishti, The Book of Sufi Healing (Rochester, Ve: Inner Traditions International, 1991) 57 24. Onlinehealthcare.com, Health Care Staff, Coriander (Dhaniya) uses and benefits. http://www.onlinehealth care.com/herbal medicines/coriander.htm 25. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 158 26. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986), 227 27. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986) 225 28. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, an Ayurvedic Guide to Herbal Medicine (Twin Lakes, Wi: Lotus press, 1986) 226 29. Naturaltherapypages.com, Natural Therapy Pages Staff, Coriander. http://www.naturaltherapypages.com.au/article/coriander 30. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide(Twin Lakes, Wi: Lotus press, 2000) 266 31. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 206 32. Medicinal and Aromatic Plant Home Page, Medicinal and Aromatic Plant Home Page Staff, Coriander. http://www.hort.purdue.edu/newcrop/medaro/factsheets/CORIANDER.html 33. Organic facts.net, Apurup Mukherjee, Health Benefits of Coriander. http://www.organicfacts.net/healthbenefits/herbs andspices/health benefitsofcoriander.html 34. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 153 35. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 154 36. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 156 37. Dr. David Frawley; Ayurvedic Healing, a Comprehensive Guide (Twin Lakes, Wi: Lotus press, 2000) 221 38. Usefulhomeremedies.com, Usefulhomeremedies.com Staff, Nose Bleeding and Epistaxis, http://usefulhomeremedies.com/nosebleeding.html 39. Kurt Schaubelt, Ph.D.; Advanced Aromatherapy, The Science of Essential Oil Therapy (Rochester, Ve: Healing Arts Press, 1998)121 40. Ezinearticles.com, K.G. Stiles, Research Linalool PropertiesImmune Stimulant, Reduce Stress & Depression, Stimulant. http://ezinearticles.com/?CorianderEssentialOilResearchLinaloolPropertiesImmuneStimulant,ReducesStressand Depression&id=2923180 41. Liveandfeel.com, Live and Feel Staff, Benefits of Coriander Plant. http://www.liveandfeel.com/medicinalplants/coriander.html 42. Anxietydisorderpro.com, Anxietydisorderpro.com Staff, Coriander HerbAn Excellent Herb For Nourishment, Digestive Problems and Minimizing Bad Cholesterol. http://www.anxietydisorderpro.com/corianderherbanexcellentherbfor nourishmentdigestiveproblemsand minimizingbadcholesterol/ 43. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 237,238,239 44. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 209,210 45. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 285,286 46. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 296, 297 47. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 301, http://www.ayurvedacollege.com/book/export/html/2
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48. Francis Brinker, N.D.. Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 299, 300, 301 49. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 303 50. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 302,303 51. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 304,305 52. Francis Brinker, N.D., Herb contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 306,307 53. Healthyojas.com, Healthyojas.com Staff, Hypertension Herbs. http://healthyojas.com/pressure/hypertension herbs.html 54. BE Lixandru, NO Dracea, CC Dragomirescu, EC Dragulescu, IL Coldea, L Anton. E Dobre, C Rovinaru, I Codita, “Antimicrobial Activity of Plant Essential Oil Against Bacterial and Fungal Species Involved in Food Poisoning and/or Food Decay”, Romanian Archive of Microbiology and Immunology, 69(4)(OctoberDecember 2010):2 http://www.ncbi.nlm.nih.gov/pubmed/21462837 55. A Pandey, P Bigonya, V Raj, KK Patel, “Pharmacological Screening of Coriandrum Sativum Linn. For Hepatoprotective Activity “, Journal of Pharmacy and Bioallied Sciences,3(3)(July 2011): 43541 http://www.ncbi.nlm.nih.gov/pubmed/21966166 56. V Nair, S Singh, YK Gupta, “Evaluation of Disease Modifying Activity of Coriandrum sativum in Experimental Models,” Indian Journal of Medical Research 135(2) (February 2012): 240245. http://www.ncbi.nlm.nih.gov/pubmed 57. VF Furletti, IP Teixeira, G. ObandoPereda, RC Mardegan, A Sartoratto, GM Figueira, RM Duarte, VL Rehder, MC Duarte, JF Hofling, “Action of Coriandrum Sativum L. Essential Oil Upon Oral Candida Albicans Biofilm Formation.”, Evidence Based Complementary and Alternative Medicine, Epub (May 21, 2011) 985832 http://www.ncbi.nlm.nih.gov/pubmed/21660258 58. P Mahendra, S Bisht, “Antianxiety Activity of Coriandrum Sativum Assesed Using Different Experimental Anxiety Models”, Indian Journal of Pharmacology,43(5)(September 2011):5747 http://www.ncbi.nlm.nih.gov/pubmed/22022003 59. V Chitra, S Leelamma, “Hypolipidemic Effect of Corriander Seeds (Coriandrum Sativum): Mechanism of Action”, Plant Foods For Human Nutrition, 51(2)(1997):16772 http://www.ncbi.nlm.nih.gov/pubmed/9527351 60. Francis Brinker, N.D., Herb Contraindications and Drug Interactions (Sandy, Or: Eclectic Medical Publications, 2001) 210
10. Abstracts These are the abstracts of the studies referred to in the paper. Indian J Med Res. 2012 Feb;135(2):2405. Evaluation of disease modifying activity of Coriandrum sativum in experimental models. Nair V, Singh S, Gupta YK. Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. http://www.ncbi.nlm.nih.gov/pubmed http://www.ayurvedacollege.com/book/export/html/2
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Abstract Background & objectives: Coriandrum sativum (CS), has been widely used in traditional systems of medicine for treatment of rheumatoid arthritis. However, the mechanism of action for its antiarthritic effects is not clearly known. Therefore, the present study was carried out to evaluate the antiarthritic activity of CS in rats in two experimental models. Methods: The antiarthritic activity of CS seed hydroalcoholic extract (CSHE) was evaluated in adult Wistar rats by using two experimental models, viz. formaldehyde and Complete Freund's adjuvant (CFA) induced arthritis. The expression of pro inflammatory cytokines (predominantly contributed by macrophages) was also evaluated. TNF α level was estimated in serum by ELISA method. TNFR1, IL1 β and IL6 expression in the synovium was analysed by immunohistochemistry. Results: CSHE produced a dose dependent inhibition of joint swelling as compared to control animals in both, formaldehyde and CFA induced arthritis. Although there was a dose dependent increase in serum TNFα levels in the CSHE treated groups as compared to control, the synovial expression of macrophage derived pro inflammatory cytokines/cytokine receptor was found to be lower in the CSHE treated groups as compared to control. Interpretation & conclusions: Our results demonstrate that the antiarthritic activity of CSHE may be attributed to the modulation of pro inflammatory cytokines in the synovium. In further studies CSHE could be explored to be developed as a disease modifying agent in the treatment of RA. Evid Based Complement Alternat Med. 2011;2011:985832. Epub 2011 May 21. Action of Coriandrum sativum L. Essential Oil upon Oral Candida albicans Biofilm Formation. Furletti VF, Teixeira IP, ObandoPereda G, Mardegan RC, Sartoratto A, Figueira GM, Duarte RM, Rehder VL, Duarte MC, Höfling JF. Department of Microbiology and Immunology, Dental School of Piracicaba, University of CampinasUNICAMP, 13414 903 Piracicaba, SP, Brazil. http://www.ncbi.nlm.nih.gov/pubmed/21660258 Abstract The efficacy of extracts and essential oils from Allium tuberosum, Coriandrum sativum, Cymbopogon martini, Cymbopogon winterianus, and Santolina chamaecyparissus was evaluated against Candida spp. isolates from the oral cavity of patients with periodontal disease. The most active oil was fractionated and tested against C. albicans biofilm formation. The oils were obtained by waterdistillation and the extracts were prepared with macerated dried plant material. The Minimal Inhibitory ConcentrationMIC was determined by the microdilution method. Chemical characterization of oil constituents was performed using Gas Chromatography and Mass Spectrometry (GCMS). C. sativum activity oil upon cell and biofilm morphology was evaluated by Scanning Electron Microscopy (SEM). The best activities against planktonic Candida spp. were observed for the essential oil and the grouped F(810) fractions from C. sativum. The crude oil also affected the biofilm formation in C. albicans causing a decrease in the biofilm growth. Chemical analysis of the F(810) fractions detected as major active compounds, 2hexen1ol, 3hexen1 http://www.ayurvedacollege.com/book/export/html/2
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ol and cyclodecane. Standards of these compounds tested grouped provided a stronger activity than the oil suggesting a synergistic action from the major oil constituents. The activity of C. sativum oil demonstrates its potential for a new natural antifungal formulation. Roum Arch Microbiol Immunol. 2010 OctDec;69(4):22430. Antimicrobial activity of plant essential oils against bacterial and fungal species involved in food poisoning and/or food decay. Lixandru BE, Drăcea NO, Dragomirescu CC, Drăg ul es cu EC , Coldea IL, Anton L, Dobre E, Rovinaru C, C odiţă I . http://www.ncbi.nlm.nih.gov/pubmed/21462837 Cantacuzino" National Institute of ResearchDevelopment for Microbiology and Immunology, Bucharest, România. Abstract: The currative properties of aromatic and medicinal plants have been recognized since ancient times and, more recently, the antimicrobial activity of plant essential oils has been used in several applications, including food preservation. The purpose of this study was to create directly comparable, quantitative data on the antimicrobial activity of some plant essential oils prepared in the National Institute of ResearchDevelopment for Chemistry and Petrochemistry, Bucharest to be used for the further development of food packaging technology, based on their antibacterial and antifungal activity. The essential oils extracted from thyme (Thymus vulgaris L.), basil (Ocimum basilicum L.), coriander (Coriandrum sativum L.), rosemary (Rosmarinus officinalis L.), sage (Salvia officinalis L.), fennel (Foeniculum vulgare L.), spearmint (Mentha spicata L.) and carraway (Carum carvi L.) were investigated for their antimicrobial activity against eleven different bacterial and three fungal strains belonging to species reported to be involved in food poisoning and/or food decay: S. aureus ATCC 25923, S. aureus ATCC 6538, S. aureus ATCC 25913, E. coli ATCC 25922, E. coli ATCC 35218, Salmonella enterica serovar Enteritidis Cantacuzino Institute Culture Collection (CICC) 10878, Listeria monocytogenes ATCC 19112, Bacillus cereus CIP 5127, Bacillus cereus ATCC 11778, Candida albicans ATCC 10231, Aspergillus niger ATCC 16404, Penicillium spp. CICC 251 and two E. coli and Salmonella enterica serovar Enteritidis clinical isolates. The majority of the tested essential oils exibited considerable inhibitory capacity against all the organisms tested, as supported by growth inhibition zone diameters, MICs and MBC's. Thyme, coriander and basil oils proved the best antibacterial activity, while thyme and spearmint oils better inhibited the fungal species. PMID: 21462837 [PubMed indexed for MEDLINE] Indian J Pharmacol. 2011 Sep;43(5):5747. http://www.ayurvedacollege.com/book/export/html/2
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Antianxiety activity of Coriandrum sativum assessed using different experimental anxiety models. Mahendra P, Bisht S. Department of Pharmacology, School of Pharmacy, Suresh Gyan Vihar University, Jaipur 302 004, India. http://www.ncbi.nlm.nih.gov/pubmed/22022003 Abstract Interest in alternative medicine and plantderived medications that affect the "mind" is growing. The aim of present study was to explore the anti anxiety activity of hydroalcoholic extract of Coriandrum sativum (Linn.) using different animal models (elevated plus maze, open field test, light and dark test and social interaction test) of anxiety in mice. Diazepam (0.5 mg/kg) was used as the standard and dose of hydroalcoholic extract of C. sativum fruit (50, 100 and 200 mg/kg) was selected as per OECD guidelines. Results suggested that extract of C. sativum at 100 and 200 mg/kg dose produced anti anxiety effects almost similar to diazepam, and at 50 mg/kg dose did not produce antianxiety activity on any of the paradigm used. Further studies are needed to identify the anxiolytic mechanism(s) and the phytoconstituents responsible for the observed central effects of the hydroalcoholic extract of C. sativum. J Pharm Bioallied Sci. 2011 Jul;3(3):43541. Pharmacological screening of Coriandrum sativum Linn. for hepatoprotective activity. Pandey A, Bigoniya P, Raj V, Patel KK. Department of Pharmacology, Radharaman College of Pharmacy, Ratibad, Bhopal, Madhya Pradesh, India. http://www.ncbi.nlm.nih.gov/pubmed/21966166 Abstract OBJECTIVE: Coriandrum sativum (Linn.), a glabrous, aromatic, herbaceous annual plant, is well known for its use in jaundice. Essential oil, flavonoids, fatty acids, and sterols have been isolated from different parts of C. sativum. The plant has a very effective antioxidant profile showing 2,2diphenyl1picrylhydrazyl (DPPH) radical scavenging activity, lipoxygenase inhibition, phospholipid peroxidation inhibition, iron chelating http://www.ayurvedacollege.com/book/export/html/2
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activity, hydroxyl radical scavenging activity, superoxide dismutation, glutathione reduction and antilipid peroxidation due to its high total phenolic content with the presence of constituents like pyrogallol, caffeic acid, glycitin, etc. MATERIALS AND METHODS: This study was aimed at investigating the hepatoprotective activity of C. sativum against carbon tetrachloride (CCl4), with estimation of serum serum glutamyl oxaloacetic acid transaminase (SGOT), serum glutamyl pyruvate transaminase (SGPT), alkaine phosphatase (ALP) and bilirubin, and with liver histopathology. RESULTS: Ethanolic extract was found to be rich in alkaloids, phenolic compounds and flavonoids, and high performance liquid chromatography (HPLC) fingerprinting showed the presence of isoquercetin and quercetin. C. sativum signifies hepatoprotection by reducing the liver weight, activities of SGOT, SGPT, and ALP, and direct bilirubin of CCl(4) intoxicated animals. Administration of C. sativum extract at 300 mg/kg dose resulted in disappearance of fatty deposit, ballooning degeneration and necrosis, indicating antihepatotoxic activity. CONCLUSION The results of this study have led to the conclusion that ethanolic extract of C. sativum possesses hepatoprotective activity which may be due to the antioxidant potential of phenolic compounds. PMID: 21966166 [PubMed] Plant Foods Hum Nutr. 1997;51(2):16772. Hypolipidemic effect of coriander seeds (Coriandrum sativum): mechanism of action. Chithra V, Leelamma S. Department of Biochemistry, University of Kerala, Kariavattom, India. http://www.ncbi.nlm.nih.gov/pubmed/9527351 Abstract The effect of the administration of coriander seeds (Coriandrum sativum) on the metabolism of lipids was studied in rats fed a high fat diet with http://www.ayurvedacollege.com/book/export/html/2
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added cholesterol. The spice had a significant hypolipidemic action. The levels of total cholesterol and triglycerides decreased significantly in the tissues of the animals of the experimental group which received coriander seeds. Significant increases in betahydroxy, betamethyl glutaryl CoA reductase and plasma lecithin cholesterol acyl transferase activity were noted in the experimental group. The level of LDL + VLDL cholesterol decreased while that of HDL cholesterol increased in the experimental group compared to the control group. The increased activity of plasma LCAT, enhanced hepatic bile acid synthesis and the increased degradation of cholesterol to fecal bile acids and neutral sterols appeared to account for its hypocholesterolemic effect. PMID: 9527351 [PubMed indexed for MEDLINE]
Guduchi: The one who protects the body http://www.ayurvedacollege.com/book/export/html/2
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By Carla Kennedy December 2009 Guduchi is one of the most highly valued and common herbs in Ayurvedic medicine. It has a rich history in the Indian subcontinent where it has been used and written about for thousands of years. It is considered one of the best rasayanas (adaptogens) and is unusual in its potent versatility. In recent years, significant progress has been attained regarding its biological activity and medicinal applications. Guduchi, as it is most commonly called, has been described as “one which protects the body”. (Pole 189) The Sanskrit and Hindi name Amrita is derived from ancient Hindu scriptures where Amrita was used to bring the dead back to life and keep gods from growing ill and old. It is no wonder that it is also referred to as “nectar of immortality” and “heavenly elixir”. Its scientific name is Tinospora cordifolia and is in the Family Menispermaceae. Common names include: Guduchi, amrita (Sanskrit), giloya, amrita (Hindi), giloe, gulancha (Bengali), gado, galo (Gujarati), duyutige, teppatige (Telugu), heartleaf moonseed, Tinospora (English). (1, 2, 9, 11) It is a woody climbing shrub that is deciduous and perennial. This herbaceous vine grows on hedges and trees. It is often seen growing up mango or neem trees. Herbalist Sebastian Pole writes that “those growing up neem trees are said to be the best as the synergy between these two bitter plants enhances guduchi’s efficacy.” It is indigenous to areas of India, Myanmar, and Sri Lanka. Guduchi typically grows in deciduous and dry forests at elevations up to 1000 ft. Its flowers bloom in summer. The male flower is small, yellow or green in color, and occurs in clusters. Female flowers are usually solitary and are green. The fruits are the size and shape of a large pea and turn from green to red when ripe in winter. The leaves are heart shaped (giving the name cordifolia to the plant) and mucilaginous. Its stems, when fresh, have a green succulent bark covered by a thin brown bark and are studded with warty lenticels. When dry, the stem shrinks and the bark separate from the wood. The roots are long narrow aerial roots that arise from the branches. The stems, leaves, and roots are used in medicine. All three parts should be collected in the summer when the bitter qualities are most abundant and, if not used fresh, dried in the shade. Guduchi grows well without fertilizer or pesticide making it simple to grow. It is easy to recognize and can be propagated by cuttings. (1, 2, 3, 4, 6) Ayurvedic Qualities Guduchi has always been a very important herb in Ayurvedic medicine. Ayurvedic herbalists generally describe it as having these qualities: (1) Rasa (taste): bitter and astringent, (2) Guna (quality): light and unctuous, (3) Virya (potency): heating, (4) Vipaka (postdigestive effect): sweet, (5) Prabhava (special action): destroys toxins both internally and externally, (6) Doshakarma (energetics): Tridoshic, VPK=. Tridoshic in nature, its bitter and astringent properties and sweet postdigestive effect reduces pitta. The bitter, astringent, and heating qualities reduce kapha. Vata is reduced by its heat and sweet postdigestive qualities. Its heat burns up ama yet doesn’t aggravate pitta and its sweet postdigestive effect gives it a nourishing rejuevenative quality. (1, 2, 7, 9) Actions and Indications http://www.ayurvedacollege.com/book/export/html/2
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Unusual in its qualities, Guduchi has a large variety of actions and is indicated in the treatment of many ailments. Ayurveda traditionally describes the following actions: Increases appetite, quenches thirst, increases strength, promotes life, increases life span, aphrodisiac, increases sexual potency, purifier of sperm, cleans the blood, relieves gout, relieves arthritis, alleviates skin disorders, destroys toxins, reduces burning sensations, reduces fevers, nerve tonic, bitter tonic, causes constipation, and rejuvenative. It is described in more modern and Western terms as having similar actions: Febrifuge, antiperiodic, alterative, diuretic, aphrodisiac, cholagogue, antiinflammatory, anthelmintic, nerve tonic, bitter tonic, antirheumatic, and detoxicant. (1, 2, 7, 9, 13) Guduchi is incredibly versatile and is indicated for potential use in the following conditions: Fever, hepatitis, liver damage, jaundice, diabetes, heart disease, tuberculosis, arthritis, gout, hemorrhoids, eczema, psoriasis, lupus, inflammatory skin conditions, autoimmune disease causing inflammation, urinary disease, secondary syphilis, bronchitis, chronic diseases of diarrhea and dysentery, seminal weakness, dyspepsia, general debility, leprosy, anemia, colic, worms, senile diseases, hyperacidity, and snake bite. (2, 7, 9) Traditional Ayurvedic Preparations A potent classical herb, Guduchi is used as an important ingredient in a number of Ayurvedic formulations. While the dried stem forms the raw material for many herbal preparations, the roots and leaves are also important. The fresh plant is said to be more effective than the dry one. However, it is traditionally dried and made into a starchy extract called Guduchi Sattva. Dr. Gyanendra Pandey writes that Guduchi Sattva “is highly valued for many ailments. Fevers, chronic diarrhea, chronic dysentery, burning sensation, secondary syphilis, chronic gonorrhea, leucorrhoea, jaundice, rheumatism, urinary disorders, and some other ailments”. Dr. K.M. Nadkarni describes how it is made “The watery extract is prepared by powdering the stem and washing out the starch with water and drying the sediment. Pandit Jayakrshna says “that as the deposit settles the sooner it is dried the better. It is similar to arrowroot in appearance.” Another common preparation is a watery extract, often called Indian quinine, which is used in malaria, leprosy, and common fevers due to cold or indigestion. In the ancient text Caraka Samhita 50 great extract categories are described and Guduchi is included in two: Antisaturative and refrigerant. (1, 2, 5) Formulas from Carakaan ancient physician The Caraka Samhita (written by Caraka between 1500BCE and 500BCE) is the oldest and perhaps the greatest classical text of Ayurveda. It contains a vast amount of information on classical Ayurvedic herbal formulas. Among them Chyavanprash is the most popular rasayana (rejuvenative tonic) formula in India today. Like all traditional Ayurvedic formulas, the exact herbal combination can differ but most ingredients are the same. At the end of Caraka’s description of the formula and how it is made he states “This is the famous “cyavanaprasa, an excellent rasayana. Particularly it alleviates cough and dyspnoea, is useful for the wasted, injured and old people and promotes development of children. It alleviates hoarseness of voice, chest diseases, heart disease, vatarakta, thirst and disorders of urine and semen. It should be taken in the dose which does not interfere with the food (intake and digestion). By using this (rasayana) the extremely old Cyavana regained youthful age. If this rasayana is used by the indoor method, even the old attains intellect, memory, luster, freedom from diseases, longevity, strength of senses, sexual vigour, increased agni (digestion and metabolism), fairness of complexion and carmination of wind. One, shedding the form of the old age, puts on that of the fresh youth.”(5) Charaka described over two dozen polyherbal formulas that include Guduchi and that are used for a wide variety of ailments. One unnamed rasayana formulation is stated “If this formulation is used regularly for three years, the person attains a lifespan of hundred years free from old http://www.ayurvedacollege.com/book/export/html/2
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age, acquires knowledge, his diseases are alleviated, poison becomes ineffective in his body which is rendered firm as stone and he becomes invincible foe the organisms. Another was described as an “intellectpromoting rasayana drug”. He states “…these rasayana drugs are life promoting, diseasealleviating, promoters of strength, agni, complexion, voice and are intellectpromoting.” (5) He described a number of antipyretic formulas. For chronic fevers, cold fevers, relapsing fevers and “certain fevers”. One antipyretic formulation has these stated qualities “These extracts are antipyretic appetizer, digestive for dosa and alleviate thirst, anorexia and distaste of mouth.” Two were to be used specifically for all types of prameha. There was also one for edema in vata combined with pitta. (5) A formulation Caraka called fifth alkali, “taken by those suffering from piles caused by kapha and vata, grahani disorder and anemia. This alkali is an excellent promoter of agni and alleviates splenomegaly, retention of urine, dyspnoea, hiccup, cough, worms, fever, wasting, diarrhea, edema, prameha, hardness in bowels, cardiac pain and all kinds of poison. After the drug is digested, the patient should eat with sweet meatsoups or milk.” (5) A medicated ghee called Guducyadi ghrta “alleviates gulma, dyspnoea, wasting and cough. Guducyadi ghrta is mentioned in the Susruta Samhita where Susruta states “…would be attended by good results in cases of consumption, asthma, cough and chronic fever”. One unnamed formulation “kept for whole night in water should be given to alleviate thirst and erysipelas”. He also described one for disorders of the female genital tract and another for kaphaja vomiting. And yet another formula for “vata vitiated … trembling of head” (5) The formula Amrta taila lists Guduchi as the main herb. Caraka writes “This oil known as”amrta taila”is one of the best oils” “It brings back to normalcy the persons with diminished energy, agni and strength and confused mind and suffering from insanity, restlessness and epilepsy. It is an excellent alleviator of vatika disorders.” “This is delivered by the teacher Krsnatreya and is honoured by physicians.” For Vrsamuladi taila he states “this oil should be used in patients broken and shattered by (disorders of) vata.” Another oil has different qualities “This known as “Mulaka taila” (oil prepared with roots) alleviates spleen enlargement, retention of urine, dyspnoea, cough and vatika disorders and promotes complexion, life span and strength.” (5) Caraka thinks highly of Amrtadya taila. “This oil when prepared is useful in all ways in vatarakta, wasting due to chest wound, afflicition by overload, deficiency of semen, trembling, convulsions, fractures and diseases generalized or localized. This known as “Amrta” is the best among oil and alleviates diseases of female genital track, epilepsy, insanity, limping and lameness and makes delivery of fetus easy.” (5) Lastly, Caraka described a number of formulas for unctuous and nonunctuous enemas. For one called Erandabasti he states “Is appetizer and reducing and alleviates pain in shanks, thighs, feet, sacrum and back; covering by kapha, obstruction of vayu, retention of feces, urine and flatus, colic pain, tympanitis, calculus, gravels, harness of bowels, piles and disorders of grahani.” Another unnamed enema is stated “This oil used in forms of intake, massage and unctuous enema alleviates quickly the disorders of skin, worms, prameha, piles, disorders of grahani, impotency, irregularity of digestive fire, excrement and three dosas. This unctuous enema provides strength to those wasted due to disease, physical exercise, evacuative measures and wayfaring, debilitated, devoid of ojas and having diminished semen. Moreover, it gives good firmness to feet, shanks, thighs, back, shoulder and waist and virility to sterile women and men.” One unnamed formula is described as “for heart, bladder, head…used as urethral douche or nonunctuous enema in a person evacuated, uncted and fomented alleviates pain in bladder and other urinary disorders.” (5) Caraka’s last unnamed unctuous preparation is described as an excellent aphrodisiac “This is excellently beneficial for man enjoying women http://www.ayurvedacollege.com/book/export/html/2
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excessively having diminished semen, suffering from chest would, wasting and intermittent fever and for women having disorders of genital track, sterility, accumulation of menstrual blood, dead progeny and amenorrhea and for those having deficiency of muscle and blood. It is excellent rasayana and destroyer of wrinkles and graying of hairs.” (5) Modern Research While a lot of preliminary research has been done, science has just scratched the surface on the potential effects of Tinospora cordifolia in the human body. Most research has been done in test tubes (in vitro) or in animals (in vivo) and has yielded some impressive results. A large variety of chemical constituents have now been isolated from Tinospora cordifolia. The major isolated compounds belong to a variety of classes such as alkaloids, diterpenoids lactones, glycosides, steroids, sesquiterpenoids, phenolics, aliphatic compounds, and polysaccharides. The leaves have also been found to be abundant in protein and fairly high in calcium and phosphorous. (3, 4, 6, 8, 11, 13) The usefulness of Tinospora cordifolia as a cognitive enhancer has been substantiated by some research. For example, healthy volunteers were given an aqueous extract for three weeks in a double blind study. They were found to have a significant increase in test scores for logical memory and verbal memory. A study gave aqueous and alcoholic extracts to normal and cyclosporine induced cognition deficient rats. Tinospora cordifolia not only enhanced the cognition in normal rats but also in the rats treated with cyclosporine. (4, 14, 15) Guduchi has been studied for its hypoglycemic actions. Crude ethyl acetate, dichloromethane (CDM), chloroform and hexane stem extracts of Tinospora cordifolia was studied for inhibition of the alpha glucosidase enzyme. The enzyme was inhibited by Tinospora and the hyperglycemic increase was decreased by 50% in normal animals and 58% in diabetic animals. Another study used an aqueous extract of Tinospora cordifolia to test insulin resistance and oxidative stress in rats. Tinospora cordifolia treatment prevented the increase in glucose by 21.3%, insulin by 51.5%, triglycerides by 54.12%, and glucoseinsulin index by 59.8 of the rats fed fructose without the addition of Tinospora extract. Also, Tinospora cordifolia treatment was effective in preventing the fructoseinduced abnormalities in the liver involving lipid peroxidation, protein carbonyl groups, GSH levels, and enzymatic antioxidants. (4, 21, 22) Tinospora supplies protection against gamma irradiation in mice. Administration of an alcohol stem extract to mice 1 hour before whole body gamma irradiation was shown to increase survival, prevent body weight loss, increase the number of colony forming unit counts in the spleen, restore total lymphocyte counts, increase impaired Sphase cell population and decrease irradiation induced micronuclei. In another study an aqueous extract was used on mice before being exposed to gamma radiation. The results showed various amounts of protection against the radiation through increased survival time and signs and symptoms of radiation sickness. (4, 11, 16, 17) Looking into the immune system’s response to tumors one study showed the activation of tumor associated macrophages in Dalton’s lymphoma, a spontaneous transplantable T cell lymphoma, in response to an alcohol extract of Tinospora cordifolia. Another study by the same authors again found an increase in the count of tumor associated macrophages. The researches also found an increase in the number and myeloid differentiation of bone marrow hematopoietic precursor cells in mice bearing Dalton’s lymphoma. Further research on it’s antitumor activities used a methanol extract found that it increased the white blood cell count, maturation of bone marrow stem cells, and increased immune response as seen in macrophage activation, and plaqueforming spleen cells. The reduction in solid tumor growth was significant. (4, 18, 19, 20) Guduchi has been one of the most versatile and important herbs in the Indian subcontinent since ancient times. An enormous amount of http://www.ayurvedacollege.com/book/export/html/2
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knowledge has been accumulated by thousands of years of direct observation and trial and error. In our modern era, impressive research has been done on the biological activity and possible application of Guduchi and its chemical constituents. Guduchi may have been favorably used for thousands of years but modern herbal pharmacology appears to have just begun to appreciate “the one who protects the body”. Works Cited 1. Nadkarni K. M., Nadkarni A.K. (Eds) Indian Materia Medica (3rd ed) Vol. 1. Mumbai:Popular Prakashan Private Limited pp. 356365, 1220 1221 2. Pandey G. (2002) Dravyaguna Vijnana (2nd ed) Vol. 1. Varuanasi: Krishnadas Academy pp. Vol. 1 pp.697710 3. Tinopsora. http://www.drugs.com/npp/tinospora.html 4. Krishna K., Jigar B., Jagruti P. (2009) Guduchi (Tinospora cordifolia): Biological and Medicinal properties, a review. The Internet Journal of Alternative Medicine Vol.6 Num.2 pp.110 5. Caraka (2008) Caraka Samhita (Sharma P. Ed. and Trans.) Varanasi: Chaukhambha Orientalia Vol.1 pp. 911, 23, 7173, 79, 85, 120, 121, 191, 266, 267, 316, 339, 427, 431, 449, 464, 477, 478, 496, 607, 610, 615, 616, 678. Vol. 2 pp.15, 21, 26, 28, 29 6. Premila M.S. (2006) Ayurvedic Herbs: A clinical Guide to the Healing Plants of Traditional Indian Medicine. New York: Haworth Press pp. 6976, 175, 176 7. Frawley D., Lad V. (2001) The Yoga of Herbs. Wisconsin: Lotus Press. Pp. 242243 8. Williamson E. M. (Ed) (2002) Major Herbs of Ayurveda. London: Elsevier Science Limited pp. 302305 9. Pole S. (2006) Ayurvedic Medicine: The Principles of Traditional Practice. Philadelphia: Churchill Livingstone pp.189190 10. Frawley D. (2000) Ayurvedic Healing. Wisconsin: Lotus Press pp.154, 158, 168, 266, 270, 282, 286 11. Evaluation of a New Class 1 Substance, Tinospora cordifolia (Guduchi) (2006 September) IJEACCM 03 Item 3.2.4 12. Ghishagratna K. K. (2003) Susruta Samhita (Dwivedi L. Ed.) Varanasi:Chowkhamba Sanskrit series Office. pp.360 13. Singh S. S., Pandey S.C., Srivastava S., Gupta V.S., Patro B., Ghosh A.C. (2003) Chemistry and Medicinal Properties of Tinospora Cordifolia (Guduchi). Indian Journal of Pharmacology . pp.8391 14. Bairy K.L., Rao Y., Kumar K.B. (2004) Efficacy of Tinospora cordifolia on Learning and Memory in Healthy Volunteers: A DoubleBlind, Randomized, Placebo Controlled Study. Iranian Journal of Pharmacology and Therapeutics. July Vol.3, No.2. pp.5760 15. Agarwal A., Malini S., Bairy K.L., Rao M.S. (2002) Effect of Tinospora cordifolia on Learning and Memory in Normal and Memory Deficit Rats. Indian Journal of Pharmacology. Pp.339349 16. Goel H.C., et al. (2004) Radioprotective Potential of an Herbal Extract of Tinospora cordifolia. Journal of Radiation Research. Vol.45 No.1. pp.6168 17. Pahadiya S., Sharma J. (2003) Alteration of lethal effects of gamma rays in Swill albino mice by Tinospora cordifolia. PubMed 18. Singh S.M., Singh N., Shrivastava P. (2006) Effect of alcoholic extract of Ayurvedic herb Tinospora cordifolia on the Proliferation and Myeloid Differentiation of Bone Marrow Cells in a Tumorbearing Host. Fitoterapia. Vol.77 Issue 1. pp.111 19. Singh N., Singh M.S., Shrivastava P. (2005) Immunomodulatory and Antitumor Actions of Medicinal Plant Tinospora cordifolia are Mediated Through Activation of TumorAssociated Macrphages. Immunopharmacology and immunotoxicology, Vol. 26 pp.145162 20. Mathew S., Kuttan G. (1999) Immunomodulatory and antitumor activities of Tinospora cordifolia. Fitoterapia. Vol.70 Issue1 pp.3543 http://www.ayurvedacollege.com/book/export/html/2
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21. Chougale A.D., Ghadyale V.A., Panaskar S.N., Arvindekar A. U. (2009) Alpha glucosidase inhibition by stem extract of Tinospora cordifolia. Journal of Enzyme Inhibition and Medicinal Chemistry Vol. 24 PP.9981001 22. Reddy S.S., Ramatholisamma P., Karuna R., Saralakumari D. (2009) Preventive effect of Tinospora cordifolia against highfructose diet induced insulin resistance and oxidative stress in male Wistar rats. Food Chem Toxicology 47(9) pp.22242229
Turmeric: “The Golden Goddess” (by Lisa Gallant C.A.S) Table of Contents 1. Introduction 2. Turmeric and Ayurveda 3. Science and Turmeric 4. References Introduction Within the cornucopia of medicinal plants, few possess such a wide spectrum of qualities and medicinal uses as turmeric. For countless centuries, many different cultures have used this wonderful, versatile herb to treat a myriad of diseases and ailments. The most well known medicinal action of turmeric is its use as a powerful antiinflammatory, the effectiveness of which is comparable to pharmaceutical medicines. However, it also acts as an alterative, analgesic, antibacterial, antiinflammatory, antitumor, antiallergic, antioxidant, antiseptic, antispasmodic, astringent, carminative, cholagogue, digestive, diuretic, stimulant, and vulnerary 6,8,10 . Modern science is beginning to recognize and understand the amazing healing qualities of turmeric and much research is currently being conducted. Turmeric has been proven effective in treating some of the most intense ailments afflicting the world today including: Arthritis, Cancer, Alzheimer's Disease, Diabetes, Multiple Sclerosis, Atherosclerosis, HIV/AIDS, Sexually Transmitted Diseases (HepatitisC, Genital Herpes) , Irritable Bowel Syndrome, Indigestion, Inflammation, Acne, Urinary Tract Infections, Kidney Infections, Gallstones, Anemia, Hemorrhoids, Liver Disease, Leprosy, Amenorrhea, Edema, Bronchitis, Common Cold, Headaches, Conjunctivitis, Bursitis, food poisoning, parasites, fever, diarrhea, poor circulation, lower back and abdominal pain. It can also be used as a mosquito repellent, wound healer, and immediate cure for scorpion stings. Turmeric helps balance the female reproductive and lactation systems, and in men it purifies and improves the health of semen. It is used to treat external ulcers that would not respond to other treatment 6,8,10 . Due to its vast array of medicinal purposes and versatility, turmeric is one of the most important herbs in any natural medicine cabinet. The Latin name for turmeric is “Curcuma Longa”, which comes from the Arabic name for the plant, “Kurkum.” 10 It comes from the Zingiberaceae family (same as ginger) and in Sanskrit is called “Haridra”(“The Yellow One”), “Gauri” (“The One Whose Face is Light and Shining”),“Kanchani” http://www.ayurvedacollege.com/book/export/html/2
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(“Golden Goddess”) , and Aushadhi (“Herb”). It is called “Jiang Huang” in Chinese, and “Haldi” (“Yellow”) in Hindi, the most common name in India 6 . The healing properties of turmeric lie in the golden fingerlike stalk, or rhizome, the same part that is used to flavor, color, and preserve food. Turmeric is commonly found in Indian curries, giving the food a golden orange color. Turmeric has also been used as a dye for mustards, canned chicken broth, and pickles. It has been coded as food additive “E100” in canned beverages, baked products, dairy, ice cream, yogurts, yellow cakes, biscuits, popcorn, sweets, cake icing, cereal, sauces, gelatins, and also direct compression tablets. In combination with annatto, turmeric is used to color cheese, dry mixes, salad dressing, butter and margarine 3 . The brilliant color has also been used for dyeing silk and wool; the robes of Buddhist monks were traditionally dyed with turmeric 10 . Turmeric is a native to South Asia , particularly India , but is cultivated in many warm regions of the world. It can be found growing extensively in all of India , but does especially well in the regions of Tamil Nadu, West Bengal , and Maharashtra 10 . It is also cultivated in Sri Lanka , Indonesia , China , Taiwan , Indochina , Peru , Haiti , and Jamacia. India is the largest producer in the world; Jamacia and Peru are the chief exporters, and Iran the largest importer. Other large importers are the United Kingdom , Japan , Canada , Sri Lanka , Singapore , and the Middle East 9 . There are two main varieties of turmeric: one with hard, rich colored, oval rhizomes, called “Lokahandi Halad” that is used mostly for dying, and a variety that is softer, larger, lighter colored with long rhizomes used mostly for eating 8 . Turmeric became valuable to humans when it was discovered that the powdered rhizome preserved the freshness and nutritive value of foods. It was originally used in curries and other food to improve storage conditions, palatability, and preservation. Because of its preservation properties, turmeric played a vital role in survival and sustainability in South Asia , and was valued more than gold and precious stones 7 . However, turmeric was eventually replaced by cheaper, synthetic preservatives. Turmeric was used much more extensively by the natives of India than today. Turmeric was highly valued by the ancient IndoEuropean people not only for its preservation properties, but for its energetic and spiritual qualities as well. The Arya culture was a group of people who worshipped the solar system and the sun as a deity. Turmeric was very sacred to them, due to its golden yellow color (like sunlight) and they believed it had special protective properties 7 . Remnants of this belief still exist today, particularly in South India , where some people wear a dried turmeric rhizome bead the size of a large grape around their neck or arm. This is an ancient talisman tradition used to ward off evil and grant to the wearer healing and protection 16 . People of ancient India believed that turmeric contained the energy of the Divine Mother, helped to grant prosperity, cleanse the chakras (energy centers in the body), and purify the channels of the subtle body 6 . Even today, Hindu people consider turmeric to have auspicious qualities, and use it in many sacred ceremonies. It is commonly made into a paste and applied to the forehead (ajna chakra or third eye) during pujas (devotional ceremonies) and weddings. During a traditional Indian wedding ceremony, the bridge and groom apply a paste of turmeric and sandalwood powder on each other's foreheads. Some women use it as a cosmetic, called “Kappumanjal” or rub it over their bodies as a detergent 8 . Traditionally, turmeric was also used to dye the marriage clothing. It was believed that any clothing dyed with turmeric was protection from fever. New clothes would sometimes be stained with a paste of turmeric, lime, and water. Today, magenta dye has become more popular 9 . Turmeric and Ayurveda Turmeric has been used for centuries in Ayurveda, the 5,000 year old natural healing system of India . It is called by 46 different synonyms, including: “pitta” (yellow), “gauri” (brilliant), and all words that indicate “night” 10 . This comes from a tradition of married women applying http://www.ayurvedacollege.com/book/export/html/2
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turmeric to their cheeks in the evening in preparation for a visit from Lakshmi (The Goddess of Prosperity) 7 . In Ayurveda, turmeric is believed to balance the three doshas (vata, pitta, and kapha). It has been used by Ayurvedic healers as medicine taken internally in the form of fresh juice, boiled tea, tinctures, or powder, and topically as creams, lotions, pastes, and ointments 1 . There are many ancient Ayurvedic formulas utilizing turmeric. Milk boiled with turmeric and sugar was a popular cold remedy and turmeric juice was used to help heal wounds, bruises, and leech bites. A paste made from turmeric, lime, and salt was commonly applied to sprains and inflamed joints 8 . Smoke made by sprinkling turmeric over burnt charcoal was used to relieve scorpion stings within a few minutes that the affected area is exposed to smoke. Inhaling the fumes of burning turmeric was also used commonly to release copious amounts of mucous and provide instant relief from congestion. The fumes also were believed to help in hysteric fits 8 . A pinch of turmeric was also used as an insect repellent in the kitchen 9 . A paste made of turmeric alone or with neem leaves was used for ringworm, itching, eczema, and any other parasitic skin condition 8 . The Charakra Samhita section on Therapeutics states that turmeric, black pepper, long pepper, and ox bile was a common remedy for consumed poison or snake bites, up until the last stage 15 . The Charakra Samhita also provides a traditional remedy for jaundice: turmeric, triphala, neem bark, bala, licorice cooked in milk and ghee of buffalo. If this did not work and there is “found residue of morbidity still lodged in the body”, inhalation therapy was indicated. Cigars were made from turmeric paste, cinnamon, castor plant root, lac, red arsenic, deodar, yellow orpiment, and nardus, smeared with ghee and smoked. Inhalation of the fumes of barley paste with ghee was also a treatment for jaundice 15 . Hemorrhoids (piles) were treated with an ointment of turmeric, hemp leaves, onions, and warm mustard oil or linseed oil, applied externally when the hemorrhoids are painful and protruding 8 . Pastes of turmeric were used for smallpox, chickenpox, shingles, ulcers, conjunctivitis, skin blemishes, malaria, and applied to the cut placenta after the birth of a child 8 . Turmeric has hundreds of molecular constituents, each with a variety of biological activities. There are at least 20 molecules that are antibiotic, 14 that are known cancer preventatives, 12 that are antitumor, 12 are antiinflammatory and there are at least 10 different antioxidants 7 . One database presented over 326 known biological activities of turmeric 12 . The rhizome is 70% carbohydrates, 7% protein, 4% minerals, and at least 4% essential oils. It also has vitamins, other alkaloids, and is about 1% resin 7 . The active ingredient in turmeric is called “curcumin”, although in its raw state turmeric only contains 25% curcumin 4 . Curcumin is the substance that is responsible for the biological activity of turmeric. Combined with black pepper, curcumin becomes 2000 times more potent 4 . Curcumin is now extracted from turmeric, sold as supplements, and is the basis of most scientific research. The active properties of curcumin are best called “protective properties”. The same components that prevent deterioration of food protect living tissue from degenerating, possibly extending the life span of our bodies 7 . Clinical and laboratory research indicates that diets that include turmeric or curcumin “stabilize and protect biomolecules in the body at the molecular level”, which is shown in its antioxidant, anti mutagenic, and anti carcinogenic action 7 . These components may work by protecting a person directly, by shielding the biomolecules, or indirectly, by stimulating the natural detoxification and defense mechanisms of the body: helping the body to heal and preserve itself naturally 7 . Current statistics show that 98% of all diseases are controlled by a molecule called NFKappa B, a powerful protein that promotes abnormal inflammatory response in the body. Excess of NFKappa B can lead to Cancer, Arthritis, and a wide range of other diseases. Studies show that curcumin subdues NFKappa B, meaning that it may work to prevent nearly all diseases afflicting our world today 4 . Science and Turmeric Scientists are beginning to realize the importance of turmeric/curcumin in treating modern disease. Much research has been conducted on the http://www.ayurvedacollege.com/book/export/html/2
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various effects of curcumin in the body; the most widely researched is that of its effects on Cancer. In both India and Pakistan , where curry/turmeric is a dietary staple, boast much lower incidence of cancer than in other countries where turmeric is not regularly consumed 2 . Turmeric is considered to fight Cancer in three ways: It neutralizes those substances and conditions which can cause cancer; It directly helps a cell retain its integrity if threatened by carcinogens (a substance showing significant evidence of causing cancer or growth of cancer cells); If a tumor does grow the curcumins can often destroy it 13 . There are many reasons why turmeric helps to destroy Cancer. One of the keys to this activity is the ability of curcumin to inhibit the enzyme Topoisomerase, which is required for the replication of cancer cells. “Topoisomerase works within the nucleus of the cell, where it first binds to supercoiled DNA and then catalyzes the passage of one DNA helix through another via a transient double stranded break. This splits the DNA and thus allows cell replication to occur. Stopping Topoisomerase stops replication which stops the spread of the problem 13 .” Curcumin is also one of the most studied natural COX2 inhibitors, which block an enzyme called cyclooxygenase2. This is beneficial because the COX2 enzyme helps make carcinogens more active in the body and allows cancerous cells to survive by growing new blood vessels 2 . In essence, curcumin completely blocks the formation of cancer causing enzymes, decreasing the likelihood of cancerous cell formation or growth. Curcumin is also rich in antioxidants, which are important disease fighting substances that help to clean up unstable oxygen molecules (free radicals) that can damage cells and cause diseases such as Cancer. Other antioxidants and COX2 inhibitors are red grapes, green tea, rosemary, and bee propolis 2 . Even when using more allopathic methods to treat cancer, turmeric/curcumin still helps to increase the effectiveness and decrease some of the side effects of cancer treatments. Current research suggests that including curcumin in the diet during the “initiation and or post initiation periods” of cancer significantly suppresses the development of chemically induced tumors 13 . In summary, research is showing that curcumin may be more effective treatment for cancer in the beginning phases of the disease, as well as preventative treatment throughout life before cancer even emerges. A study performed in 1992 on 16 cigarette smokers who took 1.5 g of turmeric a day for 30 days had much lower mutagenic levels in their urine than those who did not include turmeric in their diet 1 . Mutagens are substances that cause cell mutation and increase the occurrence of cancer. There is, however, some new research suggesting that taking curcumin may counteract the effectiveness of chemotherapy. Thus, many cancer treatment programs are developing a periodic schedule of use to avoid any issues 13 . “We have not found a single cancer on which curcumin does not work”, states Dr. Bharat Aggarwal, who conducts cancer research at the Jawaharlal Nehru Centre for Advanced Scientific Research in Bangalore , India 4 . Ayurveda especially recommends turmeric for cancers of the female reproductive system, specifically breast and uterine cancer, and to treat benign tumors as well 11 . Although the current research looks promising, there have been very few long term tests performed on large quantities of humans. Turmeric was recently nominated by the National Cancer Institute for more study so we can look forward to many more research findings in the future. Turmeric is also a powerful antiinflammatory herb. It has been shown to be helpful in the treatment of Arthritis, Rheumatoid Arthritis, Osteoarthritis, injuries, trauma, and stiffness from both under activity and over activity 10 . It is also helpful after surgery to decrease pain, inflammation and accelerate healing. One study conducted in 1986 showed that a dosage of 1200 mg of curcumin a day was more effective in reducing postsurgical inflammation than either the placebo group or antiinflammatory medication normally prescribed 5 . In India , turmeric is considered the standard antiinflammatory, and yogis use it to help keep their tendons and ligaments free from injury and to assist in their asana practice 6 . In the same way, it minimizes pain and inflammation related to any kind of exercise or strenuous activity. Majeed states: “Perhaps http://www.ayurvedacollege.com/book/export/html/2
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Turmeric's most important antiinflammatory mechanism centers on its effects on the Prostaglandins (PGs), a large family of potent lipids produced by the body. PG1 and PG3 calm the body while PG2 inflames the body. Turmeric is a potent inhibitor of cyclooxygenase 5lipoxygenase and also 5HETE production in neutrophils. Reducing these enzymes means less arachidonic acid metabolism, which means less PG2, which means less pain and inflammation 7 .” Some sources suggest that turmeric/curcumin is most effective for acute inflammation, and not for chronic 1 . Many sources recommend turmeric for Arthritis but the scientific evidence is still unclear and much more research is underway. Turmeric also has a special action to purify and nourish the blood and skin. External application stops pain and swelling, heals wounds rapidly, and treats many skin diseases ranging from acne to leprosy. The classic way to apply turmeric topically is as an “Ubtan”: a blend of turmeric, chickpea flour, sesame or almond oil, a little fresh cream and honey. This will clear up skin blemishes, and increase the natural glow and radiance of the skin 16 . Turmeric essential oil works wonderfully as an external antibiotic to prevent infections in wounds. A nice formula for a wound healing salve is a mixture of olive oil, beeswax, tea tree oil, aloe, turmeric, arnica, slippery elm, red clover, thyme oil, and vitamin E 9 . Since turmeric is bitter and antiinflammatory, it is excellent for hot skin diseases, red rashes, and especially wet eczema 16 . Turmeric essential oil, mixed with citronella, tulsi, and vanillin, works as a powerful insect repellent, and is a natural alternative to D.E.E.T, the most common chemical insect repellent commercially available. Studies show that D.E.E.T. is extremely toxic, hazardous to the environment, and actually kills plant and insect life that it contacts 3 . Turmeric also protects the liver from toxins and pathogens. It is known to both destroy m toxins in the liver, and to rebuild the liver after a toxic attack 16 . Turmeric increases the secretion and movement of bile, and may prevent all forms of liver disease. Excessive use of drugs and/or alcohol can tax the liver and lead to liver diseases 16 . One study shows that curcumin blocks some of the harmful side effects of cigarette smoke, and prevents dangerous chemical formation after eating processed food 11 . It is also helpful in treating food poisoning. Traditionally, about 5 grams of Turmeric is taken with a glass of whey, morning and evening, for a month to activate and rebuild a liver 8 . Another good liver remedy could be based on Turmeric, Kutki root, and Milk Thistle seeds. In essence, turmeric helps keep the liver healthy so it can do its job of keeping the body detoxified. Ayurveda uses turmeric to purify and move the blood, as it is a wonderful alterative. It helps to remove stagnant blood while stimulating the formation of new blood tissue 6 . Turmeric regulates menses, and decreases the intensity and pain of menstrual periods, and of uterine tumors. Turmeric is a mild and supportive uterine stimulant and its many actions on the liver suggest that it may assist in balancing hormone levels as well 16 . Turmeric also plays a role in pregnancy and birthing in India . Traditionally, it is said that taking turmeric when pregnant will ensure that the child will always have beautiful skin 16 . (However, turmeric is a mild uterine stimulant, so there is a chance of over stimulation; it is essential to consult a healthcare practitioner before taking any herbs during pregnancy.) Turmeric taken in the last two weeks of pregnancy in warm, organic milk helps to expedite a simple birth, while increasing the health of the mother and child as well. Turmeric is also an analgesic (pain reliever) and is sometimes used in natural childbirth to decrease pain 16 . Turmeric also has a special action to help the entire GastroIntestinal system by increasing intestinal flora and generate healthy digestion 6 . It is traditionally used for weak stomachs, poor digestion, dyspepsia, parasites, abdominal cramps, to normalize metabolism, to help digest protein and http://www.ayurvedacollege.com/book/export/html/2
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breakdown of fats, to increase absorption, and the ability of the stomach to withstand digestive acids 6 . Turmeric is also a carminative: it helps to decrease gas and distention. According to Ayurveda, plants that treat digestion are often the most important herbs of all since digestion is the basis of mental and physical health. Prashanti de Jager states, “Turmeric is one of the best carminatives because though it leans towards being heating pungent, it is very balanced and does not aggravate any of the doshas if taken in normal amounts, a few grams per day 16 .” As a vulnerary it also helps to nurture and heal mucous membranes; it has a strong protective effect against food and materials that are corrosive to the stomach and intestines as from food poisoning. In a 1989 double blind study (the participants and researches did not know which groups were taking the herb or the placebo) conducted in Thailand , 500mg capsules of curcumin were given to 116 adults suffering from indigestion at six different hospitals. Stunning results showed that 90% of those taking the curcumin felt full or partial relief after seven days, while 53% of the placebo group felt relief 1 . Another major use of turmeric is support of the respiratory system. As an antioxidant it protects the lungs from pollution and toxins. It also helps the oxygen transfer from the lungs to the blood. Turmeric with ghee is traditionally used to get rid of cough and to treat asthma 8 . It also supports the heart in many ways. A study conducted in 1992 shows that turmeric may assist in lowering cholesterol and prevent Atherosclerosis (blockage of arteries that can cause heart attack and/or stroke) 12 . Animal studies have shown that turmeric lowers cholesterol levels and inhibits the oxidation of LDL (“bad cholesterol”, responsible for clogging of arteries). When LDL becomes oxidized, it creates deposits in the walls of blood vessels and contributes to the formation of arteriosclerosis. Turmeric may also prevent platelet buildup along the walls of injured blood vessels, another common cause of blood clots and artery blockage that can result in heart attacks and strokes 12 . Studies are also underway regarding turmeric's believed effects in treating and preventing neurological diseases such as Multiple Sclerosis and Alzheimer's Disease. This belief generates from the realization that elderly Indian people who eat turmeric on a regular basis are far less likely to develop these ailments than those who do not eat turmeric. In fact, Alzheimer's Disease is 4.4 times less common among older adults in India than in the United States 4 . It has been noted that people taking antiinflammatory medication for Arthritis are less likely to develop Alzheimer's Disease 1 . Since turmeric possesses such a powerful antiinflammatory action, scientists speculate that it most likely will have a preventative effect on such disorders. More research is needed in this area to prove such theories. New research also suggests that turmeric may play a vital role in fighting HIV/AIDS, particularly HIV, Type 1 10 . In a recent study at the Jawaharlal Nehru Centre for Advanced Scientific Research in Bangalore , India , when scientists 'fed' curcumin to HIVinfected cells in the laboratory, the virus stopped replicating 17 . Several studies have shown that people who have HIV and AIDS are deficient in many antioxidant vitamins and minerals, and it is believed that it is the powerful antioxidant properties of turmeric that combat the disease 17 . "Curcumin's antioxidant properties will protect your DNA from the ravages of the virus. It's also antimicrobial, so it will help prevent the many opportunistic illnesses associated with HIV and AIDS," says Dr. Susan Kowalsky, N.D., a naturopathic doctor in Norwich , Vermont 18 . In a study at Harvard Medical School , research showed that curcumin prevented the reproduction of HIV by blocking a specific gene that activates the virus and causes it to spread. Another study showed that it may help decrease the reproduction of HIV 18 . This is a currently major topic of research, so we can look forward to updates in the near future. Turmeric can obviously stand the test of time. It has been worshipped, reveled and revered by people for centuries, and still today it is one of the most significant players in the prevention of serious disease as well as the general afflictions of living. Much more research is underway to prove http://www.ayurvedacollege.com/book/export/html/2
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scientifically what the ancient people of India have known for centuries: that turmeric is one of the most powerful plants on the planet. Whether suffering from an acute or chronic disease, aches and pains, bumps and bruises, or as preventative maintenance, turmeric can and should be utilized by everyone on a regular basis. In the words of David Frawley: “If I had only a single herb to depend upon for all possible health and dietary needs, I would without much hesitation choose the Indian spice turmeric 16 .” Without a doubt, this writer feels exactly the same. References 1. Whole Health MD.com , Article: “Turmeric”. http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10062,00.html 2. Whole Health MD.com , Article: “Cancer Fighters in Your Spice Rack,” 3/21/2001 . http://www.wholehealthmd.com/news/viewarticle/1,1513,844,00.html 3. The Wikipedia Encyclopeida http://en.wikipedia.org/wiki/Turmeric 4. Sundaram, Viji. Article: “Don't Go Easy on Turmeric: It Prevents and Cures Cancer”: IndiaWest , 2005 5. HealthNotes , Article: “Turmeric”, 2002. http://www.drugstore.com/templates/hnotes/default.asp?catid=41779&aid=33... 6. Frawley, David & Vasant Lad, The Yoga of Herbs . Lotus Light Publications, 1993. 7. Majeed, Muhammed; Vladimir Badmaev; Uma Shivakumar; R.Rajendran, eds., Curcuminoids ; antioxidant phytonutrients. NutriScience Publishers, Inc, 1995. 8. Nadkarni, K.M., The Indian Materia Medica. Bombay Popular Prakashan, 1976. 9. Kaushik, Purshotam, Haridra (Turmeric): Antibacterial Potential . Chowkhamba Sanskrit Series Office, Varanasi , 2003. 10. Williamson, Elizabeth , ed., Major Herbs of Ayurveda. Churchill Livingstone, 2002. 11. Pook, Sally, “ Curries May Help to Combat Cancer”. Article: news.telegraph.co.uk http://www.ayurvedacollege.com/book/export/html/2
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12. University of Maryland Medical Center , Article: “Turmeric”. http://www.umm.edu/altmed/ConsHerbs/Turmericch.html 13. Cancer Research , Article: “Chemopreventive Effect of Curcumin , a Naturally Occurring AntiInflammatory Agent, during the Promotion/Progression Stages of Colon Cancer ” Cancer Research 59, 597601, February 1, 1999 . 14. Cole GM , Lim GP , Yang F , Teter B , Begum A , Ma Q , HarrisWhite ME , Frautschy SA . “Prevention of Alzheimer's disease: Omega3 fatty acid and phenolic antioxidant interventions.” Neurobiol Aging. October 30, 2005 . 15. Dash, Bhagwan and R.K. Sharma, Caraka Samhita . Chowkhamba Sanskrit Series Office, Varanasi ,India , 2001. 16. Prashanti de Jager, Article: “Turmeric: The Ayurvedic Spice of Life”, 2003. 17. SciDev.net , Article: “Turmeric can Combat malaria, Cancer Virus, and HIV”. March 6, 2006 . http://www.scidev.net/news/index.cfm?fuseaction=printarticle&itemid=1987... 18. Mother Nature.com, Article: “HIV and AIDS”. http://www.mothernature.com/Library/Bookshelf/Books/23/102.cfm 19. PubMed, Article: “In Vitro and in Vivo AntiTumoral Effect of Curcumin Against Melanoma Cells.” http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dop...
Better Known as Turmeric By: Ivy Cannon Introduction Over thousands of years, turmeric has served many purposes. This versatile root's bright yellow color has always been used for paints and dyes. Far superior to its use for color are its many culinary applications and medicinal purposes. Because of its widespread use, this wonderful root has nearly as many names as uses. Numerous are the names given to this amazing root but it is most commonly known as Turmeric (Curcuma longa). "Curcuma is Latinization of Arabic alkurkum [rfi..SJI], which originally means saffron but is now used for turmeric only." [1] Turmeric is sometimes called indian saffron, golden goddess, haridra, haldi, jiang huang, curcuma longa, kha min chan by the Thai, kunir in Indonesia, kurkuma by the Germans and Terre merite in France. In almost every language it means "yellow root." In India alone it has over 10 different names: halad, haradi, nisa, kancani, pasupu, makhal, halud, ladir, pivari and yositpriya. Haradi is a plant native to southern India and Asia, and it is closely related to ginger. 'Turmeric (Curcuma longa) is a rhizomatous herbaceous http://www.ayurvedacollege.com/book/export/html/2
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perennial plant of the ginger family, Zingiberaceae." [2] "A tall herb, rootstock large, avoid, with sessile cylindric tubers orangecolored inside. Leaves very large, in tufts up to 1.2 meters long, including the petiole which is as long as the blade, oblonglanceolate, tapering to the base. Flowering in autumn, spikes 1015 cm long; peduncle 15 cm or more, concealed by the sheathing petiole; flowering bracts pale green; bracts of coma tinged with pink." [3] The root looks much like ginger with a more orange skin that is thinner. The inside of risa is a yellowishorange color. Another variation is known as kunkum. Kunkum is red on the inside and considered sacred thus not used for cooking. Only the yellow haridra is eaten, and it is essential in most Indian cooking. Aside from being such a great herb for cooking, nisa is one of the most important herbs for both internal and external medicinal use. Understanding the chemical components of ladir is necessary when learning how to use the root effectively. A closer look at curcumin through the lense of science reveals it's healing essence. "Turmeric contains up to 5% essential oils and up to 5% curcumin, a polyphenol." [5] "An active principle curcumin, yellow coloring matter and turmeric oil (or turmeriol) of specific odor and taste, and yellow color." [6] "Curcumin is the active substance of turmeric and curcumin is known as C.I. 75300, or Natural Yellow 3. The systematic chemical name is (1E,6E)1,7bis(4hydroxy3methoxyphenyl)1,6heptadiene3,5dione." [5] "Fresh rhizomes yield 0.24% oil, containing zingiberene." [6] The plant kingdom classification of turmeric shows its close relation to ginger. o o o o o o
Kingdom: Plantae Plants Subkingdom: Tracheobionta Vascular plants o Superdivision: Spermatophyta Seed plants Division: Magnoliophyta Flowering plants o Class: Liliopsida Monocotyledons, Subclass: Zingiberidae o Order: Zingiberales Family: Zingiberaceae Ginger family o Genus: Curcuma L. curcuma Species: Curcuma longa L. common turmeric [4]
Traditional Uses Traditionally the active principle curcumin, which gives turmeric its bright yellow color, was used as a fabric dye. It's use in this application has varying results and ultimately the color it produces fades fast. "Essentially turmeric makes a poor fabric dye, as it is not very light fast. However, turmeric is commonly used in Indian and Bangladeshi clothing, such as saris and Buddhist monks' robes." [7] Even though we now have superior synthetic dyes this root is still used by many cultures as a coloring agent. We may be able to easily replace kunir with a synthetic dye, but we can not employ a different herb to replace it's numerous culinary and medicinal applications. Probably best known for its classic application as a fundamental spice in the curry armamentarium, turmeric is a significant ingredient in most commercial curry powders. Its bright gold color gives curries their characteristic hue and adds an attractive tone, especially to vegetable combinations. Jiang Huang is mostly used in savory dishes, as well as some sweet dishes such as the cake sfouf. "Although most usage of turmeric is in the form of rhizome powder, in some regions leaves of turmeric are used to wrap and cook food. In Goa and Dakshina Kannada (Karnataka state, India), turmeric plant leaf is used to prepare special sweet dishes, patoleo, by layering rice flour and coconutjaggery mixture on the leaf, and then closing and steaming it in a special copper steamer (goa)." [8] Indian saffron is used in so many indian culinary delicacies it's a shame one can't list them all. Some applications include dishes such as dal soup, kitchadi, bhaji, subji, rice khir, raitas, chutneys and pickling. In a more http://www.ayurvedacollege.com/book/export/html/2
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modern culinary application, "Turmeric (coded as E100 when used as a food additive, indicating how it is used as a food coloring since it normally gives food slightly yellow color) is used to protect food products from sunlight."[9] This commonly found food additive has also been proven beneficial to your health. For many thousands of years kunir has been used in a laundry list of applications with effects on all the tissues of body and several body systems. "Turmeric is the best medicine in Ayurveda. It cures the whole person. Turmeric's rasa (taste) is pungent, bitter, astringent, the virya (effect on digestion) is heating with a pungent vipaka (post digestive effect). Turmeric can be used by all doshas (body types). Turmeric helps digestion, maintains the flora of the intestine, reduces gas, has tonic properties and is an antibiotic. Turmeric can be used for cough, sty, diabetes, hemorrhoids, cuts, wounds, burns and skin problems. It helps reduce anxiety and stress." [10] Its herbal actions include a digestive stimulant, carminative (dispel gas), alterative (cleanses circulatory system), vulnerary (heals the skin), hemostat (stops bleeding), antibacterial, purification of tissue while supporting tonification (increase tissue) and emmenagogues (action on female reproductive system). "Its use is indicated when indigestion, poor circulation, cough, amenorrhea, pharyngitis, skin disorders, diabetes, arthritis, anemia, wounds, or bruises are present." [11] Over the centuries it has been used for the treatment of snake bites and scorpion stings. Even now when western medicine is unavailable to those living in more isolated areas, halad is an effective treatment. "The smoke produced by sprinkling powder of turmeric rhizome over burning charcoal will relieve scorpion sting when the part affected is exposed to the smoke for a few minutes." [12] More uses for this wonderful herb include: • • •
for anemia, take a bowl of yogurt with 1 tsp turmeric. Eat on empty stomach morning and evening. Do not eat after dark. for cuts, wound and fungal nail infections, apply mixture of Yz tsp turmeric & 1 tsp aloe vera gel to affected area. for external hemorrhoids, apply a mixture of Yz tsp of turmeric and 1 tsp of ghee locally at bedtime. [10]
Effects on Body Tissues From an Ayurvedic perspective, we can look at each tissue of the body and see how turmeric plays a role in the health of that tissue (dhatu). Here are a few ways haridra works on each tissue of the body, although it is not limited to these actions. In the lymphatic system, known as the rasa dhatu, turmeric purifies the lymphatic fluid, removes stagnation, reduces excess heat associated with low intermittent fever and reduces inflammation of mucous membranes. In the circulatory system, the rakta (blood) benefits greatly from turmerics effects. Some of these include: stimulation of blood tissue development, regulation of blood glucose levels, removal of stagnation in the liver, antimicrobial properties that fight bacterial and viral infections as well as inflammatory conditions and a hemostatic property which acts as a coagulant. It's effectiveness as a hemostat makes it useful for mild internal bleeding due to diseases such as ulcerative colitis. The leaves of kunir also have an antipyretic (cools blood & liver) effect. In the mamsa dhatu or muscle tissue, one may notice benefits for complexion. A paste made of flour and halad is used for treatment of ringworm or other parasitic skin conditions. For a heated skin condition such as herpes simplex virus, one could apply ladir in aloe vera gel to the affected area. The same mixture of turmeric and aloe vera gel taken internally, is used to combat the systemic heat and viral infection associated with a herpes flare up. A haridra and salt paste may be applied to bruises or traumatic injuries where swelling has occurred to not only reduce the swelling, but alleviate some of the pain as well. Nisa may also be used for acne in conjunction with sandalwood. http://www.ayurvedacollege.com/book/export/html/2
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Fat tissue, also known as the medas dhatu, is affected in many ways by jiang huang. Through its purification and clearing stagnation in the liver, it increases function of gallbladder and bile production. This stimulates digestion of fats while also having the ability to aid in the digestion of protein through assisting the pancreas in its digestive functions. All of these factors lead to the maintenance of a healthy body weight. Turmeric stimulates flow through the circulatory system by promoting removal of old red blood cells and production of new red blood cells. The asthi dhatu, or bones, are the site of production for new red blood cells. Golden Goddess has an alkalizing effect on the blood which promotes healthy bones. When the blood ph is low and the body is highly acidic, the blood borrows minerals such as calcium from the bones to bring its ph to a more alkalized environment. This borrowing from the bones leads to a weakening. Over time this can lead to the disease osteoporosis. Through its antimicrobial properties and stimulation of healthy red blood cells, risa can prevent infections of the bones such as osteomyelitis. Indian Saffron is known as a protector against stress and anxiety. It purifies the plasma which is the vital spinal fluid that feeds the brain. With healthy pure rasa (lymph) feeding brain function the entire nervous system is supported. In a recent study on alzheimer's disease haldi was proven to be therapeutically beneficial. "Alzheimer's disease (AD) is a neurodegenerative disorder and the most common form of dementia, affecting more than 5.4 million people in the USA. Some natural products may be used as AD therapeutics from a variety of biological sources, including the anti amyloid agent curcumin, isolated from turmeric." [21] While pivari has a purifying effect, lets not forget its support in tonification (building) of tissue. Mostly associated with use for the female reproductive system it is used as a general tonic and stimulant. Safe for use during later trimesters of pregnancy, its stimulating effect can promote menstruation and thus should be avoided during early conception. While its tonifying and purifying effects maintain healthy reproductive tissue, it's antimicrobial properties make it useful in the treatment of sexually transmitted diseases such as gonorrhea.
Effects on Body Systems There are specific body systems that the golden goddess has more of an effect on than others. One of these is the circulatory system. "The rhizome is used as a stimulant; and is externally applied to bruises, cuts, ulcers, sprains and pain. It is orally given in blood diseases. Employed in intermittent fevers. Its used externally on bruises and snake bites." [13] In the event of a sprain or pain one can employ various applications of turmeric rhizome. "For general muscle strain, apply warm ginger paste with turmeric (one tsp ginger with Yz tsp turmeric) to the affected area twice a day. Wrap the affected area in a piece of gauze or cotton cloth. A warm compress may be applied for further relief of pain." [14] Healing time for this kind of injury can be increased by daily internal use. "A good antibacterial for those chronically weak or ill. It not only purifies the blood, but also warms it and stimulates formation of new blood tissue. Golden Goddess gives the energy of the Divine Mother and grants prosperity. It is effective for cleansing and purifying the channels of the subtle body." [11] Long term use of ladir has been proven to be an essential part of preventative and holistic medicine. In the digestive system indian saffron is best known for its treatment of inflammation and indigestion with flatus. Although this herb is warm and stimulating, it does not create heat in the liver and actually moves stagnant heat out of the liver and small intestine. For this reason it is sometimes http://www.ayurvedacollege.com/book/export/html/2
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given during bouts of diarrhea. Kunir may be added to high protein food to assist digestion and prevent the formation of gas. It is effectively used to maintain the flora of the large intestine and prevent the formation of toxins. Best taken in a portion of 13 grams of powder with food. In one western study scientist looked at the effects of turmeric as an antiinflammatory in the colons of mice. "The biological activity of Curcuma extract was evaluated against Carbachol induced contraction in isolated mice intestine." [19] Alternating administration of either curcuma longa or a placebo, observations were held for a period of two weeks. In conclusion the study demonstrated, "Curcuma extract has a direct and indirect myorelaxant effect on mouse ileum and colon, independent of the antiinflammatory effect. The indirect effect is reversible and noncompetitive with the cholinergic agent. These results suggest the use of curcuma extract as a spasmolytic agent." [19] Ultimately this study confirms the anti inflammatory and bowel tonic effect nisa has on the digestive system. Golden Goddess is said to assist in the digestion of proteins which in turn assists the pancreas in its activities. These effects are not limited to the pancreas' exocrine functions. For reasons that are still being studied turmeric helps support blood glucose levels. "Health benefits of curcuminoids from C. longa as antioxidants, anticancer and antiinflammatory molecules have been well documented. We report here for the first time that Bisdemethoxycurcumin (BDMC) from C. longa, acts as an inhibitor to inactivate human pancreatic aamylase, a therapeutic target for oral hypoglycemic agents in type2 diabetes." [20] "For the treatment of diabetes, turmeric is also useful. Take four to five 00 capsules after each meal to return the blood sugar levels to normal." [15] Certainly halads promotion of a healthy liver aids in the storage of glycogen and regulation of glucose. This storage and regulation allows the pancreas to function optimally. In the respiratory system haridra is good for fighting infections such as bronchitis. A common treatment for a cold is; "Fresh juice (1020 gms) of turmeric or drink 1 cup milk boiled for 3 minutes with 1 tsp turmeric before bed." [16] To combat cough, sore throat and relieve inflammation in the throat, prepare a turmeric and salt gargle (2 pinch : 2 pinch) in one cup hot water. A "milk turmeric decoction is said to be beneficial for cold, diarrhea, intermittent fever, dropsy, jaundice, liver disorders, urinary diseases, worms (add sugar follow with purgation & enema), trauma and fracture." [17] For sinus inflammation add a pinch of risa to your neti pot or make a medicated oil. The kunir oil may be added to a neti pot or a few drops inserted directly into each nostril.
Western Studies There have been many studies held on the effects of jiang huang as an antiinflammatory for the bowels, an antimicrobial for the blood and a blood sugar regulator. More recent studies are showing the effects of halad on cancer cells. One thing we know from collective research is that it reduces heat in the liver by balancing or alkalizing the blood ph. In many cases cancer patients have a low ph. Here are two studies that support the theory of turmeric's benefits for cancer patients. Study 1 "Animal and laboratory studies have found that curcumin, an antioxidant that is an active ingredient in turmeric, demonstrated some anticancer effects. Antioxidants are compounds that can protect the body's cells from damage caused by activated oxygen molecules known as free radicals. However, clinical research is needed to determine curcumin's role in cancer prevention and treatment in humans. Several types of cancer cells are inhibited by curcumin in the laboratory, and curcumin slows the spread of some cancers in some animal studies." http://www.ayurvedacollege.com/book/export/html/2
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[22] Study 2 "Curcumin (diferuloylmethane), the yellow pigment in Indian saffron (Curcuma longa; also called turmeric, haldi, or haridara in the East and curry powder in the West), has been consumed by people for centuries as a dietary component and for a variety of proinflammatory ailments. Extensive research within the last decade in cell culture and in rodents has revealed that curcumin can sensitize tumors to different chemotherapeutic agents. Chemosensitization has been observed in cancers of the breast, colon, pancreas, gastric, liver, blood, lung, prostate, bladder, cervix, ovary, head and neck, and brain and in multiple myeloma, leukemia, and lymphoma. Similar studies have also revealed that this agent can sensitize a variety of tumors to gamma radiation including glioma, neuroblastoma, cervical carcinoma, epidermal carcinoma, prostate cancer, and colon cancer. Although it acts as a chemosensitizer and radiosensitizer for tumors in some cases, curcumin has also been shown to protect normal organs such as liver, kidney, oral mucosa, and heart from chemotherapy and radiotherapyinduced toxicity. These preclinical studies are expected to lead to clinical trials to prove the potential of this ageold golden spice for treating cancer patients." [23] While there are many theories to support kunir's versatile uses, some studies suggest otherwise. "Curcumin (CUR) is the major orange pigment of turmeric and believed to exert beneficial health effects in the gastrointestinal tract and numerous other organs after oral intake. However, an increasing number of animal and clinical studies show that the concentrations of CUR in blood plasma, urine, and peripheral tissues, if at all detectable, are extremely low even after large doses. In view of the very low intestinal bioavailability, it is difficult to attribute the putative effects observed in peripheral organs to CUR. Without testing the fecal matter for concentrations of CUR it can't be said that turmeric has, poor permeation from the intestinal lumen to the portal blood." [18] Just because haridra hasn't shown up in the urine, blood or plasma, doesn't mean it's confined to the intestine. Perhaps once in systemic circulation the compound changes or is picked up by different organs resulting in a low concentration of CUR in the blood, plasma and urine. It would be helpful to conduct a study that could confirm the concentration of CUR in the intestine and fecal matter after high dosages. With the growing trend of turmeric studies, we will soon gain a deeper understanding of the many benefits of this amazing herb. Even with all the recent studies, thousands of years of use are evidence that turmeric is a priceless resource. It is an essential part of everyone's health. Used in preventative measures and ongoing treatment, it has countless uses and applications. Its is no wonder that nisa has been so prized for so long in India and other eastern cultures. Through it's culinary applications and medicinal uses, golden goddess has become an integral part of the survival of human health. Now readily available around the world, it is being used more and more. The bright orange color of turmeric can be spotted wherever you go even when you may not recognize it by name.
Bibliography 1/3. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 2. Chan, E.W.C. et al.; Lim, Y; Wong, S; Lim, K; Tan, S; Lianto, F; Yong, M (2009). "Effects of different drying methods on the antioxidant http://www.ayurvedacollege.com/book/export/html/2
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properties of leaves and tea of ginger species". Food Chemistry 113 (1): 166172.doi:10.1016/j.foodchem.2008.07.090. 4. [usda.gov] Plants. USDA. Plant Profile. Curcuma Longa L. common turmeric Web. 24 Sept. 2012
5. [www.wikipedia.org] article. turmeric. (2)composition Web. 24 Sept. 2012 6. Gernot Katzer's Spice Pages. "Turmeric". Etymology. Last Modification 19 Mar. 1999 Web. 24 Sept. 2012 7. [www.wikipedia.org] article. turmeric. (1.5) dye Web. 24 Sept. 2012 8/9. [www.wikipedia.org] article. turmeric. (1.1) culinary uses Web. 24 Sept. 2012 10. Usha Lad & Dr. Vasant Lad. Ayurvedic Cooking for SelfHealing. Second Edition. Page 215216. The Ayurvedic Press, Albuquerque 87112. Copyright 1994, 2009 11. Dr. David Frawley and Dr. Vasant Lad. The Yoga of Herbs. Second Edition. Page 149. Lotus Press Twin Lakes, Wisconsin. Copyright 1986, 2001 12. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 13. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 14. Dr. Vasant Lad. "Ayurveda The Science of SelfHealing." Page 160. "Muscle Strain & Pain." Lotus Press Twin Lakes, Wisconsin. 15. Dr. Vasant Lad. "Ayurveda The Science of SelfHealing." Page 141. "Turmeric." Lotus Press Twin Lakes, Wisconsin. 16. Usha Lad & Dr. Vasant Lad. Ayurvedic Cooking for SelfHealing. Second Edition. Page 215216. The Ayurvedic Press, Albuquerque 87112. http://www.ayurvedacollege.com/book/export/html/2
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Copyright 1994, 2009 17. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 18. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Biofactors. 2012 Sep 20. doi: 10.1002/biof.1042. [Epub ahead of print] "Curcumin uptake and metabolism." Metzler M, Pfeiffer E, Schulz SI, Dempe JS. Source Department of Chemistry and Biosciences, Chair of Food Chemistry, Karlsruhe Institute of Technology (KIT), Adenauerring 20a, D76131 Karlsruhe, Germany. [email protected]. Web. 24 Sept. 2012 19. [Pub.Med.gov US National Library of Medicine National Institutes of Health] PLoS One. 2012;7(9):e44650. Epub 2012 Sep 12. "Curcuma longa Extract Exerts a Myorelaxant Effect on the Ileum and Colon in a Mouse Experimental Colitis Model, Independent of the Anti Inflammatory Effect." Aldini R, Budriesi R, Roda G, Micucci M, Ioan P, D'ErricoGrigioni A, Sartini A, Guidetti E, Marocchi M, Cevenini M, Rosini F, Montagnani M, Chiarini A, Mazzella G. Source Ospedale Policlinico S.Orsola and Dipartimento di Scienza dei Metalli, Elettrochimica e Tecniche Chimiche, Universita degli Studi di Bologna, Bologna, Italy. Web. 2 Jul. 2012 20. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Food Chem. 2012 Dec 15;135(4):263842. doi: 10.1016/j.foodchem.2012.06.110. Epub 2012 Jul 13. "Discovering Bisdemethoxycurcumin from Curcuma longa rhizome as a potent small molecule inhibitor of human pancreatic aamylase, a target for type2 diabetes." Ponnusamy S, Zinjarde S, Bhargava S, Rajamohanan PR, Ravikumar A. Source Institute of Bioinformatics and Biotechnology, University of Pune, Pune 411 007, Maharashtra, India. Web. 2 Jul. 2012 21. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Future Med Chem. 2012 Sep;4(13):175161. "Natural products as a rich source of tautargeting drugs for Alzheimer's disease." Calcul L, Zhang B, Jinwal UK, Dickey CA, Baker BJ. Source Department of Chemistry & Center for Drug Discovery & Innovation, University of South Florida, FL, USA. http://www.ayurvedacollege.com/book/export/html/2
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Web. 25 Sept. 2012. 22. [www.cancer.org Find Support & Treatment Treatments and Side Effects Complementary and Alternative Medicine Herbs, Vitamins, and Minerals] "Turmeric" Last Medical Review: 11/28/2008 _ Last Revised: 11/28/2008 Web. 24 Sept. 2012 23. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Nutr Cancer. 2010;62(7):91930. "Curcumin, the golden spice from Indian saffron, is a chemosensitizer and radiosensitizer for tumors and chemoprotector and radioprotector for normal organs." Goel A, Aggarwal BB. Source Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA. Web. 25 Sept. 2012
Triphala: Ayurvedic formula for the Modern World. By: Rodrigo M. Pocius I. Introduction to Triphala II. Constituents 1. Amalaki A) Botanical Description B) Ayurvedic Description 2. Bibhitaki A) Botanical Description B) Ayurvedic Description 3. Haritaki A) Botanical Description B) Ayurvedic Description III. Triphala: General uses and other benefits 1. Digestion http://www.ayurvedacollege.com/book/export/html/2
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2. Gouty Arthritis 3. Healing compound for wounds 4. Antioxidant and free radical scavenger 5.Anti Cancer Compound 6.Protection against Gamma Radiation IV. Conclusion V. Abstracts VI. Photo Credits End notes
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Ayurvedic nutrition and diet: an ancient traditional perspective Healthy Digestion Healthy Body! According to Ayurveda, the traditional medicine of India, the digestive system is the physical root of most diseases in the body. In other words, as disease develops, its early signs are often seen as digestive problems. Gas, constipation, diarrhea, indigestion and bloating are all considered to be warning signs of future problems that are more serious. If the digestive system is properly cared for many diseases can be averted and diseases that are present have a better chance of healing. Ayurveda places a lot of emphasis of the care of the digestive system. In doing so, Ayurveda addresses not only what food is best for an individual but how food is eaten and how it is combined. If proper food is taken and it is taken in the proper manner most digestive problems go away. For those that do not, Ayurveda utilizes herbs to normalize the function of the digestive system. How do you know if you have digestive problems that may cause future challenges? Most of the signs are obvious. If you have gas, bloating, constipation, diarrhea or cramping you have mild but important signs of imbalance. If you have been diagnosed with irritable bowel syndrome, ulcers, ulcerative colitis, diverticulitis or GIRD (gastrointestinal reflux disorder), your challenges are more serious but can still be helped. The knowledge of Ayurveda is important to the correction all digestive imbalances. Proper digestion begins not with what you eat but how you eat! Here are five simple but important guidelines to assure that your digestion is optimal. 1. Begin meals with a moment of relaxation or grace: When the body is relaxed and focused on the food, digestive enzyme secretion is maximized. 2. Eat in a calm environment: When the mind is involved in drama and emotion, digestion is disturbed. Turn off the TV, don't discuss intense issues at the dinner table and avoid eating while driving in the car. 3. Chew your food well: Digestion begins with chewing. Proper chewing allows enzymes in the saliva to begin the digestive process. Food should be chewed until it is an even consistency. 4. Eat until you are satisfied, not till you are full: Overeating is one of the major causes of digestive upset and subsequent disease in Western countries. The surest way to extend life for most people is to eat less! It is important to learn the difference http://www.ayurvedacollege.com/book/export/html/2
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between genuine hunger and the desire for pleasure through taste. 5. Rest before going on to the next activity: For optimal digestion, it is important to rest after eating. Failure to rest means that the body's physiology will switch away from digestion and toward the activity of the muscles of the body. This leaves poorly digested food in the digestive system. It is best to wait at least 20 minutes before going on to the next activity. Simply eating food properly will alleviate a lot of chronic digestive problems there by preventing more serious disease. When this is combined with a healthy diet, the effect is even more dramatic and almost all digestive problems disappear. Ayurveda teaches that the best diet is the one that is proper for a person's constitution, or unique balance of body energies. People with a more vata nature or those who suffer from constipation and gas tend to need more cooked foods taken with some oil and spices, including salt. It may come as a surprise to find that raw salads can cause more gas. Those with a more pitta nature or those who suffer from burning indigestion and loose stools need to eat more raw foods and take food that is less spicy and less oily. Deep fried foods are the worst food for people with pitta imbalances. Those with a kapha nature or those who tend to feel heavy and sluggish and sometimes get nauseous after eating require food that is dry, light and spicy. People with a kapha nature thrive as vegetarians. What food should you eat? Ayurveda teaches that everyone is a unique individual. Nothing is right for everyone but everything is right for someone. Ayurveda is a path of finding out what is right for you. For the best personalized dietary plan, consult a Clinical Ayurvedic Specialist. In addition to supporting dietary and lifestyle changes, your Clinical Ayurvedic Specialist may design individualized herbal formulas to give your digestive system and the rest of your body its best chance of getting well.
Principles of Ayurvedic Nutrition Ayurveda is based on the belief that nothing is right for everyone and everything is right for someone. This belief comes from an understanding that each of us is unique. Simply put, each of us is biochemically different with different hormonal, enzyme levels and neurotransmitter levels. Each person reacts to the world in different ways. If we are all different, why would we even consider the idea that there must be one program of nutrition that is best for everyone? Where did the idea come from? The United States Department of Agriculture publishes daily recommended allowances of vitamins and minerals. For decades people have taken these guidelines as the “bible” and carefully read food labels to understand how much of each nutrient they are getting. The American Heart Association also publishes recommendations for the amount of fruits, vegetables, grains and dairy people should consume. People routinely use these guidelines to see how they measure up. These guidelines are based upon statistical models of the “average American” and research based in “current science.” The problem with statistical models is that the average American is a myth found only in statistical research papers. In real life, individual needs can vary significantly. Meanwhile, current science is simply the best conclusion that can be made given available data. The problem with “current science” is that it is quickly outdated and never complete as new information is constantly being gathered. What is accepted as the truth today is often found to be wrong tomorrow. A good case in point is the intake of cholesterol. While America has become obsessed with lowering cholesterol intake, studies published over the last couple of years in the prestigious British Medical Journal reveal that low cholesterol numbers, while protecting against cardiovascular disease, seem to increase the risk of certain cancers. In addition, supplements and herbs once thought to be “quackery” are now observed to have complex biochemical interactions beneficial in a wide variety of conditions. http://www.ayurvedacollege.com/book/export/html/2
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What should a person do? There are many ideas on the bookshelves about how to eat and stay healthy. There are diets named after the people who wrote the books, diets named after the foods eaten, diets named after blood types and diets that promise to keep you in the “zone”. New books and ideas are published every month. Ayurveda is a 5000 year old science that aims to help a person understand what is right for them as a unique individual. By evaluating how a person’s digestive system, nervous system and other systems of the body function and by evaluating a person’s body structure, a Clinical Ayurvedic Specialist designs a diet specific to clients needs. Ayurvedic Medicine teaches that people who have a “vata” nature, or those people who are thin, dry and often feel cold, need more grains, oils, salt and a little spice in their diet. Those who do not receive enough are prone to anxiety, constipation and sleeplessness among many other conditions. They need nourishing foods and often have difficulty maintaining a vegetarian diet. People of vata nature should avoid too many salads and fruits as well as beans and take in more grains, dairy and nuts. People of “pitta” nature, or those who tend to be warm and have a more intense and highly focused nature, are understood to need more raw vegetables and food which are only mildly spiced. Hot, spicy food is believed to lead to a greater incidence of skin rashes, liver weakness and anger. Large salads are wonderful. People of “kapha” nature, or those who tend to be overweight or stocky and often move and speak very slowly, benefit from lighter foods such as vegetables and salads and thrive on hot, spicy foods. If sweet, heavy, oily foods are taken in too great of a quantity it can lead to greater mucous accumulation as well as further weight gain and diabetes mellitus. People with a kapha nature should avoid all sweets, dairy and nuts and most grains such as wheat and rice. However, grains such as quinoa and millet can be taken. Nothing is right for everyone, everything is right for someone. Ayurveda avoids the “everybody must” dogma in favor individually tailored food programs to meet the needs of individuals. With a proper diet and lifestyle, Ayurveda’s goal is to help each person reach their maximum potential, physically, emotionally and spiritually. Simple Ayurvedic Food Tips for Each Dosha
Best Foods
Vata
Pitta
Kapha
Cooked grains, butter, dairy, nuts, cooked vegetables
Raw Salads, cooked grains, milk, seeds
Salads, cooked vegetables, spicy foods, quinoa, millet, corn flour and buckwheat
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Raw salads, fruits, beans
Hot, Spicy foods, sour foods, deep fried foods, fermented foods such as yogurt and vinegar.
Dairy, meat, cheese, nuts, wheat and rice
Fats and Oils Has Science Gone Astray? Fats, the long time enemy of those who want to prevent heart disease, is getting a second look in light of new evidence that reveals that fats may play an important role in the prevention of some cancers. Recent research published in the British Medical Journal has revealed that while low levels of fats protect us against heart disease, they may also increase our susceptibility to certain kinds of cancers. Another study revealed that milk fats contain substances protective toward our bodies which prevent some cancers from forming. In light of this new research, it is important that each person reassess their attitudes toward fats and oils. Cardiovascular disease (CVD: heart disease and strokes) is the number one killer in the United States. Each year it kills more than twice the number of people as all cancers combined. Modern methods of nutrition have focused on the prevention of this group of diseases though diet and exercise. A diet low in saturated fats and cholesterol has been the cornerstone of prevention. Repeated studies have concluded that lower blood cholesterol levels and trygylcerides (circulating fats) reduce the incidence of these conditions. In addition, it has been shown that exercise also lowers their incidence in part through raising HDL and Lowering LDL. (HDL and LDL are often called good and bad fats; they are proteins that carry fat within the body). The new research showing that lower fat levels may increase the incidence of some cancers should not come as a great surprise. Fat has always been known to play an important role in the body, particularly in the production of all cell membranes, many hormones, the sheaths that surround nerves, and the oils that keep our skin healthy. Those who receive too little fat in their diet are more likely to suffer from a multitude of conditions including hormonal imbalances, brittle hair and nails, dry skin and Raynaud's disease (cold, painful sensations in the fingers, toes, ears and nose due to vasospasm of the small vessels.). It would be wrong to conclude that fat is either absolutely good for us or absolutely bad for us. Perhaps this is why there has been so much confusion and disagreement among the experts. Effective arguments can be made for either point of view. Dean Ornate, MD, well received as an expert in nutrition, advocates very low fat diets as being optimal for preventing and reversing, heart disease. Another recognized expert, Robert Atkins, MD, blames heart disease on high carbohydrate diets and advocates low carbohydrate, high protein diets. He does not recommend restricting fat. Could both experts be right? Perhaps, future research will try to answer an as yet, unasked question. Could higher levels of fat be good for some people and harmful for others? If so, who would fall into each category?
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Ayurvedai, the traditional healing system from India, is based upon the understanding that each person is an individual with unique nutritional needs. Ayurveda teaches that those people of vata nature, who are lighter, thin boned, have narrow faces and thin, scanty hair, dry skin and a nervous or anxious nature benefit from extra fats and oils in their diet. In fact, according to Ayurveda, the oils reduce their risk of cardiovascular disease. Meanwhile, those of a more pitta nature, who have a moderate build, focused, intense, deep set eyes and early graying of the hair and those of kapha nature (stocky, dense bones, short necks, round faces, generally calm and relaxed) become unhealthy when exposed to too much fat. Those of a kapha nature are understood to be the most susceptible to traditional risk factors of cardiovascular disease. Increased body weight is a known risk factor of CVD and kapha individuals having a slower metabolism are often overweight. With all of this conflicting information, what is a person to do? I am reminded of the wise words of the great rishi (mystic) Patanjali in the Yoga Sutras. In summary he says, "...take only those foods which are pure and produce a clear mind. Take them all in moderation." Moderation is the best choice for the general community. If you are very thin, do not fear fats, they are your friend. As Ayurveda teaches, they may reduce your risk of CVD and also of other conditions such as anxiety. It is best to take healthy fats from naturally occurring sources such as vegetable oils, nuts, milk and eggs. Oils such as olive, sesame and ghee are the best as they are somewhat heavy oils. They have a moderate percentage of saturated fats and are high in monounsaturated fats. If you are heavy, reduce your intake of fats. Not only will they increase your risk of CVD but also of diabetes. If you do take oils, use polyunsaturated oils such as safflower, they are lighter. Everyone should avoid excessive unnatural fats such as those from deep fried foods and oils which are old and rancid. For specific individualized dietary plans, see a Clinical Ayurvedic Specialist. And, remember, to further reduce your risk of cardiovascular, avoid smoking, exercise regularly, relax often and have your blood pressure checked regularly. Beware of modern science. There is a tendency to leap into the current theories being promoted as though they express the whole truth. Modern science is outdated every ten years, replaced by newer, still incomplete information. It was, after all, "modern science" that once told us that babies would thrive more on bottled milk than on breast milk, that the chemical DES was safe for pregnant woman, that marijuana has no useful medical value and that you can safely loose weight by taking the drug phen phen. Modern science still tells us that pesticides in reasonable doses are safe. Use common sense and intuition. All great traditional healing sciences (Native American, Ayurvedic, Chinese) focus on principles of truth, based in spirit, tested though time and which stand eternal. Moderation is the safest approach unless a person is guided by an expert in the field.
Ayurveda and the mind: a new perspective in the management of mental illness Insanity: Ayurvedic vs. Western Medicine Perspectives http://www.ayurvedacollege.com/book/export/html/2
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By: Alexandra Compson November 4, 2010 INTRODUCTION The condition of “insanity,” better known to the modern world as “psychosis,” is an illness of the mind that has been recognized throughout history within every known society. Today, insanity is characterized by the adherence to fixed, delusional beliefs existing outside the normal range of one’s subculture, including hallucinatory experiences and thought disorders in which the mind does not follow any rational line of thinking[1]. Within the field of Western medicine, psychosis is viewed as a complex of visible symptoms and effects rather than as an indicator of a simple root cause. From this view, it appears that the primary threat posed by the condition is its potent ability to “prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others.”[2] The main goals of Western medicine in the treatment of psychosis includes the reduction of both positive and negative symptoms produced by the illness, maintaining or increasing cognitive abilities, minimizing side effects, reducing secondary diseases, preventing relapse, and enhancing the sufferer’s quality of life. In contrast, the Ayurvedic approach to insanity rests on the premise that, “All mental disease originates in a lack of clarity (sattva) within the mind.”[3] Halpern, p. 332. Thus, Ayurveda’s primary goal of treatment is the cultivation of sattva, a state of mind that, according to basic Ayurvedic tenets, can be attained through proper diet and lifestyle. Very little information can be found in Western medicine advocating either diet or lifestyle as a foundation of mental clarity or a cure for mental illness. In order to compare the Western and Ayurvedic approaches to insanity, we must first explore what “insanity” means within each worldview. How does the Western world’s understanding of insanity differ from that of Ayurveda’s? What sorts of treatment methods are utilized by these two medical sciences in its management? The objective of this paper is aimed towards the exploration of and answers to these questions. WESTERN MEDICINE’S VIEW OF INSANITY A Brief History As mentioned previously, “Madness, the nonlegal word for insanity, has been recognized throughout history in every known society.”[4] It is known that primitive cultures turned to witch doctors or shamans to apply magic, herbal mixtures, or folk medicine to rid deranged persons of evil spirits or bizarre behavior[4]. However, it was the relatively recent years of the 18th century that saw the seeds of modern psychiatry begin to sprout. Though the Ancient Greeks and Romans had progressive ideas regarding mental illness, the Middle Ages witnessed the end of such revelations. It wasn’t until the 1700s that this tide again began to turn, as the French and British introduced humane treatment of the clinically insane[5]. The late 19th century advent of psychoanalysis led to increasingly enlightened exploration and treatment of mental illness. In retrospect, it seems inevitable that psychiatrists and their counterparts in the psychoanalytic field would soon begin to feel uncomfortable with the term “insanity” and its obscure definition within the realm of scientific medicine[6]. By the mid20th century, insane asylums were outdated, and “Increasing disillusionment with and desire to distance theory and practice from the field’s asylumdominated past provided further impetus for physicaians to leave the 19th century traditions behind…”[6]. Being able to define the difference between “normalcy” and insanity is part of what moved psychiatry and the psychoanalytic field to where it is today[5]. Insanity is no longer considered a medical diagnosis in the United States, http://www.ayurvedacollege.com/book/export/html/2
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although it is still a legal term[6]. “Psychosis” has become the modern medical equivalent of the term “insanity.”[4][5][6] Insanity Defined from a Western Medical and Psychological Perspective According to the American Medical Association, psychosis is a mental condition defined as: “A severe mental illness in which a person loses touch with reality, experiences unusual perceptions (hallucinations), and holds false beliefs called delusions. Psychotic disorders include schizophrenia (an illness involving delusions, hallucinations, abnormal speech, and strange behavior) and delusional disorder (in which a person has a persistent belief that seems very real to him or her but is not shared by others.”[3] pp. 575576 Understanding Insanity from a Western Medical and Psychological Perspective The understanding of factors that define mental pathology and those that define “normalcy” are largely prescribed by one’s society and culture. For example, a behavior that may be seen as problematic in our society may be seen as normal within another society[8]. In Western medicine the mental illness known as “psychosis” is a syndrome classified as either “organic” (nonpsychological) or “functional” (psychological). Psychosis arising from “organic” conditions are associated with numerous medical or pathophysiological diseases including electrolyte disorders [9], multiple sclerosis10] and syphilis[11], whereas “functional” psychosis can be caused by a variety of dysfunctions such as biochemical changes within the brain or differences in the brain’s ability to function and process information[8]. Western Medical Etiology In Western medical thinking, insanity, or psychosis, is largely known to be caused by various medical conditions and organic disorders (e.g. thyroid abnormalities[1]). In addition, the introduction of foreign chemicals into the body (e.g. alcohol, cocaine, various prescription drugs) may also disturb normal neurological processes. In Western medicine the above pathologies are known to cause structural defects and/or physiologic brain dysfunction, which, in turn, can lead to the onset of psychosis within the affected individual[1]. Signs and Symptoms Symptoms of psychosis may include disordered thought and speech[2], false beliefs that are not based in reality (delusions)[2], hearing, seeing, and/or feeling things that are not there (hallucinations)[2], thoughts that “jump” between unrelated topics (disordered thinking)[2], and what is known as “disturbance of affect”[1] in which a person’s apparent emotions are not consistent with their thoughts or fluctuate rapidly[1]. Western Medical Treatment Various treatment methods are available in the management of psychosis, though treatment depends largely upon the cause, diagnosis or diagnoses of the psychosis. Most treatment methods, however, typically begin with the administration of antipsychotic medication as the first line of treatment, while hospitalization is often required to ensure the patient’s safety. Cognitive behavioral therapy[12], family therapy[13] and animal assisted therapy[14] is supported by growing evidence in the management of symptoms and for the patient’s general long term wellbeing. Electroconvulsive therapy (also known as electric shock treatment) may be applied if all other treatments prove ineffective. Additional treatment methods include early intervention in psychosis, a relatively new but effective concept based upon the observation that identifying and treating a person in the early stages of psychosis can significantly improve their longterm outcome[15]. This approach advocates use of intensive multidisciplinary techniques during the “critical period” – the period when intervention is seen as critical to the outcome of the patient’s condition – and prevents longterm morbidity associated with chronic psychotic illness. Cognitive behavioral therapy during this “critical http://www.ayurvedacollege.com/book/export/html/2
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period” can aid further in the delay or prevention of psychosis[16]. AYURVEDIC VIEW OF INSANITY Insanity Defined from an Ayurvedic Medical and Psychological Perspective According to the Ayurvedic text Ashtanga Hridayam, “Unmada (insanity) is of six kinds, by each dosa separately, by the combination of all of them, by sins and by poison. Unmada is mada (toxicity, disorder) of the manas (mind) produced by the dosas (vata, etc.) moving in the wrong paths (because of their increase).”[17] Murthy, p. 56. Similarly, the Ayurvedic text Charaka Samhita defines insanity as the perversion of the mind, intellect, consciousness, knowledge, memory, desire, manners, behavior, and conduct[18]. Understanding Insanity from an Ayurvedic Medical and Psychological Perspective Ayurveda views mental disease as the result of a lack of clarity (sattva) within the mind[4]. As the quality of sattva becomes diminished within the mind, it is only a matter of time before imbalances appear within the three biological humors: vata, pitta and kapha[19]. In his book, Ayurveda and the Mind: The Healing of Consciousness, Dr. David Frawley states, “Health problems, whether physical or mental, are not merely personal problems, but energetic problems in the mindbody complex. They are not so much personal or moral failings as an inability to harmonize the forces within us.”[19] Within the classical texts, six types of unmada (insanity) are described. These include one for each dosha (Vatonmada, Pittonmada, Kaphonmada), one for a combination of all three doshas (Sannipatonmada), one due to mental shock (Citta Ghataja Unmada) and one caused by poisons (Visaja Unmada)[17]. According to Ayurveda, the mind, or manas as it is known in Sanskrit, is composed primarily of the air and ether elements[19]. Thus, of the three doshas vata is commonly behind most psychological disorders[19]. Excess air within the mind causes mental instability and agitation, which leads to excessive thinking, worrying, and ultimately the perception that our problems are much worse than they really are[19]. “The mind becomes overly sensitive, excessively reactive, and we take things too personally. We are prone to premature or inappropriate action that may aggravate our problems.”[19] Frawley, pp.154155. Pittatype psychological disturbances occur moderately, as pitta tends to have strong selfcontrol[19]. However, pitta’s tendency to be self centered and antisocial can lead to problems, while its fire and heat often creates a narrow, quarrelsome mind[19]. Excess aggression and hostility are the root cause behind most pittatype psychological disorders[19]. “Typical Pitta is the overly critical type who finds fault with everyone, blames other people for everything, sees enemies everywhere, is always on guard and ready for a fight.”[19] Frawley, pp. 155156 Psychological disorders due to kapha dosha are least common to occur due to the dosha’s inherently strong, stable nature. Problems can arise, however, when vitiated kapha produces blocked channels and clouded senses[19]. Excess kapha within the mind causes mental dullness, congestion and poor perception[19]. According to Frawley, Ayurveda sees the deluded mind as a condition dominated by the quality of tamas or darkness[19]. The mind is absorbed in a blank state in which consciousness of the body is obscured or lost[19]; it is a mindless, nonfeeling state of inertia: “…like a drunk lost in a drunken stupor lying halfconscious on the floor.”[19] pp. 294295. The quality of tamas generally dominates within the schizophrenic mind as well[19]. In this condition, a person goes into trances, sees hallucinations, hears voices, etc.; the mind is absorbed in its own fantasies and the patient loses conscious control over their own mind[19]. Frawley states, “All these are not merely aberrations in the brain. They may include psychic abilities or psychic sensitivities but are beyond the control of http://www.ayurvedacollege.com/book/export/html/2
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the person. The person may connect up to the astral plane and lose contact with physical realities. In these cases, the mind goes into an absorption of the dull or blank type and sometimes an astral entity comes in to use the mind.”[19] p. 297. Interestingly, according to Frawley all severe mental derangement involves some type of astral entity possession or influence[19]. Ayurvedic Etiology The Charaka Samhita states, “One of the criteria for the disease process to rapidly manifest, occurs in these circumstances: when his mind is afflicted over and over again by passion, greed, excitement, fear, attachment, exertion, and grief. In the circumstances…the mind gets seriously affected and the intellect loses its balance. So the doshas aggravated and vitiated enter the cardiac region, obstruct the channels of the mind resulting in insanity.”[20] p. 89. Furthermore, the text cautions against the disharmonious acts of Prajnaparadha (intellectual blasphemy, the failure of the intellect, or crimes against wisdom[21] p. 7) and its ability to provoke the gods who in term cause the insanity. Within Ashtanga Hridayam, Vagbhata relates, “Indulgence in unsuitable (unhealthy) foods and drinks, foods which are spoilt, unaccustomed, containing dirt (contaminated) and using (foods, and drinks) in improper manner; those who are dejected (due to worry, grief, etc.), who are of weak mind, by the effect of sudden increase of diseases, emaciated persons indulging in activities in improper ways, committing mistakes in the procedure of worship of the worshipful, by committing sinful acts, loss of balance of mind, by the effect of strong poisons or weak poisons by these causes the doshas getting increased in the heart (mind) in persons of feeble mind, produce vitiation of the mind, and destroying (invading) the manovaha srotas (channels of the mind) cause unmada (insanity); dhi (discriminating/deciding capacity) vijnana (capacity of special knowledge to understand the science, arts etc.) and smriti (power of remembrance of earlier happenings) having become abnormal (lost or impaired) make the body lose the feeling of happiness and unhappiness and like a chariot devoid of a charioteer, the person begins to resort to activities without any thinking.”[17] pp. 5657. In Ayurveda two types of insanity are described: According to B.S. Venkataram in his article “Ayurvedic Definitions and Classification of Manovikara,” nija rogas, or insanity due to endogenous conditions are, “…caused by irregular food habits and psycho behavioral excess resulting in the impairment of the Sarira [body] dosha physical element.” [22] p. 60. Falling under the category of nija roga, manasa (psychological) rogas occur due to the gain of undesired objects or losing the desired object/cherished ones, resulting in the impairment of the Manodosha (mental elements)[22]. Insanity due to exogenous conditions are caused by injuries, poison, fire, and wind[22]. The Charaka Samhita adds that exogenous insanity may be caused by the “…effects of sinful activities in a past life. Lord Punarvasu Atreya considers intellectual blasphemy as the Nidana (causative factors) of this condition.”[20] p. 93. As the dominant dosha within the mind, vatatype psychological disturbances occur most commonly. Fasting, irregular eating habits or insufficient food, and the excessive intake of dry, cold foods easily weaken and upset the vatadominated mind[19]. “…Disturbing sensations are hard for Vatas to handle, particularly too much exposure to mass media, loud music or noise. Drugs and stimulants easily derange them… Excessive or unnatural sexual activity quickly drains their often low energy. Stress, fear and anxiety affect them emotionally because they lack calm and endurance. Violence and trauma leaves them hurt and withdrawn. Neglect or abuse as a child creates a predisposition for a Vataderanged psychology.”[19] Frawley, p. 155 Pittatype psychological disorders occur due to conditions of excess heat[19]. Overly hot, spicy foods easily disturb the pitta mind[19]. Strong, bright colors and sensations irritate their senses[19]. Exposure to violence and aggression increase similar attitudes within them[19]. Sexual frustration, excessive anger and ambition often cause problems as well. Frawley expounds, “Too competitive an education or too much conflict in childhood are additional factors.”[19] p. 156 http://www.ayurvedacollege.com/book/export/html/2
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The basis of kaphatype psychological disorders lies within the consumption of excess sugar and oily foods. Excess pleasure, enjoyment, attachment, too much sleep, sleep during the day, and lack of exercise add to the potential of a psychological disturbance within the kaphatype individual[19]. In addition, “Emotional problems combine with Kapha physical conditions like overweight congestion. Educational factors include being overly indulged as a child or emotionally smothered by parents.”[19] Frawley, p. 157. Signs and Symptoms “In unmada (insanity) produced by (increased) vata, the body is emaciated the person weeps becomes angry, laughs, smiles, dances, sings, plays musical notes, speaks, does movements of the different parts of the body, and makes loud sound – all these at improper time and place; imitates the sound of the flute, vina (lute) etc. violently and often; froth exudes from the mouth, roams about constantly, speaks too much, decorates himself with nondecorating things, attempts to travel on things which are not vehicles; desires foods but abuses them after obtaining, the eyes protruding and red in color and the disease (symptoms) appearing after the food is digested.”[17] Murthy, pp. 5758. Excess vata within the mind causes the individual to become ungrounded and unrealistic, producing overactive and wrong imaginations, hallucinations and delusions[19]. Over activity of the mind results in dispersed lifeforce energy (prana), leaving the afflicted weak, with a diminished connection to the physical body and physical reality. Vatatype psychological disorders are behind feelings of fear, alienation, anxiety, and nervous breakdowns[19]. Insomnia, tremors, palpitations, unrest, and rapid shifts in mood are due to vata as well. Frawley adds, “Insanity of the manicdepressive type, or schizophrenia, is an extreme Vata imbalance.”[19] p.155 “In unmada (insanity) caused by pitta, the patient threatens others, becomes angry, attacks others with the fist, stones etc. desires cool shade and cold water, remains naked, has yellow color (of the skin etc.) sees fire, flames, stars and lamp which are not actually present.”[17] Murthy, p. 58. Excess pitta (heat) within the mind produces agitation, irritation, anger, and possible violence[19]. “The overheated body and mind seek release in venting the builtup tension. Pitta types can become domineering, authoritarian or fanatic. When disturbed they may have paranoid delusions, delusions of grandeur, or can becomes psychotic.”[19] Frawley, p. 156. “In unmada (insanity) caused by kapha, the person has loss of appetite, vomiting, very little of desires, foods and talk; desire for the woman (sex) and solitude, copious saliva and nasal secretions flowing, terrifying activities, hatredness to cleanliness, sleep, swelling of the face, symptoms strong during nights and soon after taking food.”[17] Murthy, p. 58. Excess kapha in the mind results in overattachment and lack in motivation and mental drive that often leads to depression, sorrow, and excessive clinging. A person becomes passive and dependent; “We want to remain a child and be taken care of…Such people often end up being taken care of by others and are unable to function on their own.”[19] Frawley, pp. 156 157. Stronger kapha types may find themselves suffering from greed and possessiveness, which renders the mind heavy, dull and depressed[19]. They want to own and control everything, but when control and ownership are lost psychological instability results[19]. In Sannipatonmada (insanity caused by the combination of all three doshas[17]), the Ashtanga Hridayam notes that symptoms attributed to all of the doshas appear simultaneously. The text cautions against the treatment of these patients, as this type of insanity is often too difficult to cure[17]. In Citta Ghataja Unmada (or insanity due to mental shock[17]), “Loss of money, wife etc. which is unbearable, which persists for long time leads to insanity. The person becomes pale, timid, faints often, weeps making sounds such ha, ha etc. (alas, that is lost, alas, that is gone, etc.) weeps without any (other) reason; dies (loses consciousness), praises the qualities of the things lost, with the mind suffering from grief he worries much, keeps awake without sleep and does unusual acts.”[17] Murthy, p. 59. Visaja Unmada is insanity caused by poisons. In this type of insanity it is said that the face turns blue, the eyes become red, there is a loss of healthy complexion, strength, physical senses, and the mind is unstable even throughout the different stages of poisoning[17]. Again, the patient who presents with this condition is seen as too difficult to cure and should be rejected by the physician[17]. http://www.ayurvedacollege.com/book/export/html/2
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Ayurvedic Treatment (Chikitsa) In his book The Roots of Ayurveda, Dominik Wujastyk states, “Any deficiency or excess of either Doshas or Dhatus or Malas may induce disease and Ayurveda always aims at keeping an equilibrium in the level of these things. Physical diseases and mental diseases are caused by the irrevelevent contacts, intellectual blaspheme and suppression of natural urges.”[23] p. 20. In Ayurveda the primary treatment goal of all psychological illness is the cultivation of sattva[3], as this is the quality that brings balance to body and clarity to the mind. The principles of treating mental disease emphasize sattvic activities that bring peace and stability into one’s life. Sattvic activities include spending more time in nature, meditation, yoga, avoiding the influence of the media, and the consumption of a sattvic diet. Internal and external oleation therapies are the cornerstone of treatment in vatatype insanity. Should the moist, heavy qualities inherent within the oil induce channel obstruction, Vagbhata recommends mixing mild purgatives with the therapeutic oils being used[17]. Numerous vata reducing impressions may be applied, as they help bring peace and stability to the vataderanged mind. Such impressions include sitting or walking quietly and peacefully in a garden, listening to calming music, and gentle exercise such as Hatha Yoga or Tai Chi[19]. For pittatype insanity, emesis, purgation, and enema therapies administered after oleation and sudation should be administered[17]. Purgative therapy for the head is also recommended[17]. Pittareducing impressions include the use of cooling colors (blue, white, silver), cool, sweet fragrances like rose and sandalwood, and the use of pittapacifying mantras such as Shrim and Sham[19]. Similar to the treatment of pittatype insanity, kaphatype insanity also calls for emesis, purgation, and enema therapies administered after oleation and sudation, including purgative therapy for the head[17]. Kapha benefits immensely from strong aerobic exercise, cultivating of detachment, and meditation on active, wrathful deities like Kali or Rudra. In the treatment of insanity due to lust, grief, fear, anger, joy, jealousy, and greed (i.e. Citta Ghataja Unmada), the patient should be exposed to the condition’s opposite qualities[17]. Lust should be met with dislike, grief with delight, fear with faith, etc. Patients suffering from insanity due to loss should be given that which is identical to what was bereaved, along with assurances and consoling words. Should the above therapies prove ineffective, alternate recommendations are described in the Ashtanga Hridayam that, while outdated, are interesting to take note of. In this section of the text Vagbhata suggests that the physician treat the patient by“…making him happy, assuring him, threatening, causing fear, beating and terrorizing him should be resorted to, oil massage, dry massage, anointing with paste, fumigation, drinking of medicated ghee should be administered; purified by these the mind becomes normal.”[17] Murthy, p. 60. Vagbhata also recommends beating the patient with lashes, binding the patient, throwing the patient into a ravine, and confining the patient in a dark room free from weapons, stones, and men[17]. The result of such therapies, he says, is the notion that the fear of death is more powerful than the troubles of the body, thus the disturbed mind becomes free of its abnormalities[17]. According to the Charaka Samhita, “Purity of the sense organs, their objects, intellect, soul and mind and normalcy of the tissues of the body are the features of (the person) cured of insanity.”[20] Dash, and Sharma, p. 66 CONCLUSION The mental condition known insanity is well known to describe a mentally unstable person. Though the term “insanity” may no longer exist as accepted medical terminology, the mental conditions that the word once described most certainly do. Insanity is a disease that has been common throughout history within every culture of the world, invoking diverse views of understanding and the development of numerous treatment methods. The Western approach to mental illness appears to be primarily concerned with the complicated, http://www.ayurvedacollege.com/book/export/html/2
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minute details of brain chemistry in its quest to understand the logistics of mental disease. The Western tendency is to concentrate on specific aspects of sensory impressions and brain lobes and the effect of various forms of multiple neurotransmitters and hormones within the body. On the other hand, the condition of mental illness is a much more accepted, explored, and understood concept within Ayurveda and Eastern medicine in general. Whereas Western medicine scrutinizes the minute, Ayurveda is much more concerned with the bigger, simpler picture of humoral and energetic imbalances, which it sees as a physical manifestation of karma that allows for the teaching of spiritual lessons. Charaka, perhaps, speculates that the avoidance of disease and conservation of health is even more simple: “The person of a strong mind who does not indulge in meat and wine; who eats only healthy food, remains clean (both physically and mentally) does not become affected by either nija or agantu unmada (endogenous or exogenous insanity).”[20] Dash, and Sharma, pp. 6566. References 1. “Health Encyclopedia – Diseases and Conditions: Psychoses.” healthscout. The HealthCentralNetwork, Inc., n.d. Web. 11 Oct 2010. . 2. “Psychosis.” National Library of Medicine, National Institutes of Health. U.S. National Library of Medicine, 7 Feb 2010. Web. 20 Sept 2010. . 3. Halpern, Marc. Principles of Ayurvedic Medicine. 9. 2. Grass Valley: California College of Ayurveda, 2007. Print. 4. Weinstein, Raymond M. “Madness.” The Blackwell Encyclopedia of Sociology. Blackwell Publishing 2007. Print. 5. “Conquering Depression: Historical Background.” SEARO. WHO Regional Office for SouthEast Asia, 18 Aug 2006. Web. 16 Sept 2010. . 6. Tighe, Janet A. “‘What’s in a Name?” A Brief Foray into the History of Insanity in England and the United States.’” Journal of the American Academy of Psychiatry and the Law Online. American Academy of Psychiatry and the Law, 2005. Web. 15 Sept 2010. . 7. American Medical Association: Concise Medical Encyclopedia. Ed. Martin S. Lipsky, MD. Random House, 2003. Print. 8. Merlino, Dr. Joseph. Wikinews. Interview by David Shankbone, 5 October 2007. Web. 13 Oct 2010. . 9. Rossman, Philip L., and Robert M. Vock. “Postpartum Tetany and Psychosis Due to Hypocalcemia.” California Medicine 85.3. 1956: 190–93. eBook. 10. Rodriguez Gomez, Diego, Elvira Gonzalez, and Oscar Perez Carral. “Acute Psychosis as the Presenting Symptom of Multiple Sclerosis.” Revista de Neurologia 41. 4. 2005: 25556. eBook. http://www.ayurvedacollege.com/book/export/html/2
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11. Karaizou, E, C Mitsonis, N Dimopoulos, K Gkiatas, I Markou, N Kalfakis. “Psychosis or Simply a New Manifestation of Neurosyphilis?” J. Int. Med. Res. 34. 3. 2006: 33537. eBook. 12. Birchwood, M, and P Trower. "The Future of CognitiveBehavioural Therapy for Psychosis: Not a QuasiNarcoleptic." British Journal of Psychiatry. 188. 2006. 108. eBook. 13. Haddock, G and S Lewis. "Psychological Interventions in Early Psychosis." Schizophrenia Bulletin. 31. 3. 2005. 697–704. eBook. 14. NathansBarel, I, P Feldman, B Berger, I Modai, and H Silver. "AnimalAssisted Therapy Ameliorates Anhedonia in Schizophrenia Patients." Psychotherapy and Psychosomatics. 74. 1. 2005. 31–35. eBook. 15. Birchwood, M, P Todd, and C Jackson. "Early Intervention in Psychosis: The Critical Period Hypothesis". British Journal of Psychiatry. 172. 33. 1998. 53–59. eBook. 16. French, Paul, Anthony Morrison. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis. Chichester: John Wiley and Sons, 2004. eBook. 17. Murthy, Prof. KR Srikantha. Vagbhata’s Ashtanga Hridayam. 3. Varanasi, India: Chowkhamba Sanskrit Series Office, 2008. Print. 18. Swami Sada Shiva Tirtha. The Ayurveda Encyclopedia: Natural Secrets to Healing, Prevention & Longevity. 1. Bayville: Ayurveda Holistic Center Press, 1998. Print. 19. Frawley, Dr. David. Ayurveda and the Mind: The Healing of Consciousness. Twin Lakes: Lotus Press, 1996. Print. 20. Dash, Bhagwan and RK Sharma. Caraka Samhita. Varanasi, India: Chowkhamba Sanskrit Series Office, 2001. Print. 21. Halpern, Marc. Principles of Ayurvedic Medicine. 9. 1. Grass Valley: California College of Ayurveda, 2007. Print. 22. Venkataram, BS. “Ayurvedic Definitions and Classification of Manovikara”. Ayurvedic and Allopathic Medicine and Mental Health: Proceedings of IndoUS workshop on Traditional Medicine and Mental Health. Bhavan’s Book University, 2003. Print. 23. Wujastyk, Dominik. The Roots of Ayurveda. London: Penguin Books, 1998. Print.
Ayurvedic & Western approaches to the treatment of Schizophrenia http://www.ayurvedacollege.com/book/export/html/2
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(by Rubén Vega, MA) Table of Contents 1. Overview 2. Introduction 3. Western definition of Schizophrenia 4. Ayurevedic Interpretation of Schizophrenia and other Psychotic Disorders 5. Western theories of the causes of Schizophrenia 6. Causes of Insanity from an Ayurvedic perspective. 7. Types of insanity (unmada) 8. Choleric Insanity: (pitta) 9. Phlegmatic Insanity: (kapha) 10. Conjunctive Insanity: (trisdosha) 11. Western Psychiatric and Psychological Treatment for Schizophrenia 12. Ayurvedic Medicine Treatment methods of Schizophrenia 13. Treatment differentiation: Vata, pitta, and kapha type insanity 14. Other important miscellaneous therapies: 1. Ancient ayurvedic herbal formulations for any mental disorders. 2. The principles of treating mental disease 15. Summary 16. References
Overview Ayurvedic medicine is one of the world’s oldest and most complete systems of natural healing which offers comprehensive and holistic treatment for physical and mental disorders. It promotes physical health and healing of the mind through diverse methods focused on treating all the physical, psychological, and spiritual aspects of each individual affected with physical and mental disorders. In a review Of the literature from the classical Ayurvedic texts to current Ayurvedic literature As well as the most current Western Psychological / Psychiatric Approaches to the treatment of schizophrenia. I will research the causes, theories, and treatment methods utilized by these two divergent approaches in the treatment of schizophrenia and other mental disorders. In addition, I will also briefly describe some of the Ayurvedic’s spiritual therapies and factors to the treatment of mental disorders.
Introduction http://www.ayurvedacollege.com/book/export/html/2
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According to the National Institute of Mental Health, approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year have schizophrenia. Schizophrenia is found all over the world, in all races, cultures and social classes. It affects 1 out of 100 people worldwide. “More than two million Americans are affected by schizophrenia and approximately 1 percent of the population develops schizophrenia during their lifetime. More than 2 million Americans suffer from the illness in a given year and one out of every 10 people with schizophrenia commits suicide.” 1. (www.nimh.nih.gov). “Approximately 10 percent of people with schizophrenia (especially younger adult males) commit suicide.”(2). (www.nimh.nih.gov). “It is generally assumed that suicide is a problem only for those with major depression. This assumption is, unfortunately, not true. Suicide rates among people with schizophrenia are alarmingly high; in fact, suicide is the number one cause of premature death. Ten to thirteen percent kill themselves, and close to fifty percent attempt suicide at some point in their lives.” (3). Keefe, H arvey, (1994). Number the citation+ give the page number from where you took quote. Schizophrenia has been considered one of the most chronic, disabling, and difficult to understand of the mental disorders since ancient times. People with this illness suffer with a loss of individual potential and personal anguish, resulting in significant psychological and social consequences. People with schizophrenia suffer terrifying symptoms such as hallucinations, delusions, and distorted perceptions of reality, disordered thinking, lack of emotional expression and communication problems. This often leaves them fearful, anxious, confused, and withdrawn for the rest of their lives. A wide range of reason or events can and might lead some people to run a risk for suicide, although this risk may be higher for individuals with schizophrenia. The underlying causes are the same for those who are afflicted with this disease. Some of the causes can be depression, feelings of hopelessness, being unemployed, being unmarried, experiencing deteriorating health and recent traumatic experiences and/or stress. Due to those reasons listed above, schizophrenia is considered a devastating disorder like no other, causing pervasive and profound social, economic and personal impact on those afflicted. Most of the people with schizophrenia continue to suffer chronically or episodically throughout their lives. It has been estimated that no more than one in five individuals recover completely. What is schizophrenia? Why is schizophrenia still considered one of the most fearsome and disabling mental disorders? What are the Western Psychiatric/psychological theories of Schizophrenia? What is the Ayurvedic interpretation of schizophrenia and mental illness? What are the treatment methods utilized by psychiatric/Psychological approaches and Ayurvedic medicine in the treatment of schizophrenia and other psychotic disorders? And, what Ayurvedic treatments are available for people suffering with mental illness? These are just a few questions that will be answered in the following pages.
Western definition of Schizophrenia According to Western Psychiatry, Schizophrenia is not a split personality condition, but a chronic relapsing psychotic disorder that primarily affects thought and behavior. According to DSMV, schizophrenia is described as “ a disturbance that lasts for at least six months and includes at least one month of activephase symptoms (i.e., two (or more) of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)”. DSMIV criteria identify five subtypes of schizophrenia: Paranoid type, disorganized type, Catatonic type, undifferentiated type, and Residual type. All of these vary by their degree of severity and symptomatology. http://www.ayurvedacollege.com/book/export/html/2
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Ayurevedic Interpretation of Schizophrenia and other Psychotic Disorders As noted by Dr. Halpern, Ayurvedic medicine offers the opportunity to understand the nature of the mind in a way that is completely unique and quite different from the variety of the Western Psychological and Psychiatric medicine models. “Ayurvedic medicine views psychotic disorders (schizophrenia) as the imbalance of energies on an inner level. According to Ayurveda and occult science, behind the gross physical is a subtle or astral body composed of the lifeforce, emotions and thoughts. The astral is a subtle form or underlying energy pattern of the physical, from which the physical is produced (3). Frawley (1989). In the ancient texts of Ayurveda, there are detailed descriptions of mental disorders known as “Unmada”, and schizophrenia can be correlated with many of the types of “Unmada. Ayurvedic’s physicians describe schizophrenia as a disorder of the mind caused by the doshas (vata, kapha, and vata.) Moving in the wrong paths due to increased toxicity. According to the classical Ayurvedic texts, the Charaka Samhita, insanity is defined as, “the perversion of the mind, intellect, consciousness, knowledge, memory, desire, manners, behavior, and conduct”. It is denominated as insanity (umada) because it is madness (mada) of the mind caused by a deviation (unmarga) of the humors”. Swami Sada Shiva Tirtha, (1998).
Western theories of the causes of Schizophrenia The real causes of schizophrenia are unfortunately not known, however, there are several theories and hypotheses of the etiology of schizophrenia. Western scientists and psychologists do not yet understand all the factors that produce schizophrenia. An interaction of sociological, biological, and psychological factors seems to contribute to the condition. Schizophrenia also may result from various factors such as drug abuse, aging, and/or brain injuries and diseases. One of the more influential views of the origins of schizophrenia is the theory of biochemical and brain dysfunction. This view attempts to “identify the biological abnormalities that are inherited or developed by persons with schizophrenia. The two most likely candidates are biochemical abnormalities and abnormal brain structure. It also involves disturbances of the brain’s chemistry, anatomy, and physiology, which in turn distort perceptions and subjective experiences. This hypothesis revolves around the idea that schizophrenic symptoms might be the result of overactivity of a neurotransmitter called dopamine.” Maxmen, J. & Ward, N. (1995). This theory is supported by the fact that drugs, which increase dopamine activity, can bring about a worsening of psychotic symptoms. The treatment methods for schizophrenia with this biological view are based on clinical research and experience. (1)Antipsychotic medications treat the symptoms of the disorder, but do not cure schizophrenia. “These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately. Antipsychotic drugs appear to be the best treatment now available, but they do not cure schizophrenia or ensure that there will be no further psychotic episodes. The antipsychotic drugs include two major classes: dopamine receptor antagonists (for example: Chlorpromazine (Thorazine), haloperidol (Haldol), sulpiride) and serotonindopamine antagonists’ drugs (per example, risperidone (Risperdal) and clozapine (Clozaril)). Kaplan, S. & Sadock, B. (1998) Genetic theories state that biology produces schizophrenia and environment alters its course. More specifically, genetic and other biological factors create various degrees of vulnerability to schizophrenia. Whether, and how severely, the predisposed individual Becomes schizophrenic depends http://www.ayurvedacollege.com/book/export/html/2
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on a mix of biological factors (e.g., severity of heredity, prenatal complications, or slow viruses). Genetic scientists believe that “some people inherit a biological predisposition to schizophrenia and, in accordance with a diathesisstress model, come to develop the disorder when they are confronted by extreme stress, usually during early adulthood.” (Gottesman, 1991). Since schizophrenia tends to be familial, but does not follow a classical pattern of inheritance, the study of genetic factors in this disorder has been complicated. It is extremely unlikely that a single gene will ever be found that is responsible for all cases of schizophrenia in the population. Another theory is based on psychosocial influences. The psychological view is based on the principle that “psychological factors are critical in the development of schizophrenia, (traumatic childhood experiences, intense negative intrafamiliar communication) substantially affect the extent of recovery; probability of relapse, overall quality of life, and the symbolic meaning attributed to the disorder.” Maxmen & Ward, (1995). The leading psychological explanations have come from the psychodynamic, behavioral, family, existential, and cognitive perspectives.
Causes of Insanity from an Ayurvedic perspective. From the writings extracted from the classical text: the Caraka Samhita by R. K. Sharma and Bhagwan Dash, the causes of inanity are due to “having unhealthy foods which area spoiled, unaccustomed, contamined and using (food and drinks) improper manner; those who are dejected due to worry, grief, etc.), who are weak mind due to the effect of sudden increase of disease, emaciated persons indulging in activities in improper ways, doing mistakes in the method of worship, by doing sinful acts, loss of balance of mind, by the effects of strong poisons or weak poisons due to these reasons the doshas getting increased in the mind in persons of feeble mind, produces vitiation of the mind, and invading the manovaha shrotas channels of the mind / caused insanity”. AsthangaHrdaya of Vagbhta: the book eight branches of Ayurveda, (1994). In current literatures, Dr. David Frawley describes that, “mental disorders are caused by emotional stress, poor upbringing, repressive religion, coming under the influence of disturbed individuals, sexual abuse or perversion, and taking drugs”. Frawley, (1989). Dr. Frawley further adds that metal illness are also caused by excess thinking or by the strain in yogic or meditation practices naively opening up to the influences the astral plane, and through occult methods”. He also states that “mental disorders, including schizophrenia are caused by a vitiation of sattva; that is, by a disturbance of the inherent clear quality of the mind. This occurs though excess rajas and tamas turbulence and darkness in the mind. Too much rajas involves excess of anger, hatred and fear, excessive nervousness, worry, and anxiety. Too much tamas involves excess sleep, dullness, apathy, inertia and the inability to perceive things as they are”. Frawley, (1996). According to the AsthangaHydaya of Vagbhata insanity is a toxicity / disorder to the mind caused by dohas (vata, etc.) moving in the wrong paths due to their increase”. It also said that having unhealthy foods which are spoiled, unaccustomed, contamined and using (food and drinks) improper manner, those who are dejected due to worry, grief, etc.), who is weak mind due to the effect of sudden increase of disease, emaciated persons indulging in activities in improper ways, doing mistakes in the method of worship, by doing sinful acts, loss of balance of mind, by the effects of strong poisons or weak poisons due to these reasons the doshas getting increased in the mind in persons of Feeble mind produces vitiation of the mind, and invading the manovaha shrotas channels Of the mind/ caused insanity”. All these corruptions causes the intelligence, understanding, and memory to go astray. Because of that, the body loses any sense of joy or sorrow, and wanders about purposelessly like a chariot which has lost its driver”. According to ancient medical texts written by the first Ayurvedic physicians, There are six kinds of insanity that arise from each of the humors, http://www.ayurvedacollege.com/book/export/html/2
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from a conjunction of them, from mental anguish, and from poisoning. Regarding the development of mental illness, Ayurvedic physician’s states that “The corruption of certain mental and physical things can cause the inflammation of the humors in the heart of someone whose mental faculty is weakened. Next, it causes defilement of the intelligence, destruction of the pathways along which mind flows and, finally, insanity. Wujastyk, (1998).
Types of insanity (unmada) Wind insanity: (vayu) “Wind gives rise to the following: an emaciated body; inappropriate lamenting, shouting, laughing, and smiling, as well as dancing, singing, playing music, talking, posturing, bursting out; repeatedly and tunelessly imitating the sound of a flute, veena, or other instrument; frothing at the mouth; constantly wandering about; ceaseless talking; using things which are not ornaments as decoration; trying to travel on things which are not vehicles; being greedy for food, but spurning it once it has been obtained; bulging, Bloodshot eyes, and illness after foods had been digested.” Wajastic, (1998). Swami Sada Shiv Tirtha notes, “Vayu insanity is also caused by fasting or an excessive intake of dry or cold foods. This affects the heart and mind with worry, passion, and anger which results in distortion of memory and perceptions.” Swami Sada Shiv Tirtha, (1998). Frawley states that when high vata, as excess ether, makes us ungrounded, spacedout and unrealistic. We may have various wrong imaginations, hallucinations or delusions, like hearing voices. High vata in the mind manifests as fear, alienation, anxiety and possible nervous breakdown. There is insomnia, tremors, palpitations, unrest and rapid shifts of mood. Insanity of the manic depressive type or schizophrenia is an extreme vata imbalance”. Frawley, (1996).
Choleric Insanity: (pitta) Choler gives rise to threatening behavior, fury, and charging at people with fists stones, and the like. The patient craves coolness shade, and water. He goes naked, and has a yellow color. He sees thing which are not there, such as ire, flames, stars, and lamps. Pitta insanity results from indigestion, excess of hot, pungent, sour, or burning foods and liquids, excesses pitta afflict the heart of the person lacking selfcontrol. Wajastic (1988). Frawley notes that the “fire and heat of pitta cause the mind to be narrowed and contentious, fighting either with others or with themselves. High pitta in the mind causes agitation, irritation, anger, and possible violence. The overheated body and mind seek release in venting the buildup tension. Pitta types can become domineering, authoritarian or fanatic. When disturbed they many have paranoid delusions, delusion of grandeur or can become psychotic.” Frawley, (1996).
Phlegmatic Insanity: (kapha) http://www.ayurvedacollege.com/book/export/html/2
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Phlegm causes the patient to lose any desire for food. It causes vomiting, and a reduction in motivation, appetite, and conversation. It causes a lust for women. It causes the patient to enjoy solitude. He dribbles mucus and snot, and is very frightening. He hates being clean. He sleeps, and has puffy face. This insanity is stronger at night, and just after eating. This is caused by the overeating and excessive use of oily foods. This is aggravated kapha afflicts the heart, troubling the mind and memory. Wajastic, (1988) Frawey stated that kapha type evolves attachment and lack of motivation lading to depression, sorrow, and clinging. The mind may be incapable of abstract, objective or impersonal thinking. There is lack of drive and motivation along with passivity and dependency”. Frawley (1996).
Conjunctive Insanity: (trisdosha) When there is a conjunction of all the sources of disease, and symptoms, then the resulting insanity is dreadful. A physician should stay away from such a patient. This caused by the excessed condition of all thee doshas. It is considered serious because the therapies will aggravate one or more of the doshas. Therefore, this condition is incurable. Wajastic, (1988). Insanity cause by loss: A person crushed by the unbearable loss of his possessions or of a loved one becomes pale, depressed, and swoons frequently. “oh, oh” he groans. He wails for no reason. He loses consciousness. He thinks a lot about the qualities of what he has lost. His mind is Distraught with grief and he cannot sleep for worrying. He thrashes about. Wajastc, (1988). Insanity caused by poison: Poison makes the face dark the complexion, strength, and senses are all ruined. The Patient is delirious even in between fits, and has bloodshot eyes. He should be avoided. Wajastic, (1988).
Western Psychiatric and Psychological Treatment for Schizophrenia The primary method of treatment for these patients is the use of psychotropic medications, which aim to mitigate symptomology such as visual and auditory hallucinations, suicidal ideation, anxiety and depression. The proper treatment of schizophrenia may include a combination of different techniques. Generally, medications for treating psychotic symptoms of schizophrenia are referred to as antipsychotic, or sometimes neuroleptics. Examples of standard antipsycotics include Thorazine, Mellaril, Modecate, Prolixin, Navane, Stelazine and Haldol. The newer antipsychotic drugs are called atypical antipsychotic medications are being used more and more frequently. They are called “atypical” because they do not have the same chemical profiles as standard medication and seem to work in a different way causing fewer side effects while helping patients to stabilize. http://www.ayurvedacollege.com/book/export/html/2
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Examples include Risperdone, Clozaril, Zyprexa and Seroquel. Most patients have to take medication regularly to keep their illness under control. It is not possible to know in advance which medication will work best for an individual. Many medication adjustments may be required. This period of trial and error can be very difficult for everyone involved. Some medications have unpleasant side effects such as dry mouth, drowsiness, stiffness, restlessness, muscle spasms, tremor, and blurring vision. I have also observed that even patients who respond well to psychotropic medication continue to have secondary symptoms such as lethargy, disinterest, excessive sleep, lack of spontaneous emotions and other symptoms of relapse. In addition, patients often develop multiple medication adverse effect, but these can be corrected by lowering the dosage or controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. “Other biological therapies such as electroconvulsive therapy, although less effective than antipsychotic drugs, may be indicated for catatonic patients and for patients who for some reason cannot take antipyshcoitc drugs. In the past, schizophrenia was treated with insulin and barbirute induced coma, but these treatments are no longer used because of the associated hazards. Psychosurgery, particularly frontal lobotomy, was used from 1935 to 1955, and is no longer considered an appropriate treatment.” Kaplan, S. (1998). Although antipsychotic medications are the mainstay of the treatment for schizophrenia, research has found that psychosocial interventions can increase the clinical status. One of the main modalities used in psychosocial therapies is behavioral therapy. This therapy uses techniques such as token economies and social skills training to increase social abilities, selfsufficiency, practical skills, and interpersonal communication. Skills based programs can lead to an improvement in life functioning and the subsequent discharge of people with schizophrenia who have had longterm stays in psychiatric facilities. Cognitive therapy is used to improve cognitive distortions, reduce distractibility, and correct errors in judgment. Group therapy focuses on real life plans, problems, and relationships. “Because patients with schizophrenia frequently become ill during the critical career forming years of life (e.g., ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many suffer with lack of social and work skills and experience as well.” (www.nimh.gov). Rehabilitation programs emphasize social and vocational training to help patients and former patients to overcome difficulties in these areas. These programs include vocational counseling, job training, problem solving, money management skills, use of transportation, and social/communication skills training. Although schizophrenia is not yet a “curable” disease, the treatment for this illness is more effective today than ever before, largely because of the careful thinking and research that has gone into it. The most successful treatment programs are the ones that use a multimodal approach. They use the proper treatment of schizophrenia that includes the following: medication, education, family counseling, residential and rehabilitation programs, selfhelp groups, nutrition, rest and exercise.
Ayurvedic Medicine Treatment methods of Schizophrenia Ayurvedic medicine is a holistic system of medicine that treats mental disorders from mild stress to severe condition, including insanity (psychosis). “Ayurveda employs whole series of yogi and spiritual therapies, including meditation, pranayama, mantra, prayers, visualizations, and http://www.ayurvedacollege.com/book/export/html/2
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rituals called “spiritual therapy” (daiva cikitsa).’ Frawley, (1998). Ayurvedic’s treatments methods first works on balancing the biological humors through appropriate physical remedial methods of diet, herbs, and exercise. One of the best Ayurvedic’s treatment for schizophrenia includes panchakarma chikitsa. Some Ayurvedic formulations are Mahakalyanak ghrita, Vachadi churna, Purana ghrita, and Saraswatharistha. According to Frawley, all psychological disorders, including psychotic disorders reflect imbalances of the three biological humors. He says, “Health problems, whether physical or mental, are not merely personal problems, but energetic problems in the mindbody complex. They are not so much personal or moral failings as an inability to harmonize the forces within us” Frawley (1996). The imbalances caused by the lack or harmony in our lives weaken the doshas that afflict the heart where there is less sattwa in ones’s life and the mind. The disease develops through the manovaha srota that sends psychic energy to the mind”
Treatment differentiation: Vata, pitta, and kapha type insanity Frawley reports that for mental disorders, including schizophrenia treatments are similar that neurosis type and Pancha karma treatment is recommended as a stronger method. Vata type insanity: Dr. Frawley states that nourishing and sedating herbs are required, especially ashwagandha and its various preparations. Sarpagandha, rauwolfia serpentine, is an important ayurvedic herb for mental disorders. Other good herbs include valerian, guggul, jatamansi and calamus. Other therapies recommended are oil and ghee therapies, including oil enemas. Oil and ghee if the air passages are not blocked and laxatives which are given with the oils and ghee to remove the blocks. Pitta type Insanity: purgation is recommended, even with strong purgatives, is often helpful. The more violent type, the more purgation is required. Good herbs for this include rhubarb root, senna and aloe. Gotu kola is generally the best herb others are bhringaraj, sandalwood and passion flower. Shatavari is good for promoting a sense of love and compassion and is better for weaker pitta types. Also, oleation and fomentation therapies are recommended, then purgatives, followed by emetics. Also, medicated enemas evacuation from the head with jatamashi and gotu kola. Kaph type insanity: is recommended spicy brainstimulating herbs. The treatment is mainly expectorant, to clear phlegm from blocking the channels and obstructing mental functioning. Important herbs are calamus, basil, bayberry, sage, myrrh, and guggul, which have good expectorant action. Other formulas include trikatu with ghee or calams ghee.
Other important miscellaneous therapies: Other miscellaneous therapies describe in current Ayurvedic texts include, Abhyanga, shirodhara, shirobasti, ghee to stimulate the mind, intellect, memory and consciousness; and applying thick ointments. In addition, other Ayurvedic treatments recommend different kinds of nasal medicines mixed with mustard and oil. It is also recommended face and head massage with mustard oil and the inhalation of mustard powder. Other more intrusive treatments recommended were bloodletting and shock treatment. Some alternative treatments recommended for the insanity by the first Ayurvedic physicians were to help the patient’s mind to become still by throwing the patient into a dry well and keep him hungry until he/she is http://www.ayurvedacollege.com/book/export/html/2
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emaciated; send a policemen to grab the patient and take the patient outside and intimidate him/her with corporal punishment, and threatening him/her in the name of the king; terrify the patient with name lions, elephants or snakes whose fangs have been drawn or with knives in one’s hands or with tribesman, enemies, or robbers; tie the patient up, flog him and then cast him/her into a pit or into a completely dark room which has no knives, stones, or people in it; and to friend may comfort the patient with conversations that inculcated virtue and profits; “ Wujastic, (1998).
Ancient ayurvedic herbal formulations for any mental disorders. 1. brahmi ghee( 4 days worth). Ingredients: Brahmi 50 mgs., shankha pushpin50 mgs., Ashwagandha50 mgs., jatamanshi 50 mgs., and Ghee 100 mgs. Dose: 1 tsp. 2 times daily. Preparation: make a paste from the herbs and roll into a ball, boil the ghee and add the paste and cook for1/2 hour, and filter. Swami Sada Shiva irtha (1998). 2. Cow’s urine potion: “Cow’s urine is cooked in about three kilograms of ghee, together with about 200 grams of asofoetida, dark salt, and a mixture of black pepper, long pepper and dried ginger this is the best thing for banishing insanity” Wajastic, (1998 ).
The principles of treating mental disease In the current body of literature, Dr. Marc Halpern writes, “All mental disease originates in a lack of clarity (sattwa) within the mind”. He adds, “The primary goal of spiritual healing is the cultivation of sattwa through proper lifestyle and through all five senses”. In addition, Dr. Halpern points out that some general principles are needed to heal the mind, including spending more time in nature, mediation practices, and yoga (8 limbs). He also adds that avoiding the influence of the media and eating a sattvic diet helps to restore the mind. Finally, it is also recommended to increase ojas and balance prana, tejas.
Summary As noted by Psychiatric professionals, schizophrenia is not yet a “curable” disease, but the treatment for this illness is more effective today than ever before, largely because of the careful thinking and research that has gone into its main treatment method, antipsychotic medication. However, it is well known the multiple short and longterm mental and physical side effects caused by antipsychotic medication. Some of the of the “less serious” side effects include dry mouth, diarrhea, constipation, cough, and blurry vision. And some of the more serious long term side effects include, tardive dyskinesia, low white blood cell count, neuroleptic malignant syndrome, memory loss, uncontrollable body movements, unexplained muscle weakness, suicidal thoughts, liver failure, diabetes, weight gain, digestive problems, heart disease, sexual dysfunction, degenerative disorders, among others. I believe the most successful treatment approaches are the ones that use a multimodal and holistic approach. Ayurvedic medicine can be of great assistance to the treatment of people suffering from schizophrenia and other psychotic disorders. In addition to all the therapies described above, Ayurvedic Medicine employs a whole series of Yogic and spiritual therapies not yet explored by Western http://www.ayurvedacollege.com/book/export/html/2
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approaches for the treatment of mental illness. Some of these spiritual therapies include meditation, pranayanma, mantra, prayer, and visualizations besides its regular physical healing means and modalities to treat mental conditions such as herbal medicine, education, yoga, diet/nutrition, aromatherapy, and color therapy. Unfortunately, Ayurvedic medicine is not totally yet incorporated as a complementary therapy to the treatment of mental disorder by Western Medical establishment. Although Western treatment methods for the treatment of schizophrenia are more effective today, still there is no cure and not a single effective Western treatment method for schizophrenia. Most of the western methods are more focused on improving their quality of life, minimize symptoms, prevent suicide, avert relapses, enhance the patient’s self esteem, and to improve social and occupational functioning. In addition, Psychiatric treatment methods are to stabilize the patient’s symptoms, reduce the need for psychiatric hospitalizations and to increase the patient’s social and independent living skills. Unfortunately there is no scientific research done on Ayurvedic treatment for schizophrenia that can validate the effectiveness of its treatment methods. Finally, Ayurvedic medicine offers a great hope for people with psychotic disorders that can help them to live a more balanced life. As noted by Frawley, “Ayurveda teaches harmony with nature, simplicity and contentment as the keys to well being. Ayurveda shows us how to live in a state of balance in which fulfillment in a matter of being, not becoming. It connects us with the wellsprings of creativity and happiness within our own consciousness, so that we can permanently overcome our psychological problems”. Frawley, (1998).
References Keefe, R., and Harvey, P. (1994). Understanding schizophrenia: A guide to the new research on causes and treatment. New York: The Free Press. Manxmen, J., and Ward, N., (1995). Essential psychopathology and its treatment. New York: Norton. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington, DC: Author. Liberman, R. (1988). Psychiatric rehabilitation of chronic mental patients. Washington, DC: American Psychology Association. Comer, R. (1992). Abnormal Psychology. New York: Freeman and company. Kaplan, H., and Sadock, B. (1998). Synopsis of Psychiatry: Behavioral Science / Clinical Psychiatry. Pa: Rose Tree Corporate Center. British Columbia Schizophrenia Society. (2001, April). Basic facts about schizophrenia: National Institute of Mental Health. (1999, June 1). Schizophrenia. Retrieved from http:www.nimh.gov/publicat/schizoh.htm A Review of Schizophrenia by Dr. B. Green, consultant Psychiatrist, UK. (1995). Schizophrenia an independent review article in Psychiatry on line. Retrieved from http://www.polit.org//schizo.htm Schizophrenia Research at the National Institute of Mental Health. (1999, April 14). Schizophrenia research. Retrieved from http://nimh.gov/publicat/schizresfact.htm American Institute of Vedic Studies Frawley, (2004) Ayurvedic Healing Course for Health Care Professionals Part IV Santa Fe, N.American Institute of Vedic Studies. .Frawley, (1989). Ayurveda and the Mind the healing of Consciousness Salt Lake City, Utah. Passage Press Wujasty, (1998). The Roots of Ayurveda. London. Penguin books http://www.ayurvedacollege.com/book/export/html/2
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Halpern. (2005) Principles of Ayurvedic Medicine. 8th edition. Grass Valley CA. California College of Ayurveda. Swami Sada Shiva Tirtha. (1998). The Ayurveda Encyclopedia. Natural Secrets to Healing, Prevention, & Longevity. First edition. Bayville. NY. Ayurveda Holistic Center Press.
Ayurvedic Approaches to the Treatment of Depression: By Laura Perlin Depression is a major health epidemic, affecting 1015% of the population of the western world.1 While almost everyone has experienced depression to some degree as a feeling of extreme sadness and melancholy, more and more people are being diagnosed and treated for clinical depression, a mood disorder characterized by ongoing sadness, anger, loss or frustration that lasts for weeks, months, or years and interferes with one’s abilities to work, go to school, and perform the functions of normal daily life. Western medicine does not attribute a precise cause to depression, and medical researchers are currently exploring theories linking clinical depression to genetics, as well as to abnormalities in brain biochemistry. Depression can be triggered by disruption to normal brain chemistry caused by factors such as longterm sleep disturbance, longterm use of drugs affecting the endocrine system, patterns of drug and alcohol abuse, and diseases of the thyroid.2 Depression can also be triggered by stressful or traumatic events. Depression is diagnosed by the ongoing presence of some or all of the following symptoms, present continuously over time and of such severity that they interfere with the functions of everyday life34: ● ● ● ● ● ● ● ● ● ●
negative distortion of worldview/negative attitude/hopelessness/pessismism helplessness/low self esteem sadness agitation/restlessness/irritability/anxiety changes in appetite/weight gain/weight loss difficulty concentrating fatigue/low energy feelings of worthlessness/selfhate/guilt withdrawal/isolation headache/stomachache/digestive disturbance
1 “Incidence of Depression and Anxiety: the Stirling County Study.” http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1349333/ 2 “Major Depression.” Causes, Incidences, and Risk Factors. http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001941/ 3 “Major Depression.” Symptoms. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/ http://www.ayurvedacollege.com/book/export/html/2
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4 “Understanding Depression.” Symptoms. http://www.webmd.com/depression/default.htm ● ● ● ●
loss of interest/pleasure in activities that were once enjoyed suicidal tendencies/preoccupation with death insomnia/excessive sleep worsening of coexisting chronic disease
In its more severe forms, symptoms of depression can become psychotic, and patients may suffer from delusions and hallucinations. In the United States, approximately 3.4% of people with depression commit suicide, and approximately 60% of people who commit suicide suffer from depression or another mood disorder.5 The main methods that allopathic medicine uses to treat depression are pharmaceutical antidepressants, the most common of which work by affecting the uptake of seratonin in the brain, and psychotherapy, which can help the patient increase awareness of thought patterns, develop skills to fight off negative thoughts, and explore unresolved personal issues.6 Additionally, western medicine recognizes the therapeutic benefits of having contact with others suffering from similar symptoms in the form of support groups. Electroconvulsive therapy (shock therapy) is used in extreme cases of depression, and light therapy is used in seasonal affective disorder, a seasonal form of depression.7 Ayurveda has a very different approach to depression, stemming from a radically different understanding of mind. In Western medicine, the understanding of mind is often limited to the function of the biochemical processes of the brain, an organ which is in itself little understood. Although consciousness, thought, emotion, and feeling are all recognized as universal realities of the human experience, Western medicine lacks a functional cohesive framework for working with these aspects of the human being. Ayurveda has a lot to offer in this respect. By providing a complex theory of the human being and of health, as well as a holistic methodology of healing and transforming consciousness, Ayurvedic psychology offers many approaches to the understanding and treatment of depression. 5 “Major Depressive Disorder.” http://en.wikipedia.org/wiki/Major_depressive_disorder 6 “Major Depression.” Treatment. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/ 7 “Light Therapy.” http://www.mayoclinic.com/print/lighttherapy/MY00195/ METHOD=print&DSECTION=all In Ayurvedic thought, consciousness, or ‘chitta,’ describes the totality of the contents of the mind, including conscious, unconscious, and superconscious thought, ideas, emotions, sensations, energy, will, memory, intuition, instinct, love and faith.8 Chitta contains all memories and attachments, all mental conditioning which distorts our perception and disturbs our emotions.9 The term ‘chitta’ encompasses the totality of our inner world, and Ayurveda and its sister science Yoga teach us that by learning to look within and observe the contents of chitta with clarity, we can grow mentally and spiritually. As human beings, we have the ability to perceive through the aspect of consciousness known as ‘buddhi,’ or intelligence. Buddhi is the aspect of consciousness that is filled with light and reveals the truth. When one’s Buddhi becomes fully developed, one becomes http://www.ayurvedacollege.com/book/export/html/2
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a Buddha or enlightened one. The main action of intelligence is to discern the true and real from the false and unreal.10 So what is the nature of the truth that is revealed when one’s intelligence is fully developed? In Ayurveda, truth is understood as the awareness, beyond time and space, beyond thought forms and forms of all types, of the unity of all existence, of all of creation pulsating together as a variegated but singular expression of the unfolding of divine consciousness. The journey to this thoughtfree awareness of one’s true identity as spirit is the journey towards moksha, liberation. This is the spiritual goal of existence. Classical Ayurveda has the goal of alleviating all disease and suffering, including that related to chitta, which includes mental, psychological and emotional suffering. Ultimately the key to health on all levels is remembering one’s true nature as spirit.11 When one remembers this truth and abides in this knowledge, one chooses actions that are congruent with health and wholeness. Rather than identifying with the chitta, the personal consciousness, as the self, one recognizes one’s broader identity (or lack thereof) as a drop of water in the ocean of consciousness, a part of the greater whole and not differentiated from it. 8 Ayurveda and the Mind. Ch 6 Conditioned Consciousness: The Greater Mental Field. 9 Ibid. p.75. 10 Ayurveda and the Mind. p. 9394. 11 Principles of Ayurvedic Medicine. p.5. Ayurveda looks at the world through an elemental model in which all aspects of manifest reality are created from the building blocks of the five elements earth, water, fire, air, and ether.12 The earth element creates all solidity and stability. Earth is heavy, gross, dense, and static. The earth element provides material form and structure. In the mind, earth creates dependability, reliability, consistency, and stubbornness. The water element embodies flow and liquidity. Water flows along the path of least resistance. It is moist, heavy, gross, and soft. The water element creates liquid matter, which has cohesion like earth but more movement and less density. In the mind, water creates love, gentleness, compassion, and attachment. The fire element represents light, heat, and transformation. It allows us to see, perceive, and change. Fire is hot, dry, mobile and sharp. Fire creates the potential for growth and evolution by allowing us to digest knowledge and experience. In the mind, fire is linked to perception, anger, judgement and criticism. Air is the source of all motion, the force that pushes. Neither fire, water, nor earth will move without the force of air behind it. Air allows us to do, to move, to breathe and to be active. Air is light, subtle, flowing, and mobile. In the mind, air is the force that moves our thoughts. Ether is the subtlest of the five elements. It is the empty space that exists all around. Ether represents the field of existence on which all that happens plays out. Ether is present between all things and thus connects all things. As the backdrop to all existence, ether is extremely light,subtle, http://www.ayurvedacollege.com/book/export/html/2
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and clear and difficult to perceive compared to the other elements. However, it is omnipresent. Without ether, there would be no consciousness because there would be no space to contain it.13 12 Ibid. p. 51. 13 Ibid. p. 5051. In Ayurvedic philosophy, the elements group together to form doshas, the three basic energies or principles that are present, in varying degrees, in all people and things.14 We each have a unique genetic blueprint, a unique constitution that accounts for the many differences in the way we look, feel, and behave. When the doshas are in balance in our bodies and minds, our health is optimal and we are peaceful and at ease. It is easier for the light of truth to shine and for perception to be clear and unmarred by negative thought patterns. However, the doshic balance can easily be disturbed by stress, environmental factors, and improper diet, which gives rise to negative emotions and physical and mental disease.15 Vata dosha is the energy of movement, comprised of the elements of air and ether. When vata is in balance, we are creative, flexible, happy, and joyous. When out of balance, vata creates fear, anxiety, and ungroundedness. Vata is related to prana, the pure life force that animates us without which we could not survive for one second.16 Prana provides us with a sense of excitement about life, an inherent enthusiasm and joy. Pitta dosha is the energy of metabolism or transformation, composed primarily of fire but always contained within water. When pitta is in balance, or perception is clear and we are logical, understanding, and quick to learner. As pitta goes out of balance, anger, jealousy, criticism and hate arise. Pitta is related to tejas, the strength of the intellect and the capacity of the mind to understand, discriminate, and know truth.17 Kapha dosha consists of water and earth, and creates structure, strength and immunity. What kapha is balanced, love, compassion, and gentleness are expressed. When there is a vitiation of kapha dosha, the mind tends towards attachment, greed, and clinging. Kapha is related to ojas, the force of stability and contentment. When our ojas is strong and healthy, we have endurance and are able to withstand 14 Complete Book of Ayurvedic Home Remedies. p. 11. 15 Ibid. p. 11. 16 Ibid. p. 12. 17 Principles of Ayurvedic Medicine. p. 237. physical and mental stress. Without adequate ojas, we lack the reserve strength to contain all the motion and activity of prana and tejas. Ojas is the protective foundation of good health.18 Another important concept in Ayurvedic physiology and psychology is ama, or toxicity. Ama is like a viscous sludge that forms when foods or experiences are not fully digested. In the physical body, ama can clog up all bodily systems and suppress their healthy function. The same is true of the mind. Things that we see or hear stay with us, often leaving negative traces on our psychic fabric. Remnants of abusive, hateful, or violent things that we have heard or experienced become a cloudy http://www.ayurvedacollege.com/book/export/html/2
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haze in our consciousness, adversely affecting our ability to see clearly, love fully, and act harmoniously. A process of purification or detoxification is often necessary to return to a state of optimal health. Finally, Ayurvedic psychology offers us the language of the three gunas of sattva (clarity), rajas (activity), and tamas (ignorance) to describe the state of a person’s consciousness. The state of the gunas is reflected in the mind and the lifestyle. As a person evolves from ignorance to understanding, and from understanding to transcendent awareness, the state of mind and actions of the person reflect this evolution. The cultivation of sattva is of great importance in rising above the negative and compelling dramas of the mind. Sattvic consciousness is joyous, calming witnessing and observing, nonjudgemental and compassionate, unconditionally loving, and without attachment. It creates a clarity and purity of mind, which allows the divine spark to shine through and a person’s highest qualities to manifest. The state of sattva is a transcendent state, in which the dualities of good/bad no longer exist. It is achieved not by analyzing and resolving one’s personal dramas and conflicts, but by letting them go.19 Rajasic consciousness is turbulent and dramatic, distorting the truth of experience through the muddy lens of the ego. It is in this state of consciousness that most of humanity finds itself. Always desiring, 18 Principles of Ayurvedic Medicine. p. 238. 19 Ibid. p. 191. striving, and struggling, rajas lacks stillness and peace. The constant internal chatter obscures the truth of our divine nature, and blinds us to our purpose and potential. As one moves from rajas towards sattva, there is a process of questioning and reevaluation. Glimpses of awareness create emotional repercussions, and there is often attachment to the cycle of growth and learning and the pain that comes with it. The rajasic state of consciousness is characterized by constant mental activity.20 The tamasic state of consciousness is rooted in ignorance, darkness and inertia. An individual with a predominance of tamas will usually not have a connection to anything beyond him/herself, seeing the world in a simplistic, selfcentered framework. There is little mental activity or deep thinking, and dullness predominates. In its more extreme forms, tamasic consciousness will express itself through violent or harmful behavior. Thus, the essence of the treatment of depression and all mental disease is to move from tamas to rajas, then from rajas to sattva, and finally to transcend sattva entirely as the mind becomes liberated from the bonds of individual egoic identity.21 Usually the totality of this process takes many lifetimes, although it doesn’t have to. By bringing the doshas into balance, purifying ama, and increasing sattva guna, an individual learns to skillfully use the human mind and the human body as tools. Remembering one’s true identity as a divine being, one wields the tools of the human form with awareness and intention, using them in the service of all beings. The sense faculties, together with the mind, get vitiated by excessive utilisation, nonutilisation and wrong utilisation of the objects concerned. This causes an impediment to the respective sense perceptions. If, again, due to correct utilisation, they come to normalcy, they http://www.ayurvedacollege.com/book/export/html/2
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bring about the respective sense perceptions properly. Thinking constitutes the object of the mind. So the proper utilisation of mind or mental faculty is responsible for normal or abnormal mental conditions. This is to say, if mind or mental faculties are properly utilised, this is conducive to the maintenance of the normal mental conditions; if not, abnormal conditions prevail.22 This condition of normal utilisation of the mind is the goal that Ayurveda strives for, using many methods of treatment including diet, herbs, mantra, pranayama, and pancha karma therapies. 20 “Anxiety and Depression.” Lecture Notes. 21 Ayurvedic Psychology: Anxiety and Depression. Disc 6. 22 Caraka Samhita. Volume 1, Chapter 8. Principles of Psychopathogenesis. V. 1516. Classical Ayurvedic texts offer an understanding of mental illness that addresses many of the symptoms, root causes, and treatments of depression. They also provide instruction on the maintenance of health and prevention of disease. Normally, mind and sense faculties remain undisturbed. In order that they are not disturbed in any way, one should make all efforts to maintain their normal condition. This can be achieved by the performance of duties after duly considering their pros and cons with the help of the intellect together with the sense faculties applied to their respective wholesome objects and by acting in contradistinction with the qualities of place, season, and one’s own consitution including temperament. So one, who is desirous of his own well being should always perform noble acts with proper care.23 The person of a strong mind who does not indulge in meat and wine; who eats only healthy food, remains clean both physically and mentally, does not becomes affected by unmada.24 Mental health issues are present in vata, pitta, and kapha forms. Mental illness of all types is addressed in classical texts under the category of ‘unmada,’ insanity, which presents itself in different forms according to the dosha(s) affected. Many of the characterizations of unmada are applicable to modern clinical manifestations of depression. Intellectual confusion, fickleness of mind, unsteadiness of the vision, impatience, incoherent speech and a sensation of vacuum in the heart (vacant mindedness) these in general are the signs and symptoms of unmada. Such a patient, with bewildered mind becomes incapable of experiencing pleasure and sorrow. He becomes incapable of conducting himself appropriately. Therefore, he loses peace of mind altogether and becomes devoid of memory, intellect and recognition. His mind wavers here and there.25 Vata type depression can often be triggered by loss, which by creating emptiness in one’s life, increases the elements of air and ether. Loss of a partner, a job, a friend or family member, or a home can all contribute to vata type depression. Certain symptoms of depression, such as emaciation, are particularly linked to disturbances in vata dosha.26 Attachment, or clinging, to the object that is lost, is an attribute of kapha type depression, characterized http://www.ayurvedacollege.com/book/export/html/2
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23 Caraka Samhita. Volume 1, Chapter 8. Principles of Preventing Psychic Disturbance. Verse 18. 24 Ashtanga Hrdayam. Volume 3, Chapter 5. Treatment of Insanity. V 59. 25 Caraka Samhita. Volume 3, Chapter 9. Treatment of Unmada: Signs and Symptoms. V 67. 26 Ibid. Etiology, Signs, and Symptoms of Vatika Unmada. V 10. by an increase in the elements of water and earth. Water creates cohesion and attachment, an enduring sense of connection, whereas earth creates a stubborn and enduring stability, a resistance to and discomfort with change. Sluggishness, lack of appetite, desire for solitude, and excessive sleep are kaphic manifestations of depression.27 Pitta type depression is often associated with the perception of failure or burnout, the state of mind that arises when one does not live up to one’s own expectations of performance or achievement. Getting fired, failing a class, or not passing an exam can all be triggers of pitta type depression. Irritablility and ‘continuous anguish’28 are classical symptoms of pitta type depression.29 It is important to remember that multiple doshas can be simultaneously vitiated, and that a patient’s experience of depression may be dualdoshic or tridoshic (sannipatika). Traumatic events or abuse may trigger depression in all individuals, although those with a vata imbalance have less stability and often less endurance in the face of trauma. In treating depression, it is important to consider which doshas are out of balance and design treatment to restore balance. An important aspect in treating depression is reestablishing a harmonious relationship with the cycles of nature. Healthy routines include waking in the morning, around the same time as the sun. Rushing should be avoided as this creates anxiety and disrupts the mind. Food should be fresh, free of chemical residues, and wellprepared, and should be consumed mindfully. Sattvic spices such as ginger, cardamom and basil open the mind and the heart.30 Herbal formulas are instrumental in lighting the path towards growth and healing. Intake of ghee builds ojas and is recommended for those suffering from diseases of “impaired intelligence and memory.”31 Healthy eating habits include sitting still while eating, resting after meals to give food time to digest, chewing all food to an even consistency, and eating without 27 Ibid. Etiology, Signs, and Symptoms of Kaphaja Unmada. V 14. 28 Caraka Samhita. Volume 2, Chapter 7. Diagnosis of Insanity. V 7. 29 Caraka Samhita. Volume 3, Chapter 9. Etiology, Signs, and Symptoms of Pattika Unmada. V 12. 30 Ayurvedic Healing. p. 325. 31 Sarngadhara Samhita. Section 3. Chapter 1. V. 12. distractions like music or television. Bedtime should be early, around 10 pm, to avoid aggravating vata. Daily practice of asana, pranayama, mantra and meditation is recommended to increase sattva. Pancha karma is recommended in the classical texts as a treatment for mental illness.32 Internal and external oleation as well as fomentation are powerful methods of liquefying ama and purifying the channels of the body. Therapeutic emesis removes excess kapha and can alleviate depression, grief and attachment. Therapeutic purgation alleviates anger and irritability (pitta), and enema therapy treats fear, anxiety, insomnia and http://www.ayurvedacollege.com/book/export/html/2
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many other symptoms of vata mental disturbance.33 The practice of pranayama, control of the breath, is the main way to increase prana, the vital life force. This can be a powerful practice for alleviation depression, especially of kaphic type. Pranayama increases the flow of energy in the nervous system and strengthens the mind. Alternate nostril breathing brings balance to the right and left hemispheres of the brain. Solar breathing can be used to alleviate kaphic depression as well. Inhaling through the right nostril and exhaling through the left burns ama and unblocks the flow of energy. The mantras RAM and YAM can be used in conjunction with this practice to bring in the energies of fire and air, respectively. Lunar breathing, which consists of breathing in through the left nostril and exhaling through the right, is calming and sedating, creating a grounding and stabilizing effect. This can be very helpful for vata and/or pittagenic depression. The mantras VAM and LAM can be used in conjunction with the solar breathing technique to activate subtle energies of water and earth.34 The practice of pratyahara, or internal withdrawal of the senses, can alleviate the negative effects of sensory overstimulation and purify the mind from the barrage of sounds and image that often prevail in modern society. One could begin treatment by reducing those sensory inputs that are most negative or injurious to the mind and senses. The mind is fed by the senses in much the same way that the body is fed by food, and junk impressions create toxicity and disease. Going hiking, spending time in nature, gardening, and contemplating the sky, clouds, and stars are all forms of bathing the senses in 32 Sarngadhara Samhita. Section 3. Chapter 1 & 3. 33 Ayurveda and the Mind. p. 203. 34 Ayurvedic Psychology: Anxiety and Depression. Disc 6 harmonious impressions. Fasting from the media, especially screenbased media, can be a very effective method of reducing vata.35 Color and aromatherapy also have applications in the treatment of depression. Use of the color gold can help to build ojas and increase mental endurance, stability and immunity.36 It is gently uplifting and transforms the consciousness to a sattvic state. Essential oils of tulsi, calamus, camphor and wintergreen can help to detoxify the channels of the mind and promote emergence from the dull haze of depression.37 Myrrh, frankincense, sage and mint promote the powers of perception.38 Mantra is a powerful tool to change the energy field of the mind. All sounds, thoughts and words have their own vibratory power that affects the mind on the subconscious level. By repeating a mantra, it is embedded into one’s consciousness. This repetition gives us the power to change the dominant thought forms of our minds. Bija mantras are single syllable sounds that have no meaning beyond the vibratory power inherent in their sound. Mantras or prayers that invoke the names of God or the divine create positive thinking patterns and help to create connection with divine forces. Extended mantras, which can also be described as prayers, invocations, or affirmations, exist in all spiritual traditions and can be used to increase intentionality and work on particular aspects of healing. The use of mantra helps the mind develop its power of concentration and memory.39 Ayurveda offers many tools in healing from depression, and as an ancient and evolving science is open to expansion and utilisation of new http://www.ayurvedacollege.com/book/export/html/2
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technologies and methods. By bringing balance to the doshas, increasing sattva, building ojas, and purifying ama, optimal health of mind and body can be achieved. Individualized treatment plans incorporate a diversity of modalities that address all aspects of the human being. Ayurvedic approaches to the treatment of depression can be combined with Western approaches 35 Ayurvedic Psychology: Anxiety and Depression. Disc 6. 36 Principles of Ayurvedic Medicine. p. 334. 37 “Anxiety and Depression.” Feb 2011. Lecture notes. 38 Ayurvedic Healing. p. 322. 39 Ayurvedic Psychology: Anxiety and Depression. Disc 7. to mental health care. The journey to perfect health is approached as a journey of spiritual development, a philosophy which heals not only the individual but also has positive repercussions throughout society. References
Agnivesa's Caraka Samhita: Text with English translation & Critical exposition based on Cakrapani Datta's Ayurvedadipika. Translators: Ram Karan Sharma & Bhagwan Dash. Chowkhamba Sanskrit Series Office. Varanasi:1994. California College of Ayurveda. “Ayurveda and the Treatment of Attention Deficit Disorder.” Ryan Strong. http://www.ayurvedacollege.com/articles/students/ADD California College of Ayurveda. “Ayurveda vs. Western Medicine Perspectives.” Alexandra Compson. http://www.ayurvedacollege.com/articles/students/Insanity California College of Ayurveda. “Ayurvedic Management of Bipolar Disorder.” Josh Greene. http:// www.ayurvedacollege.com/articles/students/Bipolar%20Disorder California College of Ayurveda. “Ayurvedic & Western Approaches to the Treatment of Schizophrenia.” Ruben Vega. http://www.ayurvedacollege.com/articles/%E1%B9%A3tudents/schizophrenia California College of Ayurveda. “An Ayurvedic and Yogic Perspective of Mental Illness.” Gauri Eleanora Trainor. http://www.ayurvedacollege.com/sites/default/files/Mental_Illness.pdf California College of Ayurveda. “Cultivation of Sattva Guna through Ayurveda and Yoga as the Basis for Stress Reduction.” Jolanda Davies. http://www.ayurvedacollege.com/articles/students/SattvaGuna http://www.ayurvedacollege.com/book/export/html/2
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Diagnostic and Statistical Manual of Mental Disorders (DSMIVTR). American Psychiatric Association. 4th Edition: 2000. ISBN 0890420254. Frawley, David. Ayurveda and the Mind: the Healing of Consciousness. Lotus Press. Wisconsin: 1996. Frawley, David. Ayurvedic Healing: A Comprehensive Guide. Lotus Press. Wisconsin: 2000. Frawley, David and Marc Halpern. Ayurvedic Psychology: Anxiety and Depression. CD set. Recorded 11/ 2006. San Francisco. Frawley, David. Yoga & Ayurveda: SelfHealing and SelfRealization. Lotus Press. Wisconsin: 1999. Halpern, Marc. “Anxiety and Depression.” www.medicinecrow.com. Webcast Lecture. Personal notes. February 1, 2011. Halpern, Marc. Principles of Ayurvedic Medicine. Textbook. 10th edition. 2010. Hay, Louise. You Can Heal Your Life. Hay House. Carlsbad, CA: 1984. Lad, Vasant. The Complete Book of Ayurvedic Home Remedies. Three Rivers Press. New York: 1998. Mayo Clinic. Mayo Clinic Staff. “Light Therapy.” http://www.mayoclinic.com/health/lighttherapy/MY00195 PubMed Health. ADAM Medical Encyclopedia. “Major Depression.” http://www.ncbi.nlm.nih.gov/ pubmedhealth/PMH0001941/ Abstract: A brief article describing clinical depression and its causes, symptoms, tests, treatment, prognosis, complications, and prevention. PubMed Central. “Incidence of Depression and Anxiety: The Stirling County Study.” J M Murphy, D C Olivier, R R Monson, A M Sobol, and A H Leighton. Department of Psychiatry, Massachusetts General Hospital, Boston. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1349333/ Abstract: Prevalence studies in psychiatric epidemiology outnumber incidence investigations by a wide margin. This report gives descriptive information about the incidence of depression and anxiety disorders in a general population. Using data gathered in a 16year followup of an adult sample selected as part of the Stirling County Study (Canada), the incidence of these types of disorders was found to be approximately nine cases per 1,000 persons per year. The data suggest that for every man who became ill for the first time with one of these disorders, three women became ill. Incidence tended to be higher among relatively young persons. These incidence rates are consistent with prevalence rates of approximately 10 per cent to 15 per cent for depression and anxiety disorders aggregated together, given an estimated average duration of illness of about 10 years. It is concluded that these incidence rates are fairly realistic in view of evidence that disorders of these types tend to be chronic. Sarngadhara Samhita: A Treatise on Ayurveda. Translator: Srikantha Murthy. Chaukhambha Orientalia. Varanasi: 1995. Swami Rama, Rudolph Ballentine, Alan Hymes. Science of Breath: A Practical Guide. Himalayan Institute Press. Honesdale, PA: 1979. Tolle, Eckhart. A New Earth: Awakening to Your Life’s Purpose. Plume. New York: 2006. Vagbhata's Astanga Hrdayam: Text, English translation, Notes, Appendix and Indices.Translator: KR Srikantha Murthy. Krishnadas Academy. Varanasi: 1995. http://www.ayurvedacollege.com/book/export/html/2
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WedMD. Depression Gateway. http://www.webmd.com/depression/default.htm Wikipedia. “Major Depressive Disorder.” http://en.wikipedia.org/wiki/Major_depressive_disorder The Yoga Sutras of Patanjali: Translation and Commentary by Swami Satchidananda. Integral Yoga Publications. Yogaville, VA: 1978.
Ayurvedic Management of Bipolar Disorder By: Josh Greene Introduction Bipolar disorder is a Western psychological diagnosis, characterized by mood swings between elation or mania and depression. It has an extensive amount of symptoms and manifestations that can vary greatly depending on the constitution, environment and imbalances of the individual. In susceptible individuals, bipolar disorder is primarily amplified by low ojas (immunity, strength, contentment, ability to cope) and high vata (biological principle of movement and dryness) in the mind and nervous system. As we shall discover, Ayurveda offers a multitude of holistic tools and ways of approaching this disease that can restore health so as to not rely as heavily on conventional treatments. Western Definition “Bipolar disorder, also known as manicdepressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daytoday tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time.” Modern psychology defines several subcategories of bipolar disorder that make up a spectrum of possible manifestations. All of these types are characterized by extreme mood swings that alternate between mania, hypomania (elevated, euphoric, hyperactive or irritable mood) and depression or can exist in a variety of combinations simultaneously. Bipolar I disorder involves episodes of the most severe high and low mood swings and is your classic manic to depressed presentation. It is defined as: “One or more manic episodes.” Bipolar II disorder is a milder form, involving episodes of hypomania that alternate with depression. It is defined as: “No manic episodes, but one or more hypomanic episodes and one or more major depressive episode.” Cyclothymic disorder describes even milder mood changes. It is defined as: “A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.” When the episodes do not fall into the previous three subcategories, the term Bipolar Disorder NOS (Not Otherwise Specified) is used and defined as: “A catchall category, diagnosed when the disorder does not fall within a specific subtype.” Another subcategory is “rapid cycling,” which can http://www.ayurvedacollege.com/book/export/html/2
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pertain to any of the aforementioned subtypes. It is characterized by frequency and is defined as: “A patient who presents with more than four or five episodes in 1 year.” This disease is quite different from normal mood states of happiness and sadness that everyone experiences, symptoms of bipolar disorder can be quite severe and potentially life threatening. Ayurvedic Definition Traditional Ayurveda has no specific equivalent disease for the diagnosis of bipolar disorder written in the classical Ayurvedic texts. One of the main ancient treatises on Ayurveda is the Charaka Samhita. It uses the term “Unmada” as a very general term for insanity. Insanity according to the author Charak is “wandering about of mind, intellect, consciousness, knowledge, memory, inclination, manners, activities and conduct.” Charak goes on to describe five different types of insanity. While none of these perfectly correlate to the western description of bipolar disorder, some of the descriptions and symptoms are similar and some parallels can be drawn. Fitting a set of symptoms into the diagnosis of a particular disease is not a prerequisite to treating it using Ayurvedic methods. Bipolar disorder manifests due to imbalances in the three fundamental biological qualities that govern the body and mind; vata, pitta and kapha; and the mental principles of sattva, rajas and tamas, which are the “qualities of consciousness.” Some modern Ayurvedic practitioners liken bipolar disorder to being a lack of stability or ojas, which leads to difficulty sustaining emotional responses. Ojas is defined to “maintain immunity, strength, integrity, and vitality.” It acts as the container that holds the other two energies in the body: tejas, the energy of intelligence and discrimination; and prana, the body’s life energy. These three subtle energies are the forces that govern the functioning of the mind. During the elated or manic phase, prana and tejas are high and during the depressive state, prana will be low and tejas can be either high or low. Signs and Symptoms (Rupa and Laksana) Bipolar disorder is a disease in which individuals experience periods of elation, either manic or hypomanic and periods of abnormal depression that interfere with functioning in daily life. In general, men tend to have more frequent elated or manic episodes, while women more often depressive episodes. The peak age of onset is in the early thirties. The elated and vata symptoms of bipolar disorder include talkativeness, excessiveness, racing thoughts, hypersexuality, euphoria and impulsive overspending (of money, time, energy). Some other manic and more pitta type symptoms include overconfidence, irritability, aggression or anger directed outwardly against other people, undersleeping and hyperactivity. On the other side of the coin are the depressive (more kaphic) symptoms of bipolar disorder, including feelings of sadness, lethargy, lack of enthusiasm, apathy, lack of appetite, lack of sexual interest, oversleeping and hypoactivity. It should be noted that while there are typical vata, pitta and kapha symptoms, you could have for example a depression that is primarily governed by vata, pitta or kapha. “There are many people who say, "well if anxiety is due to vata then depression must be due to kapha, because it is heavy." Well, that’s sometimes true, but not always true in fact severe depression tends to be more of a vata condition.” Emptiness, hopelessness, difficulty concentrating or making decisions, insomnia, restlessness, memory problems, uncontrollable crying, weight loss, despair and even suicidal thoughts are also all symptoms of depression that are chiefly vata symptoms. All of these listed symptoms can manifest in the short term as well as the long term and can appear in countless combinations, making each patient a unique case. Etiology and Pathology (Nidana and Samprapati) In western medicine the exact cause of bipolar disorder is unknown. Genetics are a substantial factor in the disease manifestation, but it rarely appears without environmental circumstances such as traumatic life events or extreme social stressors. It is found to be more common among http://www.ayurvedacollege.com/book/export/html/2
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individuals who are affluent, extroverted, achievementoriented and use activity to combat depression. Outwardly, bipolar disorder is seemingly two opposing high and low conditions that have a pendulum type correlation to each other. However there can be aspects of anxiety, elation or mania even during depressive states and vise versa. While multiple doshas will likely be involved in the oscillations of bipolar disorder, the very changeability of this disease points to an underlying variable vata imbalance as the principal doshic disturbance. “High Vata in the mind manifests as fear, alienation, anxiety and possible nervous breakdown. There is insomnia, tremors, palpitations, unrest and rapid shifts in mood. Insanity, of the manic depressive type or schizophrenia, is an extreme Vata imbalance.” More specifically, the cause is primarily samana vayu (vayu is another word for vata). Dr David Frawley refers to samana vayu as “the equalizing life energy.” Samana vayu literally means, “balancing air.” “In the mind, the role of samana vayu is to balance and stabilize the other vayus. When it is healthy, the other vayus find greater stability. When it is disrupted, a person loses control of his thoughts and feelings. Samana vayu is also responsible for absorbing sensory impressions into the workings of the brain and mind.” The other two vayus that play an essential role in this disorder are prana and vyana. When prana vayu is disturbed it affects our thoughts and emotions. Prana is also responsible for the intake of impressions into the brain and mind as well as movement of neurotransmitters through the nervous system. Vyana is also responsible for movement in the nervous system and circulation of thoughts and emotions. Aggravated pitta pushed by vata leads to the mental principle of rajas, which may result in mania. Rajas is defined as “quality of consciousness; the principle of kinetic energy; active, mobile.” It is responsible for all movements, changes and excitability. Aggravated kapha pushed by vata leads to the mental principle of tamas, which may result in depression. Tamas is defined as “quality of consciousness; inertia.” and is responsible for sleep, heaviness, dullness and depression. These two principles of the three basic mental states are destructive. The third being sattva which brings balance, light and purpose. The higher the air element in the vata, the faster the individual moves through the different cycles. Regardless of the doshic imbalance, all patients suffering from bipolar disorder are likely to have low ojas (contentment, ability to cope, vitality and immunity). This low ojas is the instability that is allowing the vata movement from one mood state to another. The patient will also be more susceptible to vata changes in mood when they are under stress. It is this stress that wears down the “container of ojas.” As was mentioned previously, bipolar disorder usually doesn’t manifest until one’s twenties or thirties. It is possible that as the patient moves out of the kapha phase of life into the busier more stressful pitta time of life, they lose the grounding of the water and earth elements and become more susceptible to the heat of pitta, which in turn contributes to the drying of vata. Changes in the underlying emotions are brought on by vataprovoking qualities in the individual’s lifestyle, habits, foods and activities. These qualities are dry, rough, light, cold, subtle and mobile. Some specific etiologies include: Eating while anxious or depressed, eating on the run, taking in stimulants such as coffee or cigarettes, using intoxicants such as alcohol or recreational drugs, following irregular routines, traveling frequently, going to bed late, loud music or noise, engaging in excessive physical or sexual activity, failing to change with the seasons (especially autumn), overloading on stimulation such as TV, mass media, suppressing inner creativity and emotional sensitivity. Bipolar disorder affects as many as 5.7 million American adults, which is about 2.6 percent of the population over the age of eighteen. The disease is also quickly on the rise especially in children; one study showed as high as a 40fold increase between 1995 and 2002. One of the reasons for this could be the increasingly vatagenic environment to which today’s children are exposed. “The fact that we have more of these problems is because our culture is over stimulating people.” “Wherever there is excess stimulation, the natural consequence is long term depression once the stimuli gets removed.” The pathology path of vata’s movement through the body begins when vata accumulates and becomes aggravated in the purishavaha srota (colon). From there it overflows into the rasa dhatu (plasma tissue), and rakta dhatu (blood tissue). If the bodies’ tissues and pathways have preexisting weaknesses due to genetics or in the case of the brain and mind, emotional trauma, then under the right conditions repeated doshic disturbances will relocate to those sites. In the case of bipolar disorder, vata moves from the plasma and blood and relocates to the mano vaha srota (pathway of the mind) resulting in loss of awareness of one’s situation and fluctuations in emotional states. It also secondarily relocates into the http://www.ayurvedacollege.com/book/export/html/2
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majja dhatu (nervous tissue) and majja vaha srota (pathway of the nervous system), resulting in biochemical changes to the neurotransmitters being released effecting our thoughts. Once vata has taken root in these tissues and pathways, it starts to manifest the myriad of signs and symptoms of bipolar disorder. Diagnosis (Nidanam) The Western diagnosis of bipolar disorder is based on symptoms and how they change and progress, as well as life and family history. There is no definitive biological test and diagnosis can be difficult even for an experienced psychologist or psychiatrist. The diagnosis is primarily based on the self history as well as what is reported by friends, family and coworkers “using the criteria for both manic and major depressive episodes.” Both of these must have been present, and the subtype of bipolar disorder will depend on the frequency, severity and duration of the episodes. In Ayurvedic medicine the label of bipolar is not really relevant to treatment. Diagnosis is based on the patient’s prakruti (underlying constitution) and the past and present history of vikruti (shortterm symptoms and doshic imbalances). The practitioner must consider the long and shortterm state of doshas and subdoshas; the patient’s levels of ojas, tejas and prana; as well as the state of mental principles, sattva, rajas and tamas. Ayurvedic practitioners must also identify the major stressors that are pushing the patient’s mental states to opposite poles. Western Medical Treatment There is no known cure for bipolar disorder. The two main Western methods for treatment are medications and psychotherapy. When used in conjunction, they have shown to be effective at preventing relapses and reducing the severity of the patient’s symptoms. As Dr David Frawley states: “Modern Medicine attempts to change the consciousness through altering the chemistry of the brain.” The main medications used are mood stabilizers such as lithium, valproic acid (Depakote) and lamotrigine (Lamictal); antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify); and lastly, antidepressants such as fluoxetine (Prozac), paroxetine (Paxil) and bupropion (Wellbutrin). These medications are an amazing product of modern science. They have a strong effect on brain chemistry and are often very useful for managing this disease and improving the lives of individuals. Any medical doctor can prescribe these medications, but typically a psychiatrist, rather than a family practice or other specialty physician, would manage bipolar disorder. The downsides to these medications include countless known side effects and imperfect research as to how they affect the body and mind in other ways especially long term. From an Ayurvedic perspective, these medications do not treat the deep doshic root causes of the disease, but rather they balance and suppress the manifesting symptoms. “One of the main problems with modern medicine is that acute care has become the primary care both for the physical and the psychological medicine, which often causes more trouble with the chronic diseases.” It is also very possible that these medicines simply move the doshas into other parts of the body, only to negatively affect the health of the individual in other ways. For example, vata being pushed into the medas or asthi dhatu could cause wasting, osteoporosis, or arthritis; vata staying in the majja dhatu could lead to other types of brain problems, such as Parkinson’s or Alzheimer’s; vata entering the shukra dhatu could cause sterility or low libido. The other main Western treatment is psychotherapy or “talk” therapy. Some common psychotherapy treatments that have been used to treat bipolar disorder are: “Cognitive behavioral therapy, helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors. Family focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full http://www.ayurvedacollege.com/book/export/html/2
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blown episode occurs.” Usually a licensed psychologist, social worker, or counselor provides these therapies. The efficacy of therapy and medications was highlighted in the largest treatment study ever conducted for bipolar disorder. Researchers compared people in two treatment groups: the first was treated with three psychoeducation sessions over six weeks, while the second was treated with medication and thirty of the above mentioned types of intensive psychotherapy sessions over nine months. The results showed that group two individuals were more likely to get well faster and stay well longer with fewer relapses, lower hospitalization rates, and greater adherence to their treatment plans. Some other Western treatment methods include electroconvulsive therapy (ECT), sleeping medications, increased omega 3 fatty acid intake, ketogenic diets and canabanoids. All of these have mixed results or insufficient data to show significant usefulness. Ayurvedic Treatment (Chikitsa) In management of any psychological disease, Ayurveda works to change the energetics of the mind. The two main Ayurvedic treatments for managing bipolar disorder center on increasing our ojas and reducing our stressors. The stronger our ability to cope and withstand the stressors of the world, the less likely our moods will fluctuate between highs and lows. When ojas is strong we are less likely to be buffeted by the doshas. The more we identify our stressors and reduce them, the less ojas will be worn down. The patient’s therapist and family are good allies in helping the patient identify these stressors. The main tools used in managing the mind are “diet and herbs on a physical level, prana and the senses working at a more subtle level, and mantra and meditation working more at the level of the mind itself.” In dealing with the doshas, vata must be balanced first even if there are other current imbalances. The practitioner does not want simply to treat the current vikruti, only to drive the movement from one mood to another. It is no coincidence that many of the treatments for vata will also build ojas. The main thing that helps both is to develop regular solid routines and stability. This includes: waking and sleeping times, eating times and food choices, work schedules and one’s general activities throughout the day. Irregular patterns place stress on our body’s ability to function at its best. Some examples of this are regular mealtimes and bedtimes. When our body’s biological clock can anticipate meal or sleep times, it will release chemicals such as amylase, pepsin and acid needed to digest food in the former and chemicals such as melatonin needed to sleep in the latter. When the body is subject to irregularity, we will be prone to problems like indigestion and insomnia that put great stress on our bodies and reduce ojas. This is especially true of digestion, since we identified samana vayu as being the main causative factor in changes from one mood to another and the digestive tract as being the primary site of all doshic disturbances in the body. Sleeping times are also important. Going to bed around 10:00pm and awakening near sunrise will help the body change mental states in the kapha times of day when it is more stable. The morning should be devoted to steady and healthy morning routines, including meditation and exercise. Since vata has the qualities of: “cold, light, mobile, dry and piercing, and follows a transverse course,” it is necessary to implement the opposite qualities in any treatment. Regardless of the type of treatment, an emphasis on warm, heavy, stable, moist, oily and dull qualities should be made. The best place to start in dealing with bipolar disorder is to identify and minimize stressors that trigger changes in the mood states. Family and friends may be useful in helping to identify what these are as patients may have some denial about this. Our society is largely work driven and it may be necessary for patients to reduce their workload in order to reduce stress and focus on their health. Prioritization of all the things one wants to do in order to create a more laid back and relaxed schedule can often be difficult. The patient’s surroundings at home can also be a major source of stress. Keeping the home tidy, free of clutter and clean helps to cultivate a more sattvic and stress free environment. Time in nature is also an excellent method for reducing stress, building ojas and pacifying vata. The most important factor concerning meals is eating at regular times each day and also making sure not to go without eating. Food pacifies vata and diet should emphasize whole grains, cooked vegetables, mung beans, meats, fresh dairy, nuts and oils in order to ground the patient and build http://www.ayurvedacollege.com/book/export/html/2
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up ojas. Generally, sweet, sour and salty tastes should be emphasized, as well as the qualities of warm, moist and heavy foods. When one is having a pitta manic phase, then cooler and blander foods may be useful, and during depressive states, spicier foods can be used. Canned, frozen, old, processed, microwaved and rancid foods should be avoided. It is also important to stabilize blood sugar. Increasing the ratio of fats and proteins in relation to carbohydrates and keeping simple carbohydrates to a minimum will help with this. Coffee and other stimulants should be avoided since they will only serve to keep someone going artificially without getting true rest and will lead to more vata imbalance. Lunchtime should be the main meal of the day. It should last at least one hour and be taken at the same time, everyday while seated in a peaceful, distraction free environment in order to let food settle and digest before moving on to other activities. Some form of grace and blessing should be given before eating in order to help center ones mind. When treating bipolar disorder with herbal therapies, nervine tonics become the most important for building stability and mental ojas. Nervine sedatives may be useful for elated or manic episodes and nervine stimulants may be useful for depressive states; however, the intent is not to force the brain out of a particular episode by providing herbal uppers or downers. While having sedatives and stimulants on hand is okay, the goal should be to balance the doshas and normalize the production of neurotransmitters using tonics. A specific formula should depend on the particular constitution and state of the patient. Some generally good herb choices for tonics are ashwagandha, brahmi, shatavari, ginseng, shanka pushpi, nutmeg, skull cap, kappikacchu, haritaki and bhringaraj. Also, jyotishmati, ginkgo, jatamamsi, oat straw, valerian root, St. John’s wort and Gotu Kola may be useful in some patients. Brahmi is a great choice for any mood state since it can both act as a mild stimulant and sedative depending on what mood state needs to be balanced. Ashwagandha is very useful for building ojas and pacifying vata in the nervous system and mind. All of these herbs should be taken with herbs that aid in their digestion and absorption. Triphala is a useful combination of three fruits that not only strongly reduces vata in the intestines, but also helps with the absorption of the other herbs and foods that are being taken and will exponentially multiply their effects. Since bipolar disorder is partially rooted in the nervous system, medicated ghees are an ideal medium for enabling these herbs to penetrate deeply into these tissues. The five sense therapies (vision, sound, taste, touch and smell) can be used to place the patient in balancing and restorative surroundings. Color therapy may be useful for the visual sense. Yellow, green, gold, blue, white, violet, and pastels in general are considered sattvic colors; gold and brown are considered to raise ojas; and yellow, green, gold, brown and purple are considered to decrease vata. Colors can be applied to clothing, home décor, meditation and flowers. Music that the patient finds enjoyable or mantra therapy may be beneficial sound therapy. Since vata is rough, dry cold and sharp, touch therapy should have the opposite qualities. Clothing worn and bedding should be soft and warm. Regular, gentle and steady massage with lots of oil is also an excellent therapy for the touch sense. While professional massage is also excellent, daily selfmassage with sesame oil is more affordable, easier to implement and offers the added benefit of selflove needed for more insecure vata type individuals. Aromas that may be useful to calm the mind during elation include sandalwood, chamomile, clary sage and jatamamsi. For depression, rosemary, cinnamon, thyme, mint and eucalyptus may be useful to help get moving. Rose, basil and lavender may add balance to bipolar disorder. They can be taken in the form of essential oils with an infuser, or by adding a few drops to a warm bath. Exercise can also be an important factor in managing the doshas, as well as helping one relax and sleep well. It is; however, important not to over exert oneself since that can deplete ojas. Generally, working out to half of one’s capacity is advised. Calming exercises like Yoga, Qi Gong, Pilates and Tai Chi are generally wise choices for all three doshas. Aikido, gardening, walking and gentle hiking are also good activities. When the patient is experiencing more pitta manic symptoms, then slow and cooling exercises are best like a cool walk in nature or slow swimming. When the patient is in a more depressive state, mild running, team sports or Bikram Yoga may be of use. Panchakarma (“the five actions”) is the main Ayurvedic method for purification. “Owing to the subtle nature of its processes, it penetrates deep into the nervous system. It is useful for psychological problems caused by excess of the three doshas. Yet it can also be helpful for psychological http://www.ayurvedacollege.com/book/export/html/2
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problems caused by internal factors, emotions and karma.” The practitioner must of course evaluate the state of the patient’s ama (toxins) and strength of ojas, before deciding on a plan for how aggressively to pursue panchakarma. Since the patient is likely to be low ojas, a slower palliative plan that focuses on strengthening the patient during purification is more likely to be useful. Since the primary problem is vata imbalance, a program with an emphasis on bastis (therapeutic enemas) should be adopted. If the patient is in a manic phase, virechana (therapeutic purgation) may be used and if the patient is in a depressed state, vamana (therapeutic emesis) may be an option. Oleation with medicated oils through abhyanga (Ayurvedic massage) is also a key therapy in palliation, as well as for managing vata whether or not it is a part of panchakarma. Shirodhara (flowing oil on the forehead) and shirobasti (oil in a crown on the head) are also highly recommended for their direct action on the brain, mind and subtle energy fields. In Ayurveda sleep is considered one of the great pillars of health. Sleep builds ojas and pacifies vata. Its importance for treatment of bipolar disorder cannot be understated. “There is also a connection between mental health and deep sleep.” “It is the state of deep sleep that allows the mind to renew itself.” Sleep allows the body and mind to naturally rest and heal. Many of the other therapies, foods and herbs listed here help to regulate the body so that it can get enough quality sleep. Most sleeping pills are a class of drugs called “hypnotics” that put the body into trancelike states that do not go through the normal sleep stages. They do not provide the same quality of sleep as a natural, healthy sleep cycle. Meditation, breath, pranayama, as well as other yogic practices, are also of great importance in managing bipolar disorder. They have the ability to cultivate a sattvic mind, as well as to teach the patient how to manage the internal channels and energy moving through their body and mind. Meditation brings us back to a state of awareness that allows us to see the transient nature of things including our own moods and emotional states. Repetition of these practices actually has the ability to change our internal biochemistry, lessening the large fluctuations in our minds. While diet, herbs and lifestyle practices can do much on an outer level to pacify doshas and prevent disease, practices like meditation work on a much deeper and more fundamental level to change the subtle energies in our consciousness. Since Ayurveda is not a quick process and relies on the development of healthy routines and habits over a lifetime, it is important for a patient already diagnosed as bipolar to continue with the treatments laid out by his or her physician. If the patient has not received a formal diagnosis and the Ayurvedic practitioner, patient, or a patient’s family has concerns about a severe mood disorder, the patient should be referred to a primary care physician for evaluation. Even if a patient currently seems stable, if there is a history of severe mood states and he or she falls back into them, then the patient will likely be unable to follow an Ayurvedic lifestyle. Western pharmacology can often provide the acute stability needed for the individual to work on developing longterm habits and routines. A year on an Ayurvedic treatment plan would be a reasonable minimal timeframe for a patient to follow before talking with his or her physician about coming off medications. Conclusion Bipolar disorder is a multifaceted disease consisting of periods of elation and depression. It is a condition of low ojas and high vata in the mind and nervous system. A regimen of Ayurvedic treatments to tonify, develop regularity and reduce stressors can help to build ojas and pacify the vayus. Ayurveda is useful for managing bipolar disorder because it is a holistic approach that looks at the constitution, the state of current imbalances, and the whole environment of an individual before deciding what is the best regimen to bring him or her into a balanced state. It provides a complete package of useful everyday tools such as lifestyle, diet, herbs, purification and meditation that best suits the specific individual. This is contrasted with Western medicine, which has the tendency to put everyone with similar symptoms into the same box and provide them with pharmacological solutions that suppress symptoms but don’t solve the underlying problem. Ayurveda not only has the ability to treat symptoms of a psychological disease like bipolar disorder, but it can also move past the disease to identify its root causes and the underlying patterns affecting the individual. Combined with meditation and other yogic practices, Ayurveda works on the subtle aspects of mind to heal consciousness and release http://www.ayurvedacollege.com/book/export/html/2
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individuals from disease. References "NIMH • Bipolar Disorder." NIMH • Home. U.S. Department of Health and Human Services, 06 Oct. 2009. Web. 02 June 2010. . American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th, text revision (DSMIVTR) ed. 2000. ISBN 0 890420254. Bipolar Disorder. DSMIVTR. Bipolar I Disorder. ^ DSMIVTR. Diagnostic criteria for 296.89 Bipolar II Disorder. ^ DSMIVTR. Diagnostic criteria for 301.13 Cyclothymic Disorder. ^ DSMIVTR. Not Otherwise Specified (NOS) Judd, Lewis L., and Leighton Y. Huey. "Part Thirteen Psychiatry." Harrison's Principles of Internal Medicine. By Eugene Braunwald. 11th ed. New York [etc.: McGrawHill, 1987. 2085087. Print. Charaka. Charaka Samhita Handbook on Ayurveda. Ed. Gabriel Van Loon. Vol. 2. Chaukhambha Orientalia, 2002. 1100. Print. Lad, Vasant. Textbook of Ayurveda: Fundamental Principles of Ayurveda. Albuquerque, NM: Ayurvedic, 2002. 308. Print. Thompson, Mary. "The Nervous System." AHP Level 2 Class. California College of Ayurveda, Grass Valley. 16 Sept. 2010. Lecture. Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 306. Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 2. Grass Valley: California College of Ayurveda, 2007. Print. Textbook. Frawley, David, and Marc Halpern. Ayurvedic Psychology: Anxiety and Depression. Rec. 18 Nov. 2006. California College of Ayurveda, 2006. CD. Ibid Harrison's Principles of Internal Medicine. 2086. Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression” ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression” ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression” http://www.ayurvedacollege.com/book/export/html/2
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Frawley, David. Ayurveda and the Mind: the Healing of Consciousness. Twin Lakes, WI: Lotus, 1997. 155. Print. Ibid "The Nervous System." Ibid Ayurveda and the Mind. 316. Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 1. Grass Valley: California College of Ayurveda, 2007. Print. 81. Textbook. Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 1. 7883. Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 308. Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 8. Ibid "The Nervous System." Yarema, Thomas, Daniel Rhoda, and Johnny Branningan. Eattasteheal: an Ayurvedic Cookbook of Modern Living. Kapaa, HI: Five Elements, 2006. 2831 Print. ^ Eattasteheal: an Ayurvedic Cookbook of Modern Living. 31. Moreno, C., G. Laje, C. Blanco, H. Jiang, A. B. Schmidt, and M. Olfson. "National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth." Archives of General Psychiatry 64.9 (2007): 1032039. Print. ^ “National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth.” Ibid Ayurvedic Psychology: Anxiety and Depression Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid Harrison's Principles of Internal Medicine. 11th ed. 2086. Ibid "NIMH • Bipolar Disorder." How is bipolar disorder treated? Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid "NIMH • Bipolar Disorder." Medications. Ibid Ayurvedic Psychology: Anxiety and Depression. http://www.ayurvedacollege.com/book/export/html/2
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Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. Chapter 6. Ibid "NIMH • Bipolar Disorder." Psychotherapy. Miklowitz DJ, Otto MW, Frank E, ReillyHarrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. Psychosocial treatments for bipolar depression: a 1year randomized trial from the Systematic Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 2007 Apr;64(4):419426. Ibid "NIMH • Bipolar Disorder." Other treatments. Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid "The Nervous System." Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid "The Nervous System." Ibid Ayurvedic Psychology: Anxiety and Depression. Bhishagratna, Kaviraj Kunjalal. An English Translation of Sushruta Samhitá: Based on Original Sanskrit Text with a Full Comprehensive Introduction, Additional Texts, Different Readings, Notes, Comparative Views, Index, Glossary and Plates. Varansi: Chowkhamba Sanskrit Series Office, 1981. Chapter 1. Print. Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid Psychology of Ayurveda: Treatment of Psychological Conditions. Ibid "The Nervous System." Ibid Ayurvedic Psychology: Anxiety and Depression. Ibid "The Nervous System." Frawley, David, and Vasant Lad. The Yoga of Herbs: an Ayurvedic Guide to Herbal Medicine. Twin Lakes, WI: Lotus, 2001. Print. Halpern, Marc. Psychology of Ayurveda: Treatment of Psychological Conditions. Grass Valley: California College of Ayurveda, 2006. Print. Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 2. 442. http://www.ayurvedacollege.com/book/export/html/2
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Ibid Psychology of Ayurveda: Treatment of Psychological Conditions. Ibid Ayurveda and the Mind. 203. Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 3. “Prana, Tejas and Ojas”. Track 4.
Bipolar Disorder: from Western Medicine and Chronobiology to Ayurveda By: Lucia Pagani Bipolar disorder (BD): a psychiatric definition and treatment Bipolar disorder (BD) is a chronic, disabling and lifethreatening illness1. Patients with a diagnosis of BD have a suicide mortality rate of more than 10 times that of the general population24. BD has a lifetime prevalence of 4.5% in the adult US population, equally affecting females and males5. Currently, BD etiology is still unknown. Recent studies hypothesize BD to be driven by the interaction between genetic and environmental factors, although no genes have been unequivocally linked to BD, yet6. The most updated edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIVTR) classifies BD as a mood disorder. The DSMIV defines BD as a “cyclic” or “periodic illness”, in which a subject experiences mood swings from positive symptoms (mania, period of elevated mood) to negative episodes (depression), most often transitioning through a euthymic phase (normal nondepressed and positive mood)7. Specific symptoms characterizing the two poles of the disease are: Mania: on the basis of the severity of the symptoms mania can be subclassified into hypomania, acute mania, and delirious mania. Hypomania is a state in which the patient has a heightened mood, high selfesteem and selfconfidence; because of that, he/she may engage themselves in other people’s lives or even in dangerous situations. Patients are distractible, present with hypersexuality, have flights of ideas and lack the need of sleep7. During acute mania phases, the symptoms of hypomania are exacerbated; in addition, hallucinations and delusion symptoms appear, together with increased strength and decreased pain threshold7. The most severe form of mania is delirious mania, in which, in addition to the exacerbation of acute mania symptoms, the patient may experience confusion, clouded consciousness, dysphoric mood, loss of selfcontrol, and catatonia7. Depression: patients experiencing depression report loss of energy and psychomotor retardation with agitation, http://www.ayurvedacollege.com/book/export/html/2
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despair, low and irritable mood and no attraction to life, eventually leading to suicidal thoughts or attempts. Depression presents with hallucinations, delusions of guilt and belief in deserved punishment, hyperphagia, leading to weight gain, hypersomnolence due to a feeling of being always exhausted, insomnia, sluggish thoughts, impaired concentration, memory and decision making7. BD is further classified as BDI and BDII, on the basis of the severity of symptoms BDI subjects experience acute and delirious mania symptoms, while BDII subjects experience only hypomania. Normally, in BD, the two phases of the disease are separated by a period of euthymia. However, sometimes a patient shows a mixture of manic or depressive symptoms, such as “weeping uncontrollably” while saying “they never felt so well in their lives”, or manic and depressive phases occur in direct succession.; these episodes are called mixedmanic episodes7. In general, women tend more toward depressive episodes, while men toward manic episodes, although the cycling, duration of each episode and the “polarity” are very subjective7. The current treatment of BD is characterized by empirical trials and many side effects; often, the treatments include a combination of several kinds of medications8 and psychotherapy. The main pharmacological classes of medications prescribed to BD patients are mood stabilizers and antiepileptic drugs9, such as lithium chloride and valproic acid. Lithium is effective in reducing mania episodes, although its mechanism of action is still unclear. Often, mood stabilizers and antiepileptic treatments are not enough to prevent manic or depressive episodes9; when the depressive phase of BD occurs, antidepressants, such as selective reuptake serotonin inhibitors or tricyclic drugs, are often administered along with mood stabilizers. In general, antidepressant treatments are used for a limited time, as it was observed that antidepressant drugs may trigger manic episodes or cause cycles to be more rapid. When manic episodes occur, antipsychotic medications, such as haloperidol, are prescribed10. All drugs used to treat BD have strong side effects, and can be toxic; moreover, the efficacy and dosage of these treatments are unpredictable and subjective. In addition to medications, psychotherapy11 and other therapies, such as electroconvulsive therapy12 for manic and depressive episodes, vagus or vagal nerve stimulation, transcranial magnetic stimulation13 and light therapy for depressive episodes14, are important for the treatment of BD. Ayurveda and BD Originating in India, Ayurveda is the most ancient health discipline. The roots of the word Ayurveda come from the Sanskrit Ayur (life) and veda (knowledge); Ayurveda is thus the science of life. In its ancient texts (“veda”) Ayurveda comprises etiology, pathology and pharmacology of diseases. Ayurveda acknowledges that the constitution and illnesses of every individual are caused by three bodily humors, or doshas: vata, pitta and kapha. According to the compendium Charaka Samhita, one of the fundamental classic texts http://www.ayurvedacollege.com/book/export/html/2
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of Ayurveda, written in the early centuries of the Common Era, the doshas are defined as “the three body energetics, made of qualities, which support right body function in right amount, and destroy right body function in excess or deficiency”15. Every dosha is built from different elements (ether, air, fire, water, earth), and thus possesses unique qualities. Vata (air and ether) is the lighter of the doshas. In the Charaka Samhita, Charaka describes vata qualities as “nonunctuous, cold, light, subtle, mobile, nonslimy and rough”16. Pitta (fire and water) is the only warm dosha., Its qualities are “slightly unctuous, hot, sharp, liquid, sour, mobile and pungent” according to the Charaka Samhita17. Kapha (water and earth) is the heavier and most still of the dosha, and it is described as “heavy, cold, soft, unctuousness, sweet, immobile, slimy”17. According to Ayurveda, when a person is conceived, the unique relative ratios of the doshas form the constitution, or prakruti. Any imbalance of this relative ratio leads to a disease. The imbalanced dosha would reside in the weakest system or organ, that can be physical (such as the digestive tract) or not physical (e.g. the mind)18. In the same way as the body presents attributes that are driven by the doshas, Charaka Samhita describes also the attributes of the mind (gunas): tamas (“inertia, dullness, sleep, darkness”), rajas (“momentum, desire, action”) and sattva (“peaceful, clear, balanced, steady”)16. The state of mind of bipolar patients is seldom sattvic; it can be said that persons experiencing milder forms of the disease (BDII) have a rajasic state of mind, while during severe episodes of depression or mania (BDI) they have a tamasic state of mind. According to Ayurveda, there are three energies that are essential for the vitality, that are subtle counterparts of the doshas: prana (“subtle energy of air as the master force behind all mindbody functions”)19, tejas (“subtle energy of fire through which we digest impressions and thoughts”)20 and ojas (“subtle energy of water as our vital energy reserve, essence of digested food, impressions and thoughts”)20. Prana is the force that allows the mind to “move and respond to challenges”, tejas allows good judgment, and ojas is the mind’s endurance, providing psychological stability20. In BD patients the level of ojas is low, and this is reflected by the mental instability that characterizes the pathology. In acute phases, prana is high during mania, where there is an excess of movement of thoughts, and low during depression, where, opposite to manic phases, thoughts become sluggish. Tejas is high in manic phases, where patients lack clarity and determination, and can be either high or low during depression19,20. Although a perfect overlap between BD and ancient Ayurveda pathology definition is not found, Charaka and Sushruta (a second fundamental classic Ayurveda author) describe symptoms of psychiatric diseases and classify http://www.ayurvedacollege.com/book/export/html/2
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them as “unmada”. Unmada comprises all psychiatric disorders and can be translated as “psychosis”21,22. In the Sushruta Samhita, unmada is subsequently divided in 6 subcategories: three due to the vitiation of a single dosha, one involving the vitiation of multiple doshas, one due to anxiety and mental stress and one caused by poison. The different types of unmada carry etiological, pharmacological and prognostic importance. Specific symptoms of BD can then be driven by specific doshas vitiating the mind (manovaha srota). Vataja unmada is characterized by vataspecific behaviors, such as “patients laugh without a reason, shout, and wander about”. Anger and hostility become predominant features for patients experiencing pittaja unmada. Kaphaja unmada is accompanied by loss of appetite, lethargic actions and voice, and increased sleeping time. From this brief overview, vataja and pittaja unmada can be associated with the western definition of mania, while kaphaja unmada would correspond closely to depressive phase. However, due to the volatile nature of the disease, BD can be considered more associated with vata imbalance; indeed “vata’s excess of air causes instability and agitation in the mind”, thus being the principle responsible for creating the space that would be eventually filled by other doshas23,24. Between the 5 different expressions of vata (prana vayu, samana vayu, vyana vayu, udana vayu and apana vayu), samana vayu, “mental digestion and homeostasis”, results as particularly compromised in BD. Vitiation of samana vayu leads to an altered homeostasis of the mind, that subsequently affects vyana vayu, increasing the circulation of thoughts, and prana vayu, altering the intake of sensory impressions in the mind20. Ayurveda recognizes that all pathologies start in the digestive system, as the accumulation and aggravation of the vitiated doshas. Prodromal symptoms of BD would be typical of vata vitiation (apana vayu) in the digestive system (purishavaha srota), affecting the moisturizing of the mucous membranes of the colon, leading to constipation. Vata would overflow from the digestive system to the mucous membranes of all the body (rasavaha srota) and the circulatory system (raktavaha srota), producing generalized dryness and fatigue. Vyana is the vayu that becomes vitiated at this level. The pathology manifests when vata relocates in the manovaha srota, the channel of the mind, and modifies and diversifies, leading to the symptoms typical of BD, caused by the vitiation of samana (restlessness, mood swings, tremors), prana and vyana vayu (vatadriven and circulated emotions and thoughts). From this perspective, it become clear that, as BD is mainly driven by vata (that may lead to the vitiation of other doshas in the mind) all actions taken to pacify vata would improve the symptomatology of BD. Vata’s principal characteristic is being mobile, thus constant routines would improve vatadriven pathology such as BD; vata is also associated with movement, that would then be reduced by “sitting or walking quietly and peacefully by” nature, listening to “calming music”, gentle massage using sesame or almond oil, calming colors (in particular gold), “rich and nourishing food abounding in sweet, salty and sour tastes”, “sweet, warm and calming” fragrances (“jasmine, rose, sandalwood, eucalyptus”). Calming activities such as gentle practice of Hatha Yoga, Tai Chi, and swimming will also have a positive effect on BD; these activities will help the mind to build peace and contentment, essential for a good prognosis of the disease. Chanting vatapacifying mantra, such as “Ram, Hrim, Shrim” is another way to ameliorate BD symptoms20. http://www.ayurvedacollege.com/book/export/html/2
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Ayurvedic pharmacopeia utilizes herbs to assist and sustain the lifestyle changes required to decrease vata in the manovaha srota. To pacify vata in the manovaha srota, nervine tonics and sedatives should be administered. Examples of these herbs, considered beneficial in the management of BD, are ashwagandha, shatavari, shank pupshi, brahmi, taken with a dipanas to help digestion. The ideal anupanas for the formulation would be ghee, since it is particularly beneficial for increasing ojas, which should be the primary goal of treatment, in order to give stability to the system25.
Chronobiology: a new branch of western medicine A relatively new branch of western medicine is chronobiology, that considers the timing of periodic phenomena of essential importance. The most important periodic phenomenon is circadian rhythm. Circadian rhythms are all the reactions and substances that occur in the body with a period of roughly 24 hours. Circadian rhythms are very well conserved through evolution, controlling the physiology and behavior of almost all living beings. In complex beings like mammals, the circadian rhythm is organized in a hierarchic fashion: the master clock, the suprachiasmatic nucleus (SCN) of the hypothalamus, that possesses an endogenous rhythm, contains an input pathway that links the external lightdark stimuli to the internal cycle and synchronizes peripheral oscillators through a variety of stimuli; thus, light is the main entrainment cue for humans. Peripheral oscillators, virtually all the cells of the body, possess the same molecular clock machinery as the SCN. The basis of the molecular machinery that constitutes the circadian rhythm is a negative feedback loop. The same clock genes that are activated and repressed in a circadian (about 24 hours) fashion are present in every cell of the body26,27. Increasing evidence highlights the link between health and proper circadian rhythm function. It is demonstrated that many pathologies lead to impairments of circadian rhythms (“sundown syndrome” in Alzheimer’s disease patients, for example) and that abnormal circadian rhythms (eating at the wrong time) can cause disorders (metabolic syndromes). Much evidence provides support for an association between circadian rhythm dysfunction and BD. Alteration of hormonal circadian rhythms (e.g. cortisol and growth hormone levels) and core body temperature in BD have been reported in early studies, suggesting an involvement of the circadian system in the pathophysiology of the disease28 35. People suffering from BD show an abnormal sleepwake cycle, in particular a reduced need of sleep and abnormal sleep architecture36; moreover, sleep disturbances are often prodromal to BD relapse37, and sleep length was found to be prodromal to mania or hypomania phases38, and is one of the main symptoms considered by the DSMIV of both mania and depression. In addition to this evidence, many genetic studies imply that mutations in a number of clock genes are associated with BD39. http://www.ayurvedacollege.com/book/export/html/2
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Quite unsurprisingly, the treatment of BD with antipsychotic drugs stabilizes the circadian rhythms seen in the amplitude of temperature rhythms, plasma melatonin, cortisol secretion levels40, although an enhanced salivary cortisol response to waking is still present in euthymic individuals41. Due to the strong impact of circadian rhythm dysfunction on mood disorders, many protocols are being developed to treat psychiatric disorders, and in particular BD, with chronotherapies, treatments specifically designed to regulate the circadian rhythms of a person, including reestablishing a good synchronization between the external lightdark cycle and internal rhythms. The main therapeutic resource of chronotherapies is the regulation of sleep and light exposure. Sleep deprivation has been widely demonstrated to have a quick, but temporary, antidepressant effect, that can manifest even after 24 hours or one night of complete sleep deprivation14,42. In depressed subjects, this treatment would “reset” the clock, ameliorating ,symptomatology. In BD subjects, however, sleep deprivation could ameliorate depressive symptoms, but could trigger mania as well43. In a recent paper, the use of sleep deprivation was administered in conjunction with other chronotherapies, such as bright light therapy, and sleep advance phase. Bright light therapy was administered the day after the sleep deprivation night for three consecutive days, while following a sleep deprivation night subjects were exposed to sleep phase advance, to reset the sleep time around 10 PM. The combination of these therapies was shown by the authors of the paper to have a fast and longlasting antidepressive effect without triggering mania44. Morning bright light therapy was attempted in depressive phases of BD, but in the vast majority of cases it would trigger mania; however, a higher dose of midday bright light was found beneficial45.
Similarities between Ayurveda knowledge and new western traditional medicine approaches to BD The first striking feature that surprises us when comparing the Ayurvedic description of unmada and the more recent diagnosis and classification of BD symptoms is the similarity between these two disciplines, developed in times so far from each other. Typical vata symptoms that have been described in ancient texts and have a counterpart in modern psychiatric diagnosis methods (e.g. DSMIV) include, for example, continuous irregular speech, excessive talking or “pressure of speech” (satatamaniyanam ca gira and bahubhasita), hyperactivity and inappropriate behaviors such as excessive smiling, laughing, or dancing (abhiksnasmitahasitanrtyagitavadi), abusive and dangerous behavior (vikrosa). Similarly, pittaja unmada symptoms such as impatience (amarsa), anger (krodha), violence (samrambhaschasthane), raised temper (rosa), sleeplessness (vinidra) are also present in the description of BD in the DSMIV. Both vata and pitta symptoms are translated as manic manifestations of the disease. Also when considering kaphaja unmada symptoms it is possible to find similarities to the DSMIV diagnosis criteria for BD, such as psychomotor retardation (stillness and sluggishness) (alpacankramana and sthanamekadese), lacking of energy (alpamati), hypersomnolence (swapnanityata)46. http://www.ayurvedacollege.com/book/export/html/2
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The main goal of chronobiology is to reestablish a physiological and personal routine in sleep and eating behaviors. This is of particular importance for a disorder as highly variable as BD in which, depending on the phase of the disease, a patient may sleep less than 3 hours per night and forget to eat, or oversleep and overeat. The same principles are considered fundamental in the management of vatadriven pathologies when samana vayu is vitiated, focusing the treatment by also improving a constant routine around sleep and eating habits20. In addition, in BD, Ayurvedic principles can offer a mechanism behind the validity and failure of certain chronotherapies. Sleep deprivation therapies used to treat depression were demonstrated to be a noneffective treatment for BD, triggering mania in a high percentage of volunteers, despite the finding that in major depression the treatment did not have side effects. Effective vatareducing practices improve rest and sleep time, therefore sleep deprivation would exacerbate vata vitiation and symptoms. On the other hand, BD symptoms were ameliorated when patients were treated with 14 hours of bedtime in the night in total darkness, that can be considered a vatapacifying technique, since people with vata vitiation are extremely sensible to stimuli (“loud music or noise”20). A similar example is the brightlight therapy used in treating BD patients that was found to be effective to treat depression without triggering mania if administered during midday, a moment of high pitta, important for properly digesting the light.
Conclusions All reported evidence points out that the proper management of the lifethreatening disease BD is still a challenge for modern psychiatry; however, the new concept of chronobiology is helping physicians with novel therapies, such as dark and light therapy, sleep deprivation and sleep phase advance therapy. Similar concepts of adhoc lifestyle changes were already suggested from early in the Common Era by Ayurvedic practitioners for the treatment of specific disorders. The ancient, yet current, Ayurvedic knowledge can be extremely important for the proper application of chronotherapies, resulting in a more personalized and affordable treatment to counterbalance subjective imbalances in BD. Taken together, chronotherapies and Ayurveda could be a new keystone in the treatment of BD.
References: 1 J. Angst & M. Preisig, "Outcome of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985," Schweiz Arch Neurol Psychiatr 146 1995): 1723. 2 E. H. Hoyer, P. B. Mortensen & A. V. Olesen, "Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993," Br J Psychiatry 176 (January 2000): 7682. 3 R. Sharma & H. R. Markar, "Mortality in affective disorder," J Affect Disord 31 (June 1994): 9196. 4 U. Osby, L. Brandt, N. Correia, A. Ekbom & P. Sparen, "Excess mortality in bipolar and unipolar disorder in Sweden," Arch Gen Psychiatry 58 (September 2001): 844850. http://www.ayurvedacollege.com/book/export/html/2
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5 K. R. Merikangas, H. S. Akiskal, J. Angst, P. E. Greenberg, R. M. Hirschfeld, M. Petukhova & R. C. Kessler, "Lifetime and 12month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication," Arch Gen Psychiatry 64 (May 2007): 543552. 6 C. E. Bearden & N. B. Freimer, "Endophenotypes for psychiatric disorders: ready for primetime?," Trends Genet 22 (June 2006): 306313. 7 J. Cooper, "Diagnostic and Statistical Manual of Mental Disorders (DsMIVTR)," British Journal of Psychiatry 179 (July 2001): 8585. 8 J. Hirschowitz, A. Kolevzon & A. Garakani, "The pharmacological treatment of bipolar disorder: the question of modern advances," Harv Rev Psychiatry 18 (SeptemberOctober 2010): 266278. 9 A. Musenga, M. A. Saracino, G. Sani & M. A. Raggi, "Antipsychotic and antiepileptic drugs in bipolar disorder: the importance of therapeutic drug monitoring," Curr Med Chem 16 2009): 14631481. 10 M. Tohen & E. Vieta, "Antipsychotic agents in the treatment of bipolar mania," Bipolar Disord 11 Suppl 2 (June 2009): 4554. 11 E. Vieta, I. Pacchiarotti, M. Valenti, L. Berk, J. Scott & F. Colom, "A critical update on psychological interventions for bipolar disorders," Curr Psychiatry Rep 11 (December 2009): 494502. 12 P. Sienaert, "What we have learned about electroconvulsive therapy and its relevance for the practising psychiatrist," Can J Psychiatry 56 (January 2011): 512. 13 C. Loo, N. Katalinic, P. B. Mitchell & B. Greenberg, "Physical treatments for bipolar disorder: a review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques," J Affect Disord 132 (July 2011): 113. 14 F. Benedetti, B. Barbini, C. Colombo & E. Smeraldi, "Chronotherapeutics in a psychiatric ward," Sleep Med Rev 11 (December 2007): 509522. 15 Gabriel Van Loon, Charaka Samhita Handbook on Ayurveda (Sharma andChaukhambha Orientalia, 2002) Car 1#57, p.36. 16 Gabriel Van Loon, Charaka Samhita Handbook on Ayurveda (Sharma andChaukhambha Orientalia, 2002) Car 1 1#58, p.38. 17 Gabriel Van Loon, Charaka Samhita Handbook on Ayurveda (Sharma andChaukhambha Orientalia, 2002) Car 1 1#60, p.38. 18 Gabriel Van Loon, Charaka Samhita Handbook on Ayurveda (Sharma andChaukhambha Orientalia, 2002) Car 3 8#101, p.137. 19 David Frawley, Ayurveda and the mind : the healing of consciousness (Lotus Press, 1997) p.23. 20 David Frawley, Ayurveda and the mind : the healing of consciousness (Lotus Press, 1997) p.24. 21 Panday Gs, Caraka Samhita: Hindi Commentary (Choukamba Publications, 1997) Car 6 6#77. 22 Shastry Ka, Sushruta Samhita: Hindi vyakhya (Choukamba Publications, 2002) Su 6 62#4. 23 Panday Gs, Caraka Samhita: Hindi Commentary (Choukamba Publications, 1997) Car 6 9#10. 24 Shastry Ka, Sushruta Samhita: Hindi vyakhya (Choukamba Publications, 2002) Su 6 62#5. 25 Vasant Lad David Frawley, The Yoga of Herbs: An Ayurvedic guide to herbal medicine (1986). http://www.ayurvedacollege.com/book/export/html/2
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26 D. K. Welsh, J. S. Takahashi & S. A. Kay, "Suprachiasmatic nucleus: cell autonomy and network properties," Annu Rev Physiol 72 2010): 551577. 27 D. K. Welsh, S. H. Yoo, A. C. Liu, J. S. Takahashi & S. A. Kay, "Bioluminescence imaging of individual fibroblasts reveals persistent, independently phased circadian rhythms of clock gene expression," Curr Biol 14 (December 2004): 22892295. 28 D. J. Kupfer, F. G. Foster, P. Coble, R. J. Mcpartland & R. F. Ulrich, "The application of EEG sleep for the differential diagnosis of affective disorders," Am J Psychiatry 135 (January 1978): 6974. 29 P. Linkowski, M. Kerkhofs, A. Van Onderbergen, P. Hubain, G. Copinschi, M. L'hermiteBaleriaux, R. Leclercq, M. Brasseur, J. Mendlewicz & E. Van Cauter, "The 24hour profiles of cortisol, prolactin, and growth hormone secretion in mania," Arch Gen Psychiatry 51 (August 1994): 616624. 30 Carroll, G. C. Curtis & J. Mendels, "Neuroendocrine regulation in depression. I. Limbic systemadrenocortical dysfunction," Arch Gen Psychiatry 33 (September 1976): 10391044. 31 P. Linkowski, E. Van Cauter, R. Leclercq, D. Desmedt, M. Brasseur, J. Golstein, G. Copinschi & J. Mendlewicz, "ACTH, cortisol and growth hormone 24hour profiles in major depressive illness," Acta Psychiatr Belg 85 (SeptemberOctober 1985): 615623. 32 J. D. Amsterdam, A. Winokur, E. Abelman, I. Lucki & K. Rickels, "Cosyntropin (ACTH alpha 124) stimulation test in depressed patients and healthy subjects," Am J Psychiatry 140 (July 1983): 907909. 33 T. Tsujimoto, N. Yamada, K. Shimoda, K. Hanada & S. Takahashi, "Circadian rhythms in depression. Part II: Circadian rhythms in inpatients with various mental disorders," J Affect Disord 18 (March 1990): 199 210. 34 E. Souetre, E. Salvati, T. A. Wehr, D. A. Sack, B. Krebs & G. Darcourt, "Twentyfourhour profiles of body temperature and plasma TSH in bipolar patients during depression and during remission and in normal control subjects," Am J Psychiatry 145 (September 1988): 11331137. 35 J. Mendlewicz, P. Linkowski, M. Kerkhofs, D. Desmedt, J. Golstein, G. Copinschi & E. Van Cauter, "Diurnal hypersecretion of growth hormone in depression," J Clin Endocrinol Metab 60 (March 1985): 505512. 36 A. G. Harvey, L. S. Talbot & A. Gershon, "Sleep Disturbance in Bipolar Disorder Across the Lifespan," Clin Psychol (New York) 16 (Jun 2009): 256277. 37 A. Jackson, J. Cavanagh & J. Scott, "A systematic review of manic and depressive prodromes," J Affect Disord 74 (May 2003): 209217. 38 E. Leibenluft, P. S. Albert, N. E. Rosenthal & T. A. Wehr, "Relationship between sleep and mood in patients with rapidcycling bipolar disorder," Psychiatry Res 63 (July 1996): 161168. 39 E. W. Lamont, D. L. Coutu, N. Cermakian & D. B. Boivin, "Circadian rhythms and clock genes in psychotic disorders," Isr J Psychiatry Relat Sci 47 2010): 2735. 40 E. Souetre, E. Salvati, J. L. Belugou, D. Pringuey, M. Candito, B. Krebs, J. L. Ardisson & G. Darcourt, "Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality," Psychiatry Res 28 (June 1989): 263278. http://www.ayurvedacollege.com/book/export/html/2
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41 D. Deshauer, A. Duffy, M. Alda, E. Grof, J. Albuquerque & P. Grof, "The cortisol awakening response in bipolar illness: a pilot study," Can J Psychiatry 48 (August 2003): 462466. 42 J. C. Wu & W. E. Bunney, "The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis," Am J Psychiatry 147 (Jan 1990): 1421. 43 T. A. Wehr, D. A. Sack & N. E. Rosenthal, "Sleep reduction as a final common pathway in the genesis of mania," Am J Psychiatry 144 (February 1987): 201204. 44 J. C. Wu, J. R. Kelsoe, C. Schachat, B. G. Bunney, A. Demodena, S. Golshan, J. C. Gillin, S. G. Potkin & W. E. Bunney, "Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder," Biol Psychiatry 66 (August 2009): 298301. 45 D. Sit, K. L. Wisner, B. H. Hanusa, S. Stull & M. Terman, "Light therapy for bipolar disorder: a case series in women," Bipolar Disord 9 (December 2007): 918927. 46 S. P. Suchitra, H. S. Devika, B. N. Gangadhar, R. Nagarathna, H. R. Nagendra & R. Kulkarni, "Measuring the tridosha symptoms of unmada (psychosis): a preliminary study," J Altern Complement Med 16 (April 2010): 457462.
Ayurveda Research Papers (CCA Student papers) The selected papers published on our website have been written by students of the California College of Ayurveda as a part of their required work toward graduation.
An Ayurvedic Approach to the Treatment of Secondary Amenorrhea By: Zoe Middlebrooks AN AYURVEDIC APPROACH TO AMENORRHEA Overview of Women’s Reproductive Cycle The glands of the endocrine system that regulate a women’s menstrual cycle are the hypothalamus, pituitary gland, and the ovaries. The hypothalamus is the master gland of the system; it secretes Luteinizing Hormone Releasing Hormones (LHRH) and stimulates the pituitary gland to release Luteinizing Hormone (LH) and Follicle ‐Stimulating Hormone (FSH). As the pituitary gland secretes LH and FSH, these hormones act on the follicle in the ovary and stimulate its maturation. At the ovary, estrogen and progesterone are released. As the follicle matures, estrogen affects the development of a woman’s body and maturing egg. At the same time, progesterone affects the development of the endometrium and the breast http://www.ayurvedacollege.com/book/export/html/2
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tissue. The hormonal flow between the three glands is a negative feedback system; if the body has enough estrogen then no LHRH is produced, however, if estrogen levels are running low, than the hypothalamus secretes LHRH. A healthy menstrual cycle is dependent on functioning of the endocrine system.1 Every month an egg matures and a woman’s body and uterus prepare for pregnancy. If pregnancy does not occur, than the endometrial lining is released. Following menstruation, the endometrial lining of the uterus builds again as the uterus prepares for a fertilized egg. During this time there is an increase in arterial and venous blood flow. This is called the proliferative phase of the uterine (menstrual) cycle. Then, during the secretory phase, the tissue leftover after the egg is released, known as the corpus luteum, secretes estrogen and progesterone to act on the uterus and body. At this point in the cycle, if fertilization has occurred, estrogen and progesterone remain high and there is no need for the hypothalamus to secrete LHRH. However, if the egg was not fertilized then production of estrogen and progesterone drops, triggering the shedding of the endometrium ‐ the start of another menstrual cycle.2 This monthly release is the motion of apana vayu. The subdosha of vata associated with downward movement.
1
Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012)
2
American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up‐ ‐to‐ ‐the‐ ‐Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.213
Menarche & Menstruation The onset of menses in a young woman is called menarche, according to the American Medical Women’s Association, this occurs “between the ages of 10 and 14, when the ovaries begin producing the hormone estrogen. This causes the hips to widen, breasts to develop, and body hair to grow. It also triggers menstruation, the monthly cycle of bleeding that is a key part of a woman’s fertility.”3 On average, menstruation lasts 3 ‐5 days. Women’s menstrual cycles can range in length from 21 to 35. A 28 ‐day cycle is the average and is thought to be the healthiest length for a woman. Health complications become more common the farther away from 28 days a women’s cycle gets. The classical Ayurvedic description of menses was more specific; according to the Astanga Hrdayamis, “in women, the rajas (menstrual blood) which is the product of rasa (the first dhatu), flows out of the body for three days, every month, after the age of twelve years and undergoes http://www.ayurvedacollege.com/book/export/html/2
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diminision by the age of fifty years.”4 There are many Sanskrit terms that refer to the menstrual cycle. In Sanskrit, “the menstrual cycle of a woman is called rajodarshana. The root raja means ‘blood’ while dharshana means ‘to see.’ Thus rajodharshana is the ‘seeing of blood.’”5 Other Sanskrit terms include rutukala, or “woman’s season,”6 arajaska from the Charaka Samhita.7 Amenorrhea
Amenorrhea is a condition in which there is an absence of menstruation. “This absence is normal before puberty, after menopause, and during pregnancy [& lactation].”8 Amenorrhea can be a primary or secondary condition. “Primary amenorrhea occurs when a woman reaches the age of 18 and has never had a period. It is usually caused by a problem in the endocrine system that regulates hormones.”9 Reasons a woman could experience primary amenorrhea include “ovarian failure,” “problems in the nervous system or the pituitary gland in the endocrine system that affect maturation at 3 Ibid. p.210 4 Astanga Hrdayam 1:360 5 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5‐ ‐4 6 Ibid. 7 Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda
Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series), Volume 5
p.155, XXX:17 8 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up ‐to ‐the ‐Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232 9 Ibid.
puberty,” or “birth defects in which the reproductive structures do not develop properly.”10 The Sanskrit term for amenorrhea from the Charaka Samhita is and nashta ‐rakta with nashta meaning lost, destroyed or missing, and rakta meaning blood.11 “Secondary amenorrhea is an absence of menstruation for greater than or equal to three months.”12 Secondary amenorrhea can be triggered by “problems that affect estrogen levels, such as stress, weight loss, exercise, or illness;” “problems affecting the pituitary, thyroid, or adrenal gland;” or “ovarian tumors or surgical removal of the ovaries.”13 Stress, whether physical or emotional, “causes low levels of FSH and LH along with low estrogen levels.”14 Another common cause is coming off of birth control. According to Rosemary Gladstar, “many women have waited for months, even years, for their menstrual cycle to return after having been on birth control pills for an extended period of time.”15 A woman experiencing Amenorrhea should consult a western doctor or other diagnostician in order to identify any obvious reasons for her lack of menses. Common diagnostic tools are blood tests for thyroid function, female and male hormone, and possible ultrasound imaging to view the reproductive organs.16 This paper will focus on the pathology and treatment of secondary amenorrhea. http://www.ayurvedacollege.com/book/export/html/2
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Pathology of Amenorrhea
According to Charaka, “a woman never suffers from gynecic diseases except as a result of affliction by the aggravated vayu. Therefore, first of all, the aggravated vayu should be alleviated, and only thereafter, therapies should be administered for the alleviation of other doshas.”17 Dr. Frawley has a similar claim, stating that “as a long ‐term or frequent condition [amenorrhea] is mainly a deficiency disease due to Vata. But other doshas can cause it as well.”18 While both pitta and vata can play a role in amenorrhea they are uncommon, and in most cases, vata is the primary vitiated dosha. The nidana, or etiology of this condition is caused by vata ‐provoking lifestyle regimens that lead to depletion. The 10 Ibid. 11 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5‐ ‐100 12 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley:
California College of Ayurveda 2012) p.5‐ ‐100 13 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up‐ ‐to‐ ‐the‐ ‐Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232 14 Halpern, Clinical Ayurvedic Medicine, 6 th Ed. (Grass Valley: California College of Ayurveda 2012) p.5 ‐100 15 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993) p.122 16 Mayo Clinic, Mayo Clinic Staff, Amenorrhea, http://www.mayoclinic.com/health/amenorrhea/DS00581 17 Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series) Volume 5 p.159, XXX:114.5‐ ‐116.5 18 Frawley, Ayurvedic Healing: A Comprehensive Guide 2 nd Ed. (Twin Lakes, WI: Lotus Press 2000) p.248
consumption of old, dry and light foods that lead to malnourishment is a very important contributing factor. So too is excessive motion such as a fast paced lifestyle filled with travel, stress and overwhelm. Physically, excessive exercise provokes vata. Symptoms accompanying amenorrhea can include other symptoms of depletion and dryness including “constipation, dry skin, dry hair, weight loss, worry and anxiety.”19 As all these symptoms are those of vata dosha, the samprapti of amenorrhea will be primarily vata associated. In Dr. Halpern’s Clinical Ayurvedic Medicine, he concisely describes the six stages of disease of amenorrhea as the vitiation of vata travels through accumulation, aggravation, overflow, relocation, manifestation, and diversification. “Vata accumulates and becomes aggravated in the purishavaha srota. It overflows to the rasa and rakta vaha srotas and relocates deeper into the rasa dhatu as well as into the medas and shukra dhatus. Relocation to the rasa dhatu leads to dryness throughout the body and a decrease in the production of menstrual fluid. Relocation to the medas dhatu results in weight loss and further drying of the body. Relocation to the shukra dhatu inhibits ovulation. Relocation to the mind results in anxiety and overwhelm along with other vata emotions. “ 20 In addition, after accumulation and aggravation in the purishavaha srota, apana vayu could relocate in the purishavaha srota with a decrease in rasa dhatu leading to a possible and likely symptom of constipation. http://www.ayurvedacollege.com/book/export/html/2
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Western Approach to Treatment
According to the Mayo Clinic staff, depending on the nidana of the amenorrhea, treatments include contraceptive pills to jumpstart the menstrual cycle, medications to treat possible thyroid or pituitary disorders or surgery in the case of tumors or structural blockages. In addition, they also mention “lifestyle and home remedies” a woman can work with, including a recommendation to “strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life.”21 The American Medical Women’s Association notes that patients are often asked to record their basal body 19 Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) p.5‐ ‐100 20 Ibid. p.5‐ ‐100/101 21 Mayo Clinic, Mayo Clinic Staff, Amenorrhea, http://www.mayoclinic.com/health/amenorrhea/DS00581
temperatures in order to help detect whether or not a woman is ovulating.22 Taking ones basal body temperature daily is also useful in bringing awareness and mindfulness to a woman’s monthly cycle and accompanying patterns. Ayurvedic Treatment
As a holistic health, in treating an absence of menses ayurvedically, a practitioner would treat the patient through their mind, body, and spirit. Their treatment plan would include dietary and lifestyle changes in addition to herbal and five sense therapies. Dietary Recommendations
As a condition of vata vitiation, women with amenorrhea will likely experience an increase in the qualities of dry, cold, light and mobile. To counteract these qualities they should alter their diet to concentrate on warm, moist and heavy foods. The most beneficial tastes for them at this time are sweet, in addition to salty and sour. The spicing of foods with dipanas is important to ensure that samana and apana vayu are functioning, as absorption and elimination of nutrients is key. Classical Ayurvedic dietary recommendations from the Susruta Samhita include taking “fish, Kulattha pulse, Masa pulse, Kanjika (fermented sour gruel etc.), Tila, wine (Sura), cow’s urine, whey, half diluted Takra, curd and Sukta.”23 These suggestions include the sweet, sour and salty tastes as well as heavy and oily foods to nourish vata. A woman with amenorrhea should increase her consumption of whole grains, root vegetables, nuts, dairy and oil. The addition of oils to the diet will be very nourishing and help to keep moisture in the body. It is also important to consider a woman’s daily caloric intake and make sure that it is adequate especially in cases of amenorrhea and vata vitiation due to anorexia nervosa or excessive exercise. For some women, taking daily supplements will help them to get any vitamins or minerals that their diet is lacking. According to the University of Maryland Medical Center, for women lacking menstruation, it may be beneficial to supplement the diet with calcium, magnesium, vitamin D, http://www.ayurvedacollege.com/book/export/html/2
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vitamin K, boron, Vitamin B ‐6, and essential fatty oils. “Women who don’t have periods are at higher risk of
22 American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up‐ ‐to‐ ‐the‐ ‐Minute Medical
Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) p.232/233 23 Bhishagratna, Susruta Samhita(Varanasi: Chowkhamba Sanskrit Series 2002) p. 146, II:22 ‐23
osteoporosis”, calcium, magnesium, vitamin D, vitamin K, and boron “may help keep bones strong.”24 Vitamin B ‐6 is recommended because it may help reduce high prolactin levels. “Prolactin is a hormone released by the pituitary gland, and women with amenorrhea often have higher levels of prolactin.”25 Essential fatty acids are important to supplement into the diet, as the human body is not able to synthesize these fats. A couple examples of oils containing omega 3 and 6 fatty acids are flaxseed oil and cod liver oil. Herbs for Amenorrhea
Herbal treatments for amenorrhea can be very effective when taken in addition to dietary and lifestyle changes. The suggested herbal treatment for amenorrhea in the Charaka Samhita is to “drink the blood of deer, goat, sheep and pig mixed with yoghurt, juice of sour fruits and ghee. She may also take the milk boiled with drugs belonging to Jivaniya group (jivaka, rasabhaka, meda, maha ‐meda, kakoli, ksira ‐kakoli, mudga ‐parni, masa ‐parni, jivanti and madhuka).”26 Only some of these classical recommendations can be utilized in the twenty ‐first century as few women will agree to drinking the blood of animals and many of the suggested herbs are no longer available. “The first six herbs listed in Jivaniya are listed in a group of herbs known as Ashtvarga ‐ eight herbs. These eight herbs became extinct 500 years ago.”27 Bhavamisra the author of Bhavaprakasa Nighantu has made some suggested substitutions for the extinct herbs; these include replacing meda and mahameda with shatavari, and jivaka and rasabhaka with vidari kand.28 In Dr. Halpern’s text he writes “herbs that are nutritive tonics should be taken along with spices to improve digestion. Most nutritive female reproductive tonics are demulcents and build the rasa dhatu supporting the production of menstrual flow.”29 Therefore, reproductive tonics, demulcents, nervine tonics, and tonifying emmenogogues are herbal categories that should be concentrated on. Most herbal treatments must be continued for several months before the menses returns as rebuilding the health and tone of the reproductive system takes time. While a woman may be tempted to work with 24 University of Maryland Medical Center, http://umm.edu/health/medical/altmed/condition/amenorrhea
http://www.ayurvedacollege.com/book/export/html/2
25 Ibid.
th
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Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series) Volume 5
p.155, XXX:101.5‐ ‐102.5
27 Skudder, Vitalizing Herbs‐ ‐Jivaniya, http://www.atreya.com/ayurveda/Vitalizing‐ ‐Herbs ‐Jivaniya.html
28 Ibid.
29 Halpern, Clinical Ayurvedic Medicine, 6 th Ed. (Grass Valley: California College of Ayurveda 2012) p.5 ‐101
emmenogogues, “purifying emmenogogues…while stimulating menstrual bleeding, should not be taken as they are drying to the body and lead to greater depletion.”30 The Jivaniya herbal substitutes of shatavari and vidari kand in addition to wild yam are nutritive female reproductive tonics that will benefit women with amenorrhea. These are the reproductive tonics are also recommended in the Dr. Halpern’s Clinical Ayurvedic Medicine text. Dong quai is another suggested herb because of its actions as a tonifying emmenogogue. The roots of these four herbs are the part of the plant used medicinally as tonics. All of them are considered to have a sweet rasa (taste). The sweet taste in Ayurveda is composed of the earth and water elements. According to Michael Tierra “it is cooling, nutritive, pleasant and softening…the essence of nourishment.”31 Shatavari
Asparagus racemosus is the variety of asparagus root used medicinally in Ayurveda, known as Shatavari. The translation of Shatavari is one “’who possesses a hundred husbands,’ as its tonic and rejuvenative action on the female reproductive organs is said to give the capacity to have a hundred husbands”32 Shatavari is an heavy and oily tonic used often in Ayurveda “for gynecological purposes and to strengthen female hormones.”33 Its demulcent quality helps to nurture the mucous membranes. “It both nourishes and cleanses the blood and the female reproductive organs.”34 Vidari Kand
Vidari Kand, or Ipomea digitati, falls into the herbal categories of rasayana and demulcent, as well as many others. This sweet root is related to the sweet potato. Studies have shown that vidari kand has “significant oestrogenic and progesteronogenic activities with no toxicity.“35 In addition, patients have responded positively when taking vidari kand as a replacement for routine hormonal therapies.36
30 Ibid. 31 Tierra, Plantetary Herbology: An Integration of Western Herbs into the Traditional Chinese and Ayurvedic Systems
(Twin Lakes, WI: Lotus Press 1988) p.41
Ed.
32 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd (Twin Lakes, WI: Lotus Press, 2008) p.183 33 Tierra, Plantetary Herbology: An Integration of Western Herbs into the Traditional Chinese and Ayurvedic Systems
(Twin Lakes, WI: Lotus Press 1988) p.321 http://www.ayurvedacollege.com/book/export/html/2
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Ed.
34 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd (Twin Lakes, WI: Lotus Press, 2008) p.184 35 Puri, Rasayana: Ayurvedic Herbs for Longevity and Rejuvenation (Traditional Herbal Medicines for Modern
Times)(London: Taylor & Francis 2002) p.306 36 Ibid.
Wild Yam Deioscorea villosa also known as wild yam is a sweet herb that “contains hormones and is an effective tonic for the female reproductive system.”37 The phytoprogesterones contained in wild yam help “to regulate the ratio of progesterone to estrogen in the system,” making wild yam beneficial to both the herbal and scientific communities.38 When treating disorders of the women’s reproductive system it is important to consider the liver. The liver is a detoxifier, filtering toxins from the bloodstream. It also plays a major role in the balance of hormones.39 When there is stagnation in the liver, these processes slow. Wild yam is a recommended herb to use in this case, in addition to working on the reproductive system. Wild yam is a great liver tonic, as it “activates and stimulates liver activity.”40 Dong quai
Dong quai, or Angelica sinensis is another sweet root that “can be used to treat almost every gynecological imbalance because of its strengthening and building qualities…Though dong quai has no specific hormonal action, it exerts a regulating and normalizing influence on hormonal production through its positive action on the liver and endocrine system.”41 It can be used in all complaints of the female reproductive system. In addition, don quai is also a mild nervine tonic, helping to lower stress by calming and relaxing the nervous system. Dipanas
Shatavari, vidari kand, wild yam, and dong quai are all heavy and cooling herbs, therefore they turmeric. Cinnamon (Cinnamomum cassia) is a good choice because of its demulcent and stimulating properties. Dried ginger (Zingiberis officinale) would be a useful carrier herb in a formula because it is also considered an emmenogogue. Turmeric (Curcumae longa) is less stimulating than cinnamon and ginger, but it helps to regulate menses by decongesting the liver.42
37 Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd
Ed. (Twin Lakes, WI: Lotus Press, 2008) p.186
38 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993) p.258 39 Ibid. p.78 ‐79 40 Ibid. p.259
41 Ibid. p.241
42 Ibid. p.244 ‐245, 274
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Anupanas When considering the appropriate anupana for these herbs in pacifying vata, it would be best to cook a formulation of these herbs into a medicated ghee or oil. A teaspoon of this ghee would be taken an hour away from food in the morning and evening. As long as there are appropriate dipanas in the medicated ghee then it could be melted into warm milk, another option is to take it with ginger tea. This treatment will need to be continued for several months in order to give the uterus and reproductive system time to rebuild itself. Chyawanprash
Chyawanprash is another beneficial herbal supplement, recommended for its nutritional value and general tonifying effects. In Parle & Bansal’s review of the herbal formula it is said that it “streamlines menstrual cycles in females.”43 Comprised of around fifty herbs, Chyawanprash is a comprehensive tonic, great for maintaining homeostasis. As the carrier, the honey in formula helps drive the herbs deep into the body’s tissues.44 In the case of amenorrhea this is useful for the honey’s action of driving the tonifying herbs into the tissues of the uterus. It is also commonly used in the reduction of stress. As a daily tonic, a woman can take 1 ‐2 teaspoons of Chyawanprash morning and evening; taking it with warm milk will enhance the tonifying effect.45 Rejuvenative Therapies
Women with amenorrhea should consider treating themselves to a series of Ayurvedic body therapies. A Bliss therapy consisting of abhyanga, shirodhara, and svedana treatments would be beneficial as these treatments are pacifying to vata and very nourishing to the system. In addition to the Bliss therapy, anuvasana and uttara bastis would help to encourage healthy downward movement and svadhisthana basti would localize energy and release to the 2nd chakra. These treatments would be most helpful if the woman repeated them every month several times until menstruation returned.46
43 Parle, & Bansal, “Traditional medicinal formulation, Chyawanprash ‐ A Review,” Indian Journal of Traditional
Knowledge 5(4)(October 2006)487
44 Ibid. p.484 45 Frawley, Ayurvedic Healing: A Comprehensive Guide 2 nd Ed. (Twin Lakes, WI: Lotus Press 2000) p.116 46 Halpern, Clinical Ayurvedic Medicine, 6 th Ed. (Grass Valley: California
College of Ayurveda 2012) p.5 ‐101
Lifestyle Changes Lifestyle and yoga therapies are very important for women experiencing amenorrhea. They need to partake in vata pacifying behaviors and http://www.ayurvedacollege.com/book/export/html/2
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therapies. Most importantly this includes rest and minimizing the amount of things or stressors that are apart of their everyday lives. In addition, women can look toward the support of other women, Yoga Nidra, daily movement, and releasing pranayama practices. Sharing Pheromones
In Herbal Healing for Women it is recommended for women experiencing amenorrhea to spend extra time surrounded by menstruating women. She states, “menstruating women secrete a chemical called pheromone. This enzyme triggers a hormonal reaction in other women which can stimulate the menstrual cycle.”47 In 1998 at the University of Chicago a study was done that demonstrates “the existence of human pheromones and identify[ing] a potential pheromonal mechanism for menstrual synchrony, as well as for other forms of social regulation of ovulation.”48 Yoga Nidra
A six ‐month trial study with women experiencing menstrual disorders suggested, “in patients with menstrual irregularities, Yoga Nidra not only has utility as a possible therapeutic strategy, but also may be a method for improving headache, giddiness, nervousness and irritability.49 In the study, amenorrhea was included in the various menstrual symptoms whose changes were tracked in both the intervention (Yoga Nidra & medication) and control (medication only) groups. In the group of women that experienced Yoga Nidra for 35 minutes five days a week for six months there was a larger decrease in the occurrence of amenorrhea than in the control group. 50 Daily Movement
When excessive exercise is not the cause of amenorrhea, it is recommended to incorporate 30 minutes of movement daily. This exercise should be gentle and can include walking in nature or a
47 Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993)
p.123 48 Stern & McClintock, “Regulation of ovulation by human pheromones,” Nature 392 (March 1998) 177 ‐179 49 Rani, Tiwar, Singh, Agrawai, “Six ‐month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform
symptoms,” Industrial Psychiatry Journal 20(2) (July ‐December 2011) 97 ‐102 50 Ibid.
restorative yoga asana practice and should only be preformed if the woman is strong enough. Yoga is beneficial when trying to bring back the menstrual cycle because when done consistently it to reduce stress and brings balance to the endocrine system. A balanced practice would include a http://www.ayurvedacollege.com/book/export/html/2
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full range of motion, focusing on inversions, twists, and backbends. “Inversions increase blood circulation, and balance your endocrine system, backbends tone your liver, and twists massage your internal organs.”51 A suggested sequence for healthy menstruation could include supta baddha konasana, adho mukha virasana, jahu sirsasana, triang mukhaikapada paschimottanasana, paschimottanasana, upavistha konasana I, parsva upavistha konasana, upavistha konasana II, viparita dandasana, setu bandha sarvangasana, savasana.52 Conclusion
Western medicine and Ayurveda both offer options for the treatment of amenorrhea. In most cases, Western medicine encourages the return of menses through the use of artificial hormone therapy. Ayuveda offers more options and avenues for treatment that allow women to bring awareness to their own cycles and lives. Taking charge of their own treatment by making positive lifestyle changes and utilizing the natural but effective medicine of herbs.
51 Sparrowe & Walden, Yoga for a healthy menstrual cycle (Boston: Shambhala Publications, Inc 2004) p.29 52 Ibid. p.11
Sources Cited • American Medical Woman’s Association, Inc., The Women’s Complete Healthbook: Up ‐to ‐the ‐ Minute Medical Information on the Issues that Concern Women Most (New York: Delacorte Press,1995) • Bhishagratna, Susruta Samhita(Varanasi: Chowkhamba Sanskrit Series 2002) • Dash & Sharma, Charaka Samhita: Text With Translation & Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika 4th Ed. (Varanasi: Chowkhamba Sanskrit Series) • de la Foret, Herbal Remedies Advice, Female Reproductive System, http://www.herbalremediesadvice.org/female ‐reproductive ‐ system.html • Frawley, Ayurvedic Healing: A Comprehensive Guide 2nd Ed. (Twin Lakes, WI: Lotus Press 2000) • Frawley & Lad, The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Ed. (Twin Lakes, WI: Lotus Press, 2008) • Gladstar, Herbal Healing for Women: Simple Home Remedies for Women of All Ages (New York: Fireside 1993) • Halpern, Clinical Ayurvedic Medicine, 6th Ed. (Grass Valley: California College of Ayurveda 2012) • Mayo Clinic, Mayo Clinic Staff, Amenorrhea, http://www.mayoclinic.com/health/amenorrhea/DS00581 • Parle, & Bansal, “Traditional medicinal formulation, Chyawanprash ‐ A Review,” Indian Journal of Traditional Knowledge 5(4) http://www.ayurvedacollege.com/book/export/html/2
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(October 2006)484 ‐488 ABSTRACT
Pheromones are airborne chemical signals that are released by an individual into the environment and which affect the physiology or behaviour of other members of the same species1. The idea that humans produce pheromones has excited the imagination of scientists and the public, leading to widespread claims for their existence, which, however, has remained unproven. Here we investigate whether humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours (thereby fulfilling the classic definition of a pheromone). We found that odourless compounds from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing ‐hormone surge of the recipients and lengthened their menstrual cycles. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones. • Puri, Rasayana: Ayurvedic Herbs for Longevity and Rejuvenation (Traditional Herbal Medicines for Modern Times)(London: Taylor & Francis 2002) • Rani, Tiwar, Singh, Agrawai, “Six ‐month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform symptoms,” Industrial Psychiatry Journal 20(2) (July ‐December 2011) 97 ‐102 ABSTRACT
Background: Emotional insecurity, stress, depressive or/and anxiety symptoms are common with variable severity among patients with menstrual disorder. Yogic relaxation therapy (Yoga Nidra) leads to conscious and subconscious recognition of these underlying psychological factors and helps releasing of suppressed conflicts. Objective: To evaluate the effect of Yoga Nidra on anxiety and depressive symptoms in patients with menstrual disorders. Materials and Methods: Subjects were recruited from the Department of Obstetrics and Gynecology, C.S.M. Medical University (erstwhile KGMU), Lucknow Uttar Pradesh, India. The subjects were randomly divided in to two groups: Intervention group (with yogic intervention) and control group (without yogic intervention). Assessments of all subjects were carried out by administering Hamilton anxiety scale (HAM ‐A) and Hamilton rating scale for depression (HAM ‐D) at baseline and after six months. Results: http://www.ayurvedacollege.com/book/export/html/2
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The mean age with S.D of the intervention group was 27.67 ± 7.85 years, and for control group was 26.58 ± 6.87 years (among completed intervention group nn = 65 and control group nn = 61). There was significant reduction of scores in HAM ‐A (P<0.003) and HAM ‐D (P<0.02) respectively in subjects with mild to moderate anxiety and depressive symptoms after six months of yoga therapy (Yoga Nidra) in intervention group in comparison to control group. Conclusion: The patients with mild to moderate anxiety and depressive symptoms improve significantly with ‘Yoga Nidra’ intervention. There is no significant improvement in the patients with severe anxiety and depressive symptoms. • • •
Skudder, Vitalizing Herbs ‐Jivaniya, http://www.atreya.com/ayurveda/Vitalizing ‐Herbs ‐ Jivaniya.html Sparrowe & Walden, Yoga for a healthy menstrual cycle (Boston: Shambhala Publications, Inc 2004) Stern & McClintock, “Regulation of ovulation by human pheromones,” Nature 392 (March 1998) 177 ‐179
ABSTRACT
Pheromones are airborne chemical signals that are released by an individual into the environment and which affect the physiology or behaviour of other members of the same species1. The idea that humans produce pheromones has excited the imagination of scientists and the public, leading to widespread claims for their existence, which, however, has remained unproven. Here we investigate whether humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours (thereby fulfilling the classic definition of a pheromone). We found that odourless compounds from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing ‐hormone surge of the recipients and lengthened their menstrual cycles. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones. • Tierra, Plantetary Herbology: An Integration of Western Herbs into the Traditional Chinese and Ayurvedic Systems (Twin Lakes, WI: Lotus Press 1988) • University of Maryland Medical Center, http://umm.edu/health/medical/altmed/condition/amenorrhea
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BUILDING OJAS: The road back to health from Chemotherapy By: Jill Talve Introduction Cancer is characterized by the spread of abnormal cells in the body. Mutated cell growth is often uncontrollable and can cause death in the individual by eventually compromising the body’s vital functions. The existence of cancer and its manifestations go back thousands of years as described in the classical texts of Ayurveda. While modern research has linked numerous causes to the proliferation of cancer cells within the body, malignant cancer cells are produced in all bodies. The general difference between a detectable cancer and that which does not develop further is the body’s immune system and its many functions. From an ayurvedic perspective, Ojas, a Vedic concept that contains the body’s defense against such pathogens , is disempowered at a time when cancer cells begin to populate. In today’s world, the abundant use of chemotherapy to eradicate many cancers can leave the body in a severely weakened state. The success of chemotherapy is often a matter of ridding the body of more malignant cells before too many healthy cells are compromised. When the body has reached this point and the chemotherapy has ceased, the body’s immune system, already compromised as evidenced by the high volume of cancer cells, is further impaired. In order for the body to continue to survive, immunity must be restored. In Ayurveda, the practice of restoring immunity is referred to as building Ojas. The cultivation of Soma, Rasayana or Rejuvenation therapies, including physical, mental , and spiritual practices must all be employed so that the body can fully recover and defend itself against future assaults.
Cancer and the use of Chemotherapy Chemotherapy is the use of certain chemicals that are introduced to the body for the purpose of destroying disease. Antineoplastic (anticancer) therapy and Cytotoxic (cellkilling) therapy are specific to treating cancer. In the article Chemotherapy and the war on cancer, a historical account of the development of chemotherapy explains that during WWII an event causing exposure to mustard gas led to a decrease in white blood cells among those who were in contact with the gas. Continued research in the 1940’s led to the experimental treatment of nonhodgkins lymphoma with nitrogen mustard. The mustard gas derivative caused a temporary regression of the mediastinal and lymphatic masses. By the late 1940’s, compounds identified as antifolates were the first drugs to induce remission in cases of acute lymphoblastic leukemia. More stabilized versions of these drugs diminished tumors successfully in Breast, ovarian, bladder, and head and neck cancers. Clinical trials continued through the 1950’s and 60’s as natural and synthetic compounds were combined and tested on tumor cells at various stages. Chemotherapy was considered as constructive adjuvant therapy following the surgical removal of tumors. Although there has been tremendous support for the development of chemotherapy since the early stages of research, there exists a parallel concern around the “Acute and longterm toxicities of chemotherapies, which affects virtually every organ in the body”. Oncologists have accepted this fact as the price for controlling such a fatal disease. In patients who are treated yearly with chemotherapy, approximately 20% are cured and another 20% experience a significant extension of life. The remaining 60% of patients experience minimum benefit from cytostatic treatment and suffer from the effects. Common side effects resulting from the administration http://www.ayurvedacollege.com/book/export/html/2
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of chemotherapy drugs include: Decrease in blood cell counts, hair loss (reversible), confusion, nausea, vomiting, ringing in ears, hearing loss, kidney damage, bladder damage, fertility impairment, lung and heart damage, mouth ulcers, decreased appetite, liver damage, photosensitivity, skin rash, seizures, loss of reflexes, and weakness. As several rounds of treatment are often dispensed over a period of time, the patient can develop psychological disturbances in anticipation of subsequent rounds. Although many of these conditions subside once the chemotherapy is over; the longterm effects force the patients to discontinue treatments and leave the person in a deeply weakened state with low quality of life.
Ayurveda and Cancer Cancer is described in the classical texts as inflammatory or noninflammatory swelling and described as Granthi (minor neoplasm) or Arbuda (major neoplasm). Granthi is the term most commonly used to describe benign tumors and is visible from the surface. Arbuda is the term that specifies a malignancy. Other terms from the texts include Gulma, which describes any palpable mass in the abdominal area; and Dwirarbuda, which refers to the spread of the malignant cells from its origin throughout the body. Malignant tumors (Tridosaja) are the result of all three doshas deeply out of balance and unable to inhibit tissue damage. According to the sushruta samhita, it is the vitiation of all three doshas that ultimately lead to the manifestation of tumors. Dr. Marc Halpern explains the evolution of a tumor to be a function of Vata ( faulty division of cells) pushing Kapha (tissue growth) and the excess of pitta creates malignancy making it sannipatika in nature . Cancer manifests differently in each individual according to their distinct exposure to pathogens and their unique constitutional makeup. Not only is the spread of cancer due to the vitiation of the Vata, Pitta and Kapha doshas, but disturbances deeply rooted in the Rakta, Mamsa and Medas dhatus.
Ayurveda and Chemotherapy Visha Dravya is a Sanskrit term that refers to poisonous drugs. Chemotherapeutic agents belong in this classification, as they all possess a hot potency. While working to destroy cancerous cells, they inadvertently destroy healthy cells within the GI tract, mucous membrane, skin, hair root, and other organs. Chemotherapy drugs embody properties that directly oppose the Rasa, Kapha and Ojas in an individual, thereby creating vitiation in the vata and pitta doshas while depleting the Kapha dosha, leading to the depletion of the rasa and Rakta dhatus and resulting in the depletion of Ojas.
Life after Chemo When the round(s) of chemotherapy end(s), many of the acute symptoms end too. However there are longterm effects that are now a part of a persons’ physical landscape. Common long –term (1 year and beyond) complaints include fatigue, anemia, neuropathy or numbness (due to injured nerves), lymphedema (arm or leg swelling), dry mouth, teeth problems, loss of taste, painful mouth and gums, jaw stiffness or jawbone changes, weight gain, weight loss, trouble swallowing, hormone depletion and lack of libido. Many of these conditions can develop months or years after the treatment has ended. There is also a large psychological component , where the entire paradigm of a healthy life is transformed. Even if the cancer http://www.ayurvedacollege.com/book/export/html/2
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is in remission, a cancer survivor can experience deep fear from the possibility of recurrence and as a result have difficulty making life decisions, such as career path or marriage. Values and goals may be altered, reflecting deeper inquiry into spiritual and existential concerns over death and dying. The psychological path of a cancer patient is constantly changing, with transitions being particularly stressful, such as the “Transition from treatment to longterm follow up.”
The Heart of Healing: Ojas “Disease always forces us to confront our attachments. All attachments are temporary and are dissolved by Nature when She feels it is time to broaden our personalities. Disease is always an opportunity to learn from our mistakes, an opportunity that nature provides us out of Her maternal magnanimity. She hopes we will learn enough so we will never be sick. She can even teach us how to overcome death ….Rejuvenation is the first step in the direction of immortality”. –Dr. Robert Svoboda To understand the ayurvedic concept of Rasayana and its protocols, it is necessary to understand the concept of Ojas . It is defined poetically in verse from the Caraka Samhita: Ojas: It maintains the living beings by its saturation; Without ojas no life of creatures exists, It is the initial essence of embryo and also the essence of the embryo’s nourishing material, It enters into the cardiac cycle first, If it is destroyed, it leads to destruction of that person, It is the sustainer It is located in the heart, It is the cream of the nutrient fluid in the body, It is where vital factors are established, It is the fruit of them or they produce various types of fruits. In the Astanga Hrdayam, Ojas is seated in the hrdaya (Heart); although it is the essence of all the dhatus. It is what regulates the body and even has a texture( viscous) and color (reddish yellow). The loss of ojas leads to a loss of life. According to Dr. Robert Svoboda , the definition of Ojas is “A hormone –like substance which is derived from Shukra. Ojas produces the aura, transmits energy from mind to body, and controls immunity.” Dr. David Frawley contends that Ojas is the is the foundation of the development of all other faculties: “ The internalized essence of digested food,water,air, impressions and thought, the basis for patience, control of the senses and mental endurance.” Many causes of the loss of Ojas are listed in the classical text and in the notes given by Professor K.R.Srikantha Murthy, who references many additional factors from other classical sources including Abhisanga (assault by evil spirits; microorganisms such as bacteria, virus, etc.) and Visa, ingestion of poisonous substances. Dr. Marc Halpern cites in The Principles of Ayurvedic Medicine that Ojas can be defined as the “force of contentment and stability.” Dr. Halpern connects the condition of low ojas with the presence of cancer in the affected tissue; and as the disease progresses, for the systemic Ojas to become lower and lower. In order for long term healing to occur, one’s Ojas needs to be rebuilt. The Astanga Hrdayam plainly states that the increase of Ojas creates “Contentment, nourishment of the body and increase of strength”. http://www.ayurvedacollege.com/book/export/html/2
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An Ayurvedic Solution “Ayurvedic Herbology reaches its culmination in the science of rejuvenation .Aimed at the renewal of both body and mind, Ayurvedic herbology does not seek simply longevity, but moves towards a life of pure awareness, natural creativity, spontaneous delight.” –Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs Rasayana, or Rejuvenation therapy, provides multidimensional relief to the many residual issues imposed on a person who has undergone chemotherapy. The general effects of rasayana therapy include Vayahsthapana (antiaging), Balya (restoring power), and Jeevaniya (improving vitality). Rasayana literally means “The path of Rasa.” This implies a journey back to health. Dr. Svoboda impresses the importance of the health of the Rasa dhatu, which is the substance by which other dhatus are formed. He continues to describe healthy Rasa as the primary element in creating healthy shukra, where ojas are produced. Bri Maya Tiwari describes rasa as “The mother essence of healing.” She continues to define Rasa as the taste we have for all things, not only with our mouths to taste food, but through sensory impressions as well. The path to healing includes all forms of Rasa, and in choosing the appropriate foods and rituals (sadhanas) in one’s daily life, one can engage in the inherent intelligence of acting in accord with their surroundings, thereby forging a clear path to health. Nourishing the Rasa requires the physical consumption of the sweet taste. Made up of the elements water and earth, it is the perfect foil to the hot, sharp qualities of Chemotherapy. Dr. Svoboda defines honey and its origins, pollen , which is referred to as the sperm of plants, as plant shukra, which increases human shukra and thereby nourishing Rasa. In this way honey is a primary food in rasayana therapy. The Sanskrit term for honey, Madhu , appears in numerous classical rejuvanative formulas. One such formula that is very popular is Chyavanprash, a spicy sweet amla based jam consisting of 5 of the 6 tastes(excludes salty). Other foods which provide the sweet taste include Whole Grains, root vegetables, fruits and milk. Foods that have the sweet taste have a cool potency(virya) and a sweet post digestive effect (vipaka). Each dhatu benefits from the sweet taste; Foods that increase the Rasa Dhatu include some dairy products, fruits and oils; Molasses, black grapes, carrots and beets enrich the rakta dhatu; Meat, grains and nuts build mamsa dhatu; Oils, dairy, wheat and nuts replenish the medas dhatu; Bone soups will aid the Asthi dhatu; Ghee , butter and nuts protect the majja dhatu; Milk, ghee, almonds and sesame seeds enliven the shukra dhatu. A balanced amount of sweet taste in accordance with one’s constitution will help the recovering patient to rebuild healthy tissue. It is also essential to eat seasonally and locally. In Maya Tiwari’s Living Ahimsa Diet, she makes a strong case for the effectiveness of honoring the cycles of nature. The presence of foods as they appear in order out of the ground is not coincidence; but rather an ancient agreement between all living things to feed and be fed at the appropriate time. Since us as humans are created from the same elements that have created the seasons, we share this inherent rhythm with nature. “Only the rhythms of the seasons have the power to fully restore our vital tissues and their innate memories that guide their form and function to perfect health”. Another important component of restoring health to a body ravaged by cancer and its treatments are the plantbased medicines utilized in Rasayana therapy. In the article published by AYU :An international Quarterly Journal of Research in Ayurveda, A trial involving a total of 36 cancer patients were divided into two control groups where one group received chemotherapy and radiotherapy and another group received the same cancer treatments along with an ayurvedic formulation Rasayana Avaleha. The results showed a clear indication that the formula helped to protect patients from the adverse effects while going through treatment. The herbs used in this formula are ones that are used in many classical rejuvenative formulas and continue to be the subject of many clinical studies. The formula contains Amalaki, Ashwaganda, Gaduchi, Yastimadhu, Jivanti, Tulasi and Pippali. Amalaki (Emblica Officinialis)or Dhatri(the nurse) is one of the strongest rejuvenatives in ayurveda. It is a premium source of vitamin C, rebuilds and retains new http://www.ayurvedacollege.com/book/export/html/2
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tissues and increases red blood cell count, and is also a major component in the rejuvanative Chyavanprash . Ashwaganda (Withania Somnifera) is considered among one of the best rejuvenative herbs for the muscles, marrow , semen and vata constitution, especially in cases where tissues are debilitated as a result of chronic disease. Guduchi (Tinospora Cordifolia) is a potent antiinflammatory and excellent tonic for the immune system. Yashtimadhu(Glycirrhiza glabra) Otherwise known as Licorice, is an effective expectorant, demulcent, emetic, Kaphacleansing agent, laxative, restorative, rejuvenative agent. , Jivanti (Leptadinia reticulate) is a natural source of Quercitin. Tulasi (Ocimum sanctum)or Holy Basil, is the most sacred plant in India, as it opens the heart and mind, clears the aura and strengthens immunity. Pippali (piper Longum), also known as long pepper is a stimulant ,expectorant and revives weakened organic functions. Flavonids as potent antioxidants are vital for protection against disease and are present in Guduchi, Ashwaganda, Amalaki, Pippali, and Tulasi. Many of these herbs have a sweet rasa, cool virya and sweet vipaka, which aid in nourishing Kapha dosha, depleted by cytotoxic chemicals. As a result these herbs serve to offset the cancer anorexiacahexia syndrome, a source of malnutrition in cancer patients. Gaduchi, Ashwaganda and Jivanti are also known adaptogens, correcting imbalances without negative side effects. To combat the psychological conditions that occur posttreatment, Dr. David Frawley, In his book Ayurveda and the Mind, highlights key rejuvenating herbs for the mind. Calamus,(acorus calamus) is a rejuvenative for the brain and nervous system, and used by the ancient Vedic seers. Calamus is currently restricted for internal use by the FDA. Gotu Kola (Centella asiatica),is a rejuvenative that increases intelligence and memory, as well as fortifies the immune system; And Shanka pushpi (Canscora desuccata). Brahmi, or Mandukaparni, (Hydrocotyle asiatica, Umbellifera, Bacopa monniera, Scrophulariaceae) is considered one of the most important nervine herbs in Ayurveda. In The Yoga of Herbs by Drs. David Frawley and Vasant Lad, Brahmi is a great rejuvenative when combined with ghee, as it revitalizes brain cells and purifies the nervous system. The Caraka Samhita has many Rasayana formulas containing the aforementioned herbs. One such formula promises that if used every day for three years a person will live a vital 100 years diseasefree, will be physically strong and solid and untouchable by poison. It begins with the herbs haritaki, amalaka, bibhitaka, haridra, salaparni, bala, vidanga, guduchi, sunthi, madhuka, pippali and katphala cooked into ghee; then amalaka powder (which has been impregnated 100 times with amalaka juice) mixed with ¼ quantity of iron powder(iron Bhasma) , combined with the herbal ghee mixture and some extra honey and sugar. 10gm of the formulation is to be taken every morning and a diet of Sali and swastika rice with ghee along with green gram or milk taken at night. If required, rasayana herbs can add bulk and increase tissue where need, but more importantly these substances will add quality tissue to the body, thereby promoting longevity and the quality of life.
Yoga According to David Frawley in his book “Ayurveda and the Mind”, Dr. Frawley defines Yoga as a means to gain awareness around the “original impetus of life”. It is the human experience to move towards integration, consciously or unconsciously, with universal wholeness and peace. This greater system of yoga can reverse psychological distress by reuniting the mind back into pure consciousness, which “resides in perfect peace.” Where the protocols of Ayurveda heal the body in a physical and subtle way, it also prepares the body for Yoga, an inner pathway that ultimately merges the mind which the “Cyclical nature of the cosmos”. Embodied in the classical eight limbs of yoga lie a treasure of healing practices for the cancer survivor. The use of asana, pranayama, mantra and meditation are invaluable tools to aid in the whole Ayurvedic healing process. Asana includes all postures, either seated of moving, that when done correctly with the right intention, can open up and loosen stagnant energies that may have played a part in causing illness. Pranayama is a method that develops and expands the energy of the lifeforce (prana) beyond its ordinary limitations . Conclusions to a pilot study showed that pranayama may improve sleep disturbance, anxiety and other chemotherapy associated symptoms. According to Dr. David Frawley, Mantra is the most important healing sound therapy in Ayurveda. The word mantra is a word that http://www.ayurvedacollege.com/book/export/html/2
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combines Trayati, that which saves, and Manas, the mind. He explains that mantra can heal emotional patterns by repatterning them where counseling or analysis cannot. The more repetition of the mantra, the more effective it is for the individual. Dr. Vasant Lad instructs that mantra should first be spoken aloud so that the sound is heard by the heart. Ultimately the vibrations of the mantra infiltrate the heart and no external sound is necessary, allowing the deepest resonance within, creating a powerful healing energy. Each person chooses their own mantra; as it is as unique as one’s own constitution. Meditation is another powerful selfhealing tool. A controlled study of ninety cancer patients showed a significant decrease in those who did mindfulness meditation for 7 weeks. 31% had fewer symptoms of stress and 65% had fewer episodes of mood disturbance than those who did not meditate. According to the American Cancer society, Some studies have also suggested that more meditation improves the chance of a positive outcome. Deepak Chopra describes the effectiveness of meditation and healing as follows: ” Rather than considering it a relaxation response, consider it as a heightened awareness or a restful alertness response. We meditate to experience an inner wakefulness, an inner knowingness that gives us a sense of control over the processes inside our body, as well as over our life experiences. In the silence of meditation there is alertness, flexibility, creativity, sensitivity, freshness, aliveness and renewal. There is pure consciousness, no contamination of experiences in the past, by memories or by cravingsawareness remain pure, full of energy, full of clarity.” Additional holistic therapies that will help an individual back to health and strengthen ojas include aromatherapy and Chromotherapy . Aromatherapy enlists the sense of smell to take in the environment . Certain plants provide energetics through their oils that are extracted from the various parts, depending on the plant. If the scent is in accordance with one’s nature, the effects can be extremely beneficial to the mind, body and consciousness. Chromotherapy, or the use of color to improve overall health, is a broad field that covers everything from decorating the home in a color scheme that is according to one’s prakriti to using colored lights to treat different parts of the body. Understanding the elemental quality of color and how it relates to nature is another way of bringing a sense of harmony to one’s environment, setting the stage for effective healing.
Soma and the quality of Life For a cancer survivor, mortality is no longer a distant concept. Many survivors do not consider themselves healthy; There is always a chance of recurrence of the disease. However, many survivors find that their life takes on new meaning after cancer. Life and living take on greater value. This attitude often leads the survivor to a more thoughtful position on spirituality. As with any crisis, a space is created where new paradigms are forged in seeking the greater meaning to life. According to David Frawley in his book Soma in yoga and ayurveda, greater longevity is only a benefit if we connect to meaning, consciousness and creativity, and doing so requires” An ability to connect with the immortal essence of our being.” This is only one aspect of Soma. Dr. Frawley interprets, through his lifelong study of the Vedic texts, a vast concept that encompasses physical and nonphysical , inner and outer manifestations of lasting bliss, resulting in the infinite quest for immortality. Soma, both material and otherwise, is rooted in the field of rejuvenation. Through traditional ayurveda therapies, diet and lifestyle , internal soma will unfold, revealing the potential for “immortality of spirit”. In exploring this inner immortality, the physical body is no longer the object of greater longevity, but rather a desire to achieve a “Greater existence in consciousness itself” provides a true prolonged existence.
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In Maya Tiwari’s The path of Practice, an autobiographical account of her victory over incurable ovarian cancer, she is summoned into healing through spiritual reckoning, after being told that nothing else could be done to save her. Her journey back to perfect health is a testament to the value of the wisdom of Ayurveda and its protocols. Along with her devotion to her daily practices(sadhanas), Tiwari simultaneously engaged deeply into an agreement with the sea of souls before her; And to connect to the supreme consciousness that provides an everlasting awareness, or pure love. For the cancer survivor, it is a long road back to health. With the use of proper diet, herbs, sensory therapies and lifestyle choices, Ojas can be strengthened. However, if the person continues to explore the relationship between their own receptivity to the healing practices and the healing practices themselves, and they make their journey about this, with an open mind and an open heart…Oja s can be restored. http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/chemotherapylanding Bruce A. Chabner and Thomas G. Roberts. (2005). Chemotherapy and the war on cancer. Nature Reviews Cancer. doi:10.1038/nrc1529 Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 http://cancer.stanford.edu/information/cancerTreatment/methods/chemotherapy.html The Medical and Psychological Concerns of Cancer Survivors After Treatment ." From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press, 2005 . Premalatha balachandran, Rajgopal Govindarajan, Canceran ayurvedic perspective.http://www.elsevier.com Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 19952012) Appendix C: Managing Cancer pg.A33. Premalatha balachandran, Rajgopal Govindarajan, Canceran ayurvedic perspective. http://www.elsevier.com Bhishagratha KL. Sushruta samhita (Varanasi:choukhamba Orientalia,1991) Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 19952012) Appendix C: Managing Cancer pg.A33. Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 Premalatha balachandran, Rajgopal Govindarajan, Canceran ayurvedic perspective. http://www.elsevier.com Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 http://www.danafarber.org The Medical and Psychological Concerns of Cancer Survivors After Treatment ." From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press, 2005 . Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161. Sharma PV, Caraka Samhita ,(Varanasi: Chaukhambha Orientalia;1981) Su30#911 Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi 2011.) Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98) 197198. Dr. David Frawley, Ayurvedic Healing For Healthcare Professionals (California College of Ayurveda, Copyright 19882011)pg.264. http://www.ayurvedacollege.com/book/export/html/2
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Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi 2011.) p.163164. Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.238. Dr. Marc Halpern, Clinical Ayurvedic Medicine (Dr. Marc Halpern and the California College of Ayurveda 19952012) Appendix C: Managing Cancer pg.A34. Vagbhata, Astanga Hrdayam Eighth edition , translated by Prof. K.R. Srikantha Murthy (Chowkhamba Krishnadas Academy, Varanasi 2011.) p.164. Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161. Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)p. 274. Ibid. Dr. Robert E. Svoboda, Prakriti: Your Ayurvedic constitution (Twin Lakes, WI: Lotus Press, 11/98)p.161. Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.277. Maya Tiwari, Living Ahimsa Diet,(Mother Om Media,2011) p.8081 Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy in reducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.161 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.242,243 Ibid,p.127128 Pal A, Sharma PP, Pandya TN, Acharya R, Patel BR, Shukla VJ, Ravishankar B. Phytochemical evaluation of dried aqueous extract of Jivanti [Leptadenia reticulata (Retz.) Wt. et Arn]. Ayu. 2012 Oct;33(4):55760. doi: 10.4103/09748520.110525. Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.102,103 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.180 Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy inreducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 Purvi Vyas,A.B. Thakar, M.S. Baghel, Arvind Sisodia, Yogesh Deole, Efficacy of Rasayana Aveleha as adjuvant to radiotherapy and chemotherapy inreducingadverseffects.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202271 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.106,107 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.171 http://www.ayurvedacollege.com/book/export/html/2
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Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)pg.199 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.240241 Sharma PV, Caraka Samhita ,(Varanasi: Chaukhambha Orientalia;1981) Ci 1.1 #77 Dr. David Frawley and Dr. Vasant Lad, The Yoga of Herbs, Second revised and enlarged edition, (Twin Lakes, WI: Lotus Press 2001)p.72 Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)p.259 Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)p. 72. Dr. Vasant Lad, Ayurveda: the science of Selfhealing, A practical guide ( twin Lakes, WI: Lotus Press 2004)p.113 Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996)p271 Anand Dhruva,MD,Christine Miaskowski,PhD, Donald Abrams, MD, Michael Acree PhD, Bruce Cooper, PhD, Steffanie goodman,MPH, and Freerick M Hecht,MD, Yoga Breathing for Cancer ChemotherapyAssociated Symptoms and Quality of Life: Results of a Pilot Randomized Controlled Trial (The journal of Alternative and Complementary medicine, Volume 18, Number 5,2012) pp473479 Dr. David Frawley, Ayurveda and the Mind: the healing of consciousness, (Twin Lakes, WI: Lotus Press 1996) Dr. Vasant Lad, Ayurveda: the science of Selfhealing, A practical guide ( twin Lakes, WI: Lotus Press 2004)p.125 Speca M, Carlson LE, Goodey E, Angen M. A randomized, waitlist controlled clinical trial: the effect of a mindfulness meditationbased stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62:613622. www.AmericanCancer society.com Transcribed from an interview with Deepak Chopra, the Oprah Winfrey show, 2013 Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.325. Dr. Marc Halpern, Principles of Ayurvedic Medicine: Tenth Edition (September 2010)p.332334. http://health.usnews.com/healthconditions/cancer/informationonsurvivingcancer David Frawley, Soma in Yoga and Ayurveda: The power of rejuvenation (Twin Lakes, WI: Lotus Press 2012) Author’s Preface. Ibid. Maya Tiwari, The Path of Practice (Ballantine Publishing, November 2000.)
Better Known as Turmeric (By: Ivy Cannon A.H.E.) Introduction Over thousands of years, turmeric has served many purposes. This versatile root's bright yellow color has always been used for paints and dyes. Far superior to its use for color are its many culinary applications and medicinal purposes. Because of its widespread use, this wonderful root has http://www.ayurvedacollege.com/book/export/html/2
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nearly as many names as uses. Numerous are the names given to this amazing root but it is most commonly known as Turmeric (Curcuma longa). "Curcuma is Latinization of Arabic alkurkum [rfi..SJI], which originally means saffron but is now used for turmeric only." [1] Turmeric is sometimes called indian saffron, golden goddess, haridra, haldi, jiang huang, curcuma longa, kha min chan by the Thai, kunir in Indonesia, kurkuma by the Germans and Terremerite in France. In almost every language it means "yellow root." In India alone it has over 10 different names: halad, haradi, nisa, kancani, pasupu, makhal, halud, ladir, pivari and yositpriya. Haradi is a plant native to southern India and Asia, and it is closely related to ginger. 'Turmeric (Curcuma longa) is a rhizomatous herbaceous perennial plant of the ginger family, Zingiberaceae." [2] "A tall herb, rootstock large, avoid, with sessile cylindric tubers orangecolored inside. Leaves very large, in tufts up to 1.2 meters long, including the petiole which is as long as the blade, oblonglanceolate, tapering to the base. Flowering in autumn, spikes 1015 cm long; peduncle 15 cm or more, concealed by the sheathing petiole; flowering bracts pale green; bracts of coma tinged with pink." [3] The root looks much like ginger with a more orange skin that is thinner. The inside of risa is a yellowishorange color. Another variation is known as kunkum. Kunkum is red on the inside and considered sacred thus not used for cooking. Only the yellow haridra is eaten, and it is essential in most Indian cooking. Aside from being such a great herb for cooking, nisa is one of the most important herbs for both internal and external medicinal use. Understanding the chemical components of ladir is necessary when learning how to use the root effectively. A closer look at curcumin through the lense of science reveals it's healing essence. "Turmeric contains up to 5% essential oils and up to 5% curcumin, a polyphenol." [5] "An active principle curcumin, yellow coloring matter and turmeric oil (or turmeriol) of specific odor and taste, and yellow color." [6] "Curcumin is the active substance of turmeric and curcumin is known as C.I. 75300, or Natural Yellow 3. The systematic chemical name is (1E,6E)1,7bis(4hydroxy3methoxyphenyl)1,6heptadiene3,5dione." [5] "Fresh rhizomes yield 0.24% oil, containing zingiberene." [6] The plant kingdom classification of turmeric shows its close relation to ginger. Kingdom: Plantae Plants Subkingdom: Tracheobionta Vascular plants Superdivision: Spermatophyta Seed plants Division: Magnoliophyta Flowering plants Class: Liliopsida Monocotyledons, Subclass: Zingiberidae Order: Zingiberales Family: Zingiberaceae Ginger family Genus: Curcuma L. curcuma Species: Curcuma longa L. common turmeric [4]
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Traditionally the active principle curcumin, which gives turmeric its bright yellow color, was used as a fabric dye. It's use in this application has varying results and ultimately the color it produces fades fast. "Essentially turmeric makes a poor fabric dye, as it is not very light fast. However, turmeric is commonly used in Indian and Bangladeshi clothing, such as saris and Buddhist monks' robes." [7] Even though we now have superior synthetic dyes this root is still used by many cultures as a coloring agent. We may be able to easily replace kunir with a synthetic dye, but we can not employ a different herb to replace it's numerous culinary and medicinal applications. Probably best known for its classic application as a fundamental spice in the curry armamentarium, turmeric is a significant ingredient in most commercial curry powders. Its bright gold color gives curries their characteristic hue and adds an attractive tone, especially to vegetable combinations. Jiang Huang is mostly used in savory dishes, as well as some sweet dishes such as the cake sfouf. "Although most usage of turmeric is in the form of rhizome powder, in some regions leaves of turmeric are used to wrap and cook food. In Goa and Dakshina Kannada (Karnataka state, India), turmeric plant leaf is used to prepare special sweet dishes, patoleo, by layering rice flour and coconutjaggery mixture on the leaf, and then closing and steaming it in a special copper steamer (goa)." [8] Indian saffron is used in so many indian culinary delicacies it's a shame one can't list them all. Some applications include dishes such as dal soup, kitchadi, bhaji, subji, rice khir, raitas, chutneys and pickling. In a more modern culinary application, "Turmeric (coded as E100 when used as a food additive, indicating how it is used as a food coloring since it normally gives food slightly yellow color) is used to protect food products from sunlight."[9] This commonly found food additive has also been proven beneficial to your health. For many thousands of years kunir has been used in a laundry list of applications with effects on all the tissues of body and several body systems. "Turmeric is the best medicine in Ayurveda. It cures the whole person. Turmeric's rasa (taste) is pungent, bitter, astringent, the virya (effect on digestion) is heating with a pungent vipaka (post digestive effect). Turmeric can be used by all doshas (body types). Turmeric helps digestion, maintains the flora of the intestine, reduces gas, has tonic properties and is an antibiotic. Turmeric can be used for cough, sty, diabetes, hemorrhoids, cuts, wounds, burns and skin problems. It helps reduce anxiety and stress." [10] Its herbal actions include a digestive stimulant, carminative (dispel gas), alterative (cleanses circulatory system), vulnerary (heals the skin), hemostat (stops bleeding), antibacterial, purification of tissue while supporting tonification (increase tissue) and emmenagogues (action on female reproductive system). "Its use is indicated when indigestion, poor circulation, cough, amenorrhea, pharyngitis, skin disorders, diabetes, arthritis, anemia, wounds, or bruises are present." [11] Over the centuries it has been used for the treatment of snake bites and scorpion stings. Even now when western medicine is unavailable to those living in more isolated areas, halad is an effective treatment. "The smoke produced by sprinkling powder of turmeric rhizome over burning charcoal will relieve scorpion sting when the part affected is exposed to the smoke for a few minutes." [12] More uses for this wonderful herb include: • • •
for anemia, take a bowl of yogurt with 1 tsp turmeric. Eat on empty stomach morning and evening. Do not eat after dark. for cuts, wound and fungal nail infections, apply mixture of Yz tsp turmeric & 1 tsp aloe vera gel to affected area. for external hemorrhoids, apply a mixture of Yz tsp of turmeric and 1 tsp of ghee locally at bedtime. [10]
Effects on Body Tissues From an Ayurvedic perspective, we can look at each tissue of the body and see how turmeric plays a role in the health of that tissue (dhatu). Here http://www.ayurvedacollege.com/book/export/html/2
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are a few ways haridra works on each tissue of the body, although it is not limited to these actions. In the lymphatic system, known as the rasa dhatu, turmeric purifies the lymphatic fluid, removes stagnation, reduces excess heat associated with low intermittent fever and reduces inflammation of mucous membranes. In the circulatory system, the rakta (blood) benefits greatly from turmerics effects. Some of these include: stimulation of blood tissue development, regulation of blood glucose levels, removal of stagnation in the liver, antimicrobial properties that fight bacterial and viral infections as well as inflammatory conditions and a hemostatic property which acts as a coagulant. It's effectiveness as a hemostat makes it useful for mild internal bleeding due to diseases such as ulcerative colitis. The leaves of kunir also have an antipyretic (cools blood & liver) effect. In the mamsa dhatu or muscle tissue, one may notice benefits for complexion. A paste made of flour and halad is used for treatment of ringworm or other parasitic skin conditions. For a heated skin condition such as herpes simplex virus, one could apply ladir in aloe vera gel to the affected area. The same mixture of turmeric and aloe vera gel taken internally, is used to combat the systemic heat and viral infection associated with a herpes flare up. A haridra and salt paste may be applied to bruises or traumatic injuries where swelling has occurred to not only reduce the swelling, but alleviate some of the pain as well. Nisa may also be used for acne in conjunction with sandalwood. Fat tissue, also known as the medas dhatu, is affected in many ways by jiang huang. Through its purification and clearing stagnation in the liver, it increases function of gallbladder and bile production. This stimulates digestion of fats while also having the ability to aid in the digestion of protein through assisting the pancreas in its digestive functions. All of these factors lead to the maintenance of a healthy body weight. Turmeric stimulates flow through the circulatory system by promoting removal of old red blood cells and production of new red blood cells. The asthi dhatu, or bones, are the site of production for new red blood cells. Golden Goddess has an alkalizing effect on the blood which promotes healthy bones. When the blood ph is low and the body is highly acidic, the blood borrows minerals such as calcium from the bones to bring its ph to a more alkalized environment. This borrowing from the bones leads to a weakening. Over time this can lead to the disease osteoporosis. Through its antimicrobial properties and stimulation of healthy red blood cells, risa can prevent infections of the bones such as osteomyelitis. Indian Saffron is known as a protector against stress and anxiety. It purifies the plasma which is the vital spinal fluid that feeds the brain. With healthy pure rasa (lymph) feeding brain function the entire nervous system is supported. In a recent study on alzheimer's disease haldi was proven to be therapeutically beneficial. "Alzheimer's disease (AD) is a neurodegenerative disorder and the most common form of dementia, affecting more than 5.4 million people in the USA. Some natural products may be used as AD therapeutics from a variety of biological sources, including the anti amyloid agent curcumin, isolated from turmeric." [21] While pivari has a purifying effect, lets not forget its support in tonification (building) of tissue. Mostly associated with use for the female reproductive system it is used as a general tonic and stimulant. Safe for use during later trimesters of pregnancy, its stimulating effect can promote menstruation and thus should be avoided during early conception. While its tonifying and purifying effects maintain healthy reproductive tissue, it's antimicrobial properties make it useful in the treatment of sexually transmitted diseases such as gonorrhea.
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There are specific body systems that the golden goddess has more of an effect on than others. One of these is the circulatory system. "The rhizome is used as a stimulant; and is externally applied to bruises, cuts, ulcers, sprains and pain. It is orally given in blood diseases. Employed in intermittent fevers. Its used externally on bruises and snake bites." [13] In the event of a sprain or pain one can employ various applications of turmeric rhizome. "For general muscle strain, apply warm ginger paste with turmeric (one tsp ginger with Yz tsp turmeric) to the affected area twice a day. Wrap the affected area in a piece of gauze or cotton cloth. A warm compress may be applied for further relief of pain." [14] Healing time for this kind of injury can be increased by daily internal use. "A good antibacterial for those chronically weak or ill. It not only purifies the blood, but also warms it and stimulates formation of new blood tissue. Golden Goddess gives the energy of the Divine Mother and grants prosperity. It is effective for cleansing and purifying the channels of the subtle body." [11] Long term use of ladir has been proven to be an essential part of preventative and holistic medicine. In the digestive system indian saffron is best known for its treatment of inflammation and indigestion with flatus. Although this herb is warm and stimulating, it does not create heat in the liver and actually moves stagnant heat out of the liver and small intestine. For this reason it is sometimes given during bouts of diarrhea. Kunir may be added to high protein food to assist digestion and prevent the formation of gas. It is effectively used to maintain the flora of the large intestine and prevent the formation of toxins. Best taken in a portion of 13 grams of powder with food. In one western study scientist looked at the effects of turmeric as an antiinflammatory in the colons of mice. "The biological activity of Curcuma extract was evaluated against Carbachol induced contraction in isolated mice intestine." [19] Alternating administration of either curcuma longa or a placebo, observations were held for a period of two weeks. In conclusion the study demonstrated, "Curcuma extract has a direct and indirect myorelaxant effect on mouse ileum and colon, independent of the antiinflammatory effect. The indirect effect is reversible and noncompetitive with the cholinergic agent. These results suggest the use of curcuma extract as a spasmolytic agent." [19] Ultimately this study confirms the anti inflammatory and bowel tonic effect nisa has on the digestive system. Golden Goddess is said to assist in the digestion of proteins which in turn assists the pancreas in its activities. These effects are not limited to the pancreas' exocrine functions. For reasons that are still being studied turmeric helps support blood glucose levels. "Health benefits of curcuminoids from C. longa as antioxidants, anticancer and antiinflammatory molecules have been well documented. We report here for the first time that Bisdemethoxycurcumin (BDMC) from C. longa, acts as an inhibitor to inactivate human pancreatic aamylase, a therapeutic target for oral hypoglycemic agents in type2 diabetes." [20] "For the treatment of diabetes, turmeric is also useful. Take four to five 00 capsules after each meal to return the blood sugar levels to normal." [15] Certainly halads promotion of a healthy liver aids in the storage of glycogen and regulation of glucose. This storage and regulation allows the pancreas to function optimally. In the respiratory system haridra is good for fighting infections such as bronchitis. A common treatment for a cold is; "Fresh juice (1020 gms) of turmeric or drink 1 cup milk boiled for 3 minutes with 1 tsp turmeric before bed." [16] To combat cough, sore throat and relieve inflammation in the throat, prepare a turmeric and salt gargle (2 pinch : 2 pinch) in one cup hot water. A "milk turmeric decoction is said to be beneficial for cold, diarrhea, intermittent fever, dropsy, jaundice, liver disorders, urinary diseases, worms (add sugar follow with purgation & enema), trauma and fracture." [17] For sinus inflammation add a pinch of risa to your neti pot or make a medicated oil. The kunir oil may be added to a neti pot or a few drops inserted directly into each nostril.
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There have been many studies held on the effects of jiang huang as an antiinflammatory for the bowels, an antimicrobial for the blood and a blood sugar regulator. More recent studies are showing the effects of halad on cancer cells. One thing we know from collective research is that it reduces heat in the liver by balancing or alkalizing the blood ph. In many cases cancer patients have a low ph. Here are two studies that support the theory of turmeric's benefits for cancer patients. Study 1 "Animal and laboratory studies have found that curcumin, an antioxidant that is an active ingredient in turmeric, demonstrated some anticancer effects. Antioxidants are compounds that can protect the body's cells from damage caused by activated oxygen molecules known as free radicals. However, clinical research is needed to determine curcumin's role in cancer prevention and treatment in humans. Several types of cancer cells are inhibited by curcumin in the laboratory, and curcumin slows the spread of some cancers in some animal studies." [22] Study 2 "Curcumin (diferuloylmethane), the yellow pigment in Indian saffron (Curcuma longa; also called turmeric, haldi, or haridara in the East and curry powder in the West), has been consumed by people for centuries as a dietary component and for a variety of proinflammatory ailments. Extensive research within the last decade in cell culture and in rodents has revealed that curcumin can sensitize tumors to different chemotherapeutic agents. Chemosensitization has been observed in cancers of the breast, colon, pancreas, gastric, liver, blood, lung, prostate, bladder, cervix, ovary, head and neck, and brain and in multiple myeloma, leukemia, and lymphoma. Similar studies have also revealed that this agent can sensitize a variety of tumors to gamma radiation including glioma, neuroblastoma, cervical carcinoma, epidermal carcinoma, prostate cancer, and colon cancer. Although it acts as a chemosensitizer and radiosensitizer for tumors in some cases, curcumin has also been shown to protect normal organs such as liver, kidney, oral mucosa, and heart from chemotherapy and radiotherapyinduced toxicity. These preclinical studies are expected to lead to clinical trials to prove the potential of this ageold golden spice for treating cancer patients." [23] While there are many theories to support kunir's versatile uses, some studies suggest otherwise. "Curcumin (CUR) is the major orange pigment of turmeric and believed to exert beneficial health effects in the gastrointestinal tract and numerous other organs after oral intake. However, an increasing number of animal and clinical studies show that the concentrations of CUR in blood plasma, urine, and peripheral tissues, if at all detectable, are extremely low even after large doses. In view of the very low intestinal bioavailability, it is difficult to attribute the putative effects observed in peripheral organs to CUR. Without testing the fecal matter for concentrations of CUR it can't be said that turmeric has, poor permeation from the intestinal lumen to the portal blood." [18] Just because haridra hasn't shown up in the urine, blood or plasma, doesn't mean it's confined to the intestine. Perhaps once in systemic circulation the compound changes or is picked up by different organs resulting in a low concentration of CUR in the blood, plasma and urine. It would be helpful to conduct a study that could confirm the concentration of CUR in the intestine and fecal matter after high dosages. With the growing trend of turmeric studies, we will soon gain a deeper understanding of the many benefits of this amazing herb. Even with all the recent studies, thousands of years of use are evidence that turmeric is a priceless resource. It is an essential part of everyone's health. Used in preventative measures and ongoing treatment, it has countless uses and applications. Its is no wonder that nisa has been so prized for so long in India and other eastern cultures. Through it's culinary applications and medicinal uses, golden goddess has become an integral part of the survival of human health. Now readily available around the world, it is being used more and more. The bright orange color of turmeric can be spotted wherever you go even when you may not recognize it by name. http://www.ayurvedacollege.com/book/export/html/2
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Bibliography 1/3. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 2. Chan, E.W.C. et al.; Lim, Y; Wong, S; Lim, K; Tan, S; Lianto, F; Yong, M (2009). "Effects of different drying methods on the antioxidant properties of leaves and tea of ginger species". Food Chemistry 113 (1): 166172.doi:10.1016/j.foodchem.2008.07.090. 4. [usda.gov] Plants. USDA. Plant Profile. Curcuma Longa L. common turmeric Web. 24 Sept. 2012 5. [www.wikipedia.org] article. turmeric. (2)composition Web. 24 Sept. 2012 6. Gernot Katzer's Spice Pages. "Turmeric". Etymology. Last Modification 19 Mar. 1999 Web. 24 Sept. 2012 7. [www.wikipedia.org] article. turmeric. (1.5) dye Web. 24 Sept. 2012 8/9. [www.wikipedia.org] article. turmeric. (1.1) culinary uses Web. 24 Sept. 2012 10. Usha Lad & Dr. Vasant Lad. Ayurvedic Cooking for SelfHealing. Second Edition. Page 215216. The Ayurvedic Press, Albuquerque 87112. Copyright 1994, 2009 11. Dr. David Frawley and Dr. Vasant Lad. The Yoga of Herbs. Second Edition. Page 149. Lotus Press Twin Lakes, Wisconsin. Copyright 1986, 2001 12. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 13. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 http://www.ayurvedacollege.com/book/export/html/2
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14. Dr. Vasant Lad. "Ayurveda The Science of SelfHealing." Page 160. "Muscle Strain & Pain." Lotus Press Twin Lakes, Wisconsin. 15. Dr. Vasant Lad. "Ayurveda The Science of SelfHealing." Page 141. "Turmeric." Lotus Press Twin Lakes, Wisconsin. 16. Usha Lad & Dr. Vasant Lad. Ayurvedic Cooking for SelfHealing. Second Edition. Page 215216. The Ayurvedic Press, Albuquerque 87112. Copyright 1994, 2009 17. Dr. Gyanendra Pandey. "Chowkhamba Krishnadas Academy." Krishnadas Ayurveda (K.A.S.) Series48. "Dravyaguna Vijnana." Part 1. Page 737745. "Haridra." Chowkhamba Press, Varanasi. Oriental Publishers & Distributors. 2005 18. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Biofactors. 2012 Sep 20. doi: 10.1002/biof.1042. [Epub ahead of print] "Curcumin uptake and metabolism." Metzler M, Pfeiffer E, Schulz SI, Dempe JS. Source Department of Chemistry and Biosciences, Chair of Food Chemistry, Karlsruhe Institute of Technology (KIT), Adenauerring 20a, D76131 Karlsruhe, Germany. [email protected]. Web. 24 Sept. 2012 19. [Pub.Med.gov US National Library of Medicine National Institutes of Health] PLoS One. 2012;7(9):e44650. Epub 2012 Sep 12. "Curcuma longa Extract Exerts a Myorelaxant Effect on the Ileum and Colon in a Mouse Experimental Colitis Model, Independent of the Anti Inflammatory Effect." Aldini R, Budriesi R, Roda G, Micucci M, Ioan P, D'ErricoGrigioni A, Sartini A, Guidetti E, Marocchi M, Cevenini M, Rosini F, Montagnani M, Chiarini A, Mazzella G. Source Ospedale Policlinico S.Orsola and Dipartimento di Scienza dei Metalli, Elettrochimica e Tecniche Chimiche, Universita degli Studi di Bologna, Bologna, Italy. Web. 2 Jul. 2012 20. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Food Chem. 2012 Dec 15;135(4):263842. doi: 10.1016/j.foodchem.2012.06.110. Epub 2012 Jul 13. "Discovering Bisdemethoxycurcumin from Curcuma longa rhizome as a potent small molecule inhibitor of human pancreatic aamylase, a target for type2 diabetes." Ponnusamy S, Zinjarde S, Bhargava S, Rajamohanan PR, Ravikumar A. Source Institute of Bioinformatics and Biotechnology, University of Pune, Pune 411 007, Maharashtra, India. Web. 2 Jul. 2012 http://www.ayurvedacollege.com/book/export/html/2
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21. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Future Med Chem. 2012 Sep;4(13):175161. "Natural products as a rich source of tautargeting drugs for Alzheimer's disease." Calcul L, Zhang B, Jinwal UK, Dickey CA, Baker BJ. Source Department of Chemistry & Center for Drug Discovery & Innovation, University of South Florida, FL, USA. Web. 25 Sept. 2012. 22. [www.cancer.org Find Support & Treatment Treatments and Side Effects Complementary and Alternative Medicine Herbs, Vitamins, and Minerals] "Turmeric" Last Medical Review: 11/28/2008 _ Last Revised: 11/28/2008 Web. 24 Sept. 2012 23. [Pub.Med.gov US National Library of Medicine National Institutes of Health] Nutr Cancer. 2010;62(7):91930. "Curcumin, the golden spice from Indian saffron, is a chemosensitizer and radiosensitizer for tumors and chemoprotector and radioprotector for normal organs." Goel A, Aggarwal BB. Source Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA. Web. 25 Sept. 2012
Brahmi: “Herb of Grace” Abstract The uses of alternative medicines have increased significantly around the world. The search for effective and safe medicines is always on as well as new uses of old medicines are being looked into. Brahmi is an Ayurvedic medicinal herb which has been used for centuries. Certain neurological disorders have limited therapeutic options in Western medicine and hospitals and research institutes across the globe are increasingly looking into Ayurvedic science for effective and safer alternatives. Brahmi is a wellknown nootropic herb and its uses in neurological and psychiatric disorders are well recognized. Its efficacy and safety is supported by research and thousands of years of knowledge and experience. Despite being such an old medicine, its new benefits are constantly being studied. Brahmi is one of the most sattvic herbs known in Ayurvedic pharmacopeia since Vedic times. Here, we will delve deep into the Brahmi plant, its science, its Ayurvedic uses and much more.
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Introduction In recent times, the use of herbal products has increased significantly in the western world as well as in the developing countries. Brahmi is an important medicinal plant that has been widely used therapeutically in the orient and is becoming increasingly popular in the west 6. Brahmi is a Sanskrit word derived from “Lord Brahma” or “Brahman”. Lord Brahma is the divinity responsible for all of the creative forces in the world and Brahman is the Hindu name given to the universal consciousness. Brahmi literally means the energy (or “Shakti”) of Brahma 8, 9, 10. Thus, Brahmi has a lot to offer to the medical world 9. The ancient Ayurvedic sages, who were also great physicians, revealed Brahmi’s role in promoting Medhya (intellect), Ayushya (longevity), Rasayana (rejuvenation), Prajnasaktivardhana (intellectual power), Hrdaya (Heart), Majjadhaty Rasayana (nervous system rejuvenation), Balya (strength, especially mind), Jivaniya (life energy), Nidrajanana (sleep), Dhana (wealth), Svara (voice), Varna (complexion) and Anuloma (redirecting the flow of vata downwards). Over the centuries, the role of Brahmi in the treatment of Kustha (leprosy/skin disorder), Pandu (anemia), Meha (diabetes), Asra Vikara (blood disorders), Kasa (cough), Visa (poison), Sopha (edema), Jwara (fever), Vatahara (vata), Unmadahara (mental illness), Unmada (insanity), Alaksmi (inauspiciousness), Apasmara (epilepsy), Papa (evil deeds), Krtya (black magic), Ruk (pain) and Manasavikara (mental disorders) has been well described 3, 5, 9, 19. Scientifically, Brahmi is known as Bacopa Monnieri L. Pennell; some of the other names it is also known as are Bacopa monniera, Indian Pennywort L. Pennell, Bramia monnieri L. Pennell, Gratiola monnieria L, Herpestes monnieria L. Kunth, Herpestis fauriei H. Lev, Herpestis monniera, Herpestris monnieria, Lysimachia monnieri L. and Moniera euneifolia 4. The herb comes from the family of Plantaginaceae; it can also be placed under families of Scrophulariaceae, Gratiolaceae, or Veronicaceae 2, 4. It commonly grows in marshy areas throughout India, Nepal, Sri Lanka, Pakistan, China, Taiwan, Vietnam & USA. In the USA, it is grown in Florida, Hawaii and other southern states 4. It is widely distributed across most regions of the world including China, India, Canada, USA, Brazil, Australia, Argentina, Nigeria, South Africa, etc. 2 Due to Brahmi’s widespread availability across the globe, it is often recognized by different names in different regions and languages. In Sanskrit, it is called Saraswati (Goddess of learning, knowledge and wisdom or the essence of the self), Somavati (containing soma or nectar), Indravalli (energy of Lord Indra), Brahmi (knowledge of Brahma or supreme reality), Adhabirni 2, JalaBrahmi, or Svetakamini 7. In Hindi, it is known as Brambhi, Safed kami (white Lord) 7, Brahmi, Jaributi (herb), Nirbrahmi, or Jalneem. In Gujarati, it is known as Jalanevari or Kadavi luni (the better herb). In English, it is called herbofgrace, Bacopa, Thyme leaved Gratiola, or Waterhyssop. It is known as Farfakh (the hottest tree) in Arabic, Jia ma chi xian in Chinese, Kleines Fettblatt, or Wasserysop in German, Medha giree (mountain of wisdom) in Nepalese, Litet tjockblad in Swedish and many more 2, 7. The plant Brahmi is a small creeping perennial with numerous branches and small, oblong, relatively thick leaves which are arranged opposite to each other on the stem. Flowers are small and light purple or white with four to five petals. It can grow naturally in wetland, shallow water, damp and muddy shores. Its ability to grow in water makes it a popular aquarium plant; it can also grow in slightly brackish conditions 4, 11. What makes Brahmi a unique plant is that even though it is an aquatic plant, it can easily be cultivated in pots, in a garden under a shade or even under full sun when http://www.ayurvedacollege.com/book/export/html/2
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provided ample water 13. The whole plant can be used for medicinal purposes. It has bitter and sweet taste (Rasa), cooling energy (Virya) and sweet postdigestive effect (Vipaka). It normalizes all three Doshas and all Dhatus (tissues), especially nerve, blood and plasma. It has an effect on numerous Srotas (system); like circulatory, digestive, nervous, excretory, muscular and reproductive 8, 9. Mandukaparni and Brahmi Since the 3rd century, ancient Ayurvedic authors like Charaka, Sushruta and Vagbhatta treated Brahmi and Mandukaparni as two different herbs 15. Later, confusion was created in the 16th century when Bhavaprakasha and Hemadri equated Brahmi with Mandukaparni 4, 15. Since then, Centella Asiatica (Gotu Kola or Mandukaparni) has been known as Brahmi, particularly in North India and Kerala 4. However, according to The Ayurvedic Formulary of India, Bacopa monnieri is Brahmi and Centella Asiatica is Mandukaparni 9. A critical study of comparative photochemistry, pharmacology and therapeutic properties of these two drugs has proven that they are distinct 15. Brahmi was used specifically in mental diseases like insanity and epilepsy, while Mandukaparni was used as a general brain tonic. Another study published in 2012 proved that these two herbs exhibited significant differences in their antioxidant values too. The study concludes that regular use of Brahmi as a supplement could be more helpful compared to Gotu Kola in the treatment of neurological disorders caused by free radical damage 14. Brahmi promotes fertility and sustains implantation; while Mandukaparni is abortifacient. Both are used for skin diseases but their therapeutic effects are different 15. Also, unlike Brahmi, Mandukaparni is a stronger diuretic 8. Hence, these two are entirely different herbs.
Brahmi and Ayurveda In India, Brahmi is largely treasured as a revitalizing herb used by Ayurvedic medical practitioners for almost 3000 years. The herb has been mentioned in several Ayurvedic treatises including Charaka Samhita and Sushruta Samhita in the 3rd century AD 11. In addition to being a well known Nootropic herb for centuries, it has also been used as an antispasmodic, alterative, astringent, cardio tonic, diuretic, anticonvulsant, anti inflammatory, analgesic, antipyretic and antiepileptic agent 8, 9, 10. Brahmi is one of the best herbs for balancing and rejuvenating Pitta, while at the same time strongly reducing Kapha 8. It enhances the quality of Sadhaka pitta which directly influences the nature of consciousness 9. It can balance Vata if taken in proper doses or with other antivata herbs 8. It aids in the recovery from exhaustion, stress, debility and aggravation of vata. It helps in all conditions with a deficient Majja dhatu; hence it is used in Parkinson’s disease, Alzheimer’s disease, dementia, ADHD, Asperger’s syndrome, autism, insomnia and depression 9. It reveals its sattvic quality by helping to give up bad habits and all types of addictions. It aids in recovery from alcoholism or drug abuse, and also helps to kick the sugar habit. For this reason it is added to many Ayurvedic formulas as a nervine agent 8. As a purifier, it is a first rate herb to cleanse the system by eliminating all sorts of poisons. It is therefore very useful in leprosy, syphilitic and scrofulous ulceration, obstinate eczema, cutaneous affections and psoriasis 12. According to Bhavaprakasha, Brahmi is useful in skin conditions with underlying nervous imbalance. In addition to a blood purifier, it strengthens the immune system, allays excess sexual desire, and is beneficial in venereal diseases, including AIDS. It also cleanses the kidneys, while calming and soothing the liver. It calms the heart and helps guard against heart attacks 8. It is beneficial in relieving tension throughout the system and helps to ease constipation from stress, relaxes muscles and alleviates menstrual pain and disorders. It has a cooling effect http://www.ayurvedacollege.com/book/export/html/2
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on Mutravaha srota (urinary system) and it cools the heat of cystitis and pain of dysuria by guiding pitta out of the system 9. Brahmi Rasayana Ancient Ayurvedic texts describe a remedy called Brahmi Rasayana which is a molecular nutrient and nutrition enhancing agent. According to Acharya Charaka, Rasayana therapy improves the nutritional status of the body, leading to the formation of better qualities of cells and tissues which can sustain aging and stress 18. Sage Sushruta explains Brahmi Rasayana as an elixir and remedial agent which improves memory and invigorate mental faculties, as well as increasing the duration of human life. After proper cleansing of the body, Sushruta describes the treatment with fresh juice of Brahmi and an extremely light diet at a specific time of the day for 21 days. It improves memory and intellectual power every week of the treatment. The complete 21day treatment removes all inauspicious features of the body and the mind. The Goddess of learning appears in an embodied form in the mind of the user and the mind gains different kinds of knowledge. It also enables the person to live for five hundred years 17. As a heart rejuvenator, it is recommended in the treatment of heart diseases 30. Acharya Charaka also used Brahmi as one of the herbs in preparation of Aindra Rasayana to treat Svitra (leucoderma), kustha (skin diseases including leprosy), Jathara (abdominal diseases including ascites), Gulma (phantom tumor), Purana pliha (chronic splenic disorders), Visama jvara (irregular fever); and in Indrokta Rasayana to improve longevity, youth, voice, complexion, nourishment, intellect, memory and strength and be disease free 5. The Rasayana specific to the brain called Medhya Rasayana slows the brain aging process and helps in regeneration of neural tissues besides producing antistress, adaptable and memory enhancing effects 18. The soothing effects on the nervous system as well as its mind enhancing capability are legendary. According to Dr. Frawely, it is the most important Nervine herb used in Ayurvedic medicine; it improves memory and aids in concentration. It revitalizes the brain cells by removing toxins and blockages within the nervous system, while at the same time having a nurturing effect. Brahmi, which grows in the Himalayas, is an important food for yogis practicing meditation. A small amount of its fresh leaves are eaten daily for rejuvenating the mind and to improve meditation. Brahmi helps awaken the crown chakra (Sahastrara; the seventh spiritual chakra in head) and balances the right and left hemispheres of the brain 8, 9. Brahmi has been used as Medhya Rasayana since Vedic times and it is still well researched in today’s medical world. Usage forms The Ayurvedic pharmacopoeia of India mentions important formulas of Brahmi as Sarasvataristha, Brahmi Ghrita, Ratnagiri Rasa, Brahmi Vati, Sarasvata Curna and Smrtisagara Rasa 19. The herb can be taken as ghrita (medicated Ghee), medicated oil, churna (powder), svarasa (fresh juice), infusion, decoction, tincture (fermented beverage), syrup, tea, lepa (paste), pill or eaten fresh (leaves). As a milk decoction, Brahmi is a good brain tonic, particularly if combined with Aswagandha 8. Sarasvataristha is a fermented beverage (tincture) in which Brahmi is the major constituent, used in the treatment of infertility, epilepsy and mental disorders 20. As a medicated oil, it helps relieve joint pain, headache and to clear the mind. When massaged on the skull, it works as a brain tonic to strengthen memory and encourage hair growth 9. Brahmi paste applied to the neck is very useful in cough and pneumonia, especially in children 12. Topical use also treats diaper rash in infants 30. Brahmi lepa (paste) helps to reduce swellings. A poultice made of boiled plant is placed on the chest in acute bronchitis and other coughs in children. Its leaves are fried in ghee (purified butter) and consumed to relieve hoarseness. Juice of its leaves is given to relieve diarrhea in children. Brahmi juice mixed with petroleum can improve symptoms when applied in rheumatism 7. As neti, Brahmi is one of the best herbs to normalize the absorption of prana through the http://www.ayurvedacollege.com/book/export/html/2
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sinus 30. A cup of fresh Brahmi tea taken with honey before meditation is also a great aid in its practice 8. When combined with ghee (purified butter) or milk, Brahmi has a tonifying, nerve nourishing and pitta cooling effect 9. Brahmi Ghrita or Ghrta (Brahmi medicated ghee) is a popular formula referenced in classical Ayurvedic texts. Charaka described the recipe of Brahmi Ghrita as one part old cow’s ghee cooked with four parts Brahmi juice and 1/4th part in total of the paste of vaca, kustha and sankhapuspi. This medicated ghee cures insanity, inauspiciousness, epilepsy and effects of evil deeds 5. In Astanga Hrdayam, Brahmi Ghrta is mentioned with herbs like vyosa, syama, trivit, danti, sankhapuspi, nrpadruma, saptala and krmihara for the treatment of insanity, leprosy and epilepsy, and to improve speech, voice, memory, intelligence and to bestow sons to barren women 6. Classical texts also mention the use of Brahmi along with other herbs in the preparation of other Ghrtas. For example: Maha paisacika Ghrta to treat insanity 6 and Tryusanadya Ghrta to cure fever, gulma (phantom tumor), anorexia, splenic disorders, headache, chest and cardiac pain, jaundice, piles, vatika type of asthila (hard tumor), phthisis and tuberculosis 5. Brahmi Ghrita can be applied as nasya in doses of five drops per nostril in the treatment of mental disorders. Brahmi Ghrita prepared with sesame or coconut oil can be massaged on the feet, large joints and ears before sleep in the treatment of anxiety and depression 20. According to Dr. Frawely, “Brahmi Ghrita is the best rejuvenative for the mind and the heart which should be kept in every home” 8. With other herbs When Brahmi is combined with other herbs, its medicated qualities are expanded even further. Taken with basil and a little black pepper, Brahmi is good for all kinds of fevers 8. When used with neem, manjishtha and turmeric, it helps in skin conditions with pitta imbalance 9. According to Dr. Halpern, a popular remedy for acne is to combine Brahmi and turmeric in equal amounts, add 1 tsp. (4oz.) of warm cow milk and ½ tsp. of ghee and taken twice a day for several months. This remedy reduces Bhrajaka pitta on the skin (acne) and makes the skin lustrous 30. Brahmi and vacha stimulate the mind with a high kapha condition, whereas; gotu kola, jatamansi and tagarah bring out its sedative effect. Brahmi combined with aswagandha, kushta, kappikacchu, shankhapushpi and bala works as a nerve tonic. Brahmi Rasayana, with ten parts Brahmi, forty parts sugar, two parts clove and one part each of cardamom and pippali, works as an antiinflammatory and nerve tonic agent. When combined with digestive stimulants like ginger and cardamom, it suppresses the appetite; with cumin, fennel and ajwan it relaxes the intestines 9. Kaya Kalpa Swami Sivananda described a very remarkable treatment called Brahmi Kalpa treatment in his book – ‘The Practice of Ayurveda’. It is a treatment of ‘Kaya Kalpa’, where ‘Kaya’ means the body and ‘Kalpa’ means transformation or rejuvenation. After going through pancha karma, he explains Kaya Kalpa treatment with fresh Brahmi leaves’ juice and fresh cow milk for 45 days. The treatment restores the aged and debilitated body to its pristine youth and vigor, reestablishes the full potential of the senses and imparts good health. It prolongs as well as improves the quality of life. It restores the natural balance of all three doshas, brings the function of sapta (seven) dhatus to a normal condition and cures many incurable diseases 12.
Brahmi and Science Over the last few decades, Brahmi has been researched extensively for its chemical constitution and identification of its therapeutic role. http://www.ayurvedacollege.com/book/export/html/2
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Compounds responsible for the pharmacologic effects of Brahmi include alkaloids, saponins, and sterols 21. Detailed investigation first reported the isolation of the alkaloid ‘brahmine’ from Brahmi 11. Later, numerous compounds have been isolated including nicotine, herpestine, betulic acid, stigmastarol, betasitosterol, as well as numerous bacosides and bacopasaponins 21. Extensive investigation on the plant extract and isolated bacosides, especially bacosides A and B, confirm their nootropic (Medhya Rasayana) action 23. Brahmi enhances the three basic components of mind: power of learning (Dhi), power of retention (Dhuti) and power of recall (Smriti) 21. Since 1993, Central Drug Research of India has been doing extensive research with Brahmi on human volunteers 13. Triterpenoid saponins and their bacosides are responsible for Brahmi’s ability to enhance nerve impulse transmission. The bacosides aid in repair of damaged neurons by enhancing kinase activity, neuronal synthesis, and restoration of synaptic activity, and ultimately nerve impulse transmission 22. A research on adults indicated that Brahmi had a significant effect upon retention of new information; improved the speed of visual information processing, learning rate and memory consolidation within 12 weeks of treatment 20. A 2012 research study on the elderly clearly demonstrated that B. monnieri suppresses AChE activity resulting in enhanced cholinergic function, which in turn enhances attention and memory processing and increases working memory 24. In children, a 12 week Brahmi treatment revealed significant benefits with improvement in sentence repetition, logical memory, and paired associate learning tasks 22. Brahmi helps in coping with combined hypoxic, hypothermic and immobilization stress that could lead to the onslaught of ‘free radicals’ (highly reactive oxygen species). Brahmi extract exhibits interesting antioxidant properties, expressed by its capacity to scavenge superoxide anion and hydroxyl radical, and to reduce H2O2 induced cytotoxicity and DNA damage in human fibroblast cells. An animal study showed its antioxidant activity in the hippocampus, frontal cortex and striatum. Brahmi extract has shown neuroprotective effect against aluminuminduced oxidative stress in rat brain; and reduced nicotineinduced lipid peroxidation and geno protection in mice. It reduces amyloid levels and can be used in the therapy of Alzheimer’s disease 11. Since mild cognitive impairment (MCI) and early phase Alzheimer's disease occur due to cholinergic degeneration and oxidative stress, Brahmi extract provides a benefit in terms of decreasing memory impairment in these two diseases and even in attention deficit disorder 24. A study has shown a protective role of bacoside A against chronic cigaretteinduced oxidative damage in rat brain 11. In the management of stress related study, Brahmi extract was found not only to induce the expression of heat shock protein (HSP 70) but also of CYP 450 enzymes in all regions of the brain. Brahmi primes the brain for stress by stockpiling and modulating the activities of useful enzymes like HSP 70, CYP 450 and SOD even before the onset of the stressful condition 11. In paranoid schizophrenia, adding Brahmi to olanzapine resulted in improvement in psychopathology as evidenced by reduction in PANSS and BPRS scores, without any treatment associated adverse effects 25. Brahmi extract has been found comparable to standard antidepressant drug imipramine in antidepressant activity in rodent animals. The same study has postulated its role on serotonin and GABA (gamma amino butyric acid) receptors in the mechanism of action for its antidepressant and antianxiety activity 11. Early research in India demonstrated that hersaponin (an active constituent of Brahmi) exhibited protection against seizures in mice; whereas another study examined the anticonvulsant properties of Brahmi extract at higher doses by its mechanism on GABA receptors 11. Animal and human studies have investigated the effect of Brahmi extract on the gastrointestinal tract. An invitro study has demonstrated its direct spasmolytic activity on intestinal smooth muscles, via inhibition of calcium influx across cell membrane channels; suggesting its benefit in intestinal spasm such as irritable bowel syndrome. Brahmi also has a protective and curative effect on gastric ulcer. A study showed that Brahmi extract significantly healed penetrating ulcers induced by acetic acid, significantly strengthened the mucosal barrier and decreased mucosal http://www.ayurvedacollege.com/book/export/html/2
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exfoliation. A methanolic extract of Brahmi given for 5 days demonstrated a dosedependent antiulcerogenic on various gastric ulcer models induced by ethanol, aspirin, two hour cold stress and four hour pylorus ligation 20. The extract also alleviated stressinduced ulcers as observed by significant reduction in LPO in rat gastric mucosa 11. Diethyl ether and ethyl acetate extract of Brahmi have slight antifungal activity but have a broad spectrum of antibacterial activity 10. Another in vitro study demonstrated its specific antimicrobial activity against Helicobacter pylori, a bacterium associated with chronic gastric ulcers 11. A recent 2013 study revealed Brahmi’s wound healing properties. Brahmi showed antimicrobial activity against skin pathogens, enhanced wound breaking strength, rate of contraction, skin collagen tissue formation, and early epithelization period with low scar area by decreasing myeloperoxidase and free radical generated tissue damage 32. Brahmi possesses antiinflammatory activity that has shown 82% edema inhibition when compared to indomethacin. It also significantly inhibited 5lipoxygenase (5LOX), 15LOX and cyclooxygenase2 (COX2) activity. Another paper supported its antiinflammatory activity via inhibition of prostaglandin synthesis and lysosomal membrane stabilization 10, 11. Brahmi extract has the potential usefulness in bronchoconstrictive and allergic conditions. Animal studies have demonstrated that it has a relaxant effect on chemicallyinduced bronchoconstriction, probably via inhibition of calcium influx into cell membranes. In vitro research using rabbit and pig aortas and pulmonary arteries has demonstrated that Brahmi exerts a vasodilatory effect on calcium chlorideinduced contraction in both tissues via interference with calcium channel flux in tissue cells. Nearly all of the Brahmi extract subfractions inhibited carbacholinduced bronchoconstriction, hypotension and bradycardia in this animal model. Another study demonstrated that a methanol extract of Brahmi possessed potent mast cell stabilizing activity comparable to disodium cromoglycate, a commonly used allergy medication 11. Recently, some studies have demonstrated Brahmi’s anticancer activity. A study on rats found that Brahmi extract promotes antioxidant status, reduces the rate of lipid peroxidation and markers of tumor progression in fibro sarcoma 10. The anticancer effect of Brahmi extracts may be due to inhibition of DNA replication in cancer cell lines 11. A study on rats revealed that pretreatment of bacoside A prevents the elevation of lipid peroxidase activity of serum marker enzymes and maintains the antioxidant system and thus protects the rats from Diethyl nitrosamineinduced hepatocellular carcinoma 10. Brahmi protects human lymphocytes against various clastogens with its high antioxidant activity since clastogens are known to induce their clastogenic effects via the production of oxidative radicals 10. More research is needed to support Brahmi’s anticancer ability. A study on rats showed Brahmi’s protective effect against morphineinduced liver and kidney toxicity 10. Simultaneous administration of morphine and alcohol extract of Brahmi significantly decreased lipid peroxidation and increased liver antioxidant enzyme level, thereby protecting the liver against morphine 28. In mice, Brahmi administration with phenytoin reversed phenytoininduced cognitive impairment, and improved acquisition and retention of memory 22. An animal study showed that high doses of Brahmi extract increased the thyroid hormone, T4. However, T3 levels remained unchanged. Based on this study, Brahmi may have a potential use in hypothyroidism, however, the doses used in this study were very high and this effect has not yet been studied in humans 26. The antifertility potential of Brahmi was studied in male mice. According to a 2009 study, Brahmi caused reversible suppression of spermatogenesis and fertility, without producing apparent toxic effects; and 56 days after treatment cessation, the parameters returned to baseline 27. According to classical texts, Brahmi can safely be used during pregnancy to help both the mother and the fetus to be strong http://www.ayurvedacollege.com/book/export/html/2
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and sattvic. Also following delivery, the child may be given a honeysweetened confection prepared with Brahmi to promote intellect 30. In addition to its beneficial effect on humans and animals, Brahmi has a favorable effect on the environment. Brahmi is a known hyper accumulator of cadmium, chromium, lead and mercury and can be used for phytoremediation 10. A 2011study reported that substantial amount of arsenate were found accumulated in the Brahmi plant, thus aiding in phytoremediation 29. Brahmi growing in contaminated areas may be toxic to health when consumed by humans 29. According to Swami Sivananda, Brahmi should not be collected from impure and unholy places; instead it should be collected from clean places with "fresh airy regions" 12.
A Final Thought Brahmi is one of the rare Ayurvedic herbs which can be grown almost anywhere when provided ample hydration and is widely available. It has been used for centuries in various forms and its advantages are supported by a vast body of literature and experience. Interestingly, the whole plant can be used for medicinal purposes. Ayurveda is the complete knowledge of life. Brahmi helps to achieve the primary goal of Ayurveda which is to prevent and treat illnesses and enhance lifespan by maintaining proper balance between the body, mind and the soul. Its therapeutic range is wide, and can be used in prevention as well as cure of a variety of disorders. It is a sattvic herb which comes from the same root as Brahman whose nature is SatChitAnanda 16. Its sattvic quality can help build strong ojas and reduce bad habits and treat addictions. It balances all doshas, dhatus and has an effect on almost all the Srotas of the human system and, based on the studies, animals, too. Being a nervine agent, it is beneficial in many neurologic and psychiatric disorders. This unusual herb has tonic, sedative and at the same time stimulant nervine effects. As a purifier, it is helpful in debilitating skin conditions. It strengthens the immune system and improves nutritional status, memory, intellect and longevity. It can help to achieve higher consciousness and improve meditation skills. By helping to open the crown chakra, it helps to achieve the highest goal of human life which is selfrealization. Its ability to be used in different forms as well as in combination with other herbs makes it a popular medicinal plant. Finally, we have to agree with Swami Sivananda, “Rarely is it possible to come across an herb of such great worth.”
References 1. 2. 3. 4. 5. 68 6. 7. 8. 9.
USDA, plants profile: ‘Bacopa Monnieri (L.) Pennell http://plants.usda.gov/java/profile?symbol=BAMO USDA, Bacopa Monnieri information from NPGS/GRIN http://www.ars.grin.gov/cgibin/npgs/html/taxon.pl?102292 National R & D Facility for Rasayana of Indian System of Medicine, Brahmi http://www.frlht.org/rasayana/node/47 The Wikipedia Encyclopedia http://en.wikipedia.org/wiki/Bacopa_monnieri R. K. Sharma & Bhagwan Dash, Charaka Samhita. Chowkhamba Sanskrit Series Office 2009, Vol III, pp. 45, 58, 447, 456; Vol IV, pp. 167 K. R. Srikantha Murthy, Astanga Hrdayam. Chowkhamba Krishnadas Academy, 2012, vol 3, pp. 60, 62 A. K. Nadkarni, Dr. K. M. Nadkarni’s INDIAN MATERIA MEDICA. Popular Prakashan 2010, Vol I, pp. 62425 Dr. David Frawley & Dr. Vasant Lad, Yoga of Herbs. Lotus press 2001, 239241 Sebastian Pole, Ayurvedic Medicine The principles of traditional practice. Singing dragon 2013, 149150
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10. D. sudharani, K. L. Krishna, K. Deval, A.K.Safia and Priya, “Pharmacological profiles of Bacopa monnieri: a review,” International Journal of Pharmaceutics, vol 1, no. 1, 2011, pp. 1523 11. Kashmira J. Gohil & Jagruti A. Patel, “A review on Bacopa monnieri: Current research and future prospects,” International journal of green pharmacy, Vol 4, Issue:1, 2010, pp. 19 12. Swami Sivananda, Practice of Ayurveda. A divine life society 2006, 121, 205207 13. Shipard, Isabell, How can I use HERBS in my daily life? 5th edition, 2007 14. Harsahay Meena, Hemant Kumar Pandey, Pankaj Pandey, Mahesh Chand Arya and Zakwan Ahmed, “ Evaluation of antioxidant activity of two important memory enhancing medicinal plants Bacopa Monnieri and Centella Asiatica,” Indian Journal of Pharmacology, 2012 JanFeb; 44(1): 114–117. doi: 10.4103/02537613.91880, PMCID: PMC3271514 15. Khare, C. P. (2003). Indian Herbal Remedies: Rational Western Therapy, Ayurvedic, and Other Traditional Usage, Botany. Springer. p. 89. ISBN 9783540010265. 16. Sarasvati Buhrman, Ph.D., “ Ayurvedic Psychology and Psychiatric Approaches to the Treatment of Common Affective Disorders,” Protocol Journal of Botanical Medicine II: 1, 18 17. Kaviraj Kunja Lal Bhishagratna, An English Translation of The SUSHRUTA SAMHITA. Bharat Mihir Press 1911, Vol II, 52226 http://archive.org/details/englishtranslati00susruoft 18. Singh RH, Narsimhamurthy K, Singh G., “Neuronutrient impact of Ayurvedic Rasayana therapy in brain aging,” Biogerontology 2008 Dec; 9(6):36974. doi: 10.1007/s105220089185z. Epub 2008 Oct 18. 19. Government of India Ministry of Health and Family Welfare Department of Ayush, THE AYURVEDIC PHARMACOPOEIA OF INDIA, Part I, Volume – II, pp. 2527 http://www.ayurveda.hu/api/APIVol2.pdf 20. Caldecott, T. "Brahmi". Ayurveda: The Divine Science of Life. Elsevier / Mosby. ISBN 0723434107. http://www.toddcaldecott.com/index.php/herbs/learningherbs/384brahmi 21. Wendy Weissner, article: “Brahmi and Cognition: Nature’s Brainpower Enhancer” http://ayurveda nama.org/pdf/resources/NAMA_Brahmi_Weissner.pdf 22. Monograph: Bacopa monnieri. Alternative Medicine Review, Vol 9 (1), 2004, pp. 7985 http://www.thorne.com/altmedrev/.fulltext/9/1/79.pdf 23. Russo A, Borrelli F., “Bacopa monniera, a reputed nootropic plant: an overview,” Phytomedicine. 2005 Apr; 12(4):30517. 24. Tatimah PethNui, Jintanaporn Wattanathorn, Supaporn Muchimapura, Terdthai TongUn, Nawanant Piyavhatkul, Poonsri Rangseekajee, Kornkanok Ingkaninan, Sakchai Vittayaareekul, “Effects of 12Week Bacopa monnieri Consumption on Attention, Cognitive Processing, Working Memory, and Functions of Both Cholinergic and Monoaminergic Systems in Healthy Elderly Volunteers,” Evid Based Complement Alternat Med. 2012: 606424, doi: 10.1155/2012/606424, PMCID: PMC3537209 25. Sukanto Sarkar, Biswa Ranjan Mishra, Samir Kumar Praharaj, S. Haque Nizamie, “Addon effect of Brahmi in the management of schizophrenia,” J Ayurveda Integr Med. 2012 OctDec; 3(4): 223–225. doi: 10.4103/09759476.104448, PMCID: PMC3545244 26. Kar A, Panda S, Bharti S., “Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice,” J Ethnopharmacol. 2002 Jul; 81(2):2815. 27. Singh, A., Singh, S. K. (2009). "Evaluation of antifertility potential of Brahmi in male mouse". Contraception 79 (1): 71–79. doi:10.1016/j.contraception.2008.07.023. PMID 19041444 28. Sumathy T, Subramanian S, Govindasamy S, Balakrishna K, Veluchamy G., “Protective role of Bacopa monniera on morphine induced http://www.ayurvedacollege.com/book/export/html/2
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hepatotoxicity in rats,” Phytother Res. 2001 Nov;15(7):6435. 29. Mishra S, Srivastava S, Dwivedi S, Tripathi RD., “Investigation of biochemical responses of Bacopa monnieri L. upon exposure to arsenate,” Environ Toxicol. 2013 Aug; 28(8):41930. doi: 10.1002/tox.20733. Epub 2011 Jun 7. 30. Dr. Marc Halpern, Clinical Ayurvedic Medicine. California College of Ayurveda, sixth edition, September 2012, pp. 247; 525, 33,88 31. Dr. Marc Halpern, Principles of Ayurvedic Medicine. California College of Ayurveda, tenth edition, September 2010, pp. 295 32. Murthy S, Gautam MK, Goel S, Purohit V, Sharma H, Goel RK. “Evaluation of In Vivo Wound Healing Activity of Bacopa monniera on Different Wound Model in Rats,” Biomed Res Int. 2013; 2013:972028. doi: 10.1155/2013/972028. Epub 2013 Jul 29.
The Magical Moringa By: Vanita Agarwal Introduction Growing up in India this humble tree grew in our backyard and it never caught my attention, though I always loved the vegetable that grew on it. As I entered into the world of Ayurveda I learnt about this most nutritious tree in the world called Moringa only to realize that this tree was a childhood friend that I had loved and this world famous Moringa was my backyard fried the drumstick tree or Sajana as we used to call it. In this paper I will attempt to cover: 1. 2. 3. 4. 5.
What is Moringa? The Nutritional value of Moringa Johns Hopkins University research on Moringa Health benefits of Moringa The qualities of Moringa from an Ayurvedic perspective
1. What is Moringa? According to Wikipedia Moringa, a native to parts of Africa and Asia, is the sole genus in the flowering plant family Moringaceae. The name is derived from the Tamil word Murungai ( ைக) [1]. It contains 13 species from tropical and subtropical climates that range in size from tiny herbs to massive trees. The most widely cultivated species is Moringa oleifera, a multipurpose tree native to the foothills of the Himalayas in northwestern India and cultivated throughout the tropics. M. stenopetala, an African species, is also widely grown, but to a much lesser extent than M. oleifera. http://www.ayurvedacollege.com/book/export/html/2
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As Moringa spread from India to other tropical and subtropical areas, it adapted to local conditions. Over time, these thirteen distinct species of Moringa developed. Scientific Classification of Moringa [1]: Kingdom: (unranked): (unranked): (unranked): Order: Family: Genus:
Plantae Angiosperms Eudicots Rosids Brassicales Moringaceae Moringa
Scientific Names of the 13 different species of Moringa found in the world today [1] 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
M. oleifera (Northwestern India) M. arborea (Kenya) M. borziana M. concanensis M. drouhardii (Southwestern Madagascar) M. hildebrandtii M. longituba M. ovalifolia M. peregrine M. pygmaea M. rivae M. ruspoliana M. stenopetala
Common Names of Moringa: While native to the Indian subcontinent, Moringa has spread throughout the tropical and subtropical regions of the world. There are over 400 names of Moringa around different parts of the world. Here are some of the many common names of Moringa: [3] Drumstick tree, Horseradish tree, http://www.ayurvedacollege.com/book/export/html/2
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Mother's Best Friend, Radish tree, West Indian ben
French
Bèn ailé, Benzolive, Moringa, Ben oléifère, Arbre radis du cheval
German
Behenbaum, Behenussbaum, Flügelsaniger Bennussbaum, Pferderettichbaum
Italian
Sàndalo ceruleo
Acácia branca, Cedra (Brazil), Portuguese Marungo, Moringuiero, Muringa Spanish
Árbol del ben, Ben, Morango, Moringa
Africa Benin: Patima, Ewé ilé Burkina Faso: Argentiga Cameroon: Paizlava, Djihiré Chad: Kag n’dongue Ethiopia: Aleko, Haleko Ghana: Yevuti, Zingerindende Kenya: Mronge http://www.ayurvedacollege.com/book/export/html/2
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Malawi: Cham’mwanba Mali: Névrédé Niger: Zôgla gandi Nigeria: Ewe ile, Bagaruwar maka Senegal: Neverday, SapSap Somalia: Dangap Sudan: Ruwag Tanzania: Mlonge Togo: Baganlua, Yovovoti Zimbabwe: Mupulanga Asia Bangladesh: Sajina Burma: Dandalonbin Cambodia: Ben ailé India: Sahjan, Murunga, Moonga; Hindi: Sahijan, Munaga, Sajana, Sindhi: Swanjera Tamil: Murungai, Murunkakkai, Morunga Telegu: TellaMunaga, Mulaga, Sajana Kannada: Nugge mara, Nugge kayi; Oriya: Munigha, Sajina Punjabi: Sanjina, Soanjana Rajasthani: Lal Sahinjano Sanskrit: Sigru Shobhanjan, Sobhan jana, Shobanjana Konkani/Goa: Moosing, Mosing Malayalam: Sigru, Moringa, Muringa, Murinna, Morunna Marathi: Sujna, Shevga, Shivga Indonesia: Kalor Pakistan: Suhanjna Philippines: Mulangai Sri Lanka: Murunga Taiwan: La Mu Thailand: Marum http://www.ayurvedacollege.com/book/export/html/2
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Vietnam: Chùm Ngây South and Central America, Caribbean Brazil: Cedro Colombia: Angela Costa Rica: Marango Cuba: Palo Jeringa Dominican Republic: Palo de aceiti El Salvador: Teberinto French Guiana: Saijhan Guadeloupe: Moloko Guatemala: Perlas Haiti: Benzolive Honduras: Maranga calalu Nicaragua: Marango Panama: Jacinto Puerto Rico: Resada Suriname: Kelor Trinidad: Saijan Oceania Fiji: Sajina Guam: Katdes Palau: Malungkai
2. The Nutritional value of Moringa The tree is often referred to as "The Miracle Tree" and "Mother’s Best Friend", which is understandable when you learn that Moringa contains a unique combination of vitamins, minerals and amino acids that make it one of the most nutritious plants ever discovered. Much of the plant is edible by humans or by farm animals. Moringa leaves Moringa leaves are exceptionally nutritious. When fresh, they are rich in vitamin C. When carefully dried, gram for gram Moringa leaves contain 24 times the iron of spinach, 16 times the calcium of milk, 9 times the vitamin A of carrots, many times the potassium of bananas, and every essential amino acid your body needs. http://www.ayurvedacollege.com/book/export/html/2
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The leaves are rich in protein, vitamin A, vitamin B, vitamin C and minerals [4]. 100g of fresh Moringa leaves have 8.3 g protein, 434 mg calcium, 404 mg potassium, 738 μg vitamin A, and 164 mg vitamin C [5]. Antioxidants Moringa contains 46 powerful antioxidants compounds that protect the body against the destructive effects of free radicals by neutralizing them before they can cause cellular damage and disease [6]. Vitamins Vitamin A (Alpha & BetaCarotene), B, B1, B2, B3, B5, B6, B12, C, D, E, K, Folate (Folic Acid), Biotin [6] Minerals Calcium, Chromium, Copper, Fluorine, Iron, Manganese, Magnesium, Molybdenum, Phosphorus, Potassium, Sodium, Selenium, Sulphur, Zinc [6] . Essential Amino acids Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine [6]. Nonessential Amino Acids Alanine, Arginine, Aspartic Acid, Cystine, Glutamine, Gl ycine, Histidine, Proline, Serine, Tyrosine [6] Vitamin & Mineral Content of Moringa: [9] All values are per 100 grams of edible portion.
Fresh Dried Leaves Leaves
Carotene (Vit. A)*
6.78 mg
18.9 mg
Thiamin (B1)
0.06 mg
2.64 mg
Riboflavin (B2)
0.05 mg
20.5 mg
0.8 http://www.ayurvedacollege.com/book/export/html/2
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Niacin (B3)
mg
8.2 mg
Vitamin C
220 mg
17.3 mg
Calcium
440 mg
2,003 mg
Calories
92 cal
205 cal
Carbohydrates 12.5 g 38.2 g Copper
0.07 mg
0.57 mg
Fat
1.70 g 2.3 g
Fiber
0.90 g
19.2 g
Iron
0.85 mg
28.2 mg
Magnesium
42 mg
368 mg
Phosphorus
70 mg
204 mg
Potassium
259 mg
1,324 mg
Protein
6.70 g
27.1g
Zinc
0.16 mg
3.29 mg
Amino Acid Content of Moringa [9]: http://www.ayurvedacollege.com/book/export/html/2
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All values are per 100 grams of edible portion.
Fresh Dried Leaves Leaves
Arginine
406.6 mg
1,325 mg
Histidine
149.8 mg
613 mg
Isoleucine
299.6 mg
825 mg
Leucine
492.2 mg
1,950 mg
Lysine
342.4 mg
1,325 mg
Methionine
117.7 mg
350 mg
Phenylalinine
310.3 mg
1,388 mg
Threonine
117.7 mg
1,188 mg
Tryptophan
107 mg
425 mg
Valine
374.5 mg
1,063 mg
3. Johns Hopkins University research on Moringa [10] : Jed W. Fahey, Sc.D. , Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences produced a very important research paper titled: “Moringa oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1.” In http://www.ayurvedacollege.com/book/export/html/2
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this seminal work, they began the process of sifting through the scientific work on Moringa, as well as the traditional, as well as anecdotal evidence for Moringa’s nutritional, therapeutic and prophylactic. In doing this, they found that much of the scientific evidence is beginning to support much of the traditional and anecdotal information.
4. Health Benefits of Moringa Moringa preparations have been cited in the scientific literature as having antibiotic, antitrypanosomal, hypotensive, antispasmodic, antiulcer, anti inflammatory, hypocholesterolemic, and hypoglycemic activities, as well as having considerable efficacy in water purification by flocculation, sedimentation, antibiosis and even reduction of Schistosome cercariae titer. Antibiotic Activity: This is clearly the area in which the preponderance evidence—both classical scientific and extensive anecdotal evidence—is overwhelming. The scientific evidence has now been available for over 50 years, although much of it is completely unknown to western scientists [10]. Phytochemicals and 6 Carbon Sugar Rhamnose: An examination of the phytochemicals of Moringa species affords the opportunity to examine a range of fairly unique compounds. In particular, this plant family is rich in compounds containing the simple sugar, rhamnose, and it is rich in a fairly unique group of compounds called glucosinolates and isothiocyanates. For example, specific components of Moringa preparations that have been reported to have hypotensive, anticancer, and antibacterial activity [10]. Antibacterial and Antifungal: Subsequent elegant and very thorough work, published in 1964 as a PhD thesis by Bennie Badgett (a student of the wellknown chemist Martin Ettlinger), identified a number of glycosylated derivatives of benzyl isothiocyanate [5] (e.g. compounds containing the 6carbon simple sugar, rhamnose) (8). The identity of these compounds was not available in the refereed scientific literature until “rediscovered” 15 years later by Kjaer and coworkers (73). Seminal reports on the antibiotic activity of the primary rhamnosylated compound then followed, from U Eilert and colleagues in Braunschweig, Germany (33, 34). They reisolated and confirmed the identity of 4(αLrhamnopyranosyloxy)benzyl glucosinolate [6] and its cognate isothiocyanate [2] and verified the activity of the latter compound against a wide range of bacteria and fungi. (Jed W. Fahey, 2005) This is clearly the area in which the preponderance of evidence—both classical scientific and extensive anecdotal evidence—is overwhelming. The scientific evidence has now been available for over 50 years, although much of it is completely unknown to western scientists [10]. ANTIBACTERIAL PROPERTIES OF MORINGA STENOPETALA [12] The main objective of this study was to isolate compounds from root wood of Moringa stenopetala and evaluate antibacterial activities of the isolated compounds. Three of the compounds namely cholest5en3ol, palmitic acid and oleic acid showed highest activity against E. coli. The observed antibacterial activities of the crude extract and the isolated compounds could justify the traditional use of the plant for the treatment of http://www.ayurvedacollege.com/book/export/html/2
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different bacterial infections [12]. H. pylori is an omnipresent pathogen of human beings in medically underserved areas of the world, and amongst the poorest of poor populations worldwide. It is a major cause of gastritis, and of gastric and duodenal ulcers, and it is a major risk factor for gastric cancer (having been classified as a carcinogen by the W.H.O. in 1993). Cultures of H. pylori, it turned out, were extraordinarily susceptible to [2], and to a number of other isothiocyanates (37, 60). These compounds had antibiotic activity against H. pylori at concentrations up to 1000fold lower than those which had been used in earlier studies against a wide range of bacteria and fungi. The extension of this finding to human H. pylori infection is now being pursued in the clinic, and the prototypical isothiocyanate has already demonstrated some efficacy in pilot studies [10]. Cancer Prevention: Since Moringa species have long been recognized by folk medicine practitioners as having value in tumor therapy, we examined compounds for their cancer preventive potential. Recently, these compounds were shown to be potent inhibitors of phorbol ester (TPA)induced EpsteinBarr virus early antigen activation in lymphoblastoid (Burkitt’s lymphoma) cells [10]. In one of these studies, they also inhibited tumor promotion in a mouse twostage DMBATPA tumor model. In an even more recent study, Bharali and colleagues have examined skin tumor prevention following ingestion of drumstick (Moringa seedpod) extracts. In this mouse model, which included appropriate positive and negative controls, a dramatic reduction in skin papillomas was demonstrated. Thus, traditional practice has long suggested that cancer prevention and therapy may be achievable with native plants. Role of Moringa on Gastric Ulcer and its use as Antacid • A study on Moringa leaf extract to determine its effect on experimental gastric ulceration concluded that the leaf extract can be beneficially used in the management of gastric ulcer in contrast to the classical antacid, antihistamine or surgical treatment [13]. • Two weeks of treatment with Moringa Oleifera healed gastric ulcer damage [14]. Role of Moringa on Muscle cramps and Sleep • Moringa is found to significantly reduces muscle cramps, decreases body temperature, and enhances sleep [15]. Benefits to Heart, Cholesterol, Triglycerides, Atherosclerotic Plaques: • Moringa has been found to have significant benefits to heart [16]. Water extract of Moringa Oleifera leaves possesses strong antioxidant activities. The prevention of artherosclerotic plaque formation in artery as well as the lipid lowering activity of the extract has been shown in rabbit fed with high cholesterol diet. M. Oleifera has high therapeutic potential for the prevention of cardiovascular diseases. • It works as well as Simvastatin in decreasing cholesterol, triglycerides, and inhibiting the formation of atherosclerotic plaques. [17] http://www.ayurvedacollege.com/book/export/html/2
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•
Moringa strengthens heart function : Prevented structural damage and prevented increases in lipid peroxidation in the myocardium [8]
Antifungal • Moringa seeds have shown antifungal ability and effectiveness against athlete’s foot [18]. Prevention of Kidney stone • Moringa water extract has shown to prevent kidney stone formation and dissolve already performed stones [19]. Liver fibrosis Oral administration of Moringa seed extract in rats reduced liver damage as well as symptoms of liver fibrosis. Moringa seed extract can act against CCl(4)induced liver injury and fibrosis in rats by a mechanism related to its antioxidant properties, antiinflammatory effect and its ability to attenuate the hepatic stellate cells activation. [20] Cancer/Chemo preventative property of Moringa • A study was conducted to find out the Chemomodulatory effect of hydroalcoholic extract of Moringa oleifera, Lam, on hepatic carcinogen metabolizing enzymes, antioxidant parameters and skin papillomagenesis in mice. The findings are suggestive of a possible chemo preventive potential of Moringa oliefera drumstick extract against chemical carcinogenesis [21] Blood glucose level and Diabetes • Variable doses of M. oleifera leaves aqueous extract administered orally to test the glycemic control, haemoglobin, total protein, urine sugar, urine protein and body weight. The dose of 200 mg kg(1) decreases blood glucose level (BGL) of normal animals by 26.7 and 29.9% during FBG and OGTT studies respectively. In sub and mild diabetic animals the same dose produced a maximum fall of 31.1 and 32.8% respectively, during OGTT. In case of severely diabetic animals FBG and PPG levels were reduced by 69.2 and 51.2% whereas, total protein, body weight and haemoglobin were increased by 11.3, 10.5 and 10.9% respectively after 21 days of treatment. Significant reduction was found in urine sugar and urine protein levels from +4 and +2 to nil and trace, respectively. The test result concluded that the study validates scientifically the widely claimed use of M. oleifera as an ethnomedicine to treat diabetes mellitus. [22]
5. Ayurvedic Perspective on Moringa According to Vaidya Mishra [23] , an Ayurvedic expert from the Shankha Vamsa lineage, Moringa is both a detoxifier as well as a tonic. http://www.ayurvedacollege.com/book/export/html/2
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Whenever we detox we also use a tonic, Moringa does both. It purifies and nourishes the blood and muscle tissues, the bone marrow and the fat tissues of any toxins at the same time nourishing it. Ayurvedic Properties/Guna of Moringa Taste (rasa)
Pungent/katu, tikta/bitter
Virya
Heating/ushna
Post
Digestive metabolic state (vipak): pungent/katu
Guna
Light/laghu, dry/ruksha, sharp/tikshana, fluid/sara
• Liver cleanser (yakrit sodhana) • Purifies Blood (rakta sodhaka) • enhances spleen/pliha • Removes worms (krmi), acidic toxins from the blood Prabhava (amavishagni) • Relieves from tumor (gulma) • Strengthens heart/ hridya, fat metabolism and weight http://www.ayurvedacollege.com/book/export/html/2
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loss/Medovishahara and regulates cholesterol. In Bhava Prakash (16 Century canonical textbook of Ayurveda), part one, authored by Bhav Mishra and Rajnigantu, Moringa is called sigru, or “it moves like an arrow” in the body because it rapidly penetrates the tissues and has deep absorption and detoxification ability, making its effect on the deep bone marrow tissue swift and effective. The Nature and Qualities of Moringa: • Hot and sharp, but also bitter and pungent • Pacifies vata and kapha (vatakaphapaha) • Pacifies kledaka kapha and increases appetite • Reduces stiffness in the jaw, relaxes the jaw and thus helps in opening the mouth (mukhajadyahar) • It is appetizing (rucyo) • Increases digestive flame (dipano) • It cleans and clears the ulcers (vranadosanut). Vrana means ulcer. • Bitter (Sigrustiktah) • Pungent and heating (Katuscosnah) • Reduces kaphapredominant swelling and water retention, which can also lead to vata imbalance. Swollen ankles are a common complication of excess weight. Threefour drumstick pods per meal begin to reintroduce the intelligence so the body does not accumulate toxins in the lower extremities. Over time, little by little, the swelling will go down and not return. (Kaphasophasamirajit) • Creates an unfriendly environment for the growth of tumors • Destroys krimi and amavisha (Krgyamvisa) • By binding the toxins in the blood, and cleaning the blood (due to its hot potency and pungent taste and post digestive taste), it relieves long term burning in the skin and stomach. • Prevents and rids the tumors. When the clean blood circulates, growth of tumors are prevented and also if tumors are present, gets rid of the tumors (gulmanut). • The Ayurvedic verse on Moringa by Bhav prakash of Bhav Mishra cites Moringa as removing acidic toxins from the blood, cleansing the blood. This in turn lowers bad cholesterol and improves cholesterol metabolism. This correlates the power of Moringa in lowering bad cholesterol and improving cholesterol metabolism. • Kidney Stones: Ushna/hot and thikshana/pungent quality of Moringa stimulates the kidneys, dysuria, increases quantity of urine, removes excess acidity in urine and calculi. Dr. JV Hebbar, summarizes several interesting facts about Moringa in his blog [24]. http://www.ayurvedacollege.com/book/export/html/2
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Sanskrit Synonyms: • • • • •
Shobhanjana – Very auspicious tree Shigru – has strong, piercing qualities Teekshnagandha – Strong and pungent odor Aksheeva – relieves intoxication Mochaka – helps to cure diseases
Classical categorization: According to Charaka Samhita – Krimighna – group of herbs that are used to treat worm infestation. Svedopaga – group of herbs that are used in Svedana (preparatory procedure for Panchakarma) Shirovirechanopaga – group of herbs that are used in Nasya Panchakarma treatment Katuka Skandha – group of herbs that have pungent taste. According to Sushruta and Vagbhata – Varunadi Group of herbs. (Hence it is an ingredient of a famous Ayurvedic medicine – Varanadi kashayam) Medicinal Qualities of drumstick tree: Rasa(taste) – Katu (Pungent), Tikta (bitter) Guna(qualities) – Laghu (light to digest), Rooksha (dryness), Teekshna (strong, piercing) Vipaka – katu (Moringa undergoes pungent taste conversion after digestion.) Veerya – Ushna – hot potency. Effect on Tridosha – Balances Kapha and Vata Varieties of Moringa: There are three varieties of Moringa explained in Ayurvedic text books. 1. Shyama – black variety 2. Shveta – white variety and 3. Rakta – red variety. It is also called as Madhu shigru. Black variety of drumstick tree is the most common. Its qualities are: http://www.ayurvedacollege.com/book/export/html/2
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Katu – pungent, Teekshna – piercing, sharp, strong Ushna – hot in potency Madhura – slightly sweetish Laghu – light to digest Deepana – improves digestion Rochana – Improves taste, Rooksha – dry Kshara – Has alkaline properties Tikta – Bitter Vidaahakrit – causes burning sensation Sangrahi – Useful to check diarrhoea Shukrala – Improves semen quantity and sperm count Hrudya – Good for heart. Cardiac tonic Pittarakta prakopana: Increases Pitta and vitiates blood. Hence, drumstick should not be consumed during bleeding disorders, duriner menstruation and for people with pimples and Pitta related skin diseases. Chakshushya – Improves vision, good for eyes. Kaphavataghna – Decreases imbalanced Kapha and Vata Vidradhi – Useful in abscess. It helps in quick wound healing of abscess, upon oral intake and external application as paste. Shvayathu – It is a good anti inflammatory herb. Krimi – useful in worm infestation in stomach and in wounds. Meda – helpful to decrease fat and obesity. Apachi – Useful in relieving carbuncles. Visha – Anti toxic. Has detoxifying action. Pleeha – Useful in spleen related diseases Gulma – Useful in abdominal bloating and tumors Ganda Vrana – Useful in lymphadenitis White variety Moringa Properties: It is quite similar to the black variety. Dahakrut – causes burning sensation pleehaanaam vidradhim hanti – useful in splenic abscess VraNaghna – helps in quick wound healing Pittaraktakrut – Increases Pitta and vitiates blood. The Red Variety, called as Madhushigru Deepana – Increases digestion power. http://www.ayurvedacollege.com/book/export/html/2
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Sara – promotes proper bowel movements. Moringa Leaves and Bark The juice extract of drumstick leaves and bark are very useful in relieving pain. They act as natural analgesic. They are used both for oral intake and also for external application as paste. In Indian household, the leaves are used to prepare Chutney and Sambar (a southindian soup). Moringa seeds uses: Moringa seeds are called as Shweta Maricha Chakshushya – good for eyes Vishanashana – anti toxic Avrushya – do not have aphrodisiac qualities Nasyena Shiro Artinut – When used for Nasya (in the form of powder or oil), it helps to relieve headache. Moringa for Headaches: Moringa leaves paste applied externally, or used as vegetable helps to relieve headache. Its seed powder, in the form of nasya treatment cures headache. Moringa for Diabetes: Many studies have been conducted to prove the antidiabetic and antioxidant effect of Moringa. Oil prepared with Moringa is useful to relieve headache, pungent, useful in skin diseases and diabetes. Moringa flowers are useful in intestinal worms. It balances Pitta and kapha. Moringa Side Effects: As explained above, it causes increase in burning sensation and is pungent. Hence, people with gastritis or sensitive stomach should use this vegetable carefully. It is not ideal to be taken during periods, since it increases Pitta and vitiates blood. It is also not ideal to be taken during bleeding disorders. http://www.ayurvedacollege.com/book/export/html/2
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Moringa during pregnancy and lactation: Moringa fruit is rich in protein, vitamins, minerals and antioxidants. Hence it can be used during pregnancy. But Moringa leaves, root bark and flowers are not indicated during pregnancy.
Conclusion: Thus we can see that this humble tree is loaded with wonderful qualities that can be used for healing by an Ayurvedic practitioner. Several scientific studies have documented its great properties of healing like antibacterial, anticancer, antiinflammatory, antifungal etc. and has been used successfully for hundreds of years.
Bibliography/References: 1. Moringa, Wikipedia. http://en.wikipedia.org/wiki/Moringa. 2. Moringa Tree, http://goodnewsaday.files.wordpress.com/2011/10/amoringatree1.jpg. 3. Trees for Life International, Moringa Tree. http://www.treesforlife.org/ourwork/ourinitiatives/Moringa. 4. Janick, Jules, Robert E. Paull, The Encyclopedia of Fruit & Nuts. (CABI, 2008): 509510. 5. Food and Agriculture Organization of the United Nations, Barbara Stadlmayr, U Ruth Charrondiere, et. al, West African Food Composition Table, http://www.fao.org/docrep/015/i2698b/i2698b00.pdf 6. Moringa Tree Foundation, Seeds of Hope, www.Moringatreefoundation.org 7. Trees for Life International, Moringa Tree. http://www.treesforlife.org/ourwork/ourinitiatives/Moringa 8. Fuglie LJ, The Miracle Tree: Moringa oleifera: Natural Nutrition for the Tropics (Church World Service, Dakar 1999), 68.; revised in 2001 and published as The Miracle Tree: The Multiple Attributes of Moringa, 172 9. All Things Moringa, H. Hiawatha Bey, www.allthingsmoringa.com 10. Jed W. Fahey, S., “Moringa Oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1.” (Vols. Copyright: ©2005 Jed W. Fahey. Baltimore, Maryland: Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences, Lewis B. and Dorothy Cullman Cancer Chemoprotection Center, 725 N. Wolfe Street, 406 WBSB, Baltimore, Maryland, USA 21205 2185.] 11. Moringa Leaves, Angela Mays, http://angelamays.com/files/2012/10/MoringaoverzBenefitsLeaves.jpg 12. Mulugeta Tesemma, Legesse Adane, Yinebeb Tariku, Diriba Muleta and Shiferaw Demise. “Isolation of Compounds from Acetone Extract of Root Wood of Moringa stenopetala and Evaluation of their Antibacterial Activities” Research Journal of Medicinal Plant, 7(1) (2013): 3247 13. Debnath S, Biswas D, Ray K, Guha D., “Moringa oleifera induced potentiation of serotonin release by 5HT(3) receptors in experimental ulcer model”, Phytomedicine, 18(23) (2011Jan15): 9195 14. Debnath, S., & Guha, D., “Role of Moringa oleifera on enterochromaffin cell count and serotonin content of experimental ulcer model,” Indian http://www.ayurvedacollege.com/book/export/html/2
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Journal of Exp Biol, 45(8), (2007): 726731. 15. Pal, S., Mukherjee, P., Saha, K., M., P., & Saha, B. “Studies on some psychopharmacological actions of Moringa oleifera Lam.”, Phototherapy Research, 10(5), (1996): 402405. 16. Chumark, Khunawat et. al, “The in vitro and ex vivo antioxidant properties, hypolipidaemic and antiatherosclerotic activities of water extract of Moringa oleifera Lam. leaves,” Journal of EthnoPharmocology 116(3) (2008 Mar 28): 439446. 17. Jain, Pankaj G. et al., “Hypolipidemic activity of Moringa oleifera Lam., Moringaceae, on high fat diet induced hyperlipidemia in albino rats,” Rev. bras. farmacogn., 20(6) (Dec 2010): 969973. 18. Chuang, P. H., Lee, C.W., Chou, J. Y., Murugan, M., Shieh, B.J., & Chen, H. M. “Antifungal activity of crude extracts and essential oil of Moringa oleifera Lam.”, Bioresour Technol, 98(1), (2007): 232236. 19. Karadi, R. V., Gadge, N. B., Alagawadi, K. R., & Savadi, R. V., “Effect of Moringa oleifera Lam. rootwood on ethylene glycol induced urolithiasis in rats.” J Enthnopharmacol, 105(12), (2006): 306311. 20. Hamza AA, “Ameliorative effects of Moringa oleifera Lam seed extract on liver fibrosis in rats.” Food Chem Toxicol. 48(1), (2010 Jan): 345355. 21. Bharali R, Tabassum J, Azad MR, “Chemomodulatory effect of Moringa oleifera, Lam, on hepatic carcinogen metabolising enzymes, antioxidant parameters and skin papillomagenesis in mice.” Asian Pacific Journal of Cancer Prevention, 4(2) (2003 AprJun): 131139. 22. Jaiswal D, Kumar Rai P, Kumar A, Mehta S, Watal G, “Effect of Moringa oleifera Lam. leaves aqueous extract therapy on hyperglycemic rats,” Journal of Ethnopharmacology, 123(3) (2009 Jun 25): 392396. 23. Adhishakti LLC, Vaidya Mishra, “Moringa Super Veggie”, http://issuu.com/vaidyamishra/docs/moringa_super_veggie 24. Dr JV Hebbar, Moringa Benefits, Medicinal Usage and Complete Ayurveda Details, http://easyayurveda.com/2012/12/06/moringabenefits medicinalusagecompleteayurvedadetails/ 25. Dr JV Hebbar, Easy Ayurveda, http://i0.wp.com/easyayurveda.com/wpcontent/uploads/2012/12/shigru.jpg http://www.ayurvedacollege.com/book/export/html/2
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The Skinny: Western and Ayurvedic Treatment Approach To Anorexia Nervosa. By: Leah Kaplan Anorexia Nervosa, the mental disorder in which individuals consciously starve themselves, remains one of the most complicated mental illnesses present today. From its first appearance in Medieval Europe to its current form, anorexia nervosa continues to baffle those who study it and destroy the lives of those stricken with it. It remains so elusive for a few reasons. One, there is no reliable source as to what causes the disease. Research shows some genetic link, and trauma seems to be involved somehow, but evidence remains loose as to how exactly those factors affect the development. The public is inclined to lay blame on the media and current ideals of female thinness, but if this were the cause the entire population would be struggling, as we are all exposed to those images and messages. Secondly, while the three medical criteria discussed in this paper, a body weight of 85% below the ideal, an intense fear of gaining weight, and amenorrhea, are consistent amongst anorexic patients, all other symptoms and signs are variable. Some patients will present with depression and apathy, while others will struggle with excessive exercise and OCD behaviors. One woman might show signs of developing osteoporosis, while another has no symptoms of this at all. As many individuals as contract anorexia, that is how many expressions of the disease there will be. This fact lends itself to Ayurveda, India’s ancient system of wellness, which views each individual as completely unique and in need of a unique healing recommendation to match. Finally, while anorexia is very much a mental disorder, the physical symptoms cannot be ignored or put on the backburner while the mental body is attended to because of the dangerous nature of the disease. It is the most deadly amongst mental disorders and must be handled with a level of seriousness to match. For this reason, Western medical science, with its abundance of research, seems more trustworthy and capable of handling treatment. By examining what both Western medicine and Ayurveda have to offer, one can develop strategies across modalities to increase healing and wellbeing for these patients and form a more complete picture of all that is needed to take care of an anorexic patient. Anorexia Nervosa (AN) is defined in the DSMV, the American Psychiatric Association’s (APA) classification and diagnostic manual, as having three criteria: 1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health; 2. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight; 3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or persistent lack of recognition of the seriousness of the current low body weight. As one can discern from this lengthy and somewhat objective criteria, anorexia nervosa is a complex and complicated disease, both to diagnose and to treat. This becomes even clearer when one considers that the origin of this disease is psychological in nature, but unlike other common psychological disorders, becomes visible primarily because of physical habits and changes. These physical changes then perpetuate the psychological changes. In their guide, Eating Disorders: Everything You Need to Know, Jim Kirkpatrick and Paul Caldwell sum up this vicious cycle, “the psychological and emotional changes initiate the physical ones, but then the physical changes reinforce the negative psychological http://www.ayurvedacollege.com/book/export/html/2
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changes.” The complexity of this cannot be overstated. From a treatment perspective, the question then becomes which do you consider first? Whatever therapies are administered to heal physical ailments as a result of starvation must also concern themselves with their psychological effects on the anoretic. And although the disease needs to be eradicated at the level of the mind, the physical body needs to be refed in a most literal way, as soon as possible; according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), “20% of people suffering from anorexia nervosa will prematurely die from complications relating to their eating disorder,” making eating disorders the most fatal of any mental disorder. But treatments that might prove extremely effective for the physical symptoms of anorexia nervosa (such as severe weight loss and amenorrhea) might be useless here due to noncompliance on the part of the anoretic. Physical treatments cannot wait for the slower, more gradual process of psychological rehabilitation, which can take years, however: the refeeding process must occur simultaneously to the psychological treatment for both bodily and mental health. As this paper proceeds to examine the Western and Ayurvedic treatments for the three medical criteria necessary for a diagnosis, this point of view will be considered for all possible therapies. Classical Ayurveda does not mention anorexia nervosa, as we understand it today, as a disease condition. The origins of anorexia nervosa can be traced back to religious fasting in Medieval Europe and the reported starvation of female saints, the most famous being Catherine of Siena (1347 1380), who “claimed to be incapable of eating normal earthly fare.” And the first medical reports of anorexia nervosa did not appear until 1689 in Thomas Morton’s “Wasting Disease of Nervous Origins.” Considering that the Classical Ayurvedic texts were written between 500 and 1500 BC, it becomes obvious why it was never mentioned: it probably did not exist. Anorexia nervosa seems to appear only after food becomes abundant and eating becomes less about survival and more about a social obligation or sensory pleasure. As Joan Jacobs Brumberg, the author of Fasting Girls: A History of Anorexia Nervosa comments in a New York Times article entitled “Anorexia: It’s Not a New Disease,” “Anorexia nervosa emerges in cultures that are foodabundant…You don’t have anorexia nervosa in the third world: what you don’t eat, someone else will.” While the specific disease anorexia nervosa is not mentioned in the Classical Ayurvedic texts, anorexia nervosa would be classified as manasika arocaka or “loss of appetite due to factors of the mind” and for management of anorexia due to psychic origin, the Cakradatta recommends that “the patient is managed with pleasing and agreeable items.” It is important to note the significant difference between anorexia, meaning loss of appetite, and anorexia nervosa, the disease described above. While this paper will address loss of appetite as it appears as a symptom in advanced stages of anorexia nervosa, it is a deep misunderstanding to think that the anoretic has lost her appetite or does not desire to eat. “Individuals with anorexia nervosa may eventually develop a true lack of appetite, but for the most part it is not a loss of appetite but rather a strong desire to control it that is a cardinal feature. Rather than lose their desire to eat, anorexics, while suffering from the disorder, deny their bodies even when driven by hunger pangs…” writes Carolyn Costin in her reference manual, The Eating Disorder Sourcebook. Thus, loss of appetite will be considered as a latestage symptom and not a causative factor. In fact, the etiology of anorexia nervosa is still very much debated. It is beyond the scope of this paper to thoroughly investigate this topic, but trauma, genetics, a perfectionistic, selfcritical personality, the influence of the media, and participation in competitive activities that have an ideal weight have all been found to be contributing factors. Due to the size and scope of this paper, descriptions and treatments will focus only on post menarche females, who account for 8595% of all cases. This is not to suggest that anorexia nervosa does not also affect males and older women. Additionally, there are as many symptoms and expressions of AN as there are patients. While this paper will only focus on three of them, it is worth noting that other symptoms will be present and can frequently include: dry skin and hair, the development of lanugo (fine hairs on the body to conserve heat), insomnia, fluid retention, decreased ability to concentrate, dullness in the mind, depression, social withdrawal, and apathy. http://www.ayurvedacollege.com/book/export/html/2
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The first medical criteria required for a diagnosis of AN, as determined by the APA, is a “refusal to maintain body weight at or above a minimally normal weight for age and height…leading to body weight less than 85% of that expected.” It is reasonable to say that all other symptoms are a cascade that originate from this one source. The refusal to maintain body weight is not due to lack of hunger, as previously noted, “but, rather, due to strict denial of that most basic of body instincts: hunger.” So, while symptomatic relief is available and will be discussed for other medical complications, to treat the physical root of anorexia nervosa is to begin a process known as refeeding. Refeeding can happen either through working with a nutritionist and team of doctors while the patient lives at home or at an inpatient clinic, either at a private institution or in the psychiatric wing of a hospital. Throughout this process, Western treatment places primary importance on the calorie level and number of exchanges (measures of carbohydrate, fat, and protein content) present in the patient’s diet. A 2013 study conducted by the University of California, San Francisco, examined caloric intakes for adolescent anoretics: “Current recommendations for refeeding in anorexia nervosa (AN) are conservative, beginning around 1,200 calories to avoid refeeding syndrome.” Refeeding syndrome is “the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally).” So one can see that there is a standardized caloric starting point for all anorexic patients. As Erin Naimi, R.D., eating disorders specialist and nutrition therapist commented in an interview for this paper, “things are pretty nonindividualized in terms of how much [food]” is given to anorexic patients in treatment. This recent study completed by UCSF concluded that higher calorie diets with phosphate supplementation actually reduced hospital stays and resulted in faster weight gain with no incidents of refeeding syndrome. This is very much against the current model of refeeding at Western treatment centers, who use “the strategy called ‘start low, advance slow.’” Calorie increases from the baseline are dependent upon how quickly the anoretic gains weight. In a hospital setting, “there is a baseline meal plan which is the same…someone who needs to gain more weight would increase to a more rigorous meal plan,” says Ms. Naimi. But while immediately beginning with a higher calorie level might have physical benefits, like faster weight gain, there are psychological factors to consider; in the New York Times article, “Protocol to Treat Anorexia Is Faulted,” a patient who underwent rapid weight gain during her first hospital stay was so traumatized by it that she immediately lost all the weight as soon as she got out. When she was re hospitalized two years later, she stayed for a longer period with slower weight gain and no such ramifications in the future. Complicating matters further, anorexics will frequently experience hypermetabolism during the refeeding process. A 2012 study found consistent “evidence of a hypermetabolic state in patients with AN during refeeding which cannot be attributed to increased body mass alone…This is a phenomenon which appears to be unique to AN patients.” This phenomenon requires caloric levels to increase rapidly and dramatically if the patient is to keep gaining weight. Increase levels too fast, however, and patients may experience “digestive disorders like constipation, diarrhea, and reflux disease. They may vomit involuntarily because the stomach and digestive capacity is diminished.” The refeeding process shows exactly why treating AN remains a delicate matter; quantity of food must be balanced with rate of weight gain and digestive capability in equal measure, with the focus also being shared by the mental health of the patient. Food choices in an inpatient program will vary from program to program, Ms. Naimi, the eating disorders specialist in Los Angeles, reports, but generally are not seen as important as caloric levels. In a strict hospital setting, the food provided for eating disorder patients is of the same quality as the food provided for all the other patients in the hospital. This usually means conventionally grown, highly processed, low quality ingredients. Foods are simple, bland, and dense, with the emphasis on the quantity of calories and number of exchanges rather than the specific foods used to deliver those measures. The strictest eating disorder programs will not even make accommodations for food allergies or vegetarianism. Other privatelyrun programs offer patients “up to three likes or dislikes, but draw the line around veganism, generally,” says Ms. Naimi. The ability to select foods from a menu is sometimes given as a privilege after the patient has gained a certain amount of weight and can be trusted to make her own meal choices. Upon arrival to an inpatient program, the anoretic does not possess the mental capacity to choose foods that are healthful for her http://www.ayurvedacollege.com/book/export/html/2
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and even more than that, cannot be trusted to make food choices that are not the direct result of the disease. This is the thinking behind stripping away any and all “preferences,” which might just be a thin veil for her disorder to control her food choices. More than anything, the lack of information available on this specific subtopic speaks volumes as to how little attention is paid to food choices for the recovering anoretic. In terms of food habits, the recovering anoretic’s entire day is structured around mealtimes and snack times. Interestingly, routine is of primary importance; breakfast, lunch and dinner are served at the same time everyday in inpatient programs. In Ms. Naimi’s experience, meals are timed so that patients finish their meals in a “normal” amount of time, with consequences if they are unable to do so. This usually means 30 minutes for each meal and 15 minutes for each snack. Ms. Naimi has never encountered a program that incorporates spiritual practices such as prayer into their mealtime routines, especially at larger, hospital inpatient centers. She says that smaller, private institutions will offer more spiritual practices, but not necessarily around mealtimes. The patients will always be monitored during meals and snacks, either by a nursing staff or by their own private therapists. These practices vary from program to program. The idea is twofold: one, anoretics, especially at the beginning, are essentially at the mercy of their disease and will try anything to not eat, so monitoring prevents them from getting out of eating; and two, especially with a therapist, the mealtime becomes a sort of therapy session, where the doctor can see the patient interact with her meal and help her deal with the thoughts and behaviors surrounding it as they arise. Following mealtime, patients will typically have some form of therapy to help them process anything that came up during the meal or quiet time to relax, journal and practice stillness after eating. From an Ayurvedic perspective, as explained in the Astanga Hrdayam, “consuming of insufficient quantity of food does not help improvement of strength, growth, and vigour, it becomes a cause for all diseases of vata origin.” Thus, the first symptom of AN, weight loss resulting in a body weight of 85% of the ideal, is an invitation for vata vitiation, and treatment would therefore be centered around vata pacification: The treatment of (increased) vata are – oleation (internal and external), sudation (diaphoresis), mild purifactory therapies (emesis and purgation), ingestion of foods which are of sweet, sour, and salt taste; warmoil bath massage of the body, wrapping the body with cloth, threatning (frightening), bath (pouring of medicinal decoctions, water, etc on the body), wine prepared from cornflour and jaggery (molasses), enema therapy with fat (oil), and drugs of hot potency, adherence to regimen of enema therapy, comfortable activities, medicated fats of different kinds (sources) prepared with drugs causing increase of hunger and improving digestion; especially anuvasana basti (oleation enema) prepared from the juice of fatty meat and oil. We have concluded that weight loss due to insufficient food qualifies as a vata imbalance and as noted above, the Astanga Hrdayama indicates the sweet, sour, and salty tastes as best for pacifying vata. So, a diet rich in these three tastes should be best for the recovering anoretic. Other qualities known to pacify vata are heavy, moist, oily, and warm foods. Refeeding according to Ayurveda follows samsarjana karma and recommends that the anoretic begins eating “the heaviest food that is well digested.” In stark contrast to the nonindividualized Western treatment approach, Ayurveda begins by tailoring the amount of food taken in to the specific digestive ability of the patient. If the patient is found to have deficient digestion, the Cakradatta recommends taking “hot ricescum mixed with hingu and sauvarcala. By this the irregular fire becomes regular and the mild one is intensified. The ricescum has eight properties – it increases appetite, cleans urinary bladder, gives energy, promotes blood, alleviates fever and pacifies kapha, pitta, and vata.” Other foods like rice water, thin rice gruel, and rice porridge are also recommended as starting points to assess digestion by. Ghee and oils are added in small amounts to the food, beginning when the patient can properly digest rice, and then increased as digestion can tolerate. Warming dipanas and appetite increasers, like Ginger, Pippali, Amalaki, and Chitrak should be taken with all http://www.ayurvedacollege.com/book/export/html/2
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meals, as well. Ginger is especially recommended for low agni in the Cakradatta, “(In case of mildness of fire) taking pieces of fresh ginger with salt in the beginning of the meal is always wholsome [sic]. It stimulates digestive fire, cleanses tongue and throat and is pleasant.” In addition to dipanas, herbs can be used to help increase weight and improve appetite, while improving the psychiatric condition of the patient. Dr. A. A. Mundewadi, Chief Ayurvedic Physician at Mundewadi Ayurvedic Clinic in Maharashtra, India, recommends Ashwagandha, Shatavari, Samudrashosh, Jayphal, and Khurasani Ova for this purpose. In addition, he, along with other sources, recommends the jam Chyawanprash to help with weight gain. No references to specific caloric levels can be found in modern Ayurvedic treatment plans for AN, an indication that the health of the digestion and pacification of vata are to be given more attention than the caloric level. While the goal of treatment is the same (weight gain), Ayurveda seems to prioritize healthy digestion above the speed with which weight is put on. Following principles of Ayurveda, more important than even the choice of foods that the anoretic is eating would be the way in which they are prepared and the way in which she is eating them. In the context of AN, these food habits become even more critical to counteract the anxiety that peaks with mealtimes. According to the Charaka Samhita, “food should be taken mindfully…food should not be taken when afflicted with grief, anxiety, confusion, fear, anger, passion or greed…Food should be taken under conducive and pleasant environment. The individual should be relaxed and happy.” Ayurvedic treatment would extend off the plate and into the very room in which meals are being held, encouraging the use of all five senses to make eating a more pleasant experience. Aromatherapy may be administered before a meal, to stimulate digestion, during a meal to calm anxiety, and after a meal to promote relaxation in the mind and reduce digestive upset. Ginger, Mandarin, and Lavender, respectively, are all indicated. Color therapy on the walls of the diningroom or as a light source can also be recruited to aid the healing process. Sattvic colors like gold, green, and blue are all indicated. In addition to these recommendations, “food should be taken when hunger is felt and not delayed or taken in a hurry or very slow.” While hunger cues are guaranteed to be distrusted at the beginning, meals can certainly not be taken in a hurry or very slowly. This seems particularly applicable to anoretics who will want to rush mealtimes to get them over with or draw them out to avoid eating. Taking an appropriate amount of time encourages mindfulness and connection of the mind to the body. In addition to maintaining a body weight that is less than 85% of the ideal, a patient must display an “intense fear of gaining weight or becoming fat…and a disturbance in the way one’s body weight or shape are experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.” This symptom moves the disease from the physical body into the deeper layers of the mental and emotional bodies, what would be considered the manomaya kosha and vijnanamaya kosha in Ayurveda. Western treatment for this fear, anxiety, and misperception incorporates psychotherapy and, to a lesser extent, medications. The use of medications is solely focused on symptomatic relief of psychological symptoms, such as anxiety, and not on the root cause of the disease. As reported by the Mayo Clinic, “there are no medications specifically designed to treat anorexia because they haven’t been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental disorders you may also have, such as depression or anxiety.” The most common medications used to treat mental symptoms stemming from AN are antidepressants, specifically Selective Serotonin Reuptake Inhibitors and antianxiety medications, like benzodiazepines. Research shows that the time of administration significantly alters the effectiveness of SSRI’s. Fluoxetine (Prozac), an SSRI, for example, has been shown to prevent relapse in anoretics, but only when given after weight restoration. Benzodiazepines, on the other hand, are best administered “when therapeutic efforts are made to counteract the pursuit of thinness and ritualistic behaviours [sic] around eating,” it was reported in a study published in The Journal of Psychiatry and Neuroscience. Further, from the same study, “despite their merits in the acute treatment of anorexia nervosa, benzodiazepines are used sparingly in clinical settings. This may be because psychotherapy, accompanied by nutritional and behavioural approaches to healthy eating and weight gain, is considered the most promising treatment.” We can conclude, http://www.ayurvedacollege.com/book/export/html/2
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therefore, that while appropriately administered drugs can be helpful in reducing relapse, the initial healing is not accomplished through pharmaceuticals. Nutritional and behavioral approaches are administered in the form of therapy, both personal and group, and through nutrition therapy and education. As far as therapeutic approaches go, cognitive behavioral therapy has been found to be most effective, generally, and even more effective than nutrition counseling. A 2003 study published in The American Journal of Psychiatry found that “cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse.” This can be attributed to the fact that it is not lack of knowledge about nutrition that is causing the anoretic to starve (on the contrary, eating disorder patients frequently display an encyclopedic knowledge of caloric contents and dietary facts), but the mental disturbances caused by the disease. Fear and anxiety like the kind displayed by anoretics would, from an Ayurvedic perspective, fall squarely under the category of vata vitiation. Specifically, prana, vyana, and samana vayu would all be vitiated in the manovaha srota. To treat this vitiation in the mind, Ayurveda provides a great variety of body therapies, lifestyle practices and herbs. As cited earlier in the Astanga Hrdayam, both external and internal oleation are strongly indicated to pacify vata in the body, as well as in the mind. In his text, Ayurvedic Healing, Dr. David Frawley recommends sesame oil massage for anorexia, with emphasis on the head and feet of the patient, as well as the administration of sandalwood oil to the head. Even though he is referring to anorexia meaning loss of appetite, the remedies are applicable, as they are designed to pacify vata. This external oleation will pacify vyana vayu as well as slow the rate of absorption of prana vayu, decreasing the speed at which thought flows through the mind and thus calming anxiety. In addition to this therapy, shirodhara, known for its effectiveness in reducing anxiety, insomnia, and nervousness would be of huge benefit to the anoretic, too. This external oleation would be best complemented by internal oleation as well, however, this brings up some of the complexities that are inherent in this most complicated disease. Firstly, agni in the advanced stage will be low, perhaps too low to digest oils without creating ama (as explored previously in this paper). Secondly, the anoretic is almost guaranteed to strongly resist taking in pure oil, which she sees as pure fat, to the point that it creates more anxiety than it is worth. Anuvasana basti, as previously recommended in the Astanga Hrdayama, would be an excellent way to apply oil internally in order to pacify vata at its root, the colon. And because it would not need to be ingested through the mouth, this internal oil application might be easier for the anoretic to swallow, as well as being of excellent benefit. Additionally, lifestyle practices that would be recommended include yoga, meditation, and time in nature. Yoga is of particular importance for several reasons. As Patricia Walden, yoga teacher, writes in the book The Woman’s Book of Yoga and Health, “besides offering emotional and spiritual support, yoga provides physiological help to reverse or minimize the longlasting effects of starving.” Physically, yoga postures can balance the endocrine system and blood pressure, calm the adrenal glands, and even jumpstart menstruation. Almost more importantly, though, yoga can arrest the sympathetic nervous system response, a fightorflight mechanism that will frequently kick in for an anoretic during and right after mealtimes, when anxiety is highest. Gentle, slow, flowing sequences that are designed to pacify vata by including lots of poses that encourage compression of the solar plexus will have the additional benefit of providing a new habit that, hopefully, in time, will replace the old starvation patterns. A 2010 study completed by the Department of Adolescent Medicine at Seattle Children’s Hospital shows very promising results; the authors of the study concluded that individualized yoga sessions decreased Eating Disorder Examination scores after 12 weeks of practice and also significantly reduced food preoccupation immediately after the practice. Finally, herbal remedies are available to treat anxiety; nervine sedatives will calm vata in the mind, while nervine tonics will build the strength of the nervous system. Dr. A. A. Mundewadi recommends “Jatamansi, Shankpushpi, Vacha, Kushmand, Brahmi, and Sarpagandgha [to treat the psychological component of anorexia nervosa].” The final symptom that will be examined in this paper is amenorrhea. This criteria was recently removed from the DSMV, the most recent version of the APA’s manual, but because of the large number of anoretics who experience amenorrhea and because of the seriousness of such a http://www.ayurvedacollege.com/book/export/html/2
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symptom, I have chosen to include it in this report. Amenorrhea is defined by the Mayo Clinic as “the absence of menstruation – one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea.” “From a traditional Western medical perspective, the loss of menses due to AN is viewed as a result of low hormone levels, specifically a lack of luteinizing hormone and follicularstimulating hormone precipitated by inadequate body fat or low weight which causes corticotropinreleasing hormone to be suppressed. But, recent studies, like the one from the Department of Pediatrics at the Schneider Children’s Hospital at the Long Island Jewish Medical Center are finding that “resumption of menses require[s] restoration of hypothalamicpituitaryovarian function, which [does] not depend on the amount of body fat.” And a 2006 study by the University Tor Vergata in Rome, Italy, found that “an adequate body composition and a well represented fat mass are certainly a necessary but not sufficient condition for the return of the menstrual cycle.” Very few studies have been conducted around treating the hypothalamic disturbance that seems to be at the root of the persistent amenorrhea. A 1976 study entitled “Amenorrhea in Anorexia Nervosa: Assessment and Treatment with Clomiphene Citrate” concludes that in patients who were still amenorrhoeic following the finding of normal LH levels, “that they have a persistent hypothalamic disorder whereby the normal midcycle peak of LH secretion does not occur. A hypothalamic disturbance has long been postulated as the cause of pituitary hypofunction in anorexia nervosa, but definite evidence has been lacking.” Due to this lack of research, Western medical treatment focuses on hormone replacement as the answer to amenorrhea, if menses has not resumed following adequate weight gain. It is recommended that patients who present with amenorrhea be placed on oral contraceptives for the health of their bones, which are already under duress from malnutrition. Osteoporosis is one of the major health concerns facing anoretics because bone density loss is believed to be irreversible and amenorrhea is seen as a major causative factor in osteoporosis. Thus it is of primary importance to replace the hormones artificially to protect the health of the bones. The common treatment plan is to keep the patient on oral contraceptives until weight is restored and then observe if menses returns. If it does not, then the patient would be placed back on oral contraceptives. As the lack of research in this area shows, the priority for AN patients is to get hormones back into the body as quickly as possible to protect the stability of the bones; amenorrhea is really only viewed as an issue if the woman wants to get pregnant, at which time they will provide medications to stimulate ovulation. Following in line with all the other symptoms before it, from an Ayurvedic perspective, secondary amenorrhea of this sort is considered a vitiation of vata in the rasa and shukra dhatus of the artavavaha srota. The shukra dhatu is the deepest dhatu of the body, so nutrition must be digested first by all six other dhatus before it can reach and nourish the shukra dhatu. Thus the treatment of amenorrhea begins with the treatment of dhatu agnis and regulation of the digestive system of a patient. Ayurveda understands that even if adequate nutrition is being taken in, the tissue being produced could be of low quality if there is disturbance in the dhatu agnis. The Cakradatta suggests a “suppository made of iksvaku (seeds), danti, pippali, jaggery, madana, yeast, madhuyasti and snuhi latex and kept in vagina” to induce menstruation. If not this, then another alternative remedy is suggested, “Japa flower mixed with sour gruel or jyotismati leaves, both fried, and ricecake of durva – woman taking any of these gains menstruation.” As Dr. Frawley notes for treatment of amenorrhea, “an antivata or tonifying diet is primarily indicated using dairy, nuts, oils, whole grains and other nourishing foods.” This is right in line with the diet discussed previously to restore the weight of the anoretic. Dipana herbs to regulate any digestive disturbances would also be indicated here. Herbs may also be used to promote menstruation, if necessary. Reproductive tonics like Shatavari, Ashwagandha, Vidari Kand, and Wild Yam are all indicated. Chyawanprash, as mentioned before, would be an excellent herbal supplement for amenorrhea. Ayurveda also recognizes the role that stress plays in amenorrhea. “Excessive motion such as a fastpaced lifestyle filled with travel, stress and overwhelm is a key contributing factor [to amenorrhea],” as is excessive exercise. Other vatapacifying therapies like abhyangha, shirodhara, and appropriate yoga (as previously discussed) would also come into play as treatments for stressrelated amenorrhea. Restorative yoga as well as Yoga Nidra would be the preferred types of yoga. Even sleeping during the day should be considered as a http://www.ayurvedacollege.com/book/export/html/2
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remedy, as suggested in the Cakradatta, “sleeping during the day is recommended in the following conditions – those who are exhausted by exercise…patients suffering from diarrhea [sic], abdominal pain, dyspnea, thirst, hiccough, and vatika disorders; those who are emaciated…” The other aspect of amenorrhea that cannot be denied is in the mind of the patient. If the eating disorder serves the function of keeping maturation and adulthood at bay, then the patient will actually desire to lose her menses. This must be dealt with on a psychological and spiritual level through therapy and selfstudy. In summary, I believe that neither Western nor Ayurvedic remedies provide the entire answer to this mysterious and dangerous illness. Rather, it seems that a treatment plan which encompasses the best of Western science along with the holistic, individualized healing therapies of Ayurveda would provide the most wellrounded and complete approach with the best possible chances of achieving recovery. Due to the severity of advanced cases of anorexia, it would be irresponsible to depend purely on Ayurveda as a healing modality; there is much more evidencedbased research around a Western refeeding model to support its use in providing nutrition to malnourished individuals safely. But for healing not just the body, but also the mind and the spirit, Ayurveda can absolutely supplement Western prescriptions. Since medications have been found so ineffective in treating AN, perhaps both providers and patients will feel more open to alternatives like herbal treatments and body therapies. And as the trend towards more conscious eating keep moving forward, one can only hope that eating disorder programs will pay more attention to not just how much, but what they are feeding their patients. Ayurveda, I believe, can be especially helpful in the treatment of amenorrhea, since the condition seems to still baffle Western medicine and appears to have so much to do with lifestyle and stress reduction. Imagine a hospital program that offered regular yoga instruction, had a meditation space, offered abhyanga and shirodhara, and encouraged reverence, rather than rigidity, around mealtimes: such a place would encourage not only the healing of bodily tissues, but the mending of the very soul itself, which can be just as starved for attention as the body it inhabits. Ms. Naimi has already seen a trend towards bringing in spiritual practices in smaller, private residential treatment centers and in private practices, so maybe the larger inpatient centers will follow suit. This would require a rethinking of the anoretic as an individual with a disease, rather than as a disease that has taken over an individual. And that can only result in deeper levels of healing and understanding of this still elusive and devastating disorder. Body Matters Australasia, Body Matters Staff, DSMV Proposed Diagnostic Criteria For Eating Disorders. http://bodymatters.com.au/wp content/uploads/2010/11/DSMVproposalsED.pdf Kirkpatrick, Jim and Paul Caldwell, Eating Disorders: Everything You Need to Know (Buffalo: Firefly Press, 2004) 17. National Associate of Anorexia Nervosa and Associated Disorders, ANAD Staff, Eating Disorders Statistics. http://www.anad.org/get information/abouteatingdisorders/eatingdisordersstatistics/ Brumberg, Joan Jacobs, Fasting Girls: The History of Anorexia Nervosa (New York: Vintage Books, 2000), 43. Kirkpatrick, Jim and Paul Caldwell, Eating Disorders: Everything You Need to Know (Buffalo: Firefly Press, 2004), 26. Halpern, Dr. Marc, Principles of Ayurvedic Medicine (California College of Ayurveda, 2010), 13. Lawson, Carol, “Anorexia: It’s Not a New Disease,” The New York Times (December 1985). http://www.nytimes.com/1985/12/08/style/anorexia itsnotanewdisease.html Halpern, Dr. Marc, Clinical Ayurvedic Medicine (California College of Ayurveda, 2012), 219. Sharma, P.V. Cakradatta: A Treatise on Principles and Practices of Ayurvedic Medicine (Varanasi: Chaukhambha, 2002) page 153, Chapter XIV, Verse 1 Costin, Carolyn, The Eating Disorder Sourcebook (Los Angeles: Lowell House, 1999), 6. http://www.ayurvedacollege.com/book/export/html/2
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Mayo Clinic, Mayo Clinic Staff, Anorexia Nervosa: Risk Factors. http://www.mayoclinic.com/health/anorexia/DS00606/DSECTION=riskfactors National Association of Anorexia Nervosa and Associated Disorders, ANAD Staff, Eating Disorder Statistics. http://www.anad.org/get information/abouteatingdisorders/eatingdisordersstatistics/. Kirkpatrick, Jim and Paul Caldwell, Eating Disorders: Everything You Need to Know (Buffalo: Firefly Press, 2004), 3134. Cleveland Clinic, Kathleen N. Franco, Eating Disorders. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry psychology/eatingdisorders/ Kirkpatrick, Jim and Paul Caldwell, Eating Disorders: Everything You Need to Know (Buffalo: Firefly Press, 2004), 25. Garber AK, Mauldin K, Michihata N, Buckelew SM, Shafer MA, Mosicicki AB. Higher Calorie Diets Increase Rate of Weight Gain and Shorten Hospital Stay in Hospitalized Adolescents With Anorexia Nervosa. J Adolesc Health 2013 Sep 17; PubMed PMID: 24054812. http://www.ncbi.nlm.nih.gov/pubmed/24054812. Mehanna Hisham M, Jamil Moledina, Jane Travis. Refeeding Syndrome: what it is, and how to prevent and treat it. BMJ 2008 June 28. 336(7659): 14951498. PMC2440847. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/ Garber AK, Mauldin K, Michihata N, Buckelew SM, Shafer MA, Mosicicki AB. Higher Calorie Diets Increase Rate of Weight Gain and Shorten Hospital Stay in Hospitalized Adolescents With Anorexia Nervosa. J Adolesc Health 2013 Sep 17; PubMed PMID: 24054812. http://www.ncbi.nlm.nih.gov/pubmed/24054812. Rabin, Roni Caryn. “Protocol to Treat Anorexia Is Faulted.” The New York Times (January 2, 2012) http://www.nytimes.com/2012/01/03/health/research/anorexicpatientscanbefedmoreaggressivelystudysays.html. Rabin, Roni Caryn. “Protocol to Treat Anorexia Is Faulted.” The New York Times (January 2, 2012) http://www.nytimes.com/2012/01/03/health/research/anorexicpatientscanbefedmoreaggressivelystudysays.html. Curran, Hannah. Hypermetabolism during refeeding in patients with anorexia nervosa. Undergraduate Awards Competition. 2012. http://www.scribd.com/doc/104433299/Hypermetabolismduringrefeedinginpatientswithanorexianervosa. Rabin, Roni Caryn. “Protocol to Treat Anorexia Is Faulted.” The New York Times (January 2, 2012) http://www.nytimes.com/2012/01/03/health/research/anorexicpatientscanbefedmoreaggressivelystudysays.html. Eating Recovery Center, Eating Recovery Center Staff, “A Day in the Life of An Eating Disorder Treatment Patient.” http://www.eatingrecoverycenter.com/patienteatingdisordertreatment/adayinthelife/ Murthy, Prof. K. R. Srikantha, Vagbhatta’s Astanga Hrdayama: Volume 1: Sutra, Sthana, and Sarira Sthana (Varanasi: Krishnadas Academy, 1991), 124, Chapter 8, Verse 33.5. Murthy, Prof K.R. Srikantha. Vagbhatta’s Astanga Hrdayama: Volume I: Sutra, Sthana, and Sarira Sthana (Varanasi: Krishnadas Academy, 1991), 183, Chapter 13, Verse 13. Halpern, Dr. Marc. Clinical Ayurvedic Medicine (California College of Ayurveda, 2012), 219. Sharma, Cakradatta: A Treatise on Principles and Practices of Ayurvedic Medicine (Varanasi: Chaukhambha, 2002), 91. Halpern, Dr. Marc. Clinical Ayurvedic Medicine (California College of Ayurveda, 2012), 219. Mundewadi, A. Anorexia Nervosa Ayurvedic Herbal Treatment (2009, February 12). http://ezinearticles.com/?Anorexia¬Nervosa¬¬ ¬Ayurvedic¬Herbal¬Treatment&id=1986631 Mundewadi, A. Anorexia Nervosa Ayurvedic Herbal Treatment (2009, February 12). http://ezinearticles.com/?Anorexia¬Nervosa¬¬ ¬Ayurvedic¬Herbal¬Treatment&id=1986631 Arunachalan, Srikantha. Treatise On Ayurveda (New Delhi: The Book Factory, 2005), 5960, referencing The Charaka Samhita, Vimana Sthana 1 http://www.ayurvedacollege.com/book/export/html/2
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& 2 and Chikitsa Sthana 15. Arunachalan, Srikantha. Treatise On Ayurveda (New Delhi: The Book Factory, 2005), 60, referencing The Charaka Samhita, Vimana Sthana 1 & 2 and Chikitsa Sthana 15. Cleveland Clinic, Kathleen N. Franco, Eating Disorders. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry psychology/eatingdisorders/ Mayo Clinic, Mayo Clinic Staff, Anorexia Nervosa: Treatments and Drugs. http://www.mayoclinic.com/health/anorexia/DS00606/DSECTION=treatmentsanddrugs Costin, Carolyn, The Eating Disorder Sourcebook (Los Angeles: Lowell House, 1999), 222. Kruger, S and SH Kennedy, “Psychopharmacotherapy of anorexia nervosa, bulimia nervosa, and bingeeating disorder,” The Journal of Psychiatry and Neuroscience (November 2000) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408011/?page=3. Pike, Kathleen et al. “Cognitive Behavior Therapy in Posthospitilization Treatment of Anorexia Nervosa,” The American Journal of Psychiatry (November 2003) http://ajp.psychiatryonline.org/article.aspx?articleID=176504. Frawley, Dr. David, Ayurvedic Healing: A Comprehensive Guide (Twin Lakes: Lotus Press, 2000), 170. Sparrowe, Linda and Patricia Walden, The Woman’s Book of Yoga & Health (Boston: Shambhala Publications, 2002), 65 Sparrowe, Linda and Patricia Walden, The Woman’s Book of Yoga & Health (Boston: Shambhala Publications, 2002), 65 Carei TR, FyfeJohnson AL, Breuner CC, Brown MA. Randomized controlled clinical trial of yoga in the treatment of eating disorders. J Adolesc Health. 2010 Apr;46(4):34651. PubMed [indexed for Medline] PMID: 20307823. http://www.ncbi.nlm.nih.gov/pubmed/20307823 Mundewadi, A. Anorexia Nervosa Ayurvedic Herbal Treatment (2009, February 12). http://ezinearticles.com/?Anorexia¬Nervosa¬¬ ¬Ayurvedic¬Herbal¬Treatment&id=1986631 Mayo Clinic, Mayo Clinic Staff, Amenorrhea: Definition. http://www.mayoclinic.com/health/amenorrhea/DS00581 University of Washington, University of Washington staff, What is the mechanism of amenorrhea in anorexia nervosa? http://depts.washington.edu/osteoed/faqs.php?faqID=93 Golden NH, Jacobson MS, Schebendach J, Solanto MV, Hertz SM, Shenker IR. Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med 1997 Jan;151(1):1621. PubMed [indexed for Medline] PMID: 9006523 http://www.ncbi.nlm.nih.gov/pubmed/9006523 Jacoangeli F, Masala S, Staar Mezzasalma F, Fiori R, Martinetti A, Ficoneri C, Novi B, Pierangeli S, Marchetti G, Simonetti G, Bollea MR. Amenorrhea after weight recover in anorexia nervosa: role of body composition and endocrine abnormalities. Eat Weight Disord. 2006 Mar;11(1):e206. PubMed [indexed for Medline] PMID: 16801735. http://www.ncbi.nlm.nih.gov/pubmed/16801735. Marshall J.C., Fraser T. Russell. Amenorrhea in Anorexia Nervosa: Assessment and Treatment with Clomiphene Citrate. Br Med J. 1971 December 4; 4(5787): 590592. PubMed PMCID: PMC1799887. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1799887/ Sharma, P.V. Cakradatta: A Treatise on Principles and Practices of Ayurvedic Medicine (Varanasi: Chaukhambha, 2002), 531, Chapter LXII, Verse 24 Sharma, P.V. Cakradatta: A Treatise on Principles and Practices of Ayurvedic Medicine (Varanasi: Chaukhambha, 2002), 531, Chapter LXII, Verse 25 Frawley, Dr. David. Ayurvedic Healing (Twin Lakes: Lotus Press, 2000), 248. Halpern, Dr. Marc. Clinical Ayurvedic Medicine (California College of Ayurveda, 2012), 5101. Sharma, Cakradatta: A Treatise on Principles and Practices of Ayurvedic Medicine (Varanasi: Chaukhambha, 2002), 99, Chapter VI, Verse 78. http://www.ayurvedacollege.com/book/export/html/2
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The Use of Sound in Healing—An Ayurvedic and Western Perspective By Parthena Rodriguez Abstract It has long been noted that particular sounds have a direct effect on the body’s ability to heal from various disharmonious states or disease. From imbalances associated with anxiety to nerve disorders and cancer, recent advances in western medicine show how sound affects us on the cellular level and can have broad, physiological healing results. Modalities shown to have beneficial effects include listening to music, toning, humming, chanting and giving one’s attention to the sounds of various instruments. This paper compares recent advances in western medicine’s ability to analyze what the ancient rishis knew long ago: that we are part of a common vibratory experience which begins with what has been known as The Word (Om) and that unhealthy or negative patterns in the body could be eliminated and health restored or helped by repeating mantra, listening to music or patterned sound, and/or becoming attuned to various rhythms or harmonies, external as well as internal. Though this knowledge is inherent and was passed down through the millennia, recent examples of specific healing effects from sound therapies are studied and documented by scientists, doctors, physicists, musicians, and modern day yogis. As western attitudes broaden, eastern teachings are being integrated and are seen as complementary, leading to a convergence of the ancient and the modern methods of healing, mind, and spirit.
The Use of Sound in Healing—An Ayurvedic and Western Perspective By Parthena Rodriguez “In the beginning was the Word and the Word was with God,” is stated in St. John’s Gospel. Johannes Kepler, the great German mathematician and astrologer writes in his Music of the Spheres, “The earth hums a tune,” and the ancient rishis uttered secret syllables before administering life saving treatments and medicine. Edgar Cayce, the great modern day mystic called sound ‘The Medicine of the Future’ and the benefits of ultrasound in modern medicine are duly noted for a number of things, including the use in healing muscles that are affected by pain. Actually, the word heal, in old English, means “to return to a sound state”’ http://www.ayurvedacollege.com/book/export/html/2
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to “make whole, sound and well. “ The Sanskrit word svanah, meaning sound or tone, generally refers to a type of synchronization. There is no doubt that human beings along with all sentient beings are a part of a vibratory experience which began with creation, ever permeating prakruti and that sound, being of that experience, plays a vital role in our emotional, physical, mental, and spiritual existence and well being. Assuming that the reader understands that sounds or vibratory patterns have an effect, this paper will delve into some of the physics of what sound is, cite examples of Western studies and Ayurvedic views as related to sound used in healing, and explore the Om sound and its vibratory significance on humankind’s fit in this universe. Sound All sounds are waves and are produced by the vibrations of material objects. These vibrations are transmitted through air or other mediums such as solid, liquid, gas or plasma. When vibrations reach the ear they are converted to electrical impulses in the brain, which we interpret as sound. However, lower frequency vibrations can also be felt by the body. Sound also has a speed at which it travels and is dependent on subtle atmospheric changes like temperature and humidity. Because sound travels in waves, it can move over very large distances. However, the linear concept of how sound travels can go quite beyond that sounds are simply waves. Paul in his book, The Yoga of Sound states that “sound is infused with intelligence—an organizing principle that shapes the forms we perceive [even] through our eyes. “ That organizing principle has been shown to affect everything down to our DNA, permeating every cell within our bodies. In other words, sound effects form, as it was proposed that sound came first, before form. This connection of sound to form was summed up when Plato said that ‘a stone is frozen music’. It is interesting to note that sound waves bend and take little energy to produce. The conceptual physicist Paul Hewitt states that “10,000,000 people talking at the same time would produce sound energy equal only to the energy of an ordinary incandescent lamp. “ Yet our sense of hearing is subtle and we are only able to hear because of our ears’ remarkable sensitivity. Medical science has even proven that our ears are “the first organ to develop in the fetus and the last organ to stop function during the process of death.” Sound has loudness which depends on the amplitude of the wave. We gauge loudness in decibels which measure common noise levels found in our environment and are registered by the human ear beginning at about 10 decibels with painful sounds beginning at about 125 db. The frequency of sound is measured in Hz, or cycles per second. Humans can hear from around 20 Hz to 20,000 Hz. However, it has also been suggested that “music or audible sounds could modulate physiological and pathophysiological processes” and that “cell types other than auditory hair cells could respond to audible sound [as] vibrotactile sensations… in the chest and throat.” Sounds, simply, have waves, patterns, and frequencies; yet, affect us in ways that are both subtle and remarkable. Pitch and quality are also ways to describe frequency and sound characteristics. For example, low pitch notes have a lower frequency of vibration than high notesthe higher the pitch, the faster the vibration and the lower the pitch, the slower. A musically pure note is one frequency, though http://www.ayurvedacollege.com/book/export/html/2
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most sounds that we experience have many different frequencies combined. Resonance is an important factor when examining sound and its quality because “when the frequency of forced vibrations on a body matches the body’s natural frequency, a dramatic increase in amplitude occurs.” This brings in the idea of a principle called prime resonance. This means that our organs and systems have their own innate frequencies. These frequencies determine how the cells and systems absorb sound or to what extent they can be reharmonized by various outside healing frequencies. And we know that our cells, organs, and systems are susceptible to a variety of environmental and emotional traumas which can deharmonize them and vice versa. For example, long term exposure to noise can contribute to the disharmony of the cells and systems in our bodies. Studies conclude that each organ as well as each cell vibrates its own frequency since cells emit sounds as a part of their metabolic processes as they interact with the frequencies in their environment. Rhythm We know that before birth, the fetus is not only encompassed in the mother’s rhythms, but is also able to hear noises outside of the womb as early as four months. Caraka notes that around the third or fourth months, the fetus begins to manifest consciousness. This is when ether or akasha, the most subtle of the five elements, becomes evident. Ether, according to Ayurveda, is responsible or associated with the sound of hearing. And from birth on, we are surrounded by rhythms and sounds that make up the vibratory experience of pattern all around us. These rhythms are noted in our immediate environment—in the seasons and in the passing of different times of day, the cycles of the moon and our patterned breathing. Even the rhythmic beats of our hearts are mirrored in great poetry and in Shakespearean plays in the form of iambic pentameter. This makes us an obvious reflection of these patterned rhythmic experiences of which even our “Milky Way Galaxy turns like a Ferris wheel” every 10 million years. Nothing in the universe escapes movement and rhythmic patterns. So sound has to be a part of a rhythmic structure that affects the cadence of our experience. The more we are in tune with waves of varying worth may determine the quality of our bodily existence in the greater scheme of life’s rhythms. Western studies and stories on the effects of sound on healing Not surprisingly, there have been numerous studies on the effects of sound on health. In Masaru Emoto’s book on water crystal healing, he is able to show how organized sound in the form of music affects the formation of patterns in water crystals which are frozen in Petri dishes under a light microscope. Through photographs, he demonstrates how water takes on expressions of sound. He also likens our body’s systems to a symphony that is healthy when it is harmoniously vibrating. As with all energy, sound moves in waves outwards, though they may affect patterns beyond ‘normal’ perception. Emoto reveals how one vibration influences another as in prime resonance. First, he shows that diseases have a measurable wave or vibration. That vibration is something termed hado and is measured using a device called a Magnetic Resonance Analyzer. The MRA measures the characteristic of the wave produced by the vibration inherent in the diseased organ. He then shows how music formulates patterned crystals when exposed to various classical musical pieces. Dr. Emoto claims that upon drinking the water that was exposed to healing music prescriptive to that patient and his disease that healing and balancing is able to take effect, correcting the energy disturbance. http://www.ayurvedacollege.com/book/export/html/2
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From analysis of each piece of music’s hado, he is able to suggest that by listening to various melodic pieces, one can be relieved from a variety of imbalances which include irritability, suppression of emotions, relationship problems, stuck thought patterns, self pity, hopelessness, deep sorrow, stubbornness, and depression. In The Mozart Effect, Campbell, a classically trained musician, begins by telling how he healed himself from a potentially deadly blood clot in the brain through internal visualization and by humming a sound which he felt helped his cells resonate a healthy pattern throughout his system. In humming a tone, I sensed the power of a sound that had warmth, brightness, and clarity. I envisioned the sound as a vibrating hand coming into my skull on the right side, simply holding the energy within. I imagined a vowel sound coming into my left hand, traveling through my heart and body, up to my right hand, and then back into my head, heart, and down through my feet. Each tone made a circuit through my body. Undergoing a series of medical tests three weeks later, the results showed that the clot had decreased from more than an inch to less than an eighth of an inch, astounding the doctor who pronounced him out of mortal danger. Most people would agree that ‘music masks unpleasant sounds and feelings’, but music, patterned sound, is also demonstrated to slow down and equalize brain waves. Campbell reminds us that varying states of consciousness are associated with different types of waves such as beta, delta, and theta and it has been proven that the slower the brain waves, the more relaxed and peaceful we feel. Respiration, heartbeat, pulse rate, as well as blood pressure have all been proven to be affected by various types of music. Campbell cites a study by researchers at Temple University who found that when our heart rates are increased, our resistance to disease is decreased. They also found that rock music increased the heart rate more than other types of music and that some forms of rock music were responsible for reducing skin resistance to stimuli. Campbell, inspired by his own healing with the help of sound, was able to show how attributes of various types of music resulted in specifically desired effects. As with prime resonance, how the listener responded to various patterned sound or music was important, so the healing effects varied “according to the composition, the performer, the listener, the posture assumed in listening, and other factors.” It is interesting to note how various musical genres have a range of effects on most listeners, again this is due to individual perception and experience. For example, chants were noted to create a sense of relaxed spaciousness, classical music with improved concentration and memory, jazz can elicit feelings that inspire and uplift, and salsa may simultaneously soothe and awaken the senses. Even heavy metal, “with its dynamic and disturbing consequence of exciting the nervous system, can help modern day adolescents release their inner rage and turmoil.” In Empower for Your Health magazine, Dr. Mark Harrell, an endocrinologist, after explaining how our biology demands rhythm, discusses how music therapy can help stroke victims and patients with Parkinson’s disease. Scientists believe that music triggers undamaged networks of nerve cells that allow translation of the beat into organized body movement. Dr. Concetta Tomaino, cofounder of the New York City Institute for Music and Neurologic Function, notes that ‘someone who is frozen (from Parkinson’s or stroke) can immediately release and begin walking. They can coordinate their steps to synchronize with the music.’ http://www.ayurvedacollege.com/book/export/html/2
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Music affects health as it influences digestion, endurance, productivity, and feelings of romance. Used along with other healing modalities, mainstream or otherwise, certain types of music are seen as helpful and prescriptive sources. In one singleblind controlled scientific study, patients who had experienced cerebral artery strokes were shown as benefiting simply from listening to music for two months. Fiftyfour patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused moods than the control group. Those findings also demonstrate “that music listening during the early poststroke stage can enhance cognitive recovery and prevent negative mood.” Using just sound waves themselves have been shown to have an effect on the human body. An example is proven in yet another singleblind study done in Finland several years ago involving fortynine volunteers in two senior citizen centers. The effect of lowfrequency sound wave therapy was shown to have a positive effect on blood pressure, mobility, as well as bone density on frail elderly subjects. In one researcher’s postlude, there are numerous examples given of people who have helped to heal or soothe themselves from varying degrees of disharmony. For example humming helped minor abrasions, listening to Mozart helped to relieve acute pain, enjoying grounding music with strong beats helped folks with anxiety, and the harp helped to relieve back pain. Music may be one of the keys to “transcending the pains of the moment…from Zen monasteries to intensive care units, accounts abound of [those] who experienced the remission of a disease or disorder as the result of some sound or melody.” Toning and humming The book Toning: The Creative Power of the Voice, Laurel Elizabeth Keys articulates stories about people who were healed with toning or relaxing into their voices. “Toning can release psychological stress before surgery, lower the blood pressure and respiratory rate of cardiac patients, and reduce tension in those undergoing MRIs and CAT scans.” Sounds seem to trigger endorphin release, thus masking pain which may help the body to heal more effectively. In Campbell’s book he, as a listening therapist, was able to detect through a patient’s voice, long dormant emotions. A fortyseven year old woman had a cyst on the right side of her right breast and Campbell heard a break in her voice when he stood on her right side. After she was able to express a long held repressed memory, she was then able to release the memory through humming. The woman’s cyst had completely disappeared within three months. Campbell also noted that humming was more helpful than singing in helping schizophrenia patients positively modify their behavior. Some people, with guidance, are able to find their own sound or resonance in order to help release unresolved emotions and pain. http://www.ayurvedacollege.com/book/export/html/2
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There is also evidence that toning and humming helped to alleviate various ailments including headaches and menopausal hot flashes. In essence, every person is seen to have a tune, a song, a hum, a string of syllables or rhythmic sounds that “resonates with his or her essence” creating “harmonious thoughts and feelings.” Jack Kornfield in his book, A Path with Heart, reminds us of the story of Siddhartha, finding his song as he sits alone by the river, taking everything in as Himself. During deep contemplation is where “we [can] experience more deeply both the beauty and the sorrow of life [listening] deeply, the great song moves through each of our lives.” Tibetan singing bowls Dr. Mitchell L. Gaynor in his book Sounds of Healing discusses his discovery of Tibetan singing bowls in helping cancer patients. As a scientist, he communicates the importance of vibrational healing through sound and how “we can order our molecular structure though sound and heal physical and emotional imbalances.” He gives one example of a woman with a tumor in her thymus gland and how singing bowls helped her to relax and reflect upon internal stresses that were the cause of the blockages in her body. By listening to “the vibration of the crystal bowl and visualizing the shape of her fears” she was able to see where the fear was stuck in her physical body, in this case, the throat. He points out that her story is not unique as most people are in so much of a rush that they don’t stop to consider what is important or missing in life, getting ‘out of tune’ with the world around them. This disharmony is usually reflected in disease or imbalance. Getting ‘back in tune’ helps us to release tensions that we are many times not even aware of. Entrainment How sound can affect us can be explained by what is termed as entrainment. Entrainment is defined as the process by which the powerful rhythmic vibrations of one object with a similar frequency causes an object to vibrate in resonance with the first object. We are not, of course, referring to our bodies as inanimate objects since human beings possess amazing complexity that complements their ability to harmonize and to adapt to the environment. Entrainment is based in rhythm and when a vibration is perceived through the auditory senses, then the combined synergy creates profound synchronicity. It has been studied then postulated that everything rhythmical is subject to entrainment, and that even people’s bodies respond to the talk of another. Dr. William S. Condon from the Boston University School of Medicine closely observed the body language of people as they listened to another person speak. “Listeners were observed to move in precise shared synchrony with a speaker’s speech.” He also noted that there was “no discernible lag even at 1/48 of a second.” An analysis of this data shows the power of entrainment works whether or not we are conscious of it. The idea that “the human organism is not only constructed according to harmonic principles, but also functions within them” is suggested by physiologist Gunther Hildebrandt. He helps us to understand the notion of entrainment since everything vibrates in a certain resonance with what is around it and that we are deeply entrenched in a great synchronized scheme. Ayurvedic examples on effects of sound. http://www.ayurvedacollege.com/book/export/html/2
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The Rishis Ayurveda, or the knowledge of the ancient rishis, is deeply rooted in the idea of entrainment and of the greater vibratory experience for which we are all striving. The rishis were also attuned to the primordial sounds and understood that everything was held together by things that we could not see. Deepak Chopra explains that “Ayurveda tells us to apply a specifically chosen primordial sound like a mold or template slipped over the disturbed cells pushing them back into line, not physically, but by repairing the sequence of sound at the heart of every cell.” In the Vedas, sound was understood to have a healing effect on its listener and, not surprisingly, various instruments were used to enable particular vibrations of sounds to prevent increases in particular doshas. On Healing Sounds of Ayurveda site, a musician offers a variety of melodies played by specific instruments in order to pacify doshic imbalances. The melodies attributed to these instruments’ sounds seem to counterbalance the effects of an imbalance. For example, the instrumental sounds of the bamboo flute are thought to prevent the increase of vata. The bamboo flute emits soft notes and has a soothing effect on its listener. This is also the flute from which Lord Krishna played his soulful calming melodies alone on a calm river. Pitta needs a strong quality to catch its attention and the sitar is believed to possess that with its nasal overtones and rich sound. The sarod is a classical Indian lutelike instrument and, with its deep and ‘awakening’ sound and clear tones, is said to help balance and enliven the kapha dosha. The sarod is not as sweet as the sitar, nor as soothing as the bamboo flute. Nadis, chanting, and mantra In The Yoga of Sound, Paul states that sound essentially “works with the transformation, restoration, and reconstitution of the energies of the soul through channels known as nadis…subtle channels of the chakra system related to the soul’s infrastructure.” In other words “sound optimizes the performance of energy vortexes or chakras which govern our emotional, psychic and spiritual states of consciousness.” Mantras, or hymns, became interwoven with all actions related to healing. Mantras, as sacred sounds, are known to affect our vibratory being and consciousness as the word mantra itself means both protection and instrument. In the Ashtanga Samgraha, chants are noted as playing a vital role in the overall healing process. From the very start of life, chants are indicated. For example, the attendant present at the birth of a child is instructed to chant a hymn into the baby’s ear right away. Mantras are also alleged to have the power to rid a child of evil demons. It was seen important that those evil spirits are won over by the chanting of certain sacred sounds or hymns. The Vedas themselves are a series of mantras, as both words and sounds awaken memory and the deep knowledge encoded in our DNA and cells. This deep encoding is linked to the primordial sound of creation and to the source from which we emanate and are deeply a part. However, it also http://www.ayurvedacollege.com/book/export/html/2
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understood that the emanator of the sound must, as stated in the Ashtanga Samgraha, be fully conscious in order to achieve the highest level of effect. As Paul reminds us, “The vibratory effects of our tones…find their way into the psyche. Let us be mindful about these tones and use our voices to heal.” The experience of mantra and chanting are best when accompanied by ritual. Ritual, in the very way that it is performed the same time each day, also mirrors the rhythmic quality of mantra or the universe’s ebbs and flows. Paul states that without sound encompassed in ritual that it is difficult to “release the accumulation of psychic toxicity in our spiritual system.” It also “allows us to experience the deep and the high, much like sound.” In a translation of the Yoga aphorisms of Patanjali, it is noted that the “repetition of sacred words or mantras is…an invaluable aid to spiritual progress.” Tapping in to our true nature, the definition of health being not forgetting who we are, is where true health lies. Any disengagement from our spiritual nature is a disconnection from the source; and overall good health is more possible when we are encompassed by our connection and in tune with our greater nature, all of which is helped by sacred sound. The rishis in Ayurveda also addressed other ways to fall ill besides disconnecting with one’s true nature. Poison is a reality of our world and the ancients understood that being poisoned or otherwise harmed by the external environment posed a very real harm to the human body. Toxins from snakes, animals and plants were believed to have possessed a fire that would severely harm one’s wellbeing. One of the suggested antidotes to poison was the use of sound. The Ashtanga Samgraha states that “Poison is full of tejas…it does not get warded off by the administration of drugs as quickly as by the use of mantras, full of satya, brahmacarya and tapas of the priest.” The physician would have to be proficient with the hymn, however as part of ‘sacred hymn’ therapy in helping the patient. Interestingly, in Traveling the Sacred Sound Current, Debroah Van Dyke notes that “sound is [also] fire…the agent of purification.” Sound, therefore has “an inherent role in the transformation of our consciousness because it is the very vibrational nature of our soul.” The creative organizing force of sound on our biology cannot be denied as sound’s power is evidenced to organize matter itself. An interpretation of the Yoga Sutras notes a sort of transcending effect of sound, one that goes beyond simply healing the body. “By making samyama [when the true nature of an object is known] on the sound of a word, one’s perception of its meaning and one’s reaction to it…one obtains understanding of all sounds uttered by living beings.” This understanding translates into one being able to “attain supernatural powers of hearing” and achieving various levels of samadhi, complete absorption. Chakras and bija mantras Chakras, the energy wheels in our subtle body, are also directed by sound. Chakras represent their own dimension as they act as a “superhighway system in which our energies travel.” Roadblocks through this highway system can be unblocked not only by visualization and physical exercises, but also by using sounds, specifically mantras, something that was known during the Vedic era. Chanting bija mantras or what are known as ‘seed sounds’ increase the rotation or the frequency of prana moving through a chakra. If the function of a chakra increases, then there is heightened awareness and change in the chakra, with the quality of that dependent upon intent and the level of http://www.ayurvedacollege.com/book/export/html/2
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the practitioner. Mantras in themselves have long been a part of Hindu cosmology. The intelligence inherent in each syllable, vowel or consonant when uttered, has very specific connections to our total spiritual being. The following is a breakdown of how bija mantras work within the body, utilizing all five elements. The bija mantra of the first chakra, Lam, helps to increase the earth element in the body. The second chakra’s bija mantra, Vam, helps to increase the water element in the body. The third, Ram, is believed to increase the fire element in both the body and the mind as the fourth chakra, Yam, increases the air element in both the body and mind. The fifth bija mantra for the throat is Ham and influences the either element, again working with the mind and body. The bija mantra Ksham influences the ether element, but goes beyond the physical and affects the astral body as well. And the crown chakra’s bija mantra, Om, influences the physical, subtle, as well as the causal body. One may also note the consonant and vowel sounds in each of these mantras, as their vibratory effects are connected back to the source of the universe and well as to the duality inherent in our current state of being. The M in each of these sounds is said to represent the maternal and material aspect of the universe. The A sound in turn represents the Father, the nonmaterial, the action of the Alpha. L (lam, earth) is a heavy, closing sound, while H in HAM (ether) is light, airy, ethereal sound, and R (ram, fire) is an energetic, fiery sound. Typically, consonants have come to reflect the hard, material aspects of the world, while vowels represent the spiritual or etheric aspects. Paul states that the movement of various appropriate tones for the individual using Vedic mantras helps to “sustain the wavelength of sound frequencies generated by our brain [and] streamlines our mental processes toward the intention of the mantra.” Focus lends itself to practice of the seventh limb in yoga, dhyana, and is the precursor to the ultimate state of consciousness, samadhi. OM One of the most interesting aspects of the Vedic mantra Om is that its uttering and meditating upon it connects us to a higher vibratory rate, linking us to the origin of Prakruti. It is, in other words, “the sound of all sounds together.” If we are to assume that the ancients were in resonance with the creation of the universe itself, then we must examine some of the theories of creation. One of those theories is that the universe was created by the ‘big bang.’ The word ‘bang’ connotes loud sound. Interestingly enough, scientists theorize that the big bang wasn’t an explosion at all. Stephen Hawking in http://www.ayurvedacollege.com/book/export/html/2
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his book The Universe in a Nutshell puts forth a multiple of theories by great physicists, most notably, Einstein. Space, so it seems, originated as a point of density when “density would have been very large.” Through Einstein’s theories and the invention of the modern telescope, Hawkins reveals that galaxies are spreading apart and that the universe “is not a cosmological constant.” The ‘primeval atom’ or big bang points to the scientific fact that our universe is expanding and that both space and time had a beginning. The expansion of the universe can be likened to our ever expanding consciousness. And the sound of Om is in resonance with this expansion as well as our consciousness which is ever changing and growing. The sound of the big bang was mathematically construed by University of Washington physicist John G. Cramer. One can listen to the sound of this expansion on audio. It is of interest to compare a modern day scientist’s rendition of ‘the big bang’ to the rishis mantra Om. The listener will notice that the ‘big bang’ is actually a hum, and is very much “what the ancient Rishis perceived in their deepest meditations. “ This hums signals an expansion, not just in matter, but also in consciousness itself. The ancients harmonized in resonance with the expansion of what we perceive as time and space as Om can be said to mirror the space time continuum. “Om is the single most important sound that can, by itself, configure the human body optimally for maximum resonance and is noted to have the ability to generate overtones or additional frequencies that occur over and above a tone.” Paul quotes a passage from the Upanishads which helps us to contemplate the depth of Om’s meaning. There are two ways of contemplation of Brahman: in sound and in silence. By sound we go to silence. The sound of Brahman is Om. With Om we go to the End; the silence of Brahman. The End is immortality, union, and peace. Even as a spider reaches the liberty of space by means of its own thread, the [person] of contemplation by means of Om reaches freedom. In other words Om “represents… the totality of all that is and all that is not.” And chanting it connects us to the Divine expansion, offering us the awareness that we are a part of everything that is and was. This glimpse of wholeness and of both surpassing and encompassing duality is offered if we simply tune into it. Summary Through these examples we can see that the Ayurvedic understanding of sound is ancient and intuitive, with deep involvement in our spiritual being and the bodies we occupy. The western interpretation includes analytical understanding of the physical nature of sound. But as the effects of sound on the body and psyche are steadily investigated, the convergence of western and Ayurvedic perspectives become more integrated. The good news is that western medicine and what we once called ‘alternative medicine’ are beginning to work together. The science of the spirit is http://www.ayurvedacollege.com/book/export/html/2
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becoming more understood as we progress on the path of the best ways to get well, stay well, and feel connected. Therefore, healing modalities become complementary, eliminating the need for isolation. Fewer and fewer western medical doctors are separating their practices from what is becoming more and more evident—that we are energetic beings and not simply made up of parts. And much is being scientifically noted about how stress and outside influences affect our wellbeing and can even be the cause of disease in the body. The connection to what we hear, as well as see, has a lot to do with how we feel. Any wellness professional, who is truly into his patient feeling whole, connected, and empowered, will be able to address that in his or her practice. At the beginning of last century, Edgar Cayce called sound “The Medicine of the Future.” Perhaps this is the future to which he was referring. Ashtanga Samgraha: Prof. KR Srikanta Murthy, Chowkumbha Orientalia, Varanasi, India (Vol 1, xiii). Mayo Clinic, Mayo Clinic Staff, Myofascial pain syndrome. http://www.mayoclinic.com/health/myofascialpain syndrome/DS01042/DSECTION=treatmentsanddrugs Don Campbell, The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit (New York: Avon Books, 1997), 10. Online Etymology Dictionary, health. http://www.etymonline.com/index.php?term=heal. Ibid. .Paul G. Hewitt, Conceptual Physics—A New Introduction to Your Environment (Boston: Little, Brown and Company, 1977), 288. Ibid 291 Russill Paul, The Yoga of Sound: Tapping the Hidden Power of Music and Chant (Novato California: New World Library, 2004), 12. Ibid, 11. Ibid. 5, 293. Ibid, 14. Ibid 5, 302. Masaru Emoto, Water Crystal Healing: Music & Images To Restore Your WellBeing (New York: Atria Books, 2006), vii. Lestard Nd, Valente RC, Lopes AG, Capells MA. Direct effects of music in nonauditory cells in culture. Noise Health 2013; 15:30714. http://www.ayurvedacollege.com/book/export/html/2
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Ibid 2, 32. Ibid 5, 293. Cymascope, Sound Made Visible. http://cymascope.com/cyma_research/soundhealinghtml. Ibid. Mayo Clinic, Mayo Clinic staff, Pregnancy week by week. http://www.mayoclinic.com/health/fetaldevelopment/PR00113. Ibid. 2, 68. Jack Kornfield, A Path with Heart—A Guide Through the Perils and Promises of Spiritual Life (New York: Bantam Books, 1993), 323. Ibid 13,vii xii. Ibid 13, x, xi. Ibid 13, 250. Ibid 2, 7. Ibid 2, 65. Ibid 2, 67. Ibid 2, 221. Ibid 2, 80. Empower Your Health Magazine, Mack Harrell, MD, FACP, FACE,ECNU, Music For Your Health. http://www.empoweryourhealth.org/magazine/vol2_issue3/musicforyourhealth. Teppo Sarkamo, et al., “Music Listening Enhances Cognitive Recovery and Mood After Middle Cerebral Artery Stroke,” Brain (2008) 131 (3): 866876. http://brain.oxfordjournals.org/content/131/3/866.full. Ibid 32. Zheng A. et al., “Effects of a Lowfrequency Sound Wave Therapy Programme on Functional Capacity, Blood Circulation and Bone Metabolism http://www.ayurvedacollege.com/book/export/html/2
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in Frail Old Men and Women.” Clinical Rehabilitation, 2009 Oct; 23 (10): 897908. http://www.ncbi.nlm.nih.gov/pubmed/19717506. Ibid 2, 64. Ibid 2, 9294. Ibid 2, 99. Ibid 2, 272. Ibid 2, 221 283. Mitchell L. Gaynor, M.D., Sounds of Healing: A Physician Reveals the Therapeutic Power of Sound, Voice, and Music (New York: Random House, Inc., 1993), 19. Ibid 20, 322. Ibid 33, 19. Ibid 33, 46 47. Ibid 33, 64). Ibid 7, Paul 135. Anodea Judith, Wheels of Life—A User’s Guide to the Chakra System (St Paul, Minnesota: Llewellyn Publications, 1998), 287. Ibid 33, 68. Ibid 2, 158. Healing Sounds of Ayurveda, Markus Frerichs. http://www.ayurvedamusic.com Ibid 7, Paul 24. Ibid 40, 279. Ibid 1, 258. http://www.ayurvedacollege.com/book/export/html/2
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Ashtanga Samgraha: Prof. KR Srikanta Murthy, Chowkumbha Orientalia, Varanasi, India (Vol 3, 2). Ibid, 58 – 61. Ibid 48, 80 Ibid 7, 68 79. Ibid 7, 111. Swami Prabhavananda and Christopher Isherwood, How to Know God: The Yoga Aphorisms of Patanjali (Hollywood CA: Vedanta Press, 1981), 203. Ibid 48, 371. Ibid 48, 451. Ibid 48, 371 Deborah Van Dyke, Travelling the Sacred Sound Current: Keys for Conscious Evolution (Brown Island B.C. Canada: Sound Current Music), 21. Ibid, 23. Ibid 52, 182. Ibid 40, 16. Marc Halpern, Principles of Ayurvedic Medicine10th ed. (California College of Ayurveda, 2010), 218. Ibid 58, 218232. Ibid 40. Ibid 7, 79. Ibid 40. Stephen Hawking, The Universe in a Nutshell: A Brief History of Time, Black Holes and Baby Universes and Other Essays (New York: Bantam Books, 2001), 22. http://www.ayurvedacollege.com/book/export/html/2
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Ibid, 21 – 23. John G. Cramer, “Sound of the Big Bang,” November 10, 2003, http://faculty.washington.edu/jcramer/BBSound.html Ibid. Ibid 7, 73 Ibid 7, 175. Ibid 7, 219. Ibid 7, 179 181.
A Perspective of the Ayurvedic Application to HIV (By Lance Roehrig) Abstract The role of traditional, complimentary and alternative health care is rapidly changing in the world climate. A greater emphasis on complimentary and alternative health care, and its practitioners, is developing in the wake of economic downturns. Healthcare and Health Insurance prioritized as a moneymaking industry rather than the greater seva, act of service, to heal and promote longevity is unsustainable. Although the care received in hospitals and by Doctors is beneficial for the most part; when the bottom line speaks louder than the individual that lies ill, great tides of change can and must occur. Communities have taken into their own hands the motto, “I am my primary care physician.” By integrating alternative health care practitioners as a tool in educated themselves in preventative and natural care, individuals empower themselves to take their health into their own hands, thus creating a truly holistic approach to health which is the very core of Ayurveda. The goal of this paper is not to prove viability of one herb, approach or method as a viable healing agent of HIV. Rather, the goal of this paper, like Ayurveda, is to show the extensive tools available to the HIV individual and in fact all individuals managing chronic disease. The important term here is managing. The goal of this paper is to show that with the use of an Ayurvedic framework; or roadmap, one can use allopathic technology in addition to the abundant tools available, thus taking back the power of healing from the healthcare industry and its beneficiaries and http://www.ayurvedacollege.com/book/export/html/2
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placing it back into the hands of each and every one of us. Introduction to Ayurveda “Forgetting our true nature as spirit is the primordial cause of disease.” – Dr. Marc Halpern Ayurveda is the ancient science of life and the world’s oldest holistic medical system. It is said to be as old as humanity itself, but scholars place the age between five and 10,000 years.[1] The term Ayurveda is derived from the two sanskrit root words “Ayus” meaning life and “veda,” meaning knowledge, “The science of life.” Ayurveda takes its origins from the spiritual texts of India known as the Vedas. The Vedas are the oldest known written text with subjects as vast as grammar, phonetics, astrology, ritual, etymology and prosody (metric verse). [2] There are four Vedas, The Rig Veda, Atharva Veda, Yajur Veda and Sama Veda. Ayurveda is a gathering of knowledge from all four texts. Vedic knowledge was perceived by merging ones consciousness with the subject of inquiry. Tajjayat Prajnalokah, “By the mastery of [one pointed focus and meditation] comes the light of knowledge.” [3] From this practice true wisdom was received as gifts from the Devas (Gods). Dr. David Frawley writes in his book Ayurveda – Natures Medicine, “[Ayurveda] is not merely a kind of antiquated folk medicine as it is sometimes considered to be.” [4] Many discoveries in modern sciences and technology can often be linked with parallel wisdom in the Vedas. “Today, quantum physicists have become the torchbearers in the realm of the ‘tinier than tiny.’ Ten million to one hundred million times smaller than the sub atom lies the level of the quanta, the new frontier of minbody research. The source of this quantum level is a field of pure energy, which serves as the underlying intelligence and glue of the entire universe. 65 years ago, quantum physicists labeled this the Unified Field. Nearly six millennia ago, Ayuvedic sages called it the Cosmic Life Force or Field of Pure Consciousness. While modern science is only beginning to understand implications of this discovery, Ayurveda has been steeped in quantum theory for a millennia.” [5] Unlike our modern age where our focused intent is outward, ancient Rishis chose to place their eye on the internal universe and in doing so they discovered this Unified Field as modern scientist call it; “[Is a,] field of consciousness, which connects every thought, wave pattern and particle of our being.” [6] It is here where we discover infinite potentiality as well as the understanding that what is in the microcosm is in the macrocosm and what is in the macrocosm is in the microcosm. Our ability to heal can be attained by simply watching the rhythms of the universe … or better yet, our own backyard. The philosophies, principles and techniques in Ayurveda, the Vedas, Tantra, Yoga; these are all part of an ancient wisdom known as Sanatana Dharma (now known as Hinduism) roughly translated as the eternal truth. As the same sun is called by different names in different countries at different times, these truths are universal and cannot be defined by time nor are written by, or for; the benefit of one man, one nation or one race. These truths have been written and passed chest –chest for the benefit of humanity. “… great rishis sat together on the slopes of the Himalayan Mountain. They discussed the occurrence of great diseases that had arisen and how to deal with them … They decided that they should ask the Gods how to stay well and avoid disease as well as how to heal those who are sick … (The rishi ) Bharadvaja was selected … as he was best suited for the mission. Bowing before Indra, he explained the reason he needed an audience before such a great God. Bharadvaja was successful and Indra taught him the knowledge of Ayurveda…” [7] Bharadvaja went on to teach many great rishis and sages the science of Ayurveda. One of the great sages was Atreya, who passed on the knowledge to Agnivesa. Agnivesa later wrote the Agnivesa Tantra, which became the Caraka Samhita after Caraka revised it. [8] The Caraka Samhita is one of the primary Ayurvedic text that many practitioners gather their information from. In it myth and history are woven revealing the secrets of Ayurveda. http://www.ayurvedacollege.com/book/export/html/2
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“Forgetting our true nature as spirit is the primordial cause of disease.” Writes Dr. Halpern. When we forget our true nature as spirit we become dominated by the ego. We are wrapped up and consumed in vrittis, the dramas of everyday life. Yogas cittavrittinirodah, Yoga is the cessation of the mind or settling of the mind into silence. [9] When we connect our physiology with the dramas of everyday life, time seems to increase and our reality becomes further attached to maya, illusion. By connecting to our ego; my car, my house, my job, my safety, my money, my family, my society, my government; and defining these transient things as I, simply, we forget. We forget our true and timeless nature is here in this infinitesimal moment of the now. It is here where the deepest secrets unravel and one can capture a glimpse into the internal pharmacy where anything is possible. Ayurveda uses the language of nature to describe the rhythms and cycles of the macrocosm and shows the similarities within the microcosm. It relates and shows how the five elements of earth, water, fire, air and ether are intrinsically connected in this beautiful lila or cosmic play, in the outer world, and how they are part of the body and the internal world. It uses the language of 10 sets of opposite characteristics: hot/cold, moist/ dry, heavy/ light, gross/ subtle, dull/ sharp, soft/ hard, smooth/ rough, cloudy/clear… to further describe and relate the harmony and the imbalance in the individual. These principles are used to describe the body, the disease and ultimately the path of healing. For example, if one were to present constipation (cold/ dry) Ayurveda recommends opposite therapy, so in said example one would employ warm, moist and nourishing qualities as an anecdote. The three causes of disease in Ayurveda outlined in the Caraka Samhita, are: 1) The unwholesome conjunction of the senses with the objects of their affection (“Having forgotten its true nature as spirit, mankind understands itself to exist only as its senses, its body and its mind … the meaning of life becomes the simple pursuit of pleasure.” 2)Intellectual blasphemy, the failure of the intellect or crimes against wisdom (“When we listen deeply inside ourselves, we find that we know how to act in ways that would bring us toward health … Yet, we often do not follow what we know to be true.”) 3)Transformation or decay due to time and motion. (There are two kinds of time: Linear time, which is static. Then there is biological time, which changes in response to motion. The faster our pace of life, biological time increases, gross motions such as air and automobile travel exacerbate this. More important than gross motions is the motion of the mind. The faster the rate of our thoughts time seems to increase and so does our biology. When the mind slows down such as in meditation or yogasana the biology also slows down.) [10] When we look at the three causes of disease we can see how the nidana or cause of HIV falls into the first two categories and the treatment and rate of action on the body falls into this third cause. Hope lies in reconnecting the individual to the eternal. We are more than our senses perceive. The path of healing lies in the ability to turn on the innate intelligence that resides within. Understanding that how we move through life and that how we perceive to move through life are two very different things and can be altered. The History of HIV “Due to funding constraints AVERT is unfortunately not able to fund any new projects, or accept project proposals until at least April 2012. Please do not send in any applications for funding until that date.” [11] 1981 was the year AIDS was first reported in the U.S. Scientists scrambled through much confusion in the first few years surrounding the illness, attempting to pin down transmission of the virus and treatment of those infected. Advancements in the 1990s with new classifications of drugs have greatly changed the landscape of treatments. [12] The genetic research places the origins of HIV in Westcentral Africa. The Mayo Clinic states, “Scientists believe a virus similar to HIV first occurred in some populations of chimps and monkeys in Africa, where they’re hunted for food. Contact with an infected monkey’s blood during http://www.ayurvedacollege.com/book/export/html/2
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butchering or cooking may have allowed the virus to cross into humans and become HIV”[13] Before 1970s 1 HIV (the virus that causes AIDS) probably transfers to humans in Africa between 1884 and 1924. 2 HIV probably enters Haiti around 1966. 1970s 1 HIV probably enters the United States around 1970. 2 African doctors see a rise in opportunistic infections and wasting. 3 Western scientists and doctors remain ignorant of the growing epidemic. 1981 1 AIDS is detected in California and New York. 2 The first cases are among gay men, then injecting drug users. 1982 1 AIDS is reported among haemophiliacs and Haitians in the USA. 2 AIDS is reported in several European countries. 3 The name “AIDS” – Acquired Immune Deficiency Syndrome – is created. 4 Community organisations in the UK and USA promote safer sex among gay men. 1983 1 AIDS is reported among nondrug using women and children. 2 Experts become more confident that the cause of AIDS is infectious. 3 Three thousand AIDS cases have been reported in the USA; one thousand have died. 1984 1 Scientists identify HIV (initially called HTLVIII or LAV) as the cause of AIDS. 2 Western scientists become aware that AIDS is widespread in parts of Africa 3 The world's first needle exchange program is set up in Amsterdam, the Netherlands. 1985 1 An HIV test is licensed for screening blood supplies. 2 AIDS is found in China, and has therefore been seen in all regions of the world. 1986 1 More than 38,000 cases of AIDS have been reported from 85 countries. 2 Uganda begins promoting sexual behaviour change in response to AIDS. 1987 1 AZT is the first drug approved for treating AIDS. 2 The UK and other countries act to raise awareness of AIDS. 1988 1 The American government conducts a national AIDS education campaign. http://www.ayurvedacollege.com/book/export/html/2
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2 Health ministers meet to discuss AIDS and establish a World Aids Day 1990 1 Around 8 million people are living with HIV worldwide, according to estimates made later. 1991 1 Thailand launches Asia’s most extensive HIV prevention program. 1993 1 AZT is shown to be of no benefit to those in the early stages of HIV infection. 1994 1 AZT is shown to reduce the risk of Mother to child transmission. 2 Infant HIV infections begin to fall in developed countries, due to use of AZT. 1995 1 The Joint United Nations Programme on AIDS (UNAIDS) is established. 1996 1 Combination antiretroviral therapy shown to be highly effective against HIV. 1 In developed countries, many people begin taking the new treatment. 2 Annual global spending on AIDS in low and middleincome countries is $300 million. 1997 1 AIDS deaths begin to decline in developed countries, due to the new drugs. 2 Brazil is the first developing country to begin providing free combination treatment. 3 In other developing countries, only a tiny minority can access treatment for HIV. 4 Around 22 million people are living with HIV worldwide, according to estimates made later. 2000 1 President Thabo Mbeki of South Africa voices support for Aids dissidents 2001 1 At a UN Special Session, world leaders set longterm targets on HIV/AIDS. 2002 1 The Global Fund established to boost the response to AIDS, TB and malaria. 2 Botswana begins Africa’s first national AIDS treatment programme. 2003 1 AIDS drugs become more affordable for developing countries. 2 The “3 by 5” campaign is launched to widen access to AIDS treatments. 3 The first HIV vaccine candidate to undergo a major trial is found to be ineffective. 2004 1 America launches a major initiative called PEPFAR to combat AIDS worldwide. 2 After much hesitancy, South Africa begins to provide free antiretroviral treatment. 2006 1 Circumcision is shown to reduce HIV infection among heterosexual men. http://www.ayurvedacollege.com/book/export/html/2
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1 28% of people in developing countries who need treatment for HIV are receiving it. 2 Annual global spending on AIDS in low and middleincome countries is $8.9 billion. 3 It is estimated that $14.9 billion would be needed for a truly effective response. 2007 1 Around 33 million people are living with HIV, according to revised estimates. 2 Another major HIV vaccine trial is halted after preliminary results show no benefit. 2008 1 A controversial Swiss study claims people adhering to ARVs have a "negligibly small" risk of transmitting HIV through unprotected sex. 2 PEPFAR is reauthorized, committing $48 billion for the next five years. 3 Michel Sidibé is named as new head of UNAIDS as Peter Piot steps down. 2009 1 President Obama announces the removal of the travel ban that prevents HIVpositive people from entering the US. 2 4 million people in developing and transitional countries are receiving treatment for HIV; 9.5 million are still in immediate need of treatment. 2010 1 The United States, South Korea, China and Namibia lift their travel bans for people living with HIV. 2 The CAPRISA 004 microbicide trial is hailed a success after results show the gel reduced the risk of HIV infection by 40%. 3 Results from the iPrEx trial show a reduction in HIV acquisition among men who have sex with men taking PREP [14] What is HIV? Western Interpretation Definition HIV (Human immunodeficiency virus): A disease of the human immune system that attacks white blood cells reducing the body’s ability to fight off illness. This condition progressively reduces the effectiveness of the immune system. Left untreated individuals become susceptible to opportunistic infections or tumors that usually are handled by a strong immune system. At this stage HIV has manifested into AIDS (Acquired immunodeficiency syndrome). [15] Etiology HIV is transmitted with direct contact with a mucous membrane or bloodstream with a body fluid containing the virus such as infected blood, semen, vaginal secretions, preseminal fluid and breast milk. Infection cannot take place via hugging, kissing, dancing or shaking hands. HIV is temperamental and cannot live long outside of the body. It cannot be transmitted by air, insect bite or water. [16] Signs and Symptoms Initially there is brief flu like systems presented two to four weeks after infection that dissipate and generally go away. Symptoms are fever, http://www.ayurvedacollege.com/book/export/html/2
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headache, sore throat, swollen glands and rash. Years later as the condition progresses some may develop mild infections or chronic conditions such as swollen lymph nodes (often a first sign) diarrhea, weight loss, fever, cough and shortness of breath. If the condition progresses and the HIV infection is not treated the disease typically progresses to AIDS. At this stage the symptoms include: soaking night sweats, shaking chills or fever, cough and shortness of breath, persistent white spots and unusual lesions on the tongue or in the mouth, headache, persistent fatigue, blurred and distorted vision, weight loss, skin rashes. [17] Complications Complications can be as individual as the person infected with HIV. From the Avert website here is a partial list of some of the most common: “Bacterial diseases such as tuberculosis, bacterial pneumonia and septicaemia (blood poisoning) Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis. Fungal diseases such as PCP, candidiasis, cryptococcosis and penicilliosis. Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus. HIVassociated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.” Complications also arise in the treatment of HIV with the side effects from the antiretroviral therapies. Some common side effects are: Hepatoxicity (liver damage), Hyperglycemia (elevated blood sugar), lipodystrophy (fat redistribution) and skin rash. [8] Test and Diagnosis The ELISA (enzymelinked immunoabsorbant) is the most common test for routine diagnosis of HIV among adults. There is however a window period after HIV infection from weeks up to 6 months where the antibodies are not produced after infection. During this time an antibody test can give a false negative. To avoid a false negative it is recommended that a second test be done three months after possible exposure. [19] Blood Tests and Treatments An HIV positive result will result with the patient being referred to an Infectious Disease Specialist (I.D. Dr.). This specialist will work with the patient and come up with a selection of drugs to treat the virus. In some cases with the advancement in research only 1 pill, once day that is a cocktail of multiple drugs is used, such as Atripla. It is imperative that the patient takes the medication as directed to curb side effects as well as drug resistance. The Mayo Clinic lists on their website the classifications of drugs for the treatment of HIV: “Nonnucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir). Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, protein that HIV uses to insert its genetic material into CD4 cells.” [20] http://www.ayurvedacollege.com/book/export/html/2
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Some of the blood tests that the I.D. Dr. will use to determine which medication to use as well as its effectiveness and the management of possible side effects are: CBC (Complete Blood Count), this will tell the I.D. Dr. the kinds and numbers red and white blood cells along with platelets; Liver Function panel to assess the function of the liver and avoid toxicity; CD4 (T Cell) count tells the I.D. Dr. how the immune system is functioning – with the standard range being between 2902077 and Viral Load. This Test measures how many counts of HIV are in the blood. Today, with increasingly newer technology, an undetectable viral load is becoming more common. [21] Ayurvedic Interpretation “Remember that no disease can harm you if agni is balance, ojas is strong and you are living a sattvic lifestyle.” – Dr. Marc Halpern No, disease can harm you if agni is balance and ojas is strong. These words written in an email by Dr. Halpern inspired the approach of this paper. How does one address Ayurveda’s message to HIV? Hope. Underlying the message of Ayurveda is a deeper wisdom of spiritual connection that can get lost in the interpretation of Ayurveda. As western minded individuals it is easy to struggle with the tendency to take Ayurveda out of its context and westernize its procedures and treatments, thus losing the very heart that differentiates Ayurveda from allopathic medicine. By simply treating the symptoms and not uprooting the entire tree of disharmony we lose the opportunity Ayurveda presents to create a deeper change within. It is the deeper meanings beyond what we see with our eyes that Ayurveda has so eloquently conveyed. Yogi Baba Prem wrote, “…one must learn to look at eastern teachings through eastern eyes. The literalist tradition, common in the west and relevant in the east, does not afford much opportunity to unlock the vast secrets held within the eastern traditions and the more familiar system of yoga.” [22] We must understand this in order to facilitate a deeper awareness within ourselves when we venture into these ancient traditions for healing. When we blend the modern treatments of western allopathic medicine with the wisdom from the east we truly discover a holistic approach to healing. “Whether animal, herb or pharmaceutical everything is medicine when given to the right person, at the right time, for the right reason. Whether animal, herb or pharmaceutical everything is poison when given to the wrong person, at the wrong time, for the wrong reason.” [23] It is by accessing these internal secrets that each one of us is gifted with; will we have the capability to surpass great odds and learn great lessons. When we step into an Ayurvedic mind, we realize that Ayurveda includes all forms of medicine as treatment and the need to battle or pit one group against another just isn’t there. Shanti, Peace. In the fullness of a harmonious and global, community mind adversity does not have a place to function. What we discover is that this subtle wisdom is the very philosophy that is capable of powerful treatment in chronic disease. When the mind, body and spirit create a harmonious community within, adversity melts and naturally the route of healing and the ability to access the internal pharmacy becomes alive. And, even in the face of chronic conditions such as HIV, one can find Shanti. * * * According to Ayurveda, HIV can be correlated to Ksaya or OjaKsaya, the loss and consumption of vital energy. “Ksaya,” is most commonly associated with tuberculosis, it is characterized as an end stage respiratory condition with all three doshas vitiated. Any disease that is not properly treated can result in this condition and is considered, rajayaksmadi, “king of diseases.” [24] In The Ayurvedic Encyclopedia, Swami Sadashiva Tirtha writes,” In an ancient Ayurvedic text, Madhava Nidan, written around 700 A.D., the author, Madhavakara foretells a disease that will come to India. From its description, we know it as HIV/ AIDS. Its cure was said to be shilajit.” [26] http://www.ayurvedacollege.com/book/export/html/2
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Nidana (Cause) HIV is a tridoshic viral infection affecting the strength and ability of the immune system to function. It causes a deficiency in lifesap, ojas. When ojas is strong the HIV virus cannot develop. Ojas is lost or diminished by excess sex, improper food, improper routine, worry and insomnia. The HIV virus uses the body’s immune cells to replicate itself. Much like a ghost, this virus does not have a body of its own and uses its host’s cells and body to function and survive. Dr. Marc Halpern, director of the California College of Ayurveda wrote on Ksaya “A lifestyle that reduces ojas leads to individual susceptibility to the condition. A lifestyle that results in a loss of shukra (vital fluid) is considered to increase the risk of developing the condition. In addition, a person is weakened by the suppression of natural urges and the intake of foods and drinks that are disharmonious.” [26] Purva Rupa (Premonitory Symptoms) According to the Ashtanga Hrydayam, the following is a list of premonitory symptoms that often precede the onset of the disease. [27] • Nasal catarrh • Increased salivation • Sweet taste in the mouth • Weak agni • Increased desire for sex and wine • Swelling of the feet and face • Dreams of being defeated by animals • Visions of dirt in foods • Denial of emaciation Rupa (Symptoms) Vata and Pitta are primary factors, however Kapha may present symptoms of congestion and lung disorders as the virus manifests. Fever, chills, headaches, tiredness, enlarged lymph nodes and general flu like symptoms in the first stages of infection. Symptoms of vata vitiation include: Fatigue, nerve disorders, cough, pain, change in voice and emaciation. Pitta symptoms include: fever, low energyburnout, yellow, green or red foul smelling sputum. Symptoms due to kapha vitiation are loss of appetite, congestion, oral candida, vomiting and dyspnea. [28] Samprapti (Pathogenesis) The symptoms that develop from HIV have one major factor in common – movement. The symptoms seem to manifest throughout the various dhatus and strotas (tissues and channels) throughout the entire body, affecting all dhatus. Because HIV affects the white blood cells, the actual infection is located in the rasa dhatu of the rasavaha strota. Dr. Marc Halpern of the California College of Ayurveda states, “It is a constituent of rasa. (lymph)” According to the Madhava Nidanam, Vata then becomes the primary vitiated dosha in the pathogenesis. Vata vitiation then leads to pushing pitta and kapha. From this we can see the condition is sannipattika (tridoshic) with vata at the root, overflowing into the rasa dhatu and the http://www.ayurvedacollege.com/book/export/html/2
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rasavaha strota and relocating to various sites through out the body creating the classic symptoms of early HIV infection as well as later stages. [29] Stage Evidence
rmd
rmd
HIV Infection/ low ojas/ reduced immuntiy
Ema ciation
Dosha Subdosha Dhatu
V
V
Incr/Decr Srota
decr
Rasa vaha Strota
Herb Categories
Herb Examples
Rasayana
Chywanprash AshwagandhaShatvari Shillajit
vyana
Rasa
apana
Medas Mam decr sa
Medo Fat tonics vaha Muscle Strota tonics
Shatavari, licorice Amalaki ashwagandha Jatamamsi/ shankha pushpi Brahmi ashwagandha
rmd
anxiety
V
prana
n/a
decr
Nervine Mano sedadtive vaha Nervine Strota tonic
rmd
Fatigue
V
vyana
rakta
decr
Rakta vaha Blood tonics Strota
Amalaki/ turmeric
rmd
HIV Infection / Fever
P
n/a
rakta
decr
Rakt vaha Strota
Turmeric/ neem/ goldenseal
decr
Rakta Blood vaha Tonics Strota
rmd
Fatigue
rmd
HIV Infection Swollen
P
K
n/a
n/a
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rakta
rasa
incr
Rasa vaha
Anti microbials
Channel clearing
Amalaki/ Turmeric
Turmeric/ Garlic 217/704
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lymph nodes
Strota
rmd
Loss of appetite
K
kledaka
rasa
rmd
Oral candida
K
Bodhaka
rasa
rmd
Depression K
tarpaka
n/a
Anti Microbial
incr
Anna vaha Strota
dipana
incr
Anna vaha Strota
Anti Musta, Pau d’arco Microbials Asofatida Anthelmintic vidanga
incr
Mano Nervine vaha stimulant Strota
Trikatu/ Ginger
Brahmi/ Calamus
Chikitsa (Treatment) Ayurveda gives the patient the framework to lead a harmonious life and build ojas. This is key in preventing the infection form further manifesting as well as managing the possible side affects associated with the pharmaceuticals employed to treat HIV. Along with numerous others, all HIV allopathic medications list possible digestive imbalances and anxiety/ depression, as common side affects that may subside as treatment continues. Little is known as to whether the psychological disturbances are caused by the disease, the medication, the outlook of the patient or a combination. These side affects in treating HIV from an Ayurvedic perspective will be taken into account below. Because Vata vitiation is of concern, a treatment for general vata imbalance is employed. Nourishing foods that are vata pacifying are consumed being aware that vata in HIV individuals can very quickly push pitta and kapha out of balance. (As HIV is tridoshic in nature. See samprapti above.) The diet will often need to be adjusted to compensate. It is interesting to note specifically the use of goat meat in soups as well as fried in ghee in Caraka Samhita. Many recipes included goat milk along with all the recipes employ ghee, cows milk, sugar and honey for their nourishing nature on vata and rasa dhatu (lymph). [30] Because HIV affects the nourishment of the tissues, regulating samana vayu ( the ability to absorb nutrients) is considered a primary focus when it comes to nutrition as well as daily routines. The annamaya kosha (food sheath or physical body) is nourished by the right foods at the right time, thus creating ojas, immunity. The daily routines are vital in treatment of HIV, keeping patterns and routine grounds samana vayu. Daily routines consist of regular bowel movements, selfabhyanga (daily oil massage), yoga, pranayama, and the routines around meals such as prayer and the routines around sleep. Tongue scraping and neti, nasal irrigation, help remove toxins and dead cellular debris from the tongue and sinus cavity. Abhyanga increases lymphatic flow from the heat it generates and can promote the detoxification of pharmaceuticals as well as the removal of the virus from the body. http://www.ayurvedacollege.com/book/export/html/2
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Considering what sort of mental impressions are being digested is a factor in healing and creating strength in the mind, nerves and musculoskeletal system. On the lecture Ayurvedic Psychology, Dr. David Frawley, comments how “…we let people into our minds that we wouldn’t let into our houses.” [31] Allowing the junk impressions into the mind is akin to eating junk food. Ojas is depleted and the body, mind and spirit must digest these junk impressions. Therefore it is paramount for the psychology and treatment of majjavaha strota and manovaha strota or the mind and nervous systems, to begin to build and nourish the environment from which one lives and functions. Auditing ones life and evaluating how nourishing each situation is within the home, career and self is extremely beneficial. How nourishing is the quality of the mind and heart? Systematically moving through each segment of the day one can audit and discover how nourishing and ojas building is each segment of the day is. Break these segments into drying, heating, cooling, astringent etc. and one can begin to see the picture and quality of the course of the day. What aspects can be nourished? Meditation can significantly effect the quality of these segments as the more one meditates and reconnects to Self, the more the various circumstance seem less important or less attachment is placed on them. Color therapies play an important role in this segment. Gold is the most healing and nourishing, an abundance of this color in the form of flowers can uplift and tonify any environment. The use of herbal Antimicrobial herbs to treat the infection and rasayana (longevity/ ojas building therapies), to increase immunity is the corner stone of the treatment for HIV. Nervine sedatives and tonics help treat anxiety while fat and muscle tonics help in weight loss. Blood tonics are used for fatigue and oil massage and nasya with herbs like ashwagandha and brahmi. The gold ash formula, Survana Vasant Malti is revered as being excellent for all immune disorders. [32] Essential oils are the rasa of the trees and plant kingdom. They prove very effective in healing and rebuilding the rasa of the human organism. Vata pacifying essential oils are highly effective in treating vata imbalance as they can be applied via Abhyanga. They are applied through the pathways of the skin, nasal passages, lungs and gastro intestinal tract. Once absorbed, essential oils quickly penetrate into the rasa and rakta (lymphatic and blood systems). As the oils circulate through the circulatory system, tissues and organs may choose any portion of the essential oil it wishes to use in the metabolic process, receiving the stimulating, sedating or beneficial property of the oil. [33] Essential oils are diluted in base oils that are constitutionally appropriate. A general accepted ratio of essential oil to base oil is about 25ml (1213) drops: 1oz base oil. See the table below for doshic appropriate base oils. [34] Essential oils can be applied to the main marma point that balances each dosha: Vata, third eye; Pitta, Heart chakra; Kapha, between the navel and pubic bone. Vata……………………...Sesame Pitta…………Coconut/Sunflower Kapha …………Canola/ Mustard http://www.ayurvedacollege.com/book/export/html/2
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Essential oils can be used as misting bottles with either healing oils or antimicrobial/ antiviral/ antibacterial oils which are great for the rooms, bedding and the space in which the HIV patient resides. The general rule is one drop per 2 oz of water. [35] Shirodhara is effective in calming the mind, relaxing the nerves and immune system, providing individuals with a profound state of rest. Deepseated stressors can be released via this treatment. [36] Mantra is sacred sound. On an esoteric level it is the sound or vibration pattern behind the universe itself. [37] Connecting to this sound vibration puts one in harmony with the universe and unlimited potentiality. It connects the individual with the sound vibrations available to awaken the internal pharmacy of healing. On a practical level it has gained wide recognition for its use in affirmations of healing. “According to the researchers, … repeating a mantram may help HIVpositive individuals examine stressful situations in a more nonjudgmental and accepting way…” [38] Gemstones can also be used as they speak to the body via outside the realm of the five senses. Stones are grounding representing the earth element however; gemstones like all of nature are composed of all of the five elements. When wearing the gemstone the qualities of the gemstone interact with the qualities of the person. Gem infusions are made by soaking the gem in a glass of water in the moon or sunlight. [39] Time moves slower as mass increases; so time moves faster in the atmosphere above earth than it does on earth. This can be noted that by large structures such as mountains and even the great pyramids in Egypt, its hypothesized time moves at an infinitesimally slower rate. [40] Pondering this opens the attitude that there is more to life than what can be understood by the five senses. Ayurvedic Treatments for HIV Pancha Karma Pancha Karma is the process of removing ama and excess doshas from the body and mind and then rebuilding the internal strength and ojas, immunity. The state of ojas is important to determine whether or not the individual is ready for pancha karma. Birmhana Chikitsa , tonification therapy may need to be performed prior to beginning a pancha karma routine. During the first stage, Purva Karma, a palliative doshic appropriate diet is indicated. During this time the built up toxins in the body from medications as well as viral debris can be thought of as moving towards the organs of elimination. Abhyanga is performed as well as color, mantra, and pranayama. The duration for this initial phase is determined by doshic imbalance. As HIV is primarly vata, then tridhoshic, balancing vata and taking care not to cause vata imbalance is key to the success of the treatment. Pancha Karma literally means the five actions. Vamana (Therapeutic vomiting), Virechana (Purgation), Basti (Enema), Nasya ( Nasal Purgation), Rakta Mokshana (Bloodletting). Therapies like anuvasana basti, tonifying enema, are employed to heal and calm vata at its root site. These therapies performed by a skilled Pancha Karma specialist help to alleviate excess doshas and bring balance to the HIV individual as well as prepare the body to receive the tonification therapies of the third step, Praschat Karma. These therapies are the tonifying and rasayana portion of the treatment and is the key in building immunity, ojas, as well as strengthen agni, the fire of digestion. The fire of agni is key in the overall health of the HIV individual. If the fire of agni burns to low, ama is left behind; if the fire of agni burns to hot, it smokes and burns and metabolizes the individual. When in balance agni burns clean and clear with no residues left. This is the goal of Pancha Karma.[41] Amalaki http://www.ayurvedacollege.com/book/export/html/2
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The amalaki fruit is also known as Dhatri, the nurse, as it is like a nurse or mother in its healing properties. It has a sweet, sour, astringent, pungent and bitter rasa, a cool virya, and sweet vipaka. It is part of the revered preparations, Chyawanprash and Triphala. It is one of the best herbs for pitta and considered a rasayana for pitta type vitiation. The amla fruit contains the equivalent of nine oranges of vitamin C, as well as studies confirmed the bioavailability of the vitamin C in amla is better than that from synthetic ascorbic acid. It has antimicrobial properties and was shown to have inhibitory effects on HIV. [42] Increased cholesterol is a common side effect in many HIV medications. Studies have shown it to reduce cholesterol. Amalaki shows antioxidant properties against oxidative stressors. [43] It is considered the best among rasayana as well as it clears all three doshas from the body. When vitality is low amla with ashwagandha, ghee and honey is restorative and invigorating. [44], [45], [46] Ashwagandha * Ashwagandha has a sweet, astringent and bitter rasa, warm virya and sweet vipaka. Its qualities are light and oily. is used in general debility and is the best rejuvenation herb for muscle, marrow and semen and for Vata constitution. [47] It is adaptagenic and increases the bodies ability to handle stressors. It is used in weakness, consumption and debility. [48] It is a nervine sedative and nervine tonic and is known to treat anxiety, arthritis, insomnia and stress as well as an antioxidant. [49] Because Vata vitiation is paramount in the treatment of HIV Ashwagandha becomes an herbal ally in treating the stressors on the nervous system from the virus and/or the medications. Ashwagandha has been shown to increase body weight and total protein content. It has been shown to have anticancerous activity and has shown to be effective against hepatotoxicity, chemical driven liver damage. [50] (*See Appendix I For related research) Shilajit A unique ayurvedic panacea or cure all. Its rasa is pungent, bitter, and salty. It’s Virya is warm and its vipaka is pungent. It is not actually an herb but a mineral pitch. “It is an exudate that oozes out from ceratain rocks in the Himalayas, as they become warm.” [51] “Shilajit is renowned as a rejuvinative tonic with specific action on the urinary, reproductive, and endocrine systems. According to Caraka, almost all diseases can be controlled or cured with the use of this substance.” [52] In a comparative study of shilajit and 2 other herbs and AZT in 2006, shilajit performed 80%90% effective against an enzyme found in HIV necessary for its multiplication. AZT was 70% effective. [53] Turmeric* “When a virus replicates the ‘long terminal repeat’(LTR) sequence is activated. Without this activation there can be no replication of a virus like HIV. Published laboratory tests, completed by researchers at Harvard Medical School in 1993, indicated three inhibitors of HIV LTR. Curcumin is one of them…” [54] Curcumin is what gives turmeric its yellow color. Turmeric works on all the tissues of the body. It has a bitter rasa warm virya and pungent vipaka. It is an antimicrobial, good for indigestion, poor circulation, cough, skin disorders, diabetes, arthritis, anemia, wounds and bruises. It helps to improve intestinal flora and is good antibacterial for those chronically weak or ill. It purifies the blood and warms and stimulates the formation of new blood tissue. It helps in digestion of protein as well as promotes proper metabolism in the body, correcting both excess and deficiencies. On an energetic level it gives the Shakti of the Divine Mother and is effective in cleansing the chakras (nadishodhana) purification of the channels of the subtle body. [55] It seems to be slightly controversial as to whether or not Turmeric is Vata/ Pitta aggravating or tridoshic. As a satvic herb Tumeric has the ability to clear the intensity, anger and heat in the blood from excess Pitta. According to Prashanti de Jager, Turmeric is tridoshic because of its herbal actions and high carbohydrate percentage (70%) – the sweet taste. [56] (*See Appendix I For related research) http://www.ayurvedacollege.com/book/export/html/2
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Triphala* Triphala, perhaps the most famous combination of herbs in the Ayurveda, Triphala is made of the three herbs amalaki, bibhitaki and haritaki. Considered a panacea for digestive disorders and is useful in almost every condition of the intestines. Triphala tones the intestinal muscles, creates regularity and dispels gas. “Triphala’s actions extend beyond the digestive system. Each herb in Triphala is itself a rasayana for one dosha… Hence, this formulation builds internal strength and ojas.” [57] Unlike overthecounter laxative and laxatives in general Triphala is not dependency forming; in fact it is a remedy for this sort of dependency. Triphala becomes and ally in the treatment of digestive imbalance occurring form the virus as well as the pharmaceuticals employed to treat HIV. The individual’s ability to digest and absorb foods properly increases when the doshas are brought into balance and removed when in excess from their sites of origin. (*See Appendix I For related research) Chyawanprash* This famed rasayana is considered the supreme rasayana of Ayurveda. It is a tasty dietary supplement that strengthens the organs under the ribs. It is very effective in the convalescence of the weak. It is made from amalaki (see below) and is the premier builder of ojas. It is heavy, sweet, sour and pungent in taste. Its vipaka is sweet. It is said to dispel drowsiness, fatigue and preserve the harmony of all three doshas. It inhibits aging, rejuvenates depleted bodies, increases all dhatus and builds ojas. Chyawanprash becomes a strong ally in the treatment of individuals with HIV in maintain tissue strength and tone and helps bring balance into Vata dosha. Note that some are heating and others are more tridoshic as well as it is heavy. Those who have ama should undergo purifaction by Pancha Karma for its most beneficial effects. Legend has it that the sage Chayavan was an old man. He was destined to marry a very young woman from his village. Fearing that he could not satisfy this young woman and produce healthy progeny, he sought the counsel of the Gods. In meditation, he was instructed in the preparation of the now famous confection. Upon eating it, he became young and virile again. Hence, chywanprash is used by those who wish to remain young for many years. [58] (*See Appendix I For related research) Gemstomes Gemstones can be worn as jewelry such as a ring or pendant. The effect is greatest when the setting is designed for allowing contact to the skin. Gold is warming and tonifying as well as tridoshic and is best for Vata. Silver is cooling and purifying and is best for Pitta. Infusions can be made by soaking the gem in water in the sunlight for Vata and Kapha, and the moonlight for Pitta. Emerald/ Jade builds ojas is a nervine sedative and is good for degenerative diseases such as HIV. Pearl/ Moonstone, increases ojas is a tonic and is calming. It reduces hyperacidity and ails the liver and kidney. Yellow Sapphire/ Yellow Topaz/ Citrine, increases ojas as well as discrimination, tejas. Reduces fear, nervousness and anxiety and is good in wasting conditions and regulates the hormonal system. [59] Aromatherapy Aromatherapy speaks to the subtle channels as well as the mind. The mind has the ability to choose to attach to healing or sorrow, in this regard Aromatics become useful in the overall well being and healing of the individual. Rose increases love, compassion, has a prabhava of reducing anger and increasing immunity. It is a antimicrobial and cools the eyes (what the body digests via the eyes.) In this manner it is used as rose water. Rose increases ojas. Sandalwood is calming to the mind, is a nervine sedative and tonic and is useful in nourishing the heart. It increases ojas and has a http://www.ayurvedacollege.com/book/export/html/2
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prabhava for reducing anxiety and fear. Lotus is tonifying on the immune system and helps build ojas. Saffron increases faith which is the antidote for Vata. It is a rasayana, builds ojas, and is considered useful in cancer and HIV. [60] Mantra Utilizing the Sanskrit language mantra is a powerful tool for healing. The Sanskrit alphabet is based on the cosmic sounds of creation and as such resonates deep within our beings. On a subtle level each letter resonates in the petals of different chakras, wheels of energy. When we use healing mantras they resonate on our physical, psychological and spiritual selves. However mantra does not need to be specifically in Sanskrit, although powerful; affirmations in ones own language can and should be considered equally as healing. In an article that Yogi Baba Prem, wrote, “Within the Atharva Veda, one can find teachings of modern day visualization and affirmation tools; with such quotes as, ‘My mind stands against disease.’ Or from the Yajur Veda (Sukla version).
Preserve my life.
Assist/Preserve my prana (lifeforce).
Assist/preserve my vyana (circulating lifeforce). Assist/preserve my sight.
Assist/preserve my ears [hearing].
Assist/preserve my speech, let it abound.
Be active in my mind.
Keep my soul.
[Keep] my light pure.
Yajur Veda XIV.17
This is a powerful affirmation for health and wellness.” [61] Maha Mritunjaya Mantra is found in the Rig Veda. It is dedicated to Shiva and is considered the Death Conquering mantra. Along with the Gayatri Mantra it is hailed as the heart of the Vedas. It is used for contemplation and meditation and is considered a nourishing mantra. Swami Satyananda Saraswati of the Devi Mandir (www.shreemaa.org) says that by reciting this mantra 108 times one receives the blessings of Lord Shiva. OM. Tryambakam yajamahe
Sugandhim pushtivardhanam
Urvarukamiva bandhanan
Mrityor mukshiya mamritat We worship the Father of the three worlds, of excellent fame, grantor of increase. As a cucumber is released from bondage to the stem, so may we be freed from death to dewll in immortality. (www.shreemaa.org) The practice of mantra should be approached with care in the HIV positive individual as to fully integrate the healing benefits and to not cause undue stress and imbalance. Intense emotions, tiredness or fatigue are signs of pressing too hard into the practice of mantra. Creating routine and allowing the practice to unfold is the key to the success of mantra japa. SoHum mantra is a wonderful mantra to begin with, as it is the natural mantra of the breath. With each inhalation and each exhalation the breath naturally repeats this powerful mantra. In the text supplement to the California College of Ayurveda, Dr. Marc Halpern guides the sohum meditation in this fashion: “Allow your mind to become completely present. http://www.ayurvedacollege.com/book/export/html/2
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Bring your awareness within and follow the flow of your breath as it moves in and out of your body. (Pause) Do not control your breath, just be the witness as it moves in and out. (Pause) And now, with each inhalation I want you to listen within the breath for the sounds soooooo as you inhale and huuuuuuuum as you exhale. Let your breath and your mantra be your point of focus. If, at any time, your mind begins to wander, gently bring it back to your breath and your mantra.” This is the secret in this meditation, find the mantra naturally within the breath rather than verbally repeating “SoHum.” Another mantra practice is reciting the Sanskrit name of the herbs that are being consumed. The names themselves are mantras and often times are broken into stories and legends that give keys into how they are used and employed as well as the energetics behind them. The act of story in this fashion speaks to the more subtle nature of the individual and works on the subconscious to heal from within. Meditation In 2008 UCLA did a study on mindfulness meditation and its effect on the CD4 count of the individual. “This study provides the first indication that mindfulness meditation stressmanagement training can have a direct impact on slowing HIV disease progression," said lead study author David Creswell, a research scientist at the Cousins Center for Psychoneuroimmunology at UCLA. [62] The benefits of meditation on the immune system and stress are numerous. When given the opportunity to quiet the mind and let go of the attachments of the day the mind, body and spirit are afforded an opportunity to heal. Meditation however is a challenging prospect for many and “to get there” is often a struggle. One must first understand that meditation cannot be taught. Meditation must be experienced. Only the technique to experience meditation can be taught. Some of the techniques noted above in the mantra section are useful as well as the use of breathing techniques such as alternate nostril breathing and observing the movement of the breath. Trataka, gazing at the flame of a lit candle or ghee lamp is another technique employed to help with meditation. One observes the candle without blinking and allows the initial tears to come and pass. Upon closing the eyes, the flame will still be able to be seen. Keep the gaze at this point until it is no longer there. In Oshos translation of the Vigyam Bhairav Tantra, he writes, “Shiva proposes one hundred and twelve methods (for meditation). These are all the methods possible. … these one hundred and twelve methods are for the whole of humanity – for all the ages that have passed and for all the ages that have yet to come. In no time has there ever been a single man, and there will never be one, who can not say ‘ These one hundred twelve methods are all useless for me.’” [63] When one is guided with a few techniques the inner light turns on and the remaining journey is lead from within. In the Yoga Sutras, sutra 1:46 refers to the waves and motions of the mind. In any given 24 hour period the mind is attached and wrapped up within five states: right knowledge, wrong knowledge, memory, sleep and the stories that we imagine due to something we see, hear, smell etc [64] When one quiets the mind beyond these five states equilibrium is created; a certain detachment is cultivated and a deep awareness and connection with spirit is rekindled. In the practice of meditation one has the opportunity to connect with Self, consciousness or God. Experiencing this aspect of the divine instills faith, the most healing emotion to vata dosha and HIV. Hatha Yoga Hatha Yoga, here referred as the general asana, posture, practice that all the styles in the west branch from. Since yogasana can increase the effectiveness of the immune system it has the potential to limit the damage the HIV virus can create. “The practice of yoga appears to improve the immune function in part by lowering levels of the stress hormone cortisol and yoga asana may boost immunity by improving the circulation of lymph, a fluid rich in diseasefighting white blood cells like lymphocytes.” When in states of secondary disease or fatigue long restorative postures such as child’s pose and savasana during a practice is very therapeutic. Grounding poses such as those were both feet are firmly on the ground help http://www.ayurvedacollege.com/book/export/html/2
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ground vata, in addition to hip compression and forward folds. Side lateral extensions and twists move the lymph and reduce pitta dosha. Back bends clear kapha and should be approached with care as they invigorate the nervous system. To stimulate the thymus, Pandit Rajmani Tigunait, PhD. Recommends two pranayama, breath techniques: Ujjayi and Bhramari. He also suggests meditating on the hollow of the throat. When one steps onto a yoga mat it is a different moment each and every time, those living with HIV need to pay particular attention to their bodies and ask “How am I feeling in this posture today?” Those that are feeling good are encouraged to do a normal, energetic yoganasana practiced balanced with plenty of restorative work. Iyengar methodology for HIV insists that one not strain during any pose or practice as well as supported inversions and restorative postures are prescribed. [65]
Conclusion In the article, “Conversations With My Virus,” Shana Cozad writes a heroic journey of acceptance of her virus and how she transforms and spiritualizes her journey. “This disease is simply remarkable at bringing out the raw and emotional and scariest aspects of Life, or Death, and often at the same time. Our culture doesn't prepare us how to deal with death very well, and as far as I am concerned, our culture has haphazard way of preparing us for life anyway.” [66] Ayurveda guides one on the journey toward equanimity and harmony. The two goals of Ayurveda are: to keep the body in a state of health and free from disease, and, To show us how to use health as a basis of, or as a part of, the path to enlightenment. [67] As noted earlier Sanskrit, the language of the Vedas, has the uncanny ability, like modern URL’s, to guide us further and deeper into stories and secrets. Ayus = life. Veda = knowledge. Ayurveda the knowledge of life. But when one meditates on this further, the question arises; what sort of knowledge? And what and how is life defined? The knowledge gifted to us by Ayurveda asks us to look deep within and find the Sadguru, the teacher within; to spiritualize our circumstances and to learn from them. When, as Shana Cozad demonstrates so heroically, we transform ill fortuned circumstances and diseases like HIV into spiritual teachers, we can then see the knowledge Ayurveda may be hoping to impart. Hatha Yoga Prayer I offer this practice to the Sadguru, the Teacher within all things, The Teacher that is the Prana (life) from which my body emerged, The Teacher that sustains and nourishes me with each breath, The Teacher whose lessons are in every life experience – even pain and death. May this practice open me to the wisdom of the Sadguru, That my mind may know peace, That my heart may know compassion And my life may offer peace and compassion to all beings. Om Shanti, Om Peace Darren Main[68] http://www.ayurvedacollege.com/book/export/html/2
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Appendix I Related Studies on the Effects of Herbs in AntiViral Therapies The role of traditional, complimentary and alternative health care is rapidly changing in the world climate. A greater emphasis on complimentary and alternative health care, and its practitioners, is developing in the wake of economic downturns. Healthcare and Health Insurance prioritized as a moneymaking industry rather than the greater seva, act of service, to heal and promote longevity is unsustainable. Although the care received in hospitals and by Doctors is beneficial for the most part; when the bottom line speaks louder than the individual that lies ill, great tides of change can and must occur. Communities have taken into their own hands the motto, “I am my primary care physician.” By integrating alternative health care practitioners as a tool in educated themselves in preventative and natural care, individuals empower themselves to take their health into their own hands, thus creating a truly holistic approach to health which is the very core of Ayurveda. “Traditional, complementary and alternative medicine (TCAM), drawn from indigenous medical and/or healing knowledge systems from around the world, has for the last 30 years been recognized by the World Health Organization (WHO) as providing culturally acceptable, affordable and sustainable primary healthcare. TCAM knowledge has been known for some time to assist with birthing practices, acute injuries, infectious diseases and parasites.” “Specific examples include the use of TCAM practitioners for HIV/AIDS prevention awareness and direct treatment of AIDS related symptoms; the use of TCAM herbs for the treatment of malaria and the use of home herbal gardens for health maintenance.” (69) Below is a listing of articles and abstracts that contributed to the research of this paper. Bombay Hospital Journal Dr. A.A. Mundewadi has been practicing Ayurvedic medicine for 25 years and has several published clinical works including one study on HIV. The results of his study showed Ayurveda to be effective antiviral and immunostimulant as well as safe for longterm use. (70) (www.ayurvedaphysician.com/) This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating disease of the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since several months. After being given Ayurvedic treatment for about 11/2 months he became alert, and could speak clearly, albeit temporarily, for 1 week. Another patient with Nephrotic syndrome resulting in longstanding generalized oedema (2 years) had complete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patient with suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, he started putting on weight. This patient later underwent a CTguided FNAC, the results of which are awaited. Another patient with history suggestive of HIV Encephalopathy was semiconscious at presentation. He was passively fed on liquid diet and a combination of both modern drugs and Ayurvedic treatment. This patient became ambulatory within 2 weeks, and after 2 months of treatment he is faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedic medicines may have multifaceted properties and need further evaluation. Conclusion The retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 to November 2004 http://www.ayurvedacollege.com/book/export/html/2
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proved the Ayurvedic medicines to be considerably effective as antiviral and immunostimulant,and safe on longterm use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regular counselling support appears to be an ideal combination in the management of HIV/ AIDS patients. Acknowledgement The medicines used in this study were purchased from Chaitanya Pharmaceuticals, Nasik and Nahar Pharmaceuticals, Gujarat. References 1 UNAIDS. Global Summary of the AIDS Epidemic. Update. December 2004. 2 UNAIDS. Epidemiological Fact Sheets on HIV/AIDS. India. Page 2. 1/9/2004. 3 Foundation for Integrative AIDS Research. Potential AntiHIV Herbs. 15/9/2002. 4 Sharma PV. Vegetable Drugs. IV Edition. Chaukhamba Publications.1978:2. 5 Dahanukar S A, Kulkarni RA, Rege NN. Pharmacology of Medicinal Plants and Natural Products. Indian J Pharmacology 2000; 32 : S81 S118. *Ayurvedic Physician, T.M.C. Office Bldg., 1st Floor, Mumbra, Thane 400612. (71)
Allopathic and Ayurvedic Approaches to Leucoderma (by Rama D. Napolitani C.A.S) Table of Contents 1. Introduction 2. Modern Medicine and Leucoderma 3. Ayurveda and Leucoderma 4. Classical Ayurveda and Svitra 5. Nidanam http://www.ayurvedacollege.com/book/export/html/2
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6. Purvarupa (earliest signs/symptoms) 7. Rupa (clinical signs/symptoms) 8. Samprapti (pathogenesis of the condition) 9. Chikitsa (Overview) 10. Herbal Chikitsa 11. References Introduction Leucoderma, also known as vitiligo is a skin disorder that affects nearly 2% of the world population. [1] Allopathy, the system of medicine in widespread practice today offers palliative measures, but no cure. By contrast, the Charaka Samhita , a two thousandyearold Indian Ayurvedic text [2] , provides a description of leucoderma with recommendations for treatment . In this paper, the modern medical understanding and treatment of leucoderma will be discussed. Then, a detailed Ayurvedic analysis and approach to management will be presented. Modern Medicine and Leucoderma Leucoderma, a Latin word, meaning ‘white skin' is caused by the destruction of melanocytes; the cells responsible for skin color. There are many theories as to what may be responsible for causing leucoderma. Researchers have suggested an autoimmunological, neurological or autocytotoxic origin. None of these have been proven definitive. [3] The disorder is said to affect all races and genders equally and in 95% of cases, leucoderma manifests before age 40. [4] As for a possible hereditary link, approximately one third of cases report a family history. The most commonly afflicted areas of the body are the sunexposed tops of hands and faces, and hyperpigmented areas of the body, such as the groin, nipples, genitalia and axilla. [5] The disorder is not infectious, nor does it cause pathological harm. However, leucoderma does leave the skin aesthetically disfigured, often causing psychological and emotional stress. In consideration of no known medical cure, allopathic treatment of leucoderma offers two approaches to the management of this disorder: protection of depigmented patches and repigmentation therapies. Due to the absence of melanocytes in depigmented skin, the body is unable to provide adequate UV light shielding from the harmful rays of the sun; thus protection of depigmented patches is of paramount importance. To minimize exposure to UV concentrated light, protective measures are encouraged, such as the application of Sunscreen 1530 SPF or the use of protective clothing. 5 In addition to protecting leucodermic patches, many cosmetic products are available that act to camouflage the affected skin. The second approach to the management of leucoderma focuses on repigmentation therapies. Common therapies are of three types: The topical application of potent corticosteroids, (PUVA) psoralen photochemotherapy and surgical therapies. Of these interventions PUVA is considered the most effective treatment available in the United States, however the treatments are timeconsuming, side effects can be severe, 4 and complete repigmentation only occurs in 1520%. 5 Interestingly, psoralens used with photochemotherapy are obtained from the ancient Ayurvedic herb known as Vakuchi (psoralea corylifolia). [6]
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Ayurveda and Leucoderma Ayurveda, a Sanskrit term meaning ‘science of life', is said to be the most ancient system of medicine in widespread practice today. In fact, the archeological findings of the ‘Bower Manuscripts' support the notion that Ayurveda has been in continuous practice for more than two millennia. [7] The practice of Ayurveda finds its roots in a body of knowledge and principles that were systematized in the Charaka Samhita , a treatise written more than two thousand years ago. In this ancient text a description and treatment for leucoderma is discussed. However, the basic theory, principles and objectives of Ayurveda will first be presented. Ayurveda, an ancient healing system and a medical science, first seeks to restore, then maintain Svastha of the body and mind. S vastha, meaning health in English, has a definition in Ayurveda that, when fully understood, sheds much light on the objective of this system of medicine. Health is defined “as physical and mental wellbeing; freedom from disease, pain, or defect; normalcy of physical and mental functions; soundness.” [8] Ayurveda, defines Svastha in Sanskrit as: “sama dosah samagnis ca sama dhatu mala kriyah prasannatmendriya manah svastha ityabhihiyate (Sushruta Samhita, 15.38) One who is established in Self, who has balanced doshas, balanced agni, properly formed dhatus, proper elimination of malas, well functioning bodily processes, and whose mind, soul, and senses are full of bliss, is called a healthy person .” [9] In this Ayurvedic definition of health, not only is the western concept of health encompassed, but there are other layers, that of the doshas, agni, dhatus, and malas. Hence, Ayurveda views health as a balance of the doshas which are vata, pitta, kapha (in consideration of one's prakruti), properly formed/functioning dhatus (seven tissues of the body), and proper elimination of malas (waste products). Thus, when Ayurveda looks at a disease such as leucoderma, invariably, these aforementioned factors are taken into account and discussed. Unique to Ayurveda, is its understanding and articulation of disease. In western medicine when a disease or a group of symptoms is examined, analyzed, then given a name, the disease has been ‘diagnosed'. In contrast, the Ayurvedic approach to disease diagnosis seeks first to define its' root, or its' roganam mulakaranani; [10] it is considered as important to define the root of a disease as it is to name a disease. In Ayurvedic medicine, the process by which a disease is understood and diagnosed is called s arvaroga nidanam and is composed of five parts: nidanam (causative factors or etiology), purvarupa (earliest signs/symptoms), rupa (clinical signs/symptoms), samprapti (pathogenesis of the condition), and upasaya (diagnostic tests). [11] Traditionally, when a disease is being discussed, the five parts of the sarvaroga nidanam will be presented. Indeed, the ancient Ayurvedic text, Charaka Samhita , presents skin disease (kustha) following this format. Classical Ayurveda and Svitra In Ayurvedic classical literature, such as the Charaka Samhita , leucoderma also known as ‘white leprosy‘ is called svitra or kilasa. [12] It is within volume III, chapter VII of this aforementioned text where “ kustha (obstinate skin diseases) and leucoderma are discussed. The sarvaroga nidanam http://www.ayurvedacollege.com/book/export/html/2
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of kustha and svitra share many common threads as will now be presented. [13] Nidanam The development of leucoderma in an individual is said to be caused by the incorporation of the following unwholesome regimes into their life: • “Intake of mutually contradictory food, and drinks which are liquid, unctuous and heavy; • Suppression of natural urges; • Performance of physical exercise in excessive heat and after taking very heavy meals; • Transgression of the prescribed order of the intake of food and with reference to heat and cold, as well as fasting; • Use of cold water immediately after exposure to scorching sun, exertion, or exposure to frightening situations; • Intake of uncooked food and/or intake of food, before the previous meal is digested; • Excessive intake of food prepared of freshly harvested grains, curd, fish, salt, and sour substances. • Untruthfulness, ungratefulness…insult of preceptors, sinful acts… misdeeds of past lives. Purvarupa (earliest signs/symptoms) • Excessive or absence of perspiration; • Discoloration of patches on the skin; • Horripilation, itching, pricking pain, physical exhaustion, mental fatigue Rupa (clinical signs/symptoms) • Daruna when dosha (chiefly) vitiates the rakta or the blood, the patches will be red in color. • Caruna when dosha (chiefly) vitiates the mamsa or the muscle tissue, the patches will be coppery in color. • Kilasa when dosha (chiefly) vitiates the medas or the fat, the patches will be white in color.” [This is the most common rupa (clinical http://www.ayurvedacollege.com/book/export/html/2
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presentation) of svitra hence leucoderma is often called kilas] Samprapti (pathogenesis of the condition) In the Charaka it says the three vitiated dosha mix with the dhatus, namely the rasa, rakta, mamsa, medas, and result in the white patches. “Ayurveda maintains that leucoderma is caused by some morbidity of the liver” which is a vitiation of pitta. [14] Below in table 1, is the authors' rendition of a samprapti for leucoderma. The format used for presentation was designed and created by Dr. M. Halpern as a tool to articulate a disease process. Table 1 : Samprapti and Herbal Chikitsa Summary –VataPitta type Leucoderma {vata pushing pitta, or primary pitta vitiation} Stage
Evidence
A/A
Possible constipation and gas
Vata
O
Mild, transient systemic dryness
Vata
Vyana
Rasa
Rasavaha srota
Demulcents
O
Mild transient feeling of cold
Vata
Vyana
Rakta
Raktavaha srota
Circulatory Stimulants
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Dosha
Sub dosha
Dhatu
Srota
Category
Laxatives Apana
Rasa
Purishavaha srota
Demulcents Carminative
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RMD
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White skin patches with irregular edges, asymmetry
Vata
Decreased Sweat
Vata
N/A
Vyana
Rasa, Rakta, Mamsa, Medas,
Rasa, Rakta, Mamsa and Medo vaha srota
Skin tonics,
Rasa
Rasavaha srota
Demulcents
Liver tonics
Svedavaha srota
RMD
Worry/anxiety
Vata
Vyana
N/a
Manovaha srota
Nervine Tonics Nervine sedatives
A/A
Possible loose stool, burning indigestion
Pitta
O
Transient mild burning mucus membranes
Pitta
N/A
Rasa
Rasavaha srota
Demulcents
O
Transient mild feelings of warmth
Pitta
Ranjaka
Rakta
Raktavaha srota
Alteratives
RMD
White Pitta symmetrical skin patches
Bhrajaka
Rasa
Mamsavaha srota, medovaha srota
Liver tonics,
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Pachaka
Rasa
Annavaha srota
Demulcents Cool dipanas
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RMD
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Excessive sweating
Pitta
Anger, criticism
Pitta
N/A
Rasa
Rasavaha srota
Alteratives
Svedavaha srota
Sadhaka
N/A
Manovaha srota
Nervine Tonics Nervine sedatives
In the above samprapti, it is indicated that vata dosha accumulates in the purishvaha srota resulting in poor elimination, then overflows into the rasa and rakta dhatu. When vata relocates to the rasa and rakta dhatu it results in deficient flow through the rasa and raktavaha srota. Coupled with pitta vitiation, in due course, an altered functioning of the liver¹ 6 occurs, which in turn contributes to impaired elimination/management of impurities in the body. It is understood in Ayurveda, that deficient flow through the raktavaha srota vitiates posaka rakta (the building blocks of the mamsa dhatu). [15] Since the mamsa dhatu is responsible for healthy skin, it stands to reason that an impairment of the skin may result. In essence, an accumulation of vata and pitta dosha and ama (toxins) in the srotas and dhatus is resulting in impaired function, as well as inferior production, of tissue. Consequently, one can understand why the Charaka says, “The patient of svitra should (first) be cleansed by the administration of elimination therapies and thereafter” [16] employ other measures. Thus it is essential that ama and excess dosha be expelled from the body, only then can the restoration of healthy tissue commence. Next, Ayurvedic treatments (chikitsa) for leucoderma will be discussed. Chikitsa (Overview) An Ayurvedic treatment plan starts with measures to arrest the ongoing aggravation of dosha in the body. The digestive track is targeted first with the implementation of a dosha appropriate diet. For example, if pittadosha aggravation were present, then a pitta pacifying diet would be implemented. Salt intake should be minimized and restricted to rock salt only, as this will further expedite recovery from kilas. [17] Concomitantly, lifestyle would be closely evaluated for possible nidanam (causative factors), and these would be corrected. Once all correctable causative factors such as lifestyle and diet have been addressed, proper eliminative measure would be taken to facilitate the removal of ama (toxins) and excess dosha from the body. Eliminative measures must initially be employed, taking into consideration a patients' agni and level of ojas, then might herbal remedies prove effective. Purification kriyas such as oleation (application of oil), svedana (fomentation or heat therapy) and vrechana (purgation) are employed to (1) “loosen and liquefy ama” and excess dosha from the various sites of accumulation in the tissue, (2) mobilize ama and excess dosha, (3) facilitate removal of ama and excess dosha from the body. [18] An additional manner of purification often mentioned with leucoderma is called rakatamoksha (therapeutic bloodletting). In this treatment, excess pitta dosha in the rakta dhatu is being removed via one of the following methods: • Removal of 300cc of blood via venipuncture (performed following oleation and svedana) [19] http://www.ayurvedacollege.com/book/export/html/2
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• Topical application of leeches to affected areas. A case study published in 2004 demonstrated complete resolution of vitiligo in a six year old boy whom had incorporated raktamoksha (per topical application of leeches) in his Ayurvedic treatment plan, “There was a marked difference in the skin color after the first (application). The skin started to appear pink. After a period of 2 ½ weeks leeches were applied again, the client continued with herbs and the local application of Bakuchi oil. Gradually the skin started getting back it's brownish hue, the hair on the scalp that had turned white at the patch started turning black again… patches regained their color fully after a period of two months” [20] With proper elimination of excess dosha and ama, then herbal remedies may prove effective. Herbal Chikitsa An abundance of herbs are mentioned in the Ayurvedic texts, many of which are readily available today. Several of these herbs have been studied in Indian laboratories. Interestingly, properties identified in the lab often support the Ayurvedically identified properties. For example, Khadira (acacia catechu), as a decoction, is recommended for treatment of leucoderma.¹ 6 The rasa of Khadira is bitter and astringent. Its' virya is cold, and its vipaka is pungent. It is said to balance both Pitta and kapha dosha. Laboratory studies have identified constituents shown to regenerate liver cells, as well as providing antifungal and antiinflammatory effects. [21] A decoction of khadira and amla is recommended as a twoounce dose every morning.¹ 7 Another herb, Vernonia anthelmintica (somaraja/kattushiragam/purple fleabane), is also reported to be an effective remedy for vitiligo. The rasa is bitter, virya is warm and the vipaka is pungent. In the Indian Materia Medica a few remedies with this herb are mentioned: (1) The powdered seeds of this herb taken with a decoction of emblic myrobalans (amalaki or nellikkai) and catechu. (2) The powdered seeds taken alone (1 tsp.) (3) The powdered seeds taken with black pepper or black sesame seeds in equal parts, daily in the morning, with warm water, just after perspiring. It is indicated that if one of the above methods is followed for one year, resolution of vitiligo will occur. [22] However, the one herb most often mentioned with leucodermic treatment is Vakuchi (psoralea corylifolia Linn). This herb is recognized as being helpful for treatment by all the major medical disciplines, Ayurvedic, Chinese, Unani, as well as Western medicine. Vakuchi, also called Bakuchi or karpkarishi has a pungent and bitter rasa, a warm virya, and a pungent vipaka. [23] Most sources suggest taking vakuchi internally as well as topically. The seeds, as a powder (churna), are recommended for internal use. The parts of the plant used for topical applications are the essential oil extracted from the seeds, or a medicated oil prepared from the seeds. As a diluted essential oil, when topically applied to white depigmented patches, it is reported to act “on both the Rouget's cells and the melanoblastic cells of the skin…stimulation (of these cells) by the oil leads them to form and exude pigment which gradually diffuses into the decolorized areas.” [24] Other methods of preparation and administration of this herb are as follows: • The paste of the seeds made with milk is rubbed into the affected parts of the skin. However if continuous application irritates the skin, the treatment should be discontinued for some time.² 5 • Equal parts of the seeds of Vakuchi, seeds of chakramarda (cassia tora), and the wood of Mahanimba (melia azdarach or persian lilac) made into a http://www.ayurvedacollege.com/book/export/html/2
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paste with rose water is applied over the white patches. The persian lilac can be substituted with Nimba (Indian lilac or neem) berries. [25] • Another formulation including vakuchi, Panchanimba gutica or Panchaamrita is recommended in daily doses of 4 drachms (this is equal 1 tablespoon). To prepare, take the five different portions of the neem tree, namely the flowers, fruits, leaves, bark, and roots 15 parts each powdered to 1 part each of the following substances: iron oxide, chebulic myrobalans, seeds of cassia tora, triphala, fruit of Semecarpus anacardium, embelia ribes, sugar, emblic seeds, curcuma longa, long pepper, black pepper, dry ginger, seeds of psoralea corylifolia, pods of cassia fistula and tribulus terrestris all powdered. Mix all together and make into paste in the juice of eclipta erecta. Then mix with the decoction (1 in 8) of the bark of acacia catechu. [26] A final area of treatment comes into focus when considering the last nidanam (causative factor) of this disorder which is, “untruthfulness, ungratefulness…insult of preceptors, sinful acts… misdeeds of past lives.” This nidanam has its' roots in the concept of karma. The law of cause and effect can be seen manifesting in many diseases afflicting our society. A person smoking daily for the past 30 years, who is discovered to have lung cancer, illustrates the concept of karma in action. Lung cancer is the effect. Smoking a known carcinogen, daily for 30 years, is the cause. This is a simplified example of karma. A more complex example is the all too often 60yearold obese male with elevated cholesterol complaining of severe sudden chest pain. After presenting to the hospital with elevated troponin levels and tombstone twave elevations per EKG, he is informed he is having a massive heart attack. When cardiac cathaterization reveals that some of the arteries leading to his heart are severely occluded, he is told that the cause of his heart attack is the severe arterial sclerosis, which was caused by his elevated cholesterol. He might then be told that the poor diet and absence of exercise that he reports caused his elevated cholesterol. In essence this is karma in action. The cause is a life long poor diet, coupled with the absence of exercise, resulting in elevated lipid levels, ultimately leading to the massive heart attack. While many behaviors are clear causes of disease, others are much subtler. Ayurveda encourages a regular practice of selfintrospection such as meditation, by which an awareness and clarity of judgement develops. People shower and brush their teeth often to maintain cleanliness of body and mouth. A regular practice of meditation can provide a similar cleansing, of the mind and thoughts. Clarity of mind produces balanced judgment and right decisions which in turn promote right actions, hence healthy results. “Character is nurtured midst the tempests of the world" Goethe Having once been rough and jagged, the weather worn surface of an ocean cliff is only now smooth and beautiful due to the indiscriminant sculpturing of powerful ocean waves. So too do the trials and tribulations of life have mysterious ways of sculpting beauty out of humanity. Perhaps disease is a method nature uses to sculpt and refine creation. Vitiligo like any other ailment affecting humanity is a manifestation of disease. In this paper its roots have been articulated, and Ayurvedic remedies presented. In Western medicine, reduction of symptoms alone is all too often the result. However, leucoderma stubbornly refuses to be cured by allopathic methods. On the other hand, many cases of leucoderma have been resolved with Ayurveda. The key to successfully treating disease is a comprehensive approach. Ayurveda offers this. The key to resolving Disease is to treat the root. Ayurveda offers this. Finally, the key to restoring health is to address the individual as a WHOLE. Ayurveda achi References [1] Zhang XJ, Liu JB, Gui JP, et al. Characteristics of genetic epidemiology and genetic model for vitiligo. J Am Acad Dermatol.2004, 51 (3): 383 http://www.ayurvedacollege.com/book/export/html/2
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90. [2] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 192. [3] Yu, Dr. HsinSu. Melanocyte Destruction and Repigmentation in Vitiligo: A Model for Nerve Cell Damage and Regrowth, J Biomedical Science 2002;9:564 [4] Moshell, Alan. Et al. National Institute of Health Pub No. 014909. May 2001 [5] Dr Su, R. Handbook of Dermatology & Venereology 2 nd Edition: www.hkmj.org.hk/skin/vitiligo/html [6] Electronic Textbook of Dermatology—Botanical Dermatology, Phytophotodermatitis, www.telemedicine.org/botanica/bot5.htm . 01/06: pg. 1 [7] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 18692. [8] Webster's New World Dictionary, Simon & Schuster, Inc. 1988 3 rd College Edition: pg. 621 [9] Lad, Vasant D. Text Book of Ayurveda, The Ayurvedic Press 2002 1 st Edition: pg. 279 [10] Athavale, Dr. V.B. Pathogenesis in Ayurveda, Chaukhamba Sanskrit Pratishthan, Delhi , 2001, 2 nd Edition: pg. 141 [11] Halpern, Dr. Marc. Clinical Ayurvedic Medicine , California College of Ayurveda, 2005, 4 th Edition: pg. viii [12] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pp. 35963. [13] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pg. 31863 [14] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 94 [15] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 3.1920 [16] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pg. 359363 [17] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 95 [18] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 8.19, 828, 8.3941 [19] Ranade, Dr.Subhash, Natural Healing Through Ayurveda, Motilal Banarsidass, Delhi , 1999: pg.159 http://www.ayurvedacollege.com/book/export/html/2
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[20] Kelkar, Dr. Rucha: Vitiligo and Blood Letting A Novel Approach: Compilation of Papers Presented at the National Ayurvedic Medical Association Conference 10/2124, 2004: pp. 6365 [21] Williamson, E. Major Herbs of Ayurveda, Churchill Livingstone 2002: pp. 1315. [22] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 1269 [23] Gogte, Vaidya V.M. Ayurvedic Pharmacology & Therapeutic Uses of Medicinal Plants (Dravyagunavignyan), Bhavan's Book University 2000: pp.436. [24] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Vol. 1: pg. 1021 [25] Dastur,J.F. Everybody's Guide to Ayurvedic Medicine a Repository of Therapeutic Prescriptions Based on the Indigenous Systems of India, Taraporevala Sons & CO. Bombay1, 1960: Pg. 209 [26] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 783 [1] Zhang XJ, Liu JB, Gui JP, et al. Characteristics of genetic epidemiology and genetic model for vitiligo. J Am Acad Dermatol.2004, 51 (3): 383 90. [2] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 192. [3] Yu, Dr. HsinSu. Melanocyte Destruction and Repigmentation in Vitiligo: A Model for Nerve Cell Damage and Regrowth, J Biomedical Science 2002;9:564 [4] Moshell, Alan. Et al. National Institute of Health Pub No. 014909. May 2001 [5] Dr Su, R. Handbook of Dermatology & Venereology 2 nd Edition: www.hkmj.org.hk/skin/vitiligo/html [6] Electronic Textbook of Dermatology—Botanical Dermatology, Phytophotodermatitis, www.telemedicine.org/botanica/bot5.htm . 01/06: pg. 1 [7] Pillai, Kandaswamy. History of Siddha Medicine, Government of Tamil Nadu Manorama Press 1979 1 st Edition: pp. 18692. [8] Webster's New World Dictionary, Simon & Schuster, Inc. 1988 3 rd College Edition: pg. 621 [9] Lad, Vasant D. Text Book of Ayurveda, The Ayurvedic Press 2002 1 st Edition: pg. 279 [10] Athavale, Dr. V.B. Pathogenesis in Ayurveda, Chaukhamba Sanskrit Pratishthan, Delhi , 2001, 2 nd Edition: pg. 141 http://www.ayurvedacollege.com/book/export/html/2
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[11] Halpern, Dr. Marc. Clinical Ayurvedic Medicine , California College of Ayurveda, 2005, 4 th Edition: pg. viii [12] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pp. 35963. [13] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pg. 31863 [14] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 94 [15] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 3.1920 [16] Dash, Bhagwan et al. Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi1, 2003: Vol. III, pg. 359363 [17] Murthy, Dr.N et al. Ayurvedic Cures for Common Diseases, Orient Paperbacks, Delhi , 1995: pg. 95 [18] Halpern, Dr. Marc. Principles of Ayurvedic Medicine , California College of Ayurveda , 2003, 5 th Edition: pg. 8.19, 828, 8.3941 [19] Ranade, Dr.Subhash, Natural Healing Through Ayurveda, Motilal Banarsidass, Delhi , 1999: pg.159 [20] Kelkar, Dr. Rucha: Vitiligo and Blood Letting A Novel Approach: Compilation of Papers Presented at the National Ayurvedic Medical Association Conference 10/2124 , 2004: pp. 6365 [21] Williamson, E. Major Herbs of Ayurveda, Churchill Livingstone 2002: pp. 1315. [22] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 1269 [23] Gogte, Vaidya V.M. Ayurvedic Pharmacology & Therapeutic Uses of Medicinal Plants (Dravyagunavignyan), Bhavan's Book University 2000: pp.436. [24] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Vol. 1: pg. 1021 [25] Dastur,J.F. Everybody's Guide to Ayurvedic Medicine a Repository of Therapeutic Prescriptions Based on the Indigenous Systems of India, Taraporevala Sons & CO. Bombay1, 1960: Pg. 209 [26] Nadkarni, Dr.K. Indian Materia Medica, Popular Prakashan LTD Reprinted 2002, Volume 1: pg. 783
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Nutritional Paradigm (By Mrunalini R. Patel, BSc.) Acknowledgments My obeisance to The Divine for leading me through life and bestowing me the opportunity to follow my life’s interest for the knowledge of Ayurveda. This paper would not be possible without the founder of CCA, Dr. Marc Halpern and the staff that are supporting the work. I thank Dr. Halpern for bringing the opportunity of learning Ayurveda in America with such clarity. He has been a part in helping me choose an appropriate title for this research paper, and is always ready to be of assistance. I thank my mentor teacher, Marisa Lauren for her guidance in the course work for the AHE and AHP programs, her encouragement has meant much. I would like to thank my unforeseen early teachers in helping me discover many Ayurvedic principles in cooking and the fine art of living. I am grateful for the occasions of being able to observe and experience life’s learning moments. I thank them for their continuous guidance: my parents, Kapurchand Shah, my academic teachers, friends and family members. Thanks also to The Aryavaida Chikitsalayam and Research Institute, Coimbatore, India for two months of wonderful insights and treatment. My deep appreciation to my husband, Sanjay, and daughter, Ravenna, for their continuous support, sense of humor and critiquing that has benefited me along the way. Finally a heart felt gratitude to the Sri Aurobindo Ashram friends in Pondicherry, India for their warmness and support. My mentor and guru Vishwajit.da Talukdar, has persevered in guiding and loving me through the most difficult of times. This paper is dedicated to The Mother and Sri Aurobindo. Om Shanti
Abstract Eating habits in affluent Westernized countries have changed rapidly with lifestyle change and the Eastern countries are following. A diet high in saturated fats, refined sugar, meat, and commercially processed foods has overtaken the use of fresh fruits and vegetables. With the rich, heavy, sweet foods that satiate the majority of stomachs, there is very little nutrient value, leading to nutritional deficiencies and health problems. To overcome the nutritional aspects, a ruinous diet and chemical supplements have become the solution. Food value goes beyond calorie and biochemical content. The subtle aspects contained within fresh naturally grown foods that provide all living http://www.ayurvedacollege.com/book/export/html/2
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beings with a powerful life force, is lost in a fast paced commercially driven mode of living. Diet means “a way of eating”, stemming from the Greek word diaita meaning “a way of life”. “Let food be thy medicine and medicine be thy food.” Hippocrates, the father of Greek medicine. How true these words are, yet society has forgotten to live by them. In the USDA food guidelines, all calorie intake is based on body mass index, gender, stage of life, and whether one is sedentary or active. (See Fig. 5.6 in the MyPyramid section). Active means at least 30mins of exercise on most days of the week and 6090mins per day to sustain weight loss. The amount of portions for each individual, from the same food group is in proportion to the amount of calories calculated for a particular group; therefore, the ratios of portions are the same e.g. a female requires less calories than a male, so the quantity is lower, however, the ratio of portions for each food group is the same as is shown for all individuals on the “MyPyramid”. The same applies for a 2yearold vs. a 12yearold; quantity is increased, however, the ratio of each food group to be consumed remains the same. The only factor that varies is the amount or quantity of portions. The guidelines provide a complete list of foods containing potassium, sodium, vitamin E, iron, nondairy calcium food, calcium, vitamin A, magnesium, dietary fiber, and vitamin C, which have been shown to be of concern amongst various population groups. The amount of these substances required for each group of calories is also provided. Each section addresses the importance of getting the required amounts of nutrients for particular age groups, groups of concern (i.e., those with health issues), and pregnant women. The guidelines do not specify the reason for the substance and its utilization within the body. In some cases the guidelines do mention the cause of some diseases through excess intake, such as sodium causing high blood pressure. There is no discretion or consideration given to what type of vegetable, fruit, oil etc. to be consumed for each individual person; the choice is left upon preference. Food groups are shown to provide the necessary fats, proteins, carbohydrates, vitamins, minerals, and sugars, which are all required for proper function of the body. There are no precautions provided on livestock meat and dairy, which may contain antibiotics and hormones, which are unnaturally fed, and the harm it may cause to individuals. Some hygiene and cooking procedures are outlined so that meats are well cooked and cross contamination is reduced. Since the current state within the US (and most western fast paced countries) faces the challenge of high obesity and related diseases, the USDA report and dietary guidelines have mainly focused attention on concern areas. For this reason, the current version of the Food Pyramid includes and emphasizes exercise and moderation of intake of fats and sugars. In Ayurvedic philosophy, the food groupings are similar to those of USDA. However, unlike the USDA, Ayurveda gives consideration to cooking preparation, storage, times, seasons, prakrīti, vikruti, stage of life, environment, lifestyle, food habits e.g. sequence of eating and pleasant eating atmosphere, where food is grown, and energetics (rasa, virya, vipaka) of food are additional factors, that govern an individual’s diet. Ideally there are factors such as when to pick fruits and vegetables, how and where to best grow them, amongst other factors, which do not require the need to delve into in this paper. Many interlayered factors are given due consideration for a diet plan to be derived at for a particular individual. All of this may sound complex, however, there is a science behind the system that renders a commonsense approach. Food charts that list each food item for the basic prakrītis/constitutions are available, and with additional factors the charts can easily be modified by an Ayurvedic practitioner. To follow the diet prescribed by Ayurveda involves some discipline and selfcontrol however, it involves a lifestyle change that leads to optimal health and http://www.ayurvedacollege.com/book/export/html/2
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longevity. “The four aims of life, dharma/to fulfill ones duty in life, artha/to attain wealth or livelihood, kāma/to attain ones desires, and moksha/liberation, are to be reached through health only” [1] “Good health stands at the very root of attaining aims in life, so it is only desirable for all” [2] There are seven types of prakrīti that can have infinite combinations based on the percentage of each dosha’s presence. Any, vikruti factors will also be taken into account, this establishes an individualistic and thorough diet plan. Each person is seen as a unique entity that has his/her own body constitution, whether that may be in the varying levels of hormones, agni/metabolism, or even neurotransmitters. This means each individual has an exclusive biochemical world that influences how it functions, thinks reacts, senses, talks, lives etc. The living biochemical bodies require a safe and nurturing environment and top grade ‘fuel’ that maintains harmony and equilibrium. What may be nurturing and advantageous to one may not be to another, if we consider the various factors that account for an individual’s diet plan, based on Ayurvedic principles. This would literally mean an individual Food Pyramid for each person. Within the subgroups of food lists, there would be preference provided according to the fresh seasonal foods available. Quantity is not based on calories but on the power of digestion and fullness of the stomach, being able to gauge what 75% full means or stopping at the first burp with the second being past the red light signal. Bringing awareness to the body whilst eating has endless benefits of increasing one’s consciousness for a harmonious life. Being aware of all the senses as we eat brings joy and increases intuitive perception, as well as showing respect, for the food and the action of taking in Earth’s bounty. Lastly, in Ayurveda, ahara/diet is not separated from lifestyle. Lifestyle that balances each individual constitution is important in maintaining balance of the subtle energies within. By subtle, it is meant to be the health that leads us to purity and sattva/equilibrium for a transformational consciousness. Only when there is balance in the mind, can the right choices be made, and when the physical body is at its optimal working level, the mind is also predisposed to attaining the best possible limits. Ayurveda looks at health as the whole body in terms of physical, mental and subtle aspects.
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Ayurveda and the Treatment of Attention Deficit Dissorder: (By Ryan Strong) Ayurveda is the worlds oldest and most complete holistic healing modality. Although Ayurveda appears in the Rig Veda, dating back over 3000 years, it is widely believed to be thousands of years older. Ayurveda in relative terms is ancient, yet it is not a relic of the past. Rooted deep in timeless wisdom, Ayurveda is ageless. It has been continually practiced for millennium, passed down from generation to generation, Ayurvedic medicine remains alive, enlightening and healing. Ayurveda recognizes life as one unified spirit that contains and connects the energy of the universe to the individual soul. Ayurveda sees every life form as a unique combination of matter, spirit and mind. It approaches healing by balancing the elemental forces that make up the physical and spiritual construct of our universe. Ayurveda is the knowledge of how to live, this knowledge brings awareness of our situation here on earth, it is very practical and yet it is profound. Awareness and understanding of our true selves, the environment, and how the two interact. Ayurveda looks at the qualities inherent in all matter, to the energy that pulses through all life. According Ayurvedic theory, there are three main constitutions make up the body. These constitutions are often referred to as doshas or humors. Every person has a unique dosha, with different combinations of ether, air, fire, water, and earth. These elements combine to make up Vata, Pitta, and Kapha. Vata dosha having more air and ether, with pitta being more so fire. Earth and water make up Kapha dosha. Ayurvedic medicine seeks to recognize the dosha in each person in order to understand any imbalances that may cause disease. By examining the doshic qualities of modern diseases, Ayurveda can balance and heal them. One such ailment that widely affects people today is Attention Deficit Disorder (ADD). This disorder was known and treated by Ayurvedic doctors in ancient times, and continues to be treated by Ayurvedic doctors today. By looking at modern and classical Ayurvedic writings to shed light on the causes, we can learn holistic treatments that can heal this disorder. This disorder considered benign by some, is very serious. Millions of people struggle with ADD, and the numbers continue to rise. ADD is defined by the Diagnostic and Statical Manual of Mental Disorders as “ inattention, compulsive behavior, and hyperactivity.”[1] According to the Attention Deficit Disorder Association www.adda.org , over eight million adults, and two million children have a form of this disorder.[2] People who suffer from ADD will have varying degrees of symptom intensity. ADD may also be referred to as ADHA (Attention Deficit /Hyperactivity Disorder). ADHD presents with more hyperactivity. ADD is further classified as Adult ADD or Child ADD. This only indicates the age of the person who has ADD and is not a differential diagnosis. ADD was recognized but not defined by the psychiatric world until the mid 1970's. Up until the last couple years, some children diagnosed with ADD were thought to grow out of the condition as they got older. It is now thought that children whose ADD symptoms disappeared as they grew up, were in fact wrongly diagnosed. It is now believed by western medicine that ADD is a life long affliction. Most people can relate to feeling unfocused, and we all have made impulsive decisions. Certainly most people at one time or another have felt http://www.ayurvedacollege.com/book/export/html/2
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hyper. So, what are the differences between common experiences, and what is experienced by people who have Attention Deficit Disorder? This question makes it hard for doctors to diagnose ADD. ADD is defined as having one or more of three main symptoms; inattention, compulsive behavior, and hyperactivity. In addition, there are nine defining secondary symptoms associated with ADD used to diagnose the condition. The most common are insomnia, learning disabilities, and delayed language development. The majority of people with ADD have two if not three of these secondary symptoms. A person suffering from this ailment will find it hard to complete tasks, meet deadlines, and manage their time. Dr. Thomas Brown author of Attention Deficit Disorder, suggests ADD effects the executive functions of the brain, “ getting started, shifting focus, making an effort, being persistent, being organized, managing time, managing frustration, and retrieving things from memory”, can all be compromised when suffering from ADD.[3] According to Dr. Russell Barkley www.russellbarkley.org, people who suffer from ADD have “impaired response, impulse control, poor sustained attention, remembering to do things, delayed development of language, poor rule following, and regulation of emotion.”[4] Any one symptom of ADD can pose a problem, but combined, these symptoms can create real life challenges to work, school, relationships, and just about every facet of life. People who suffer from ADD will be plagued with many difficulties. Dr. Russell Barkley lists that , “up to 36% of people with ADD will drop out of high school, up to 40% suffer from low selfesteem, up 25% will suffer from clinical depression, and up to 25% will suffer from long term addiction to drugs and or alcohol.”[5] According to Kenneth Appelbaum in The American Journal of psychiatry, up to 45% percent of American inmates may suffer from ADD.[6] Although there has never been a widespread study on American inmates, a study published by the Norwegian University of Science and Technology, suggests that ADD is very prevalent in the inmate population in Norway.[7] The Suicide and Mental Health Association International, http://suicedandmentalhealthassociationinternational.org, website, Lists higher rates of “failed marriages, motor vehicle accidents, teen pregnancy, and increased rates of suicide by ADHD sufferers.”[8] In the book Driven To Distraction by Dr. Edward M. Hallowell and Dr. John J. Rately, they suggest that men and women who have ADD will seek out stimulation, negative or positive, from drugs, sex, and excess eating. A study published by the a Nutritional Disorder Clinic in Toronto Canada, suggests a link between obesity and ADD.[9] It suggests that treating ADD may became an affective tool in fighting obesity. ADD can damage the health of the person who has it. The inability to focus and to be able manage ones time, actions, and thoughts can create real hardships in all aspects of life. Failure can strongly weigh upon a person with ADD, when they are unable to meet goals necessary to move forward in life. This syndrome does not just effect the individual, but also affects the society as a whole. Author and Psychologist Dr. Edward M. Hallowell states that,” ADD is almost always accompanying problems such as a learning disabilities and or low selfesteem,” and that if left untreated, “it leaves millions of children and adults misunderstood and unnecessarily floundering and even incapacitated.”[10] Western medicine does not know the cause of ADD. There are several theories that underline possible causes of ADD, but nothing has been proven. Some believe exposure to environmental toxins while in the womb may have caused ADD. Others blame sensitivities to sugar, and synthetic food additives. The increased exposure to television and the internet is a popular theory. Many authors will site the combination of all three of these. However, there is no consensus, or solid evidence supporting them. Currently the most accepted theory is that ADD is a genetic http://www.ayurvedacollege.com/book/export/html/2
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disorder, and that is hereditary. Scientists have compared brain function and activity of a person with ADD to that of a person without it, using various tests that take images of the brain. According to the Dana Foundation www.dana.org, an organization dedicated to the study of brain science, “people with ADHD have differences in brain structure and function, especially in chemical regulation of dopamine and norepinephrine.”[11] , suggesting that lower levels of these neurotransmitters may cause ADD symptoms. Dopamine and norepinephrine have critically important roles in our brains, both are key for stimulating many different areas of the brain in order for us to function properly, and especially in stimulating our brains in order for us to focus. Current research indicates the frontal lobe, basal ganglia, caudate nucleus, cerebellum, as well as other area of the brain, play a significant role in ADHD (ADD) because they are involved in complex process that regulate behavior.”[12] The role of dopamine and norepinephrine regulation in patients with ADD is considered the most important in treatment, from a western science view point. The treatment for ADD consists of medication, counseling, and cognitive behavioral therapies, with the main focus being pharmaceutical medications. The most commonly prescribed medications are central nervous system stimulants like Ritalin and Adderal. Both theses medication speed up the release of dopamine and norepinephine, increasing brain function. Anti depressant drugs and other nonstimulant drugs are also used. It is thought that anti depressant medications will increase up take and absorption of neurotransmitters in the brain, thus increasing brain activity. Both types of medication are prescribed to children and adults. These medications do not cure ADD. The symptoms associated with ADD cease only for the time the medication is active within the body. When the medication wears off, the symptoms return. A patient taking these medications are to continue taking them throughout their life. In order for an Ayurvedic treatment of ADD, the disorder must be seen from a Ayurvedic perspective. The doshic imbalances that cause the symptoms of ADD must be recognized in order to balance them. Looking for references in the Caraka Samhita in regards to ADD, we can interpret what ADD would have been classified by Ayurvedic doctors during ancient times. Although the western classification will not be identical, the symptom picture will remain the same. We can find passages in the Caraka Samhita that sight symptoms associated with inattention, hyperactivity and compulsive behavior. The inability to keep a steady thought stream or focus, is described in the Caraka Samhita as one of twenty main blocks of Vata in the body. In chapter XXVIII verse 198, The Caraka Samhita states, “ If vyanavayu is occluded by pranavayu, then there will be loss of all the senses, and there will loss of memory as well as strength.” The Vata dosha is a combination of ether and air. The qualities of Vata are light, cold, rough, and subtle. Because of these qualities, it is the most changeable and moveable. Being that it is the most moveable, it can easily become imbalanced, and cause imbalances in the other doshas, Kapha, and Pitta. Vata plays many roles within our bodies and minds. Vata dosha being in balance is vital to the health of our bodies and mind. Vata, although one dosha, is divided up into five subcategories, classifying the different actions and movements of Vata into and out of our body. The two subcategories referred to in the cited quote from the Caraka Samhita refer to Prana and Vyana. Prana Vata is responsible for bringing in all of the sensory perceptions of the environment outside of us. Prana Vata relays information we experience from the world around us to the http://www.ayurvedacollege.com/book/export/html/2
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mind through the nervous system. According to Ayurveda the nervous system and Prana Vata are intricately connected. Proper function of Prana Vata is key for proper neurological function. Vyana is the circulation and movement of the Prana once it is in the body and mind. Because of the world around us, the Prana we take in may in a sense become toxic. These sensory impressions may be considered toxic for the following reasons: they may not be harmonious, they may be become too much, and over load or overwhelm the neurological system. Prana can obstruct Vyana, and because of this, Vata dosha in the mind and body may become disturbed. This disturbance is an over stimulation of Prana Vata. According to Ayurveda too much stimulation can increase the prana of the mind. This excessive movement of the mind due to an over stimulation of the neurological system deranges the mind, and upsets the balance of our bodily system as a whole. The high Vata in the mind will not only cause emotional and behavioral symptoms but will also manifest as bodily distress as well. Vata can cause numerous symptoms that include weight loss, weight gain, constipation, hyperactivity, insomnia, disorientation, confused speech, light headed, confusion and depression. Dr. David Frawely states that, “ Vata is aggravated by excess and wasteful mental activity like worry and too much calculation about things,” he goes on to say that, “ Vata people should not read too many newspapers or magazines, or watch several television programs at the same time, as these agitate Vata and the mind.”[14] To look at another cause of ADD we may examine the description of mental illness in the Caraka Samhita, Ch IX, verse [67], it describes that “unmada (mental illness) is a wandering mind, intellect, consciousness, knowledge, memory, inclination, manners, activities and conduct.”[15] Describing the possible causes for imbalances, it says that any one or all of the three doshas, Vata, Kapha, Pitta, may cause mental illness, or mental illness may be due to outside factors. The outside factors that may cause, what Ayurveda deems “a wandering mind”, may be the environmental pollutions of the modern world. An exogenous factor causing ADD may be the vast amount of information we are exposed to through our eyes and ears. With the inventions of modern transportation, film, TV, internet, cell phones, video games, and so forth. These images may be too much for some brains to process. They may disturb the flow of Vata, and damage the nervous system. Not only is the mind subjected to fast moving images and sounds, but it has to deal with the consequence of their qualities. Many images are in fact negative, and can also cause disturbances in Vata. Mass media may be considered to be harmful because of it's over stimulation. This over stimulation is also often accompanied by negative subtle forms of advertising, that among many things: subjugates women, propagandizes violence, war, and greed. According to the Nielson report, a company that tracks advertising and programing, “the average person is exposed to 1600 advertising messages a day, has their TV on for 7.5 hours and watches about 4.5 hours daily.”[16] Prana is not just the images we see, but it is also the smells, textures, tastes and sounds. It is the food and water we consume. Exposure to harmful toxins in our food and water may be other exogenous factors. Fluoride, a chemical found to lower cavities, is added to the water supplies across the United States. In fact, according to a study done in Brazil at the University Federal de Parana, fluoride even in small quantities may cause “memory impairment” and is considered harmful to neurological function.[17] Other factors may include the standard American diet. According to the American Heart Association, “The average American consumes 22 teaspoons of sugar a day.”[18] Many people eat processed foods that contain additives like MSG and caffeine. The outer environment for many humans is harmful, sometimes deadly. Many cities and towns are polluted exposing humans to harmful pathogens, chemicals, and air pollutants. http://www.ayurvedacollege.com/book/export/html/2
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Attention Deficit Disorder may be a result of too much exposure to the harmful substances in our environments, of too much Prana flowing into our nervous systems. The over stimulation of our day to day lives, may increases the flow of Prana Vata until it is too much for the body to handle. Vedic scholar Dr. David Frawely describes it as ''Vata (high air) is damaged by too many stimulating impressions, particularly those of an artificial nature.”[19] Vata is a combination of air and ether. According to Dr. Marc Halpern a leading Ayurvedic healer and educator, “ In the case of hyperactivity and attention deficit disorder there is an excess in the qualities of air and ether and deficiency in the qualities of earth. Hence, from the perspective of Ayurveda, ADD and ADHD are conditions of increased expansive and creative energies and decreased in stability.”[20] To treat the symptoms of ADD, Ayurveda seeks to counterbalance the unstable elemental forces of ether and air by increasing the grounding element of earth. In treating ADD, Ayurveda approaches the symptoms and the underlying causes by working with many treatments, including diet and lifestyle changes and specific herbs that improve cognitive function. These treatments include cleansing possible toxins known in Sanskrit as Ama, that have built up in the body and even the mind. To treat ADD, Ayurveda looks at each individual case, and does not prescribe one treatment, nor does it view any one protocol to be appropriate for any one person. Everyone has a unique make up of doshic qualities, with varying degrees of elemental make up. Each person has a different level of strength, or vital energy. Vital energy in Ayurveda is known as Ojas. Determining the level of the ojas is key in any treatment plan of ADD. If the cause of the doshic imbalance is deemed that of exogenous factors, treatment may include cleansing toxins from the body and mind. However, if the ojas in the individual is low, cleansing is contraindicated, because cleansing may increase depletion of Ojas. ADD is a Vata disorder, that has increased elements of air and ether, this causing too much movement in the mind and body. To balance Vata, actions, food, and herbs of apposing qualities of ether and air are administered. The increased Prana causes agitation to the nervous system. This flow must be slowed, grounded and stabilized. Herbal medicines, routines, and foods that are slow, heavy and sweet have the elemental qualities of earth. They generally build tissues and ojas, which will nourish and calm Vata. To fully treat ADD Ayurveda seeks to reverse the cause of the imbalance. This is paramount and must be looked at and dealt with for healing inattention, compulsive behavior, and hyperactivity. To reverse the cause of ADD, a lifestyle that is first and foremost regular must be experienced. Regularity of sleep patterns, eating patterns, and avoiding anything that disrupts, or over stimulates the senses. Steady routines stabilize Vata and negate the ill effects that irregularity causes. Individuals with ADD also must limit activities like TV, internet, and travel. They must avoid stimulants like refined sugar and caffeine. The relief an individual may experience by using stimulates to see through the fog of inattention is momentary. The use of stimulants will increase the disturbance to Vata, and will weaken the nervous system, and lower ojas. Over stimulation of any kind must be completely avoided, and is vital for successful long term treatment. Building Ojas is key to having and maintaining healthy minds, nervous systems, and bodies. Healthy levels of Ojas will help stabilize the mind and counter the symptoms of inattention, compulsive behavior, and hyperactivity. Ojas will also protect people from substances or environmental factors that cause Vata disturbances. Creating consistent patterns in our life, avoiding mass media, building Ojas, and clearing Ama in the the mind and body will heal ADD. Ayurveda utilizes a large spectrum of herbal remedies to address neurological disorders caused by doshic imbalances. Holistic Ayurvedic herbal medicine seeks to bring balance to the entire body system. For example, if a person is suffering from symptoms like inattention, hyperactivity, or http://www.ayurvedacollege.com/book/export/html/2
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compulsive behavior, Ayurvedic medicine will employ herbal remedies that both seek to give symptomatic relief, and repair and rebuild healthy tissues in the entire body. Rasayana therapies that include herbal preparations are useful tools in treating the nervous system and mind of a person suffering from ADD. Rasayana is defined as rejuvenation. Ayurvedic rejuvenation therapies that will treat both the Vata in the mind and nervous system, according to The Ayurvedic Encyclopedia are, “oil and ghee therapies are given to remove block.”[21] The Ayurvedic Encyclopedia also includes “abhyanga, ingestion of ghee to stimulate the mind, intellect, memory, and consciousness.”[22] The Ayurvedic Encyclopedia also sites the use of the herb Brahmi with ghee.[23] In the case of ADD a herbal medicine prepared with the herb Bramhi (bacopa monniera) would be administered. A study done in Australia by the Brain Sciences Institute at Swinborne University in Victoria, studied the effects of Bramhi on people. The study revealed to modern scientists what Ayurveda has known for centuries, noting; “cognitive enhancing effects in healthy humans after 90 day administration of the bocapa monniera extract.” Other therapies to improve the mind and nervous system include nasya, mana shuddi, and pratyahara. Nasya is medicated oil administered into sinuses through the noise. Nasya medicated with herbs that ground Vata, and clear the mind will be very helpful in the treatment of Vata symptoms associated with ADD. According Vedic scholar Dr. David Frawley, “ Nasya and neti are important treatments of Vata conditions in the nervous system and mind”... “They help restore the organic equilibrium of the mind and body and hormonal secretions that hormonal secretions that are ruled by Prana.”[25] Mana Shuddi is mental cleansing. This can be achieved by pratyahara, which is fasting from one or more of the senses. Resting our senses by withdrawing from hearing, seeing, touch, tastes and smell, we rest the nervous system and also cleanse the mind. Both of these practices help build Ojas and increase the stability of the mind. According to The Ayurvedic Encyclopedia the yoga posture Shavasana, also known as corpse pose is a good way to practice Pratyahara.[26] The Ayurvedic approach is to balance elemental qualities by determining the underlying doshic imbalance, state of ojas, and toxin (ama) build up. Attention Deficit Disorder can be fully treated by Ayurveda. The combination of symptoms may be the result of a combination of causative factors. Regardless of the causes western medicine may discover for ADD, be it genetic, environmental, dietary, or a combination of all three, the Ayurvedic treatments will remain the same, and stand the test of time. The treatment will remain as effective today as it was 3000 years ago. However it is clear from the research that ADD is serious, for the individual suffering from it, and the effects on the society as a whole. The modern day world is over stimulating to the senses, and toxic to the mind and body. To combat ADD and to reverse the causes, we must reduce the speed and volume of modern life. We must live in the natural rhythms of day and night. The food we eat need to be appropriate for our needs, organic and fresh. The air we breath must be clean, and the water we drink and give to our children must be pure. Vata is the most sensitive dosha, exhibiting symptoms of imbalances much Quicker than the other doshas. Perhaps it might be wise to view ADD, as an early warning. Maybe those suffering from these Vata imbalances or “ADD”, are the metaphoric canary in the mines. An alarm, warning us of the deeper issues that may come to manifest. The rising ADD population may represent pending issues the world faces. The human species is living out of balance from nature and because of that, the planet as a whole is suffering. Using Ayurveda as a lens to perceive the world, we can both heal much of what has been done, and we can see the causes for the issues. Ayurveda works both to minimize and end suffering, but http://www.ayurvedacollege.com/book/export/html/2
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more importantly, it seeks to reverse the cause. Ayurs is the root sanskrit word meaning “to align”. It is this aim of aligning with spirit, mind and body that Ayurveda seeks to attain. It is the truth of our reality that we must align ourselves with, to live in, and to abide in. The pure radiance of health and happiness is our birth right. Living in balance and harmony is not some idealistic dream, but a life style we can fully realize. It is not a foreign science we must adopt, but is the unnatural lifestyle of most modern cultures we must unadopt. Living in balance is moving through life with our hearts fully open, and hearing life by listening to our soul. Only then can we live in alignment, to be in tune with our higher self. From our higherself we know and make right choices. This is what it means to live righteously. To make the right choices, from the foods we choice to eat, from how we eat them, and for all the other millions of decisions we make. In ayurs, in alignment we simply live right. This is Ayurveda, this is knowledge of life. References 1. The American Psychiatric Association, The Diagnostics and Statistical Manual of Mental Disorders 4th Edition: (Washington D.C.: The American Psychiatric Association, 1994) 85. 2. The Attention Deficit Disorder Association. Www.add.org.mc/page?citepageid=92501eorgid=atdda. “Over eight million people” (19962009) 11/25/09 3. Brown, E. Thomas, The Unfocused Mind in Children and Adults: (New York: Integrated Publishing Solutions, 2005) 21. 4. Russel, A. Barkley PhD. D. The Official Site www.russelbarkley.org/adhd.fucthtm. “Up to 36% of people with ADD.” (2006) 11/15/09 “Getting started, shifting focus.” (2009) 11/15/09 5. Russel, A. Barkley PhD. D. The Official Site www.russelbarkley.org/adhd.fucthtm. “Up to 36% of people with ADD.” (2006) 11/15/09 “Getting started, shifting focus.” (2009) 11/15/09 6. Kenneth L. Appellbaum, M.D., “Assessment and treatment of correctional inmate with ADHD,” The American Journal of Psychiatry 165( December 2008):1520 11/25/09 Http://ajp.psychiatryonline.org 7. U.S. National Library of Medicine. Www.pubmed.gov.ncbi.nlm.nih.gov/sites/entrez. “prison ADD” Rassmusen K. Alvmikr. J am acad psychiatry law. (2001) Pmid 29 (2) : 18693. 11/25/09 8. The Suicide and Mental Health Association International. Www.suicideandmentalhealthassociationinternational.org/adhsui.html. “Failed marriages, motor vehicle accidents” (20042006) 11/25/09 9. Fleming, Levy. Nutritional Disorder Clinic. Http://www.ncbi.nih.gov/pubmed//9223848?itool “Obesity and ADD.” Pmid: 19223848 : Canada (2009) 11/25/09 10. Hallowell, M. Edward; Ratey, J. John, Driven to Distraction : (New York: Simon and Shuster, 1995)Preface xi. 11. The Dana Foundation. Www.dana.org/news/brainnews/detail.aspx?id=10398. “People with ADHD have differences in brain.” Mchann, Guy MD. (2007) 11/25/09 12. The Dana Foundation. Www.dana.org/news/brainnews/detail.aspx?id=10398. “People with ADHD have differences in brain.” Mchann, Guy MD. (2007) 11/25/09 13. Sharman P. V. , Charaka Samhita : (Varanasi: Chaukambha Orientalia, 2003) 481. http://www.ayurvedacollege.com/book/export/html/2
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14. David Frawely, AYURVEDIC HEALING FOR HEALTHCARE PROFESSIONALS PART IV :(New Mexico:NorthAmerican Institute for Vedic Studies, 2006)66. 15. Sharman P. V., Charaka Samhita : (Varanasi: Chaukambha Orientalia, 2003)160. 16. The Neilson Company. Http://blogneilson.com/neilsonwire/onlinemobile/americans. “The average person is exposed to.” (2009) 11/25/09 17. U.S National Library of Medicine. Www.ncbi.nlm.nih.gov/pubmed/19957215?itool. “Memory impairment” Pereira Dombrowski. Sector de ciencias biologicals. Brazil. Pmid: 19957215 (2009) 11/25/09 18. American Heart Association. Www.circ.ahajurnals.org. “The average American consumes.” R.K. Johnson (2002) 11/25/09 19. David Frawley, Ayurvedic Healing for Healthcare Professionals Part IV : (New Mexico: North American Institute for Vedic Studies,2006)62. 20. California College of Ayurveda. Www.ayurvedacollege.com/articles/drhalpern/clinic/hyperactivityadd. “In the case of hyperactivity and attention deficit.” (2009) 11/25/09 21. Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)466. 22. Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)467. 23. Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)468. 24. U.S. National Library of Medicine. Www.ncbi.nlm.nih.gov/pubmed/18683852?itool. “Cognitive enhancing effects in healthy.” Stough C. Downy: Brain and Science Institute. Australia. Pmid: 18683852. (2008) 11/25/09 25. David Frawley, Neti, Healing Secrets of Yoga and Ayurveda: (Wisconsin: Lotus Press,2005)54. 26. Tirtha, Swami Sada Shiva, The Ayurvedic Encyclopedia: (New York: Ayurvedic Holistic Center Press, 1998)280.
Ayurveda – An ancient healing system’s gifts to the Modern Woman By Sandhiya Ramaswamy || Dhanvantari Stotram || Om Sankham Chakram Jaloukaam Dadhadamruta GhatamChaaru Dorbhicchaturbhihi Sookshma Swacchati Hrudayaamsuka Parivilasan Moulim Amboja Netram Kaalaambodojvalaangam Katitata Vilasat http://www.ayurvedacollege.com/book/export/html/2
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Chaaru Peetaambaraadyam Vandey Dhanvantarim Tam Nikhila Gada Vana Proudda Daavaagni Leelam Salutations to him, Lord Dhanvantari, who is holding in his four hands a Conch, a Disc .a Leech and a pot of celestial ambrosia in whose heart shines a very clear, gentle and pleasing blaze of light, which also shines all around HIS head and lotus eyes. On the dark blue/black water his body is luminous and splendid. His waist and thighs are covered in yellow cloth and who by his mere play destroys all diseases like a huge forest fire. || Mahalakshmi Gayatri || Om Mahalakshmyai cha vidmahe Vishnu patnyai cha dhimahi Tanno Lakshmihi prachodayat Om. Let us meditate on the Great Goddess Sri Lakshmi, the consort of Sri Maha Vishnu. May that effulgent Maha Lakshmi Devi inspire and illumine our mind and understanding.
Acknowledgements I would like to offer my sincere thanks to my teachers at the California College of Ayurveda – Rob Talbert, Hema Ravikumar, Marisa Larsen, Mary Alice Quinn who have inspired me every step of the way. My thanks to Dr. Marc Halpern, who has put together such an amazing course of Ayurvedic study. I also offer my thanks to my wonderful classmates at CCA, my friends and members of my family who have encouraged me along the way and offered me their unconditional support. Most of all, I thank Lord Dhanvantari, the God of Ayurveda, who has offered me divine guidance, illuminating my path every step of the way.
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Ayurvedic Approach to AgeAssociated Macular Degeneration (by Rammohan V Rao PhD,C.A.S) Table of Contents 1. Abstract 2. Eyes, Vision and Macular Degeneration 3. Types of Macular Degeneration Abstract Macular degeneration also called as Age related macular degeneration (ARMD) is an age associated chronic eye disease and is a very common cause of reduced vision among older individuals over the age of55 years. The condition is characterized by degeneration of lightsensing cells of the central region of the retina the rnacula which malfunction and eventually die, resuhing in a gradual decline and loss of central vision, while peripheral vision is retained. MD is the main cause of blindness in the United States and accounts for blindness in approximately 80 percent of people who are 75 or older. The condition affects more than 10 million Americans and this number is predicted to increase as the ''baby boomers" age. Eyes, Vision and Macular Degeneration The retina, which is situated at the back of the eye, contains an extraordinary photosensitive array ofcells that line the back ofthe eye. The light fulling onto these cells in the retina is transfurmed into electrical signals which arc transmitted to the brain centers !bat process and interpret them. The retina has two main parts the macula and the peripheral retina 13. The rnacula is the part of the retina that is responsible fur seeing line detail (see fig below), such as reading, seeing fueial features and interpreting different colors. The macula is made up of densely packed lightsensitive cells called cones and rods. These cells, particularly the cones, are essential for central vision. The cones are responsible for color vision, and the rods enable the individual to see shades ofgray 13 http://www.ayurvedacollege.com/book/export/html/2
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The choroid is an underlying layer of blood vessels that noutishes the cones and rods of the retina. A layer of tissue furming the outermost surfuce of the retina is callcd the retinal pigment epithelium (RPE). The RPE is a eritical passageway fur nutrients from the choroid to the rerina and helps remove waste products from the retina to the choroid. It is this part of the retina that is affected by agerelated macular degeneration and results in debilitating loss ofvital central or detail vision 13. Types of Macular Degeneration Read Full Article
A Survey of Marmani Chikitsa By: Emily Laine Levoy Introduction Ayurveda, the knowledge of life, is India’s most ancient system of healing. Its fundamental aim is to bring each and every one of us into alignment with our true nature as Spirit, and thus allow us to be our best, healthiest, Selves. Through the application of myriad therapies using herbs, colors, aromas, foods, breath, movement, meditation, oil, massage and more, Ayurveda prescribes a unique program to balance the unique constitution of each unique individual that exists in the world. Ayurveda’s origins are in Samkhya philosophy, which teaches that in the beginning there existed only Purusha, the potential for pure consciousness, and Prakriti, the potential for pure matter. Purusha desired to know itself and merged with Prakriti in the act that was the beginning of the world as we know it. From this merging the cosmic vibration of Aum emerged, the qualities of Sattva (clarity or mind), Rajas (motion or life), and Tamas (inertia or matter) were produced, and the five basic elements of earth, water, fire, air, and ether were created. The elements are the building blocks for all that exists, and their physical and subtle forms are the basis for Vata (physical air and ether), Pitta (physical fire and water), and Kapha (physical water and earth), and for Prana (subtle air and ether), Tejas (subtle fire and water), and Ojas (subtle water and earth). It is with these six elemental combinations that Ayurveda diagnoses and treats it’s patients. Under the umbrella of Ayurvedic treatments falls Marma Therapy, also called Marmani Chikitsa, which involves the stimulation of sensitive points to promote healing in the physical, mental, and energetic planes by affecting the flow of prana. Marma points can be found all over the body from the hands and feet to the trunk and head, and when manipulated via massage, pranic healing, oil and herb application, heat, or pressure, can “alter both the organic functions and structural conditions of the body” (Muley). Since all was created from Purusha and Prakriti, all matter is fundamentally the same. While it may be difficult to perceive this oneness of all, marma points provide a super sensitive entry point into these more subtle realms of the physicalenergetic connection that resides in all of us. In the words of Dr. Vasant Lad, “Like quantum mechanics, Ayurveda holds that a human being is not a solid, stable material structure but an everchanging, dynamic collection of energy and intelligence in http://www.ayurvedacollege.com/book/export/html/2
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the larger field of energy and intelligence that is the universe.” (Lad, 19) Marma points are vortexes of prana, the life force that can be used as a gateway into this dynamic field. The purpose of this exposition is to provide a general overview of the origins and classical uses of marma, as well as a survey of the application of marma therapy in the modern age. For in depth information on any specific marma point, therapy, or Ayurvedic concept please refer to the copious information available in the sources cited at the end of this paper. History and Evolution: The aim of marma therapy in the modern day is to promote healing, however as vital points of life marma have also been used for harm. In his course on marma therapy, Dr. Marc Halpern said, “any area of the body that can be harmed with a forceful blow can be healed with a therapeutic touch,” and it is this dichotomy that can be seen in the history and evolution of marma. An important part of Ayurveda, Yoga, and the martial arts of Southern India, marma originated in the most ancient of Indian civilizations known as the IndusSarasvati culture (3500 1700 BCE) which was located in the north of India and evolved along with other Vedic disciplines from this time.2 Emphasized as a means to inflict injury on an opponent, as guidelines for healing wounds,4 and as a map for the use of body armor in combat, marma points were an integral part of South Indian martial arts and “the path of the warrior who learned to master his Prana for both defensive and offensive purposes”(Frawley, 8). Wartime surgeons in classical times were versed in the energetics of marma points in order to provide the best possible care on the battlefield.8 References to marma points can be found in a wide variety of ancient texts including the Rig Veda, Mahabharata, Charaka Samhita, Sushruta Samhita, and classical yogic texts where marmas are incorporated with asana, pranayama, and the nadis.2 A noted Ayurvedic surgeon, Sushruta is recognized as the leading contributor to the classical study of marma. His text, the Sushruta Samhita, defines marma as fatal spots8 and contains details for manipulating marmas through surgical techniques and in the treatments of acute conditions. In the section of his text on anatomy there exists documentation on the location and effects of each marma point (detailed below) and this knowledge has evolved with each generation of practitioner.4 Interestingly, in his commentary of the Sushruta Samhita, Prof K.R. Krikantha Murthy specifically comments on the use of marma for therapeutic effect as is common in modern day. “ A recent trend among some Ayurveda scholars is an attempt to equate and correlate knowledge of Marma with the ancient Chinese method of treatment known as Acupuncture. Though recognition of special spots on the body is common to both, the aim of approach of each one is thoroughly opposite of the other. While Ayurveda describes the ‘Marma’ as seats of prana… the descriptions are mainly intended to warn the surgeon not to cause injury [where as] Acupuncture… spots are considered centers of ‘vital energy’ that when stimulated by sharp needles… brings about cure of many diseases. Nowhere in Ayurvedic texts is there any suggestion of meddling with the Marma for either relief of pain or for cure of diseases” (Murthy, 115). Dr. Frank Ros, however, states that errors were made in earlier translations of the Sushruta Samhita, and upon further review, “evidence was found showing that the marmas correspond precisely with traditional acupuncture points used to treat the vital organs in the flow of qi” (Frawley, http://www.ayurvedacollege.com/book/export/html/2
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215). The terms dhamanis and siras were previously misinterpreted to mean arteries and veins, when actually they correspond to the channels, which control the flow of prana (or qi). Many prominent Ayurvedic scholars agree with Dr. Ros’s statement, including Dr. Vasant Lad whose entire book, Marma Points of Ayurveda, is a comparison of Marma and Acupuncture Whether marma were classically used for healing or not, it is nonetheless now commonly used as such in Ayurvedic clinics and schools around the world. Locations, and Categorizations: According to Sushruta and Dr. David Frawley there are 107 marma, though others including Vagbhata and Dr. Vasant Lad indicate there to be 116 or 117. Vagbhata says that “structures which show irregular pulsation and where the pain on pressure persists can be labeled as Marmasthana” (Muley). Sushruta categorizes marma according to the following tissue types: Mamsa (Muscular) Marma, Sira (Venous) Marma, Snayu (Ligament) Marma, Asthi (Bony) Marma, and Sandhi (Joint) Marma.8 Some say marma may contain all five tissue types, and some may contain only two. Marma can be measured by the unit angula, which are defined as “the width of the patient’s middle finger measured across the proximal interphalangeal joint” (Lad, 316). The following table and diagram of marma points with their location and size is composed of the 107 marma according to Sushruta. While there are descriptions available as to the locations of marma points on the physical body, every body is different, thus is may take a trained marma therapist to locate the specific points. Number of Points
Marma
Location
Size
Adhipati
Crown Chakra
½ 1 angula
Amsa
Shoulder
½ 2 angula
Amsaphalaka
Shoulder blade
½ 2 angula
Ani
Lower region of upper arm and upper leg
½ 4 angula
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Apalapa
Armpits
½ 2 angula
Apanga
Outer corner of each eye
½ 2 angula
Apastamba
Medial and inferior ½ 2 to nipples angula on abdomen
Avarta
Midpoint above each eyebrow
½ 2 angula
Bhavi
Inside of upper arm
1 2 angula
Basti
Lower 4 abdomen/ 1 angula bladder
Brihati
Broad region of upper back
½ 2 angula
Guda
Rectum
4 1 angula
Gulpha
Ankle
2 2 angula 4
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Hrdaya
Heart
angula 1
Indrabasti
Center of forearm ½ 4 and lower angula leg
Janu
Knee
3 2 angula
Kakshadhara
Coracoid Process
1 2 angula
Katika Taruna
Hip joint
½ 2 angula
Krikatika
Neck joint
½ 2 angula
Kshipra
Between thumb and index finger and ½ 4 between angula big toe and second toe
Kukundara
Sides of the lower iliac spine
½ 2 angula
Kupara
Elbow joint
3 2 angula
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Kurcha
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Bottom of thumb and big toe
4 4 angula
Kurchashira
Base of thumb joint and base of big toe joint
1 4 angula
Lohitaksha
Lower frontal end of shoulder and hip joint
½ 4 angula
Manibandha
Wrist
2 2 angula
Manya
Side of the neck
4 2 angula
Nabhi
Naval
4 1 angula
Nila
Base of the throat
4 2 angula
Nitamba
Upper buttock
½ 2 angula
Parshva Sandhi
Upper hip
½ 2 angula
Phana
Side of each
½ 2 angula
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nostril Shankha
Temple
½ angula 2
Shringataka
Just below each cheek bone
4 4 angula
Simanta
Sagittal Suture of skull
4 5 angula
Sira Matrika
Base of the neck
4 8 angula
Stanamula
Nipples
2 2 angula
Stanarohita
Superior and medial to nipples
½ 2 angula
Sthapani
Third eye ½ 1 center angula
Talahrdaya
Center of palm of hand and sole of foot
½ 4 angula
Utkshepa
Above ears
½ 2 angula
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region of upper thigh
Urvi
1 2 angula
Vidhura
Behind and below ears
½ 2 angula
Vitapa
Perineum
1 2 angula
As their origins lie in combat, five types according to the result of injury additionally categorize marma points. The following information comes from Prof K.R. Krikantha Murthy’s translation of the Sushruta Samhita: • Sadya Pranahara: Immediately causing death • The marma of this type are Shringataka (four points), Adhipati (one point), Shankha (two points), Kanthasira/ matrika (eight points), Guda (one point), Hrdaya (one point), Basti (one point), Kshipra (four points), and Nabhi (one point). According to Sushruta, Sadya Pranahara points have the qualities of fire, and this is why they quickly cause death. Some classical physicians said that Sadya Pranahara points are those containing all five tissue types (Mamsa, Sira, Snayu, Asthi, and Sandhi). Sushruta disagrees and says that all five tissue types are present in the below four types of marma. • Kalantara Pranahara: Causing death after some time • Kalantara Pranahara have the qualities of water and fire, thus with their hot/fiery qualities kill debilitated people quickly, and with their cold/watery qualities kill others after some time. Sushruta designates the following marma as Kalantara Pranahara: Stanamula (two points), Stanarohita (two points), Apalapa (two points), Apastamba (two points), Simanta (five points), Tala (four points), Indrabasti (four points), Katika Taruna (two points), Brihati (two points), and Nitamba (two points). • Visalya Pranahara: Fatal if pierced • Visalya Pranahara points have the quality of air, thus are fatal if the air residing in the marma is disturbed. If pierced, the air will remain undisturbed if the foreign object is not removed, but upon removal of the foreign object air will be allowed to escape from the marma and thus cause death. Marma of this type are Utkshepa (two points) and Sthapani (one point). • Vaikalyakara: Disability causing • Sushruta describes Vaikalyakara marma as “possessing qualities of the moon/water” and explains that the corresponding stable and cold qualities help with the sustenance of life when these points are injured. Thus, only disability is caused. Points of Vaikalyakara nature are Lohitaksha (four points), Ani (four points), Janu (two points), Urvi (four points), Kurcha (four points), Vitapa (two points), Kupara (two points), Kukundara (two points), Kakshadhara (two points), Vidhura (two points), Krikatika (two points), Amsa (two points), Amsaphalaka (two points), Apanga (two points), Nila (two points), Manya (two points), Phana (two points), and Avarta (two points). • Rujakara: Pain causing http://www.ayurvedacollege.com/book/export/html/2
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o The final categorization of marma point is Rujakara, which designates points composed of the qualities of fire and air, which produce pain. These marma are Gulpha (two points), Manibandha (two points), and Kurcha Sira (four points). Relations to Ayurveda & Diagnosis Ayurveda bases its diagnoses on the fundamentals of the three doshas: Vata, Pitta, and Kapha. As already explained, each dosha is a combination of two elements, and it is the qualities of these elemental combinations that provide clues as to the nature of a given imbalance. Treatment is then accomplished using the opposite qualities to those of the condition . Conditions of Vata nature will present with qualities such as cold or dry, and they may have decreased tissues, energy, pain, or insomnia. Sensitivity upon light pressure of a marma would be indicative of Vata. Pitta conditions will display warm or hot qualities such as fever, anger, or bleeding, and would be indicated by sensitivity to moderate pressure on a marma. Kapha conditions will be those of heaviness such as water retention, excess weight, tissue, mucus or swelling. Heavy pressure causing sensitivity would indicate a Kapha imbalance at the site of a marma. Any of the qualities of a specific dosha can be observed at the site of a marma to provide clues to determine the best course of treatment. Different marma points also relate specifically to different doshas and body systems, and can be used both to indicate an imbalance, and in the treatment. These relationships are detailed in the tables below: Relationship of Doshas, Subdoshas, and Marma Points Vata Pitta Kapha Prana Vayu
Adhipati
Sadhaka Pitta
Adhipati
Tarpaka Kapha
Adhipati
Sthapani
Simanta
Simanta
Phana
Hrdaya
Hrdaya
Vidhura
Alochaka Kurcha Pitta
Shringataka
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Kshipra
Kurchashira
Talahrdaya
Sthapani
Bodhaka Kapha
Shringataka
Udana Vayu
Nila
Apanga
Manya
Manya
Bhrajaka Nila Pitta
Phana
Krikatika
Manya
Avalambaka Hrdaya Kapha
Amsa
Talahrdaya
Stanamula
Vyana Vayu
Hrdaya
Amsa
Talahrdaya
Brihati
Katika Taruna
Kledaka Kapha
Nabhi
Amsaphalaka
Pachaka Pitta
Nabhi
Apastamba
Talahrdaya
Apastamba
Kurchashira
Kshipra
Kurchashira
Sleshaka Kapha
Janu
Samana Vayu
Nabhi
Indrabasti
Kupara
Apastamba
Ranjaka Pitta
Nabhi
Manibandha
Kurchashira
Kupara
Gulpha
Janu
Katika Taruna
Apana Basti
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Krikatika
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Guda
Kukundara
Vitapa
Talahrdaya (feet)
Lohitaksha (Legs)
Utkshepa
Relationship of Body Systems and Marma Points
Circulatory System
Hrdaya, Nabhi, Kupara, Brihati, Janu, Lohitaksha, Sira Matrika
Digestive System
Nabhi, Indrabasti, Kurchashira, Parshvasandhi, Shankha
Female Guda, Vitapa, Reproductive Gulpha, Basti
Lymphatic System
Hrdaya, Kshipra, Stanamula, Lohitaksha, Amsaphalaka, Nila
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Muscular System
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Kurchashira, Kakshadhara, Stanamula, Stanarohita, Guda
Nervous System
Adhipati, Simanta, Sthapani, Apalapa, Apastambha, Shringataka
Respiratory System
Talahridaya, Kshipra, Hridaya, Phana, Sthapani
Skeletal System
Kukundara, Katikataruna, Janu, Manibandha, Simanta
Urinary System
Basti, Guda, Kukundara
Methods of healing through Marma There are many methods through which healing such as massage, oils, heat, herbs, and pranic healing which a trained therapist whilst interacting with marma points may employ. There are other therapies such as yoga postures and meditation, which a person can use to independently affect their marma points and with the right knowledge affect the flow of their own prana. Below some of these techniques are described. Massage/ Therapeutic Touch One of the most basic treatments in Ayurvedic Medicine is Abhyanga, the Ayurvedic Oil Massage. A rejuvenating therapy with strokes http://www.ayurvedacollege.com/book/export/html/2
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coordinated with the five Vayus, or directions of Vata dosha, Abhyanga affects marma points through therapeutic touch, and through the healing qualities of the oils and any herbs or aromas that are used. Specific attention to marma points may be included in the massage, but marma points are affected simply through the flow of Abhyanga strokes without specific concentration, Acupressure (also called Mardana by Dr. Frawley) is another form of therapeutic touch where firm pressure is held on a specific marma or collection of marmas until associated tension or pain is reduced or released. The pressure used should be quite firm for Kapha conditions, moderate for conditions of Pitta, and light for those of Vata nature. Herbs Ayurveda uses a vast breadth of herbs and formulations for internal and external healing. The topical application of herbal medicated oils, pastes, and powders may be used to elicit a desired effect from a specific marma. Dr. Frawley recommends Guggul as the most well rounded herb for marma therapy, citing it’s clearing properties and it’s affinity for reducing pain and promoting the flow of energy. For healing of a specific condition an herbal formula with properties specifically targeted toward the desired result should be used. Oleation Most commonly used as part of the Abhyanga massage, the application of oils is deeply therapeutic most especially for conditions of Vata nature but can be therapeutic for imbalances of all doshas. Warm sesame oil is best for the treatment of Vata, and the essential oil of sandalwood, calamus, or cinnamon can be added. For pitta coconut or sunflower oils are best, potentially mixed with the essential oils of sandalwood or rose. For Kapha, oil is generally contraindicated however sesame and mustard oil mixed together with the essential oils of camphor, menthol, or wintergreen would be balancing.2 Another technique would be applying oil locally to the specific marma points that are being used for healing, rather than applying oil to the whole body as in Abhyanga, Pranic Healing Pranic Healing involves transmitting energy from the healer to the client and can be accomplished by placing one’s hands above the specific area of the body (or in this case the marma point) that is the target of the healing. In Ayurvedic terms marma points are part of the Majja dhatu, or nervous system, which is governed by prana. Pranic healing can assist in the harmonious interaction of prana vayu (the flow of cellular intelligence), sadhaka pitta (present especially in the gray matter of the brain) and tarpaka kapha (the white matter covering the brain), to promote greater healing in the physical, mental, and emotional bodies. When contemplating the manipulation of the emotions, energetic body, or physical points remote to a specific marma it is interesting to note the correlation with modern superstring theory which considers all particles to be made of “infinitesimally small vibrating strings”5 which are the foundation of all energy. The oneness of mindbody and how it may be bundled as vibrating energy that is interconnected to everything else in the universe, is the basis of what may be called the "Cosmic Connection". Furthermore, vibrating bundles of energy (i.e., vibrating strings of mutual harmonic http://www.ayurvedacollege.com/book/export/html/2
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resonance that have coalesced to form an electromagnetic field operating at a given frequency not unlike a frequency for a radio station, for instance) create fields of influence around their physical selves. A physical manifestation of the energy of thoughts is the instincts and/or emotions as they elicit as a response to a specific stimulus.7 Since all matter, all emotions, and all thoughts are considered to be energy, and since all energy is thought to be made up of the same fundamental component, it becomes clear how the manipulation of certain points on the body could promote healing elsewhere. According to Dr. Deepak Chopra, “Once you strip off its physical mask, a cell is really a junction point between matter and consciousness, a station where the quantum mechanical body and the outside world intersect.” (Chopra, 178) Yoga Asana Yoga is known to increase general pranic levels and also directly affects marma points through compression in certain poses.11 For example, Janu Sirsasana (seated forehead to knee pose) compresses Nabhi, Janu, and Sthapani marma as the third eye connects with the knee, and the abdomen is contracted. Sirsasana (headstand) stimulates Adhipati through the connection of the crown chakra with the earth. Halasana (shoulder stand) affects Hrdaya, Nila, and Nabhi as the frontal plane of the body is contracted and may also affect Brihati and Krikatika on the posterior plane. With a thorough knowledge of marma points and yoga postures, a great variety of therapeutic applications may be derived. Meditation Healing may be brought on by meditation upon a specific marma point, or set of points, to promote the free flow of prana independently of a therapist. Simply concentrating one’s energy on the specific point(s), or by following the flow of energy within the body to or from a specific point, or by performing a complete rotation of consciousness around all the marma points of the body, awareness and healing may be achieved. Conclusion The subject of Marma Therapy is vast and complex, with varying opinions from many prominent Ayurvedic physicians and scholars. All seem to agree on at least one thing: that marma points are regions on the body powerful enough that they can be used for harm or healing. The experience of the author in the realm of using marma points for healing has been quite potent, through meditation, yoga postures, massage, and pranic healing techniques used on her self and in the use of therapeutic touch and pranic healing transmitted to others, and this experience was her motivation for embarking upon this research. Bibliography: 1. Bhishagratna, Kaviraj Kunja Lal. An English Translation of the Sushruta Samhita. Calcutta: Published by Author, 1911 2. Frawley, Dr. David. Ayurveda and Marma Therapy. Wisconsin: Lotus Press, 2003 3. Halpern, Marc, The Importance of Marma Therapy in Ayurvedic Practice: http://www.ayurvedacollege.com/importancemarmatherapy http://www.ayurvedacollege.com/book/export/html/2
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ayurvedicpractice 4. Lad, Vasant. Marma Points of Ayurveda. Albequerque: The Ayurvedic Press, 2008 5. Smith, William L. The Human Electromagnetic Energy Field: It’s Relationship to Interpersonal Communication: http://www.journaloftheoretics.com/articles/42/Smith.htm 6. Swami Vivekananda Yoga Anusamdana Samsthana, Bangalore, India, Effects Of Yoga Practice on Acumeridian Energies: Variance Reduction Implies Benefits for Regulation: http://www.ncbi.nlm.nih.gov/pubmed/23439630 7. Halpern, Marc. Ayurvedic Marma Therapy. Course Supplement, 2004 2012. 8. Murthy, Prof. K. R. Srikantha. Illustrated Sushruta Samhita, Vol 1,2,3. Varanasi, Uttar Pradesh, India: Chaukhambha Orientalia, 2010. 9. Chopra, Deepak. Perfect Health. New York: Three Rivers Press, 1991 10. Muley, SK, Associate Professor and Head, Department of Sharira Rachana, Government Ayurved College, Nanded, Maharashtra, India, Study of Vaikalyakara Marma with special reference to Kurpara Marma: http://www.ncbi.nlm.nih.gov/pubmed/22661839 11. Niharika Nagilla, Swami Vivekananda Yoga Anusamdana Samsthana (SVYASA), Bangalore, India, Effects of yoga practice on acumeridian energies: Variance reduction implies benefits for regulation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573545. 12. Caraka. Caraka Samhita. R.K. Sharma and Bhagwan Dash translation. Varanasi, India: Chowkhamba Sanskrit Series Office, 1976.
Allopathic and Ayurvedic Approaches to Hypothalamic Amenorrhea By Sharyn Galindo There are two kinds of Hypothalamic Amenorrhea, primary and secondary. Primary refers to females that have not yet had their periods by the age of sixteen. Secondary, is when a woman who previously had normal periods, temporarily or permanently stops menstruating. While many women skip an occasional period, amenorrhea is diagnosed if a woman has missed three or more in a row. This secondary amenorrhea, also known as “Functional” amenorrhea is what will be addressed in this paper. Hence, "Hypothalamic amenorrhea" can technically be defined as the cessation of menstruation due to a dysfunction of hypothalamic signals to the pituitary gland resulting in a failure of ovulation or stimulation of ovulation. Typically, young women who are affected by the condition have no obvious structural abnormalities of the hypothalamus or the rest of the brain, pituitary gland, or ovaries. This common type of functional amenorrhea is a diagnosis of exclusion. Hyperprolactinemia, primary deficiency of gonadotropinreleasing hormone, and other hormonal and electrolyte abnormalities must be ruled out. Affected women are reportedly more likely to be underweight, athletic, engaged in "intellectual" professions, or exposed to social stress than women without the disorder.1 In addition, hypothalamic amenorrhea may be preceded by a history of irregular menses and may last several months to years. When it occurs in association with weight loss or intense exercise, hypothalamic amenorrhea is considered to result from energy deficiency. Deficits in nutrients, hormonal perturbations, or both may signal to the brain, leading to the disruption of the pulsatile secretion of gonadotropinreleasing hormone and luteinizing hormone as well as disruption of the menstrual cycle. On the other hand, hypothalamic amenorrhea has also been described in http://www.ayurvedacollege.com/book/export/html/2
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nonathletic women of normal weight a variant that may be associated with psychogenic factors such as stressful life events or adverse childhood experiences.2 An association between menstrual aberrations and stressful situations has long been recognized. For example, women frequently start their menstrual periods on their wedding days or when their husbands return home from military service. Women hospitalized for depression are commonly reported to have amenorrhea. Fifty percent of women in concentration camps developed amenorrhea which persisted throughout their detention. In addition, it has been repeatedly demonstrated that a considerable number of women develop menstrual aberrations, and as high as 20% develop amenorrhea when undergoing the stress of separation.3 There are examples of it happening at the time of breaking up with a significant other/life partner, desertion by a parent, and leaving home. Moreover, psychogenic amenorrhea, like exerciserelated amenorrhea, has been associated with subtle deficits in calorie and macronutrient intake, as well as with neuroendocrine abnormalities. Thus, a central signal related to energy deficit may be the common factor underlying the two forms of hypothalamic amenorrhea.4
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Ayurveda, Death & Dying by Renee Traub Introduction: The intent of this research paper is to look at death and dying from an Ayurvedic perspective, specifically to assist those in the hospice and end of life caregiving field in learning to spiritualize the death process for themselves, their patients and patient families. This paper will utilize Ayurvedic principles and introduce practices that caregivers, professionals and families can implement with patients in the process of dying. My intention is to expand Ayurvedic practice into a field where it can be used to open the door to mindful, aware and compassionate dying. My interest in this topic stems from my professional experience as a neonatal ICU nurse for 28 years and a hospice nurse for 3 years, as well as my experience last year around my mother’s passing. Oftentimes I have felt like a midwife to the soul. I have experienced the sacredness of death and this is what I would like to share with the public. Research sources include ancient and modern Ayurvedic texts, allopathic medical journals, and alternative and complementary texts relating to the topic. To echo the work of Dr. Mits Aoki, I would like to “make death a work of art, a great achievement for the patient and a time of growth, understanding and closeness for family members.1 ” Principles of Ayurveda Ayurveda is a traditional Indian medical system with a scientific basis. It incorporates mind, body, and spirit in its understanding of the human being. Ayurvedic medicine complements Western medicine by focusing more on root causes rather than symptomatic treatment. Self care practices are foundational for a healthy life. Examples of Ayurvedic practices are meditation and breathing techniques. Preventative medicine is emphasized as it is easier to put into effect than treating disease that has already manifested. Prevention means empowering patients to make positive lifestyle changes and behavior changes by educating and incorporating diet, spirituality, psychology, herbal medicine, and detoxification (known as pancha http://www.ayurvedacollege.com/book/export/html/2
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karma). Ayurveda reminds us that our true nature as human beings is spirit, and to connect to something greater than ourselves. Ayurveda means “science of life.” It is a science because it contains systematically applied knowledge that has been proven in its effectiveness over thousands of years of continual application. Ayurveda supports balance in all aspects of life physical, mental and spiritual. In the words of doctor and author Vivek Shanbhag, Ayurveda “respects the uniqueness of the individual, considers all the levels of the individual, emphasizes prevention, [and] empowers everyone to take responsibility for their own well being.2 ” 1 Aoki, Dr. Mitsuo. www.livingyourdying.com “Helping Others Live with Dying.” 2 Shanbhag, Vivek. A Beginner’s Introduction to Ayurvedic Medicine: The Science of Natural Healing and Prevention Through Individualized Therapies. Keats Publishing, Inc: CN, 1994. p. 9 According to Ayurveda, doshas are forces of nature that combine into the tapestry of life. The human body is composed of the three doshas and operates based on their functioning, If the doshas are out of balance with one another, there will be a disturbance in the function of the body and/or mind. Often health or disease is discussed in terms of the balance existing between the three doshas. The three doshas are vata, pitta, and kapha. On a cosmic level, one can say that vata relates to wind, pitta relates to the sun, and kapha relates to the moon and the earth.3 In short, doshas are forces that govern the physiology of the human being.4 Ayurveda “recognizes that each person is made up of a unique body type and a unique psychological personality.5 ” We all have our own individual doshic combination from the moment of conception, and this is what accounts for our differences as people. Vata dosha represents the forces of movement. Vata is active and dynamic, like the wind. Vata makes things happen in the body and mind, and is responsible for all movement, including the breath, the circulation, and movement of thoughts. People who have a lot of vata can be energetic, vivacious social butterflies. They can be very vibrant, enthusiastic and creative. Every dosha has its balanced side, as well as its out of balance side. When vata is out of balance, a person may be flighty, fickle, fearful and insecure. Excess vata can manifest in worrying, a fragile nervous system, anxiety and exhaustion. In order to heal, patients with vata imbalances will need a lot of hand holding, support, nurturing and a deep sense of connection with others. The force of vata dosha is inherently dry, cold and light. It is the dosha that governs depletion, destruction, decay, necrosis, debility, dissolution, and the process of wasting away and shutting down. For these reasons it is especially correlated with the active dying process. Signs of impending death such as a change in smell, bodily organs shutting down, core temperature instability, gurgling breathing (death rattle) and the mottling of the skin are all vata symptoms. Terminal agitation, a dying patient’s behavior of responding unpredictably, is also linked to vata, and may include speaking to those who have already passed on, being spaced out or not present, non responsiveness, outbursts of tears or yelling, and other behaviors displaying the movement and rapid dynamism of vata. Vata dosha benefits especially from therapies involving calming, grounding and peaceful touch and sound. Pitta dosha represents the forces of transformation and metabolism in the body and mind. It is very active in the digestive system, the liver, eyes, and the rational aspect of the intellect. Pitta dosha allows food to transform into energy and experiences to transform into opinions, analysis and evaluations. Pitta is hot and fiery, and has rough, sharp, and clear qualities. Individuals with a lot of pitta in their unique doshic combination can http://www.ayurvedacollege.com/book/export/html/2
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often be confident, organized, driven, bright, passionate and disciplined. However, like fire, pitta can easily become uncontained. This creates an excess of heat in body and mind, expressing itself in outbursts, anger, tantrums, criticism, resentment, jealousy and rage. 3 Heyn, Birgit. Ayurvedic Medicine: The Gentle Strength of Indian Healing. Thorsons Publishing Group: Vermont, 1987. p. 13. 4 Halpern, Dr. Marc. Principles of Ayurvedic Medicine. California College of Ayurveda: California, 1995. p. 53 5 Shanbhag. p. 10. The process of dying is neither controlled nor precise. This can be a challenge for pitta individuals who can be over controlling and demanding, especially in times of stress. Strong willed people who are used to being leaders and making things happen find that they have no control over the dying process, and this is difficult for pitta. Sometimes pitta patients and/or family members are very direct and intense, and communicate in a way that is explosive and sharp due to their feelings of helplessness and powerlessness. Strategies to support pitta patients and families in the dying process include cooling, relaxing and stress diffusing forms of aromatherapy, breathing practices, yoga nidra and guided meditation. Kapha dosha represents the forces of stability and structure in the body and mind. It is the container for vata and pitta doshas. Kapha dosha provides the physical form and material structure of the body. Linked with the qualities of earth and water, kapha is wet, dense, heavy, slow and steady. In the mind, kapha dosha describes qualities of gentleness, calm, consistency, and dependability. Individuals with a lot of kapha in their unique doshic combination can often be nurturing, affectionate, compassionate and loyal. However, when kapha is out of balance, these same qualities can become stubbornness, lethargy, withdrawal, depression, and issues of attachment and possessiveness. Kaphic individuals, unlike vata and pitta, are slow to change, but once change is implemented, they are steady and enduring in new habits. When working with kapha individuals in the death and dying journey, it is important to understand that they may experience a longer grieving process. Watery emotions such as tears may be present. Kaphas can also internalize emotions and not show them, even though they feel very deeply. Honoring relationships is very important, as is self care for caregivers and families who have created deep attachments to individuals who have passed on. In order to understand Ayurvedic psycho spiritual healing, one must also understand the concept of gunas. Guna is a Sanskrit word meaning attribute or quality.6 It describes a person’s state of mind or state of consciousness. The three gunas are sattva, rajas and tamas. Sattva guna describes a state of consciousness that is peaceful, calm and balanced. Rajas guna describes a state of mind that is full of movement and activity, constantly creating turbulence and drama. Tamas guna describes a state of consciousness that is inactive, dull and stuck. A colleague has beautifully put this in terms that are understandable: “A person who is a vegetarian, practices yoga daily, meditates daily, is emotionally stable and has a good work/life balance could be described as sattvic; a person working in the corporate field who is highly committed and driven, spends most of their waking hours at work, works hard and plays hard, is a competitive sportsperson, and eats meat every day could be described as rajasic; and a person who sits at home all day every day watching TV, eating microwaved food, and not exercising could be described as tamasic7 ” 6 Klutznick, Karen. http://www.kkayurveda.com/ayurvedabasics/thegunas.html http://www.ayurvedacollege.com/book/export/html/2
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The concept of chakras is important to understand when considering health from a mind/body/spirit perspective. Chakras are energy centers in the body that “show how the life force...directs and guides the physical body through the nervous system.”8 Chakras are composed of energy that ranges from being more open, flowing and functioning to more closed and blocked. Because chakras are not in the physical body, they can be worked with through energetic techniques such as meditation, mantra, color therapy and visualization. The seven major chakras correspond with the movement of energy through the spinal cord. This paper will introduce two more concepts in Ayurveda that connect to the subject of death and dying. These concepts are prana and ojas. Prana is the lifeforce behind all creation that each person is linked to through the breath. The process of breathing brings prana into the body. Individuals with healthy prana radiate a strong sense of aliveness, vibrancy, and sparkle. They are full of life. Ojas relates to the strength of the immune system. Strong ojas creates physical and mental endurance and the capacity to get things done despite stress. Individuals with strong ojas are centered and grounded, and less reactive than those with weak ojas. Weak ojas creates hypersensitivity to the environment, as well as sensory overload and decreased immune system function. Individuals with depleted ojas are often exhausted physically and emotionally. Introduction to Hospice Hospice is a care model that provides palliative care to individuals who are in the process of dying. Hospice is a way to deal realistically and honestly with terminal disease. It offers hope of dignity and comfort for patients and families.9 This model of care, focused on palliation rather than curative therapies, neither hastens nor prolongs death, allowing nature to take its course.10 Hospice care can take place at a dedicated hospice facility, nursing home, hospital, or at the patient’s home. Patients are generally put on hospice towards the very end of life, generally no longer than six months. The current model of hospice care centers around making the patient comfortable, managing patient pain, educating family members on the death and dying process, and helping the family organize and prepare for their loved one’s death. Hospice describes an interdisciplinary team which may include doctors, nurses, social workers, assistants, chaplains and grief counselors. Individuals in the process of dying undergo many changes physically, mentally and spiritually. Often they become drawn inward, sleeping more and showing disinterest in food, guests and other activities. The body weakens, and the mind may become agitated and confused. Fear and sadness may arise, as well as feelings of not wanting to be a burden. The patient may wish to talk about the past and review her/his life. Elizabeth Kubler Ross, pioneer in the field of near death studies, identified five stages of grieving for the imminent loss of one’s life: denial, anger, bargaining, depression and acceptance,11 The process of death has been studied forthousands of years, and is described in ancient texts in similar terms as today: While approaching death, the process of destruction is initiated in the body. Functions of various limbs and organs of the body get disturbed….drainage of strength from limbs, cessation of movement, destruction of sensory/tactile, impairment of consciousness, restlessness in the mind, affliction of the mind with fear, deprivation of memory and intellect….radical change in the conduct...wasting of muscle tissue and blood….morbid changes in the smell of the body...discoloration of the body, dryness in the orifices of the body.12 In my experience, hospice is all about being present with what is. The practice of being unconditionally present and just listening, without having http://www.ayurvedacollege.com/book/export/html/2
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one’s own agenda, can be incredibly profound. Caring for the dying can be a deep spiritual calling where one is open to whatever comes up, and willing to give whatever is needed. In the words of spiritual teacher Ram Dass: Whenever I tried to impose my model of a good death on a situation, or been attached to a particular outcome, it has backfired. But when I meet the person with love, without wanting anything, I become a safe haven. When I could remain conscious, aware of my own thoughts and feelings, waves of sadness or pity, aversion or fear, as well as my own temptation to react, I could bring soul quietness and a feeling that what was happening was alright. This inner calm seemed rock like it its stability.13 Hospice creates an attitude of service to the body, mind and spirit of the patient. Hospice has really made a difference in the lives and deaths of those it has touched, and by adding complementary Ayurvedic practices, opportunities are created to deepen compassion, mindfulness and integration. Timeline of Hospice Care14 1948: The term hospice, from the same linguistic root as hospitality, is first applied to specialized care for dying patients by physician Dame Cicely Saunders of the UK. 1963: The concept of hospice is introduced to the medical community of the US by Saunders. 1967: Saunders opens the first modern dedicated hospice facility in the UK. 11 KublerRoss, Elizabeth. On Death and Dying. Scribner: New York, 1969. 12 Caraka Samhita. Vol 2. Chapter 5. v. 9091. 13 Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. p. 178. 14 timeline information courtesy of National Hospice and Palliative Care Organization, Alexandria, VA. 1969: Elizabeth Kubler Ross publishes On Death and Dying, a controversial book which sparks widespread public conversation on death and dying care in the US. 1974: Florence Wald of Yale University opens first hospice care facility in the US. 1982: Medicare begins to cover hospice benefits. 1984: Standardized hospice accreditation is initiated through the Joint Commission on Accreditation of Healthcare Organizations. 1986: Medicare hospice benefits are expanded and made permanent by US Congress. 2002: Department of Veterans Affairs launches program expanding hospice services to veterans and also providing continuing education in hospice and palliative care to clinicians. 2006: American Board of Medical Specialties recognizes hospice and palliative medicine as a medical specialty. In recent years, research and policy work has been done in areas of hospice for HIV/AIDS patients in sub Saharan Africa, pediatric hospice, expansion of hospice services for veterans and provision of hospice to individuals who are incarcerated. http://www.ayurvedacollege.com/book/export/html/2
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Ayurvedic Aromatherapy Aromatherapy is the use of the sense of smell for healing. High quality essential oils distilled from plant sources can affect moods, balance the nervous system, and help calm and refresh the body and mind. Aromatherapy works powerfully on the mind, and helps create sattva, allowing for greater peace and serenity in the final stages of life.15 The sense of smell is perceived through the evolutionarily oldest part of the brain, the limbic system, which responds to stimuli instantly, without thought.16 Scents have the ability to penetrate deeply into the brain, and chemically alter the functioning of the nervous and endocrine systems. Studies have found that aromatherapy massage decreases anxiety, promotes relaxation, and stimulates autonomic nervous system function, especially in instances of palliative care.17 The application of aromatherapy in a hospice care setting can take many forms, all of which are user friendly. Essential oils can be purchased in health food stores or online, and many of the oils suggested here are inexpensive. It is important that essential oils are pure and of good quality. “Fragrance oils” aren’t true essential oils be aware of synthetic and adulterated oils used in the cosmetic and food industry. They do not have the therapeutic value of natural oils.18 Essential oils can be added to a tub of warm water for a foot or hand soak, added to a massage oil, or dripped into a spray bottle full of water. Bear in mind that essential oils should generally not be placed directly on the skin. One drop of an oil can be placed on a cotton ball to scent a room. A spray bottle of rose water hydrosol can be used instead of rose essential oil, which is more cost effective.19 15 Sushruta Samhita. Section 8, verse 10. 16 Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998. p. 12. 17 American Journal of Hospice and Palliative Care. “The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.” Downey et al. Aug/Sep 2009. Excellent oils for reducing anxiety, stress and worry are lavender, chamomile, clary sage, lemon balm, rose geranium, rosemary and sandalwood. Lavender creates a calm and positive attitude and stimulates brain secretions of serotonin, as well as calming and soothing the nervous system.20 21 Lemon balm, also known as melissa, is an excellent restorative of the nervous system.22 Rosemary is known to ease emotional tension.23 Sandalwood is known to relieve irritability that stems from anxiety.24 Chamomile is a nervine sedative specific to anxiety and stress.25 Clary sage is useful in cases of despair stemming from anxiety and stress.26 Feel free to make your own oil blends and remember that one drop goes a long way; only a few drops are needed in a foot bath or 4 oz spray bottle. Many oils are helpful in aiding relaxation and supporting restful sleep. This allows patients to respond to the stresses of living and dying from a more peaceful place. Oils specific to this purpose are lavender, chamomile, frankincense, jatamamsi, lily, nutmeg, rose and sandalwood. Lily soothes the nerves and relieves irritability.27 Many of the oils listed in for anxiety, stress and worry are also helpful with stress relief and relaxation. Anger and resentment can arise at different stages of the dying process, especially in patients with high pitta. Resistance to the dying process, asking “why me?”, loss of control over the body and one’s life, and family related dramas that come up during difficult times can all cause pitta to rise. Spearmint, lemongrass, fir and cedar can all rebalance the body and cool hot feelings.28 Lavender, rose and sandalwood are excellent oils for http://www.ayurvedacollege.com/book/export/html/2
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relaxing and purifying a heated pitta mind. Rose increases love and compassion.29 Sandalwood deeply nourishes the heart.30 Jasmine is great for releasing anger, and purifying the mind and emotions.31 32 Lily calms the heart and soothes the nerves, reducing irritability and increasing faith and devotion.33 18 Wall, Carly. p. 16. 19 Edgar Cayce Rosewater is highly recommended and inexpensive. Reputable brands of essential are Floracopeia, Simplers, Mountain Rose, Young Living and Doterra. 20 Wall, Carly. Setting the Mood With: Aromatherapy. 21 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 22 Wall, Carly. Setting the Mood With: Aromatherapy. 23 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 24 Ibid. 25 Page, Linda. Healthy Healing. Quality Books Inc: 1985. 26 Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996. 27 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 28 Wall, Carly. Setting the Mood With: Aromatherapy. 29 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 30 Ibid. Loss, sadness, depression and grief are often present in the dying process. Patients may have regrets from the past, sadness at not being able to accomplish things they want to, and grief at saying goodbye to loved ones. Gently uplifting oils can be beneficial in shifting the mind and increasing movement towards acceptance. Coriander, pine and helichrysum are great for softening the grief process.34 Rose is a wonderful soothing oil for the mind and an anti depressant, allowing for greater experience of love and increased self esteem.35 Rosemary, tulsi (holy basil), patchouli, cardamom and wintergreen also help alleviate depression.36 37 Citrus oils such as bergamot, lemon and orange are very uplifting.38 break through despondency.39 Cypress and eucalyptus can help break through despondency.39 Aromatherapy can bring about a sattvic state of consciousness, spiritualizing the death process and awakening higher awareness. Scent has the power to bring us back into alignment with our authentic self. Oils that have this property have been used in many of the world’s spiritual traditions. Frankincense creates a space of purity in which higher virtues can come forth.40 Sandalwood and rose are other herbs that possess this sacred quality. Essential oils can be selected for their therapeutic purposes and used not only in aromatherapy, but also in touch therapy or massage. Massage and Gentle Touch Massage has a long history as an integrative part of many healing traditions, including Ayurveda. Ayurvedic massage can feed the senses and nourish the body and mind through the application of therapeutic touch. It supports restful sleep and a calm, happy mind.41 A recent study of complementary practices in a hospice setting found that massage was not only beneficial to patient care, but reported by patients themselves as the http://www.ayurvedacollege.com/book/export/html/2
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most beneficial treatment they received. 42 Sharing massage with a patient or loved one can be a deep expression of love, care and compassion. Especially while caring for those in hospice, it is important to maintain a sattvic touch, which is light, mild, gentle, balancing, harmonizing, warm, pleasant, sweet and nourishing.43 When massage is done with love, care, gentleness and sensitivity, it will increase sattva in the patient. The massager must also have a sattvic quality in their attitude and manner of application.44 Healing benefits of massage and application of oils build up over time, and are also immediately beneficial to skin, muscles and the nervous system.45 31 Halpern, Dr. Marc. p. 324. 32 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 33 Ibid. 34 Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991. 35 Wall, Carly. Setting the Mood With: Aromatherapy. 36 Halpern, Dr. Marc.. p. 324. 37 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 38 Page, Linda. Healthy Healing. Quality Books Inc: 1985. 39 Young, Gary. Aromatherapy: The Essential Beginnings. 40 Frawley, David. Ayurvedic Healing for Healthcare Professionals. 41 Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998. p. 60. 42 American Journal of Hospice and Palliative Care. “Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” Downey, et al. Aug 2009. Massage is recommended for patients with high vata, pain and hypersensitivity, as well as any disturbance of the mind, emotions and nerves.46 Sesame oil and almond oil are recommended as they are softening to the tissues of the body. Mild and sweet essential oils such as sandalwood, rose and lavender can be added.47 Incorporating aromatherapy into massage helps the mind and body prepare for a deeper opening. Gentle massage of patients is recommended three times a week, or even daily. Frequency of this practice allows oils and herbs to penetrate deep into the skin, creating permanent changes.48 Techniques and supplies for this practice are very simple. Purchase cold pressed, organic sesame or almond oil at a health food store. Pour some oil into a bottle and store the rest in a cool, dark place. Add essential oils according to patient needs. Warm oil prior to application in a hot water bath in a sink or a pan. Test temperature on wrist before use. Pour oil in hand liberally, and use both hands to spread oil along body part. Use long strokes for long parts, such as arms, legs, and torso, and use circular strokes around joints. Rub the oil in and allow the body to soak it up. Maximum absorption is important and may take 20 minutes or more. Stress reducing or mindfulness practices such as meditation may be done while the oil is absorbing. After absorption, pat off excess with a cloth, and if necessary, some warm water. Removing oil with soap is not recommended.49 If massaging the whole body is not available, a simple foot and scalp massage will have many of the same therapeutic benefits, and will assist in relieving sleeplessness and fatigue.50 Head massage can relax the entire body by relaxing the nervous system and relieving mental strain and stress.51 and scalp.52 Brahmi oil, available online, is especially recommended for the soles of the feet and scalp. 52 http://www.ayurvedacollege.com/book/export/html/2
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Altars and Color Therapy 43 Frawley, David. p. 502. 44 Ibid. 45 Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 167. 46 Sushruta Samhita. Section 5, verses 9091 47 Frawley, David. p. 506 48 Ibid. 49 massage technique from Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 168. 50 Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996. p. 45. 51 Charaka Samhita.Vol 1. Section 5, verse 8183. 52 Lad, Vasant.p. 260. The visual images that we take in through our sense of sight can bring pleasure or pain. The sense of sight can trigger memories, feelings and thoughts that are sattvic, rajasic or tamasic. The skillful use of color can add psychological harmony and peace of mind, and contribute positively to a patient’s emotional well being during the dying process.53 This happens on a very subtle level and the psychological effects of color are not always consciously apparent to the viewer. Color is vibrational energy that enters the eye and goes directly to the brain and mind.54 Color therapy can be applied in many ways. Various methods include surrounding ourselves in therapeutic color choices through clothing, linens, window coverings, paint choices, colored light bulbs, flowers, candles, artwork and nature imagery. Soft lights can be used instead of fluorescent or neon, and full spectrum light bulbs can be used in winter.55 Choosing decor with awareness of the specific effects of different colors can calm the mind and increase sattva. The color gold is especially powerful in harmonizing the mind, strengthening the heart, and supporting ojas and immune and endocrine system health.56 Gold also provides stability, relieves anxiety, uplifts the spirit, and supports greater awareness and transformation of consciousness.57 For these reasons, gold is highly beneficial in hospice care settings. The colors white and blue can also be used therapeutically. White invokes purity, virtue and spirituality, and calms the heart, mind, nerves and emotions.58 It promotes meditation and spiritual awareness, and supports a state of mind that is expansive, flowing, clear and effortless. 59 Although these aspects are beneficial, white can increase vata and is not recommended in excess. Blue spiritualizes anger, antidotes the critical mind and reduces attachment and pitta, however, blue is very cold, light and dry and in excess, can increase vata.60 Another way to experience color is through creating an altar. An altar creates a physical and tangible sacred space to facilitate mental and spiritual peace.61 Co creating an altar with a patient allows for intimacy, connection, grounding and creativity. Any objects can be used that have meaning and provide inspiration. http://www.ayurvedacollege.com/book/export/html/2
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Mantras, Music and Affirmations 53 Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998. p. 319. 54 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. p. 126. 55 Tirtha, Swami Sadashiva. p. 319. 56 Ibid. p. 320. 57 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126. 58 Tirtha, Swami Sadashiva. p. 321. 59 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126. 60 Ibid. 61 Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999. p. 24. The sense of hearing, like the sense of sight, can be used in ways that create harmony and peace, or in ways that agitate and disrupt the mind and body. Hearing is the first sense that develops in utero. The fetus reacts to its mother’s voice and external sounds as early as 4 ½ months.62 Hearing is the last sense to go as people transition into death. Even unresponsive patients can often hear what is said to them. Relaxing music, uplifting mantras such as ‘om,’ and affirmations are all sattvic tools that can be incorporated into patient care. An affirmation is a positive, personally inspiring phrase that is a powerful tool to focus positive intention and counteract previous negative conditioning.63 Affirmations can be used to shift awareness and belief. They can be played in the background, repeated aloud by patient or caregiver, written and placed around the space, or repeatedly mentally. Patients and caregivers can develop their own affirmations, or use existing ones such as: May I be free from suffering, May I be at peace, May my heart flower.64 Other helpful affirmations are: I am at peace in this moment. I release control; I embrace the unknown.65 Repeating affirmations creates the openness in mind and heart to receive what is longed for. If possible, repeat affirmations, or have them playing in the background, throughout the day. Mantras are sound forms that create a shift in consciousness. Like affirmations, they can be chanted aloud or internally, or listened to in music. To pacify vata, and create sattva, mantras need to be soft, warm, soothing, and calming.66 Patients should only chant out loud briefly, if at all, as this can deplete energy. The mantra ‘om’ (rhymes with ‘home’) balances mind, body and spirit, promotes awareness, harmonizes the nervous system and clears the energy.67 The mantra ‘lum’ (rhymes with ‘chewing gum’) can be used to stabilize, ground, calm, and bring joy, happiness and contentment, and is especially useful when vata is high.68 Mantras resonate with the chakras and help to spiritualize the awareness on a subtle level. Music can support the dying process in ways ranging from stress relief, to bedside support, to grief recovery. Because music reaches a deep, non rational part of the mind, it is ideally suited to shift feelings such as grief, fear, anxiety, sadness and anger that create rajas in the mind. Music can release blocked or painful feelings and can stimulate positive ones such as hope, love and gratitude. Sharing music together can lead to sharing of the emotions that the music brings up.69 70 http://www.ayurvedacollege.com/book/export/html/2
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62 Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999. p. 23 63 Simpson, Liz. p. 138. 64 Levine, Stephan. Healing Into Life and Death. Doubleday: New York, 1987. p. 2324. 65 Ibid. p. 27. 66 Tirtha, Swami Sadashiva. p. 314. 67 Ibid. p. 312. 68 Ibid. p. 313. 69 Levine, Stephan.. p. 25. 70 http://www.growthhouse.org/music.html This website streams music that is intended to support the death process and patients in hospice and palliative care settings. Sound is a nutrient for the spirit as well as for the body.71 When the moment of transition into death arises, chants can be used to say goodbye. Stephan Levine suggests: Go in beauty. Peace be with you. Til we meet again in the light.72 Another chant, made famous in Kundalini Yoga circles, that can be used comes from a popular song from the 1960s: May the longtime sun shine upon you, May all love surround you, And the pure light within you guide your way home.73 Meditation Practices for Hospice and Palliative Care Meditation is a journey to the center of our own being.74 Meditation can be done anywhere, at any time, sitting, lying down, or walking.75 One can meditate with a mantra, a thought or feeling, by looking at nature, thinking about God, feeling pure love, or with any technique that doesn’t cause strain, anger or worry that one is not doing it properly.76 There are countless techniques for meditation, and they are all valid. The technique introduced here is simple to learn and to practice. Any other techniques can also be used. The most important aspects to practice are devotion and sincerity.77 Meditation is an art of bringing harmony to body, mind and consciousness.78 It has been shown to be clinically beneficial in healing body and mind.79 It gives us a respite from the pressures of life. As we relax, the heart beats more slowly and the blood pressure lowers. Meditation helps retrain response mechanisms so we don’t react as strongly or as negatively to adverse situations. It gives us the ability to be more centered, and more in control of our reactions.80 Meditation allows the mind to be healthy and sattvic, alert, positive and calm.81 When we meditate, we release rajasic mental states such as fear, worry and anger and replace them with positive attitudes.82 By practicing meditation as regularly as possible, we gradually gain control over the flow of our emotions and movement of our minds. This allows us to turn awareness inward.83 71 Levine, Stephan.. p. 25. 72 Ibid. p. 27. 73 lyrics written by Incredible String Band. 74 Novak, John. Ananda Course in SelfRealization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997. p. 13. http://www.ayurvedacollege.com/book/export/html/2
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75 Tirtha, Swami Sadashiva.. p. 595. 76 Ibid. 77 Ibid. 78 Lad, Vasant..p. 76. 79 International Journal of Palliative Nursing. “Mindfulness Based Cognitive Therapy.” KabatZinn, Dr. Jon. June 2001. 80 Novak, John. p. 15. 81 Ibid. 82 Ibid. p. 16. 83 Ibid. One advantage of the form of meditation outlined below as a treatment method is that it is very safe, has no side effects, and is easy to teach and share.84 This form of practice creates the ability to look within and contact the deeper aspects of consciousness. In So Hum meditation we sit quietly and watch our breath.85 Patients can be in supine position or seated. Keeping the spine straight is helpful. Patients can be supported with pillows to suit their comfort. Begin by allowing the mind to be present. Let go of stories in the mind and thoughts about what’s going on elsewhere. Relax and be comfortable. Take a few deep breaths in, if possible. Inhale and exhale through the nose, if possible. As you inhale, mentally think ‘so’ (rhymes with ‘no’). As you exhale, mentally think ‘hum’ (rhymes with ‘chewing gum’). Continue this pattern of repeating ‘so hum’ with the breath. The syllable ‘so’ represents the life force entering the body through inhalation, and the syllable ‘hum’ represents the release of limitations through the exhalation.86 If the mind starts to wander, just bring it back to focus on the mantra and the breath.87 Breathe through whatever comes up. In this practice, for most people, the breath naturally deepens. You will very likely become distracted, just bring the mind back to focus on the breath and mantra, be gentle with yourself, and keep going. When beginning this practice, 2 3 minutes of practice is suggested. Practicing consistently brings benefit. After the practice is finished, allow a few moments to bring the mind back to normal awareness.88 Another practice that supports deep relaxation and spiritualizing one’s awareness is yoga nidra. Yoga nidra begins with the patient in a supine position, supported with pillows for comfort. This practice is guided by a soothing voice, and many good recordings are available.89 Yoga nidra takes the body through a total relaxation process, calms the mind and releases tension and stress. Yoga nidra brings the mind to focus on different parts of the body, feeling them distinctly, and then fully relaxing. It brings the mind to focus and creates intention. Although it is not intended to cause one to fall asleep, one will receive benefit even if one is asleep. If possible, keep the mind alert and focused. When practiced effectively, this technique is as restorative as sleep.90 Breathing Practices for Hospice and Palliative Care The breath is the primordial life force governing mental and physical function. One’s breath is the essence of one’s life. The first breath is taken shortly after arriving in the world, even before the umbilical cord is cut. The breath continues, unbroken, until death. Breathing does not require conscious attention, but by choosing to bring awareness to the breath, one can influence the body and mind. Mindful breathing clears the mind, brings calm and allows individuals to connect their personal energy with the universal energy.91 http://www.ayurvedacollege.com/book/export/html/2
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84 Frawley, David. p. 517. 85 Lad, Vasant..p. 79. 86 Ibid. 87 Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004. p. 9091. 88 For different meditation techniques, consult the many books of Pema Chodron, as well as titles by Stephan Levine Who Dies? and Healing into Life and Death. 89 Yoga nidra recordings are widely available on CD, iTunes and YouTube. The recording of Dr. Marc Halpern guiding Yoga nidra is recommended. 90 Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999. p. 61. To practice mindful breathing, sit or lie in a comfortable position. Relax the shoulders. Breathe deeply and slowly, allowing the breath to come from the abdomen. Imagine that the belly is breathing, rather than the chest. If possible, have the entire breathing movement come from the diaphragm. After a few minutes, observe the effects of this practice on the body and mind. Support for Caregivers Caregivers for the dying often become distressed, depressed and drained of energy. They often become the second patient.93 In times of stress it is easy to focus one’s attention outward, and forget one’s own needs. There may seem to be no time for caregivers to focus on their own needs such as nourishing and healthy food, sleep, quiet time or meditation and time to unwind in nature or with loved ones. For those who devote their time to caring for the ill and dying, it is especially important to prioritize self care, ask for help and delegate responsibility to others.
Studies have shown that caregivers experience a rise in anxiety, depression and salivary cortisol, and that regular practice of yoga and meditation reduces all three of these symptoms.94 Caregivers can use all five of their senses to create harmony, peace and balance.95 The recommendations outlined in this paper can also apply to caregivers. Massage nourishes the sense of touch, aromatherapy can influence the mind through the sense of smell, relaxing music and healing mantras can serve as sound therapy and color therapy can be applied through flowers and pleasant visual impressions. Caregivers need to bring their attention to keeping ojas high, therefore, ojas building foods are recommended, such as nourishing soups, dates, almonds, and hearty grains such as basmati rice, quinoa and oatmeal with warming spices. Helping others have a peaceful and dignified death, either as a professional or familial caregiver, is heart centered work. Caregivers in hospice situations extend themselves above and beyond usual boundaries. Having a “good death” is important to people, and contributing to that end is a deep calling and not something that everyone is called to do.96 In order to be able to continue to give, one must avoid draining one’s self. Ayurveda has profound wisdom to offer in this capacity. Conclusion
91 Chopra, Deepak and David Simon. p. 99104 92 Ibid. 93 Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996. p. http://www.ayurvedacollege.com/book/export/html/2
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34. 94 Evidence Based Complementary and Alternative Medicine. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Danucalov et al. April 2013. 95 Sushruta Samhita. Section 8, verse 10. 96 Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013. Ayurveda is an ancient system that can be used to offer ease and comfort to patients in hospice care settings, as well as their family and caregivers. Techniques explored in this paper help support relaxation, manage stress and anxiety, and create feelings of peacefulness and upliftment. These practices assist all who are involved in experiencing and being present to the sacredness of dying. Through Ayurveda, we can explore the dimension of spirituality within us, unlocking greater capacity to love, care and be compassionate. Bibliography Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996. Charaka Samhita. Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004. Danucalov et al. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Evidence Based Complementary and Alternative Medicine. April 2013. Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. Downey, et al.“Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” American Journal of Hospice and Palliative Care. Aug 2009. Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999. Frawley, David. Ayurvedic Healing for Healthcare Professionals. California College of Ayurveda: Nevada City, CA, 1988. Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999. Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. Halpern, Dr. Marc. Principles of Ayurvedic Medicine. California College of Ayurveda: California, 1995. Heyn, Birgit. Ayurvedic Medicine: The Gentle Strength of Indian Healing. Thorsons Publishing Group: Vermont, 1987. initiateayurveda.blogspot.com Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996. Kabat Zinn. “Mindfulness Based Cognitive Therapy.” International Journal of Palliative Nursing. June 2001. www.kkayurveda.com Kubler Ross, Elizabeth. On Death and Dying. Scribner: New York, 1969. Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998. Levine, Stephan. Healing Into Life and Death. Doubleday: New York, 1987 livingyourdying.com Novak, John. Ananda Course in Self Realization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997 Page, Linda. Healthy Healing. Quality Books Inc: 1985. http://www.ayurvedacollege.com/book/export/html/2
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Shanbhag, Vivek. A Beginner’s Introduction to Ayurvedic Medicine: The Science of Natural Healing and Prevention Through Individualized Therapies. Keats Publishing, Inc: CN, 1994. Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999. Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013. Sushruta Samhita. Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998. Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998. What Hospice Is, What Hospice is Not. Patient education pamphlet distributed by Vitas Innovative Hospice Care. Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991. Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996. Abstracts from Contemp Nurse. 2013 Aug 4. Home is where I want to die: Kelly's Journey. Sneesby L, Mater C. Abstract The definition of a "good death" is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack & Seymour, 2011) 70% of Australians express the desire to spend their last days at home. In reality only 16 % of people die at home (Preferred place of death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care. from Evid Based Complement Alternat Med. 2013 Apr 18. A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients. Danucalov MA, Kozasa EH, Ribas KT, Galduróz JC, Garcia MC, Verreschi IT, Oliveira KC, Romani de Oliveira L, Leite JR. Abstract Familial caregivers of patients with Alzheimer's disease exhibit reduced quality of life and increased stress levels. The aim of this study was to investigate the effects of an 8 week yoga and compassion meditation program on the perceived stress, anxiety, depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a stress reduction program for a 2 month period (yoga and compassion meditation program YCMP group) (n = 25) or an untreated group for the same period of time (control group) (n = 21). The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after intervention. The groups were initially homogeneous; however, after intervention, the groups diverged significantly. The YCMP group exhibited a reduction of the stress (P < 0.05), http://www.ayurvedacollege.com/book/export/html/2
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anxiety (P < 0.000001), and depression (P < 0.00001) levels, as well as a reduction in the concentration of salivary cortisol (P < 0.05). Our study suggests that an 8 week yoga and compassion meditation program may offer an effective intervention for reducing perceived stress, anxiety, depression, and salivary cortisol in familial caregivers. from Am J Hosp Palliat Care. 2009 Aug Sep Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients. Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE. Abstract Improving end of life care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates' assessment of patients' benefit from the study intervention, suggested significant gains from massage the treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard end of life care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for end of life studies. from Am J Hosp Palliat Care. 2009 Aug Sep Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients. Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE. Abstract Research suggests that aromatherapy massage (AM) is increasingly being used by cancer patients, especially in the palliative care setting, although few studies have assessed its effectiveness. I wanted to find out whether AM reduces anxiety in patients with a primary malignant brain tumour attending their first follow up appointment after radiotherapy. Eight patients were recruited to the study, which comprised three methods of data collection: the measurement of physical parameters; the completion of Hospital Anxiety and Depression Scales (HADS); and semi structured interviews. The results from HADS did not show any psychological benefit from AM. However, there was a statistically significant reduction in all four physical parameters, which suggests that AM affects the autonomic nervous system, inducing relaxation. This finding was supported by the patients themselves, all of whom stated during interview that they felt 'relaxed' after AM. Since these patients are faced with limited treatment options and a poor prognosis, this intervention appears to be a good way of offering support and improving quality of life. from Int J Palliat Nurs. 2001 Jun; http://www.ayurvedacollege.com/book/export/html/2
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The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Abstract Mindfulness is a lifetime engagement not to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.Mindfulness is a lifetime engagement not to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.
Ayurvedic Approach to Down Syndrome by Vidya Venkatesh TABLE OF CONTENTS ITEM PAGE Acknowledgements……………………………………………………………………………………………….4 Abstract………...…………………………………………………………………………………………………5 Chromosomes and Cells………………………………………………………………………………………….5 Types of Down Syndrome………………………………………………………………………………………..5 Signs and Symptoms…….……………………………………………………………………………………….6 Etiology…………………………………………………………………………………………………………..6 Treatment………………………………………………………………………………………………………...7 Prevention………………………………………………………………………………………………………..7 Ayurvedic Interpretation of the Mind……………………………………………………………………………8 The Five Layers of Human Existence (Koshas)…………………………………………………………………9 Ayurvedic Interpretation of Karma……………………………………………………………………………...10 Classical Ayurveda Interpretation of Down syndrome………………………………………………………….10 Nidhana (Causes)………………………………………………………………………………………………..10 Rupa (Symptoms)……………………………………………………………………………………………….11 Samprapti (Pathology)…………………………………………………………………………………………..11 Vata Samprapti…………………………………………………………………………………………......11 Kapha Samprapti…………………………………………………………………………………………...13 Chikitsa (Treatment)…………………………………………………………………………………………….13 http://www.ayurvedacollege.com/book/export/html/2
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Herbs………………………………………………………………………………………………………..14 Nervous System Treatment and Enhancement……………………………………………………………..15 Meditation…………………………………………………………………………………………………..15 Pranayama………………………………………………………………………………………………….15 Panchakarma……………………………………………………………………………………………….15 Abhyanga, Shirodhara, and Swedhna—Bliss Therapy…………………………………………………….16 Basti………………………………………………………………………………………………………...16 Nasya (with Brahmi Ghee)…………………………………………………………………………………16 Color Therapy………………………………………………………………………………………………17 Marma Therapy……………………………………………………………………………………………..17 GTherapy…………………………………………………………………………………………………..18 Rasayana (Rejuvenation) Therapies…………………………………………………………………………….18 Aromatherapy………………………………………………………………………………………………18 Mantra Therapy…………………………………………………………………………………………….18 Diet…………………………………………………………………………………………………………18 Conclusion………………………………………………………………………………………………………18 References……………………………………………………………………………………………………….19 Photo Credits…………………………………………………………………………………………………….20
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Ayurvedic Approach to Stress by Jeff Mortlock What is stress, and what does it mean to us as people or more specifically what does it mean to the ayurvedic practitioner? It's one of those words that are much overused, or so casually, or so incorrectly that we actually lose the real meaning of the word and its significance. Stress is also commonly called anxiety, tension, etc. Stressors which are events that provoke stress are in themselves not a bad thing as one may think by the commonly overused cliches that we often hear. They are a very necessary function of the psyche and the body to deal with different situations, both positive and negative. "Life stressors involve changes in your environment that your central nervous system must adapt to during the course of daily living. Stressors include either positive or negative life events ( e.g . death, divorce, new job, new house, new baby) that require you to adapt to these changes in your life. Stress results when pressures, challenges, or demands in life exceed your coping abilities. Stress can manifest itself in physical, emotional, or behavioral http://www.ayurvedacollege.com/book/export/html/2
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symptoms." 1 "Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. What is stressful to one person is not necessarily stressful to another." 2 Stress in everyday life isn't necessarily a bad thing; however, unchecked or negative stress can be a bad thing causing many conditions that we'll look at in this paper. A little stress can be a motivating thing to get your work done on the job for example. It can make you more aware in a situation that requires serious attention. It can also be used as a life saving safety mechanism e.g. in wartime, the soldier runs or just reacts without really thinking. 1 ''The Phases of Stress" in The Cleveland Clinic Health and Information Center, Available on the World Wide Web @ www.clevlandclinic.org/health/health info/docs/0200/0296.asp?index=5274 2 Christo Hallos, "Medical Encyclopedia: Stress and Anxiety" in Medline Plus, June 17, 2005 , Available on the World Wide Web @ www.nlm.nih.gov/medlineplis/ency/article/00321 l .htm However, too much stress, or a strong response to stress, is harmful. It can set you up for general poor health as well as specific physical or psychological illness like infection, heart disease, or depression. "Persistent and unrelenting stress often leads to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs." 3 Low emotional states or poor health conditions can cause stress as well. "Anxiety is often accompanied by physical symptoms, including: Twitching or trembling Muscle tension, headaches Sweating Dry mouth, difficulty swallowing Abdominal pain (may be the only symptom of stress, especially in a child)" 4 These are some of the multitude of symptoms that can occur: fatigue diarrhea lack of concentration sleeping problems irregular heartbeat Irritability (anger) Almost all of these symptoms seem to point to a marked increase or imbalance in the vata dosha. However, all three doshas can play a role. Generally, vata individuals are likely to develop vataaggravated stress reactions, such as anxiety or fearfulness, even phobias or anxiety neurosis. Pitta individuals increase in pitta during stressful situations and typically react to stress in the form of anger. They may also suffer from hypertension, peptic ulcer, ulcerative colitis, and other pitta disorders. http://www.ayurvedacollege.com/book/export/html/2
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"Kapha individuals under stress can develop under active thyroid function, slow metabolism, and even increased blood sugar, leading to a prediabetic condition. 3 Ibid. 4 Ibid. They tend to eat and eat and eat and become chubby." 5 From a physical point of view, ''the human body responds to stressors by activating the nervous system and specific hormones in the endocrine system The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the blood stream These hormones speed up the heart rate, breathing rate, blood pressure and metabolism Blood vessels open wider to let more blood flow to large muscle groups. Putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body's energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment." 6 "Cortisol also curbs functions that would be nonessential or detrimental in a fightor flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and the growth processes." 7 Sushrut points out in the Sushruta Samhita that "a person with an uniformly healthy digestion, and whose bodily humors are in a state of equilibrium, and in whom the fundamental vital fluids course in their normal state and quantity, accompanied by the normal processes of secretion, organic function, and intellection, is said to be a healthy person." 8 ''The natural reaction known as the stress response. Working properly, the body's stress response enhances a person's ability to perform well under pressure. But the stress response can also cause problems when it overreacts or fails to turn off and reset itself properly." 9 5 Vasant Lad, The Complete Book of Ayurvedic Home Remedies, (New York: Three Rivers Press 1998), 259 6 D'Arcy Lyness, PhD "Stress" in TeensHealth, July 2007 Available on the World Wide Web @ http://www.kidshealth.org/teen/your _mind/emotions/stress.html 7 Mayo Clinic Staff "Stress: Unhealthy response to the pressures oflife" September 2006 Available on the World Wide Web @ www.nlm.nih. gov/medlineplus.stree.html 8 Kaviraj Kunjalal Bhishagratna, trans., Sushruta Samhita. 3rd ed. (India: Chowkhamba Sanskrit Series Office, 2005) 131 9 D'Arcy Lyness, PhD "Stress" in TeensHealth, July 2007 Available on the World Wide Web @ http://www.kidshealth.org/teen/your _mind/emotions/stress.html There are three phases of stress. PhaseIhas to due with the body's response to stress. Events can trigger this like divorce, finances, accidents, etc. Also, less tangible reasons might include worries, regrets, memories, etc. and how our mind interprets these mental processes. Phase II is how we interpret the stressors and our ability to cope with them Our beliefs and values determine how we will likely view these stressors. If we view them as threats or pressures, or we're feeling over attached to things or outcomes then that could compromise our ability to cope. http://www.ayurvedacollege.com/book/export/html/2
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Phase III "Reaction to stress might create or worsen physical, emotional, or behavioral symptoms. Physical high blood pressure, heart disease, ulcers, strokes, rashes, migraine, tension headaches Emotional anxiety, depression, anger, forgetfulness Behavioral overeating, poor appetite, drug abuse, excessive smoking, irritability, social withdrawal, insonmia" 10 As previously mentioned that a little stress can be good in certain situations and then the body resets itself; however, the stress due to physical threats in previous eras doesn't apply to us nearly as much as it once did. The more psychological threats/stress apply to us much more often in the modern day world, especially in the western world, where man maybe more than anywhere seeks happiness and security outside of himself and in artificial ways. The thing about psychologically stressful situations more so than physically stressful situations is that the body tends to stay in the stressed mode for longer and longer periods of time. The stress with physical threats comes and goes rather quickly and the body resets, but the psychological can last for long periods of time. This can really start to breakdown the bodies systems ifstressed for an extended period of time. 10 "The Phases of Stress" in The Cleveland Clinic Health and Information Center, Available on the World Wide Web @ www.clevlandclinic.org/health/health info/docs/0200/0296.asp?index=5274 Now, focusing on some of the major symptoms, problems, and diseases that stress can have on a person and how the ayurvedic system of medicine approaches these. Along with some of the different treatments, methods, and protocols that ayurveda suggests to help alleviate these problems. Ayurvedic methods of cure are very individualized for each patient so in a general paper regarding a particular topic more generalized methods must suffice. One of the major problems that occur with too much stress for an extended period of time would be depression. Depression needless to say is a very big problem in our society. Depression may affect most people at some point in their life to a greater or lesser degree, but when it starts to become prolonged, or it starts to affect the ability to act and interact in normal life situations, then it becomes a problem that should be addressed. Depression is more on the emotional level than the physical level and is a very reactionary symptom of stress. As Dr. David Frawley states, "depression follows stress, overwork, overexertion, and trauma, particularly adrenal fatigue. Itis generally a sign oflow Ojas and weak immune function. Depression is the most common kapha disorder." 11 Kaphas often suffer from low energy, a slower metabolism, weight gain, and attachment. These things can lead to depression. Vatas can also be affected by stress and depression. The vata type is usually more sensitive and may feel hurt more easily. ''Vata type depression is associated with feelings of abandonment, lack of love and nurturing in life. It can become severe or even suicidal" 12 Pitta depression is in large part due to a failure in their plans, a set back. The pitta type could take into consideration a sayingIheard a monk once say "if you want to make God laugh, tell him your plans for the future." 11 David Frawley, Ayurvedic Healing, 2 nd ed., (Twin Lakes, WI: Lotus Press, 2000) 324 12 Ibid. 324 http://www.ayurvedacollege.com/book/export/html/2
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With somebody that's so stressed as to fall into depression one of the hardest things is to get the patient to comply with any treatment. Dr. Frawley recommends that the first thing to be done is to initiate change and encourage activity of any kind to help restore some interest in life. A few of the general ayurvedic methods of treatment for depression would be a light stimulating diet that's well spiced with herbs that open the mind e.g. ginger and basil. There should be exposure to positive sights and sounds, like walking in nature. There should be exposure to stimulating and positive aromas like camphor or tangerine. Exercise and pranayama are very good to bring in new fresh energy and prana. A good herb to take is calamus taken as a tea with ginger and honey. And, as with any good ayurvedic regiment keeping the apana going with a mild laxative e.g . triphala. Tension is another big symptom of stress. Vagbhata wrote of tension in the Astanga Hridayam and said "that when vata getting inside the arteries/nerves present in the sides of the neck cause their stiffuess and then spreads to all parts of the body, constricts the shoulders, then makes the body bend forwards like a bow; produces bouts of convulsions, loss of movement of the eyes, move of yawnings, grinding of the teeth (rigidity of the jaw or lock jaw) vomiting of kapha (mucus), pain in the flanks, inability of speech, loss of movement of the lower jaw, back and head. This is called Anaryama (inward bending)." 13 This is obviously an extreme example of tension related symptoms; however, many people experience several of these on a regular basis. Headaches and neck stiffuess seem to be ubiquitous. Ayurveda would address tension with looking at a dosha balancing diet as should always be addressed, as well as nerviness sedatives and tonics such as Ashwaganda and jatamamsi and perhaps an analgesic like feverfew. Lifestyle issues are likely going to need to be addressed, what's making the person so tense and stressed, job, marriage, lack of rest, etc. Other of the five sense therapies like massage, shirodhara, and aromatherapy can be very helpful. 13 Board of scholars, trans., Astanga Hridayam. Vol 2 first ed. (India: Sri Satguru Publications), 129 Chronic fatigue is something else that is common that can be hrought on by stress. "Fatigue is physical and mental stress." 14 Fatigue is also called shrama and it's a condition of increased vata. An obvious treatment for fatigue would be a lot ofrest. A vata reducing diet one that is tonifing and strengthening. Sense therapies such as daily abhyanga ''removes fatigue and stress from work and life overall." 15 Morning rosemary baths are good as well. A pitta type person suffering from stress may suffer from ulcerative colitis. This is actually a pitta/vata type condition in that it's a chronic inflammatory disease causing ulcerations. The cause or etiology of this disease is a ''vata and pitta vitiating lifestyle and dietary imbalances. Emotionally this condition occurs in individuals who are prone to worry and anxiety combined with intensity and I or anger." 16 The pathology of this disease is that pitta has relocated to the colon, from the small intestine. Vata has relocated from the large intestine to the small intestine and this combination of heat and dryness causes ulcerations in the mucosa! wall The doshas both relocate in the mind as well. This causes the anger and anxiety. Some of the treatments ayurveda would recommend are following a vata/pitta pacifying diet. '"friphala in the form of shita kshaya should be considered for the longterm care of the colon. Takra is also beneficial for normalizing digestion. With nutmeg and licorice added, absorption is improved and both vata and pitta are pacified." 17 Stress can produce sleeping problems and this is a major problem with many, many people. Many things can cause sleeping problems; however, this is just focused on the sleep that is troubled by stress and anxiety. In these cases it's usually a vata disturbance. A vatavitiated lifestyle often leads to anxiety, worry, and overwhelm which in turn can disturb sleep. "Sleep disturbances are accompanied by fear, worry, and anxiety. http://www.ayurvedacollege.com/book/export/html/2
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14 Vasant Lad, The Complete Book of Ayurvedic Home Remedies, (New York: Three Rivers Press 1998), 177 15 Swami Sada Shiva Tirtha, The Ayurvedic Encyclopedia, (Bayville, NY: Ayurveda Holistic Center Press), 207 16 Marc Halpern, Clinical Ayurveda Medicine, 5 th ed. (Grass valley, CA: California College of Ayurveda) 142 17 Ibid, 144 Sleep is restless, fitful, and light. Other systemic signs of vata disturbances are likely to be found." 18 Sleeping problems in particular to the vata type that we're discussing here, are really a problem that requires most if not all of the five sense therapies. Lifestyle is important to look at, what may be something that is disturbing or causing anxiety in the person. Maybe a very disturbing work environment, a tyrannical boss, or an extremely chaotic or loud workplace. Too much coffee or caffeinated drinks. Too much TV before bedtime. A long fierce commute can be very unsettling. These are things to consider along with a myriad of other things in our vatavitiated society. Some of the things that may help a person with sleeping troubles are being quite after dark before bedtime. Rising with the sun and keeping a regular routine is helpful. Turn the TV off early, or never turn it on in the first place. Read a spiritual book to calm the nerves and uplift the soul, bathe in the peaceful vibrations of meditation before bed, or even twice a day if possible. Meditation works on all levels of a person physical, mental, spiritual. It also affects all three bodies physical, astral, and casual. On a practical physical level "p racticing meditation has been shown to induce some changes in the body, such as changes in the body's [fight or flight] response. The system responsible for this response is the autonomic nervous system (sometimes called the involuntary nervous system). It regulates many organs and muscles, including functions such as the heartbeat, sweating, breathing, and digestion, and does so automatically." 19 It's believed to slow the sympathetic nervous system, while boosting the parasympathetic nervous system, which slows the breathing and heart rate. Exercise, preferably a grounding or restorative hatha yoga routine may be helpful. A warm bath before bedtime is relaxing, perhaps with a little jatamamsi or lavender essential oil. A vata reducing diet needs to be kept. 18 Ibid, 639 19 National Center for Complementary and Alternative Medicine (NCCAM), Meditation for Health Purposes, Baime , Davidson, et al., February 2006, page 3 "Boiled milk builds ojas, promotes sleep (with warm nervine herbs). Boiled, it reduces Vayu and Kapha." 20 Anger is another problem that stress can produce, especially in the pitta type person. "Anger and hostility are signs of aggravated pitta in the nervous system. Pitta is necessary for right understanding and judgment, but when it gets disturbed or out of balance, it creates misunderstanding and wrong judgment, leading to anger and hostility. The aim is to bring pitta back to its normal constitutional function." 21 Many ifnot most people in our society create a tremendous amount of stress on themselves to keep up with everybody else, and even compare themselves to others to see if there up to standards with everybody else. People even create a false sort of desire for what others have; they have a tribal mentality to keep up, because somebody or some advertising has made them believe that they're less than others ifthey're without something. This can really create a lot of stress and anger in a person ifthey're so gullible as to follow this perverted rational Krishna in the Bhagavad Gita says, "brooding on sense objects causes attachment to them. Attachment http://www.ayurvedacollege.com/book/export/html/2
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breeds craving; craving breeds anger. Anger breeds delusion; delusion breeds loss of memory (of the Seit). Loss of right memory causes decay of the discriminating faculty. From decay of the discrimination, annihilation (of the spiritual life) follows." 22 This is a problem that can obviously run very deep, but from an Ayurvedic perspective we can view it as a primary pitta imbalance, as well as a case of prajnaparadha. Some of the Ayurvedic methods to overcome this stressinduced anger would be to follow a pittapacifying diet, lay off the chili peppers, citrus and sour foods. Avoid alcohol and caffeinated drinks. 20 Swami Sada Shiva Tirtha, The Ayurvedic Encyclopedia, (Bayville, NY: Ayurveda Holistic Center Press), 146 21 Vasant Lad, The Complete Book of Ayurvedic Home Remedies, (New York: Three Rivers Press 1998), 124 22 Paramahansa Yogananda, trans., The Bhagavad Gita, (Los Angeles, CA: Self Realization Fellowship, 1995), 307 "Have a pitta pacifying drink. Into 1 cup of grape juice, add Ya teaspoon cumin, Ya teaspoon fennel, and a Ya teaspoon sandalwood powder. This cooling pitta pacifying drink will help to settle angry feelings and other pitta symptoms such as burning in the stomach." 23 A pitta in a hot climate should try to keep cool ifpossible; hot weather can really stress a pitta. Some lunar pranayama would be good. Avoid overheating exercise routines e.g . jogging at noon or hot yoga. As far as the deeper issues the best thing there is to do for prajnaparadha is meditation. A person with issues of stress and anger could immensely benefit by disconnecting with ahamkara (ego) little by little. Introspection while being quite is an excellent tool for anyone as well. Heart disease is another area where stress has been known to cause or be a causative factor. In ayurveda and also "according to Oriental medicine, the heart, not the brain, is the seat of consciousness." 24 Dr. Frawley explains that what we feel in our hearts is who we truly are, not necessarily the passing thoughts that we think in our heads. He goes on to say that "heart diseases reflect deepseated issues of identity, feeling, and consciousness." 25 Considering this train of thought, it's easy to see why emotions and stress, as well as the obvious physical reasons of overeating, eating the wrong foods, lack of exercise, etc. can cause trouble with the heart. Allopathic medicine as well as Ayurvedic medicine sees that high stress can be a causative factor inheart disease as reported in the British Medical Journal (BMJ). "Both prevalence and incidence of angina increased with the perceiving of stress...high stress was associated with a 23 Vasant Lad, The Complete Book of Ayurvedic Home Remedies, (New York: Tbree Rivers Press 1998), 125 24 David Frawley, Ayurvedic Healing, 2 nd ed., (Twin Lakes, WI: Lotus Press, 2000) 209 25 Ibid, 209 higher rate of admissions related to cardiovascular disease." 26 In the Journal of the American Medical Association (JAMA) an article about stress research states that the authors looked at the behavior and biological mechanisms through which stress contributes to disease and weighed the results to whether stress plays a role is cardiovascular disease as well as others. "Those studies reveal that stress plays a role in triggering or worsening depression and cardiovascular disease." 27 General Ayurvedic treatment would emphasize extended rest. An extended retreat in a natural setting could due wonders, especially if the person has been a stressed out city dweller for a period of time. Meditation is great for calming the mind and emotions. A doshically appropriate diet is http://www.ayurvedacollege.com/book/export/html/2
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always important, but considering the vikruti, getting that under control first, while working toward the primary doshic routine. Certain herbs are great in different combinations, depending on the individual's particular problem and constitution; however, Arjuna is a tridoshic favorite for heart ailments mixed in combination with constitutionally correct herbs. Stress can play a huge role in our lives, and for many, or even most it plays a role on occasion or even on a daily basis. As we've seen it contributes or even causes disease. It can cause simple things like occasional sleepless nights or chronic insomnia. Can contribute to angina, or to fullblown heart attacks. Stress can lead to ulcers, anger, depression, tension, chronic fatigue, as well as a myriad of other symptoms and diseases. As we can see Ayurvedic medicine can actually play a major role in mitigating or even eliminating these kinds of problems. 26 Macleod, Smith, et al., ''Psychological Stress and Cardiovascular Disease" British Medicine Journal, May 2002 Available on the World Wide Web @www.bmj.com/cgi/reprint/16 17130/538.pdf 27 Cohen, JanickiDeverts, and Miller, "Study of Relationship Between Chronic Diseases and Stress" Medical News Today, Oct 2007 Article adapted from original press release, Available on the World Wide Web @www.medicalnewstoday.com/printerfriendlynews.php?newsid=85162 To summarize some of the different treatments and approaches that ayurveda would take in an approach to help somebody suffering from too much stress in their life: • A constitutional balancing diet is always in the forefront of treatment. What is the person putting into their body three times a day, everyday? Is it correct for that individual? • How's the elimination? The apana needs to be moving everyday so toxins don't build up and overflow into the rasa and rakta dhatus and get carried into other weakened parts of the body. This can be easily addressed with herbal formulas as needed, such as mild laxatives like triphala, psyllium, flaxseed, etc. • With the proper herbs that are nervine sedatives and tonics like ashwaganda and jatamamsi, these can be of great value. • Meditation is a very important treatment, it actually a lifestyle, not so much a treatment, but it could be used as one in the beginning, working with a person new to ayurveda. Disconnecting from the ego, withdrawing from the senses, realizing that your not just this little body, but that you're part of the whole, and that behind all oflife's drama (lila) it's all okay. There's nothing better than this for stress relief. • A life routine especially for vatas, and occasionally we may want to be a little spontaneous if kapha gets a little too lazy. • Five sense therapies are very beneficial in the relief of stress and anxiety. Of course depending on the persons constitution the treatments will vary to some degree; however, getting out into nature and seeing the trees and sunlight does everybody good. Using some aromatherapy in a warm bath or diffuser is soothing. Paying attention to the environment that your in, is it well kempt or sloppy. Are the colors in your house good for you, as well as the clothes you wear? Is your environment too noisy or restless? All of these things need to be addressed at some point. Of course taken slowly as to not overwhelm the patient, seeing they're already stressed. •
Getting the right kind and amount of exercise for your constitution and level of health.
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• •
Monitor your thinking and introspection. Get plenty ofrest.
All of these things, or depending on the individual a few of these things can and will make a difference to lessen stress.
Ayurvedic and Allopathic Approaches to Migraine Headaches By Patricia J. Brinkmann Table of Contents CONTENTS Page Number Abstract 3 Western Interpretation of Migraine Headache 3 Classic Migraine 3 Common Migraine 3 Cluster Migraine 4 Complicated Migraine 4 Abdominal Migraine 4 Basilar Migraine 4 Benign Exertional Migraine 4 Headache Free Migraine 4 Hemiplegic Migraine 4 Menstrual Migraine 5 Ocular Migraine 5 Opthalmoplegic Migraine 5 Status Migrainosus 5 NonFood Related Triggers 6 Food Related Triggers 7 Allopathic / Pharmaceutical Treatment Options 8 Nonsteroidal AntiInflammatory Drugs 8 http://www.ayurvedacollege.com/book/export/html/2
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Triptans 9 Ergotamine Tartrate 9 Midrin 9 Ayurvedic Interpretation of Migraine Headache 9 Diseases of the head 10 Vata Type Headache 10 Pitta Type Headache 12 Kapha Type Headache 15 Suryavarta Headache 16 Treatments 16 Herbs for Headaches 16 Biofeedback 17 Visualization 17 Meditation / Deep Breathing / Progressive Muscle Relaxation 18 Cervical Correction Device 18 Reflexology 18 Cervical Manipulation and Massage 18 Conclusion 18 References 19
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Eczema and Vicharchika: A Review From Western and Ayurvedic Perspectives: A Review of the Literature by Jessica Houghton Introduction Eczema is the common name given to Atopic Dermatitis, a chronic inflammatory skin condition that typically begins in the first few years of life. It is the most widespread skin disease of infancy and childhood1 and is often the initial indication that a child will develop further allergic conditions such as allergic rhinitis and allergic asthmaHthe beginning of the soHcalled “atopic march.”2. It was once thought of as solely a disease of childhood, but is becoming increasingly prevalent in all age groups. Although it does sometimes begin and resolve itself during childhood, it can progress into adulthood, or simply have a later onset for some individuals. There have been many significant scientific discoveries in recent years about the causes of eczema including the discovery of the filaggrin gene and the loss of barrier function, and also the current understanding of the role of the mast cell in allergic reaction. In addition, there have been highly credible theories as to what serves as the catalyst for the disease, http://www.ayurvedacollege.com/book/export/html/2
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including the hygiene hypothesis and the misuse of topical steroids. Atopic dermatitis is characterized cracked or scaly skin, discolored patches, erythema (red skin), papules, exudate (oozing), and intense pruritus (itching), which can secondarily cause insomnia and diminished quality of life. It may present differently, combining any of these symptoms, depending on the age and nature of the patient, as well as the stage of the disease. Eczema is usually classified in three distinct stages: infancy, childhood, and adolescent/adulthood. Beginning in the second or third month of life, it often appears as patches on the cheeks referred to as “milk crust” and later in the flexures of the arms and legs. It is reminiscent of seborrheic dermatitis, also known as “cradle cap.” At this point, the condition may or may not yet have developed into an atopic condition3. As the disease progresses into childhood, the eczematous lesions can be found on the flexural areas such as the innerHelbow, neck, and wrists. Even if the disease does resolve itself during adolescence, abnormal dryness and lichenification may remain in the affected areas. Although about 60% of the childhood cases of eczema will disappear completely4, it frequently persists into adulthood. It can also develop for the first time at this later stage. The areas classically affected during this period are the flexures as well as the orbital and perioral regions of the head and most appear as dry, lichenified plaques5. The psychological effects of eczema must be considered as well for both children and adults. Living with atopic dermatitis can have a profoundly negative effect on quality of life. Constant itching and scratching, soreness, pain, and discomfort can lead to high stress levels and sleep deprivation. Lifestyle may be affected, as the patient’s activities might be restricted. Depression is also a concern as the patient might begin to feel hopelessness, embarrassment, despair due to the chronic nature of the disease6. The specific definition of atopic dermatitis should be mentioned as the term “eczema” is often separated into two separate categories: atopic (extrinsic) dermatitis and atopiform (intrinsic) dermatitis; or in other words, allergic eczema and nonHallergic eczema, respectively. According to the World Allergy Organization (WAO), atopy and atopic conditions are defined only in association with IgEHmediated pathophysiology7. This pertains to the body’s ability to create the allergic antibody in response to an antigen. By exclusion, this would signify that only atopic dermatitis is specifically allergyHinduced eczema. There is some debate over whether there are indeed two distinct forms; it is postulated by some that non IgEHassociated eczema may represent a transitional phase of the IgEHassociated form in infancy8. At the stage when an infant or child contacts the earliest signs of eczema, in about half the cases, there is no evidence of IgEHmediated sensitization9. These patients are not yet technically considered “atopic” but could progress into allergic sensitization. What provokes the disease to progress from a nonHallergic condition to an allergic one and potentially pushes the patient to develop other atopic diseases such as asthma and hay fever? The etiology of eczema isn’t entirely clear. However, there is considerable research as to what causes it to manifest and several theories have been produced as a result. Most certainly, it is a multifactorial condition that occurs due to both genetic and environmental factors10.
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Healthy Breast Milk By: Jessica Skandunas Softly…. quietly….. gently we begin, “It’s time to nurse, my baby,” I sing. Your mouth opens wide, I soon hear you swallow, You’re drifting to dreamland, I’m tempted to follow. Blissfully we sit, wrapped up in each other, Connected, in sync; baby and mother…. Breast feeding is intended to be a joyful loving connection, a graceful welcoming and comfort of a soul into a new body. The mothers breast being located in the Anahata chakra (heart center) of the body signifies that the breast are an instrument of love, and nurturing, meant to give love outwardly through breast milk and to connect in an intimate way. It is a silent language of love. In an optimal setting breast milk is amrita, nectar, for the growing child. In Ayurveda it is known as the essence (upadhatu) of the rasa dhatu. “In fetal life, the baby receives nourishment from the mother through the placenta. After birth, the baby continues to receive all its nutrients from the mother through breast milk.” [1] The health of the mother is of huge importance in Ayurveda through all phases of bearing a child. In an optimal scenario the mother will have gone through a purification therapy (pancha karma) prior to becoming pregnant and then during pregnancy maintained herself in a healthful & harmonious way according to her dosha. Once labor has commenced the breast begin their job. The hormone prolactin is responsible for the secretion of the milk. It first flows in the form of colostrum. “This special milk is yellow to orange in color and thick and sticky. It is low in fat, and high in carbohydrates, protein, and antibodies to keep your baby healthy. Colostrum is extremely easy to digest…it is low in volume (measurable in teaspoons rather than in ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.” [2] This type of pre milk substance flows for about 24 days before the letdown of the actual milk.
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Implementing Ayurvedic Practices and Philosophy in Pregnancy By: Kelly Stoinski Every thought, action, and decision a pregnant mother makes is directly correlated to the health, vitality, and essentially, the life potential of the child. She must be mindful that every element, food article, aroma, sight, and sound entering or surrounding her body impacts the fetus, directing the dependent soul to a greater state or to a more weakened state of health. Holistic care relating to pregnancy becomes essential as soon as the mother and father even decide to embark on the journey of parenthood—before conception even takes place. Ayurvedic practices and principles applied to the pregnant mother and her pending child provide a sincere potential for an enriched pregnancy and birthing experience, contributing to greater mental, emotional, spiritual, and physical health of the mother, child, and father. How can the modern, westernborn mother implement the http://www.ayurvedacollege.com/book/export/html/2
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ancient teachings of Ayurveda as she embarks on the journey to bring a vital new life into this world? This review of literature will offer an array of insight shedding light on how the three pillars of life, herbal treatments, five sense therapies, and spiritual practices can be incorporated and utilized throughout the pregnancy experience. THE THREE PILLARS OF LIFE As much as her lifestyle allows, the pregnant mother would greatly profit adhering to the Ayurvedic principles encompassing the three pillars of life. Proper routines around food, sleep, and sexual practices will establish a foundation for an ameliorated and more harmonious pregnancy. Considering that all food ingested by the mother supplies the fetus with the building blocks of development, the highest quality and ideal quantities of foods should be consumed. The foundation of an expecting mother should emphasize a balanced kapha increasing food regimen, accentuating the sweet and salty tastes and limiting the bitter and pungent tastes. Chopra, in his holistic pregnancy book, Magical Beginnings and Enchanted Lives, infuses Ayurvedic concepts when dealing with western pregnancies. He mentions that even though the mother will tend toward “sweet foods” (meat, dairy, grains, nuts, etc), all six tastes—sweet, salty, sour, pungent, butter, and astringent— play an essential role in optimizing the nutrition available to the mother and her baby. Sweet tastes impart nourishing and tonifying attributes that encourage healthy tissue formation. Sour foods, such as citrus fruits, berries, and fermented foods, aid in digestion and stimulate the appetite; sour fruits specifically provide adequate amounts of vitamin C and flavonoids—which contribute to healthy cell development and immune function. Salty tastes, when naturally integrated in foods, support waterabsorption, enhance digestion, and can be sedating. These include seaweed, seafood, and the natural mineral salts found in fruits and vegetables. Pungent tastes, such as common culinary spices like garlic, chili peppers, onion, clove, cayenne, cinnamon, ginger, etc., help to stimulate and support digestion and metabolism, relieve nausea, and cleanse the sinuses and respiratory system. Bitter tastes are found in an array of green and yellow vegetables that contain important phytochemicals that support immune function, promote healthy growth, and often encourage cleansing and detoxification of the body. The last taste, astringent, initiates a drying response on the mucosa and creates a “puckering effect” throughout the body. Astringents include cranberries, pomegranates, asparagus, and many beans and legumes—which contribute complete and abundant sources of valuable proteins and complex carbohydrates1. So what does a mother want to achieve during pregnancy in regards to her dhatus (tissues) and body? The mother wants to foster a nourishing home and foundation for the developing fetus; without getting too absorbed by calories, meal sizes, and “pregnancy diets”, the mother will achieve balanced nourishment by simply emphasizing sweet, salty, and sour tastes that primarily tonify and fashion healthy tissue formation. Albeit, elevated intake of pungent, astringent, and bitter tastes deplete, dryout, and exasperate purification of the mother’s body. All six tastes are vital, yet concocting the ideal balance of all the tastes in each meal is the ultimate—and, yes, obtainable—goal of the mother. The Sushruta supports that, “the food should by amply sweet, palatable (ojas producing food), wellcooked, prepared with appetizing drugs and abounding in fluid substances2;” overall, highlighting sweet, cool, and moist qualities. The Charaka Samhita and Sushruta Samhita describe similar “special pregnancy” dietary regimens: in the first month, according to the Charaka, the mother is to consume large quantities of cold, unprocessed milk; in the second month, “only milk prepared with sweet drugs;” milk with ghee (clarified butter) and honey added in the third month; ten grams daily of milk butter in the fourth month; in the fifth month, she is suggested to take ghee; ghee with sweet herbs should be taken in the sixth and http://www.ayurvedacollege.com/book/export/html/2
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seventh months; and, for the final months leading up to delivery, the mother should include milk gruel cooked with ghee into her diet3. This tonifying regimen is encouraged to be included in conjunction with a nutritious, balanced, and complete diet. The Sushruta recommends nearly identical additions of milk and/or ghee at the progressing stages of pregnancy, but also encourages the intake of shashtika rice with milk in the third month, with curd in the fourth, with milk in the fifth, and with clarified butter in the sixth month of pregnancy. The addition of animal flesh soups to her diet along with including abundant emollient fatty substances is also noted as supportive to the mother especially in her later months of pregnancy4. The Sushruta is adamant that, “if treated on these lines, the enceinte [fetus] remains healthy and strong, and parturition becomes easy and unattended with evils5.” Ramesh Nanal, a practicing Ayurvedic practitioner for over 35 years, incorporates useful pregnancyrelated nutrition and specific food advice in his research; he succeeds in amplifying the clarity of the valuable information offered in the Caraka. He supports that stabilization of the fetus in the first trimester is essential—hence the importance of consuming sweet, cooling, and liquid food as suggested by the Sushruta. Garghasthapan foods (stabilizing to the fetus) help to anchor the placenta, and Nanal provides the example of supplementing with one tablespoon of Water Chestnut powder (Singhoda) decocted in a cup of warm milk with ghee, taking up to four cups a day. When the heart becomes active around the fourth month, “more pure kapha and rakta is essential for the fetus here6,” and thus, a higher quantity of milk curds with rice and ghee should be consumed during breakfast and lunch. In the fifth month, the mana (mind) of the fetus becomes active, and the buddhi (the intellect) enters the fetus at month sixth; Hyridra foods (ojas/immune building foods) become highly important, Nanal recommending an increased intake of milk (milk being described as “boon to the making of mind7”) along with ghee and rice. As the last trimester nears and the fetus’s organs and systems become more developed, Nanal merely states that the mother now “requires a specific prescription for each individual body constitution8” that also acknowledges her overall health and any lingering symptoms. Nanal goes on to introduce a few specific foodbased supplements to deliver additional support and nourishment to the expecting mother: • Garden cress seeds roasted in ghee and mixed with milk and sugar taken in the last months help with tonification, general debility, and pregnancy anemia. • Crab, corn, and egg soup or soy milk with egg yolks consumed after the second trimester is noted to assist with strong bone formation in the fetus. • Spinach soup with onions and carrots also support bone health of both mother and child, along with helping with pregnancy anemia. • Apricots—naturally very high in vitamin A—with honey is depicted as a very effective nervine tonic, yet also assisting with constipation, preventing infections, increasing healthy blood formation, and reducing the chances of cellular degeneration. • Banana with dates, figs, and ghee taken every day in pregnancy is said to be a superior overall tonic that also improves and increases blood, preventing anemia to a great extent. • When soaked and ground in water, black currents can be helpful in all urine disorders while also helping to alkalize the body and tone the large intestine. • Dates soaked in milk overnight, ground in the morning, and mixed with cardamom and honey assists in healthy blood and bone formation in the fetus. • Mango juice with ghee and milk taken two times daily may prevent fetal abnormalities, increase fetus’s defense against infections, aid in proper development, ease delivery, and prevent postpartum complications.9 http://www.ayurvedacollege.com/book/export/html/2
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Supplementing an already nutritious, abundant, and whole diet with balanced, nutrientdense foods compared to supplementing with bottled, store bought vitamins will do more to holistically support and nourish the mother and child. The Charaka notes that, “the entities derived from nutrition are these such as– formation of the body, growth, continuance of vital breath, contentment, corpulence and vigor,10” portraying the special importance of a proper and complete diet for a mothertobe. Ayurveda principles strongly support that the foods one consumes is only a component of achieving a healthy and complete diet; the proper routines and practices around eating contribute immeasurably to the inclusiveness of one’s diet. To benefit more fully from her meals, the mother should eat her meals in a peaceful and beautiful environment, eliminate alcohol, nicotine, and nonprescription drugs from her life, eliminate caffeine if possible, honor her appetite (eating only when she feels hungry and stopping when satisfied), refraining from overeating by paying attention to when her stomach is 2/3rds full, eat freshly prepared foods, reduce icecold foods and beverages, drink plenty of pure, room temperature water every day, sit quietly for a few minutes following each meal, and honor any cravings that arise, yet indulging with awareness.11 In regards to cravings, both the Sushruta and Charaka agree that desires shouldn’t be ignored. The Sushruta averring: “A physician should cause the longings of a pregnant woman to be gratified inasmuch as such gratifications would alleviate the discomforts of gestation; her desires being full filled ensure the birth of a strong, longlived, and virtuous son. A nonfulfilment of her desires during pregnancy proves injurious both to her child and her ownself12,” and the Charaka agreeing that “whatever she wants should be provided to her except those which damage the fetus13.” The other two pillars are considerably more direct. Regarding sleep, the mother should get a full night of sleep, avoid day sleep, avoid sleeping on her stomach and back (unless properly supported with an incline), and shouldn’t oversleep to prevent lethargy in herself and in birthing a lethargic and lazy child. The Sushruta supports that sexual intercourse should be avoided because of fear of harm to the child14 and the Caraka compromised with sexual activity being acceptable one time each month. However, with current research regarding sex and pregnancy, experts support that, “sex during pregnancy is extremely safe for most women with uncomplicated, lowrisk pregnancies15.” Each pregnancy is unique and sexual desire can vary with each women, thus the mother should remain present with what feels appropriate and appealing to her, simply using her desires as her best guide. In general, however, it should be acknowledged that sexual intercourse in excess is depleting to both partners and that special care, more gentle practices, increased mindfulness, and emphasizing the sacredness around sexual union becomes valuable and supportive to the pregnant couple. Ayurveda is all about balance and catering to the uniqueness of all individuals, so regarding the pillars of life and all other practices falling under the Ayurvedic umbrella, always looking at what will best support the unique mother at the present is fundamental. HERBS AND PREGNANCY Herbs are quite a controversial topic when it comes to their consumption during pregnancy, especially when considering that medicinal quantities of any herb can have unpredictable consequences on individuals. However, herbal practices have boomed immensely in the west, steering more mothers toward herbal consumption during pregnancy. Inexorably, this has led to expanded knowledge of how herbs affect pregnant woman and their babies. In Aviva Romm’s research and time in practice as a midwife and herbalist, she summarizes herbs repeatedly observed to be safe and effective, those commonly used but may be harmful, and herbs to avoid all together during pregnancy. Romm acknowledges: “Overall, most herbs are safe, with little evidence of harm. Few reported adverse events have occurred, and those that have been reported typically involve the consumption of known toxic herbs, adulterants such as unsafe herbs or even pharmaceuticals additives, or inappropriate use or dosage of botanical therapies16.” Caution should always be taken, of course, and Romm and other sources state that, if anything, the majority of herbs should be http://www.ayurvedacollege.com/book/export/html/2
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avoided all together in the first trimester17. Through scientific evaluation and clinical trials, Romm lists a handful of herbs seen repeatedly to be safe during pregnancy. Red raspberry leaf was found to be a mineralrich, nutritive uterine tonic that, with longterm, lowdose (1.55 gm in tea/infusion) use leading up to parturition, can promote an expedient labor with minimal bleeding. To reduce the duration or occurrence of upper respiratory symptoms, intermittent use of Echinacea (as tincture) has been deemed safe. Chamomile tea in moderate amounts can assist in relaxation, insomnia, and flatulence during pregnancy. In the case of a urinary tract infection, concentrated, pure cranberry juice (taking up to 32oz/day) is the ideal, nonantibacterial treatment that is safe and effective for pregnant women. Ginger, mentioned in many texts and research, is commonly recommended as a safe treatment for nausea, vomiting, and general morning sickness as long as the daily dose doesn’t exceed one gram of dried ginger powder18. Even the Natural Medicine Comprehensive Database, an extensive, online resource providing “Unbiased, Scientific clinical Information in Complementary, Alternative, and Integrative Therapies,” remarks ginger as one of the best known herbal treatments for morning sickness in pregnancy, stating: “Clinical research in pregnant woman suggests that ginger can be used safely for morning sickness without harm to the fetus19.” Other herbs, like Nettle to reverse irondeficiency, cramp bark for irritable uterus relief, licorice (only for shortterm use not exceeding a week) utilized for sore throat symptoms, motherwort for labor pain, black and blue cohosh and castor oil to simulate labor, and the external application of tea tree oil, garlic, and calendula oil for vaginal yeast infections are also notable treatments, yet less scientific research has been conducted to back up their safety—only traditional usage and empirical evidence is available20. So, what herbs should soontobe mothers avoid all together? The American Pregnancy Association lists saw palmetto, goldenseal, dong quai, ephedra, yohimbe, pau d’arco (in large doses), passion flower, black and blue cohosh (for women who are not at term), roman chamomile, and pennyroyal as herbs that are likely unsafe or unsafe for oral consumption during pregnancy. Possibly unsafe herbs may include aloe, ginseng, feverfew, kava kava, and senna, but like with most herbs, adequate research is limited21. Generally noted from the Caraka, “the diseases of the pregnant women should be managed with diet and drugs consisting mostly of soft, sweet, cold, pleasant and delicate things22.” While this is quite vague, the idea of judging herbal effects based on their gentler qualities could be of use for the pregnant mother trying to avoid harm. Throughout the Vedas, while herbal recommendation (usually via external application) are noted for use in regards to serious pregnancy complaints and disorders, little is to be found mentioning common herbal use safety during pregnancy. The Sushruta, pertaining to the overall health benefits for mother and fetus, does however include that, “the growth, memory, strength and intellect of a child are improved by the use of four following medicinal compounds, used as linctus (pras’a): 1) wellpowdered gold, kushtha, honey, clarified butter and vacha; 2) brahmi, shanka pushpi, powdered gold, clarified butter, and honey; 3) shanka pushpi, honey, clarified butter, powdered gold and vacha; and 4) powdered gold, maha nimba, white vacha, clarified butter and honey23.” As the mother progresses through her final term, bastis (enemas) are commonly employed to balance vata, particularly apana vayu—which is the vayu governing the decent of the child through the birth canal. A specific basti formulation the Sushruta suggests to help “restore vayu in her body (nervous system) to normal and to cleanse bowels, [is an] anuvasana basti(enema) with bala, atibala, shatapushpa, palala (flesh), milk, cream, oil, salt, madana fruit, honey and clarified butter.” It was then stated to follow with a basti made with milk and a decoction of Madhuradigana24. While the Charaka was vaguer, stating simply to “give unctuous enema with the oil cooked with sweet drugs25,” they can both be interpreted to support that tonifying, oilbased enemas with nourishing herbs, and maybe even nervines, would be beneficial to the mother during the eighth and ninth months of pregnancy. While ancient Ayurvedic remedies may be difficult to apply, utilizing Ayuverdic principles with the available herbs can benefit the western mother. http://www.ayurvedacollege.com/book/export/html/2
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While taking caution and/or seeking herbal advice from an expert is never a bad idea in the case of including herbs during pregnancy, the moderate use of herbal nutritive teas and cooking spices are generally considered safe to be used freely. And, again referencing Romm, a final general list of safe herbs to use for mild pregnancy complaints—having only slight variation in the medical research she gathered—include: Echinacea, St. John’s wort, peppermint, spearmint, ginger root, fennel wild yam, meadowsweet, blue and black cohosh, red raspberry leaf, evening primrose, garlic, aloe, chamomile, pumpkin seeds, and ginseng26. Herbs, however, aren’t paramount to a healthful, joyous, and symptomfree pregnancy. Through diet, including proper daily routines and practices, and managing overall stress of the mind and body, an expecting woman may find she has no need to reach in the herbal cabinet for symptomatic relief. DAILY ROUTINES AND PRACTICES The ancient Vedic practioners are adamant about implementing more sattvic routines and rituals in daily life. The Sushruta claims: “Those women who are devout in their worship of the gods and the Brahmins and cherish a clean soul in a clean body during pregnancy are sure to be blest with good, virtuous and generous children; whereas a contrary conduct during the period is sure to be attended with contrary fruits2.” Today, we may not be as devout in our thinking, but promoting and conducting practices that support spiritual growth, keep the body clean and healthy, and keep the mind calm and joyous can support and enhance the experience leading up to and following parturition. Before uncovering the practices most beneficial to the mothertobe, the Sushruta obstinately remarks on actions prohibited during pregnancy: “A woman should avoid all kinds of physical labor, sexual intercourse, fasting, causes of emaciation of the body, daysleep, keeping of ate hours, indulgence in grief, fright, journey by carriage or in any kind of conveyance, sitting on her haunches, excessive application of Sneha (oil) karmas and venesection a the improper time (after the eight month of gestation), and voluntary retention of any natural urging of the body28.” Even with these “don’ts” having been recorded in texts thousands of years ago, these simple examples still can provide a baseline of actions to avoid during pregnancy in the modern day. Implementing yoga (encompassing meditation and breathing), increased overall mindfulness, and five sense therapies as routine practices during pregnancy is supported by the ancient texts, and all can be safely and conveniently integrated into an expecting mother’s day. While strenuous exercise is almost always prohibited during pregnancy, conducting some form of exercise can be beneficial in maintaining the strength of a pregnant woman’s body—especially as the fetus grows and her energy and physical demands increase. To maintain bone strength, muscle tone (of all organs), heart endurance, and to keep her mind at ease, mild to moderate (depending on previous fitness and exercise routine before pregnancy) exercise should be adhered to daily starting at around the second trimester—because of the instability of the fetus in the first trimester, much more caution should be taken during that time. Brisk walks in nature, swimming, tai chi, and yoga are just a few examples of exercise options that will holistically sustain the mother. Yoga, the sister science of Ayurveda, is not only ideal because of its physical benefits, but yoga helps to calm the mind, alleviate stresses, and as Chopra puts it, “yoga awakens mind/body harmony, making it easier for you to make choices that are good for you both physically and emotionally29.” Because prenatal depression has been noted to be a progressively prevalent factor, recorded to affect as many as 49% of pregnant women, and being observed to be “a risk factor for prematurity, for developmental delays, and for http://www.ayurvedacollege.com/book/export/html/2
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later behavior problems in childhood and adolescence30,” safe and noninvasive measures to mitigate depression in pregnant women should be encouraged. In Tiffany Field’s study utilizing yoga and tai chi as a complementary therapy for prenatal depression, anxiety, and sleep disturbances, she found that women who participated in tai chi/yoga sessions for 20 minutes daily for 12 weeks while in their second and third trimester (weeks 22 to 34 of pregnancy) depicted greater decreases in all three areas she observed. They utilized the Center for Epidemiological StudiesDepression Scale (CESD), which is a selfreport assessing the frequency of present depressive symptoms including: “depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, loss of energy, and disturbances of sleep and appetite31.” With only positive results recorded, this study supports that yoga and/or tai chi is a costeffective, safe, and convenient way to successfully reduce depression and associated symptoms during pregnancy. Yoga can be modified for all levels, and yoga encompasses not just asana (the physical practice) but also breathing techniques, mindfulness, and meditation, making it accessible to everyone in some form. In a comprehensive literature review conducted by Kathryn Curtis, Aliza Weinrib, and Joel Katz on implementing yoga and its subsequent effects on pregnancy and the labor/delivery experience, they concluded that yoga is indicated during pregnancy having supportive psychological, physiological, neuromuscular, and immunological impacts on the mother throughout term and through and following parturition32. One of the studies they examined was a monitored yoga program lasting 1214 weeks which compared pregnancyrelated discomfort in women who completed the program to those receiving standard hospital care. The findings support that a “prenatal yoga program is safe for pregnant women and can reduce the discomforts of pregnancy and increase maternal selfefficacy and selfconfidence33.” A second noteworthy study mentioned in the review described a holistic 16 week long (week 20 to 36 of pregnancy) program including asana, breathing techniques, lectures, and deep relaxation techniques. Not only did the yoga group show significantly greater improvements in physical, psychological, environmental, and social domains tested, but the author pronounced yoga as “a noninvasive and costeffective way of improving quality of life and interpersonal relationships during pregnancy34.” With this last study, the experience of the mother throughout and following labor was examined. After a 10 to 12 week yoga program (throughout week 2628 to week 3738) was followed, maternal comfort, objective and subjective pain, length, augmentation, and the use of medication all in relation to labor, along with the overall birth outcome, was recorded. For the mothers who followed the yoga regimen, the first stage and the total duration of labor was significantly shorter, selfreported and observed pain scores were drastically lower, and evidence supports that maternal comfort at four different assessment points during and following labor was seen to be significantly higher than the mothers not following the yoga program35. While caution and medical approval should always be considered with all actions during pregnancy, overall, yoga asana, breathing techniques, and meditation/mindfulness practices most likely will only provide relief and increased comfort during and following pregnancy. Yoga encompasses such a broad spectrum of practices and asanas, so for a mother new to yoga, where is a good place to start? Chopra’s book includes many asana, breathing, and meditation practices suitable for pregnant women. Slowing down with yoga will encourage the mother to bring more awareness to her breath, while also helping with joint flexibility, balance, and muscle tone. Poses, and their potential benefits, that Chopra recommends include as follows: • Butterfly pose with spine extended straight and slowly lengthening forward. This pose slowly opens up the pelvic girdle, which by increasing flexibility in this region, the mother may experience more ease upon delivery as the baby passes through that region. • Cat and Cow pose working deeply and slowly with the breath as she moves from one position to the next. This benefits the mother by increasing spinal flexibility and hip mobility, also helping with low back pain that is often experienced with pregnancy. http://www.ayurvedacollege.com/book/export/html/2
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• Squatting pose with feet planted on the floor, hips reaching toward the floor, elbows pressing out on the inside of the knees, and breathing to extend the spine and squat lower in the pose. This works to widen the pelvis and has been observed to ease labor and reduce the chance of perineal tearing—this pose also commonly practiced around the world as a birthing position because of these noted benefits. • Pelvic Tilts/ Bridge pose with legs perpendicular to the floor and hips lifted off the floor extended towards to sky, while the shoulders ground into the floor. This assists with spinal flexibility, relieving lower back congestion and improving overall circulation in the pelvic region. • Half pigeon, with straight spine and slowly walking the hands forward, is another great pose to open up muscles and fascia in the hips and groin region. • Child’s pose with the belly resting between the knees spread wide on the floor and arms extended forward. The mother will find greater ease in her back muscles, hips, and pelvic region, while also allowing belly muscles to soften and relax. • Simple twists, whether sitting upwards or performed from laying on her back, are great for massaging internal abdomen organs and lengthening the spine36. Chopra also mentions Kegel exercises, relating to mula bhanda in the yogic realm. Regularly practicing these can drastically improve pelvic muscle tone and the functions of the organs in that region. Strengthened pelvic muscles can aid in preventing urinary incontinence, improving circulation around the pelvis, and preventing hemorrhoids, while easing delivery because of more control contracting and relaxing those muscles37. These practices conclude some simple examples that even mothers who have never before taken a yoga class can perform and receive much benefit. Endless yoga asanas are recognized that support the mother, but trained guidance and the use of props may be necessary to ensure no harm is done. Maintaining mindfulness and awareness of breath not only as she stretches and opens her body through yoga asana, but as she endures all her activities and actions should be a primary goal of the mother as she carries her baby and prepares for birth. More and more research and controlled trials are being conducted on mindfulness, pranayama, and mediation during pregnancy as an effectual and riskfree method of decreasing stress and anxiety. Especially considering the negative impacts of stress on the mother and infants, including reduced adaptive immunity, lower birth weights, increased chance of preterm births, and cognitive, emotional, and developmental deficiencies in infants—and considering the harmful nature of reducing stress symptoms with pharmaceuticals—simple, noninvasive approaches are becoming key to help with stress and depression in pregnant women. In Ka Po Chan’s study, he implemented an Eastern Based meditative intervention (including mindful eating, mindful walking, mindfulness prenatal and postnatal exercises, daily practice of ‘self help, helping others,’ crisis intervention: turn curse into blessing, daily practice of ‘bliss,’ three minutesbreathing practice, body scan, mindful breathing, etc.). He compared the birth weight, maturity, Apgar score (simple assessment of how the baby is doing at birth), and umbilical cord blood cortisol levels in babies whose mothers followed the integrative meditative approach to those who didn’t. His “evidence suggests that meditation as an intervention has a strong relationship to positive health outcomes, overall wellbeing and adjunctive treatment for diseases38.” The infants of the intervention group also portrayed a better response to stimulus along with having better overall temperament39. In another study that also focused on mindfulness, the author designed a randomized controlled study to evaluate the effects of an existing mindfulness meditation program in a sample of pregnant women experiencing elevated levels of stress. They described mindfulness to refer to “a process that cultivates a mental state of awareness and acceptance of present moment experiences, including one’s current sensations, thoughts, bodily states, and environment40.” With sharp contrast to the control group, the mindfulness intervention led to a decline in pregnancyrelated anxiety and perceived stress, along with revealing an overall increase in mindfulness41. In a final related study involving the regular practice of Bhramari pranayama (bee breath) for two months by pregnant http://www.ayurvedacollege.com/book/export/html/2
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women as a potential measure to prevent the occurrence of preeclampsia, there was a “statistically significant reduction in basal BP, response to cold stress (body’s reaction to hand immersion in cold water) and basal pulse rate after two months of this yogic practice42. They supported that pranayama practiced overtime can restore the balance between the sympathetic and parasympathetic components of the autonomic nervous system, revealing how these practices not only help the body on the emotional level when dealing with stress and anxiety, but on a physical—even quantitative—level as well. While these studies disclose just a few examples of a small handful of complementary practices, all defend that implementing a regular mindfulness/meditation and breathing practice—all of which fall under the “Ayurvedic approach”— throughout pregnancy will only bring an increased sense of ease and wellbeing to the mother and her baby during and following pregnancy. FIVE SENSE THERAPIES Ayurveda strongly asserts the importance of balancing and supporting the five senses; five sense therapies and overall awareness of how the mother and fetus are effected by the external world through the five senses is an essential component to a balanced pregnancy. Not only will the mother feel more at ease and supported, but the fetus’s development prior to and following birth is significantly influenced by tastes, smells, touch, sounds, and sights the mother comes in contact with. Chopra elaborates on this concept, including ideas on how to encourage balance through the information perceived by the five senses of the mother and fetus: The fetus is quite sensitive to outside sounds; studies support that by eighteen to twenty weeks, the fetus is hearing and responding to outside sounds. Experiments where small microphones were placed inside the womb of a pregnant women revealed that over half the words spoken by a man and over a third of the words spoken by a woman were understood. The mother’s voice is the most recognized and responded to, and if the father’s voice it frequently present, fetuses have been observed to respond to his voice soon after birth43; thus, the mother and father should be regularly talking, singing, telling stories, etc. to the unborn child throughout pregnancy. The mother, also being sensitive to sounds, will benefit by surrounding herself with calming and beautiful sounds. That could be in the form of music she enjoys and inspires her, positive and supportive conversations, or going out in nature and enveloping herself with the abundant, serene sounds of the natural world. Chopra notes that “pleasing sounds can lower blood pressure, enhance immunity, and reduce anxiety44.” Sounds and music can also be utilized to balance a dosha vitiation: with more anxiety and vata present, gentle and calming music will help to ground the mother; with heated emotions and heightened pitta, cooling and soothing sounds will suffice; and, with lethargy, melancholy, and more kapha present, uplifting and revitalizing music can support increased energy and motivation. While intently utilizing beautiful sounds will positively impact the mother and fetus, distressing, loud, obnoxious noises and stressful and odious conversations may have an antagonistic effect and, if possible, should be avoided. The fetus is also directly affected by touch: “Pressure through external massage leads to changes in fetal activity and heart rate, and by six months in the womb the unborn baby is as responsive to touch as a oneyearold baby45.” As the mother changes her position, so does the fetus; studies reveal how rapid and abrupt movements of the mother trigger a motor response and alter heartrate in the fetus. On the opposing end, fluid and rhythmic movements of the mother, such as dancing, tai chi, and yoga, can bring ease to both mother and child. Daily fullbody selfoil massage (abhyanga) is a practice recommended as an essential component of balancing regular routines in the Ayurvedic realm, and the pregnant mother would greatly benefit from incorporating a daily 10 to 20 minute abhyanga into her morning. Not only is the oil nourishing and tonifying, the rhythmic movements and strokes of gentle massage assists with lymph flow, circulation, immune function, and http://www.ayurvedacollege.com/book/export/html/2
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delivers an overall improved sense of wellbeing. If stretch marks are a concern, applying body butters, coconut oils, or avocado oils with the addition of vitamin E and/or the essential oils of chamomile and helichrysum may bring relief to prone or affected regions. Different oils may also have distinctive influences on the mother: sesame, almond, and walnut oils are heavier, warmer oils that help to pacify vata; coconut, avocado, and olive are cooler oils that are thought to be more balancing to pitta; and, mustard seed, sunflower, and safflower oils, which are warmer and less dense, are valuable to kapha. Warming these oils, infusing them with doshicappropriate essential oils, and/or following the massage with a warm bath will augment the benefits and increase the sensations of this soothing oil therapy. Specific massage of the perineum (the area surrounding the birth canal) in the months leading up to birth will become an essential addition to the mother’s daily massage routine. Chopra mentions that this will not only aid in keeping the tissues nourished, but it will mildly stretch the tissues and better prepare them for a delivery, decreasing the chance of tearing or injury in that region46. Uttara bastis (an herbal oil enema of the vaginal canal where one to two ounces of warm, medicated oil is held in the vagina as the pelvis remains in an upwardtilted position) is an Ayurvedic practice used for the same tonifying purposes, but with an advantage of administering herbal oils for broader effects on the mother and womb. The Charaka mentions a slightly different approach, proclaiming that, “A swab soaked with [sweet herbal] oil should be placed inside the vagina to lubricate the seat of the fetus as well as the entire genital tract” with added benefits of softening “the entities which hold the fetus, womb, waist, sides and back of the woman at the time of delivery, wind gets in normal course, urine and feces in normal state get through the passage easily; skin and nails also become soft, strength and complexion are improved and she delivers the child as desired, excellent and healthy with ease and in time47.” Because of how essential is it to support and normalize apana vayu (the downward flow that will govern the safe and easy delivery of the fetus) in an expecting mother—especially in the last half of the third trimester—these practices will do more than nourish and strengthen the perineal tissues, but will also support the other physical and subtle actions that apana vayu governs. Comment [KS1]: The womb is generally a dark place exposing the fetus to an insignificant amount of light (2 to 10% of visual outside light is thought to be perceived by the fetus), and the fetus has been observed to be only slightly responsive to changes in lighting and visuals of the outside world. However, the sights and visual exposures of the mother can impact the fetus because of how the mother responds on a more subtle level. Exposure to violence, gore, and distasteful images and scenery impairs the mother, even being noted to suppress the immune system49. In contrast, being encompassed by beauty and kind acts enhances immune function in the mother—and thus the child. Creating a home environment that is beautiful and begets delight (even including color therapy concepts to bring greater balance), getting out in nature every day, gazing into the starry sky each night before bed, and incorporating balancing color meditation (based on doshic vitiations) can all add to the wellbeing of the mother, and in essence, the fetus. Tastes ingested by the mother slightly impact the fetus, studies suggesting that “an unborn baby will increase or decrease his swallowing based on the flavors present in the amniotic fluid50.” Sweet tastes are observed to be the most desirable to both the fetus and mother—as we have already explored—and bitter tastes are seen to be the least desirable, being depicted by babies swallowing less when bitter tastes are injected in the womb. Much has already been imparted on the matter of tastes and nutrition for the mother to be, so just a final reminder of the importance of including all six tastes on a daily basis and excluding all foods perceived as “distasteful’ and invoking a negative response in the mother, and by default, the fetus. The final sense, smell, has a slight—yet notable—influence on the fetus. Evidence suggests that babies remember smells and tastes they are http://www.ayurvedacollege.com/book/export/html/2
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exposed to in the womb and are likely to express greater preference for foods whose fragrances they were exposed to during pregnancy. Because the child only knew the scent of his mother’s amniotic fluid for the first nine months of life, studies have depicted that “if a newborn baby is given the choice of suckling on her mother’s unwashed breast, which secretes a smell similar to the smell of amniotic fluid, or on a breast that has been washed, more than 75% of the time the newborn will choose the breast with the familiar amniotic smell51.” The tastes, and thus the smells, entering the mother’s body does subtly transfer to the fetus, but the scents and aromas in the mother’s environment will be more impactful on her wellbeing, moods, behaviors, and energy levels. Unpleasant odor can deplete and offset the mother, while pleasant and tasteful aromas can soothe and encourage an increased feeling of peace. Intentional aromatherapy—essential oils, fresh flowers, natural wax candles, etc being all great options—can be utilized to calm or uplift the mother, balancing vitiated doshic states experienced throughout and following pregnancy. A few examples of vata pacifying, calming aromas include lavender, geranium, chamomile, vanilla, juniper, and rose. To counter pitta and intense/heated feelings, scents like jasmine, rose, neroli, mandarin, sandalwood, and lavender are seen to cool and soothe. Invigorating and purifying scents that may assist in pacifying stagnation and kapharelated symptoms of the mind include cinnamon, juniper, ginger, bergamot, and citrus aromas. Diffusing, burning, incorporating these in massage oils and baths, or simply keeping a scented vile or spritzer bottle handy are all great methods of utilizing the profound effects of aromatherapy. Considering how intake through the senses influences the mother and fetus, the mother should utilize this knowledge to create a more balanced pregnancy. The Sushruta was adamant that negative exposure of the five senses can be harmful to the mother and fetus, strongly asserting, “she should not touch nor come into contact with unclean, deformed or maimed persons, and should forego the use of fetid smelling things, avoid dreadful sites and painful and agitating sounds and the use of dry, stale, and dirty food as well as that prepared overnight52.” While we can’t expect a mother to constantly be in control of all the qualities she is taking in through her senses, she can, however, achieve more mindfulness of what she is exposed to in her environment and how to mitigate the aspects that aren’t supportive. Pregnancy is a sacred time and should be treated as such. Commonly in the west we assist pregnant mothers with not much more than increased food intake, prenatal supplements, and regular doctor checkups. While many successful births have occurred following the standard western lifestyle, Ayurveda looks deeper into optimizing health, ease, and vitality of the physical and subtle bodies of both the mother and fetus. Following a balanced, tonifying diet with the addition of food supplements for nutrient and rejuvenating support, including safe herbs only when necessary, incorporating an individualized exercise and yoga asana routine for the mother, implementing a meditation and pranayama practice, and utilizing therapies and simple lifestyle choices to bring balance in through the five senses are all effective regimens that play a preventative, stabilizing, and, overall, supportive role for the mothertobe. To create a pregnancy experience that is void of stresses, frustrations, and unnecessary discomforts and abundant in love, contentment, ease, and joy is absolutely an achievable goal. Implementing Ayurvedic practices in a way that is compatible with the lifestyle of a westernborn mother will assist in obtaining this goal, not only as she carries the child, but as she goes through labor, delivery, and caring for the child postpartum. Ayurveda isn’t a cure, but merely a balancing wayoflife that supports our body, and ultimately our soul, as we embark on the journey of life; and, if we are so destined, this journey may include the magical experience of pregnancy. Endnotes: 1. Deepak Chopra, David Simon, Vicki Abrams, A Holistic Guide to Pregnancy and Childbirth: Magical Beginnings, Enchanted Lives (New York: Three Rivers Press, 2005), 7680. http://www.ayurvedacollege.com/book/export/html/2
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2. Kaviraj Kunka Lal Bhishagratna, Sushruta Samhita: An English translation, Volume II (Calcutta, 1911) 216217. 3. Gabriel Van Loon, Charaka Samhita: An English Translation (P.V. Sharma and Chaukhambha Orientalia Publishers, 2005), chapter 8, sutra 32. 4. Ibid. 2, p. 217218. 5. Ibid. 2, p. 218. 6. Vaidya R. M. Nanal, “Food In Pregnancy an Ayurvedic Overview,” Ancient Science of Life 28.1 (2008): 30. Print. 7. Ibid. 6, p. 30. 8. Ibid. 6, p. 31. 9. Ibid. 6, p. 32. 10. Ibid. 3, chapter 3, sutra 12. 11. Ibid. 1, p. 9192. 12. Ibid. 2, p. 139. 13. Ibid. 3, chapter 4, sutra 17. 14. Ibid. 2, p. 137. 15. WebMD, Denise Mann, Sex during Pregnancy: Is It Safe? http://www.webmd.com/baby/features/sexduringpregnancyisitsafe 16. Aviva Romm, “Herbs for the Momtobe,” Mothering: (January/February 2008). 56. 17. Ibid. 18. Ibid. 16, p. 59. 19. Natural Medicines: Comprehensive Database, Natural Medicines Staff, Natural Medicines Used during Pregnancy and Lactation. http://naturaldatabase.therapeuticresearch.com/ce/ceCourse.aspx?s=ND&cs=&pc=11102&cec=1&pm=5. 20. Ibid. 16, p. 61. and Ibid. 19. 21. American Pregnancy Association, American Pregnancy Association Staff, Herbs and Pregnancy. http://americanpregnancy.org/pregnancy health/herbsandpregnancy/. 22. Ibid. 3. 23. Ibid. 2, p. 238. 24. Ibid. 2, p. 217218. 25. Ibid. 3, chapter 8, sutra 32. 26. Ibid. 16, p. 57. 27. Ibid. 2, p. 143. 28. Ibid. 2, p. 137. 29. Ibid. 1, p. 111. 30. Tiffany Field, Miguel Diego, Jeannette Delgado, and Lissette Medina, “Tai Chi/yoga Reduces Prenatal Depression, Anxiety and Sleep Disturbances.” Complementary therapies in clinical practice 19.1 (2013): 6–10. PMC. Web. 21 Feb. 2015. 31. Ibid. 32. Kathryn Curtis, Aliza Weinrib, and Joel Katz, “Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions,” EvidenceBased Complementary and Alternative Medicine, 2012 (April 2012) 1. 33. Ibid. 32, p. 78. 34. Ibid. 32, p. 67. http://www.ayurvedacollege.com/book/export/html/2
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35. Ibid. 32, p. 8. 36. Ibid. 1, p. 110124. 37. Ibid. 1, p. 124. 38. Ka Po Chan, “Prenatal Mediation Influences Infant Behavior,” Infant Behavior & Development 37 (2014): 558. 39. Ibid. 38, p. 560. 40. Christine M. Guardino, Christine Dunkel Schetter, Julienne E. Bower, Michael C. Lu, and Susan L. Smalley, “Randomized Controlled Pilot Trial of Mindfulness Training for Stress Reduction During Pregnancy,” Psychology & health 29.3 (2014): 335. PMC. Web. 20 Feb. 2015. 41. Ibid. 40, p. 343. 42. Sanjeev Rampalliwar, Chanda Rajak, Ravikant Arjariya, Meghna Poonia, Ritu Bajpai, “The effect of Bhramari pranayama on pregnant women having cardiovascular hyper reactivity to cold pressor test,” National Journal of Physiology, Pharmacy, and Pharmacology 3(2)(2013): 137141. 43. Ibid. 1, p. 2728. 44. Ibid. 1, p. 27. 45. Ibid. 1, p. 30. 46. Ibid. 47. Ibid. 3, chapter 8, sutra 32. 48. Ibid. 45. 49. Ibid. 1, p. 60. 50. Ibid. 1, p. 32. 51. Ibid. 1, p. 33. 52. Ibid. 2, p. 216217.
Irritable Bowel Syndrome: The Ayurvedic Approach By Branislava Petric Introduction (General and Western Approach) Irritable Bowel Syndrome (IBS), known as an irritable colon, is a very common reason for visits to primary care physicians or gastrointestinal specialists. IBS causes great distress to patients. It is an idiopathic, functional, gastrointestinal disorder characterized by abdominal pain and altered bowel habits, including diarrhea, constipation, alternating diarrhea and constipation, distension, bloating, nausea, and sensation of incomplete evacuation. There also may be symptoms of the upper gastrointestinal tract (GI) such as heartburn, chest pain and dysphagia. Also, there is broad range ofnonGI tract symptoms. These may include somatic and psychological symptoms such as fatigue, irritability, headache, anxiety, depression, and even urologic dysfunction and gynecologic symptoms. Because of such a wide range of symptoms, clinicians should use the MANNING CRITERIA to increase correctness of the diagnosis of IBS, which is defined as "abdominal pain or discomfort that is relieved by defecation or associated with change in stool frequency or consistency, abdominal distension, the sensation of incomplete evacuation and the passage of mucus". http://www.ayurvedacollege.com/book/export/html/2
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[l] Epidemiology Prevalence of IBS varies between 10 to 22% of the US population. It is believed that as much as 30% of the population might have had it during some period of their lives. About 6080% of IBS sufferers are women. Researchers aren't sure why this is so, but they suspect that changing hormones in the female menstrual cycle may have something to do with it. IBS can affect people of all ages, but it is more likely to occur in people in their teens through their forties. Many adults have IBS. However, fewer than half of adults with symptoms seek medical attention. IBS is a worldwide disorder with a similar prevalence rate in both developed and developing countries. Etiology and Pathogenesis ''JBS is called a functional disorder because no structural, biochemical or infectious etiology has been found." [2] There is definitely a disorder of motor and sensory functions of the GI tract. Some other functional disorders of the GI are noncardiac chest pain and nonulcer dyspepsia. They both share underlying pathogenesis mechanisms with IBS: a) Stress is often considered an important factor but there is no proof that it is the direct cause of IBS. Most likely, stress can lead to exacerbation of !BS. More than half of IBS sufferers who seek medical help have underlying anxiety or somatiz.ation. Those who do not seek medical help are similar psychologically to normal individuals. b) Abnormal myoelectrical activities have formed in the colon and small intestines. Differences are reported between patients with constipation predominant and diarrhea predominant symptoms. c) One study describes that "IBS patients often have lower visceral pain threshold, reporting abdominal pain at lower volumes of colonic gas insufilation or colonic balloon inflation than control group. Although many patients complain of bloating and distention, their absolute gas volume is normal. Many patients report rectal urgencies despite small rectal volume of stool." [3] d) Women and patients with increased life stressors at the onset of bacterial gastroenteritis have increased risk of developing postinfection IBS. It is possible to find inflammatory cells in mucosa, submucosa and muscular layer of intestines. Symptoms and Signs Abdominal pain is cramplike and intermittent in the whole abdominal area or specifically the lower abdominal area Onset of pain is common with change of stool frequency and usually relieved by defecation. Itdoes not occur during sleep. Patients can have: I. 2. 3.
Constipation predominant type (infrequent bowel movement less than three times per week, a bard lump stool with straining) Severe diarrhea predominant type (frequent and loose stool more than three times per day and mucous is frequently seen) Constipationdiarrhea alternation type.
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Diagnostic Evaluation The diagnosis of IBS is based on detailed history evaluation, physical examination, laboratory tests, and further testing that is needed to exclude other diseases. Symptoms must be present at least three months before the diagnosis can be made. It is important to exclude other diseases, especially those which can threaten the life of patients, but it is also important not to overtest. First, dietary history should be evaluated: • caffuinated beverages or food and beverages sweetened by fructose or sorbitol may cause cramps, bloating and diarrhea • a three week trial of a lactose free diet should be done in order to exclude lactose intolerance • emotional and social life should be examined for symptoms like stress, panic disorders and/or depression, which are often present with GI symptoms Physical examination is unremarkable, mild tenderness may be present Any lumps in abdomen, an enlarged liver or spleen, or positive observable blood tests, require further evaluation. Inwomen, endometriosis should be excluded. Patients should be asked about red flags for disorders other than IBS, especially patients older than 40 years of age. Symptoms such as severe constipation or diarrhea, nocturnal diarrhea, weight loss, history of cancer and inflammatory bowel disease must be considered and included in further examination. Laboratory tests usually test for the complete blood count, serum albumin ESR, and thyroid function. Jn patients with diarrhea, serological test for celiac disease and stool examination for ova and parasites should be done. Jn patients under the age of 45, flexible sygmoidoscopy should be considered to exclude ulcerative colitis. Jn patients over the age of 45 who have not had a previous evaluation, a barium enema or a colonoscopy should be performed in order to exclude malignancy. Jn a differential diagnosis, colonic neoplasia, inflammatory bowel disease, hypo or hyperthyroidism, chronic endometriosis or other causes of chronic diarrhea must be excluded. Jn women, prior sexual or physical abuse should be taken into consideration. Therapy General Measures First of all, physicians should reassure patients that JBS is not a life threatening disease. They should provide support, educate patients about JBS, and explain all stress foods and lifestyle choices which can cause exacerbation of problems. They should discuss the importaoce of mindgut interaction; explain the circu/ous vitiosus phenomena, that the more you worry about functional symptoms, the more anxiety and distress you will feel. Dietary Measures Patient must learn that fatty foods, caffeine, fructose, sorbitol, legumes, crucifers, raw onions, grapes, plums, garlic, red vine, and beer exacerbate symptoms. Jn patients with constipation, high fiber foods may help. Pharmacological Measures Pharmacological measures are predominantly symptomatic. More than twothirds of JBS patients have mild symptoms. Drug therapy is for the one third with severe symptoms. Here are some drugs which may help patients with severe symptoms: http://www.ayurvedacollege.com/book/export/html/2
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a) Antispasmodic agent: and anticholinergic agent which is used for treatment of acute episodes of pain and bloating. (belladonna, hyoscyamine). Anticholinergic side effects are common; some side effects are urinary retention, tachycardia, dry mouth and constipation b) Antidiarrheal (loperamid) usually used prophylactically in stressful situations c) Anticonstipation agent's trial of fibers supplementation with psyllium, methylcellulosis, polycarbophil, bran can be helpful for treatment of constipation but may exacerbate intestinal gas or bloating. Milk of magnesia may increase stool frequency and reduce straining. d) Psychotropic agents are beneficial for patients with pain and bloating. Low doses of tricyclic depressants and anxiolytics should be used only in acute anxiety episode because of their habituation potential. e) Serotonin receptor agonist and antagonists, tegaserod and alosetron. Tegaserod increases stool frequency, improves stool consistency, and reduces abdominal pain and bloating. Alosetron is used for treatment of women with severe IBS with predominant diarrhea It alters visceral sensation through blocking of 5HT3 receptors, increases the pain threshold and slows colonic transit time. Other therapies a) Behavioral modification with relaxation techniques, biofeedback and hypnotherapy may be helpful to some patients. Sometimes, evaluation by a psychiatrist or psychologist should be done. b) Alternative medicine therapies. According to James Braly, MD (medical director of lmmuno Lab, INC in Fort Lauderdale, FL), nuts, seeds, fruits with small seeds, alcohol, caffeine, and spices should be avoided. He also recommends supplements, including zinc, vitamin A, primrose oil, entericcoated peppermint oil and ginger, all of which have a good reputation of helping. Chamomile, valerian, rosemary, balm have antispasmodic effects. c) David Hoffinan recommends mixtures of tincture of bayberry, gentian, peppers and wild yam in equal parts.
The Ayurvedic Approach to IBS Introduction and definition In Ayurvedic literature, the symptoms, called grahani, resemble most of the IBS symptoms, which can occur due to a number of factors: improper eating, drinking, exercising too soon after eating, forcing or restraining natural urges, taking chemical drugs, etc. Grahani is a pathological condition of the function and integrity of the GI tract, especially of the small intestine tract, which is the site of enzymes (digestion), of absorption of nutrition from food and the release of undigested food to the large intestines. IBS is a disorder characterized by abnormally increased motility of the small and large intestines. Stodies show that ''the circular and longitudinal muscles of the small bowels and sigmoid colon are highly susceptible to motor abnormalities. As a result, many factors could influence their contraction rate and lead to excess activity of their function, which is the basis of IBS. So, Ayurveda evaluation of IBS is made by search of various root causes of excessive GI motility through determination of the imbalances in the functioning mode."[4] The Ayurvedic history of IBS http://www.ayurvedacollege.com/book/export/html/2
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IBS has been a problem for people for thousand of years and has been mentioned in the earlier literatures of Ayurveda. Basic causes of IBS (Etiology or Nidana] [5] 1. Toxins accumulating in tissue blocking the circulation. 2. Poor nutrition, like consumplion of heavy food, overeating, consumption of improper food, consumption of too many fluids or fluids that are too cold. 3. Poor digestion as a result the intake of improper food at improper times, or skipping meals 4. Imbalance of the nervous system 5. Accumulation of physical and mental stress 6. Diminished natoral resistance and immunity (low ojas) 7. Disruption of natural biological rhythm Rupa (Signs and Symptoms) Besides all the symptoms mentioned in the general introduction like diarrhea, constipation, alteration of diarrhea and constipation, gas, distension and abdominal pain (severe in Vatatype), there may be evidence of malabsmption on the tongue. Malabsmption is a state of weakness of the small intestine and can be created by any dietary extremes: food that is too hot or too cold, too much sweet food, a diet that is too complex or too irregular, overeating or too much fasting, and junk food. Extreme eating can bring imbalance of the digestive fire. Nidana (Etiology) According to Ayurvedic literature, the most important causes of IBS is Vata vitiation and low ojas, caused by stress and different diet and lifestyle imbalances: quality of food (extreme tastes and qualities), overeating, certain lifestyle (stress, too much traveling, ignoring bodily urges and irregular sleeping patterns). Pitta vitiation can be combined with Vata, but Vata is predominant. Also, food intolerance (dairy or grains), rather than food allergy could be present in 3366%of IBS patients. An imbalance between two neurotransmitters, serotonin and norepinephrine, may cause problems. Therefore, interaction between the brain and gut is disturbed. A history ofuse of acetaminophen is associated with diarrheapredominant IBS (imbalance of action of the neurotransmitter serotonin). Reproductive hormones in women, specifically progesterone, which is high in the postovulatory phase, can cause constipation. Also, before or during the onset of menstruation, women may report loose stool or dianhea As mentioned before, stress, because of a variety ofreasons, can cause IBS: financial or marital problems, death in family, and especially emotional, sexual and physical abuse are all possible causes of stress. We should mention anxiety, depression, and hostile feelings as well. Samprapti ( Pathology) In the Vata type IBS, ''Vala accumulates and becomes aggravated in the purishavaha srota (colon) and overflows to the rasa and rakta dhatus. http://www.ayurvedacollege.com/book/export/html/2
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Itthan relocates to the small intestine where it vitiates samana vayu and disturbs agni."[3]. The symptoms are gas, distention, malabsorption, and diarrhea/constipation alternation. IfVata relocates into mamsa dhatu of mahavaha srota, cramping is present. Ifirregular habits vitiate samana vayu in the manovaha srota, the mind becomes unstable and the patient may experience "anxiety due to prana vayu vitiation and worry due to vyana vayu vitiation"[5] Inthe Vata/Pitta type, "pachaka pitta accumulates and becomes aggravated in the small intestine where it causes burning indigestion and loose stool. It overflows to the rakta dhatu where it vitiates ranjaka pitta causing increased systemic heat. Pitta then relocates into the mind, disturbing sadhaka pitta and causing anger. This is combined with the pathology described under vata."[6] The enzyme secretion due to all the causative factors is disturbed by the dominant dosha, and the result is secretion of enterotoxins. They cause acidification of fuod, which damages the mucous membrane of the intestines. The result is disturbance in apana vayu, or the evacuation of bowel contents. Excess mucous in the stool is a very frequent symptom and it isnot related to mucous injury, but may be related to cholinergic hyperactivities. Abdominal pain in IBS patients is probably "caused by abnormally strong contractions of the intestinal smooth muscles or by an increased sensitivity of the intestine to distention."[6] Upasaya (Diagnosis) Some Ayurvedic literature states that there are two different types ofIBS (Vata and Ptta/Vata); others state that there are four types or even six. 1. Vata or the constipation type of JBS with all vata symptoms: dryness of skin and mucous, constipation or alternation of constipation and diarrhea, a cold feeling thirst, bloating, insomnia, anxiety, fissures, weight loss. 2. Pitta or the diarrhea type of JBS with presence of hotness, thirst, heartburn, diarrhea, irritability, anger, sweating, inflammation, fever, and foul smelling stool. 3. Kapha or dysentery type ofIBS, with presence of nausea, indigestion, heaviness in the chest and abdomen, foul smelling belching, mucus in the stools, sluggish bowels and lethargy. 4. Tridoshic or complex type of!BS with combined symptoms of all the above types. 5. Accrual type of !BS has combined symptoms of all three doshas with a lot of borborygmi, undigested food and alternation of several days of accumulation of stools followed by several days of passage ofloose stools. It is a chronic type of !BS. 6. Tympanites type of !BS is chronic as well and its symptoms are rumbling sounds in abdomen and increased bowel movements with undigested food particles. "[7] Western medicine diagnostic methods are explained in a general approach. They are very useful in Ayurveda diagnostics, but the most important thing is determination of which doshas are involved after taking a detailed patient's history of symptoms, lifestyle and habits. Clinical Course and Prognosis IBS is generally difficult to cure and it takes time. According to Ayurveda scholars and practitioners, it is curable in children, difficult to treat in middle age patients and incurable in older patients. The chronic types of IBS are very difficult to cure or even incurable. Chikitsa (Therapy) http://www.ayurvedacollege.com/book/export/html/2
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Vata type IBS: The most important thing in Ayurveda therapy is reducing stress. All stressreducing measures are helpful: meditation, pranayama,, doing asanas, aromatherapy, gem therapy, color therapy and massage. Routine in everyday life is important, like regular sleeping and eating, and avoiding stressful situations. Generally, sattvic life is important. The Ayurveda practitioner should give lifestyle advice. Understanding of dosha involvement is important and unique and it is an essential tool in Ayurvedic healing of IBS. Besides stress management and diet, herbs are part of therapy as well. Digestive tonics like chitrakadi vati and shankha vati are beneficial for the elimination of enterotoxins. That could be followed with the administration of medicinal ghee preparation like dashmuladi ghrita. Triphala is beneficial as a long term formula in the form of shita kshaya. In 8oz of room temperature water, !tbs of triphala should stand overnight or for one day and should be consumed without the powder on the bottom. Nutmeg is beneficial for malabsorption, cramping and vatatype diarrhea. Carminatives, like asofoetida and ginger are good in case of distention and gas. Ashwaganda is beneficial as a nerving tonic and generally calm vata. Sesame oil can be used with food or as massage oil or enema The abdomen should be massaged 5 min. before soaking in warm water. Ginger.fennel, clove, cardamom will stimulate digestion, absorption and clear ama from the digestive system. Hingvashtaka chuma, in a dose of Itsp, mixed with I tsp of ghee twice per day, followed by hot water, is a good remedy for flatulence. Shanka pushpi andjatamamsi are used in case of anxiety as a nervine sedative. Light food is advised in treatment of Vata IBS. Food like bread, cheese, red meat, and foods that are cold, hard, dry and raw should be avoided. A light fast, like consuming only vegetable soups, takra, a little basmati rice, or kitcharee, is beneficial. Takra, which is half buttermilk, half water, churned with asofoetida, rock salt and cumin is an excellent digestive astringent and improves the consistency of stool. It contains Lactobacillus bacteria, which helps to restore the normal flora of the intestines. VataPitta type of IBS The important thing is to manage the mind and digestive system. Because pitta and vata are involved, it is important to manage both. It is important to use bitters to cool the annavaha srota and the rakta dhatu. "A good choice is aloe vera, because it is moist and a not too strong bitter alterative and it will not vitiate vata. Caution must be present because oflaxative effecta of aloe vera, and long term of use can lead to dryness." [8] Red raspberries are an example of astringent herbs which are a good choice for pitta diarrhea. Fennel, coriander, cardamon are excellent dipanas for this type of IBS. Pitta emotions like anger, intensity, can be alleviated by cool nervines like shankhapushpi and gotu kola. Sandalwood powder in ghee is good for cooling pitta. Turmeric, guducci, shatavari are all excellent for balancing pitta. Demulcents like licorice, marshmallow, besides aloe vera and shatavari, are good for burning diarrhea and smelly gas. Sweet, bitter and astringent foods are the right choices for this type of IBS. General principles of eating light, easily digestive foods (like vegetable soups, kitcharee, takra with a good choice of spices) are applicable to diet for this type of IBS. Avoiding greasy and fried food is important. Patients with chronic IBS need tonification, so bala and shatavari may be used. Lifestyle changes 1. 2. 3. 4. 5.
Increase dietary fibers. Restore healthy balance of bacteria in GI tract. Identify and remove food intolerances. Mindbody therapy. Bring daily routine into life.
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6. 7.
Be aware that IBS is not life threatening health problem. Learn not only what the right food is, but also how to prepare and combine food properly.
Conclusion MS is an intriguing disorder and a challenge for any health practitioner. Fortunately, this disorder is not lifethreatening but it can make life very difficult for IBS sufferers. It is important that practitioners and patients are aware that a cure may take time. Patients need to learn how to cope with and minimize the symptoms of their disorder in the case that it isnot curable. [1] [2] Harrison's Principles of Internal Medicine, pg 1646 [3] Current Medical Diagnosis and Trea1ment, pg.593 [4] www.theraj.com/ibs/index.h1ml Maharishi Ayurveda Approach to ms, pg 1of 6 [5] MHalpern, Principles of Ayurveda Medicine, Digestive System, 138 [6] M. Halpern, Principles of Ayurveda Medicine, Digestive System, 140 [7] Mishra, L. Scientific Basis for Ayurvedic Therapies, pg 359 [8] MHalpern, Principles of Ayurveda Medicine. Digestive System, 141
Bibliography Fauci, Braunwald, Isselbacher, Wilson, Martin, Kasper, Hauser, Long. Harrison's Principles of Internal Medicine. McGraw Hill, 1998. Tierney, JR L ., McPhee, Stephen J., Papadokis, Maxine A.. Current Medical Diagnosis & Treatment. Lange Medical Book/ McGrawHill, 2004. Krapp, Kristine and Longe, Jaqueline L.. The Gate Encyclopedia of Alternative Medicine. Gate Group, 2000. The Burton Goldberg Group. Alternative Medicine, The Definitive Guide. Fife, Washington: Future Medicine Publishing, 1994. Frawley, Dr. David. Ayurvedic Healing .Twin Lakes, WI: Lotus Press, 2000. Mishra, Lakhmi Chandra. Scientific Basisfor Ayurvedic Therapies. Boca Raton London New York Washington D.C.: CRC Press, 2004. Halpern, Dr. Marc. Principles of Ayurvedic Medicine. Grass Valley, CA: California College of Ayurveda, 2002. Murthy, Prof. Dr. K.R Srikantha. . Madhava Nidhanam (Roga Viniscaya). Varanasi, India: Chankhamba Orientalia, 2004. Dash, Dr. Bhagwan. Ayurvedic Remedies, Ayurvedic Curesfor Common Disease. Full Circle Publishing Ltd., 1997. http://www.ayurvedacollege.com/book/export/html/2
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www.theraj.com/ibs/index.html Maharishi Ayurveda Approach to IBS
It’s All In Your Gut: The MicrobiotaMental Health Connection by: Greta KentStoll For thousands of years Ayurveda has emphasized the critical nature of digestion and its impact on the entire health of the organism. Modern science is starting to catch on to this connection, with the emergence of compelling research on the connection between gut health and mental health. Studies are now making it into the mainstream. In October 2014 there was a story on NPR entitled “Gut Bacteria Might Guide the Workings of Our Minds.” In the news report Rob Stein says “There’s growing evidence that gut bacteria really might influence our minds.”1 Dr. Emeran Mayer, a professor of medicine and psychiatry at UCLA, discusses recent research in which he conducted MRI scans on thousands of volunteers and then compared their gut microbe makeup to their brain structure. In sixty of those volunteers he found a distinct correlation between how areas of the brain connect and the type of bacteria dominant in their gut. The bacteria in our guts may influence the circuitry in our brains.1 Additionally, researchers at McMaster University, in Ontario, conducted studies on mice in which they altered their gut environments and observed whether the change in gut bacteria influenced characteristics such as boldness, timidity, and aggression. The findings were compelling: researchers observed that when timid, anxious mice were given the gut bacteria of fearless mice they became less anxious and timid.1
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Kaya Kalpa and the Alchemical Tradition in Ayurveda and Siddha Medicine By Ione Linker ‘History’ of Kaya Kalpa “Ten thousand years ago, a King of India had a problematic, headstrong daughter, who refused to marry any of the eligible princes who were presented to her. In anger and frustration the king decreed that she was to be blindfolded and placed in the castle courtyard in the midst of all her http://www.ayurvedacollege.com/book/export/html/2
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suitors. The man she first touched was to be her husband and their children would continue the Royal line. On that day an elderly holy man wandered into the courtyard to deliver herbs to the King's physician and, by chance, was touched first by the princess. Even though he pled exemption due to his advanced age and holy vows, the King's word was law and they were to marry in three months time. The holy man consulted his teacher about his problem and the teacher instituted an intensive program to rejuvenate and energize. For 90 days the holy man ate a special diet, performed breathing techniques, took ritual herbal baths and was anointed with sacred oils. At the end of that time his hair had turned from gray to black, a new set of teeth had grown into his mouth, and his skin and body were youthful and strong. He married the Princess. They had many children and of course lived happily ever after. This was the beginning of Kaya Kalpa treatment. Vigorously suppressed by the British, it almost was lost. There are now fewer than 30 practitioners in the world.” 1 This “history” of the mysterious ancient rejuvenation process of ‘Kaya Kalpa’ is found on the websites and in the brochures of many of those few presentday practitioners of updated forms of this treatment. ‘Kaya Kalpa’ is most often referred to in passing in Ayurvedic literature as a mystical or legendary process used to revitalize and even immortalize the most spirituallyevolved saints and sages in ancient India, and not described as a realistic or repeatable therapy.
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Promoting the Health of Mother and Baby During Pregnancy Using Ayurveda by Christine Visco Introduction Pregnancy is a happy andjoyous time of life for many women. It can also be a challenging time of life as tbe mother's body goes through numerous changes in order to create and support the development of a new life. Ayurveda is an excellent addition to the care provided by medical doctors and midwives. Ayurveda creates support for the physical, mental/emotional and spiritual bodies of the mother and her baby. This paper is written for Ayurvedic practitioners, alternative care practitioners, mothers and fatherstobe, and other people who already have some basic knowledge of Ayurveda and who want to apply and broaden that knowledge to include care during pregnancy. Topics covered within the paper include modern references and classical texts. Several of the books referenced include much more information on this topic than is covered in this paper and readers are encouraged to seek out those sources. Promoting the Health of Mother and Baby During Pregnancy Using Ayurveda begins with a month by month description of developments during pregnancy. Itthen covers the topics of apana vata, nutrition, tbe daily routine, yoga asana, meditation, happiness, challenges, herbs as well as herb examples and herb research, treatments, classical month by month regimens, Indian herbal gbees, Sanskrit terms for pregnancy, and preparing for the baby. http://www.ayurvedacollege.com/book/export/html/2
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Month by Month Description of Pregnancy using Classical Texts and Modem Research Month 1: The embryo takes the form of ajelly. 1 A gelatinous substance is formed.2 The zygote begins to divide immediately after conception. Itthen travels down the fallopian tube and embeds in tbe thick lining of the womb where it links up with the mother's blood vessels.' Fertilization and implantation into the uterine wall occur. The baby's brain, heart and spinal cord begin to form. Baby is 1/25th of an inch long.4 Month 2: The embryo takes the form of a knot (a male), an elongated muscle (a female), or a tumour (a eunuch).' The molecules of air, fire, earth, water and ether are acted upon by pitta, vata, and kapha an elongated shape indicates a female, a lumplike appearance indicates a male and a tumourlike shape indicates an absence of sex.6 The embryo floats in a fluidfilled sac; it has a simple brain, spine and central nervous system. The digestive and respiratory systems are beginning to develop.7 The baby's heart begins to beat, the neural tube along the baby's back closes, the umbilical cord appears, and the fmgers and toes form. Baby is Y.inch long.8 Month 3: All senses and limbs as well as their organs appear.9 Lumps appear that will form the hands, legs and head.10 The fetus has all the sense organs as well as completely formed limbs including fingers and toes. The heart starts beating and circulates blood. 11 Movement begins, neurons multiply, sex may be apparent, and fingernails and toenails appear. Baby is 3 inches long and weighs 4/5 of an ounce.12 Month 4: The mother feels excess heaviness in her body due to the stabilization of the fetus.13 All limbs and organs become more distinct; viscus of the heart allows consciousness to form. Desires of the heart are thus made manifest to the mother and must be followed so that the baby is not born deformed.14 The fetus has a neck as well as joints in the arms and legs. The hard bones begin to develop.15 The baby flexes and kicks, hormone effects are apparent, skin begins to form and facial expressions are possible. Baby is 4 to 5 inches long and weighs just less than 3 ounces. 16 Month 5: There is an increase in flesh and blood of the fetus; the mother may get thinner. 17 The fetus gains the mind (manah) and wakes up from its sleep of subconscious existence.18 The fetus is quite active, kicking and turning. The sex organs are visible and there is a fine, hairy covering called a lanugo that has developed. 19 Fat stores begin to develop, the baby begins to hear, movement begins to happen, urine is produced and eyebrows appear. Baby is 6 inches long and weighs about 9 ounces.20 Month 6: There is an increase in strength and complexion of the fetus; the mother may lose her strength and complexion.21 Cognition (buddhz) enters the fetus. The fetus straightens out and becomes erect.22 A grayishwhite, cheesy coating called vernix covers the skin. Sweat glands form.23 Bone marrow begins producing blood cells, taste buds develop, practice breathing occurs as amniotic fluid moves into and out of the lungs, a regular sleeping and waking cycle appears, and foo1prints and fingerprints form. Baby weighs 1 Y.to 2 pounds.24 Month 7: There is an all around development in the fetus; the mother may become deficient in all aspects of her health.25 All limbs and members of the body are developed.26 Fat starts to accumulate under the skin and the brain develops dramatically. The baby can suck its thumb and respond with facial features to different tastes.27 Eyes can open and close, it's movements are forceful, and hiccups can be experienced. Baby weighs 3 to 4 pounds.28 http://www.ayurvedacollege.com/book/export/html/2
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Month 8: Ojas moves back and forth between mother and baby. The mother may experience a wavering feeling of sorrow and joy due to this movement. The unsteadiness of the ojas makes delivery during this month dangerous.29 Ojas does not remain stable and birth at this time isn't safe.30 The baby's head is now proportionate to the rest of the body.31 There should be at least 10 movements every 2 hours but they will be less forceful. Pupils can constrict, dilate, and detect light. Baby is 16 to 19 inches long and weighs 6 to 6 Y,pounds.32 Month 9: Normal delivery takes place between the beginning of the 8"' month and before the end of the 10"' month (counting lunar months of 4 weeks).33 Most of the lanugo hair and vernix have been lost The skin will be flesh colored and plump. The baby shifts to a head down position.34 Fat continues to accumulate, organ function improves, and the placenta provides antibodies. Baby is 19 to 21 inches and weighs 7 to 8 pounds.35 Apana Vata Apana Vata must be kept in balance during pregnancy. Itis the downward moving flow of energy in the body and must not be too strong or too weak. Most ayurvedic recommendations will be to balance apana vata. An emotional disturbance that can be caused by excess vata is anxiety. Foods, rest, and oil massage will be prescribed in order to restore balance.36 ''The apana vata is key to maintaining the pregnancy as well as birthing the baby at the time of labor.'.37 Nutrition Food needs to be fresh and wholesome. Fresh vegetables and fruits, whole grains, and dairy products are the mainstay of the diet. Eat organic; avoid packaged foods, irradiated foods or genetically engineered foods. Food should be delicious and usually cooked because it is easier to digest.38 Vegetable intake is extremely important. Dark, leafy greens like collards, kale, broccoli and green lettuces as well as squashes, sweet potatoes, and carrots should be eaten at least daily. A broad range of vitamins and nutrients will be provided by these vegetables.39 "The mother should be given whatever she wants during this period except perhaps those that are harmful for the foetus.',40 Denial of desires can lead to aggravation of vata. Even things which are harmful can be used ifthey are processed or combined with things that are wholesome.41 Gratifying her desires will result in a strong, longlived, virtuous son. "A nongratification of any sensual enjoyment by its mother during gestation tends to painfully affect the particular senseorgan of the child.42 Eat all 6 tastes (sweet, sour, salty, pungent, bitter, and astringent), but emphasize sweet, sour, and salty. Examples include dairy (whole milk, butter and yogurt), sweeteners (honey and natural sugar), oils (olive oil and ghee), fruits, vegetables, beans (mung beans or split mung dahl), spices (fennel, cumin and ginger), and nuts (blanched almonds).43 http://www.ayurvedacollege.com/book/export/html/2
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How food is eaten is just as in3portant as what food is eaten. The mother should feel light, happy and satisfied after her meal. She should not feel unconliortable, have gas or pain, or feel dull.44 Rec=endations include eating the main meal at noon, waiting at least 3 hours between meals, and sitting down while eating. Also, she should taste the food, not have distractions, and avoid overeating.45 Sattvic foods will build ojas. These include many of the ones previously listed but most in3portantly include milk and ghee (clarified butter). Milk should be taken warmed wiili cardamom or turmeric added for better digestion. It is recommended to take it as a snack and not wiili a meal. Ghee is a nourishing, unctuous food. It promotes digestion and is digested quickly.46 Sattvic food is especially good for building ojas during ilie gth monili. Ghee, milk, dates, apricots, and sesame seeds are all recommended. 47 Tamasic foods often produce ama instead of ojas. These are hard to digest foods like meat, eggs, alcohol, aged cheese, leftovers, fermented foods, mushrooms, onions, gar1i.c, and peanuts.48 It is important to keep the fetus nourished throughout pregnancy. Dr. David Bruker presented research ilia!shows low birth weight may be linked to disease later in life. The theory is that ifnutrients are insufficient then they will be diverted from organ development to more important areas like brain development During the time an organ is developing it needs to receive ilie correct nutrition or it may never develop properly.49 Weight gain is extremely individualized '"The most important factor seems to be a steady weight increase on healthy foods." Ifthe diet is high quality then there shouldn't be any worries about whether the weight gain is too high or too low. It is important to pay attention to the body's messages. Eating when hungry, even if in the middle of the night is important.50 The greatest care is required during the first trimester and last trimester. During the first trimester, emphasis should be placed on nurturing the uterine bed by consuming foods that help the rasa and rakta: juicy fruits, coconut water, and milk. During the last trimester, there should be less fat, less salt and less water in the diet.51 "Excellent nutrition includes pure water, controlled breath, abundant light, loving and respectful relationships, beauty and harmony in daily life, positive, joyous thoughts, and vital foodstuffs."52 Ayurveda practitioners have a wide range of beliefs about what foods should be consumed for optimum health. Practitioners range from raw food vegetarians, vegetarians, vegans and meat eaters. "If you do include meat, fish, poultry and eggs in your diet now, DO NOT attempt to drastically change your diet during pregnancy. This could trigger a release of toxins to your child, plus the body will need to use different enzymes and digestive juices to build and assimilate vegetable protein rather than animal protein." It is important for everyone but especially those who choose to eat meat to ensure that the elimination system is functioning properly.53 The Cleveland Clinic says that vegetarians can have a healthy pregnancy and remain on their diet. Important facts to remember are that 200 to 300 more calories each day are needed, a variety offoods should be consumed and enough protein should be eaten. Three servings each day are http://www.ayurvedacollege.com/book/export/html/2
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recommended of protein. Nutrients to focus on include calcium, iron, vitamin C, folic acid, vitamin A and vitamin Bl2.54 The body needs 15% more energy, Khalsa recommends 300500 more calories each day.55 If there is any doubt about adequate nutrition, supplements should be taken.56 She also recommends extra calcium during the 2••half of pregnancy to ensure adequate jaw growth.57 The work of Dr. Weston A. Price studied isolated nonindustrialized peoples and the relationship of diet to human health. "Dr. Price's research demonstrated that humans achieve perfect physical form and perfect health generation after generation only when they consume nutrientdense whole foods and the vital fatsoluble activators found exclusively in animal fats.'"'8 The Foundation recommends pregnant women consume cod liver oil, raw milk, butter, eggs, fresh liver, seafood, beef and lamb, coconut oil, bone broths, soaked whole grains and fresh fruits and vegetables.59 The Foundation also provides resources for obtaining healthy foods and food preparation techniques that could be beneficial to anyone.60 Daily Routine Two of the main components of a daily routine are going to bed early and getting up early. It's important to go to bed during the kapha time of day (6pm to 1Opm). It is easier to fall asleep and sleep will be more restful. It is important to wake up before the kapha time of day (6am to 1Oam). Energy, vitality and alertness are greater if waking before 6am.61 Naps should be avoided except during the hot summer months.62 Rest though should be frequent and before feeling tired Rest is especially needed in the first two months of pregnancy as well as the last two months.63 Abhyanga, a fullbody selfmassage, is important to perform each day. Stress and fatigue that may push vata dosha out of balance are relieved through abhyanga. Warm sesame oil by placing a container in warm water. Apply oil with an open palm using long strokes on the long bones and circular strokes on the joints. Massage all parts of the body and very gently apply oilto the abdomen. A warm bath or shower after the abhyanga helps open the channels of circulation.64 Massage of the nipples is recommended after the 4"' month.65 Foot massage can also be used to help balance vata. Energy will be kept flowing throughout the body and all systems will be stimulated. This would be an excellent activity for the partner to perform. Use sesame or almond oil. Warm baths are also an option that can relax the muscles allowing better circulation and preventing stagnation of toxins. 66 A sitzbath is recommended a few times each week or every night for the last 6 weeks prior to birth. A handful of linden flowers steeped in one liter of water and added to the bath will aid in softening the perineum. 67 For those mothers new to Ayurveda, the book Aveda Rituals by Horst Rechelbacher offers a very easy introduction to Ayurveda as well as the parts of the daily routine.68 For further guidance on the daily routine, see "The Daily Routine" under "Ayurveda" on the website http://www.dragonflyhealing.net 69 Yoga As11na Walking, swimming and yoga asanas are the best exercises.70 All normal asanas can be practiced during the first trimester. During the 2nd and 3rd trimesters, do not put pressure on the abdomen; examples would be cobra (bhujangasana) and bow poses (dhanurasana). Inverted postures should not be practiced during the 3rd trimester. The best asanas encourage pelvic and hipopening; these can be done sitting or standing. Examples http://www.ayurvedacollege.com/book/export/html/2
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would include bound angle sitting pose (baddha konasana) and open legs forward bend (upavista konasana). Postures that promote flexibility and strength of the spine are also good.71 Khalsa's book The Gift of Giving Life includes a 20 page chapter on breathing, yoga and relaxation. She discusses several yoga positions that can be practiced daily; both why and how are covered.72 Some yoga studios offer special classes for pregnant mothers. One example is Down Doggie Yoga Studio in Grass Valley, CA which offers a special program called Bodhi Baby Yoga.73 The owner of the studio Deborah Jordan says, "Yoga not only helps a pregnant women exercise but teaches her how to relax into discomfort. Yoga is nurturing and teaches us to relate to our bodies and ourselves with compassion and respect. Prenatal yoga empowers a woman as she prepares for childbirth and parenthood by turning her attention inward strengthening her confidence, her ability to trust her intuition, to speak her truth for the health and wellbeing of herself, her baby, and her family."74 The Gunasheela Surgical and Maternity Hospital in Bangalore, India conducted a study of 335 women. Approximately half practiced one hour of yoga each day including postures, breathing and meditation. The other half walked 30 minutes twice a day. They began the study with women between 18 and 20 weeks of pregnancy. The conclusion of the study determined that yoga is safe. Italso improves birth weight and decreases preterm labor. "Complications such as isolated intrauterine growth retardation (IUGR) (p < 0.003) and pregnancyinduced hypertension (PIH) with associated illGR (p < 0.025) were also significantly lower in the yoga group."75 Meditation During pregnancy, entrainment occurs. "Entrainment is the tendency of natural cycles to come into coordination with each other." Bonding between mother and baby occurs as the two entrain; their biological rhythms matching eacb other. A research project that studied the effects of mothers who practiced Transcendental Meditation and their babies quiet alertness showed that those who practiced this technique had double the quiet alertness of those who did not meditate. 76 The mind must be trained in order to experience relaxation of the body. "We have found that easy, fast birthing is highly dependent on the ability to relax and surreoder to the process of birthiog." The mind can be calmed by concentratiog on the breath. Allow breath to move in and out of the body as waves move in and out from the shore. "When we relax the body and bring the breath into a relaxed rhythm, we can then begin to hear the message of the internal voice and can even heal our aches and pains.'m ''The aura of a pregnant woman is one of the easiest to see, for it is particularly luminous and full of gold.'' ''The gold colour in the aura indicates that the pregnant woman is intensely connected to high spiritual beings who support and foster the embryo. Pregnancy is therefore a privileged time for spiritual growth. Itis a time to do a lot of meditation and enlightening reading, and to work at developing intuition and perception. "78 Happiness Maternal attitude is the most important factor in determining the child's physical and emotional wellbeing. Growing up in India, Dr. Reddy observed the family and friends of the pregnant mother; they provided her with much emotional support. The family often cooked special treats and http://www.ayurvedacollege.com/book/export/html/2
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friends would bring gifts and sweets. The culture believes that for the baby to be happy, the mother must be happy. The mother would take more rest and the father and inlaws would help out with household chores.79 Music can play a role in happiness. Several studies have shown that uplifting, soothing music helps increase the baby's intelligence.80 "The sound of the veena (Indian string instrument which is held by the Goddess Saraswati), flute and Samaveda mantras gives health to the pregnant woman and the child within." An example of a CD is "Garbh Sanskar : Blessings For The New Arrival".81 A search conducted on Amazon.com of the word "Garbh" showed 4 CDs available. Baby showers over 5 separate months are traditional in India. Starting in month 3, the family and friends hold a shower to celebrate the five senses, one each month. Usually they are in this order: sight, taste, hearing, smell, and touch. Each shower celebrates a sense by giving gifts that stimulate that sense organ.82 Babies are able to remember things from their neonatal experience as well as learn while in the womb. Children have memories of incidents, they remember music that was played and they've shown knowledge of academic subjects that were taught. Babies also remember painful memories. Those born to parents who had fights were more likely to have health issues. Those exposed to hard rock would move violently in the womb.83 During the 4"' month, it is important for the mother to have happy relationships especially with the father. This is due to the heart developing as the seat of consciousness. Ifthere are disturbances during this time the baby's heart could develop defects. Before this time the baby is connected by astral projection only but after this time the mental body of the baby is connected to the physical body.84 About the 5"' month, the mother's navel begins to protrude out. The navel point is where 72,000 nerve endings unite just under the navel. These nerve endings become more exposed to outer vibrations. The mother's ability to feel her environment and those around her increases dramatically. This sensitivity needs to be honored and used as a method of protection for both mother and baby.85 During the 8"' month, the ojas moves between mother and baby. It is important to rest during this time and eat ojas building foods. The mother shouldn't waste energy and should let the energy go inward She should spend time in nature as well as chant and meditate. Things to avoid include overwork, worry, anger, hunger, excessive sex, sorrow and devitalized food 86 "Ayurvedic teachings promote a proper attitude of worship towards all pregnant women's.7 The mother needs a "clear joyful spirit" in a clean body. She should wear clean and white garments. She should avoid dreadful sights, painful or agitating sounds. Agitating emotions of the mind are dangerous (anger, fright, etc). She should not carry a heavy load or talk in a loud voice. The food she eats should be "...sweet, palatable, well <:ooked, prepared with appetizing drugs and abounding in fluid substances."88 "The child in the womb feels pain in the same part of its body as the one in which its mother feels any; whether this (pain) may be from an injury or through the effect of any deranged rnorbific principle (dosa) of her organism."89 Challenges http://www.ayurvedacollege.com/book/export/html/2
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Many of the health challenges of pregnancy can be prevented by paying attention to nutrition. Low blood sugar contributes to mood swings and morning sickness. Insufficient calcium contributes to hypertension, backaches and severe labor pains. Lack of nutrients also contribute to varicose veins, constipation, anemia, hemorrhoids, and skin discoloration. Preeclampsia can be linked to acute malnutrition. 90 The best method of taking care of challenges is to resolve imbalanced conditions before pregnancy. Pregnancy increases all three doshas: vata with change and expansion, pitta with metabolism and heat increased, and kapha with increased bulk of body. These changes effect the woman's constitution as well as interacting with the baby's constitution and environmental influences. Therapies and herbs which distwb apana vata must not be used. Prevention is the easiest approach to health.91 Challenges can still occur despite the best efforts. These can include backache, high or low blood pressure, painful breasts, constipation, heartburn, hemorrhoids, indigestion, kidney problems, leaking urine, nausea and vomiting, nerves, insomnia, swelling of hands and feet, tingling and numbness of limbs, varicose veins, and other complications.92 Susun Weed's book The Wise Woman Herbal for the Childbearing Year covers many recommended foods and herbs that can be used during pregnancy to maintain and improve health. 93 Also, Khalsa's book The Gift of Giying Life, covers many herbal and nonherbal solutions to challenges that develop during pregnancy.94 The classical texts describe 9 diseases peculiar to pregnancy: anorexia, nausea, dryness of mouth, vomiting, edema, fever, anemia, retention of urine and diarrhoea.95 Herbs "Don't take herbs during your pregnancy unless you are absolutely certain they are safe. Herbs are powerful and can have harmful effects on you and your baby ifthey are not safe for pregnancy.' 86 ''The FDA urges pregnant women not to take any herbal products without talking to their midwifes or doctors first Women are also urged to consult a trained and experienced herlialist (or other professional who is trained to work with hems) if they want to take herbs during their pregnancies." Some hems cause uterine contractions, miscarriage, premature birth and birth defects. Herbs should be used with caution.97 Greater caution with herb use is advised during the first trimester as well as with signs of a fragile pregnancy; that is why herb lists will differ.98 Herbs should be taken more for their nutritive value. Emmenagogues, purgatives and toxic herlis should generally be avoided Very hot or very cold herbs as well as spicy hems and bitter hems should be used carefully. Hems for rebuilding the reproductive tissue are helpful: ashwagandha, bala, shatavari, white musali, and kapikacchu. Chyavan Prash is recommended. Pitta women do well on shatavari and kapha women do well on cardamom, fennel and basil. 99 The Natural Medicines Database rates hems based on safety. Red raspberry leaf, peppermint leaf, ginger root, slippery elm bark, oak straw, blond and black psyllium, garlic and capsicum have all been rated Likely Safe or Possibly Safe.100 This means there have been scientific evaluation, clinical and human studies that showed no adverse affects.101 Dandelion, German chamomile, and nettles have all been rated Insufficient Reliable Information Available. 102 This rating means there has been insufficient scientific evidence supporting their use.103 Nettles have also been rated http://www.ayurvedacollege.com/book/export/html/2
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Likely Unsafe. The reason for this rating may be concern about what part of the plant is used and how much. Saw palmetto, goldenseal, dong quai, ephedra, pay d'arco, passionflower, black and blue cohosh, roman chamomile, and pennyroyal are rated Likely Unsafe or Unsafe. 104 The proper time to use a specific hem needs to be researched in depth. An example is blue cohosh. Itshould not be used during pregnancy due to its effect of uterine stimulation. "It may be used in the 9th month of pregnancy, under the guidance of a trained health care professional. "105 Its typical use at that time is in a "Mother's Cordial", a formula that is used during "...the last 3 weeks of pregnancy as a partus preparator." This formula has been used for over a I 00 years. Ittones those muscles that are weak and relaxes those muscles that are spastic.106 Herbal infusions can supplement the need for increased nutrition. Infusions of red raspberry leaves or nettles are recommended for those with pitta or kapha dosha and infusion of oatstraw is recommended for vata dosha.101 Aroma therapy is another method of using herbs. Some essential oils that are considered safe to use during pregnancy include mandarin, tangerine, grapefruit, roman cahmomile, geranium, rose maroc, rose bulgar, ylang ylang, lavendar and jasmine. 108 Mitti Attar (baked earth) is a vata pacifying oil that is rubbed on the belly of a pregnant woman when the baby is too active.109 Some oils which are not safe to use during pregnancy include basil, cinnamon, clove, peppermint, and thyme. Research is necessary before use as with any herb.110 Examples of common herbs used during pregnancy Nettle Leaves (Urtica dioica) PKV+111 It has the most chlorophyll of any herb. It includes almost all known vitamins and minerals necessary for human health and growth. The taste is deep and rich and the infusion is a dark green color approaching black Nettle will aid the kidneys, nourish the mother and fetus, ease leg cramps and muscle spasms, reduce hemorrhoids, decrease pain during and after birth, prevent hemorrhage after birth, and increase richness and amount of breast milk.112 It also prevents kidney and bladder infections, prevents anemia, and glucosuria. 113 Nettles is high in vitamins A, C, K, calcium, potassium, and iron. Despite the Natural Medicines Database giving nettles a rating of Unsafe, it is highly recommended by midwives and herbalists. 114 Red Raspberry Leaves (Rubus) PKV+ (in excess)115 "It contains fragrine, an alkaloid which gives tone to the muscles of the pelvic region, including the uterus itself." It prevents miscarriage and hemorrhage, eases morning sickness, reduces pain during labor and after birth, and assists in the production of plentiful breast milk. It contains vitamins C, E, A and B as well as calcium and iron.116 "Some studies have even reported that using red raspberry leaf during pregnancy can reduce complications and the use of interventions during birth." There is some controversy about which trimesters it can be used safely; many only use it during the 2ru1 and 3"' trimesters. 117 Dandelion Leaves (Taraxacum officinale) PKV+118 Itis rich in calcium and folic acid.119 It promotes general wellbeing, improves appetite, and reduces skin complaints. 120 It is best for treating preeclampsia. Three ounces of fresh or cooked greens are recommended daily. Dandelion heals the liver, helps kidney function and provides a source of calcium and potassium. It can also be taken as an infusion. 121 It can relieve mild edema and nurish the liver.122 Oatstraw (Avena Saliva) VPK+ 123 It is rich in calcium and magnesium. It helps relieve irritated skin, restlessness, and anxiety.124 Both oats http://www.ayurvedacollege.com/book/export/html/2
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and oatstraw can be taken with similar effects. It promotes a strong nervous system and endocrine system and also can ease spasms and inflan Jmation. 125 Oatstraw is an excellent rejuvenative for women weakened and tired by childbearing or who have had repeated pregnancies. 126 Ashwagandha (Withania sornnifera) VKP+ and Arna + (in excess) "...is a good food for weak pregnant women; it helps to stabilize the fetus." 127 Shatavari (Asparagus racernosus) PVK+ or Arna + "...its quality is sattvic and aids in love and devotion." It is a general, reproductive, and nervine tonic as well as a nutritive, rejuvenative, and denrulcent. 128 Oatstraw, Ashwagandha, and Shatavari are all rejuvenative tonics (rasayana karma) that "...rebuild the bodymind, prevent decay, and postpone aging." They increase the quality of the body and build ojas.129 Vidari, shatavari, yasthimadhu, and hrahrni are all considered lifebuilding herbs that can be taken in milk and are rec=ended during the 2•• and 3"' months. Brahmi can be taken after the 3"' month to help calm the nerves and is also considered a sustainer of pregnancy. From the 4"' to the 7"' month, hems like ashwagandha, kraunch beej, and guduchi are advised to strengthen the uterine muscles and provide nourishment to the embryo. They also help prevent intrauterine growth retardation. After the 7"' month, hems which are mild diuretics and urinary antiseptics are recommended such as gokshuru and sariva. Basil, which is antispasmodic is advised in small quantities. 130 Study of safety and efficacy of herbs during pregnancy The Graduate Department of Pharmaceutical Studies at the University of Toronto, Canada has produced a series of articles reviewing the safety and efficacy of selected hems doring pregnancy and lactation. These articles appeared in The Canadian Joornal of Clinical Pharmacology issues for Fall 2006 and Winter 2008. The researchers searched 7 electronic databases and compiled data. Summaries of the research follow: "...Panax ginseng was not associated with adverse effects when used during pregnancy."131 "There is no direct evidence of safety or harm to the mother or fetus as a result of consuming cranberry during pregnancy." 132 "In pregnancy, there is poor evidence based on theoretical and expert opinion and in vitro studies that chastetree may have estrogenic and progesteronic activity, uterine stimulant activity, emmenagogue activity and prevent miscarriages. "133 "Based on the available scientific information, blue cohosh should; 1) be used with extreme caution during pregnancy ..."134 "Ginkgo should be used with caution during pregnancy, particularly around labour where its antiplatelet properties could prolong bleeding time." 135 "Caution is warranted with the use of St. John's wort doring pregnancy until further high quality human research is conducted to determine its safety."136 "Echinacea is nonteratogenic when used during pregnancy." 137 "Black cohosh should be used with caution during pregnancy, particularly during the first trimester where its purported labourinducing effects could be of concern,..."138 Research Study in Norway http://www.ayurvedacollege.com/book/export/html/2
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Between February and June 2001, 400 women were interviewed within 3 days of giving birth concerning their use of herbs during pregnancy at Ullevltl University Hospital in Oslo, Norway. 36% used one or more herbs during their pregnancy and frequency of use increased by trimester. The first trimester being the least and third being the most. "The most commonly used herbs were echinacea, ironrich herbs, ginger, chamomile and cranberry." 39"/o of the women had used herbs that are considered harmful or lacking adequate data for safe use.139 ''Women between 26 and 35 years with a prior history of herbal drug use and highknowledge about herbs, are more prone to using herbal drugs in pregnancy." 140 Treatments "A pregnant woman is to be treated very cautiously as ifone is walking with a pot full of oil, in hand without letting a drop to fall." Drugs, diet and other therapies should be soft, sweet, cold, pleasant and tender. "She should not be administered emesis; purgation, sirovirecana (therapy for the elimination of dosas from the head) and raktamoksana (bloodletting)."141 "During the seventh month, the abdominal skin gets stretched giving rise to itching and striations, which are, called kikkis. This should be treated by taking sips of the infusion of berries or butter medicated with Manjistha, the application of the pulp of sandalwood and lotus or of a paste made of neem, basil and manjistha, or oil medicated With Karveer 1eaves or J.asmm. e.,,142 In the 8"' month, it is recommended to start doing perinea! massage 4 or 5 times each week. Itcan be done by the woman or her partner. "Directions: Wash hands, then use licorice ghee as a lubricant and insert one or two fingers along the bottom of the vagina. After a couple of inches there is a "dropoff ' where the inner edge of the muscles lie. Massage the whole bottom half of this vaginal sling gently yet firmly enough to create a defmite stretching, burning sensation." Continue this stretching until birth. 143 During the last month, the woman should be given a small, gentle therapeutic oil enema to ensure apana vata is balanced. After this enenia, she needs to eat a vata reducing diet, adjusted to the season and her constitution. Itis important to not aggravate apana vata during this time and the woman should avoid getting jarred, holding back gas or urine or bowel movements and she should not get chilled.144 Another version says to give a simple enema and then follow it with a retention enema of oil boiled with some hems and this may be repeated. Tampons soaked in this same oil are kept in the vagina.145 Spotting of blood during any month should be considered serious. Treatment for this can be found in the Masanurnasik Chikitsa. 146 Month by Month Regimens from the Classical Texts Month 1:Take wholesome food morning and evening. Drink milk regularly; it may be taken cold.147 Month 2: Take boiled milk with herbs having a sweet taste.148 Month 3: Take milk mixed with honey and ghee.149 Take sastika rice with milk.150 Month 4: Take milk along with 12g of butter.151 Take sastika rice with curd Also, take milk and butter and soup http://www.ayurvedacollege.com/book/export/html/2
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made with wild animal meat 152 Month 5: Take ghee.153 Take sastika rice with milk. Also, take food with milk and clarified butter. 154 Month 6: Take ghee boiled with sweet herbs.155 Take sastika rice with ghee. Also, take gruel with clarified butter.156 Month 7: Follow the directions for month 6. Ifitching develops in the chest due to pressure of the foetus, use kneading and friction massage on the area. Food should be sweet in taste and alleviate vata. Eat small amounts and don't add extra fat or salt. Water can be taken in small amounts after eating.157 Month 8: Take milk and gruel added with ghee.158 An enema should be given for restoring the nervous system and cleansing the bowels that should be followed by an enema made of oil prepared with milk and herbs.159 Month 9: Receive an enema of oil boiled with sweet herbs. Cotton swabs soaked in this oil should be kept in the vagina for oleating the uterus and genital tract. Itwill support softening of the placenta, pelvis, waist, sides of the chest and back; downward movement of vata; normaliz.ation of urine and stool; softening of skin and nails; promotion of strength and complexion; and delivery with ease.160 Herbal Ghee taken In India In southern India it is connnon to prescribe the woman to take one tablespoon of herbal ghee daily during the 2 and 3"' trimesters. During the 4"' and 5th months, Kalyanakam Ghrut is taken to develop the mental faculties and bodily systems. Itprevents anemia and also congenital abnormalities. During the last months, Thanka Sree Ghrut is taken to ensure complete development, a full term normal delivery and good fortune for the child.161 Sanskrit Terms for Pregnancy There are a number of Sanskrit terms which may be useful to know if looking over the classical texts or researching Indian web sites. The term for embryo is garbha. The general management of pregnancy falls under Garbhini Vyakaran. The development of the fetus in the uterus is described under Garhavakranti. Special regimens for each month are prescribed under Garbhini Paricharya. The delivery area is the Sootikagar. Diseases particular to pregnancy are called garbhopadravas. Other terms to know includejeevaneeya which means lifebuilding, garbhasthapak which means it helps the blastocyst implant into the endometrium of the uterus, and prajasthapan which means sustainer of pregnancy. 162 Preparing for the Baby Preconception and pregnancy are the times to make all the plans for the delivery and postpartum recovery. Guidance may be needed concerning whether to use a doctor or a midwife, where the delivery is planned to take place, and who the mother wants present during the delivery. Consideration should be given to whether a birth attendant or doula is desired Decisions should also be made for how the mother and baby will be cared for in the 40 days after birth. Big changes are not recommended during this time. Many families choose to move house during pregnancy; one study showed 79% of expectant http://www.ayurvedacollege.com/book/export/html/2
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mothers were planning a move. The increased vata during "...a move can actually delay a mother's bonding with her baby after birth, or contribute to postpartum depression. "163 Books based on Ayurveda that can provide guidance for delivery and after birth include Tarn Taran Kaur Khalsa's The Gift of Giving Life Volumes 1 and 2164 Dr. Kumuda Reddy's For a Blissful Baby16 and Abhimanyu Kumar's Child Health Care in Ayurveda. 166 Two books expected to be published in 2008 by Ysha Oakes and Apama Khona1kar are Fortv Two Days for Fortv Two Years and Ayurvedic Cooking After Childbirth. Oakes provides training that she calls Postpartum AyurDoula Care through the Rocky Mountain Institute for Yoga and Ayurveda in Denver, CO. 167 Getting to know the local resources is important. Examples inNevada County, CA include Birth and Early Parenting Educators, http://www.be,pe.info/ 168 and Down Doggie Yoga Studio, http://www.downdoggieyogastudio.com Down Doggie lists local resources for prenatal and postnatal care resources under links on their website.169
Conclusion Ayurveda provides significant assistance to women during pregnancy and it is a complementary addition to the care provided by medical doctors and midwives. Motherstobe undergo many changes to their physical and emotional being during their 9 months of pregnancy as they create and support a new life. Ayurveda provides nutritional advice as well as practices such as meditation, the daily routine, yoga asanas, and considerations for happiness. Herbs can be used to assist the pregnant mother to feel her optimum as well as overcome challenges. Extreme care must be exercised though when choosing to take herbs and several resources should be referenced before considering an herb safe to use. The trimester it is allowed, quantity and part of plant all need to be researched. Mothers who already practice Ayurveda will simply expand their knowledge and application while those new to Ayurveda will find it to be of assistance during their life changes.
Endnotes 1 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 391. 2 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 159. 3 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 67. 4 Mayo Clinic staff. "Fetal Development, What Happens During the First Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/prenatalcare/PROOl l2/METHOD=orint 5 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 391. http://www.ayurvedacollege.com/book/export/html/2
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6 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 159. 7 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 67. 8 Mayo Clinic staff. "Fetal Development, What Happens During the First Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/prenatalcare/PROOl l2/METHOD=orint 9 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 391. 10 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 159. 11 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 6869. 12 Mayo Clinic staff. ''Fetal Development, What Happens During the First Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/prenatalcare/PROOl l2/METHOD=orint 13 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 398. 14 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 160. 15 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 69. 16 Mayo Clinic staff. ''Fetal Development, What Happens During the First Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/prenatalcare/PROOl l2/METHOD=print 17 Caraka Samhita. Vol II,editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 398. 18 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 162. 19 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 70. 20 Mayo Clinic staff. ''Fetal Development, What Happens During the Second Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.ayurvedacollege.com/book/export/html/2
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http://www.mayoclinic.com/health/fetaldevelopment/PR00113/ME1HOD=print 21 Caraka Samhita. Vol II,editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 299. 22 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 162. 23 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 7071. 24 Mayo Clinic staff. ''Fetal Development, What Happens During the Second Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic.com/health/fetaldevelopment/PR00113/ME1HOD=print 25 Caraka Samhita. Vol II,editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 399. 26 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 162. 27 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 71. 28 Mayo Clinic staff. ''Fetal Development, What Happens During the Third Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic.com/health/fetaldevelopment/PR00114/ME1HOD=print 29 Caraka Samhita. Vol II,editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 399. 30 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 162. 31 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 72. 32 Mayo Clinic staff. ''Fetal Development, What Happens During the Third Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/fetaldevelopment/PROOll4/METHOD=print 33 Caraka Samhita. Vol II,editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 400 401. 34 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 73. http://www.ayurvedacollege.com/book/export/html/2
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35 Mayo Clinic staff. ''Fetal Development, What Happens During the Third Trimester?" Mayo Foundation for Medical Education and Research, Jul 25, 2007. http://www.mayoclinic. com/health/fetaldevelopment/PROOll4/METHOD=print 36 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 50. 37 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears.htm 38 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 76. 39 Romm, Aviva Jill. Natural Healing for Babies & Children. Sri Satguru Publications, Delhi, India, 1996, p. 57. 40 Caraka Samhita, Vol II,editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 397. 41 Caraka Samhita. Vol II,editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 298. 42 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 160. 43 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 79. 44 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 80. 45 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 8283. 46 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 86. 47 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears. htm 48 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 87. 49 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 89. 50 Romm, Aviva Jill. Natural Healing for Babies & Chil
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51 Nagral, Kumud: "Concept of Safe Motherhood in Ayurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedafozyou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayuryed for Modem Medical Practitioners. Chaukhamba Sanskrit Pratishthan DeJhi, 2008. 52 Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing, Woodstock, New York, 1986, p. 17. 53 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1: A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 97. 54 ''Nutrition During Pregnancy for Vegetarians". Cleveland Clinic Center for Consumer Health Information. http://www.clevelandclinic.org/healtb/healthinfo/docs/1 600/1674.asp?index.=4724 55 Khalsa, Tam Taran Kaur. The Gift of Giying Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 100. 56 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1 : A Woman' s Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 95. 57 Khalsa, Tarn Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 104. 58 "About the Foundation". The Weston A. Price Foundation for Wise Traditions in Food, Fanning, and the Healing Arts. http://www.westonamice.org/splash2.htm 59 "Diet for Pregnant and Nursing Mothers". The Weston A. Price Foundation for Wise Traditions in Food, Fanning, and the Healing Arts. http://www.westonaprice.org/children/dietfonnothers.html 60 "About the Foundation". The Weston A. Price Foundation for Wise Traditions in Food, Fanning, and the Healing Arts. http://www.westonaprice.org/splash2.htm 61 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 9597. 62 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 98. 63 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 91. http://www.ayurvedacollege.com/book/export/html/2
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64 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 101102. 65 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovezy and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 80. 66 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears.htm 67 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 117. 68 Rechelbacher, Horst Aveda Rituals. Henry Holt and Company, LLC, New York, 1999. 69 Visco, Christine. "The Daily Routine." http://www.dragonflyhealing.net/dailyroutine.htm 70 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 103104. 71 Frawley, David and Kozak, Sandra Summerfield. Yoga for your Type. Lotus Press, Twin Lakes, WI, 2001, p. 197. 72 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ Chapter 5, p. 54. 73 Down Doggie Yoga Studio, http://www.downdoggieyogastudio.com 74 Jordan, Deborah. "Yoga, Conscious Birth and Conscious Parenting." Bodhi Baby Yoga, Down Doggie Yoga Studio, http://www.downdoggieyogastudio.com/article conscbirth.html 75 Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR "Efficacy of yoga on pregnancy outcome". Journal of Alternative and Complementary Medicine, 2005 Apr;l1(2):23744. 76 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 3637. 77 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1: A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 6566. http://www.ayurvedacollege.com/book/export/html/2
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78 Sagan, Samuel. Awakening the Third Eye, 3rd edition. Clairvision School, 2007. http://clairvisionorg/ 79 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 107108. 80 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 110111. 81 Patwardhan, Sushama. "Gatbha Sanskar (prenatal education)". Ayurveda For You. http://ayurvedaforvou.com/women/garbhasanskar.html 82 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 110111. 83 Romm, Aviva Jill. Natural Healing for Babies & Children. Sri Satguru Publications, Delhi, India, 1996, p. 58. 84 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears.htm 85 Khalsa, Tam Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1 and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 38. 86 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayurvedicforchildbearingyears.htm 87 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayurvedicforchildbearingyears.htm 88 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 253. 89 Susruta Samhita. Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 159. 90 Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing, Woodstock, New York, 1986, p. 17. 91 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears.htm http://www.ayurvedacollege.com/book/export/html/2
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92 Khalsa, Tam Taran Kaur. The Gift of Giying Life. Vol. 1: A Woman's Guide to SelfDiscoverv and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1 and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 8693. 93 Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing, Woodstock, New York, 1986, p. 17. 94 Khalsa, Tarn Taran Kaur. The Gift of Giving Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1 and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ p. 84. 95 Nagral, Kumud: ''Concept of Safe Motherhood inAyurved". The Journal ofFamily Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayuryedaforvou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayurved for Modem Medical Practitioners, Chaukhamba Sanskrit Pratishthan Delhi, 2008. 96 Romm, Aviva Jill. Natural Healing for Babies & Children. Sri Satguru Publications, Delhi, India, 1996, p. 60. 97 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.americanpregnancy.org/pregnancyhealth/naturalherbsvitamins.html 98 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/fhayuryedicforchildbearingyears.htm 99 Frawley, David Ayurvedic Healing. A Commehensive Guide, 2nd edition. Lotus Press, Twin Lakes, WI, 2000, p. 256257. 100 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.americanpregnancy.org{pregnancyhealtb/naturalhei:bsvitamins.html 101 "Safety Ratings Natural Medicines Database". American Pregnancy Association. http://www.americanpregnancy.org/pregnancyhealtb/naturalsafetyrate.html 102 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.americanpregnancy.org/pregnancvhealtb/naturalherbsvitamins.html 103 "Safety Ratings Natural Medicines Database". American Pregnancy Association. http://www.americanpregnancy.org/pregnancyhealtb/naturalsafetyrate.html 104 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.ayurvedacollege.com/book/export/html/2
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http://www.americanpregnancy.org/pregnancyhealtb/naturalherbsvitamins.html 118 Frawley, David and Lad, Vasant The Yoga of Herbs.An Ayurvedic Guide to Herbal Medicine, 2nd edition. Lotus Press, Twin Lakes, WI, 2001, p. 114. 119 Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing, Woodstock, New York, 1986, p. 22 & 35. 120 Romm, Aviva Jill. Natural Healing for Babies & Children. Sri Satguru Publications, Delhi, India, 1996, p. 60. 121 Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing, Woodstock, New York, 1986, p. 51. 122 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.americanpremancy.org/megnancyhealth/naturalhei:bsvitamins.html 123 Frawley, David and Lad, Vasant The Yoga of Herbs.An Ayurvedic Guide to Herbal Medicine, 2nd edition. Lotus Press, Twin Lakes, WI, 2001, p. 208. 124 ''Natural Herbs and Vitamins During Pregnancy". American Pregnancy Association. http://www.americanpregnancy.org/pregnancyhealth/naturalhei:bsvitamins.html 125 Weed, Susun S. Wise Woman Hei:bal Healing Wise. Ash Tree Publishing, Woodstock, New York, 1989, p. 200. 126 Weed, Susun S. Wise Woman Hei:bal Healing Wise. Ash Tree Publishing, Woodstock, New York, 1989, p. 204. 127 Frawley, David and Lad, Vasant The Yoga of Herbs.An Ayurvedic Guide to Herbal Medicine, 2nd edition. Lotus Press, Twin Lakes, WI, 2001, p. 160161. 128 Frawley, David and Lad, Vasant The Yoga of Herbs.An Ayurvedic Guide to Herbal Medicine, 2nd edition. Lotus Press, Twin Lakes, WI,2001, p. 183184. 129 Frawley, David and Lad, Vasant The Yoga of Herbs.An Ayurvedic Guide to Herbal Medicine, 2nd edition. Lotus Press, Twin Lakes, WI, 2001, p. 7273. 130 Nagral, Kumud: "Concept of Safe Motheihood in Ayurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedafozyou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayurved for Modem Medical Practitioners, Chaukhamba Sanskrit Pratishthan Delhi, 2008. http://www.ayurvedacollege.com/book/export/html/2
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131 Seely, Dugald; Dugoua, JeanJacques; Perri, Daniel; Mills, Edward; Koren, Gideon; "Safety and efficacy of panax ginseng during pregnancy and lactation", The Canadian Journal of Clinical Phannacology Vol 15 (1) Winter 2008:e87e94; January 18, 2008, http://www.cjcp.ca/hm/ 132 Dugoua, JeanJacques; Seely, Dugald; Perri, Daniel; Mills, Edward; Koren, Gideon; "Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation", The Canadian Journal of Clinical Pharmacology Vol 15 (1) Winter 2008:e80e86; January 18, 2008, http://www.cicp.ca/hm/ 133 Dugoua, JeanJacques; Seely, Dugald; Perri, Daniel; Koren, Gideon; Mills, Edward; "Safety and efficacy of chastetree (vitex agnuscastus) during pregnancy and lactation", The Canadian Journal of Clinical Pharmacology Vol 15 (1) Winter 2008:e74e79; January 18, 2008, http://www.cjcp.ca/hm/ 134 Dugoua, JeanJacques; Perri, Daniel; Seely, Dugald; Mills, Edward; Koren, Gideon; "Safety and efficacy of blue cohosh (caulophyllum thalictroides) during pregnancy and lactation", The Canadian Journal of Clinical Phannacology Vol 15 (1) Winter 2008:e66e73; January 18, 2008, http://www.cicp.ca/hm/ 135 Dugoua, JeanJacques; Mills, Edward; Perri, Daniel; Koren, Gideon; "Safety and efficacy of ginkgo (ginkgo biloba) during pregnancy and lactation", The Canadian Journal of Clinical Pharmacology Vol 13(3) Fall 2006:e277e284; November 3, 2006, http://www.cjcp.ca/hm/ 136 Dugoua, JeanJacques; Mills, Edward; Perri, Daniel; Koren, Gideon; "Safey and efficacy of St. John's wort (hypericum) during pregnancy and lactation", The Canadian Journal of Clinical Phannacology Vol 13(3) Fall 2006:e268e276; November 3, 2006, http://www.cjcp.ca/hm/ 137 Perri, Daniel; Dugoua, JeanJacques; Mills, Edward; Koren, Gideon; "Safety and efficacy of echinacea (echinacea angustifolia, e. purpurea and e. pallida) during pregnancy and lactation", The Canadian Journal of Clinical Pharmacology Vol 13(3) Fall 2006:e262e267; November 3, 2006, http://www.cjcp.ca/hm/ 138 Dugoua, JeanJacques; Seely, Dugald; Perri, Daniel; Koren, Gideon; Mills, Edward; "Safety and efficacy of black cohosh (cimicifuga racemosa) during pregnancy and lactation", The Canadian Journal of Clinical Pharmacology Vol 13(3) Fall 2006: e257e261; November 3, 2006. http://www.cjcp.ca/hm/ 139 Nordeng H, Havnen GC. "Use of herbal drugs inpregnancy: a survey among 400 Norwegian women.." Pharmacoepidemiology and Drug Safety. 2004 Jun;13(6):37180. 140 Nordeng H, Havnen GC. "Impact of sociodemographic factors, knowledge and attitude on the use of herbal drugs inpregnancy." Acta obstetricia et gynecologica Scandinavica. 2005 Jan;84(1):2633. 141 Caraka Samhita, Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 478. http://www.ayurvedacollege.com/book/export/html/2
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142 Nagral, Kumud: "Concept of Safe Motherliood inAyurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedaforvou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayuryed for Modern Medical Practitioners, Chaukhamba Sanskrit Pratishthan Delhi, 2008. 143 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/tbayurvedicforchildbearingyears.htm 144 Rafael, Terry. "A Primer on Ayurveda for the Childbearing Years. Part 3: Ayurveda for Pregnancy and Childbirth." Special Delivery, Vol 24, Issue 3, Page 2, Association of Labor Assistants and Childbirth Educators, Sept 2001. http://www.wisewomanhood.com/tbayurvedicforchildbearingyears.htm 145 Nagral, Kumud: "Concept of Safe Motherhood inAyurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedaforv ou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayuryed for Modern Medical Practitioners, Chaukhamba Sanskrit Pratishthan Delhi, 2008. 146 Nagral, Kumud: "Concept of Safe Motherliood inAyurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedaforvou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayuryed for Modern Medical Practitioners, Chaukhamba Sanskrit Pratishthan Delhi, 2008. 147 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 486. 148 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 486. 149 Caraka Samhita. Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 486. 150 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 253. 151 Caraka Samhita Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 486. 152 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 253254. 153 Caraka Samhita, Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 487. http://www.ayurvedacollege.com/book/export/html/2
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154 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 253254. 155 Caraka Samhita Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 487. 156 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 253254. 157 Caraka Samhita Vol II, editors R.K. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 487. 158 Caraka Samhita, Vol II, editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 488. 159 Susruta Samhita, Vol 2. Kaviraj Kunjalal Bhishagratna Chowkhamba Sanskrit Series Office, Varanasi, India, 2nd edition, 2002, p. 254. 160 Caraka Samhita. Vol II, editors R.K.. Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Golghar, India, 2003 reprint, p. 488 489. 161 Patwardhan, Sushama. "Garbha Sanskar (prenatal education)". Ayurveda For You. http://ayurvedafozyou.com/women/garbhasanskar.html 162 Nagral, Kumud: "Concept of Safe Motherhood in Ayurved". The Journal of Family Welfare. June 1997. 43 (2). P. 5357. Location :SNDT Churchgate. From Ayurveda for You, http://ayurvedaforv ou.com/women/motherhood.html Note: Dr. Nagral is the author of Ayuryed for Modern Medical Practitioners. Chaukhamba Sanskrit Pratishthan Delhi, 2008. 163 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999,p. 107. 164 Khalsa, Tam Taran Kaur. The Gift of Giying Life. Vol. 1:A Woman's Guide to SelfDiscovery and Natural Childbirth. Ancient Healing Ways, Espanola, NM, 1983. Note: Volumes 1and 2 can be purchased at Ancient Healing Ways, http://www.ahealing.com/ 165 Reddy, Kumuda; Egenes, Linda; and Mullins, Margaret. For a Blissful Baby. Samhita Productions, New York, 1999. 166 Kumar, Abhimanyu. Child Health Care in Ayurveda Daya Publishing House, New Delhi, India, 1999. 167 Oakes, Ysha and Khonalkar, Apama. Forty Two Davs for Forty Two Years and Ayurvedic Cooking After Childbirth. Not yet published. http://www.sacredwindow.com/Rocky Mountain Institute for Yoga and Ayurveda, http://www.rmiva.org 168 Birth and Early Parenting Educators, http://www.bene.info/ http://www.ayurvedacollege.com/book/export/html/2
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169 Down Doggie Yoga Studio, http://www.downdoggieyogastudio.com
Shilajit: Conqueror of Mountains & Destroyer of Weakness By: Jamie Munson Introduction The fascinating herbal matter known as shilajit has profound effects on the physical body and mind including the capability of life expansion. This thick, blackishbrown, sticky substance is made from plants and organic matter that have been trapped by many layers of rocks over millions of years in the areas surrounding India, China, Tibet, Nepal, Pakistan, Central Asia and Scandinavia. The extreme variations of hot and cold weather combined with the massive pressure from the weight of the mountains creates the mineral rich matter to flow out of the rocks. [1, 2] In some areas, footlong scorpions will sting the rocks and the poison that is dispersed causes the shilajit to flow out of the rocks. [3] There are four different types of Shilajit: Copper (Tamra) that is blue in color, Silver (Rajat) which is white in color, Gold (Sauvarna) that is red in color, and Iron (Lauha) which is blackish brown in color and is the kind that is used for healing. [4] Shilajit was first discovered by Himalayan villagers. They would observe large white monkeys gather and journey to the mountain tops each summer. The monkeys were frequently seen eating a soft, black substance that the villagers eventually realized came from the Himalaya Mountains. The villagers then started consuming this organic matter. It didn’t take long for them to realize its’ amazing healing powers of both physical and mental health, as well as increased muscle and bone strength and the potential of increased longevity. [5] Researchers have found plant organisms in shilajit from multiple species including: Trifolium repens, Euphorbia royleana, Pellia, Minium, Barbula, StephenrencellaAnthoceros, Fissidens, Asterella, Plagiochasma, Thuidium, Marchantia and Dumortiera. [6] Shilajit has been found in the Tibet, Altai and Caucasus Mountains, as well as the Gilgit Baltistan region of northern Pakistan, but it is found most commonly in the Himalaya Mountains. There are many different names for this tarlike mass which are: silajit, salajeet, shilajeet, mumijo, momia, moomiyo, shargai, black asphaltum, asphaltum punjabianum (Latin), mineral pitch or mineral wax (English), dorobi, barahshin, bragshun or baraga shun, chaotong, and wu ling zhi. [7] Shilajit contains over 85 natural ionic minerals as well as fulvic acid, humic acid and imperative phytonutrients. According to Chakrapani Ayurveda Clinic & Research Center in India, the chemical configuration of fulvic acid is: “100% natural organic water extraction from 75 million year old earthly deposit and contains approximately 74 essential complexed and dissolved minerals and trace elements. It contains 42% fulvic acid solids.” [8] Andy Kahn writes in his report titled “What is Shilajit?” saying, “The fulvic acid in shilajit is in its most natural and pure form. Fulvic http://www.ayurvedacollege.com/book/export/html/2
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acid is required to dilate the cell walls and transport the minerals deep into the cells.” What he means by dilation of the cell walls is that fulvic acid increases intracellular mineral concentrations via facilitated transport. If we can’t absorb the vitamins and minerals that enter our body, our tissues become deficient and we lack energy, both physical and mental. These deficiencies may speed up the aging process also known as senescence. Fulvic acid allows the 85+ minerals from shilajit to enter into the cells of the body rapidly and can “effectively prolong cell life and keep it healthy for a very long time.” [9] The main chemical components of shilajit are: humic acid, fulvic acid, benzoic acid, benzoates and high concentration of vitamin A, B, C esters. It is made up of 6080% organic matter, 2040% mineral matter and 5% of trace elements. [10] Shilajit consists of mainly humic substances which are the end results of deterioration from plant and organic matter. These microorganisms are split up into three subcategories: humins, humic acid, and fulvic acids based upon their solubility in water and pH levels. Fulvic acid is soluble in water under different pH conditions. Humic acid is soluble in water under alkaline conditions. Humins are not soluble in water under any pH condition. Fulvic acid has a very low molecular weight and higher oxygen content than other humic acids which enables it to be absorbed really well into the intestinal tract and eliminated from the body within hours. It increases permeability of biomembranes, which makes it possible for better absorption or assimilation of other active components by sensitizing the cell membranes. It also carries antioxidants, antiinflammatory properties, memory enhancers, and antiaggregation of tau proteins which help with Alzheimer’s disease. Here are some other molecules found in shilajit: dibenzoalphapyrones, amino acids, sterols, eldagic acid, albumins, aromatic carboxylic acids, some fatty acids, gums, triterpenes, benzocoumarins, latex, polyphenols, resins, phenolic lipids and specific species of polysaccharides and lignins. The variation in molecular components is generally determined by the region from which the shilajit is obtained and the source of origin is still under controversy. [11, 12] Uses Around the World Shilajit is one of the most impeccable tonifying and rejuvenating herbal remedies that exist, which is why it is referred to as the conqueror of mountains and destroyer of weakness. It states in the Charaka Samhita, “There is no curable disease in the universe which is not effectively cured by silajatu when administered at the appropriate time, in combination with suitable drugs and by adopting the prescribed method. When administered to a healthy person, with similar conditions it produces immense energy.” [13] The Yoga of Herbs by Dr. David Frawley and Dr. Vasant Lad says, “Shilajit possesses great curative powers and is considered capable of treating many diseases, particularly those of the aging process.” The indications for shilajit in this book are: parasites, diabetes, skin diseases, obesity, insanity, jaundice, epilepsy, gall stones, asthma, dysuria, menstrual disorders, cystitis, sexual debility, edema, hemorrhoids, and kidney stones. They also list a precaution of not using shilajit for febrile diseases which are conditions characterized by fever. [14] The Way of Ayurvedic Herbs by Karta Purkh Singh Khalsa and Michael Tierra state that shilajit is unique in being a strong detoxifier yet an incredible builder of muscle and tissues. They also say that this treasure of healing is the best for tonifying the kidneys and urinary system. Its remarkable effects even go so far as to dissolve gallstones and kidney stones. [15] Shilajit ingestion is recommended during rejuvenation therapy which is described by Lord Punarvasu Atreya in the Charaka Samhita as “… ambrosia and is beneficial to the gods, the sons of Aditi. It has unimaginable and wonderful (beneficial) effects. It promotes life, maintains positive http://www.ayurvedacollege.com/book/export/html/2
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health, preserves youth and cures morbid sleep, drowsiness, physical as well as mental fatigue, laziness and weakness. It maintains proper balance among vata, kapha and pitta; it produces stability, cures slothness of the muscles, stimulates the enzymes responsible for digestion and metabolism and brings about excellence in luster, complexion as well as voice. By the administration of this therapy, the great sages like Cyavan etc. regained their youth and were liked most by women. Their muscles became compact, even and well proportioned. Their bodies became compact and stable. They were endowed with excellence of strength, complexion and senses. They were persons of unchallengeable prowess everywhere. They developed powers of resistence to hardships.” [16] Vata, pitta and kapha mentioned above are known as the three doshas in Ayurveda. Dr. Halpern states in his book, Principles of Ayurvedic Medicine, “The physiology of the human being is governed by three main forces, which are commonly known as the three doshas.” Dosha literally means to cause harm, which is what happens in the body when they are not functioning correctly. When they are in balance, they keep the body healthy and all the systems working smoothly. The doshas reflect the three basic functions of all existence which include: the force behind all physical creation with kapha, the force that has a difficult time maintaining creation with pitta, and the force that basically destroys creation with vata. “Kapha energy creates only by building new tissues. Pitta maintains by regulating metabolism and vata destroys through the wear and tear of action and activity.” [17] Each individual has their own make up of all three doshas which is what makes everyone unique. This is referred to as their constitution. Ayurvedic practitioners look at the individual’s constitution to determine how best to treat any imbalance they may be experiencing. Charaka Samhita states that shilajit should be taken in a hot decoction along with other herbs that alleviate vata, which include qualities of heavy, moist, dense, and heating. Charaka Samhita goes on to say that shilajit mixed with iron and taken with milk is an elixir for long life and happiness. It promotes wealth, memory, and intellect while producing sturdiness of the body and preventing diseases and the ageing process. [18] Ayurvedic Classification The energetic qualities of herbs are classified into three groups known as rasa, virya and vipaka. Rasa is the taste you experience and your first initial reaction to the substance. There are six tastes in Ayurveda: sweet, sour, salty, pungent, astringent, and bitter. These six tastes can either increase or decrease the doshas which will have a positive or negative effect on the body. Dr. Halpern states in his book Principles of Ayurvedic Medicine, “When a person consumes the proper amount of each taste, the body responds with the production of healthy tissues and normal physiology. When too much or too little of a specific taste is taken, the body responds with faulty function. The result is disease.” Virya means potency and refers to the heating or cooling effect the substance will have on the body. If it has a warm virya, it will pacify vata and kapha while increasing agni. If it has a cool virya, it will pacify pitta while decreasing agni. Our digestion is created by a force in our body that is referred to as agni. The tastes that have a warm virya are pungent, sour and salty. Cooling virya tastes include sweet, bitter and astringent. Vipaka is the long term, postdigestive effect the substance has on the body after it is digested. The three vipakas are sweet, sour and pungent but should not be confused with the rasa qualities because they have different effects on the body. Dr. Halpern goes on to describe the three vipakas with their long term effects as, “Substances with a sweet vipaka nourish the body. They are most often alkaline substances that increase saliva. They also aid elimination. Substances with a sweet vipaka tend to increase kapha dosha and pacify vata and pitta doshas. Substances with a sour vipaka increase the acidity of the body, improve the function of the digestive enzymes and generally aid digestion. They are also somewhat nourishing and generally increase the tissues of the body. They also improve elimination. Substances with a sour vipaka increase the pitta and kapha doshas and http://www.ayurvedacollege.com/book/export/html/2
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pacify the vata dosha. Substances with a pungent vipaka are purifying and reduce the dhatus of the body. They tend to constrict the tissues of the body and dry them out. In the colon, they are likely to increase gas. Substances with a pungent vipaka increase the vata and pitta doshas while pacifying the kapha dosha.” [19] When Dr. Halpern mentions that a substance will increase a dosha, this means it will vitiate the dosha or cause an imbalance in the body if used over a period of time. According to The Yoga of Herbs, the rasa of shilajit is astringent, pungent, and bitter. The astringent taste has a cool virya and a pungent vipaka and its most prevalent qualities are dry and cool. This taste will pacify pitta and kapha dosha while vitiating vata dosha. The pungent taste has a warm virya and a pungent vipaka and its major qualities are hot, dry, mobile, and light. This taste will pacify kapha while vitiating pitta and vata. The bitter taste has a cool virya and a pungent vipaka and its main qualities are light, dry, cool, and mobile. This taste will pacify pitta and kapha while greatly vitiating vata. The virya of shilajit is warm and its vipaka is pungent. The warming effect vitiates pitta but it is a wonderful substance to use with vata and kapha doshas. [20, 21] One of the oldest classical Ayurvedic text books titled Charaka Samhita describes shilajit as cooling, bitter and saline; and pungent in vipaka from the stone that contains iron. It also states that shilajit has the smell of cow’s urine. [22] Review of the Research Literature An article written by Cathy Wong, ND Alternative Medicine Expert says “Shilajit is touted as a natural remedy for the following health problems: anemia, asthma, chronic bronchitis, chronic fatigue syndrome, diabetes, digestive disorders, eczema, high cholesterol, osteoarthritis, and ulcerative colitis.” It also protects against osteoporosis by strengthening bones, alleviates anxiety, protects against stress, and may be very useful in the treatment of Alzheimer’s disease. [23] The Indian Materia Medica states that shilajit is a laxative, antiperiodic, febrifuge, and a bitter stomachic tonic. It is used with neembark and blackpepper as an antiperiodic to people suffering with fevers in the form of an infusion. [24] An antiperiodic is “a drug that prevents the regular recurrence of symptoms,” and febrifuge is a medicine used to reduce fever which is also known as an antipyretic. [25, 26] An abstract from Pubmed states that “The safety of shilajit is well documented based on animal and human studies. Various research studies indicate that shilajit exhibits antioxidant, antiinflammatory, adaptogenic, immunomodulatory, and antidyslipidemic properties. Animal and human studies indicate that shilajit enhances spermatogenesis. Furthermore, animal and human data support its use as a ‘revitalizer’, enhancing physical performance and relieving fatigue with enhanced production of adenosine triphosphate which is the body’s energy source. Key constituents in shilajit responsible for these effects appear to be dibenzoapyrones and fulvic acid and their derivatives.” [27] A study on the effects of shilajit as an antimicrobial, antioxidant and antiulcerogenic on gastric ulcers in rats comes to the conclusion of having strong antimicrobial actions against: Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtillis, Escherichia coli, and Candida albicans. The article continues to say “The presence of polyphenols compounds such as fulvic acids, triterpenoids and benzoic acid in shilajit samples have antioxidant activity, cellular repairing and regeneration, played very important role in decrease acid pepsin secretion, cell shedding, gastric ulcer index, tendency to increase mucin secretion and carbohydrate/protein ratio which have very important role as antioxidant effect and anti http://www.ayurvedacollege.com/book/export/html/2
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inflammatory.” This was in regards to morphological and histological findings of the stomach. It is also listed in this section that antianxiety and antistress effects of shilajit, assists in the healing of gastric ulcer, as well as the antiinflammatory action in helping wound healing occur more rapidly. The conclusion of this study states that shilajit has antiulcer, antioxidant, hypolipidenic, regenerative and repairing effects on ulcer induced rats. The antiulcer effect may be due to the combination of actions including: antiinflammatory, antimicrobial, antioxidant, antianxiety, anti stress, healing and regenerative effects. Further investigations of the total and complete action of shilajit are required before all actions can be affirmed. [28] Shilajit was a component in another study for its effects on behavioral symptoms of chronic fatigue syndrome (CFS) by regulating the hypothalamicpituitaryadrenal axis and mitochondrial bioenergetics in rats. The main ingredients of shilajit used were dibenzoapyrones and fulvic acid. The rats were forced to swim for 15 minutes for 21 consecutive days to bring upon CFS. The rats were given treatments of shilajit for 21 days prior to being exposed to the swimming exercises. CFS behavior consequences were measured by immobility and the climbing period. PostCFS anxiety levels were determined by elevated plus maze (EPM) tests. “Shilajit reversed the CFSinduced increase in immobility period and decrease in climbing behavior as well as attenuated anxiety in the EPM test. The results indicate that Shilajit mitigates the effects of CFS in this model possibly through the modulation of hypothalamuspituitaryadrenal axis and preservation of mitochondrial function and integrity. The reversal of CFSinduced behavioral symptoms and mitochondrial bioenergetics by Shilajit indicates mitochondria as a potential target for treatment of CFS.” [29] Shilajit was used in a new drug preparation called MumiyoVitas in patients with objective and subjective symptoms with obstruction to the urinary bladder who had prostate hyperplasia. This study consisted of 38 patients that had stage III benign prostate hyperplasia. They were given 0.2 grams of MimiyoVitas one to two times a day for six months. “Effects were studied of the drug on the urologic symptomatology and quality of life of patients presenting with ongoing micturitional disturbances, functional state of detrusor vesicae, prostate volume and urethral resistance.” The results showed therapeutic benefits in these patients. [30] Processed shilajit was used in a study for the safety and spermatogenic activity in patients with low sperm count which is highly common with male infertility. 60 men participated in this evaluation and they all had a sperm count below 20 million. They were given 100 mg capsules of processed shilajit two times a day after large meals for 90 days. Total luteinising hormone, folliclestimulating hormone (FSH), semenogram, and serum testosterone were all recorded before the treatment and after it was finished. Oxidative stress and the content of semen and biochemical parameters for safety were observed as well. The results showed that “28 patients who completed the treatment showed significant (P<0.001) improvement in spermia (+37.6%), total sperm count (+61.4%), motility (12.417.4% after different time intervals), normal sperm count (+18.9%) with concomitant decrease in pus and epithelial cell count compared with baseline value. Significant decrease of semen MDA content (18.7%) was observed.” MDA was the marker for oxidative stress. “Serum testosterone (+23.5%; P < 0.001) and FSH (+9.4%; P < 0.5) levels significantly increased.” The study also came to the conclusion that shilajit was safe to use at that dosage. [31] Another study was done on the effects of shilajit as a fertility agent in male and female rats. They were given shilajit orally to seven week old rats for a total of six weeks. The male rats had significantly higher sperm count numbers in the testes and epididymides. There was also an increase in the number of seminiferous tubular cell layers in the testes of the treated rats. The effects of shilajit in the female rats were observed by the ovulation inducing activity. Ovulation was induced in seven out of nine rats over a five day period. The results showed that shilajit has a positive http://www.ayurvedacollege.com/book/export/html/2
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effect on spermiogenic and ovogenic conditions in mature rats. [32] Shilajit was used in a study on the effects of intracranial pressure, brain edema, and neurologic outcomes following a traumatic brain injury in rats. They observed how shilajit affected intracranial pressure (ICP), bloodbrain barrier (BBB) permeability, brain edema, and neurologic outcomes after brain trauma. The rats were given shilajit at one, 24, 48, and 72 hours following the head trauma. Shilajit treated groups showed a significant decrease in brain water. Intracranial pressure also showed a major decrease at 24, 48, and 72 hours after trauma. There was an improvement in the rate of neurologic outcomes with shilajit treated groups at four, 24, 48, and 72 hours after trauma. The conclusion of the study states “The present results indicated that Shilajit may cause in improvement of neurologic outcomes through decreasing brain edema, disrupting of BBB, and ICP after the TBI” (trauma brain injury). [33] A remarkable study was conducted on 20 patients with human immunodeficiency virus (HIV) and their effects of taking shilajit with Anti Retroviral Therapy (ART). ART is a successful treatment that reduces both the morbidity and mortality of HIV infection but it is not accessible in many countries and very expensive. Unfortunately, it is a rarity that HIV will be eliminated, and resistance to the drug is a total setback while undergoing long term therapy. Shilajit is a rasayana, meaning it helps to build a healthy immune system which is very imperative with people who are HIV positive. The conclusion of the effects of Shilajit+ART in patients with HIV show they “responded better to ART both clinically and biochemically. The results show that Shilajatu decreases the recurrent resistance of HIV to ART and improves the outcome of the therapy.” [34] Shilajit was used in a study for its role in the prevention of Alzheimer’s disease. “Studies suggest that shilajit and its active principle fulvic acid, as well as a formula of shilajit with B complex vitamins, emerge as novel nutraceutical with potential uses against this brain disorder.” Nutraceuticals are important in the prevention of this disease, along with a healthy diet and nutritional supplements. [35] Recent investigations of a different study show that fulvic acid blocks tau selfaggregation as well. This opens a lot of doors in the search for preventing Alzheimer’s disease. This study also states that shilajit is “a nutraceutical product of demonstrated benefits for human health.” [36] There are many benefits attributed to shilajit based upon: tradition, classical text books of Ayurveda, natural instinct from animals, personal accounts, and most recently scientific studies. Many of the biochemical processes have been defined; however, the full effects of shilajit on the human organism requires further investigation. There is hope for a very promising future in the mental and physical longevity of this organic mineral resin from the Himalaya Mountains.
Stress Management through Shirodhara By Leslie Flynn In yogic sciences there are a number of procedures explained for relaxation of body and mind. By these procedures like meditation and relaxation the mind comes down to a tranquil state, it reduces stress, helps in normal and better function of mind. All the benefits of meditation and relaxation are achieved by the procedure of Shirodhara. 4 Shirodhara is no doubt the most popular Ayurvedic treatment in the West. Shirodhara is a classical and a wellestablished ayurvedic procedure of slowly and steadily dripping medicated oil or other liquids on the forehead. The word shiro http://www.ayurvedacollege.com/book/export/html/2
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means head and the word dhara means stream. 11 This procedure induces a relaxed state of awareness that results in a dynamic psychosomatic balance. 2 Shirodhara is one of the most powerful treatments to relieve Vata (wind) in the mind. Preoccupied with swarming thoughts, the mind has a difficult time slowing down. This can lead to inability to handle stress, creating nervousness, anxiety, depression, insomnia, fatigue, psychological disorders, and more. Shirodhara is the specific treatment for these orders and any other disorder that is stress related. With eighty percent of all disease in the West now attributed to stress, Shirodhara becomes one of the most important treatments. 11 Shirodhara: Classical Descriptions and Types Shirodhara is a titillating form of snehana treatment, whereby the oil or therapeutic substance methodically drips along a course thread onto the forehead. A metal or clay vessel, the dhara patra, is suspended directly above the forehead. 10 This treatment involves pouring a stream of oil over the guest’s forehead. Most commonly medicated sesame oil is used for this treatment. Traditionally, specifically prepared herbalized oils, milk, or buttermilk are used. 11 The oil or other fluid is poured into the pot, and then seeps through a hole in the bottom of the pot and slides down a 4inchlong thread, half of which hangs through the hole. The drops of oil from the thread drip directly onto the subject’s third eye, or center of the forehead. An ancient technique, Shirodhara is meant to be maintained at a certain rhythmic speed while awakening the third eye. Vast and miraculous healing occurs when this technique is performed to perfection. The rhythm of the oil trickling onto the third eye, which is the seat of our cognitive vision, evokes deep cognitive memories. Through the arousal of these memories, bodily tissues are transformed and good health is restored. Before Shirodhara is administered, the preliminary procedure of abhyanga massage is performed. A soporific treat, Shirodhara soothes and invigorate the senses as well as the mind. A total state of wellness is induced in the process. 10 There are several kinds of dhara techniques, depending on the medium for dripping. For example, takra dhara uses takra that is prepared with the curd of cow’s milk. Kshira dhara uses cow’s milk mixed with some medicinal herbs such as Sida cordifolia or Asparagus rasemosus. Taila dhara uses medicated oil mixed with cow’s milk, water, herbs, and sesame oil. 9 Generally, sesame oil processed with various Indian herbs is used for Shirodhara. However, milk and buttermilk processed with herbs are also used in this treatment depending on the condition. Shirodhara with Brahmi oil may be beneficial for moderate to severe insomnia. 1 Brahmi is one of the most sattvic herbs known in Ayurvedic pharmacopeia since Vedic times. It aids in the recovery from exhaustion, stress, debility and aggravation of vata. 12 Shirodhara by Bala Taila, which is known to have a beneficial effect on all the sensory organs and to make the patient quiet and calm. Continuous pouring of Bala Taila on the forehead for a specific period has a tranquilizing effect and induces sleep. The effect on the mind is such that the patient is said to become free from anxiety and stress. Bala Taila Shirodhara also modifies the energy condition of the mind. 3 Lavender Shirodhara is superior to plain Shirodhara in its’ anxiolytic and ASCpromoting effects. The mechanism of Shirodhara with lavender oil is related to the wellknown soothing effect of lavender. Lavender oil may stimulate the olfactory nerves, and impulses may be transmitted to the hypothalamus to soothe the mood and alter the autonomic nervous balance. Linalool, the main constituent of lavender oil, may also be absorbed into the bloodstream through the skin or mucosa of the respiratory tract. The complicated pharmacophysiopsychologic effects of lavender Shirodhara reflect a principle of traditional Indian oil therapy. 5 http://www.ayurvedacollege.com/book/export/html/2
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Insomrid and Shirodhara with luke warm milk have potent effect on the management of Anidra, Insomnia. The milk used for the Shirodhara has Madhura Rasa, Snigdha Guna, Sheeta Veerya and Madhura Vipaka which subside Vata and Pitta Doshas and increases the Kapha Dosha. It also increases Tamoguna in the Shirah Pradesha. Hence it helps in production of Nidra. 4 Herbs, Oils, and other Preparations Commonly used in Shirodhara Shirodhara is administered by gently and methodically pouring warm herbalized oil over the forehead. This procedure synchronizes brain waves and profoundly coordinates and calms the mind, body, and spirit. 11 Common Ayurvedic medicated oils contain many herbs as well as other constituents, including various kinds of polyphenols and volatile terpenes, and the concentration of these constituents greatly fluctuates depending on where they are harvested, prepared, and the season, so that speculation on the precise mechanism of Shirodhara would be difficult. Plain sesame oil at 39 degrees C may stimulate thermosensors in the skin, such as transient receptor potentialvanilloid 3 (TRPV3), to evoke nerve impulses in the trigeminal cranial nerve of the forehead, inducing the somatoautonomic reflex. Viscid, dripped oil itself pulls as well as pushes the scalp hair while running down on the scalp skin. The weight of sesame oil (about 16 grams on the forehead) may stimulate epithelial Na channels (ENaCs) pressure sensors in the skin. The hair follicles have sensory fibers around them. Dripped oil may stimulate the myelinated nerve fibers (ABfiber) of the trigeminal nerve to induce the somatoautonomic reflex, resulting in HRV changes. 8 The guest’s comfort is crucial. The room has to be the right temperature (warm), absolutely quiet, and the neck and low back have to be supported appropriately. The type of vessel that is used can alter the effectiveness of the treatment. Classically copper is used as it has effectiveness mostly for Vata and is also balancing for Pitta and Kapha. A coconut vessel is said to be one of the best and is suited for all three types. The most revered in India is a vessel made out of five metals called pancha dhatu. This metal is a combination of copper, nickel, brass, silver, and gold. 11 Different liquids are used depending on the conditions being treated. Commonly used liquids include water, various oils, buttermilk, or coconut water. 14 First, the oil stream or dhara should be thick and heavy. Second, the oil stream should be continuous so that if the treatment needs to last an hour, it can be provided. Third, the oil needs to be warmed and needs to be maintained just above body temperature at all times. The fourth component is that the stream needs to be moveable and not stationary. 11 Season: All Year Dashamula Oil Vata Disorders: 16 c water, 1 c dashamula powder, 4 c sesame oil Warm Sesame Oil Vata and Kapha Disorders: 4 c sesame oil for Vata, 3 c for Kapha disorders Warm Sesame Oil Pitta Disorders: 2 c sesame oil, 1 ½ c pure ghee Licorice Oil Pitta Disorders: 12 c water, 3 c sesame oil, ¾ c licorice powder Other Shirodhara Substances Body Type: all types , conditions Urinary disorders, heart disease, indigestion, anorexia, diseases of the eye and ear, premature graying and balding, headache, insomnia, exhaustion, weakness of the joints, fear and anxiety. A total restorative for all three doshas. Takra Dhara (medicated buttermilk) 1 c certified raw milk, 2 c water, 1 c amalaki powder http://www.ayurvedacollege.com/book/export/html/2
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Milk and Musta Cream 16 c water, 4 c milk, 1 c Musta powder, 2 c takra dhara (medicated buttermilk) Time of Application: 7:00 to 10:00am 10 Treatment Time: It is recommended that the Vata treatment be longer than the Pitta and the Pitta treatment be longer than the Kapha. In extreme Vata imbalances the treatment can last 60 minutes. Vata – 3040 minutes Pitta2530 minutes Kapha2025 minutes Pitta Horizontal Pattern: Directing dhara (oil stream) across forehead, starting just above eyebrows, going from ear to ear without losing oil contact, working up to just past hairline. Kapha Vertical Pattern: Like a zigzag/updown pattern working back and forth across forehead. Vata Stationary Pattern: Holding oil stream over third eye for extended period of time. 11 The recipe for oleation therapy can be given exceeding the limit of seven days only when the body is not saturated with medicated ghee, etc., within the prescribed limited period of seven days. Though it is mentioned that the minimum period of oleation should be three days, there are recipes which cause instantaneous oleation even with one day. Oleation therapy alleviates aggravated vayu, softens the body and disintegrates the adhered morbid material [in the channels of circulation]. In the person who has undergone oleation therapy, fomentation liquefies the adhered morbid material (even) in the fine channels of the body. 8 The Ayurvedic Practitioner determines both the duration and number of days according to the patient’s age, constitution, and dosha status, and the severity of the disease. 1 Indications Patients of Insomnia with mild hypertension, mild depression and anxiety disorders without any complications of any other diseases. 4 Shirodhara is suitable for patients suffering from Shiroroga, metabolic disorders, and the different kinds of mental diseases described in Ayurveda. 3 It has long been conducted to combat insomnia, headache, anxiety neurosis, depression, schizophrenia, motorneurosis, depression, schizophrenia, motor neuron disease, hypertension, and several kinds of psychosis. 9 Shirodhara has been shown to be effective in attention deficit/hyperactively disorder in children, hypertension, menopause, cerebral ataxia, general anxiety disorder, headache, and insomnia. 1 Vata Disorders: prickling pain in the head; loss of hair; loss of hearing; fatigue and mental exhaustion; grayish coating on the tongue; dryness of face and scalp; constipation. Pitta Disorders: burning sensation in head and body; ulcerated or inflammatory conditions of the head; pharyngitis; conjunctivitis; excess sweating; dimness of vision; blood disorders; hemorrhaging; jaundice; herpes; yellowish coating on the tongue; greenish or yellowish coloring of urine and feces. Kapha Disorders: excessive sleep; heaviness of body; indigestion; mucus; obesity; weak digestion; white coating on the tongue; white urine and feces; loss of appetite; repulsion for food; anorexia. In addition to relieving the disorders listed above, this treatment has the added effect of http://www.ayurvedacollege.com/book/export/html/2
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awakening the third eye, invigorating the boy and mind, and stimulating cognitive memories. 10 Contraindications Patients with alcohol dependency or drug dependency. Patients with acute illness like Cardio Vascular Accident, Congestive Cardiac Failure, Myocardial Infarction, Chronic Obstructive Pulmonary Disorders, meningitis, acute pain conditions. 4 Research into the Effects of Shirodhara on the Mind Along with the economic advancement, man is going far away from Nature, and in order to find an honorable place in the society, he is often exposed to physical fatigue and mental tension. This stressful living is the raisen d’ etre for many of the present day maladies of psychoneurotic nature. According to ayurveda, the function of the mind and nerves is dependent upon vayu or vata. All the functions of the body, according to ayurveda are controlled by three elements which in ayurvedic parlance are called doshas. 7 The complicated pharmacophysiopsychologic action of Ayurvedic oil treatment may provide a useful model for future pharmacophysiopsychotherapy. 5 Shirodhara is one of the oil treatments originating from Keraliya Panchakarma. The neurophysiological mechanism of the effects of Shirodhara on the psychophysiological changes may be related to the tactile stimulation of the skin or hair follicles innervated by the first branch of the trigeminal nerves (ophthalmic nerve). The impulses would be transmitted to the thalamus through the principal nucleus and forward to the cerebral cortex (somatosensory field) or limbic system. 9 While most Ayurvedic therapies have their impact on the physical and energy sheaths of the subtle body system, Shirodhara most effectively purifies the mental sheath, where patterns of behavior (vasanas) and emotional traumas can distract the mind from its’ role in supporting good health and spiritual growth. When during a therapy the guest is taken into a deep, meditative state of silence, the basal metabolic rate is significantly lowered, and with successive treatment, it is lowered even more. If the body were a lake, it would become totally calm and crystal clear. In this state the body experiences itself more profoundly as a unified field of consciousness rather than thousands of physical parts. In this procedure the metabolic rate drops, and the brain waves become slow and coherent. The state of calm achieved with Shirodhara is unparalleled by other relaxation techniques, and it brings the nervous system into the depths of inner silence. In Ayurveda, pain has a specific purpose in the body. Pain is said to be the direct opposite of bliss or pure consciousness. The purpose of the pain is to bring the body’s awareness to the pain and then through the pain to establish itself in the bliss. Let’s say the body is deeply settled and the protective nervous system is disarmed during a Shirodhara or a twoperson Ayurvedic massage. In this deep stillness the nervous system becomes aware of any stress or strain that inhibits the flow of stillness into every cell of the body. The goal is to have this pure experience of consciousness in every cell of the body – moving pure consciousness from the bliss sheath (anandamaya kosha) to the physical sheath (annamaya kosha). When this happens, the chakras and nadis can carry the kundalini Shakti up the spine to its’ goalthe bindu point on the top of the chakra system. This process cannot be completed unless the physical, energy, and mental sheaths are balanced, stable, and functioning in harmony. Shirodhara works mainly in the manomaya kosha, or the mental sheath. If the mental sheath is not balanced, then the pull of the old vasanas and samskaras will distract the mind in the discernment sheath from being able to choose wisely in the direction of spirituality. These impressions are held captive in the limbic system or the emotional cortex of the brain. With an unpurified mental sheath, choices will be in http://www.ayurvedacollege.com/book/export/html/2
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the direction of supporting the status quo set up by the old, deepseated patterns of behavior. Once the mental sheath is cleared, the individual mind can choose, without distraction, to move into the bliss sheath or anandamaya kosha. Once the bliss sheath is activated, the flow of Shakti and consciousness can freely move through each kosha creating better health, peace of mind, and spiritual progress through one’s life. As you can see, if the subtle bodies, doshas, vayus, nadis, chakras, and srotas are blocked, then physical imbalance, emotional disturbance, and mental unrest will be the accepted human condition (which it is in our current society). 11 A standardized Shirodhara leads to a state of alert calmness similar to the relaxation response observed in meditation. The clinical benefits observed with Shirodhara in anxiety neurosis, hypertension, and stress aggravation due to chronic degenerative diseases could be mediated through these adaptive physiological effects. A total feeling of wellness, mental clarity, and comprehension is experienced in this process. 2 Shirodhara stimulates the pineal gland which produces the hormone melatonin. Melatonin regulates the wake and sleep cycles of the body. 6 In the procedure of Shirodhara, a particular pressure and vibration is created over the forehead. The vibration is amplified by the hollow sinus present in the frontal bone. The vibration is then transmitted inwards through the fluid medium of cerebrospinal fluid (CSF). This vibration along with little temperature may activate the functions of thalamus and the basal fore brain which then brings the amount of serotonin and catecholamine to the normal stage inducing the sleep. The procedure of Shirodhara brings the Sanjnavaha Srotas in peaceful state of rest which helps in inducing sleep. The process of Shirodhara also produces a meditation effect which helps to overcome the complaint of insomnia. The method Shirodhara produces almost similar effects as that of Yoganidra technique in yogic science. 4 Conclusion Shirodhara is becoming increasingly popular in day spas, especially in North America, where it is used to relieve fatigue and promote relaxation. 14 As oil is poured on the forehead, the nervous system is deeply stilled. The brain waves slow down and become coherent. Once the brain is quieted, the pranavaha and manovaha srotas begin to transport prana, oxygen, and other necessary nutrients to the brain. When the brain is quieted and the srotas are activated, the cerebral circulation is greatly improved, and access to these mood stabilizing receptors is enhanced. The result: better brain function, mood stability, and improved stress handling ability. 11 Shirodhara may be the oldest but the most skillful healing technique that manipulates cerebral circulation, cerebral function, and the state of consciousness. It may provide a new tool and new knowledge for modern brain research into consciousness. Furthermore, it may open new paradigms for exploring what we refer to as spiritual biotechnology. 9 In India, Shirodhara is a common and ageold Ayurvedic practice, and the clinical benefits are being observed by vaidyas in thousands of patients.2 Shubham bhavatu! God Bless You! 14 References 1. Vinjamury, Sivarama Prasad et al. “Ayurvedic Therapy (Shirodhara) for Insomnia: A Case Series.” Global Advances in Health and Medicine 3.1 (2014): 75–80. http://www.ncbi.nlm.nih.gov/pubmed/24753997 PMC. Web. 21 Feb. 2015. 2. Dhuri, Kalpana D., Prashant V. Bodhe, and Ashok B. Vaidya. “Shirodhara: A PsychoPhysiological Profile in Healthy Volunteers.” Journal of Ayurveda and Integrative Medicine 4.1 (2013): 40–44. http://www.ncbi.nlm.nih.gov/pubmed/23741161 PMC. Web. 21 Feb. 2015. http://www.ayurvedacollege.com/book/export/html/2
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3. Kundu, Chittaranjan et al. “The Role of Psychic Factors in Pathogenesis of Essential Hypertension and Its Management by Shirodhara and Sarpagandha Vati.” Ayu 31.4 (2010): 436–441. http://www.ncbi.nlm.nih.gov/pubmed/22048535 PMC. Web. 22 Feb. 2015. 4. Pokharel, Sanjay, and Ajay Kumar Sharma. “Evaluation of Insomrid Tablet andShirodhara in the Management of Anidra (Insomnia).” Ayu 31.1 (2010): 40–47. http://www.ncbi.nlm.nih.gov/pubmed/22131683 PMC. Web. 22 Feb. 2015. 5. Fenghao Xu, Kazuo Uebaba, Hiroko Ogawa, Takeshi Tatsuse, BingHong Wang, Tatsuya Hisajima, and Sonia Venkatraman. “Pharmaco PhysioPsychologic Effect of Ayurvedic OilDripping Treatment Using an Essential Oil from Lavendula angustifolia”, The Journal of Alternative and Complementary Medicine. October 2008, 14(8): 947956. doi:10.1089/acm.2008.0240. http://www.ncbi.nlm.nih.gov/pubmed/18990044, http://online.liebertpub.com/doi/abs/10.1089/acm.2008.0240 6. Gotmare Ashish, Tawalare Kiran, Nanote Kalpana, Dehankar Manisha. “Godugdha Shirodhara: A Non Pharmacological Treatment of Nidranash (Insomnia). (Moksha Publishing House, 2013) doi:10.7897/22774343.04417 http://www.ijrap.net/admin/php/uploads/1058_pdf.pdf 7. RK Sharma and Bhagwan Dah, Charaka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2014) vol. V, preface. 8. RK Sharma and Bhagwan Dah, Charaka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2014) vol. VI, ch. 1, verses 78. 9. Uebaba K, Xu FH, Tagawa M, Asakura R, Itou T, Tatsuse T, Taguchi Y, Ogawa H, Shimabayashi M, Hisajima T. “Using a Healing Robot for the Scientific Study of Shirodhara” http://www.ncbi.nlm.nih.gov/pubmed/?term=shirodhara+healing+robot PMID: 15825848 [PubMed indexed for MEDLINE] March/April 2005 10. Maya Tiwari, Secrets of Healing, (Twin Lakes Wisconsin, Lotus Press, 1995), 150156. 11. Dr. John Douillard, The Encyclopedia of Ayurvedic Massage, (North Atlantic Books, Berkeley, California, 2004), 1415, 1920, 36, 51, 8990, 271279. 12. Brahmi: “Herb of Grace“, 1, 3. http://www.ayurvedacollege.com/articles/students/Brahmi 13. Sunil V. Joshi, Ayurveda & Pancha Karma, (Twin Lakes Wisconsin, Lotus Press, 1997), 281 14. WebMD http://www.webmd.com/vitaminssupplements/ingredientmono1215 shirodhara.aspxactiveingredientid=1215&activeingredientname=shirodhara http://www.ayurvedacollege.com/book/export/html/2
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The Living Knowledge of Healing Through Nature: An Ayurvedic Management to Epidemic Disease By Michael Van Sciver Abstract: Human beings, interdependent and impermanent like all the innumerable creatures throughout existence, have abided by the natural rhythm of creation, maintenance and destruction from their inception. This mechanism has kept Homo sapiens’ population in balance and interwoven with the multifaceted tapestry of earthly cohabitants, whilst insuring human’s environmental impact remain subject to the function of a normal, healthy cycle characterized by the stages of accumulation, aggravation, and alleviation. But, with the development of widespread agriculture and industry, the pollution of humans took a new diseased pattern. The byproducts of human life moved from accumulation and, rather than naturally alleviating, began to overflow, relocate, manifest, and diversify. This disruption of the natural order has become so rampant that it presently affects the flow of the elements, humors, and forces, which sustain all life on this tiny planet. Humans can look at these past 10,000 years of history as a global diagnostic test, from which they have learned much. With this knowledge they are empowered to reverse their impact, refine their behaviors, and thrive in accord with innate, universal law. Methods: A review of the literature was conducted, including: classical Ayurvedic, Buddhist and Vedic texts, contemporary peerreviewed research articles, and contemporary texts from fields such as: Ayurveda, Environmental Science, Permaculture, and Ecopsychology. Currently, the creatures of earth find themselves in a precarious situation. The climate is experiencing a time of atmospheric disequilibrium. This changing atmosphere has an effect on ecosystems, weather patterns, and species at large. Scientists know this to have happened before. The earth was conquered by a species once in the past, which rapidly introduced a gas into the atmosphere at a radically abnormal concentration. This species was ancient cyanobacteria and that climate changing gas was exhaled oxygen as a product of respiration. Since those earliest colonizers, the earth has played host to 2.3 billion years worth of species, more than 99 percent of which have gone extinct.1 A stark amount of these lost species have been shown to die off in relative chronological proximity to others in what are considered at least five different “great extinctions”. Humankind now finds itself conveniently at the driver’s seat of another such extinction episode. This presents a sequence of questioning. If Homo sapiens is a part of nature, and change is natural, is climate change not a natural event? Should people work to reverse this process, and if so, how can they be successful? What is the nature of existence? How can one define balance? How has anthropocentric entropy gotten so carried away? It is the intent of this paper to demonstrate the methods for an individual to find health through connecting with nature; however, in a time of pervasive disconnection, one must take a very long view in order to address this issue. Luckily, for those who do wish to find personal and ecological health, become established in their selves, lead an abundant life, and even actualize liberation from the cycles of suffering, the ancient and living knowledge contained in the Science of Life, Ayurveda, has much to offer. To properly treat a disease, there are associated factors a qualified physician must first thoroughly understand. The disease is surely a product of a certain imbalance of elements. So, the disease itself has a unique elemental constitution. Along with an imbalance, the diseased being also has an original constitution distinctive to its identity. The same is true for every potential treatment. An appropriate therapy is one that restores balance to the elemental composition and flow. In order to comprehend the components at play, it is best to realize their origins. http://www.ayurvedacollege.com/book/export/html/2
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According to Sankya Philosophy, a foundation of Ayurvedic and Yogic theory, the materialization of our current universe involved 25 aspects of reality, or tattvas. The last five of these tattvas to be produced were the five elements to which we are accustomed, ether, air, fire, water, and earth.2 This origination came from the merging of the potential for matter with universal consciousness, and its products are the base material for all forms and beings. This event of divergence from a single origin into the infinite complexity of life is summed up in one line by the author Patañjali in verse 4.14 of his Yoga Sūtras, “The things [of the world] are objectively real, due to the uniformity of [the gunas that underpin] all change.”3 Gunas here is referring to primordial qualities, namely purity, activity, and inertia. Middle Way Buddhists, like the sagephysician Nāgārjuna, similarly consider all compounded things to be of dependent origination and empty of inherent existence. By reverse engineering this evolutionary process, Nāgārjuna articulates a remedy, “Through meditatively cultivating the wisdom of reality, which is the same [for all phenomena] and is moistened with compassion, for the sake of liberating all sentient beings, you will become a Conqueror endowed with all supreme aspects.”4 In the BhagavadGītā, Lord Krishna also speaks of this equipoise, “Those with the vision of eternity can see that the imperishable soul is transcendental, eternal, and beyond the modes of nature. Despite contact with the material body, O Arjuna, the soul neither does anything nor is entangled.”5 So, if each person in absolute reality is actually pure, unobstructed consciousness and beyond the elements, why should one bother with constitution, imbalance, and disease? The five elements emanated from the creation of the five elementals, tanmátras, or senses. These senses are a product of Támasa Ahamkára, the most rudimentary form of egoism.6 Functioning in a personified entity, these attributes will inevitably give rise to sense desires. It is desire that acts to mar an individual and causes them to succumb to the sway of attachment and aversion to the aggregates of relative reality, and suffer. This causes one to forget their nature as an immortal soul, build identity around impermanent forms, and entrench their self further in an illusion. From this deluded mindframe, one proceeds to act. These actions become habits, and the individual drifts further into psychosis. Fortunately, adepts such as Patañjali and Gautama Buddha, each with their respective eightfold path, have provided a template for cleansing the obscurations of desire and remembering ones Natural Great Perfection. To have the strength to stand on this kind of path requires profound determination and stamina both mentally and physically. So one who wishes to know their true self, be free from the brambles of suffering, and taste bliss beyond duality, must maintain the body and mind; for, these faculties will together serve as a vehicle along the Way. The Ashthāñga Hrrdayam begins, “Obeisance be, to that Apūrva vaidya (unique/unparalleled/rare Physician) who has destroyed, without any residue, (all) the diseases like rāga (passion/desire) etc. which are constantly associated (innate/inherent) with and spread all over the body, giving rise to outshukya (anxiety), moha (delusion) and arati (restlessness). [A] person desirous of (long) life which is the means (instrument) for achieving dharma (righteousness), artha (wealth) and sukha (happiness) should repose utmost faith in the teachings of Āyurveda.”7 According to this genesis story, the five elements subsequently combined, ether with air, fire with some water, and a majority of the water with earth, in the formation of three distinct humors. These humors characterized as wind, bile, and phlegm, respectively, are the means by which all mundane phenomena, from the digestion of food to the procession of the seasons, occur. Thus, the healthy functioning of natural systems is dependent upon the balance of these three humors. In The Ambrosia Heart Tantra it is said, “Wind is characteristically rough, light, cold, subtle, hard and motile. Bile is characteristically oily, acrid, hot, light, badsmelling, bears the quality of purging and is moist. Phlegm is characteristically cool, heavy, acts as a softening agent, and is gentle, firm and sticky”8 By adhering to daily and seasonal patterns of action and sensory intake, one can work in accord with the natural rhythms of the humors to prevent overflow in the accumulation of any. The roles of these three are concurrent throughout the ancient texts. Lord Dhanvantari in the Sushruta Samhita draws a parallel between the external force of wind, vata, and the internal nerve force, váyu. He says that, “Váyu, in its normal or undisturbed condition, maintains a state of equilibrium between the different Doshas http://www.ayurvedacollege.com/book/export/html/2
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(humors/faults) and the root principles of the body (Dhátu); it further tends to maintain uniform state in the metabolism of the body, (protoplasmic, Agni) and helps the organs of senseperception in discharging their specific functions.”9 Sage Rigpé Yeshé in commentary on Shakyamuni Buddha’s Heart Ambrosia Tantra root text describes bile, pitta in Sanskrit, as the active force in the body governing hunger and thirst, digestion, heightened bodily heat, complexion, courage and intelligence. He goes on to elucidate phlegm, kapha in Sanskrit, as that which gives structure mentally and physically, aids in sleep, connects and protects the joints, “gives patience and lubricates the body, making it soft.”10 In the external universe these same doshas have similar effects. Charaka says “As the loka (macrocosm) is afflicted or maintained respectively by the morbidity and normal state of the wind, sun and moon, so also the adhyāthaloka (sentient world or microcosm) is afflicted or maintained respectively by the morbidity and normal state of váyu, pitta, and kapha.“11 Vata is the vitality behind all eolian phenomena, and is often associated with destruction and decay. Kapha is associated with generation and life springing from the ashes of ruin. Pitta is known as the sustainer and oversees productive activity. So biological, geological, annual and diurnal sequences begin with the aggravation of kapha, during such time pitta is accumulated, as the potential for production ripens, and vata is alleviated while decayed material is subjected to organization and utilization. As more stored energy is put into pitta’s manufacturing plants, kapha is alleviated, giving less structure and order to insure the system’s strength, which allows the turbulent vata to accumulate. Then with the full alleviation of kapha, pitta begins to burn its remaining resources, and the decay of vata rules aggravation, which gives fodder for the reaccumulation of kapha and the reset of the series. Excessive accumulation and aggravation of any of these humors can result in a system overflow, rather than alleviation, which is the pathway of disease. Dr. Vasant Lad reminds one to rely upon the qualities of the doshas in order to decipher which is the culprit in pathogenesis. He says, ”We must understand whether the person is in the acute, subacute, or chronic stage of disease.” And he also indicates one to note whether the condition is with or with out āma.12 Āma can be thought of as a toxic sludge built up by improper digestion of the food, which travels into deeper and deeper tissue layers, increasingly polluting bodily functions. So the logical first step for healing when āma is present would be to right digestion and eliminate the contamination of āma in the system. After one has thoroughly cleansed the different tissue layers, they can begin to tonify, and after each layer of tissue has been tonified, the body will build ojas. “Ojas is the essence related to vitality and immunity”, says Dr. Lad.13 Charaka insists that maintenance of the cardiovascular system; happiness, tranquility and wisdom are vital factors in the preservation of ojas. 14 However, he argues, “nonviolence stands the first and foremost among the promoters of longevity of living beings.”15 So the formula for health is taking form. One should regulate digestion so as to prevent from the formation of āma. One should also abide by the natural rhythms of the primordial humors, so as to prevent the overflow of any, while working to preserve and promote ojas through support of the mental, emotional, and physical heart. It should be understood that the heart is considered the seat of consciousness and thus the place where happiness, tranquility, compassion and wisdom reside. How can one truly alleviate āma, incorporate circadian routine, and build ojas in a world where they are constantly bombarded with interference from sources such as: radiation, plastic pollution, season disruption, sound pollution, light pollution, electromagnetic field pollution, air pollution, water pollution, soil degradation, deforestation and so forth? Furthermore, how can one balance the doshas inwardly, while the environment is in a state of everincreasing disarray? In a diseased environ, how can a person have any confidence that food or herbs taken will have their intended effect? The word apocalypse, one suited to describe the visions of this current crisis with its multifarious manifestations, comes from the Greek word apokaluptein, meaning to uncover or reveal.16 Could all these catastrophic events, biodiversity loss and mass extinction, upsetting of the carbon cycle and its effects such as ocean acidification, asynchrony with the cosmos through light pollution, and the like, actually be apocalyptic in the Greek sense that they are disclosing a deep truth? The great 19th century physician Edward Bach lends a valuable insight. “Let it be briefly stated that disease, though apparently so cruel, is in itself beneficent and for our good, and if rightly interpreted, it will guide us to our essential faults. If properly treated it will be the cause of the removal of those faults and leave us better and greater than before.” 17 So what lesson can the http://www.ayurvedacollege.com/book/export/html/2
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so called “wise man”, Homo sapiens, learn from this diseased world concerning his faults? Again it would be useful to consult the mystic clarity of Charaka: For example, when the rulers of states, towns, cities and countries transgress the righteous path and rule their subjects by sinful means then their subordinates… add to this sinful situation. Their sinful acts perforce make the righteous acts to disappear. Because of the disappearance of righteous acts, even the gods desert the people living in these places. Such are the places where seasons are impaired. Consequently either there is no rainfall in time or there is no rainfall at all or there is abnormality in the rainfall; air does not blow properly; there is abnormality in the earth, water (reservoirs) get dried up, drugs lose their normal attributes and get impaired. Then there is impairment of the country because of the impairment of food and drinks.18 To fully appreciate the meaning of this assertion it is indispensible to comprehend two fundamental themes. First, according to traditional Indo Vedic philosophy, gods personify different aspects of nature. For instance, Indra represents rain and thunderstorms. So for a land to lose the presence of the gods would mean its people have forgotten how to honor nature, and thus, have severed the lifeline to the organic world. Here righteous acts are those generated by right motivation, and thus do not involve profiting from the loss of others, and instead are meant to benefit beings and lead toward liberation. Secondly, religious activity, regardless of a personage’s spiritual faith, is characterized by the habitual actions consistently committed. This perpetual pursuit defines ones values and shapes their reality. So if politicians honor wrong views and the state awards misconduct, righteous activities like compassionate care and following one’s dharma, life mission, will fall out of favor in wake of superficial material wealth, comfort, and convenience. As a prescription for such a time, in the Sutra of the Medicine Buddha, it is written, “if calamities such as epidemics, …untimely wind and rain, or drought arise in a country, the ruler of that country should give rise to the heart and mind of compassion for all sentient beings…that country will be able to quickly attain peace and stability.19 And Charaka also offers a rejuvenative therapy to be administered for the same affect, but presents the idea that this revolutionary solution to remove pollution could also come from the individuals within a society adopting truthful and compassionate means of being and honoring the natural world.20 The path towards healing often requires reversing the etiology, i.e. changing the behaviors that lead to sickness. In the case of climate change, this would involve a reconnection to nature and an allowance for the different elemental cycles, which humans now grasp scientifically, to return to closed loops. There is much healing to do, but the potential for success is high, as there is such a clear path forward. Simply doing less or reverting to a preindustrial/preagricultural system is not probable or likely feasible; however, this resolution will involve doing more. It will take all the cumulative wisdom, lovingkindness, and ingenuity of Homo sapiens to achieve homeostasis and the conditions for a life of lasting leisure. So what is the etiology resulting in the contemporary calamity? One should remain mindful of the elements, the procession of the doshas, and the normal progression of stages from accumulation to aggravation to alleviation. One can then observe that similar cyclical patterns have been scientifically verified for many of the periodic elements, such as oxygen, carbon, magnesium, sulfur, iodine, nitrogen, phosphorous and potassium. For instance, carbon is stored in all organic material, released upon decay or combustion, and returned to either the soil or the atmosphere. From the soil it is recycled into the formation of new organic life forms, and from the atmosphere it is absorbed through respiration, mostly by photosynthetic organisms. This is one loop left open, and that has moved far beyond overflow. This is a story that should be familiar to the reader, carbon sequestered long ago in the form of coal, oil, natural gas, and tar sands has been unearthed and burned for fuel. Humans have been using http://www.ayurvedacollege.com/book/export/html/2
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burned carbon in the form of wood, charcoal, and coal since prehistoric times, but until the Industrial Revolution, the amount of atmospheric carbon emitted by this process was never enough to really overwhelm the earth’s carbon breathing creatures. Since the onset of industry, however, carbon has been accumulating in the atmosphere, with the world’s vegetation, algae, and oceans absorbing as much as they could; yet, it continued to accrue in a manner consistent with disease. As a greenhouse gas, atmospheric carbon in the forms of carbon dioxide and methane acts to trap the suns heat, causing warming. This heating effect is strongest at the poles, where it has been causing the steady recession of icecaps and permafrost. These long frozen vicinities themselves store a great amount of carbon, which is released upon their melting. This loss of white earth results in the lessening of the albumin effect, the ability of the earth to reflect the suns rays. This heating has farreaching results as it progresses further into disorder. This changes and intensifies weather patterns, as there is more moisture holding capacity in a warmer atmosphere, precipitation events are larger and more destructive. At the same time droughts worsen as evapotranspiration is increased by warmer temperatures and the earth is left susceptible to bigger forest fires, which further attribute to the perverted carbon cycle.21 Excess carbon absorption by the oceans chemically lowers their pH which intern has far reaching implications. Carbon overflow is the most immediate threat to the existence of life, as it is known on the earth. And one can observe objectively the maturation of the karmic seeds of which the Medicine Buddha and Charaka had warned. It is simply because of desire for shortterm convenience over longterm sustainable happiness and the corruption of policy makers that this occurred. Today the advancements of technology exist to sustainably meet the world’s power demand, if only people can let go of the mislead notion that one can gain while causing demise, and embrace the values of compassion for beings. It is not necessarily the devious plans of sinister societies that caused this outcome, instead ignorant illusion. A similar, perhaps less daunting story can be told over and over again as the misappropriation of resources has achieved epidemic proportions. Even sand has been so poorly over harvested that it is one of the biggest illegal trades on the planet. All over developed nations, illegally mined oceanic sand it utilized for the construction of skyscrapers, glass, and the extractions of rare earth metals to create electronics. This dredged sand causes the deaths of many sea creatures and attributes strongly to erosion in places where a rising sea is already a serious concern.22 Squandering resources is at the core of all environmental problems the world over. This act of profiting from destruction is exactly the kind of ‘sinful’ practice Charaka described as a contributing factor for epidemics. These transgressions represent the typical business plan since the Industrial Revolution. Despite the flowering abundance of natural systems, many have been exploited to, or beyond, the brink of recovery. As all life is intertwined and interdependent, anthropogenic phylogeny loss is worsening by the day.23 According to 20 years of research from the United Nations, measuring the necessity for biodiversity, There is now unequivocal evidence that biodiversity loss reduces the efficiency by which ecological communities capture biologically essential resources, produce biomass, decompose and recycle biologically essential nutrients. There is mounting evidence that biodiversity increases the stability of ecosystem functions through time. The impact of biodiversity on any single ecosystem process is nonlinear and saturating, such that change accelerates as biodiversity loss increases. Diverse communities are more productive because they contain key species that have a large influence on productivity, and differences in functional traits among organisms increase total resource capture. Loss of diversity across trophic levels has the potential to influence ecosystem functions even more strongly than diversity loss within trophic levels. Functional traits of organisms have large impacts on the magnitude of ecosystem functions, which give rise to a wide range of plausible impacts of extinction on ecosystem function.24 http://www.ayurvedacollege.com/book/export/html/2
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This loss of ecosystem function has direct, debilitating effect on the health of the Homo sapiens organism. A multitude of minerals have leached from the soil and are causing severe mineral deficiency in many people. For instance, magnesium is now found at observably low concentrations in most soil. Magnesium has been shown to sustain beneficial gut microbiota which support healthy states of body and mind.25 In America’s Pacific Northwest, salmon (Oncorhychus sp.) have become disunited from their alpine stream breading grounds through the over production of dams. This has not only significantly limited a once abundant protein source, but also has broken the cycle that would normally return phosphorous, nitrogen, and other key nutrients to forests as far as 1,000 miles from the coast. In the downstream flow, such dams have also blocked crucial habitat forming sediment. Salmon are correspondingly under extreme pressure from climate change.26 Resulting from the decline of Pacific salmon stocks, the Southern Resident orca whale (Orcinus orca) is now in danger of extinction. 27 From similar stories of anthropocentric habitat and food loss, many of the earth’s classically iconic creatures are now listed as endangered. In Sumatra, the endemic rainforest home of elephants (Elephas maximus sumatranus), tigers (Panthera tigris sumatrae), rhinos (Dicerorhinus sumatrensis) and orangutan, ‘man of the forest’ (Pongo abelii), has mostly been lost in wake of palm oil plantations. The American grasslands, once home to millions of buffalo, have been converted to raise grain and legumes to be fed to domesticated species like cows in fed lots across the country. These animals are subject to deplorable living conditions and contribute heavily to climate change, as their waste is not sequestered properly. This waste and chemicals from the massive industrial grain and legume production fields pollute waterways and create dead zones in deltas all across the country. Land use change to intensive monocrop farming leads to extensive destruction of microbes, macronutrients and trance minerals. 28 Beyond impacting the soil, water, plants and animals, on which man ultimately depends, chemical fertilizers and pesticides have been linked directly to the degradation of human health.29, 30 Industrial sized animal rearing has lead to the overuse of antibiotics in healthy animals, causing extreme bacterial resistance to these valuable medicines.31 In Mongolia shamans speak of the decline in species like the snow leopard, caused by over grazing of sheep limiting the range and number of native mountain goats, from the landscape as “the mountain losing its echo”.32 As demonstrated, science can verify the impact loss of ecosystem function can have on human health, but how can one ever quantify the lossofawe man experiences when he can no longer be inspired by iconic creatures and settings? How can one measure the psychological impact turning rainforest and water bodies like the Aral Sea into a desert, removing entire mountains from the landscape via strip mining and mountain top removal, or introducing billions of gallons of toxic ‘produced water’ and upsetting the geological balance via hydrofracking has? How can one cope with the emotions accrued by bringing the polar bear (Ursus maritimus) or the giant panda (Ailuropoda melanoleuca) to extinction? The results of many studies suggest time in nature is of supreme benefit.33,34 35, 36 Yet there are very few places on earth where one can experience true nature, free from sound, or other forms of pollution. How can one sleep with the cycles of the doshas in the midst of light pollution so strong their pineal gland cannot suitably secrete melatonin. The plastics of human’s consumerism are overrunning the oceans and causing harm upon consumption by creatures ranging from coral to whales. These plastics are shown to cause hormonal imbalance and gene change in oceanic species like zebrafish (Danio rerio)37 as well as humans.38 Today’s average, fastpaced lifestyle, with the need for instant gratification, has allowed for the ubiquitous use of pharmaceutical pills and thus a legacy of iatrogenic illnesses. Does one need a study to demonstrate the necessity of seeing the night sky, taking clean water and food, having medicine that is safe, or being able to hike in the woods? The healing prowess of compassion can incite humans to act and save places and animals and ultimately care about themselves enough to acknowledge the selfdestruction inherent in ignorance. By realigning ones lifestyle to wisdom, purpose, and joy, one can change the trajectory of their life. This will affect positive change proximally and distally along the capacious branches of the tree of life. The work that reconnects is that which creates a real working relationship to the land. The science of sustainability is gaining strength everyday. http://www.ayurvedacollege.com/book/export/html/2
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Ancient principles and ideas are now reborn with new insights. The way to health for the individual is the return to health of the systems. It is now understood that the most successful indigenous cultures were neither hunter/gatherers nor agriculturist, rather they were tenders of the wild. They learned to maximize nature’s abundance by working with the elements and not viewing themselves as separate from their surroundings. They were able to balance production with ecosystem diversity and resilience. This was accomplished through the implementation of diverse resource management techniques such as: burning, pruning, sowing, weeding, and tilling.39 “In traditional cultures, there are connections between the plant growing in its environment, its creative transformation into useful items, and the use itself.” says M. Kat Anderson.40 By reestablishing a relationship with the land, people can better understand the complex systems at work and how to maintain or optimize them. Anderson proceeds, “Achieving sustainable use of the earth’s resources will involve cultural changes as much as advances in knowledge and transformation of economies.”41 The science of permaculture (permanent agriculture) offers a series of methods aimed to bridge the gap between present problems and future success by reimagining methods for working with resources. One of the fathers of permaculture, Bill Mollison, set out five major principles: 1. Work with nature, rather than against the natural elements, forces, pressures, processes, agencies, and evolutions, so that we assist rather than impede natural developments. 2. The problem is the solution; everything works both ways. It is only how we see things that makes them advantageous or not (if the wind blows cold, let us use both its strength and its coolness to advantage). A corollary of this principle is that everything is a positive resource; it is just up to us to work out how we may use it as such. 3. Make the least change for the greatest possible effect. 4. The yield of a system is theoretically unlimited. The only limit on the number of uses of a resource possible within a system is in the limit of the information and the imagination of the designer. 5. Everything gardens, or has an effect on its environment.42 This science shows a great potential to heal and feed the world.43 Permaculture echoes Ayurvedic principles, guiding one to elemental harmony, grace, and abundance. As humans decentralize their food sources and begin to consume local and seasonal fair, not only will they reestablish a culture with the land and its beings, they will regenerate a synchronistic routine with the doshas. John Douillard in his book, The 3Season Diet, expounds that, in order to pacify the doshas at their time of accumulation and aggravation, one must simply eat with the rhythm of local, seasonal harvests.44 Another regenerative and rejuvenative living Science of Life, Ecopsychology, maintains, “We are mentally, more than physically, isolated from the natural world.”45 So accordingly, humans must first change their minds in order to manifest new physical circumstances. Henry David Thoreau reverberates this sentiment,” There must be the copulating and generating force of love behind every effort destined to be successful.”46 In deduction, for one to be healthy, they must have right motivation, practice righteous activities, foster a compassionate and wise heart, respect natural laws, and live in accordance with such laws. This kind of spiritual, cerebral, and somatic activity will spread from an individual, eventually blessing all beings. Nature truly depends on the consideration and endeavor of humans to thrive, just as they are intimately reliant upon the utilities of the universe. http://www.ayurvedacollege.com/book/export/html/2
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Endnotes 1. National History Museum, Mass Extinctions. http://www.nhm.ac.uk/natureonline/life/dinosaursotherextinctcreatures/massextinctions/ 2. Bryant, Edwin F. The Yoga Sūtras of Patañjali (North Point Press, 2009) p. xlvii 3. Ibid. 428 4. Hopkins, Jeffery Nāgārjuna’s Precious Garland (Snowlion Publications, 2007) 73 5. Prabhupāda, A.C. Bhaktivedanta Swami BhagavadGītā: As It Is (The Bhaktivedanta Book Trust, 1986) 677. 6. Bhishnagratna, Kinja Lal Sushruta Samhitá (Bharat Mihir Press, 1911) 114. 7. Murthy, Prof. K.R. Srikantha Vāgbhatha’s Ashthāñga Hrrdayam (Chowkhamba Krishnadas Academy, 2013) Vol. 1 Chapter 1, 3. 8. Dönden, Dr. Yeshi The Ambrosia Heart Tantra (The Library of Tibetan Works and Archives, 1977) 67. 9. Ibid. 6, 23. 10. Ibid. 8, 66. 11. Sharma, Dr. Ram Karan and Vaidya Bhagawan Dash Caraka Samhitā (Chowkhamba Sanskrit Series Office, 2014) Vol. 4 chXXVI 292, 547. 12. Lad, M.A.sc., Vasant Textbook of Ayurveda Vol. 3 (The Ayurveda Press 2012) 425. 13. Ibid., Vol. 1 208. 14. Ibid. 11, Vol. 1 ch XXX 1314. 596. 15. Ibid., paragraph 15 596. 16. Landau, Sidney I. The New International Webster’s Collegiate Dictionary of the English Language (Trident Press International, 2002) 33. 17. Bach, Edward Heal Thyself (Keat’s Publishing Inc., 1997) 11. 18. Ibid, 11 Vol. 2 ch III, 1920 147. 19. Yun, Venerable Master Hsing Sutra of the Medicine Buddha (Buddha’s Light Publishing, 2005) 3233. 20. Ibid 11, Vol 2 Ch III, 1218 146. 21. Baird, Colin and Michael Cann Environmental Chemistry (W.H. Freeman and Company, 2008) 205229 22. The Ojos Negros Resource Group, Sand Mining Facts. http://threeissues.sdsu.edu/three_issues_sandminingfacts01.html 23. Nature, Biodiversity Loss and its Impact on Humanity. http://www.nature.com/nature/journal/v486/n7401/full/nature11148.html 24. Nature, Consequences of Climate Change on the Tree of Life in Europe. http://www.nature.com/nature/journal/v470/n7335/full/nature09705.html 25. Cambridge, Dietary Magnesium Deficiency Alters Gut Microbiota and Leads to Depressionlike Behavior. http://www.ncbi.nlm.nih.gov/pubmed/25690713 26. Nature, Adaptive Potential of a Pacific Salmon Challenged by Climate Change. http://www.nature.com/nclimate/journal/v5/n2/full/nclimate2473.html 27. NOAA, Effects of Salmon Fisheries on Southern Resident Killer Whales. http://www.westcoast.fisheries.noaa.gov/protected_species/marine_mammals/killer_whale/effects_fisheries.html 28. Elsevier, Soil Carbon, Nitrogen and Phosphorus Changes Under Sugarcane Expansion in Brazil. http://www.ncbi.nlm.nih.gov/pubmed/25688522 29. Bio Med Environ Health, Agricultural Chemical Exposures and Birth Defects in the Eastern Cape Province, South Africa: a casecontrol study. http://www.ncbi.nlm.nih.gov/pubmed/14613490 http://www.ayurvedacollege.com/book/export/html/2
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30. Asian Pacific Organization for Cancer Prevention, Relationship Between Exposure to Pesticides and Occurrence of Acute Leukemia in Iran. http://www.ncbi.nlm.nih.gov/pubmed/25640359 31. Oxford Journal, Botanical Alternatives to Antibiotics for Use in Organic Poultry Production. http://www.ncbi.nlm.nih.gov/pubmed/25743421 32. MacEachen, James The Leopard in the Land (2015) 33. Health Place, Green Space, Health and Wellbeing: Making Space for Individual Agency. http://www.ncbi.nlm.nih.gov/pubmed/25453749 34. Health Place, The Role of Natural Environments within Women's Everyday Health and Wellbeing in Copenhagen, Denmark. http://www.ncbi.nlm.nih.gov/pubmed/25435057 35. Elsevier, Is Physical Activity in Natural Environments Better for Mental Health than Physical Activity in Other Environments? http://www.ncbi.nlm.nih.gov/pubmed/22705180 36. UC Berkley, Add Nature, Art and Religion to Life’s Best Antiinflammatories. http://newscenter.berkeley.edu/2015/02/02/antiinflammatory/ 37. Chemosphere, Longterm Effects of Bisphenol AF (BPAF) on Hormonal Balance and Genes of Hypothalamuspituitarygonad Axis and Liver of Zebrafish (Danio rerio), and the Impact on Offspring. http://www.ncbi.nlm.nih.gov/pubmed/25723718 38. PLoS One, An Investigation of the Endocrinedisruptive Effects of Bisphenol A in Human and Rat Fetal Testes. http://www.ncbi.nlm.nih.gov/pubmed/25706302 39. Anderson, M. Kat Tending the Wild (University of California Press, Ltd. 2005) 127. 40. Ibid. 338. 41. Ibid. 361. 42. Mollison, Bill Permaculture: A Designer’s Manual (Tagari Publications, 1988) 35. 43. Fresh Lands Environmental Action, Feeding and healing the world: through regenerative agriculture and permaculture. http://www.ncbi.nlm.nih.gov/pubmed/23469709 44. Douillard, John The 3Season Diet (Three Rivers Press, 2000) 9. 45. Cohen, Ed.D., Michael J The Web of Life Imperative (Institute of Global Education, 2003) 45. 46. Thoreau, Henry David, The Journals of Henry David Thoreau (New York Review of Books, 2009) 110.
The Power of Medicinal Plants for Managing Type II Diabetes Mellitus By: Deepa V. Malavalli http://www.ayurvedacollege.com/book/export/html/2
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Contents: Page Introduction 4 Diabetes viewed from a Western Perspective 5 Diabetes viewed from an Ayurvedic Perspective 8 Herbs that alleviate or prevent Type II Diabetes 11 Turmeric 10 Amla 11 Fenugreek 12 Black Cumin 14 Curry Leaf 15 The Drumstick Tree 17 Conclusion 20
See PDF Article
The Use of Herbs as Part of an Ayurvedic Treatment Approach to Diabetes Mellitus and Blood Glucose Imbalances By: Airlie Ellsworth Introduction http://www.ayurvedacollege.com/book/export/html/2
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The average American consumes 22.7 teaspoons of sugar per day. With this constant overdose of both refined and natural sugar it’s no surprise that 347 million people worldwide have diabetes mellitus – a figure that has climbed from 153 million just 35 years ago1. What’s even more alarming is that greater than 35% of Americans have prediabetes2, which puts them at increased risk for conditions such as hypertension and heart disease, Alzheimer’s, cancer, polycystic ovarian syndrome, anxiety, depression, and sleep disorders; as well as inflammation, male pattern baldness, food cravings and mood swings, poor circulation, high cholesterol, and high levels of stress hormones3. Luckily, making small changes to our diet and lifestyle can make big improvements in our health and wellness. In this paper I will briefly review the body’s physiology as it pertains to maintaining stable blood glucose levels; the various diseases associated with imbalanced blood glucose levels: hypoglycemia, prediabetes, and types 1 and 2 diabetes mellitus; review and discuss several herbs which are commonly used to treat these diseases: gurmar, cinnamon, fenugreek, aloe vera, shallijit, and jambu; then consider diet and lifestyle recommendations that are beneficial in their management. Physiology of blood sugar Our bodies have a complex and intelligent way of maintaining homeostasis. To sustain healthy blood glucose levels, glucagon and insulin are released via a negative feedback loop as follows: the onset of hypoglycemia (a drop in blood glucose levels) stimulates the release of glucagon from alpha cells in the pancreas. The glucagon then acts on hepatocytes (liver cells) to promote the formation of glucose from lactic acid and amino acids (a process called gluconeogenesis) and accelerate the conversion of glycogen into glucose (a process called glycogenolysis). These reactions cause hepatocytes to release glucose into the blood stream more quickly, which raises the blood glucose level. If blood glucose continues to rise, hyperglycemia (high blood glucose levels) inhibits the release of glucagon and stimulates the secretion of insulin by beta cells in the pancreas. Insulin has a variety of effects: it acts on specific cells in the body to increase facilitated diffusion of glucose into cells, it speeds up the conversion of glucose into glycogen (glycogenesis) and the synthesis of fatty acids (lipogensis), it slows glycogenolysis and gluconeogenesis, and it increases the uptake of amino acids by cells. All of these reactions cause blood glucose levels to fall. If blood glucose levels drop back into hypoglycemic range, the release of insulin is inhibited, which stimulates the release of glucagon, and the cycle repeats to right itself4. When sugars and simple carbohydrates are ingested, the pancreas is forced to produce and secrete excess insulin to help move the sugars from the blood stream into the cells. A diet high in sugar forces insulin levels to spike more frequently than the body can handle. This fatigues the pancreas and causes the cells to become resistant to allowing in any more glucose. As a result of this excess glucose in the blood, levels remain unnaturally high. Insulin then stores this lingering glucose as fat, causing weight gain and an increase in unhealthy cholesterol5. If hypoglycemia is ‘belownormal’ blood glucose levels and hyperglycemia is ‘abovenormal’ blood glucose levels, what then are considered ‘normal’ bloodglucose levels? Nancy Klobassa Davidson, a registered nurse who specializes in diabetes, recommends a normal fasting blood glucose target range of 70100mg/dL6, with ‘fasting blood glucose’ being the blood sugar level first thing in the morning before eating breakfast7. While this seems like a fairly broadranging safety zone, studies have found that the risk of cardiovascular and degenerative diseases increases significantly when fasting blood glucose levels rise above 85mg/dL. One such study, published in Diabetes Care Journal in 1999, tracked the fasting blood glucose level of 1,998 nondiabetic men over a 22year period. This research showed that men whose fasting blood glucose level rose above 85mg/dL were 40% more likely to die of cardiovascular concerns8. Conditions associated with blood glucose levels http://www.ayurvedacollege.com/book/export/html/2
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Hypoglycemia The Merck Manual Home Health Handbook defines Hypoglycemia as “abnormally low levels of sugar (glucose) in the blood”9. Besides being a side effect of the treatment of diabetes mellitus, there are two other types of hypoglycemia that occur due to abnormal endocrine functions: in reactive hypoglycemia blood glucose levels drop within a few hours of eating; in fasting hypoglycemia one experiences incredibly low blood glucose levels in the morning or if meals are skipped10. Symptoms of hypoglycemia generally include sweating, shaking, faintness, nervousness, hunger, palpitation, weakness, an inability to concentrate, headache, and general anxiety. If no known cause for the hypoglycemia can be detected, such as a tumor in the pancreas, a reaction to drugs, or some other disease11, then this condition can be treated Ayurvedically as a vata vitiation. When pitta is vitiated as well as vata, anger and irritability may also be exhibited12. PreDiabetes When blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes a person is considered prediabetic. People have prediabetes if their fasting blood glucose level is between 101 mg/dL and 126 mg/dL13. Diabetes Mellitus – Type 1 & Type 2 Diabetes mellitus is “caused by an inability to produce or use insulin”14. As discussed in the previous section, insulin is responsible for helping usher glucose from the blood into the cells via facilitated diffusion. Without sufficient insulin, blood glucose levels remain abnormally high while levels in the cells become deficient. These two imbalances combine to produce the symptoms of diabetes mellitus15. There are two types of diabetes mellitus. Type I, previously known as insulindependent diabetes mellitus, occurs when a person’s immune system destroys the pancreatic beta cells. As a result little or no insulin gets produced. Without insulin there is no means by which glucose can be carried into cells, so the cells signal to the brain that they need energy. Appetite increases and fat cells begin to break down. In order to maintain balanced blood glucose levels, patients with this condition require insulin injections. Of the two types of diabetes, type I accounts for only 10% of cases; most people with type 1 diabetes develop the condition by the age of 3016. Madhu meha, literally ‘sweet or honey like urine’ is the Sanskrit name for type 1 diabetes mellitus. Ayurveda attributes madhu meha to a vitiation of vata dosha17 . Though the Dravyaguna Vijnana translates madhu meha to ‘diabetes’ in general18, here we use it to mean the vataja type 1 diabetes. The majority–90%–of cases of diabetes mellitus is type 2 diabetes. In type 2, formerly known as ‘noninsulindependent diabetes mellitus’, the pancreas continues to produce insulin, but the body develops a resistance to it19. When sugar enters the bloodstream, insulin also rises to help carry the glucose into cells. If a diet is high in sugar, then over time more and more insulin is needed to complete this transfer. Dr. John Douillard writes on LifeSpa.com: “Normally just one unit of insulin is needed to deliver 10 mg of glucose into the cell, but as the blood sugars stay chronically high, it can eventually take 10 units of insulin to deliver the same 10 mg of glucose into the cell.”20 Iksu meha translates from Sanskrit as ‘sugar urine’. It is so named for the extra sweet nature of the urine, caused by the excess glucose being flushed from the body. This is the classical Ayurvedic description of type 2 diabetes, which is seen as a vitiation of kapha dosha21. http://www.ayurvedacollege.com/book/export/html/2
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One of the hallmark symptoms of both madhu meha and iksu meha is prameha (polyuria). Dr. Preeti Kishore on MerckManuals.com explains: “When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine”22. This causes the kidneys to excrete additional water to dilute the large amount of glucose. As a result of this excessive urination, abnormal thirst is also a symptom of diabetes mellitus. Other indications include weight loss, excessive hunger, blurred vision, nausea, drowsiness, and decreased endurance23. Disease management using herbs The primary longterm effects of poor blood glucose regulation are the result of impaired circulation caused by vascular blockages. Diminished circulation may lead to kidney failure, blindness and neuropathy24. Because madhu meha is an autoimmune disease and classified as a vata vitiation, and iksu meha is caused by obesity and classically seen as a kapha vitiation, they are managed differently. There are similarities however, and so both benefit from taking herbs that help tone the endocrine system (endocrine tonics), reduce blood glucose (hypoglycemic), and increase circulation (circulatory stimulants). Bitter and astringent herbs are also important in treating iksu meha. The following are some herbs that have been used to help regulate blood glucose level and aid in the management of hypoglycemia, madhu meha and iksu meha. Gurmar Gurmar (gymnena sylvestre), specifically the leaf, has an astringent quality and is one of the primary herbs used in Ayurvedic medicine to treat blood glucose imbalances such as madhu meha, especially during the initial onset of the disease, and to prevent it from worsening. It’s also proven useful in swaying sugar dependency, thus helping to reduce excessive blood glucose levels. Its Sanskrit name, madhunashini, translates to “what destroys the sweet taste”25. In their book ‘The Yoga of Herbs’, Doctors David Frawley and Vasant Lad explain that gurmar “counters our cravings for sugar, dulling the taste buds, and soothing the nerves. It helps control the appetite and reduce sugar cravings. It calms and soothes the liver and pancreas.”26 This herb has an active component called gymnemic acid that has been found to successfully decrease glucose absorption, thus aiding in weight loss. There are also elements of this herb that prevent the accumulation of triglycerides in the liver and muscles, and help to decrease the accumulation of fatty acid in the circulatory system27. While these are beneficial side effects that help reduce the accumulation of kapha dosha associated with iksu meha, the other effects of the herb–dulling of the taste buds, reduction of sugar cravings–diminish the amount of sugar ingested, thus decreasing its tax on the body in a preemptive way. Cinnamon Dr. John Douillard reports that “according to the US Department of Agriculture, cinnamon helped reduce risk factors associated with diabetes and heart disease”28. Despite this claim, cinnamon (cinnamomum zeylanicum), an easily accessible and popular circulatory stimulant and alterative, has yielded mixed results when tested in its efficacy to balance blood glucose levels. In 2013 a metaanalysis was done to address these conflicting results of past research. (The primary focus of the experiments and research reviewed had been on iksu meha patients.) This metaanalysis, which included a total of 543 participants who had been administered varying doses of cinnamon, concluded that the ingestion of cinnamon lead to significant statistical decreases in fasting blood glucose levels29. Two such studies support these findings. http://www.ayurvedacollege.com/book/export/html/2
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In 2003, 30 men and 30 women with iksu meha were divided randomly, some given cinnamon, the others a placebo. After 40 days, those in the placebo group showed no change in their blood glucose levels while the cinnamon showed to have reduced fasting blood glucose levels–as well as reduced triglyceride levels, LDL cholesterol and total cholesterol–in the treatment group. This study concluded that the inclusion of cinnamon in the diet of those suffering from iksu meha would help reduce the risk factors associated with this disease30. A similar study was performed in 2012 with 44 participants and the results were on par; after eight weeks of taking three grams of cinnamon per day, fasting blood glucose levels in those in the placebo group were unaffected while those in the treatment group showed a significant reduction31. In 2011 a group of researchers at Mahidol University in Bangkok did a similar metaanalysis that yielded different results than those in the 2013 review. After identifying and statistically comparing nine randomized placebocontrolled trials with almost 500 participants total, they found no evidence that cinnamon helped control blood glucose levels. Their calculations did, however, substantiate that fenugreek may prove effective in doing so32. Fenugreek Fenugreek (trigonella foenumgraecum) has been cited in both Ayurvedic and Traditional Chinese Medicine texts as being useful in the treatment of madhu meha and iksu meha. The seeds in particular have an affinity for regulating insulin33. Metaanalysis of 10 western clinical trials moderately supports this therapy, though the researchers report that a more “well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.”34 It is the bitter nature of fenugreek that is beneficial, as bitter herbs are useful in reducing fat and regulating glucose metabolism. In this way fenugreek is helpful in such conditions as diabetes35. Aloe Vera Another bitter tonic that has been shown in clinical trials to be valuable in the regulation of blood glucose levels in iksu meha is aloe vera. Aloe regulates sugar and fat metabolism36. A study completed in Iran analyzed the results of 85 studies (18 human and 67 animal) that measured the efficacy of glucose lowering abilities of medicinal plants. The findings placed aloe vera at the top of the list37. Shallijit Shallijit is described in The Yoga of Herbs as “one of the wonder medicines of Ayurveda… It is not an herb, but a kind of natural mineral pitch from the Himalayas and carries the healing power of these great mountains… [It] possess great curative powers and is considered capable of treating many diseases…including diabetes…”38 As an endocrine tonic, shallijit supports the pancreas in insulin secretion and so is beneficial in treating both madhu meha and iksu meha. Jambu Though less common in the west, jambu (syzygium cumini) is cited in the Dravyaguna Vijnana as being, “an esteemed drug for diabetes mellitus...one of the important antidiabetic drugs studied”39. The fruit is sometimes used, however, it’s the seeds that really prove an effective hypoglycemic agent. They are recommended to be taken orally in powder form as a single drug or as part of an herbal antidiabetic formula. In either form of administration, the seeds’ power is useful to reduce blood and urine sugar in diabetes40. http://www.ayurvedacollege.com/book/export/html/2
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Herbal antidiabetic and blood glucose stabilizing formulas can easily be found at reputable herbal pharmacies or can be created at home using wellsourced herbs. One such formula, designed and sold by Dr. John Douillard includes gurmar (leaf), fenugreek (seed), cinnamon (bark) and shallijit, each of which have been discussed here as valuable herbs in the treatment of blood glucose related diseases. Diet & Lifestyle Besides the use of ‘plant drugs’, the Caraka Samhita stresses dietary regulation in the treatment of these diseases. It also prescribes baths and physical exercise in their management41. More so than in herbal treatment, madhu meha and iksu meha differ in how they’re managed using diet and lifestyle. It’s important when treating madhu meha Ayurvedically that the patient also be working with a western medical doctor to receive insulin injections. As it is a vatatype disease, a vata reducing diet and lifestyle should be strictly maintained. Western doctors encourage the same, suggesting adherence to routines, especially around eating. The Mayo Clinic maintains, “Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too”42. It is recommended that patients follow a traditional diabetic diet, eating the right mix of vegetables, fruits, proteins, fats and starches at each meal, and to be extra mindful of taking in the same amount of carbohydrates at every meal and snack because of its effects on blood glucose levels. Small meals at regular intervals are the best way to keep blood glucose levels in check. If there’s weight loss, tonifying foods such as nuts, bone marrow, whole grains and meat should be emphasized43. Exercise can help because of the way it improves the body’s response to insulin44, though caution should be taken to avoid anything too strenuous; gentle or restorative yoga is optimal. Meditation and yoga nidra are also recommended because of their grounding, stabilizing and rejuvenative power. Mantra can be used as a form of meditation, reciting the bija sounds of ‘lam’ (Muladhara chakra) and ‘vam’ (Svadhisthana chakra) to reduce the light, mobile quality of vata and increase the denser, heavier qualities of earth and water. Oil therapies such as abhyanga and shirodhara are worthwhile as they reduce stress and build ojas. Vatapacifying aromas such as sandalwood, cinnamon, rose and lavender can be added to the oil for potency. People suffering from iksu meha can benefit greatly from Ayurvedic treatments. As it is a kapha vitiation, diet should be light and should emphasize the bitter and astringent tastes so as to support weight loss45. A nutritious balance to any meal is 50% vegetables, 25% protein, and 25% whole grain or healthy starches46. Fruit, though full of important vitamins, is high in sugar and so should be eaten minimally, especially dried fruit as the drying process concentrates the sugar content47. Along with the bitter herbs discussed in the last section, pungent spices such as ginger, oregano, turmeric and basil can be added to food. If possible, patients should complete a Pancha Karma treatment to purify their tissue and remove the toxins that block the glucose from entering the cells. Besides weight loss, vigorous exercise is a wonderful way to reduce blood glucose levels as it makes cells more receptive of glucose; glucose passes more readily through the cell membrane when we exercise. The more strenuous the activity, the longer the effects last48. Invigorating pranayama practices like surya bhedana and kapalabhati are valuable because of their capacity to increase circulation. Abhyanga can be productive, though dry powders should be used to increase stimulation. Both circulation and stimulation are also enhanced by spicy scents such as clove, patchouli, cedar and eucalyptus. http://www.ayurvedacollege.com/book/export/html/2
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Conclusion Maintaining homeostasis of blood glucose levels is a complex process involving the release and use of insulin to carry glucose out of the blood stream and into cells. Imbalance and disease occur when the pancreas is unable to produce enough insulin to support the movement of glucose from the blood to the cells, when the body builds up a resistance to insulin, or when the cell receptor sites become blocked and no longer allow glucose to pass through. Hypoglycemia, madhu meha (type 1 diabetes mellitus) and iksu meha (type 2 diabetes mellitus) are conditions associated with the imbalance of blood glucose levels. Herbs have proven to be effectual in the management and stabilization of blood glucose levels as well as in treatment of madhu meha and iksu meha. This paper highlighted a select sample of those that have garnered attention for their usefulness in this therapy. Though cinnamon is a widely accepted ‘plant drug’ used to regulate blood glucose levels, statistical findings are rather inconclusive in its efficacy as it pertains to these two diseases. It does, however, hold enough character to be regarded as beneficial in stabilizing blood glucose in those prone to episodes of hypoglycemia. While doing research for this paper, clinical trial reports and metaanalytical reviews on herbal treatments for hypoglycemia were not found to be as prevalent in the public databases. Because madhu meha is an autoimmune disease, herbs act more as a support to western treatment than as a treatment in an of themselves. Fenugreek shows to aid in insulin regulation, and shallijit supports the pancreas by its endocrine tonifying tendencies. With regards to the herbs discussed in this paper, iksu meha is more versatile in its response to herbal remedies. Gurmar is favourable because it counters sugar cravings and decreases glucose absorption. Fenugreek is a successful medicine because of its ability to metabolize fat. Similarly, aloe metabolizes fat and also regulates sugar. Shallijit’s ability to support the pancreas benefits those who suffer from iksu meha as well as madhu meha. Though no reported research on jambu was reviewed, it has long been esteemed for its hypoglycemic action and so is useful in reducing blood glucose in those who either cannot produce enough insulin naturally or for those who have build up a tolerance to it. Scientific measurement proves that herbs can successfully assist in the treatment of these diseases, but changing dietary and lifestyle habits are paramount. By reducing and/or eliminating those physical, mental and emotional behaviours, as well as addressing the mental, emotional and spiritual beliefs that lead to an imbalance in the first place, herbs become a complementary support to a greater Ayurvedic treatment plan that affects wellness and healing on every level of our being. End Note References [1] John Douillard’s LifeSpa, John Douillard, DC, The NotSoSweet History of Sugar Part II. http://www.lifespa.com/notsosweethistorysugar partii.html [2] Center for Disease Control and Prevention, CDC Staff, 2011 National Diabetes FactSheet. http://www.cdc.gov//diabetes/pubs/estimates11.htm http://www.ayurvedacollege.com/book/export/html/2
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[3] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 6. [4] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 709. [5] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 5. [6] Mayo Clinic, Nancy Klobassa Davidson, RN, Know Your Blood Glucose Target Range. http://www.mayoclinic.org/diseases conditions/diabetes/expertblog/blood... [7] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 11. [8] VJ Bjornholt, G Erikssen, E Aaser, et al. “Fasting Blood Glucose: An Underestimated Risk Factor for Cardiovascular Death. Results from a 22 Year FollowUp of Healthy Nondiabetic Men.” Diabetes Care (January 1999): 4549 Abstract: Because of the available conflicting epidemiological data, we investigated the possible impact of fasting blood glucose as a risk factor for cardiovascular death in nondiabetic men. This study reports the results from a 22year prospective study on fasting blood glucose as a predictor of cardiovascular death. Of the 1,998 apparently healthy nondiabetic men (aged 4059 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were included in the study in which also a number of conventional risk factors were measured at baseline. After 22 years of followup, 483 men had died, 53% from cardiovascular diseases. After dividing men into quartiles of fasting blood glucose level, it was found that men in the highest glucose quartile (fasting blood glucose > 85 mg/dl) had a significantly higher mortality rate from cardiovascular diseases compared with those in the three lowest quartiles. Even after adjusting for age, smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s, and physical fitness (Cox model), the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.041.8). Noncardiovascular deaths were unrelated to fasting blood glucose level. Fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middleaged men. [9] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [10] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3.5758. [11] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [12] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 360. [13] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [14] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721. [15] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... http://www.ayurvedacollege.com/book/export/html/2
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[16] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [17] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 340. [18] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 910. [19] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721. [20] John Douillard’s LifeSpa, John Douillard, DC, Western Docs Are Not Prescribing This Critical Test! http://www.lifespa.com/westerndocs arenotprescribingthiscriticalte... [21] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 339. [22] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [23] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet... [24] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 342. [25] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243. [26] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243. [27] R Pothuraju, RK Sharma, J Chaggalamari, et al. “A Systemic Review of Gymnema Sylvester in Obesity and Diabetes Management.” Journal of the Science of Food and Agriculture (March 2014): 834840. Abstract: The prevalence of obesity is associated with many healthrelated problems. Currently, more than 300 million people are considered to be obese. According to the World Health Organization (WHO), by 2030, 87 and 439 million people will be affected in India and the world, respectively. Today, herbal medicines are gaining interest in the treatment of obesity and diabetes, because of their minimal side effects. Gymnemic acid an active component isolated from Gymnema sylvestre has antiobesity and antidiabetic properties, decreases body weight and also inhibits glucose absorption. Several components extracted from Gymnema prevent the accumulation of triglycerides in muscle and liver, and also decrease fatty acid accumulation in the circulation. In this paper, an attempt has been made to review the effects of various extracts from Gymnema sylvestre in the regulation of carbohydrate and lipid metabolism in both animal and clinical studies. [28] John Douillard’s Life Spa, Jouhn Douillard, DC, Have a Cinnamon Holiday Season! http://lifespa.com/haveacinnamonholidayseason.html [29] RW Allen, E Schwartzman, WL Baker, et al. “Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and MetaAnalysis”. The Annals of Family Medicine (September/October 2013): 452459 Abstract: Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemiclowering effects, but studies have been small and show conflicting results. A prior metaanalysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and metaanalysis of RCTs evaluating cinnamon’s effect on glycemia and lipid levels. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared http://www.ayurvedacollege.com/book/export/html/2
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with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A1c), fasting plasma glucose, total cholesterol, lowdensity lipoprotein cholesterol (LDLC), highdensity lipoprotein cholesterol (HDLC), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using randomeffects models. In a metaanalysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (−24.59 mg/dL; 95% CI, −40.52 to −8.67 mg/dL), total cholesterol (−15.60 mg/dL; 95% CI, −29.76 to −1.44 mg/dL), LDLC (−9.42 mg/dL; 95% CI, −17.21 to −1.63 mg/dL), and triglycerides (−29.59 mg/dL; 95% CI, −48.27 to −10.91 mg/dL). Cinnamon also increased levels of HDLC (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A1c levels (−0.16%; 95%, CI −0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDLC (I2 ranging from 66.5% to 94.72%). The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDLC, and triglyceride levels, and an increase in HDLC levels; however, no significant effect on hemoglobin A1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear. [30] A Khan, M Safdar, MMA Khan, et al. “Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes”. Diabetes Care Journal (December 2003) 32153218. Abstract: The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes. A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 ± 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20day washout period. After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol (12–26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant. The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases. [31] M Vafa, F Mohammadi, F Shidfar, et al. “Effects of Cinnamon Consumption on Glycemic Status, Lipid Profile and Body Composition in Type 2 Diabetic Patients”. International Journal of Preventative Medicine (August 2012): 531536. Abstract: Type 2 diabetes is the most common metabolic disorder worldwide. Traditional herbs and spices can be used to control blood glucose concentrations. The objective of this study was to evaluate the effects of the daily intake of three grams cinnamon over eight weeks on glycemic status, lipid profiles and body composition in type 2 diabetic patients. A double blind, randomized, placebo controlled clinical trial was conducted on 44 patients with type 2 diabetes. Participants were randomly assigned to take either a three g/ day cinnamon supplement (n=22) or a placebo (n=22) for eight weeks. Weight, height, body fat mass and systolic and diastolic blood pressure were measured at baseline and after intervention. The fasting blood glucose, insulin, HbA1c, total cholesterol, LDL C, HDL C, Apo lipoprotein A I and B were measured at baseline and endpoint. From 44 subjects participated in this study 37 completed the study. There were no significant differences in baseline characteristics, dietary intake and physical activity between groups. In the treatment group, the levels of fasting blood glucose, HbA1c, triglyceride, weight, BMI and body fat mass decreased significantly compared to baseline, but not in placebo group. No significant differences were observed in glycemic status indicators, lipid profile and anthropometric indicators between the groups at the end of intervention. These data suggest that cinnamon may have a moderate effect in improving glycemic status indicators. [32] N Suksomboon, N Poolsup, S Boonkaew, et al. “MetaAnalysis of the Effect of Herbal Supplement on Glycemic Control in Type 2 Diabetes.” Journal of Ethnopharmacology (October 2011): 13281333. http://www.ayurvedacollege.com/book/export/html/2
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Abstract: A variety of herbs have been used in traditional medicine for the treatment of diabetes. However, evidence is limited regarding the efficacy of individual herbs for glycemic control. We performed a systematic review and metaanalysis to evaluate the effect of herbal supplement on glycemic control in type 2 diabetes. Randomized controlled trials were identified through electronic searches (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) up until February 2011, historical searches of relevant articles and personal contact with experts in the area. Studies were included in the metaanalysis if they were (1) randomized placebocontrolled trial of single herb aimed at assessing glycemic control in type 2 diabetes, (2) of at least 8 weeks duration, and (3) reporting HbA(1c). Treatment effect was estimated with mean difference in the final value of HbA(1c) and FBG between the treatment and the placebo groups. Nine randomized, placebocontrolled trials (n = 487 patients) were identified. Ipomoea batatas, Silybum marianum and Trigonella foenumgraecum significantly improved glycemic control, whereas Cinnamomum cassia did not. The pooled mean differences in HbA(1c) were 0.30% (95% CI 0.04% to 0.57%; P = 0.02), 1.92% (95% CI 0.51% to 3.32%; P = 0.008), and 1.13% (95% CI 0.11% to 2.14%; P = 0.03), respectively, for Ipomoea batatas, Silybum marianum, and Trigonella foenum graecum. The corresponding values for FBG were 10.20mg/dL (95% CI 5.32 mg/dL to 15.08 mg/dL; P<0.0001) and 38.05 mg/dL (95% CI 9.54 mg/dL to 66.57 mg/dL; P = 0.009), respectively, for Ipomoea batatas and Silybum marianum. The current evidence suggests that supplementation with Ipomoea batatas, Silybum marianum, and Trigonella foenumgraecum may improve glycemic control in type 2 diabetes. Such effect was not observed with Cinnamomum cassia. Given the limitations of the available studies and high heterogeneity of the study results for milk thistle and fenugreek, further high quality, large controlled trials using standardized preparation are warranted to better elucidate the effects of these herbs on glycemic control in type 2 diabetes patients. [33] M Tierra, CA, ND, Planetary Herbology (Lotus Press, 1988) 301302. [34] N Neelakantan, M Narayanan, RJ de Souza, et al. “Effect of Fenugreek (Trigonella foenumgraecum L.) Intake on Glycemia: A MetaAnalysis of Clinical Trials.” Nutrition Journal (January 2014): 1317. Abstract: Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the longterm effect on glycemia remains uncertain. We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis. PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using randomeffects models. A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by 0.96 mmol/l (95% CI: 1.52, 0.40; I² = 80%; 10 trials), 2 hour postload glucose by 2.19 mmol/l (95% CI: 3.19, 1.19; I² = 71%; 7 trials) and HbA1c by 0.85% (95% CI: 1.49%, 0.22%; I² = 0%; 3 trials) as compared with control interventions. The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality. Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence. [35] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 56. http://www.ayurvedacollege.com/book/export/html/2
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[36] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 100. [37] AA Rashidi, SM Mirhashemi, M Taghizadeh, et al. “Iranian Medicinal Plants For Diabetes Mellitus: A Systemic Review.” Pakistan Journal of Biological Science (May 2013): 401411. Abstract: In the Iranian traditional medicine a significant usage of herbs is promoted for their antidiabetic activity. The aim of this review to assess the efficacy of glucose lowering effects of medicinal plants cultivated in Iran. An electronic literature search of MEDLINE, Science Direct, EMBASE, Scopus, Web of Science, Cochrane Library Database, Ebsco and Google Scholar from database inception conducted up to May 2012. A total of 85 studies (18 humans and 67 animals) examining 62 plants were reviewed. The quality of Randomized Controlled Trials (RCTs) assessed by using the Jadad scale. Among the RCTs studies, the best results in glycemic control was found in Aloe vera, Citrullus colocynthus, Plantago ovata, Silybum marianum, Rheum ribes and Urtica dioica. The majority of plants that have been studied for antidiabetic activity showed promising results. [38] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 250251. [39] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826. [40] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826. [41] PV Sharma, Caraka Samhita, Vol II (Chaukhamba Orientalia, 1983), 118. [42] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseasesconditions/diabetes/indepth/diabetes... [43] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 344. [44] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseasesconditions/diabetes/indepth/diabetes... [45] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 346. [46] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 9. [47] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 20. [48] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseasesconditions/diabetes/indepth/diabetes... http://www.ayurvedacollege.com/book/export/html/2
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Understanding Alcoholism; with an Ayurvedic Assesment of Treatment By Tina Quint Alcoholism is a serious addiction that can be described as an irresistible urge to consume alcohol. 1 Generally, people who suffer from alcoholism are well aware of the effects on their body; but they cannot resist the urge to consume alcohol. 2 Alcoholism has four distinct symptoms: 1. 2. 3. 4.
A strong need/desire to drink. Inability to limit the number of drinks (loss of control). Withdrawal symptoms, such as sweating, shaking and nausea once drinking has stopped (physical dependence). A need to drink greater amounts of alcohol to get ''high" (tolerance). 3
Alcohol causes people to lose control of their senses; therefore leading to one drink too many. Overstepping of your body's tolerance to handle alcohol is alcohol abuse. Continuing in this pattern will lead to addiction, also known as alcoholism. 4 Alcoholism is chronic and can last a person's lifetime. A person's lifestyle, as well as genetics, can have a factor in the development of alcoholism. s Other factors affecting alcoholism are age; race or ethnicity; physical condition; atnO\mt of food consumed before drinking; how quickly alcohol is consumed; use of drugs or prescription medications; and or family history. 6 So, what is alcohol? Alcohol is the intoxicating ingredient known as ethyl alcohol or ethanol found in beer, wine and liquor that has been produced by the fermentation of yeast, sugars and starches.7 A one 12ounce beer has about the same amount of alcohol as a 5ounce glass of wine or a 1.5 ounce shot of hard liquor. Keep in mind that it is not the alcoholic beverage or drink that affects a person the most, moreover, it is the amount of ethanol consumed. 8
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Cultivation of Sattva Guna Through Ayurveda and Yoga as the basis of Stress Reduction By: Jolanda Davies Stress “...a state of mental, emotional or other strain” Concise Oxford English Dictionary, Eleventh Edition “...any factor that threatens the health of the body or has an adverse effect on its functioning....the existence of one form of stress tends to diminish resistance to other forms. Constant stress brings about changes in the balance of hormones in the body” Oxford Concise Medical Dictionary, Seventh Edition The word stress has been used in physics for hundreds of years; however seven decades ago it was redefined by Hans Selye, a brilliant Canadian stress researcher, as “the nonspecific response of the body to a demand for change.” [28] p. iv. The word stress was part of vernacular speech and became a buzzword that signified different things to different people. Some used it to refer to an annoying or distressful situation, while for others it was the resultant unpleasant emotional or physical symptoms that were experienced [28]. Paul J. Rosch, the President of The American Institute of Stress, says their clinical and experimental research confirms that stress is all about the level of control one feels they have which is determined by perceptions and expectations, “many times we create our own stress due to faulty perceptions.” [28] p x. “Too much stress hurts. It hurts relationships and work performance. It hurts health and quality of life. It hurts the enjoyment of yourself, others and life” [28] p. 2. In this paper I will discuss how developing the qualities of Sattva through the ancient sciences of Ayurveda and Yoga will benefit the body and the mind for the management of stress, developing control in day to day life, or indeed how to change ones perceptions and expectations. The Effects of Stress “Stress is a normal physical response to events that make you feel threatened or upset your balance in some way” [22] When you sense danger, Dr. Palmer says the body's defences kick into high gear in a rapid, automatic process known as the „fight or flight‟ reaction, or the „stress response‟. “The stress response is the body‟s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. The stress response also helps you rise to meet challenges” [22]. “Stress switches on brain circuits and hormones that prepare the body to protect itself in dangerous situations.” [28] p. 5 As people grow older they lose the emotional flexibility, to release and let go, therefore stress accumulates [28]. “Your mind and brain hold onto past fears and disappointments and project future ones. Your emotions stay drained, and your nervous system stays strained. You get trapped in your stresses. When this happens, your heart feels dismayed and your spirit feels constricted.” [28] p. 3. Childre and Rozman discuss the body chemistry when stress is experienced. “A cascade of 1,400 different biochemicals is released by the body as soon as it senses stress. These hormones and neurotransmitters affect how you perceive and feel. High stress keeps your system bathed in stress hormones, which speeds up your biochemical aging clock, draining emotional buoyancy and physical vitality. Stress makes you feel like you are living to survive instead of to enjoy http://www.ayurvedacollege.com/book/export/html/2
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life. Your perceptions and feelings signal your body to release stress hormones into your system, depressing your mood and decreasing your ability to face the day‟s challenges.” [28] p. 85 The stress response also includes the activity of the adrenal, pituitary and thyroid glands of the endocrine system. The adrenal medullas produce adrenaline which is released into the blood supply. Adrenaline increases both the heart rate, and the pressure at which the blood leaves the heart; dilates bronchial passages and dilates coronary arteries; skin blood vessels constrict and there is an increase in metabolic rate. Also gastrointestinal system activity reduces which leads to a sensation of butterflies in the stomach. [22]. “Strong emotions, like anger or fear, release a lot of adrenaline into your system, but adrenaline doesn‟t stay in the bloodstream for long. This is why anger or fear can give you a surge of energy and a temporary high but leave you feeling drained afterward. Too much adrenaline, too many ups and downs, can lead to high blood pressure and burnout.” [28] p. 85 In a stressful situation, the anterior hypothalamus activates the pituitary gland to release adrenocorticotrophic hormone (ACTH) into the blood which then activates the adrenal cortex to synthesise cortisol. In Dr. Palmer‟s description of the physiology of the stress response, he discusses the effects of cortisol. “Cortisol is an important hormone in the body. It has been termed „the stress hormone‟ because it is secreted in higher levels during the body‟s response to stress, and is responsible for several stressrelated changes in the body.”[23]. While cortisol is an important hormone, “when you chronically produce more than you need, it can lead to a host of problems. Over time excessive levels of cortisol can cause sleeplessness, loss of bone mass and osteoporosis, allergies, asthma, acid reflux, ulcers, low sperm count, redistribution of fat to the waist and hips, and fat build up in the arteries, which can lead to heart disease and numerous other diseases (McCarty, BarriosChoplin, et al. 1998). All of these are the bodys efforts to protect itself.” [28] p. 86. Negative emotions fuel higher cortisol levels. This means “that every time you are anxious or angry, or even rehash a stressful situation, your brain signals your adrenal glands to pump more cortisol into your system. Excessive amounts of cortisol linger in the bloodstream for hours, which can tend to increase feelings of anxiety.” [28] p. 86. Too much cortisol also depresses the immune system, opening the door to infection and other diseases. [22] As a result the adrenal gland may malfunction which can result in tiredness with the muscles feeling weak; digestive difficulties with a craving for sweet, starchy food; dizziness; and disturbances of sleep [22]. “Chronic stress can lead to excessive secretions of these hormones that can lead to both serious psychological effects (depression) and physiological effects (malaise and susceptibility to infections).” [6] p. 287 “Precipitating events or „stressful‟ life events can lead to depression in some people and discouragement in others. One is an illness and the other is a natural response to misfortune.” De Paulo says the answer to the question whether stressful life events cause depression is how the brain responds to environmental influences. He says medical researchers who follow the teaching of the great psychologist Walter B. Cannon understand stress to mean the nervous systems hormonal and behavioural responses to intensively unpleasant conditions. However, he does point out that depression can lead to stress, “a person may already be depressed and not know it, and because of the depression will have excessive anxiety”, especially he says, in somewhere like the work place and may not be able to perform due to the anxiety which in turn leads to stress. [2] p. 6566 Tortora and Grabowski discuss how stress can lead to certain diseases by temporarily inhibiting certain compounds of the immune system, and that people under stress are at a greater risk of developing chronic disease or dying prematurely. As an example they discuss Interleukin1 (IL1), a cytokine secreted by macrophages of the immune system, as an important link between stress and the immunity: “In response to infection, inflammation and other stressors, IL1 stimulates the production of immune substances by the liver, increases the number of circulating white blood cells that are phagocytes, activates cells that participate in immunity, and induces fever. All these responses result in powerful immune response.” However, they go on to explain that “IL1 also stimulates the secretion of ACTH (adrenocorticotrophic hormone) which stimulates the production of cortisol, which not only provides resistance to stress and inflammation, but also suppresses further production of IL1.” [3] p. 545 http://www.ayurvedacollege.com/book/export/html/2
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The American psychological Association say when you feel like you are losing control or feel overwhelmed, that you should pay attention to the body‟s warning signs,(as listed below). They say these are just some of the ways that your body tells you it needs maintenance and extra care. [4] Headaches, muscle tension, neck or back pain Upset stomach Dry mouth Chest pains, rapid heart beat Difficulty falling or staying asleep Fatigue Loss of appetite or overeating „comfort foods‟ Increased frequency of colds Lack of concentration or focus Memory problems or forgetfulness Jitters Irritability Short temper Anxiety [4] The Mayo Clinic agrees also, saying “when you recognise common stress symptoms you can take steps to manage them.” They have divided the effects of stress into three categories; effects of stress on your body, effects of stress on your thoughts and feelings and the effects of stress on your behaviour. [5]. Table 1 lists these effects in each category as laid out by the Mayo Clinic staff. Table1: Effects of stress by Mayo Clinic staff Gunas Effects of stress on Effects of stress on your your body thoughts and feelings
Effects of stress on your behaviour
Headache
Anxiety
Overeating
Back pain
Restlessness
Under eating
Chest pain
Worrying
Angry outbursts
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The Sanskrit word guna means “quality or attribute one of three qualities of Nature (Prakruti): sattva, rajas, tamas” [9] p. 10.6. Dr. David Frawley describes the relationship between Primal Nature or Prakruti and the three gunas, “Primal Nature, Prakruti, is not a homogenous substance but the seed ground of multiplicity....Prakruti holds in herself all the forms of creation which manifest through her three main qualities, the gunas of sattva, rajas, and tamas.” [8] p. 27. All forms of creation include the human being and all its levels of existence. When Prakriti manifests creation “the three qualities differentiate, with sattva giving rise to the mind, rajas generating the lifeforce, and tamas creating form and substance through which the 377/704
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Drug or alcohol abuse physical body comes into being.” [8] p. 28. Before manifestation, Prakruti, the seed potential for creation, “holds these three qualities in equilibrium, in which rajas and tamas are merged into sattva,” [8] p. 28 because, “sattva is the balance of rajas and tamas, combining Heart palpitations Depression Increased smoking the energy of rajas with the stability of tamas.” [7] p. 34. Dr Frawley says that all objects in the universe consist of various combinations of the three gunas and that they are the most subtle qualities of High blood Sadness Social withdrawal Nature that underlie matter, life and mind and help us to understand pressure our mental and spiritual nature and how it functions. [7] p. 30 Within Nature Rajas “is the active, stimulating or positive force that initiates change, disturbing the old equilibrium. Tamas is the Decreased Anger Crying spells obstructing or negative force which sustains previous activity. Sattva immunity is the neutral or balancing force, harmonising the positive and the negative, which oversees and observes.” [8] p. 27. Dr Frawley says that all forces are necessary for ordinary activity. Stomach upset Feeling insecure Relationship conflicts However, these forces also have spiritual implications “which can either expand us into wisdom or contract us into ignorance.” [7] p. 29. “Sattva is the quality of light, love and life, the higher or spiritual Sleep problems Lack of focus force that allows us to evolve in consciousness.” When cultivating this force, Sattva, we attain dharmic (true to our Nature) virtues of faith, honesty, selfcontrol, modesty and truthfulness [8] p. 27. Burnout “Rajas is the quality of twilight, passion, and agitation, the intermediate or vital force, which lacks stability or consistency” [8] p.28. Cultivating rajas, David Frawley says “gives rise to emotional Forgetfulness fluctuations of attraction and repulsion, fear and desire, love and hate.” [8] p. 28 Whereas Tamas is the quality or force of “darkness, nonfeeling and death, the lower or material force” David Frawley says Tamas “drags us down into ignorance and attachment....causing dullness, inertia, heaviness, emotional clinging and stagnation.” [8] p. 28 These qualities of nature, in terms of the mind “make it possible to determine the general state of a person‟s consciousness.” [14] p. 254. Dr David Frawley in his book about the healing of consciousness says “for any real healing of the mind to be possible, we must understand these forces (the gunas) and learn how to work with them as they exist, not only in the world, but also in our own psyche.” [7] p. 30. Although the state of the gunas are present within the consciousness, they are, Dr Halpern says “reflected in the mind” and “the dominant guna is a reflection of the evolution of the soul as it grows from ignorance to awareness and from awareness to transcendence.” [14] p. 254. “Sattwa is known as mind. It controls the body by conjunction with the self. Psyche is of three types according to strength – superior, medium and inferior. Accordingly the persons are also (of three types) having superior, medium and inferior psyche. Amongst them, those having superior psyche are, in fact, sattwasara (with sattwa as essence). They are seen unmoved even in severe afflictions – innate or exogenous – due to predominance of sattwa quality.” [27] Vimanasthanam, Chap. III, verse 119, p. 382 Heart disease
Irritability
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Dr. Halpern uses the analogy of a lake to liken sattva guna to the mind. “Imagine a still lake early in the morning before the sun has risen. There is no wind and the lake looks like a sheet of glass or a mirror.” [14] p. 254. Ayurvedic theory describes the primordial cause of disease as “forgetting our True Nature as Spirit.” Dr. Halpern says once we have forgotten our True Nature as Spirit, we become dominated by the ego and we live our life as sensory beings, in constant pursuit of sensory pleasure. He says through this pursuit we tend to overindulge and this leads to a host of energetic and physical imbalances which lead to disease. A sattvic individual is “unattached to the physical world.....their minds are at peace and they appear happy and content....through clarity of the mind, the sattvic person sees nothing to be angry about, nothing to be sad about and nothing to fear. There is only unconditional love and absolute faith.” [14] p. 254. Just like the lake “when it is clear, pure and still, the light of the stars and the moon are reflected off it” so too is our True Nature as Spirit revealed, “when our mind is clear, pure and still, the light of God is reflected through it.” [14] p. 254. “It is the principle of clarity, wideness and peace, the force of love that unites all things together.” [7] p. 31 Manas prakruti is a term that defines the mental constitution and is described in terms of the three gunas (sattva, rajas and tamas). “Sattva qualities of the mind are clarity, alertness, attentiveness, understanding, purity, compassion and cooperation. Rajas qualities include ambition, self centeredness, selfishness and restlessness. Tamas qualities express in the mind as dullness, gloominess, sadness, depression and laziness” [17] 174. To be freed from this material world of rajas and tamas, Vasant Lad says there needs to be release from tamas and rajas by controlling desire, temptation, agitation and lethargy. “The mind should be pure, which is sattva. Sattva will bring clarity, purity and insight.” [17] p. 175. However, Lad goes on to explain “to create balance, sattva, rajas and tamas must be balanced which means having a balanced diet, moderate amount of sleep (tamas), moderate levels of activity (rajas) and moderate meditation (sattva)” [17] p. 176. Rajas is responsible for movement, but we should have Sattvic movement, which is good conduct. Tamas is inertia, but we need Sattvic inertia, which is sound sleep. Samadhi or absorption is a state of balance between the gunas. A state which is beyond these qualities because the three gunas are so balanced that they merge into prakruti, which merges into Purusha (realisation of the True Nature as spirit). Manas prakruti is therefore the mental constitution when the gunas are balanced and in a state of nirguna. [17] Dr. Halpern comments on the lack of clarity (sattva) within the mind. He says rajas and tamas are the true causes of mental disease and hence disease begins when a person forgets their true nature as Spirit. This causes imbalances, which are perceived in the mind as disturbing emotions. These emotions are disturbances in prana1, tejas2 and ojas3 and they ultimately lead to imbalances in the physical body via vata4, pitta5 and kapha6. Dr. Halpern says that healing is through the cultivation of sattva to make the mind clear and pure so the memory of one‟s true nature is restored and a person is empowered to act harmoniously. [14] The process of cultivating sattva occurs through all five senses through proper lifestyle. Manas vikruti is the unbalanced mental state. Dr. Vasant Lad lists five main causes of manas vikruti: 1. Inappropriate diet 2. Inappropriate lifestyle 3. Lack of clarity in relationships 4. Repressed emotions 5. Stress [17] Dr. Vasant Lad says psychological stress is caused by not being in the present moment as it is. Instead “in the present moment we see „what is‟ and immediately we create stress by seeing the opposite of this which is „what should be,‟ „could be‟ and „would be‟ ” [17] p. 184. However, he says these are mere emotions and „what is‟ is reality and „what should be‟ is illusion, yet, he says, we always run after the illusion and this is a cause of manas vikruti. “manas prakruti is the now, the present...‟should be,‟ „could be‟ and „would be‟ are the shadows of manas vikruti.” [17] p. http://www.ayurvedacollege.com/book/export/html/2
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184. He says we have to surrender to the eternal present. Vasant Lad also talks of emotional stress which is “a reaction from the past to the perception and sensation of the present.” [17] p. 184. When the past meets the present it is bound to cause a reaction in the form of emotion. The past is gone and dead, whereas the present is now, fresh and alive. “If we are not happy with the present, the past suddenly creates what „should be,‟ „could be‟ and „would be,‟ trying to overlay the present, “this is how human beings live in the past” [17] p. 184 which as Vasant Lad says causes stress. To cultivate sattva guna, to move from manas vikruti to manas prakruti, Dr Frawley says that Yoga and Ayurveda emphasise its development. Yoga practice he says has two stages: the development of sattva guna (purification of mind and body) and transcendence of sattva (going beyond the body and mind to our True Self – comes from higher meditation practices). He quotes that “sattva body and mind are less likely to suffer from disease and more able to continue in a state of balance.” [8] p. 30.” Sattva guna is the key to Ayurvedic healing and is developed through right diet, physical purification, control of the senses, control of the mind, mantra and devotion.” David Frawley says that disease is a tamasic state and brings about the accumulation of negative thoughts and emotions on a psychological level, as well as toxins and wastes on a physical level. “Health is a Sattvic state of balance and adaptation which prevents any excess from occurring.” [8] p. 30. Dr. David Frawley discusses the functions of the mind and “understanding the gunas of the mind and changing them from tamas to sattva is the key to mental health.” [7] p. 138. He lists how sattva manifests in the layers of the mind as shown in Table 2. Table 2
Function of the mind
Sattva
Inner peace, selfless love, faith, joy, devotion, Consciousnesses compassion, receptivity, clarity, good intuition, deep (chitta) understanding, detachment, fearlessness, inner silence, clear memory, calm sleep, right relationships
Intelligence (Buddhi)
Discrimination between the eternal and the transient, clear perceptions, strong ethics, tolerance, non0violence, truthfulness, honesty, clarity, cleanliness
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Mind (Manas)
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Good selfcontrol, control of senses, control of sexual desire, ability to endure pain, ability to withstand the elements (heat & cold), detachment from the body, does what one says
Spiritual idea of self, selflessness, surrender, devotion, Ego (Ahamkara) selfknowledge, concern for others, respect for all creatures, compassion
Ayurveda Ayurveda is a system of healing that has its roots in ancient India. It is thought by many scholars to be the oldest healing system extant on the planet. Knowledge of Ayurveda originates in the Sanskrit language and the term Ayurveda comes from the roots „Ayus’ and „Veda’ – ayus meaning life and veda meaning knowledge, hence Ayurveda is the Knowledge of life. Dr. Vasant Lad states that the knowledge contained in Ayurveda deals with the nature, scope and purpose of life, and includes its metaphysical and physical aspects – health and disease, happiness and sorrow, pain and pleasure. He says “Ayurveda defines life as the conjunction of body, mind and spirit, found in Cosmic Consciousness and embracing all of creation.” [15] p. 1. Hence, there is no part of our existence that Ayurveda does not address. “Mind, self and body – these three make a tripod on which the living word stands. That (living body) is Purusa (person), sentinent and location of this Veda (Ayurveda). For him alone this Veda is brought to light.” [27] Sutrasthana, Ch. I, verse 4647, p. 6. The knowledge of Ayurveda was revealed through the hearts of the enlightened rishis (seers), “it is not a creation made by the mind of man but rather a revelation from the hearts of meditative sages.” [15] p. 3. Students came to study with them, and the rishis imparted knowledge as they experienced it in deep states of meditation. The term „knowledge of life‟ is not simply the understanding of the facts of life but it is a deep knowing of Truth, “to know something means to become one with the knowledge” [16] p. 3. To have health means to become one with the knowledge of the self. In Sanskrit, the word for perfect health is svastha. The term comes from the root sva meaning self and stha meaning established, therefore the term svastha, for perfect health, means established in the self. [16] p. 4, Being established in the Self is to have a deep knowing of the Truth of the Self which brings about svastha. “Health is the natural end result of living in harmony. Disease is the natural end result of living out of harmony. Healing is the process of returning to harmony.” [16] p. 2. “In Ayurveda sattva guna is the state of balance that makes healing happen.” [8] p. 29. In order to have perfect health sattva guna must be developed, it is “the key to Ayurvedic healing” and can be developed “through right diet, physical purification, control of the senses, control of the mind, mantra and devotion.” [8] p. 30. By cultivating sattva guna “a person grows and evolves, awareness increases....further growth and evolution (of the soul) leads to higher states of awareness and realisation of God. This is sattva.” [16] p. 258. In his definition of disease Dr. Halpern says understanding what health is, disease can be understood as its opposite. “Disease is anything less than perfect health...Any disturbance of a person‟s peace of mind and wellbeing, no matter how slight, implies disease.” [16] p. 5. The Caraka http://www.ayurvedacollege.com/book/export/html/2
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Samhita quotes, “perverted, negative, and excessive use of time, intelligence and sense objects is the threefold cause of both psychic and somatic disorders.” [27] Sutrasthana, Ch. I, verse 54, p. 7. Ayurvedic concepts define disease not only as physical, but as subtle and spiritual also. It states the primordial cause of disease as “forgetting our true nature as spirit” [16] p. 6. Dr Halpern explains this loss of awareness is forgetting that a part of God resides within each of us. He says this piece of God is the principle of atman7 in Sankhya8 philosophy, “it is our spirit or soul.” [16] p. 6. Dr. Halpern says once we forget our true nature as spirit, we understand ourselves only as body and mind, and become wrapped up in the stories and dramas of the physical world which results in disturbances of the mind and mental tranquillity. These disturbances cause challenging emotions to rise and upset the biological energies that control the body which results in physical disease. [16] p. 6. The Caraka Samhita quotes “the object (of Ayurveda) is to protect the health of the healthy and to alleviate disorders of the diseased.” [27] Sutrasthana, ch. XXX, verse 26, p. 240. Achieving perfect health through Ayurveda is “related almost directly and proportionally to proper lifestyle and state of mind” [16] p. 1. This proper lifestyle “is an art of daily living that has evolved from practical, philosophical and spiritual illumination rooted in the understanding of Creation” [15] p. 1. “As health improves, with proper lifestyle and a peaceful state of mind, life expands with equal tenacity.”[16] p. 1. Ayurveda provides the insight for each person to create a way of life that is in harmony both with the world of nature and our higher Self. [8] p. 4. Ayurveda considers proper lifestyle to surround the three pillars of life and through this sattva is cultivated. [14] p. 332. The three pillars of life are; proper management of food and digestion, proper management of sleep and proper management of sexual energy. “Through proper digestion our bodies are able to distract, from the food, all of the nutrients present as well as the life energy (prana1). The end result of proper digestion is ojas3, a subtle energy that protects the body and mind from disease.” [16] p. 54. Proper digestion is achieved by eating the ideal food choices for each individual‟s unique constitution9 and consuming it following the Ayurvedic guidelines of healthy eating. Sleep, the second pillar, is essential for the wellbeing of any person. The body uses sleep as an opportunity to use its energy for healing and repairing any damage to the body that accumulated during the waking hours. If the body does not receive enough sleep it cannot repair the damage caused by stress and strain. Too little sleep results in weakening of the body tissues, while too much sleep results in tissues that become excessive, stagnant, lethargic and immobile. [16] The third pillar, the management of sexual energy is important because sexual release is understood to reduce the energy available for supporting the healing of the body and mind. Excessive sexual indulgence can leave a person in a weakened and exhausted state. Sexual energy called shukra is needed to build ojas3, the energy that provides stability to the body and mind and underlies the strength of the immune system. When shukra is depleted, ojas3 becomes depleted as well. [16] p. 5455. “diet, sleep and celibacy, if these three are observed properly and thus the body is supported well by these pillars, it continues well endowed with strength, complexion and development till the completion of lifespan.” [27] Sutrasthana, Ch XI, verse 35, p. 75. Creating balance by structure in life helps reduce the effects of stress says Robert Svoboda [1] p. 123. He says that stress, or rather an improper reaction to stress can cause disease and it impairs the ability of the immune system. Stress occurs every time you have to adapt to a new situation. Every time your environment, physical, mental, emotional, social and spiritual surroundings change, you must change along with it and develop a new equilibrium with it. Your resilience, your ability to cope with the change, is your immune system, and as stress increases, strain on the immune system grows. When the strain becomes too great the immune protection fails, this is due fundamentally to a weakness of ojas3. [1]. Ojas3 is a substance that can be produced, collected and stored and is the “foundation of your physical immunity, and produces your aura8. Your aura8 is your first line of defence from the outside. It is a buffer against all the negativity which is consciously and unconsciously projected against us each day...The weaker your aura8, the less stress you can simply shrug off and ignore.” [1] p. 125. “Ayurveda believes that routine discipline, for body and mind, actively strengthens immunity” [1] p. 99. Dr. Halpern discusses the importance of daily routines, habits and rhythms saying they are the http://www.ayurvedacollege.com/book/export/html/2
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single most important determinant of wellbeing. Healthy habits create a healthy life; unhealthy habits create an unhealthy life. “It is here in the lifestyle that the causative factor of disease is identified. Thus healing occurs by correcting the habits that are causing illhealth and adopts habits that bring about harmony and healing.” [14] p. 448. “He who constantly thinks of (reviews, examines) how his day and night are passing (and adopts the right way only) will never become a victim of sorrow.” [26] Sutrasthana, Chp. II, verse 47, p. 31. Ayurvedic concepts describe the physiology of the body being governed by three main forces, which are commonly known as the three doshas. “Although dosha literally means faulty or to cause harm, they only do so when they are functioning abnormally. When functioning normally, they maintain the good health of the body and guide all the normal bodily processes.” [16] p. 69. The three doshas are vata4, pitta5 and kapha6 and the “human constitution9 or prakruti, is the inherent ideal balance of the three doshas within the individual.” [16] p. 71. Dr. Halpern says this ideal balance is determined at conception and does not change throughout a person‟s lifetime. Vikruti is the nature of the imbalance, “anything other than balance, present at the moment of conception, creates disease, vikruti defines the nature of the disease and healing is the process of returning the vikruti to the state of prakruti.” [16] p. 100. Ayurveda and Yoga emphasise a pure vegetarian or what is called a sattvic diet – a diet to encourage the development of sattva, the higher qualities of peace, love and awareness. Ayurveda emphasises right diet as the foundation of all healing therapies, it is the first and most important form of medicine. Ayurveda recommends Sattvic food because sattva creates balance, eliminates harmful factors and helps reduce all the doshas. [8] David Frawley says, with ahimsa (nonharming) being the basis of sattva “a sattvic diet is first of all vegetarian, avoiding any products that involve killing or harming of animals, Sattvic diet emphasises natural foods, foods grown in harmony with nature, on good soils, ripened naturally, cooked in the right manner and with the right attitude of love. Such foods are carriers of prana1 and consciousness.” [8] p. 168. Ayurveda prescribes dietary regimens for the different doshas. [8]. “Strength and life depend on diet.” [27] Vimanasthanam, Chp III, verse 120, p. 382 Herbs are used to nourish and repair the body and the mind. “Nervines are herbs that strengthen the functional activity of the nervous system. They may be stimulants or sedatives and can be used to correct excesses or deficiencies of nervous function. They have a strong action on the mind and are useful in promoting mental health and clarity as well as aiding in the treatment of psychological imbalances and mental diseases.” [25] p. 66. Many of these herbs are fragrant because “aromatic herbs work directly on prana1, the prime energy of the nervous system......they open the mind and senses, clear the channels, relieve congestion, stop pain and restore the smooth flow of energy in the mindbody system” [25] p. 67. Frawley and Lad comment that vata4 emotions, experienced with stress, like fear and anxiety damage the nerves and cause insomnia, mental instability, nerve pain, cramping and numbness which may lead eventually to the wasting away of nerve tissue. “Most nervines particularly those that are aromatic move vata4 and so help remove the obstructed vata4 or life energy behind these disorders.” [25] p. 67. However, they also point out that vata4 nervous conditions require nutritive herbs when there is deficiency of nerve tissues and therefore the use of nerve tonics are appropriate. They go on to talk of the pitta5 type emotions, which are experienced during stress, such as anger, hatred, envy, which heat up the blood, liver and heart, “they can cause hypertension, insomnia, irritability and other nervous and mental imbalances. They can also burn out the nerves, a condition of high pitta5, aggressive, „business executives‟ life style.” [25] p. 68. Frawley and Lad mention that often these pitta5 conditions can be treated with bitter tonics or purgatives, but most of the herbs that act upon the mind are cooling in energy, “this is because the mind is unbalanced largely by negative emotions, which are like pitta5, and create heat. A calm and clear mind is usually a cool mind.” [25] p.68. Kapha6 nervous conditions are more a matter of dullness, lethargy and hypoactivity of the nervous system, suffering from greed, desire and attachment, clinging to the past. In terms of the mind and nerves kapha6 requires stimulation. Frawley and Lad recommend nervines that are aromatic, stimulating and decongesting. [25]. “Oil massage (Abhyanga) is an important Ayurvedic therapy, not only for physical but for psychological conditions. Oil massage is calming to http://www.ayurvedacollege.com/book/export/html/2
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the mind, nurturing to the heart, and strengthening to the bones and nerves.” [7] p. 201. Dr. John Douillard comments on the goals of Ayurvedic massage, “to prepare the koshas12 to facilitate the flow of consciousness and shakti13 through each of these fields.” [29] p. 24. He says “when the subtle bodies are balanced, then each sheath or kosha – including all aspects of mind, body, spirit and emotions – can function up to its full harmonious potential.” [29] p. 24. Dr Douillard discusses the benefits of Shirodhara as one of the most powerful treatments to relieve vata4 in the mind. “When vata4 is in excess the mind can easily become over stimulated. Preoccupied with swarming thoughts, the mind has a difficult time slowing down. This can lead to an inability to handle stress, creating nervousness, anxiety, depression, insomnia, fatigue, psychological disorders and more. Shirodhara is the specific treatment for these disorders and any other disorder that is stress related. Shirodhara works mainly in the manomaya kosha, or mental sheath. It is here that the mind holds onto past impressions that create imbalanced desires (vasanas) and habitual patterns of behaviour (samskaras). As oil is poured on the forehead, the nervous system is deeply stilled.” [29] p. 271. Pancha Karma is the main Ayurvedic method of physical purification. “Owing to the subtle nature of its processes, it penetrates deep into the nervous system. It is useful for psychological problems caused by excess of the three doshas. Yet it can also be helpful for psychological problems caused by internal factors, emotions and karma.” [7] p. 203. Ayurveda also utilises subtle therapies such as colours, gems and aromas to alter sensory input so to control the mental and emotional condition. [7] Yoga Dr. David Frawley describes Yoga as one of the most extraordinary spiritual sciences that mankind has ever discovered. “It is like a gem of great proportions, containing many facets whose light can illumine the whole of our lives with great meaning” [8] p. 3. It dates back over five thousand years and Frawley says “it is one of the few spiritual traditions that has maintained an unbroken development throughout history.” [8] p. 3. It covers and comprehends the whole of the human existence, “from the physical, sensory, emotional, mental and spiritual to the highest Selfrealisation.” [8] p. 3. The methods used are “physical postures, ethical disciplines, breath control, sensory methods, affirmations and visualisations, prayer and mantra, and complex meditative disciplines.” [8] p. 4 Within his Yoga Sutras Patanjali Maharishi compiled these methods into „The Eight Limbs of Yoga‟ or „Ashtanga Yoga.‟ These eight limbs form the systematic path of Raja Yoga. [9].Dr. Frawley describes as follows: 1. Yama – Rules of Social Conduct 2. Niyama – Rules of personal Behaviour 3. Asana – Physical Postures 4. Pranayama – Control of the Vital Force 5. Pratyahara – Control of the Senses 6. Dharana – Right attention or Control of the Mind 7. Dhyana Meditation 8. Samadhi Absorption Yama and Niyama Dr. Frawley says the Yamas and Niyamas are the dharmic (natural/true law that governs the universe) foundation of Yoga and Ayurveda. [8] p. 51 He lists the yamas or dharmic principles of social behaviour as follows: http://www.ayurvedacollege.com/book/export/html/2
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Ahimsa (nonviolence) Satya (truthfulness) Asteya (nonstealing) Brahmacharya (control of sexual energy) Anabhinivesha (nonclinging) [8] p. 51 Swami Sivananda, in his commentaries on the Yoga Sutras of Patanjali, does not mention anabhinivesha but comments on Aparigraha (non coveting), as does B.K.S Iyengar in his Light on Yoga. “Aparigraha is freedom from greed or covetousness. One should not try to keep or try to get in possession anything beyond the very necessaries of life.” [11] p.31. Dr. Frawley states that right social behaviour is important for health, psychological wellbeing and spiritual development. “If we follow these observances, we will have no harmful impact upon the world and not get entangled in external complications of wrong relationships or wrong possessions.”[8] p. 51. The niyamas or dharmic principles of personal behaviour, as listed by Frawley, are as follows: Saucha (purity) Santosa (contentment) Tapas (selfdiscipline) Svadhyaya (study of the Self) Isvara Pranidhana (surrender to God) [8] p. 51 “These are the lifestyle principles necessary to establish a personal yogic practice in life. They are also the basis of Ayurvedic life regimens for constitution9 balancing....Yama and Niyama constitute the dharmic or ethical foundation for all right living......These two sets of principles go together. Unless we have integrity in our social interactions, we cannot have it in our personal behaviour and vice versa.” [8] p. 52. In the Astanga Hrdayam it cites a verse that too discusses moral behaviour, “compassion with all living beings, granting of gifts, controlling the activities of the body, speech and mind, feeling of selfishness in the interests of others (looking after the interests of others as his own) these are sufficient rules of good conduct (moral behaviour)” [26] Sutrasthana, Chp. II, verse 46, p. 31. Asana (posture) “By practicing them one develops agility, balance, endurance and great vitality. Asanas have been evolved over the centuries so as to exercise every muscle, nerve and gland in the body.......and they keep the body free from disease. They reduce fatigue and soothe the nerves. But their real importance lies in the way they train and discipline the mind.” [10] p. 20. Backing up his comment Iyengar goes on to talk of the health that is gained from the practice of asana. “It is a state of complete equilibrium, of body, mind and spirit.” “Purity of mind is not possible without purity of the body in which it dwells.” [9] p. 2.25. Focusing on asana for health and awareness Dr. David Frawley says “asanas keep the body in the best possible health” and “release tension at a deep level from the tissues, organs and joints.” [8] p. 205. He says that asanas provide specific positions and movements to strengthen and stretch the musculature to effectively move the body away from small pains and illnesses back to perfect and normal balance. [8] p. 205. “While asana can be a discipline in its own right, asana as exercise or as therapy should not be confused with the role of asana in classical yoga......Asana is mainly http://www.ayurvedacollege.com/book/export/html/2
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meant to help reduce rajas or the quality of turbulence that disturbs the mind” [8] p. 206 and perhaps most importantly “they begin a systematic cleansing of the tissues” [8] p. 205. Emotional tension is always reflected somewhere in the body, “every mental knot has a corresponding physical knot and vice versa. The aim of asana is to release these knots. Asanas release mental tension by dealing with them on a physical level.” [20] p.11. To understand how asanas can be of benefit to reducing symptoms of stress one must be aware of the mind body connection. Frawley talks about asana creating a free flow of energy in order to help direct our attention within, but he also says that this flow of energy can be focused on the body to treat its ailments. “Our physical posture affects our health, vitality and awareness. The mindbody complex consists of various interrelated channels – from those which carry food to those which carry thoughts. These channels are held together on a physical level by the musculoskeletal system, the shape of which is determined by our posture.” [8] p. 208. This is important for the healthy functioning of the mind and the body as “wrong posture creates various stresses, causing contractions that impair or block the proper flow through the channels. It inhibits the circulation of energy and nutrients while allowing toxins and waste materials to accumulate....As mind and body are interconnected, physical blockages intertwine with mental and emotional blockages and hold various addictions, compulsions and attachments.” [8] p. 208 “Ayurveda recommends asanas as its most important lifestyle recommendation....it also prescribes asanas as an important treatment measure for various diseases.” [8] p. 207. Dr. Halpern states that Ayurveda approaches asana from an understanding of individuality. “Asanas are categorised for their effects on vata4, pitta5 and kapha6 and takes into consideration the type of asana, as well as the flow and the speed in which it is practiced.” [14] p. 453. On discussing vata4 asanas Dr. Halpern says the important mobility quality of vata4 needs to be balanced and therefore asanas for vata4 imbalance should be practiced slowly with great attention to focus and detail. Proper practice helps bring focus to the vata4 mind. He goes on to say that standing poses emphasise stability and sitting poses are calming to the mind reducing anxiety. With Pitta5 asanas care should be taken not to overheat the body whereas kapha6 imbalances benefit from flow sequences with greater speed. [14]. As with all imbalances “asanas bring harmony and balance to the physical body, particularly the musculoskeletal system that is the support of the body. Asana is part of the Ayurvedic treatment system for the physical body. Postures can be used to increase vitality or to balance the doshas. They can be adjusted to target certain organs or weak spots in the body.” [8] p. 52 Pranayama (control and expansion of vital energy) “Prana1 means breath, respiration, life, vitality, wind, energy or strength....Ayama means length, expansion, stretching or restraint. Pranayama thus connotes extension of breath and its control.” [10] p. 22. Iyengar talks of the yogi‟s life being measured by the number of breaths rather than the number of days and therefore the yogi will follow proper rhythmic patterns of slow deep breathing. “These rhythmic patterns strengthen the respiratory system, soothe the nervous system and reduce cravings.” [10] p. 22. These cravings are the mind displaying impurity. Iyengar says the mind is twofold – pure and impure. “It is pure when it is completely free from desires and impure when it is in union with desires.” [10] p.23. Therefore from the practice of pranayama “desires and cravings diminish and the mind is set free” [10] p. 23. The benefits are physical too and Iyengar mentions a quotation that was often said by the seventeenthcentury mystic Kariba Esken: “if you would foster a calm spirit, first regulate your breathing, for when that is under control, the heart will be at peace; but when breathing is spasmodic, then it will be troubled. Therefore, before attempting anything, first regulate your breathing on which your temper will be softened, your spirit calmed.” [10] p. 23 Sivananda teachers training manual discusses how prana1 connects the body and the mind, “the highest and most subtle manifestation of prana1 is thought. The grossest manifestation of prana1 in the human body is in the motion of the lungs. If the motion of the lungs is stopped, all other energy and movements in the body will stop automatically. In order to control subtle prana1, i.e. the thoughts, the yogi begins by controlling the breath.” [9] p. 2.25 http://www.ayurvedacollege.com/book/export/html/2
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Pranayama includes all ways of energising the vital force (prana1) through the body, senses and mind by developing and expanding the energy of the life force. Dr. Frawley says that prana1 is our energy and if we do not have sufficient energy we cannot do anything in life. “Pranayama provides this needed energy for both body and mind.” [7] p. 271 The various types of pranayama lead to a condition of energised relaxation, “when the breath is at peace, the life force is calmed and the senses, emotions and mind are put to rest. The disturbed movements of our vital urges cease to trouble us with their desires and fears.” [7] p. 272. A number of research and clinical studies have pointed to the need for patent, well functioning nostrils to support mental and physical health. Swami Niranjanananda Saraswati, in his discussion on nasal obstruction research, discovered the incidence of various ailments were greater in patients suffering from one sided nasal obstruction. [19] “The breath alternates cyclically from one nostril to the other approximately every ninety minutes. There is a period of three to four minutes in each ninety minute cycle when the breath crosses over from one side to the other” [19] p. 104. This is important because during this crossing over the breath flows equally through both nostrils, “and this is the period traditionally advocated for successful and spontaneous meditation.” [19] p. 105. Since meditation, in the broadest sense, involves “placing the mind in a calm and concentrated state” [8] p. 286. The breath must therefore be regular and relaxed to “induce relaxation, regularity, and integration of the body‟s rhythms and processes so that they work in harmony together.” [19] p. 101. If the breathing is irregular and tense this can lead to “disordered, mental activity and chaotic thinking pattern, as well as physical emotional and mental disease.” [19] p. 101. There is a harmonising influence on the brain and the autonomic nervous system by the practices of pranayama. “The right side of the brain is activated when the left nostril is flowing, the left side of the brain is activated when the right nostril is flowing and whenever both nostrils flow equally, “every faculty of the human brain is functioning in an optimal and integrated manner.” [19] p. 106. “It is believed that during inhalation, the flow of air in each nostril stimulates specific unilateral autonomic nerve centres lying within and beneath the mucous membranes (in the nose). These specific stimuli subsequently influence the autonomic processes of respiration, circulation, digestion and so on.” [19] p. 107. Swami Niranjanananda suggests that the “autonomic nervous system, and its two complimentary components – the excitatory sympathetic nervous system (pingala nadi10) and the relaxatory parasympathetic nervous system (ida nadi11) – can be activated from the nasal mucous membrane region.” [19] p. 107. In this light, he says, we can begin to anticipate the farreaching effects of yogic practices such as pranayama upon the whole autonomic nervous system, and hence upon the endocrine and physiological functions. [19] The subtle body is a field of energy. Through it, flows prana1 within subtle channels called nadis12. These channels permeate the entire subtle body. Dr. Halpern says the mind cannot function without the nadis and the nadis cannot exist without the mind, “the mind can be understood to be the sum total of all the nadis....the mind is the field and the nadis are the channels through which pranic energy flows.” [14] p. 275. The nadis energise the subtle body in a manner similar to the way the nervous system energises the physical body and “when the nadis are functioning properly, the mind is clear and vibrant.” [14] 275. Dr. Halpern continues to discuss the relationship between the mind and flow through the nadis, “mind is the initiator of pranic movement....altered flow through the nadis will also affect the mind.” “When flow is normal, a person is emotionally stable.” [14] p. 275. Any imbalance of the doshas within the mind thus alters the flow through the nadis. This alters a person‟s enthusiasm, clarity, peacefulness and bliss. To restore balance pranayama methods are used for working with the subtle energies of the body (prana1, tejas2 and ojas3) and influencing the flow of prana1 through the nadis. [14] Dr. David Frawley says pranayama, specifically alternate nostril breathing (nadi shodhana or anuloma viloma), is an important key to physical and mental health because it keeps the nadis clear and maintains a balanced flow between Ida11and Pingala.10 He says the “left nostril is lunar or kapha13 predominant, promoting the breath through it increases bodily tissues, Ojas3 (basis of the immune system) and gives nourishment to the outer mind.” [7] p. 276. He lists some of the effects of stress that are counteracted from left nostril breathing; insomnia, anxiety, anger and agitation (restlessness). The right nostril is solar and promoting the breath through it “increases courage and motivation...and counters poor digestion, http://www.ayurvedacollege.com/book/export/html/2
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depression and laziness.” [7] p. 227. “Therefore pranayama should be done daily with a sattwic state of mind so that the impurities are driven out of Sushumna nadi and purification occurs” Hatha Yoga Pradipika, chapter 2, verse 6 Pratyahara (control of the senses) If there is rhythmic control of the breath through pranayama one will be able to prevent the senses from running after external objects of desire, this is done through the fifth stage of Yoga, control of the senses. To have purity of mind is not simply closing off the senses but to have right management of them and the ability to go beyond them, “it is not suppression of the senses but their right application, which includes the ability to put them to rest.” [8] p. 53 A Sattvic mind is one that is pure, when all desires and fears are annihilated, but there is impurity when the mind is in bondage with objects of desires. Iyengar says “the yogi knows that the path towards satisfaction of the senses by sensual desires is broad, but that it leads to destruction” [10] p. 25. In his book about the healing of consciousness, Dr. Frawley more accurately describes pratyahara as a “withdrawal from distraction,” rather than a withdrawal of the senses, which means detaching the mind from the impulses deriving from the senses, without this control the mind becomes fragmented and we have no internal stability. [7] p. 280. Pratyahara restores the proper relationship between the mind and the external world and cuts off the reception of negative influences and in turn opens up the reception of positive influences from within. [7] p. 283. Control of the senses is keeping the mind aloof from the senses and in control of their input. [7]. One of the three main causes of disease in Ayurveda is „the unwholesome conjunction of the senses with the objects of their affection‟. “Our senses are the vehicles through which we relate to the world around us.” [16] p. 7 Dr. Halpern describes the senses as “portals, or gateways, into our body, our mind and our consciousness.” [16] p. 7. The constant intake of energetic and physical impressions are either “harmonious or disharmonious in relation to a person‟s constitution9 and thus can take a person toward harmony and health or toward disharmony and disease.” [16] p. 7. Dr. David Frawley says wrong use of the senses may be excessive, deficient or improper and how we use our senses determines the kind of energy we take in from the external world. [7]. Ayurveda uses the five sense therapies to bring about healing through the senses; “taste therapy in the form of diet and herbs, touch therapy in the form of massage, visual therapy in the form of colours, sound therapy in the form of mantra and smell therapy in the form of aromatherapy.” [16] p. 7 Ayurveda also prescribes „spending more time in nature‟, “this allows for peaceful harmonious impressions to enter consciousness through all five senses. In nature the fresh wind caresses the skin, the smells of flowers and trees caress the nose, the sights of mountains, streams, trees, flowers and ocean caress the eyes and the sounds of birds, wind and water caress the ears.” [14] p. 333 Intellectual blasphemy (the failure of the intellect or crimes against wisdom) is another cause of disease outlined in the Caraka Samhita. This is failure to follow what we know to be true to bring health and peace of mind. Dr. Halpern gives examples of staying up too late, eating too much, eating the wrong food. The intellect is connected to both the senses and the soul, the senses lead it astray while the soul leads it to harmony, however, “the whispers of the soul are hard to hear over the ruckus of the senses, hence we usually follow our senses desires. Ayurveda uses Yoga to train the intellect to listen deeply and hear the voice of the soul, when the voice is heard there is awareness of the connection to God” [16] p. 8 Dr Halpern says this connection fills the listener with spiritual energy that empowers them to overcome the temptations of the senses. [16] The Caraka Samhita cites a short quote which sums up the importance of controlling the senses, “the cause of happiness (health) is only one – balanced use (of the senses)” [27] Sarirasthanam, Ch. I, verse 129, p. 408. http://www.ayurvedacollege.com/book/export/html/2
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Dharana (control of the mind) The sixth stage is reached “when the body has been tempered by asanas, when the mind has been refined by the fire of pranayama and when the senses have been brought under control by pratyahara.” [10] p. 27. David Frawley explains this as right attention, the capacity to bring all our mental energy, at will, to whatever we need to examine. Therefore dharana involves developing and extending our power of attention [8] p. 53. In the second Yoga sutra Patanjali, says what Yoga is, „Yogas chittavrttinirodhah’ – “Yoga is restraining the activities of the mind.” [12] p. 140. In order to achieve the true peace of Union (uniting the individual with the Universal Soul [12] p. 140 .i.e. realising True Nature) it is the mind and nothing else, that must be corralled and controlled. When the peace of Union is achieved the state of mind is unruffled and calm in all situations. [12] p. 140. “The quality of our attention in life determines our state of mind.” [7] p. 283. Dr. Frawley says the methods used some are the same as those in pratyahara, but pratyahara gathers the energy of the mind; then dharana focuses it. [7] Dhyana (Meditation) David Frawley explains that meditation is not actually a technique, infact meditation techniques more properly belong to pratyahara or dharana. “True meditation is the natural state of awareness, not a method. But this requires some preparation to reach, indicated by the other limbs of yoga” [8] p. 54 Therefore meditation is a state that is reached through techniques involved in pratyahara and dharana. Dharana sets our intention on a particular object and dhyana holds it there, as Frawley says “sustained dharana in time becomes dhyana.” [7] p. 289. Therefore sustained attention or “a continuous flow of perception (or thought) is Dhyana.” [11] p. 154. To get to this stage, Sivananda explains, “there must be a gradual ascent in the stages of Yoga.” [11] p. 155. Dr. Frawley agrees with this saying “true meditation cannot be achieved by a restless or emotionally disturbed mind. It requires properly developed concentration, which itself rests on control of the body, senses, vital force and mind.” [7] p. 290 Thus it is necessary to practice all the stages of Yoga as laid out by Patanjali. The tools or techniques that are generally used to begin meditation, Frawley says, are prayer, mantra, pranayama or visualisation, from this, formless meditation can proceed, like sitting in silence, practicing selfinquiry, or performing devotional meditation. [8] p. 289. Meditation with form employs the same techniques as pratyahara and dharana, holding the mind on a particular object, but sustained over a longer period and that any object which draws the mind can be used, he gives examples of a form in nature, a deity2, a guru, yantra3 or a mantra. [7] p. 289. Formless meditation involves sustained awareness on truth principles such as „all is the Self‟ or on the Void which transcends all objectivity. [7] p. 289. Whatever the „object‟ B.K.S. Iyengar says “the mind when it contemplates an object is transformed into the shape of that object.” [10] p. 30. Thus contemplation on Pure Consciousness (True Nature) “there is no other feeling except a state of SUPREME BLISS.....He sees the light that shines in his own heart.” [10] p. 30 This all depends on the predominance of sattva guna within our entire nature otherwise, “to simply try not to think is to put ourselves into a blank state, in which our consciousness is not transformed but merely put to sleep.” [7] p. 290. For this reason, we must first purify our life and mind. David Frawley goes on to discuss the importance of meditation for the maintenance of stress. He says that much of what is referred to as meditation today is more properly pratyahara (like visualisation) or dharana (concentration techniques) and such techniques are useful for calming the mind, “stress is an accumulation of tension in the mind. Meditation, expanding the mental field, relieves it.” [7] p. 291. Ayurveda prescribes meditation as a way of increasing sattva as a principle of treating mental disease. “Most forms of meditation create greater stillness in the mind and deeper awareness. In stillness, a person cannot help but see past the illusions of creation and connect more deeply with spirit.” [14] p.333 Samadhi (absorption) “At the peak of his meditation he passes into the state of Samadhi, where his body and senses are at rest as if he is asleep, his faculties of mind and reason, are alert as if he is awake, yet he has gone beyond consciousness. The person in a state of Samadhi is fully conscious and alert.” [10] p. http://www.ayurvedacollege.com/book/export/html/2
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31. “Samadhi is our capacity to merge with things in consciousness that shows our joy and fulfilment in life.” [8] p. 54 Conclusion “To have sattva predominant in our nature is the key to health, creativity and spirituality. Sattvic people possess a harmonious and adaptable nature which gives the greatest freedom from disease, both physical and mental. They strive toward balance and have peace of mind that cuts off the psychological root of disease. They are considerate of others and take care of themselves.” [7] p. 34. Sattva creates balance, eliminates harmful factors and helps reduce all the doshas and as Dr Halpern mentions, anything other than balance of the doshas, creates disease. [16]. As described, stress has many potentially harmful effects on the body, mind, emotions and behaviour, which effectively speaking in Ayurvedic terms, is an imbalance of one, two or all three doshas. Vasant Lads comment, discussed on page 9, stress can be caused by not living in the present moment as it is, backs up Paul J. Rosch‟s experiments, (as discussed on page 2), which demonstrated stress is all about the level of control one feels they have which is based on their perceptions and expectations. Not being happy in the present moment is only a result of perceptions and expectations of what the present moment „should be‟. Creating sattva through Yoga and leading an Ayurvedic lifestyle brings about awareness of the Self. To get here there must be perfect health. Perfect health or svastha, is achieved by being established in the Self, being established in the self is having a deep knowing of the Truth of the Self, knowing the Truth of the Self is realising that a part of God or atman7 resides within us. This level of clarity can only be obtained with a Sattvic body and mind; “unless the mind is calm and clear, we cannot perceive anything properly. Sattva creates clarity, through which we perceive the truth of things.” [7] p. 32. To be able to perceive the truth of things has been declared to take away all the miseries and pain of life. [9]. Practicing the techniques of Yoga and Ayurveda allows the mind to be calm, the senses to be brought under control and the body, mind and spirit to be purified, the body in this state of svastha is not attached to the illusions of „what should be‟ or „what could be‟ but instead accepts „what is‟ as the truth of the present moment is clear. “Yoga and Ayurveda emphasise the development of sattva.” [8] p. 29.
Excessive use of the sweet taste: Effects on the body and mind (by Debi Mueller C.A.S) Table of Contents 1. Abstract 2. List of Terms 3. The Role of Taste in Nutrition http://www.ayurvedacollege.com/book/export/html/2
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4. The Role of the Sweet Taste 5. Elements of the Sweet Taste and Foods Predominately of Sweet Rasa 6. How Overuse of the Sweet Taste May Develop 7. Affects of Overuse on the Body 8. Affects of Overuse on the Mind 9. Conclusion Abstract The role of the six (6) tastes as related to the health of body and mind was documented in the ancient text as the Rishis note their impact on the body and mind. The sweet taste in particular was observed to be of significance due to the percentage of this taste in the human diet in general. In a review of the literature from the classical Ayurvedic texts to current Ayurvedic writers, as well as recent scientific evaluations, the affects of overuse of any taste has been shown to have serious negative outcomes. This paper will review that information which focused on the overuse of the sweet taste. One suggested process which leads to over indulgence of the sweet taste will be described, and a recital of the problems caused from this use in both the physical body and the mind will be provided. List of Terms
Sanskrit
English interpretation or equivalent
ap
water
prthvi
earth
agni
fire
vayu
wind (or air)
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akasa
ether
mahabhuta
great element
rasa
taste
dhatus
tissues
tejas
fire
dosa or dosha
constitution or humor
priya
delicious
hita
wholesome
Vata, Pitta, Kapha
the 3 constitutions (air, fire, water)
ahamkara
ego
prameha
condition of excessive urination, diabetes
The Role of Taste in Nutrition http://www.ayurvedacollege.com/book/export/html/2
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According to the Caraka Samhita as translated by R. K. Sharma and Bhagwan Dash , "There are six rasas (tastes), viz. sweet, sour, saline, pungent, bitter and astringent. When employed properly, they maintain the body and their incorrect utilization results in the vitiation of the dosas ." [1] Further, it is noted, "Measurement of food is, in fact, of two types, viz. food as a whole and of its different ingredients having different tastes like sweet, sour, etc. If food as a whole is taken according to the prescribed measurement but its ingredients having different tastes like sweet, sour, etc. are not in prescribed ratio, the equilibrium of dhatus and dosas gets definitely disturbed due to imbalance in the ratio of the composing rasa s (tastes). Consequently the timely digestion of food as a whole will also be affected." [2] In the current body of literature, Dr. Marc Halpern writes, "The ancient Rishis of India who developed the Ayurvedic system of living did not know about proteins, carbohydrates, and fats. Rather, they approached nutrition from an energetic perspective. They learned that if the qualities of a human being were understood and the qualities of a food source were understood, then it could be predicted what effect would occur when they were mixed together." [3] The focus of developing a healthy diet began with the energetic, or elemental make up of the foods as it compared to and supported an individual's constitutional make up. This elemental combination was observed by the ancients as they came to understand the building blocks of a healthy diet. Caraka wrote, "Rasa or taste is the object of gustatory sense organ, as distinct from the objects of the other sense organs. Primarily ap is the substratum of rasa. Besides, prthvi also indirectly serves as a substratum thereof. "The qualities of preceding basic elements ( akasa, vayu, agni, ap and prthvi ) are included in the succeeding ones; so the qualities of ap is automatically included in prthvi. To sum up, ap and prthvi are the substrata for the manifestation of taste ( rasa). That is to say, taste (rasa) can manifest itself only through ap and prthvi. These two mahabhutas , (in addition to the remaining three) are also responsible for the manifestation of specific rasas like sweet, etc. For example, taste is sweet when there is predominance of the qualities of ap and it is sour when the qualities of prthvi and tejas are predominant." [4] Therefore, identifying and understanding the elemental nature of the tastes within food serves as the basis for defining good nutrition. The Role of the Sweet Taste Of the six (6) tastes, the sweet taste is found to be highly significant. The classical literature notes, "Sweet, sour, saline, pungent, bitter and astringent" this is the sixfold collection of tastes "In this classification, sweet taste occupies the first position inasmuch as it plays an important role in the diets of all living things" [5] Current day Ayurvedic experts acknowledge the first position of the sweet taste as well. In his writings, David Frawley states, "In terms of nutrition, sweet is most important generally for everyone, as it possesses the highest nutritive value." [6] There is agreement of the value and necessity of the sweet taste prevailing in the diet. It has been found to be the predominate taste with most foods containing the elements of ap (water) and prthvi (earth) as their key constituents. The energetics of these elements as provided by the sweet taste are necessary for the health of all living things. http://www.ayurvedacollege.com/book/export/html/2
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Frawley goes on to describe the positive affect of the sweet taste as he writes, "Each taste has its specific therapeutic actions. Sweet taste is building and strengthening to all body tissues. It harmonizes the mind and promotes a sense of contentment. It is demulcent (soothing to the mucous membranes), expectorant and mildly laxative. It counters burning sensations." [7] All of these aspects of sweet are supportive of the digestive processes. Digestion being at the root of all health or disease, it is essential to have an abundance of supportive intake. In concert with Subhash Ranade, Frawley further points out, "Sweet taste has the same nature as the body, increasing bodily tissues including plasma, blood, muscle, fat, bone, nerve and reproductive. It prolongs life, nourishes the sense organs, imparts vigor and improves the complexion. It has a lubricating effect on skin, hair and voice and promotes strength. Psychologically, it promotes cheerfulness, energy and happiness, containing the energy of love." [8] In support of the importance of the role of the sweet taste, John Douillard writes, "The sweet taste, when taken in its natural form (such as rice, bread, or pasta) along with the other tastes, provides a "satisfaction factor." Without it, most people will leave the table feeling unsatisfied, although unable to pinpoint why" [9] Most people would agree that a meal which is satisfying is most desirable. Feeling satiated allows one to move into the flow and expectations of life more easily. The sweet taste provides a key element of making food not only wholesome, but delicious. These two critical fundamentals of our diet were addressed by Caraka as follows, "the food should be delicious ( priya) and wholesome ( hita ). If the food is only delicious but not wholesome, then this does not contribute to the sustenance of the body and nourishment of the sense organs and their objects, namely smell, taste, vision, touch and sound in the body. Similarly, if the food is only wholesome, but not delicious, then this does not provide nourishment to the senses and their objects in the body instantaneously. Therefore, the food should be both delicious and wholesome." [10] Elements of the Sweet Taste and Foods Predominately of Sweet Rasa The sweet taste is made of the elements of water and earth. Water provides the very essence of taste. It is through the moisture that the sensory organ of taste is able to operate. As noted previously, sweet is the predominant taste. Most foods include in their make up the sweet rasa , often with one or more of the other rasas. In evaluating the rasa of specific foods, Dr. Vasant Lad has identified all meat as having a sweet rasa, frequently in addition to an astringent rasa; dairy products, with the exception of yogurt, have a sweet rasa; oils carry a sweet rasa , except for white mustard oil; all sweetners, legumes, grains, nuts, seeds, and fruits have sweet rasas; most vegetables also have sweet rasas, with the notable exceptions of cauliflower, celery, leafy lettuce, onion and radish. Of the main food substances, only herbs and spices are found frequently not to carry sweet rasas, nevertheless, even some of these are known to have a sweet rasa . [11] As you can see from this list, it would be very rare to consume a reasonable meal without ingesting a high percentage of the sweet taste. It is essential that our diet predominates in the sweet taste as both classical authors and current writers have noted the positive role of sweet in our diet. Frawley, however, points out "everyone needs a certain amount of each of the six tastes. The relative proportion differs according to the constitution or humor of the individual. Too much of any taste can become harmful to any constitution type, as can too little." [12] Taking into consideration the constitutional make up of an individual, judgment should be used to provide a higher degree of sweet for Pitta individuals, a moderate amount for Vata, and less for Kapha , ingesting only as much as is necessary for healthy tissue manufacture. [13] With all of the positives provided by the sweet taste for the health of the body, it is necessary to have a clear picture of what can happen that causes http://www.ayurvedacollege.com/book/export/html/2
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an individual to overuse the sweet taste and the resulting negative consequences. How Overuse of the Sweet Taste May Develop As we assimilate all of the information presented above, it becomes key for a practitioner or follower of Ayurvedic principles to understand what may be at the root of developing a habit of overusing the sweet taste. Douillard sets groundwork for understanding this issue when he writes, "The problem doesn't originate with the sweets. If we are not nourishing our minds, bodies and emotions properly with all six tastes in each meal, we will become emotionally susceptible. The nutritional foundation needed to support balance in times of stress simply won't be there. As a result, wherever we have a weak link, whether emotional or physical, we will break down." [14] In our society, with its fastpaced and aggressive nature, it becomes a perpetually increasing situation that we do not nourish our bodies, minds or emotions. Douillard additionally notes, "The sweet taste of food (often in the form of junk food) is frequently abused in the attempt to make up for the lack of satisfaction in one's life. Sweets are then inappropriately tried and found guilty for causing a multitude of food and sugar addictions." [15] From this we can draw the conclusion that sweets, especially in the form of simple sugars or noncomplex carbohydrates, i.e., junk food, can provide a temporary consolation for the lack of satisfaction in our life. This is supported by Dr. Robert Svoboda as he writes, "All addictions are fundamentally addictions to the Sweet Taste, the Taste that creates satisfaction in ahamkara" Addiction to sugar is a good example of how addictions develop. If you search for satisfaction primarily in your food instead of in your life you may well become addicted to sweets. If you are not careful to select healthful Sweet foods like fruit and whole grains, you will probably fall prey to sugarfilled junk foods like doughnuts for your Sweet fix. When you eat too much white sugar for too long it will exhaust your system's ability to digest it. This will make you hypersensitive to it, which will aggravate Vata" [16] In numerous medical research studies, as reported in multiple journals including "Pharmacological Biochemical Behavior","Obesity Research," and "Neuroreport," scientists have shown that when rats had high levels of simple sugars introduced into their diet, intake of healthy chow diminished. Of significance are the following findings: • When allowed liberal access to a 20% sucrose solution in addition to their normal diet, even after introducing a drug to block pain, the rats increased their sucrose consumption and steadily decreased consumption of normal chow. [17] • After being food deprived for 12 hours daily, rats were offered 25% glucose as well as the standard chow; after being deprived of the glucose and chow, they showed signs such as teeth chattering, tremors and head shaking typically associated with signs of opioid withdrawal; indicating sugar dependency. [18] • Rats given 25% glucose solution with chow for 12 hours and then deprived of food for 12 hours doubled their glucose intake in 10 days and developed a pattern of excessive intake in the first hour of daily access. [19] In interpreting the information provided by the Ayurvedic writers as well as that of the medical researchers, it appears that when one attempts to find fulfillment of body, mind and spirit through the overuse of the sweet taste, a strong potential exists to move toward the most immediate form of http://www.ayurvedacollege.com/book/export/html/2
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sweet digestible. That includes processed sugars and alcohol. [20] Frawley notes that it is the stronger pure forms that aggravate the doshas . First it will impact the one it typically aggravates, but after excessive use even the dosha(s) it typically alleviates will become deranged. For the sweet taste the pure form is sugar, any form of pure sugar. [21] Affects of Overuse on the Body The literature reports a plethora of negative impacts of overuse of the sweet taste on the body. Beginning with the Caraka Samhita it was identified that overindulgence or addiction to habits and foods that aggravate kapha are responsible for the causation of prameha . [22] This is a condition of excessive urination and has come to be known as diabetes mellitus. Current Ayurvedic scholars report, "Too much sweet damages the spleen (pancreas) [23] ; "Sweet taste creates heaviness that obstructs the channels" [24] ; "(it) increases kapha and decreases pitta and vata. It is cold, damp and heavy for digestion, reducing agni. Excess use of the sweet taste produces such kapha disorders as obesity, lethargy, heaviness, loss of appetite, edema, dyspnea, cough, cold, constipation and vomiting." [25] Many of these same symptoms are echoed by Dr. Lad and he adds diabetes and abnormal growth of muscles. [26] In the medical science community a myriad of studies have been conducted to determine the impact of certain variables within the diet. These experiments go far in supporting the Ayurvedic knowledge with empirical data. In the "British Journal of Nutrition" it was reported that ingestion of pure carbohydrate or pure protein resulted in lower overall cognitive performance. Their findings supported the need for a balanced glucose metabolism. [27] Another statement of the concept of using all six tastes in appropriate balance. A study done by the Department of Food Science and Human Nutrition at Michigan State University looked at diet quality and risk factors for cardiovascular disease in U. S. adults. Of interest in this study was the finding that a managed carbohydrate diet actually decreases the risk of cardiovascular disease. However, both the source and amount of intake of carbohydrates are important. When carbohydrates were ingested as simple sugars it was shown that there was "a greater effect on raising triglyceride and total cholesterol than starch and a substantial effect on lowering HDLcholesterol." [28] This study went on to report that "the highest quintile of carbohydrate intake (>57.5% in men and >59.1% in women) was associated with higher concentration of serum triglyceride and lower HDLcholesterol "it was predicted that the more insulinresistant an individual, the greater would be the negative metabolic effects of highcarbohydrate, lowfat diets." [29] A study conducted in Argentina fed rats on a sucrose rich diet and found significant evidence that it "induces hypertriglyceridemia and insulin resistance." [30] A study reported in the "Journal of Obesity Related Metabolic Disorders" indicated that "when offered a choice of foods, rats typically prefer high fat and/or highsugar food items over their nutritionally balanced chow diet. In addition, they may increase their total energy intake by 2040% and consequently develop mild to moderate obesity." [31] Numerous other studies have found evidence of: http://www.ayurvedacollege.com/book/export/html/2
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• sugarinduced hypertension [32] • suppression of neuronal survival signals by hyperglycemia resulting in transient forebrain ischemia (stroke) [33] • development of kidney stones from sucrose intake [34] • increased risk factors for lung cancer due to high dietary sugars [35] • increased susceptibility to neurotoxins with excessive dietary intake of sugars [36] These symptoms primarily define kapha type disorders. These findings therefore support the understanding and wisdom of both the ancient and current acknowledged teachers of Ayurveda with regard to the physical body. Affects of Overuse on the Mind When attempting to understand the impact of overuse of any of the tastes, it is important to evaluate the doshic balance of the individual. To comprehend the impact of abuse of the sweet taste on the mind, it is important to distinguish it from the body. Frawley writes, "Nature has many ways of making human beings and every possible variety must be manifested. Moreover, the energetics between the outer and inner aspects of our nature are not always of simple correspondence "we must not treat psychological conditions simplistically according to the physical Dosha . The physical body may not simply reflect the mental nature, but may try to balance or compensate for it." [37] Therefore, the mental constitution of an individual must be taken into account when evaluating the amount of any of the tastes that will support health. Ayurvedic philosophy identifies the mind as existing in the subtle or astral body. Frawley describes it as "being the most subtle form of matter." [38] He goes on to point out that "the mind can be easily affected and disturbed, easily excited, depressed or distracted. It can overreact to momentary impressions" Indeed there is nothing more difficult to control than the mind. Inability to control the mind causes sorrow and is behind the disease process." [39] In assessing the impact of the sweet taste then, it is essential to understand both the physical and mental constitution as well as understanding that the mind is the more difficult to balance. Therefore, once out of balance, it will cause numerous physical and emotional conditions. It is unhealthy sensory habits that results in the vitiation of prana vayu leading to addiction. As noted by Marc Halpern, "the largest amount of prana or prana vayu enters the body through our mouth and our nose "when prana vayu is disturbed within the mind, it creates excessive thought and most importantly fear, worry, nervousness and anxiety." [40] In the Caraka Samhita, the Principle of Psychopathogensis states, "The sense faculties, together with the mind get vitiated by excessive utilisation, nonutilisation and wrong utilisation of the objects concerned. This causes an impediment to the respective sense perceptions" The sense faculties get vitiated due to the excessive utilisation, nonutilisation, wrong utilisation of their respective objects. The vitiated sense faculties, in their turn, also vitiate the mind." [41] Frawley and Ranade note that when derangement to the senses occurs, as through overuse of any taste, there will be impairment to the mind. [42] As quoted earlier, Svoboda states clearly that "all addictions are fundamentally addictions to the Sweet Taste, the Taste that creates satisfaction in ahamkara" [43] In the Yoga Sutras Patanjali, it is stated, "In subtle form, these obstacles can be destroyed by resolving them back into their primal http://www.ayurvedacollege.com/book/export/html/2
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cause [the ego]" [44] It follows that overuse of the sweet taste plays a serious role in the vitiation of the mind which impacts perception, the ability to think and function clearly, and maintenance of mental and emotional stability in life. Conclusion Diet and nutrition are at the core of the Ayurvedic philosophy of health and balance. This essential fact is made obvious when evaluating the most basic of dietary concepts: tastes. As I reviewed the literature, classical and current, as well as notable empirical evidence, it became clear that excessive intake of the sweet taste can lead the mind, and then the body, to a condition of imbalance and possible addiction. The evidence points to the move from healthy amounts and types of sweet substances to the ingestion of high volumes of the purest form of sugar. The physical maladies resultant from this excessive intake will continue to increase until it is acknowledged that the mind and emotions must be addressed at the root of the problem. Ayurveda provides the solutions to both physical and mental vitiation. In dealing with any physical disease, it will be necessary to address mental states to see overall improvement and for balance to be reestablished. As Caraka noted, when the sages desired healthy, long life, they turned to Ayurveda, "the immortal and sacred (science of life)." [45] The translators, Sharma and Dash, comment "They (the sages) found in this science various prescriptions dealing with the avoidance of the unwholesome habits and acceptance of wholesome ones and thereby attained inexhaustibly long life and well being devoid of all miseries." [46]
[1] R. K. Sharma and Bhagwan Dash, trans., Caraka Samhita . Vol II, 1:4 ( India : Chowkhamba Sanskrit Series Office, 2000), 113. [2] Ibid., Vol I, 5:4, 106. [3] Marc Halpern, Principles of Ayurvedic Medicine . 4 th ed. ( Grass Valley : California College of Ayurveda, 2002). 6:3. [4] Sharma. and Dash, trans., Caraka Samhita . Vol I, 1:64, 4546. [5] Ibid., 1:65, 46. [6] David Frawley, Ayurvedic Healing , (Salt Lake City, UT: Passage Press, 1989), 16. [7] Ibid., 16. [8] David Frawley, and Subhash Ranade, Ayurveda, Nature's Medicine , ( Twin Lakes , WI : Lotus Press, 2001), 134. [9] John Douillard, Body, Mind and Sport , rev. ed. (New York: Three Rivers Press, 1995), 91 http://www.ayurvedacollege.com/book/export/html/2
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[10] Sharma, and Dash, trans., Caraka Samhita . Vol IV, 15:12 , 8. [11] Vasant Lad, Ayurveda The Science of SelfHealing , 2 nd ed., (Wilmot, WI: Lotus Press, 1985), 92 " 99B. [12] Frawley, Ayurvedic Healing , 16. [13] Ibid., 16. [14] Douillard, Body Mind and Sport , 91. [15] Ibid., 91. [16] Robert E. Svoboda, Prakriti Your Ayurvedic Constitution , Rev. Enl. 2 nd ed., (Bellingham, WA: Sadhana Publications, 1998), 68. [17] G. M. Schoenbaum, R. J. Martin, D. S. Roane, "Relationships between sustained sucrosefeeding and opioid tolerance and withdrawal." in Pharmacological Biochemical Behavior abstract Vol 34(4): 9114. Dec, 1989. Available from the World Wide Web @ http://www.ncbi.ilm.nigh.gov search 2623045. [18] C. Colatuoni, et al., "Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence." in Obesity Research abstract Vol 10(6): 47888. June, 2002. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 12055324. [19] C. Colatuoni, et al., "Excessive sugar intake alters binding to dopamine and muopioid receptors in the brain." in Neuroreport abstract Vol 12(16): 354952. Nov, 2001. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 11733709. [20] Svoboda, Prakriti Your Ayurvedic Constitution , 68. [21] Frawley, Ayurvedic Healing , 18. [22] .Sharma and Dash, trans. Caraka Samhita Vol III 6:4, 298. [23] Frawley, Ayurvedic Healing , 19. [24] Frawley and Ranade, Ayurveda Nature's Medicine , 138. [25] Ibid., 134. [26] Lad, Ayurveda The Science of SelfHealing 2 nd ed., 90. [27] K. Fischer, et al., "Cognitive performance and its relationship with postprandial metabolic changes after ingestion of different macronutrients http://www.ayurvedacollege.com/book/export/html/2
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in the morning." in British Journal of Nutrition abstract Vol 85(3): 393405, March 2001. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 11299085. [28] Eun Ju Yang, et al., "Carbohydrate Intake is Associated with Diet Quality and Risk Factors for Cardiovascular Disease in U. S. Adults: NHANES III." in Journal of the American College of Nutrition, Vol 22, No. 1, 7179. 2003. Online journal available from the World Wide Web @ http://www.jacn.org/cgi/content/full/22/1/71. [29] Ibid.. [30] A. Chicco, et al., "Muscle lipid metabolism and insulin secretion are altered in insulinresistant rats fed a high sucrose diet." in Journal of Nutrition abstract Vol 133(1): 12733. Jan, 2003. Available from the World Wide Web @ http://nchi.nlm.nih.gov search 12514279. [31] A. Sclafani, "Psychobiology of food preferences." in Journal of Obesity Related Metabolic Disorders abstract Vol 25 Suppl 5:S136. Dec, 2001. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 11840208. [32] H. G. Preuss, et al., "Sugarinduced blood pressure elevations over the lifespan of three substrains of Wistar rats." in Journal of the American College of Nutrition abstract Vol 17(1):3647. Feb, 1998. Available from the World Wide Web @ http://www.ncbi.nlm.nih.gov search 9477388. [33] Q. He, K. Csiszar, and P.A. Li, "Transient forebrain ischemia induced phosphorylation of cAMPresponsive elementbinding protein is suppressed by hyperglycemia." in Neurobiological Disorders abstract Vol 12(1):2534. Feb, 2003. Available from the World Wide Web @ http://www.nchi.nlm.nih.gov search 12609486. [34] N. J. Blacklock, "Sucrose and idiopathic renal stone." in Nutrition and Health abstract Vol 5(12):917. 1987. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 3313140. [35] E. De Stefani, et al., "Dietary sugar and lung cancer: a casecontrol study in Uruguay." in Nutrition and Cancer abstract Vol 31(2):1327. 1998. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 9770725. [36] K. Olivier, et al., "Glucose feeding exacerbates parathioninduced neurotoxicity." in Journal of Toxicology and Environmental Health abstract Vol 22;63(4):25371. June, 2001. Available from the World Wide Web @ http://ncbi.nlm.nih.gov search 11437059. [37] David Frawley, America Institute of Vedic Studies Ayurvedic Healing Correspondence Course For Health Care Professionals Part II. (Santa Fe, NM: American Institute of Vedic Studies, 1999). 27. [38] Ibid., 101. [39] Ibid. http://www.ayurvedacollege.com/book/export/html/2
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[40] Halpern, Principles of Ayurvedic Medicine., 2:19 . [41] Sharma and Dash, trans., Caraka Samhita , Vol 1 8:15 , 169170. [42] Frawley and Ranade, Ayurveda: Nature's Medicine ., 258. [43] Svoboda, Prakriti, Your Ayurvedic Constitution ., 68 [44] Sri Swami Satchidananda, trans., The Yoga Sutras of Patanjali. (Yogaville, VA: Integral Yoga Publications, 1999), 93. [45] Sharma and Dash, trans., Caraka Samhita , Vol 1 1:24 , 21. [46] Ibid., 1:2729, 23.
Ghee: An Ayurvedic and Biochemical Treatise By: Catherine Robbins Introduction: Ghee, the golden elixir of Ayurveda is an oil with a long and interesting history. A staple of Indian, Arabic, and North African cooking, it is also found throughout Indonesian societies. Ghee is the rendered fat of butter. Butter is made in several different ways, which result in butters with slightly different fat, water and milk solids content. Desi ghee is the traditional Indian ghee made from cow’s milk that is first collected and saved for a few days to “culture”. The cultured milk is then churned to produce butter. Churning separates the emulsified fats in the milk from the liquid or aqueous portion of the milk. The left over liquid is called buttermilk and is used for drinking and other cooking. In American creameries, the milk is usually not cultured and it therefore produces butter that has a slightly different fatty acid and water content [1]. The rendered oil known as ghee is called ghrita in Sanskrit, the traditional language of the ancient texts of Ayurveda. The Brihat Treya, the three most important Ayurvedic texts are the Caraka Samhita [2, 3], the Shushruta Samhita [4] and the Ashtanga Hrdayam [5], and date back as far as 500BC in written form. It is in these ancient writings where we learn the multiple uses and the powerful medicinal effects of ghrita. Caraka clearly states the indications for ghee: “promotes memory, intelligence, agni, semen, ojas, Kapha and medas. It alleviates Vata, Pitta, poison, insanity, phthisis, inauspiciousness and fever. It is the best of all fats, is cold, madhura rasa, madhura vipaka, has 1000 potentialities and so, if used properly according to prescribed methods, exerts 1000 types of action.” Su27#231232 [2, 3]. Caraka then goes into a greater discourse on each use listed for ghee throughout the text. Sushruta makes an even stronger statement on the medicinal uses of ghee, “Ghrita is sweet, mild in action, soft, cold in potency (Virya), not http://www.ayurvedacollege.com/book/export/html/2
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increasing moisture in the tissues, lubricating, relieves upward movement in the alimentary tract, insanity, epilepsy, colic, fever, and distension of the abdomen, mitigates vata and pitta, kindles agni, increases memory, wisdom, intelligence, complexion, voice, beauty, softness of the body, vitality, vigor, strength, and span of life; is aphrodisiac, good for vision, increases kapha, wards off sins and inauspiciousness, destroys poisons and demons.” He further elaborates on the properties and applications of ghees obtained from the various types of animal milks including human, elephant and camel milk, Chap XLV #5v19 [4] stating ghee from cow’s milk is superior for all ailments. In the Ashtanga Samgraha, Vagbhata tells us the use of ghee for snehavidhi adyaya or oleation therapy “is best for those desirous of intelligence, memory, wisdom, good digestive capacity, for those suffering tumors, sinus ulcers, worms, diseases of kapha, medas and vata origin” Chap 25 10 11 [6]. The quotes of these authors are very strong statements and in today’s medical world where the search is on for THE one pharmaceutical “magic bullet”, ghee appears to be just that. Table 1 Indication for ghee
Dosha/Subdosha Reference involved
Promotes memory
Vata (prana, samana vyana)
Caraka, Sushruta,Vagbhata
Promotes Vata (prana, intelligence/wisdom samana vyana)
Caraka, Sushruta,Vagbhata
Enkindles agni/digestive capacity
Pitta (pachaka)
Caraka, Sushruta,Vagbhata
Promotes semen/vigor
Shukra agni, apana vayu
Caraka, Sushruta
Promotes ojas/vitality
Kapha kshaya
Caraka, Sushruta
Promotes kapha/medas
Kapha kshaya
Caraka, Sushruta
Cures diseases of kapha/medas
Kapha kshaya
Vagbhata
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Alleviates Vata
Vata vruddhi
Caraka, Sushruta,Vagbhata
Alleviates Pitta
Pitta vruddhi
Caraka, Sushruta
Poison
Vata, Pitta, Kapha[7]
Caraka, Sushruta
Insanity
Vata
Caraka, Sushruta
Epilepsy
Vata
Sushruta
Phthisis (tuberculosis)
Vata, Pitta, Kapha[7]
Caraka
Upward moving Vata in alimentary tract
Vata
Sushruta
Colic, constipation/gas
Vata
Sushruta
Tumors
Kapha
Vagbhata
Sinus Ulcers
Pitta
Vagbhata
Fever
Pitta
Caraka, Sushruta
From the above table, it is clear that ghee can be tridoshic in small doses. It has a sweet rasa, with a cold virya and a sweet vipaka with gunas or qualities being light, penetrating and unctuous [2, 4, 8, 9]. Ghee’s unctuousness makes it an excellent internal and external lubricant for treating Vata’s dryness, roughness and emaciation and Kapha’s hardness. Its cooling virya makes it excellent for placating excessive Pitta and yet, it can stimulate agni without exacerbating Pitta aggravations. Ghee also has a prabhav that allows it to take on the properties of herbs it is processed with without losing its own gunas [2]. This means if it is cooked with a heating herb, the ghee will pass on this property without giving up its own oily, cooling properties. This makes ghee an excellent anupana and its spreading nature can take the intention of herbs in to the deep tissues. Dr. Vasant Lad of the Ayurvedic Institute in Albuquerque, NM calls ghee a catalytic agent or yogivahi that carries the medicinal properties of herbs it is processed or taken with in to the tissues [10]. Again, when pondering all the possible uses for ghee from an Ayurvedic standpoint, it would seem that ghee is like the “magic bullet” so sought after in Western medicine [11], however, when the subject of dietary fat arises in the American public discourse, the first questions raised http://www.ayurvedacollege.com/book/export/html/2
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invariably have to do with is ghee safe? Isn’t ghee just rendered animal fat and shouldn’t we all be avoiding animal fat in general? Isn’t ghee, being a byproduct of butter, high in cholesterol? Whenever the discussion turns to fat in the American diet, there is so much contradictory information in the public domain, a formalized understanding of fat biometabolism can be truly useful in understanding how ghee could be good. To that end, let us take a closer look at what fat is and how, when and why humans require fat in their diet, not only to survive, but to also lead healthy productive lives. The skinny on fats: what’s a fatty acid and why is it essential? Lipids are one of the four major classes of bioorganic compounds required by living organisms, the other three being carbohydrates, proteins and nucleic acids. Unlike the other three classes of important biochemical compounds, lipids are not characterized by structure but rather, by selective solubility in various solvents. Technically speaking, a lipid is an organic (carbon containing) compound found in living organisms that is insoluble or sparingly soluble in water but is very soluble in nonpolar solvents [12, 13] such as oil. There is great structural diversity among lipids leading to the following five classifications: 1. 2. 3. 4. 5.
Energy Storing lipids: triacylglycerolsa Membrane Lipids (phospholipids, sphingoglycolipids and cholesterolb) Emulsification lipids (bile acids) Messenger lipids (steroid hormones, cholesterolb and eicosanoids) Protective coating lipids (plant waxes)
Fatty Acids (FAs) are naturally occurring monocarboxylic acids which generally contain an even number of carbons in their carbon chainc where Long Chain FAs = 1226 carbons, Medium Chain FAs = 610 carbons and Short Chain FAs = 46 carbons in length. FAs are rarely found free in nature as they are usually part of more complex lipid molecules [13, 14]. A further delineation of FAs is the degree of saturation. Saturated FAs (SFAs) have no carbon carbon double bonds in the carbon chain. Monounsaturated FAs (MUFAs) have one carbon carbon double bond in the carbon chain and Polyunsaturated FAs (PUFAs) have two or more carboncarbon double bonds in the carbon chain. Up to 6 double bonds are found in biologically important PUFAs. Double bonds are significant to the biochemistry of FAs because it is at these highenergy bonds that important biochemical reactions take place. In plants, FAs are found mostly esterified to glycerol as triglycerides and they make up ~7% of the dry weight of a plant [14]. Plant FAs are generally unsaturated (UFAs) as demonstrated by the fact that they are liquids at room and body temperature. Seed and nut oils have much higher FA content, but again are mainly unsaturated and in the form of triglycerides. Coconut oil is heavily saturated at 86.5% while olive and safflower oil have 13.8% and 7.5% saturation, respectively [16]. In general, SFAs come from animal sources and UFAs come from plant sources although there is great variability in the FA makeup of various types of plants and animals. Ruminant animals such as cows, goats and sheep have much higher SFAs than fish or fowl. Ruminant animals rely on http://www.ayurvedacollege.com/book/export/html/2
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gut bacteria to breakdown plant based foods such as grass, forage or corn into usable energy via the anaerobic process of fermentation. The fermentation carried out by the gut bacteria and the rumen stomach together are considered more or less a hydrogenation chamber where plant based UFAs are hydrogenated with the main waste product being gaseous methane. Usable byproducts of ruminant fermentation are volatile short chain SFAs such as acetic acid, proprionic acid and butyric acid and they are a main source of energy for the animal. They also occur in the food we get from the animals such as meat, milk, cheese and butter. Other animal meats such as chicken and fish are generally lower in SFAs because those animals do not ruminate or, ferment their food before digesting it as do cows [17]. The chemical properties of FAs and the lipids that contain them are a function of the length of the carbon chain they contain and the degree of saturation. SFAs that have fewer than 8 carbons are liquid at body temperature and those containing 10 or more carbons are solid at body temperature. The presence of double bonds lowers the melting point, hence SFAs have a higher melting point than UFAs with the same number of carbons in the chain. The greater the degree of unsaturation, the lower the melting point and this is due to decreased molecular attraction between carbon chains [12, 13, 18]. The carboncarbon double bonds in UFAs are usually (but not always) in a cis configuration, which introduces a bend in the carbon chain. Such bends prevent UFAs from packing as tightly together as SFAs. The greater the number of double bonds, the less efficient this packing is and the lower the melting point of the lipid [12]. In humans, most FAs come from the diet although the body can make many fatty acid containing molecules with two key exceptions: the highly unsaturated linoleic acid and alphalinolenic acid. These two FAs have unsaturation beyond carbons nine and ten which the human body cannot synthesize. Because these two FAs cannot be synthesized from lipid precursors in the body, they are considered essential and must be obtained from the diet. These are PUFAs and their exclusion from the diet leads to severe gastrointestinal and skin lesions similar to Pellegra (vitamin B3 deficiency). Since FAs are abundantly available in both plant and animal based foods, it is a rare situation where an individual is suffering from essential FA depletion. On the other hand, it is generally accepted that diets very low in fat need to be supplemented with linoleic and alpha linolenic acid [20, 21]. Saturated FAs have been long associated with cardiovascular disease, cerebrovascular disease and atherosclerosis [22, 23]. Although the data have not always been strong, they appear to be consistent across years of published research indicating that a diet high in saturated fats increases the risk of coronary artery disease (CAD) [24]. Mechanistically, this increase for CAD risk appears to involve increased Low Density Lipoprotein (LDL), which has been linked to atherosclerosis, a precursor to cardiovascular disease CVD [25, 26]. On the other hand, some SFAs such as caproic acid (5 carbons), caprylic acid (8 carbons), decanoic acid (10 carbons) and stearic acid (18 carbons) have been shown to have no effect on LDL cholesterol [27]. Interestingly, butyric acid, the 4 carbon volatile SFA which is found at 25% by weight in butter and ghee has been shown to be antiinflammatory in Crohn’s disease, to improve insulin sensitivity, increase energy expenditure in a diabetic mouse model, and to be a modulator of the immune response and inflammation as well as an antitumor agent [2730]. Unsaturated FAs come in 2 types: Monounsaturated (MUFAs) and polyunsaturated (PUFAs). The one carboncarbon double bond in MUFAs is generally in the cis configuration and the dietary effect seen in many studies is to reduce cardiovascular risk [31]. Examples of MUFAs are palmitoleic acid and oleic acid. Examples of PUFAs are linolenic acid and alphalinoleic acid. PUFAs have more than one carboncarbon double bond and another important differentiating factor is where along the carbon chain the double bonds occur. 3 PUFAs have their first double bond http://www.ayurvedacollege.com/book/export/html/2
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at the third carbon from the methyl end of the carbon chain and the 6 PUFAs have their first double bond at the 6th carbon from the methyl end of the carbon chain. These two families of PUFAs have received a lot of attention in Western science ever since it was discovered that linoleic acid and alphalinolenic acid are essential [20, 21]. 3 and 6 Fatty Acids: Linoleic acid (LA) is an ω6 PUFA, an 18 carbon monocarboxylic acid with two cis conjugated (separated by one carbon with a single bonds) carboncarbon double bonds, one that is six carbons from the methyl end and one nine carbons from the methyl end [12, 13] and it has a melting point of 5 C. This means LA is a liquid at body temperature 37 C [18]. The word “linoleic” comes from the Greek “linon” for flax and “oleic” meaning of or relating to oleic acid (found at high concentrations in olive oil) and it is the most common PUFA found in both plant and animal tissue [12, 13]. LA is further metabolized to arachidonic acid (AA), which is metabolized into the proinflammatory type eicosanoid prostaglandins, thromboxanes and leukotrienes [12, 18, 24, 32]. When it became clear that a diet high in PUFAs had positive effects on heart health, people were encouraged to increase the intake oils high in PUFAs such as corn, peanut and safflower. Currently, LA provides approximately eightyfive percent of American’s energy intake from PUFAs [24, 33]. Alphalinolenic acid (ALA) is an ω3 PUFA, an 18 carbon monocarboxylic acid with three cis conjugated carboncarbon double bonds the first of which is at the third carbon from the methyl end of the molecule and has a melting point of 11 C [12, 13, 18, 34]. Like LA, ALA is a liquid at room and body temperature. In the human body, ALA is a precursor to eicosapentaenoic acid (EPA) (20 carbons) and docosahexaenoic acid (DHA) (22 carbons), two long chain ω3 PUFAs that came to light during epidemiological studies of Eskimo/Inuit tribes who consume large amounts of ω3 PUFAs from the fat from fish yet have low rates of CVD [24, 33, 35, 36]. Other positive effects attributed to ω3 PUFAs, especially EPA and DHA are antithrombotic, anti Alzheimer’s and proimmune response [35, 3740]. cis and trans FAs: Most, but not all high energy carboncarbon double bonds that occur in nature and the human body are in the cis configuration where the substituent groups on either carbon involved in the double bond are on the same side of the molecule in three dimensional space. The trans configuration is when the substituent groups are on the opposite sides of the molecule around the carboncarbon double bond. Carboncarbon double bonds introduce rigidity to chains of carbon molecules and energetically speaking the trans configuration is the most chemically stable. This is why “hydrogenated” FAs as in shortening are in the trans configuration; industrial hydrogenation is an uncontrolled reduction reaction where hydrogen is added to the double and triple bonds of vegetable oils in a random, energetically favored way [18]. Biochemical hydrogenation as takes place in ruminant animals gives rise to mostly the cis configuration and the products are recognized by other biological systems such as in humans. Also, during industrial hydrogenation, some of the cis FAs are also converted to trans FAs through a process call cistrans isomerization and this dramatically alters the shape of the fatty acid chain. Not surprisingly, trans FAs produced by uncontrolled hydrogenation are not recognized structurally by the enzymes that normally process FAs in the body and tend to collect in the liver and at sites of atheroma growth, hence they are now associated with higher CVD risk [18, 41]. http://www.ayurvedacollege.com/book/export/html/2
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Cholesterol: What is it and is it really “bad”? Cholesterol is a steroid. A steroid is a lipid structure based on a fusedring system that involves three 6membered carbon rings and one 5 membered carbon ring. Cholesterol in an integral component of cell membranes and a precursor for other steroid based lipids [12, 13, 18]. Cholesterol is the most abundant steroid in the human body. It is found in cell membranes, nerve tissue and brain tissue and is also found in nearly all bodily fluids in some form or another. Some cholesterol is taken up from the diet in the small intestine, but the majority of cholesterol is synthesized in the liver and to some degree in other organs [12, 13, 18, 22]. Ingested cholesterol decreases the amount of cholesterol produced by the body via a negative feed back system. Since cholesterol is not water soluble, it is packaged with FAs and protein by the body for circulation to where it is needed. These proteins are called lipoproteins [12, 13]. Low density lipoproteins (LDL) generally carry cholesterol from the liver to the tissues and high density lipoproteins (HDL) carry excess cholesterol back to the liver. Because of cholesterol’s abundance in the body in both healthy and pathological conditions, it has been closely studied for its role in atherosclerosis for over a century [43]. Originally, it was found as a crystalline component of atherosclerotic plaques and gallstones. It is also known that there is a direct correlation to age and the lipid and cholesterol content of the aorta of humans [44]. This led to Anitschkow’s landmark study where he showed that feeding rabbits pure cholesterol dissolved in oil led to the development of atherosclerotic lesions [45]. Normally rabbits do not ingest measurable amounts of cholesterol as the cholesterol content of plants is considered negligible [43] and rabbits are obligate herbivores. Clearly, rabbits are not the best cholesterol model on which to base human medicine. Regardless of the fact that rabbits and humans process dietary cholesterol differently, the “Lipid Hypothesis” [46] was born and cholesterol found in LDL as a therapeutic target has been doggedly pursued by the Western medical and scientific community in the search for a treatment for atherosclerotic diseases ever since. With the advent of statins in the 1980s, the lipid hypothesis gained solid acceptance and the data show that for people suffering from hyperlipidemia, dietary and lifestyle changes along with the use of a statin can dramatically normalize dyslipidemia and reduce the primary and secondary risk for cardiovascular disease [47, 48]. Although the cholesterol in LDL as a primary therapeutic target has shown great success at reducing cardiovascular risk over the years, there is a plethora of data that suggest cholesterol alone is not the causative agent in cardiovascular disease [22, 27, 31, 33, 4951]. In fact, inhibition of cholesterol biosynthesis has also been associated with impaired insulin secretion and other cholesterol mediated membrane processes involving exocytosis [52]. Exocytosis is the main process by which cells secrete bioactive molecules such as insulin, neurotransmitters and hormones. These data suggest that when cholesterol levels are unnaturally low due to medications such as statins, a whole host of serious medical syndromes are experienced by a small subset of patients [48, 53, 54] ranging from rhabdomyolysis to death [55]. One of the most interesting findings was in the ENHANCE study of a combination of Simvastatin, a statin and Ezetimibe, a cholesterol uptake inhibitor. This was an imaging study looking at regression of fatty plaques in the arteries due to combination therapy. Combination therapy of statins with other lipid lowering medications has shown additive results in normalizing dyslipidemias [56]. On the other hand, the data on the regression of plaques due to aggressive statin and/or combination therapy have been mixed suggesting that statins play more of a role in plaque stabilization and that plaques rarely regress very much quantitatively [57]. Patients on the combined therapy of Simvastatin + Ezetimibe achieved tremendous reductions in LDL cholesterol and yet the patients experienced growth of fatty plaques in their arteries [58]. The study was http://www.ayurvedacollege.com/book/export/html/2
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subsequently stopped early [59] because of this. There were also a slightly higher number of patients on combination therapy who developed cancer, but the study did not continue long enough to determine if this was a significant outcome. This result and similar results in other studies where the LDL and total cholesterol levels have been severely reduced and yet have not resulted in greater health benefit to the patient have left Western researchers puzzled as to what actually contributes to atherosclerotic plaque growth [48, 57, 59, 60]. It has also caused many researchers to reevaluate cholesterol not as a “bad” or a “good” thing, but rather as an integral membrane steroid responsible for many important physiologic activities that can under certain conditions contribute to the pathology of atherosclerotic plaques. On the other hand, it is now being established that one can lower the cholesterol too much with unhealthy outcomes in certain patients. The original “Lipid Hypothesis” is actually a consensus on the idea that there is a direct correlation between plasma levels of cholesterol and the development of coronary artery disease [61]. At the time of its development, it was quite plausible. In fact, as stated before, many lives have been saved, improved and prolonged as a result of making the treatment of elevated plasma cholesterol in LDL a primary therapeutic target. However, this hypothesis completely fails to explain the results seen in the ENHANCE study and other, lesser known instances where a patient cohort with high LDL cholesterol fail to develop cardiovascular disease [62, 63] or where statin therapy does not reduce CVD risk [63]. Attention is now turning more to the role of fat in the diet and more specifically, the role of the 3 and 6 MUFAs and PUFAs. This new body of evidence points to the importance of a high 3: 6 ratio not only for cardiovascular health, but overall health in general. The historical diet in this country 100 years ago favored 3 FAs because our food animals were fed mainly a diet high in forage and grass. As stated before, 3s have been associated with the antiinflammatory pathways in the body. 3: 6 ratios are estimated to have been ~ 9:1 for ruminant animals who were grass fed [24]. With the advent of the post WWII cornbased feed for cattle and other food animals in the United States, that ratio has turned in favor of the 6s at a ratio of 2030:1 depending on one’s diet [24]. Recall again, that the 6 FAs, although considered essential, are highly correlated with the inflammatory pathways in the body. The Union of Concerned Scientists has suggested that returning the feeding of the US’s food animals to a grass and forage based system could not only restore farmland ecosystems depleted under the strain of chemical fertilizers and pesticides, but that doing so could go a long way in improving the baseline health of the population at large [24]. Other data further demonstrate that even the saturated fats from plants are associated with less CVD risk than saturated fats from animals and that by substituting 2% of energy from meat SFAs with energy from dairy SFAs was associated with a 25% reduction in CVD risk [64]. It seems a more thorough understanding about the metabolic processes involving fats in the body may lead to a better understanding of atheroma formation, CVD risk and prevention. What is the Fat and Cholesterol Content of Ghee? Ghee is the rendered fat of butter, therefore it is considered to be 100% fat. As discussed earlier, not all fats are created equal, so what is the chemical fatty composition of ghee? Table 2 FA Composition of 100 g ghee[65] http://www.ayurvedacollege.com/book/export/html/2
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Component
Home made ghee [65]
Melting Commercial Point ghee [65] [66]
Triglycerides
97.8%
98.6%
Cholesterol
178.2 161.7 mg/100g mg/100g
148 150°C
Phospholipids
28.6 10.4 mg/100g mg/100g
Vitamin E
305 ug/100g
491 ug/100g
Vitamin A
447 ug/100g
584 ug/100g
Butyric acid C4 SFA
4.56% by wt[67]
7.9°C
Decanoic C10 SFA
1.8% by wt
1.3% by wt
31.6°C
Lauric C12 SFA
2.1 % by wt
2.6% by wt
43.2°C
Myristic C14 SFA
13.8% by wt
14.3% by wt
54.2°C
Palmitic C16 SFA
33.0% by wt
32.8% by wt
62.9°C
Stearic C18 SFA
11.8% by wt
12.0% by wt
69.6°C
Oleic C18
30.2%
30.0% by
13
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MUFA
by wt
wt
14°C
Linoleic C18 PUFA
2.1% by wt
2.6% by wt
5°C
These fatty acids exist in ghee in the form of triglycerides, which make up the bulk(~98%) of ghee. In order to identify them, they are hydrolyzed to liberate them from the triglyceride molecule [65]. Butyric acid is one of the volatile fatty acids found in butter and ghee and when it is hydrolyzed to the free form, it gives off the well known “rancid” smell associated with spoiled dairy products. It is included here because it is found in a relatively high concentration in ghee compared to other volatile FAs [67] and has been associated with decreased inflammation in and normalization of several pathological processes, especially gastrointestinal inflammation [2730]. What is surprising is actually how low the cholesterol concentration reported here is, yet it is consistent with other reports [67] of the cholesterol content of ghee. People who have been advised by their doctors to follow a low fat/low cholesterol diet are counseled to take in less than 300 mg of cholesterol a day from a 1000 kcal/day diet where 30% of the calories come from fat, as outlined in the Step I diet by the NIH Heart, Lung and Blood Institute [68]. 100 g of ghee is reported here to contain 178.2 mg cholesterol and reported elsewhere to contain ~900 kcal [67] of total energy. If one tablespoon of ghee weighs ~ 14 g (data empirically determined), then it contains ~ 126 kcal of total energy and ~25 mg of cholesterol. Vagbhata suggests using the least quantity of ghee that is effective for treating the patient, Chap 25 sutra1920 [6], depending on the agni and the disease being treated. It is reasonable then, to assume one tablespoon of ghee a day can be part of a low fat/ low cholesterol Step I diet without putting the patient at risk for complications of too much cholesterol. The melting point data are very telling about the nature of cholesterol. A melting temperature of 150 C is very high and it tells the chemist that cholesterol is a compound with strong intermolecular attractions. The density of cholesterol is 1.067 g/cm3, which makes it denser than water (1 g/cm3). The density of most of the long chain FAs is ~ 0.89 g/ cm3. In an effort to make cholesterol less dense for transport through the blood, the body esterifies it to a FA carbon tail and packs it into LDL. The chemist’s interpretation of the phenomenon of observing crystalline cholesterol in arterial plaques and gallstones depends on Density (D) and Melting Point (MP). The magnitude of both properties makes cholesterol a happier molecule when it is nice and orderly next to another cholesterol molecule until a crystal is formed. The concepts of Entropy Ssurr, Enthalpy H and Gibbs Free Energy G illustrate this from a thermodynamic standpoint. Entropy Ssurr is a measure of disorder in the universe and in general, is always increasing or becoming more positive. Enthalpy H is a measure of the energy required or released from a process. Here we are looking at the enthalpy of fusion between molecules of cholesterol. Gibbs Free Energy G is a measure of the energy available in a system to do work. Here we are looking at the free energy of cholesterol crystallization at body temperature. In general, for a process to be spontaneous, Ssurr >0, H <0, and G <0. “A process is spontaneous in the direction in which Gibbs Free Energy, G decreases” [69]. The free energy, G required to hydrolyze the ester bond between the FA tail and its cholesterol molecule is “supplied” from the tremendous free energy given up during cholesterol crystallization ( G becomes more negative) because heat flows out of the system when cholesterol molecules crystallize. How do we know heat must flow out when the cholesterol crystallizes? The Melting Point: MP tells us a lot of energy must be put into the system in order to begin to separate molecules of cholesterol from each other, the Enthalpy H of fusion. This is the same amount of energy or heat that will be given up by the molecules coming http://www.ayurvedacollege.com/book/export/html/2
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together and it is exactly this kind of thermodynamic balancing act that drives all the chemical reactions in the body[12] including the crystallization of cholesterol in fatty plaques and blockages. Further, if one compares the relative melting points of all the lipids present in ghee to that of cholesterol, one would expect to see cholesterol as the only crystallized lipid at body temperature. None of the other lipids present in ghee could even begin to crystallize under the conditions present in the body as 37 C is very close to their respective melting points. Body temperature, 37 C is 111 C below the melting point of cholesterol. What this means is that from a chemical perspective, cholesterol molecules want to adhere to each other strongly and are making relatively slow molecular motions. In contrast, 37 C being above or very close to the other FA melting points means these other FAs are undergoing relatively fast molecular interactions and they experience much poorer intermolecular attractions than cholesterol. Does observing cholesterol crystals in plaques make cholesterol the causative agent for plaque formation? The answer is no, as plaque formation has been demonstrated to begin with endothelial insult followed by fatty streak formation from macrophages attempting to clear away the initial injury [25, 26, 61]. Plaques form over these areas of injured endothelium attracting more macrophages, cytokines and other inflammatory biomolecules as the body attempts to heal the injury. Further, it is now widely accepted that the kind of plaques most likely to rupture are not the large crystalline, stable plaques seen in angina pectoris, but rather, plaques causing only 2030% stenosis or lumen narrowing. These smaller plaques have no cholesterol or other crystalline deposition, yet are highly associated with inflammation and the data show it is these lesser plaques that do not even show up by angiography which carry the highest risk for rupture and thrombosis formation [70, 71]. Biochemistry and the Doshic Effects of Ghee How does ghee accomplish all the medicinal effects listed in the ancient texts? Table 1 lists some of the actions of ghee given by the ancient authors and yet, there has been very little formal Western investigation into these claims. On the other hand there has been some research done on biochemical components of ghee and some of these data will be reviewed here. The ancient texts tell us that ghee has antipitta properties and that small amounts of it can stimulate agni without aggravating pitta [2, 4, 6]. Ghee is relatively high in a volatile FA called Butyric Acid (BA) and it is this acid in the free form that gives the rancid smell of spoiled dairy products [1, 72]. BA is an important short chain (4 carbon) FA, and is one of the several short chain FAs that is also produced by anaerobic fermentation of undigested dietary fibers in the colon. Recent data have shown that colonic irrigation with solutions of BA not only relieve the inflammation associated with Crohn’s disease, but also results in transcriptional changes in gut mucosal cells that are associated with increased FA metabolism and decreased oxidative stress [27, 28, 73]. Ghee is said to increase agni [24, 6]. Increased agni can be viewed as an increase in energy expenditure. When one is burning calories effectively, the body will respond by increasing hunger to take in more food to support that expenditure. In the diabetic mouse model, BA has been shown to increase energy expenditure and reverse insulin insensitivity, which from an Ayurvedic standpoint is viewed as compromised agni of Kapha origin [74, 75]. Further, BA has been shown to have antitumor activity [29, 30] which can be attributed to pacifying Kapha dosha. These data can be interpreted as increasing agni by pacifying Kapha but without aggravating Pitta. http://www.ayurvedacollege.com/book/export/html/2
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The ancient texts tell us that ghee is also good for persons who desire intelligence, good memory and wisdom [6]. Alzheimer’s disease is a neurodegenerative disease characterized by progressive cognitive and memory decline leading to dementia [76]. From an Ayurvedic standpoint it is viewed as a result of Vata dosha having relocated in the majja and mano vaha srotas. Vata is cold, rough and dry and the unctuousness of ghee comes from the fat content. Docosahexaenoic acid (DHA) deficiency in particular has been shown to correlate with impaired brain function [77] as seen in Alzheimer’s. Not only is ghee unctuous and penetrating, it is also high in the FA precursors for DHA lending to the Ayurvedic notion that ghee improves brain functioning. This view can be expanded further to understand how ghee can ameliorate other brain diseases of Vata origin such as epilepsy and insanity even in the absence of Western style data. Research more specific to ghee has been done in the area of cholesterol research. Historical data have been confusing, presenting contradictory effects of ghee on serum cholesterol levels. This may be due to the use of vanaspati ghee or ghee made with hydrogenated vegetable oil [78] in older studies. More recent work shows that ghee can slightly raise total cholesterol levels, but does so by raising the HDL, the so called good cholesterol from the Western standpoint [79]. The National Cholesterol Education Program (NCEP) recommendations for cholesterol management state that when HDL is raised above 60 mg/dL, it is considered a negative risk factor for CVD [80]. The increase in HDL cholesterol seen with ghee can be interpreted as reducing CVD risk from the standpoint of the NCEP guidelines. There has also been a question about the formation of cholesterol oxidation products (COPS) which are reported to be atherogenic and angiotoxic [81]. Kumar, et al., specifically studied the effect of ghee and COPS found in ghee from prolonged heating on serum and liver lipids in male Wistar rats [65]. First they demonstrated that heating did indeed decrease cholesterol levels and increase the COPS levels in ghee. However, animals fed ghee or ghee with significant levels of COPS both showed an overall decrease in serum lipids over a dietary range of 2.5%10%. Later work suggests this decrease in serum levels of cholesterol may be due to increased secretion of biliary lipids [82], one of the main ways the body removes excess fat from ingested foods before it can enter the systemic circulation. Studies that take into account ghee’s prabhav for carrying herbs to the deep tissues have been done using the Western scientific model. For example, Oza, et al. studied Bhringarajadi Ghrita Rasayana in premature aging. Here they were able to demonstrate the reversal of several Ayurvedic parameters of aging such as muscle weakness and mental acuity. They concluded that Bhringarajadi Ghrita probably acts at the level of the dhatuagni which leads to improvement in the overall health of the dhatus and hence, the person [83].
Conclusions: Ghee is an important medicine in Ayurveda having tridoshic and doshic specific rasayana properties. In the West, the use of ghee as medicine has been circumspect because of its association with dairy products and saturated fatty acids. Ghee is a liquid at body temperature and is only ~ 68% saturated which means it cannot go in to an organism and suddenly become “solid”. Cholesterol, which is found in ghee esterified to FAs has been implicated in CVD, but research through the years has demonstrated that cholesterol is not the causative agent for atheroma formation. Although, cholesterol does not appear to be the causative agent, controlling the biosynthesis of cholesterol has reduced the primary and secondary risks associated with elevated serum cholesterol. That said, the amount of cholesterol in 13 tablespoons of ghee is in line with the NHILBI’s recommendations for a low fat/low cholesterol diet. Further, attention is turning from cholesterol specifically to the role of 3 and 6 PUFAs in http://www.ayurvedacollege.com/book/export/html/2
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CVD. Our current corn based food chain system has shifted the ratio of PUFAs favoring 6 over 3. Animals fed grass based diets produce products that are higher in 3 than 6. 6 PUFA involvement in pro inflammatory processes versus 3 involvement in antiinflammatory processes may explain the high degree of CVD risk seen in the West. The body of evidence on ghee in specific, controlled Western style clinical trials is small, yet promising for explaining the Ayurvedic actions of ghee to the Western medical community. Regardless, the ancient texts of Ayurveda clearly state the many medicinal applications of ghee and it is considered one of Ayurveda’s most potent medicines. Perhaps going forward, more Western style research will be done to support the many Ayurvedic medicinal claims for ghee, but that remains to be seen. On the other hand, the predictive value of the science that is Ayurveda should be enough for most practitioners to have confidence using ghee in the treatment of appropriate patients.
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9. Vagbhata, A. Gupta, and Y. Upadhyaya, Astangahrdayam : Vidyotini bhasatikavaktavya parisistasahitam. Sa*mskara*na 14. ed. 2003, Varanasi, Bharata: Caukhambha Samskrta Samsthana. 48, 616 p. 10. V, L., Textbook of Ayurveda General Principles of Management and Treatment. 1st ed. Vol. 3. 2012, Albuquerque: The Ayurvedic Press. 646. http://www.ayurvedacollege.com/book/export/html/2
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11. Magic Bullets. Amer J Pub H, 1953. 43(7): p. 917918. 12. Nelson, D.L., A.L. Lehninger, and M.M. Cox, Lehninger principles of biochemistry. 5th ed. 2008, New York: W.H. Freeman. 1 v. (various pagings). 13. Stoker, S., General, Organic, and Biological Chemistry. 3rd ed. 2004: Houghton Mifflin Co. 797. 14. Hoffmann, D., Medical herbalism : the science and practice of herbal medicine. 2003, Rochester, Vt.: Healing Arts Press. 666 p. 15. ChemAxon. Marvin Sketch Freeware. [cited; Available from: https://www.chemaxon.com/products/marvin/. 16. Lawrence, V., et al., Garlic effects on cardiovascular risks and disease, protective effects against cancer, and clinical adverse effects, in Evidence report/technology assessment, no. 20. 2000, Agency for Healthcare Research and Quality: Rockville, MD. 17. R, B. Rumen Physiology and Rumination. 2009 [cited; Available from: http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/herbivores/rumination.html. 18. Solomons TWG, F.C., Organic Chemistry. 9th ed. 2007, Hoboken, NJ: Wiley & Sons. 19. Wikipedia. File:Rasyslami.jpg. Wikipedia [cited; Available from: http://en.wikipedia.org/wiki/File:Rasyslami.jpg. 20. Burr GO, B.M., Miller ES, On The Essential Fatty Acids in Nutrition. J Biol Chem, 1932. 97(1): p. 18. 21. Burr GO, B.M., A NEW DEFICIENCY DISEASE PRODUCED BY THE RIGID EXCLUSION OF FAT FROM THE DIET. J Biol Chem, 1929. 82(2): p. 345367. 22. H, P., The Genesisi of Atherosclerosis. Bull. N.Y. Acad. Med, Feb 19, 1963. 23. Kinsell LW, e.a., Amer J Clin Nutr, 1958. 6(6). 24. Clancy, K., Greener Pastures: How grassfed beef and milk contribute to healthy eating. 2006, Union of Concerned Scientists. 25. Steinberg, D., Thematic review series: the pathogenesis of atherosclerosis. An interpretive history of the cholesterol controversy: part I. J Lipid Res, 2004. 45(9): p. 158393. http://www.ayurvedacollege.com/book/export/html/2
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26. Steinberg, D., Thematic review series: the pathogenesis of atherosclerosis. An interpretive history of the cholesterol controversy: part II: the early evidence linking hypercholesterolemia to coronary disease in humans. J Lipid Res, 2005. 46(2): p. 17990. 27. German JB, D.J., Saturated Fats: What Dietary Intake? Amer J Clin Nutr, 2004. 80. 28. Di Sabatino A, e.a., Oral Butyrate for Mildly to Moderately Active Crohn's Disease. AIlment Pharmacol Ther, 2005. 22. 29. Gao Z, e.a., Butyrate Improves Insulin Sensitivity and Increases Energy Expendeture in Mice. Diabetes, 2009. 58. 30. Sossi, P., Butyric Acid: what is the future for this old substance? Swiss Medical Weekly, 2012. 142: p. W13596. 31. KrisEtherton, P.M., et al., Highmonounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr, 1999. 70(6): p. 100915. 32. Wikipedia. Linoleic acid. [cited; Available from: http://en.wikipedia.org/wiki/Linoleic_acid. 33. KrisEtherton, P.M., W.S. Harris, and L.J. Appel, Omega3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol, 2003. 23(2): p. 1512. 34. Wikipedia, Alpha Linolenic Acid. 35. Simopoulos, A.P., Omega3 fatty acids and cardiovascular disease: The epidemiological evidence. Environ Health Prev Med, 2002. 6(4): p. 2039. 36. Sinclair, H.M., Prevention of coronary heart disease: the role of essential fatty acids. Postgrad Med J, 1980. 56(658): p. 57984. 37. Beydoun M, e.a., Plasma n3 fatty acids and the risk of cognitive decline in older adults: Atheroclerosis Risk in Communities Study. Am J Clin Nutr, 2007. 85(4). 38. Harris, W.S., Omega3 fatty acids and cardiovascular disease: a case for omega3 index as a new risk factor. Pharmacol Res, 2007. 55(3): p. 21723. 39. Hashimoto M, H.S., Neuroprotective and Ameliorative Actions of Polyunsaturated Fatty Acids Against Neuronal Diseases: Beneficial Effect of Docosahexaenoic Acid on Cognitive Decline in Alzheimer’s Disease. J Pharmacol Sci, 2010. 116: p. 150162. 40. Santora, R. and R.A. Kozar, Molecular mechanisms of pharmaconutrients. J Surg Res, 2010. 161(2): p. 28894. http://www.ayurvedacollege.com/book/export/html/2
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41. Iwata, N.G., et al., Trans fatty acids induce vascular inflammation and reduce vascular nitric oxide production in endothelial cells. PLoS One, 2011. 6(12): p. e29600. 42. Pharmacy, V.S.o. [cited; Available from: http://www.people.vcu.edu/~urdesai/intro.htm#Numbering. 43. Frantz, I.D., Jr., Lipids and atherosclerosis. Cancer Res, 1981. 41(9 Pt 2): p. 371821. 44. R, S., Physiol Chem, 1926. 160. 45. N, A., Verhanderlung den Deutschen Pathologischen Gesellschaft, 1925. 20. 46. Duff, G.L. and M.G. Mc, Pathology of atherosclerosis. Am J Med, 1951. 11(1): p. 92108. 47. Vagelos PR, G.L., Medicine, Science and Merck. 2004, Cambridge, UK: Cambridge University Press. 48. Ridker, P.M., The JUPITER trial: results, controversies, and implications for prevention. Circ Cardiovasc Qual Outcomes, 2009. 2(3): p. 27985. 49. Roizen M, O.M., YOU on a Diet: The Owner's Manual for Waist Management. 1 ed. 2006, New York, NY: Free Press, a division of Simon & Shuster. 369. 50. Wang, C., et al., Effects of omega3 fatty acids on cardiovascular disease. Evid Rep Technol Assess (Summ), 2004(94): p. 18. 51. JS, G., Atherosclerosis: Viewing the Problem from a Different Perspective Including Possible Treatment Options. Lipid Insights, 2011. 4. 52. Xia F, e.a., Inhibition of Cholesterol Biosynthesis Impairs Insulin Secretion and Voltage Gated Calcium Channel Function in Pancreatic Bets cells. Endocrinology, 2008. 149. 53. Klopfleisch, S., et al., Negative impact of statins on oligodendrocytes and myelin formation in vitro and in vivo. J Neurosci, 2008. 28(50): p. 1360914. 54. Xia, F., et al., Inhibition of cholesterol biosynthesis impairs insulin secretion and voltage gated calcium channel function in pancreatic beta cells. Endocrinology, 2008. 149(10): p. 513645. 55. Evans M, r.A., Effects of HMGCoA reductase inhibitors on skeletal muscle: are all statins the same? Drug Safety, 2002. 25(9). 56. Brown, A.S., Use of combination therapy for dyslipidemia: a lipid clinic approach. Am J Cardiol, 2002. 90(10B): p. 44K49K. http://www.ayurvedacollege.com/book/export/html/2
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57. K, N., Qualitative Plaque Stabilization But Not Quantitative Plaque Regression. Circulation Journal, 2012. 76. 58. Kastelein, J.J., et al., Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med, 2008. 358(14): p. 143143. 59. Berensen, A., Drug Has No Benefit in Trial, Makers Say , in New York Times. 2008: NY, NY. 60. Rossebo, A.B., et al., Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med, 2008. 359(13): p. 134356. 61. Steinberg, D., Thematic review series: the pathogenesis of atherosclerosis. An interpretive history of the cholesterol controversy, part V: the discovery of the statins and the end of the controversy. J Lipid Res, 2006. 47(7): p. 133951. 62. Futterman, L.G. and L. Lemberg, Apo aI Milano. Am J Crit Care, 2005. 14(3): p. 2447. 63. Nabel, E.G. and E. Braunwald, A tale of coronary artery disease and myocardial infarction. N Engl J Med, 2012. 366(1): p. 5463. 64. de Oliveira Otto, M.C., et al., Dietary intake of saturated fat by food source and incident cardiovascular disease: the MultiEthnic Study of Atherosclerosis. Am J Clin Nutr, 2012. 65. Kumar VJ, S.K., Lokesh B, Effect of dietary gheethe anhydrous milk fat, on blood and liver lipids in rats. J Nutr. Biochem., 1999. 10. 66. BeareRogers J, e.a., Lexicon of lipid nutrition (IUPAC Technical Report). Pure and Applied Chemistry, 2001. 73(4). 67. S, C. COW’S GHEEGO GHRIT FA COMPOSITION OF COW'S GHEE. Dec 30, 2012 [cited; Available from: http://ayurvedaconsultants.com/caseshow.aspx?ivalue=engoogle3001. 68. NIH Heart, L.a.B.I. Low Calorie Step I Diet. 2012 [cited; Available from: http://hp2010.nhlbihin.net/oei_ss/download/pdf/PRACTICAL1.pdf. 69. Zumdahl SS, Z.S., Chemistry, Ch7. 7th ed. 2007, Boston, MA: Houghton Mifflin Company. 1056. 70. Li, J.J., Inflammation: an important mechanism for different clinical entities of coronary artery diseases. Chin Med J (Engl), 2005. 118(21): p. 181726. 71. Li, J.J., Inflammation in coronary artery diseases. Chin Med J (Engl), 2011. 124(21): p. 356875. http://www.ayurvedacollege.com/book/export/html/2
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72. Wikipedia, Butyric Acid. Wikipedia. 73. Vanhoutvin, S.A., et al., Butyrateinduced transcriptional changes in human colonic mucosa. PLoS One, 2009. 4(8): p. e6759. 74. V, L., Textbook of Ayurveda: A Complete Guide to Clinical Assessment. 2006, Albuquerque, NM: The Ayurvedic Press. 75. Halpern, M., Textbook of Clinical Ayurvedic Medicine, Part I. 2010. 76. Wikipedia, Alzheimer's Disease cited: http://en.wikipedia.org/wiki/Alzheimer's_disease 77. Cole, G.M., Q.L. Ma, and S.A. Frautschy, Omega3 fatty acids and dementia. Prostaglandins Leukot Essent Fatty Acids, 2009. 81(23): p. 21321. 78. Sharma, H., X. Zhang, and C. Dwivedi, The effect of ghee (clarified butter) on serum lipid levels and microsomal lipid peroxidation. Ayu, 2010. 31(2): p. 13440. 79. Shankar RS, e.a., Serum Lipid Response to Introducing Ghee as a Partial Replacement for Mustard Oil in the Diet of Healthy Young Indians. Indian J. Physiol. Pharmacol., 2005. 49(1). 80. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 2002. 106(25): p. 3143421. 81. LL, S., Review of Progress in Sterol Oxidation 19871996. Lipids, 1996. 31. 82. Kumar VJ, S.K., Lokesh B, Hypocholesterolemic efect of anhydrous milk fat ghee is mediated by increasing the secretion of biliary lipids. J Nutr. Biochem., 2000. 11. 83. Oza DN, e.a., Evaluation of Bhringarajadi Ghrita Rasayana in Premature Aging. Ayu, 2009. 30(2).
Male Pattern Baldness (by Scott Ryals C.A.S) Table of Contents http://www.ayurvedacollege.com/book/export/html/2
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1. Allopathic Perspective on Androgenetic Alopecia 2. Hair Structure 3. Structure of the hair root 4. What Causes Androgenetic Alopecia? 5. What areas of the scalp are most affected? 6. How is male pattern balding diagnosed? 7. Can male pattern balding be treated? 8. Minoxidil (Rogaine) 9. Administration 10. Results 11. Side effects 12. Finasteride 13. Spironolactone 14. Surgery 15. Zinc 16. Skinoren / Azelaic Acid 17. Saw Palmetto Extract 18. Ayurvedic Approach to Alopecia 19. Pathogenesis Of baldness and Premature Graying of Hair 20. Line of treatment 21. Recipe of medicated oil, etc. 22. Recipe for Restoration of Hair 23. Herbs recommended for treatment In Caraka 24. Current Ayurvedic Treatment 25. Ayurvedic Oil Massage 26. Ayurvedic Diet for Hair 27. Ayurvedic Herbs For hair loss 28. Conclusion 29. Bibliography 30. Image Credits Allopathic Perspective on Androgenetic Alopecia Hair Structure Hair is composed of strong structural protein called keratin. This is the same kind of protein that makes up the nails and the outer layer of skin. http://www.ayurvedacollege.com/book/export/html/2
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Each strand of hair consists of three layers. 1. An innermost layer or medulla, which is only present in large thick hairs. 2. The middle layer known as the cortex. The cortex provides strength and both the color and the texture of hair. 3. The outermost layer is known as the cuticle. The cuticle is thin and colorless and serves as a protector of the cortex. Structure of the hair root Below the surface of the skin is the hair root, which is enclosed within a hair follicle. At the base of the hair follicle is the dermal papilla. The dermal papilla is fed by the bloodstream which carries nourishment to produce new hair. The dermal papilla is a structure very important to hair growth because it contains receptors for male hormones and androgens. Androgens regulate hair growth and in scalp hair androgens may cause the hair follicle to get progressively smaller and the hairs to become finer in individuals who are genetically predisposed to this type of hair loss. [1] What Causes Androgenetic Alopecia? “ The hair follicle is a structure that encases the lower part of the hair shaft. Each follicle contains blood vessels that nurture new hair growth. All of our hair follicles are present at birth, and throughout our lifetime each follicle grows and sheds single hairs in a repetitive cycle. The growth phase for a single new hair lasts two to three years. At the end of this time, growth ceases and the follicle enters a resting phase. After three to four months in the resting phase, the hair is shed and the next growth cycle begins. On a normal scalp, approximately 80 to 90 percent of follicles are growing at any time. And each day, about 75 follicles shed their hair and the same number enter a new growth phase. Men and women experience Androgenetic Alopecia with equal frequency, although it may be camouflaged better in women. People who experience this type of hair loss have some hair follicles with a shorter than normal growth phase and produce hair shafts that are abnormally short and thin. These follicles are said to be "miniaturized." They develop because of hormonal changes that occur in the hair follicle itself, although men with male pattern balding also may have higher levels of dihydrotestosterone (a byproduct of testosterone) in the blood. Khalitya1
What areas of the scalp are most affected? In men, Androgenetic Alopecia is characterized by gradual hair thinning that most often affects the crown and frontal areas of the scalp. In many http://www.ayurvedacollege.com/book/export/html/2
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men, the hairline around the temples regresses. As it moves back to the midscalp, an Mshaped hair pattern develops. The hair in areas affected by hair loss may be of various lengths and thickness, and the presence of uneven lengths and texture is a classic sign of male pattern balding. Women may have similar patterns of hair loss, although typically the hair loss is a little more diffuse than in men, and women rarely experience loss of all their hair.” [2] How is male pattern balding diagnosed? “Androgenetic Alopecia can usually be readily diagnosed in men based on visual inspection of the scalp. A family history of similar hair loss also is suggestive of Androgenetic Alopecia. The diagnosis of Androgenetic Alopecia in women is similarly based on the history and visual inspection of the scalp. The scalp should be inspected carefully, however, for signs of hair disease such as scarring or follicular plugging. In addition, other causes of hair loss should be considered, including certain illnesses (such as hyperthyroidism, hypothyroidism, or iron deficiency) or medication side effects (such as anticoagulants, anticonvulsants, beta blockers, and antidepressants). Women may rarely experience hair loss due to an excess of male hormones (androgens). Typically these women have other signs of androgen excess, such as menstrual irregularities, acne, and excess hair growth in other areas. However, given the frequency with which Androgenetic Alopecia occurs in women, no extensive testing is necessary unless one of these other signs of androgen excess is present. Can male pattern balding be treated? Two medications, Minoxidil and Finasteride, are available to treat male pattern balding in men; only Minoxidil is used in women. A medication called Spironolactone is also sometimes used in women. Surgical options may also be considered in some cases.” [3] Minoxidil (Rogaine) “Minoxidil promotes hair growth by lengthening the growth phase of hair follicles and causing more follicles to produce hair. The hairs that are produced tend to be larger and thicker. Minoxidil is a liquid preparation that is applied directly to the scalp. It is available in both 2 and 5 percent solutions, although the 5 percent solution has been shown to be more effective in men and is probably also more effective in women. It can be purchased overthecounter without a prescription Administration Minoxidil is a scalp treatment, not a hair treatment. One milliliter of the solution should be applied twice a day to the affected areas of the scalp using a dropper or pump spray device. The solution should be lightly spread over the affected area with a finger, and does not need to be massaged into the scalp. People using Minoxidil must have a normal, healthy scalp since cuts or openings can allow the solution to be absorbed into the bloodstream. http://www.ayurvedacollege.com/book/export/html/2
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Results Minoxidil must be used twice a day for at least four months before the initial response to treatment can be gauged. When it is effective, people usually begin to shed less hair within two months after the start of treatment, and by four to eight months hair begins to grow. The effects of Minoxidil usually stabilize after 12 to 18 months of use. Treatment must be continued indefinitely. If Minoxidil is discontinued, any hair that has been maintained or regrown as a result of the medication will be lost.” [4] “Not all people benefit from Minoxidil. Best results are obtained when baldness has been present for less than 5 years, when it affects the crown of the head (the vertex), and when it is less than 10 centimeters in diameter. Studies have shown that up to onehalf of men and women with vertex hair loss experience cosmetically significant results with Minoxidil. Side effects Minoxidil causes few side effects. Occasionally, the skin may become irritated. Systemic side effects are possible if Minoxidil is absorbed through cracks or cuts in the scalp. Patients with a history of heart disease, in particular, should watch for systemic side effects such as an increased heart rate, edema or swelling (for example in the hands or feet), or weight gain. Women treated with 5 percent Minoxidil may occasionally develop increased facial hair. Finasteride Finasteride decreases dihydrotestosterone levels, resulting in an increased amount of hair covering more of the scalp. It cannot be used in women of reproductive age because of concerns regarding abnormal genitalia development in male fetuses. One study that evaluated the use of Finasteride in postmenopausal women with Androgenetic Alopecia found that finasteride did not improve hair loss. Thus, Finasteride is not currently recommended for women at any age. Finasteride is taken orally in men at a dose of 1 milligram (mg) per day. Higher doses of Finasteride (such as those used to treat some prostate conditions) can cause side effects including sexual dysfunction and decreased sex drive. However, such side effects are rarely seen with the 1 mg dose used to treat hair loss.” [5] “A small study suggested that Finasteride worked better than 2 percent Minoxidil and there may also have been a benefit with combination therapy. Studies comparing Finasteride and 5 percent Minoxidil have not been performed. However, clinical observations suggest that Finasteride is easier to use. Because of this, men may be more apt to take it consistently and it may yield better outcomes. Spironolactone Spironolactone blocks the action of the hormone Aldosterone. Women with Androgenetic Alopecia who do not respond to Minoxidil may benefit http://www.ayurvedacollege.com/book/export/html/2
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from the addition of Spironolactone. A typical dose would be 100 to 200 mg per day. Surgery For some patients, surgery may be a preferred form of treatment. Surgical options include hair transplantation, in which healthy follicles from other parts of the scalp are transplanted to areas affected by baldness. Scalp reduction is another procedure sometimes performed. In scalp reduction, bald patches of the scalp are removed and the remaining skin is sutured together.” [6] Beth G Goldstein, MD University of North Carolina at Chapel Hill Adam O Goldstein, MD, MPH University of North Carolina at Chapel Hill RetinA / Tretinoin ” Retin was originally used in the treatment of acne and other skin disorders. However studies have shown that RetinA alone or in combination with Minoxidil can result in moderate to good hair growth in individuals with Androgenetic Alopecia and Alopecia Areata. Many dermatologist recommend using Tretinoin in combination with Minoxidil to increase the effects of both these products. Side effects of RetinA include blistering, altered pigmentation and increased sensitivity to light. If a gel is used it is suggested that Minoxidil be applied in the morning and RetinA gel in the evening to reduce the problems caused by sunlight. Zinc Some vitamins have been shown to inhibit the activity of 5alpha reductase and the subsequent production of (DHT) dihydrotestosterone. These vitamins therefore may be of great benefit in the treatment of Androgenetic Alopecia or pattern baldness. There have been studies in which Zinc is shown to inhibit 5 alpha reductase activity and it has therefore been concluded than Zinc is beneficial in disease and disorders related to an excess in dihydrotestosterone (DHT). There have also been studies which have shown that vitamin B6, Zinc and Azelaic Acid combined together even at very low concentrations produced a 90% inhibition of 5 alpha reductase activity. Skinoren / Azelaic Acid Azelaic Acid like RetinA is more commonly used in the treatment of acne and other skin conditions. Recently the potential effect of using Azelaic Acid in the treatment of Androgenetic Alopecia has been looked at and discussed.” [7] “Studies carried out in France in the late 80's were to assess the effects of Zinc Sulphate, a Azelaic Acid on the human skin. The result of these studies demonstrated that at high concentrations Zinc could completely inhibit the activity of 5 alpha reductase. Azelaic Acid was also shown to be a potent inhibitor of 5 alpha reductase. Inhibition was detectable at concentrations as low as 0.2mmol/l and was complete at 3mmol/l. When Zinc, http://www.ayurvedacollege.com/book/export/html/2
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Vitamin B6 and Azelaic Acid where added together at very low concentrations which had been ineffective alone, 90% inhibition of 5 alpha reductase was achieved. Saw Palmetto Extract Studies have shown that Saw Palmetto is an effective antiandrogen. It acts in a similar way that Propecia does. Firstly it lowers levels of DHT in the body by blocking 5 alphareductase. Secondly Saw Palmetto block receptor sites on cell membranes required for cells to absorb DHT. Although no studies have been carried out on Saw Palmetto and its relation to hair growth. Studies have been performed on the use of Saw palmetto in the treatment of benign prostatic disease, which similar to Androgenetic Alopecia, also depends on the production of dihydrotestosterone. All of the studies that have been performed to date show that Saw Palmetto is an effective antiandrogen and has shown conclusively to be effective in the treatment of benign prostatic disease. One may assume from this that since Saw Palmetto is an effective antiandrogen and is used in the treatment of prostatic disease then it may also be effective in the treatment of Androgenetic Alopecia.” [8] Ayurvedic Approach to Alopecia Pathogenesis Of baldness and Premature Graying of Hair “The tejas (heat) of the body in association with vayu and other dosas, scorches up the hairroot (scalp) giving instantaneous rise to Alopecia in men.” [9] Line of treatment “In Khalitya (Alopecia), the patient should, in the beginning, be given elimination therapies (emetis, purgation, etc.), and thereafter, be given nasya (inhilation therapy with medicated oil, and application of paste of drugs over the head.” [10] Recipe of medicated oil, etc. "Medicated oil should be prepared by cooking with vidarigandha (salaparni), prsniparni, brhati, kantari and gokshura, or with Jivaniya group of drugs, viz., jivaka, rsabhaka, meda, mahameda, kakoli, mudgaparni and masaparni. Inhalation therapy with these medicated oils or with Anutaila cures Alopecia and graying of the hair” [11] http://www.ayurvedacollege.com/book/export/html/2
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Recipe for Restoration of Hair Application of three paste of tila, amalaki, kiñjalaka, madhuka and honey over the head restores the colour of the hair, and promotes hair growth.” [12] Herbs recommended for treatment In Caraka
Khalitya2
Khalitya3
Khalitya4
Brhati, Solanum Indicum Kantari, Solanum Xanthocarpum Amalaki Terminalia Chebula
Khalitya5
Khalitya6
Khalitya8
Gokshura, Tribulus Terrestris Madhuca Esculenta, Madhuka http://www.ayurvedacollege.com/book/export/html/2
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Karanj kiñjalaka, Pongamia Glabra
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PrsniParni, Desmodium Gangeticum
Khalitya13
Bhringaraj, Eclipta Alba
Current Ayurvedic Treatment “In Ayurveda, hair is considered to be a byproduct of bone formation. The tissues responsible for building bones are also responsible for the growth of hair. Ayurveda doctors believe that early hair loss is related to body type and the balance of the mindbody constitution (doshas) and those who have excess pitta in their system, are likely to lose their hair early in life, or have prematurely thin or gray hair. Excess pitta in the sebaceous gland, at the root of the hair, or folliculitis can make the person start losing hair. Hair loss is treated in Ayurveda with a combination of diet, herbs, oil massage, meditation, aromatherapy, breathing and yoga. To reduce pitta and preserve the health of hair, drink 1/3 cup aloe vera juice. Alternately, you can take 1 tablespoon aloe vera gel with a pinch of cumin 3 times a day for about 3 months. Baldness is treated by bleeding from the forehead after treatment with oils and sweating, followed by lotions and pastes of manahsila, kuttannata, devadaru, gunja, malati, karavira, citraka, naktamala, blue and green vitriol, and black pepper. Ayurvedic Oil Massage To pacify pitta, rub some coconut oil on your scalp and on the soles of your feet at bedtime. Massage your scalp with Brahmi oil or Bhringaraj oil at bedtime to help prevent hair loss. Massage the hair with vitamin E oil. This also may prevent or slow down the hair loss.” [13] Ayurvedic Diet for Hair http://www.ayurvedacollege.com/book/export/html/2
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“Eat a handful of white sesame seeds every morning. One handful of these small seeds contains about 1,200 mg. of calcium and magnesium. Take some yogurt everyday (unless you are allergic to milk). Ayurvedic Herbs For hair loss Use the following herbal combination: Dashmula 5 parts Bhringaraj 4 parts Jatamamsi 3 parts Add 1/2 teaspoon of this mixture to 1 cup of goat's milk. Heat to boiling, and drink at bedtime.” [14] Conclusion The process of doing this research has been very enlightening and has presented some surprises for me. To understand that “hair Loss” is actually a misnomer, since the hair follicle actually goes dormant and has the ability to be reactivated with proper diet, lifestyle and herbal treatment. It also is very clear that the herbs recommended for treating an enlarged prostate and the herbs recommended for treating Androgenetic Alopecia are often exactly the same. As one who has Androgenetic Alopecia, I have started some of the treatments suggested, out of curiosity and a belief that it is possible to regenerate cells (far more often then I was lead to believe). Time and my ability to adhere to a consistent therapeutic regimen will determine my success. Bibliography Caraka Samhita Text in Sanskrit with a New English Translation & Critical notes based on Cakrapanis Ayurvedadiplka Dr. R. K. Sharma & Dr. Bhagwan Dash http://www.follicle.com/section2/2.html http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm Image Credits http://www.unyamaneegarden.com/ http://www.holisticonline.com/ http://uwadmnweb.uwyo.edu http://www.ayurvedacollege.com/book/export/html/2
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http://biotech.tipo.gov.tw http://www.ecoplanet.com/ [1] http://www.follicle.com/hairstructurelifecycle.html [2] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 [3] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 [4] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 [5] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 [6] http://www.nlm.nih.gov/medlineplus/hairdiseasesandhairloss.html http://patients.uptodate.com/topic.asp?file=gen_hlth/2877 [7] http://www.follicle.com/section2/2.html [8] http://www.follicle.com/section2/2.html [9] CarakaSamhita VOL IV Chapter XXVI Page 509 and 510 [10] CarakaSamhita VOL IV Chapter XXVI Page 540 and 541 [11] CarakaSamhita VOL IV Chapter XXVI Page 540 and 541 [12] CarakaSamhita VOL IV Chapter XXVI Page 543 [13] http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm [14] http://www.dreddyclinic.com/findinformation/aa/alopecia/alopecia_3.htm
Care of Non Ulcer Dyspepsia (by John Sekerka C.A.S) Table of Contents 1. Introduction 2. References Introduction Upset stomach or occasional heartburn may not be due to excess stomach acid but there are several OTC medications available to reduce stomach acid and apparently solve the problem. What are the options a person has when they have an upset stomach or NUD (nonulcer dyspepsia) due to eating? Is there one problem or many? Should the treatment be the same for each person or should it depend upon the person? Are medications ever necessary? With the heavy promotion of antacids and many other medications for heartburn and indigestion, many people may not know that there http://www.ayurvedacollege.com/book/export/html/2
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are other choices for these very common problems. First a look at the problem from the Western point of view, both mainstream and nondrug approach and then the Ayurvedic view. NUD is upper abdominal pain without an ulcer, which is twice as common as an ulcer and may lead to one. In half of the cases of NUD or indigestion no cause is found, but medication is commonly used to control symptoms. Allopathic medicine is focused on organic damage and may over look function of the GI tract. The gastrointestinal tract is a very integrated system via nervous and hormonal regulation, and all medications have side effects of disruption or turning off some of the GI function. There is poor understanding of NUD and consequently no specific care from standard medical treatment. NUD can resemble GERD, ulcers, gastritis, or hiatal hernia but if there is no cause or damage found it is called NUD or functional dyspepsia, or just plain indigestion with no apparent treatment. The symptoms are similar for each condition: dull ache, uncomfortable fullness, or static stomach, distention, overt pain or burning or both with or without nausea. Excess stomach acid is not thought to be the problem, more likely inadequate protection of the stomach from the acid. The symptoms may also be due to slower gastric motility or to increased gut sensitivity. Psychological issues also affect NUD. Stressful events produce responses in the gut, but people with NUD do not seem to have more stress in their lives than those without NUD. Do those with NUD react more strongly to stress leading to symptoms? Relaxation techniques have been shown to reduce gastric acid secretions in hyperchlorhydric patients. Balancing digestive function by reducing stress maybe partially attributed to a global nervous system shift from a sympathetic to a parasympathetic tone (1). Diet involvement in NUD is important but not well defined. Certain foods and other substances are known to increase symptoms; spicy, acidic, and high fat foods, alcohol, tobacco, coffee, analgesics and other medications. These are reduced or eliminated to help with symptoms. In a functional approach to health and nutrition diet and eating habits play a more important role than the standard allopathic model. The following is a functional view of digestion. Digestion begins with the cephalic phase in which any sensory stimulus or even thoughts can provoke a digestive related response in the body. These include thermodynamic, salivary, cardiac, mesenteric blood flow, diuretic, digestive enzyme secretion, altered gastric acid secretion, altered intestinal motility, release of GI hormones and other intestinal process changes (2). Impulses travel via the vagus nerve to the stomach where acetylcholine stimulates mucus, acid, and pepsinogen secretion in the body and gastrin release in the antrum. The response is greater to foods that the person likes and is less in bland foods, an important fact with an anorectic client (3). To fully support digestion eating in a calm manner and chewing properly are necessary. For some this may be more helpful than relying on digestive enzymes, glandulars, bitters, or other digestive aids. In the mouth or lingual phase adequate salivary output is necessary for proper digestion. Besides enzymes like alpha amylase the saliva also contains other important substances such as mucopolysacirides, ion containing fluids, and transcobalamin III necessary for vitamin B12 absorption. The digestion of fats is initiated in the month by lingual lipase from glands at the base of the tongue. Lingual lipase hydrolysis short chain and medium chain triglycerides more readily than it does long chain triglycerides. This is also true of gastric lipase. Both lipases are resistant to the proteolytic enzymes and the acid environment of the stomach,so that the digestion of the short and medium chain triglycerides continues in the stomach, but the main digestion of fats is done in the small intestine. Dehydration can reduce salivary output as can old age and thus reduce the digestive response. http://www.ayurvedacollege.com/book/export/html/2
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Digestion in the stomach results from proper coordination of hydrochloric acid and pepsin along with other substances. Gastrin and intrinsic factor are the other two compounds that are exclusively produces in the stomach. In the gastric phase stimulation of secretions is by direct contact with food, a rise in ph, and by distention or mechanoreceptors. Besides the main job of digesting protein foods, appropriate amount of hydrochloric acid is necessary for: The absorption of minerals. Acidbase balance. To kill microorganisms. Converts pepsinogen to pepsin (at ~ ph of 2). Inhibits the secretion of gastrin. And stimulates the secretion of secretin. Gastrin stimulates the secretion of acid and pepsinogen, increases gastric blood flow, circular muscle contractions in the stomach, and growth of the mucosa of the stomach and small intestine. Thus there are not only many coordinated responses to food for adequate secretions and proper digestion, but also feedback systems to down regulate the secretions when they are no longer needed. Mixing of the stomach contents is from the middle of the stomach toward the duodenum. This mixing, with downward pressure from the upper part of the stomach, help to empty the contents. The time required to empty the stomach depends on several factors. Solids, lipids, and solutions of high osmotic pressure empty more slowly than solutions that are isotonic. Solids empty more slowly than liquids. There are receptors in the duodenum that respond to lipid content, acidity, and osmotic pressure of the chyme. Some of the factors involved in the emptying are gastrointestinal hormones and neurological reflexes. The enterogastric reflex inhibits peristalsis in the antrum, which is next to the duodenum, because of high or low osmotic pressure, or when acidity is high in the duodenum. Particle size, viscosity of the chyme, and volume of the gastric contents also affects emptying time (4). Emotional stress affects motility through the autonomic nervous system. Hypochlorhydria – inadequate secretion of gastric acid by the parietal cells in the stomach wall is a component of poor digestion. A diet of excess protein increases acid production and high fat diet encourages over secretion of acid. Medications to reduce acid, H2 histamine receptor blockers and proton pump inhibitors are now available OTC so that diet induced hyper acidity becomes medication induced hypoacidity in many U.S. adults with causes of indigestion not explored. Research suggests that low gastric acidity may influence the development of diseases such as: Rheumatoid arthritis Acne rosacea Celiac disease Diabetes mellitus Eczema Hepatitis Asthma and others (5). The ability to produce acid decreases with age and over half the population over 60 has insufficient secretory ability. Common sign and symptoms http://www.ayurvedacollege.com/book/export/html/2
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of low gastric acidity are: Bloating, belching, burning, and flatulence immediately after meals A sense of fullness after meals Indigestion, diarrhea, or constipation Mild food allergies Undigested food in the stool Post adolescent acne Nausea after taking supplements And other sysmptoms Chronic reduction of gastric acid secretion invites bacterial over growth in the stomach (Heliobacter pylori) and the small intestine which compromises nutrient digestion and absorption especially B vitamins , iron, and calcium. H. pylori does not appear to cause ulcers but let untreated may lead to atrophic gastritis (6). I f gastritis progresses to an ulcer then H. pylori has to be addressed usually with acid controlling medication and antibiotics. In the treatment of NUD it is recognized in allopathic medicine that there is no reason for medication but it is often given because of its placebo effect and the drugs are considered safe. Though excess acid may not be the problem in the short term some people feel better with medication to reduce acid or to increase the rate of stomach emptying (7). Treatment also requires dietary and lifestyle changes to reduce symptoms. First a look at the medications then the diet and other changes. Drugs that were developed for ulcer treatment are now being used for any problem that manifests itself as acid indigestion even if there is no known ulcer. The following are the drugs commonly used: Antacids are used to neutralize acid: Those with aluminum can cause constipation, those with magnesium can cause diarrhea, prelief (calcium glycerophosphate) is taken at meals to reduce stomach acid. H2 histamine receptor blockers to reduce acid secretion from the parietal cells, via histamine release stimulated by the vagus nerve. This includes Tagamet, Pepsid, Axid, and Zantac. The proton pump inhibitors: Previcid, Prilosec, Nexium, Aciphex, and Protonix that are so heavily advertised today, and are in use more now than the H2 histamine receptor blockers. Motility agents that speed up gastric emptying and increase lower esophageal sphincter (LES) pressure. Reglan, and Propulsid. And protective type drugs: Cytotec, Arthrotec, and Carafate (8). In the case of an infection or apparent infection of H. pylori the common medication of PeptoBismol has been shown to be affective with a usual four times a day dosage over two weeks with less side effects than the typical drug and antibiotic therapy (9). The possible side effects of these medications are numerous, as listed below (10). that turn off stomach acid secretions, like Prilosec and Prevacid: Diarrhea, abdominal pain, nausea, vomiting, heartburn, liver necrosis, pancreatitis, Headaches, back pain, anemia, infections, and others. http://www.ayurvedacollege.com/book/export/html/2
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Gastric motility drugs like Propulsid and Reglan: Ventricular tachycardia, and fibrillation, headache, diarrhea, abdominal pain, nausea, constipation, joint aches. Cytoprotective agents like Cytotec that increase bicarbonate and mucus production: Nausea, vomiting, gas, heartburn, diarrhea, constipation, abdominal pain, abortion, Menstrual irregularities, headaches, depression, impotence, chest pain, arrythmia, High blood pressure, blood clots, GI bleed, liver malfunction and others. Stomach coating medication for protection from acid like Carafate: Diarrhea, nausea, vomiting, dry mouth, turns off pepsin , and contains Aluminum, which has possible links to Alzheimer's disease and bone loss. H2 blockers – Tagamet, Zantec, Pepcid, Axid, Mylanta – which turn down acid production: Impair liver detoxification processes thus increase the side effects of other drugs and environmental chemicals that use the same detoxification pathways. Arrthymias, Hypertension, headaches, liver malfunction, hair loss, anemia, arthritis, blockage of Nerve conduction in the heart, and others. The above medications are intended to reduce the symptoms of NUD and reduce any pain associated with it, but end up causing more GI problems and further cover up the causes of the indigestion. There are several supplements and medications, listed below, that can worsen the symptoms of GERD and may also negatively effect NUD (11). Large doses of vitamin C Potassium supplements White willow bark Calcium channel blockers for high blood pressure Certain antibiotics Red yeast rice Fosamax NSAIDS (Motrin, Aleve, Nuprin, Orudis) Theophylline Glucosamine Fish oil capsules Aspirin, which can also affect the stomach lining directly. The health and proper function of the stomach is dependant on the balance of the defensive factors (mucin secretion, cellular mucus, bicarbonate secretion, mucosal blood flow, and cell turnover), and the aggressive factors (hydrochloric acid, pepsin, H. pylori, bile salts) (12). The role of the defensive factors is gaining importance over simply reducing the aggressive factors. With more evidence of adverse effects of the various drugs more research is being done with herbs to find new compounds to aid in ulcer treatment without the side effects, which may also prove beneficial in treating NUD. In a review of antiulcer drugs of Ayurveda, authors R.K. Goel and K. Sairam listed the commonly used herbs of Ayurveda and the studies with various herbal extracts and their use in ulcer treatment. The extracts used were fresh juice, water decoction, ethanolic ,methanolic , hot http://www.ayurvedacollege.com/book/export/html/2
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water, acetone, chloroform, and petroleum ether extracts. For the following herbs they were extracted from one of the first five methods: ashwaganda, shatavari, licorice root, brahmi (Bacopa monniera), gotu kola (Centella asiatica), and amla. Aswaganda showed antistress activity which wasn't specified. The other herbs had no effect on the acidpepsin secretion but an increase in the defensive factors of mucin secretion and the life span of the mucosal cells. Shilajit had a per se effect of both reducing acidpepsin secretion and increase in mucin secretion (13). Several antiulcer compounds have been isolated from ginger and studies have shown that ginger increases gastrointestinal propulsion (14). In the conclusion of the review the emphasis was on standardized active constituents of the herbs and not use of the whole herb. In a nonmedication approach to better digestion there are several herbs, juices, and other compounds used to heal the stomach, or aid in digestion. Common ones are DGL – deglycyrrhizinated licorice, sulfate mucin, aloe juice, ginger tea, chamomile tea, fresh vegetable juices (cabbage, carrot, cucumber, beet), digestive enzymes, baking soda, and even PeptoBismol. DGL is licorice with the compound that is responsible for hypertension removed. It is known to normalize LES (lower esophageal ) pressure, increase the protective factors of the stomach, increase immunity by increase in secretin, and is antinflamatory and antioxidant (15). Of the vegetables juices cabbage is recommended more than any other to help heal the stomach lining. There are also various combinations of digestive enzymes and gladulars for those with poor digestion. Chinese and Ayurvedic herbal formulas for digestion are available through supplement suppliers with only general guidelines on their use. In the Western view whether mainstream allopathic or a natural approach certain dietary and lifestyle changes have to be made if a person with NUD is to have an improvement in symptoms and better digestion. It is well recognized that digestion is improved if a person eats in a calm and relaxing environment. Some health care practitioners emphasize this much more than others. This and proper chewing is the beginning of proper digestion. Appropriate sized meals are important since large meals take longer to digest, distend the stomach and increase acid production, and expose the stomach longer to the aggressive factors of digestion. There is the need to eliminate or reduce offending foods such as orange juice, tomato products, other acid foods or ingredients, radishes, spicy foods, fatty foods, excessive protein, dry beans, or any other foods an individual may have symptoms with. Substances to avoid if causing problems are alcohol, tobacco, coffee, caffeineated tea, colas, Ibuprofen and other NSAIDS, aspirin, or any other medication that causes symptoms of NUD. Some healer also emphasize proper food combining or simplifying meals for easier digestion. Others are adamant about cutting out all processed foods from the diet and eliminating any foods with additives or preservatives. There is also the possibility of a food allergy in which case the offending foods will have to be identified and eliminated. This could be a lengthy and difficult process and would not usually be done unless all other changes proved unfruitful. Food combining deserves further expounding since it is commonly referred to for digestive ailments in natural health and nutrition literature. The principal is fairly simple, don't eat foods together that don't digest well together. This won't overtax the digestive enzymes and compromise digestion. Food combining can be somewhat to very restrictive even though there is little scientific evidence that certain foods inhibit the secretion of digestive enzymes. This is not to say there has not been success to varying degrees with food combining. The most common rule is not to eat fruit, or sweets, with meals. Fruits digest sooner than other foods and they can be fermented by microorganisms before the heavier foods are digested. The resulting gas can distend the gut and cause bloating and indigestion. The gas is also toxic to the nerves and tissues, causing an inflammatory reaction that impairs normal peristaltic action (16). Also milk dose not combine well with any foods and is best eaten alone. A person would make their meals as simple as necessary to have good digestion, starting with mono meals if necessary. Other foods can be added one at a time as all previous foods are well tolerated. A person then builds a history of what they can and cannot eat and what foods they tolerate together. http://www.ayurvedacollege.com/book/export/html/2
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In the CarakaSamhita chapter – xv treatment of grahani dosa the digestion function, dysfunction, and treatment are discussed. This is the classical Ayurvedic approach which will be summarized, then the modern interpretation will follow. That which has an influence on the stomach and thus important in the care of NUD will be noted. All digestion is dependant upon proper functioning of the digestive fire or agni. Jatharagni (enzymes in the GI tract), bhutagnis (the elemental agnis – enzymes to transform heterogenous elements into homologous ones) dhatuagnis (enzymes for the synthesis of the seven categories of tissues) make up the 13 agnis of which jatharagni is the most important for the other depend upon its proper functioning, and is considered to be the most important sustaining factor of living beings (17). Since it resides in the GI tract it will be referred to as agni in this report. Ingested food needs to be both delicious and wholesome to nourish the senses, the sense organs, and the rest of the body. Once ingested the food is mixed with dravas (liquids) of saliva and other fluids of the GI tract that contain the enzymes or agni . Samana vayu in its normal state will stimulate agni appropriately. Too little samana vayu and agni is low and digestion is inadequate. Too much and agni is too hot and digestion too fast which may deplete the kapha in the stomach making it more suseptable to symptoms of NUD or eventually to an ulcer. During the first stage of digestion in the mouth and stomach, or the kapha stage, the sweet taste is digested. Once the semidigested (vidagdha) food mass leaves the stomach it is sour. This sour stuff stimulates the production of pitta (bile), and since pitta is sour it gets stimulated by sour food matter (18). Thus the appropriate amount of pitta or acid needs to be produced in the stomach for proper digestion or agni there before leaving the stomach and continuing to stimulate normal pitta and agni for optimal digestion. Ajirna or indigestion is caused by the vitiation of agni. This is caused by the following: Eating too fast, over eating , or irregular eating. Intake of unwholesome, heavy, cold, ununctuous, or contaminated food. Improper use of purgation, emetic, and oelation therapy. Emaciation as a result of disease. Living in improper country, or seasons. Suppression of natural urges. The vitiated agni is then abnormally sour and works like poison or can be the beginning of several diseases (19). When pitta is excessive it is Amla pitta or acid gastritis a type of grahani disorder. The seat of agni is in the grahani or small intestine and stomach, which may not be used exactly the same way as in modern anatomy and physiology. The signs and symptoms of amla pitta are indigestion, mental fatigue, nausea, sour and bitter belching, and heartburn. Other pitta symptoms in the digestive system and elsewhere are yellow tongue coating, red tongue, loose stools, and anger. High vata will have less acid and burning and will have a more static or nervous stomach. Other high vata symptoms in the digestive system are gas or belching, bloating, constipation, erratic appetite, a brownish and dry tongue coating, and nervousness or anxiety. There will also be pain with both conditions. High kapha will have sluggish digestion in the stomach but not likely to suffer from NUD as much as high pitta and high vata so only pitta and vata out of balance will be considered. Agni has four different states: normal, irregular, sharp or high, and low. In the normal state a person would eat the right quality and quantity of food and there would be proper digestion, metabolism, and tissue development. This is helped with a balanced samana vayu. With any of the abnormal http://www.ayurvedacollege.com/book/export/html/2
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agnis digestion and tissue development is compromised. Sharp agni can cause depletion of tissues if not enough food is eaten. Irregular agni usually results in an under nourished individual with an under developed body as in a typical vata type person. Low agni is associated with excessive development of poorer quality tissue as in a kapha type person. Grahani (small intestine) is the site of agni and grahani and agni can be used interchangably because agni restrains (grhnati) the downward movement of undigested food and retains it until it is fully digested in the region above the unbilicus (20). Likewise food is also retained in the stomach until it is fully digested. When agni is weak food is only partly digested and there is some undigested food in the stools. Vatika grahani (caused by vitiated vata) is caused by intake of pungent, bitter, astringent, cold dry foods, not enough food, over exertion, suppression of natural urges, and excessive sexual intercourse. Vayu gets aggravated, suppresses agni, and food is not easily digested. In paittika grahani pitta is aggravated by foods that are pungent, heavy (ajirna), vidahi (cause burning sensation), sour, alkaline, etc. This aggravated pitta supresses agni. A person has foul smelling and sour belching, heartburn, anorexia, thirst, and loose stools (21). When ama becomes manifest because of the aggravated dosa in the grahani, and food is not fully digested, then emetic therapy should be given. After the amasaya (stomach including small intestine) is cleased of the ama by purgation and fasting the patient should be given a light diet and herbs that stimulate digestion (22). If pitta is aggravated then digestive stimulants that are bitter should be given along with sweet ingredients. If vata is aggravated then digestive stimulants mixed with ghee, salty, and sour items are helpful. Samana vayu in particular is regulated with medicated ghee and promotes the proper functioning of the gastric fire. If the gastric fire gets suppressed because of urdhvavata (upward movement of vata) the patient should be given niruha and anuvasana medicated enemas (23). In the Ayurvedic view digestion in the stomach cannot be completely separated from digestion in the small intestine since the seat of agni lies mainly in the small intestine but also in the lower part of the stomach. Digestion is a continuum and the stomach and small intestine and the whole GI tract is interdependent. Indigestion or NUD begins with eating habits and improper food choices, but most digestive disorders begin in the stomach or are first noticed there (24). The digestive problems may then continue into the rest of the GI tract. From indigestion comes ama which disrupts not only the digestive system but also the immune system and results in low energy. The two sub doshas of most concern are pachaka pitta and samana vayu. When pachaka pitta is high there is excess gastric acid and the typical symptoms of heartburn, sour belching, and other pitta symptoms in the GI tract and mind. With high samana vayu there is nervous stomach and variable appetite, digestion, and peristalsis (25). There could also be other vata symptoms in the rest of the GI tract and mind. So hyperacidity could also occur with vata and a weak digestion where the food stays too long in the stomach which is then exposed to acid after the food can no longer buffer the acid. Apana vayu could also be involved. If it is not properly flowing downward, with possible gas and constipation, then this could slow or alter digestion further up in the GI tract and indirectly affect stomach functioning and emptying. Or apana vayu could rise upward due to nervous system vata stress and negatively effect digestion (26). Low kapha may accompany high vata and there is not adequate protection for the stomach lining from the acid even if the acid is not in excess. The eating habits that lead to excess pitta and hyperacidity are eating too much, or eating foods that are too sour, spicy, or fatty, too many sweets which can also be fatty, too much alcohol, tea, or coffee, poor food combining, and too much salty foods. Eating habits that would throw vata out of balance and lead to NUD would be eating irregular meals, eating too much, eating cold, dry, or raw foods, eating too much variety at a meal, or eating foods that are hard to digest. Other eating habits that could cause NUD with anyone are eating when not hungry, eating poorly prepared or cooked foods, eating too much processed foods instead of freshly prepared foods, and eating leftovers. In the Ayurvedic view food, eating habits, and herbs make up the treatment for NUD. For a vata person with NUD meals may have to be smaller and more frequent, regular, and generally cooked foods. A pitta person can eat three regular meals a day, more raw food, and more variety in a meal than a vata person. A vata person needs rich and moderately spicy food , while a pitta person needs less richness and spice. Each person should also http://www.ayurvedacollege.com/book/export/html/2
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take those foods that digest easily for their constitution, or pacifying for the high dosha. Skipping a meal until the appetite comes back may be needed. To avoid digestive difficulties the first step would be to follow Upayogasamatha the general guidelines for healthy eating according Ayurveda (27). To begin eat in a proper place or setting. The main point is that it is calm and peaceful. The mind should also be peaceful when eating, prepared by saying grace. This is done with awareness of the sacredness of the experience and acknowledges the spirit of the food. The food should be prepared in a loving way or in a sattvic state of mind. The food is then eaten with no distractions and a calm mind including confidence that what a person is eating is perfectly fine so there is no anxiety about eating. Time is taken to chew the food properly or to an even consistency and to fully taste and enjoy the meal. The food should be warm, and moist with some richness, which stimulates digestion, is more easily digested, and is more nourishing than dry food. It could also be said that food should be freshly prepared and cooked since it would also be warm and moist and best for digestion. Foods of opposite potencies should not be eaten in equal amounts so that they cancel each other out and end up with a neutral potency that does not promote digestion. A small amount of cool spices may be included in a dal for instance but the overall spice mix would be warm for a vata digestion. Only enough liquids to aid in eating should be taken with a meal. The more liquid the meal the less other liquid is needed, and it should not be cold. A person is best eating until about 75% full, to room for the stomach to mix and digest the food. One should feel satisfied but not full. Eating in a calm manner, chewing appropriately, taking the time to eat, and being aware of eating without distractions will give one the opportunity to sense when they are satisfied but not full. It is best to rest and not do any intense mental or physical activities after eating for up to an hour if possible. If work or other strenuous activities cannot be avoided then a smaller or lighter meal might be in order. Once the meal is finished one should not eat again until they are hungry, or the previous meal is fully digested. This is usually three hours or more. If it is sooner the person may want to or need to eat larger meals. If too long a time has past the person may have eaten too large a meal or need to strengthen their agni. Eating before the previous meal is fully digested will mix ahara rasa with the new food and vitiate all three doshas (28). This will disrupt proper digestion. Following the Upayogasamaatha will for most people alleviate their NUD or indigestion. If that is not sufficient then each person needs to follow a diet plan for their dosha as outlined above and specifically avoid foods that aggravate them. A general diet plan for vata and pitta follows (29). A diet for vata types would include fruits except dry fruits, unless well soaked, apples, pears, and melons. A large variety of vegetables can be tolerated if properly cooked and spiced if needed or with ghee. The cruciferous vegetables may not be tolerated but some may depending on the individual. Other common vegetables that may cause some indigestion are artichokes, asparagus, cucumber, green beans, potatoes, spinach, tomatoes, turnips, and zucchini. It is more important to avoid too much raw vegetables and eat cooked vegetables, and avoid mushrooms and lettuce. For grains stick to wheat, rice, and oats. For beans only mung usually. All nuts, seeds, and oils are acceptable, as is dairy except ice cream because it is too cold. Condiments are fine and can help to pique the appetite. Sweeteners should be used in moderation and best not to use refined sugar. Animal foods are nourishing and grounding for vata but consideration should be given to the karmic consequences of eating when there is no necessity to do so. For pitta types generally avoid sour, pungent, and salty foods when there is any imbalance or tendency to get out of balance. For fruits eat sweet and astringent ones like apples, dates, figs, mango, grapes, melons, pears, persimmons, and plums. Certain fruits may cause problems – citrus, strawberries, cherries, bananas, and any sour tasting or under ripe fruit. Vegetables to avoid are hot peppers, onion, garlic, radishes, etc. Others that may be a problem are beets, carrots, spinach, chard, tomatoes, and parsley. For grains basmati rice, oats, wheat, and corn are recommended. Most dry beans can be digested well except lentils. Nuts are limited for use, best are coconut and sunflower seeds. For oils coconut, sunflower, ghee, olive, and corn. For dairy, sour products – yogurt, buttermilk, aged cheeses limit or avoid. For sweeteners all are ok http://www.ayurvedacollege.com/book/export/html/2
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except honey and molasses. No condiments are good because of the salt and or vinegar. For animal foods egg whites and white chicken meat are good (30). This is a general list to help someone dominated by a vata or pitta constitution but is not all inclusive. Each person must also be aware when they eat if a particular food or combination of foods aggravates their digestion if they are to learn to improve their digestion and health. If a person is a duel dosha, vata – pitta, then they would have to take in foods acceptable to both doshas and avoid or limit those foods that aggravate both doshas or strongly do so to either dosha. Or if one dosha is predominately out of balance then that one would take precedence over the other dosha and the secondary dosha may not need to be addressed at that time. If a person still has NUD after following the above guidelines then digestion may be weak and proper food combining would be appropriate. The summary of proper food combining follows: (31) Bitter green salads should be eaten at the end of the meal not the beginning since bitter taste reduces agni. Astringent foods or tea should be taken at the end of the meal or between meals because astringent taste reduces the secretion of digestion enzymes. Sweets are best eaten at the beginning of the meal because they are preferentially digested and will interfere with digestion if eaten later in the meal by stopping digestion at that point to digest the sweets. Sweets can also be eaten separately between meals. When digestion is very challenged eat only one carbohydrate and only one protein at a meal, in general simplify the meal as much as needed to improve digestion. Avoid any difficult to digest foods such as cruciferous vegetables, raw onions, fried foods especially breaded and fried foods, heavy sweets that have high fat content, and dried beans. For NUD there is also herbal treatment for the dosha out of balance. For a high pachaka pitta cool and demulcent herbs are used. The bitter and sweet taste predominate with a cooling effect to reduce acid and also cool the liver, small intestine, and pancreas. Typical herbs are aloe gel, amalaki, barberry, cilantro, coriander, gentian, licorice, marshmallow, shatavari, and Avipattikar churna. Other spices that can be used unless pitta is very high are cumin, fennel, mint, and turmeric. Avipattikar churna is taken after meals to reduce acidity. Bitters can also be taken before meals to counter high pitta (32). Avipattikar churna : trikatu, triphala, cyperus, vidanga, cardamom, cinnamon leaf, cloves, trivit, raw sugar. Take 14 grams 23 times a day after meals with warm water. For high vata or high samana vayu in the stomach and digestive system the types of herbs given are carminatives to calm the system and help balance digestion. Commonly used herbs are fresh ginger, cardamom, basil, fennel, cloves, and camomile. Spices are best taken with food or something sweet or demulcent to counter the dryness of the spices. Vata in the stomach is also likely to dry out the stomach lining and a demulcent would be beneficial. Since the site of accumulation for vata is in the colon, herbs for the colon may also need to be given to help reduce vata in the stomach. In that case the formula Asafoetida 8 is appropriate, to counter gas, bloating, and constipation. Triphala would also be used for constipation since it is the chief laxative in Ayurveda (33). Another approach is to treat NUD by increasing the agni or by alleviating the indigestion. The following are modern Ayurvedic remedies (34). To http://www.ayurvedacollege.com/book/export/html/2
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rekindle agni use: Before a meal Fresh ginger with a little lime juice and a pinch of salt, or ginger tea. Garlic pwd. ¼ tsp., ½ tsp. trikatu, and a pinch of rock salt. One clove fresh garlic chopped with ¼ tsp. cumin pwd. a pinch of rock salt, a pinch of trikatu, and a tsp. of lime juice. Ayurvedic herbal wine, Draksha. Use 2 to 4 tbs with equal amount of water. A tea of ginger, brahmi, and chamomile (equal parts) for emotional causes After a meal a tea of bay leaves with a pinch of cardamom may help to improve agni. For indigestion there are several options: Fresh pineapple juice with pinch of ginger and black pepper, and ½ tsp. sugar. Onion juice, fresh ¼ cup, with ½ tsp. honey, and ½ tsp. black pepper. Fresh garlic one clove chopped with a pinch of salt and a pinch of baking soda. Juice of ¼ of a lime in one cup of water, add ½ tsp. baking soda and drink right away. This drink is for acute indigestion. For chronic indigestion : trikatu 1 part, chitrak 2 parts, kutki 1 part. Take ¼ tsp. before meals, with a little honey and fresh ginger juice. Cumin pwd. 1/3 tsp., a pinch of asafetida, and a pinch of rock salt. Take with warm water. Chew Ajwan seed ½ tsp. with ¼ tsp. baking soda and take with warm water. Chew a mixture of roasted fennel, cumin, and coriander seeds ½ tsp. Or a tea of the above three seeds, equal amounts of each ½ tsp. per cup of water. Or a tea of angelica, chamomile, and comfrey equal amounts, ½ tsp. per cup. The approach to nutrition is similar in the natural western and the Ayurvedic viewpoints, and there are some differences. Both emphasis eating wholesome unprocessed foods, organic when possible, healthy eating habits, and appropriate amounts of food for normal healthy digestion. But Ayurveda has Upayogasamaatha, the guidelines for healthy eating that acknowledges all levels of our being that need nourishment and can be practiced by anyone regardless of their spiritual outlook. In the care of NUD a western medicine approach, a natural health or nutritional approach, and an Ayurveda approach to healing have much in common but there are also some differences. The typical allopathic practitioner, usually an M.D., has extensive knowledge of human anatomy and physiology. They are trained to diagnose illness or diseases and when there is no manifest disease then there is often no protocol to follow in the care of the patient. Signs and symptoms maybe ignored assuming they will naturally abate, while not looking further for the causes. The patient maybe pacified with medication and the M.D. may feel it can do no harm. This is a narrow version of allopathic health care but it is typical of acute care medicine with the administration of only standardized pharmacological medications for any ailment the standard. At the other end of the spectrum M.D. and natural care practitioners are practicing medicine without medicine, using only supplements, herbals, extracts, enzymes, and an http://www.ayurvedacollege.com/book/export/html/2
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increasing number of what are considered natural products with little or no side effects. More time and care is taken with the patient to discover the underlying cause of the problem the patient presents with and not just focusing on symptoms. In acute care medicine bodily systems are separated while in a holistic view the body is integrated, and the approach to health is preventative or even to optimize health. Ayurveda's goal is to keep the body and mind healthy and to guide one on their path in life. It can touch every aspect of a person's life, and is intended to as a person is ready to let Ayurveda into their body, mind, and inner life. Comparing just the physical health aspect of each approach Ayurveda is similar to the holistic form of health care that treats each individual as an individual, with natural healing methods in assessment, diagnosis, nutrition, herbs and supplements, and other therapies. Ayurveda differs in that it is a fully integrated system consistent throughout the care of the client. The principals and therapies are in harmony with each other and support each other in the healing of the patient. In holistic care of NUD a less specific approach is used. Though a person is treated as an individual some may be given similar care of NUD though their constitutions are different. Though there is the attempt to treat the whole person and as an individual there is still a temptation to treat the symptoms or the disorder and not the imbalance that caused the symptoms. Holistic care has the benefits of extensive knowledge of the human body from medical school and research, a vast array of newer diagnostic tests that are useful in discovering underlying causes of GI symptoms, and a large choice of supplements, herbs, probiotics, natural foods, etc. for their clients. The holistic or natural or functional medicine care still has some of the analytical approach that is the hallmark of modern science and western medicine. Though the amount of knowledge and wisdom is enormous the modern systems are not completely integrated; in philosophy, principals, and practice as Ayurveda is. It might be seen as the difference of nature and science. Our bodies and minds are a part of nature and Ayurveda is natures medicine. Science is descriptive of nature and can be very knowledgeable of nature but is still separated from nature. Using science to help us heal can be very beneficial but it is still putting science first and not allowing direct communication from nature to teach and to heal directly. References 1,2,5. Clinical Nutrition; A Functional Approach. The Institute for Functional Medicine. Gig Harbor , WA . Bland JS, et al. 3,4. Zeman FJ, Clinical Nutrition and Dietetics. Macmillian Publishing Company, 2cd Ed. 1991. 6,9,10, 15, 16. Rogers SA. No More Heartburn. New York : Kensington Publishing Company, 2000. 7.Frishman RG. The Sensitive Gut. Boston : Harvard Medical School Health Publications Group, 1996. 8, 11. Bonci L. American Dietetic Association Guide to Better Digestion. New Jersey , John Wiley & Sons, Inc. 2003. 12, 13, 14. Gael RK, Sairam K. AntiUlcer Drugs From Indigenous Sources with Emphasis on Musa Sapientum, Tamrabhasma, Asparagus Racemosus, and Zingiber Officinale. Indian Jr. Pharm 2002; 34:100110. 17, 1823. Caraka Samhita: R.K. Sharma, Bhagwan Dash. Varanasi India . Chaukhamba Sanskrit Series, 1992. 24, 25, 29, 30, 32, 33. Frawley D. American Institute of Vedic Studies Ayurvedic Healing Corresponding Course for Health Care Professionals, http://www.ayurvedacollege.com/book/export/html/2
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Parts III and IV. Santa Fe NM . American Institute of Vedic Studies, 2002. 27, 28, 31. Halpern M. Principals of Ayurvedic Medicine, 5 th Ed. California College of Ayurveda. Grass Valley , CA. 2003. 26. Douillard J. Ayurvedic Specific Condition Review: Peptic Ulcer. John Douillard Lifespa: Rejuvenation Through Ayurveda. 34. Lad V. The Complete Book of Ayurvedic Home Remedies. New York , Three Rivers Press 1998.
Menopause from an Ayurvedic perspective (By Deva Khalsa) Table of Contents Introduction………………………………………………………………………. 2 What is menopause?..............................................3 Hot Flashes………………………………………………………………………… 5 The Doshas………………………………………………………………………… 8 Dhatus……………………………………………………………………………….. 10 Herbs…………………………………………………………………………………. 15 Pathology of Menopause…………………………………………………… 18 Hormone Replacement Therapy………………………………………… 21 Diet……………………………………………………………………………………. 25 Conclusion………………………………………………………………………... 27 Endnotes/abstracts……………………………………………………………. 28 http://www.ayurvedacollege.com/book/export/html/2
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Mosquito Bites and Bee Stings Symptoms, Pathology, and Remedies as seen threough the wisdom of Western Medicine, Homeopathy, and Ayurveda (By Katrina Johnson) — Table of Contents — Introduction i Morphology and Physiology of Mosquitoes and Bees 1 Mosquito Bites 1 Bee Stings 5 Mosquito Bite Reactions vs. Bee Sting Reactions 7 Anaphylaxis 7 Western Medical Treatment of Mosquito Bites and Bee Stings 8 Western Medical Treatments for Mosquito Bites and Bee Stings 8 Western Herbal Treatment of Mosquito Bites and Bee Stings 10 Western Herbal Remedies for Mosquito Bites and Bee Stings 10 Homeopathic Understanding of Mosquito Bites and Bee Stings 12 Homeopathic Remedies for Mosquito Bites and Bee Stings 13 Ayurvedic Understanding of Mosquito Bites and Bee Stings 14 Ancient Wisdom from the Ashtanga Hrdayam 16 Ancient Wisdom from the Sushruta Samhita 18 Ancient Wisdom from the Charaka Samhita 20 Charaka’s Remedies for Mosquito Bites and Bee Stings 23 http://www.ayurvedacollege.com/book/export/html/2
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Additional Ayurvedic Remedies for Mosquito Bites and Bee Stings 26 Conclusions 29 Endnotes / References / Journal Abstracts 35
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Musculoskeletal Injuries: A Comparison of Western Allopathic and Ayurvedic Treatments ( By: Anna Holden) The human body is a wonder. The structure of our skeleton, combined with the fluid strength of our muscles and the tendons and ligaments that connect muscles and bones together, makes the human body a biomechanic masterpiece. It is able to move through several planes of motion by the grace of our spine, which can move in four different directions, allowing us perform a multitude of physical activities. For example, we are capable of flowing through sun salutations, propelling ourselves forward to walk or run, and find dynamic stability and balance while surfing or skiing. When anatomical principles are followed, including proper alignment and attention to proper range of motion, our bodies can function with ease. If, however, we continuously practice activities with improper alignment, or we are pushed out of alignment by some outside and unseen event, our bodies can experience pain and injury. Sometimes, pain can arise without any acute episode. The Western Medical model has a fairly succinct system for managing both acute and chronic injury, and is only starting to look towards ancient healing systems like Ayurveda for healing injury. Traditional Ayurvedic treatment of injury includes some Western allopathic methods, but moves beyond them to include healing of the mind, body and spirit. This paper will explore the Western allopathic and Ayurvedic treatments for both acute and chronic injury and/or pain. For the purposes of this paper, injuries will be divided into two categories: acute and chronic. Acute injuries are those with a sudden and severe onset of pain, possible swelling and the inability to place weight on the area, abnormal ranges of movement, weakness and tenderness. Chronic injuries may start out as acute injuries but continue to persist in the body. One way to gauge whether an injury has become chronic is when pain is experienced during participation in physical activity or exercise after the acute injury has been healed, a dull ache occurs during rest, or when there is persistent swelling . Chronic injury can also be defined as pain lasting greater than three months . Acute Injury Some of the most common acute injuries are sprains and strains. Sprains occur on ligaments and strains affect muscles and tendons. Ligaments are bands of connective tissue that connect bone to bone and hold joints, like the shoulder, together. Tendons are bands of connective tissue that connect muscles to bones. A sprain is a stretched or torn ligament, while a strain is a stretched or torn muscle or tendon. Sprains and strains share some similar symptoms, which include pain and swelling. With a sprain, however, there may also be bruising, inability to move the affected joint http://www.ayurvedacollege.com/book/export/html/2
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and a popping or tearing sound. The symptoms of a strain may also include muscle weakness, muscle spasm and trouble moving the affected muscle . Western Treatments of Acute Injury The most commonly recommended Western allopathic treatment of sprains and strains is to use the R.I.C.E. method: Rest, Ice, Compression and Elevation. Following this method, at the onset of injury the activity should be discontinued and the injured area of the body should be rested. Next, an ice pack should be applied to reduce swelling and inflammation. An Ace bandage or other clean wrap can be used to compress the injury, keeping swelling at bay. Finally, the injured area should be rested in a position elevated above the heart. Other Western allopathic treatments of sprains and strains includes the use of NSAID pain relievers, immobilization of the injury, and rehabilitation exercises to restore proper range of motion. Also, a program of strengthening and stretching the affected area should be followed so that scar tissue will not build, which could increase the possibility of reinjury. Additional Western modalities of injury treatment include electrical stimulation, alternating cold and hot packs, ultrasound and massage . In certain conditions, including tearing of ligaments, tendons or muscles, the patient may require surgery to repair the damaged tissue. As the above methods point out, treating acute injury involves managing symptoms and resting the injured area. In addition to symptom management, some literature points to taking preventative measures to reduce the likelihood of experiencing injury or reinjury. Preventative measures are different based on where in the body injury is more prone to occur, but all preventative measures have the same basic principles of stretching what is tight, strengthening what is weak and improving range of motion in all directions . Less commonly focused on in the Western allopathic literature of acute injury recovery and prevention is proper diet, however, one article suggests that athletes experiencing acute injury should follow a diet high in vitamins and minerals obtained from healthy sources like fresh vegetables. It also suggests athletes eat “balanced protein,” and to avoid overeating so as not to gain weight while injured . Ayurvedic Treatment of Acute Injury Ayurvedic treatment of acute injury takes a more holistic approach. While Ayurvedic treatment follows the same general course as Western allopathic treatment in that it aims to reduce inflammation and swelling and to restore the muscle, tendon or ligament to its proper healthy function, Ayurvedic knowledge allows for identification and treatment of the many subtleties within injuries. These include noticing the different types of inflammation and swelling, observing different forces at work within the injury and addressing them individually, and keeping in mind the unique constitution of the individual so that the healing program can be as unique as they are. In addition, Ayurveda acknowledges at the energetics of an illness or injury, takes into consideration the amount of toxins or ama a patient may have in their body, and assesses how well prana, the lifeforce energy responsible for all movement in the body, is flowing in the injury itself and in the patient’s body in general. In order to understand Ayurvedic treatment, it is important to understand the basics of Ayurveda itself. Ayurveda is a holistic system of health that utilizes the fiveelement theory, which underlies all life on the planet. The five elements – earth, water, fire, air and ether – combine to create the three doshas. Doshas are the forces within nature and our bodies that are responsible for all action and inaction, including the formation of our tissues, the metabolism of thought and food, and all movement in the body including nutrients in and out of cells, breath in and out of the lungs, http://www.ayurvedacollege.com/book/export/html/2
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creative flow from our minds out our hands as well as speech and muscle movement. The definition of dosha is “fault” or “imperfection,” which explains how these forces can move to excess through improper diet or lifestyle and create a state of disease in the body. In the case of acute injury, vitiation of the doshas usually occurs from outside factors like unexpected events. In Ayurveda, both the treatment and management of disease is based on the qualities of imbalances found in the body. Ayurveda relates every state in nature, and thus in our bodies, back to their most basic building blocks – the elements and qualities that they are made of. Once the basic qualities of an imbalance are understood, we are able to provide treatments that balance the disease or injury. The most primary principle of Ayurvedic treatment is that “like increases like, and opposites reduce each other .” In Ayurveda, dry is treated with moist, cold is treated with heat, heavy is treated with light and so forth . The Ayurvedic author M.S. Valiathan, who translated the ancient Ayurvedic text the Susruta Samhita, does not talk about injury management specifically, but he does talk about the treatment of swelling and inflammation that occur from traumas like “excessive jolting…” . These types of “generalized swellings,” as he calls them, can be attributed to either vata, pitta, kapha or all three doshas (sannipata). Vata swelling appears red or black in color and includes prickling, soft, fleeting pain. Pitta swelling has a yellow or red coloring to it, is soft and hot to the touch and spreads quickly. Kapha swelling is pale or white in color, feels cold and smooth, spreads slowly and may itch. In general, Valiathan recommends that anyone with swelling, regardless of the cause, should avoid sour and salty foods, and heavy foods such as milk, sugar and ghee . This is because most generalized swelling is due to increased water retention in that area, caused by Kapha dosha, and because the water element in the body (i.e. swelling) is increased by the intake of the aforementioned foods. Based on the type of swelling and inflammation, mentioned in the previous paragraph, Ayurvedic treatment can include herbal formulas containing properties to treat the imbalance with its opposing qualities. Some of the herbs Valiathan recommends to treat swelling include vidanga, trikatu, haritaki, guggulu, fresh ginger, punarnava and pippali . The classical Ayurvedic text the Ashtanga Hridayam, by Vagbhata, does not talk about muscle injuries specifically, but does talk about the healing of traumatic injuries, which he defines as those “wounds which occur suddenly.” Vagbhata also recommends treating with opposites. He recommends treating inflammation in acute traumatic injury with a topical herbal application, called a lepa, using herbs with a cold potency, sweet taste and unctuous properties . These three qualities – cold, sweet, and unctuous – help to reduce inflammation and heat. Most modern Ayurvedic sources encourage the use of external herbal compounds, like lepas, for treating acute injury. Lepas are medicinal herbs made into a paste with oil, aloe, or another liquid, then applied to the skin. An article in Yoga Journal Magazine recommends the use of herbal compounds to improve the circulation of prana, or life force energy, and blood around the injury. The article states that, if applied correctly, the active ingredients in the herbs will be absorbed by the skin, thereby reducing pain and swelling and improving circulation. The article also suggests the use of herbs such as Salai guggul, kapitthaparvi, and bola, both internally and externally to reduce pain, strengthen bones and joints, and cleanse the blood of toxins . Additionally, white willow bark – the herb that inspired Westerners to create Asprin – is recommended as an analgesic and antiinflammatory. This article also recommends that the patient rest and ice the injury. An article by Alakananda Ma, an Ayurvedic Practitioner, recommends reducing pittatype pain and inflammation through the use of pitta reducing herbs that have an affinity for joints and muscles. These include guduchi, tulsi, turmeric, licorice and the formula Kaishore guggulu, all http://www.ayurvedacollege.com/book/export/html/2
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taken internally. Additionally, the patient could drink antiinflammatory teas like ginger or tulsiturmericginger. For localized healing, the author recommends the use of antiinflammatory oils like castor and mahanarayan to be massaged into the affected area, and then rinsed off in a hot shower. Once inflammation is gone, the patient could massage the area with one of the aforementioned oils, and then follow with a ginger or baking soda bath. For muscle tendon injuries where there is no inflammation present, Ma also recommends Patrapinda Sveda therapy. Patra means “the leaves of medicinal plants,” pinda means, “bolus,” and sveda means fomentation or heat therapy . Therefore, Patrapinda Sveda is the application of medicinal leaves fried in ghee or oil, and wrapped in a muslin cloth to form a bolus. The bolus is then massaged into the injured area, where the medicinal properties of the plant will absorb into the skin and provide pain relief via softening of the tissues. Additionally, Ma recommends that once an acute injury has healed past any inflammation, a yoga therapy program should be started that addresses any pain, underuse, loss of conditioning and join laxity. Finally, muscles should be slowly conditioned to sustain maximum functional capacity. The treatments that Ayurveda offers to heal acute injury can be summed up by the treatments offered at a clinic in Kerala, India, which specializes in Ayurvedic sports medicine. The treatments utilized by Ayurveda to heal acute injury are: internal medicines (like herbs and diet), external medicines (like lepas and patrapinda sveda), varma chikitsa (procedures to increase joint mobility and function and decrease pain), pancha karma (removing toxins and cleansing the body), and traditional physiotherapy. With this holistic approach, Ayurvedic treatment of injury can be a good route to healing and even an alternative to surgery . Chronic Injury As stated above, chronic injury can be described as injury lasting more than three months, or twelve weeks. The original cause of chronic musculoskeletal pain may have been an infection, injury, or wear and tear from incorrect movement over an extended period of time. Chronic pain or injury are often difficult to manage because many times the cause is unknown , and sometimes pain occurs in the body for no apparent orthopedic reason, with no acute episode of injury. Both Western medicine and Ayurveda offer treatments for chronic injury. Western Allopathic Treatments of Chronic Injury and Pain For the most part, Western treatment of chronic injury includes following the plan laid out for acute injury, and then adding a recovery and maintenance phase of healing. In the recovery phase, the American Academy of Physical Medicine and Rehabilitation recommends building strength and flexibility around the injured area to repair normal function and range of motion. Then, they suggest a maintenance phase during which the patient minimizes the chances of injury recurrence by engaging in a supervised, totalbody fitness program . Chronic injury, however, can have more of an effect on the body than just the area of injury and surrounding tissues. Longterm chronic injury and/or pain can have psychological effects also. Often, pain can change the regular patterns of a person’s life, their relationships to others and the way they function in everyday life. Reduced coordination or strength in an area of a body can make a person less independent than they once were, and create a need for them to rely more on others. These changes due to pain, when left untreated, can lead to psychological problems and even more pain . The Mayo Clinic conducted a study on pain and depression. They describe the link between pain and depression like a cycle: http://www.ayurvedacollege.com/book/export/html/2
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Pain and depression are closely related. Depression can cause pain – and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain . Therefore, not only does pain affect the physical body, it also affects how a person thinks and feels. When thoughts and emotions are particularly negative, they can increase the pain that the person experiences . There are some Western techniques for addressing the emotional/psychological component to pain. They include occupational therapy, and psychotherapy or counseling. Occupational therapy helps people manage both the physical and psychological effects of pain. Occupational therapists teach people to manage their daily activities and lifestyle in accordance with their pain or injury through several methods. They teach people how to identify behaviors that increase pain and then offer alternative methods instead, and methods for decreasing the frequency or intensity of pain. They teach patients new ways for using their bodies to decrease pain during everyday tasks. Occupational therapists also help the patient by collaborating with their team of health care professionals to keep a clear path of treatment . Psychotherapy or counseling can help patients by guiding them to reduce stress and tension, and to make lifestyle changes when necessary. Because of the aforementioned link between pain and depression, it can often be difficult to tell which came first if there was no acute injury to musculoskeletal tissue. In these cases, psychotherapy can be quite effective at getting to the bottom of what is causing the pain and/or depression – whether it be a stressful job, a negative living situation, or an unsupportive relationship. Patients may be guided through counseling to change the situations that may be aggravating their chronic pain or injury . Ayurvedic Treatment of Chronic Injury and Pain Similar to Western Allopathic treatments of chronic injury, Ayurvedic treatment of chronic injury and pain will firstly follow their same treatments for acute injury, and also include phases in treatment for maintenance and prevention. All of the aforementioned Ayurvedic treatments would continue to be applied as needed for pain and healing of tissues. Also similar to Western medicine, Ayurveda treats chronic injury and pain with both physical application and psychotherapy – specifically, Ayurvedic psychology, which differs from Western. Ayurveda always includes treatment of the mind, body and spirit, and believes that health and healing must address each of these aspects of our being. In addition, because it believes that every physical manifestation had first a subtler component, complete Ayurvedic treatment will provide treatment for pain and injury through subtle body anatomy, including the nadis, chakras and auric field. Beginning with treatment for the physical aspects of chronic injury, Ayurvedic body therapies for chronic pain would include those listed above – internal medicine, external medicine , varma chikitsa, Pancha Karma and physiotherapy – but would be adjusted as necessary as vitiated doshas come into balance. Next, a patient would be treated using Ayurvedic psychology, which teaches the patient about who they are as an incarnated soul and the specific growth and challenges that they may face in the this life. From this understanding of soul development, the patient can gain an understanding of their pain or injury in the context of their life journey. This can help a patient understand the lesson behind the pain, which can change the perception of pain from something that occurred outside “to” the patient to a signal from the body to create change within the patient’s life. Additionally, while Western psychology focuses on revisiting the past in order to understand how a current situation manifested, Ayurvedic psychology emphasizes taking stock of the current situation and making positive changes to transcend the situation and create the life that is wanted. http://www.ayurvedacollege.com/book/export/html/2
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To begin to address chronic musculoskeletal pain and injury through Ayurvedic psychology, the practitioner may look at the tissues affected and their related psychological function. Musculoskeletal injuries, by definition, are those that affect the muscle tissue, tendons and ligaments, and bone tissue. Ayurveda calls muscle tissue and ligaments mamsa dhatu, and the related psychological function is courage, fortitude and self confidence. Symptoms of deficient mamsa dhatu can result in muscle wasting, loose ligament (which often cause many chronic injuries in athletes), and fear, worry, low selfconfidence and low selfesteem. The Ayurvedic term for bone tissue is asthi dhatu, and its related psychological function is stature and the ability to stand tall. Deficient asthi dhatu can result in osteoporosis and other weakbone disorders, as well as arthritis. Using the above information as a guide, the patient should be guided to recognize what in their life is causing them to feel a lack of confidence and support, and be guided toward building confidence and selfesteem so that they can stand tall and have no doubt that they can support themselves. In order to do this, we must understand all aspects of the Self – moving past the physical body and into the subtle and causal aspects of our existence. Ayurvedic philosophy states that all physical reality had a subtler component that preceded it, so only addressing the physical component is not necessarily addressing the root cause. For mindbodyspirit healing, Ayurveda will of necessity address the subtle components of pain – the underlying thoughts, behaviors or attitudes that may keep the body in distress. Looking at the bodily tissue associated with the injury is just one way to treat the underlying psychological issue. Additionally, chronic pain can be assessed based on where it is in the body and how that relates to the subtle or astral body and the chakra system that energizes it. The subtle body is an energetic copy or template of the physical body and is projected by the seven chakras, which are the energetic templates of the nerve plexuses of the body. Our chakras serve two basic purposes – first as pumps that run energy through our bodies via the nadis, or energetic channels that run along the spine, and second as determinants of our experience. Chakras can run two types of energy – ordinary subtle energy, which is necessary for everyday experience and function; and heightened subtle energy, which changes our perceptions and allows our consciousness to be raised. When energy in a chakra is partially blocked or moving too slowly, disease in the physical body may manifest. Until the underlying issue has been addressed at the chakra level – which usually includes selfreflection and work in underlying values, beliefs, and emotional attachments – the physical pain will persist. Much research has been conducted and written about the different chakras and the life lessons they provide. Therefore, the location of the chronic injury or pain as it relates to the nearest chakra can give the practitioner more information about the cause and purpose of the pain and how to treat it. There are several healers in the alternative medicine field who work with this principle. Some do not fall fully into either the Western allopathic model or the Ayurvedic model, but I will include them here because they utilize the ancient wisdom of the subtle body system, which originated from the same source as Ayurveda. Carolynn Myss, in her book “Anatomy of the Spirit,” describes in detail the seven chakras and the common injuries, diseases, and afflictions that occur because energy in that chakra is stagnant or blocked. Her first principle of whole body healing is that our subtle biography becomes our physical biology. She says: As our lives unfold, our biological health becomes a living, breathing biographical statement that conveys our strengths, weaknesses, hopes and fears. . . . All our thoughts, regardless of their content, first enter our systems as energy. Those that carry emotional, mental, psychological, or spiritual energy produce biological responses that are then stored in our cellular memory. In this way our biographies are woven into our biological systems, gradually, slowly, every day.
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This is very similar to the Ayurvedic principle that every physical manifestation first had subtler origin. In her book “Women’s Power to Heal Through Inner Medicine,” Ayurvedic author Maya Tiwari emphasizes this principle when she says, “Our bodies are made of consciousness and spirit . . . . In order to heal, we need to appease vital tissue memory and nourish and nurture the whole self. What Tiwari and Myss are saying is that what we believe about our world, and especially how we think and act on those beliefs will affect our biological health. People with chronic pain, then, are receiving constant signals from the body that something is not right and that there are beliefs, thoughts, values, lifestyle choices or relationships that are continuing to create disharmony in the subtle body system. Myss’ second principle for subtle body health is that personal power is a necessity for health. This relates directly to what was stated above, that in Ayurveda, people with chronic musculoskeletal injuries must be treated for the psychological conditions of lack of confidence, selfesteem, and ability to stand up and support one’s self. Tiwari’s writings support this with an entire chapter entitled, “Your Own Energy is Your Best Medicine .” Both Myss and Tiwari argue that our attitude can cause us to either keep healthy personal power and selfesteem, or cause us to lose power. Myss uses the example of a woman who came to her with chronic pain. She had no acute episode responsible for her pain or exhaustion, however, she believed she was inadequate and constantly criticized her children in order to make them dependent on her and give her a sense of purpose. Because she believed she was inadequate, she consistently gave away her power to this belief, which left her with no personal power with which to heal herself . Only a change in her beliefs and attitudes about herself could change the flow of energy through her chakras and keep her subtle body energy at a healthy level. Myss’s third principle of healing – that you alone can help yourself heal also closely follows the Ayurvedic understanding that we carry within us the innate ability to heal ourselves, and that real healing comes from the inside, through selfinquiry, selfacceptance, and understanding of our true nature as spirit. The Western allopathic model is set up in such a way that we give up our power to self heal and instead turn our physical bodies over to someone with more “credentials” for healing. This model leaves us with a great sense of helplessness and defeat when it comes to pain and injury. Instead, the philosophy laid out by Ayurveda and Myss – that each of us has within us the power to heal – teaches us that not only are we responsible for our health, but we are also responsible, at some level, for creating the injury or pain. Embracing this can give us the power needed to heal, because it allows us to recognize that by participating in our healing, we are healing our mind, body and spirit as one – not turning the physical body over to someone else for partial healing. Similarly, in “You Can Heal Your Life,” Louise Hay guides readers toward healing disease, including chronic pain and injury, in the body. She believes in principles that closely follow Ayurvedic philosophy: We are each responsible for all of our experiences. Every thought we think is creating our future. The bottom line for everyone is, “I’m not good enough.” It’s only a thought, and it can be changed. We create every socalled illness in our body. http://www.ayurvedacollege.com/book/export/html/2
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We must be willing to begin to learn to love ourselves. Selfapproval and selfacceptance in the now are the keys to positive changes. When we really love ourselves, everything in our life works. Hay affirms that the path to healing all disease, including chronic pain or injury, is through releasing the negative emotional patterns (subtle body anatomy) that create pain in the physical body by learning to love the self. She relates physical injury to the subtle body cause behind it – our attitudes and beliefs about our world and ourselves. Then, she guides readers stepbystep through a series of positive affirmations designed to change negative thought patterns. Ayurvedic treatments for chronic injury and pain on the subtle body level to address chakra or energy imbalance could include selfinquiry, meditation, pranayama, sound therapy (both listening to music and chanting), and repeating affirmations or Sanskrit chants. Because chronic injury or pain is signal that there is a longterm imbalance in the body, subtle body healing is critical in addressing the underlying cause of discomfort and eliminating it from the body. Both Western medicine and Ayurveda treat chronic injury and pain through both physical modalities and psychotherapy (the body and mind). However, because Ayurveda believes in the connection of the mind, body and spirit, it is able to take a healing a step further with its utilization of subtle body anatomy to aid in understanding and releasing the underlying causes behind chronic injury and pain that Western medicine often misses. Conclusion Both Western Medicine and Ayurveda offer options for healing acute and chronic injury. When working with acute injury, Western medicine generally utilizes a onesizefitsall approach that generally helps people recover; however, through its doshic theory, Ayurveda has a more intricate healing method and can offer more individualized healing. For chronic injury, Western medicine has recognized that both the body and the mind must be treated in order to realize healing. However, Ayurveda’s knowledge of the subtle body system make it an excellent choice for patients ready to take charge of their own healing path and realize healing of the entire mind, body and spirit. Author’s Notes I have personally experienced chronic, low back injury and pain for most of my life, but more extensively the past three years. I have experienced severe ligament laxity (hyper mobility) of the sacral iliac joint and pelvis, resulting in near constant pain and discomfort. I originally tried a Western approach that included ice, heat, NSAID pain relievers, rest and physical therapy. I did not heal. I turned to an alternative approach to healing which included Yoga, meditation, yogabased physical therapy, visceral manipulation therapy and an Ayurvedic diet and lifestyle. All of these modalities helped the physical manifestation of my injury, but did not provide complete healing. I was only able to fully heal when I learned about the subtle body connection and dove into figuring out what negative beliefs and attitudes I held about myself. Then, I came to recognize how my current lifestyle and relationship was constantly and consistently reinforcing those negative beliefs. For me, the changes http://www.ayurvedacollege.com/book/export/html/2
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necessary to bring about healing required that I learn to find the courage to let go of fear and have faith that if I love myself, and I follow the path of selflove and Spirit, I would be taken care of. It was through the lesson of chronic injury and pain that I was able to learn the lesson of selflove and realize fullbody healing. References National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Eastyto Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d National Institute of Neurological Disorders and Stroke (NINDS), NINDS Staff, NINDS Back Pain Information Page, http://www.ninds.nih.gov/disorders/backpain/backpain.htm Medline Plus, Medline Plus Staff, Sprains and Strains, http://www.nlm.nih.gov/medlineplus/sprainsandstrains.html Medline Plus, Medline Plus Staff, Sprains and Strains, http://www.nlm.nih.gov/medlineplus/sprainsandstrains.html Mayo Clinic, Mayo Clinic Staff, Hamstring injury, http://www.mayoclinic.com/health/hamstringinjury/DS01183/METHOD=print National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Eastyto Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIAMS Staff, What are Sports Injuries? Fast Facts: An Eastyto Read Series of Publications for the Public, http://www.niams.nih.gov/Health_info/Sports_Injuries/sports_injuries_ff.asp#d American Academy of Physical Medicine and Rehabilitation (AAPM&R), AAPM&R Staff, Overview of Neck Pain, http://www.aapmr.org/patients/conditions/msk/spine/Pages/OverviewofNeckPain.aspx Active.com, Nancy Clark, Injury, Diet and Recovery: Guidelines for Nutrition and Healing. http://www.active.com/nutrition/Articles/Injury__diet_and_recovery__Guidelines_for_nutrition_and_healing.htm Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 59. Charaka. Edited by Bagriel Van Loon. Charaka Samhita: Handbook on Ayurveda, Volume 1. (P.V. Sharma & Chaukhambha Orientalia). Su10#6. Valiathan, M.S. The Legacy of Susruta. (Orient Longeman Private Limited, 2007), 346. Valiathan, M.S. The Legacy of Susruta. (Orient Longeman Private Limited, 2007), 346. Valiathan, M.S. The Legacy of Susruta. (Orient Longeman Private Limited, 2007), 347. http://www.ayurvedacollege.com/book/export/html/2
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Valiathan, M.S. The Legacy of Susruta. (Orient Longeman Private Limited, 2007), 347. Vagbhata. Translated by Prof. K.R. Srikantha Murthy. Vagbhata’s Astanga Hrdayam. (Chowkhamba Press, Varanasi, Fifth Edition, 2009), 247. Chapter 26, Verse 1. Vagbhata. Translated by Prof. K.R. Srikantha Murthy. Vagbhata’s Astanga Hrdayam. (Chowkhamba Press, Varanasi, Fifth Edition, 2009), 248. Chapter 26, Verse 7. Yoga Journal, James Bailey, L.A.c, M.P.H. Damage Control. http://www.yogajournal.com/health/550 Banyan Botanicals. Alakananda Ma. Rotator Cuff Injuries in Your Ayurvedic Practice. http://www.banyanbotanicals.com/bv/rotatorcuff All About Ayurveda. Dr. Rayhuram Y.S. Patra Pinda Sweda…Herbal rejuvenation of back and spine..in back pain severe. http://drraghuramys.wordpress.com/2009/11/10/patrapindaswedaherbalrejuvenationofbackandspineinbackpainsevere/ Kottathil Ayurveda Hospital. Hospital Staff. Ayurvedic Sports Medicine. http://www.kottathilayurveda.com/ayurvedicsportsmedicine.html Chronic Pain. National Institute of Neurological Disorders and Stroke staff. http://www.nlm.nih.gov/medlineplus/chronicpain.html American Academy of Physical Medicine and Rehabilitation (AAPM&R). AAPM&R Staff. Overview of Neck Pain. http://www.aapmr.org/patients/conditions/msk/spine/Pages/OverviewofNeckPain.aspx The American Occupational Therapy Association, Inc. (AOTA). AOTA Staff. Managing Chronic Pain. http://www.aota.org/Consumers/consumers/HealthandWellness/Pain/35137.aspx The Mayo Clinic. Mayo Clinic Staff. Pain and Depression: Is there a link? http://www.mayoclinic.com/health/painand depression/AN01449/METHOD=print Medline Plus. Medline Plus Staff. Low back pain – chronic. http://www.nlm.nih.gov/medlineplus/ency/article/007422.htm The American Occupational Therapy Association, Inc. (AOTA). AOTA Staff. Managing Chronic Pain. http://www.aota.org/Consumers/consumers/HealthandWellness/Pain/35137.aspx Medline Plus. Medline Plus Staff. Low back pain – chronic. http://www.nlm.nih.gov/medlineplus/ency/article/007422.htm Charaka. Edited by Bagriel Van Loon. Charaka Samhita: Handbook on Ayurveda, Volume 1. (P.V. Sharma & Chaukhambha Orientalia). Su11#55. Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 181. http://www.ayurvedacollege.com/book/export/html/2
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Halpern, M. Principles of Ayurvedic Medicine. (California College of Ayurveda, 2009). 198, 199. Myss, C. Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 40. Tiwari, Maya. Women’s Power to Heal Through Inner Medicine. (Mother Om Media, 2007). 91. Tiwari, Maya. Women’s Power to Heal Through Inner Medicine. (Mother Om Media, 2007). 91. Myss, C. Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 44,45. Myss, C. Anatomy of the Spirit: The Seven Stages of Power and Healing. (Three Rivers Press, 1996). 47. Hay, Louise L. You Can Heal Your Life. (Hay House, Inc. 2004). Xiii
POPULATION HEALTH THROUGH SENSORY EXPERIENCES: LIFESTYLE AND CULTURAL INFLUENCE ON THE SENSES By: Elana Berman Introduction The impressions of the five senses are experienced differently throughout life based on a variety of factors. Through the examination of geographical differences and community development in various cultures, it is clear that disease precedence differs. The following essay examines and identifies trends in each population segment. Every culture, living environment and financial status impacts the way of life in various regions throughout the world. This study addresses life in developed and in developing countries. Some locations utilized in the Western world include Los Angeles, California and France. Examples from the eastern world and of developing countries include urban and rural locations in India. Disease affecting factors differ greatly between the eastern developing and western developed world. One factor, which Ayurveda considers the root of physical disease, is food, diet and digestion. Ayurveda teaches that most disease and doshic imbalance first occurs in the mahavaha srota, also known as the digestive tract.9 Through the development of unplanned cities and the corresponding population increase, the availability of sustainable natural foods decreases. Many of India’s metropolitan cities have developed without planning. Unplanned cities lack consideration for http://www.ayurvedacollege.com/book/export/html/2
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projected population growth and all of the necessities that an exponentially growing population requires for survival. On the opposite side of the spectrum, this essay looks at life in planned western cities. I compare and contrast the variety of sensory experiences that humans perceive while living in unplanned versus planned cities and rural versus urban environments. Disease exists throughout the world’s populations. I attempt to identify causes and trends for disease occurrence through a comparison of use of the senses. The Causes of Disease In Ayurveda, the “science of long life” there are three causes of disease according to its oldest text Charaka Samhita. First is disharmonious use of the senses, which occurs when the senses, also viewed as gateways into our body, mind and consciousness are used primarily for the pursuit of pleasure for the physical body. This disharmonious use occurs as a result of forgetting the existence of our higher selves or the existence of any divine form. Essentially, this disharmony results in conjunction with the primary cause of disease, which is forgetting our true nature as spirit.6 The second cause of disease is called prajnaparadha, which translates from Sanskrit as failure of the intellect. This intellectual blasphemy results when we hear the voice of the intellect louder than the voice of the soul. This failure of the intellect also results from the primary cause of disease, when we forget our connection to the divine. The practice of disharmonious behaviors despite the fact that we know they are disharmonious causes decision making based on the lower self. The lower self speaks to us through sensory or physical desires.10 Parinama is the third cause of disease, which means transformation or decay due to time. Time can be further defined as the act of living life. As we live and have experiences the elements of the world stress our bodies. The very act of living causes a natural degradation of the body. After all, we are not placed in this world to live forever. Rather we are here, Sankhya philosophy says, to fulfill our karma and samskaras in order to experience life and then return to our unmanifested home in the divine form. The nature of life is to move, exist, think and participate as time moves forward. Technological advances such as flying and driving accelerate this transformation through hastened means of movement.11 The movement of the mind is at the forefront of this cause of disease. Our state of mind, in the present or future and active or distracted, directly correlates to the movement of biological time. When we live outside of the present moment, it is impossible to have singlepointed concentration also known in the realm of Yoga philosophy as dharana. With the practice of dharana, parinama slows down and harmonious use of the senses prevails. This discipline leads to slower aging and reduced impact of stressors on the body.7 How Ayurveda Heals with the Senses In this 5000yearold eastern medicine lineage, the five senses of sight, smell, touch, taste and sound are used to reduce doshic and elemental imbalances in an effort to create harmony. Ayurveda aims to achieve this homeostatic state by optimizing an individual’s surroundings based on individual needs. An individual’s needs are determined by a combination of factors. An individual’s elemental constitution at the time of conception, called Prakruti, and an individual’s current state of imbalance, called Vikruti. With these two factors, Ayurveda treats with customized sensory therapies to bring a person to optimal health. Each of our physical experiences in the gross body affects the deeper bodies and subtler senses. Our physical sensory intake impresses the astral senses through its effect on the chakras, which are subtle energy centers in the body. The astral body is also affected by the flow of prana, or http://www.ayurvedacollege.com/book/export/html/2
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energy, through nadis, which are energy channels in the body. These astral experiences then affect the subtlest of all bodies, the causal body. This body lies beyond the physical world. Karma and samskaras cause a soul to physically manifest in the cycle of reincarnation.12 Introduction to the Five Senses Ayurveda uses a variety of approaches to integrate holistic sensory therapy into healing the 3 different bodies: physical, subtle and astral. The sense of smell, while experienced in most actions in life, can be treated through the use of aromatherapy. The sense of vision can be modified through color therapy. The sense of touch can be affected through body therapies. The sense of hearing can be impacted through the use of chanting, japa and bija mantras. The sense of taste is affected everyday by diet and herbs.3 None of these senses exist independently as they each affect the sensory lens through which all other senses and experiences are perceived. It is in this context that the practice of pratyahara is a useful tool. Pratyahara is one of the 8 limbs of yoga and is the discipline of withdrawal of the senses. Through this practice we become aware of extrasensory perceptions and singular sensory experiences further emphasizing the practice of dharana with single pointed focus.4 Case Study of Sensory Experiences in a Developing Urban Area One of the most important resources in life is food. It represents one of the three pillars of life according to Ayurveda.13 India’s urban obesity rate was 24.8% in 2006.5 While this disease prevalence is common in most urban environments, it is often due to a variety of increasingly sedentary lifestyle factors. In urban India it presents for some unique reasons associated with the lack urban planning, which affects the population’s food resources. A large proportion of urban India is unplanned cities and the growing disease rates and obesity epidemic statistics demonstrate some of the consequences of improper planning. In New Delhi, the availability of sustainable food and nutrition shadows in comparison to the today’s population. In order to feed the exponentially growing population of Indian cities, food must be imported from outside the region. Fertile lands are being destroyed in order to provide space for the increasing housing requirements of a growing population.15 A lack of planning causes inconsideration for the fact that these new inhabitants may well have a roof over their heads but will not have access to fresh and local foods. As food undergoes longer transport time before it reaches consumers, it has to contain more preservatives. These additives affect the digestion and level of sattwa in consumers. Additionally, the longer time that passes between the time that food is taken from its source, for example plucked off a tree or harvested, the lower the level of prana and nutrition in the foods. According to Ayurveda, a high prana diet containing all of the 6 tastes and rich in fresh foods is one key component to maintaining health.9 Aside from the sense of taste and foods consumed, the lifestyle in India’s unplanned cities provides a plethora of interesting sensory experience. Some of these experiences are wholesome, for instance holy sites and spiritual enclaves within the daily routine. However, many of these sensory experiences are unwholesome. New Delhi is a good example. Moving through any space all the senses are stimulated, however movement through space in Delhi overwhelms the senses with unwholesome experiences. These disharmonious experiences add to disharmonious use of the senses and may arguably contribute to India’s growing obesity rates.14 http://www.ayurvedacollege.com/book/export/html/2
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Pollution generation is increasing from construction projects, transportation emissions due to automobiles and waste quantities. The smell of diesel permeates streets. The sound of begging homeless and insistent shop keepers fight to be heard of roaring motor bikes and revving rickshaws. Pedestrians feel gusts of sweltering hot air polluted by the dust of nearby construction sites. The sight of dirt and trash amongst hurrying people moving rapidly through their day pollute the visual senses. The senses are stimulated if not over stimulated by the pungency of life in New Delhi. All of these experiences are primarily rajasic and tamasic, causing unsettling of the mind. Disease starts in the subtler body before manifesting in the physical body and relocating to deeper srotas. It is therefore arguable that these unwholesome sensory experiences contribute to physical disease.16 Case Study of Sensory Experiences in a Developing Rural Area As history demonstrates, people settle in areas where life is viable. Some of the earliest traces of civilization in the Mesopotamia Era near the Nile River demonstrate that. People gather near rich soil and water sources where one of their three basic needs of life, is most easily sustained. Rural towns and villages have a produce output that mirrors or in the case of agriculture towns exceeds, the needs of local people. As a result, locals have access to fresh, unpreserved and natural food sources thereby promoting healthier diet and digestion. With Ayurveda teaching that the root cause of disease is in digestion, arguably rural inhabitants would have less disease as a result of the availability of healthier foods. Examining the obesity and obesity risk rates in metropolitan and rural areas of India demonstrates a drop in incidence in rural populations. A 2001 study concluded that obesity rates in urban Indian slums is growing and in need of timely addressing and public education.1 Likewise the incidence of coronary artery disease, hypertension, and Diabetes Mellitus Type 2, all of which are commonly associated with excess body weight, are significantly more prevalent in urban areas. This increased prevalence is stated to be a result of sedentary lifestyle and higher fat intake.2 It is reasonable to conclude that while growing in incidence, the obesity rates in rural India shadow in comparison to that of metropolitan India. The unique question is what causes that increased fat intake and sedentary lifestyle from an Ayurvedic Perspective. Comparison of Rural and Urban Sensory Experiences When considering the other sensory experiences of rural India, they tend to be more harmonious than that of urban areas. The eyes are exposed to plentiful natural images of trees, plants, the Himalayan mountain range, and other life forms living in their natural habitats. Witnessing the way other organisms live harmoniously in their environments and being surrounded by so many organic life forms, influences the way in which humans live and reinforces that humans thrive in natural environments too. When in a metropolitan city, people lack this experience and live mostly in between concrete and constructed walls, inorganic surroundings. Their eyes are often tired and dry due to the Vata and Pitta doshas prevalent in an urban environment and then lack the nourishing tarpana therapies needed to rejuvenate.8 This causes the metropolitan population to lose touch with nature and consequently, their true nature as spirit. In rural environments, the sense of smell is less synthetically influenced and more from natural sources. The surrounding flowers and plants prevail as well as the daily work performed in livestock, farming and agriculture industries. The rural population is more commonly immersed in plants, animals and produce, all naturally produced products. While the majority of people may consider not all of these smells pleasant, they are all naturally derived smells, which bring people closer to our true nature as spirit. Adversely, in an industrialized urban environment, the smells that prevail are those of city life and work including print cartridges, automobile emissions, mostly artificial and pollutant smells. http://www.ayurvedacollege.com/book/export/html/2
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The sense of hearing in rural India is permeated by animal sounds of nearby cattle and shepherds passing through. The natural sounds of wind and leaves outweigh the motorbikes, rickshaws and buses passing through. In a metropolitan city the opposite is true. While planned cities present parks and opportunities to be immersed in planned natural settings, even so, the sound of transportation and business supersedes. The sense of touch differs in the way people move, interact, and live. The work of rural versus metropolitan Indians differs and results in more harmonious experiences with nature in the rural environment. In cities, people do not touch each other and interact physically. In smaller towns and villages, people are friendlier, more intimate and more often physically interact. It is fair to generalize that the rural population experiences more physical intimate contact than the metropolitan population. A Comparison of Sensory Experiences in France and Los Angeles In France, architecture and planning prevail. French culture relishes aesthetic beauty and takes every opportunity to optimize sensory experiences. Once of France’s bestknown strengths is cuisine. French food contains high quality fresh ingredients. One French ideology is to enjoy and indulge in each experience that we have. Despite the use of whole milk, full cream and rich chocolate ingredients, France has a lower obesity rate compared to America. One different factor is mode of transportation. In cities like Paris, Lyon and Marseille, the three largest cities of France, the majority of the population use public transport for their daily commutes. These cities have planned networks and bus services that cover the entire metropolitan areas creating links between all suburbs and housing areas with most places of employment. Shops and outdoor markets are planned along the way, which many residents reach via walking on their route. By taking the metro, buses and walking to and from work and to achieve most of life’s daily needs, the sensory experience of the French differs greatly from that of Americans. In Los Angeles, the majority of the population travels through town in a car since public transportation is limited, leaving patches of unconnected areas. By creating a sprawling city with limited transport services, the population is additionally forced to sit in traffic in their cars. In the following comparison, we will use a car with closed windows, as that is the most common method of use for modern vehicles. These modes of transportation impact the amount of physical activity required by populations. Sitting in a car as compared to walking to the metro, riding the metro and walking out of the metro deliver very different sensory experiences. Walking provides movement of the body through space allowing nature’s elements like wind, rain and temperature to be felt. Being in a car allows a controlled environment and climate in which nature’s changes are not as greatly experienced due to the protective nature of the vehicle. Additionally, walking through a French city provides an opportunity to smell the plants and trees on the street, wafts of baking baguettes and croissants from boulangeries and dog feces which sprinkle the ground by day’s end. Comparatively, a car will provide a concentrated smell of body odor and possibly car emissions. There is a limited exchange between the natural world and constructed city to the interior of a car than when an individual walks down the road. Conclusion http://www.ayurvedacollege.com/book/export/html/2
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The very nature of our lives makes us susceptible to an everchanging variety of sensory experiences, which affect our elemental makeup, every millisecond. It is within our reasonable control to choose our surroundings. An Ayurvedic lens helps us to decipher what is complementary to our natures. At the same time, some circumstances and situations are more challenging to change. Both the harmonious and disharmonious sensory experiences in our lives affect the incidence of health and disease. Urban planning has the ability to affect disease incidence as a result of the sensory experiences it addresses, creates and alleviates. From waste management and transportation to lifestyle and food sources, urban planning helps provide more harmonious environments. That said, rural life helps even more. Rural living keeps people closer to nature than any urban environment can possibly try. Being in harmony with nature keeps us in sync with our true nature as spirit. When we supersede the sensory distractions that can get in the way of harmonious living life, disease has the ability to disappear. Whether unplanned or planned, rich or poor, rural or urban, the sensory experiences that surround our lives are arguably within our control. If urban environments explored ways to integrate rural lifestyle qualities into its planning and construction, the prevalence of disease would diminish in urban areas. That is not to say that when urban diseases diminish no disease will exist. In the cycle of life and karma we each have lessons to learn and pain and disease to experience as our teachers. By cutting through the disharmonious lifestyles of an urban environment, people may have the opportunity to be even closer to their samskaras and deal with them directly. Though it is also arguable that the disease and disharmonious experiences of an urban environment may be the perfect medicine for some people. As after all, we are all exactly where we need to be and learning the right lessons that we need to learn at any given phase of life. Wherever you live, if you live consciously with awareness for your surrounding and sensory experiences, you can accept the rajas, which will transform, if conscious, into sattwa. If we take the research, the facts and the stories, and bring it into the now, we can live in the present. Bibliography 1. Misra A, Pandey, RM, Devi JR, Sharma R, Vikram NK, Khanna N of The Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, “High prevalence of diabetes, obesity and dyslipidemia in urban slum population in northern India.” International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity (2001, 25(11):17229) http://ukpmc.ac.uk/abstract/MED/11753596/reload=0;jsessionid=BE09C556E9D20A03D3038054C94B1B03 2. “Prevalence of type 2 diabetes mellitus and risk of hypertension and coronary artery disease in rural and urban population with low rates of obesity” by Ram B Singh, Sarita Bajaj, Mohammad A Niaz, Shanti S Fastogl, M Moshiri in The International Journal of Cardiology (September 1, 1998). http://www.sciencedirect.com/science/article/pii/S0167527398001417 3. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Page 325. 4. Yoga Sutras of Patanjali. Sutras 2.54 – 2.55 Pratyahara or Sense of Withdrawal http://swamij.com/yogasutras25455.htm http://www.ayurvedacollege.com/book/export/html/2
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5. Page 3 Chart PPT by Anoop Misra Director, and Head Department of Diabetes and Metabolic Diseases Fortis Hospitals, New Delhi. www.sph.umn.edu/img/assets/25422/Anoop_Misra.pdf. 6. R.K. Sharkma, Bhagwan Dash. Volume 1, Charaka Samhita I:56, Page 41 7. Yoga Sutras of Patanjali. Sutras: 3.13.33: Dharana, Dhyana, Samamdhi http://swamij.com/yogasutras30103.htm 8. Vagbhata’s Astanga Hrdayam. Volume 1, I3.5, Page 283 9. R.K. Sharkma, Bhagwan Dash. Volume 1, Charaka Samhita V:1V:13, Page 105111 10. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Pages 5 6. 11. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Pages 6 7. 12. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Pages 199 – 202. 13. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Pages 4143. 14. Malhotra, Shriya, “Population Health Through Inclusive Urban Planning: Healthier Communities and Sustainable Urban Development in Indian Cities” in Sustainable Development in the Urban Environment (2010). 15. Malhotra, Shriya, “Population Health Through Inclusive Urban Planning: Healthier Communities and Sustainable Urban Development in Indian Cities” in Sustainable Development in the Urban Environment (2010). Page 6. 16. Halpern, Marc Dr., Principles of Ayurveda (Tenth Edition, September 2010). Pages 240 – 245. http://www.ayurvedacollege.com/book/export/html/2
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Prolactinoma and Ayurveda By: Tesia Love An Ayurvedic Interpretation and Approach to the Treatment of ProlactinSecreting Adenoma of the Pituitary Gland INTRODUCTION Prolactinoma, a prolactinsecreting benign tumor (adenoma) of the anterior pituitary gland, is the most common type of pituitary tumor existing in 5 to 10 percent of the adult population1 and accounts for 30 to 40 percent of all pituitary adenomas;2, 3 however, symptomatic prolactinomas are fairly uncommon.4 In those diagnosed with symptomatic prolactinomas and consequently hyperprolactinemia (excess levels of the prolactin hormone in the blood) the condition can impact fertility, libido, vision, and neurological health in both women and men, and affect a woman’s bone health.2 Prolactinomas are four to five times more common in women than in men.5 In a healthy, nonpathological woman prolactin, also known as luteotropic hormone or luteotropin, is responsible for the growth and development of breasts during pregnancy and the initiation and sustained production of breast milk following delivery (provided that a woman nurses).4 In men, the normal role of prolactin is unclear, but it is suspected to play a role in male fertility.6 ETIOLOGY Pituitary tumors, including prolactinsecreting adenomas, “develop from one single abnormal cell that multiplies into many abnormal cells, eventually forming a tumor.” 3 The cause for this development is unknown, but prolactinoma has been suspected to be caused by the genetic condition Multiple Endocrine Neoplasmia Type 1 in some patients.2 Most often, prolactinomas are considered sporadic and therefore not genetic.4 In addition, there is animal research to support speculation of the role of estrogen and xenoestrogen bisphenolA in the development of prolactinomas.7, 8 Once a prolactinsecreting adenoma has formed, it is likely to cause hyperprolactinemia. While other conditions can cause hyperprolactinemia such as other pituitary tumors that may block the flow of dopamine from the hypothalamus to the pituitary gland (dopamine is responsible for inhibiting prolactin in men and women), liver failure, kidney failure, some medications, stress and hypothyroidism1, 12 prolactinomas account for about 30 percent of hyperprolactinemia cases.9 SYMPTOMS Symptoms of prolactinoma vary for men and women and vary depending on whether or not the prolactinoma is of micro size (<10 mm) or macro http://www.ayurvedacollege.com/book/export/html/2
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size (>10 mm). Women may experience the following:2, 7 ● ● ● ● ● ● ●
Amenorrhea (Secondary) or Oligomenorrhea (absence or irregularity of menses not associated with pregnancy or menopause) Galactorrhea (Lactation not associated with pregnancy or recent childbirth) Infertility Breast Tenderness Low Libido Headaches, particularly between the eyebrows (More likely with macroadenoma) Vision Changes (More likely with macroadenoma)
Men may experience the following symptoms as well:2, 7 ● ● ● ● ● ●
Low Libido Infertility Gynecomastia (Enlargement of breast tissue) Impotence Headaches (More likely with macroadenoma) Vision Changes (More likely with macroadenoma)
Normally, hypothalamic dopamine inhibits the secretion of prolactin in a woman who is not pregnant or nursing; however, high levels of prolactin in the blood due to a secreting adenoma or nipple stimulation block the secretion of dopamine and therefore prolactin levels remain elevated. High prolactin levels also inhibit the release of luteinizing hormone releasing hormone (LHRH) from the hypothalamus and therefore inhibit the secretion of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the pituitary gland to the ovaries, thereby inhibiting ovulation and the menstrual cycle. Also as a result, low estrogen levels inhibit libido in women. Low LHRH secretion in men results in abnormal testicular function and therefore low testosterone levels, low libido, and decreased fertility.5 Prolactinomas greater than 10 mm in size (macroadenomas) can potentially press upon the optic nerve and/or invade the cavernous or sphenoid sinuses (location of the trigeminal nerve) causing headaches and vision changes.18 Various types of headaches are possible, including cluster headaches or shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Headaches are also possible in patients with prolactinoma despite tumor size.11, 19 DIAGNOSIS A diagnosis of prolactinoma is made with blood tests showing elevated levels of prolactin on at least two occasions. Normal prolactin levels in both men and women who are not pregnant or nursing is 0 to 20 ng/ml. Microadenomas are suspected with the presentation of moderately elevated levels of prolactin at 30 to 200 ng/ml. Macroadenomas usually present prolactin levels at over 500 ng/ml.1 Diagnosis is confirmed with a magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan to “define the presence of a lesion compatible with a pituitary tumor.” 12 http://www.ayurvedacollege.com/book/export/html/2
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WESTERN TREATMENT In Western medicine, the first line of approach to treating both symptomatic micro and macro secretingprolactinomas is dopamine agonist drugs, including bromocriptine, pergolide, quinagolide, and cabergoline. These drugs mimic dopamine, and when given at the appropriate dosage, they normalize prolactin levels. Some patients will experience not only the normalization of prolactin levels, but also tumor shrinkage as a result of the medication. Consequently, such patients may be able to decrease their dosage over time and even cease taking medication after several years of treatment; however, the tumor may grow back.12, 2 Some patients have to take dopamine agonist drugs for life in order to manage the condition. Under proper care, all patients are monitored regularly with blood testing and imaging.2 Side effects of the listed dopaminergic drugs may include dizziness and nausea.2 In addition, the efficacy of the drugs may decrease with longterm use, so for both reasons, patients are started on low doses with dosage increased as needed. Most patients are able to tolerate these drugs, particularly cabergoline and quinagolide, but there are some people who are unable, and therefore, have to defer to other treatment options.13 Surgery and radiotherapy are the other two treatment options when a patient refuses or fails to respond well to pharmaceuticals.12, 2 Side effects of surgery may include damage to the normal tissue of the pituitary gland resulting in diabetes insipidus or the need for hormone replacement therapy. Other rare side effects of surgery may include postoperative bleeding, spinal fluid leak, stroke, or death.17 During pregnancy, a woman’s pituitary gland increases in size and prolactin levels naturally rise significantly and progressively as it prepares the breasts for lactation.1, 5 Since the dopamine agonists used to treat prolactinoma and hyperprolactinemia suppress prolactin levels in the blood, special consideration must be given to female patients who become or wish to become pregnant while being treated for both conditions.2 Research shows that dopamine agonists, particularly bromocriptine and cabergoline, do not pose adverse effects to babies born from mothers who were treated with these drugs even during the first trimester of pregnancy.16 “In women with microadenomas, pregnancy generally has little impact on their adenoma, delivery is normal and breastfeeding is allowed.” 15 However, as soon as pregnancy is suspected, women are taken off of the medication. AYURVEDIC INTERPRETATION An Ayurvedic interpretation of the development and treatment of prolactinsecreting adenoma of the pituitary gland can be inferred from the Ayurvedic understanding of anatomy, tissue development, and doshic qualities. Considering first the location of the pituitary gland being in the head, particularly the brain, what is the significance of the head? Chapter 17, verse 12 of the Charaka Samhita states, “the head is the substratum of elan vital and all the sense faculties. So it occupies the first place amongst the vital organs of the body.” 27 This is in alignment with the western, scientific understanding of the the brain as the control center of the body, including the pituitary gland, which is referred to as the master gland.3 Being a part of the nervous system, Ayurveda considers the brain to be majja dhatu and part of the majjavaha srota. As stated in Principles of Ayurvedic Medicine by Dr. Marc Halpern, “the majja dhatu is commonly translated to mean the nervous system. However, the majja dhatu really relates to anything that fills an empty hollow space.” The pituitary gland is located in the base of the brain in a small, bony cavity (hollow space) of the skull called the sella turcica.3 Other relevant tissues involved in the condition of prolactinoma and majja dhatu include the optic nerve, which may be compressed by a macroprolactinoma, and the neurotransmitter dopamine (also considered part of the nervous system and thus majja http://www.ayurvedacollege.com/book/export/html/2
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dhatu). The Ayurvedic explanation of dhatu formation agrees with the western, scientific understanding of the impact of pituitary gland dysfunction on the reproductive system. As the sixth dhatu, majja dhatu precedes the formation of shukra dhatu (ovaries and testes) and therefore, provides the posaka (unstable) majja to the shukra agni to transform posaka majja into shukra.28 If the formation of majja dhatu and posaka majja is of poor quality or there is faulty shukra agni, then the formation quality, quantity and function of shukra and artava dhatu will be disturbed. Dr. Sarita Shrestha notes that while classical Ayurvedic texts do not refer to hormones, hormones are considered to be dhatu agni.20 This makes sense given the role of hormones as transformational signals and metabolic directors to other sites of the body. Thus, prolactin could be considered shukra dhatu agni or artava dhatu agni. Milk ducts, the stanyavaha srota, originate in the artava dhatu. Classical Ayurvedic texts do not specifically discuss pituitary tumors or pituitary hormones; however, volume two of the Sushruta Samhita discusses the development and treatment of tumors (Gulma and Arbuda/Arvuda) and glandular swellings (Granthi).20, 21, 22, 23, 24, 25, 26 More specifically, gulma is understood to refer to hard, palpable masses in the abdomen (abdominal tumors), granthi refers to glandular swellings, benign tumors, or a tumor that is visible from the surface, and arbuda refers to a cancerous malignancy.29 Chapter 11, verses 11 12 of the Sushruta Samhita, volume two states, “the large vegetation of flesh which appears at any part of the body, becomes slightly painful, rounded, immovable and deepseated, and has its root sunk considerably deep in the affected part, and which is due to the vitiation of the flesh and blood by the deranged and aggravated doshas is called an arbuda (tumor) by the learned physicians. The growth of an Arbuda is often found to be slow, and it seldom supperates [form or discharge pus]. The characteristic symptoms of an Arbuda which owes its origin to the deranged condition of the vayu, pitta, kapha, flesh or fat, are respectively identical with those, which mark the cases of Granthis, brought about by the same deranged principles of the body.” 24 Benign tumors, such as pituitary adenomas, are slow growing.30 Hence, one can infer from Sushruta that a prolactinoma is an arbuda or granthi. In considering the subtle body, it is likely that the ajna chakra (6th) may play a role in the pathology and/or treatment of prolactinoma and other pituitary adenomas. The ajna (“third eye”) chakra, “is the command station of the body and mind … contains the subtle qualities of ether … [and] affects the functions of the pituitary gland and hypothalamus.” 28 Increased flow through this chakra correlates to excess function of the pituitary and hypothalamus glands. SAMPRAPTI (PATHOLOGY) “From an Ayurvedic perspective, tumor formation is a condition of vata/kapha origin. Vata is responsible for the faulty division of cells and kapha for their growth. Hence, vata pushes kapha out of balance resulting in tumor formation. Benign tumors take on a predominantly kapha appearance,” writes Dr. Halpern. He continues, “Kapha plays the predominant role [in the development of granthi benign tumors] as it enters the affected dhatus.” 29 Considering the potential role of vata, even in the development of a benign tumor, apana vayu accumulates and becomes aggravated in the rasa of the purishavaha srota and overflows to the rasa and rakta dhatus of the rasavaha and raktavaha srotas respectively. Prana vayu (of the http://www.ayurvedacollege.com/book/export/html/2
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head) and vyana vayu (“plays a role in the movement of the nerve energy”28) relocate to the majja dhatu of the majjavaha srota causing cell division (movement). Given that kapha (water and earth) is “the force of stability in the body,” is responsible for growth, and plays a lead role in the development of a benign tumor, kledaka kapha accumulates and becomes aggravated in the rasa of the annavaha srota, and overflows to the rasa and rakta dhatus of the rasavaha and raktavaha srotas respectively.28 Kapha then relocates to the majja dhatu of the majjavaha srota resulting in abnormal tissue growth (tumor) of lactotrophs of the anterior pituitary gland (majja). According to the Sushruta Samhita, Chapter 11, verse 2, “the deranged and unusually aggravated vayu, etc. (pitta, kapha), by vitiating the flesh, blood and fat mixed with the kapha (of any part of the organism), give rise to the formation of round, knotty, elevated swellings which are called granthi (glandular inflammation).” In chapter 11, verses 3 5 “...the kaphaja granthi is slightly discolored and cold to the touch. It is characterised by a slight pain and excessive itching, and feels hard and compact as a stone. It is slow or tardy in its growth and exudes a secretion of thick whitecoloured pus when it bursts.” 26 While Sushruta’s account of granthi formation does not fully explain the development of a pituitary tumor, it does suggest the kaphogenic development of a slowgrowing tumor. As a result of the benign pituitary tumor and increase in prolactin secretion, symptoms (rupa) follow that result in further kapha and vata vitiation in other dhatus and srotas, including: ● Nonpregnancy/nursing Related Lactation: Tarpaka and avalambaka kapha relocates to the rasa dhatu of the stanyavaha srota. ● Irregular/Scanty Menses (Nashta Rakta): Excess shukra dhatu agni (hyperprolactinemia) “burns up” or depletes shukra dhatu allowing apana vayu to flow into the artavavaha srota resulting in anovulation and a lack of menses. Vata (apana) may then relocate to asthi dhatu of the asthivaha srota resulting in decreased bone health and possible osteoporosis if left untreated.4 Vata may also relocate to the rasa dhatu of the artavavaha srota causing vaginal dryness, a possible side effect of anovulation and reproductive hormonal imbalance.4 ● Headaches (Shiro Roga) and Vision Changes: Tarpaka kapha in the majja of the majjavaha srota (pituitary tumor) obstructs the majja (optical nerve and other cranial structures) resulting in vata pain and deranged alochaka pitta leading to vision changes. NIDANA (CAUSES) Referring to kaphogenic diseases of the head, chapter 17, verses 24 25 of the Charaka Samhita states, “by sedentary habits, sleep during the daytime (when it is not desirable), excessive intake of heavy and unctuous food, the kapha of the head gets vitiated and causes headdisease.” 31 Considering the samprapti, the nidana of a benign tumor (arbuda/granthi) of the majja dhatu in the majjavaha srota includes: Possible Vata Nidana ● ● ●
Vataaggravating diet Excess intake of cold, dry and light foods Irregular routines
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Likely Kapha Nidana ● ● ● ●
Kaphaaggravating diet Excess intake of heavy, unctuous, cold food Sedentary habits Sleep during the daytime
SADHYASYATA (PROGNOSIS) An arbuda/granthi of the majja dhatu in the majjavaha srota (benign, prolactinsecreting tumor of the pituitary gland) is difficult to cure, not only from a western medical perspective, but also from an Ayurvedic perspective. Prolactinoma potentially involves the vitiation of two doshas in the sixth dhatu layer (majja).28 According to Sushruta, a benign pituitary tumor is incurable. The Sushruta Samhita, Chapter 11, verses 17 18, volume two states, “... the following types of arbuda (tumors) should be likewise regarded as incurable, those which appear in the cavity of a srota channel or an artery, or any vulnerable point of the body and are characterised by any sort of secretion and also immovable, should be deemed incurable. … An arbuda of whatsoever type, never suppurates owing to the exuberance of the deranged kapha and fat as well as in consequence of the immobility, condensation and compactness of the deranged doshas.” As stated earlier, the pituitary gland resides in the cavity of the sella turcica.3 Indeed, some patients require lifelong, western pharmaceutical treatment in order to manage their prolactinoma.32 CHIKITSA (TREATMENT) Despite the prognosis of ‘difficult to treat or cure’, and even potentially ‘incurable’, Ayurveda provides possibilities for cure, including approaches to tumor reduction and the management of prolactinemia. Sushruta (volume two, chapter 18, verses 28 40) presents an array of possibilities for the treatment of arbuda; however, all of the treatments presented call for external applications directly to the tumor.26 This approach is not applicable in the case of pituitary tumors. As with any Ayurvedic treatment, the first step is to clear ama (toxicity) and regulate agni (digestive fire). If the patient is strong enough, the patient should undergo panchakarma (langhana chikitsa) to clear ama and alleviate excess kapha and vata doshas from the body. Following purvakarma, an emphasis of vamana, niruha and anuvasana basti, and nasya therapies should be considered. Nasya is likely to be a very effective therapy in order to remove vitiated doshas from the head. If a patient is not strong enough, a palliative approach to clear ama and regulate agni should be taken (shamana chikitsa).28 Following shodhana chikitsa (langhana or shamana chikitsa) and samsarjana krama, a variety of kaphapacifying dietary, lifestyle, herbal and body therapies should be considered in the Ayurvedic treatment of prolactinoma. Care must also be taken to prevent vata vitiation. http://www.ayurvedacollege.com/book/export/html/2
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In addition to directing treatment to emphasize tumor reduction (kapha pacification), the management of prolactin levels with dopaminergic herbs should also be a part of treatment if a patient is not managing prolactin with an integrative approach that includes western, dopaminergic drugs. Diet, Lifestyle and Sensory Therapies in the Treatment of Prolactinoma In order to reverse the nidana, a kaphapacifying diet should be followed and include an emphasis on bitter and pungent tastes. A lifestyle including stable routines (to manage vata), no oversleeping, and exercise (including kaphapacifying yoga asana) should be followed. Appropriate body therapies in addition to nasya may include medicated shiro basti and shirodhara using light oils, such as safflower. Abhyanga, along with anuvasana basti, will also be important for managing vata. Aroma therapies may include the use of frankincense, which has been shown (boswellia sacra) to have antitumor properties.34 Other kapha pacifying essential oils to consider include, myrrh, basil, wintergreen and cinnamon. Chromotherapies may include exposure to the kaphavata reducing colors of yellow and green as well as the balancing effects of the color gold.28 Given Ayurveda’s comprehensive approach to treatment that addresses mind, body and spirit, other subtle therapies to be considered include daily meditation, visualization of a healthy pituitary gland and tumor shrinkage, alternatenostril breathing for balancing nadi flow, and the chanting of all seven bija mantras (if the patient’s ojas is strong). The chanting of kshum (6th chakra bija mantra) to balance the ajna chakra may also be helpful due to the chakra’s connection to the hypothalamus and pituitary gland.28 Therapeutic Herbs in the Treatment of Prolactinoma and Hyperprolactinemia Dr. David Frawley explains in Ayurvedic Healing that the herbal treatment for cancer should include all of the following categories of action: alteratives, circulatory stimulants, immune strengthening tonics, expectorants, and strong bitter or pungent herbs with fatreducing and toxin destroying properties.33 While prolactinoma is not regarded as cancerous,4 an herbal, anticancer approach should prove beneficial in efforts to reduce tumor size or growth. All of the herbal categories Frawley mentions have antitumor properties.36 Dr. A. A. Mundewadi is Chief Ayurvedic Physician at Mundewadi Ayurvedic Clinic based at Thane, Maharashtra, India. He states, “pituitary gland tumors (which secrete excess prolactin) may be treated with Kanchnaar Guggulu, Panch Tikta Ghruta Guggulu, Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), Mogra (Jasminum sambac) and Musta (Cyperus rotundus).” 38 Given that symptoms of prolactinoma, such as amenorrhea, galactorrhea, and impotence are the result of the secreting pituitary adenoma, the focus of herbal treatment for prolactinoma should be placed on tumor reduction and managing prolactin levels. This is likely to be best achieved with microadenoms. Macroadenoms may require western medical treatment depending on the severity of symptoms, such as headaches and vision changes from nerve compression. In addition to a variety of kaphapacifying, reducing herbs, the following herbs should be especially considered for tumor reduction:35, 36 http://www.ayurvedacollege.com/book/export/html/2
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Guggulu Rasa: Bitter, Pungent, Astringent Virya: Warming Vipaka: Pungent (Reducing) Guna: Light, Penetrating, Dry Doshic: VPK (P+ in excess) Dhatus: All tissues Srotas: Circulatory, Digestive, Nervous, Respiratory Actions: Antiinflammatory, antiplatelet, anticholesterolaemic, astringent, antiseptic, immune stimulant, emmenagogue, Uses: Clears ama, Penetrates deeply into the tissues, menstrual irregularities, tumors Contraindication: Pregnancy, Breastfeeding Kanchanar Rasa: Bitter, Astringent Virya: Cold Vipaka: Pungent Guna: Dry, Light Doshic: K, P , V+ Dhatus: Blood, Muscle, Fat, Bone, Reproductive Srotas: Female Reproductive Actions: Lymphatic, alterative, astringent, haemostatic, vulnerary, uterine tonic, antispasmodic, emetic, expectorant, antiinflammatory Uses: Tumors and Glandular Swellings(All forms of swellings, lumps, growths), Fibroids, Endometriosis, Cysts Contraindications: Pregnancy, Constipation Kanchanar Guggulu Formula Rasa: Virya: Vipaka: Guna: Doshic: Dhatus: Srotas:
Bitter, Astringent, Sweet, Pungent Heating Pungent Dry, Light K, VPK= Plasma, Blood, Fat, Bone, Reproductive Circulatory, lymphatic, eliminator
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Actions: Antiinflammatory, lymphatic, antitumour, antiplatelet, diuretic, reduces cholesterol, alterative, decongestant Uses: Destroys ama, tumors, growths and cancers, Formula Includes: Kanchanar, Triphala (amalaki, haritaki, bibhitaki), Trikatu (black pepper, long pepper, ginger), Varuna, Cardamom, Guggulu, Cinnamon “Growths: Kañcanara guggulu is a specific for clearing all growths and fluidbased accumulations in the body. It specifically reduces swellings and lumps(soft/hard/palpable/fixed/moveable)by drying the excess kapha. It is a favoured formula used in cancer caused by excess kapha. Also consider it in anal fistulas,abscesses and chronic skin lesions.” Sebastian Pole 35 The following herbs should be especially considered for inhibiting prolactin:35, 37, 39, 40, 41 Vitex (Chasteberry) (Agnus Castus) Rasa: Bitter, Pungent, Astringent Virya: Cooling and Warming Guna: Dry Actions: Emmenogogue, Vulnerary, Dopaminergic, Progesteronic, Uses: PMS, Menstrual Irregularities, Menopause, Ovarian Cysts, Breast Lumps, Prolactinoma. Contraindications: Pregnancy, Breastfeeding Note: Minimal chronic known toxicity. Kappikacchu (Cowhage) (Mucuna pruriens–Semen) Rasa: Virya: Vipaka: Guna: Dosha: Dhatu: Srota: Actions: Uses:
Sweet, Bitter Hot Sweet Unctuous, Heavy VP, K+ All tissues, especially nerve and reproductive Nervous, reproductive, digestive Aphrodisiac, Antispasmodic, Carminative, Dopaminergic Parkinson’s Disease, Low Libido, Impotence, Spermatorrhea
While kappikacchu is dopaminergic and research show that it may have an inhibitory effect on prolactin, it is kapha increasing, so may not be ideal for prolactinoma. It may be better used for other hyperprolactinemia conditions. http://www.ayurvedacollege.com/book/export/html/2
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CONCLUSION Ayurveda, whether used as a complementary approach to the allopathic treatment of prolactinoma or as an alternative, offers the possibility of complete healing. This is especially true for those with microprolactinomas and moderate prolactin elevation. As a complementary approach, Ayurveda can support healing by reversing the nidana and alleviating vitiated kapha and vata while a patient stabilizes his or her prolactin levels with prescription drugs. As an alternative approach, Ayurveda offers another option to those who have adverse reactions to pharmaceutical medication, lack insurance, or simply refuse to use allopathic treatment. By addressing diet, sleep, daily routines, mediation, exercise, and other lifestyle choices, Ayurveda leaves no aspect of living unaccounted for. Everything we do, consume, think, speak, or say has an influence on our health and can either encourage disease or promote healing. The comprehensive, healing protocols of Ayurveda offer sufferers of prolactinoma a proactive role in their healing that goes beyond taking daily medication, getting yearly MRIs and hoping for the best. Symptoms of prolactinoma and hyperprolactinemia nashta rakta (amenorrhea) or oligomenorrhea, inappropriate lactation (galactorrhea), shiro roga (headaches), vision changes, infertility, and/or low libido can result from various other causes. If these symptoms appear, especially together, a medical evaluation is required to confirm (or rule out) hyperprolactinemia and the presence and size of a secretingpituitary adenoma. Due to the consequences of abnormally high prolactin levels (infertility, increased risk of osteoporosis, low libido, possible tumor growth), an integrative approach to care, combining allopathic and Ayurvedic medicine, should be taken in order to monitor prolactin levels and tumor size. Herbal management of prolactin may be tried for a period of time before a patient is put on cabergoline or another dopamine agonist while using Ayurvedic approaches to clear ama, restore agni and alleviate vitiated doshas to reduce tumor size. Many questions remain to fully understand the cause and treatment of prolactinoma, including: ● How may estrogen play a role in the development of prolactinoma? ● What is the comparative analysis of those diagnosed with prolactinoma (noting tumor size) and their exposure to xenoestrogen? ● What is the comparative analysis of those diagnosed with prolactinoma (noting tumor size) and their prakruti and vikruti at the time of diagnosis? ● What are the effects of vitex on estrogen, progesterone and prolactin at varying dosages? ● What are the effects of kanchanar, guggulu, and/or kanchanar guggulu on tumor size? According to the Neuroendocrine Clinical Center at the Massachusetts General Hospital, “Autopsy studies indicate that 25 percent of the U.S. population have small pituitary tumors. Forty percent of these pituitary tumors produce prolactin, but most are not considered clinically significant. Clinically significant pituitary tumors affect the health of approximately 14 out of 100,000 people.” 42 While the number of those affected with prolactinoma is small, each individual life is significant and optimal health is a birthright for all, therefore, further research and contemplation is needed from both an allopathic and Ayurvedic perspective to more fully understand and better treat prolactinoma.
APPENDICES APPENDIX I Endnotes http://www.ayurvedacollege.com/book/export/html/2
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APPENDIX II Samprapti Chart APPENDIX III Clinical Abstracts APPENDIX I ‐ ENDNOTES
1 Pituitary Network Association, PNA Staff. https://www.pituitary.org/library/disorders.aspx?page_id=1053 2 Medline Plus, Nancy J. Rennert, MD, Updated December 11, 2011. http://www.nlm.nih.gov/medlineplus/ency/article/000336.htm 3 American Brain Tumors Association, ABTA Staff. Pituitary Tumors Brochure PDF. http://www.abta.org/secure/pituitarytumorsbrochure.pdf 4 National Endocrine and Metabolic Diseases Information Service, Staff, Updated April 6, 2012. http://endocrine.niddk.nih.gov/pubs/prolact/prolact.aspx#common 5 Britannica, Robert D. Utiger, Prolactin and Prolactin Deficiency and Excess, http:// www.britannica.com/EBchecked/topic/478570/prolactin 6 Fraioli F, Paolucci D, Dondero F, Spera G, Isidori A. “Prolactin secreting adenoma in man and the role of prolactin in spermatogenesis.” Journal of Endocrinological Investigation. 1980 Apr Jun;3(2):15561. http://www.ncbi.nlm.nih.gov/pubmed/7391522 7 Kipak K. Sarkar, “Genesis of Prolactinomas: Studies Using EstrogenTreated Animals,” Pituitary Today: Molecular, Physiological and Clinical Aspects. Front Horm Res. Basel, Karger, 2006, vol 35, pp 3249 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882189/ 8 Tatiana Goloubkova, Maria Flávia M. Ribeiro, Luciene P. Rodrigues, Ana L. Cecconello and Poli Mara Spritzer, “Effects of xenoestrogen bisphenol A on uterine and pituitary weight, serum prolactin levels and immunoreactive prolactin cells in ovariectomized Wistar rats.” Archives of Toxicology, Vol. 74, Number 2 (2000), 9298. http://www.springerlink.com/content/01mqcap3wwbw1umk/ 9 American Society for Reproductive Medicine, Hyperprolactinemia Fact Sheet, Staff. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/Prolactin_Excess.pdf 10 Nomikos P, Buchfelder M, Fahlbusch R. “Current management of prolactinomas.” Journal of NeuroOncology, 2001 Sep;54(2):13950. http://www.ncbi.nlm.nih.gov/pubmed/11761431 11 M. J. Levy, M. S. Matharu, K. Meeran, M. Powell, and P. J. Goadsby. “The clinical characteristics of headache in patients with pituitary tumours.” Brain: A Journal of Neurology. (August 2005) 128 (8):19211930. http://brain.oxfordjournals.org/content/128/8/1921.full http://www.ayurvedacollege.com/book/export/html/2
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12 Verhelst J, Abs R. “Hyperprolactinemia: pathophysiology and management.” Treatments in Endocrinology. 2003;2(1):2332. http://www.ncbi.nlm.nih.gov/pubmed/15871552 13 Ciccarelli E, Camanni F. “Diagnosis and drug therapy of prolactinoma.” Drugs. 1996 Jun;51(6):95465. http://www.ncbi.nlm.nih.gov/pubmed/8736617 14 Syed Ali Imran, Ehud Ur, and David B. Clarke. “Managing ProlactinSecreting Adenomas During Pregnancy.” Canadian Family Physician. April 2007 vol. 53 no. 4 653658. http://www.cfp.ca/content/53/4/653.full 15 ChristinMaître S, Delemer B, Touraine P, Young J. “Prolactinoma and estrogens: pregnancy, contraception and hormonal replacement therapy.” Annales d’Endocrinologie (Paris). 2007 Jun;68(23):10612. Epub 2007 May 30. http://www.ncbi.nlm.nih.gov/pubmed/17540335 16 The Pituitary Society, Staff. Fertility Issues. http://www.pituitarysociety.org/public/specific/prolactinoma/fertility.aspx 17 Massachusetts General Hospital Neuroendocrine Clinical Center. Frequently Asked Questions About Transsphenoidal Surgery For Pituitary Adenomas: A Patient Guide. http://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm 18 University of Michigan Health System: Prolactinoma. Staff. http://www.med.umich.edu/1libr/aha/umneuro_prolactinoma.htm 19 Pituitary Network Association, By Peter N. Riskind, M.D., Ph.D. Headaches and Pituitary Tumors. https://www.pituitary.org/library/library_detail.aspx?page_id=1284 20 Dr. Sarita Shrestha: Women’s Health. http://www.saritashrestha.org/women.html 21 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Series Office, 2nd Edition. 2000) Chapter 9, Verses 28 29 22 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Series Office, 2nd Edition. 2000) Chapter 9, Verses 30 33 23 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Series Office, 2nd Edition. 2000) Chapter 11, Verses 2 5 24 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Series Office, 2nd Edition. 2000) Chapter 11, Verses 11 12 25 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Series Office, 2nd Edition. 2000) Chapter 11, Verses 17 18 26 Sushruta. Sushruta Samhita Volume II (Varanasi: Chowkhamba Sanskrit Studies Office, 2nd Edition. 2000) Chapter 18, Verses 28 40 27 Charaka. Charaka Samhita Volume I (Varanasi: Chowkhamba Sanskrit Studies Office.) Chapter 17, Verse 12 http://www.ayurvedacollege.com/book/export/html/2
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28 Marc Halpern, DC, CAS, PKS. Principles of Ayurvedic Medicine, 10th Ed. Pg. 81, 9495, 144, 219, 229, 334 29 Marc Halpern, DC, CAS, PKS. “Managing Cancer, Part II: Ayurvedic Knowledge and Holistic Therapy” Textbook of Clinical Ayurvedic Medicine Part II. 2003. Pg. 1, 4 30 Benjamin Frank Miller. MillerKeane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health (WB Saunders Company. 1997, Sixth Edition). Pg. 1667 31 Charaka. Charaka Samhita Volume I (Varanasi: Chowkhamba Sanskrit Studies Office.) Chapter 17, Verse 24 25 32 Colao A. “Pituitary tumours: the prolactinoma.” Best Practice and Research: Clinical Endocrinology and Metabolism. 2009 Oct;23(5):57596. http://www.ncbi.nlm.nih.gov/pubmed/19945024 33 David Frawley. Ayurvedic Healing: A Comprehensive Guide, 2nd edition. (Twin Lakes: Lotus Press. 2000) Pg. 286 287 34 Mahmoud M Suhail, Weijuan Wu, Amy Cao, Fadee G Mondalek, KarMing Fung, PinTsen Shih, YuTing Fang, Cole Woolley, Gary Young, and HsuehKung Lin. “Boswellia sacra essential oil induces tumor cellspecific apoptosis and suppresses tumor aggressiveness in cultured human breast cancer cells” BioMedCentral Complementary and Alternative Medicine. 2011; 11: 129. Published online 2011 December 15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258268/ 35 Sebastian Pole. Ayurvedic Medicine: The Principles of Traditional Practice (London/Philadelphia: Churchill, Livingstone, Elsevier, 2006) Pg. 191 192, 204 205, 306 307 36 Dr. David Frawley and Dr. Vasant Lad. The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 2nd Edition. (Twin Lakes: Lotus Press 1986, 2001) Pg. 33, 39, 49, 56, 63 37 Sliutz G, Speiser P, Schultz AM, Spona J, Zeillinger R. “Agnus castus extracts inhibit prolactin secretion of rat pituitary cells.” Hormone and Metabolic Research (University of Vienna, Austria). 1993 May;25(5):2535. http://www.ncbi.nlm.nih.gov/pubmed? term=vitex%20agnus%20pituitary%20gland 38 Dr. Abdulmubeen Mundewadi. Female Infertility Ayurvedic Herbal Treatment. http://ezinearticles.com/?FemaleInfertilityAyurvedic HerbalTreatment&id=1486596 39 Leblanc H, Yen SS. “The effect of Ldopa and chlorpromazine on prolactin and growth hormone secretion in normal women.” American Journal of Obstetrics and Gynecology. 1976 Sep 15; 126(2): 1624. http://www.ncbi.nlm.nih.gov/pubmed/961756 http://www.ayurvedacollege.com/book/export/html/2
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40 Peter Holmes. The Energetics of Western Herbs: Treatment Strategies Integrating Western and Oriental Medicine, Volume Two, 3rd Edition. (Boulder: Snow Lotus Press, 1997) Pg. 597 599 41 Michael Tierra. Planetary Herbology. (Twin Lakes: Lotus Press, 1988) Pg. 282 42 Massachusetts General Hospital Neuroendocrine Clinical Center. Prolactinoma Resources. http://pituitary.mgh.harvard.edu/prolacti.htm APPENDIX II SAMPRAPTI CHART RUPA
SAMPRAPTI DOSHA SUBDOSHA DHATU
DHATU SROTA Incr/Decr
HERBS
PPM Sluggish Digestion & Nausea
A/A
Kapha
Kledaka
Rasa
Increase
Annavaha
Dipanas
MT Systemic Swelling
O
Kapha
N/S
Rasa
Increase
Rasavaha
Diuretics Diaphoretic
MT Lethargy & Pale
O
Kapha
N/S
Rakta
Increase
Raktavaha
Circulatory Stimulans
Growth of anterior pituitary adenoma
RMD
Kapha
Tarpaka
Majja
Increase
Majjavaha
Antitumor
Non pregnancy related breast lactation
RMD
Kapha
Rasa
Increase
Majjavaha
Anti galactogues
Medas
Increase
Male breast tissue
RMD
http://www.ayurvedacollege.com/book/export/html/2
Kapha
Tarpaka Avalambaka
Avalambaka
Stanyavaha
Medovaha
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growth
Rakta
Increase
Raktavaha
Alteratives
PPM Constipation A/A & Gas
Vata
Apana
Rasa
Decrease
Laxatives Purishavaha Demulcents Carminative
MT Systemic Dryness
O
Vata
Vyana
Rasa
Decrease
Rasavaha
Demulcents
MT Feeling cold & fatigue
O
Vata
Vyana
Rakta
Decrease
Raktavaha
Circulatory Stimulants
Decrease
Shukravaha (Men) Artavaha
Emmenogogues Reproductive Tonics, Demulcents
Irregular and/or Absence of Menses, Low libido
RMD
Vata
Apana
Vaginal Dryness
RMD
Vata
Vyana
Shukra
Decrease
Artavaha
Demulcents
MT Bone weakness RMD (risk for osteoperosis
Vata
Apana
Asthi
Decrease
Asthivaha
Bone Tonics
Shukra Artava
APPENDIX III CLINICAL ABSTRACTS 6 Fraioli F, Paolucci D, Dondero F, Spera G, Isidori A. “Prolactin secreting adenoma in man and the role of prolactin in spermatogenesis.” Journal of Endocrinological Investigation. 1980 Apr Jun;3(2):15561. http://www.ncbi.nlm.nih.gov/pubmed/7391522 Abstract The case of a 23yearold man with a pituitary prolactin secreting adenoma is described. With the exception of prolactin all endocrinological parameters were normal. This finding provided an ideal opportunity to assess the role of prolactin on spermatogenesis. Sperm analysis and light microscopy examination of testicular biopsy showed normal spermatogenesis. Electron microscopic studies of the testicular specimen revealed the http://www.ayurvedacollege.com/book/export/html/2
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presence of undivided spermatids, containing two or more nuclei, partially embedded in a developing common acrosome. Morphological studies demonstrated a constant "paired" situation. In most instances two sperms were contained in a single membrane; no single sperm was detected. Following treatment with 5 mg/day bromocriptine prolactin levels decreased and this peculiar abnormality disappeared. In fact, after 2 months of treatment the sperm abnormalities were markedly reduced, whereas no change was found after a period of 120 days. Since this was the only alteration found in the patient with high prolactin levels, a correlation was sought between prolactin levels and cell division. Considering the similarities between prolactin and growth hormone, it might be possible to attribute to prolactin a growth hormone role in the germinal epithelium. This action could be either direct or indirect via an intermediate growth factor. 7 Kipak K. Sarkar, “Genesis of Prolactinomas: Studies Using EstrogenTreated Animals,” Pituitary Today: Molecular, Physiological and Clinical Aspects. Front Horm Res. Basel, Karger, 2006, vol 35, pp 3249 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882189/ Abstract Prolactinsecreting adenomas (prolactinomas) are the most prevalent form of pituitary tumors in humans. Our knowledge of the formation of these tumors is limited. Experimental work in animal has uncovered that estradiol exposure leads to prolactinoma formation via orchestrated events involving dopamine D2 receptors, transforming growth factorβ (TGFβ) isoforms and their receptors, as well as factors secondary to TGFβ action. Additionally, these studies determined that TGFβ and bFGF interact to facilitate the communication between lactotropes and folliculostellate cells that is necessary for the mitogenic action of estradiol. The downstream signaling that governs lactotropic cell proliferation involves activation of the MAP kinase p44/42dependent pathway. Pituitary tumors are primarily adenomas; they account for approximately 10–15% of intracranial tumors. They cause significant morbidity due to local invasion, hypopituitarism or hormone hypersecretion [1, 2]. Pituitary tumors are classified as either functioning and secreting excessive amounts of active hormones, or as endocrinologically inactive and secreting no hormones or inactive hormones. Pituitary tumors are also classified by virtue of their size into the arbitrary division of those less than 1 cm as microadenomas and those more than 1 cm as macroadenomas. Pituitary tumors secreting excess prolactin are characterized as prolactinomas. Prolactinomas are the most frequently occurring neoplasm in the human pituitary [3, 4]. In the general population, 1:2,800 men and 1:1,050 women are considered to have prolactinomas [5]. In human subjects, prolactinomas occur as both macroadenomas and microadenomas. In addition, mixed growth hormone and prolactinsecreting adenomas are documented to exist in a substantial number of acromegaly patients. Hyperprolactinoma is a condition in which plasma prolactin (PRL) levels are elevated above normal levels. Hyperprolactinemia, with elevation of serum prolactin of more than 200 ng/ml, is characteristically associated with prolactinomas [6]. Hyperprolactinemia causes reproductive dysfunction such as amenorrhea, galactorrhea, and infertility in women [7]. Amenorrhea and galactorrhea may occur alone or together [8]. Up to 25% of patients with secondary amenorrhea have been diagnosed with hyperprolactinemia. Many of these patients showed microprolactin adenomas or macroprolactin adenomas in the pituitary. Although treatments that alter central dopaminergic neuronal functions cause an elevated serum PRL level, in most cases hyperprolactinemia is due to a pituitary tumor. In women, prolactinomas are mainly microadenomas. These microadenomas are rarely associated with hypopituitarism or central nervous system dysfunction. Idiopathic hyperprolactinemia, without demonstrable pituitary or hypothalamic disease, has also been identified. In men, prolactinomas are mainly macroadenomas [9]. These patients often exhibit gynecomastia, impotence, decreased libido, and reduced reproductive hormone levels [10]. The genesis of prolactinoma in lactotropes of the pituitary gland or other pituitary tumors remains for the most part a subject of speculation and debate because cells involved in the formation of adenoma may be derived from monoclonal or polyclonal expansion and may have phenotypes that http://www.ayurvedacollege.com/book/export/html/2
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change during tumor development and therefore are very hard to discern. However, information of genetic modifications that increase the risk factors for lactotropic tumors has begun to decipher from animal studies in which prolactinoma is induced by estrogen. 8 Tatiana Goloubkova, Maria Flávia M. Ribeiro, Luciene P. Rodrigues, Ana L. Cecconello and Poli Mara Spritzer, “Effects of xenoestrogen bisphenol A on uterine and pituitary weight, serum prolactin levels and immunoreactive prolactin cells in ovariectomized Wistar rats.” Archives of Toxicology, Vol. 74, Number 2 (2000), 9298. http://www.springerlink.com/content/01mqcap3wwbw1umk/ Abstract Considerable attention has currently been focused on bisphenol A (BPA), an environmental endocrine disrupting chemical that has oestrogenic activity. In vitro and in vivo shortterm assays have shown that BPA is weakly estrogenic. In addition, the issue of species and straindifferences in susceptibility to BPA was raised. The treatment of ovariectomized (OVX) Wistar rats with BPA at doses of 11–250 mg/kg per day, s.c., for 7 days, resulted in significant dosedependent regrowth of uterus in uterotrophic assay. Additionally, the stimulation of anterior pituitary gland growth and induction of hyperprolactinaemia, as determined by wet organ weight and radioimmunoassay (RIA), respectively, were also dosedependent (at 128 and 250 mg/kg per day, P < 0.05). Prolactin immunostaining of anterior pituitary glands revealed that BPA at a dose of 250 mg/kg per day increased the number of prolactinimmunopositive cells by 63% compared to OVX rats. These results demonstrate that the reproductive tract and neuroendocrine axis of Wistar rats are able to respond to BPA. Furthermore, the pituitary gland hypertrophy and hyperprolactinaemia can be mediated, at least partly, by increase in number of prolactinimmunoreactive cells. The longterm consequences of this proliferation are yet unknown but neoplasm formation is an obvious possibility. 10 Nomikos P, Buchfelder M, Fahlbusch R. “Current management of prolactinomas.” Journal of NeuroOncology, 2001 Sep;54(2):13950. http://www.ncbi.nlm.nih.gov/pubmed/11761431 Abstract Prolactinomas constitute the largest group of pituitary adenomas in autopsy series. However, their relative incidence in recent surgical series is much less impressive since medical treatment with dopamine agonists is routinely employed, which in many cases leads to tumor shrinkage and normalization of prolactin levels. The clinical symptoms of hyperprolactinemia are menstrual dysfunction and galactorrhea in women and loss of libido and potency in men. Prolactinomas may present also as space occupying sellar mass lesions impinging on the adjacent structures like the pituitary gland, cavernous sinus and optic nerves. The standard primary treatment is medical by dopamine agonists. Prolactinomas are the prototype of tumors, the growth of which can be reliably and safely inhibited by specific drugs other than cytostatic chemotherapy. These unfortunately have side effects, like orthostatic hypotension, nausea and vomiting. The effects induced by dopamine agonists are suppressive but not tumoricidal. Thus, the therapeutic effect is only maintained as long as the drug is administered. Consequently. in most cases, treatment has to be continued life long with a few exceptions, in whom normoprolactinemia persists even after discontinuation of dopamine agonists. Main indications of surgery in prolactinomas are intolerance of the medication, and tumors not responding to dopamine agonists. Occasionally, these may ultimately require radiation therapy. Remission rates in large series of surgically treated prolactinomas vary between 54% and 86%. In our consecutive series of 540 surgically treated prolactinomas, the normalization rate after transsphenoidal surgery basically depended on the preoperative prolactin levels, tumor size and extension. The remission rate of 82% in microprolactinomas with initial prolactin levels <200 ng/ml would even in small adenomas make one consider surgical treatment as an interesting alternative to longterm medical treatment. http://www.ayurvedacollege.com/book/export/html/2
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11 M. J. Levy, M. S. Matharu, K. Meeran, M. Powell, and P. J. Goadsby. “The clinical characteristics of headache in patients with pituitary tumours.” Brain: A Journal of Neurology. (August 2005) 128 (8):19211930. http://brain.oxfordjournals.org/content/128/8/1921.full Summary The clinical characteristics of 84 patients with pituitary tumour who had troublesome headache were investigated. The patients presented with chronic (46%) and episodic (30%) migraine, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT; 5%), cluster headache (4%), hemicrania continua (1%) and primary stabbing headache (27%). It was not possible to classify the headache according to International Headache Society diagnostic criteria in six cases (7%). Cavernous sinus invasion was present in the minority of presentations (21%), but was present in two of three patients with cluster headache. SUNCTlike headache was only seen in patients with acromegaly and prolactinoma. Hypophysectomy improved headache in 49% and exacerbated headache in 15% of cases. Somatostatin analogues improved acromegalyassociated headache in 64% of cases, although rebound headache was described in three patients. Dopamine agonists improved headache in 25% and exacerbated headache in 21% of cases. In certain cases, severe exacerbations in headache were observed with dopamine agonists. Headache appears to be a significant problem in pituitary disease and is associated with a range of headache phenotypes. The presenting phenotype is likely to be governed by a combination of factors, including tumour activity, relationship to the cavernous sinus and patient predisposition to headache. A proposed modification of the current classification of pituitaryassociated headache is given. 12 Verhelst J, Abs R. “Hyperprolactinemia: pathophysiology and management.” Treatments in Endocrinology. 2003;2(1):2332. http://www.ncbi.nlm.nih.gov/pubmed/15871552 Abstract Hyperprolactinemia is commonly found in both female and male patients with abnormal sexual and/or reproductive function or with galactorrhea. If serum prolactin levels are above 200 microg/L, a prolactinsecreting pituitary adenoma (prolactinoma) is the underlying cause, but if levels are lower, differential diagnoses include the intake of various drugs, compression of the pituitary stalk by other pathology, hypothyroidism, renal failure, cirrhosis, chest wall lesions, or idiopathic hyperprolactinemia. When a pituitary tumor is present, patients often have pressure symptoms in addition to endocrine dysfunction, such as headaches, visual field defects, or cranial nerve deficits. The large majority of patients with prolactinomas, both micro and macroprolactinomas, can be successfully treated with dopaminergic drugs as firstline treatment, with normalization of prolactin secretion and gonadal function, and with significant tumor shrinkage in a high percentage of cases. Surgical resection of the prolactinoma is the option for patients who may refuse or do not respond to longterm pharmacological therapy. Radiotherapy and/or estrogens are also reasonable choices if surgery fails. In patients with asymptomatic microprolactinoma no treatment needs to be given and a regular followup with serial prolactin measurements and pituitary imaging should be organized. Currently, the most commonly used dopamine agonists are bromocriptine, pergolide, quinagolide and cabergoline. When comparing the plasma halflife, efficacy and tolerability of these drugs, cabergoline seems to have the most favorable profile, followed by quinagolide. Ifprolactin levels are well controlled with dopamine agonist therapy, gradual tapering of the dose to the lowest effective amount is recommended, and in a number of cases medication can be stopped after several years. Evidence to date suggests that cabergoline and quinagolide appear to have a good safety profile for women who wish to conceive, but hard evidence proving that dopamine agonists do not provoke congenital malformations when taken during early pregnancy is currently only available for bromocriptine. Once pregnant, dopamine agonist therapy should be immediately stopped, unless growth of a macroprolactinoma is likely or http://www.ayurvedacollege.com/book/export/html/2
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pressure symptoms occur. At our institution patients with symptomatic prolactinomas, both micro and macroadenomas, are treated with cabergoline as the firstline aproach. In the small group of patients who do not respond to this treatment, or who refuse longterm therapy, surgery is offered. Radiotherapy is given if both pharmacologic therapy and surgery fail. 13 Ciccarelli E, Camanni F. “Diagnosis and drug therapy of prolactinoma.” Drugs. 1996 Jun;51(6):95465. http://www.ncbi.nlm.nih.gov/pubmed/8736617 Abstract A prolactinsecreting pituitary tumour is the most frequent cause of hyperprolactinaemia that commonly occurs in clinical practice. Prolactinomas occur more frequently in women than in men and may differ in size, invasive growth and secretory activity. At presentation, macroadenomas are more frequently diagnosed in men. Specific immunohistochemical stains are necessary to prove the presence of prolactin in the tumour cells. The main investigations in the diagnosis of a prolactinsecreting adenoma are hormonal and radiological. As prolactin is a pulsatile hormone, it is a general rule to obtain several blood samples by taking a single sample on 3 separate days or 3 sequential samples (every 30 minutes) in restful conditions. Prolactin levels of 100 to 200 micrograms/L are commonly considered diagnostic for the presence of a prolactinoma; however, prolactinoma cannot be excluded in the presence of lower levels, and prolactin levels > 100 micrograms/L are present in some patients with idiopathic hyperprolactinaemia. Several dynamic function tests have been proposed to differentiate idiopathic from tumorous hyperprolactinaemia. Although they could be used for group discrimination, these tests cannot be used for individual patients. To differentiate between a prolactinoma and a pseudoprolactinoma, thyrotrophin response to a dopamine receptor antagonist may be used, as only prolactinomas may have an increased response. A short course of dopaminergic drugs may also be of some help, as in macroprolactinomas only a shrinkage may be observed. After hyperprolactinaemia is confirmed, imaging with computerised tomography (CT) and magnetic resonance imaging (MRI) are necessary to define the presence of a lesion compatible with a pituitary tumour. There is now a general agreement that medical therapy is of first choice in patients with prolactinomas. Bromocriptine, the most common drug used in this condition, is a semisynthetic ergot alkaloid that directly stimulates specific pituitary cell membrane dopamine D2 receptors and inhibits prolactin synthesis and secretion. In most patients, a reduction or normalisation of prolactin levels is usually observed, together with the disappearance or improvement of clinical symptoms. The sensitivity to bromocriptine is variable and patients may need different dose of the drug. Bromocriptine is also able to shrink the tumour in most patients; however, a few reports of disease progression during therapy have been described. The need for close followup, including prolactin levels and CT or MRI studies, is therefore emphasised. Bromocriptine is conventionally given in 2 or 3 daily doses; however, a single evening dose has been shown to be equally effective. Bromocriptine is usually well tolerated by the majority of patients; some adverse effects (nausea, vomiting, postural hypotension) may be initially present, but they usually wear off in time. To prevent such adverse effects it is advisable to start treatment with a low dose during the evening meal and gradually increase the dose over days or weeks. A few patients are unable to tolerate oral bromocriptine, so different formulations of bromocriptine or alternative dopamine agonist drugs (lisuride, terguride, metergoline, dihydroergocryptine, quinagolide, cabergoline, pergolide) have been proposed. Of particular clinical relevance because of their good tolerability and sustained activity are cabergoline and quinagolide. Particular attention should be paid to pregnancy in prolactinoma patients, as tumour enlargement has been reported. As the risk for this occurrence is low in patients with microprolactinoma, there is a general agreement that the drug can be stopped once pregnancy is diagnosed. In patients with macroprolactinoma the risk of tumour enlargement is higher. Therefore, primary therapy with bromocriptine until the tumour has shrank is suggested before pregnancy is attempted. Bromocriptine should be stopped as soon as pregnancy is confirmed ... http://www.ayurvedacollege.com/book/export/html/2
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14 Syed Ali Imran, Ehud Ur, and David B. Clarke. “Managing ProlactinSecreting Adenomas During Pregnancy.” Canadian Family Physician. April 2007 vol. 53 no. 4 653658. http://www.cfp.ca/content/53/4/653.full Abstract OBJECTIVE To determine an appropriate approach to managing prolactinsecreting adenomas of varying severity in pregnant women. SOURCES OF INFORMATION MEDLINE was searched using the key words “hyperprolactinemia,” “prolactinoma,” “pregnancy,” and “management.” Experience from a multidisciplinary tertiary care centre was also reviewed. Recommendations are based on mostly levels II and III evidence. MAIN MESSAGE With appropriate management, most women with hyperprolactinemia can achieve pregnancy. Although most women with prolactinsecreting adenomas during pregnancy need only careful observation, others might require medical treatment or even surgical evacuation. Ideally, such patients should be managed by multidisciplinary teams. In the absence of such teams, most pregnant women with small tumours can be managed safely by their primary physicians. Those with large tumours should be referred to specialists. CONCLUSION Family physicians play an important role in managing women with prolactinomas during pregnancy. Knowledge of current approaches to management is crucial in determining when and how to refer these patients. Prolactinsecreting adenomas are the most commonly encountered pituitary tumours in women of childbearing age.1 Hyperprolactinemia interferes with the hypothalamicpituitaryovarian axis at various levels and is responsible for about a third of all cases of female infertility.2 Although the true prevalence of hyperprolactinemia is difficult to establish, it is estimated that among women presenting with reproductive disorders, approximately 15% with anovulation and 43% with anovulation and galactorrhea have hyperprolactinemia.3 With adequate management, most women are expected to achieve successful pregnancies; however, managing prolactinomas during pregnancy poses a unique challenge. When there is no dedicated multidisciplinary team, family physicians have an important role in managing these patients. This article focuses on the issues pertaining to management of prolactinomas during pregnancy. These issues are illustrated by 3 clinical cases of varying severity. The purpose of this article is to help family physicians provide highquality care to most pregnant women with uncomplicated prolactinomas and identify patients who need to be referred to specialists. 15 ChristinMaître S, Delemer B, Touraine P, Young J. “Prolactinoma and estrogens: pregnancy, contraception and hormonal replacement therapy.” Annales d’Endocrinologie (Paris). 2007 Jun;68(23):10612. Epub 2007 May 30. http://www.ncbi.nlm.nih.gov/pubmed/17540335 Abstract The stimulatory role of estrogen on prolactin secretion and on proliferation of lactotropic cells is well established in terms of physiology but could this phenomenon be extended to include harmful effects of estrogens on prolactinoma? The aim of this review is to provide an uptodate assessment of this subject with regard to pregnancy, use of contraceptive pills and postmenopausal hormone replacement therapy. Dopamine agonists allow women presenting prolactinoma to recover their ovulation cycles and become pregnant. There is no adverse data concerning the safety of dopamine agonists such as bromocriptine, if the woman is treated during the first trimester of pregnancy but there is little information regarding the most recent treatments such as cabergoline or quinagolide. In women with microadenomas, pregnancy generally has little impact on their adenoma, delivery is normal and breastfeeding is allowed. Concerning macroprolactinomas, tumor progression during pregnancy is possible and endocrine followup remains necessary. Contraceptive pills containing estrogen and progestins are currently the besttolerated and the most http://www.ayurvedacollege.com/book/export/html/2
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effective contraception. This type of contraceptive has long been avoided in patients presenting prolactinoma. While the literature has little to say on this subject and provides no adverse information, professional experience suggests that this attitude should be amended and that women presenting microprolactinoma should be allowed to use current contraceptive pills (containing 30 microg or less of ethinyl estradiol). The most important problem to overcome with this type of prescription, which masks the clinical consequences of hyperprolactinemia, is the possibility of overlooking hypophyseal disease that could result from this approach. The problem of macroprolactinoma is different; the possibility of prescribing contraceptive pills must be evaluated on a casebycase basis and the impact of the drug on the adenoma must be very closely monitored. Estrogen replacement therapy in patients presenting hypogonadism should be attempted in patients with a history of prolactinoma and standardmonitoring precautions should be taken. In menopausal women, when replacement therapy is desirable, the presence of a microprolactinoma should not by itself avoid this prescription. 32 Colao A. “Pituitary Tumors: The Prolactinoma” Best Practices and Research in Clinical Endocrinology and Metabolism. 2009 Oct;23(5):57596. Source: Department of Molecular and Clinical Endocrinology and Oncology, Federico II University http://www.ncbi.nlm.nih.gov/pubmed/19945024 Abstract This review focus on the epidemiology, diagnosis and treatment of prolactinomas. In particular, attention was given to recent data showing a high prevalence of these tumours in the general population, 35 times higher than previously reported. The diagnosis of hyperprolactinaemia has been simplified in recent years, and only prolactin (PRL) assay and magnetic resonance imaging of the sella are required. Nonetheless, macroprolactinaemia should be assessed in patients with hyperprolactinaemia in the absence of clinical symptoms of elevated PRL levels. The recent evidence that medical therapy with dopamine agonists should be continued lifelong has been confirmed by several studied. The patients achieving disappearance of the tumours and suppression of PRL levels during treatment are those showing the highest likelihood to have persistent remission of hyperprolactinaemia after treatment withdrawal. 34 Mahmoud M Suhail, Weijuan Wu, Amy Cao, Fadee G Mondalek, KarMing Fung, PinTsen Shih, YuTing Fang, Cole Woolley, Gary Young, and HsuehKung Lin. “Boswellia sacra essential oil induces tumor cellspecific apoptosis and suppresses tumor aggressiveness in cultured human breast cancer cells” BioMedCentral Complementary and Alternative Medicine. 2011; 11: 129. Published online 2011 December 15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258268/ Abstract Background Gum resins obtained from trees of the Burseraceae family (Boswellia sp.) are important ingredients in incense and perfumes. Extracts prepared from Boswellia sp. gum resins have been shown to possess antiinflammatory and antineoplastic effects. Essential oil prepared by distillation of the gum resin traditionally used for aromatic therapy has also been shown to have tumor cellspecific antiproliferative and proapoptotic activities. The objective of this study was to optimize conditions for preparingBoswellea sacra essential oil with the highest biological activity in inducing tumor cellspecific cytotoxicity and suppressing aggressive tumor phenotypes in human breast cancer cells. Methods Boswellia sacra essential oil was prepared from Omani Hougari grade resins through hydrodistillation at 78 or 100 oC for 12 hours. Chemical http://www.ayurvedacollege.com/book/export/html/2
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compositions were identified by gas chromatographymass spectrometry; and total boswellic acids contents were quantified by highperformance liquid chromatography. Boswellia sacra essential oilmediated cell viability and death were studied in established human breast cancer cell lines (T47D, MCF7, MDAMB231) and an immortalized normal human breast cell line (MCF102A). Apoptosis was assayed by genomic DNA fragmentation. Antiinvasive and antimulticellular tumor properties were evaluated by cellular network and spheroid formation models, respectively. Western blot analysis was performed to study Boswellia sacra essential oilregulated proteins involved in apoptosis, signaling pathways, and cell cycle regulation. Results More abundant high molecular weight compounds, including boswellic acids, were present in Boswellia sacra essential oil prepared at 100 oC hydrodistillation. All three human breast cancer cell lines were sensitive to essential oil treatment with reduced cell viability and elevated cell death, whereas the immortalized normal human breast cell line was more resistant to essential oil treatment. Boswellia sacra essential oil hydrodistilled at 100 oC was more potent than the essential oil prepared at 78 oC in inducing cancer cell death, preventing the cellular network formation (MDA MB231) cells on Matrigel, causing the breakdown of multicellular tumor spheroids (T47D cells), and regulating molecules involved in apoptosis, signal transduction, and cell cycle progression. Conclusions Similar to our previous observations in human bladder cancer cells, Boswellia sacra essential oil induces breast cancer cellspecific cytotoxicity. Suppression of cellular network formation and disruption of spheroid development of breast cancer cells by Boswellia sacra essential oil suggest that the essential oil may be effective for advanced breast cancer. Consistently, the essential oil represses signaling pathways and cell cycle regulators that have been proposed as therapeutic targets for breast cancer. Future preclinical and clinical studies are urgently needed to evaluate the safety and efficacy of Boswellia sacra essential oil as a therapeutic agent for treating breast cancer. 37 Sliutz G, Speiser P, Schultz AM, Spona J, Zeillinger R. “Agnus castus extracts inhibit prolactin secretion of rat pituitary cells.” Hormone and Metabolic Research (University of Vienna, Austria). 1993 May;25(5):2535. http://www.ncbi.nlm.nih.gov/pubmed? term=vitex%20agnus%20pituitary%20gland Abstract In our studies on prolactin inhibition by plant extracts we focused on the effects of extracts of Vitex agnus castus and its preparations on rat pituitary cells under basal and stimulated conditions in primary cell culture. Both extracts from Vitex agnuscastus as well as synthetic dopamine agonists (Lisuride) significantly inhibit basal as well as TRHstimulated prolactin secretion of rat pituitary cells in vitro and as a consequence inhibition of prolactin secretion could be blocked by adding a dopamine receptor blocker. Therefore because of its dopaminergic effect Agnus castus could be considered as an efficient alternative phytotherapeutic drug in the treatment of slight hyperprolactinaemia. 39 Leblanc H, Yen SS. “The effect of Ldopa and chlorpromazine on prolactin and growth hormone secretion in normal women.” American Journal of Obstetrics and Gynecology. 1976 Sep 15;126(2):1624. http://www.ncbi.nlm.nih.gov/pubmed/961756 Abstract The time course of simultaneous changes in prolactin (PRL) and growth hormone secretion in response to a single dose of Ldopa and chlorpromazine was determined in normal women. LDopa induced greater, but shorter (30 minutes), growth hormone release than concomitant http://www.ayurvedacollege.com/book/export/html/2
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suppression of PRL secretion. The PRL peak following chlorpromazine occurred at the same time as the nadir of PRL after Ldopa (3.5 hours). The quantity of PRL release inhibited by Ldopa equaled the amount of PRL secretion during the period of rebound, suggesting Ldopa inhibits PRL release, but not synthesis, by the pituitary.
Pulse Diagnosis: How do we read the heart beat? (by Noah Volz C.A.S) Table of Contents 1. Introduction http://www.ayurvedacollege.com/book/export/html/2
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2. Dr. John Douilliard 3. Dr. Vasant Lad 4. Levels of the Pulse 5. 1 st and 7 th Level Organ Pulses 6. 3 rd Level Subdoshas 7. 4 th Level Subtle energies 8. 5 th Level Dhatus (Tissues) 9. Second and Sixth Level Manas Prakriti (Flow of Consciousness) 10. Dr. Smita Naram 11. Vikriti Dosha/ Prakriti Dosha 12. Agni and Ama 13. Vata pushing Ama and Doshas 14. Dhatus (tissues) and Ojas (most refined tissue) 15. Comparison and Contrast 16. References Introduction Ayurvedic Medicine has been using the pulse as a form of diagnosis since it was created 5000 years ago. Those who are familiar with modern Ayurvedic medicine think of the scenario where an Indian doctor takes your pulse and looks at your tongue and then can tell you what you've eaten for dinner the night before. Although many intuitive doctors have this capability this paper is more concerned with the methodology of the pulse. What are these doctors looking for? How do they interpret their findings? What can the pulse offer us as health care practitioners? What can be identified as fact by being repeatable with adequate practice? This will become more clear to us as we begin to understand what the pulse is and what it has to teach us. To do this we will look at the methodology and lineages of Dr. John Douilliard, Dr. Vasant Lad, and Dr. Smita Naram. Then we will compare and contrast these doctors' methods and ideas. The goal of this analysis is not to determine the efficacy of the pulse as a diagnosis method, but to understand the methodology of the pulse more clearly as a diagnostic tool. In Ayurvedic medicine the pulse is used in conjunction with Darshana (pure observation and inspection), and Prashna (questioning). It is all three of these that must be employed to reach a complete diagnosis. Pulse diagnosis is best understood through the teachings of those who have been practicing and teaching it the longest. We will begin the journey of understanding the pulse through the three most revered methods in the West. An assessment of their similarities and differences will follow. Concluding with the relevance pulse diagnosis has to emerging practitioners here in the west. Let us begin by holding the threads that weave Ayurveda and the pulse together. The overall method of taking the pulse begins with the placement of the fingers. The index finger is placed below the radial styloid. The radial styloid is the protruding wrist bone on the thumb side of the hand of the pulse recipient. The middle finger and ring finger are placed next to the index finger. The pulse taking fingers are adjusted along the underside of the arm to find where the pulse is the
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strongest. The pulse is the beating of blood through the arteries as it moves outward from the heart. The blood carries nutrients to each cell in the body, just as thought is transferred through chemical reactions in the cells simultaneously, intelligence is found in the blood in the information it carries to each cell. In Ayurveda this information carried by the blood is made of the 5 elements: earth, water, fire, air and ether. These are the scientific building blocks of Ayurveda. The 5 elements are used to explain in simple terms what science has determined through complex experiments. These elements combine in three distinct ways in the physical form. These are the Doshas , psychophysiological functional principles of the body. The three Doshas are Vata which combines the elements of air and ether. Pitta is fire and an aspect of water. Kapha is water and earth. We can find the Doshas in the qualities and textures that can be felt in the pulse. The Doshas have concrete qualities that are made when their respective elements are combined. Doshas being combinations of elements are not only found in the body, but also in the environment. As we look at the natural world we can see the dominance of air and ether in the dry barren plains of the high mountain desert of central Arizona . Vata is seen in the rough and rugged change of season characterized by Fall in the northern hemisphere. Pitta is characterized by summer heat, hard work, and intensity. Kapha is embodies the spring moisture of the Northwestern states of Washington and Oregon . This is when the qualities of earth and water are the most noticeable. Like the environment, Doshas can be supportive or destructive to our total well being. Doshas and their qualities are also found in the pulse. Think of the pulse like a cardiograph: a computer readout graphically recording the physical or functional aspect of the heart. Like the graph being sketched across the screen of the computer the pulse has its own rate, crest, wave, amplitude, and cessation. These individual characteristics define the overall movement, quality, and rhythm of the pulse. In these broader categories the Doshas of Vata , Pitta , and Kapha can be distinguished based on the smaller movements sketched graphically by a cardiograph. In pulse diagnosis our fingers become the receptors that transfer the information of the heart beat graphically into a more concrete image. The Gati (movement) is best defined by the natural world. A snake as it swiftly slithers out of danger or attentively rests on a warm rock when felt characterizes Vata. The elements that make up Vata are air and ether and they are swift and light as they slither through the fingers. A frog on land bounds powerfully, a frog in water pumps its legs and arms in strong fluid motions. The elements of fire and an aspect of water characterize Pitta bounding into the fingers, strong and forceful, but without the sharp quality of the snakes bite. A swimming swan methodically bobs its head as it gracefully moves across the water. The elements of earth and water in Kapha glide into the fingers. The Gati is considered the most important part of the pulse as it makes up the crest and wave of our computerized image or the movement of an animal. Vata has the quality of a snake. Pitta is a frog. Kapha is a swimming swan. In Western diagnostics it is only the rate of the pulse that is taken. The rate is dependant on the dominance of the Doshas in Ayurveda. Vata is 8090 beats per minute. Pitta is 7080 bpm. Kapha is 6070 bpm. The rhythm of the pulse can be irregular or regular. An irregular pulse has no distinguishable pattern. Its intensity and rhythm fluctuates wildly. Vata is irregular. A regular pulse in consistent, it pumps in the same rhythm and amplitude. Its crest and wave are even. Pitta is regularly irregular, meaning that if it skips a beat it always skips that beat, and thus the pattern repeats itself. The amplitude of the pulse is the force or http://www.ayurvedacollege.com/book/export/html/2
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strength with which the beat moves into the fingers. Pitta's intensity is high, Kapha's consistency is moderate, and Vata's variability is low. Overall the characteristics of each dosha are: Vata is feeble and light as it slithers into the fingers. Pitta bounds into the fingers strongly and clearly. Kapha slides into the fingers slow and cloudlike. These are elaborated on in the graph below. VATA
PITTA
Characteristics
Fast, feeble, cold, light, thin, disappears on pressure
Prominent, strong, deep, slow, broad, high amplitude, hot, wavy, thick, cool or forceful, lifts palpating warm, regular finger
Location
Index
Middle
Ring
Gati
Sarpa (Cobra)
Manduka (Frog)
Hamsa (Swimming Swan)
Vega (Rate)
8095
7080
5060
Tala (Rhythm)
Irregular
Regular
Regular
Bala (Force)
Low +
High +++
Moderate ++
Akruti (Tension and Volume)
Low
High
Moderate
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Tapamana (Temperature)
Cold
Hot
Warm to cool
Kathinya ( vessel wall)
Rough, hard
Elastic, flexible
Soft thickening
(Lad, 14)
Anyone can recognize that there are differences between their pulse and that of others. What these differences mean is what Ayurveda has refined over its 5000 year existence. The Pulse can be read like a book, and the categories and qualities mentioned above are the alphabet that we will use to learn from this book. Understanding movement, rate, and rhythm of the pulse can be a tool for understanding the body. The beauty of this is that the symptoms of disease manifest in the pulse long before they do in the body. An example of this is when a chemical imbalance occurs in the blood before their aggregate affects produce symptoms in the body. The characteristics and the movement of the pulse are symptoms of the functioning of the body. Interpreting the meaning behind what is felt in the pulse has been done by many generations of masters. It is their knowledge, expressed through the refined methodology of their technique that will guide us through the great river of the pulse, following the current looking for the continuity and conflict between methods. We will explore the ways of ancient wisdom and compare the differences and similarities between these time testedmethods of pulse diagnosis. When the Doshas are found in the pulse, how can they be seen in the body? Are the different methods consistent in assessing the link between the pulse and the body? Ayurvedic knowledge shows the myriad of ways that the Doshas are responsible for imbalances. One can feel the Doshas in the pulse and thereby also determine the imbalance. Are pulse methods consistent in determining Doshic aggravation in the body? Each method will be looked at and then assessed in combination with the other methods to illuminate what the pulse shows on its own, and what each method uniquely brings to the pulse. Let's take a journey with Dr. John Douilliard, Dr. Vasant Lad, and Dr. Smita Naram to find the ways in which the pulse can teach us about our way back to optimal health. Dr. John Douilliard John Douilliard begins with identifying V,P,K in the movement, rate, rhythm, strength, and quality of the pulse. Douilliard says that the dominant qualities of the Doshas should be felt in their respective fingers. The index finger is for Vata, the middle finger is for Pitta, and the ring finger is for Kapha . The pulse will feel like a snake (V), frog (P), and swan (K) under these fingers when the pulse is in balance. When feeling the pulse, distinguish what Doshas are in which finger. As mentioned before, the Doshas should be found more in one finger than in the others. The Doshas will permeate more than its dominant finger and spread to other fingers as well. Or the Doshas could leave its finger completely when we are imbalanced. If you feel a Vata pulse in the Pitta finger than an imbalance may be present. In the beginning, focus is placed on differentiating between the V,P, and K pulse. As each finger has unique characteristics that are most prevalent under that finger, each finger has different levels of http://www.ayurvedacollege.com/book/export/html/2
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intensity or amplitude. The amplitude is the strength with which the pulse moves into the finger. As each Dosha has unique characteristics the amplitude is relative to itself and not to the other fingers. For example a vibrant Kapha pulse will never jump into the finger with the same amplitude as a strong Pitta pulse. Because the quality of the Pitta pulse is to jump and the quality of the Kapha pulse is to glide. The relative intensity is given a number; 3 being the highest and one being the lowest. When taking the pulse, the relative strength thumping into a finger is given a number. This information is valuable for establishing ones Nature. As each person has their own unique body type built by genetic information, they also have their own unique nature. The Doshas combine to make a unique psychophysical being. This is called Prakriti or Nature. This combination of all three Doshas is their natural state of balance at birth. By ascertaining the amplitude we can know the person's Prakriti . If for example you feel a Vata 3, Pitta 2, and Kapha 1 then the body type for this person would be 50% Vata , 30 % Pitta and 20% Kapha . The body type is that persons balanced state or Prakriti . This is the balance point where that individual is the most optimally healthy. When taking the pulse the fingers can lie on the surface or press deeper to find different levels of the pulse. The change in the pressure on the vein, changes the meaning of the pulse. There are three levels of the pulse in this method. The first level is the superficial level, the way the pulse feels at the surface level of the wrist. The last level is the deepest level. Move from the superficial level to the deep pulse by pressing deeper into the underarm and noticing the quality of the pulse. It is described by Douilliard as throwing your buoy into the lake. The buoy sinks to the bottom, like the fingers moving to the bottom of the pulse. Once the bottom has been touched, you come up a little until you can feel the pulse again. Then move towards the uppermost surface of the lake and feel the difference in quality at the superficial level. In Douilliard's method the deep layer of the pulse is the layer of the soul. It is the deepest layer and the root of our being. By misusing our intellect Pragna Parad we move away from the essence of our being, which is infinite. The deep layer of the pulse is this ground on which truth and wisdom grow. The superficial pulse is the material form, or our body. The pulse that links the two becomes important in this method later on. It is the junction point pulse and the bridge between the two. It is here that the imbalance that is causing disease in the body can be felt. The Gap pulse as it is called is very important in this method. The pulse is influenced by our external environment. By taking the pulse at different times of the day and in different seasons V,P,K can be found. The seasons where each Dosha is provoked are: Vata in the fall and early winter, Pitta in the summer, and Kapha in late winter and early spring. See below
Provoked
Accumulating
Alleviated
Feb.1June 1
Kapha
Pitta
Vata
June 1 Oct 1
Pitta
Vata
Kapha
Oct 1 Feb 1
Vata
Kapha
Pitta
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The Doshas also relate to the times of the day. Vata is the most prominent from 3 until sunset (7), Pitta rules the hours from 11 3, and Kapha is in charge from sunrise/sunset until 11. See the chart below
Provoked
Accumulating
Alleviated
7am11am / 7pm11pm
Kapha
Vata
Pitta
11am3pm / 11pm3am
Pitta
Kapha
Vata
3pm7pm / 3am7am
Vata
Pitta
Kapha
Another technique used to familiarize oneself with how the pulse changes and what the presence of the Doshas feels like in the pulse is to take the pulse at meal time. As Fire is used to digest food, Pitta peaks as you are eating your meal and for approximately 15 minutes after the meal. Kapha takes over as the food is assimilated and the steady qualities of earth and water are needed. When Vata returns to the pulse approximately 4 hours later, the food has been completely assimilated and it is time for another meal. The pulse can also be used in a therapeutic way. When one takes their own pulse the fingers give feedback to the entire system of where there is a site of weakness or imbalance. Even when the intellect cannot seize the wisdom of the pulse our body and mind adapt to remedy the vitiation felt in the pulse. Douilliard has many testimonials that account for his understanding of the pulse as a therapeutic technique. Determining a balanced and imbalanced pulse is the key link to using pulse diagnosis. Using all the previous methods to familiarize ourselves with the qualities of the pulse and levels of the pulse, we can begin to use this information to determine whether the pulse is balanced or imbalanced. We begin by becoming familiar with the deep pulse as we move from the deep pulse to the superficial pulse. If the overall quality is consistent from the deep to the superficial and there are no spikes at any level then the pulse is considered balanced. The deep and superficial levels have different qualities themselves, so the practitioner must know the qualities of each level to know if the pulse is balanced all the way through. The pulse is taken for a 23 day period to establish if the pulse is truly consistent and to rule out any variations that may be based on seasons, meal times, or other external factors. The same is true for imbalance. If a definite spike or variation in the overall character of the pulse can be determined over a 23 day period of time than treatment will be based on that variation. Once we know if the pulse is balanced or not we can begin to use our sensitivity to find where in the body there is weakness or Doshic aggravation. In this method each finger tip is broken down into five parts, four distinct quadrants (14) and the entire length of the finger tip (5). These relate to different Subdoshas . A Subdosha is the subdivision of the three Doshas. Each Subdosha has locations and functions that are related to the predominant http://www.ayurvedacollege.com/book/export/html/2
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qualities of the Doshas within the body. 1 2 3 4 1 2 3 4 1 2 3 4 The figures above are the finger tips and the numbers correspond to the quadrants of each Subdosha . Douilliard sets out in his Pulse course from LifeSpa the Subdoshas and their relationship to the parts of the fingers. The four parts of the finger tip, with the 5 th being the entire circumference of the finger tip, are broken down below into their different Subdoshic functions. Number 1 is always closest to the radial styloid of the pulse recipients hand and 4 is closest to their heart. VATA V1 Prana Mental, Respiratory, Neurological V2 Udana Ears, Nose, Throat, Neck, and Speech V3 Samana Digestion, improper formation of tissues, anorexia, diarrhea 4 Apana Excretion, Constipation, Menstrual, Sexual V5 Vyana Circulatory, Systemic disease PITTA P1 Pachaka Digestion, jaundice, acid stomach, jaundice P2 Ranjaka Blood disorders, liver P3 Sadhaka Decisiveness, Memory, Intelligence, Spiritual inclination, Emotions P4 Alochaka Vision, Eyes P5 Brajaka Skin disease KAPHA K1 Kledaka Digestion, mucous, the root of all other Kapha's K2 Avalambaka Back, Heart, Lungs K3 Bodhaka Taste, Smell K4 Tarpaka Senses, Cough, Nasal Congestion, Cerebral spinal fluid, headache K5 Shleshaka Joint pain, congestion (Douilliard, 2930) These are the main points of Douilliard's technique. His methodology is very experiential and he believes that the experience of the pulse must come first. The technique builds on the previous lessons and ends with the specificity of determining where in the body an imbalance is based on its Subdoshic correspondence in the finger tip and the characteristic amplitude and quality. Dr. Vasant Lad Levels of the Pulse There are seven levels of the pulse that are discerned in Dr. Lad's lineage. 1. The deepest level of the pulse is the Prakriti . 2. Then up from there Manas Prakriti (2 nd ), 3. Dhatus (3 rd ), 4. Ojas/Tejas/Prana (4 th ), 5. Subdoshas (5 th ), 6. Manas Vikriti (6 th ), 7. Vikriti (7 th ). In each level many sensations can be experienced and eventually understood by the advanced practitioner. We must remember that feeling initially http://www.ayurvedacollege.com/book/export/html/2
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takes place in the mind and then in the fingers. It is our mind's eye that truly reads the pulse and not the fingers alone. At each level of the pulse there is a minor variation in the spike of the pulse. As one continually moves from deep to superficial pulses they begin to differentiate between the many levels of the pulse. (Lad, 36) 1 st and 7 th Level Organ Pulses The organ pulses can be felt in both the Prakriti and Vikriti levels. The first level corresponding to Prakriti is associated with the superficial organs. The seventh level corresponds to Vikriti ans is associated with the denser organs deeper within the abdomen. Organ pulses are taken on both the right and left hand of the recipient. The table below links the finger, Dosha , level, and organs together. Right Side
Dosha
Vata
Pitta
Kapha
Finger
Index
Middle
Ring
Superficial
Colon
Gallbladder
Pericardium
Deep
Lung
Liver
Circulation
Dosha
Vata
Pitta
Kapha
Finger
Index
Middle
Ring
Superficial
Small Intestine
Stomach
Bladder
Left Side
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Heart
Spleen
Kidney
(Lad, 47) 3 rd Level Subdoshas The third level down are the Subdoshic pulses, unlike Douilliard, Lad separates the tip of the pulse feeling finger tips into 5 segments. On Vata finger beginning from the most distal point from the heart the Vayus or winds go in order from Prana, Udana, Vyana, Samana, Apana . On the Pitta finger from thumb to heart is Pachaka, Ranjaka, Bhrajaka, Alochaka, Sadhaka. On the Kapha finger moving towards the heart is Kledaka, Avalambaka, Sleshaka, Bodhaka, Tarpaka . See the table below. Like Douilliard, spikes on one of these places on the finger indicate an imbalance in that Subdosha . The Subdoshas actions and functions are always the same. (Lad, 85)
4 th Level Subtle energies Ojas , Tejas , and Prana are the subtle energetic parts of Kapha , Pitta , and Vata respectively. Ojas can be felt in the ring finger, which is attuned to Kapha . Tejas is felt in the middle finger and Prana in the index finger. Prana , Tejas , and Ojas relate to the body in many ways even though they are the subtle counterparts of the Doshas . In the endocrine system, Prana is related to equilibrium and adaptability to different situations. Prana is found in the pituitary and pineal gland. Tejas is responsible for the digestion and metabolism of the thyroid gland and pancreas. Ojas deals with reproduction, the most unrefined of endocrine secretions, since the endocrine fluid is created from the reproductive fluid. Ojas also governs energy reserves and is found in the testes, ovaries, and adrenals. The subtle energies influence the physical body. Prana , Tejas , and Ojas are the primary energizing principles of the body as expressed by the immune system. The immune system is a collaboration of all the systems for maintaining health and neutralizing disease. The pulse as expressed through the chemical and physical actions of the blood is mirrored in the subtle energies. Prana is the underlying movement that defines where the immune response will be most prevalent. Tejas is the active, fiery element that mobilizes the tools of the immune system. Ojas is the innate capacity of the system, its tool box and energy supply for coming back into balance. On the fourth level of the pulse these qualities can be determined. Lad mentions that the detection of these differences is subjective. Listen to the amplitude of the highest point of the pulse's crest, its spike, in each finger. Give the strength of the spike a number. Three is a strong sharp lunge into the finger and one is a feeble prick. This numbering system and identifying method is the same as Douilliard's body type differentiation. But instead of looking for variation as Douillard's method does, Lad's method believes all three subtle energies should be equal and at the three strength http://www.ayurvedacollege.com/book/export/html/2
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level if they are optimally healthy. (Lad, 108) 5 th Level Dhatus (Tissues) At the fifth level of the pulse we can assess the strength and quality of the tissues. The seven tissues are Rasa (Plasma and Fluid), Rakta (Blood), Mamsa (Muscle), Medas (Fat), Asthi (Bone), Majja , (Marrow) and Shukra/Artava (Reproductive Tissue male and female). Healthy Dhatus will not spike, it is when the Dhatus have been invaded by excess Doshas or are weak that a spike will be felt. The quality of the spike is very important. If it is sharp and intense then there is Pitta in that tissue. If it is dull and solid then Kapha and if it is feeble and threadlike then Vata is present. The male and female reproductive tissues are found at the center point of the finger tip on every finger when a spike is detected. Because the reproductive tissue is felt on all three center parts of the fingers it is not only the quality of the spike, but whether the finger is V,P, or K that determines the imbalance. When a spike is felt on the ring finger in the proximal position (close to the heart) the Rasa is compromised, on the distal position Rakta. On the middle finger proximal is Mamsa and distal is Meda . On the index finger proximal relates to Asthi and distal to Majja .
(Lad, 94) Second and Sixth Level Manas Prakriti (Flow of Consciousness) The second and sixth levels of the pulse are finely tuned to the mind. It is here that we discover our mental imbalance or balance and identify the deeper flow of consciousness as defined by chakras. It is here in the mind that objective reality is converted into subjective reality through our senses and perceptions. These levels are the bridge between body and mind, objective and subjective. As the majority of this technique is subtle and quite different than the previous techniques the aspects that relate most directly to the other levels of the pulse will only be described. These levels of the pulse take a sensitive awareness and cannot adequately be described in a technical way. Again the tips of the fingers are divided into thirds. In this level VPK can be felt in all three fingers. The third of the finger closest to the heart relates to K, the third in the center to P and the third towards the thumb to V. Vata felt on the distal edge of each finger, Pitta in the middle and Kapha proximal to the midline of the recipient. Each of these Doshas is influenced by a Guna (quality of the mind) this is how the characteristics of the Dosha will manifest in the mind. In the second level of the pulse the qualities of the mind are Sattva , Rajas , and Tamas . Sattva is the underlying energy of peace and truth. Sattva has an inward and upward movement bringing us towards our true nature. It is the true state of consciousness: light, stable, harmonic, and virtuous. Rajas are the qualities of passion, turbulence, activity, distraction, assertion, motivation, and movement. Its action is outward, egoistic, selfseeking, and self motivated. Tamas is cloudy, dull, sticky, cold, and stagnant. It is the inertia of downward motion causing decay, degeneration, and death. The second level pulse is connected moment to moment to our minds eye. (Lad, 135) The sixth level of the pulse relates to the seven Chakras . The seven Chakras are the energy centers of the subtle body. There are many of them, but the pulse identifies the seven that lie along the spine. They show how the life force directs and guides the physical body through the nervous system. The crown center Chakra can be felt as a spike at the center part of all the pulse taking fingers if it is blocked. On the ring finger the root Chakra is felt in the distal position (close to the thumb, far from the heart) and the navel Chakra is felt on a proximal position. On the middle finger a spike on the edge closest to the thumb is the will Chakra and towards the heart is the heart Chakra . The Index finger can feel the throat Chakra on its distal edge and the third eye Chakra on its proximal edge. http://www.ayurvedacollege.com/book/export/html/2
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Manas Prakriti does not change unless the Chakras are open and one becomes enlightened. A spike indicates an imbalance or blockage in these subtle energy centers. (Lad, 132) The chakras in the table below are related to the elements and organs for further clarification of their physical manifestation.
CHAKRA
ELEMENTS
SENSE ORGANS
ACTION ORGANS
Muladhara Root
Earth
NoseSmell
Anus
Svadhithana Navel
Water
TongueTaste
Reproductive organ
Manipura Will
Fire
EyesSight
Feet
Anahata Heart
Air
SkinTouch
Hands
Vishuddha Throat
Ether
EarsSound
Mouth
Ajna Third eye
Mind
Mind
Mind
Sahasrara Crown
Spirit
Virtual Nervous Sys
VNS
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Vikriti Dosha/ Prakriti Dosha Prakriti is the nature of an individual. It is established by the percentage of each dosha that makes up their unique constitution. The Prakriti is felt in the same fingers as the other two methods: the index (V), middle (P), and ring finger (K). The difference is that Vata is felt on the superficial level, Pitta is felt on the middle level of the middle finger, and Kapha is felt in the deep level of the ring finger. If the pulse is going into some other level than this site that means that there is an imbalance. This imbalance is called Vikriti . Vikriti is when the D oshas are not in balance within the body and symptoms of disease can become apparent. (Naram, slide1) Agni and Ama Agni and Ama are the most important factors that cause disease. Both can be felt in the pulse. Agni is the fire of transformation. Agni is not only in the digestive system as the fire of digestion, Jathara Agni . There is an Agni at each level of the tissues, Dhatus . Agni can be high, Tikshna : low, Manda ; and variable, Vishanagni . If the agni at any of these levels is not functioning properly then Ama can form. Ama is undigested food mass that turns toxic and can obstruct the channels of the body. If any of the Agni's become deranged then Ama can form in the tissues. The three Agni abnormalities can be felt in the pulse. (Naram) Vata pushing Ama and Doshas As Vata rules movement it can push Ama deeper into the tissues as well. When Ama is in the digestive system it can be removed easily. When Vata pushes it deeper into the tissues more preparation of the body must be done to return the Ama to the digestive system for easy elimination. When Ama or Doshas are present in excess, blockages can occur. This obstruction of natural flow ( Vata ) can be felt in the pulse. Vata can also degenerate the tissues because of its drying nature. This creates a deficiency and weakens the amplitude of the pulse. (Naram, s6) Dhatus (tissues) and Ojas (most refined tissue) The tissues were mentioned earlier. Their individual strengths are determined by the tissue Agni's . If the Agni is strong and stable the tissues that are created will be of high quality. If Vata is felt in a certain place in the pulse the tissues are considered deficient. Ama in the pulse can also produce low quality tissue. The tissues themselves and their quality and quantity can be felt in the pulse. Ojas , which is the vital essence of all the tissues, can be felt in the pulse as well. If Ojas and the Dhatus have little strength or have the characteristics of Vata, then the body will show weakness and symptoms may arise. Comparison and Contrast There are many methods used to read the pulse. Each technique has its own way of determining what the characteristics of the pulse mean. All methods determine the Doshic involvement through the parameters of movement, amplitude, width, rhythm, and overall characteristics. The http://www.ayurvedacollege.com/book/export/html/2
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interpretation is based on what each method is looking for. Douilliard looks in the pulse for movement and contrast. Like a hunter in the woods the color of a snow white rabbit moving across the green forest floor will catch attention. Douillard begins by familiarizing us with the qualities of the pulse and their meaning, and then uses that information to interpret the most prevalent characteristics of the pulse. Dr. Lad embraces the complexity of the pulse and sees the entire body from its most subtle layers to its grossest manifestation in the pulse. The knowledge of a refined practitioner who has taken many pulses is paramount to distinguishing between the many levels of the pulse. The intuition and clarity of the pulsetaker allows for precise interpretation after intense discipline in the art of pulse reading. Dr. Smita Naram looks into the pulse for signs of deficiency and excess that ultimately started in the digestive system and amidst the chemical and enzymatic reactions that create each individual tissue. In her technique, the pulse will tell us the health of the body's transformative power ( Agni ), movement of substances through the body (Vata), and where an excess is occurring ( Ama ). Pulse diagnosis is a competent method when performed by each of these practitioners, but with so many variations and differences between methods, how can it be useful for everyone? There are similarities between the methods, and these are found in the foundations of the pulse. By looking at the similarities and differences between these three methods we recognize a wide range of interpretations. Still each method relies of recognizing the qualities of Vata , Pitta , and Kapha within the pulse. In every method the Doshas are found within the blood beating through the veins. Each Dosha has its own characteristic quality, movement, rhythm, strength, and width. All methods use this information to draw conclusions. The conclusions are different based on the unique methodology of each method. The table below compares the different levels and places where the tissues are felt, where and how imbalances are read in the pulse, qualities of the subtle energies, etc. In each level and for each part of the body the Doshas are understood by their individual characteristics manifesting in the flow of blood through the pulse. How they are understood appears to be subjective because of the variations in methodology.
Category
Dr. John Douilliard
Dr. Smita Naram
Dr. Vasant Lad
Levels
3
3
7
Dhatus
Not mentioned
Felt
Felt
Ojas
In Gap pulse
As essence of all Dhatus 4 th level K finger
Subdosha
Quadrants
Not mentioned
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Prakriti
Deep level
Not mentioned
Deep level
Vikriti
Superficial level
On many levels
Superficial level
Manas
Deep level
Not mentioned
2 nd and 6 th level
Fingertips
Felt in different places
Spikes at different places
Therapeutic Yes
Yes
Agni
Meals felt in pulse
Dhatu agnis
Dhatu agnis
Pulse felt
Radial artery
8 places on body
8 places
Practice
Self first
On others
Self first
What conclusions can be drawn about the importance and efficacy of the methodology of the pulse based on this information? As we have seen from the beginning. All methods are looking for the presence of the Doshas in the pulse. This is in line with the ancient texts of Ayurveda. As we move further into the understanding of the pulse we find that the way the Doshas manifest in the body is interpreted differently by different lineages. Each method has proven its worth and ability to properly assess the imbalances of an individual. The aspects of the pulse although they have their similarities are not consistent enough to be objective. Pulse techniques rely on the basics until they develop sensitivity to the more subtle aspects of the pulse through practice, intuition, and study. The most consistent aspect of the pulse is feeling Vata in the index finger, Pitta in the middle finger, and Kapha in the ring finger. In each method the practitioner is looking for characteristics of the pulse that are either forceful or weak. The variations that are sought are not always the same in each method, but it is the looking for variation that allows the pulse to be effective. Once establishing what balance feels like in an individuals pulse, then imbalance can be differentiated. This differentiation varies between the http://www.ayurvedacollege.com/book/export/html/2
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methods, but in each method there is a clear movement away from what is considered by that method to be balance. The difficulty lies in the subjective nature of the methods to determine what Dosha and imbalance is actually occurring based on the qualities of the pulse. This assessment can only shed light on the truth that the pulse varies and can be read with practice and commitment. How the pulse is read varies widely between the methods. Every pulse has a distinguishable rate, characteristic, movement, rhythm, and amplitude. The unique ways the Doshas speak within the pulse are understood differently in each method. This understanding is the link between the pulse and Doshic manifestation in the body. The alphabet is the same for each method, but the words that are formed are as different as French, English, and German. References Douilliard, John, Dr. John Douilliard's Ayurvedic Pulse Reading Course, 1998 Dr John Douilliard Lad, Vasant, Secrets of the Pulse: The ancient art of Ayurvedic Pulse Diagnosis, 1996 The Ayurvedic Press Naram, Smita, Ayushakti Slide Presentation , 2000 Ayushakti Naram, Smita, email correspondence with Noah Volz 2005
THE SOUND OF HEALING: By Dena Jackson The science of Ayurveda is designed to help us live in harmony with our environment. Part of living in harmony with one’s environment includes balanced use of the senses. This can be a challenge, as we are literally barraged with sensory input on a daily basis. In the audio realm alone, we are subjected to tv, radio, traffic and construction noise, airplanes, trains, electrical vibrations and conversations, to name a few. Outside of actively retreating into nature, if we listen carefully, the sounds of nature penetrate the manmade noise at times, providing a temporary solace. Apart from external noise, we also deal with our internal sounds – thoughts – which may be shaped in large part by the external sounds. For example, if we are surrounded by people telling us we are stupid, our thoughts may reflect those words, and in turn, the vibrations of the body may be altered. The use of sound as a healing therapy has existed for centuries. From the mantras of the Rig Veda, an ancient Vedic text, to modern gadgets, there are many therapies that utilize sound as the basis of healing. Some are passive, such as modern vibroacoustic therapy, while others require more participation on the patient’s part, such as in the repetition of mantras. Sound therapies include music, chanting, Tibetan singing bowls, and the modern BETAR table. This paper will explore some of these modalities. Why does sound heal? Everything in nature vibrates at a particular frequency, including plants, rocks, stars, television sets, cellular phones and, of course, our bodies. When the body is continually exposed to vibrations similar, but not natural to its own frequencies, the new vibratory patterns may cause the natural frequencies to alter their vibrations to the new patterns. Dutch scientist Christian Huygens observed this principle, called entrainment, in 1655. He discovered that when he hung two clocks with different pendulum speeds close to each other on the same wall, the pendulums would ultimately synchronize and swing at the same speed. When our natural frequencies become “out of tune,” the body may become out of balance and we may become ill. The same process that can cause our vibrations to be unhealthy can also be used to restore the vibrations to homeostasis. Sound healing seeks to return our vibratory patterns http://www.ayurvedacollege.com/book/export/html/2
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to their natural state. Sound not only heals physical, mental and emotional trauma, but it also is a conduit for progress on our individual spiritual journey, as some sounds lead us to higher levels of consciousness. MUSIC It is a wellaccepted principle in the modern world that music affects moods. Film makers use music in movies to evoke an emotional response. Music is played in stores and restaurants, with the intent to entice us to buy more. Those of us who are musically inclined may have our own individual repertoire that we draw upon to either change or enhance a current mood. Consciously or unconsciously, we may choose certain music when we are sad, reinforcing the emotion. We may choose different music when we decide it’s time to let go of the sadness. The same songs to which we cling during certain periods in our lives may have a completely opposite effect, or even seem annoying, when in a different mood. It is also a fairly wellaccepted axiom that music affects health. Music therapy is a recognized allied health profession (a clinical health profession outside of medicine, nursing or dentistry). Most of the mainstream population is familiar with the Mozart effect, the theory that listening to Mozart’s music will make a person smarter. A recent article in Science Daily reports on a new study performed in Tel Aviv, during which preterm infants were exposed to 30 minutes of Mozart music each day. The researchers discovered that these babies used less energy after the music sessions, thereby increasing their ability to rapidly gain weight. Dr. Dror Mandel, one of the researchers, stated that, "It's not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated.” Dr. Mandel offers a possible explanation, “The repetitive melodies in Mozart's music may be affecting the organizational centers of the brain's cortex," he says. “Unlike Beethoven, Bach or Bartok, Mozart's music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed.” Each doshic type is balanced by certain styles of music. According to Pratima Raichur, in her book “Absolute Beauty,” vata types are balanced by slow, soft music with low tones and easy rhythms. Good choices for vatas include folk music, waltzes and ballroom music, due to their rhythmic nature. Also, the repetitive character of classical Indian music, Gregorian chants, classical Bach and Haydn help to balance the irregular, erratic qualities of the vata prakruti or vikruti. Contemporary “easy listening” and “light sounds” are more balancing to vata types than rap or rock music. Bri Maya Tiwari, in her book, “The Path of Practice” lists musical instruments that balance each dosha. Each dosha is balanced by vocals, Himalayan singing bowls and the piano and harmonium, played in the manner most appropriate for that dosha. Choices for vata include sitar, guitar, violin, mandolin and bass among stringed instruments; Incan panpipes, didgeridoo and chimes among wind instruments; all drums and percussion instruments. Pitta types are balanced by soothing, mellow music with medium tones and tempo. According to Raichur, pitta types need music “just slow enough to slow you down a bit but fast enough not to spark your impatience.” These sounds include jazz, opera, Benny Goodman, James Galway and some New Age sounds. The instrumental list according to Bri. Maya Tiwari includes flute, clarinet and saxophone among reed instruments; harmonica; violin, mandolin and dulcimer among stringed instruments; accordion and bagpipes among wind instruments; and all percussion instruments, including gentle drums. Kapha types are balanced by energizing, spicy, passionate music with higher tones. According to Raichur, “The harder the beat and the higher the volume, the better for staid Kapha.” These sounds include opera, classical Handel and Beethoven, loud electric music, R&B, Latin, rock and rap. Kaphabalancing instruments, according to Tiwari, include tabla, conga and water drums, as well as all other types of drums; all keyboard instruments; bells and chimes among percussion instruments; and didgeridoo, panpipes and the accordion among wind instruments. http://www.ayurvedacollege.com/book/export/html/2
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• Vibroacoustic Therapy Vibroacoustic therapy utilizes mechanical devices that passively deliver sound waves directly to the body in order to balance the physical, mental and emotional states. The BETAR (Bioenergetic TransductionAided Resonance) system is one such device. The BETAR vibroacoustic therapy system, designed by Peter J. Kelly, consists of a table, similar to a massage table, in which speakers are embedded at various distances along the midline of the table, aligning with the chakra points. Music is played while the client lies on the table. The client may choose from various types of music ranging from soft, soothing music to quick drum rhythms. Embedded within the music are the specific tones that resonate with each chakra. The music is literally felt as the vibrations from the speakers penetrate the body. The experience is often referred to as a BETAR ride. According to the website , “Like ripples on a pond, the sound waves delivered by the focused speaker array resonate outward through every muscle, organ and joint in the body a gentle music massage that melts away deeplyheld patterns of tension, stress and pain. Riders float away from the cares and concerns of everyday life, a visit to a personal musical sanctuary where healing can take place.” Peter Kelly also designed devices known as “MoodOMatics.” These small devices, based on Nicola Tesla’s bifilar coil technology, produce low frequency waves in order to induce either a state of relaxation or sleep. The waves, if perceived at all, may be heard as a low humming noise. The Relaxation Mood Tone Generator emits waves at the same frequency as the earth’s natural resonance. Known as the Schumann Earth Resonance Frequency, this frequency, until the modern age, was the dominant frequency at which the earth resonated. The earth’s natural frequency itself has been altered by the multitude of electronic objects we currently employ to make our lives easier. The Sleep Mood Tone Generator emits waves at a slightly slower speed, similar to delta waves produced by the brain. Both devices operate by drowning out other dominant frequencies, such as those created by power lines, in a small area around the device. • Tibetan Singing Bowls Tibetan singing bowls are handmade bowls, composed of various types of metals, usually combinations of bronze, copper, gold, nickel, silver zinc, tin and iron. These bowls produce various tones by striking a wooden mallet either on the side of the bowl or rubbing the mallet around the outside of the bowl. A therapy session using bowls consists of the therapist placing bowls of assorted sizes on the chakra points of the body and playing the bowls, again, by either striking or rubbing the side of the bowl. The therapist will choose bowls appropriate to the chakra tones or to the part of the body that needs to be balanced. The Sound, Mind, Healing and Education website quotes a November 2005 Massage Magazine article called “Samvahan, Vibrational Healing from India,” describing the theory behind Tibetan Bowl Sound Therapy. “'The sound waves from the bowls spread, as the concentric waves from a stone dropped in a pond, into larger and larger circles through blood, flesh, organs and even bones, relaxing them and at the same time harmonizing and energizing them. In this way the more than 100 trillion cells that are the building blocks of the human body are receiving a gentle cell massage. A visual example of the cleansing power invoked here is what happens when we put jewelry or dentures into a supersonic bath and see how in a short while all the dirt and grime is shaken loose. The sound therefore is releasing energy blockages through out the body. The bowl vibrations are soothing enough to calm the nervous system yet powerful enough to travel deep into the body to penetrate the bones.'” • Raga and Gandharva Veda Music Raga, an ancient healing form of music, is the music of the universe, said to have been taught to the rishis by Shiva himself. Musicians construct complex melodies in rhythm with the cosmos according to six seasons – spring, summer, early fall, fall, early winter and winter. Bri. Maya Tiwari, in the Path of Practice , says, “According to Vedic thought, every raga has existed since the time of transmission from Shiva; thus musicians who are said to have composed ragas, in actuality discovered a particular musical piece that was already known to the universe.” According to Ayurveda, each dosha accumulates, peaks and retreats each day. This play of the doshic tides occurs twice in each 24hour period. Maharishi Gandharva Veda music is a system of music designed to be played during specific doshic periods. Maharishi Mahesh Yogi, the founder http://www.ayurvedacollege.com/book/export/html/2
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of Transcendental Meditation, has worked to revive this type of music, based on ragas. Nature’s vibrations change during the day and the music is written in synchronization with those vibrations. The vibrations from the music will not only influence the body, but also the environment in which it is played, neutralizing negative vibrations in the immediate area and creating a calm, peaceful atmosphere. • Kirtan Kirtan is the practice of chanting, or repetitive singing, various names of the Divine. The experience of Kirtan is different than listening to music. In a group kirtan, the leader, called a wallah, sings a mantra, typically in Sanskrit, with the audience repeating it. A person doesn’t need a good singing voice to be a part of a kirtan. The voice may be the instrument, but the singing comes from the heart. The vibrations caused by the singing allow the participants to connect with their inner being and with each other. According to Ragani, a gifted kirtan singer, in an interview by Linda Johnsen for her book, Kirtan! Chanting as a Spiritual Path , “You feel the whole room go silent, and you sit there and your eyes are closed and you realize there are several hundred people in the room. You open your eyes and look out on a sea of faces and there’s not one person you recognize, yet you feel connected to every one.” Chanting, once thought by many to be an obscure custom, is now being scientifically studied by the medical community. In a 2010 study performed at the Parmala Hospital in Bengaluru, India , the effect of chanting on neck pain was investigated. Participants were trained in yogic mind sound resonance technique (MSRT), which consisted of repeating the syllables A, U, M, Om, and then the Mahamrityunjaya mantra. The control group received 30 minutes of conventional physiotherapy followed by 20 minutes of nonguided supine rest for 20 minutes. The study group received the same 30 minutes of therapy followed by 20 minutes of MSRT accompanied by an audio CD. The study group showed significantly better results in pain levels, tenderness, neck flexibility and anxiety. Several studies have been conducted on the use of Kirtan Kriya, a Kundalini yoga meditation technique, during which participants chant several primal sounds, both out loud, then silently, while simultaneously performing a specific mudra (hand position) with each sound. One study, published in 2009 in the journal Nuclear Medicine Communications , assessed changes in brain function during this type of meditation. Brain scans of 11 participants were compared while in a resting state and during the practice of Kirtan Kriya. The study revealed that there was a marked increase in brain activity in areas of the brain that control memory. One particularly significant finding was that the increase in brain activity occurs in the first part of the brain to experience a functional decrease in Alzheimer’s patients. In another study published in the Journal of Alzheimer’s Disease in 2010, the Alzheimer’s Research and Prevention Foundation along with the University of Pennsylvania , brain function and cognitive testing were reviewed in a group of patients experiencing memory problems. They were instructed to practice Kirtan Kriya for 12 minutes per day. In addition, another group listened to Mozart violin concertos for 12 minutes, rather than practicing meditation. The Kirtan group showed increased cerebral blood flow, while the Mozart group showed a nonsignificant increase in different regions of the brain. MANTRAS The subject of mantra is so vast that an entire branch of yoga, Mantra Yoga, is devoted to its exploration. In an introductory note to Dr. David Frawley’s book Mantra Yoga and Primal Sound , Sampadanada Mishra defines mantra: “The word Mantra is derived from the root sound “man” which means to think, to contemplate or meditate on, to perceive, to understand or comprehend. The sound tra at the end of the word Mantra is a suffix added in the sense of instrumentality. So, Mantra, as per its etymology, is an instrument of or a means for contemplation, meditation, comprehension, perception and of thought. Mantra, in fact, unites the mind with the pure sound.” The physical body is surrounded by the subtle body, a body of energy that exists beyond our sensory realm. Mantric sounds create or restructure http://www.ayurvedacollege.com/book/export/html/2
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the vibratory patterns in the subtle body, which effect changes in the physical body. Dr. Frawley explains , “Just as asana puts the body into a certain energetic posture in which higher forces can be released, so too each mantra puts the mind into a certain pose in which it can become a conduit for a higher flow of energy and grace. Each mantra like each asana has its intention, form and means of adaptation. Much like each asana, each mantra has its signature energy that brings about a specific effect upon the mind and can be understood according to its sound, meaning and application.” Mantras may take the form of syllables, known as seed (bija), sounds, or they may be used as words and verses. The Rig Veda, the oldest of the Vedic texts, is composed solely of mantric verses, known as hymns. Although not a comprehensive practice, simply listening to the Rig Veda as it is being chanted can have profound effects upon one’s being. Many yoga traditions continue to chant individual mantras from the Rig Veda that have been handed down orally from teacher to disciple. Two examples include the Gayatri Mantra and the Mahamrityunjaya Mantra, both of which find their roots in the Rig Veda. Yoga traditions use mantras as a focal point in meditation to give the mind something to do while drawing the attention ever inward, leading the practitioner to union with the inner Self. The Yoga Sutras expound upon the practice, maintaining , “The word expressive of Isvara [God] is the mystic sound OM. To repeat it with reflection upon its meaning is an aid. From this practice, all the obstacles disappear and simultaneously dawns the knowledge of the inner Self.” All mantras, and in fact, all sounds, emanate from the primal sound Om. In true yoga traditions, the Teacher or Guru initiates the student with a personal mantra that has been energized by force of the Guru and the Tradition. The student usually performs japa, a practice involving using a mala, a necklace of 108 beads plus one Guru bead, to count a specified number of mantra repetitions within a certain time period. This practice helps to reinforce the mantra into the student’s being. The mantra protects the student. The student uses the mantra to guide the mind into meditation and repeats it any time the mind remembers it. Eventually, with persistent practice, the mantra becomes so much a part of the student that it continues to be repeated in the unconscious mind. Although mantras can be recited by anyone, they have the most power, and thus yield the maximum benefit, when passed from teacher to student in a formal tradition. The sounds of the Sanskrit alphabet itself are balancing to the body. In fact, each letter of the alphabet has a specific sound and equivalent vibration, which corresponds to a particular part of the body. This is known as the Mantra Purusha. Through the use of the various sounds of the Mantra Purusha, we can “tune” our subtle body, correcting or redirecting the flow of energy from the subtle body into the physical body. These mantras can be combined with other mantras to create various effects. Mantra purusha sounds also correspond to marma points or regions, and thus may be chanted while stimulating marma points, increasing the healing effect. Mantras may be chanted while performing asanas, directing energy to specific areas of the body. Dr. Frawley in Mantra Yoga and Primal Sound describes in detail the Mantra Purusha and methods for its application. Bija mantras may have various applications. In addition to energizing specific parts of the body, mantras can be used to heal chakras suffering from insufficient flow. For example, the mantra vam can increase flow through the second chakra, svadhistana. The mantras may be used to increase elements in the body. Vam can bring more water qualities into a dry body. Bija mantras are also associated with specific bodily tissues. Vam can be used in cases of emaciation, increasing fat in the body. Mantras may be chanted out loud or internally. They may be chanted in the form of daily acknowledgements to the Divine. They may be used in conjunction with breathing practices, known as pranayama. In fact, the breath contains its own mantra. So is the sound the breath makes upon inhalation and ham is the sound the breath makes upon exhalation. This mantra can be chanted alone. Or the practitioner may choose another mantra to chant with the breath, depending upon the effect the practitioner wishes to achieve. For example, according to Dr. Frawley , chanting certain mantras with the breath will either increase or decrease the dominant element. Chanting ram in conjunction with breathing in the right http://www.ayurvedacollege.com/book/export/html/2
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nostril, through which flows fiery energy, will increase the fiery qualities. Chanting ram in conjunction with breathing in the left nostril, through which flows watery energy, will help to dry out the watery qualities. The ancient Vedic texts contain many references to mantras in relation to curing diseases. For example, the Atharva Veda contains mantras (charms) for specific diseases, i.e. fever, headache and cough . Mantras can be used to infuse herbs in order to give them extra healing power. The Caraka Samhita directs the practitioner in numerous situations to infuse herbs with mantras in order to boost their healing properties. For instance, Caraka describes birth rites as follows: “1. First of all, the child should be given honey and ghee impregnated with mantra prescribed for this purpose in the Vedas; 2. Thereafter, following the same procedure, milk from the right breast should be given to the child at first; 3. An earthen jar filled with water should be impregnated with mantras and kept near the head of the child. The milk inside the breast (mother or nurse) should also be impregnated by mantras before it is administered to the child. ” • Nada Yoga Nada Yoga is one of the more esoteric branches of yoga, involving advanced practices. Typically, aspirants practice other forms of yoga for extended periods of time, in order to prepare the body and mind before reaching the level of consciousness required to practice nada yoga. Raja yoga is one such form of yoga, in which the aspirant practices eight limbs. The first four limbs make up hatha yoga: yama (observances), niyama (restraints), asana (postures) and pranayama (breathing practices). The next four limbs are meditative: pratyahara (withdrawal of the senses), dharana (concentration), dhyana (meditation) and samadhi (superconsciousness). The word nada means sound. While mantra yoga involves syllables and words, nada yoga focuses on our internal sounds. The practitioner transcends various levels of being, moving from the gross levels into ever more subtle regions. External musical forms, such as kirtan and raga lead one to the internal, celestial music. External sounds are known as “struck” sounds or ahata nada. In other words, the sounds and vibrations are produced by one object striking another. Once the practitioner has withdrawn the senses and transcends the layers of external sounds, internal sounds become apparent. These internal sounds are known as “unstruck” sounds or anahata nada. The sounds are not produced, but are heard by the consciousness. Focusing on internal sounds, the practitioner first hears more gross internal sound and then hears progressively more subtle sounds which spring from silence. The Hatha Yoga Pradipika provides an outline of the practices of Nada Yoga. SILENCE One might wonder why the topic “silence” is included in a paper regarding sound. As indicated above, we live in a world full of sound. It is rare to find silence. It is common for people to be uncomfortable in silence or even to fear it. When people are in a room together, they tend to converse to fill the silence. When alone, most of us will play music or have the tv on for background noise. Even in the absence of external noise, the untrained mind, when faced with silence, will attempt to fill it with any number of ridiculous thoughts. It is in the silence after kirtan that is most powerful. Bhagavan Das, in Linda Johnsen’s interview, describes the experience: “Nada Yoga means tuning in to the inner nada, the inner Shakti. We use the external singing and music as the tuning mechanism. When the music stops we enter the silence. Go into it because it echoes into the inner nada and the inner nada will take you to God.” When a person sits in meditation and repeats a mantra, eventually the mantra will stop, leading to silence. Swami Rama of the Himalayan Yoga Tradition, in his book The Path of Fire and Light, Volume 2, devotes a chapter to the science of sound. In his examination of the mantra Om, he states , “…the mantra Om is composed of three parts: A, U, M – AUM – but the finest and most powerful part of Om is actually the silence preceding and following the sound….All sounds come from Om, and are finally annihilated and then go back into Om. The sound Om has no http://www.ayurvedacollege.com/book/export/html/2
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meaning if you do not know the silent hidden part of it. AUM stands for the waking, dreaming and sleeping states, respectively; the silent part signifies the fourth state, turiya. You have to go to silence to fathom the state of turiya.” From a BETAR ride to a mantra meditation, if a person is open, a sound therapy session is followed by silence. As Ayurveda teaches us, the root of all disease is ignorance of our true nature as spirit. Silence allows us an opportunity to connect to that nature; it is thus in silence that real and lasting healing takes place. SUMMARY The above information is presented as a very brief overview of a vast field of study. It is but the tip of an enormous iceberg. In fact, it has been a challenge to complete this paper. As I began to study each topic, I became so fascinated, that I would easily get sidetracked. In addition, I found it difficult to condense each topic into a few coherent paragraphs. As sound healing becomes more mainstream, and further scientific studies confirm the value these therapies provide, perhaps the unprecedented level of unhealthiness existing in the world today can be decreased. It is possible for diseases to be healed or prevented through the use of sound. It can be done with no side effects or invasive, costly procedures and without dependence on toxic drugs. Sound healing exists in many forms and can be used in any phase of an individual’s spiritual progress. It is appropriate for those wishing to address physical or mental issues, as well as for those progressing toward enlightenment. The deeper the practice, the more profound will be the results. Sound is a powerful tool for healing, not only for the physical body, but for returning us to the silence from which all sound, and indeed all matter, originates, assisting us in the quest to remember our true nature as spirit. It is only upon reaching that realization that we will be truly and completely healed.
The Ayurvedic Clinician: the mindful approach to enhancing your clinical skills Lelisa Balderama California College of Ayurveda Introduction The presence of the clinician and the trust built with the client is itself an essential aspect of the client’s healing process. “Indeed it may be that the physician’s (clinician’s) most potent therapeutic instrument is the self.”[13]. This paper discusses selfawareness, intuition and empathy—three important characteristics for the clinician to cultivate. The model, narrative medicine, emphasizes these three characteristics in fostering a therapeutic relationship with the patient. It also discusses the role of evidencebased medicine approach for the Ayurvedic Clinician. http://www.ayurvedacollege.com/book/export/html/2
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The goal is to be a “mindful clinician”—one who is a detached observer to one’s physical and mental processes in their daily tasks. This cultivation of self reflection enables the clinician to clarify his values so that he “can act with compassion, technical competence, presence, and insight.” [5] SelfAwareness Goleman claims that emotional intelligence is the key to success. He cites Salovey who categorizes emotional intelligence into five domains: 1. Emotional knowledge: recognizing our true feeling as it happens. 2. Managing emotions: handling one’s feelings that builds on self awareness; the capacity to rise above distress 3. Motivating oneself: harnessing one’s emotions to move forward, to act on an idea or to accomplish a goal. 4. Empathy: the capacity to know other people’s needs and wants 5. Handling relationships: the ability to thrive in relationships. He also cites John Mayer who states that emotions can color the way we feel and think and therefore can define the limits of one’s capacity to “use our innate mental abilities and so determining how to do in life.” [6] Reflection and selfawareness help the physicians (clinicians) to examine what is important and meaningful to them and therefore are able to deal more effectively with the difficult demands of their profession and resolve problems. This capacity for critical selfreflection pervades in all areas of their practice: the ability to communicate their knowledge as well as elicit information from their patients, the ability to make evidencebased decisions and perform technical skills, and the ability to define their values and act on those values.[5] Caraka Samhita also addressed this level of mindfulness: “Knowledge of the science of medicine is likened to the light for the purpose of illumination; one’s own mental faculty to the eye (for the purpose of seeing things).” He further claimed that when intelligence is combined with clarity, the physician makes no errors during the course of his treatment of a patient. The capacity to be aware depends upon the presence of mindfulness. It means paying attention without judgment but with purpose and intention. “Its power lies in its practice and applications”. While the concept is simple, it is not necessarily easy. The patterns of unawareness and automatic thinking will strongly resist one’s effort when disciplining the mind to be still and silent. It takes consistent effort to change these patterns but as the mind is emptied of the daily distractions, then “creativity, intelligence, imagination, clarity, determination, choice, and wisdom” will arise within you. This effort to simply be with the present moment is called a “meditation practice”. It is not a ‘doing’ but ‘being’. It is not about improving yourself but appreciating where you already are. It is realizing that what you do at this moment shapes what happens the next moment. [9] “The gentle letting go of the demands and attachments of your mind represents the highest level of true strength and character in a human being.” [8] A mindful clinician diminishes the boundaries between technical, cognitive, emotional and spiritual aspects of the practice. It is not only knowing the correct course of action, but recognizing the obstacles that blind your decisionmaking process. An umindful clinician puts forth the energy in blaming himself or others rather than being receptive to the lessons his errors has presented while the mindful clinician recognizes the incompetence and will develop a means to improve his weaknesses so that he is mentally and technically better prepared for the next situation. [5] Intuition Earl Spencer speaking of his late sister, Diana, Princess of Wales, shared that her gift was intuition which he described as “the distinctive feel for what is important” ( Funeral Service Tribute, September 6, 1997, cited by Epstein [5] ). The Oxford Dictionary defined intuition as an “immediate apprehension by the mind without reasoning.” (cited by Epstein [5] ). It has been described as a combination of insight and instinct, and an understanding based on previous knowledge. Some aspects of intuition relates specifically to perceptionthe recognition of patterns and subtle distinctions. [5] http://www.ayurvedacollege.com/book/export/html/2
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In the medical environment intuition is viewed not as an “esoteric talent” but is attained through knowledge and experience and that it is a carefully learned skill; it is an essential tool which enables the clinician to gain knowledge without direct evidence while engaging with the patient. [2] A research article interviewed 14 homeopaths in which 4 themes were presented to explore the nature of intuition and how it is used in a clinical setting: Theme 1: How homeopaths recognize and describe intuition. Most described it as a ‘gut feeling’, inkling’, ‘a sense’ and ‘a picture’. There was an awareness of intuition in which the participants reported how aware or conscious they were when experiencing their intuition; the descriptions implied a keen ability to read their patient’s nonverbal behavior or to sense the underlying message than what the patient is sharing which was then integrated into their case information. The intuitive perception seems to arise from empathizing with the patient. Researcher noted that it appears that the intuitive practitioner receive and understand useful information automatically, a “gestalt intuition”—using information perceived to fill in gaps, missing pieces or subtle connections between pieces of information. Most practitioners felt that the extraction of relevant information occurred rapidly and that it was difficult to pinpoint what led to the intuitive judgment. Theme 2: Beliefs about the origin of intuition. Most felt that it arose mainly from knowledge and clinical/personal experience. Others described their intuition as a natural ability. Overall intuition was perceived as an integration of knowledge and personal intuition. Theme 3: Types of intuition. Two types of intuitions experienced by the parishioners were identified and what their specific roles were during consultations. Intuitive perceptions is intuition based on careful attention picking up cues from verbal and nonverbal behaviors which provided a deeper and more insightful understanding of their patients. Intuitive hypothesis generation is a deductive process in which the intuition manifests itself through a sudden idea, followed by a series of testing their intuitive hypothesis and consequently helping them in their decision making. This type of intuition suggests a lack of trust in their ‘hunches’. Theme 4: The Selective Use of Intuition: Trusting Intuition. The participants would only use their intuition when they felt it was valid and reliable. It is applied in two aspects: use of intuition about patients and the therapeutic relationship and intuitions about the treatment/prescriptive part of the practice. The patientbased intuitions were trusted at all stages throughout the consultation process but intuitions for remedy ideas and prescribing decisions depended when the intuition happened. If it happened during the early stages of the consultation, most practioners would wait until they have a detailed and quantifiable information before relying on the intuitive remedy. [1] The use of intuition as clinical skills involves many methods. Kaplan talked about the “importance of unsolicited symptoms meaning that the clinicians should value “symptoms spontaneously offered by the patient far more than those given in response to direct questions”. It means that a clinician must be comfortable with silence so that the patient is given a space to share spontaneously and from this an intuitive clinician is able to elicit the deeper story of the patient’s mental/emotional processes. Kaplan shared a story from his mentor, Dr. Denis Somper, a classical homeopathic physician.. A woman in acute pain was describing her pain which she began to do and eventually remained silent. As usual, he remained silent and waited for the next ‘unsolicited symptom’. The woman feeling uncomfortable thumped her fist on the desk and yelled at the Dr. Somper: “don’t’ just sit there, do something”. The patient has not shared it but she demonstrated her symptom: angry when in pain. Dr. Somper gave her Chamomilla and it worked. Part of intuition is knowing when to be silent. Another way to develop intuition is cultivating a heightened awareness to nonverbal cues, from the dress of the patient, the patient’s patterns or responses, posture, speech, changes of moods, gestures of despair, joy and other emotions, and use of space. Kaplan points out that these observations apply to both the waiting room and the consulting room. When he sees a patient reading or carrying a book in the waiting room, he will often initiate a short conversation about the book or related subject which may offer clues about possible remedies for the patient even before the official consultation. [3] An intuitive approach in the clinical practice both encapsulates the rational and emotional aspects of patient support; fostering it can improve the quality of consultation by facilitating http://www.ayurvedacollege.com/book/export/html/2
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connection with the patient to improve decision making and patient outcomes. [10] Empathy Empathy is a way of understanding an individual’s subjective experiences by sharing that experiencing while maintaining the stance of an observer. The physician resonates with the emotional and cognitive aspects of the experience drawing from his background knowledge and previous experiences (consciously/unconsciously). These empathic messages come through posture, facial expression, emotional expression (laughs, grunts, groans) and more explicitly through his use of language and how it is conveyed (Goleman: 90% or more of an emotional message is nonverbal [6] ). For example, a doctor was seeing a young mother for gastrointestinal symptoms and shared with him that her teenage son had been hurt and was in the hospital. She was elusive about the details but the doctor sensed her agitation and through various means conveyed the message; “it is scary when your children are ill” which eventually open the guarded patient and she broke down sobbing. She then related more details about her son’s incident; it was the first time that she had been able to cry about it. Acknowledging the patient’s feelings is empowering and makes patients feel seen and heard. The doctor related another story of a medical student he was observing. During the consultation, the patient who was previously reserved became animated when asked about the presence of a headache. “I don’t even know what a headache is. I never had a headache in my life.” For some reason, this was significant to the patient, but the student, missing it, let the moment pass. A different approach would have been to say, “You are a very lucky man!” This simple acknowledgement gives the patient a chance to elaborate on the details if he wished and it would have enhanced the physician/patient attachment by affirming the patient’s success. [7] Caraka Samhita gave a gentle reminder: “ When a physician who even if well versed in the knowledge of the disease and its treatment does not try to enter into the heart of the patient by virtue the light of his knowledge, he will not be able to treat the disease.” [3] Often patients are unaware of are confused by their emotional state and identifying the emotion helps to diffuse it and can mobilize the patient to confront its true meaning. Starting gently like saying “you seem upset” rather than “you seem angry” is less confrontational. Naming the emotion can be a good starting point of discussion. A doctor related that a patient visited his office for checkups once a month for 1 year with minor aches or complaints that seems elusive to a diagnosis. Once the doctor saw through the pattern, instead of reassuring him, he simply acknowledged the patient’s concern and that he would keep a close eye on him. At the end of the year, the patient informed the doctor that his brother died of cancer at his current age and was afraid that it would happen to him, too. [13] Physicians who scored high on patient satisfaction also scored high on test on sensitivity to emotions. And physicians who were more empathic were seen more as being effective in alleviating their patient’s sense of concern about their illness. In general, it is more important for patients to have a physician who is compassionate than a physician who is technically competent in determining the patient’s commitment to the therapeutic relationship. Studies have shown that many patients go to the physician’s office with physical complaints with an underlying psychosocial order. When the physician’s empathy facilitates the patient’s to more freely express his/her emotions and alleviate the distress, it can liberate the physician from having to listen or evaluate other somatic complaints, which can lead to invasive and perhaps harmful investigative procedures. Another role for empathy is in the management of shame and humiliation during the consultation process. Patients are often in the position to reveal personal information that they may feel is demeaning. This is especially true in this era where there is a correlation of patient behavior (such as poor diet, cigarette smoking, dangerous sexual practices, etc) and certain diseases. The patient’s sense of shame about his weaknesses and inability to care for himself can cause him to suppress important information. The empathic physician behaves in a way that will allow him “to be invited within the patient’s protective barriers.” Empathy also helps the physician to be more understanding or tolerating towards patient behaviors that would otherwise seem alien or inappropriate. Dealing with a noncompliant patient is probably one of the most frustrating tasks for a practicing physician (or clinician); with this type of patient, the physician feels undermined in his efforts to be helpful. A wise physician would need to put himself on http://www.ayurvedacollege.com/book/export/html/2
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the side of the patient without being judgmental (instead of taking the punitive stance). When empathy is used the physician acknowledges that patient behave in ways that are rational to them based on their own sets of assumptions, and experiences; he is able to set aside his own preconceived notions so that he can be fully present with the patient. [13] Caraka Samhita emphasized the importance of nonjudgment: “Persons can further be considered to be authoritative only when they are free from prejudices of all kinds and who can see things objectively and in an infallible manner.” While he noted that this kind of absolute authoritativeness can only be found in the gods, nevertheless, he noted that human beings have the capacity at some level. [3] Goleman believes “Being able to manage emotions in someone else is the core of the art of handling relationship” [6]. Diagnosing and understanding the patient’s affective state is just one aspect of empathy. It is what the physician does with this understanding—“that is, what the physician gives back to the patient—that gives empathy its therapeutic efficacy.” [13] Narrative Medicine “Stories are medicine”. They have such power and yet it does not require a person to action or be but to simply listen. Stories set the “inner life to motion” and this is especially important when the person’s inner world is feeling frightened wedged or corned. [11] The sick person creates a personal illness narrative as a way to organize and give meaning to the events of his life. Part of that ordering is the need to tell the story—it is an evolving dynamic tale yet often there is no listener to acknowledge it. (Kleinman cited by Zinn [13]). The empathic clinician facilitates the patient’s building of the illness narrative that will make sense and give value to the experience. Medicine practice with narrative competence, is called narrative medicine—“it is the ability to acknowledge, absorb, interpret, and act on the stories and plights of other”. Methods such as reflective writing and reading of literature are used so the physicians can reach and join their patients in illness as well as recognizing their own journey through medicine. People with medical problems need physicians (or clinicians) who can understand their diseases, treat their sickness, and accompany them through the illness. Along with their scientific knowledge, physicians need to the ability to listen to their patient’s story, reflect and honor the story so that their decisions and actions demonstrates what’s best for their patient. Charon believes that narrative competence enables the physician to practice medicine with “empathy, reflection, professionalism, and trustworthiness.” Narrative knowledge is what one uses to understand the significance and message of the stories through cognition, symbolism and affective means: Who tells it? Who hears it? Why and how is it told? Barbara Herrnstin Smith (cited by Charon [4] ) defines narrative discourse as “someone telling someone else that something happened.” This definition implies that it requires a teller and listener, a writer and a reader, and a conveyance of message. Like a narrative, medical practice requires an interaction with another and that an authentic connection can be transformative to all participants. [4] As the physician listens to the patient’s narrative story, he enters into the world of the patient through drawing from his own memories, experiences, associations, imagination, and interpretations to identify the theme or the main thread of the story. By listening first, the physician is in a better position to answer the patient’s narrative questions: “what is wrong with me,” “why did this happen to me?” Often there are no clear answers but by being an empathic witness to the patient’s narrative story, the physician can proceed to his tasks such as diagnosing, interpreting findings, conveying information to the patient and engaging the patient in obtaining effective care. If the physician cannot perform these narrative tasks, the patient might not weave the whole story, might not ask the most revealing questions and might not feel heard. The result of the diagnostic process might be unfocused, the clinical relationship shallow and ineffective. [4] Physicians have turned to studying literature to grow in their personal understanding of the illness. There are now literature seminars and reading groups in the medical setting—physicians are reading wellwritten stories about illnesses to deepen their skills as readers and listeners. They are realizing that reflective narrating “illuminates aspects of the patient’s story—and of their own—that may otherwise not happen without the narrative”. Narrative writing by students and physician has become a staple in many medical schools and hospitals to increased reflection, self http://www.ayurvedacollege.com/book/export/html/2
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awareness, and learning to see the illness through the patient’s eyes. Physicians are writing about their patients’ stories, showing up in special columns in the journals and in books and essays and some are allowing their patients to read what they have written about them. Through the narrative processes of reflection and examination both physician and patient grow in understanding about the illness and how to manage it. [4] Charon writes a narrative story about her patient Ms Lambert (not her real name) who is 33 yearold woman with ChariotMarieTooth disease. Many of her family members (grandmother, mother, nieces) have the disabling disease as well. Ms. Lambert, despite being wheelchair bound, lives a dynamic life. She has a son, vivacious, smart and energetic; she observes that her son has developed weakness in his legs. As she shares with her doctor, she is engulfed in sadness for her son. The doctor feels her pain and grieves along with the patient. The doctor shares a section in the article she wrote in which she describes her patient’s pain, her patient’s story. Ms. Lambert, after reading her story realized more clearly the depth of her anguish. Her sisters’ dismissal of her concerns regarding her son had added to her suffering. She felt relieved that her physician seemed to understand her pain. She asked if she could show the article to her sisters and added, “Then maybe they can help me.” Such is the power of the narrative process. [4] EvidenceBased Medicine Evidencebased medicine integrates “individual clinical expertise and the best external evidence from systematic research. Clinical expertise means proficiency and judgment acquired through clinical experience and practice. Clinical evidence means clinically relevant research regarding accuracy and precision of diagnostic testing, the significance of prognostic markers, the efficacy and safety of rehabilitative treatments and preventive regimens. New research findings deemed as clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with more powerful, more accurate, more efficacious and safer.” It involves seeking the best external evidence with which to answer the clinical questions. However while external clinical evidence can inform, it is depended upon the individual’s clinical expertise to decides whether that particular data applies to the individual patient. And if so, how the clinician does integrate it into a clinical decision. Evidencebased decision models, while very powerful tools, are not always used by clinicians especially in complex situations. Some aspects of the patient, such as personality, do not fit in predefined categories. [12] “Medicine is both science and narrative, both reason and intuition.” [10] Being a good physician doesn’t just appeal to the best evidence as relying on it can limit the clinician to further reasoning and to deeper exploration. A mindful approach is: “compassionate informed action in the world, to use a wide array of data, make correct decisions, understand the patient, and relieve suffering.” In the ancient text, Caraka Samhita, this integration of art and science was implied: “Pratyaksa or direct observation is that which is comprehensible by an individual through his own senses and mind. Anumana or inference is the indirect knowledge based on reasoning.” [3] Conclusion The Ayurvedic Clinican’s main role is to foster an optimal healing environment for the patient. Thus, the clinician must understand the dynamics of the mental, emotional and physical aspects of the client and how its imbalances can distort the true nature of the individual and deplete the resources within himself/herself to heal. The Ayurvedic Clinician must also draw out the narrative illness of the patient, listen to its meaning, and to be there when the story unfolds and reveals its courage and its fears. In short, the clinician must be fully present with the patient. The following are some of the qualities that Caraka Samhita deemed a good “disciple” (medical student): tranquility, generosity, aversion to mean acts, perseverance, freedom from vanity, presence of intellect, power of reasoning and memory, inquisitiveness for truth, modesty and absence of ego, ability to understand the real meaning of things, good character, purity, conduct, love for study, enthusiasm and sympathetic disposition.” [3] http://www.ayurvedacollege.com/book/export/html/2
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These are the qualities that reflect selfawareness, empathy, and intuition which in turn cultivates the inner self. When the inner self is nurtured, healing occurs within and we begin to trust ourselves more. Jampolsky stated, “ In developing trust we unlock the power and wisdom that is within us”. [8] The Ayurvedic approach uses that same principle to bring healing to our patients. What we as clinicians strive for (to be whole in spirit) is what we wish for our patients and our community. That shared goal brings a unique dynamic between the Ayurvedic clinician and patient in the medical realm.
The Role of Ayurveda vs. Western Medicine in the Treatment of Hepatitis C (by Ellen Shearer, C.A.S.) Table of Contents 1. Introduction 2. Function of the Liver 3. Tests 4. Western Medical Treatment of Hepatitis C 5. Genotype patterns 6. Genotype and treatment 7. Western Holistic Treatment of Hepatitis 8. Ayurveda and the Liver 9. Ayurvedic Treatment of Hepatitis C 10. Summary Introduction Hepatitis C is a recently discovered disease. Until 1989 medical science was unaware that it even existed. There was no name for it and people that had it and actually had symptoms, either went undiagnosed or the liver problems were labeled as other diseases. Before the disease was identified doctors were seeing patients with a form of hepatitis that was labeled ?non A or non B? hepatitis. Once they discovered that it was a different and unique form of hepatitis, they named it hepatitis C. It has been called the silent killer. Doctors quickly realized that this ?new? form of hepatitis was particularly deadly because patients often had little or no symptoms other than flu like aches and pains, fatigue and occasionally, elevated liver enzymes (ALT and AST) until their liver failed due to cirrhosis or cancer. Although this was particularly troubling, they soon realized that because the disease had only recently been discovered, that infected people had unknowingly been donating blood and that the disease had been transmitted through blood transfusions. The U.S. Centers for Disease Control estimates that over the coming decade the death toll from hepatitis C will triple, surpassing that of AIDS. Four times as many Americans are infected with the hepatitis C virus as with HIV. http://www.ayurvedacollege.com/book/export/html/2
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Hepatitis C is caused by many viruses, which are extremely small germs that can mutate and multiply after invading a host. It invades through the blood or other bodily fluids causing infection and inflammation of the liver, which leads to complications or death. Liver enzyme tests sometimes reveal high levels of bilirubin, which causes jaundice, severe itching and yellow urine and can lead to cirrhosis causing coma or death. There is a higher risk of liver cancer with Hepatitis C infection. It is responsible for more than onethird of all liver transplants. [1] The disease is not casually spread. It can be transmitted through the transfer of infected blood either by sharing intravenous drug paraphernalia or hospital workers accidentally being stuck with a needle used on an infected patient, an actual blood transfusion, straws used to snort cocaine, tattooing and other sources of potential blood to blood contact. What is particularly frightening about the disease is that those who have the disease seldom realize they are sick when they first become infected. They may remain symptom free for decades and pass the virus through straws, needles or shared toothbrushes and razors. [2] HCV is not a fragile organism. No one knows how long it can survive in microscopic traces of dried blood; after 3 months, it is still active and infectious. Fortunately, persontoperson infection is rare even through sex but what is even more worrisome is that for 10 percent of people with the disease, the route of infection cannot be determined. [3] Most people don't think about their liver. They are unaware of the functions taking place within their body by this important organ. When a doctor tells them there is a problem with their liver they are usually shocked. The liver can slowly start to fail for a variety of reasons such as viruses, bacteria, cirrhosis, or cancer with little or no outward symptoms. Function of the Liver Unlike other organs in the body the liver has many functions. The stomach digests, the heart beats, the brain thinks but the liver performs multiple duties. Unlike other organs it can actually "regenerate" itself by expanding to fill the empty space if part of it is damaged or removed! One exception to this would be if it were permanently scarred with cirrhosis. A person can live without a gallbladder or spleen, a kidney or lung but they cannot live without a liver. Everything that enters the body through any method must pass through the liver. Besides being a very efficient filter, the liver plays a role in many other areas of the body. It helps to build muscles by metabolizing proteins. It regulates energy by storing glucose in the form of glycogen for use when needed. It maintains hormonal balance by regulating hormonal production. It helps to process vitamins and minerals as well as any ingested drugs. [4] The liver being the most active gland of the body secretes about 600800ml of bile daily. The metabolic functions of the liver include metabolism of fats, proteins, minerals, and carbohydrates. It also has secretory and excretory functions. [5] In Western medicine the liver functions as the gatekeeper and regulator of nutritional health and provides a purifying system as well. It weighs about 3 pounds and contains four sections called lobes. Within each lobe, lobules contain liver cells and passageways for blood circulation, called sinusoids. It is within the lobules that the specialized liver cells transform chemical substances into nutrients the body can use or neutralizes potential toxins to protect the body from damage. Because the liver plays a major role in the circulation and the composition of blood, its health has an impact on all body systems, from hormone regulation to thinking. [6] Tests
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Liver function tests are performed that determine the way the liver is performing. These are for AST, SGOT, ALT, GGTP, AP, bilirubin, and albumin. These letters are acronyms for enzymes proteins inside of cells. AST for example stands for aspartate amino transferase. This enzyme used to be called serum glutamic oxalacetic transaminase (SGOT), hence the two names. ALT = amino alanine transferase, GGTP= gamma glutamyl transpeptidase, and AP= alkaline phosphatase. Different cells have different enzymes inside them, depending on the function of the cell. Liver cells happen to have lots of AST, ALT, and GGTP inside them. When cells die or are sick the enzymes leak out causing the blood level of these enzymes to rise, which is a way of determining if the cells in question are sick. [7] Serum total bilirubin is increased in hepatocellular damage (infectious hepatitis, Liver disease, kidney disease, and malnutrition are the major causes of low albumin). A diseased liver produces insufficient albumin. [8] Additionally, if hepatitis is suspected then an HCVRNA test will be run to test for evidence of HCV antibodies and if present then a PCR test will be run to test the viral load of HCV present in the blood. Western Medical Treatment of Hepatitis C There are currently two drugs on the market that are used to treat hepatitis C. These are interferon, which is supposed to boost immunity, and ribavirin, which attacks the virus. There are, unfortunately many side effects associated with the drugs including fever, aches, pains, flulike symptoms, hair loss and severe depression just to name a few. These drugs are not effective against many of the genotypes associated with the virus. They are effective in only 1040% of all patients. These genotypes are mapped globally. Genotype patterns It is believed that the hepatitis C virus has evolved over a period of several thousand years. This would explain the current general global patterns of genotypes and subtypes: 1a mostly found in North & South America; also common in Australia 1b mostly found in Europe and Asia. 2a is the most common genotype 2 in Japan and China. 2b is the most common genotype 2 in the US and Northern Europe. 2c the most common genotype 2 in Western and Southern Europe . 3a highly prevalent in Australia (40% of cases) and South Asia . 4a highly prevalent in Egypt 4c highly prevalent in Central Africa 5a highly prevalent only in South Africa 6a restricted to Hong Kong, Macau and Vietnam 7a and 7b common in Thailand 8a, 8b & 9a prevalent in Vietnam 10a & 11a found in Indonesia http://www.ayurvedacollege.com/book/export/html/2
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Genotype and treatment Current scientific belief is that factors such as duration of a person's HCV infection, their HCV viral load, age, grade of liver inflammation or stage of fibrosis may play an important role in determining response to interferon treatment. Recent studies have suggested that a person's HCV subtype (or subtypes) may influence their possible response to interferon, or interferonribavirin combination treatment. [9] Genotype 1b appears to be at the greatest risk for increased risk of development of hepatocellular carcinoma (HCC) in cirrhosis. Western Holistic Treatment of Hepatitis Several herbs and supplements are used to treat hepatitis currently. These are as follows: Milk Thistle Picorhiza Licorice Vit C Vit E Phyllanthus Burdock Danbdelion Reishi mushrooms Turmeric Schizandra Alpha Lipoic Acid NAcetylcysteine Selenium Zinc [10] Ayurveda and the Liver In Ayurvedic medicine the liver is the seat of ranjaka pitta along with the spleen. The definition of Pitta literally means bile, which is ranjaka pitta. Ranjaka pitta gives color to all the tissues. The Sanskrit word ?ranjaka? means to give color. Ranjaka pitta is responsible for erythrogenesis, the creation of red blood cells in the bone marrow, which are mixed with rasa dhatu, the plasma. Thus, ranjaka pitta is responsible for giving color to the blood. [11] The function of ranjaka pitta in the liver is the disintegration of hemoglobin, which produces heme and globin. From heme, bile is produced, and that bile is ranjaka pitta. Its' job is to give color to the urine, feces and sweat. http://www.ayurvedacollege.com/book/export/html/2
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Ranjaka pitta in the stomach is intrinsic factor, which is responsible for production of blood in the bone marrow. Ranjaka pitta in the spleen kills bacteria and parasites as well as produces some white blood cells (rasa dhatu), so its job is more protective. There is a functional integrity between the liver, stomach, spleen, and bone marrow. If the function of the liver is affected the bone marrow will also be affected. If the function of the stomach is affected, it will affect the liver. In a way, the spleen is to filter the blood and to send unwanted heavy, old red blood cells to the liver; the liver destroys them and separates the hemoglobin from the blood. Then the liver utilizes the hemoglobin that is liberated for the production of bile salts, pigment and enzymes. Therefore, when the spleen is enlarged the liver may also be enlarged and vice versa. [12] The Sanskrit word for liver is "yakrut". "Ya" means circulation and "krut" means action. Yakrut is an important seat of fire the seat of anger, hate, envy, and jealousy. These emotions need to be processed and metabolized. These emotions want to come out but, if we suppress them, they accumulate in the tissues and lead to disease. Ayurveda does not separate emotions from the organs. We cannot separate body from mind and mind from consciousness. [13] Disorders of ranjaka pitta include hepatitis, anemia, chronic fatigue syndrome, and mononucleosis. Excessive bile production or a blockage in the flow of bile usually indicates high pitta, which in turn affects the agni or enzyme activities responsible for absorption, digestion and metabolism. Pitta can be aggravated by many factors of diet and lifestyle. These would include alcohol abuse, eating red meat, eating too much spicy or oily, heavy foods, lack of sleep, too much direct exposure to the sun and smoking. When pitta becomes aggravated liver diseases can result such as hepatitis and cirrhosis. Although viral type hepatitis such as hepatitis C is not mentioned in the classic Ayurvedic texts, similar symptoms are described under "kaamala". Ayurveda describes two basic types of kaamala (hepatitis or jaundice). 1. Shakhasrita is caused by the minimal aggravation of pitta and kapha, and is easily curable. 2. Kumbha kaamala results from very high pitta and is difficult to cure. It can become incurable if not attended to immediately. Panaki and haleemaka are two other types of hepatitis or jaundice that are explained in Ayurvedic texts. Panaki is late stage kaamala. Haleemaka is an advanced stage of anemia that occurs when both the vata and pitta are out of balance. [14] [15] [16] Pathogenesis Due to the aggravation of pitta by excessive alcohol intake, too much heavy, oily, spicy food, etc. the liver can become diseased. When pitta is out of balance and disease begins in the liver this can result in disease of the blood, muscle tissue, and biliary system. The manifestation of this disease will be ?kaamala' or jaundice. The symptoms of "kaamala include: •Loss of appetite and taste • Generalized weakness http://www.ayurvedacollege.com/book/export/html/2
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• Yellowish discoloration of the eyes, nails, oral cavity, and urine • Vague body pains • Burning sensation • Weakness in all sensory organs [17] Once hepatitis is advanced and the immune system is highly comprised emaciation will be present as well. Ayurveda teaches us that hepatitis involves all systems in the body including musculoskeletal, cardiovascular, and the gastrointestinal system as well as the skin. Symptoms of hepatitis such as generalized edema ( shotha), excessive thirst (atitrishna), bloody stools (krishna varna mala mutra), vomiting blood (rakta yukta chardi), red eyes (rakta netra), dizziness (bhrama), drowsiness (tandra), total loss of appetite (teevra agni mandya), and hepatic coma (nashta sanjna) indicate that the liver disease is at an incurable stage, and the patient is believed to be terminally ill. [18] Usually liver disease will present itself with certain signs and symptoms. These may include fatigue, jaundice, loss of appetite, mild fever, joint aches and pains, occasional nausea and or vomiting. Through the pulse you will feel many imbalances including but not limited to prana vata, vyana vata, apana vata, samana vata, sadhaka pitta, pachaka pitta, ranjaka pitta, rasa, rakta and medas dhata. The eyes may appear yellowish and burn which will show up as alochaka pitta in the pulse; the skin may have hives or rashes, which can show up as bhrajaka pitta in the pulse as well. The tongue will have a deep redness indicating the heat of rakta and ranjaka pitta. Palpating the abdomen may reveal a swelling or tenderness in the upper left quadrant where the liver resides. There will be other information available as to the type of lifestyle the person has lived, their constitution and physical strength. Out of balance pitta, and poor agni play important roles in the symptoms of hepatitis and other liver disorders. In addition, low ojas is the essence of the immune system. Low ojas makes a person more vulnerable to immune system dysfunction or infections such as hepatitis. According to Vaidya Ranjeet Nimbalkar, hepatic liver disease is caused by "vimargagamana", which is abnormal flow of constituents in other srotas resulting in abnormal accumulation of that constituent in the srota in which it is abnormally flowing. Also, it causes its defiiciency in its own srotasa. In the case of kaamala there is vimargagamana of raktamala pitta into the raktavaha srota, which should be going to the annavaha srota and excreted trough the purishavaha srota. Due to some abnormality of yakruta it flows into the rakta and then to all of the body. In the case of raktapitta, liquid part of various dhatus because of excessive heat of pitta, drains into rakta increasing its quantity. This is vimargagamana of uadaka of various dhatus in rakta, because of some functional abnormality of yakruta. Rasa and rakta, being liquid dhatus are more prone for vimargagamana. Also rasa and rakta dhatus are responsible for nourishment of all the other dhatus." Ayurvedic Treatment of Hepatitis C Any diet or lifestyle activity that aggravates pitta can be a contributor to hepatitis. These would include: 1. Alcohol abuse 2. Red meat 3. Spicy, oily, heavy foods http://www.ayurvedacollege.com/book/export/html/2
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4. Lack of sleep 5. Too much sun exposure 6. Smoking Treatment would be to balance pitta dosha and should be individually based for each person's imbalances. Herbs, meditation, diet and bodywork would all play an important role in the treatment. Diet should consist of the following: 1. sweet and bitter vegetables 2. sweet, ripe fruits 3. mung dahl, lentils 4. grains oats, basmati rice, barley 5. dairy butter, buttermilk, milk, cream 6. spices coriander (fresh and dried), fennel, cardamom, dill, turmeric Yoga postures for those strong enough to perform them should include vajraasana, shalabhasana, halasana, padahastasana, savasana, abdomen lift and stomach lift which are helpful in liver disorders. These should be performed early in the morning or evening. Avoid hot showers or baths. Pranayama breathing is effective. Meditation and chanting mantras in a quiet place is important as well. Walks in nature or gazing at the moon are balancing for pitta as well. The herbs that are important and effective for treating liver disorders are: Bhumyamalaki Bhringaraj Turmeric Guduchi Haritaki Kalmegha Kutki Musta Pippali Punarnava Licorice Panchakarma therapies important for liver ailments and excess pitta would include, poorva karma (prepurification measures), abhyanga, pinda sveda, virechana (using avipattikara churna or triphala churna) pizzhichil, and yapana basti (using licorice, guduchi, katuki and manjista with milk and honey). [19] After panchakarma subjects should follow the diet and lifestyle that will establish the balance of pitta. This would include avoidance of afternoon sleeping, exposure to hot sun, exertion, anxiety, alcohol abuse, smoking and irregular eating habits. Diet should be mainly fresh vegetarian food as outlined above. http://www.ayurvedacollege.com/book/export/html/2
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Rasayana therapies after panchakarma should include pippali for fever fatigue, inflammation, liver and spleen enlargements. The dose would be 1 tablespoon twice a day. Also ashwagandha, sariva, jiraka, draksha would be given in the form of a churna for fatigue, immune enhancer and rejuvenator and to decrease the viral load. The dose would be 1 tablespoon twice a day. Lastly triphala at night would be given for immunodeficiency and chronic illness. This would be one tablespoon at night with warm water. [20] Summary Western medicine at present offers little in the way of treatment or cure of Hepatitis C. The drug treatments have many side effects and almost no effectiveness in eradicating the virus. Western holistic medicine offers some positive therapies for protecting the liver and supporting the immune system. Ayurveda offers a total approach to support and treatment of people with hepatitis. While no long term studies have been done in the treatment of hepatitis C and Ayurveda, the diet and lifestyle changes offer much in the way of balancing and enabling the immune system to fight off the virus. Additionally, Ayurveda emphasizes disease prevention as well as achieving a goal of total health. The historical information provided in the ancient texts about ayurvedic herbs and treatments describe how to protect, detoxify and improve the health of those with diseases of the liver. [1] MEDLINEplus "New Drug Hope for Millions of Hepatits C Victims" [2] Cohen, Misha, Gish, Robert, MD "The Hepatitis C Help Book"(2000) p.1 [3] Buhner, Stephen, "Herbs for Hepatitis C and the Liver" (2000) p. 2 [4] Palmer, Melissa, MD," Hepatitis Liver Disease" (2000) p. 13 [5] Kulkarni, P.H., el al. "Ayurved and Hepatic Disorders"(2001) p. 42 [6] Cohen, Misha, Gish, Robert "The Hepatitis C Help Book"(2000) p. 19 [7] Hepatitis Central: Lab Tests [8] Hepatitis Central: Lab Tests [9] Hepatitis Central: Genotypes Explained [10] Buhner, Stephen, "Herbs for Hepatitis C and the Liver" (2000) p. 282 [11] Lad, Vasant, M.A.Sc., Textbook of Ayurveda Fundamental Principles (2002) p. 57 [12] Lad, Vasant, M.A.Sc., Textbook of Ayurveda Fundamental Principles (2002) p. 5758 [13] Lad, Vasant, M.A.Sc., Textbook of Ayurveda Fundamental Principles (2002) p. 58 [14] Charaka Samhita: Nidanasthanam, chapter 1, stanzas 611. Ed. P.V. Sharma, Chaukambha Orientalia, Varanasi, India 1981 [15] Yogaratnakara: Vol I. Pradhamakanda verse 35. Chaukambha prakashan, Varanasi, 1989 [16] Sarangadhara Samhita, chapter 1 verse 13. Chaukambha Orientalia, Varanasi, India, 1989 [17] Mishra, Shri K. MD, "Ayurvedic Medicine" (2000) p. 818 [18] Susruta Samhita: Sutrasthanam. Motilal Banarasidas Publishers. New Delhi. 1983. [19] Mishra, Shri K. MD, ?Ayurvedic Medicine? (2000) p. 818 [20] Hepatitis C:Choices Appendix IV, Ayurvedic Medicine,Ayurvedic Herbs Used to Treat Liver Disorders p. 1012 http://www.ayurvedacollege.com/book/export/html/2
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Western and Ayurvedic Approaches to the Treatment of Early Stage Prostate Cancer By: Suzanne Mansell Introduction: Prostate cancer is cancer that occurs in a man's prostate — a small walnutshaped gland that produces the seminal fluid that nourishes and transports sperm. [1] Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. The 2012 prostate cancer statistics from the American Cancer Society are as follows: [17] • • • •
About 241, 740 new cases of prostate cancer will be diagnosed. About 28, 170 men will die of prostate cancer. About 1 man in 6 will be diagnosed with prostate cancer during his lifetime. About 1 man in 36 will die of prostate cancer.
Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. More than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today. [17] According to the most recent data*, when including all men with prostate cancer: • • •
The relative 5year survival rate is nearly 100%. The relative 10year survival rate is 98%. The 15year relative survival rate is 91%.
Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some forms of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. [1] * Fiveyear relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. [17] Prostate cancer has been classified into four stages: [1, 17] Stage I: This stage signifies cancer in its earliest stages that is confined to a small area of the prostate. When viewed under a microscope, the cancer cells are not considered aggressive. Stage II: Cancer at this stage may still be considered small, but may be considered aggressive when cancer cells are viewed under the microscope. Alternatively, cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland. Stage III: The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues. http://www.ayurvedacollege.com/book/export/html/2
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Stage IV: The cancer has grown to invade nearby organs or spread to lymph nodes, bones, lungs, or other organs. This paper will focus on the interpretation and treatment of early stage prostate cancer from both the Western medical and Ayurvedic perspectives.
Western Interpretation and Diagnosis of Prostate Cancer Causes. Western physicians are not certain what causes prostate cancer. Physicians know that prostate cancer begins when cells in the prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can break off and spread to other parts of the body. [1, 17] Risk Factors. Factors that can increase the risk of prostate cancer include: age (over 65), ethnicity (black men have a greater risk of prostate cancer than do men of other races), family history of prostate cancer, nationality (prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands and less common in Asia, Africa, Central America, and South America), and obesity. [1, 17] Symptoms. While prostate cancer that is more advanced may cause signs and symptoms, such as trouble urinating, decreased force in the stream of urine, blood in the urine, blood in the semen, swelling in the legs, discomfort in the pelvic area, or bone pain, prostate cancer may not cause signs or symptoms in its early stages. [1, 17] Screening for Prostate Cancer. Whether to test healthy men with no prostate symptoms for prostate cancer is controversial. Medical organizations do not agree on the issue of screening and whether it has benefits. Prostate screening tests might include a digital rectal exam (DRE) and a prostate specific antigen (PSA) test. Prostatespecific antigen (PSA) is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. PSA helps liquefy the semen. A small amount of PSA normally enters the bloodstream. Cancer cells usually make more PSA than do benign cells, causing PSA levels in the blood to rise. But PSA levels can also be elevated in men with enlarged or inflamed prostate glands. [1, 17] Diagnosing prostate cancer. If an abnormality is detected on a DRE or PSA test, the physician may recommend tests to determine the presence of prostate cancer, such as ultrasound or prostate biopsy. [1, 17] Determining whether prostate cancer is aggressive. When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. Moreaggressive cancer cells have a higher grade. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer). [1,17] Determining how far the cancer has spread. The following imaging tests may be recommended to determine if the cancer has spread beyond the http://www.ayurvedacollege.com/book/export/html/2
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prostate: bone scan, ultrasound, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). [1,17]
Western Treatment and Prevention of Early Stage Prostate Cancer Treatment: The prostate cancer treatment options below depend on several factors, such as how fast the cancer is growing, how much it has spread, overall patient’s health, as well as the benefits and the potential side effects of the treatment. • Radiation therapy. Radiation therapy uses highpowered energy to kill cancer cells. Side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur. There is a small risk of radiation causing another form of cancer, such as bladder cancer or rectal cancer, in the future. Radiation therapy is generally an option for early and late stage cancers. [1, 17] • Hormone therapy. Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy is generally used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with earlystage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Hormone therapy also increases the risk of heart disease and heart attack. [1, 17] • Surgery to remove the prostate. Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. [1, 17] • Freezing prostate tissue. Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. Cryosurgery may be an option for men who have not been helped by radiation therapy. [1,17] • Heating prostate tissue using ultrasound. Highintensity focused ultrasound treatment uses powerful sound waves to heat prostate tissue, causing cancer cells to die. [1,17] • Chemotherapy. Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. [1,17] • Active Surveillance. In active surveillance, regular followup blood tests, rectal exams and possibly biopsies may be performed to monitor progression of the cancer in lieu of additional treatment. [1, 17] Note: active surveillance is sometimes called “watchful waiting;” however, some physicians make the distinction that “watchful waiting” is a less intensive form of followup that may result in fewer tests and rely more on changes in a man’s symptoms. [17, 2] For men diagnosed with a very early stage of prostate cancer, Western physicians have conceded that active surveillance is a viable option. It is http://www.ayurvedacollege.com/book/export/html/2
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considered when the cancer is not causing symptoms, is expected to grow very slowly, and is confined to a small area of the prostate. It may also be considered for a man who has another serious health condition or an advanced age that makes cancer treatment more difficult. However, active surveillance is considered to carry the risk that the cancer may grow and spread between checkups. As a result, men with early stage prostate cancer who wish to start treatment are also offered the options of radiation therapy and surgery. [1, 2, 17] Prevention: To prevent prostate cancer, Western medical physicians generally recommend maintaining a healthy weight, exercising, and choosing a healthy diet. [1, 17] • Some studies have found that men who are overweight may have a slightly lower risk of prostate cancer overall, but a higher risk of prostate cancers that are likely to be fatal. [1, 17] • Studies have found that men who get regular physical activity have a slightly lower risk of prostate cancer. Vigorous activity may have a greater effect, especially on the risk of advanced prostate cancer. [1, 17] • Several studies have suggested that diets high in certain vegetables (including tomatoes, cruciferous vegetables, soy, beans, and other legumes), grains, or fish may be linked with a lower risk of prostate cancer, especially more advanced cancers. [19, 20, 21] • Studies have shown that men who eat a lot of red meat or highfat dairy products appear to have a slightly higher chance of getting prostate cancer. However, some studies indicate this may be a result of meat heated at high temperatures. [1,17, 22] • Studies of men who drink green tea or take green tea extract as a supplement have found a reduced risk of prostate cancer. [1] Active Holistic Surveillance: An integrative approach to treatment and prevention: Active “holistic” surveillance is a term coined by Dr. Aaron Katz, Director of the Center for Holistic Urology at Columbia University Medical Center. Active holistic surveillance involves: [2]
• Changes in diet, including the reduction or elimination of red meat and dairy. • Dietary supplements, including herbal antiinflammatories, omegathree fatty acid supplements, and vitamin D. • A reasonable exercise program (aerobic exercise at least three times per week). • Some method of stress reduction (such as yoga or meditation). • PSA testing every three to four months and a repeat DRE every six months. • A repeat biopsy at 12 to 24 months, even in cases where the PSA is stable, to ensure the cancer volume has not increased and that the Gleason score does not need to be updated. Dr. Katz advises the use of active holistic surveillance if a patient’s: [2] •
PSA is below 10 and a Gleason score under 7; and
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• • • • •
Disease is at stage I or II; and MRI shows no cancer growth outside the prostate gland; and Cancer is not palpable in DRE; and Biopsy shows fewer than four of at least 12 cores to be positive for cancer; and Less than half of any core taken is cancerous.
Substantiating Dr. Katz’s advice, a recent study in the New England Journal of Medicine concludes that among men with localized prostate cancer detected during the early era of PSA testing, surgery did not significantly reduce allcause or prostatecancer mortality, as compared with surveillance, through at least 12 years of followup. [18]
Ayurvedic Interpretation of Prostate Cancer Cancer According to Ayurveda In classical Ayurvedic literature, a detailed description is provided for various types of tumors. Terms such as gulma, granthi, utseda and arbuda are used for specific tumor conditions. Arbuda, in particular, is a malignant tumor or cancerous growth. According to Ayurveda, the cancer disease process happens at the subtle cellular level. At the cellular level, each cell is a center of awareness, a conscious microscopic life. There is a flow of communication from one cell to another, and every cell has cellular integrity and governs its own metabolic activity. [3] However, poor communication can occur at the cellular level if cell membranes are clogged with ama, or toxins. Since each cell has its own self esteem and self importance (ahamkara), if a cell becomes isolated from others it becomes lonely. A lonely cell starts to act independently, producing its own enzymes and its own agni. The cell continues to grow independently and, as a result, it becomes malignant. These arbuda cells have a distorted self and hyperactive metabolism, demanding more metabolic output and attacking their neighboring cells. As a result, they end up converting neighboring cells into cancerous cells. [3] Classical Signs and Symptoms (Rupa)
According to classical Ayurveda, pain (ruja), weakness (daurbalya), malnutrition (alpa poshanam), extreme fatigue (balakshaya), as well as bone fractures (asthi bhagnata) and even paralysis (pakshavadha) are signs and symptoms of cancer. [3] Classical Causes (Nidana)
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According to the ancient text, Madhava Nidanam, there are specific etiological factors that can lead to cancer. [3, 4] • • • • • • • • • • • •
Overexposure to solar radiation (atapa) Substances that have irritating properties, like drugs or alcohol (vidahani annapanani) Penetrating cytotoxic drugs (tikshnani aushadhani) Toxic metabolic waste at the cellular level (cellular ama) Incompatible food (viruddha ahara) Wrong lifestyle (viruddha vihara) Genetic predisposition (bija dosha) Parasites or microorganisms in the blood (sukshma krimi) Occupational hazards and exposure to toxic substances (vyavasaya) Psychological and emotional factors, such as unresolved grief or stress (mano vedana) Age, in that people over 65 are more prone to cancer of the prostate or colon (vardhakya) Pollution (paryavartanam)
Pathogenesis (Samprapti) From an Ayurvedic perspective, tumor formation is a condition of vata kapha origin. Vata is responsible for the faulty division of cells and kapha for their growth. Therefore, vata pushes kapha out of balance resulting in tumor formation. While benign tumors take on a predominantly kapha appearance, in malignancies, pitta is also vitiated and the condition becomes tridoshic in nature. In these conditions, the agni of the affected tissue is increased making it very aggressive to its surroundings as it slowly digests the tissues of the body. Over time vata imbalance predominates and the condition leads to severe wasting of the tissues of the body. As cancer begins, ojas in the affected tissue is low, and, as the condition progresses, systemic ojas becomes lower and lower. [5] Muscular tissue is the most common dhatu affected by cancer, although any dhatu can be affected. While benign tumors of muscular origin are most often described as kapha entering into the mamsa dhatu of the mamsavaha srota (even though it may be vata that has pushed kapha), malignant tumors of muscular origin are most often described as pitta vitiation in the mamsa dhatu of the mamsavaha srota (even though vata and kapha are also vitiated). [5] Prostate Cancer According to Ayurveda
From an Ayurvedic perspective, prostate cancer is a tumor of the prostate gland involving vitiation of all three doshas (vata, pitta, and kapha). Because the prostate gland forms part of the male reproductive system (shukra dhatu), prostate cancer reflects the physical, emotional, and spiritual relationship that the affected man has had with his reproductive capacity. Because the shukra dhatu is the seventh and last dhatu, any disorder at this level also reflects the overall relationship with the entire body. [6] http://www.ayurvedacollege.com/book/export/html/2
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Causes of Prostate Cancer—The Physical Level
Prostate cancer arises from a combination of doshic disturbances in the shukra dhatu and accumulation of ama in the vicinity of the prostate gland. Once one dosha is provoked in the shukra dhatu, and this provocation goes unchecked, the other two doshas will gradually accumulate, leading to tridoshic provocation. [6] Vata Provoking Factors. There are many factors that lead to vata provocation in the shukra dhatu. These include: [6, 7] • Overuse of the sexual organs • Hasty or surreptitious sexual activity without time to relax afterwards • Holding back the natural urge to ejaculate once at the point of ejaculation • Excess bicycle riding, or other forms of "bumpy" activity involving sitting astride a saddle • Exposure to electromagnetic fields, microwave or radiation • Vataprovoking habits to the entire system (i.e., lack of regular routines, drinking coffee, overconsumption of raw or dry foods, lack of adequate fluidintake) • Stress (particularly because vata dosha governs the nervous system). Vata dosha also increases with age. Because vata dosha is irregular, dry, and moving by nature, it can cause digestion to become more irregular. This contributes to more ama being produced and spreading to the tissues. Additionally, the prostate is located in the area of the body that is governed by apana vayu, which includes the colon, lower abdomen, elimination, and reproductive areas. Therefore, anything that aggravates apana vayu creates pressure on the prostate. So if the flow of energy and nutrients to the prostate area gets blocked by ama, and the flow of impurities out of the area gets obstructed, the prostate gets weaker and more and more imbalanced. [7] Pitta Provoking Factors. Pitta may be provoked in the shukra dhatu due to exposure to infection. Consumption of alcohol, spicy food, salt, or sour fruits, may also provoke pitta in shukra. If anger or frustration is associated with the reproductive act, pitta may quickly become provoked in the reproductive system. [7] Kapha Provoking Factors. Stagnation of creative energies, excess sleep, lack of exercise, a sedentary lifestyle, and a high fat diet, may cause kapha to accumulate in the shukra dhatu, leading to benign prostatic hypertrophy or, if the other doshas become involved, to prostate cancer. [7] Effects of Ama and Other Toxins. Because of its anatomical position, the prostate gland is vulnerable to the accumulation of ama in both the urinary bladder and the colon. Benign prostatic hypertrophy may cause partial or complete urinary retention, leading to ama and infection in the urinary bladder. As a result, this causes ama to accumulate in the prostate gland, where a malignancy may eventually develop. Toxins accumulated in the colon and rectum readily transfer to the prostate gland, where these toxins may give rise to cancer. Thus, any factors that create toxins in the colon are directly implicated in the causation of prostate cancer. Environmental toxins ingested in food and accumulated in the colon may expose http://www.ayurvedacollege.com/book/export/html/2
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the prostate gland to carcinogenic chemicals such as pesticides and solvents. The shukra dhatu is also particularly vulnerable to the effects of radiation exposure. [7] Causes of Prostate Cancer—The Subtle Level
In addition to a toxic environment, devitalized foods, and sedentary lifestyle, cancer, in general, can be caused by lack of spiritual purpose or effort in life. Suppressed emotion or emotional stagnation can lead to accumulation of toxic material and excess doshas. [8] Additionally, imbalances or blockages of energy associated with either the first or second chakra can lead to disorders of the prostate gland, and, eventually to prostate cancer. The prostate gland is associated with muladhara chakra (the first chakra), as it governs procreation among other functions. There is also a connection between the prostate gland and svadhisthana chakra, the second chakra. All nonprocreative aspects of sexual intercourse are related to svadhisthana chakra, as well as creative energy. Therefore, addressing the overall relationship with sexuality, procreation, and the entire spectrum of generative and creative energy becomes important. [7]
Ayurvedic Treatment (Chikitsa) and Prevention of Prostate Cancer The Ayurvedic healing process for prostate cancer approaches the patient on several levels: physical, mental, emotional and spiritual. Healing Process—The Physical Level
Herbs. Generally, herbs utilized in the treatment of cancer can be taken internally or applied over the tumor as a paste, acting directly on the cancer and supporting a deeper healing when used in accordance with the patient's vikruti. [11] Specific references to the treatment of tumors (arbuda) in the classical texts indicate the application of herbal poultices and fomention for vata arbuda, herbal poultices, fomentation and herbal purgatives for pitta arbuda, and the application of hot plaster after herbal emetics or purgatives for kapha arbuda. [12, 13] In the treatment of prostate cancer, herbs may be utilized to support the health of the urogenital system, reduce tumor growth and perhaps limit metastasis. Specific herbs for the urogenital system. • Gokshura is noted to be one of the most important herbs for the urogenital system. Gokshura is tridoshic, diuretic, rejuvenative, nervine, and soothing to the urinary tract. [6, 8, 9] • Punarnava is another important herb that rejuvenates the urinary tract. It is also useful in the treatment of cancer because it reduces swellings, and its alkaloid has a specific anti cancer effect. However, it should not be used in cases of dehydration or emaciation. [6, 9] • Additional herbs that support healthy urination include: white sandalwood, guduchi, shilajit, and pumpkin seeds. [6, 9] • Herbs that support the shukra dhatu and maintain testosterone production include: gokshura, bala, shilajit, zinc bhasma, and saw palmetto. [7, 9, 10] http://www.ayurvedacollege.com/book/export/html/2
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•
Herbs that specifically support prostate health include: o Guduchi, turmeric, and zinc B=bhasma. They enhance immunity in the prostate area. [7] o The combination of guggul and zinc bhasma. They are a traditional ayurvedic remedy for balancing the size and health of the prostate. Turmeric and guggul are both effective antiinflammatory herbs, as well. [7] o Ashwaganda. It provides longterm support and nourishment to the prostate gland. [9] o Bala, kapikacchu, and marshmellow. They are effective for enlarged prostate problems. [8] o Kachnar and guggul. They help maintain prostate health and function as both have a specific effect in clearing ama from the blood, muscle, and fat tissue, and help maintain the normal size of the prostate gland by supporting balanced cell production. [7] o Rabdosia. It is one of the active anticancer herbs in the formula PC SPES, which has undergone successful clinical trials for prostate cancer. [10]
Herbs having tendencies for breaking down tumors. The two most important herbs used in treating prostate cancer are kutki and shilajit. They are both contained in the formula, Chandraprabha. • Kutki is a purgative and breaks down fecal matter, thus helping to remove ama from the colon. It tends to break down tumors due to its scraping effect. [6, 9] • Shilajit’s main action is on the urogenital system, and it has a specific effect in reducing both benign and malignant swelling of the prostate. [6, 8, 16] Additional anticancer herbs. Many of the herbs that are credited with the potential to heal cancer are strongly purifying, ridding the body of toxins, excess dosha and ama. Examples of strongly reducing herbs with a reputation to destroy tumors include red clover, burdock root, dandelion root, guggul, turmeric and chaparral. [5, 10] Green tea, cat's claw, manjishta, madagascan periwinkle, shatavari, and brahmi (bacopa monniera) have also been wellstudied and identified as anticancer herbs. [5] Tonification or Purification Therapy. If prostate cancer patients begin Ayurvedic treatment early when they are strong, the practitioner would take the patient through a period of purification followed by a period of tonification or rejuvenation leaving the patient's body purified (reducing ama and excess dosha) and their immune system strong. Patients who are weak would undergo strengthening or tonification therapy to invigorate the immune system. [11] Managing the Digestive System. According to Ayurveda, a healthy digestive system supports the healing of all tissues of the body. The digestive system is managed though the removal of ama, proper diet and herbs as well as vamana, virechana and basti applied appropriately with due regard for prakruti and vikruti. [5] Diet. Since prostate cancer is a tridoshic provocation, according to Ayurveda, the diet should be a balanced one, avoiding extremes that could further provoke one of the doshas. A diet of warm, cooked, easily digestible, light yet nourishing foods are best. Organic vegetables cooked in mild spices, whole grains, light proteins such as mung dhal soups, and sweet, juicy fruits will nourish the body and pacify all three doshas. [6, 7] http://www.ayurvedacollege.com/book/export/html/2
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Eliminating Ama. To prevent further accumulation of ama in the colon, an Ayurvedic regimen for the maintenance of agni, the digestive fire, would be followed. This involves practices, such as, leaving at least three hours between meals or snacks, not sleeping within two hours of eating, not combining incompatible foods, and avoiding old, cold, and stale foods and drinks. Also, triphala is considered an effective herbal formula to maintain a clean, healthy colon and prevent further exposure of the prostate gland to colonic ama. [6] Healing Process—The Mental, Emotional and Spiritual Levels
• Dr. Marc Halpern of the California College of Ayurveda advises mental purification and rejuvenation as part of the healing process. He concludes that, “purifying the mind through periods of silence and a lack of sensory stimulation helps support healing.” Meditation and shirodhara can help produce inner silence, while nasya supports mental purification. [11] • Dr. Halpern also purports that mental rejuvenation must follow mental purification. Mental rejuvenation can be accomplished through the use of oil therapies, such as shirodara or abhyanga. Daily selfabhyanga is considered an important act of selflove, as it rebuilds ojas in the mind. [11] • The patient’s relationship with sexuality and procreation can be addressed, as an immature or unintegrated approach to sexuality is viewed as harmful as it sets up a negative energy pattern related to the reproductive system and causes unhealthy behaviors that directly damage the prostate gland. [6] • The patient’s relationship with creative expression can be addressed, as a life devoid of meaningful creative expression is considered a physically, mentally, and spiritually destructive situation. According to Alakananda Devi, whenever the energy of creation is absent, the energy of destruction (tamas) will take over. This destructive energy will readily find expression within the shukra dhatu, the tissue associated with procreation, generation, and creation. [6] • In the Vedic system, cancer is viewed as a psychic disorder, a disruption in the aura allowing the entrance of a negative astral force. Emotional cleansing, mantra, pranayama, and meditation are viewed as important methods to counter this disruption. Gem therapy is considered helpful to balance the aura and protect the life. For example, blue sapphire set in gold is considered the best gem for antitumor properties. Dr. David Frawley states, “Chanting OM is excellent for opening up the aura and clearing the psychic air. The mantra RAM is best to give protection and bring down the Divine healing force. HUM is effective for casting out negative lifeenergies.” [8] • Yoga asanas reduce tension and inner restrictions that may be blocking the healing process. [11] • Visualization is the process of engaging the imagination in the process of healing. By visualizing a positive outcome, the chances of survival and healing are noted to increase. [11] • Sattvic practices, such as spending time in nature, are considered important for keeping the mind clear and supporting the healing process. Sattvic practices assist in the healing of karma. [11] Additional Ayurvedic Therapies and Prevention Guidelines
Additional Daily Therapies •
Daily castor oil massage of the prostate using coldpressed castor oil can be helpful. [6]
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• Daily perineal exercises (the practice of ashvini mudra) can enhance circulation and lymphatic drainage of the prostate. [6] • The use of anuvasana and niruha basti can bring herbs close to the location of the prostate gland. A decoction involving dashmoola would be appropriate. These therapies are ideal for pacifying vata dosha; but can be designed so that kapha is not vitiated. [6, 9] • Yoga asanas that apply perineal pressure can be useful. Examples include: kukutasana, gomukhdsana, padpedandsaan, and salabhasana (locust pose), as well as the inverted poses, sirsasana and sarvangasana. [6] Additional Ayurvedic Prostate Cancer Prevention Guidelines In order to prevent the onset of prostate cancer, patients are advised to: • Pacify vata (by creating regular routines around eating and sleeping, slowing down, resting) and apana vayu (through daily abhyanga massages and ensuring regular bowl movements). The classical text, Caraka Samhita, reiterates the importance of pacifying vata in regards to cancerous tumors: “In case of gulma, pacification of vayu should be done properly with all means because after vayu is won over, even the small remedy alleviates the other aggravated dosha.” [14] • Take short breaks frequently and try to stretch or take a short walk. This will restore the normal flow of energy, blood, and nutrient fluid to the prostate area. [7] • Avoid alcohol and caffeine consumption, as both create abnormal urine production and irritate the bladder. Take the necessary time to empty the bladder completely. Drink water throughout the day to prevent the urine from becoming too concentrated. [7] • Not suppress the urge to urinate as it can lead to further urogenital complications. [15]
Conclusion As Dr. Marc Halpern states, “The Western approach to managing cancer brings both opportunities for cure as well as great challenges.” [23] Because the word “cancer” has frightening implications for many patients, overtreatment of early stage cancerous conditions, such as prostate cancer, has become a commonplace occurrence in order to fight the “war” on cancer. In other words, the treatment often becomes more invasive than the disease condition itself. However, the ancient knowledge of Ayurveda, immersed in the wisdom of Nature, provides clues to the healing process that, although may not be substantiated by research—yet, may one day bring an end to suffering.
References [1] MayoClinic.com: Prostate Cancer http://www.mayoclinic.com/health/prostate cancer/DS00043/TAB=resources [2] Katz, Aaron Dr., The Definitive Guide to Prostate Cancer (Rodale: New York), 2011. Pages 8992. [3] Lad, Vasant, BAM&S, MASc. “The Concept of Cancer in Ayurveda,” Ayurveda Today, Vol. 18, number 2. Fall 2005. Pages 50, 51, 53. [4] Madhava Nidanam: K.R.L. Gupta, Second edition, Sri Satguru Publications, Copyright 1997, Delhi, India. [5] Halpern, Marc, Dr. “Managing Cancer, Part II.” Published on CA College of Ayurveda (http://www.ayurvedacollege.com), July 29, 2009. [6] Devi, Alakananda: Prostate Cancer http://www.alandiashram.org/school/school_html/reviews/prostate_cancer.html [7] Maharishi Ayurveda Newsletter: A Powerful Approach to Prostate Health http://www.ayurvedacollege.com/book/export/html/2
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http://www.mapi.com/ayurveda_health_care/newsletters/ayurveda_prostate_health.html [8] Frawley, David, Dr. Ayurvedic Healing: A Comprehensive Guide, Second edition (Lotus Press: Twin Lakes), 2000. Pages 261, 284. [9] Halpern, Marc, Dr. Clinical Ayurvedic Medicine Student’s Textbook, Part One Sixth Edition 2001 2008, California College of Ayurveda. Chapter Three. [10] Tierra, Michael Dr. Treating Cancer with Herbs: An Integrative Approach (Lotus Press: Twin Lakes), 2003. Pages 121, 208209, 223. [11] Halpern, Marc, Dr. “Managing Cancer, Part III.” Published on CA College of Ayurveda (http://www.ayurvedacollege.com), August 11, 2009. [12] Sushruta Samhita (Vol.2): Kaviraj Kunjalal Bhishagratna, Chowkhamba Sanskrit Series Office, Varansi, 2002. Chapter XVIII, lines 2835. [13] Cakradatta: Translated and edited by PV Sharma, Chaukhhambha Publishers, Varanasi, India, 2002. Chapter XLI; lines 4952. [14] Caraka Samhita, Translated and edited by P.V. Sharma, Chaukhambra Orientalia, Varansi, 2003. Vol. 1, Chapter V, line 17. [15] Caraka Samhita, Translated and edited by P.V. Sharma, Chaukhambra Orientalia, Varansi, 2003. Vol. 2, Chapter IX, lines 3248. [16] Frawley, David, Dr. and Dr. Vasant Lad. The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, Second edition (Lotus Press: Twin Lakes), 2001. Pages 250251. [17] American Cancer Society: Prostate Cancer, http://www.cancer.org/cancer/prostatecancer/detailedguide/prostatecancerkeystatistics [18] Wilt, T.J., Brawer, M.K., Jones, K.M., et al. “Radical prostatectomy versus observation for localized prostate cancer.” New England Journal of Medicine. 2012 July 19; 367(6):203213. [19] Chavarro, J.E., Stampfer, M.J., Sasso, M.N., et al. “A 22yr prospective study of fish intake in relation to prostate cancer incidence and mortality.” American Journal of Clinical Nutrition, 2008 Nov; 88(5); 1297303. [20] Hebert, J.R., Hurley, T.G., Olendzki, B.C., et al. “Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross national study.” Journal of the National Cancer Institute. 1998 Nov 4;90(21):163747. [21] Higdon, J.V., Delage, B., Williams, D.E., et al. “Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis.” Pharmacol Res. 2007 Mar; 55(3):22436. Epub Jan 25, 2007. [22] Joshi, A.D., Corral, R., Catsburg, C., et al. “Red meat and poultry, cooking practices, genetic susceptibility and risk of prostate cancer: results from a multiethnic casecontrol study.” Carcinogenesis. 2012 Nov;33(11):210818. Epub 2012 Jul 20. [23] Halpern, Marc, Dr. “Managing Cancer, Part I.” Published on CA College of Ayurveda (http://www.ayurvedacollege.com), July 29, 2009
Women's Infertility An Ayurvedic Perspective By: Sirisha Karamchedu Acknowledgements http://www.ayurvedacollege.com/book/export/html/2
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I humbly seek this opportunity to bow to the almighty for offering his divine guidance, illuminating my path every step of the way and empowering me to this journey of Ayurveda. Many thanks to Dr. Marc Halpern, who has put together such an amazing course of Ayurvedic study. I would like to offer my sincere thanks to my teachers at the California College of Ayurveda, who have inspired me every step of the way. I am very thankful to Marisa Laursen for her kind timely suggestions and guiding my life. The truth dawns on me that words suffer stringent limitation. I have not been able to find words enough to express my love, respect and gratitude for her. I would like to offer my thanks to my wonderful classmates at CCA, my husband and friends who have encouraged me along the way and offered me their unconditional support. I am thankful to all those beautiful souls that have helped me directly or indirectly in this journey.
Abstract Infertility is the failure to naturally conceive a child even after one or more years of regular unprotected coitus or to carry a pregnancy to full term. Reasons such as weight, diet, smoking, other substance abuse, environmental pollutants, infections, medical conditions, medications and family medical history could affect conception in couples. Infertility can arise from either of the partners. In men, infertility is usually because of low numbers or poor quality of sperm and occurs in a woman when she does not produce eggs regularly or because her fallopian tubes are damaged or blocked and the sperm cannot reach her eggs. The current research paper focuses on infertility in women and presents infertility from the lens of Ayurveda.
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Ayurvedic Treatment of Cancer The following article series was written by Dr. Marc Halpern. Part one focuses on the basics of cancer from a Western perspective while part two and three will focus on Ayurvedic knowledge of Cancer and its herbal, nutritional and holistic management. By far, cancer is the most feared of all disease. Taunting humanity with the threat of a slow, painful death it is often the first disease people think they have when they experience pain or feel a lump in their bodies and the last they want to talk about. Going to the doctor, patients wait with baited breath for the phone call that tells them, yes or no. That one phone call either brings tremendous relief, exhilaration and an appreciation for life or it brings shock and despair. While cancer is a devastating disease, the likelihood of dying of cancer is much less than dying from cardiovascular disease (heart attacks and strokes). Cardiovascular disease remains the number one killer and is responsible for three times as many deaths as all cancers combined. Still, approximately one in five people will develop some form of malignant cancer at some time in their life. http://www.ayurvedacollege.com/book/export/html/2
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Managing Cancer Part I This is the first of a three part series exploring cancer. Part one focuses on the basics of cancer from a Western perspective while part two and three will focus on Ayurvedic knowledge of Cancer and its herbal, nutritional and holistic management. Introduction By far, cancer is the most feared of all disease. Taunting humanity with the threat of a slow, painful death it is often the first disease people think they have when they experience pain or feel a lump in their bodies and the last they want to talk about. Going to the doctor, patients wait with baited breath for the phone call that tells them, yes or no. That one phone call either brings tremendous relief, exhilaration and an appreciation for life or it brings shock and despair. While cancer is a devastating disease, the likelihood of dying of cancer is much less than dying from cardiovascular disease (heart attacks and strokes). Cardiovascular disease remains the number one killer and is responsible for three times as many deaths as all cancers combined. Still, approximately one in five people will develop some form of malignant cancer at some time in their life. What is Cancer? Cancer is a proliferation of cells in the body which undergo unregulated growth. These cells often spread by seeding themselves though out the body. Typically growing in the form of tumors, new tumors emerge as cells take root and grow in different parts of the body. Death occurs when the body's life support functions are compromised due to the cellular damage. When cancer is talked about, what is meant is a malignant tumor. A malignant tumor is one with the tendency to grow and invade surrounding tissues. Benign tumors, while still cancerous pose a much lesser threat. They are encapsulated and are much less likely to spread. Often, they can be removed surgically and no additional treatment is required. Metastatic tumors are malignancies which have already spread. Metastatic cancers are generally the most dangerous. Determining the Prognosis The prognosis for a cancer patient decreases significantly with metastasis. This is the main reason the medical profession encourages routine tests for early detection. A patient's prognosis also decreases with the extent of metastasis. The more sites, the less likely recovery is. Another factor in the prognosis is the exact location of the tumor. A tumor located in a vital organ or near a vital function of the body is more difficult to treat. Finally, the type of cell involved in the cancer can indicate how aggressive the cancer will tend to be. The Many Causes of Cancer
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While most people will never have cancer, every body produces cancerous cells. Every day, even in healthy people, malignant cells are formed and circulate. In a normal, healthy body, these cells are destroyed by the body's immune system. In patients who develop cancer, something has compromised the body's ability to effectively deal with these cells. Developing cancer is dependent upon many factors. Most certainly, one of these is genetic. The body has certain genes called "Oncogenes." Oncogenes are mutated genes which regulate cell growth. Proteins in these genes signal the cell to divide when it is not suppose to. Exposure to environmental carcinogens and viruses are responsible for converting regular genes to "Oncogenes." Our bodies are designed to deal with this threat. Additional genes called "Tumor repressor genes" normally suppress or regulate growth. Mutations however can cause these genes to fail and again, unrestricted growth occurs. Chromosomal abnormalities have been linked to a large number of cancers including leukemia and lymphoma. Viruses appear to play an important role in the onset of cancer. A virus is a strand of genetic material that is able to insert itself into the DNA of its host, replicate and thereby alter the functions of the host. While often the body's defenses can rid itself of the aggressive intruder, other times the intruder imbeds itself deep inside the DNA and the body appears defenseless against it. Altering the bodies DNA, these mutations can be passed down from generation to generation. Viruses are the closest physical evidence that there is to support something akin to the idea of possession. Common viruses known to cause cancer include HPV (Human Pappilloma Virus) , CMV (Cytomegalo Virus), EBV (Epstein Barr Virus) and Hepatitis B. In addition, any pathogen that causes chronic inflammation increases the risk of cancer. Environmental contamination is often blamed for causing cancer. Indeed, environmental contaminants have been proven to increase cancer risk. Chemical carcinogens cause cells to mutate through a series of stages. These stages of mutations are often dependent upon contact with ordinary chemicals which by themselves are not a threat but when combined with a carcinogen triggers mutation. These chemicals are called "co carcinogens. The list of common chemicals known to cause cancer is very long and include many pesticides, diesel exhaust, lead based paint fumes, formaldehyde and a variety of hair dyes. The cause of cancer is complex. There are many factors that contribute. In additional to genetic tendencies, viruses and environmental contaminates, ultraviolet light, radiation from xrays, nuclear power plants and nuclear weapons testing and the use of immunosuppressive drugs all are important factors. In addition, people with a history of autoimmune diseases, whose immune systems are clearly not functioning properly, are also at higher risk. The Red Flag Signs and Symptoms Early signs and symptoms of cancer are not often present. Cancer often develops in the body for quite some time before the body's functions are compromised and symptoms are noticeable. This is one more reason why early detection through non invasive testing is so important. Patients who experience unexplained weight loss, night sweats, unexplained pain (especially at night) and abnormal bleeding from any orifice should seek a complete examination as soon as possible. http://www.ayurvedacollege.com/book/export/html/2
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The Major Cancers Lung cancer is the most common form of cancer and is the leading cause of all cancer deaths. Bronchogenic carcinoma responsible for 90% of all lung cancers is very aggressive, Eighty seven percent of these cancers are attributed to cigarette smoking. Colorectal Cancer is the second most common cancer. It tends to affect adults over the age of 40. Scientists accept that a diet low in fiber and high in animal protein contributes to this condition. A vegetarian diet that includes whole grains should significantly reduce the risk. A simple blood test is available for screening called CEA (Carcinoembryonic Antigen). Breast Cancer affects 13% of woman by age 95. This is the most common form of cancer in woman. While many middle aged woman develop breast cancer, risk increases dramatically after age 75. Eighty percent are first discovered by the patient as a lump. By the time they are discovered, many have metastasized into surrounding lymph. Early detection through daily breast examinations and mammograms offers the possibility of finding the cancer prior to metastasis and greatly improves prognosis. Studies show that annual mammograms reduce the mortality rate of breast cancer by 25 30%. While there are risks of radiation exposure from mammograms, most medical professionals believe that the potential benefits outweigh the risks. Breast cancer is responsible for 3.5% of all deaths in woman. A woman who is free of cancer in her lymph nodes following therapy has a 10 year survival rate of 80% Woman with a family history of breast cancer and those who have taken birth control pills are at higher risk. Other factors that increase risk include becoming pregnant after age 30 and early start of menses, late occurrence of menopause, radiation exposure and hormone replacement therapy. Prostate Cancer is the most common malignancy in men over age 50. Some studies have shown that a majority of men will develop prostate cancer if they live long enough. While generally a slow growing, mildly aggressive cancer it does have the ability to metastasize and kill. Blood tests (Prostatic Specific Antigen test) can reveal the presence of prostate cancer. While a positive test indicates cancer a negative test can not rule it out. The value of all blood screening tests for cancer is controversial. Endometrial Cancer is the 4 th most common malignancy in woman. Risk increases dramatically after age 40 and peaks between ages 50 60. The greatest correlated risk factor is obesity. Other important risk factors include: estrogen replacement therapy, the choice to have or the inability to have children (nulliparity) , ovulatory disorders and late menopause. The condition has also been correlated with high estrogen levels in the body in comparison to progesterone. Most cases present with abnormal vaginal bleeding as the first sign. Cervical Uterine Cancer is the result of sexually transmitted pathogens and is less common than endometrial cancer. Risk increases with the number of sexual partners a woman has had and with the early loss of one's virginity. Human Papilloma Virus (HPV) clearly plays a role. HPV is the cause of genital warts. Cigarette smoking also increases the risk. Ovarian Cancer affects one in 70 women. And one of every one hundred woman dies of it. Its incidence increases around menopause and in post menopausal woman. Surprisingly, the risk of developing ovarian cancer decreases with oral contraceptive use. Known risk factors include obesity, nulliparity, infertility, late childbearing and late menopause. A blood test is available for screening. The test is called CA125. The accuracy of all http://www.ayurvedacollege.com/book/export/html/2
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blood screening tests is controversial. Malignant Melanoma is the most aggressive form of skin cancer. While the condition is very aggressive and very often fatal when diagnosed in its late stages, early diagnosis leads to a nearly 100% cure rate. Other skin cancers such as Basal cell and Squamous cell carcinomas are less aggressive with lower rates of metastasis. Medical treatment of these cancers is quite effective. American Cancer Societies Recommended Screening Procedures
Procedure
Frequency
Self Breast Exam (Screen for breast cancer)
Monthly after age 18
Breast Exam by a professional (Screen for breast cancer)
Every 3 years age 18 40. Every year after age 40
Pap Smear Test (screens for endometrial cancer )
Yearly age 18 65 and then at the doctors discretion
Pelvic Examination (Screen for multiple cancers of the female reproductive system)
Every 13 years, age 18 40, then yearly
Chest Xray (Screen for lung cancer)
Only if there is high risk
Sputum Cytology (Screen for lung cancer)
Only if there is high risk
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Rectal Exam (Screen for prostate cancer)
Yearly after age 40
Blood PSA (Screen for prostate cancer)
Yearly after age 50
Stool exam for occult blood (Screen for colorectal cancer)
Yearly after age 50
Sigmoidoscopy (Screen for colorectal cancer) Every 35 years beginning age 50 Traditional Cancer Therapy Traditional cancer therapies are based on two simple principles. Remove the cancerous cells when possible and destroy any cells that remain. To accomplish these goals, surgery is utilized when a malignant cancer is found that has not metastasized. Surgery may also be performed if there is metastasis if the removal of a tumor will increase the quality of life or if all surrounding lymph nodes are easily accessible. Either in addition to or as an alternative to surgery, radiation therapies are employed. These therapies utilize gamma, neutron, proton, and electron radiation to destroy localized tumors. For some cancers such as Prostatic cancer and certain brain cancers, a radioactive seed may be implanted into the tumor to destroy the tumor from the inside out. Radiation may also be employed as an isotope injected into the blood if the cancer has a tendency to pick up the isotopes from the blood stream. This is common to thyroid cancers. While radiation damages or kills malignant cells it also causes damage to near by healthy cells. Chemotherapy is the use of drugs to destroy cancer cells. Drugs are non specific and are spread throughout the entire body. These drugs are highly toxic and destroy both healthy and cancerous cells. As crude as it sounds, the success is dependant upon the ability of the drug to kill the cancerous cells before it kills the patient. Common side effects of chemotherapy include vomiting, mouth sores, hair loss and loss of appetite. For some cancers, endocrine therapies are somewhat effective. Endocrine therapies involve altering levels of hormones in the body. In the management of prostate cancer, an orchietomy (removal of the testes) may be performed to decrease testosterone levels. In addition, estrogen may be administered. By decreasing testosterone and increasing estrogen the growth of prostatic cancer cells is slowed. Other cancers such as breast http://www.ayurvedacollege.com/book/export/html/2
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cancer respond positively to lower estrogen levels. A drug called Tamoxofin is sometimes used as a part of the treatment for breast cancer. It works by lowering estrogen levels. In addition, the ovaries are often removed to further reduce estrogen levels. Biological Therapies are employed in the treatment of certain blood and lymph cancers. Interferon and Interleukins are antiviral drugs. These slow down the progression of leukemia and lymphomas and in some cases leads to cure. The Western approach to managing Cancer brings both opportunities for cure as well as great challenges. With early detection, prior to metastasis, Western Medicine can often offer patients excellent results. However, the long term prognosis for cancers which have metastasized is much less optimistic. In part two of this series, the Ayurvedic knowledge and approach to cancer will be explored as well as important nutritional and herbal therapies.
Managing Cancer Part II Part one of this series detailed the Western understanding of cancer, its pathophysiology, statistics, screening tests and treatment. In part two of this three part series the Ayurvedic concepts of gulma, granthi and arbuda shall be introduced. Ayurvedic Terminology and the Field of Cancer Cancer has been understood to exist for thousands of years. While cancer may be more prevalent today in part because people live to a greater age than in the past, Cancers have always occurred. Healers since the beginning of time have tried to understand the condition and manage those who have been suffering. Classical Ayurvedic texts have several references to cancer. Some terms used to describe the condition are general while others are much more specific. Practitioners should familiarize themselves with common terminology so that they can benefit from historical knowledge as well understand information that is published in India . The following terminology describes the most basic concepts. Gulma is a term used to describe any palpable hard mass in the abdomen. This does not mean that gulma is cancer but rather any hard, tumor like mass in the abdominal region. Granthi is a term for a tumor, lump or nodule that is visible from the surface. These tumors often open up on the surface of the skin as an ulcer (vrana). Granthi may be benign or malignant; however the term is most often used to describe benign tumors. Arbuda is the most specific term for a cancerous malignancy. Dwirabuda indicates that the malignancy has metastasized or spread from its initial site to other parts of the body. http://www.ayurvedacollege.com/book/export/html/2
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Samprapti From an Ayurvedic perspective, tumor formation is a condition of vata kapha origin. Vata is responsible for the faulty division of cells and kapha for their growth. Hence, vata pushes kapha out of balance resulting in tumor formation. Benign tumors take on a predominantly kapha appearance. In malignancies, pitta is also vitiated and the condition becomes sannipattika in nature. In these conditions, the agni of the affected tissue is increased making it very aggressive to its surroundings as it slowly digests the tissues of the body. While at first, the interplay of the doshas may not be clear, over time vata imbalance predominates and the condition leads to severe wasting of the tissues of the body. Ojas in the affected tissue is always low as Cancer begins. As the condition progresses, systemic ojas becomes lower and lower. Muscular tissue is the most common dhatu affected by cancer though any dhatu can be. Benign tumors of muscular origin are most often described as kapha entering into the mamsa dhatu and the mamsavaha srota. This is true even though it may be vata that has pushed kapha. Malignant tumors of muscular origin are most often described as pitta vitiation in the mamsa dhatu and mamsavaha vaha srota. This is true even thought there is simultaneous vitiation of vata and kapha. As the condition progresses, additional sites (dhatus and srotas) of the pathology become important. Gulma Types: There are eight basic types of gulma. One related to each dosha, one from each combination, a tridoshic type and one type due to disorders of the artava. Nidana: A long list of non specific causes are provided by the classical texts for the origin of gulma that include the suppression of natural urges, grief, becoming weakened by fever, vomiting or diarrhea and then eating food that vitiates vata. Other causes include drinking cold water when hungry and beginning purification without proper oleation and fomentation. These causes are quite generalized toward poor health practices and emphasize those that vitiate vata. Purvarupa: Generalized purvarupa include all kinds of digestive disturbances such as belching, borborygmi, gas and constipation. Comparative Rupa: (Dual dosha and tridoshic gulma combines the symptoms of the involved dosha) Vataja gulma presents with tumors in the large intestine or pelvic region. There may be pain in the in the neck and head with fever. Patients feel cold and the spleen is often enlarged. There are usually signs of digestive discomfort such as constipation and borborygmi (intestinal churning). The mouth and skin are usually dry. Patients usually lose weight as the condition progresses. The skin, nails, eyes and feces typically become dark or gray. Texts describe the tumor as feeling as if one was being swarmed by ants. Pain is throbbing or cutting. The tumor may appear to move about and change in size and shape. Naturally, symptoms are worse on an empty stomach and during the vata times of day. Pittaja gulma presents with tumors in the small intestine or solar plexus. Patients feel greater pitta type digestive discomforts such as hyperacidity http://www.ayurvedacollege.com/book/export/html/2
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and diarrhea. Patients run fever and the skin, nails, eyes and feces may become yellow. Pain at the site of the tumor may be described as burning. Pain is naturally worse during the pitta times of day and shortly after eating as food is digesting. Kaphaja gulma presents with tumors in the chest or stomach. Patients present with typical symptoms of kapha vitiation such as loss of appetite and nausea. In addition, taste is significantly reduced and patients feel cold with a low fever. The skin, nails, eyes and urine take on a whitish hue. The tumor appears deep, hard, and heavy and is non mobile. Not surprisingly, the tumor does not produce much pain and grows slowly in size. Symptoms are worse during kapha times and immediately after eating. Raktaja Gulmais a tumor arising from the blood in the artavavaha srota and occurs only in woman. This is the term used to describe of ovarian cysts and uterine fibroids. The condition is described as being like a false pregnancy where a mass forms instead of an embryo. KRL Gupta in his commentary on the Madhava Nidanam tells of an embarrassed physician who told a woman and her family she would die of the Gulma. He stated that it would increase in size, it would produce great pain and that nothing could be done for her. The woman was isolated from friends and family and left to die where upon she delivered a healthy female child. Because of the difficulty of diagnosing Rakta gulma and pregnancy, ancient texts recommend waiting until the 10 th month to treat the condition. The distinguishing feature is whether or not there is movement of the fetus. Naturally, in our modern age a distinction can be made quite early. This condition often presents with excessive menstrual bleeding leading to fatigue with anemia. Samprapti: The primary cause of gulma is stated to be vitiation of vata but this can mix with doshas in other locations. Vitiated doshas failing to be eliminated remain in their home site or may mix with the other doshas in the digestive tract. The path of elimination of the doshas is obstructed in both an upward and downward manner preventing elimination. Excess dosha then becomes palpable as a lump Prognosis : Single dosha involvement is the easiest to treat, dual dosha is more difficult and sannipattika type is stated to be incurable through Ayurveda. According to the Madhava Nidanam, the prognosis is terminal if the tumor fills the abdomen, has the shape of a tortoise shell, there is loss of appetite, debility, nausea, cough, vomit, discharge of mucous from the mouth and nose and loss of taste or smell. Systemic swelling is also a poor sign. Gulma Chikitsa Regardless of the type of gulma, patients benefit from a diet that is warm, light and oily. This diet reflects the predominance of vata in the pathology. Over the region of the tumor, oleation and fomentation are recommended to pacify vata. Blood letting at the site of the tumor is also classically recommended. Agni should be properly managed. In most cases, agni will be low and hence a dipana is suggested to be taken in takra if possible. A simple formula recommended by Chakradatta is Yavani Takra prepared by mixing Yavani (Henbane: Hyoscymus Niger ; nervine sedative, antispasmodic and pain reducer) with a pinch of salt into takra. Vata Gulma benefits from anuvasana basti if the tumor is below the umbilicus. A vata type tumor above the umbilicus requires oral oleation. Chakradatta suggests mixing 1 part ginger with 4 parts sesame oil and 2 parts jaggery taken in hot milk. Other medicines recommended by Chakradatta include castor oil or garlic taken in warm milk. Purifying bastis may also be performed in accordance with the principles governing such therapy. Pitta Gulma benefits from the intake of bitter medicated ghee as the preferred method of oleation. This should be followed by fomentation and http://www.ayurvedacollege.com/book/export/html/2
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then purgation. Milk basti prepared with bitter herbs help to reduce the size of the tumors. Blood letting should also be considered. Kapha Gulma benefits from fasting and the practice of vamana. While internal oleation is not necessary, a paste of sesame, castor, linseed or mustard oil should be applied to the site of the tumor and this should be followed by fomentation. Herbs taken should have a strong pungent and / or bitter quality. Virechana should be performed using castor oil. Niruha basti should be performed using dashmool. Dual and tridoshic gulma benefits from the combined treatment of the doshas involved. Special herbs mentioned in classical texts to be used to help break up the tumor include calamus, long pepper, chitrak and hing. As these herbs are all warming they are best for gulma that is vata ? kapha in nature. Rakta Gulma is best treated with oleation and fomentation followed by purgation. In order to break up the tumors, herbs with an alkali quality (strong caustic bases) are recommended. Common herbs that are important in the management of rakta gulma include ashoka and manjistha. It is important to note that it is expected to be seen that the proper treatment of rakta gulma will lead to a temporary increase in bleeding. Care should be used to make sure that the patients does not become too weak from the treatment. Granthi (Benign Tumors) Types: Granthi is categorized to be of 9 kinds by Vagbhat. There is one caused by each dosha, and six categorized by the tissue that is vitiated. These tissues are: rakta, mamsa, medas, asthi, sira (vein) and vrana (ulcer). Other authors have added additional types such as nadi dhatuja, lasika granthi, lasika vahini and tilaja Samprapti: Kapha plays the predominant role as it enters the affected dhatus. The most common dhatus affected are medas, mamsa and rakta. The result is slow growing cancer of a benign nature. Rupa: Vataja granthi presents with a visible tumor that is black or dark in color and is non fixed. It is able to move from place to place if pushed. Its size may fluctuate. It tends to be soft and if pricked, exudes a clear, thin fluid. Pittaja granthi present with burning over the tumor. The tumor or the region surrounding it will be yellow or red in color. The tumor suppurates quickly and easily and exudes a warm blood when pricked. Kaphaja granthi presents as a painless, hard tumor whose color is pale. The area around the tumor is cool and itches. The tumor suppurates slowly and if pricked, exudes thick, white, cloudy pus. Raktaja granthi presents with symptoms similar to pitta and a loss of tactile sensation. This is believed to be causes by an infestation of parasitic worms. Mamsaja granthi presents essentially as a myoma or benign tumor of the muscle. Closely related are myxomas which are tumors of the connective http://www.ayurvedacollege.com/book/export/html/2
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tissues called snayuaja granthi in Ayurveda. These are large, hard tumors which are moist or oily and tend to be very vascular. They ulcerate and bleed easily and often become malignant. These tumors are associated with meat consumption. Medaja granthi presents similar to a lipoma or fatty tumor. These often occur on the back, neck, shoulders and wrists. They are caused by either the intake of too much fat or faulty fat metabolism. With kapha at the root of these tumors, they present as being soft. Vata contributes to the condition causing the tumors to also have a movable nature. When they ulcerate, they exude a coppery, black or white fatty fluid. There may be itching with this type of tumor as well but no pain. Asthi granthi presents similar to an osteoma and also as bone spurs. They often occur secondary to fractures and boney stress. These tumors appear as hard growths within the bone. Sira granthi are vascular tumors such as angiomas. While they may be benign, many become malignant. They are stated to follow the sudden exposure to cold water on the feet. Sira granthi are painless and they do not pulsate. Vrana granthi refers to tumors which form of the dried blood surrounding a wound or ulcer. Vrana means ulcer. Nadi dhatuja granthi refers to benign tumors of nerve origin such as neuromas and neurofibromas (schwann cell tumors). These present as masses within nerve tissue. Lasika granthi refers to lymphadenomas. This is a general term for any tumor of the lymph glands. These may become malignant. Lasika vahani refers to lymphangiomas. These are masses of anomalous lymph vessels that are present at birth. Tilaja granthi refers to skin cancer. Though categorized as a type of granthi it should be listed as a type of arbuda as these are malignant cancers. Sadhyasyata (Prognosis) Ayurvedic prognosis depends on factors such as the relationship of the condition to the patient?s constitution, age and the season the condition occurs within. Those arising from the three doshas, rakta and medas are curable and consider easier to treat. Those that are large, hard and located on marmas along with those occurring in or on the throat and abdomen are said to be incurable. Granthi Chikitsa According to Vagbhatta benign tumors that have not suppurated are treated in a manner similar to swelling. In addition, purification therapies should be applied following proper oleation. When purification is complete, a penetrating paste can be applied to the tumor. One simple suggested paste is that of turmeric, manjishta and mung dal. The area is then fomentated and squeezed gently as the tumor ripens. This procedure is repeated over and over. The goal is to draw the tumor out. This treatment is true for tumors of all three doshas but most especially http://www.ayurvedacollege.com/book/export/html/2
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those of vata nature. Due to the application of heat and paste, the tumor should ripen and allow itself to be squeezed. If this does not occur the tumor should be removed by surgical means. It was well known that if the entire tumor was not removed it would surely grow back again. In the case of pitta granthi, it is recommended to apply leeches to the tumor and heat is avoided or minimized. The open wound should be washed with cool infusions of herbs and allowed to heal. Arbuda (Malignant Cancers) Types: There are six kinds of malignancies. They are vataja, pittaja, kaphaja, raktaja, mamsaja and medaja. Sarcomas are considered a type of mamsaja arbuda. Arbuda Chikitsa The classical management of Arbuda (malignancy) is considered to be similar to the management of granthi (benign tumors) in so much as the treatment noted under granthi is applied first. In addition, poultices are prepared with specific herbs, spices and oils and applied to the tumor. Herbs are chosen which pacify the affected dosha. This is then followed by localized steam therapy such as nadi swedana. Specific formulations for each poultice are provide in Chakradatta and other classical texts. According to Sushruta, vataja arbuda chikitsa responds to a simple poultice prepared with boiled fatty meat and spices. Pitta arbuda chikitsa requires milder fomentation and purgation in addition to the other therapies while kapha arbuda chikitsa requires both vamana and virechana be performed. Medaja Arbuda (Fatty malignancy) is first fomentated and then the surgically opened. According to Sushruta, the wound is then thoroughly cleansed, sutured and plastered with healing herbs. Conclusion Ancient knowledge provides important clues for the modern practitioner who desires to provide his / her patient with the best possible care. In this modern age cancer remains a primary threat to society and Western medicine offers little in the way of conventional treatment for many types of cancer. Thus, we must look for answers in the timeless sciences steeped in the knowledge, lore and wisdom of Nature herself. There lie treasures to be rediscovered that may one day bring an end to suffering. References: Clinical Methods in Ayurveda: Prof K.R. Srikanta Murthy: Chaukambha Orientalia, Second Edition, Copyright 1996 Ashtanga Hrdayam: First ed, translation by: Prof. K.R Srikantha Murthy: Krishnadas Academy , Varanasi , Copyright 1995 http://www.ayurvedacollege.com/book/export/html/2
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Madhava Nidanam: K.R.L. Gupta, Second edition, Sri Satguru Publications, Copyright 1997, Delhi , India . Sarngadhara Samhita: Prof K.R. Srikantha Murthy, Chaukhambha Orientalia, Second edition, Copyright 1995. Delhi , India . Cakradatta: Translated and edited by PV. Sharma, Chaukhumbha Orientalia. First Edition, Copyright 1994. Caraka Samhita: Translated by R,K. Sharma, Commentary by Bhagwan Dash, Chaukhambha Sanskrit Series. First Edition, Copyright 1998. Varanasi , India . Sushruta Samhita: K.L. Bhishagratna, Chaukhambha Press, Fourth Ed, Copyright 1991, Varanasi , India
Ayurvedic treatment of cancer Ayurveda herbs and therapies for cancer This is the third in a three part series on cancer. In part one, Dr. Halpern detailed the Western understanding of cancer, its pathophysiology, statistics, screening tests and treatment. In part two, he introduced the Ayurvedic concepts of gulma, granthi and arbuda and their classical treatments. In this issue, Dr. Halpern provides a complete overview of the many potential holistic treatments that may be offered by the practitioner of Ayurveda. Introduction Patients who present with cancer have three basic options for treatment. The first and the most conventional treatments utilize chemotherapy, surgery and radiation. Second are a wide range of alternative therapies, and third is a combined approach. There are benefits and challenges regardless of which decision is made. Conventional treatments for cancer have varying success rates. For some cancers, when caught early, conventional therapies do have a high success rate. Success decreases as the cancer progresses. For some cancers, such as pancreatic cancer, there is little conventional medicine can do to effect a cure even if it is caught early. Conventional medicine, backed by extensive scientific studies, offers the patient the opportunity to know what they are getting into before treatment begins. Statistics are available for the success and failure of treatment. A list of side effects for each treatment is also available. This information is important to patients who will be making choices that literally affect their own life or death. Alternative medicine offers many possible therapies, ranging from dietary changes, the use of herbs, and nutritional supplements to psychic, crystal and energy healing, visualization therapies, prayer and meditation, light and color therapies and much more. While there is anecdotal evidence of success with many of these methods, alternative methods lack the studies and statistics that show success and failure. As a result, those who choose alternative methods of healing from cancer are doing so primarily on faith or an inner belief system that supports this path. Some patients and practitioners choose to integrate conventional and alternative therapies. The attitude of some oncologists (cancer specialists) is that if it won't hurt you, go ahead and try it. This attitude becomes more pervasive as the condition spreads and http://www.ayurvedacollege.com/book/export/html/2
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conventional treatments fail. At this time, both practitioner and patient start looking for miracles. One concern of the oncologist is that some alternative medicines might interfere with the effectiveness of their conventional medical treatment. As a result, many oncologists tell their patients not to utilize herbs while also undergoing chemotherapy. This concern is justified, because herbs do contain active pharmacological substances that may support or interfere with treatment. While some research is now being done on drug and herb interaction s , extensive and conclusive knowledge is not available. The Role of the Practitioner The first decision facing a patient is what path to choose. Conventional? Alternative? Integrative? There is no one right answer. In my practice, patients are encouraged to make their own decision, as it is their life that is on the line. The practitioner must act as a resource to help educate their patient about the possibilities. The more the practitioner knows about the type of cancer and the available treatments, the more they can educate their patients. No practitioner, medical or alternative can make promises of a cure. Healing is the work of God and Nature. The practitioner can only hope to be a conduit of practical knowledge, universal energy and divine love. There is more to healing than the medicine (conventional or alternative) the patient takes. It is not just the practitioner's vital knowledge that is important, but their heart. A practitioner is who is compassionate, kind and present is one who is prepared to be a conduit for the divine. Knowledge is useful and important, but it is not the stuff of miracles. Miracles often arise out of the patient and practitioner relationship, because when the patient has faith, confidence and belief in the practitioner, hope is kindled and healing is possible. Studies have shown that the role of the mind and the disposition of the patient are important to the final outcome of any treatment. Practitioners who understand this keep the door open to miracles. The Role of the Patient Healing from cancer requires not only a skillful, knowledgeable and compassionate practitioner but a responsible, insightful and compliant patient who understands their role in the healing process. The process begins by gathering information about their condition, the choices available for treatment, and the known information about the success and complications of each approach. For the patient ready to take responsibility for their choices and insightfully engage fully in the process of healing, many questions arise. What does this disease have to teach me? What role did I play through my actions, thoughts and emotions in creating the condition? What can I change in order to better align myself with the energies of nature? Patients willing to engage in heart opening practices open themselves up to receiving divine grace and its power of healing, stimulating self compassion and selflove. Patients must also be willing to undergo lifestyle changes, the hardest and most powerful part of the healing process. Changes in lifestyle can remove and break the offending pattern of actions that bring about imbalance. That in turn creates a new form of suffering. This is called tapas the process of giving up attachments that ultimately provides the patient with new power. Personal power or the boons (graces) of the divine, this power is among the most potent forces of healing. Also, the best patient is compliant, doing all that the practitioner asks and allowing the practitioner to guide them through the healing process. When the hearts of the patient and practitioner are open, divine love and light have two paths through which they can enter, bringing about the miracle of healing. The Ayurvedic Approach to Healing http://www.ayurvedacollege.com/book/export/html/2
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The physical level Ayurveda approaches the patient on several levels of causes, including physical, emotional and spiritual. The most superficial level is approaching the symptom, which is the tumor itself. On the most superficial physical level are herbs that can reduce tumor growth and perhaps limit metastasis. Herbs can be taken internally or applied over the tumor as a paste, acting directly on the cancer and supporting a deeper healing when used in accordance with the patient's vikruti. The practitioner must also decide if the patient requires tonification or purification therapy. Strong patients with ama require purification therapies in accordance with their prakruti and their vikruti. Purification therapies reduce ama along with excess dosha. By cleansing the srotas and the subtle nadis of the body, prana can flow freely and support the healing process. Purification is a reducing therapy, reducing the dhatus of the body as well as the doshas. Since this weakens the body, it should only be performed in patients who are strong enough. Purification therapy can be similarly viewed as cytotoxic, meaning it destroys cells. When applied properly, cellular destruction is directed primarily toward the cancerous cells. Patients who are weak should undergo strengthening or tonification therapy. These therapies attempt to build up the strength (ojas) of patient. Consisting primarily of oil therapies and rejuvenative herbs, these therapies are not directly beneficial for destroying cancer cells, but do invigorate the immune system. A strong immune system is required for controlling the growth of cancer cells. Ideally, patients begin Ayurvedic treatment early when they are strong, allowing the practitioner to take the patient through a period of purification followed by a period of tonification or rejuvenation. This process leaves the patient's body purified and their immune system strong. In addition to the management of ama and ojas, the most important system of the body to manage is the digestive system. Considered the root of physical disease, a healthy digestive system supports the healing of all tissues of the body. The digestive system is managed though the removal of ama, proper diet and herbs as well as vamana, virechana and basti applied appropriately with due regard for prakruti and vikruti. The Mental Level The role of the mind in healing must be emphasized as mental disturbances are a more subtle cause than the physical imbalances in the doshas. Healing the mind is therefore more difficult and requires positive selfinquiry and insight. Studies have indicated that positive thinking activates the immune system and supports healing. Yet, positive thinking is not easy to sustain. A consciousness that is more tamasic or rajasic will have a difficult time sustaining a positive focus. Mental and emotional challenges produce blockages in the flow of energy in the physical body. The physical body is capable of manifesting what the mind imagines. Unhealthy imaginings (images produced deep within our consciousness), appear first in the astral body (dream body) and can eventually manifest in the physical body as disease. Healing begins with the purification of the mind. Periods of silence and a lack of sensory stimulation are the best methods of purifying the mind, and can then be supported through the use of herbs such as brahmi, tulsi and calamus. In addition to the internal use of these herbs, shirodhara can help produce inner silence while tonifying the mind. Nasya supports mental purification. For patients with a more tamasic nature, this path of healing is very difficult. They will often lack the motivation for selfinquiry and will not fully engage in the subtle therapeutic process. These patients benefit from traditional Western psychotherapy, which begins the process of selfawareness through exploring and releasing repressed feelings. By removing obstruction to the flow of prana in the body, psychotherapy can be an important part of the patient's healing process. So much of one's mental power of healing lies in their capacity to experience self love. A lack of selflove, contentment and compassion equates to a lack of mental ojas and are the additional roots of all diseases including cancer. Hence, mental purification is the process of removing these negative feelings. Mental rejuvenation must follow mental purification. This is accomplished through the use of oil therapies such as shirodhara and abhyanga. While all types of oil massage are beneficial, daily selfabhyanga is the most important act of self –love because it rebuilds ojas in the mind. Caring for the body nurtures the ego, while devotional practice s nourish our higher spiritual Self. The Spiritual Level Our spirit is essentially pure, perfect and is not truly in need of healing. However, our spirit is bound to the cycle of birth and death through the Karma generated by the actions of our ego. Spiritual healing is the process of removing or healing our karma, which plays a role in all disease. Cancer has a cause. While some of those causes are exogenous, others are endogenous, arising from within. They originate in the samskaras deeply imbedded within our consciousness and manifest in part through our genetics and i n part through the desires (vasanas) that generate our actions. Our genetic predispositions combine with the choices we make to bring http://www.ayurvedacollege.com/book/export/html/2
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about our challenges. In this case, the challenge is cancer. Spiritual healing is the healing of the samskaras and the underlying karma that generated it. In doing so, cancer magically seems to disappear. Hence, healing is learning. When the lesson is learned, the condition is no longer necessary. Lessons often surround destructive lifestyle habits, thoughts, and emotions, and exist to give us the opportunity grow, learn and evolve on our journey toward enlightenment. Without suffering, we would have no feedback about how we are living or progressing on our spiritual journey. Healing the spirit by removing our karma and freeing ourselves from suffering and the wheel of rebirth is the greatest journey of all. It is often the most difficult and lengthy path of healing, but also the most complete path. While this part of the healing journey will go on for the patient's entire life, and even their next, each change in the patient's consciousness alters how they manifest in this lifetime. Even small changes at the level of consciousness can be enough to heal cancer! The Power of Visualization Visualization is the process of engaging the imagination in the process of healing. Because of the strong mind/body connection, what is imagined affects our physiology. This includes our immune system. By visualizing a positive outcome, chances of survival and healing are increased. To be successful, patients should engage in the process several times per day, sitting quietly for 15 to 30 minutes. Healing visualizations can be quite varied, and often include: seeing the body's immune system destroying the cancerous tumors; visualizing the body as strong, healthy, active and serviceful, and visualizing divine light and love entering the body through the crown or heart chakras bringing about healing by loving the cancerous cells to death. Sattvic Healing Practices Sattvic practices are important for keeping the mind clear and supporting the healing process. A clear mind reflects the light of God. Sattvic practices assist in the healing of karma. Patients benefit from spending more time in nature, taking walks in the forest or by the ocean. Meditation is the king of all sattvic practices. By finding the inner silence the patient dives deep into the well of unlimited potential. Yoga asana is the queen of sattvic practices, and is among the most transformative practices a person can engage in. Gentle motions reducing tension and inner restrictions combined with diaphragmatic breathing makes yoga asana a perfect metaphor for flowing with nature, allowing her energies to course through us, removing blockages and promoting healing. All patients with cancer will benefit by reducing stress and engaging in activities that bring joy, and should be encouraged to pursue their love of art, music, writing, and other forms of self expression, and be surrounded by loving friends and family. Dietary Therapies Ayurvedic knowledge about diet is quite extensive and patients should follow a diet appropriate to their prakruti and vikruti. Conventional wisdom teaches us that certain foods should be emphasized and others avoided. Cancer patients should avoid all processed, genetically engineered foods, refined sugars, and foods that contain additives. These foods are tamasic in nature and, according to Ayurveda, clog the channels and upset normal bodily functions. Patients should also avoid overeating. Following the accepted Ayurvedic guidelines for healthy eating include saying grace before eating, avoiding too much water with meals, chewing food properly, combining foods appropriately and resting for a while after eating. Proper food choices are essential to normalize digestion and prevent the formation of ama. Water taken throughout the day should be as pure as http://www.ayurvedacollege.com/book/export/html/2
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possible. The exact diet a patient with cancer should follow depends upon their prakruti, vikruti, state of ama, agni and ojas. The practitioner must make decisions based upon sound reasoning allowing some room for intuitive creativity. For prevention of cancer, it is widely held, even in scientific circles, that a diet which includes large amounts of fruits and vegetables is most likely to prevent cancer. Fruits and vegetables have been found to contain a wide range of phytochemicals that are being shown in animal studies to reduce the incidence of many cancers. Some of these phytochemicals and the foods they are found in include: Sulforaphane (cauliflower), P. Coumaric Acid (tomatoes), Genistein (soy beans), Capsaicin (chili peppers) and Flavanoids (citrus fruits). Healing Cancer with Herbs While everyone is looking for the definitive cure for cancer in an herb, Ayurvedic practitioners know that healing is more than taking a pill. Herbs offer great potential to stimulate the healing process and can even destroy cancer cells. This property of an herb (or drug) is called the cytotoxic effect. While studies reveal that herbs have cytotoxic or antineoplastic (preventing cancerous cell growth) activity, few have documented their exact effect. Historical references often state simply that herbs are beneficial in a general sense, but do not specify which types of cancer they are effective for, or at what stage. In the classical Ayurvedic literature, there are listings of complex formulations for the treatment of various types of arbuda (malignancy). Many of the herbs that are credited with the potential to heal cancer are strongly purifying, ridding the body of toxins, excess dosha and ama. Most of these purifying and reducing herbs are bitter in taste. While there are hundreds of herbs with presumed anticancer effects, several examples of strongly reducing herbs with a reputation to destroy tumors include red clover, burdock root, dandelion root, guggul, turmeric and chaparral. Other specific herbs have been well studied, and include: Green tea (Camellia sinensis), has been shown to reduce the incidence of a variety of cancers, including the most impossible to cure, pancreatic cancer, and also to prevent stomach, colon, and breast and lung cancer. This conclusion was based upon a study of the population of China which showed that as tea consumption increased, cancer rates sharply decreased. A study in Japan showed green tea to reduce the likelihood of metastasis in patients with breast cancer and overall improved prognosis. Still, the main action of green tea appears to be preventative and its effects in patients with cancer are largely unknown. Cat's claw (Uncaria tomentosa) has been shown to actually reduce cancerous cellular growth. These studies were performed on leukemic cell lines in 1998. Manjishta (Rubia cordifolia) has been shown to have mild antineoplastic activity and is often used as a part of uterine and ovarian cancer formulas. Madagascan Periwinkle (Vinca Roseus) is an example of an herb from which anticancer drugs have been produced. The young leaves contain two phytochemicals used to produce the drugs vinblastine and vincristine. These drugs help to treat leukemia and lymphoma. It has also been used in the treatment of breast cancer. Shatavari (Asparagus racemonus) and Brahmi (Bacopa Monniera ) has also have been found to possess anticarcinogenic activity. An alcoholic extract of both herbs has been shown to be effective in reducing epidermal carcinoma of the nasopharynx. Shatavari is a rare example of a nutritive herb with anticarcinogenic properties. Ayurvedic Energetics of all Anti Cancer Herbs Mentioned in this Article
Common
Botanical
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Name
Name
Cat's Claw
Uncaria tomentosa
Bitter
Cool
Pungent
PK V+
Green Tea
Camellia sinensis
Astringent
Cool
Pungent
PK V+
Manjishta
Rubia cordifolia
Bitter
Cool
Pungent
PK V+
Madagascan Periwinkle
Vinca roseus Catharathus roseus
Unknown
Unknown
Unknown
Unknown
Shatavari
Asparagus racemonus
Sweet
Cool
Sweet
VPK+
Guggul
Commiphora mukul
Bitter, pungent, astringent, sweet
Warm
Pungent
VK P+
Red Clover
Trifolium pratense
Bitter, sweet, sweet
Cool
Pungent
PK V+
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Burdock
Arctium lappa
Bitter, sweet
Cool
Pungent
PK V+
Turmeric
Curcuma longa
Bitter, astringent, pungent
Warm
Pungent
VK P+
Chaparral
Larrea Divaricata
Bitter
Cool
Pungent
PK V+
The proper management of a patient with cancer requires all of the skills of the practitioner. Armed with knowledge, compassion and an open heart, the practitioner is prepared to engage the patient and the disease. When working with a patient who is willing to engage in self – inquiry and insight and is able to make lifestyle changes the stage is set for miracles to occur. Through the grace of God and the love of Mother Earth, healing is possible.
General Ayurveda articles Ayurveda, Service, and Enlightenment Each person is put on this planet for a purpose. Ultimately, according to Sankhya philosophy, our highest purpose is simply to have experience. That will happen no matter what we do. The question is, what will we do and what will the impact be upon our life and our soul? If we are living in harmony with the rhythms of life, the nature of our service varies with our stage of life. During our formative years (kapha time), our primary role is to learn and grow. At this age, we generally take more than we give. This is natural. Service that does occur is more of an experiment designed to further our learning about life. When a Boy Scout performs community service, the lessons they are learning generally exceed the service they are providing. It is during the second phase of life that nature has intended for us to become serviceful. This phase could be called the service phase. Ayurveda calls it the pitta phase. At this time, we take our preparation and put it to use. The quality of our preparation significantly impacts the quality of the service we provide. This phase begins biologically between the ages of 13 and 16 though we generally don't enter this phase in modern society till http://www.ayurvedacollege.com/book/export/html/2
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between the ages of 18 and 22. Some enter even later. When we do, we take on a job or a career. This time of life is designed such that each person becomes a part of the community, providing a service that allows the community to function. In the ideal capitalistic society, each person is rewarded according to the quality, quantity and importance of the services provided. During the third phase of life, nature has intended for us to reflect upon the work we have provided and the life we have lived. This is the vata time of life and could be called the phase of reflection and teaching. This period generally begins the ages of 55 and 70. During this time of our lives, each person benefits most by spending more time in meditation and reflection and cultivating their spiritual connection. While service is winding down, it is not altogether over. The person in their vata time of life, reflecting upon what they have learned now has a responsibility to share and pass on the wisdom and experience they have gained. This can occur in several ways. One is through spending time with those beginning their service phase. Those in the vata time of life make the best coaches. Technology may change but not the fundamentals that drive individuals. There is great value in the wisdom that resides in the heart of the elderly. Another way for those in the vata time life to serve is to be of some assistance in childrearing. While it is not practical for those in the vata phase to take on a primary role, a supplemental role that supports the family unit is of value and often reduces the stress upon the parents in their pitta phase. Sadly, reflecting the dysfunction of the family unit and society as a whole, those in their vata time of life do not often receive the opportunity to share what they have learned. Often rejected by their own children or kept at a distance, the elderly die with their secret wisdom. The person who enters the vata time of life and is unable to serve the next generation is also going to be less healthy as a result. Thus, it is a loselose situation between the elderly and their children. To keep healthy, the elder can choose to share their knowledge with those who are receptive. Through volunteer organizations in most communities, the elderly can find fulfillment in passing on their knowledge and wisdom. The elder must often seek out this resource, however, as no one else will do it for them. Thus, each person has ultimate control over to what extent they serve. At any stage of life, service is important. Service helps the youth learn, the adult contribute to the functioning of society, and the elder pass on their knowledge and wisdom. When service is provided in the spirit of selflessness, service transcends the realm of the physical and enters the spiritual. Provided in this manner, service becomes a means of exhausting karma and liberating the soul as the individual moves closer to enlightenment. However, when service is provided merely for what a person will receive in return, karma is accumulated and the chains that bind the soul to the physical realm become stronger. This individual continues on in the drama of the physical illusion and all the pleasures and suffering that come with it. Recognition of the phases of life provides each individual with a road map of understanding how to best be of service. Surrender to the divine currents that move us through these phases is a prerequisite to selfless service and the spiritual benefits that come with it. Health is achieved by humbly providing service to the best of one's ability.
Ayurveda, Spirituality and Meditation Ayurveda, the traditional healing system of India is often looked at as a way of optimizing the functioning of the body. Ayurveda is capable of assisting in the healing of many conditions as well as extending life itself. http://www.ayurvedacollege.com/book/export/html/2
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The knowledge of Ayurveda has its roots in the Vedas, the sacred texts of India from which many spiritual philosophies and religions have sprung. These include Hinduism, Buddhism, Jainism, Yoga and others. It is a science not only of the physical body, but it goes beyond into the understanding of consciousness itself. Ayurveda's sister, Yoga, is quite well known for its physical stretching exercises. Yoga is actually much more than thisit is a complete science and philosophy leading to enlightenment. Likewise, Ayurveda is much more than a science of understanding what foods are right for you. It is a science of using health as the basis of one’s journey toward enlightenment. In fact, Ayurveda and Yoga are two sides of one coin. Ayurveda keeps the physical body healthy so that one can pursue spiritual goals while yoga is the path of spirituality. Ayurveda is not a religion any more than yoga is a religion. They are spiritual sciences applicable to one’s journey regardless of religious faith. Both sciences support a person on their journey toward selfrealization or the direct knowing of their nature as spirit or soul. Scriptural study, whether it come from the East or West, illuminates this journey. Ayurvedic psychospirituality is based on the idea that we are all souls growing and evolving toward enlightenment or reunification with God. This can easily be viewed as entering the gates of heavenfor what is more heavenly then becoming one with God? Along this journey of our evolution there are naturally challenges which inspire us to grow and evolve. Some come to us in the form of health challenges, others are challenges in relationships or finances. They are in a sense gifts, for without them there would be no motivating force behind our growth as spirits. The three Gunas are the grounds from which we come to understand ourselves emotionally and spiritually. Guna is defined as the qualities of nature. Sattva is the quality of clarity and purity. When our minds are sattvic, or pure, there is a natural innate connection between ourselves and God. With this awareness, our highest most virtuous qualities manifest. Our minds are much like a still lake and the light that reflects through it is the light of God. Rajas is a state of activity and distraction where we forget our true nature as spirit and get wrapped up in the dramas of our lives. As a result we get caught in the experience of emotion and the challenging feelings of fear, worry, anxiety, anger, resentment, and attachment. If you imagine the clear lake of sattva, rajas is that lake after a rock has been thrown in and now it is disturbed. Each wave is a challenging emotion. Tamas is a state of darkness and inertia. In this state of being, not only are we unaware of our connection with God or spirit, but we spiral down into our own darkness and become harmful to ourselves or others. With our darker nature being dominant, we take actions such as violence or vindictive behaviors, or possibly addiction and suicide. Any harmful act reflects our own Tamasic nature. If you recall the clear lake of sattva which had become rajasic when the rock was thrown in, now it has been stirred up and is muddy. The darkness is Tamas. It is our spiritual journey to move from dark to light, from ignorance to awareness, or from tamas to sattva. It is said in Ayurveda that Rajas and Tamas are the causes of disease. The actions taken and the emotions felt by the rajasic and tamasic mind upset the balance of the three Doshas (bioenergies governing the functions of the physical body): Vata, Pitta and Kapha, thus leading to physical disease. Sattva is the sole cause of health. Disease cannot affect the sattvic personthe one who has awakened into the light, therefore we could say that disease is the end result of http://www.ayurvedacollege.com/book/export/html/2
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forgetting our true nature as spirit. Once we forget, we act out of harmony with nature. These actions bring about disease. Healing involves the cultivation of harmony or sattva. Ayurveda sees disharmony as the sole cause of disease. Healing takes place through a harmonious relationship with our environment. Ayurveda prescribes many regimens to bring about harmony or sattva in our lives. These regimens are numerous and to the beginner can quickly seem overwhelming to perform. Recommended actions include eating slowly in a peaceful environment, using proper aroma and color therapy, going to bed early, awakening with the sun or earlier, applying oil to the body, meditation, yoga and many more. Students often ask why it is so difficult to adopt a harmonious lifestyle. The answer is simple. It is because we are not yet fully awakened to our spiritual nature. How can we live in harmony if we are not connected to our higher purpose in life? Without knowledge of higher awareness, it is our human nature to act as though we are only our senses and our mind. Our senses fear what is uncomfortable and desire only what gives us pleasure or great highs. The creation of harmony in our lives brings with it a rejection of that which brings us our highs, for each high is just a fleeting moment destined to pass and leave us desiring more. Ayurvedic and yogic practices bring us peace, not highs. They sustain us; they do not burn us out. Yet to get to this place, one must go through the fire of awakening our self awareness. This process is honest and not always pleasurable. With honesty about ourselves at first there is discomfort and pain so we move away from it. We drop those practices which, though difficult, lead to harmony and light because the light hurts our eyes. So how do we go about creating harmony? How do we become successful travelers on our journey? There are many roads of empowerment but none is greater than our own direct self experience of God. This is achieved primarily through meditation and prayer. In the quietude of consciousness lies the light of God, the infinite. This light can fill us and sustain us, it can empower us to create change. The more that we come to know our nature as God or spirit, the more we are empowered to act harmoniously. The process begins for many with formal meditation. It ends when we meditate every action in our lives. When our lives become a meditation, ego slips away, exposing our true nature. Now we are ready to join pure consciousness, pure awareness. We become one with God. Namaste.
Ayurvedic Education in the New Millenium As we move further into the new millennium, there is a growing fascination with the traditional wisdom of ancient India. Perhaps, this is because it is based on laws of nature that are timeless. Hence, it is as relevant to our well being today as it was thousands of years ago. This is especially true for Ayurveda, the ancient and holistic healing system, which has been practiced in India for over 5,000 years. Ayurveda is a complete medical science. There are even many Ayurvedic specialties including geriatrics and pediatrics along with internal medicine. In India today, Ayurvedic medicine flourishes along side Western allopathic medicine. Many Indian physicians are trained in both disciplines. While the structure of the professions may seem similar in some aspects, their understanding of disease and approach to improving health are entirely different. http://www.ayurvedacollege.com/book/export/html/2
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Western health care systems are based on statistical models of healing. Rather than healing the individual who has a disease, Western medicine focuses on healing only the disease. Statistics tell physicians what methods will alleviate the symptoms of disease in most people. This method is useful for improving public health but does little for the individual who does not fit into the statistical norm. Ayurveda understands that each person is a unique individual and each person's path toward health and healing is equally unique. Ayurveda is based on the idea that each person has a fundamental balance of energies in their body which make up their particular constitution, with each person's constitution being uniquely their own. Determined at the moment of conception, an individual's constitution determines what is in harmony and what is out of harmony for each person. If a person exposes themselves to environmental influences (sound, color, aroma, and food) that are not harmonious with their fundamental nature, disease will result! As a person reestablishes a harmonious lifestyle, people heal and diseases no longer express themselves. Ayurveda understands that symptoms are only the body's way of communicating disharmony. When an area of disharmony is corrected, the symptoms disappear. By contrast, the Western method of drug treatment defines cure as the alleviation of symptoms. This is most often accomplished by providing patients drugs that cover up symptoms. This method essentially silences the body's voice. With the voice (symptom) silenced, a person is able to continue a disharmonious lifestyle. However, the body's voice cannot be silenced forever. Eventually, either the symptoms return or new symptoms emergeoften more severe than the original. There are many holistic health traditions and each has its own idea about the cause and correction of disease. Ayurveda is unique in that in begins with an understanding of a person physically, emotionally and spiritually. In this way, Ayurveda is truly holistic, accounting for the whole individual. Most alternative health care systems only address either the physical body or the mind body connection. Ayurveda's body mind spirit approach is capturing the hearts of people throughout America who realize that we are indeed individuals at each and every level. One of Ayurveda's basic tenants is that nothing is right for everyone and everything is right for someone. This principle teaches that all disciplines and therapies have value. Ayurveda is a science of understanding what will work best for a specific person. It is not a dogmatic science stating that everybody must live one way or take one path toward healing. Ayurveda is defined as the "science of life". Hence it encompasses everything that affects one's life. Ayurveda is a path of finding out what has value for an individual. Some people thrive on spicy foods while others get indigestion. Some people need more sleep than others do. Through Ayurveda, people learn what foods, herbs, colors, aromas and sounds are best for them. In today's modern world, stress is the number one cause of disease and unhappiness. Ayurveda's basic principle is that where there is harmony, there is health. Where there is disharmony there is disease. Ayurveda is the path of returning to harmony. This concept of harmony means living in harmony with one's environment through each of the five senses. This way of life is stress free. And, by reducing stress on the system, Ayurveda heals. Ayurveda focuses on natural, holistic therapies that create an optimum environment in the body for healing to take place. By maximizing the body's healing potential, the body has the best possible chance of healing itself. Ayurveda utilizes dietary, herbal, aroma, color, sound and massage therapies as well as yoga and meditation to bring about healing. Today's Ayurvedic practitioners are well trained in each of these areas allowing them to work with nature to correct imbalances within the body. In America today, Ayurveda is growing into a complete health care profession that is based on timeless natural laws of health and healing. The http://www.ayurvedacollege.com/book/export/html/2
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Ayurvedic profession, though relatively new in America, is growing rapidly. Demand for Ayurvedic practitioners is also growing rapidly. A career in Ayurveda is rewarding on every level. The California College of Ayurveda (CCA) was the first stateapproved College for the clinical study of Ayurveda in the U.S. The CCA has a clear focus and intention to thoroughly train Ayurvedic practitioners. Our program leads to certification as a Clinical Ayurvedic Specialist (C.A.S.). A C.A.S. is one part coach, one part counselor, one part teacher, and one part guide along the journey. Providing healthcare through Ayurveda unleashes the potential of the human body, mind and spirit. Since opening its doors in 1995, more than 100 C.A.S. practitioners have graduated and established practices. And, nearly 50 more will graduate each year. In 1998, with the help of the College's students and graduates we formed the California Association of Ayurvedic Medicine (CAAM). And, in 1999, we helped form the National Ayurvedic Medical Association (NAMA). As the Ayurvedic profession has grown, the College has evolved to meet the changing needs of the profession. Today, the College's Clinical Ayurvedic Specialist program is more extensive than ever before. The main center of the California College of Ayurveda lies in Grass Valley. In addition, the College has expanded to offer satellite classes in the San Francisco Bay Area as well as Southern California. The California College of Ayurveda is the largest and most successful college of its kind in the country! New C.A.S. programs begin every few months and are offered in two formats: Full Time and Extended Weekend courses. In addition to its educational facility, the College runs the world class Ayurveda Healthcare Clinic. People from across the country receive the highest quality of Ayurvedic health care in an environment that is nurturing as well as academic. The College's clinic offers personal consultations and health care coaching to help people understand their true constitutional nature and make positive lifestyle and dietary changes. The College's clinic also offers pancha karma services. Pancha Karma is the process of purifying and rejuvenating the body. Utilizing specialized massage techniques, oil therapies and other exotic techniques, pancha karma is a process a patient goes through to create the deepest physical and emotional healing possible. Patients often receive 5 10 days of continuous therapies lasting 23 hours each day. This special program removes toxins from the system and restores the internal vital energy to the body. The process is both rejuvenating and deeply spiritual. Healing is a journey. The path to optimal health is neither short nor easy. Ayurveda, however, offers clear guidelines on how to succeed along that path. Most patients who enter into Ayurvedic care continue with a practitioner for 612 months. During this time the practitioner develops and implements a program of care based upon the uniqueness of the individual. And, most importantly, the practitioner educates the patient to understand their constitution and how they relate to the world around them. With this knowledge, a person can create and environment supportive to the healing process. People are like plants. If plants receive the proper quality and quantity of sunlight, food and water, they will thrive and produce lots of flowers and have a rich color. However, if the environment is less than optimal, the plant may live but it will not thrive. It's color will not be as rich nor its flowers as numerous. People are very much the same. If the environment is not optimal, people live but do not thrive. Creating an optimal environment takes time and should not be rushed. It involves subtle, though significant lifestyle changes. Making these changes parallel a change or growth in consciousness. As consciousness evolves, the experience of life changes from one of unhappiness and disease to one of joy and optimal http://www.ayurvedacollege.com/book/export/html/2
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health.
Cultivating the Ayurvedic Profession In 1995 The California College of Ayurveda (CCA) opened its doors with the commitment to provide the finest Ayurvedic education available in the United States and in fact, to provide Ayurvedic education on par with our colleagues in India. Today, nearly two years later, this goal has became a reality. Ayurveda is the traditional medicine of India. Translated from the Sanskrit, Ayurveda means the knowledge or wisdom of life. While a medical science, its scope enters into the realms of the spirit and the transformation of consciousness. Ayurveda's fundamental philosophy is that disease is the end result of living out of harmony with our environment and in order to reestablish optimal health, we must discover where we are living out of harmony and then adopt a life style which brings us back into harmony. This simple philosophy takes the individual onto a journey which goes deep inside of one’s nature. Utilizing methods of care such as Pancha Karma (detoxification), proper diet, yoga, meditation, herbalism, aroma therapy, color therapy, sound therapy and lifestyle analysis, Ayurveda guides the individual back onto their path toward optimal health. We relate to our environment through our five senses When we have harmonious relationships, our bodies and minds are healthy and stable. However, when we indulge our senses in disharmonious ways our bodies suffer and disease is the end result. We make choices every day, our health is the end result of these choices. While the benefits of a proper diet are well known, we also make choices of how to use our other senses. For instance, each day with our sense of vision, we can either choose to look upon beauty or upon violence. Simply surrounding ourselves with flowers aids our healing process and strengthens the body and mind. Gazing at nature’s gifts brings harmonious energy into our body. Looking at violence on television, movies or in real life causes our minds to become toxic. Because of the mind body relationship, our bodies follow by becoming ill. We also see this happen when we sit in front of a computer for long hours or get lost in the concrete jungle of the city. Spending time in nature aids our body’s healing process. As important as vision is, all of our senses are equally important. Taste, touch, sight, sound and smell bring energy into our bodies. If we take in harmonious energy, health is the end result. In Ayurveda we recognize that everyone is an individual and has a unique constitution. This constitution determines what is harmonious for you and what is disharmonious. Not everything is right for everyone and everything is right for someone! Hence, Ayurveda is a path of self knowledge which guides harmonious action. Becoming popular in the 1980’s, interest in Ayurveda has grown steadily leading to the formation of the first formal Ayurvedic colleges in this country. Approved by the State of California, The California College of Ayurveda is the first stateapproved college for the study of Ayurvedic medicine in the country. Committed to excellence, the CCA offers a twoyear training program which combines classroom education and independent study culminating in a sixmonth clinical internship, either in the student’s own community or at CCA’s clinic, the Center For Optimal Health . The College attracts a diverse body of students from around the world. Considered the first clinicallyoriented program of study to exist outside of India, the CCA program has been approved for its authenticity and comprehensive approach through Ayurved/Shikshan Mandal, a government http://www.ayurvedacollege.com/book/export/html/2
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authorized accrediting agency in India. This acknowledgment allows these graduates to perform an additional internship in India if they desire. Dr. David Frawley, the Director of the American Institute of Vedic Studies in New Mexico and author of Ayurvedic Healing and theYoga of Herbs , states: "The CCA is the finest Ayurvedic educational institution in the United States. At a time when Ayurveda is growing rapidly, the CCA sets the standard for educational quality. Their program of study and internship have brought Ayurvedic education to a whole new level in the West. They are truly leaders within the profession." At a time when so many are taking a second look at how we approach health care in the United States, the role of Ayurveda should not be underestimated. The CCA, in conjunction with other leaders in the Ayurvedic profession such as Dr. Deepak Chopra, are challenging the way ordinary people view their bodies, their health, and the cause of disease. As we establish an independent Ayurvedic profession in this country, the impact that we will make will change the course of health care forever.
Dealing with Conflict: A Yogic Perspective Conflict appears to be a part of many lives. It seems to be all around us. It is prevalent in the Ayurvedic and Yogic communities, in the family and on the World stage. To be alive as a separate entity on this planet sometimes means bumping into other peoples separate identities. We identify our selves with many things: our bodies, our clothing, our personality, our work and our history are only a few. Most people also identify themselves with their beliefs and perceptions. We tend to believe that how we see the world is the right view of reality. People of pitta nature are most challenged by overly identifying with their perceptions. The fire in the mind is capable of burning away false illusion and revealing truth. This occurs when the mind is perfectly clear and the individual is purely sattvic. As most people are not purely sattvic, there is some distortion to what a person of pitta nature perceives. Taking their perceptions as real, leads a person of pitta nature toward intense feelings. When a person of pitta nature's perceptions conflict with another person, the feeling that arises is anger. Anger generates the actions of conflict. In the bar, it creates a brawl, in the family an argument; in political organizations it generates angry letters and counter letters to the membership. Much of society deals with anger in the "civilized" fashion of law suits. There must be a lot of anger as there are a lot of lawsuits. In the macrocosm of a country's collective consciousness, nations deal with anger in the form of war. In the microcosm of our own lives all harmful actions (physical or otherwise) taken out of anger and frustration is an expression of our warlike nature. Pitta is the warrior. Always right, the war becomes a passionate, self righteous conflict. George Bush is a warrior. Ariel Sharron is a warrior. Sadam Hussein is a warrior. Bin Laden is a warrior. Some members of CAAM are warriors, some students are warriors and some teachers are warriors. Warriors live for the righteous fight. Warriors live to be right. Warriors destroy to be right. That is, until they awaken. As the person of pitta natures becomes more sattvic, the mind becomes clear and the pitta person perceives the higher truth. There comes the http://www.ayurvedacollege.com/book/export/html/2
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realization that each soul is growing, learning and evolving and taking the best actions they can based on where they are on their journey. I really don't believe that anyone wakes up in the morning as says to themselves, OK, I'm a bad guy, how can I do some really bad things today. Rather, most people rationalize their actions in a manner that makes them feel good about themselves and look good to others. Ordinary people believe their own rhetoric and believe they are right. Having pierced the illusion, the sattvic pitta person chooses to remain above the maya (the play of consciousness) and does not engage their enemy in battle. To do so only is to deny the Truth they see so clearly. In Vedanta, "Tat Twam Asi" means "thou art that". When we engage others in righteous holy wars, we are our own enemy. When we harm them, we harm ourselves and we remain bound to the wheel of life, death and suffering. In the absence of anger there is both compassion and amusement. There is compassion for the struggling soul and amusement when we find ourselves being drawn into a conflict when we know better. Amusement often acts as a windshield wiper as we drive down the highways of life. Seeing clearly through a clean windshield (the mind) we can exit the highway and take the road less traveled up to the highest summit. From there it is all clear. Want to live in a peaceful world? We must first make peace with ourselves. Then, we can make peace with our families and our communities. When enough people live this way, we shall no longer express our collective consciousness in the form of War. Peace begins with each one of us. Peace begins with compassion.
Empowerment, Spiritual Growth, and Optimal Health Ayurvedic health care at its best facilitates a transformation of consciousness leading toward harmonious actions, optimal health, and peace of mind. There is no real healing without a transformation of consciousness. We create our current life situations. This is true of our entire experience of life: financial, career, material, emotional, relationships, and our health. Realizing that we are the creators of our experience offers us a tremendous opportunity to create the experience that we want to have. After all, only if we have the power to create our experience can we have the power to change it. If our experience now is one of sickness, by taking control over the experience we can recreate a state of health. The power to create one's experience is what is often called " personal power." It is cultivated by taking responsibility. Real power begins with responsibility. Only by taking responsibility does anyone gain the ability to respond. When we shunt responsibility on to others or onto factors outside of ourselves, we become disempowered. We become the victims of factors that are out of our control. Vedanta, the great teaching that underlies most Vedic systems of spirituality, teaches that the world we live in is a reflection of what is going on inside of us. It is nothing more and nothing less. "Neti Neti," not this, not that , is an important mantra. It is the negation of the outside world and its experience. It focuses truth toward the inside. At our core lies the power to create. http://www.ayurvedacollege.com/book/export/html/2
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Yes, we are all "Creators." We do it every day and most of the time we keep recreating the challenges we experience again and again. We do this subconsciously, ignorant of how to work with the power of creation. Stuck in a circular path of recreation, we figure that the cause of our illnesses and unhappiness must lie outside of ourselves. The cause must be the pathogens, the government, the boss, the employees, the kids, the parents, the corporations, etc., etc. WAKE UP! The cause is inside. That is the only cause that makes a difference. Most people shy away from taking responsibility. After all, who wants to be responsible for illness and suffering? This is because most of humanity is very JUDGMENTAL. When judgment is added to responsibility it becomes BLAME. No one wants to be blamed for anything. We are quick to accept responsibility for the good in the world and just as quickly shield ourselves from the blame for what goes wrong. There is no reason to ever accept blame. Take away the judgment and there is only cause and effect. This is the law of KARMA, and karma is nonjudgmental. It is a reflection of past actions. If you do not like the effect, put new causes into action. Create new effects! Vedantic thinking is very empowering! So the question of the day is, "What are you going to do differently NOW?" I will suggest that, deep down; each person already knows what he or she needs to do differently. Most people, deep inside, recognize the disharmonious actions that they are performing and know that they need to change them. If a person takes some quiet time for selfreflection and inquiry, the changes that need to be made become clear. Doing them is the challenge. This is where Clinical Ayurvedic Specialists can come in. Our job is to support positive change and growth toward optimal health and peace of mind. Sometimes, our job is as simple as reminding patients to look within and identify their disharmonious actions. Other times, we peek in their lives and help them to identify those actions. Once the actions that need to be changed are identified our role is simple: hold the patient accountable. We must be a constant reflection of what they already know. Do not be afraid to remind your patients that they have the power to change. Do not be afraid to remind them that they control the outcome of their care. Do not be afraid to give them the power to control their lives. When they take true responsibility for their circumstances and move toward greater harmony, they are harnessing the power of the divine, and this fills up every cell of their body. Healing is a matter for fact. Where there is harmony, there is health. Where there is disharmony, there is disease. To be effective in helping people accept responsibility for their level of health and peace of mind two things are necessary. First, take responsibility for your own. That's right; begin today and stop blaming others. Second, practice nonjudgment. It's not easy, so practice on yourself first before practicing on others. Watch what happens. Watch how your own life begins to change as you stop blaming yourself and start taking full responsibility. You will begin to feel something special you may have never felt before. That special something is "unconditional self love." When you have enough of it, you will naturally begin sharing it. You won't have a choice, your cup will overflow. In your consultations, unconditional love and compassion will create a sacred space for healing to occur. When you purify yourself of judgment, your patients will feel more comfortable opening up and becoming vulnerable with you. Begin by watching your words. Let go of right and wrong, good and bad, praise and blame, because you can't have one without the other. Change the words as you hear them come out of your mouth. Later, watch your thoughts. Pay attention. Change them too as they arise. Smile within when you catch yourself. That smile is an act of selfcompassion. http://www.ayurvedacollege.com/book/export/html/2
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With practice, we can all become more nonjudgmental, compassionate, unconditionally loving people. Through our practices, we can inspire others to become more so as well. With clarity, and some effort, we can take full responsibility for our lives, become divinely empowered individuals, and build lives of greater health and peace of mind. If that is not enlightenment on earth, I don't know what is.
Metals In Ayurvedic Medicine It was reported in the Journal of the American Medical Association that some Ayurvedic herbal formulations have been found to contain heavy metals known to be toxic. The herbs analyzed were sold in the Boston Area. As soon as the report came out, the California College of Ayurveda was contacted by the media for comment. This prompted us to look further into the story. Here is what we have learned. The contaminated product was mostly gathered through Indian grocery stores with a 20 mile radius of Boston. The herbs tested included Mahayogaraj guggulu and others containing bhasmas. Bhasmas are metals that go through a purification process that turns them into ash. Because there have been questions in the past about the saftey of bhasmas, these are not supposed to be sold in the United States. Indian groceries however sometimes import through small distributors bypassing US regulations. We have no reason to suspect the inclusion of any metals from popular suppliers such as Bazaar of India, Om Organics or Banyan Trading. In addition, here at the California College of Ayurveda, almost every formulation is mixed at our pharmacy from raw herbs and we know exactly what is going into them. Those formulations that we do receive prepared for us are recieved from reputable distributors who have assured us of purity and we are not at all concerned. It should be noted that the pharmaceutical and medical industry love to promote contamination of Indian and Chinese herbs as it suits there interest. You won't see it in American newspapers but the Indian Supreme Court just ruled against Coca Cola requiring them to label their product in India as containing pesticides known to be harmful to one's health. This is a political as well as a health issue. The California College of Ayurveda advocates for the importation clean and pure herbs and we support controls to assure that only quality herbs are imported from all regions of the world. It is important to note that there is no such thing as an Ayurvedic herb. Marketers of herbs from Indian have used the name Ayurveda as a tool to sell herbs. In actuality, there are Indian herbs, American Herbs, European Herbs, South American herbs and so on. Ayurveda is the paradigm in which it is used. When any herb from any part of the World is used based on the Ayurvedic understanding of the nature of the patient, the nature of the diseae and the nature of the substance, this is the practice of Ayurveda.
Om Namo Narayanaya: A Vedic Children’s Story For a Modern Time http://www.ayurvedacollege.com/book/export/html/2
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Once upon a time, there was a king named Arrogance. King Arrogance was the ruler of the largest kingdom in all the world. Although he ruled only his part of the world, he looked out upon the entire world as his true kingdom and he felt responsible for all of the world’s peoples. King Arrogance was for the most part, a good King to his people and his people, for the most part liked him. King Arrogance wanted the people of the whole world to become like his own people. He wanted them to live the way his own people lived. He wanted them to think the way his own people thought. He wanted to be their king. There were many smaller kingdoms in the world. One was ruled by another king who the rest of the world called King Rage. King Rage was an angry king. Many thought he was a crazy king. He did crazy things and often he brought harm to his own people and sometimes to the rest of the world. His kingdom was small and he wanted it to be larger. He did not like King Arrogance because King Arrogance has a larger kingdom and had more power in the world. King Arrogance did not like King Rage because he was not very nice, respectful or obedient. One day, the two kings got angry with each other and got into a fight. Then, they decided to go to war. They called all of their soldiers and sent them into battle. Meanwhile, somewhere in the kingdom was a boy, an ordinary boy. He was playing outside with a ball. He kicked the ball as hard as he could and the ball rolled down a hill of grass into some bushes and trees. The boy chased the ball and when he found it, he found himself in a beautiful field of flowers. He sat down to admire the beauty of the field and the sweet smelling flowers. There, as he sat, quietly, he had a vision. A radiant being floated toward him. The being was both beautiful and awesome, powerful and quiet. I am Narayana, the being said. I am the God of Peace.” The boy prostrated before the great God and said why have you come to me. The God said, “You are the one I have chosen. Go to the battlefield where there is war and in my name bring peace.” Then, the magical, being disappeared. The boy did not know what to do. He was after all, not a great God but a small boy. How could he bring peace? However, when God asks you to do something, the boy knew he should at least do his best. So, he set out for the great battle field. As he approached the battle field he saw great bombs exploding. He saw men and woman in uniforms with guns in their hands fighting with one another. He did not know how he could stop anyone from fighting. Who would listen to him? What would he say anyway? The boy closed his eyes and saw the image of Lord Narayanaya, the God of peace. With this image firmly in his mind, he walked into the middle of the battle field and sat down. He kept his eyes closed as if in a dream and continued to see the image of the God of Peace. The two generals leading their armies saw the boy and ordered their troops to stop fighting so that the boy would not get hurt. When the guns stopped firing they heard the voice of the boy singing the name of the God of Peace. The Boy was chanting, “Om Namo Narayanaya. Om Namo Narayanaya. Om Namo Narayanaya,” Over and over he chanted. The two armies stopped and listened as the words resonated from the boy’s lips the boy’s voice echoed through the country side. Its vibration http://www.ayurvedacollege.com/book/export/html/2
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entered the hearts of the soldiers. Hearing the name of the God of Peace being chanted so beautifully, the two armies dropped their guns. Deeply moved, they walked toward the boy and surrounded him. There, they sat with him and began to chant, Om Namo Narayanaya. As they chanted their hearts became purer and purer and arrogance and rage faded away. They felt only the love that was inside of them. When the two kings heard what was happening they came to the battle field. They ordered their armies to fight. Victory for our kingdom they each called out. The soldiers did not move. They kept on chanting. The kings, in frustration picked up a soldiers gun and fired it into the air to scare the soldiers. Still, the soldiers did not move. Still they chanted. Om Namo Narayanaya. As the soldiers chanted, the words that resonated from their lips entered into the hearts of the two kings. The words stirred great conflict inside of themselves. One king was moved to sit down and chant with the boy and the soldiers. His heart became pure. The other king could not let go of his pride. He jumped up and down, yelled and screamed and then, he picked up a gun. His aim was not very good. He fired a shot at the soldiers. The bullet bounced off a rock and stuck the king. He died and arrogance and rage died with him. Their hearts pure, the soldiers and the one king, set out to spread peace throughout the world. Whenever they came to a conflict, they chanted, Om Namo Narayanaya, Om Namo Narayanaya, Om Namo Narayanaya. Today, during times of conflict, Yogi’s by themselves or in groups often sit quietly and chant the name of the God of Peace hoping that their words will purify the hearts of those who are in conflict.
The Dharma of the Clinical Ayurvedic Specialist Dharma means service. A person's dharma is how that person is going to contribute to society. We all have a contribution to make. Together, when everyone is performing their service the world functions well. Like the links in a chain, when all are present and connected, the chain is strong. When someone is missing or not performing their duty, the entire chain becomes less effective. The term dharma, as it is commonly used, implies a spiritual purpose, a higher purpose beyond one's desires. This is the purpose assigned to you by the divine. It is a purpose that matches your unique gifts and abilities. While it may make you stretch, it also helps you to reach beyond your self perceived limitations and manifest a greater amount of your potential. The dharma of the Clinical Ayurvedic Specialist (CAS) is to bring the knowledge and light of Ayurveda to one's community. Through educational programs and one on one consulting, the CAS practices as a one part teacher, one part healer, one part doctor and one part coach on each person's journey toward optimal health and well being. Exactly how each CAS accomplishes this depends upon their own dharma, gifts, abilities and inspiration. Ayurvedic knowledge is the cornerstone of harmonious living. This information is more important today than ever. As elements of our society have moved further and further away from nature, Ayurveda serves as a reminder of our connection to all of creation. Ayurveda has the potential to http://www.ayurvedacollege.com/book/export/html/2
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reconnect each person back to source. Ayurveda and its sister science Yoga help each human being to recall their connection to nature and spirit and in doing so, reestablish harmony, health and wellbeing. Of course, knowledge itself is useless unless there is a practical application that benefits humanity. The CAS must take this knowledge and move it from their head to their heart and out through their hands. This is the work that all students begin at internship and continues with as they go into practice. The practice of Ayurveda means touching the hearts of your clients / patients and stimulating a transformation of consciousness within them. The more hearts that are touched, the more consciousness that is healed, the more peace and harmony there is the world. Yes, the Clinical Ayurvedic Specialist has a dharma that is not only interpersonal but also global. As the consciousness of each individual heals, so too does the consciousness of a community, a city, a state, a country and a planet. It is gift to know one's dharma. It is as if God has spoken and you have heard. At that time, all that is left is to surrender and serve. These two tasks are not as easy as they sound. Surrendering is perhaps the most difficult action any human being can take. It means putting aside one's personal desires and goals in favor of service to the divine. It takes tremendous faith and courage to act in a selfless manner. Selflessness is by nature very scary. Our self or ahamkara struggles to maintain its current existence. It does not like change or growth. A new way of being threatens the very existence of self. As a result, we usually sabotage our growth as the self fights back to maintain the status quo. One way this appears as higher Self doubt. Is my perception of my dharma my imagination or is it a truly divine offering? If it is my imagination, am I giving up my pursuit of personal gain for no real reason?.î This type of higher Self doubt troubles many people whose faith is not secure. As a result, most higher pursuits fall short as the person eventually gives up, going back to a self existence. Some never gain the clarity to see the door of dharma. Of those who do, few walk through. It takes great courage and faith. Success in life has many measuring sticks. Most measure it based on money and power. Few measure it based on service and accomplishment. Surrendering to dharma assures a balanced success based upon all parameters. The universe supports those who align with its divine intention. It is possible to become overly attached to one's dharma. When this occurs, a person struggles to fulfill their dharma at all cost. Perceiving themselves as on a mission from God, they feel justified destroying all who stand in their way. History is filled with such individuals spreading hate and violence in the name of God. Such fanatical behavior is not true service to ones dharma but rather a mixing of self and Self. The ego takes on responsibility for fulfilling the dharma. Rather than surrendering and allowing the divine to flow through one's self, this individual blocks the flow of the divine, harnessing instead the power of the will. Dharma can never be fulfilled in this manner. The harmonious fulfillment of dharma is a gentle, loving process built upon steady hard work and devotion to higher principles. As human beings, we easily fall back into the dark shadow of the ego. But, within each of us is the light of the divine. As we open to the loving light, the darkness is dispersed. As the Clinical Ayurvedic Specialist serves their community with love and respect, consciousness is healed and dharma is fulfilled. May we all work with through our own gifts and talents to bring the knowledge of Ayurveda to light in this modern age. May we all fulfill our dharma. http://www.ayurvedacollege.com/book/export/html/2
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The Sacred Journey of the Patient and the Practitioner The most important thing a Clinical Ayurvedic Specialist can do is support their patients to successfully implement the principles of Ayurveda into their lives. These principles, when properly followed assure that the body and mind of the patient will be balanced, peaceful, and optimally healthy. Natural law is such that if the principles of Ayurveda are followed, healing will take place within the limits of nature and matter. This is guaranteed. The human body has a tremendous capability to heal itself, whether a person is suffering from Irritable Bowel Syndrome, Asthma, Multiple Sclerosis, or Depression. From an Ayurvedic perspective, the body and mind heal naturally and completely when the laws of nature are applied to the practice of healing. There are times, of course, when healing is not possible. (Such times, however, are comparatively few.) Healing is not possible when tissue is damaged beyond the ability of nature to bring about healing. A line can be crossed, where even the most heroic natural measures will not bring about healing. For example, if an arm is severed, the body will not heal without surgical intervention. Likewise, many conditions in their late stages produce such severe tissue damage that the body cannot repair itself. Ayurvedic healing supports the body to heal itself. Nature works through the body's innate healing potential. If the body and mind are aligned with the power of nature, the body's healing mechanisms are empowered and their full potential realized. Miracles occur all the time. It is a miracle when the body and mind, working with nature, heals itself. These are not real miracles, however. They appear to be miracles to most people who do not understand or perceive the ways of Nature. This is the Science of Natural Healing. Our job is to help miracles occur by aligning our patients with Nature. We do this through lifestyle counseling. By helping people to understand their prakruti (Nature) and their vikruti (imbalance), we help them begin to see who they are and how they relate to the world around them. When we establish a plan to help bring them back into balance using the five sense therapies and daily/seasonal routines, we are educating them in what they need to do to allow the healing forces of nature to flow through them. As they make changes in their lives, they remove the obstructions that interfere with this flow. Change comes slowly to most people. Our job is to be loving and caring guides on their journey. We hold the space for them to grow and evolve. They do the real work, as they face the demons of their harmful habits. Our job is comparatively easy: we tell them where they are and remind them of where they are going; when they get lost, we help them find their way back to the path. We have faith in the process. Our confidence carries them till they develop faith for themselves. We hold the space of nonjudgment so they can feel comfortable looking their demons in the eye. We hold the space of unconditional love and it fills them up, sustaining them as they move forward on their journey. We are all healing to some degree. We are slowly regaining our memory of our true nature as spirit. Likewise, we are all suffering, as a result of our amnesia. This is true of the healers as well as of the patients. Let us always remember what an honor it is when a patient comes to us for guidance on their journey. Let us hold the sacred space and walk forward together. http://www.ayurvedacollege.com/book/export/html/2
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Twelve General Guidelines For Healthy Eating The way in which you eat your food is even more important than what you eat. Even foods that usually cause imbalance will be digested reasonably well, if the proper rules are followed. Likewise, if you eat the correct foods in the wrong way your digestion will be compromised, and gas, indigestion and the formation of ama will follow. If you follow these food habits and choose the correct foods then your digestion will be maximized, and you will experience optimal digestion. 1. Chew your food until it is an even consistency before swallowing. 2. Do not eat while being distracted by television, excessive conversation or reading. 3. Do not drink cold drinks just prior to eating. This weakens digestion. 4. Do not drink large quantities of liquid during meals, as this also weakens the digestive fire. A halfcup of room temperature water is about right, on the average. Dry meals may require more, and moist meals, like soup, require none at all. It is okay to sip a little wine during a meal. 5. Eat only food prepared by loving hands, in a loving way. The energy of the cook is always in the food. Avoid eating food prepared with resentment. We take in not only the food, but also the emotions of the chef. 6. Make eating a sacred ritual. Pause for a moment, relax, and say grace before you start. 7. Following your meal, relax for a short while to let your food digest before going on to the next activity. 8. Eat at a moderate pace until you are threequarters full. 9. Allow three hours between meals to allow your food to digest. 10. Digestion is strongest around noon, when the sun is at its peak. The body's rhythms mirror those of the universe. Therefore, it is best to eat your largest meal at noon. The morning and evening meals should be lighter. 11. Take all water and drinks at room temperature or warmer. Cold drinks destroy the digestive fire and decrease digestion. This is true not only at mealtime, but all day long. 12. Allow three hours between meals for food to digest. This allows most people three to five meals per day. Those with a vata nature or imbalance should eat four to five times per day.
What is Ayurvedic massage (abhyanga)? Techniques and principles Ayurveda, the ancient science of healing from India has always utilized massage as a part of its regimens for healing. From an Ayurvedic perspective, different forms of massage are useful to different people. The form of massage utilized is based upon a person’s constitution and imbalance. One’s constitution is the inborn or inherent balance of energies in his or her body and mind. In Ayurveda these are quantified in the understanding of the Doshas. There are three Doshas known as Vata, Pitta and Kapha. These three energies control the formation and functions of the body on the physical and emotional levels. In harmony the body is healthy but as the doshas move out of harmony the body expresses itself in the form of http://www.ayurvedacollege.com/book/export/html/2
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disease. Each individual has his/her own unique balance of these energies. As a result each individual expresses himself differently in the world. Each person has a different type of body frame, degree of oiliness in the skin, sensitivity to pain and many more characteristics that can be understood by knowing a person’s unique constitution. This is why Ayurveda sees all people as individuals recognizing that one person’s elixirs is another person’s poison. As an example, people of Kapha nature have skin which is naturally oily, soft, and supple. They also tend toward being heavy, feeling cool and moving slowly. If these individuals use cooling oils like coconut, the cool and heavy quality of the oil will sedate them even more and may cause oozing skin conditions. On the other hand warm, lighter oils like safflower can be added to another warm oil like almond to make a much more balancing massage oil for Kapha individuals. In addition other warm, stimulating essential oils could be added. While other people of Kapha nature can do well with warm, stimulating oils, they also thrive with dry massage using powders. In addition to the science of choosing or making oils for massage, Ayurveda recommends different forms of massage for different people. These principles can help a person understand why some people are drawn to polarity when others are drawn to deep tissue therapy and Rolfing. If a person is receiving the wrong form of massage for them, it can lead to greater imbalance physically and emotionally. Following our example above, people of Kapha nature who tend to be stocky, muscular, carry a little more weight and tend toward lethargy benefit from deep tissue massage which is more stimulating while gentle massage strokes like effleurage or polarity can add to their already sedate nature. Massage is also used in the Ayurvedic therapy known as Panchakarma. This is a therapy, which aids in detoxification. While massage with appropriate oils is only one part of this therapy, the knowledge of its role helps a person understand the effects of massage on their individual body type. During this form of massage called abyhanga, two practitioners participate in a rhythmic massage, which in conjunction with the oils used, liquefies toxins in the body so they can be easily expelled through other processes. Finally, another area Ayurveda includes which is related to massage is the art of “Marma Point Therapy.” Marmas are special energetic points in the body with relationships to organ function, metabolism and emotional states. They bare similarities to Acupuncture points and many scholars hold to the view that Ayurveda is the foundation of Chinese medicine. Marma points are typically stimulated by hand pressure, massed with special oils or stimulated with medicated steam.
Introduction to Ayurveda articles The following articles were written by Dr. Marc Halpern
Aging and Health: An Ayurvedic Perspective Physicians often quip that no matter how good we are, our patients will eventually die. It is true that regardless of human invention and new http://www.ayurvedacollege.com/book/export/html/2
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technologies each and everyone of us will eventually take that journey into the unknown we call death. The goal of modern medicine is to delay that journey and to improve the quality of life while we are here. It is to this end, that Ayurveda offers humanity the greatest hope of achieving both of these goals. Ayurveda means the “science or knowledge of life.” It is a complete system of understanding the human being and his relationship with the world around him. If an individual is living in harmony with their environment, optimum health is possible. However, the further out of harmony an individual is living, the less likely it is that they will reach their full life potential in either length or quality. In order to maximize life potential, it is taught in Ayurveda that each person must learn to live harmoniously with the world through their five senses. Our senses are like portals or gateways into our body, mind and consciousness. If we take in sensory impressions that are healthy, we will in turn be healthier. If we take in that which is unhealthy, the body suffers. It is often said that “we are what we eat”. In fact, we are what we eat, smell, see, hear and touch. Through our senses, we absorb the world around us. While the human body and mind can survive on low quality sensory impressions it can not thrive. Ayurveda is not simply a science of how to care for the body but also the mind. The MindBody connection is well established, both in the East and the West. Stress is recognized as an important contributor to disease. The damaging effects of stress on our immune and endocrine systems are well documented. Stress plays an important role in the both the onset and the prognosis of most diseases. Ayurveda is a science of stress reduction. One facet of living a harmonious life of low stress is using the senses properly. Low quality food is a stress on the physical system. Likewise, inappropriate smells, sights, sounds and touch can be just as or more stressful. While the proper use of the senses is important to reducing stress, complete stress reduction requires control of the mind as well. Toward this end, Ayurveda employs the techniques of Yoga to bring about greater peace of mind and stillness. When the mind can focus on the present moment and resist wandering off into past or future dramas, stress is reduced and time appears to slow down. As the mind slows down and relaxes so to do internal bodily process. Heart rate slows down and contractions become stronger and more regular, there is decreased activity in the sympathetic nervous system and the secretion of stress chemicals such as epinephrine is reduced. When the mind is calm, both the mind and body are healthier. As we age, we begin to realize the accumulated effects of decades of stress and poor lifestyle. We experience the results of this in the form of cardiovascular disease and the deterioration of all of the tissues of the body. The bones become osteoporotic, neurons in the brain degenerate, muscles atrophy and tissues become drier. The list of age related diseases is long. Each is the end result of decades of wear and tear. Healing is the process of restoring optimal function. Health is the experience optimal function. Ayurveda offers people the opportunity to maximize their healing potential and restore optimum health. Through proper lifestyle and medicines provide to us by nature in the form of herbs, both the cause and the symptoms of many agerelated diseases can be eradicated. The role of Ayurveda is to remove the cause of disease and gently support the healing processes of the body with natural remedies. Each of us is a unique individual and each disease is also unique. Two patients who suffer heart attacks do not necessary have the same cause of their condition and therefore, the cure may be different as well. It is the goal of Ayurveda to understand the unique nature of the patient and the unique nature of the disease. With this understanding, the Ayurvedic physician is able to prescribe the best individualized program of care and then support the http://www.ayurvedacollege.com/book/export/html/2
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patient as they progress on their journey back to optimal health. Ayurveda maximizes the potential of the patient heal, regardless of the disease. Patients under Ayurvedic care can expect both an increase in the quality of life and the length of life.
Ayurveda for the 21st Century Ayurveda, which literally means "The Science of Life," is the healing science from India. It has been practiced for over 5,000 years by millions of individuals to assist the body in journeying back to optimal health. More and more people are discovering that these ancient principles are easily applicable to modern life and that they have the power to create health and contentment. Health comes when we live in harmony with our true nature as spirit. Ayurveda allows us to get a glimpse of our individual true nature and to find the best ways to live a life of balance. It provides holistic understanding and healing to people on all levels: physically, emotionally, and spiritually. Ayurveda uses a multitude of healing modalities including herbs, diet, colors, aromas, sound, lifestyle recommendations, pancha karma, meditation, and yoga.
The Clinical Ayurvedic Specialist and the Ayurvedic Health Practitioner Clinical Ayurvedic Specialists (C.A.S.) and Ayurvedic Health Practitioners (A.H.P.) are the most thoroughly trained practitioners in the field of Ayurveda in the United States. With nearly 400 graduates, CCA provides both academic and clinical training in preparation for students to go into private practice. It is the dharma (purpose) of a C.A.S. and an A.H.P. to share their knowledge and principles of Ayurveda to uplift the health and wellbeing of the community. Our graduates are trained to understand a client physically, emotionally, and spiritually. From this understanding, they identify the client's constitution and the nature of any imbalances, and then design and implement an appropriate treatment program. One part healer, one part counselor, one part coach, and one part guide, our graduates help people create optimal conditions for healing, balance and harmony in their lives. Ayurvedic health practitioners and Clinical Ayurvedic Specialists transform the lives of their clients. Clinical Ayurvedic Specialists are the doctors of the future, using principles from the past to help people achieve balance, harmony, and health in the present.
Professional Opportunities Clinical Ayurvedic Specialists and Ayurvedic Health Practitioners have many options for using their training in the field of holistic health and education. An A.H.P. or C.A.S. may choose to enter into private practice, join other health care practitioners at a wellness center, teach public education classes on Ayurvedic principles, supervise a pancha karma center, teach at an Ayurvedic college, or conduct workshops and seminars. Ayurvedic Health Practitioners and Clinical Ayurvedic Specialists who are already licensed health care providers may use their Ayurvedic training to enhance their current healthcare practices. All graduates have the unique opportunity to decide in what way they will use their education to serve their community and the planet. Ayurveda is based upon a deep communion with the spirit of life itself and a profound understanding of the movement of the lifeforce http://www.ayurvedacollege.com/book/export/html/2
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and its different manifestations within our entire psychophysical system. As such, it presents a helpful alternative to the technical and mechanical model of modern medicine, the limitations of which are gradually becoming evident through time. It is a truly holistic medicine whose wealth we have just begun to explore in the Western world. Dr. David Frawley Author, CCA Advisory Board
Ayurveda: Maximizing the Potential For Healing Ayurveda is the ancient and traditional medicine of India. A holistic form of medicine, Ayurveda focuses on creating an optimal environment within the body for healing to take place. The goal of Ayurveda is to support the body’s internal healing capability. The science of Ayurveda views the human being as a dynamic, life affirming organism that in its natural state is healthy, free from disease and at peace with life. Optimum health occurs when the natural process of the body are not interfered with. This happens without effort when the human being is living a harmonious life. Disharmony of any kind, physical, mental, emotional or spiritual is the cause of disease from an Ayurvedic perspective. Disharmony occurs when a person is out of tune with the environment or other people. In order to maximize the healing capability of the body, the Clinical Ayurvedic Specialist (C.A.S.) helps their clients reestablish harmony through learning to follow a healthy lifestyle. The five senses are portals or gateways into the body, mind and consciousness. Through them, impressions from the environment are absorbed. When healthy impressions (healthy foods, visual impressions, sounds, smells and touch) are taken in, the body responds by reaching its full potential. When low quality impressions are taken in, the body responds with less than optimum function and becomes susceptible to disease. Western Medicine acknowledges two principles in the onset of disease. One is the role of virulence or the strength of a pathogen such as a bacteria or virus. The second is resistance or the ability of the host (the person) to ward off the disease. This second component is called immunity. It is the function of Ayurveda to maximize immunity and defend against disease. These principles are also true on the mental level. Mentally and emotionally, stress is the pathogen. A person’s ability to resist stress is the “immune system” of the mind. Ayurveda not only attempts to maximize physical immunity but also mental immunity. While Ayurveda is excellent preventative medicine, it also supports the capacity of the body to heal. Hence, Clinical Ayurvedic Specialists routinely work with sick clients. However, the focus of their healthcare is not on the eradication of the disease but rather on the underlying causes of the disease. By eliminating the underlying causes, the body heals itself. This self – healing model is paramount to understanding the benefits to Ayurveda. While mechanistic models of well being view the patient as a machine with parts to be replaced and chemicals to be added or subtracted to get the right balance, Ayurveda is a vitalistic system of well being respecting the life affirming energy of the body. Ayurveda views the body as http://www.ayurvedacollege.com/book/export/html/2
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intelligent down to the cellular level and even the subatomic level. The role of Ayurveda is simply to support the work of the innate intelligence. The Clinical Ayurvedic Specialist counsels clients to create a lifestyle of harmony through the five senses. Using dietary, herbal, color, aroma and massage therapies along with yoga and deep relaxation, Ayurvedic practitioners help their clients understand how their current lifestyle may be creating disease and offers suggestions and support to create a newer, healthier lifestyle. Each change made reduces stress and increases the healing capacity of the body. Is what is right for one person, right for everyone? Not according to Ayurveda. Ayurveda views each person as unique with individual needs. We may all be human but we have slightly different physiologies and emotional tendencies. Ayurveda teaches that for this reason, each person’s path toward optimal health is also unique. Nothing is right for everyone and everything is right for someone. Ayurveda resists the temptation to sell one program to every person. Rather, Ayurveda emphasizes an individualized approach to lifestyle. Some people thrive as vegetarians and others as meat eaters. Some thrive on spicy food and others on bland food. Some do well with raw foods and other better with cooked foods. Ayurveda is a path of understand what is right for the individual, not the masses. Ayurveda is neither a statistical form of medicine or a health fad, it is a science, based upon understanding individualized needs and meeting those needs to bring about the best a person can be.
Ayurveda: Medicine Of The Past, Medicine Of The Future Once upon a time, some 5,00010,000 years ago, there lived an ancient people who inquired into the world in which they lived. They looked to the skies and saw the celestial lights, and wondered in awe about their origin and meaning. They looked around at the world and wondered, "why am I here and what is the meaning of my life"? They knew the world around them was fraught with challenges and potential dangers, and they asked, how can I stay safe and healthy? These people were among the earth's oldest human inhabitants, and they lived in the land known today as India. To answer their questions, the wisest and most learned of the clan went forth to seek explanations from the Gods. These wise men and women were known as rishis, the ones who had the gift to attune themselves to the ways of the Gods. As they meditated deeply, the Gods came to them, and answers were given. They learned about astrology and astronomy, about health, about air, fire and water, and they learned about ritual. This knowledge was passed down through generations with songs and chants, and then it was written down in the oldest of books now existing on the planet: the Vedas. The wisdom of the Vedas is vast. The knowledge pertaining to health is known as Ayurveda, or the science of life. The knowledge of Ayurveda was given to the rishis so that they might know how to stay physically and emotionally healthy, in order to pursue their deeper spiritual goals. The Vedic teachings thrived in India, and Ayurveda thrived as well, for several millennia. Scholars, philosophers, and doctors journeyed from afar to India to study, and each took pieces of this knowledge home with them. It was a golden age of increasing understanding and deepening spirituality. Then, between 700 and 1000AD, India was invaded by the Middle East. The Muslims went on antiHindu crusades and destroyed many of the http://www.ayurvedacollege.com/book/export/html/2
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ancient books. The knowledge of Ayurveda began to slip away. In the 1800s the British invaded India, destroying what was left. Schools were closed and books were destroyed, until Ayurveda vanished into the corners of society. In place of the Ayurvedic schools, western medical schools were established. It wasn't until 1947, when India gained her independence, that strong interest in Ayurveda was renewed. At this point, scholars and spiritual teachers tried to pick up the pieces of this profound science. Schools reopened and began to train Ayurvedic physicians. By the early 1990s there were several hundred small Ayurvedic schools in India. Even so, India is a vast country, and the number of Ayurvedic practitioners relative to the population is very small. As of today, Ayurveda remains subordinated to the westerninfluenced health care system. In the West, a great interest in the science of Ayurveda began to emerge as westerners started to question the tenets of their own health care system. In the mid1980s, profound writers like Dr. Deepak Chopra and Dr. Vasant Lad, along with Dr. David Frawley and the Maharishi Mahesh Yogi, began to enlighten readers and listeners about this ancient wisdom. Interest mushroomed, and now we see the very first Ayurvedic Colleges opening in the United States, offering formal study of this ancient knowledge. Ayurveda is a science that is, first and foremost, about creating harmony with one's environment. Ayurveda teaches us that when we live in harmony we shall be healthy, and that disease is the normal expression of living out of harmony. Hence, Ayurveda is a health care discipline that begins by asking us to look inside of ourselves so that we may discover how we are living out of harmony. Only then can we make the life changes necessary for healing to take place. In this way, Ayurveda gives us back both responsibility for our well being as well as the power to create our state of health. Ayurveda teaches us that we are all unique individuals and that each individual's path toward perfect health is equally unique. Ayurveda is not a dogma of "how to"; rather it is a system that illuminates our unique journey and helps to guide us to our destination. Ayurveda utilizes diet, herbs, aromas, colors, meditation and yoga, along with special cleansing techniques known as Pancha Karma, to assist each person in his or her process. Most importantly, however, Ayurveda helps each person to look at their lifestyle and discover areas that are disharmonious, while at the same time empowering greater harmony. Ayurveda says that where there is harmony, there is health.
Ayurveda: The Art of Stress Management Ayurveda, literally translated means the “knowledge of life.” It is the traditional healthcare system of India. Ayurveda is based on the idea that a life and lifestyle of harmony is the basis for optimum health. It can be said that where there is harmony there is health and where there is disharmony there is disease. Ayurveda is the science of creating harmony between a person and their environment. It is well accepted that stress is the greatest threat to the well being of people. Stress weakens the immune system making the host (you and I) more http://www.ayurvedacollege.com/book/export/html/2
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attractive to the multitude of pathogens present in the world. As the strength of the host diminishes, the ability of the microorganism to penetrate its defenses increases. Stress plays a role in the onset of just about every disease people face from the common cold to heart disease. Not only is stress invisible, it is created by the person who is affected by it. This realization helps people understand that just as they have the ability to create the experience of stress, they also have the ability to create the experience of peace of mind. Ayurveda, and its sister science Yoga are a path to personal power helping people learn how to gain control over the mind. Once in control, a person is no longer the slave of their thought process but rather its master. A lifestyle based in harmony is a stress –free lifestyle. Ayurveda applies its principles to both the mind and the body. Though the practices of meditation and yoga, Ayurveda helps a person expand their perception of themselves and how they relate to the world around them. While so many people are plagued with fear, anger, anxiety and / or depression, Ayurveda helps people to come to the realization that life can be and is beautiful! Ayurvedic lifestyle begins with an understanding who one’s constitution. This is the inherent balance of the three doshas (biological energies) determined at the moment of conception. Each person’s constitution defines their uniqueness. Ayurveda understands that nothing is right for everyone and everything is right for someone. Ayurveda is nondogmatic. Each person’s path toward health and harmony are is unique. Ayurveda is the path of finding out what is right for the individual. This path includes learning to live harmoniously through each of the five senses. Hence, through diet, aromatherapy, color therapy, sound therapy and touch (massage) therapy along with yoga and meditation, Ayurvedic practitioners slowly guide their patients back to living in harmony with their true nature. Success on this path takes time and patience but pays great rewards. Along the way, Ayurvedic practitioners utilize their vast knowledge of herbalism to support the process and allieviate suffering. Stress reducing herbs are called nervine sedatives and include herbs such as valerian root, jatamamsi, shankha pushpi and thousands of others found throughout the world. More importantly, the Ayurvedic pharmacopia includes an understanding of rasayanas or rejuvenatives. These special herbs build up the bodies resistance to stress and increases its endurance. These herbs are especially beneficial to those who are highly sensitive to stress. These herbs include ashwaganda, bala and amalaki and many others. According to Ayurveda, the greatest factor in a person’s sensitivity to stress is a substance found within all cellular tissues and the mind. Ayurveda calls this substance ojas. Ojas is the essence of the immune system and provides the mind with both stability and contentment. Ojas is produced by the body as the body digests nourishing foods. Hence, a nourishing diet combined with excellent digestion is the key to building ojas. Ayurveda places great emphasis on proper digestion. This includes selecting the proper foods for a person’s constitution as well as eating them properly. Long term problems with digestion and elimination deplete the body of ojas. Ojas is protected by a lifestyle that avoids overindulgence, includes significant rest and reinforces self –love. In summary, Ayurveda helps a person come to a better understanding of themselves and their relationship to the world around them. By adopting a healthy lifestyle, Ayurveda helps people reduce stress. By reducing stress, each person can attain optimum health and peace of mind.
Ayurveda: What is Your Constitution? http://www.ayurvedacollege.com/book/export/html/2
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More and more, people come up to me on the street and ask me "what is my constitution?" Other times, they ask "what is my dosha?" They mean the same thing. According to Ayurveda, the traditional medicine from India, a person's constitution is the balance of the three doshas (biological forces that govern the body) inherent within an individual. A person's constitution determines what a person is naturally attracted to and what causes a person to become out of balance, sick and diseased. Depending upon a person's constitution, they may thrive as a vegetarian or need meat; they may thrive on spicy foods or get burning indigestion. Our constitution determines how we relate to the environment. The wise individual, with this knowledge, creates an environment that is supportive to who they are as a unique individual. Ayurveda teaches that where there is harmony with our environment there is health, where there is disharmony there is disease. The environment consists of anything we experience through our five senses. So, while many people agree that we are what we eat, Ayurveda takes this a step further and teaches that we are what we eat, smell, touch, hear and see. Thus, a Clinical Ayurvedic Specialist (C.A.S.), trained at the California College of Ayurveda, helps people to understand their constitution and how to create a harmonious environment. There are three basic constitutional types. However, everyone is a unique mix of them. For each type, a different diet is recommended as well as different forms of aroma, color, sound and massage therapies. The three types are called Vata, Pitta and Kapha. People of vata nature have a predominance of the qualities cold, light, dry and mobile. They tend to become cold easily and often prefer to wear a sweater or shawl even when others are not cold. They are usually the last to turn on the air conditioning and first to complain when a room is too cold. They like to sleep with extra blankets. They are often of lower body weight and this is reflected in their long narrow bones. Many fashion models have a vata type of body with long legs, long necks and long tapered fingers. People of vata nature often experience dry skin, dry eyes and a dry colon which causes a tendency toward constipation and gas. Their mobile nature is seen in their fast speech patterns and chatty nature. It can also be seen in their tendency to become scattered and more easily overwhelmed. People of vata nature often have a fragile, nervous disposition. Their challenges often revolve around staying focused. People of pitta nature are most often hot. They are likely to be the first people to want to put on the air conditioner and they are likely to kick off the covers on a warm night. Because they have a greater amount of internal heat, it is not unusual to see them wearing shorts in the cool fall or spring weather while others are wearing a light sweater. Heat often builds up in the intestines and leads to softer and looser stools or diarrhea. Pitta people usually have moderate body builds, not very heavy or very thin with good muscular development. Their skin may be prone to red rashes or acne and is often oily. People of pitta nature often have a clear but sharp way of communicating. Their focused and direct language and actions may irritate other people but they can be counted on to get the job done. They most often have a passionate and intense disposition. Their challenge revolves around a lack of patience for those who are not as focused and directed as they are. People of kapha nature are most often heavy, cool, slow and moist. Because of their heavy nature, they have a stocky body build. This is not to say that people of kapha nature are overweight. No, their natural body type is denser than others. Their bones are shorter and thicker. Often their neck appears to be sitting close to their shoulders and their fingers are short and thick. What really identifies a person of kapha nature is their slower, easy going nature. These people speak and move slowly and are not likely to get upset. They often have a sweet and gentle disposition. Their challenge however revolves around getting motivated and lacking spontaneity. Hence, once a person of kapha nature has made up their mind they http://www.ayurvedacollege.com/book/export/html/2
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are not likely to change it. So, what if a vata person lives with a pitta person? Basically, the pitta person kicks the covers off while the vata person is pulling them on and they may argue over the temperature to set the thermostat. The pitta usually wins as a person of pitta nature has a stronger more dominating personality. There may also be challenges about being on time. People of pitta nature really like to be on time and get irritable when they are late. People of vata nature may want to be on time but because they get distracted just can't seem to make it. If a person of vata nature lives with a person of kapha nature, the person with a kapha nature will usually watch the person of vata nature move around fast in a nervous sort of way and wonder what all the fuss is about. Meanwhile the person of vata nature, who is easily excited, will wonder why their partner is not as excited about life as they are. Neither one of them is likely to fuss about time very much as vata may be late because they get distracted and kapha tends to be late because they move slowly. Both really annoy pitta. If a person of pitta nature lives with an either a person of vata or kapha nature, they are likely to be somewhat critical of their partner for not being more like them. They may try to convince their partner that something is wrong with them and that they know what it is. People of pitta nature are sure they are right. If it seems like no matter what constitution you are you have some physical and personality challenges, it's true. We all do. I've yet to meet the perfectly, enlightened being of perfect health and peace of mind. Ayurveda teaches that we are all growing, learning and evolving, and that by understanding our nature, we can evolve faster and learn to appreciate ourselves and others for each of us is unique. Self love, nonjudgment, compassion and unconditional love are the foundation of all spiritual growth. It's nice to know that each constitutional type has its unique gifts. People of vata nature have the capacity for divine enthusiasm and inspiration. They are often creative and in touch with the subtle world in ways pitta and kapha can only imagine. People of pitta nature have the capacity for clarity of mind that allows them to become great leaders and teachers of humanity. People of kapha nature can be a deep well of love, gentle kindness and nurturance. Indeed, we are all unique, and while there are three basic energies, we are all a unique combination, and no two people have ever been created alike. By understanding our constitution we can choose proper foods to support us and colors, aromas and sounds to surround ourselves with. Ayurveda teaches that each person has the capacity for perfect health and peace of mind. The journey to accomplish this is one that begins with self understanding. With this knowledge and the support of a teacher or practitioner, each person can begin to create a lifestyle that creates harmony within. Health is our natural state and is the end result of living in harmony. Disease is the natural end result of living out of harmony. Ayurveda is the path of reestablishing harmony so that health can reemerge. While people with all kinds of conditions seek and are benefited by ayurvedic health care, it must always be remembered, that it is nature that heals and not the practitioner. It is the Clinical Ayurvedic Specialists job to simply support nature as it works from within the patient. Before deciding what your constitution is and changing your diet or lifestyle, it is always best to consult with an Ayurvedic health professional. A http://www.ayurvedacollege.com/book/export/html/2
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Clinical Ayurvedic Specialist will help you determine what your constitution is, help you understand the nature of any imbalances, and establish a plan to help you get back into balance. Most importantly, a good practitioner will coach you toward success in establishing your new, stress free lifestyle.
Ayurvedic Healing Practices to Help Kids Grow Up Easier Ayurveda Has Helped Kids With Allergies Anemia Anorexia/Bulimia Arthritis Asthma Attention Deficit Disorder ADHD Middle ear dysfunction Balance problems Bipolar disorder Blindness(certain types) Brain damage
Cancer Cerebral Palsy Chronic Fatigue Syndrome Colds Dental problems Depression Developmental delays Diabetes Digestion problems Ear Infections Epilepsy Hyperactivity Hypoglycemia
Influenza Learning difficulties Measles Migraine Headaches Mumps Nausea Nutrition problems Personality disorder Psychotic episodes Short term memory problems Spasticity Stress
Ayurveda Can Help In The Following Areas Spirit: Clarity deepens ones personal connection. Body: Ayurveda supports all body functions. http://www.ayurvedacollege.com/book/export/html/2
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Mind: Ayurveda brings peace and calm to the mind. Emotions: Ayurveda brings emotional balance. Social: Ayurveda supports social skills.
Brief Description Of Ayurveda The traditional medicine of Indiawhich literally translated means “the science or knowledge of life,” can support the healing process from almost any condition or illness. It is often referred to as “the Mother of all healing” and focuses on health, rather than illness. Ayurveda truly treats the whole person. It is based on the idea that each person is unique, each imbalance is unique, and each person’s path toward healing is unique. Therapies utilized include dietary, herbal, aroma, color, sound, massage, meditation, yoga, and lifestyle.
Success With Ayurveda Tom, an eight year old, suffered from frequent urination. With Ayurveda, the frequent urination was resolved in three months. Jackie, a three year old, had recurrent episodes of pneumonia. After six months of Ayurvedic treatment, the frequency of lung infections decreased dramatically. Alice, a four year old, was plagued with eczema on her legs and elbow. Her parents tried many remedies to no avail. After only one month of Ayurveda the condition disappeared.
Ayurveda Is Appropriate For Ages It is appropriate from birth to adulthood. How well the treatment works on which age varies according to the nature and degree of the imbalance. Some treatments work on all ages, including infants, while others require greater active participation, so the http://www.ayurvedacollege.com/book/export/html/2
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child must be older.
Children & Youth’s Reactions To Ayurveda Children usually enjoy the wide variety of therapies employed in their treatment.
Extra Care Is Needed Beyond taking herbal medicines, Ayurveda requires a lot of work on the part of both child and parent.
Contraindications: When Ayurveda Should Be Avoided There are none that apply all of the time. Severe, sudden onset of symptoms and/or severe conditions should be evaluated by a medical doctor. A lack of involvement by the patient or parents makes treatment very difficult. Herbs alone may help, but the whole treatment brings about the best results.
History Ayurveda evolved in India approximately 5,000 years ago. Complete Ayurvedic hospitals and universities exist in India. Although Ayurveda is new to America it has been growing in popularity for about 20 years. Key figures in Ayurveda include Dr. David Frawley, Dr. Vasant Lad, Dr. John Doulliard, and Dr. Deepak Chopra.
Basic Concepts And Components Of Ayurveda Disease is caused by living out of harmony with our environment. Health is the natural result of living in harmony. Healing is the process of returning to harmony. We are all unique (as defined by our constitution) and our path toward healing is also unique. http://www.ayurvedacollege.com/book/export/html/2
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Ultimately, the cause of all disease is forgetting our true nature as spirit. This separation causes us to act only as a body and sense organ. This leads to indulgences, which cause disease.
Description Of A Typical Session On the initial visit, a full and complete history is taken on the physical, emotional, and spiritual states of the individual. Tongue and pulse examinations are performed along with observation of body structure. Time is spent in consultation, examination, and on patient education. In the followup, time is spent checking how the patient is implementing the treatment plan.
Major Differences Of Opinion Between Practitioners Some practitioners may rely entirely on pulse diagnosis while others may rely more on the complete history and examination. Some practitioners may focus only on diet, herbs, and lifestyle while others may include the additional modalities of yoga, meditation, aroma, color, sound, and massage.
Fees/Costs In 2007 Initial visits vary from $75 to $225. Followups are from $75 to $175. Fees vary according to location in the country and experience of practitioner.
Average Time Per Session Session time varies according to training and experience, but the initial visit is generally two hours and follow ups are 45 minutes.
Recommended Length Of Time Between Sessions http://www.ayurvedacollege.com/book/export/html/2
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Recommended time between sessions is one week to four weeks.
Estimated Length Of Time Before Improvements Can Be Expected This varies between four to eight sessions.
Suggestions To Make Ayurveda More Effective The practitioner should have experience working with children. Herbs can be mixed with juice to improve the taste. Parents need to support the plan made by the practitioner. Parents may need to be in an Ayurvedic program as well.
Other Methods That Are Similar To Ayurveda None
Other Methods That Complement Ayurveda Acupuncture Chiropractic
Nature And Length Of Training To Be A Practitioner In the U.S., education varies and includes onsite and home study. Hours of education vary up to 1,700 hours. Independent and home study increase the number of hours significantly. Certification may take up to three years. Training at the California College of Ayurveda includes more than 1,700 hours of total education, including internship. Training covers all aspects of Ayurvedic science. http://www.ayurvedacollege.com/book/export/html/2
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Special Training Needed To Work With Children & Youth None
Certifications/Licenses Held By Practitioners Clinical Ayurvedic Specialists receive stateapproved certification. There is currently no licensing required for Ayurvedic practice.
Professional Associations To Contact For Names Of Local Practitioners National Ayurvedic Medical Association. Website: www.ayurvedanama.org California Association of Ayurvedic Medicine. Website:www.ayurvedacaam.org Please see the website of the California College of Ayurveda for a listing of practitioners. Go to: www.ayurvedacollege.com.
Number Of Certified Practitioners In U.S Approximately 500 in the United States
What To Look For When Choosing The Best Practitioner Check the amount of training. Check the amount of experience. Check references. Check reputation. Evaluate their curiosity about your child or youth. Ask the practitioner about the extent of their training: where and for how long, and how were they tested for competency. Has the practitioner been certified, and by whom? Contact the certifying organization and verify. http://www.ayurvedacollege.com/book/export/html/2
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Leading Clinics, Centers, Practitioners California College of Ayurveda; 1117A East Main Street; Grass Valley, CA 95495; 5302749100; Fax 5302747350; Website: www.ayurvedacollege.com; Email:[email protected]; Founder: Dr. Marc Halpern The Ayurvedic Institute; P.O. Box 23445; Albuquerque, NM 871921445; 5052919698; Fax: (505) 2947572; Website: www.ayurveda.com/index.html.Founder: Dr. Vasant Lad
Resources, Research Papers, Books, DVD’s, Websites There are hundreds in the U.S. and thousands in India, mostly on the pharmacological aspects of the herbs and on the benefits of meditation. Dozens of articles/research papers are available on the website of the California College of Ayurveda: www.ayurvedacollege.com.
Bibliography Atreya, David Frawley. Practical Ayurveda: Secrets for Physical, Sexual & Spiritual Health. ME: Weiser Books, 1998. Frawley, David, M.D. Ayurveda and the Mind: The Healing of Consciousness. WI: Lotus Press, 1997. Frawley, David, M.D. Yoga & Ayurveda: SelfHealing and SelfRealization. WI: Lotus Press, 1999.
Helpful Tips For Parents To improve digestion, make sure the child eats in a quiet, peaceful environment without the distractions of television, reading, or excessive talking. To improve digestion and many other conditions, avoid feeding children all junk foods including white sugar, canned foods, old foods, and fast foods. To calm children’s minds, spend more time with them in nature. To help heal children of many conditions, parents need to cultivate greater faith, compassion, and unconditional love, and then bring this into their relationship with the child. http://www.ayurvedacollege.com/book/export/html/2
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Biography Of Dr. Marc Halpern, DC, CAS, Author Years Experience: Fifteen Approximate number of children & youth patients: 200 in Ayurveda, 500 in Chiropractic Degrees: Doctor of Chiropractic through Palmer West Chiropractic College Post Graduate Certification in Holistic Health Care through New York Chiropractic College Ayurveda Certification through the American Institute of Vedic Studies
Statement By Dr. Marc Halpern, DC, CAS I became interested in Ayurveda and meditation in an effort to heal myself of a lifethreatening and debilitating disease. In 1987, I was crippled with severe arthritis, anemia, and liver dysfunction. Utilizing Ayurveda, meditation, and other methods of alternative medicine, I was able to heal myself. My work today is the result of that journey. Today, I teach Ayurvedic seminars around the world, and am the President of the California College of Ayurveda. I am on the founding board of the National Ayurvedic Medical Association and California Association of Ayurvedic Marie Mulligan’s Comment About Ayurveda: My family has benefited from Ayurveda. I have referred patients to Ayurveda providers and most have done well. Unlike Chinese Medicine there is no licensing for Ayurveda practitioners at the state or national levels at this point. Make sure you carefully choose practitioners. Rick Geggie’s Comment About Ayurveda: Any healing system that is as old as Ayurveda must work well. How both the complexity and the simplicity of it work so well to help children fascinate me. Children find Ayurvedic practices calming so they tend to like going to Ayurveda practitioners. Over the years I noticed that children from families following an Ayurvedic lifestyle did very well in living and learning. Picking an experienced practitioner is important. Dr. Halpern’s contribution to this outstanding book for parents at Growing up easier
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Ayurvedic Questionaire While it is always most accurate to be fully evaluated by a trained Ayurvedic practitioner filling out the following questionnaire can give you insight into the balances of energies unique to your body. As you fill out the following questionnaire, give yourself two points if a statement is clearly true for you. Give yourself one point is it is somewhat true. Give yourself no points if it is clearly not true. Add up the total number of points for Vata, Pitta, and Kapha. This will give you the relative dominance of each of the forces in your constitution. You may not necessarily be dominant in one type but may be a unique blend of the three. Vata Questions 1. I am thin and my body build is "slight." 2. I have a difficult time gaining weight or I am like a yoyo going up and down. 3. My skin tends to be dry. 4. I feel cold often compared to others and I do not sweat very easily. 5. My complexion is dull gray or dusty. 6. When my digestion is not normal I tend toward constipation. 7. The shape of my face and jaw line is long and narrow. 8. When I am healthy I have a lot of energy and enthusiasm but focusing can be difficult. 9. I am prone to feeling nervous or anxious. 10. I tend to be a light sleeper and often suffer from insomnia. Pitta Questions 1. I am of moderate weight and my build is moderate with good muscle tone. 2. My weight is steady and fluctuations are small. 3. My skin tends to be oily. 4. I often feel warm and sweat easily. 5. My complexion is rosy. 6. My digestion is not normal I tend toward diarrhea or burning digestion. 7. The shape of my face and jaw like is angular. 8. When I am healthy I have a lot of energy and I am very focused. 9. I am prone to feeling irritated, angry and resentful. 10. I sleep well and wake up easily. I may be awoken by dreams. http://www.ayurvedacollege.com/book/export/html/2
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Kapha Questions 1. I am of "stocky" body build and I often carry some extra weight. 2. It is difficult to lose weight. 3. My skin tends to be oily. 4. I often feel cold and sweat easily. 5. My complexion is pale. 6. My digestion is generally good though I may occasionally have some constipation. 7. The shape of my face is round. 8. When healthy I move slowly and have a lot of endurance. 9. I am prone to feeling lethargic and depressed. 10. I sleep deeply and sometimes have a difficult time waking up.
Getting Results Through Ayurveda Ayurveda, the traditional healing system of India is more than a path toward optimal health and healing. It is a path toward harmony, peace of mind and enlightenment. Ayurveda merges the physical art of healing with the spirituality inherent in Yoga. In this union, Ayurveda offers healing for the body, mind and spirit. Ayurveda is a theoretical path which, when properly applied, promises perfect health and enlightenment. In order to be valuable to the general population, it must also be practical. Healing through Ayurveda involves more than simply taking herbs and watching one’s diet. It involves transforming ones lifestyle so that it is in harmony with their environment. This equates to how one uses their 5 senses to take in the environment. Through the proper use of aromas, colors, sounds, taste and touch. Ayurvedic practice creates an optimum environment within the body for healing to take place and for optimal health to emerge. Transformation of our habits is rarely an easy task. Motivated by desperation, changes can sometimes come easily. However, lacking a crisis, the motivation for personal change wanes. Often times, a person chooses to put up the chronic, mildtomoderate discomfort rather than make the changes they know would be beneficial. At the California College of Ayurveda we teach our practitioners how to help their clients get the results they desire. A person must make communication to successfully implement program of care their practitioner recommends. Our graduates take the following to maximize client success: Step One: Be Focused: The practitioner and the client choose one task to focus on such as implementing the proper diet for the clients constitution. Step Two: Spiritual Counseling: An Ayurvedic practitioner helps the client succeed. Each week or two the practitioner and the client have a follow http://www.ayurvedacollege.com/book/export/html/2
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up visit to see how the client is doing, implementing the assigned program of care. Step Three: Adding more tasks: Only when the client is successful should the practitioner assign more tasks to accomplish. Step Four: Accountability: In the case that the client has not implemented change or task, the practitioner and the client must explore what got in the way of success. This process takes a client closer to the core of what is obstructing their well being. During this stage, the practitioner uses their creativity, counseling and coaching to address core concerns. With a refreshed approach, the assignments might be reduced or different assignments recommended. Through focus, accountability, and coaching, clients gradually become successful transforming their lives into a lifestyle based in harmony. The belief of Ayurveda is that where there is harmony there is health and where there is disharmony is disease. A disharmonious life always leads to physical or mental disturbance. Symptoms are simply the body’s voice communicating disharmony. Hence, without the creation of harmony, there can be no complete and total healing.
Health at Every Age All of life flows like the seasons, a perpetual cycle where what is normal (healthy) today flows into what is normal (healthy) for tomorrow. Health is not a static way of being but a dynamic flowing expression of optimal well being. Early in our life, from birth to puberty, our bodies are growing rapidly. Our physiology is designed for helping us to achieve a full grown, strong body. During this first phase of life, Ayurveda defines health as the formation of healthy tissues in the body. During this period the body needs foods that are deeply nourishing. These foods are heavy and contain an abundance of the earth element. Foods such as milk, nuts and grains are very important. These foods support the building of bodily tissue. Too much of these foods however leads to building too much tissue. These children become overweight. Hence, it is important that children learn not to overindulge. Rarely however, do high quality heavy foods cause children to become overweight. Rather, it is the heavy junk foods that are primarily responsible. Ice cream, candy other sweets, while rich in earth element are the culprits of weight gain. The earth element builds tissue. During childhood, it is important to choose healthy forms of the earth element to bring into body. Ayurveda describes the second phase of life as the time of action and service. It is during this phase of life we begin to contribute to society. Having been properly nourished as a child, the body and mind are now capable of optimally performing. During this phase of life when the body stops growing until retirement (physiologically between age 50 ñ 70) health is defined as the capacity to perform service without obstruction. Hence, a healthy individual is not impaired. These people are able to fully express themselves without the limitations of a physical or psychological challenge. In order to be healthy at this age, a strong desire to be of service is important. In this way, a person is flowing with the rhythms of nature. In order to sustain the body, it is important to recognize that the body needs less food. As the body's tissues are no longer growing, less nourishment is required. During this phase of life, it is very important to take smaller portions during meals. A failure to do so will result in middle age weight gain. Since most people do find themselves overeating during this stage, it is important to take in a greater amount of lighter but healthy foods. http://www.ayurvedacollege.com/book/export/html/2
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During this phase of life, the proportion of vegetables and fruits in the diet should increase. The third and final phase of life is the time of reflection. During this phase of life, we have the opportunity to reflect on the life we have lived and what we have learned. If we are so fortunate, we will have the opportunity to share what we have learned with others playing the role of the elder teacher. Absent that opportunity, a person may spend time in meditation, contemplation and perform volunteer work assisting those who are still in their second phase of life. Grandparents may also help with the grandchildren freeing up the parents to perform other duties. Health in this phase of life is defined as having the capacity to reflect. During this phase of life, the body tissues are beginning to break down. This is natural. This is also a time of preparation for the final transition. To extend life, it is important to take in nourishing tissue supporting foods rich in the earth element. This is not for the purpose of growing new tissue but rather for sustaining what is already there and slowing down the aging process. It is natural for the appetite to dwindle during this phase. Hence, it is important to eat small amounts three to five times per day. Eating too much will result in weight gain and its associated health challenges. Eating too little will result in weight loss and quicken the deterioration and ultimate demise of the body. According to Ayurveda, during the first phase of life we are most prone to mucousy conditions caused by taking in too many rich and junk foods. During the second phase of life we are most prone to the diseases of stress as we work hard to accomplish our goals. During the third phase of life, we are most prone to diseases of deterioration. These are hastened by living out of harmony during one's life. The first phase of life is a time of learning. This is the ideal activity for children and society is generally in rhythm with this aspect of nature. This is not however the ideal time to push children too hard or too fast into service. Simply put, children should not work for money but rather for experience. It is best if the motivation to work comes from a desire to serve rather than to be rewarded. The child who is raised in harmony with nature's rhythm is best prepared to enter life's second phase. The second phase of life is a time of service. This is the time when the young adult chooses a career. The well prepared child grows up healthy and energetic with a desire to be of service. Healthy young adults are motivated to express themselves in the world and in doing so contribute to the lives of others. The healthy young adult is ready and willing to work hard. Some young adults are not yet ready. Some still require further preparation. By delaying entering into the workforce (service force), the young adult is attempting to stay in the first phase a life, a comfortable phase where they are taken care of. From an Ayurvedic perspective, this is symptomatic of an imbalance and is neither ideal nor healthy. However, the child who has not been properly prepared during the first phase benefits more from continued preparation than from entering into the work force when they are not ready. The third phase of life is a time of reflection. If an elder is forced to work into their later years the consequence will be additional suffering. Working hard after the age of 65 is out of rhythm of nature. The time of reflection is delayed and there may be little time to teach and share what one has learned. A body that works hard into the later years will deteriorate faster. It is time for society to support our elders and provide for them at least the basic necessities to allow for reflection and sharing. In return, our elders become our teachers. Ayurveda is a science of understanding nature's laws. They are not negotiable. If we live in harmony with nature, we reap the benefits of good health. If we do not, we suffer. The season of our life is just one of nature's laws. Those who live a life in rhythm with nature age gracefully, remain well, and have great peace of mind. Knowledge of nature's rhythms can help guide each of us to find satisfaction and health at every age. http://www.ayurvedacollege.com/book/export/html/2
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Health, Harmony and Peace of Mind Through Ayurveda The journey toward perfect health and the journey toward enlightenment are in many ways parallel paths. As we grow and evolve as spirits, we learn to live in evergreater harmony with our environment. Harmony brings peace of mind and, according to Ayurveda, perfect health. The term for perfect health in Ayurveda is Svastha. Literally translated Svastha means "to be fully established in the Self". Hence, when we are fully established in knowing our true nature as God, we express our full potential. This represents optimal health for that person. Ayurveda is a journey to perfect health, peace of mind and, ultimately, to enlightenment. By the very laws of Sankhya philosophy, human incarnation is disharmonious. Once incarnated, humanity forgets its true nature as spirit and lives as a physical being guided by the senses. This journey is one of the pursuit of pleasure and the avoidance of pain and suffering. This simplistic and, as some writers have stated, animalistic existence brings about both physical and emotional pain and suffering. The process of healing is the process of remembering. When a person remembers their true nature as spirit, they become empowered to master the senses and make choices that bring harmony, not pleasure. The fruit of this action is peace of mind and wellbeing. When we live out of harmony we suffer. In the physical body suffering takes the form of pain and symptoms of disease. Ayurveda understands that these symptoms are simply the body’s voice communicating that we are living out of harmony. When we change our life and recreate a life of greater harmony, our bodies reflect this change. There is less suffering. The greater the change toward harmony, the more radiant the body becomes. The mind is no different. It is subtler, but the same laws apply. Symptoms of a diseased mind include unhappiness, depression, sadness, anxiety, anger and any other emotion other than peace of mind. These symptoms are also communicating that we are living out of harmony, that some aspect of our life is disharmonious. Healing is the process of returning to harmony. Once back in harmony the body and the mind have no reason to communicate symptoms. The body becomes at ease; the mind becomes at peace. In this state, awareness reawakens to its true nature as spirit. Selfrealization has occurred and the individual soul continues its advance toward enlightenment. When Selfrealization occurs twenty four hours a day, seven days a week, the door opens to becoming a Jivan Mukta; a liberated soul, and enlightenment ensues. Ayurveda teaches us that we are all unique individuals. We were conceived with a unique constitution or fundamental balance of energies that define who we are on the physical level. It defines what we are naturally attracted to and what causes us to move out of balance and experience disease. Depending on our constitution, we thrive in a particular environment. We take our environment in through the senses, which are the portals to our body and consciousness. The energies we take in either blend with us or disrupt our harmony. Proper diet (taste), aromas (smell), sounds (hearing), colors (vision), and touch are essential to maintaining internal equilibrium. When harmonious impressions are taken in, the body is healthy and the mind peaceful. When disharmonious impressions are taken in, the body and mind suffer. Hence, Ayurveda focuses on helping individuals understand themselves as unique beings. With that understanding, a person can become empowered to make choices that are in http://www.ayurvedacollege.com/book/export/html/2
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harmony with who they are. Ayurveda teaches us that nothing is right for everyone but everything is right for someone. Ayurveda is the path of understanding what is right for you. Ayurveda also teaches us that it is not only the intake of sensory impressions that determines our wellbeing it is our lifestyle as a whole. Proper daily regimens are essential: A regular schedule that includes meditation, yoga practices, abhyanga (morning application of body oil), proper eating habits and proper hygiene brings about good health and peace of mind. When combined with proper intake of sensory impressions, the depth of the peace and wellbeing we experience is infinite. The Three Constitutional Types and Their Path Toward Health, Harmony and Peace of Mind Vata Individuals The constitution of vata individuals contains a great deal of air and ether, which means they tend toward the qualities of coldness, lightness, dryness and instability. These qualities may be experienced as feeling cold easily, having a thin body structure, dry skin, a tendency to move quickly, difficulty staying focused and frequent changes of interests. These individuals have a lot of interests and often drift from teacher to teacher, job to job, and relationship to relationship. It is important for people with this constitution to follow a lifestyle that emphasizes opposite qualities. Warm or cooked heavy foods provide nurturing and grounding. Oil in the food and applied to the body alleviates dryness. Regular routines and disciplines create stability and improve focus. Pitta Individuals The constitution of pitta individuals contains a great deal of fire and a small amount of water. These people tend to feel hot, have oily skin and a moderate body build. They tend to be focused, goal oriented individuals with a competitive and intense nature. Pitta individuals tend to complete what they begin before moving on to the next goal. They enjoy the satisfaction of completion but experience emotional and physical turmoil when failing or losing. People of pitta nature are balanced by a lifestyle that emphasizes cool and dry impressions through the senses as well as greater spontaneity and playfulness. For example, raw salads and foods that are not too spicy are best. These individuals find it easy to adopt routines, but more playfulness and less seriousness is needed to bring balance Kapha Individuals The constitution of kapha individuals contains great amounts of earth and water. These people tend toward the qualities of heaviness, coldness, oiliness and stability. They tend to move slowly, act slowly and stick with the routines they develop. Their challenge can be in adopting new routines, as change is difficult. These individuals also have a tendency toward becoming overweight and lethargic. http://www.ayurvedacollege.com/book/export/html/2
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People of kapha nature require the qualities of lightness, dryness and warmth to bring them balance. Light, spicy cooked foods are best. Oils are to be avoided. A routine emphasizing spontaneity and movement is essential. Creating a lifestyle in harmony with our constitution is not easy but it is the most important thing in life. The difficulty associated with the task causes many seekers of good health and peace of mind to give up. But why? Do we expect peace of mind, perfect health and enlightenment to be easy? If it were easy we would all have it and then why would we be here? Sankhya philosophy teaches us that we are only here to experience creation and relearn about ourselves as spirit. The journey of our learning is the journey of the soul finding its way back to God. If we knew everything, what would there be to experience and learn? Each of us must simply do our best and realize that growing toward perfect health and enlightenment takes time. With this attitude, wherever we are on the journey is perfect. We can love ourselves in spite of our perceived imperfections. With selflove comes patience. Patience is a peaceful tool to carry on the journey toward both perfect health and enlightenment. Hari Om Tat Sat
Panchakarma: The Ayurvedic Science of Detoxification and Rejuvenation Ayurveda, which literally means "the knowledge of life," is the traditional healing science of India. Viewing disease as the natural end result of living out of harmony with our environment, Ayurveda emphasizes reestablishing harmony and balance as the means of recreating a state of optimal health in our bodies and minds. While Ayurvedic methods utilize many therapies including herbs, diet, aromatherapy, color therapy, mantras, yoga, meditation and general lifestyle counseling, the most profound of all treatments is that of Pancha Karma. Pancha Karma is the traditional form of detoxification of the body and mind that facilitates rejuvenation. It has been utilized for thousands of years as a method of staying healthy, young and vital. According to Dr. Marc Halpern, the Founder and Director of the California College of Ayurveda, "Panchakarma is the single most powerful tool we use in Ayurveda for purifying the body and rebuilding its internal strength. It is an essential part of the treatment for any chronic disease, both physical and mental." Pancha Karma is unlike any other detoxification program because it is fundamentally designed to remove a different form of toxin. While many toxins exist in our environment which accumulate and harm our bodies, Ayurvedic Pancha Karma addresses a special toxin called ama which is formed within our own bodies. Ama is the byproduct of inadequate digestion. It has the qualities of stickiness and heaviness. In our bodies it clogs our systems and damages our tissues. It is among the most damaging of forces in our bodies and contributes to disease. http://www.ayurvedacollege.com/book/export/html/2
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Here is an analogy to help you understand how ama is formed. Imagine that there is a fire inside your stomach. Think of a campfire. If the fire is weak, it cannot burn up the wood put on it. Instead, the wood smolders and begins to smoke. In the end, charred bits are left and the wood is not efficiently turned into ash. Poor digestive fire, or digestive strength, leads to food being improperly digested. This results in gas, bloating, burning indigestion, or constipation. In addition, a residue of this poorly digested food accumulates in your digestive tract and overflows into your bodily systems. This residue is called ama. Ayurveda links the occurrence of ama in the body and a weak digestive system to the cause of such chronic conditions such as candida, chronic fatigue syndrome, migraine headaches, chronic respiratory disease and many other conditions. The process of Pancha Karma removes ama and clears the way for the body to reestablish an internal state of balance and harmony. Ama may be present in the body if there is a coating on the tongue. A normal tongue appears pink throughout, but as ama accumulates in the digestive system, the tongue may appear with a white, yellow, green or gray film over it. In addition, in some cases the body and breath develop a strong odor and the stool becomes dense and sinks to the bottom of the toilet. (According to Ayurveda, the normal stool should float). If you have any of these signs, panchakarma treatment may be indicated. In addition, Panchakarma has a profound effect on stabilzing the mind and emotions, restoring mental calm, helping to clear out and overcome deep seated unresolved emotion. This paves the way for becomming reunited with the pure essence of Being and union with the Divine. The Process of Pancha Karma Pancha Karma therapy begins with proper preparation. This includes several days or weeks of a special diet and herbs which begin the process of loosening up the ama and bringing it back to the digestive system for elimination. While the person is eating special foods and taking special herbs, oil and heat therapies are applied. These include the deeply relaxing therapies of Shirodhara, Ayurvedic massage, and Swedana. Shirodhara is a unique therapy where the client lies down upon a massage table with their eyes covered. Then, a specially prepared warm herbal oil is poured in a thin steady stream through a spicket directly onto the forehead and sixth chakra. This blissful therapy purifies the mind, alleviates anxiety, reduces headaches and expands awareness. Shirodhara can be administered by itself or as part of a Pancha Karma regime. During Ayurvedic massage two practitioners perform a choreographed hand dance upon the body. Using oils blended with special herbs, this form of massage specifically loosens up the ama stored in the tissues so that it can move back to the digestive system. Not only is it cleansing, but it is deeply relaxing. Ayurvedic massage can be administered by itself or as a part of Pancha Karma. Swedana is a fullbody steam therapy. Special herbs are fused into the steam and together the heat and herbs dilate the channel systems of the body allowing the stored ama to move back into the digestive system. http://www.ayurvedacollege.com/book/export/html/2
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Once all of the ama is back in the digestive system, the next phase is to eliminate it from the body. This is achieved by the administration of a purgative to cleanse the small intestine and herbal enemas to cleanse the colon. A special form of cleansing is applied to the sinuses called nasya. Following the application of oil and heat over the sinuses, the herbal oils are administered directly into the nasal passages. This procedure not only eliminates ama but is helpful in the treatment of chronic allergic sinusitis and sinus headaches. Rejuvenation With the body clear of toxins and ama, it is much like a clean slate. Now the internal energy of the body can be rebuilt. The rebuilding process strengthens the digestive system and the immune system and entails taking additional special foods and herbs. These herbs are designed to enhance the strength of immune system and are revered for extending life. The end result of Pancha Karma is an optimally functioning digestive system and renewed internal energy. After receiving Pancha Karma the mind is light and clear, the body is pure and the energy is high. For many it is a lifechanging experience. Dr. David Frawley, renowned Vedic scholar says in his book, Ayurveda and the Mind, "Pancha Karma is the main Ayurvedic method for physical purification. It is useful for physical problems caused by excesses of the three doshas. Yet it can also be helpful for psychological problems caused by internal factors, emotions and karma.” Pancha Karma is traditionally used in the healing of many diseases. It is an intensive therapy best performed at a time when the patient has adequate time to rest. Brief Pancha Karma programs last 7 days. This is followed by a period of rejuvenation which can be done at home. Extensive programs can be designed for up to one month.
Preventive Medicine, Stress and Ayurveda In this age of modern medicine, preventive medicine has become a wellrespected concept. Over the last 20 years, the general public and the allopathic establishment have evolved to a place of recognizing the importance of prevention. Prior to the mid 1970's, the term, "preventive medicine" was rarely heard in traditional circles. The concept was relegated to a small subculture of freethinking individuals who were into "organic living.” Eventually the wisdom of this simple philosophy could not be denied. Quickly interest grew and preventive medicine entered the mainstream. More and more articles appeared in magazines such as Time , Prevention, and Newsweek, and numerous bestselling books appeared on the market, each claiming to keep an individual eternally healthy through proper health practices, including diet, vitamins, and other substances like apple cider vinegar. One of the pioneers in preventive medicine was a medical researcher named Hans Selye, who rocked the traditional medical establishment with his book, The Stress of Life. Published in the 1950's, this book by Selye charted the body’s reactions to stress and was able to produce a model for stress as an important, overlooked cause of disease. His research was well documented and established that stress fatigues the body’s physiological http://www.ayurvedacollege.com/book/export/html/2
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homeostatic mechanisms causing the body to malfunction and create disease. He implicated arthritis, cancer and connective tissue disorders (i.e. fibromyalgia, Lupus, etc.) as stress responses by the body. This naturally challenged the medical approach of looking for pathogenic organisms as the cause and drug treatment as the cure. Mr. Selye did not suggest treatmenthe simply addressed the effect of stress. Since then, many ideas have emerged on how to keep the damaging effects of stress from affecting our lives. Preventive medicine implies doing something to prevent disease and has taken four different and distinct directions. First, early detection has been well promoted by the mainstream medical community. Women are recommended to have routine mammograms, and both men and women are recommended to have periodic colonoscopies as a means of detecting early cancers. While this does not really prevent disease, it does lead to early detection, and thus to better treatment results. The second concept involves preventing the effects of stress from harming us. This has led to the use of a wide assortment of nutritional products, including stress vitamins (mostly Bvitamins), antioxidants (which decrease cellular destruction and aging), micro nutrient support (kelp, Blue Green Algae) and other nutrient support. This approach has created a new multibilliondollar industry intent upon selling the public the idea that the only way to stay healthy is to take these products. There is merit to this approach and certainly, to some degree, these products do work; but their effectiveness is limited. The third method involves purifying our bodies as a way of keeping environmental poisons (pesticides, heavy metals, industrial chemicals, hormones, etc.) from harming us. This has led to the expansion of the organic health food and water purification industries. In addition, many new products are on the market to help us remove toxins from our bodies. Most of these are herbal alteratives (blood and liver purifiers) and purgatives or laxatives to cleanse the colon. Pancha Karma, the Ayurvedic science of purification also addresses these toxins, as well as toxins created internally through the poor digestion of food. The fourth method, although probably the least favorite of society as a whole, is perhaps the most important of all. It involves looking at our lifestyle and recognizing how our choices about how we live and act are producing stress, which is slowly killing us. This subject takes the discussion away from how to manage stress and enters into the subject of how to prevent it. Of course, some stress is a part of being alive. As Hans Selye points out, without it our bodies could not grow stronger. Stress challenges our bodies. If we rise to the challenge, we usually become stronger as a result. So, while it may not be practical to remove all stress from our lives, much of it is selfgenerated and therefore unnecessary. It is on this subject that Ayurveda speaks most directly. Ayurveda is the science of producing harmony in our lives. In Ayurveda we say that where there is harmony, there is health; where there is disharmony, there is disease. The term harmony in this context means creating a harmonious relationship with our environment through our five senses. Exposing ourselves to harmonious tastes (foods and herbs), sights (colors and beauty), smells (aromatherapy), sounds (music and mantra), and touch (massage and oils) creates a state of harmony within our bodies. This state of harmony prevents disease. Ayurveda looks at the growth of disease as one would look at the growth of a tree. With no disrespect to our tree friends, this is just an analogy. There is a seed which sprouts and develops roots. The stalk grows and the trunk thickens. Branches spread and leaves grow. Most of what we call disease or symptoms are the leaves. They are distant from their origin or roots. Most treatments for disease, allopathic or herbal, are like trimming back the leaves. Some go deeper to the branches, and some cut down the tree all together. But what about the roots? With its roots intact, a hearty, http://www.ayurvedacollege.com/book/export/html/2
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persistent tree grows back, and the weary gardener has to keep pruning and pruning. The seed, or root of all disease, from an Ayurvedic perspective, is the disharmony of our actions. Eating improper foods, listening to disharmonious music, etc. can produce direct physical stress. A weakened body cannot tolerate continued stress and crumbles into the darkness of disease. Not only does Ayurveda discuss physical stressors, but also those of the more subtle emotions. Mental disease can also be looked at as the same tree. The leaves far distant from the roots are serious diseases such as psychosis and schizophrenia. The closer branches are the milder conditions like panic anxiety, and the still closer conditions of the trunk, mild diseases like anger, worry, grief and attachment. At the root, Ayurveda sees a person as having forgotten their own true nature as spirit or as the part of themselves connected to God. Ayurveda sees God as that which connects us all together. When we forget, as we so often do, we act as if we are separate from one another. This sense of separation is at the root of emotional challenges. Understanding this, Ayurveda utilizes meditation and yoga as a path to quiet our inner chatter and dialogue. In the stillness created, a person perceives the truth of their existence and all emotions are transcended. In comparison to the truth, we could say our emotions seem insignificant and our attachment to them rather humorous. In the area of disease prevention, Ayurveda teaches us that through a healthy lifestyle that is individually designed to be harmonious with our own unique nature (our constitution), and the practices of meditation and yoga, a person can reach their potential physically, emotionally and spiritually. In this state, disease does not exist. It serves no purpose. For what is disease, really? It is our body communicating disharmony. Remove the disharmony and you remove the disease. Preventive medicine is an exciting step forward on our journey to live without disease. As the journey continues to unfold, we will find that it parallels our journey to enlightenment or the perfecting of our nature. Early detection of disease, reducing the effects of stress, and purifying our bodies are important steps on our journey toward keeping ourselves healthy. Our lifestyle choices reflect our deepest natures, and as we change, so does our health. Namaste.
Principles & Practices of Ayurveda Introduction Ayurveda, which literally translated means "the science or knowledge of life" is the traditional medical system of India. Its origin dates back an estimated 510,000 years, and it is widely considered to be the oldest form of health care in the world. It is understood by most scholars that, as knowledge of Ayurveda spread out from India, it influenced the ancient Chinese system of medicine, Unani medicine, and the humoral medicine practiced by Hippocrates in Greece. For this reason, Ayurveda is often referred to as the "Mother of all healing." The knowledge of Ayurveda has its written origins in the Vedas, the sacred texts of India, believed to be the oldest writings in the world. Written in Sanskrit, the Vedas cover a vast number of subjects from grammar to health care. The Vedas were written approximately 2500BC or earlier. Current knowledge about Ayurveda is mostly drawn from relatively later writings, primarily the Caraka Samhita (approximately 1500BC), the http://www.ayurvedacollege.com/book/export/html/2
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Ashtang Hrdyam (approximately 500 AD), and the Sushrut Samhita (300 400AD). These three classics describe the basic principles and theories from which Ayurveda has evolved. They also contain vast clinical information on the management of a multitude of diseases. Later writings and research expand on this early clinical information. Ayurveda is based on the premise that disease is the natural end result of living out of harmony with our environment. Natural is an important word because Ayurveda understands that symptoms of disease are the body's normal way of communicating disharmony. With this understanding of disease, Ayurveda's approach to healing becomes obvious: to reestablish harmony between self and environment. Once reestablished, the need for the body to communicate disharmony diminishes, symptoms dissipate, and healing is said to have occurred. Ayurveda understands each person and the disease the person is manifesting as a unique entity. It could be said that no two people are alike, and no two diseases are alike. Therefore, Ayurveda does not approach the cure of a disease as much as it approaches the cure of a person. This approach vastly differs from allopathic medicine. Where allopathic medicine looks for a drug that will cure a statistically significant number of people for a specific condition, such as rheumatoid arthritis, Ayurvedic medicine looks for a treatment that will cure an individual person of their unique presentation of the disease. Since no disease affects two people in exactly the same way, no two cures are exactly the same. Principles For the Ayurvedic practitioner, it is necessary to understand the nature of the patient, the nature of the disease, and the nature of the remedy. Only then will a physician be able to provide the greatest care. The qualities of Nature are said to be either heavy or light, cold or hot, stable or mobile, sharp or dull, moist or dry, subtle or gross, dense or flowing, soft or hard, smooth or rough and cloudy or clear. A person, a disease or a remedy is understood to have a unique combination of these qualities. It is the goal of the Ayurvedic practitioner to understand as many of the qualities as they can about their patient and their patient's condition. A person may be heavy or light, move quickly or slowly, feel more warm or cool, have a sharp or dull mind, have moist or dry skin. These are examples of understanding the nature of a person.Similarly, a disease like arthritis may be defined as producing sharp or dull pain, migrating (mobile) or localized to one or more joints (stable), producing vasodilatation around the joint (warm), or vascular constriction (cool). By understanding the presentation of a disease through its qualities, the uniqueness of a disease is understood. Herbal remedies are also understood in terms of their qualities. Substances that are nourishing are described as being heavy, such as licorice. Substances that are depleting are light, such as red clover. Some herbs create warmth in the body, such as ginger, and others cool the body, such as goldenseal. The fundamental principle of treatment in Ayurveda is to treat the disease with the qualities opposite to its nature. Cold diseases are treated with warm remedies, heavy diseases are treated with light remedies, and so on. Ayurveda describes the human being as being composed of five elements, three doshas (biological energies), seven dhatus (tissues), and numerous srotas (channels). The five elements are ether, air, fire, water, and earth. These five elements, which also make up all of Nature, are not meant to be taken literally. They are ideas described as elements. They are the ideas of space, motion, heat, flow, and solidity respectively. They have the qualities as noted above. The three doshas, the biological forces that govern the functions of the body, are composed of these elements. http://www.ayurvedacollege.com/book/export/html/2
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Vata dosha is a biological force which governs all motion in the body. Composed of ether and air, it is light, dry, mobile, and cool. People with a predominance of this energy in their bodies tend to exhibit these characteristics. They tend to be thin, have dry skin, feel cold easily, and move and speak quickly. They also tend to have a greater amount of cold emotion, such as anxiety and fear. Vata dosha imbalance can affect any system of the body and cause an increase in those qualities. For instance, the respiratory system becomes dry as seen in dry asthma and nonproductive coughs. The digestive system becomes dry and constipated, an abnormality of motion. Dryness may precipitate stone formation in the kidneys or gall bladder, and an increase in the motile quality of vata in the nervous system is understood to cause hyperexcitability. The cold nature of vata can become severely disturbed and cause Raynaud's syndrome. Wasting conditions are viewed as an increase in the light quality of vata. Therefore, anywhere in the body where there is an increase in the qualities of vata, there will be physiological disturbance. Pitta dosha is a force which govern all digestion in the body. Composed primarily of fire, it is hot, light, exhibits flow, and is sharp. It contains a little water, and thus it is neither very moist or dry. People with a predominance of pitta in their bodies exhibit these qualities. They feel warm and are less affected by cold weather. They have a rosy complexion, are moderate and reasonably steady in their weight, have a mesomorphic body build, and can have a sharp and intense personality. This personality tends to be challenged by a greater amount of heated emotion such as anger, resentment, and jealousy. As pitta governs digestion, the digestive system tends to be strong. There is little trouble digesting food. Bowel movements occur frequently, 23X per day. Pitta dosha imbalance can affect any system in the body but is predisposed to affect systems that are said to contain a lot of fire. When pitta affects a system, usually greater heat builds at that location. The liver, small intestine, blood, skin, and eyes are systems in which pitta exerts a great influence. Hepatitis, hyperacidity, acne and conjunctivitis are examples of heated pitta conditions in these regions of the body. Pitta disturbance can affect any system. Infections anywhere in the body producing heat and fever are understood as pitta disturbances. Kapha dosha is a biological force which governs growth in the body. Composed of water and earth, it is heavy, moist, stable, soft, and dull. People with a predominance of kapha in their bodies tend to carry more weight, have thicker, denser bones and skin, and have a more traditional endomorphic body build. They also tend to have moist supple skin and full, thick hair. This person's personality tends toward being relaxed and not easily disturbed. They talk and move slowly. They can be challenged by heavy feelings, such as lethargy and rigidity. When kapha increases in the body, there is a greater production of mucous which, like kapha, is heavy, thick, and moist. There may also be swelling and weight gain. While kapha can affect any system of the body, the stomach and lungs are the most susceptible. It is here that we see several common signs of kapha disturbancenausea, limited appetite and mucous formation. Conditions such as obesity, some cancers, chronic bronchitis, lung congestion, and fluid retention syndromes have a kapha disturbance as a component of the pathophysiology. While the doshas are seen as the causative agents of disease, dhatus, upadhatus, and srotas are understood to be the site of the disease. Dhatus are tissues, upadhatus are additional tissues, and srotas are channel systems. There are seven tissues; plasma, blood, muscle, fat, bone, marrow, and reproductive tissue. Unlike Western medicine, which understands each tissue to be separate, Ayurveda understands each to be dependent upon the tissues preceding it for its nourishment and health. Hence, a problem which develops in one tissue, if not corrected, will eventually have systemic consequences. Pathology in Ayurveda can be partially understood in terms of what dosha is affecting what dhatu. When vata enters a dhatu, that dhatu becomes lighter, drier, and hypermobile. When pitta enters, it becomes heated, and when kapha enters, it becomes heavier, moister, and more stable. In a muscle, vata disturbance causes wasting and atrophy, pitta disturbance causes infection and inflammation, and kapha disturbance causes excessive growth. http://www.ayurvedacollege.com/book/export/html/2
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Srotas are channel systems similar to the organ systems of the human body. The major srotas are somewhat equivalent to the respiratory system, digestive system, reproductive system, cardiovascular system, urinary system, and water metabolism system. These are additional sites of disease where doshas may become aggravated. During the metabolic processes of the body, Ayurveda recognizes that metabolic waste is produced and must be properly eliminated to maintain optimal health. Waste materials are called malas. Obstruction to their removal is another causative factor in disease. According to Ayurveda, each person has a constitution that was determined at conception. This constitution is the inherent balance of these three doshas. The constitution determines a person's basic body type and personality. While other factors influence the formation of both the body and personality, the constitution provides the predisposition in much the same way as a person's genetics. It is a common misconception that Ayurveda groups people according to three types. In actuality, there are infinite combinations and permutations of these three basic energies in each person. Therefore, we see that each person is understood to be unique. The Ayurvedic practitioner's first objective is to understand the nature or constitution of the patient. This tells the practitioner who they are treating. Next the practitioner attempts to understand the disease or the nature of the imbalance. Ayurvedic pathology is understood according to the doshic imbalance and the imbalance of qualities within the body. The practitioner assesses the state of the doshas, dhatus, upadhatus, srotas, and malas of the body. The overall strength of the body is an important factor in future treatment and is assessed as well. The term ojas is applied to the strength of the body, although more accurately it is that which gives the body the ability to endure stress. While pathology is important to understanding the nature of the disease, equally important is etiology. Etiology is understood according to how the patient's lifestyle, habits, and environment caused the doshas to become disturbed. A lifestyle which emphasizes a fast pace, changes of job or relationship, travel, fast foods, and dry, light foods, such as a vegetarian diet, is likely to cause an aggravation to vata dosha. A lifestyle which is intense, competitive, highly focused, and which emphasizes spicy hot foods is likely to aggravate pitta. Kapha is aggravated by a sedentary lifestyle and a diet of heavy, moist foods, such as milk, yogurt, and meat. Forms Of Therapy Understanding the nature of the person and the nature of the disease, the practitioner can now design a treatment program to guide the patient back into balance. This program utilizes what is commonly called five sense therapies as its foundation, along with specialized treatments for the mind and bodily purification and rejuvenation. Using the sense of taste, the practitioner is able to prescribe a diet consisting of the opposite qualities of the disease or imbalance. This diet is very specific and describes the exact foods in each category a patient may consume. This includes specific meats, dairy, nuts, vegetables, etc. In addition, the practitioner recommends herbs that work along similar principles. In addition to the effects that herbs have on the energetics and qualities of the body, Ayurveda recognizes that some herbs also possess the capability to have strong effects on specific organs and symptoms. This fact is taken into consideration in the design of the formulations. http://www.ayurvedacollege.com/book/export/html/2
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Using the sense of vision, color therapies are utilized. Colors are understood to possess the same qualities as all of Nature and, again, colors are prescribed that have the opposite qualities of the disease. Colors can have strong special effects on specific diseases, and this is recognized and considered in designing a treatment. The ears provide a vehicle for treatment using sound therapies. Ayurveda has traditionally utilized sound energies called mantras for healing. Different sounds affect the doshas in different ways. These sound energies are understood to stimulate specific organs and endocrine glands, possibly affecting hormonal production. Aroma therapy provides treatment through the sense of smell. The qualities of a smell have different effects upon the doshas. For example, sweet smelling fragrances increase kapha but bring balance to vata and pitta. Through the skin, the application of specific oils and massage are utilized. Different strokes and pressures affect the doshas in different ways. The patient may be told to apply massage to him/her self or massage may be applied by the practitioner. For the treatment of the mind, Ayurveda merges with its sister science from India, yoga. By using yoga and meditation, the patient is encouraged to adopt a lifestyle emphasizing peace of mind and connection to God. The resultant stress reduction is an understood component of the healing process. Ayurveda also emphases the importance of keeping the body clean and pure. Toxins, both external and intrinsic to the body, interfere with the flow of waste material out of the cells resulting in impaired function. To remove these toxins, Ayurveda employs a technique known as Pancha Karma, meaning "the five actions." This is a program performed for 728 days at a specialized center that utilizes a restricted diet, massage therapies, additional medicated oil therapies, medicated steam therapies, and elimination therapies such as enemas, purgation, and nasal/sinus cleansing with special oils snorted into the nasal passages. This last treatment is called nasya. Historically, and in some parts of the world currently, two additional therapies are utilized. They are therapeutic vomiting and blood letting with leeches. In addition to these physical modalities, the patient retreats from the world and enjoys time for meditation and reflection. While each therapy is understood to be important, Ayurveda emphasizes lifestyle analysis and change as the most significant aspect of the healing process. The practitioner helps a patient understand how lifestyle has contributed to the origin of the present condition and offers support as the patient attempts to create a new lifestyle in greater harmony with their constitution. After evaluating the patient, the Ayurvedic practitioner designs a program utilizing the therapies noted above. These therapies may be instituted over a period of time and are generally not prescribed all at once, as they may prove to be overwhelming for a patient to implement successfully. Demographics There are no formal studies on how many patients utilize Ayurvedic medicine and principles in their lives. Since Ayurveda is a relatively new science in the West, the percentage is probably low. Worldwide, the traditional medicine of Ayurveda is still used primarily by the poor in India http://www.ayurvedacollege.com/book/export/html/2
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who are unable to afford Western medicine. Indications and Reasons For Referral Ayurveda is a complete medical science which should be considered whenever allopathic medicine is unable to produce the desired results. As Ayurveda includes protocols for the care of every system of the body, it can play a role in the management of any case. It is being used most effectively in the United States on patients with chronic and sub acute disease. It is not generally recommended for acute diseases. Ayurvedic lifestyle therapies may also be utilized effectively to enhance wellness and prevent disease. Research Base Research in Ayurveda has centered around the pharmocological use of Indian herbs. In the botanical and Ayurvedic medicine journals, literature detailing herb constituents, actions, indications, and contraindications is abundant. Successful treatment of a multitude of diseases using herbs from India are well documented. Clinical evidence suggests that there are few harmful side effects from Ayurvedic treatment, and this is supported by 5000 years of anecdotal evidence. Druglike Information /Safety The actions of most herbs and the crossreactions of herbs and drugs have not been studied in great detail. History suggests few harmful interactions, and most herbs are safe in the hands of a qualified practitioner. Practitioners are educated regarding which herbs and procedures are to be avoided by pregnant and lactating woman. Botanical research journals contain the latest information on the actions, effects, and side effects of many herbs. The Indian Materia Medica by Nadkarni, is the principle book summarizing research on herbs used in Ayurveda. Visiting a Professional A patient who visits an Ayurvedic practitioner should expect to receive an evaluation consisting of a minimum of a history of the chief complaint, past medical history, a review of systems, and a review of any medications, herbs and vitamins the patient may be taking. Observations are made of the shape of the face, size of the neck, size and depth of the eyes, color, quantity and quality of hair, thickness of the skin and width of the bones. Detailed examination procedures include the pulse and the tongue. Examination of the abdomen and the taking of vital signs completes the evaluation. After the examination, which usually lasts about one hour or longer, the practitioner spends time educating the patient about their findings. During this report of findings, the practitioner educates the patient about Ayurveda and their imbalances. In Ayurveda it is said that it is more important what the patient knows than what the doctor knows. A patient should leave with a clear understanding of their path back to health. Followup visits are scheduled to support patients as they make progress and confront challenges. Followup visits include ongoing counseling and education. Additional therapies are integrated into the program slowly, over time, as the patient strives to create a lifestyle of harmony through the five senses. http://www.ayurvedacollege.com/book/export/html/2
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Credentialing /Training Currently, there are only a few places in the United States where practitioners receive thorough training. Programs vary from one to two years in duration and often include parttime classroom education and independent study. In California graduates of the California College of Ayurveda receive certification as a "Clinical Ayurvedic Specialist" and use the initials C.A.S. This is the only institution in the United States offering complete clinical training for the practitioner. Other training programs vary in duration and focus. At most schools, the focus is on the philosophical and fundamental principles of Ayurveda. There are also homestudy programs offered through the American Institute of Vedic Studies and by specific teachers. These programs focus on the philosophical and fundamental principles as well. What to Look for in a Provider When looking for a practitioner of Ayurveda, evaluate the extent of their education. Check to see if anyone or any organization has certified their competency. If possible, research the organization that certified them. Always try to meet with the practitioner and discuss the cases they have managed and their results. Ask how they manage cases and what criteria they use to assess progress. The California College of Ayurveda maintains a list of graduate practitioners throughout the United States.
Rejuvenation and Pancha Karma The California College of Ayurveda’s “Healing Experience” utilizes some of the most powerful tools used in Ayurveda to restore balance to the body and mind. Receiving the specialized body therapies are one of the most powerful experiences our patients have while under our care and sometimes even in their lives. There are two kinds of Healing Experience Programs. Our patients are either prescribed a Rejuvenation therapy Program or Pancha Karma. Your practitioner will make the determination as to which therapy is best suited for your needs.
Rejuvenation Therapy Rejuvenation is the process of building up your internal strength and your ability to withstand stress. This is the ideal program for those who feel weak, are experiencing chronic disease or are exhausted or debilitated. This Healing Experience lasts between 310 days and includes therapies that are both deeply relaxing and deeply nourishing. During this program, you will be receiving blissful oil massages (abhyanga) provided by one or two practitioners at a time. You will also be receiving a beautiful therapy in which as stream of warm herbal oil is poured in a continuous stream over your forehead (shirodhara). This is often followed by a relaxing herbal steam bath (svedana). We call the combination of these therapies “Bliss Therapy.” There are other relaxing and nourishing therapies that are sometimes prescribed as well including special oil treatments for back pain (katti basti) emotional hurt (hrd basti), chronic fatigue (adrenal baths) and more. Relaxing facials to improve skin tone and complexion are often integrated into these therapies. These programs are individually designed to meet your specific needs.
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Pancha Karma Pancha Karma (Panchakarma) removes toxins that have accumulated in the body. These toxins are often buried deep inside the tissues of the body where Ayurveda teaches they interfere with normal body functioning. These toxins, called “ama” weaken the body, making the body more susceptible to disease and making it more difficult for the body to heal itself. Pancha Karma (Panchakarma) is a process which when applied properly, helps you to make a giant leap forward in your health and wellbeing. The first phase of your Pancha Karma program is called the Preparation Phase or Purva Karma. This phase begins about one week before you come to our clinic. During this phase of your care, you will follow a special food program and take special herbs. The next phase of your care is the Therapeutic Phase or Pradhan Karma. During this phase, you will typically spend between 5 and 14 days at our clinic receiving a variety of therapies including the “Bliss Therapies”. This program is designed to quiet and purify your mind as well as your body. Special therapies for purifying your small and large intestine as well as you sinuses will be applied. The final phase of your care is the Reintegration Phase or Praschat Karma. This is the process of reestablishing a long term food program and a healthy lifestyle. This phase typically lasts 30 days. During this time, you will be receiving regular follow up consultations at which time you will be receiving ongoing lifestyle, herbal and dietary advice.
Status & Development of Ayurveda in the United States (USA) The Early History of Ayurveda in the United States Interest in Ayurveda in the United States began in the 1970's, largely as the result of efforts by the Maharishi Mahesh Yogi organization of Transcendental Meditation. Interest continued to grow as Indian physicians came to the United States in the 1980's. Among these physicians were Dr. Vasant Lad, Dr. Sunil Joshi and Dr. B.D. Triguna. In the late 1980's Dr. Deepak Chopra wrote "Perfect Health", his famous introductory book on Ayurveda for the general public. This opened the door to India’s ancient healing science for many Westerners. Furthermore, several American pioneers helped attract attention to Ayurveda and influence its growth. They include Dr. David Frawley, of the American Institute of Vedic Studies, and Dr. Robert Svoboda, a Westerner who completed India’s BAMS program. As interest and awareness grew, training programs of various degrees emerged with the intent to train practitioners. In 1995 two students of Dr. David Frawley founded the first two schools of Ayurveda: The California College of Ayurveda and the New England Institute of Ayurvedic Medicine. The California College of Ayurveda, founded By Dr. Marc Halpern, was formed on the West Coast of the United States and became the first professional training program to seek and attain State Approval to operate making it the first formal professional training program to operate outside of India. The California College of Ayurveda has established itself as a leader in Ayurvedic education and continues to operate today. Aside from Dr. Halpern’s efforts to develop the profession of Ayurveda in the United States, several graduates of the College have made important contributions. Mamta Landerman, a 1997 graduate of the program assisted Dr. Halpern with the founding of the California Association of Ayurvedic Medicine and became its president. Devi Mueller, a graduate of the College’s southern California’s branch went on to become President of the National Ayurvedic Medicine Association. The New England Institute of Ayurveda, founded by Dr. Abbas Quatab, was formed on the East Coast of the United States. The New England Institute of Ayurvedic Medicine did not seek State Approval or a license to operate and closed several years later. The New England Institute of Ayurvedic Medicine, though short lived, played a significant role shaping Ayurveda on the East Coast. Notable graduates include Hilary Garivaltis who went on to become the dean http://www.ayurvedacollege.com/book/export/html/2
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of the Kripalu School of Ayurveda and president of the National Ayurvedic Medical Association. Another graduate, Genevieve Ryder, founded the most popular journal of Ayurveda in the United States called Light on Ayurveda Journal. The State of Ayurvedic Education in America As of this writing, the quality and curricula of educational programs in the United States continues to vary widely. In 2004, the National Ayurvedic Medical Association established the first educational standards in the United States consisting of a minimum of 500 hours of education. Graduates of schools that meet these minimum standards are able to receive practitioner status in the national association. These standards, while not legal precedents, have motivated schools to uplift the quality of their practitioner training programs. The focus or vision of schools varies in the United States. The California College of Ayurveda is the leader in clinical practitioner training with the intention of educating its students to be fully qualified practitioners capable of disease management as well as preventative medicine lifestyle training. Most other schools focus on training students in lifestyle management and do not address clinical disease management. Ayurveda training programs in the United States fall into four major categories: (1) correspondence programs; (2) fulltime training programs; (3) weekend training programs; (4) shortterm seminar courses. There is also a division within practitioner training programs, with some of these programs offering internship and others not. (1) Correspondence Programs: Correspondence programs enable the student to study exclusively at home and correspond with questions to the school. Some correspondence courses include internetbased study; others include reading the textbook prepared by the instructor. Many require assignments in addition to reading. Testing varies with each program. Today, there are at least half dozen different correspondence courses available in the United States. Credit hours are arbitrarily assigned by the course developer. The National Ayurvedic Medical Association does not recognize correspondence course hours toward national certification. (2) FullTime Training Programs: The two main institutions conducting fulltime study in the United States are the California College of Ayurveda, directed by Dr. Marc Halpern, and the Ayurvedic Institute, directed by Dr. Vasant Lad. In recent years, additional training programs have emerged and include programs offered at the American University of Complementary Medicine. Each institution’s program varies in length and in curriculum. Still, all three programs are highly regarded. (3) Weekend Training Programs: There are approximately ten weekend training programs in the United States. Students attend school, most often one weekend per month, over a predetermined period of time. Program lengths vary and are often broken up into levels. To become a practitioner, programs vary from 12 weekends on the shorter end to 35 weekends at the California College of Ayurveda. (4) ShortTerm Seminar Courses: Shortterm seminar courses are very popular in the United States. These courses vary considerably in quality and content. Many are simple introductory courses, while others focus on a specific modality. These courses are popular for selfhealing as well as for training massage and spa therapists in various aspects of Ayurvedic massage and beauty care. (5) Internship Programs: The California College of Ayurveda was the first school to offer an internship training program in the United States whereby students can directly treat patients under supervision in a college clinic or in their own community. Internship training at the college today includes six months of internship in preventative medicine and six months of internship in clinical medicine. Today, most schools offer some form of internship training. The nature of the internship varies considerably with some schools allowing interns only to observe patient care while others allowing students to practice on other students.
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State Approval and the Certification of Schools In most States, schools require State approval to operate. State approval is based primarily upon financial stability and professional operation. Several institutions in the country have successfully bypassed State regulations by declaring themselves religious institutions or churches or by structuring their program in ways to avoid State regulation. While State approval is required for nonreligious institutions, there are several programs operating in the United States without proper approval by their State governing body. These schools, operating illegally, are generally much less professionally run. Because of limited oversight, these schools continue to operate. The National Association has not taken any action against these schools. Development of Ayurvedic Associations The National Ayurvedic Medical Association is the major body in the United States representing the Ayurvedic profession. A nonprofit association, it was founded in 1998 by four individuals: Dr. Marc Halpern, president of the California College of Ayurveda, Wynn Werner, administrator of the Ayurvedic Institute, Kumar Batra, and Cynthia Copple. The bylaws of the organization were not filed until 2000. The National Association represents the interests of Ayurvedic practitioners while trying to advance the Ayurvedic profession. The Association has held annual conferences attracting approximately 200300 practitioners each year since its inception. The Association's most important accomplishment to date has been the establishment of minimum practitioner standards. More recently, another Ayurvedic Association formed in the United States. This association, called the Association of Ayurvedic Professionals of North America has focused on a close relationship with India and the recognition of Indiatrained Ayurvedic physicians. The California Association of Ayurvedic Medicine was the first established Ayurvedic State Association in the United States. A nonprofit association, it was founded by Dr. Marc Halpern along with his graduate students in 1997. The organization has held several State conferences attracting 75300 practitioners during its early years but has since discontinued running conferences. The State Association has been minimally active in recent years. The Association has adopted the National Association's guidelines for practitioner training. Regulation of Ayurveda in the United States of America There is no significant regulation of Ayurvedic practice or education in America. Schools in most states must apply for a State license or State approval to provide education. Several states do not have this requirement. The practice of Ayurveda is not formally regulated either. None of the fifty states require a license to practice Ayurvedic health care. Ayurvedic massage is regulated through the massage laws of most states. In five states, California, Idaho, Minnesota, New Mexico and Rhode Island, specific laws, often referred to as “Health Freedom Acts”, were passed protecting the practice of alternative medicine and the practitioners who provide those services. The practice of Ayurveda is protected within these laws so long as the practice falls within the limitations of the law and does not impinge on the scope of practice of other licensed health care professions. Additional states are actively pursuing similar laws. Scope of Practice and Other Issues of Practice http://www.ayurvedacollege.com/book/export/html/2
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Having no formal scope of practice defined through legislation, the practice of Ayurveda is defined more by what cannot be done than by what can be legally practiced. While the laws in each state vary, there are many commonalities to these laws that restrict the practice of Ayurveda, the medical practice acts established in each state being the most significant. The following is a list of actions that, in this author's opinion, are generally considered illegal in the United States. • Practitioners cannot call themselves a Doctor, even if possessing a doctorate degree from India or a PhD. degree in the United States. The use of the title “Doctor” is restricted to licensed physicians of Medicine, Osteopathy, Chiropractic or Naturopathy. While this is true in a clinical setting, those possessing a doctorate degree of any kind may be referred to as “Doctors” in an academic setting and may also place the title doctor in front of their name on books and published papers. • Practitioners may not diagnose medical disease. A practitioner cannot act in the capacity of a licensed health care physician and provide a diagnosis of a disease using common Western medical terminology. This does not mean, however, that a practitioner cannot use their Classical Ayurvedic understanding of disease to come to an understanding of a patient's condition. Hence, a practitioner of Ayurveda may declare that a patient is suffering from a vitiation of pachaka pitta in the rasa dhatu of the annavaha srota but may not declare that the patient is suffering from hyperacidity or an ulcer, or the Sanskrit equivalents: Urdvarga Amlapitta and Grahani. • Practitioners cannot interfere with the prescriptions or recommendations made by a licensed physician. A practitioner who tells a patient not to take their medications is considered practicing medicine without a license. • Practitioners cannot invade the body or perform any other procedure that penetrates the skin or any orifice of the body. This places the practice of nasya and basti in jeopardy. Even simple surgical procedures may not be performed nor may acupuncture. The Ability of Indian Trained Ayurvedic Practitioners to Practice in the United States Indiatrained Ayurvedic physicians who come to the United States on a work visa or through immigration may practice Ayurveda within the allowable scope as defined above. However, they may not use the title “Doctor” and the title may not be implied in any clinical setting. Should a physician trained in a foreign country practice as such, they place themselves in jeopardy of legal actions including deportation (if a noncitizen) or imprisonment (if a citizen). Cultivating an Ayurvedic Profession Within the United States There are several diverging viewpoints on this subject. One states that Ayurveda should be a subspecialty of allopathic medicine. In this scenario, education and the ability to practice would only be available to medical doctors and other licensed health care physicians. The other view is that the Ayurvedic profession should remain independent and grow on its own, training its own practitioners. Separate schools would train Ayurvedic practitioners who would practice either independently or in a complementary/integrated manner with allopathy. As the director of the California College of Ayurveda, I have supported the independent profession viewpoint. This view is consistent with the models established by the Acupuncture, Chiropractic and Naturopathy professions in the U.S.A. Divergent points of view also exist as to the longterm scope of practice to be pursued in the United States. There are some with the viewpoint that Ayurveda should be practiced as it is in India and that education should follow a similar model. There are others who believe that, due to certain entrenched restrictions on the practice of Medicine in the United States, it would http://www.ayurvedacollege.com/book/export/html/2
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be impossible to develop Ayurveda in the United States along such integrated lines. Hence, a new model of clinical education is required that better fits the Western environment. Still, there are others who feel that the practice of Ayurveda should be restricted to lifestyle management only and should not enter into the realm of disease management. It has been the position of the California College of Ayurveda to pursue a Clinical model of training and practice that develops practitioners who can work within the restrictions imposed by US laws but still practice most of the classically recommended natural practices and procedures for the purpose of serving humanity. The California College of Ayurveda has pioneered Western clinical Ayurvedic education since its inception in 1995 and has expanded this model as the school and profession has grown. Which model of Ayurvedic education becomes established in the United States will depend upon the actions of the National and State Associations, schools and activists within the country and abroad. While the infrastructure of the Ayurvedic profession in the United States has developed and improved over the past ten years, greater infrastructure is still needed. Absent is a serious body that regulates schools in the United States. The profession is in need of an accreditation agency that regulates and unifies the actions of schools so that graduates of all schools have similar education, training and competency. The Role of India and the Future of Ayurveda in the United States While Ayurveda in the United States grows according to its own course, the role of India is crucial in the development of Ayurveda abroad. Actions taken that support, nourish and strengthen the profession in America are needed. Nourishing actions include teacher and information exchanges and general support for the activities of the National Ayurvedic Medical Association. Unfortunately, the actions of some highly motivated physicians from India have been less than supportive. Rather than providing nourishing support, their actions have attempted to purify Ayurveda in the United States by attempting to undermine the actions of individuals who are working to build a profession that fits within the Western paradigm. These Indian physicians promote an indocentric philosophy whereby they can only see or accept Ayurvedic practitioners who are trained and practice exactly as they are and do in India. While the Indian model of Ayurvedic education and practice is the recent historical standard, it has evolved in India based more on 20th century politics and culture than on classical scripture. With a different culture and political landscape in the United States, it is natural that Ayurveda will evolve differently in this country. What is important is that the practice of Ayurveda remains true to its classical bodymindconsciousness paradigm. It is the philosophical and spiritual (not religious) constructs that separate Ayurveda from any other system of medicine in the world and it is this that must be preserved above all else. Conclusion Although progress is slow, the Ayurvedic profession is growing steadily in the United States of America. Educational institutions are becoming more established and associations are working to give the profession a voice and address regulation issues. Ayurveda is likely to continue to grow in America and eventually take its place among the other licensed health care professions. Dr. Marc Halpern, D.C., C.A.S., P.K.S. (Ayurvedacharya), is the Founder and President of the California College of Ayurveda. He is one of the pioneers of Ayurveda in the West and is considered to be a preeminent practitioner and teacher of Ayurveda in the United States. He is one of the few Westerners ever recognized in both the United States and in India as an authority on the subject of Ayurveda and was awarded the All India Award for Best Ayurvedic Physician. A pillar in the development of the profession in the United States, he is the cofounder of the National http://www.ayurvedacollege.com/book/export/html/2
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Ayurvedic Medical Association for which he served as Chairman of the National Committee on Ayurvedic Education from its inception in 2000 until 2005. He is also a cofounder of the California Association of Ayurvedic Medicine. A Doctor of Chiropractic with postgraduate certification in Holistic Medicine, Dr. Halpern has studied with many noted teachers from India and the United States. Last updated February, 2011
The Journey Into Ayurveda Ayurveda, which literally means the knowledge or wisdom of life, is the traditional medicine of India. Over the past decade, its popularity as an alternative or complement to Western Medicine has grown steadily. Brought into the mainstream public eye by Dr. Deepak Chopra M.D. in 1991, his book Perfect Health enlightened millions of readers about this ancient healing art. Since that time, interest in Ayurveda has grown steadily and Ayurveda is quickly establishing itself as a unique health care profession. Focusing on how we relate to our environment, Ayurveda views the cause of disease as the natural expression of the body and mind to living out of harmony with its environment. From this perspective, we can begin to understand that Ayurvedic treatments center around helping each individual move back into a harmonious relationship with their environment. In Ayurveda, we understand that where there is harmony there is health, and where there is disharmony, there is disease. Our environment consists of everything that we experience through our five senses. Thus what we eat, look upon, smell, touch or listen to, affects our wellbeing. The goal of Ayurveda then is to help each person take in the impressions that are right for them. In Ayurveda, each person is seen as a unique individual with unique genetics and biochemistry. Hence, what is right for each individual is different. We call a person’s uniqueness their "constitution." Your constitution describes who you are at the most fundamental level. The concept that we are all different is unique to Ayurveda. As a result of this understanding, Ayurveda prescribes a different program to each individual based upon their constitution and the nature of the imbalance within them. This avoids the "Everybody Must" syndrome that infiltrates many systems of healing. The "Everybody Must" syndrome says that everyone must follow one specific path in order for healing to take place or to establish optimal health. Ayurveda vehemently disagrees with this notion and subscribes to the philosophy that "nothing is right for everyone and everything is right for someone." I am reminded of the story of Lord Buddha who upon selecting his personal physician sent several physicians into the forest with the task of finding as many plants as they could with no medicinal value. Each physician brought back many samples of plants that they felt from their experience and meditations had no value. One physician by the name of Jivaka came back empty handed. He explained his frustration to Lord Buddha. "I am afraid I have failed you, he began, I have spent much time in the company of all of the plants in the forest but there is none that I can find with no value to someone." Upon hearing this, Lord Buddha selected Jivaka as his personal physician. Indeed, Ayurveda recognizes that medicine exists everywhere and often in the most unlikely of places. Not only are plants and herbs sources of http://www.ayurvedacollege.com/book/export/html/2
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medicine but Ayurveda also uses aromas, colors, sound, special forms of massage and food as healing tools. It is through our senses that we experience the world around us. If we take in harmonious impressions through our senses, we can expect to experience greater calm, clarity and peacefulness and thus, via the mind/body relationship, greater physical health. If we take in disharmonious impressions, we create agitation in the mind and this leads to disease. We will now explore the fundamentals of each of the five senses. Through our eyes we take in thousands of impressions each day. These impressions are actual energies with different vibratory rates. Each color is a different energy or vibrates at a different rate. Some colors are harmonious for us and some agitate us in subtle ways. We interact with color all the time through the clothes we wear and our home environment. Conscious use of color can help create an environment for healing. While some color therapists attribute healing qualities to certain colors, Ayurveda once again teaches us that each person is an individual and hence, every color has a healing capacity if prescribed for the right person. Not only is color important but also how colors interrelate. Clashing colors in general create greater agitation while those that blend harmoniously create a greater sense of calm. In Ayurveda, we also look at the quality of the impression received by the eye. Violent images as seen in real life or in the movies create agitation and disharmony. Viewing nature and flowers creates a feeling of calmness and clarity and thus benefits our journey toward health. Through the sense of taste, we interact with the foods we eat. Each of the six tastes affects the body and mind differently. Each taste has its benefits and each has its negative consequences if we overindulge in them. Sweet taste, as an example, is very nourishing and builds tissue and strength, but overindulgence, as we all know, leads to excessive weight gain, diabetes and other complications. In Ayurveda, we do not count calories, grams of fat, or the cholesterol content of food. From an Ayurvedic perspective, if we learn what balance of tastes are right for us, then we will eat in harmony with our body’s constitution and the body will respond with greater health. Some benefit from hot, spicy food while others from milder or bland foods. Some people benefit from meat while others thrive as vegetarians. Some people need the nourishment of sweettasting grains and others the cleansing qualities of bitters. What tastes and types of foods are correct for each individual depends upon that person’s constitution and the nature of any imbalances that may be present. Our ears take in the vibratory energy of sound. Some sounds are calming and others agitating. Of course, which sounds balance our energy depends again on our constitution. We may think that only quiet, calming sound is healing. Again, we must remember the tenet of Ayurveda that teaches us that what heals each person is different. For instance, agitating music can also be motivating. If lethargy and depression is a challenge, motivation is what you want. Meanwhile, for anxious individuals, the calming nature of new age music is beneficial. In Ayurveda, special sound energies called mantra are sometimes prescribed to induce specific reactions in the body. Through our nostrils we entertain the sense of smell. Aromatherapy is an important part of Ayurveda, as smell has long been known to evoke emotion. From the perfumes and scents long used in mating rituals to the relaxing feelings evoked by a walk through a rose garden, aromas have always played a large role in our lives. While most people use aromas (perfumes and aftershaves) unconsciously, Ayurveda teaches us that some aromas create harmony while others contribute to disharmony and ultimately to disease. From this understanding we can see that aromas are also medicine in the context that they can be intelligently used to balance the subtle energy of our bodies. In Ayurveda specific aromas are prescribed to aid the healing process. http://www.ayurvedacollege.com/book/export/html/2
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Touch is a very important aspect of Ayurveda. Through Ayurvedic massage, the body and mind are nurtured. The skin is seen as a receptacle of a variety of energies. Some forms of massage are aggressive while others are soothing. What type aids an individual’s healing process depends upon the constitution and the nature of the imbalance. Through the knowledge of Ayurveda, different oils are selected for each individual. These oils are chosen based upon their unique properties. Some are warming while others are cooling. Some nourish the body through the skin while others are less effective. In addition, specific hand motions are utilized to balance the subtle energies defined by Ayurveda. These subtle energies are known as doshas or humors in Ayurveda. There are three fundamental doshas known as Vata , Pitta, and Kapha. How they combine and in what percentages make up a person’s inborn constitution. No two people share the same constitution. This natural unique balance of energy is essentially an energetic blueprint of the person on the physical and emotional level. Through understanding the constitution we can predict where in the body weaknesses are likely to occur and thus take measures to prevent disease. Likewise, a Clinical Ayurvedic Specialist can observe how the current balance of these energies is out of balance with their inborn ideal, and thus come to an understanding of how a disease took root in the body and began to grow. With this knowledge, regimes can be prescribed to reestablish balance and often reverse the effects. Our constitution can be described as an energetic template of our genetic blueprint. Our genetics have been shown to be the basis of our individuality. Our genetics control how we are likely to react to our environment and can also be used to predict predispositions toward certain diseases. They also determine our biochemical individuality. This individuality affects everything from our unique nutritional needs to how we respond to different drugs, foods, colors, aromas, temperatures and everything else in our environment. Indeed, if we can understand our constitution, we can begin to take conscious control over our choices and choose those that will lead us toward optimal health.
The Path Back to Perfect Health Have you ever wondered why we become ill? Do you lack the energy or vitality that you had years ago? Have you spent your time and money searching for a cure to what ails you only to walk away somewhat disappointed each time? Have you given up? Do you believe that perfect health is possible? Ayurveda, the 5,000 year old healing science from India becoming increasingly popular in the United States, offers answers to the question: Can I become perfectly healthy again? The answer is yes but the path is not a simple one. Ayurveda is a journey into understanding ourselves and how we create disease. Ayurveda begins with helping a person to understand what their unique constitution or mind – body type is. Once we begin to understand this we can then understand how we interact with our environment. This is the most important gift of Ayurveda because this allows us to control our environment in ways that create harmony instead of disease. Ayurveda is based on the idea that we are all unique individuals with unique constitutions. As a result, each of our paths to create health is different. For instance, some people thrive on a vegetarian diet while others become weak or ill. In the same way people are not bothered by spicy diet while others get indigestion. These types of unique needs are not only true for diet but for every aspect of our environment including colors, sound, aromas, and work. http://www.ayurvedacollege.com/book/export/html/2
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By helping a patient, an Ayurvedic practitioner starts by understanding the patient’s constitution and helps them control their environment in ways that can produce health for them. Treatment programs involve putting the patient on the appropriate food program, preparing herbs to assist healing, educating the patient about what colors and aromas support their well being and perhaps most importantly, analyzing the patient’s lifestyle to determine where there is harmony and where there is disharmony. It is in the details of our lives that we often see the root origins of disease. We may find ourselves caught up in addictive habitual patterns of overwork. We may find ourselves moving quickly rushing about like a speeding car perpetually late for an appointment weaving in and out of traffic. Our illnesses, to follow this metaphor, may be likened to a car accident. The ayurvedic doctor analyzes a patient’s life from a non judgmental point of view simply looking for harmony and disharmony. Sleep patterns and eating patterns along with work are all examined. Yoga and meditation are a part of the Ayurvedic prescription for perfect health. Both vigorously train the body and mind to manifest harmony. An Ayurvedic practitioner guide you in methods of yoga and meditation that are harmonious for your unique constitution. Ayurveda is based upon an understanding of the three doshas. These are the forces that govern the functions of the body and the mind. It is the balance of these three forces that defines your constitution. While all three exist inside of each of us, the balance of them is unique. The three forces are known as Vata, Pitta, and Kapha.
The Doshas Vata is often likened to the wind. Its qualities are light, dry, cool and mobile. People with a strong Vata nature tend to be light of weight, have long narrow bones, dry skin, and often feel cold. Emotionally individuals of Vata nature or imbalance are prone to fear and worry. These individuals are most prone to diseases of the large intestine, immune system, nervous system and joints of the body. Constipation, nervousness, anxiety, colitis, arthritis and chronic fatigue syndrome to name only a few are diseases associated with Vata imbalance. In order to bring balance to Vata these individuals need heavier, more nourishing diets, greater calmness and stability and more oils in the diet. Pitta is often likened to fire. Its qualities are hot, light, and slightly moist. It is unstable. People of strong Pitta nature or imbalance tend to be of moderate weight with good muscle tone. They tend to feel warm and seem to sweat easily. Emotionally these individuals are prone to heated emotions such as anger, resentment and jealousy. These individuals are most prone to diseases of the small intestine, liver, spleen, thyroid, eyes and blood. Diarrhea, hepatitis, infections, hyperthyroidism, acne and other skin dieases are common during Pitta imbalance. In order to bring balance to Pitta an Ayurvedic Doctor prescribes a mildly spiced diet, which is heavy or nourishing and slightly dry. Relaxation and play are advised and inner work to develop compassion is recommended. Herbs are prescribed to facilitate the process. Kapha is often likened to mud, a mixture of earth and water. Its qualities are heavy and cool, damp and stable. People of strong Kapha nature or imbalance tend to carry more weight naturally. They have thick bones and slower metabolisms. They have strong bodies. They are not necessarily overweight, however being stocky comes more naturally. If these individuals try to lose too much weight in order to look like societies idea of ideal, they will create imbalance, disharmony and disease. Emotionally people of Kapha nature are most prone to melancholy, lethargy, and depression. These individuals are most prone to diseases of the stomach, lungs, pancreas and sinuses. Diseases such as diabetes water retention, http://www.ayurvedacollege.com/book/export/html/2
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nausea, and congestive mucous conditions are common diseases of Kapha imbalance. To correct an imbalance in Kapha an Ayurvedic practitioner prescribes a diet, which is light, dry and very spicy. Vegetarian diets are beneficial and inner work to release attachments is advised. Herbs help facilitate the process. Which you may see yourself in these stereotyped descriptions, most of us are a combination of these three body/mind types. An Ayurvedic practitioner can help you understand your constitution and prescribe a program of care to help you reestablish balance and hence to reestablish health. The path of creating health is a personal one. It often leads into a deeper understanding of ourselves. While an Ayurvedic practitioner can be a guide on your journey, ultimately it is a path we walk alone. Good luck on your journey.
The Path of Self Healing Most traditional and nontraditional forms of healing share some very basic and common similarities. While their methods may differ, they are alike in that each form of healing utilizes some external method to create a change in the function of the body. The Medical Doctor uses drugs and surgery. The Chiropractor uses the spinal adjustment. The Homeopath uses a specific remedy and the Herbalist uses herbs. The Acupuncturist uses needles and the Body Worker uses his hands. With each method, the patient is a passive participant hoping to be healed by a skilled practitioner. External healing techniques help to heal the symptom but ignore the underlying cause. Healing the symptom has value, it alleviates suffering and should not be ignored, but it is limited. Unless the underlying cause within the person is corrected, soon the person will unconsciously create a new illness to take its place. I recall a patient I treated early in my career for stress induced headaches. I succeeded in alleviating this “symptom” with chiropractic care. He continued on with no internal change having been made. Years later, he died of a heart attack. Was this man really healed when he came to see me? I think not. His headache had been a smoke alarm warning him of a deeper fire. I unplugged the smoke alarm but in ignorance, allowed the fire to destroy his house. The path of selfhealing is not an easy one. In fact it is the most difficult path because it is a path into the self. It is a path of selfdiscovery on the physical, emotional, and spiritual levels. This path encompasses one’s whole being and is the basis of holistic healing. This is a path that each person must walk for themselves; no one can walk it for them. Other people can serve as guides along the way: doctors, shamans, healers and teachers. However, choose your guides carefully. A helpful guide is one who is willing to teach you, but then is willing to let you walk your own path and does not demand that you walk theirs. The path of selfhealing is an arduous one. It often requires many stops along the way for directions. To succeed requires commitment, patience, http://www.ayurvedacollege.com/book/export/html/2
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selfcompassion, and selfunderstanding. The path of selfhealing is also very rewarding. This journey brings along with it many gifts. These gifts are more valuable than precious gemstones and makes all the work and time spent worth while. These gifts bring about our healing on the physical and emotional level that our growth spiritually. Good luck on your journey. Namaste
Understanding the Cause and the Cure of Disease: An Ayurvedic Perspective Have you ever wondered why we become sick or what is the ultimate cause of disease? These topics have been a personal interest for more than fifteen years and have led me to the study of several alternative health care systems including Chiropractic, Homeopathy, Chinese Medicine and Allopathic Medicine, in addition to Ayurvedic Medicine. Understanding the cause of disease is profound and yet simple. If we can understand the cause of disease then we can begin the process of determining the cure. Each system of conservative and alternative medicine has its own unique perception of the cause of disease. Based upon this perception, each system sets about to develop a cure. For instance, Allopathic Medicine, also known as traditional Western Medicine, looks to pathogens (bacteria, viruses, fungus, etc.) as the cause of disease and based upon this model develops drugs to kill the pathogens. Chiropractors look at the cause of disease as misalignments or abnormal function of the bones of the spine. which creates an interference with nerve function. Thus, the cure is an adjustment or manipulation of the bones of the spine to correct the misalignment, opening the pathways for proper nerve function. Every system of health care has its own model, and I have studied most along my journey. Too often I was left with a remaining question. Why? For instance, why do we become susceptible to the pathogens when we have an immune system which is supposed to keep us healthy? Why do the bones of the spine become dysfunctional? There must be answers. There must be deeper levels of cause. If so, then the pathogen causing an infection or the vertebrae causing nerve interference is only a symptom of some deeper underlying cause! I searched long and hard for that underlying cause and it was in the science of Ayurveda that I found it. Ayurveda teaches us that all disease begins when we are living out of harmony with our environment. When we take in inappropriate impressions from our environment through any of our five senses, we weaken the body and create an internal environment which supports the creation of disease. In this environment bacteria, viruses and other pathogens thrive, and muscles tense and alter the function of vertebra interfering with nerve function. We could ay that energy flow is disrupted in the body. The ramifications of understanding the cause of disease are numerous. Models can be created both to prevent and to treat disease. If disharmony is the cause of disease then the recreation of harmony is the cure. This is what the science of Ayurveda is all about. One realization of this model is that both the creation and the healing of disease is under our control. It is a disturbing thought that we participate in http://www.ayurvedacollege.com/book/export/html/2
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the creation of disease but an empowering thought that we can also participate in the cure! Ayurveda takes health into the realm of personal responsibility, and once we enter that realm we are no longer random victims of the multitude of diseases that afflict humanity. In addition, we become empowered to participate in our own healing process! Healing through Ayurveda involves all five senses. Through taste, we utilize proper diet and herbs. Through sight we utilize proper color and beauty. Through smell we utilize aromatherapy. Through sound we utilize music and sound energies. Finally, through the skin we take in specially prepared herbal oils and receive massage. In addition to five sense therapy, Ayurveda advocates the periodic removal of accumulated toxins and food residues through specialized purification procedures called Pancha Karma. Ayurveda is not a system of healing in which everyone does the same practices. In fact, rarely are two programs exactly alike. Ayurveda sees each person as an individual with a different internal balance of energy called one's constitution. Understanding a person’s constitution allows the Clinical Ayurvedic Specialist (a certified practitioner of the science of Ayurveda), to set up a program of care specific for that individual. This program helps them to reestablish harmony with their environment thus creating an optimal internal environment for healing to take place. For instance, some people thrive on hot spicy foods, while for others it gives diarrhea and indigestion. Understanding the internal energy of the body, the Clinical Ayurvedic Specialist can predict the reactions a person will have and thus can recommend a food program specific to that individual, not only with foods but also with herbs, colors, aromas, etc. An important part of a healthy lifestyle from an Ayurvedic perspective is relaxation and peace of mind. To this extent, Ayurveda utilizes meditation and yoga as healing tools. These two powerful tools have been well documented to reduce stress and aid the function of the immune system. We do not have to be sick. Through unhealthy life practices, our bodies become weak. Through healthy practices they can become strong once again and remain strong. Ayurveda is the science of reaching our full healing potential. With the tools of Ayurveda, a person can take back control over their health and well being. These tools lead to the formation of an ideal internal environment which supports the healing process. It does not negate the value of using allopathic medicines in acute disease but simply gives a person a deeper understanding of the process of becoming optimally healthy. Each person takes a journey when they become ill. The path back to health can be a difficult one. Ayurveda acts like a guide shedding light upon that journey; a teacher, sharing the tools and wisdom of the process; a counselor, supporting you as you travel; a healer awakening the healer within you.
The Five Elements in Ayurvedic Medicine The five elements represent the most important foundational concept in Ayurveda. More than physical elements, the five elements represent ideas that are fundamental to nature and matter . The five elements are collections of qualities that together form the building blocks of nature. If a person http://www.ayurvedacollege.com/book/export/html/2
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truly understands the five elements, the doorway of knowledge opens to understanding creation itself . In the body, each element is associated with different tissues and functions. In the mind, the elements are associated with personality characteristics. In the medicines, the elements determine their actions. Knowledge of the five elements is part and parcel of Ayurveda. The student who does not properly understand the five elements, cannot properly understand Ayurveda.
The Five Elements: Ether in Ayurveda Author: Dr. Marc Halpern Published: Light on Ayurveda Journal Copyright: California College of Ayurveda. Do not duplicate or distribute without written permission. The element ether, called “akasha” in Sanskrit is the first of the five great elements (pancha mahabhutus). It comes first because it is the most subtle of the elements. Often referred to as “space” it is the essence of emptiness. It is the space the other elements fill. The origin of ether is shabda. Shabda is the tanmatra or primordial, unmanifested form of sound. Shabda is the primordial space from which vibration emerges long before it takes the form of sound in the ear. Sound and ether are inseparable. Because of their intimate relationship, the ear is considered the associated sense organ of the element ether and voice (mouth) is its organ of action. Hearing loss and loss of the voice are difficulties that are often due to vitiation of the ether element in the body. Ether has qualities. However, these qualities are based more upon the absence of its opposing quality than on the actual quality itself. For instance, ether is cold. It is cold because it lacks warmth created by fire. Ether is light because it lacks the heaviness created by earth and water. Ether is immobile because it lacks the propulsive nature of air. Ether is subtle because it lacks the profound presence of the more obvious elements. Ether is also omnipresent. It is everywhere. It is the substratum from which all other elements are derived. Ether is a part of all other elements. Within any aspect of creation, ether may be found. Ether is the most expansive of the elements. Without form or boundaries, ether has no limits. Because of its expansive quality, ether is the cause of differentiation. Unrestrained, ether awaits a propulsive force to assist it in moving outward from the center of oneness. As a result form is able to take shape and differences emerge. In the formation of the embryo, it is ether that is responsible for allowing change and growth to take place. Ether creates the space for the other elements to fill. That which is the most subtle and difficult to perceive is a function of the element ether. The mind is composed of ether. It is formless and nearly impossable to contain. While the mind becomes easily disturbed, ether represents the substratum upon which thoughts and emotions ride like waves upon the ocean. The sattvic or undisturbed mind is an expression of the essence of ether. In the body, ether is expressed within the empty spaces. The hollow of the empty intestines, blood vessels, bladder and the lungs are filled with ether. Vitiation of ether in the body results in an increase of space and a decrease in structure. The result is the destruction of tissue. Parkinson's disease is an example of a condition where space is created in the body where once there was cellular structure. The loss of dopamine producing cells in the substantia nigra of the brain stem creates an increase in emptiness. A similar state is seen in the pancreas due to the destruction of islet cells. Vitiation of space (ether) contributes to the symptomatic dysfunctions that follow. The Vata dosha contains both ether and air. Hence, any vitiation of ether will ultimately result in a vitiation of Vata. Therefore, one method of controlling vata dosha is to prevent ether from increasing. Ether is prevented from increasing by filling the emptiness in our lives. Our lives become full, not by being busy, but by being nourished physically and emotionally. Proper nourishment acts as a container for ether and the vata dosha. Moist, heavy, satisfying foods pacify ether as the empty space of the digestive system becomes full. Emotionally, love is the highest form of nourishment. By taking in the other elements the natural tendencies of ether are pacified. All of creation is made up of the five http://www.ayurvedacollege.com/book/export/html/2
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elements in different proportions. In our diet, the bitter taste contains the most ether, although ether by itself is tasteless. The bitter taste is composed of both ether and air and it is air that provides the uniqueness of the taste. Consuming bitter foods is an excellent way to increase the influence of the ether element. This is wonderful if a person is overly constricted and driven by their routines. However, an excess of ether in the diet, especially the diet of the individual with a vata constitution can result in becoming too expansive. While this increases creativity it also leads to becoming ungrounded. Obviously, a balance is desired. The winter is the season of ether. The season of ether begins after the leaves have fallen and earth is barren. Nature intends for everything and everyone to become lighter at this time. There is a danger of becoming too light at this time if the proper precautions are not taken. Thus, human beings have historically prepared for this season by storing up food and other supplies to see them through this period of emptiness. In the cycle of life, death is the time of ether. The body disintegrates and the elements flee their boundaries. All that remains is the subtly of our spirit. Ether characterizes the elemental make up of the individualized soul while it maintains its separateness from the whole of Purusha. Purusha itself however is unmanifested and thus in accordance with the principles of Sankhya philosophy precedes the manifestation of all elements. Hence, it is subtler still than ether and because of this, it is far beyond our ability to capture it in words. Purusha is without attributes. Purusha is the primordial essence of ether.
The Five Elements: Air in Ayurveda Author: Dr. Marc Halpern Published: Light on Ayurveda Journal Copyright: California College of Ayurveda. Do not duplicate or distribute without written permission. The element air, called “vayu” in Sanskrit is the second of the five great elements (pancha mahabhutus). It comes second because it evolves from ether. As the potential inherent within space becomes active, the result is air. The air element represents the capacity for motion or kinetic energy. Air represents all forces and the movement that transpires as a result of those forces. The origin of air is sparsha. Sparsha is the tanmatra or primordial, unmanifested form of touch. Sparsha is the potential of the touch experience, expressed in its most subtle form. Touch and air are inseparable. Because of their intimate relationship, the skin (through which we receive touch) is considered the associated sense organ of the element air and the hands (through which we reach out and touch the world) are its associated organ of action. Hence, disorders of tactile perception and those of grasping are the result of disturbances in the functions of the air element. To know air is to know its qualities. Air is mobile, cool, light, dry, rough, subtle, flowing, sharp, clear and hard. Although air is subtle, its effects are observable and so we have a sense of what it is. We associate the element air with the air we breathe. Thus, the ancient rishis recognized air as the immediate source of life. A lack of air will kill us faster than a lack of any other element. Thus, the concept of vayu (air) is synonymous with that of prana (life energy). In nature, the ancient rishis described air in five forms according to its direction of movement: inward (prana); outward (vyana); upward (udana), downward (apana) and that which balances and stabilizes these movements, a force that pulls to toward the center (samana). These five types of movements are called both the five vayus and the five pranas. In the body, air is expressed in the form of motion and life. The force allowing blood to circulate, breath to move, nerve impulses to glide, http://www.ayurvedacollege.com/book/export/html/2
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thoughts to flow and joints to propel our movement through the world are all possible because of the element air. Air is the force behind all motion. Disturbances in the functions of air result in aberrant motion. Air may move too fast, too slow or become obstructed and blocked. Each occurrence produces different effects depending upon the location of the air that is disturbed. Excess motion in the nervous system results in hyperexcitability; deficient motion produces sluggishness and dullness, blocked flow results in a complete loss of motion. For example, in the digestive system excess flow results in diarrhea, deficient flow in sluggish motion and blocked flow in either severe constipation or complete obstruction. In the joints, excess motion results in hypermobility, deficient motion in decreased range of motion and blocked flow in a frozen joint. In the circulatory system, excess motion can result in rapid heart rate, decrease flow in a sluggish heart rate or poor circulation, while blocked flow results in catastrophic consequences robbing the affected area of its blood supply resulting in tissue ischemia (lack of oxygen) leading to necrosis (death of the tissue). The Vata dosha contains both air and ether. Any vitiation of air will ultimately result in a vitiation of Vata. Vata remains healthy when motion is controlled but able to flow without obstruction. Control prevents excess flow while freedom prevents stagnation. Balance is they key to healthy vata. Control of air is attained through the development of steady routines. Steady, healthy routines subsequently keep the vata dosha from becoming vitiated. A diet that is heavier will also support the development of the stability that controls motion by balancing the light quality of the air element. Emotionally, surrender leads to the highest manifestations of motion (air) and this requires faith. Thus, air flows freely in through a body and mind that has cultivated an attitude of surrender and faith in both self and the divine. By taking in the other elements the natural tendencies (qualities) of air are pacified. All of creation is made up of the five elements in different proportions. In our diet, the bitter taste contains the most air. . The bitter taste is composed of both air and ether and it is air that provides the uniqueness of this taste. Consuming bitter foods is an excellent way to increase the influence of the air element. This is wonderful if a person is sluggish or lazy. However, an excess of air in the diet, especially in the diet of an individual with a vata constitution can result in too much motion. While this increases activity it also leads to a loss of stability and dryness. A proper balance in accordance with a person’s constitution and current state of health is always preferred. Autumn is the season of air. The season of air begins as the leaves begin to fall. The weather becomes cooler and there is a sense of transition or movement in the weather. Air represents the gradual weakening of nature as it moves away from its full bloom and moves forward to face the dormancy of winter. Nature intends for everything and everyone to become lighter at this time. There is a danger of becoming too mobile and light at this time if the proper precautions are not taken. To live in harmony with this time of year means to spend time reflecting on the activities of the past spring and summer. While motion is natural at this time, excess motion may be perceived in the body and mind as an increase in anxiety, restlessness or sleeplessness. While it natural to become lighter at this time, excess lightness may be experienced as depletion. Once again, a proper balance in accordance with a person’s constitution and current state of health is always preferred. In the cycle of life and death, air represents the transitional period between being our most productive and the last years of our life. Women go through the transition of menopause at this time while men find themselves desiring retirement. The idea of motion is reflected in the transition. To live in harmony with this time it is necessary to spend some time reflecting upon the decades of our lives. While motion is natural at this time, http://www.ayurvedacollege.com/book/export/html/2
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excess motion makes the transition more difficult and may be perceived as anxiety, restlessness, sleeplessness, palpitations and in the transient hot flashes many woman experience. Dr. Marc Halpern is an inspiring teacher of Ayurvedic medicine. An internationally recognized expert, he is the Founder and director of the California College of Ayurveda and cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He received the AllIndia award for “Best Ayurvedic Physician” from the Hakim Ajmal Khan Memorial Society, presented to him by the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He sits on the advisory board of Light on Ayurveda Journal.
The Five Elements: Fire in Ayurveda Author: Dr. Marc Halpern Published: Light on Ayurveda Journal Copyright: California College of Ayurveda. Do not duplicate or distribute without written permission. The element fire, called “tejas” in Sanskrit is the third of the five great elements (pancha mahabhutus). It comes third because it evolves from ether and air, containing the essence of these elements within it. Ether provides fire the space to exist within. Air provides fire the capacity to burn. It is because of air that fire will never be still. The fire element represents the capacity for heat and light. Fire is the generator of energy in the body just as the sun is the generator of energy for the earth. Fire represents all sources of energy in the world including solar, hydroelectric, nuclear, fossil fuel and biodiesel. Fire is the process of liberating energy from its source. The origin of the fire element is the tanmatra of vision called rupa. Rupa means form or color. Both form and color are the result of perception. Rupa is the tanmatra or primordial, unmanifested form of perception, light, vision and thus the fire element. Fire and the visual sense have a special relationship. Fire provides the light for perception. The eyes are the vehicle through which light is digested and perception takes place. Hence, disorders of visual perception are primarily those of the element fire. The feet are the organ of action associated with the fire element. It is through the feet that we react to what we see. Use of the feet allows a person to change direction based upon perception. Not only may the direction be changed but the intensity of progress. The choice of direction and the intensity of action are functions of the fire element. To know any element is to know its qualities. Fire is hot, light, dry, rough, subtle, flowing, sharp, clear and soft. Fire is neither stable nor mobile. Fire neither stands still nor generates motion. Inherent within fire is air and it is the air that provides fire with its mobile quality. Although fire is subtle, its effects are clearly observable and so we have a clear sense of what it is. It is the heat of fire that is most recognizable. We associate the element fire with the fires we can see. The ancient rishis idea of fire was more comprehensive. Fire represents light, heat, and luster, the power of transformation, energy, understanding and metabolism. http://www.ayurvedacollege.com/book/export/html/2
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In the human body, fire is expressed in five distinct ways. The fire that provides our body with the capacity to digest food is called pachaka agni. The fire that ignites the intellect, digests ideas and allows for understanding is sadhaka agni. The fire of perception that that digests visual impression into recognizable images is called alocaka agni. The fire that energizes and invigorates the body adding color to the body is called ranjaka agni. The fire that digests touch and sunlight and gives off the radiance associated with healthy skin is the light provided by bhrajaka agni. Because fire has a destructive quality, in the body it is always mixed with a small amount of water to keep it from destroying the tissues. The container of fire and water is Pitta. Hence, the five agni’s are also called the five types of pitta. Excess fire in the body results in a build up of heat. Naturally, deficient fire results in a feeling of being cold. There are other ramifications. As heat builds up in the body, there is a need to eliminate excess. Hence, the body sweats and urinates more and the stools become looser and more frequent. The luster of skin increases and the eyes shine brighter. The mind becomes sharper, more focused and the intellect strengthens. If fire increases too much, there are negative consequences. The skin may erupt in red rashes, the eyes become blood shot, the mind becomes intense, the tissues of the body may become inflamed and there may be fever. A lack of fire in the body results in a loss of luster as the skin takes on a gray or pale tone and metabolism slows down. In the digestive system food is poorly digested, in the mind it becomes difficult to digest new information. As the body tries to hold on to heat; sweating, urination and bowel elimination all decrease. The pitta dosha contains both fire and water but it is fire that plays the more dominating role. Hence, any vitiation of fire will ultimately result in a vitiation of pitta. Pitta remains healthy as the fires of the body are well tended. Tending the fire in the body begins with monitoring pachaka agni or the fire of digestion. When the digestive fire is healthy, there is little gas and elimination is regular occurring on a daily basis 12 times per day. The digestive fire is increased primarily by hot, spicy sour and salty foods and is decreased by both heavy and cold foods. Hence, if digestion is weak and the fire low, the diet should made lighter and spicier until digestion normalizes. All of creation is made up of the five elements in different proportions. In our diet, the pungent, sour and salty tastes contain the most fire. Of these, the pungent taste will increase fire the most rapidly but it is the sour taste that has the greatest long term effect. Pickled foods, yogurt and foods marinated in vinaigrette are example of sour foods. Summer is the season of fire. At this time of year, the rotation of the earth around the sun results in longer daylight hours as the fiery sun plays a great role in our lives. The air is warmer, the light is longer and the activity of the people and plants reach their peak. Summer is the most naturally active time of year. So long as the weather does not become unbearably hot, summer is the time to do all of those things you planned for during the late winter and spring. It is the time of year to work diligently to fulfill dharma. Care must be taken however because if a person becomes too focused and intense, fire will increase too much and pitta will become vitiated. Thus, it is important to keep one’s fire in check and spend some time by the cool water while maintaining a diet that is cooler and less spicy. In the cycle of life and death, fire represents our most productive years. Having been well prepared for this cycle of life during one’s youth, these years are for the fulfillment of dharma. Each person’s capacity for work and service is greatest during this phase of life. Regardless of constitution, from puberty through the transition into old age, the fire burns bright inside of us. For those with a naturally fiery nature, it burns brightest and these individuals must be careful not to work too hard and burn themselves out. http://www.ayurvedacollege.com/book/export/html/2
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Dr. Marc Halpern is an internationally recognized expert in the field of Ayurvedic Medicine. He is the Founder and director of the California College of Ayurveda and cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He received the AllIndia award for “Best Ayurvedic Physician” from the Hakim Ajmal Khan Memorial Society, presented to him by the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He sits on the advisory board of Light on Ayurveda Journal. Contact him through www.ayurvedacollege.com.
The Five Elements: Water in Ayurveda Author: Dr. Marc Halpern Published: Light on Ayurveda Journal Copyright: California College of Ayurveda. Do not duplicate or distribute without written permission. The element water, called “apas” in Sanskrit is the forth of the five great elements (pancha mahabhutus). It comes fourth because it evolves from ether, air and fire containing the essence of these elements within it. Ether provides water the space to exist within. Air provides water with the ability to move and flow. The relationship between fire and water is more esoteric. Air creates the friction that generates the heat of fire. Fire moves in a fluidic or flowing manner. In each evolution from one element to the next, nature becomes denser. As fire becomes denser it cools and takes greater form. This is the form of water. The water element represents fluidic matter and the cohesive principle of physics. . Water is the protector of the body. It provides the body with its most basic nourishment. Water protects against the dissolution of the ether element, the roughness and motion of the air element and the heat of the fire element. The water element sooths all pain and inflammation in the body. The origin of the water element is the tanmatra of taste called rasa. Rasa in this context is the primordial causation of the experience of taste. Rasa is the causal energy that provides the potential for the experience of taste to occur. It is not the taste itself. However, since taste depends upon the water element for its manifestation, disorders of the ability to taste are due to an imbalance of the water element. Water: Sense Organ and Organ of Action The tongue is the vehicle through which the rasa tantatra manifests. The tongue is the sense organ of water. Through the tongue we taste the world around us. It is interesting to note that the taste buds of the tongue only work, when water or saliva is present. No water, no taste. The urethra is the organ of action. Through the male urethra, highly potentized reproductive fluid is expelled from the body. Through the male and female urethra, water is expelled in the form of urine. Imbalances of the water element in the body can be observed by monitoring changes in a person’s experience of taste as well as through alterations of urine or seminal fluid. The Qualities of Water http://www.ayurvedacollege.com/book/export/html/2
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To know any element is to know its qualities. Water is cool, stable, heavy, moist, smooth, gross, flowing, dull, cloudy and soft. The water element is the antidote to symptoms that have the opposite qualities in the body. It is important to take in the qualities of water when you are feeling too warm, ungrounded, emaciated, dehydrated, rough, lacking in selfesteem, obstructed and immobile, irritable with a sharp tongue, transparent and vulnerable or if your heart has become too hard. The Five Waters of The Body In the human body, water is expressed in five distinct ways known as the five types of kapha. . The water that protects the mouth against the actions of chewing and against the enzyme that begins the breakdown of carbohydrate (salivary amylase) is called bodhaka kapha. Bodhaka kapha is the salivary fluid and also the mucous membrane secretions of the lips, checks and pharynx. The water that protects the mucous membranes of our stomach against the acids that aid digestion is called kledaka kapha. The water that stablizes the flow of neurological impulses and protects the nerves of the brain is called tarpaka kapha. The water that protects the joints from the friction of motion is called sleshaka kapha. Sleshaka kapha is found in the synovial fluid that moistens joint surfaces and in the burse that allow tendons to glide smoothly over each other. The water that protects the respiratory system from the movement of breath (A drying process) is called avalambaka kapha. Avalambaka kapha keeps the mucous membranes of the bronchi and lungs healthy and also provides the fluids that support the pleura and pericardium. . Water and the Kapha Dosha The kapha dosha contains both water and earth. It is water that is responsible for most of the protective and healing aspects of the kapha dosha. As water is the foundation for earth in the body (water supports earth’s heavy, stable qualities) an increase in the qualities of water will result in weight gain and sluggishness. Consequences of Excess and Deficient Water on the Dhatus Tending the waters of the body begins with caring for kledaka kapha in the stomach. The stomach is the home of the kapha dosha. If the qualities of water increase too much, they overflow from the stomach into circulation and flood the tissues of the body. When food is taken in that is too moist or oily, water builds up and reduces the strength of the digestive fire. Digestion becomes impaired and food moves slowly through the digestive system. The accompanying reduction in appetite and a sense of heaviness in the abdomen are among the earliest signs that kapha is increasing and out of balance. As water overflows from the digestive system, it often settles in the watery tissues of the body. These tissues are the rasa (plasma), medas (fat) and shukra (fluidic reproductive tissue) dhatus. The quantities of these tissues increase resulting in edema, obesity and an increase in genital waste secretions (smegma). Secondary watery tissues increase as well resulting an increase in menstrual flow in women and in breast milk supply. Unfortunately, the quality of the increased breast milk and menstrual fluids are of poor quality and are often mixed with mucous. Water deficiency results in many of the opposite qualities. The rasa, medas and shukra become too dry resulting in dehydration, dry mucous membranes, dry skin, weight loss and weakness in the reproductive tissues respectively. A dry rasa also results in a decrease in urination, sweating and in the formation of dry, hard stools. In addition, the lips and eyes become dry. Water in the Diet In our diet, the sweet taste is the main source of water. Cooked grains, nonfermented dairy, oils, nuts and fatty meats are foods with ample water http://www.ayurvedacollege.com/book/export/html/2
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element within them. The proper intake of these foods supports healthy water element in the body. Excess intake results in the symptoms of excess noted above. Deficient intake results in the symptoms of deficiency. Water and the Seasons Spring is the season of water. It is the season in which the water stored within the snow begins to flow from the mountains into the rivers and streams. Water is the source of life and the container of prana. As the water begins to flow, life grows in its wake. Spring is sweet and its sweetness nourishes all of life. During this time, the water element in our bodies naturally increases and flows . It is important to keep the water from overflowing in our bodies at this time by making sure that we do not over indulge in sweets, meats and oils. Water and the Cycle of Life In the cycle of life and death, water represents the years of our learning in preparation for performing dharma. Our water years are the years of cohesion. These are the years of schooling and training as we attract and draw in the knowledge and information we will later use during our fiery pitta time of life. Dr. Marc Halpern is an internationally recognized expert in the field of Ayurvedic Medicine. He is the Founder and director of the California College of Ayurveda and cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He received the AllIndia award for “Best Ayurvedic Physician” from the Hakim Ajmal Khan Memorial Society, presented to him by the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He sits on the advisory board of Light on Ayurveda Journal. Contact him through www.ayurvedacollege.com.
The Five Elements: Earth in Ayurveda Author: Dr. Marc Halpern Published: Light on Ayurveda Journal Copyright: California College of Ayurveda. Do not duplicate or distribute without written permission. The element water, called “prithvi” in Sanskrit is the fifth of the five great elements (pancha mahabhutus). It comes fifth because it evolves each of the other four elements (ether, air, fire and water) containing the essence of these elements within it. Ether provides earth the space to exist within. Air provides earth with subtle movements seen on a subatomic level. Fire (energy) is latent within earth, bound by the chemical bonds of nature that hold structure together. Einstein quantified the relationship as E=MC2. E (energy) represents the fire element. M (mass) represents the earth element. C (Speed of light) represents the air element. Water is also inherent within earth. Water is the bridge between the gaseous state of mater and the solid state. As matter becomes denser, gas (air, ether and fire) coalesce into water (fluidic matter). The process of densification continues until matter becomes solid. Earth is the elemental representative of the solid nature of matter. . http://www.ayurvedacollege.com/book/export/html/2
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The Earth element represents solid matter and the structure of the universe. Earth gives form to the human body and to all of creation. The structure provided by earth is the conduit through which the other elements flow. All elements are born of ether and contained within earth. The origin of the earth element is the tanmatra of smell called gandha. The state of the earth element in the body and the capacity to smell are deeply connected. Gandha tanmatra is the primordial cause of the experience of smell. It is the seed energy or potential, emerging from the causal body that sprouts into the earth element. The earth element then builds the potential for the experience of smell in the subtle body and the structures through which smell can be experienced in the physical body. Thus, the Gandha tanmatra is not the smell itself but smell is dependent upon it. Disorders of the ability to smell reflect an imbalance of the earth element. Earth: Sense Organ and Organ of Action The nose is the vehicle through which the gandha tanmatra manifests. Through the nose we take in the scents of creation. These impressions enter the body, mind and consciousness deeply affecting us physically and emotionally. The rectum is the organ of action. Through consumption and defecation, the balance earth element in the body is regulated. If too much earth is released as occurs in diarrhea, body structure weakens. If too little earth is released as occurs in constipation, the body remains strong for a while but becomes more and more toxic. Because the earth element and smell are intimately connected, both diarrhea and constipation negatively impact the ability to smell. Excess earth element can obstruct the sense of smell while deficient earth element can weaken the structures responsible for smell. Thus, healthy elimination is essential to the balance of the earth element, the sense of smell and the overall wellbeing of the body. The Qualities of Earth To know any element is to know its qualities. Earth is cool, stable, heavy, dry, rough, gross, dense, dull, clear and hard. The earth element is the antidote to symptoms that have the opposite qualities in the body. It is important to take in the qualities of earth when you are feeling too warm, ungrounded, chaotic, emaciated, fluidic, lacking in selfesteem, feeling insignificant, irritable with a sharp tongue, vulnerable or if you can not withstand stress. Earth and the Kapha Dosha The Kapha dosha is made up of earth and water. Water with its cool and soothing properties provides the primary protection of the body against the factors of heat (pitta) and movement (vata). Earth provides underlying structure and foundation that allows for the growth and development of tissues. As kapha dosha increases in the body, there is a general increase in both fluid and structure, though one can increase less than or without the other. Increases in the earth element results in a thickening of the structures of the body. Of the seven dhatus of the body, earth is found in significant quantity in the mass that makes up the mamsa and medas dhatus. It also makes up the solid structural component of the ashti dhatu. These three dhatus are immediately dependent upon a healthy earth element in the body. While the other dhatus do not have large amounts of earth contained with them, they could not hold their form without it. Thus, earth provides the basic structure of the rasa, rakta, majja and shukra dhatus as well. Thus, the entire body is dependent upon the earth element for its health and wellbeing. Consequences of Excess and Deficient Earth on the Dhatus Earth enters the body through the foods we consume. While the earth element provides the structure of all food, is found in the largest amounts in grains, nuts, legumes and meats. It is found in moderate amounts in dairy products and in small amounts in fruits, vegetables and spices. When an http://www.ayurvedacollege.com/book/export/html/2
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excess of the earth element is taken into the body, as occurs with overeating, the tissues of the body are provided with an excess of raw material for building new tissues. Existing structures become larger where an increase in size is possible and thicker / denser where the potential for longitudinal growth is limited. Excesses of earth that exceed the bodies’ capacity to convert it into other structures are stored in the body as a part of the medas dhatu (fat). An examination of a patient with large amounts of the earth element in the body reveals thick skin, strong finger nails, large muscles and coarse, dense hair. Deficiencies in the earth element in the body result in a weakness of body structures. Lacking in the raw materials to build solid tissues, the bones become weakened and osteoporosis places the bones at risk of fracture. Muscle mass is reduced and body fat decreases. As one function of the earth element is to retain heat, the bodies’ ability to regulate internal temperature decreases and an individual easily feels cold. Lacking in substance, a person with a deficiency of earth is unable to stand up against the challenges of the world and is easily pushed aside by stronger forces. Earth and the Seasons Earth is prevalent in the seasons of late winter and early spring. In the late winter, the earth element is most predominant as the environment is dry, static, solid and relatively dormant. Water that has fallen in form of snow is locked up in a solid state and unable to flow. In the early spring, as water begins to flow, the earth element provides the substance that will be utilized to begin building new structures as evidenced in the budding of trees. During the winter, it is important to make sure that the quantity of earth element is properly proportioned in the diet in accordance with prakruti and vikruti of the patient. In general, due to the seasonal influence, less earth element should be consumed than at other times of the year. However, too little of the earth element in the diet at this time will make it difficult to maintain strength and body temperature. Thus, fasting and strong purification should be avoided during the excessively cold winter months. As the waters begin to flow in the early spring, purification is more optimal. If a great amount of the earth element is taken in excess during the dormancy of the winter, there can be a great increase in body fat. Earth and the Cycle of Life In the cycle of life and death, earth represents the gestational period inside the womb where the basic structure of the body is formed. During this time, proper maternal nutrition providing the necessary earth element is essential for proper growth and development. A lack of earth element at this time can permanently cripple a child. The earth element continues to play an important role in the development of the child until growth is complete. Dr. Marc Halpern is an internationally recognized expert in the field of Ayurvedic Medicine. He is the Founder and director of the California College of Ayurveda and cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He received the AllIndia award for “Best Ayurvedic Physician” from the Hakim Ajmal Khan Memorial Society, presented to him by the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He sits on the advisory board of Light on Ayurveda Journal. Contact him through www.ayurvedacollege.com.
The Seven Dhatus (tissues) in Ayurvedic Medicine http://www.ayurvedacollege.com/book/export/html/2
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The seven dhatus are the seven tissues of the body: In English they are; plasma, blood, muscle, fat, bone, marrow / nerve and reproductive tissue. In Sanskrit, they are rasa, rakta, mamsa, medas, asthi, majja and shukra. These are the structures that make up the body. However, like most concepts in vedic literature, they are much more than their onedimensional definitions, they are integral to understanding the relationships of the tissues in the body and they are sites that doshas enter when they cause disease. An understanding of the seven dhatus is important to understanding pathology or, what goes wrong in the body. When a dosha enters a dhatu, a proper understanding of the dhatu helps the practitioner predict the symptoms that will manifest and provides clues to the best treatment. The following articles were written by Dr. Marc Halpern, College Director.
Rasa Dhatu: A closer look Advanced Ayurvedic Theory Rasa dhatu refers to the primary waters of the body. The word rasa means sap, juice or liquid. In the physical body, rasa refers directly to the plasma or non cellular portion of the blood, the lymph and interstitial fluids. As watery secretions, rasa dhatu relates indirectly to breast milk and menstrual fluid. Rasa is more than fluid, it is nourishment. Sugar and nutrients mix with the plasma and are carried by vyana vayu to all of the tissues of the body. As such, when rasa dhatu is healthy, a person feels satiated. The satisfaction one feels is both physical and psychological. Physical satisfaction is the sense of health and wellbeing that every cell experiences when it is well nourished. Psychological satisfaction is the feeling that our most basic needs have been met. As a result, there is a solid foundation for healthy psychological growth. With physical and psychological satisfaction, the foundation is set to be of service to society and fulfill one’s dharma. The rasa dhatu, being made up of the element water, has similar qualities. It is cold, heavy, moist, soft, stable, smooth, flowing, cloudy, gross and dull. These qualities are very similar to kapha dosha, which is made up of water and earth. Thus, the health of rasa dhatu plays an important role in determining the health of kapha dosha. In the formation of the dhatus, kapha is the mala (waste product) produced by the formation of rasa dhatu. When rasa dhatu is depleted, the qualities of kapha and water diminish. The skin becomes dry and rough, dryness in the bowels produces constipation and dry mucous membranes lose their ability to resist disease becoming fertile ground for infections. In addition, the secretion of breast milk is diminished in nursing mothers and menstrual flow becomes scanty. In the mind, nothing seems right. There is growing dissatisfaction that can not be easily satiated by changes in the environment. It is vata and pitta doshas that are the cause of rasa dhatu depletion. Vata dosha, made up of air and ether, enters the rasa dhatu and dries it out. Pitta dosha, made up primarily of fire, enters the rasa dhatu and burns it out. Activities that reduce rasa dhatu are those that increase vata and pitta doshas. Activities such as excessive travel, talking too much, being very busy and a diet that lacks in water and oils increase vata dosha. Pitta dosha http://www.ayurvedacollege.com/book/export/html/2
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increases due to a lifestyle that is too highly focused, competitive and intense as well as from a diet that is too spicy hot. Thus, a lifestyle that increases vata or pitta dosha decreases the rasa dhatu resulting in dissatisfaction in the mind and the consequences of dryness in the body. When rasa dhatu is in excess, the qualities of water and kapha dosha increase. Excess leads to water retention, swelling and mucous formation in the body. In women, menstrual flow becomes heavier and lasts longer. The mind becomes dull, cloudy and sluggish, and it lacks luster. The mind is happy but that happiness is superficial. It is dependent upon retaining the material objects of satisfaction. It is kapha dosha that increases the rasa dhatu and the rasa dhatu that increases kapha dosha. The two are inseparable. It is the water element that feeds both of them. Kapha dosha increases when a person becomes too lazy or quiet and when the diet is too moist and heavy. In the subtle body, the qualities of water flow through svadhistana chakra and ida nadi bringing about deeper feelings and drives including: desire, compassion and love. When rasa dhatu is healthy, these feelings and drives are well balanced within the constitutional nature of the individual. As rasa dhatu becomes depleted, the flow of watery qualities through the nadi and chakra decreases, resulting in a decrease in these feelings and drives. When rasa dhatu is in excess, these feelings and drives increase. However, as they increase beyond their constitutional balance, they become tainted by the attachments and the desires of the ego. Healing rasa dhatu means restoring the proper quantity and quality of water. The proper quantity is based upon the constitutional tendency of the individual. Those with more kapha in their constitution will naturally have more rasa dhatu. This makes depletion less likely and excess more likely. Those with more of a vata or pitta constitution tend to have a naturally lower amount of rasa dhatu and are more susceptible to depletion. Those with a pitta nature tend to have a little more rasa than those with a vata nature as pitta dosha naturally contains some water. The quantity of rasa dhatu depends upon fluid intake. While it is logical that water itself would build the rasa dhatu, this is not entirely true. Rasa is more than water; it is the water that carries dissolved nutrients. Salt and sugar are the most important of these nutrients. Salt, in addition to its many physiological functions, helps retain water in the body. Sugar is the primary nutrient of the body. As a result, taking juice is the best way to replenish rasa. Rasa is also replenished through the intake of saptype fluids such as maple syrup and agave nectar. Thus, herbal teas that are sweetened with these substances are much better than water alone in rebuilding rasa dhatu. The quality of the rasa dhatu is dependent upon the health of agni or digestion. Rasa dhatu is produced from the digestion of food and liquid. Food and liquid are initially digested in the digestive system and according to ayurvedic theory, turned into ahara rasa (milky substance similar to chyle). This fluid is then further digested within the sleshma dhara kala by the rasagni. The health of this fire determines the quality of rasa produced. When the rasagni is ideal, healthy rasa dhatu is produced along with minimal kapha dosha. In other words, transformation is efficient and there is little waste product produced. When the rasagni is low, the efficiency of the transformation is reduced. The quantity of rasa produced is actually greater but it is of poor quality. In addition, excessive waste is produced so kapha dosha increases. When the rasagni is too high, it efficiently converts ahara rasa to rasa dhatu but also burns up some of the rasa dhatu that is being produced. Thus, a smaller amount of rasa dhatu is produced and there is deficiency. There is also minimal waste. Thus, kapha dosha is reduced. The state of rasagni is dependent upon jatharagni the main digestive fire. If jatharagni is healthy, so too will be the rasagni. In order to determine the health of the rasagni it is necessary to observe the results of digestion – the rasa dhatu. The rasa dhatu can be observed by evaluating the state of http://www.ayurvedacollege.com/book/export/html/2
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the mucous membranes of the body as well as the quantity and quality of any breast milk or menstrual fluid produced. It is easiest to observe the mucous membranes by looking inside the mouth, at the lips, or at the eyes. If the membranes are dry, red or inflamed or if the lips are cracked, then rasa dhatu is depleted. The state of the skin also tells about the state of rasa. When rasa dhatu is severely diminished, sweating is decreased and the skin becomes dry and cracked. If the cause of the depletion is due to rasagni being too strong, there will be signs of excess heat such as burning and redness of the membranes. This is due to an increase in pitta dosha. If the cause of depletion is due to vata dosha, it will have been caused by an insufficient intake of appropriate fluids along with a fluctuating, unstable agni. There is simply not enough fluid to build adequate rasa dhatu and, due to the variable nature of rasagni, that conversion is poor. On the other hand, if the mucous membranes are excessively moist or mucusy, if the skin is excessively moist and if menstrual fluids and breast milk are produced in excess, rasagni is low and rasa and kapha dosha are in excess. In order to raise the state of jatharagni and rasagni and lower the amount of rasa being produced, it is important to take in hot spices such as ginger, cumin and black pepper. These should be taken while reducing the amount of salty and sweet fluids in the diet. In order to lower the state of jatharagni and rasagni and increase the amount of rasa being produced, it is important to takes in heavy, harder to digest foods such as fats and oils. These foods are classified as having a sweet taste and include many nuts and meats. Nuts contain large amounts of oils and meats contain salty juice (animal rasa and rakta). Food should be cooked in large amount of ghee and other oils as well. These foods should be taken with an appropriate but not excessive amount of spice. I should note that the bitter taste also reduces rasagni. However, when rasa dhatu is already depleted, it should not be used as it has a drying nature. In summary, rasa dhatu provides the body and mind with sustenance. It is the sap that runs through the vessels of our bodies. It is important to take good care of it and assure that life is satisfying.
Rakta Dhatu: A closer look Advanced Ayurvedic Theory Rakta dhatu refers to the primary fire of the body. The word rakta means colored as well as reddened. Depending upon its usage, it can also mean impassioned. Each of these meanings has important implications from the perspective of health and healing. In the physical body, rakta refers directly to the blood, specifically the red blood cells, and indirectly to the tendons and the bile. Rakta dhatu is more than blood. It is the carrier of the fire that invigorates the body and mind. As such, when rakta dhatu is healthy, a person feels energized with a healthy passion for life. When rakta dhatu is in excess, heat in the body increases, the tissues of the body experience inflammation, and the mind experiences greater intensity and sharper focus. When rakta dhatu is deficient, the heat in the body decreases and the tissues of the body become cold and stiff while the mind loses its sharpness and focus. http://www.ayurvedacollege.com/book/export/html/2
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The rakta dhatu, being made up primarily of the element fire, has similar qualities. It is hot, light, dry, hard, unstable, rough, flowing, clear, subtle and sharp. These qualities are very similar to pitta dosha which is made up of mostly fire and a little water. Thus, the health of rakta dhatu plays an important role in determining the health of pitta dosha. In the formation of the dhatus, pitta dosha is the mala (waste product) produced by the formation of rakta dhatu. Rakta dhatu also has a special relationship to the liver. The liver is the site of origin of the raktavaha srota the channel through which the unstable form of rasa (posya rasa dhatu) must pass prior to the formation of rakta. When the rakta dhatu is overheated, so too is the posya rasa dhatu. As a result, the liver and spleen become overheated and possibly enlarged. This is what occurs during hepatitis. When rakta dhatu is depleted, the qualities of pitta dosha and fire diminish. A person feels cold, the skin loses its luster becoming pale or dusty gray, and coldness causes the body to hold on to heat by becoming constipated and by reducing urination and sweat. In the mind, depletion of the rakta dhatu leads to dullness, and difficulty processing and understanding new information. This often leads to confusion and misunderstandings. When the rakta dhatu is in excess, the qualities of pitta dosha and fire increase. A person feels warmer. As heat builds up in the body, the body tries to release the heat. This occurs in several ways. One way is through the skin. Vasodilatation brings blood to the surface in order to cool it off. This makes the skin appear redder. At first, the skin takes on a nice luster but if the heat continues to build, rashes develop. Vasodilatation may also be seen in the eyes which also become reddened. The body tries to release the excess heat along with the malas of the body. The frequency of bowel movements increases and the stools may become loose. The frequency of urination also increases. The most noticeable sign of the body trying to reduce excess heat, however, is often experienced as an increase in sweat. If the excess heat can not be adequately removed, it will result in burning sensations within the mucous membranes and eventually inflammation and fever. As the heat spreads, any tissue or organ can be affected. It is vitiation of the pitta dosha that causes the rakta dhatu to increase. This is often a confusing concept as pitta dosha, being light, depletes the rest of the dhatus. Pitta dosha, however, increases the rakta dhatu due to their similar natures. The fire of pitta increases the fire of the rakta dhatu. An increase in the rakta dhatu results in feeling warmer and more intense. Lifestyle factors that increase the rakta dhatu are those that increase pitta dosha such as intellectual study, focus and exercise as well as a diet that is too hot and spicy. While pitta dosha vitiation usually increases the rakta dhatu when it goes on for too long or becomes too intense, it will eventually burn out the dhatu. This results in a decrease in the dhatu. The body becomes unable to hold onto the heat – feels cold and becomes easily fatigued. Most practitioners equate this with a vata imbalance. However, it is the result of burn out. When the rakta dhatu has increased, all of the activities of the body become more intense. In women, menstrual flow intensifies becoming very heavy but only for a few days. A person’s mood intensifies and small things seem very important. One’s sense of dharma intensifies but the imbalance leads to a state of mind in which the end justifies the means. Thus, integrity is often compromised for the sake of accomplishment. As heat builds throughout the body, there is joint and skin inflammation, redness of the eyes and even the blood vessels themselves become inflamed. Fever is possible. Many of these symptoms occur within the family of Rheumatic or Connective Tissue Disorders. These diseases result in an auto immune response that generates inflammation. It is the pitta dosha that increases the rakta dhatu and the rakta dhatu that increases the pitta dosha. The two are inseparable. Thus, whenever pitta dosha is vitiated, the rakta dhatu must be treated and visa versa. Vata vitiation results in a decrease of the rakta dhatu. The light nature of vata dosha can reduce the red blood cells count. The cold nature of vata dosha reduces the firecarrying capacity of the rakta dhatu. As a result of depletion, the body becomes both cold and fatigued. Activities that reduce http://www.ayurvedacollege.com/book/export/html/2
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the rakta dhatu are those that vitiate vata dosha such as irregular eating habits and skipping meals. These habits result in malabsorption and malnutrition. Vitiation of kapha dosha has an interesting effect on the rakta dhatu. Due to its heavy and gross nature, kapha dosha increases the rakta dhatu. This may result in a greater number or size of the red blood cells. However, due to the cold nature of kapha dosha, the quantity of heat carried by the rakta dhatu decreases. Thus, the patient experiences a lack of energy (sluggishness) as well as a feeling of being cold. Lifestyle factors that vitiate kapha dosha within the rakta dhatu include laziness, a lack of exercise, a disinterest in intellectual exploration and a diet that is bland. In the subtle body, the qualities of fire flow through the manipura chakra and the pingala nadi bringing about strong and intense drives and feelings including: passion, focus, reason and logic. The state of the rakta dhatu is tied to the flow of prana through these energetic channels. When rakta dhatu is healthy, these feelings and drives are well balanced within the constitutional nature of the individual. As rakta dhatu becomes depleted the flow of fiery qualities through the nadi and chakra decrease and there is a decrease in these feelings and drives. When rakta dhatu is in excess, these feelings and drives increase. However, as they increase beyond their constitutional balance, they become tainted by the attachments and the desires of the ego. Healing the rakta dhatu means restoring the proper quantity and quality of fire in the body and mind. The proper quantity is based upon the constitutional tendency of the individual. Those with more pitta in their constitution will naturally have more rakta dhatu. This makes depletion less likely and excess more likely. Those with more of a vata constitution tend to have a naturally lower amount of rakta dhatu and are most susceptible to depletion. Those with a kapha constitution tend to have an adequate quantity of rakta dhatu. However, the dhatu tends to be of poorer quality. The quantity and quality of rakta dhatu depends upon the intake of the fire element. Food must first be digested by the main digestive fire (jatharagni). This produces ahara rasa which is then digested by rasagni to produce rasa dhatu and its related tissues. A portion of the rasa dhatu is then digested by the raktagni to produce rakta dhatu and its related tissues. When rakta agni is functioning properly and when it has received adequate rasa for transformation, the rakta produced will be of an ideal quantity and of the highest quality. When the raktagni is low, a greater amount of rakta is produced. However, this is of poor quality. This occurs when kapha is vitiated. When raktagni is too high, less rakta is produced but it is supercharged in the sense that it is very hot. This is what occurs when pitta is vitiated. When raktagni is variable, too little rakta is produced and it is of poor quality. This is what occurs when vata dosha is vitiated. Thus, the care of the rakta dhatu is dependent upon the health of raktagni. Since the health of the rakta agni is partially dependent upon the health of jatharagni, attention must be paid to both agnis in order to restore health. In order to evaluate the health of the rakta dhatu, the blood should be evaluated. The red blood cell count tells of the quantity of rakta dhatu that is present. Cellular morphology and the levels of hemoglobin are indicators of its quality. Of course, not all ayurvedic practitioners have the ability to order blood tests or have been trained to read them. And, even if they were, blood tests alone are insufficient to tell the health of the rakta dhatu as the dhatu is more than blood. Some imbalances do not show up in the blood tests but can be observed in other ways. Examination of the rakta dhatu should include an examination of the complexion of an individual, palpation of the liver for size and tenderness and observation of the sclera of the eyes for red or yellow discoloration. The tendons of the body should be palpated and the practitioner should inquire if there is a history of tendonitis. The tendons are an upadhatu of the formation of the rakta dhatu. Tendonitis is one indicator of pitta vitiation within the rakta dhatu. While taking the case history, the practitioner should also inquire as to whether there is a recent history of abnormal bleeding from any part of the http://www.ayurvedacollege.com/book/export/html/2
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body. When pitta enters the rakta dhatu, bleeding in the body tends to increase. While many of these indicators are found in the late stages of rakta dhatu vitiation by pitta dosha, the earliest indicator is often just feeling warmer than usual or becoming more sensitive to heat.
Mamsa Dhatu: A closer look at the muscles from the ayurvedic perspective Advanced Ayurvedic Theory Mamsa dhatu refers to the muscles of the body, but the term literally means flesh or meat. In the physical body, mamsa dhatu refers directly to the muscles and indirectly to the ligaments and skin, which are upadhatus formed as the unstable form of rakta dhatu (posaka rakta) is converted to mamsa dhatu. Mamsa dhatu is more than muscle; it is the provider of strength, courage, fortitude and selfconfidence. It is also the vehicle through which we express ourselves. When healthy, our muscles work in a modest fashion to express the needs and desires of the ego, while also available to express the creative inspiration of the Divine. In other words, our flesh (body) is the expressive vehicle of both the jivatman (that part of our soul that identifies with the ego) and the paramatman (that part of our soul that identifies with the Divine). Muscle is built from earth and fire and is then motivated by air. Earth provides the substance from which the bulky structure of muscle is made. Fire ignites the engine that directs its focus and action. Muscle is a highly metabolic tissue. While earth and fire play their fundamental roles in building the tissue, it is air that inspires and initiates its motion. In order to produce healthy mamsa dhatu, adequate earth must be consumed through the diet. Earth element is found in large amounts within grains, nuts, meats and legumes. Consumption alone, however, is not enough to build mamsa dhatu. The earth element must be properly digested so that its qualities can be reused to build mamsa dhatu. Thus, jatharagni (main digestive fire) must be healthy, as well as the mamsagni – the agni which transforms posaka rakta dhatu into mamsa dhatu. While the function of the mamsagni is partially dependent upon jatharagni (the health of all secondary agnis depend on jatharagni), mamsagni itself is affected directly by exercise. The more a person exercises, the stronger mamsagni becomes. When mamsagni is too low, and there is adequate earth taken into the body, muscle and other tissues form but they are of low quality. As such, they are hard but proportionately weak. These muscles can do little work relative to their size. When mamsagni is too high, and there is adequate earth taken into the body, the muscles that form will be lean and strong but prone to inflammation. When mamsagni is balanced, the earth that is taken in will be converted to muscle that is healthy and capable of large amounts of work without injury. http://www.ayurvedacollege.com/book/export/html/2
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In the event that there is not enough earth element present to generate mamsa dhatu, then the body tissues that are formed will always be inadequate regardless of the state of mamsagni. However, if mamsagni is strong, the body will become very lean, the tissue formed will be prone to inflammation and eventually, if there is not enough earth to sustain the muscles, the agni itself will begin to devour the mamsa dhatu and there will be muscle wasting. Udana vayu is the force that inspires the contraction of muscle so that work (expression) can be accomplished. When mamsa dhatu is healthy, work is generated in a balanced and healthy manner. In the sattvic individual (one with a pure consciousness), the work generated is an expression of the Divine will. In the rajasic and tamasic individual (one with a distracted or ignorant consciousness), the work generated is an expression of personal will or ego. Mamsa dhatu, made up of earth and fire, has the following qualities: hot, heavy, dry, hard, unstable, rough, dense, cloudy, gross and sharp. These qualities are similar to a combination of pitta and kapha doshas and, as such, these doshas play the greatest role in its development and health. A balanced kapha dosha provides for proper structure and a balanced pitta dosha for proper metabolic function. Disturbances in these doshas are responsible for alterations of form and function. The amount of muscle and the thickness of the skin and ligaments depend upon a person’s constitution. Those with a vata prakruti have minimal amounts of muscle and thin skin and ligaments even when healthy and balanced. Those with a pitta nature have moderate muscular formation along with a moderate thickness of the skin and ligaments. Those with a kapha nature have larger muscle mass with thicker skin and ligaments. Regardless of the dosha, the tissues are healthy if they are consistent in formation with the doshic balance of the individual and are tone and supple. Vitiation of kapha dosha in the mamsavaha srota (channel that carries posaka rakta dhatu) results in low mamsagni. This results in excessive mamsa dhatu formation but the tissue formed is hard and inflexible. In addition, the upadhatus (secondary tissues) are similarly affected. Thus, the skin and ligaments of the body become thicker, harder and tighter. Psychologically, selfconfidence is quiet and strong but the motivation and courage to take action is lacking. Vitiation of pitta dosha in the mamsavaha srota results in high mamsagni. This results in less mamsa dhatu formation though the tissue formed is strong and lean. Skin and ligaments also become thinner and all three are prone to inflammation and injury. Psychologically, there is strength of will along with the courage to take chances and move forward. Selfconfidence is high. This is not necessarily as good as it sounds. Remember that pitta vitiation is an imbalance. Thus, the sense of confidence and strength that is present is driven by the ego. It is the confidence and strength of will that often results in injury and inflammation within the mamsa dhatu from pushing too hard. Vitiation of vata dosha in the mamsavaha srota results in a variable mamsagni. This also results in minimal tissue formation and the tissue formed is weak. In addition, the skin and ligaments become thinner and prone to injury. Vata vitiation within the mamsa dhatu is responsible for the greatest number of challenges within the tissues surrounding the joints of the body. Psychologically, a lack of mamsa dhatu results in a lack of emotional strength, courage and selfconfidence. This creates timidity, along with physical and emotional fragility. Summary of the Effects of Dosha Vitiation on the Mamsa Dhatu http://www.ayurvedacollege.com/book/export/html/2
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Vata Pitta Kapha Tissue Minimal tissue Minimal to moderate tissue Excessive tissue Muscle form and function Weak and prone to injury Strong but prone to inflammation Hard and inflexible Psychological Emotional fragility, low selfconfidence High selfconfidence, strong will Quiet selfconfidence, lacking in courage In the subtle body, the health of the mamsa dhatu is directly dependent upon the flow of prana through muladhara, manipura and vishuddha chakras. Through muladhara chakra, the prana that carries the qualities of the earth element flows allowing us to feel grounded and anchored to our bodies and to the body of planet earth. Proper tissue development is dependent upon a healthy connection to the mother Earth. Through manipura chakra, the prana that carries the qualities of the fire element flows igniting the metabolic functions of the body and mind – increasing will and motivation. The role of vishuddha chakra is less important in mamsa development but quite important as regards the proper use of the dhatu. Vishuddha chakra is the home site of udana vayu – the force that inspires the muscles to act and, in doing so, express ourselves. Only when the doshas are in a healthy state of balance is it possible to utilize the mamsa dhatu at the highest level. A healthy body allows for the complete fulfillment of dharma. Doshic disturbances of the body, disturbing the mamsa dhatu, interfere with one’s ability to serve. Healing the mamsa dhatu means restoring the proper quantity and quality of earth and fire in the body and mind. The proper quantity is based upon the constitutional tendency of the individual. Those with more kapha in their constitution will naturally have more mamsa dhatu. This makes depletion less likely and excess more likely. Those with more of a vata constitution tend to have a naturally lower amount of mamsa dhatu and are the most susceptible to depletion. Those with a pitta nature tend to have a moderate quantity of mamsa dhatu and are prone to depletion secondary to excessive fire. In order to evaluate the health of the mamsa dhatu, the muscles, ligaments and skin should be evaluated. Visual inspection allows for a quick assessment of muscular development. Palpation of the muscles provides an indicator of tone. Palpation of the ligaments and the joint capsule may reveal tenderness due to either vata or pitta vitiation. Vata vitiation within the mamsa dhatu results a low pain threshold and high pain sensitivity. This tissue surrounding the pain will feel cool to the touch. Pitta vitiation within the mamsa dhatu produces pain as well but the tissue surrounding the pain will feel warm and may appear reddened. Kapha vitiation rarely produces pain but the muscles will be taught and motion limited. The tissue may feel fluidic or boggy. The skin should be evaluated as well for excessive dryness, red rashes and fluidity reflecting vata, pitta and kapha doshas respectively. Once the mamsa dhatu is vitiated, it is important for treatment to be as specific as possible. While general lifestyle treatments that pacify the vitiated dosha are important, the more specific the treatment is, the more successful the outcome will be. Proper Treatment of the Mamsa Dhatu When kapha has entered the mamsa dhatu and mamsavaha srota, the best treatment is reducing the quantity of heavy foods and increasing agni in order to enhance muscle metabolism. Heavy foods such as nuts, grains, meats and legumes should be minimized and lighter foods such as http://www.ayurvedacollege.com/book/export/html/2
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vegetables and seeds should be increased. The pungent taste is the best taste as it reduces mamsa dhatu and increases agni. Thus, foods should be prepared accordingly and oral supplementation with hot spicy herbs such as the trikatu combination is appropriate. Exercise is the surest way to increase mamsagni and reduce the dhatu but only if food intake is minimized. Aerobic exercise is best. If a patient lifts weights then light weights should be lifted with many repetitions as the joints move through their full range of motion. Additional time in the sun is also supportive. Yoga asana to improve flexibility and heating pranayamas are also recommended. When pitta has entered the mamsa dhatu and mamsavaha srota, the best treatment is to reduce the strength of jatharagni and mamsagni. Jatharagni is reduced through the intake of cooling foods such as milk, butter, bitter vegetables, wheat and oats. The best taste for a quick effect is the bitter taste as it quickly reduces all agnis. The sweet taste, however, is better for the longterm management of high agni. Because it is heavy, its effects are longer lasting. Being moist, the sweet taste also provides protection against the heat. Thus, muscle or ligamentous inflammation responds quickly to bitter herbs such as kutki, gentian and barberry. Longterm treatment and also prevention of future inflammation can be better accomplished through the use of licorice root, shatavari or slippery elm. These herbs, being rejuvenative, also help restore the injured tissue. Exercise should be completely avoided as this increases mamsagni. Once inflammation is resolved, however, exercise can slowly begin but only in proportion to the amount of earth element that requires digestion. Excessive time in the sun should be avoided. Pranayama practices that are cooling should be practiced. Cooling forms of yoga asana may be practiced as soon as the inflammation is reduced. When vata has entered the mamsa dhatu and mamsavaha srota, the best treatment is to stabilize jatharagni and mamsagni and increase the intake of the earth element in proportion to the strength of agni. Stabilization is accomplished through the formation of regular daily routines – particularly those surrounding eating and sleeping habits. Earth element is increased through the intake of heavier foods such as grains, meats, nuts and legumes. In order to support and stabilize agni, warm spices should be taken but not those that are very hot. The best tastes are sweet and sour as they contain earth element. The sour taste containing fire element is even more beneficial as it has a longterm stabilizing effect on agni. When the sweet taste is utilized, it should be warmed with spices to add fire. For example, when sweet herbs such as ashwagandha, shatavari, licorice and slippery elm are used, they should be mixed with warmer spices such as ginger, cumin or cinnamon. Exercise may be performed but only in proportion to the amount of earth element that is in need of digestion. Thus, more exercise can be recommended so long as more nourishment is provided. Pranayama practices that balance agni, such as alternate nostril breathing, are beneficial. Yoga asana may also be practiced but should be restorative to the physical and energetic systems of the body. In summary, a healthy mamsa dhatu is necessary to do the work of life. In order to keep it healthy, it is important to know one’s prakruti and vikruti and then to take the appropriate actions that are necessary to restore balance.
Medas Dhatu: A closer look http://www.ayurvedacollege.com/book/export/html/2
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Advanced Ayurvedic Theory Medas dhatu refers to the fatty tissues of the body. While the term can literally be translated to mean fat, conceptually it means the concentrated waters of the body. In the physical body, in addition to body fat the medas dhatu relates to sebum (skin oil) and the greater and lesser omentums which are its updhatu. These tissues are the primary storage sites for excess body fat in the abdomen. Medas dhatu is formed as posaka mamsa dhatu flows into the medo dhara kala and is digested by the medagni. The waste products produced by the formation of medas dhatu are the skin secretions of sweat and sebum (oil). Medas dhatu is built primarily from the water element and secondarily from earth. The presence of water reveals the nourishing nature of fatty tissue. The presence of earth reveals its role in stabilizing the functions of the body and mind. Medas dhatu has a counterproductive relationship with the remaining elements. As it fills the empty space of ether it reduces inspiration. In excess, this results in a closed mind. It also acts as an obstacle to air slowing down the movements of the body. In excess, it creates lethargy. And it suppresses fire reducing metabolic activity. In excess, digestion becomes sluggish and all dhatus begin to increase. However, for these same reasons it is protective against conditions of excess ether, air and fire. In order to produce healthy medas dhatu, adequate earth and water must be consumed through the diet. Consumption alone does not guarantee that healthy medas will be formed. The two elements must be properly digested so that their qualities can be used to build body fat. Thus, jatharagni (main digestive fire) must be healthy. If it is not healthy, rather than forming healthy medas dhatu, these same foods will produce ama and toxify the body and mind. Pathology and the Medas Dhatu When kapha vitiates the medovaha srota and medo dhara kala, the medagni becomes low. As a result, the qualities of earth and water taken into the body are digested slowly causing a greater amount of fatty tissue to form. The tissue formed is of low quality. While the excess quantity produces weight gain, the low quality clogs the channels of the body, obstructs body motion, stagnates circulation and leads to greater emotional attachments. When pitta vitiates the medovaha srota and medo dhara kala, the medagni becomes too high. As a result, the qualities of earth and water are burned up quickly leading to little medas production. The medas that is produced is of high quality but there is simply not enough to provide protection, stability and deep nourishment. This results in weight loss and the body and mind becomes dry, fragile, hard and depleted. When vata vitiates the medovaha srota and medo dhara kala, the medagni becomes variable. The qualities of earth and water that have been consumed are irregularly digested. Less medas dhatu is produced and it is of poor quality. Once again there is weight loss and the body becomes dry, fragile, hard and depleted. The poor quality of the tissue produced contributes to irregular deposits of fat with the walls of the arteries and the body and mind become hard. Psychology and the Medas Dhatu Medas dhatu is more than the fatty and oily tissues of the body. It plays an important role in our capacity to love and be loved. You may recall that http://www.ayurvedacollege.com/book/export/html/2
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the health of the rasa dhatu plays an important role in the capacity of a person to feel satisfied. This satisfaction however is fragile and dependent upon being constantly fed. For this reason it is often short lived. The medas dhatu being a concentrated form of rasa deepens and stabilizes this feeling. When the medas dhatu is healthy, there is a deeper and longer lasting satisfaction that is less easily disturbed providing a solid foundation for love. The psychological aspect of medas dhatu is closely related to the functions of the majjavaha and samjnavaha srotas. The role of medas dhatu within the majjavaha srota is to protect the nervous system from excessive stimulation and in doing so keep the body calm. In the samjnavaha srota, a subtle channel located in the heart that connects individualized consciousness with the divine, a much more subtle form of medas protects consciousness from the intensity of the light of pure awareness. As medas dhatu and kapha dosha increase, the majjavaha srota becomes sluggish and less responsive. As neurological responses slow so too does thought and the mind appears dull. The samjnavaha srota becomes cloudy reducing awareness. As a result, the mind gets wrapped up in the dramas of attachment such as dependency, clinging and desire. Love becomes conditional and takes the form of deep attachment. As medas dhatu and kapha dosha decrease, the majjavaha srota becomes excessively excitable. The samjnavaha srota (channel of consciousness) becomes extraordinarily clear but also fragile and the light of pure awareness becomes irritating and agitating. This occurs as vata or pitta doshas reduced medas dhatu. As a result, the mind gets wrapped up in fear, anxiety or anger. Love becomes difficult to feel and when it is experienced, it is intense but fragile. In this state, the emotional heart is easily hurt and it is difficult to recover from feelings of betrayal or the grief of loss. In the subtle body, the health of the medas dhatu is directly dependent upon the flow of prana through muladhara and svadhistana chakras. Through muladhara chakra, prana carries the qualities of the earth element throughout the subtle body creating the feeling of being grounded and stable. Through svadhistana chakra, prana carries the qualities of water affecting our capacity to desire and experience pleasure through the senses. Thus medas dhatu, related to the flow of water is the physical manifestation of sensory desire. Strong sensory desire brings about increased medas dhatu (body fat). In the sattvic individual, kapha is in a balanced state with agni and only a healthy amount of high quality medas is produced and stored. In addition, there is proper flow of prana through the muladhara and svadhistana chakras. Earth and water are balanced for the constitution. Psychologically, the unencumbered heart sees clearly by the divine light without being blinded or agitated by it. The foundation for love is not only established, it becomes unconditional. Excessive or deficient medas dhatu is a consequence of a rajas or tamasic consciousness leading the mind into the dramas of samsara (worldly existence) and away from the doorstep of unconditional love Evaluating the Medas Dhatu In order to evaluate the health of the medas dhatu visual examination of the physical body is necessary. When medas dhatu is healthy, the body has an appropriate amount of body fat, the skin and hair are neither too oily nor dry and the voice is melodious and soft. Excessive medas dhatu reveals itself as excessive soft tissue, particularly in the abdomen. In addition, the skin and hair will be excessively moist and oily and the voice may become obstructed by oily phlegm. Deficient medas dhatu is observed as minimal body fat exposing the articulations of the body and the ribs. The face may appear gaunt. In addition, the skin and hair will be dry and there may be deeps cracks over the lips and on the tongue. The voice may crack often or become piercing, whiney or high pitched. http://www.ayurvedacollege.com/book/export/html/2
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Proper Treatment of the Medas Dhatu Healing the medas dhatu means restoring the proper quantity and quality of water and earth in the body and normalizing the flow of these qualities through the chakras. The proper quantity varies with the constitution of the individual. Those with more kapha in their constitution will naturally have more medas dhatu. This makes depletion less likely and excess more likely. Those with more of a vata constitution tend to have a naturally lower amount of medas dhatu and are the most susceptible to depletion. Those with a pitta nature tend to have a moderate quantity of medas dhatu and are prone to depletion only when exposed to excessive heat or when affected by a vata imbalance. When kapha has entered the medas dhatu and medovaha srota, the best treatment is reducing the quantity of heavy foods and increasing agni in order to enhance fat metabolism. Fatty foods such as nuts and fatty meats should be minimized and lighter foods such as vegetables and seeds should be increased. The pungent and bitter tastes reduce medas dhatu. Of the two, the pungent taste is best as it also increases agni. Thus, foods should be prepared accordingly and oral supplementation with hot spicy herbs such as the trikatu combination is helpful. Exercise including vinyasatype yoga practice along with exposure to the sun and saunas increases medagni and reduces the medas dhatu. Heating pranayamas such as kapalabhati and surya bhedana also reduce the medas dhatu. Bija mantras such as ham, yam and ram are beneficial as they increase the dry and light qualities that reduce medas. Patients should also avoid excessive sleep. When pitta has entered the mamsa dhatu and mamsavaha srota, the best treatment is to reduce the strength of jatharagni and medagni. Jatharagni is reduced through the intake of cooling foods such as milk, butter, bitter vegetables, wheat and oats. The best taste for a quick effect is the bitter taste. The bitter taste is very reducing and ideal when there is infection. Bitter herbs are stronger than foods and include kutki, gentian and neem. However, because the bitter taste is reducing it will lower the quantity of medas in the body. Thus, if the patient is in a state of depletion the sweet taste is best as it is both cool and nourishing. Sweet herbs that reduce agni include shatavari, slippery elm and licorice. The bija mantra vam is best as it cools and increases the qualities of the water element. When vata has entered the medas dhatu and medovaha srota, the best treatment is to stabilize jatharagni and medagni and then slowly increase the intake of the water and earth elements as agni becomes stronger and more stable. Stabilization is accomplished through developing regular daily routines – particularly those surrounding eating and sleeping. Earth element is increased through the intake of heavier foods such as grains, meats, nuts and legumes. In order to support and stabilize agni, warm spices should be taken but not those that are very hot. Examples include fennel, fresh ginger and fenugreek. The best taste is the sour taste as it increases and stabilizes the fire while nourishing the body. The sweet taste builds medas dhatu but should be taken with warm spices to assure that agni is strong enough to digest it. For example, when sweet herbs such as ashwagandha, shatavari, licorice and slippery elm are used, they should be mixed with warmer spices such as ginger, cumin or cinnamon. Exercise should be minimized in the depleted patient. Pranayama may be practiced in proportion to the patient’s state of ojas. Alternate nostril breathing is best. Yoga asana may also be practiced but should be restorative to the physical and energetic systems of the body. The best bija mantras to chant are lam and vam which increase the qualities of earth and water respectively. Patients should be supported to sleep well and if necessary a little longer than usual until balance is restored. In summary, a healthy medas dhatu is lead to a body that acts like a well oiled machine and a heart that is capable of love and devotion. In order to keep it healthy, it is important to know one’s prakruti and vikruti and then to take the appropriate actions to restore balance.
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Asthi Dhatu: A closer look at the bones from the ayurvedic perspective Advanced Ayurvedic Theory (the seven dhatus part V) Introduction Asthi means bone. The asthi dhatu gives solid structure to the body. In the physical body, asthi dhatu is formed as posaka (unstable) medas dhatu flows into the purisha dhara kala and is digested by the asthiagni. In addition to the formation of the bones of the body, teeth are formed through this process and are thus the upadhatu (secondary tissue) of the production of asthi dhatu. The waste products (malas) of this metabolic process are the hair and nails. The purisha dhara kala is the membrane that holds the asthi agni. Purisha means “feces”. The term is also used to describe the large intestine as in the purishavaha srota. Here lies an important clue of the relationship between health of the large intestine and that of the bones. The large intestine is the home site of vata dosha. The close relationship between these two tissues reveals the susceptibility of the bones to vata disorders. When there is pathology in the large intestine (gas, constipation) the pathology is transferred to the bones which become more porous and air filled. Such is the case of osteoporosis. Bones are made up of a solid structure organized as a matrix. This matrix can be visualized as the letter X. The lines that form the letter are solid and made of earth. The space between the lines are filled with air. Thus, bones create a solid but light structure allowing the body to easily move. Long bones have a hollow core that is filled with hemopoetic tissue called the marrow. This is an aspect of the majja dhatu. When the asthi agni is low, asthi dhatu is produced in excess. When this occurs, the tissue produced is denser. Those with a kapha nature having lower agni produce thicker and denser bones. Those with a pitta nature, having higher agni produce bones that are not as dense but are more metabolically active. This can lead to narrowing and weakness in the bones as well as inflammation if pitta becomes vitiated. Those with a vata nature, having a variable agni produce less asthi dhatu and that which is produced is of poorer quality. It is thinner and more fragile. In order to produce healthy asthi dhatu, adequate earth and air must be consumed in the proper balance through the diet. Earth is present in sweet foods such as grains and nuts and astringent foods such as beans. Air is present in bitter and pungent foods such as most vegetables. Consumption http://www.ayurvedacollege.com/book/export/html/2
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alone does not guarantee that healthy asthi will be formed. The two elements must be properly digested so that their qualities can be used to build bones. Thus jatharagni (main digestive fire) must be healthy. If it is not healthy, rather than forming healthy bones these same foods will produce ama and toxify the body and mind. Pathology and the Asthi Dhatu Bone pathologies can be simple or complex. Vata vitiation leads to weak or fragile bones that become osteoporotic and fracture easily. Pitta vitiation leads to bone infections (ostoemyelitis) and inflammation. Kapha vitiation leads to excessively thick, dense bones. Other diseases of the bones are more complicated. Osteoarthritis is a combined vatakapha condition in which vata (age, motion and stress) is responsible for provoking growth in an irregular fashion leading to bone spurs. Rheumatoid arthritis is a sannipatika condition whereby vata pushes kapha to cause irregular bone growth. Vata fans the flames of pitta causing inflammation and bone destruction. Ama is also present. Osteoblastic bone cancer is a sannipatika condition whereby vata simultaneiously pushes kapha (bone growth) and fans the flames of agni within the affected tissue creating a high metabolic state for growth. Osteoclastic bone cancer has a dual dosha pathology whereby vata combines with pitta resulting in a high metabolic state that destroys bone tissue. Psychology and the Asthi Dhatu Asthi dhatu is more than the structural tissues of the body. On a psychological level it is what allows a person to stand up for them selves within the world. Ones stature is not a function of size but quality. When the asthi dhatu is weak, so is one’s ability to stand solid in the face of adversity or controversy. This should not be mistaken as courage. It is steadfastness. It is the ability to be unwavering in one’s convictions. When the asthi dhatu is healthy there is a healthy confidence in one’s ideas, decisions and beliefs. As the asthi dhatu increases and becomes excessive, the qualities of the earth element increase and a person becomes overly attached, obstructive and stubborn. It becomes difficult to move or shift directions. When the asthi dhatu is deficient, the qualities of the earth element decrease and there is little attachment causing a person to shrink to the background flowing with the will of others. Kapha dosha is responsible for excesses in asthi dhatu. Vata dosha is responsible for deficiencies. Short term pitta imbalances do not greatly affect the psychological aspect of the asthi dhatu. However, long term vitiation burns out the dhatu resulting in deficiency. In the subtle body, the health of the asthi dhatu is dependent upon the flow through the muladhara chakra. Prana flowing through this chakra carries the qualities of the earth element throughout the subtle body and creates a solid sense of self. The flow of prana through anahata and vishuddha chakras are also important. Through these chakras, the qualities of air and ether are circulated respectively. As the flow of prana increases through these chakras so too do their respective elemental qualities and this results in a weakening of the asthi dhatu both physically and psychologically. Evaluating the Asthi Dhatu As you can not assess the health of the asthi dhatu directly except through medical testing, it is necessary to assess the asthi dhatu via the upadhatus and malas of its production. Thus, by examining the hair, nails and teeth the practitioner can infer the state of the asthi dhatu. When the asthi dhatu is deficient, hair density becomes scant. Hair loss may be distributed throughout the scalp or in patches. In addition, palpation of the nails reveals that they have become thin and break easily. The teeth will appear crooked or become darker (gray) than usual. These findings are consistent with deficiency due to vata vitiation. http://www.ayurvedacollege.com/book/export/html/2
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When the asthi dhatu is in excess, hair density if full. In addition, the nails are thick and the teeth large, straight and white. These are the signs of kapha vitiation within the asthi dhatu. However, these findings are more difficult to discern than deficiency as a person with a kapha prakruti will also exhibit these same findings. Thus, secondary signs of kapha vitiation should also be observed most especially those within the digestive system such as sluggish digestion and the mind such as stubbornness. When these findings are present in addition to dense hair, thick nails and white teeth it can be assumed that kapha has entered the asthi dhatu. When pitta has entered the asthi dhatu, the teeth and nails will become a pale shade of yellow and the hair will lose its color and turn gray. Over time, the nails will nails will become weaker and the hair may fall out as deficiency sets in due to burn out. Proper Treatment of the Asthi Dhatu Healing the asthi dhatu means restoring the proper quantity and quality of earth and air in the body and normalizing the flow of these qualities through the chakras. The proper quantity varies with the constitution of the individual. Those with more kapha in their constitution will naturally have strong asthi dhatu. This makes depletion less likely and excess more likely. Those with more of a vata constitution tend to have a naturally lower amount of asthi dhatu and are the most susceptible to depletion. Those with a pitta nature tend to have a moderate quantity of asthi dhatu and are prone to depletion only when exposed to excessive heat for an extended period or when affected by a vata imbalance. Diet and the Asthi Dhatu When vata dosha has entered the asthi dhatu the best treatment is to increase the quantity of earth element in the diet. Earth is found in the largest amount in sweet tasting foods such as grains, meats, nuts and bones and to a lesser degree in root vegetables. It is not found to any significant degree in fruits or leafy green vegetables. Thus, these should be deemphasized in the diet. When kapha dosha has entered the asthi dhatu, the best treatment is to decrease the quantity of earth element and increase the quality of the air element. Foods that are high in air include most fruits and leafy green vegetables. Note that excessive fruit may aggravate the watery aspect of kapha and so caution should be taken. The pungent and bitter tastes are best for increasing the qualities of air in the body. Thus, increasing the use of spices is important. In general, the diet should be light. When pitta has entered the asthi dhatu, it is important to decrease the quality of the fire element. Thus, the diet should be cool and deemphasize hot spices and cooked oils. Cooling foods that also nourish asthi dhatu such as whole milk, wheat and other grains should be taken. Beans may be taken if they are digested well and gas does not form.. Exercise, Yoga and the Asthi Dhatu Exercise increases the asthi agni supporting the formation of high quality boney tissue. Care should be taken when exercising however as weakness in the asthi dhatu makes the bones more likely to fracture. Thus, when significant weakness is present the patient should begin with mild weight bearing exercises. Walking is a healthy place for most patients to begin. However, in the most severe situations as often occurs in the elderly it may be best to begin with a reduced weight bearing exercise such as water aerobics. As time goes on exercise can become more weight bearing and may be practiced for longer periods of time. Weight bearing exercises are particularly beneficial for the spinal column, hips and legs but do not benefit the wrists and shoulder. Additional exercises that place stress on these joints are also important. A properly designed yoga practice can place appropriate stress on each of the joints of the body strengthening the asthi dhatu while providing the additional benefits of deep relaxation and mindfulness. http://www.ayurvedacollege.com/book/export/html/2
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Meditation, Chanting and the Asthi Dhatu Meditation for spiritual realization increases the qualities of the ether element in the body and mind. Thus, meditation for healing the asthi dhatu must be modified. Meditaiton while sitting on the floor creates a closer connection with the earth and is better than in a chair. Attention on the muladhara chakra and its connection to the earth also supports building the qualities of the earth element. Visualization of earth energy entering from the base of the spine during meditation and being circulated by the muldhara chakra creates a greater sense of feeling grounded and steady. This supports asthi dhatu. The mantra of the Muladhara chakra is lum. Quietly chanting lum with attention on muladhara chakra enhances the qualities of earth in the body and mind. Meditations that increase ether and air are beneficial when asthi dhatu is in excess and the earth element is too strong. Air fills the space created by ether and this purifies the asthi dhatu. Meditations on the anahata chakra and vishuddha chackras and chanting their respective bijas mantras; yum and hum increase the qualities of air and ether respectively. Herbs and the Asthi Dhatu: Several herbs are beneficial for treating bone weakness (osteoposis) and support healing due to fractures. These conditions are most commonly due to vata dosha vitiation. For these conditions comfrey, oatstraw and amalaki are all excellant. Comfrey has long been used for supporting the healing of bones following fracture. It is cooling and moist and blances vata and pitta doshas.. Oatstraw is a cool tonic that also also balances vata and pitta and has been shown to stimulate bone growth. Amalaki, an outstanding general tonic for the body is also traditionally used to support bone development. Bhringaraj is a important herb that can be used for both tonfiication of the bones and purification. It is most benefical for pitta dosha. Guggul and kutki are two herbs that are specific for purification of the bones and best for treating kapha dosha in the asthi dhatu. In summary, a healthy asthi dhatu leads to strong bones capable of carrying us though our lifetime. They allow for motion when movement is necessary and steadiness in the face of adversity. In order to keep the dhatu healthy, it is important to know one’s prakruti and vikruti and then to take the appropriate actions to restore balance. Dr. Marc Halpern is the founder and President of the California College of Ayurveda. An internationally respected expert in the field of Ayurvedic medicine, Dr. Halpern received the award for Best Ayurvedic Physician from the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He is a cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He is on the advisory board of Light on Ayurveda Journal in the United States and the Journal of Research and Education in Indian Medicine in Varansi, India. He can be reached at www.ayurvedacollege.com or [email protected]. Or by phone at 1866 541 6699
Majja Dhatu: A closer look at the nervous system from the ayurvedic perspective http://www.ayurvedacollege.com/book/export/html/2
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Advanced Ayurvedic Theory Introduction Majja means marrow as in bonemarrow (asthimajja). However, the term has become synonymous with nervous system which like bone marrow, is encased within bone. The skull is the casing of the brain. The vertebra are the casing of the spinal cord. While the brain and spinal cord make up the central nervous system, the Majja dhatu is associated with the entire nervous system. The nervous system and the bone marrow are treated as homologous structures in ayurveda. In the physical body, Majja dhatu is formed as posaka (unstable) asthi dhatu flows through the majjavaha srota into the majja dhara kala and is digested by the majjagni. In addition to the formation of the marrow, the sclera and the sclerotic fluids of the eye are formed. These are the updhatus of the production of majja dhatu. The waste products (malas) of this metabolic process are eye secretions. The health of the majja dhatu is dependent upon the state of the majjagni residing within the majjadhara kala. When the kala is infiltrated by vata dosha, agni becomes variable. When it is infiltrated by pitta dosha, agni typically become increased. When kapha dosha infiltrates the kala, agni becomes low. The state of agni determines the quantity and quality of the tissues that are formed, Kapha dosha vitiation complex of the kala results in excessive tissue formation though it is of low quality. Majja dhatu (nervous system) becomes denser and thicker resulting in slowing down the movement of nerve impulses (prana). This is observable in the mind as slower processing of sensory information and in the body as slower response times. Should kapha dosha increase further, not only might it slow down the flow prana, it may block or obstruct its flow. This results in aberrant flow. Symptoms of aberrant pranic flow secondary to a blockage mimic those of vata dosha and are often misdiagnosed as a primary vata imbalances. Pitta dosha vitiation results in minimal to moderate tissue formation. The tissue formed is highly efficient. Prana moves effectively through the nervous system. Processing and response times quick. However when pitta dosha increases too much the tissue formed becomes overly heated and prone to inflammation and excessive metabolism. Inflammation results in neuritis. Excessive metabolism results in burning out the protective structures surrounding and within the nerves. Deterioration of the myelin sheath as occurs in multiple sclerosis and post viral syndromes are examples. Within the brain, neurological structures may burn out as well. This occurs in some cases of Parkinson’s disease and dementia. Vitiation of vata dosha results in irregular tissue formation and the tissue that is formed is of low quality and fragile. Prana may move excessively or irregularly. When formation is minimal the stabilizing factors within the nerve are diminished and prana move quickly without restraint. Reactions are often sudden, too quick and not measured. Thus they may be dramatic. When formation is irregular, prana may also move in an irregular manner appearing at times to be excessive and other times deficient. This results hyper and hypo activity. In addition motion may be jerky as occurs in tics and some tremors . Long term vata imbalance ultimately results in drying and thinning of the tissues of the nervous system resulting in an inability of prana to move effectively. This appears like a kapha imbalance as flow of prana is deficient. Its inability to move however is not due to obstruction but to damaged structure. Discerning this condition from a primary kapha condition requires observing the http://www.ayurvedacollege.com/book/export/html/2
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broader effects of the dosha upon the body. In order to produce majja dhatu the primary elements that must be taken in the proper balance are air and water. The balance of air regulates the flow of nerve impulses. Water provides a counter balance to air, protecting the nerve against excessive motion and agitation. The brain as well the myelin that surrounds the structure of the nerve consists largely of fat. It is composed primarily of the element water and has kaphalike characteristics. Pathology and the Majja Dhatu Following accumulation and aggravation in the mahavaha srota (digestive system), the doshas overflow into the rasa and raktavaha srotas before relocating into the majjavaha srota and majja dhatu. While any dosha can relocate into the majja dhatu, pathologies of the nervous system are termed Vata Vyadhi meaning a disease of vata nature. Thus, nerve pathologies cause symptoms commonly associated with vata including pain and alterations of motion. Even still, vata dosha is not always the cause of the problem. Vitiation of pitta dosha leads to inflammation and over a long period of time can burn out the myelin and nerve tissue. Vitiation of kapha dosha may slow down nerve conduction, decrease the rate of processing information or cause blockages resulting in the aberrant flow of nerve impulses. Ama when present further complicates the condition. Psychology and the Majja Dhatu On a psychological level majja provides our sense of fulfillment, filling the void that we experience within. When majja dhatu is healthy, there is a sense of fullness and completion. When deficient, there exists a hollow feeling of emptiness. In excess, there is the feeling of stagnation that comes with being too full. Neither the body nor mind wants to move or work. There is a loss of motivation. In the subtle body, the majja dhatu is dependent upon the flow of prana primarily through svadhistana and anahata chakras. Through these chakras the qualities of water and air circulate respectively. Evaluating the Majja Dhatu The state of the majja dhatu may be assessed in many ways. While the nerves themselves can not ordinarily be seen, their function can be easily tested using standard Western neurological tests. Without western medical training, the health of the majja dhatu can also be inferred by observing the quantity of exudate produced from the eyes in the morning, the color of the sclera and the general luminosity of the eyes. This latter criterion is based on the subtle perception of the practitioner. Exudate that is dry and crusty is indicated of vata dosha imbalance. A large quantity of oily or mucousy exudate is indicative of a kapha imbalance. Yellow exudate which may be a little oily is indicative of the involvement of pitta dosha. Evaluation of the color of sclera is important as well. A dark, dull, gray indicates that vata has become vitiated. A yellow sclera indicates that pitta is vitiated. A white sclera that is dull indicates that kapha is vitiated. In observing the general luminosity of the eyes, a decrease in luminosity indicates the kapha has become vitiated. The eyes appear cloudy and dull. Interest is present but processing occurs slowly. An increase in luminosity is indicative of pitta vitation. The eyes appear to intensely interested, deeply engaged and too highly focused. Vitiation of vata dosha causes the eyes to appear vacant, lacking in attention and real interest. http://www.ayurvedacollege.com/book/export/html/2
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Proper Treatment of the Majja Dhatu Healing the majja dhatu means restoring the proper balance of the qualities of water and air within the dhatu. This process begins with taking the qualities of the elements in through the senses and then properly digesting them. While dietary intake is always the most important factor in healing the physical body, the nervous system is particularly sensative to input from all of the other senses as well. Diet and the Majja Dhatu When vata dosha has entered the majja dhatu the best treatment is to increase the quantity of water element in the diet. Water is found in the largest amounts in moist, oily foods and in those that are the most nourishing. Milk and ghee are the two most important substances. Milk and ghee restore deficient majja dhatu. Milk should always be taken warm with spices added to assure proper digestion. Ghee may be added to the milk or to other foods. In order to maximize the oily quality, the four fats are often recommended. The four fats are: ghee, bone marrow, sesame oil and muscle fat. Either ghee by itself or the four fats may be utilized as an anupana for the intake of herbs that nourish the majja dhatu. When pitta dosha has entered the majja dhatu, the best treatment is to cool the dhatu utilizing the sweet taste. The sweet taste is not only cool but also nourishing. Once again, increasing milk and ghee consumption are outstanding choices for dietary treatment. Sesame oil should not be taken however as it is too warming for regular use. Although the bitter taste is also cooling and pacifies pitta dosha, it should be used with caution as it can reduce the dhatu and aggravate vata dosha. When kapha dosha has entered the majja dhatu, the best treatment is to increase the flow of prana and decrease the qualities of water utilizing the bitter and pungent tastes. Raw vegetables, particularly leafy greens are best. In general the diet should be very light and dry and foods should be well spiced. Fasting is often appropriate and patients with a kapha imbalance may fast on light vegetables juices taken with spices for several days to a week. Exercise Yoga and the Majja Dhatu The flow of prana is directly related to the motion of the body and the mind. As motion increases, so does the flow of prana. Thus, when vata is vitiated in the majja vata, patients should not engage in activities that involve significant movement such as running, tennis, racquet ball and so on. Slower activities such as swimming and yoga better support the healing process. As there are many forms of asana, slower and gentler approaches are best. However, if the imbalance is severe, patients should avoid all activity. Slower approaches to activities are also best for pitta dosha when it settles in the majja dosha. Slower, gentler approaches are cooling as well as stabilizing. When kapha dosha is vitiated in the majja dhatu activity should be increased. Mindful movements are always preferred in ayurveda. As such, yoga is the favored approach. Of course, benefit can also be gained from other mindful activities such as running. However, mindfulness is difficult to achieve during competitive games such as tennis and racquetball. Asana practices that are more active and flowing are preferred over gentle, slower practices. Meditation, Chanting and the majja Dhatu The goal of yoga, according to the Yoga Sutras of Patanjali is union with the divine through bringing stillness to the flow of prana in the mind and body. For this purpose, meditation is the most important and effective tool. As the movement of the mind becomes more focused the flow of prana becomes slower and more directed toward the object of meditation. Traditionally, the object is divine consciousness. One side effect of this process is stress reduction. Stress reduction and a calmer mind support the healing of vata imbalances within the majja dhatu. Thus patients with vata type http://www.ayurvedacollege.com/book/export/html/2
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neurological disorders should meditate. However, those patients who are too depleted should use caution as excessive meditation increases the light quality and brings about greater purification. Meditation is strongly recommended when pitta or kapha doshas are the causative factor in the condition. Note however that when kapha is the causative factor meditation must be balanced with activity. Meditation without the proper balance of activity will cause those with a kapha imbalance to become more lethargic decreasing the flow of prana and compromising the quality of the meditative experience. Singing kirtan and chanting generally increases vata dosha and decrease kapha dosha through specific mantras may alter this effect. When vata is strongly vitiated it is best to minimize vocal expression. When kapha is vitiated, it is best to increase vocal expression. The bija mantra yum increases the flow of the qualities of air through the anahata chakra. The bija mantra vum increases the flow of the water qualities through svadhistana chakra. Herbs and the Majja Dhatu: When vata has entered the majja dhatu, the patient should be given herbs with a tonifying and sedating action. Among the best of these herbs are ashwaganda and shank pushpi. Other beneficial herbs when combined properly include jatamamsi and bala. When pitta has vitiated the majja dhatu, the best herbs are cooling and sedating. Among the best herbs are brahmi, shank pushpi and kappikachu. Brahmi is best when ama is present as its light and bitter nature will not increase ama. Shank pushpi and kappikachu are best when no ama is present as they are heavier and moist. Other beneficial herbs include: Skull cap, vidari kand and chrysanthemum flower. St. Johns Wort and oatstraw. When kapha enters the majja dhatu, the patient should be given herbs with light, mobile qualities that purify the tissue. One of the most renowned herbs for this is calamus. Other beneficial herbs include bayberry, tulsi and sage. . Lifestyle and the Healing of the Majja Dhatu Lifestyle is the primary cause of disease and its correction is the most important component of its cure. No where is this more obvious than when the majja dhatu has become vitiated. When vata is vitiated, the patient should get more rest and avoid stressful situations. Travel should be minimized. Daily routines should be established that are practiced with consistency. It is best if a friend is near by to provide added support and ease the burdens of daily life. When pitta is vitiated, the patient should get more rest. It is particularly important to avoid conflict and competition. The patient should be educated to understand that excessive focus will over heat the nervous system. Thus, activities that are light hearted or fun should be encouraged. When kapha is vitiated an active lifestyle is called for that includes less sleep and greater engagement in the world. Spontaneity should be supported. Regular routines should be adopted so long as those activities are active and engaging. Dr. Marc Halpern is the founder and President of the California College of Ayurveda. An internationally respected expert in the field of Ayurvedic medicine and Yoga Therapy, Dr. Halpern received the award for Best Ayurvedic Physician from the Indian Minister of Health and Family Welfare, Dr. A. Ramdas. He is a cofounder of the National Ayurvedic Medical Association and the California Association of Ayurvedic Medicine. He is on the advisory board of Light on Ayurveda Journal in the United States and the Journal of Research and Education in Indian Medicine in Varansi, India. He can be reached at www.ayurvedacollege.com or [email protected]. Or by phone at 1866 541 6699 http://www.ayurvedacollege.com/book/export/html/2
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Shukra Dhatu: A closer look Advanced Ayurvedic Theory Shukra means bright, pure and radiant. It can also mean the “essence” of something. In Ayurveda, the term is commonly used to describe both the male semen and the female egg, as they contain the essence of all of the other dhatus (tissues) of the body. Shukra is the seventh and final dhatu in the dhatus formation cycle. A person who has healthy shukra has a brightness of confidence with eyes and skin that seem to radiate light. A sensitive individual can perceive this light. Others may notice it as luster or may simply feel the strength and confidence of the one who possesses it. At times, two distinct terms are used to describe the male and female seed. Shukra universally applies to sperm but can also apply to the entire makeup of semen. Artava is the equivalent term used to mean ovum. However, artava also refers to the menstrual blood, a product of rasa dhatu. Thus, shukra is the best term to describe the factor that nourishes both the male and female reproductive tissues. In the physical body, shukra dhatu is formed as posaka (unstable) majja dhatu flows through the shukravaha srota into the shukra dhara kala and is digested by the shukragni. While some texts, such as Charaka, say there is no waste product of the formation of shukra dhatu, others state that the waste product formed is genital waste called smegma. Unlike the other dhatus, there is no unstable form of shukra dhatu to be digested and transformed into another dhatu. Shukra is the end of the line in the dhatu transformation cycle. There is, however, an aspect of shukra dhatu that undergoes a different type of transformation called sublimation. From the sublimation of shukra, ojas is formed and ojas then becomes a part of every dhatu providing it with strength and stability. The journey from rasa to ojas is a cycle that takes six days according to vaidya Charaka and one month according to vaidya Sushruta. The health of shukra is dependent upon the state of shukragni. When the kala housing the agni is vitiated by vata dosha, agni becomes variable resulting in a low quantity of poorly formed tissue. In men, sperm count may be low and there may be a decrease in motility. In women, the formation of the egg and its response to the hormones that trigger development and ovulation may be compromised. When the kala is vitiated by pitta dosha, quantity is also lowered and the resulting tissue becomes overheated resulting in possible inflammation in the ovaries and testes and other tissues associated with the shukravaha srota. When the kala is vitiated by kapha dosha, the quantity of shukra increases but it is of poor quality. While in men sperm count will be normal or increased, motility may be decreased. In women, there may occur obstructions to the development of the ovum or its release. This is one cause of ovarian cysts. In order to produce shukra dhatu, the primary element that must be consumed is water. Water is the primary nourishment of the body and of the dhatus, and shukra is its most refined form. Other dhatus that are predominant in the water element are the rasa and medas dhatus. The rasa dhatu is closest to actual water though rasa, meaning juice, contains many dissolved micronutrients within plasma, lymph and interstitial fluids. Medas http://www.ayurvedacollege.com/book/export/html/2
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dhatu is more refined and stores the energy of water as body fat. Body fat is a semisolid mix of water and earth. The water of shukra dhatu is the essence of these other waters. Only the most highly nourishing foods contain the essence of water and only proper digestion liberates it as shukra. Foods that have a high shukra potential are unctuous (slimy) and include milk, meat juice, ghee and nuts. Pathology and the Shukra Dhatu While any dosha can overflow from the mahavaha srota and enter into the shukra dhatu and shukravaha srota, damage to the dhatu and srota are most commonly caused by vata dosha. A vatavitiating diet and lifestyle dries out the shukra dhatu and its related fluids resulting in infertility. The dhatu and srota are also damaged by suppressing sexual desire. Within modern Western society there is much confusion and insecurity surrounding sexual expression. Due to the mindbody relationship, there is little doubt that this affects the health of the related organs. Psychology and the Shukra Dhatu On a psychological level, shukra dhatu is related to the ability to sustain creativity. When the dhatu is healthy, there is a natural creative instinct and an ability to see the creative act through to completion. When the dhatu is deficient, there may still be a creative instinct but the ability to follow it through to completion lessens. Thus, creative endeavors and plentiful and completion of creative projects is a challenge. This is typical of vata psychology and becomes more of a challenge as vata becomes more and more vitiated. When the dhatu is in excess, it can actually block the creative instinct. However, any creativity that does arise is likely to be slowly and steadily manifested. This is the nature of kapha psychology and becomes greater as kapha becomes vitiated. In the person with a more pitta nature, the heat that enters the dhatu brings passion into their creative pursuits. When it is vitiated, pitta can burn out the creative instinct and the ability to follow through. Evaluating the Shukra Dhatu In men, the shukra dhatu can be directly assessed via examination of the ejaculate. The main factors to observe are color, volume, sperm count and motility. Color and volume can be easily observed with the eye. Count and motility must be observed microscopically. Observation of the color of the ejaculate reveals various shades of white. A gray shade reveals that vata is predominant within the dhatu. Yellow indicates that pitta is predominant and a pale white color is indicative of kapha. Observation of quantity reveals the largest volume in those with a kapha nature and the lowest in those with a vata nature. Upon microscopic examination, a low sperm count with low motility indicates a greater likelihood of vata vitiation though this can be found with pitta vitiation as well. A normal sperm count with low motility is more commonly a sign of kapha imbalance. In women, direct examination of the shukra dhatu requires an examination of the ovaries. This is most commonly performed utilizing diagnostic ultrasound though other tests may be employed. The health of the shukra dhatu can also be inferred by the regularity of menstrual cycle. An irregular menstrual cycle is indicative of vata dosha vitiation in the shukra dhatu and associated ovulatory disorders. Most disorders of the female reproductive system are due to vata dosha vitiation. Pitta disorders may be revealed through an intense menstrual flow. Kapha disorders may be reveals through a long and mucusy discharge. However, these findings are not specific to the shukra dhatu and indicate only that the doshas have http://www.ayurvedacollege.com/book/export/html/2
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vitiated the artavavaha srota (channel of the female reproductive system). Proper Treatment of the Shukra Dhatu Healing the shukra dhatu entails both proper nourishment and the proper management of sexual energy. As most conditions of the shukra dhatu are caused by depletion of the dhatu secondary to vata vitiation, tonification is the most common treatment approach. However, excessive dhatu due to vitiation of kapha dosha requires proper purification. Diet and the Shukra Dhatu For the management of depletion due to vata or pitta dosha in the shukra dhatu, a proper diet is one that assures that the foods taken in are nourishing enough to rebuild the shukra dhatu. Sweet tasting foods such as milk, ghee and nuts are among the best for providing this nourishment. While each of these is ideal for vata dosha, care should be taken in the management of pitta dosha, as nuts tend to be warming. Each of these foods, being heavy, must be properly digested, otherwise they will result in ama formation. For the management of kapha in the shukra dhatu, a purifying diet emphasizing the bitter and pungent taste is best. Herbs and the Shukra Dhatu In order to tonify the shukra dhatu, a category of herbs called vajikaranas or shukralas are best. Vajikaranas build sexual energy and shukralas build the semen. These terms are often interchangeable and, in the West, they are typically called aphrodisiacs and reproductive tonics respectively. Some of the best reproductive tonics are ashwagandha, vidarikand, bala, gokshura, shatavari and wild yam. Shatavari and wild yam are specific for women. Ashwagandha is specific for men. Even still, at times, all of these herbs are used for both men and women. These herbs can be used for depletion caused by either vata or pitta in the shukra dhatu when used in proper combinations. In order to maximize the potency of the medicines, they are best prepared in the form of a medicated ghee and then added to warm whole milk along with spices to assist digestion. For the management of kapha in the shukra dhatu, purifying herbs include cloves and pippali. These excite sexual energy in the short term and reduce it in the long term. Two other important herbs are kushta and katphala. These have the quality of shukrashodana (purifiers of the sexual energy and organs) when taken regularly. All of these reduce kapha in the shukra dhatu. Lifestyle and the Healing of the Shukra Dhatu When any dosha has vitiated the shukra dhatu, it is important to examine the patient’s lifestyle. Here lie the clues to the cause of the condition, as well as the most important aspects of treatment. Regardless of the dosha at cause, all patients should be encouraged to develop healthy, steady routines. Steady routines are important to all three doshas, as vata dosha is king among them in the cause of all reproductive disorders. In addition, when vata dosha is vitiated, patients should be encouraged to rest more often. When pitta dosha is vitiated, patients should be discouraged from intense or competitive activities and to rest more often. When kapha dosha is vitiated, patients should be encouraged to increase their exercise and activity level. http://www.ayurvedacollege.com/book/export/html/2
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Proper Management of Sexual Energy There is a lot of confusion and misconception about what constitutes the proper management of sexual energy. There is no doubt, however, that its proper management is important to one’s wellbeing. Caraka named brahmacharya as one of the three pillars of life along with proper diet and rest. Brahmacharya means celibacy and it is generally agreed that celibacy properly practiced leads to the longest and healthiest life. However, it is also agreed that those who are strong can engage in sexual activity with no negative consequence to their health. Thus, it can be understood that it is not sexual activity that weakens a person but rather a weak person is weakened further by sexual activity. In this person, sexual energy must first be restored. This is the process of vajikarana therapy. Ayurveda does not place a strong emphasis on morality as a function of sexual expression. Nor does Ayurveda have a preference for a monastic or celibate lifestyle. Rather, the degree to which a person engages in sexual activity is a function of the health of the shukra dhatu and a person’s dharma. If the dharma of a person lies within the world as a householder—one who gets married and has a family—then sexual expression is a natural and healthy part of a relationship. Two partners who are healthy should engage in sexual activity for the purposes of producing offspring and for the purposes of opening their hearts to each other and the divine. Care should be taken that the sexual activity does not become excessive. If the dharma of a person lies outside the world as a spiritual monk, then sexual expression is forbidden. This is not an issue of morality but practicality. For the monk, building up one’s shukra is necessary for its transmutation into ojas. High levels of ojas are necessary for performing intense spiritual practices. The most common question I am asked is how much sex is appropriate for the householder. The answer lies in the state of a person’s shukra. When shukra is abundant and the resulting ojas is strong, and one is involved in a loving relationship, healthy sexual expression brings great joy and intimacy as well as offspring. Excessive sexual expression is that amount in which the signs of low shukra or low ojas become apparent. There is exhaustion, a loss of luster and a lack of creativity or an ability to sustain creative endeavors. Those with low shukra should refrain from sexual activity until the shukra is restored. There is no magic formula for the restoration of shukra. It is always being produced as a part of the digestion of the foods we eat. For restoration to occur, it must be produced faster than it is expelled. Abstinence provides for the quickest restoration. Those with a kapha nature have the greatest constitutional tendency to be able to sustain sexual energy and can generally have more sex without creating depletion. Those with a vata nature tend to have lower levels of shukra and thus their interest in sex is highly variable and they should be more careful. Those with a pitta nature, having some water in their constitution, have more moderate tendencies though there is much passion within their actions. In general, the stronger the practices of raja yoga (asana, pranayama, meditation), the less sexual activity a person should engage in, as their practices require high levels of shukra and strong ojas.
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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 deepset 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 malabsorption 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. http://www.ayurvedacollege.com/book/export/html/2
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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 finetune 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 threeday flareup 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 reinstituted 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.
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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 http://www.ayurvedacollege.com/book/export/html/2
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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 http://www.ayurvedacollege.com/book/export/html/2
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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 http://www.ayurvedacollege.com/book/export/html/2
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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 rehydrate 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 http://www.ayurvedacollege.com/book/export/html/2
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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 http://www.ayurvedacollege.com/book/export/html/2
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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: 12 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 12 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 http://www.ayurvedacollege.com/book/export/html/2
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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 psychospiritual 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. http://www.ayurvedacollege.com/book/export/html/2
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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 Table of Contents 1. Introduction 2. Purvarupa (Prodomal symptoms) 3. Types of Kasa 4. Rupa (symptoms) 5. Chikitsa: Treatment and Management Introduction http://www.ayurvedacollege.com/book/export/html/2
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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 http://www.ayurvedacollege.com/book/export/html/2
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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, Large amounts of mucous, sticky, yellow in color 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; VPK+) . These are commonly used and may be prepared as ghrita (medicated ghee). Popular herbs used http://www.ayurvedacollege.com/book/export/html/2
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in the West include licorice (glycyrrhiza glabra; VPK+) and wild cherry bark (prunis virginiana, prunia serotina; VPK+). 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; VPK+) and vasa (adhatoda vasica; PK V+). Western herbal alternatives include licorice (VPK+), mullein (verbascum thapus; PKV+) and wild cherry bark (prunis virginiana, prunia serotina; VPK+). 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; PKV+) as well as well as Western alternatives such as goldenseal (Hydrastis Canadensis; PKV+) and echinecea (Echinecea augustifolia, echinecea purpura; PKV+). 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; VKP+). 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; KVP+) and chitrak (plumbago zeylancia; KVP+). 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, http://www.ayurvedacollege.com/book/export/html/2
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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. http://www.ayurvedacollege.com/book/export/html/2
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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 overeating. 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. http://www.ayurvedacollege.com/book/export/html/2
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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 http://www.ayurvedacollege.com/book/export/html/2
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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 antiinflammatory 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.
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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. http://www.ayurvedacollege.com/book/export/html/2
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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 selfobservation 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. http://www.ayurvedacollege.com/book/export/html/2
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They often occur along with nausea or vomiting. These severe headaches can last a few hours to a few days and affect 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 http://www.ayurvedacollege.com/book/export/html/2
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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. http://www.ayurvedacollege.com/book/export/html/2
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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 23 million Americans or about 1% of the adult population. It is 23X 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 http://www.ayurvedacollege.com/book/export/html/2
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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 antiinflammatory 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. Longterm 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 antiinflammatory, 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 antimicrobial. 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 antiinflammatory 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 antiinflammatory and analgesic, useful in arthritis, nerve pains and back pains. http://www.ayurvedacollege.com/book/export/html/2
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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 antiinflammatory. 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. http://www.ayurvedacollege.com/book/export/html/2
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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 antipsychotic 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 NMPTP or Meperidine (1menthyl4phenyl1,2,5,6tetra 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 http://www.ayurvedacollege.com/book/export/html/2
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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. Ldopa 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). Ldopa 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 (VPK ++, sweet/bitter/cool/sweet), vata must be pacified at its site of origin in the colon, site of overflow in the rasa http://www.ayurvedacollege.com/book/export/html/2
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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, bittercoolsweet) 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 pittavitiated 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 Ldopamine 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 Ldopa 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 Ldopa. 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 http://www.ayurvedacollege.com/book/export/html/2
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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; 12:4954 3. Langston JW, Ballard P, Tetrud JW, Irvin I. Chronic Parkinsonism in humans due to a predouce of Meperidine. Analog synthesis. Science 1984; 219; 979980 4. Caraka Samhita Vol. 14, Bhagwan Dash and R.K. Sharma, Chowkhumba Sanskrit Series, Varanasi, (General Reference used for concepts, not specific information) 5. Ashtanga Samgraha of Vagbhata Vol., 13 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 GourieDevi, 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 491492. 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 4748. 9. Principles of Internal Medicine: Harrison 10. Damodaran M, Ramaswamy R. Isolation of Ldopa from the seeds of Mucuna Pruriens. Biochemistry 1937;31:214951 11. Dutt VC. Materia Medica of Hindus. Varanasi: Chowkumbha Saraswalibhawan, 1980: 148149 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; 1716 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 110 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 http://www.ayurvedacollege.com/book/export/html/2
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often prescribed central nervous system depressant drugs in the opiate class as well as dopamine agonists (supporters) such as Ldopa, 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 selfhealing 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 vatapitta pacifying program of diet, herbs and http://www.ayurvedacollege.com/book/export/html/2
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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. http://www.ayurvedacollege.com/book/export/html/2
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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 handtohand 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 reawakening 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 sixday Marma Therapy Course and the fiveday 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 http://www.ayurvedacollege.com/book/export/html/2
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clothes on or off. It is safe, simple, effective and it supports the counseling work of the practitioner, as well as the handson 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 http://www.ayurvedacollege.com/book/export/html/2
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“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
Yoga and Ayurveda Pranayama, Yoga, and Ayurveda Abstract With the growing awareness of Ayurvedai in the West, a more complete picture of the yogic path is beginning to emerge. This path reconnects the knowledge of two of India’s greatest ancient sciences. Together, they comprise a whole whose two sides, like those of a coin, are really inseparable. Ayurveda brings to Yoga an understanding of how to remain physically and emotionally healthy while on the path to enlightenment. Yoga brings to Ayurveda a deeper purpose for remaining healthy, that purpose being to attain enlightenment.
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Definition Pranayama, the yogic art of breathing, comes from the root words prana and ayama. Prana means “life force” and ayama means “expansion, manifestation, or prolongation.” The practice of pranayama therefore is the practice of expanding our own prana so that it harmonizes with the universal prana. This results in oneness or merging of a person’s own consciousness with universal consciousness. It is in this union that we realize we are not simply a limited physical body, but are, in fact, an immortal spirit. Pranayama is breath control on the physical level and prana (life force) control on the subtle level. This is achieved through conscious inhalation (puraka), exhalation (recaka), and retention (kumbhaka) of breath along with focused attention on some particular part or area of the physical or subtle body, such as the heart or sixth cakra (the socalled “third eye”) at the middle of the forehead.
Historical Context in Yoga An early extant text of HathaYoga (which includes pranayama) is the HathaYogaPradipika, written by Svatmarama. Later important texts include the ShivaSamhita and the GherandhaSamhita. The YogaSutra of Patanjali, the most famous of all Yoga texts, was written over a thousand years before the HathaYogaPradipika. While describing the eightfold path of RajaYoga (which includes HathaYoga), it does not go into great detail on either pranayama or asana, but instead explores the philosophy of Yoga and gives an overview of its methodology. The HathaYogaPradipika, on the other hand, contains detailed descriptions of proper preparation for pranayama, along with instruction on its practice and warnings against its improper use. The mastery of prana is one of the main goals of the yogi or yogini on his or her way to enlightenment. Control over pranic flow opens the door to higher consciousness and mastery of the illusion of time and space within the physical body.
The Historical Context of Pranayama in Ayurveda Classical Ayurvedic texts such as the CarakaSamhita do not specifically mention pranayama. However, these texts deal extensively with the subject of prana and its functions in both health and disease. Modern Ayurvedic practitioners approach the yogic pranayama techniques from the perspective of health maintenance and disease management, and not as much from the spiritual perspective. Writings on the functions of the subtle body have been produced by many great yogis and sages throughout the ages. The most prolific modern author to research and recommunicate these ideas is David Frawley, author of Tantric Yoga and the Wisdom Goddesses, Ayurveda and the Mind, and Yoga and Ayurveda. These three texts are recommended for deeper exploration of this subject.
Cautions Regarding the Practice of Pranayama The practice of pranayama has always been surrounded by an air of mystery. Since such practice is a gateway to yogic powers (siddhis), gurus have traditionally been hesitant to teach it until the disciple was able to prove his or her readiness. Readiness meant achieving a significant degree of success with the yamas and niyamas as well as asana. These practices prepare the body and mind to manage the increased vibratory energy that comes with heightened prana. Inappropriate or immature use of pranayama has been stated to cause great harm both to the body and the mind[1]. In addition, the reckless sharing of the knowledge of pranayama is understood to dissipate its potency[2]. Many great yogis have known of the dangers of pranayama when performed incorrectly: “. . . faulty practice puts undue stress on the lungs and diaphragm. The respiratory system suffers and the nervous system is adversely affected. The very foundation of a healthy body and a sound mind is shaken by faulty practice of Pranayama.”[3] http://www.ayurvedacollege.com/book/export/html/2
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Imbalances caused by the improper practice of pranayama have been observed by both yogis and Ayurvedic practitioners alike. When a person begins to practice prematurely, before diet and lifestyle have been properly regulated, a person is in danger of heightening the prana while the energy channels (nadis) are still obstructed. This results in the prana charging recklessly through the body causing both physical and psychological imbalances[4]. A common cause of imbalance is attempting to progress too quickly. By aggressively practicing pranayama without the proper preparation, the wellbeing of the student is at great risk—even death is possible.5 Hence, gradual, slow progress is recommended. Some of the dangers of pranayama lie in the bandhas and kumbhakas, which, if performed improperly, cause pranic disturbances. Bandha means “bondage” or “holding,” referring to the contraction and holding of a body part. This is the method by which yogis control and channel the flow of prana, ultimately guiding it into the central canal, sushumnanadi. Kumbhaka is the restraint of the breath. Both of these practices powerfully interact with the pranic energy and when performed improperly can lead to catastrophic consequences. The three major bandhas are: (1) Jalandharabandha:Here the chin is brought down to the notch at the top of the sternum. This regulates pranic flow to the brain, lungs, and heart. It is performed at the end of inhalation and during retention. This pushes pranavayu downward toward the chest. (2) Uddiyanabandha: Here the abdomen is contracted and drawn in, which lifts the diaphragm up into the chest. It is performed at the end of exhalation, during bahyakumbhaka (retention following exhalation).[6] (Brahmananda’s commentary on the HathaYogaPradipika states that this is the natural experience of exhalation and does not have to be consciously practiced[7] ) (3) Mulabandha: Here the perineum is contracted. This increases the upward flow of udanavayu and decreases apanavayu. With proper practice and combination of these three bandhas, the energy of apanavayu moves upward to unite with pranavayu in the chest, which has been forced downward. Their unification pushes the fused energies into the sushumnanadi where the ultimate benefits of pranayama are realized.
The Right Environment for Yogic Pranayama Practice The ideal environment for yogic practices in general is one that is bug free, clean, quiet, and safe with provisions and a moderate climate. Cleanliness aids healthfulness. Quietude assists the inward journey of the practitioner. Safety dissipates fear. Provisions negate the need for gathering or earning. A moderate climate that is bug free assures comfort. The yogi or yogini, free of concerns, is now able to focus on his or her practices. While historically a yogi might have had to build a hut in a nonpopulous area, today ashramas provide the ideal setting.
Effects on the Subtle Body Pranayama serves several purposes in Yoga. First, it is the method by which the nadis, particularly the idanadi and pingalanadi are purified, allowing prana to flow into the central channel, the sushumnanadi. In the ordinary state, prana flows with regularly alternating dominance through the idanadi and the pingalanadi. The effect of this backandforth fluctuation is mental activity. Pranavayu (one of the five major modalities of prana) functions within the superficial mind (manas), which processes the world in which we live. Attached to the five senses and dominated by the superficial mind, which is filled with idle chatter, pranavayu carries the energy of emotion. When the nadis become purified through proper lifestyle and the practice of pranayama, prana is drawn into the sushumnanadi and is carried upward by udanavayu (the upward moving modality of http://www.ayurvedacollege.com/book/export/html/2
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prana). Then prana becomes the energy of immortality and guides the unfolding of our consciousness. Breathing and metabolic rates are extraordinarily slow, mental chatter stops, and the yogi experiences bliss or “that” which has no words. Pranayama is also a preparatory practice for the deeper stages of meditation. Toward this end, pranayama begins the process of balancing the flow of energy through the idanadi and pingalanadi, which relate to activity in the right and left sides of the brain.[8] Pranic energy normally resides in these channels, but when they become pure and their flow balanced, the prana moves into the sushumnanadi. Once there, the mind of the yogi becomes still, the fluctuations of thought disappear, and consciousness expands. The further stages of dharana (concentration on a single point) and dhyana (sustained concentration or meditation) focus and hold the yogi’s attention within the void of the sushumnanadi. Through pranayama performed properly along with appropriate bandhas, kundalini, the “serpent fire,” which usually lies dormant at the base of the spine, awakens. Then it rises through the sushumna nadi and the yogi’s consciousness is liberated. A third purpose of pranayama is the extension of life.[9] Prana is life, and its mastery through pranayama prolongs life. With proper practice the yogi is able to control prana in such a way that there is no dispersion of the life force. Ayurveda teaches that one fundamental cause of disease and death is parinama, or time in relation to motion. In other words, the faster we move the faster biological time moves forward. This motion is not only physical but mental as well. The result is aging, decay, and death. Through pranayama and meditation, the motion of the mind slows and can even be stopped. The result is the elongation and possible suspension of biological time. In the stillness created, the body is relaxed and prana flows freely without obstruction through the physical body to heal and repair any damaged areas. Ayurveda recognizes three bodily humors (doshas) called vata, pitta, and kapha i(wind, bile, and phlegm), which are closely related to three energies prana, tejas, and ojas—life force, “fire/glow,” and subtle energy. Whereas the doshas function primarily on the annamayakosha or physical body, their energetic counterparts function primarily on the manomayakosha or subtle body. Mind (manas) and intellect (buddhi) are both superficial aspects of and operate within the broader field of consciousness (citta). As I have already mentioned, manas processes the ordinary physical world. Buddhi also has two aspects, a higher and a lower. The lower aspect, which is attached to the senses, organizes the sensory input from our world and compartmentalizes our experiences so we can learn from them. The higher aspect is not attached to the senses. It draws knowledge and wisdom from atman, which is connected to the cosmic stream of knowledge, the “Great” (mahat). From this connection, a person receives “higher guidance” to act in ways that are sattvic and not sensory based (rajasic and tamasic). Prana manifests within our mind and consciousness as enthusiasm for life. Its normal function provides motivation for living. Tejas is the aspect of fire that provides illumination. Its normal function provides motivation for knowing truth, and its outward expression manifests through our intellect. Ojas, the substance that provides the mind with stability, manifests in our consciousness and mind as contentment. In the sushumnanadi, tejas can be understood as dormant kundalini energy. Heightened prana is the force that raises kundalini though the central nadi, which is stabilized and supported by ojas. Yogic practices purify the nadis and remove obstructions to the flow of kundalini. They also increase the activity of prana, which stokes the fire of kundalini. As kundalini awakens, it rises through the central channel. Ideally, this brings about peacefulness, higher consciousness, and powers (siddhi). There are, however, potential complications.
Imbalances in the Subtle Body Caused by Faulty Pranayama Practice Whereas the ideal balance of the three doshas is determined at conception and the ordinary person strives to maintain balance, a yogi strives to steadily increase the subtle energies of prana, tejas, and ojas. As prana rises, consciousness expands, as tejas rises perception expands, and as ojas rises contentment deepens. When all three energies rise proportionally, a person maintains health and balance physically and emotionally while gaining the benefits of practice. However, when prana or tejas rise without ojas, serious complications manifest. http://www.ayurvedacollege.com/book/export/html/2
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As prana rises within the body, it tends to dry out ojas. This is simply a function of its dry, airlike quality. Similarly, as tejas rises, it tends to burn out ojas, a function of its firelike nature. Ojas, being comprised primarily of water, functions to protect, though, as I have noted, it is in danger of becoming depleted as prana and tejas rise. Once depleted, the result is serious imbalance in both the physical and subtle body. Ojas is responsible for containing prana and tejas (kundalini) as the latter rises through the sushumnanadi. If ojas becomes depleted, kundalini energy exits the sushumna and rages like a wildfire through the body and mind causing destruction. Ayurveda understands this to be the cause of many imbalances. Symptoms of low ojas include poor stamina, sensitivity to minor environmental, mental, or physical stresses, chronic irritability, and easily losing one’s mental or emotional balance. Disturbances of prana appear as anxiety, hyperactivity, depression, and uncoordinated thought processes. Finally, tejas imbalances manifest as gullibility or cynicism. The exact nature of the imbalance can be determined by knowledgeable yogis or vaidyas (Ayurvedic practitioners), who then can administer a prescription to restore balance in the system. It is not only the sushumna that is in danger of this imbalance. These three subtle energies also function in the manovahasrota and the samjnavahasrota. These are the channels of the mind and of consciousness. If ojas becomes depleted, the mind becomes unstable and the stream of consciousness is interrupted. The result is disturbed emotions, pathological thoughts, and susceptibility to influences from the subtle worlds. Western psychologists would classify this as psychosis. Knowledge of the subtle energies of the body, whether through Yoga or Ayurveda, teaches that proper preparation is required before an aspirant attempts to utilize yogic techniques such as pranayama. Yogic texts have clearly warned unprepared students, without going into detail to explain the physiology behind the warnings. Knowledge of the subtle energies of prana, tejas, and ojas makes clear why proper preparation is necessary.
Proper Preparation Yoga doctrines teach that preparation means practicing the yamas and niyamas as well as following an appropriate diet. In addition, it is stated that persons of kapha nature may need to practice the six yogic kriyas or purification practices.[10] These practices include: dhauti, bastii, neti, tratak, nauli, and kapalabhati. Knowledge of the three subtle energies makes clear the importance of assuring that ojas is healthy before a person begins to practice the yogic techniques, which activate prana and tejas. Ojas is strengthened by activities that provide stability and nourishment. Hence, healthy and consistent daily routines combined with proper diet lay the foundation for building ojas. The yamas and niyamas of Yoga articulated by Patanjali provide a living foundation for Yoga practice based on integrity, insight, discipline, and morality, which leads to the fortification of consciousness. Without this, true enlightenment becomes impossible and any apparent gains made will simply inflate the ego and bind the practitioner further to the endless cycle of life and death. Ayurvedic regimens called dinacarya (“daily work”) set forth daily routines unique for each person’s constitutioni and are designed to protect ojas. While for the most part deemphasizing moral and spiritual considerations, Ayurveda sets forth regimens to protect the body and mind. These regimens manage the three pillars of life: rest, digestion, and sexual energy in an effort to preserve and maintain ojas. Hence, practice of the yamas and niyamas combined with Ayurvedic lifestyle and dietary regimens appears to offer the aspirant the most complete preparation for his or her quest. They make it less likely that complications will arise on the journey.
The Yogic and Ayurvedic Diet http://www.ayurvedacollege.com/book/export/html/2
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Proper diet is an important part of the classic HathaYoga path. However, there are some modern yogis who deemphasize it.11 Yoga traditionally emphasizes a moderate diet consisting of sweet, nourishing foods such as grains, some beans, milk, ghee, and honey, as well as fruits and vegetables. Sour, salty, and pungent foods are to be avoided. Alcohol and meat are strictly prohibited. In addition, food should be consumed only when fresh.[12] In general, sattvic foods are preferred over rajasic or tamasic foods. Sattvic foods are foods that are fresh and pure and produce clarity in the mind and health within the body. Rajasic foods create agitation and tend to be spicy, while tamasic foods are heavy and produce mental dullness and disease. Meat, canned food, and old food fall into this category.[13] The sweet taste is the most powerful for increasing ojas; thus the yogic diet is formulated to build ojas. Care must be taken, however, as many sattvic foods such as fruits and vegetables do not build ojas. Hence, to assure that ojas is plentiful, the aspirant should consume milk, ghee, grains, and some nuts in addition to fruits and vegetables. In order for the body to produce ojas, it is necessary for proper digestion to occur. Without proper digestion, ama (internally created toxicity) is created instead of ojas. Ayurvedic texts thus outline regimens that not only include what to eat but how to prepare food and then how to eat it in ways that protect agni (the body’s internal fire that digests food). A healthy agni is essential to producing ojas. There is much Ayurvedic literature available that addresses the unique dietary needs of each person according to his or her constitution, and the student of Yoga is well advised to pursue such reading or consult with a practitioner of Ayurveda.
Physiological Effects on the Body When practicing pranayama, the yogi observes several effects. First, sweating may occur, a sign the nadis are being purified.[14] In addition the yogi may observe tremors or shaking as well as various other neurological sensations, including seeing colors and lights and hearing inner sounds. Pranayama also has been reported to have the following physiological effects: improved circulation, purification of the lungs, physiological support for the liver, spleen, and kidney, stimulation of peristalsis improving fecal excretion, sharpening of the intellect, and improved memory.15 Pranayama is further understood to be effective in treating conditions of the respiratory, circulatory, and nervous systems, which are most directly dependent on pranic flow.[16] The practice of pranayama decreases the rate of respiration and elongates the breath. As yogic texts equate breath with life, they interpret this to imply that life is elongated as well. Pranayama cultivates the pranaagni or the fire that digests prana. It is this digestion that transmutes prana into its higher form, where it acts as a force for the transformation of consciousness. It is also this agni that is responsible for purifying the nadis.17 Inhalation feeds the fire. Retention purifies the prana. Exhalation rids the body of its waste byproduct. As the pranaagni slowly builds, the body begins to lightly sweat. This aids the purification of the subtle nadis. Pranaagni is the heat associated with the kundalini, but it is not limited to the kundalini. Pranaagni converts breath into life on the physical level and life into immortality or enlightenment on the subtle level.
Types of Pranayama and Their Effects from an Ayurvedic Perspective Ujjayi: This pranayama is performed by inhaling through both nostrils as if drawing water up a pipe. A hissing noise is made in the back of the throat during inhalation. Inhalation is followed by retention, and exhalation is done through the left nostril, which reduces mucus in the throat, builds the digestive fire, and purifies all tissues and nadis.18 Ujjayi also aerates the lungs, decreases phlegm, http://www.ayurvedacollege.com/book/export/html/2
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and tones the nervous system. It has been recommended that those individuals suffering from hypertension or coronary artery disease perform this pranayama without retention.[19] This mild form of pranayama increases prana, which secondarily increases tejas. Excessive practice increases vata and pitta in the physical body. Surya Bhedana: Solar Breathing is performed by inhaling through the right nostril (pingala), followed by retention, and then by exhalation through the left nostril (ida). This form of pranayama heats the body, increasing both tejas and prana. It is a moderately aggressive pranayama that pacifies kapha, increases pitta, and is neutral to vata. According to the medieval HathaYogaPradipika, this is beneficial for diseases of vata.20 Nadishodana: This technique, which is also called “alternate nostril breathing” or anulomaviloma,[21] is performed by sitting in the appropriate posture and inhaling through the left nostril (ida), followed by retention, and exhalation through the right nostril (pingala). The process is repeated beginning with inhalation through the right nostril, followed by retention and exhalation through the left nostril.[22] This pranayama is often considered to be the most basic type and the most effective for purifying the nadis. Altermate nostril breathing increases prana. Its effect on tejas is mild in the short term; however, excessive practice will still stoke the fire of tejas. It is considered the best pranayama practice for individuals of vata constitution as it is gentle and creates calm. In healthy individuals it pacifies vata and is neutral to pitta and kapha. Bhastrika: This breathing practice is described as mimicking the action of a bellows (bhastrika) blowing on a fire.[23] As the name suggests, it consists of a series of rapid inhalations and exhalations. The exhalations are made by forcefully contracting the lower abdominal muscles and pushing air out of the lungs. The inhalations are made by releasing these contracted muscles and allowing the breath to passively flow into the lungs. Some Yoga authorities recommend against practicing this technique until the nadis are purified by alternate nostril breathing.[24] Several variations exist for bhastrika, including inhalation through the right nostril and exhalation through the left. This pranayama is very aggressive and requires the most preparation. It is also among the most important as it arouses kundalini and drives it though the three granthis (obstructions), located in the first, second, and sixth cakras.[25] This awakening occurs only with repeated practice and proper preparation and can take lifetimes to achieve. Bhastrika is very heating and is not for those with weak constitutions or eye, ear, or blood pressure pathology.[26] Ayurveda considers this form of pranayama to increase pitta. It is best for those of kapha constitution and may be practiced in limited amounts by those with a vata constitution. BhramariPranayama: This breath is similar to ujjayi, but instead of a hissing sound is accompanied by a humming sound, like a bee makes (bhramari). The classic texts describe the sound of the bee in great detail: The sound on inhalation resembles a female bee and on exhalation a male bee.27 This form of pranayama has been reported to be beneficial in the treatment of insomnia.[28] A cooling breath, bhramari increases prana, pacifies pitta, and may aggravate vata and kapha. The cooling action of the pranayama prevents a rapid rise in tejas. Sitkari: This is performed by inhaling through the tongue, which is slightly protruded from the mouth while the lips are pursed, followed by retention and then exhalation through both nostrils.29 Sitkari increases prana and cools and pacifies pitta, while possibly aggravating vata and kapha. The cooling action of the pranayama prevents a rapid rise in tejas. Shitali: Similar to the previous pranayama, shitali is performed by sticking the tongue further out between the lips and curling it into a straw. Inhalation is followed by retention and then exhalation takes place through both nostrils. Described as a cooling breath, it soothes eyes and ears and has been noted to remove illness of the spleen, liver, and gall bladder, and to eliminate fever.30 This pranayama also increases prana. It is cooling and pacifies pitta while possibly aggravating vata and kapha. The cooling action of this practice prevents a rapid rise in tejas.
Proper Practice
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While pranayama can be practiced in many postures, siddhasana is the most highly regarded.31 Still, any posture that keeps the spine erect is considered adequate for practice.[32] While different ratios of inhalation to exhalation and retention have been mentioned, it is often recommended to begin simply by equalizing the lengths of inhalation, exhalation, and retention. This is called samavritti pranayama.33 In order to achieve this, a person may first have to keep retention following inhalation to a lesser amount, slowly building up over time until it is equal to inhalation and exhalation. Retaining the breath after exhalation, or bahyakumbhaka, is not recommended for beginners. Once the student is competent in samavritti pranayama, bahyakumbhaka can be added beginning with a lesser amount of time and working up to an amount equal to the other phases. Another way to practice pranayama is with ratios that are not equal. Called vishamavritti pranayama, the standard approach is to work toward a ratio of 1:4:2:1, that is, inhalation, inner retention, exhalation, and outer retention respectively.
Conclusion Knowledge of the principles of Ayurveda is essential for every student who begins to walk the path of Yoga. With this knowledge, students learn the reasons behind the practices of HathaYoga and are able to walk their paths in a safe and rewarding manner. If problems do arise on the path, students should consider seeing a practitioner of Ayurveda to gain the insight and direction necessary to heal themselves.
Endnotes 1. Swami Vishnudevananda, Hatha Yoga Pradipika, Containing the Commentary Jyotsna of Brahmananda (Delhi: Motilal Banarsidass/Om Lotus Publications, 1987), pp. 11 and 19 and chapter 2, sutras 15–17. 2. Ibid., chapter 1, sutra 11. 3. B. K. S. Iyengar. Light on Yoga (New York: Schocken Books, 1976), p. 434. 4. Vishnudevananda, op cit., p. 56. 5. Ibid., chapter 2, sutras 15–17. 6. Dr. K. S. Joshi. Yogic Pranayama (Delhi, India: Orient Paperbacks, 1983), p. 38. 7. Vishnudevananda, op. cit., p. 74. 8. Ibid., p. 5. 9. Ibid., chapter 2, sutra 3. 10. Ibid., chapter 2, sutra 23. 11. Iyengar, Light on Yoga, p. 426. 12. Vishnudevananda, op. cit., chapter 1, sutras 58–60. 13. B. K. S. Iyengar, Light on Pranayama (New York: Crossroad, 1999), p. 43. 14. Vishnudevananda, op. cit., chapter 2, sutra 12. 15. Iyengar, Light on Pranayama, pp. 48–49. 16. HansUlrich Rieker, The Yoga of Light: Hatha Yoga Pradipika (London: Georg Allen & Unwin, 1971), part 2, chapter 6, sutras 56–57. http://www.ayurvedacollege.com/book/export/html/2
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17. David Frawley, Yoga and Ayurveda (Twin Lakes, Wis.: Lotus Press, 1999), p. 114. 18. Vishnudevananda, op. cit., chapter 2, sutras 52–53. [Ed.: The prescription to exhale through the left nostril is not universal.] 19. Iyengar, Light on Yoga, p. 443. 20. Vishnudevananda, op. cit., chapter 2, sutra 50. 21. Ibid., p. 51. 22. Ibid., chapter 2, sutras 7–10. 23. Ibid., chapter 2, sutras 59–62. 24. Ibid., p. 81. 25. Ibid., p. 83. 26. Iyengar, Light on Yoga, p. 450. 27. Rieker, op cit., part 2, chapter 6, sutra 67. 28. Iyengar, Light on Yoga, p. 451. 29. Rieker, op cit., part 2, chapter 6, sutras 56–57. 30. Ibid., part 2, chapter 6, sutras 53–55. 31. Vishnudevananda, op. cit., chapter 1, sutra 38. 32. Iyengar, Light on Pranayama, p. 55. 33. Ibid., p. 61.
The Practice of Yoga Nidra Introduction Yoga Nidra means yogic sleep. It is a state of deep conscious relaxation and is a form of pratyahara or the turning inward of awareness. It is considered to be an active or preliminary form of meditation though many of the benefits of meditation are also realized through this state of consciousness. In the state of Yoga Nidra the body appears to be asleep but awareness is acutely present. The mind does not wander aimlessly or drift into dramas or dreams. Rather, the “witness” emerges. This is that part of the self that watches our experience from a place of detachment. Unemotional and absent of thought, awareness of the witness brings about great joy and peace. Yoga Nidra is not a technique but rather a state of consciousness. There are several techniques that can lead a person into this state. In the method taught at the California College of Ayurveda the participant is led on a conscious journey of awareness inside their body. At first, the mind is directed to focus on singular parts of the body learning to identify blockages to the flow of prana (energy). These blockages create tension. As the practitioner succeeds in letting go of the tension, prana flows freely and higher awareness develops. One of the early realizations is that the body is not a solid structure but rather a densely packed field of energy. At this time the practitioner realizes that he or she is neither their body nor their http://www.ayurvedacollege.com/book/export/html/2
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mind. The practitioner then asks him or herself the most basic and important question: who am I? The answer is not found through the intellect but realized through the experience. We are that which lies beyond the body and the mind. We are nothing more than the embodiment of consciousness. The product of this state of awareness is pure bliss. According to the teachings of Yoga and the other great philosophical traditions of India, we are Pure Consciousness experiencing life though a body and mind. Blockages exist in the subtle channels of our body called nadi. There are 72,000 nadi. While most of those nadi are related to the functions of the body and mind, there are specific channels related to consciousness. To one degree or another, we all experience a certain amount of blockage within these channels. This blockage causes us to forget our true nature as Spirit and the wholeness inherent in all of existence. As a result, we experience separation and suffering. The practice of Yoga Nidra is an active practice of purifying these channels bringing about a return of greater awareness. While higher awareness is certainly the most important goal of this practice, the benefits are felt not only in the channels of awareness but in all 72,000 nadi. In other words, prana flows more freely in the body and mind supporting the healing process. The practice of Yoga Nidra is one of the most beneficial practices for selfhealing. How to Achieve the State of Yoga Nidra Yoga Nidra is most commonly achieved through guided meditation or instruction from a teacher. The teacher uses his or her voice to guide the awareness of the student and takes the student deeper within. The teacher’s voice is the first focal point. The teacher guides the student to examine individual parts of the body and to seek out areas of holding, control or tension. These are areas of disturbed pranic flow. Following the teacher’s guidance, the student then relaxes those areas allowing the prana to flow more freely. The teacher’s voice guides the student through the body. Each body part is the second focal point of the process. At the end of the process, the entire body is deeply relaxed, the student has remained awake and now is the state of consciousness called Yoga Nidra. The Origins of Yoga Nidra No one knows the origins of Yoga Nidra for certain. The term is quite ancient. It is mentioned in the Devi Bhagavat wherein Lord Vishnu reclines on Naga Shesha and creation manifests as if creation is the manifestation of his dream. The term is also mentioned in Hatha Yoga Pradipika and Taravali. However, in none of these references is there instruction or great explanation of the concepts. One of the earliest “modern” teachers was said to be Paramyogeshwari Sri Devpuji who died in 1942. He was said by his devotees to be an incarnation of Lord Vishnu. One of his disciples was Bhagavan Sri Deep Narayan Mahaprabhuji who lived in Rajasthan. He lived from 1828 to 1963. Yes, that is 135 years. He was revered by his devotees as an avatar (a divine incarnation). Some of his writings about Yoga Nidra are preserved and they are quite beautiful and poetic. Bhagavanji had two main disciples to whom he is said to have passed on this knowledge. One was Swami Muktananda (1908 – 1942) and the other was Swami Sivananda (1887 – 1963). Modern Yoga Nidra What is practiced and called Yoga Nidra today comes from this lineage of teachings. Modern teachers have developed their knowledge into a variety of similar but different forms. One of most well known modern teachers is Swami Satyananda Saraswati who passed in 2009. He was the http://www.ayurvedacollege.com/book/export/html/2
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founder of the Bihar School of Yoga. He is often credited with reviving this knowledge. It is said that he had a vision of Swami Sivananda who blessed him as Swamiji left his body in Rishikesh. Through that vision, Swami Sivananda is said to have passed on the knowledge of Yoga Nidra to Swami Satyananda. It is widely regarded, however, that Swami Satyananda developed his own approach or his style of Yoga Nidra, which some believe was influenced by the Tantric practice of Nyasa or focusing mantras on body parts and organs. One of Swami Satyananda’s disciples is Swami Janakananda who went on to found the Scandinavian school of Yoga in 1970. Swami Janakananda and his disciples have strongly promoted Yoga Nidra and sponsored a considerable amount of research on the subject, some of which has been published, demonstrating the different brain wave patterns while in the Yoga Nidra state of consciousness. Another proponent of Yoga Nidra was Swami Rama, the founder of the Himalayan Institute who passed in 1996. While I do not know from whom he learned Yoga Nidra, he did develop a unique approach to taking students into that state of consciousness. Most recently in 2006, Richard Miller, the founder of the International Association of Yoga Therapy developed his own style of Yoga Nidra and brought it into VA hospitals in order to help heal soldiers with PTSD. He discusses his studies in a recently published book. He calls his technique iRest. My Own Journey into Yoga Nidra In 1987 I was very ill with an autoimmune disorder that left me crippled. During my healing process, I went to see a healer who had been trained in the Philippines. He laid his hands on me and, as a result, my body temperature rose from 99 degrees to 105 degrees over the next two days. It then stayed between 103.5 and 105.5 for the next two weeks. During that time, I came into awareness of the witness within me, that part of myself untouched by the disease. I also developed an extraordinary ability to perceive the subtle flow of energy in my body. For two weeks, I laid in bed spending time conscious, witnessing and examining my subtle body, aware that I was not this body. In that state, I became conscious of blockages in the flow of energy (prana) and how to release them through conscious intention. As I mastered that ability, I began to heal. As my fever came down, I lost the acute ability but remembered clearly that state of awareness and strived to recreate it in order to continue my healing process. I had limited results until I found a recording of guided meditation by a teacher named Mary Richards who passed away in 2009. I let her voice guide me and I returned back to the state of conscious deep relaxation and once again began to perceive the flow of subtle energy and remove remaining blockages. I practiced this technique 23X per day for the next 10 years as I combated severe Chronic Fatigue following the autoimmune illness. With no trace left of the condition by 1997, my practice was reduced to once per day and then in recent years to a few times per week preferring instead to focus on mantra meditation. I began to teach programs to my patients and the public in Conscious Deep Relaxation in 1993 and taught regularly until 1997 until my work with the California College of Ayurveda consumed much of my time. I only learned of the name Yoga Nidra in 2005 and came to realize that I had been practicing this technique for 18 years through the Grace of the Divine. I had stumbled upon this state of consciousness and did not know that such a long tradition existed. In 1999 or perhaps 2000, I visited the Sivananda Yoga Retreat in the Bahamas. As part of my service, I taught the senior teachers the process of conscious deep relaxation for the purposes of their own healing. In 2009, I was asked by the head spiritual teacher at the ashram, Swami Swaroopananda, to begin teaching workshops again after a 13year hiatus and this time to train additional teachers. Naturally, I was honored and this seemed like an appropriate next step for the work that had begun within me 23 years earlier. As such, I conducted the first teacher training http://www.ayurvedacollege.com/book/export/html/2
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program in 2010. Conclusion Yoga Nidra is an extraordinary technique for both developing consciousness and for selfhealing. In our deepest states of relaxation, the physiology of the body returns to a state of balance from which healing occurs. Yoga Nidra is not magic. It works within the laws of nature. Where healing is possible, Yoga Nidra will maximize the ability of the body and mind to heal itself. Yoga Nidra supports the immune system, the nervous system, the endocrine system and all of the organs of the body. Yoga Nidra is an outstanding complementary approach to supporting the healing process of patients suffering from cancer, heart disease, autoimmune disorders, chronic fatigue, pain and much more.
Yoga and Ayurveda: Children of the Vedic Teachings Have you ever wondered why some asanas seem to leave you feeling calm, still, centered and balanced while others seem to leave you agitated, sore and off center? Take the case of a thirtyone year old woman who came for treatment with repeated neck pain and nervousness. She had been practicing yoga for six years and could not understand why she was having such difficulty. Our work with Ayurvedai, the 5,000 year old "knowlege of life," helped this woman to understand how the Yoga asanas she had been practicing affected the movement of energy in her body. She found out that some of the asanas she had been practicing aggravated the subtle energies of her body. She also learned new asanas, which were more in harmony with her unique energetic balance. With this new knowledge she was able to modify her practice and eliminate her neck pain and nervousness while bringing greater well being to her body and mind. In addition to the profound dietary and lifestyle advice that Ayurveda is most well known for, Ayurveda also sheds profound new light on the practice of Yoga. Yoga and Ayurveda are in fact, two paths intertwined in such a close relationship that it is hard to imagine traveling down one of these paths without knowledge of the other. Yoga is the ancient art and path of preparing the body and mind for the eventual liberation and enlightenment of the soul. Ayurveda is the ancient art and science of keeping the body and mind healthy so that individuals can pursue the goals in life that they have set for themselves. The popularity of Yoga in this country has been growing steadily since Swami Vivekananda first brought the ideas of Yoga to the West in 1893. While Yoga found a welcome home in the West, its sister, Ayurveda, was left behind in India, a distant counterpart to these important Vedic teachings. Today, just over 100 years later, Ayurveda has landed on this distant western continent in search of its sister, in search of its other half. Ayurveda does not come to this country empty handed but brings with it many gifts. It brings with it the knowledge of how to keep the physical body healthy and how this relates to ones spiritual journey. It brings a gift specific to the yogi: the knowledge of how the asanas affect each one of us. Ayurveda sheds light on which specific asanas are best for each individual. http://www.ayurvedacollege.com/book/export/html/2
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The Vedas, the oldest known writings and teachings, are the origins of both of these ancient arts. The Vedas are comprised of five books. One of them, the Yajur Veda, is considered by scholars as the origins of the knowledge of Yoga. Ayurveda has its roots within the Rig and Artharva Veda. According to Dr. David Frawley, Vedic scholar, "Yoga is the practical side of the Vedic teachings while Ayurveda is the healing side." In practice, both of these paths overlap a great deal. Classical yoga has, as a part of its traditions, an aspect which addresses health and health practices. It is not simply asanas for differing conditions, but purification practices as well. In the same vein, Ayurveda is much more than dietary principals. Ayurveda can be seen as the science of understanding how we interact with our environment and how to alter our environment in such a way that it is harmonious with our deepest nature. Ayurveda is the science of how energies interact. As such, Ayurveda addresses our entire lifestyle including exercise and Yoga. Ayurveda sees each individual's path toward perfect health as a unique path, hence Ayurveda can help us to understand which Yoga asanas are best for each individual as well as understand how the different forms of Pranayama affect us. Ayurveda and Yoga are so closely related that it is argued as to whether Patanjali, considered by many to be the father of Yoga, and Caraka, often considered as the father of Ayurveda, may have in fact been one and the same person. The name "Caraka" translated means "the wanderer" or "the traveler." It is surmised that in his travels around India he may have been known by different names. While the Yoga Sutras of Patanjali are the definitive work on Yoga, the Caraka Samhita is considered the definitive work on Ayurveda. Whether Patanjali and Caraka were indeed one person will never likely be known. Philosophically, both Yoga and Ayurveda are rooted in the same basic philosophy of Sankya, one of six schools of classical Indian philosophy. The foundation of this philosophy can be described as follows: 1. There exists a fundamental state of pure being that is beyond intellectual understanding and which all life consciously strives for. This is the state of enlightenment or self liberation (Moksha) 2. Suffering is a part of our lives because of our attachment to our ego or selfidentity (Ahankara). 3. The path toward ending suffering is the path of dissolving or transcending our ego (Ahankara). In doing so all fear, anger and attachment are eradicated. 4. To achieve this goal, we must live a purely ethical life. These practices are described as the Yamas and Niyamas of the Yoga Sutras of Patanjali. 5. Any disturbance within the mind or body interferes with this path. Ayurveda is the science of keeping the biological forces in balance so that the mind and body may be healthy. Ayurveda is based on the idea that there exists three forms of the life force called Doshas. They are Vata, Pitta and Kapha. We are all made up of a unique combination of these three forces. This unique combination, determined at the moment of conception, is our constitutioni or Prakruti. These forces constantly fluctuate according to our environment which includes our diet, the seasons, the climate, our age and many more factors. The current state of these three doshas most commonly defines our imbalance or our Vikruti. Since we all have a unique constitution, and unique imbalances, it makes sense that each person's path toward health will likewise be unique. This is a major principal of Ayurveda. In addition, what will keep each of us healthy is also unique. Understanding our prakruti and our vikruti offers each of us the potential to make correct choices for ourselves along our paths. http://www.ayurvedacollege.com/book/export/html/2
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To understand these forces and how they interact with our environment it is necessary to understand the five elements. The ancient Vedic people defined the world by what they saw around them. Without the benefit of fancy instrumentation, it was easiest to define the world by what they knew. Hence, the five elements became a way to describe all things. The five elements of the Ayurvedic system are: earth, air, fire, water and ether. These elements are not meant to be taken literally but are to be seen as metaphors or ideas. When something is hard or dense, they said that it had a lot of earth in it. Something, which is moist, was said to be composed of water. When something was light and had great movement they said it was made up of a lot of air. If something was hot they said it had a lot of fire in it. The last element is harder to describe. Ether is the idea of connectedness. It is that which connects all things together and is the space that the other elements fill. Whether we are talking about diet, the weather or yoga, all things can be described in terms of these five elements and this includes the three doshas. Vata is said to be made up of air and ether. It is compared to the wind and is said to be light, drying, cooling and capable of movement. Pitta is said to be made up of fire and water. Considered to be mostly fire, it is said to be hot, light and neither too dry or moist and is immobile, though it can be easily moved by the wind (Vata). Kapha is said to be made up of water and earth, which combine like mud. Kapha is heavy, moist, cool and stable. The importance in understanding the Doshas is that like increases and like opposites balance each other. Hence, that which has similar characteristics as the Dosha will increase it and that which has opposite characteristics will decrease it. Knowing this we can adjust our Yoga practice, diets and other factors from our environment to affect these forces in ways that help us to create greater balance and harmony. The three Doshas fluctuate constantly. As they move out of balance they affect certain areas of our bodies in certain ways. When Vata is out of balance, typically in excess, we are prone to diseases of the large intestine like constipation and gas along with disease of the nervous system, immune system and joints. When Pitta is in excess we are prone to diseases of the small intestine like diarrhea along with diseases of the liver, spleen, thyroid, blood, skin and eyes. When Kapha is in excess we are prone to diseases of the stomach and lungs, most notably mucous conditions along with diseases of water metabolism such as swelling. Another pillar in the construct of Ayurveda is the understanding of the three Gunas, or qualities of nature. This is the science of Ayurveda applied to the emotional and spiritual aspects of an individual. Understanding the qualities of nature leads to greater understanding of ourselves and our spiritual journey along with how our lifestyle choices and actions affect that journey. The three Gunas are Sattva, Rajas and Tamas and again all things can be described as a combination of them. That which is sattvic is said to be light, clear and stable. Sattva is the state of being which comes from an awareness of our connectedness to God or Purusha and in which we manifest our highest expression and most virtuous qualities. The pure state of sattva can be said to be that of enlightenment. That which is rajasic is said to be active, agitated, turbulent or motivated. Rajas is the state of being which comes from a distraction from our truest essence. In this state we are unaware of our connectedness to our spirit and as such manifest the emotions we've come to label as "challenging". These emotions include fear, worry, anger, jealousy, attachment and depression. Rajasic action is the cause of pain and suffering. That which is tamasic is said to be heavy, dull, dark and inert. In this state we are expressing our darker nature and become harmful to others or http://www.ayurvedacollege.com/book/export/html/2
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ourselves. The actions include violent or vindictive behavior toward others along with selfdestructive behaviors such as addiction, depression and suicide. The importance in understanding the gunas is that, like the doshas, like increases like. When we live a lifestyle that is tamasic, we increase the influence of tamas within ourselves and bring about destruction. When we live a lifestyle, which is sattvic, we increase the influence of sattva within us and enhance our spiritual growth and evolution. Cultivating sattva brings freedom from disease while the manifestation of rajasic and tamasic behaviors causes disease. Understanding these principals allows us to structure our environment, diet and yoga practice in ways that support our spiritual growth as well as our well being. Understanding the principles of Ayurveda allows us to apply these principles to many aspects of our lives. Lets take a look at the implications of Ayurveda on the practice of Yoga. In order to understand how the principles of Ayurveda affect our practice of Hatha Yoga we must first understand the energetics of movement. All movement/activity is by nature rajasic and heating to the body. Yet, some movements are more heating and others are less so. Likewise, some movements are more rajasic and others are less so. Those, which are less so can also be said to encourage greater sattva. Generally speaking the slower the movement the less rajasic and the less warming to the body and mind. The faster the movement the more rajasic and the more heating. In this context Hatha Yoga along with other disciplines like taichi are inherently less rajasic than say, jogging or aerobics. It can also be said that any form of movement practiced with great awareness is more sattvic. Those that are practiced with distraction or less attentiveness are more rajasic. Thus one way to enhance our experience of Yoga is to practice slowly and with greater awareness of how we are feeling and what our breath is like. To practice yoga without awareness is to invite injury; to practice with awareness is to invite learning about us. Can any movement be purely sattvic? This is questionable. The inherent nature of movement is rajasic, as rajas is the principal of energy and movement requires energy. Hence, the sattvic qualities of one's nature is most advanced in meditation where one can find silence and stillness and become pure awareness. It is important to note at this time that while movement is by nature rajasic, this does not make it bad for us. That which is rajasic serves the useful purpose of stimulating our bodies and minds allowing for activity to take place. We could not function in our world without a part of us being rajasic. When we transcend our rajasic nature and become enlightened, we no longer function in this physical world in the same way. Taking the principles of movement into account we can begin to see that people of vata constitution or imbalance are most supported by a yoga practice which is calming, quieting and yet warming. People of pitta nature or imbalance are most supported by a yoga practice, which is calming, quieting and less heating. And, people of kapha nature are most supported by a yoga practice, which is stimulating and warming. Each individual has different needs. To practice in a way that does not support you is to invite greater imbalance and the related consequences. In developing a healthy yoga practice students must not only take into consideration their constitution and imbalance but also their age, the season of the year and the times of day they practice. These influences affect the balance of energies in our bodies and hence this must be reflected in a healthy yoga practice. http://www.ayurvedacollege.com/book/export/html/2
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When designing a yoga practice for yourself the influence of the season, your age and the time of day are not as important as your overall vikruti or imbalance. These should be seen as the factors that modify your practice but not the factors that create it. Your vikruti is, in fact, the single most important determinant of your entire lifestyle regime. It is even more important than your constitution! When you are in near perfect balance you can create a program based almost entirely on your constitution, the seasons and time of day as the most important determinants. This program will help you to stay in balance. In Ayurveda it is understood that at different times of our lives different doshas play a greater role. This is a part of the natural fluctuation of these forces. It is said that when we are born our bodies and minds are more affected by kapha and that this is true until puberty. During this time our bodies are growing at a rapid rate requiring a greater influence of the earth element. Hence during this time in our lives, regardless of our constitution, kapha is likely to be increased unless we take measures to balance it. From puberty until around our retirement years the influence of pitta increases. This is because these are our years of greatest productivity requiring a greater influence of fire. The later years, post retirement are the time of our lives most dominated by Vata. This is a time of reflection and the influence of ether increases. During each of these periods we must pay attention to the effect our age has on us and modify our practice appropriately. In this sense, when we are young, our bodies can better tolerate the more aggressive styles of yoga. As we age we need to practice more calming asanas. The seasons also affect a healthy practice. Remember that like increases like. Hence the season of cold dampness increases kapha. The season of warm weather increases pitta and the season of cool dryness increases vata, as does the windy season. In different parts of the country these take place at different times and hence placing the names of traditional seasons upon them can be confusing. During the kapha season it is best to alter your Yoga practice to help balance its influence. Hence, a practice, which is more stimulating and warming, is better at this time. In the pitta season a practice which is not as warming is best. In the vata season a calming practice supports greater health. Finally, the time of day we practice will affect the balance of the doshas. Kapha naturally increases within us during the hours of 6:00 until 10:00 in the morning and evening. This is the time when we are moving slowly in the morning and slowing down toward the end of the day. Pitta naturally increases between the hours of 10:00 and 2:00 a.m. and p.m. This is the time the digestive fire is at its height, and in the day times parallels the movement of the sun to its peak. Vata naturally increases within us between 2:00 and 6:00 a.m. and p.m. This is a time of transition from night to day and back again. Most people practice yoga in the early morning. This is the most sattvic time of day when there is greater stillness and quiet and the energy of our environment is most sedate. The time of vata is closely related to sunrise and sunset. Before 6:00, during the time of vata a quieter and gentler practice is recommended. During the sunrise and sunset, vata is most stimulated and so calming asanas at these times are best. After 6:00 in the morning, the time of kapha, a more stimulating practice is appropriate. Putting this into examples: Let's say you are of a vata nature or imbalance (vata is the most common imbalance), it is the cool dry or windy season, and you are 67 years old practicing Yoga at 5:00 a.m. Your health would be best served practicing a routine to balance vata (vata routine described later). Suppose you are of pitta nature and of vata imbalance. Practice a regimen that will balance vata first. Then modify it later so that it does not aggravate Pitta. As you are balancing Vata you may modify your program so that is it warm but not extremely heating. With this in mind let's take a http://www.ayurvedacollege.com/book/export/html/2
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look at some yoga asanas. Asanas for Vata The asanas which are most suitable for vata are those which are calming and grounding by nature. This will balance the tendency for those with a vata imbalance to be "spacey" and agitated or nervous. These asanas will help allay fear, worry and anxiety on the emotional level and also improve vata physical imbalances such as constipation, lower back pain and joint pains. These asanas compress the lower abdomen or cause the lower abdomen to become taut. The lower abdomen, pelvis and large intestine are the main residence of vata in the body. In addition, asanas that strengthen the lower back help alleviate vata. In general most yoga asanas are good for bringing greater balance to Vata since most asanas are calming to the mind. There are, however, some which are more exceptional and some which should most certainly be avoided. The following will focus on these since it would be tedious to list every asana. One exceptional asana is Uttanasana (forward flexion from a standing position.) To perform this asana, stand erect with your feet about a shoulder width apart. The arms may be raised over the head as you reach to the sky or you may wish to bend the elbows clasping the opposing arms just above the elbow as you let your forearms rest on or just above the crown of your head. Keeping your back straight slowly bend forward from the hips as you exhale. Bend as far forward as you comfortably can. Your hands may touch the floor in front of your feet, remain crossed as you hold the opposing arm or if you are very flexible, be placed just behind your heels. For the less flexible the hands may be placed upon blocks which rest on the floor. Let gravity assist the lengthening of your spine. All standing asanas tend to be grounding if awareness is placed on the feet honoring the connection between your body and the earth. It is important to note that this asana can put quite a strain on an injured lower back, so care should be used and there are many modifications that may be made by an alert Yoga instructor. If the lower back is simply tight, a condition related to imbalanced vata, this is an excellent asana. The seated version of this asana, Paschimotanasana (seated forward bend) will have similar value and may be easier if your back is sore. Vajrasana with forward bending, (child's pose) is another excellent asana for bringing compression to the pelvis and Vata region. To perform this asana, sit upright with your knees flexed and placed underneath your buttocks. Keeping your arms to your side, bend forward from the hips until your head is resting on the floor in front of you. If you do not have the flexibility to place your head on the ground, place a folded blanket or a pillow on the floor in front of you for your head to rest upon. Compression asanas are excellent for constipation and for chronic gas. Another very good compression asana aiding the lower back and constipation but is more advanced is BaddhaYoga Mudra. (The bound Yogic Seal.) Supta Virasana (supine backward bend) is another exceptional asana for vata. To perform this asana, sit in Virasana. Move the legs out to the side of the pelvis so that the buttocks slide down inbetween both legs. Place the hands on the soles of the feet and lean back onto the elbows. This may be enough extension for many people. If you are flexible enough gradually lower your back down to the floor. Your hands may lie by your side or be stretched above the head to achieve greater lengthening of the spine. While this stretch does not compress the pelvis, it creates a mild extension of the lower abdominal muscles and lower back. This action increases the pressure in the pelvis again alleviating vata. According to Dr. Vasant Lad, this asana is particularly useful as a part of treatment for Vata type asthma conditions. Another asana, which extends the lower back and places pressure on the pelvis, is Dhanurasana (bow pose). To perform this asana, lay on your stomach with your arms to your side. Lift the head, shoulders and chest off of the mat and bend both knees. Reach back and take hold of the ankles. Let your legs draw your chest further into the air so that your body weight rests on the pelvic region. This is essential for the maximum relief of Vata. http://www.ayurvedacollege.com/book/export/html/2
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Sitting asanas like Virasana, Siddhasana and Padmasana are very calming poses which sedate vata's agitated nature. These meditative poses are excellent for calming the nervous system, a common site for vata imbalance. Calming the nervous system aids in the healing of anxiety, nervousness, sciatica and muscle spasm. Padmasana (lotus pose), while calming and sedating, also moves energy upward toward the head. This is not very grounding but can be helpful in alleviating vata type depression. Placing attention on the tailbone during this pose helps make this a more grounding asana for vata. The most calming pose of all is, of course, the supine Savasana (corpse pose). People of vata nature should avoid certain asanas. They should particularly avoid those which are overly stimulating to the nervous system such as repetitive Sun Salutations (Surya Namaskar) and those which place excessive pressure on sensitive joints in the body. The cervicothoracic junction is one of these areas. This is the bony region where the neck meets the shoulders. Here, large vertebrae stick out like "sore thumbs". People of vata nature and imbalance tend to have weaker bones, less fatty padding, looser ligaments and are more susceptible to pain. For these reasons Salamba Sarvangasana (shoulder stand) and Halasana (plow) should be avoided or modified by placing a blanket under the shoulders for extra padding. This also decreases the extreme flexion the neck is placed in. Even still, people of vata nature or imbalance should not hold these poses for very long or they will risk injury. Asanas For Pitta The best asanas for pitta are those, which are calming, and not overly heating. People of pitta nature or imbalance tend to be more assertive and intense individuals. Calming poses help sedate their intensity and their sattvic nature helps these people to transcend the emotions of anger and resentment that they are more prone to. By alleviating pitta, these asanas are good as part of the treatment for such conditions as ulcers and hyperacidity, liver disease and acne. Asanas which help balance pitta are those which place pressure on the naval and solar plexus region. This region is the residence of Pitta, which resides in the small intestine and directly affects the liver and spleen and helps regulate the strength of the digestive fire. An exceptional asana for bringing balance to pitta is Ustrasana (camel pose). To perform this asana sit in Virasana and then extend the knees to a right angle as though you are standing on your knees. Place your palms on your buttocks. Move your thighs and pelvis forward as you extend the lower back. Allow your hands to fall onto to the heels of your feet. Gently extend you neck. Remember to breathe while in any posture. This asana opens up the abdomen, solar plexus and chest allowing for freer movement of energy through these regions. Other excellent solar plexus extension poses for pitta is Bhujangasana (the cobra) and Dhanurasana (bow pose described above.) These asanas can play a role in the treatment of ulcers and hepatitis. To perform the Cobra lie face down with your feet together and ankles extended. Bend the elbows and place your hands flat on the floor by your lower ribs. (Less flexible individuals may choose to place the palms on the floor at shoulder level.) Upon inhalation extend the elbows and raise the head, chest and abdomen off the floor while keeping the pelvic bones on the floor. The head may be held in a neutral position or in extension. Compression of the abdomen helps to alleviate pitta as well. [Authors note: It is my hypothesis that compression decreases the flow of energy through the solar plexus (site of the third chakra) sedating Pitta while extension increases circulation through the solar plexus breaking up stagnation and freeing up the circulation. There is no reference for this.] Both compression and extension are important to keeping the pitta in http://www.ayurvedacollege.com/book/export/html/2
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balance. Exceptional abdominal compression asanas for balancing Pitta are Janu Sirsasana and Paschimottanasana (previously described). To perform Janu Sirsasana sit on the floor with both legs extended out in front of you. Bend one leg forward and place the sole of the foot against the inside of the opposite thigh. Bend forward over the extended leg from the hips keeping the back straight. Along with compressing the solar plexus and pelvic regions, both Janu Sirsasana and Paschimottanasana stretch the lower back and hamstring muscles. Yoga asanas, which should be avoided for people of pitta imbalance or constitution, are headstands. Headstands are heating to the body and much of this heat accumulates in the head and the eyes. The eyes are organs controlled mainly by pitta as they are involved in metabolism of light and visual impressions. For this reason, headstands can contribute to the onset or make worse diseases of the eyes. Individuals with diabetes should avoid all inversions as a complication of this condition causes hardening of the small blood vessels in the eyes. This makes them more susceptible to damage from the increase in blood pressure in the head. People with glaucoma should avoid inversions as well, due to the increase in intraocular pressure. If a person of pitta constitution chooses to do headstands, perhaps because they have no serious imbalance, then the headstand should be held for a very short period of time. Asanas for Kapha Asanas which are most suitable for kapha are those which are more stimulating and heating to the body. These help to balance the heavy, slow cold and sedated nature of kapha. Asanas best suited to individuals of kapha nature or imbalance are those which open up the chest. The stomach and chest are the areas where kapha accumulates. In the chest, kapha takes on the form of mucous. These asanas are excellent for the prevention and treatment of congestive conditions like bronchitis and pneumonia as well as constrictive conditions such as asthma and emphysema. Exceptional asanas for kapha are Ustrasana (camel pose, already described above) and Setu Bandhasana (bridge pose). To perform this asana, lie flat on your back with your arms to your sides. Allow the palms to face down toward the floor. Using your elbows and forearms raise your trunk off of the mat as you keep your head and feet on the ground. Next extend the head and increase the arch of the spine so that there is a smooth arc from your heels to your head. If you have the strength, you may place your hands on your thighs and support your body weight with your head and feet. As a gentle alternative to this posture, a person may lie on their back in extension over a bolster and a pillow. (For a demonstration of this see page 80 in Yoga, the Iyengar Way.) Both of these do an excellent job opening the chest allowing for greater circulation of energy through this region. These asanas also affect the flow of energy through the heart chakra aiding the development of compassion and unconditional love. The calming and sedating effect of most asanas needs to be balanced by other asanas that are more stimulating and heating for those of Kapha nature and imbalance. Surya Namaskar (Sun Salutation) is a very good aerobic exercise for kapha when done repetitively and helps in the treatment of obesity and depression, two common kapha conditions. This group of movements can perhaps be said to be the ideal asana for Kapha as it is very active, creates heat, and opens the chest. The strength enhancing asanas like Vasisthasana (sage pose) also increase the heat of the body and are excellent as well. People of kapha nature can best handle strength poses as their joints and muscles tend to be strong and stable. Increasing flexibility is extremely important for those of kapha nature, as it is the tendency of kapha to become overly stiff or rigid. The sun salutation is the ideal asana for Kapha as it is very active, creates heat, and opens the chest. There are twelve parts to this asana. To perform the sun salutation, begin by standing erect with the feet touching each other. Bend the elbows and bring the palms together in the http://www.ayurvedacollege.com/book/export/html/2
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middle of the chest. This is position one. Raise the arms above the head and extend the neck and torso backward. This is position two. Bend forward and bring the hands to the floor. Keep the knees straight. This is Uttanasana and is position three. From this position lunge backward with the left leg as you bend the right knee. The knee of the left leg may lie on the floor. The foot of the right leg should be between both hands. This is position four. Bring the right leg backward and place it by the left leg as you bring your buttocks high into the air. (This is the "downward facing dog" position.) This is position five. Allow the elbows to come to the floor then glide your body forward into Bhujangasana (cobra pose). A variation includes keeping the knees and pelvis off the ground in this pose with less extension placed upon the lower back. (This is called "upward facing dog".) This is position six. Position seven returns us to downward facing dog. Next lunge the left leg forward as we bring our pelvis low to the ground. The left foot is placed between the hands and the knee is bent, held close to the chest. This is position nine. Bring the right foot forward as you return to Uttanasana (standing forward bend). Extend upward to a standing position and raise the arms once again over the head extending the back and head as in position two. This is position eleven. To complete the cycle, return the hands to the chest, palms together. This is position twelve. Sun salutations are excellent for anyone during the Kapha hours of the day. People of Kapha nature should do the most repetitions and they should be performed with greater speed. While in general, people of Vata nature should avoid this asana, it may occasionally be performed very slowly and with great awareness. This will decrease its Vata aggravating tendencies. People of Pitta nature should avoid this series, as it is very heating or should do limited repetitions, preferably during Kapha hours. Few asanas are harmful to kapha as their nature allows them to benefit from all forms of stretching and movement. However, two weak areas of the body for kapha individuals are the lungs and the kidneys. Asanas, which place excessive pressure on the lower abdomen, if held for too long, may aggravate the kidneys. Asanas like Dhanurasana (bow pose) is one such pose. Awareness of breath while practicing yoga is very important as it is an aid to the awareness of the body. If a pose is creating pain or if a person is stretching too far, most often, the body will react with an alteration of breathing prior to an injury taking place. This alteration may be a shortening of the breath or an increased rate of breathing. In this way, awareness of breath leads to awareness of the body. Practicing with awareness increases the sattvic nature of one's practice of yoga and as such enhances ones spiritual development. People of all constitutional types should perform the asanas with slow, quiet, yet full breaths. This type of breathing calms vata and pitta. People of kapha nature should breathe in the same manner when performing gentle stretching asanas but should balance the calming, sedating effect of these asanas and the accompanying slow breathing pattern with active and strengthening asanas which allow the breath to become quicker and shorter. This form of breathing warms and stimulates the body and mind and hence brings greater balance to kapha. Pranayama and Ayurveda Pranayama, the art of yogic breathing, is an art shared within the tradition of Ayurveda. It has been associated in the West as a part of the yogic practices for affecting the flow of energy through the body and for creating an experience of both blissfulness and oneness with the cosmic life force. Ayurveda compliments this knowledge by describing how the different forms of pranayama affect the three doshas and how pranayama can be used in practical ways as a part of the healing process. Like all things of nature, the different forms of pranayama can be understood as heating or cooling and sedating or stimulating. http://www.ayurvedacollege.com/book/export/html/2
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Lunar pranayama, the act of inhaling through the left nostril and exhaling through the right nostril, has a cooling and calming affect upon the mind and hence the body. Thus this form of yogic breathing helps bring balance to pitta and its subtler mental counterpart, tejas. Solar pranayama, the act of inhaling through the right nostril and exhaling through the left nostril, has a heating and stimulating affect on the body and mind. Thus this form of yogic breathing brings greater balance to kapha and its subtler mental counterpart, Ojas. Vata, and its subtle mental counterpart Prana, are balanced by alternating the two breathing techniques or by inhaling and exhaling through both nostrils simultaneously with attention and awareness. This action is calming and is neither too warming or too cooling. These forms of pranayama mentioned are a good general practice along with one's Hatha Yoga practice. It is generally recomended, however, that a person practicing pranyama be of strong body and mind. This is a person who has prepared themselves with years of Hatha Yoga practice and has been trained by an experienced pranyama teacher. These basic forms of pranyama can be practiced by anyone with minimal instruction who understands their Ayurvedic constitution and Vikruti, and is willing to begin slowly and practice on a regular basis. The first time they are practiced, however, should be with a trained practitioner who can teach the finer points. While recommended as a general practice, pranyama is especially important for those suffering form respiratory ailments. These breathing techniques can be very useful as part of an overall program for allergies, asthma, sinus conditions and chronic colds. Bhastrika, the breath of fire, by its very name tells us of its energetic properties. This form of yogic breathing involves forced exhalation through the nose with natural inhalation. This action is very heating and stimulating. It is best performed by those of kapha constitution and avoided by those of vata and pitta. According to Dr. Versant Lad, "This exercise is the equivalent of running two miles." It is a good part of a complete program for the treatment of obesity as it stimulates metabolism and increases the breakdown of fat. Sheetali, a form of pranyama where one inhales and exhales through a rolled up tongue, is a form of pranyama which is cooling and hence a natural part of the process of bringing pitta into balance. Both Bhastrika and Sheetali circulate the pranic energies more aggressively and as such require greater instruction. They should not be practiced without the guidance of a trained practitioner of pranyama. Ayurveda and the branches of the Yoga Tree Yoga is defined as the "union" with god or Purusha (That which is without form and not of the material world.) There are many paths to this state of enlightenment. The major branches of the yoga tree defined by Georg Feurstein describe these different paths. There are of course, as many paths as there are people. Ayurveda, by viewing each person as an individual with unique gifts as well as unique challenges, helps us to understand how each of us may be naturally more attracted to one path and more repulsed by another. Bhakti Yoga, or devotional yoga, is the path of learning about us through learning about our heart and our ability to love unconditionally. This http://www.ayurvedacollege.com/book/export/html/2
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unconditional love is for all people, including us and for the Divine. This path is most attractive to those of kapha constitution as in their more sattvic expression, devotion is a natural state. The gift of love, compassion and devotion are kapha's natural gifts and the path of Bhakti yoga can help them to discover it. While this path is for all that choose it, those of strong vata or pitta natures may find it more difficult as it does not stress their natural gifts. Jnana Yoga, the path of discernment, often referred to as the "path of the sage", is the path of becoming clearly perceptive to truth. In this way one becomes capable of distinguishing false imagination from absolute reality. This path requires a person to directly dissolve the ego, which acts as a filter and distorts the truth. Understanding Ayurveda, we may postulate that this very difficult path is most suited for those of pitta nature, who in their more sattvic way of being, allow the fire which burns in the mind to burn away false imaginings from reality. The path of Jnana yoga emphasizes the natural gifts of pitta. This path may be more difficult for those of greater vata and kapha nature. Tantric yoga, the path of transcending the self through sacred ritual and the worship of deities, emphasizes the realization that all that is around us is divine and that nothing separates the unholy from the holy. Through ritual, all things are honored as sacred. The path to the embodiment of these principals appears to be most suited for those of vata constitution who by their nature tend to be more open to experimentation, ritual and the abstract. This path to the esoteric suits the nature of vata well, as they are often more sensitive to subtle energies of their bodies and surroundings. In their more sattvic expression, people of vata nature are divinely inspired and their creativity is just one of their gifts to the world. Tantric yoga may be a more difficult path for those of strong pitta and kapha natures. Karma Yoga, the path of selfless action, is the path of surrendering the self or ego through service. This path of learning about ourselves and finally transcending ourselves is a path suited for all constitutional types. All individuals are bound to the physical world by their karma. In this context karma refers to any action which springs from the ego and sets in motion a cascading series of effects. This is a particularly useful though challenging path for those of pitta nature who by the nature of their intensity are often most focused on achieving through their work. Selfless action creates balance to their otherwise rajasic nature. In Ayurveda, balancing the effects of the doshas is only one half of the formula to creating health and well being. The other half is developing a more sattvic lifestyle and learning to express our more sattvic nature. Our sattvic nature is that aspect of ourselves, which through an awareness of our connectedness to Spirit, allows us to express our highest or most virtuous qualities. In this state we realize three fundamental truths: 1. All things material are illusions. This includes not only our expensive toys, but also our emotions and our thoughts. 2. The universe is unfolding perfectly and we fit into that perfection, even with our challenges. 3. We are all spirits growing and evolving. Until we become enlightened we will continue to have challenges. When we realize these three truths three results become apparent: 1. We need not be attached to anything material since all is transient. With this realization we can let go of our idea of ourselves and in the process let go of depression and over sentimentality. 2. If the universe is unfolding perfectly we can have faith and trust in this process. Hence, we can let go of fear and worry. 3. We all have challenges and hence it becomes unnecessary to judge others or ourselves since each of us is perfect for where we are in our continued evolution. With this realization we can let go of all judgment and the anger, resentment, and hatred associated with it. http://www.ayurvedacollege.com/book/export/html/2
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Yoga, along with meditation and proper lifestyle, in harmony with one's nature, is the Ayurvedic path toward balancing the doshas and enhancing Sattva. Through this path each of us can reach our full potential and achieve the goals in our life we have set. In this light we can begin to see Yoga and Ayurveda as separated children of the Vedic teachings being reunited in modern times. Both bring gifts to help guide us along our paths. Blessings upon your journey. References 1. Caraka Samhita: Translated by R.K. Sharma and Bhagwan Dash. Chowkhamba ©1972 2. Ayurvedic Healing: By Dr. David Frawley. Passage Press © 1989 3. Ayurveda; The Science of Self Healing: By Dr. Vasant Lad Lotus press ©1984 4. Living Yoga; A comprehensive Guide for Daily Living: Edited by Georg Feuerstein, Stephan Bodian with the staff of the Yoga Journal. Yoga Journal, ©1993 5. Yoga; The Iyengar Way; By Silva, Mira and Shyam Metha. Knopf ©1992 6. Ayurveda Home Study Coarse: By Dr. David Frawley. ©1992 7. Yoga and Ayurveda Workshop Notes: Margo Gal. 8. Integral Yoga Hatha: Yogiraj Sri Swami Satchidananda. ©1970 Table 1: Summary of the three doshas.
Yoga and Ayurveda: Two Sides of One Coin In our Western culture, many people use Yoga asana as a stretching tool to keep the body limber and agile. To this extent there is no better practice. Traditionally, however, Yoga postures are a part of a much greater spiritual journey. Yoga is a complete science of helping the mind to become clear or pure. A clear mind is not affected by stress and a clear mind produces a healthy body. While the health benefits of a mind at peace are irrefutable, what is even more exciting is that a person with a clear mind is also aware of their deeper spiritual nature or connection. We say in Ayurvedaithat all disease is the end result of forgetting our spiritual nature. Hence, Ayurveda and Yoga strive to help a person reconnect to their true nature through direct experience. Yoga and Ayurveda are so closely related they are often looked at as two sides of one coin. In fact, Ayurveda is the healing side of Yoga, and Yoga is the spiritual side of Ayurveda. Together they encompass a complete approach to the well being of the body, the mind, and the spirit. With even a little knowledge of Ayurveda, the practitioner of Hatha Yoga can refine their practice so that it is in harmony with their internal balance of energy. As with diet, herbs, aromas, etc., some Yoga postures are best for one person while others can cause greater imbalance. http://www.ayurvedacollege.com/book/export/html/2
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Knowledge of one's constitutional balance (a balance between, what is known in Ayurveda, as the Vata, Pitta, and Kapha doshas) can allow the Yoga practitioner to use asanas to improve their health and well being. Those people with an imbalance in Vata dosha tend to experience greater lightness, coldness, and mobility. They may suffer from weight loss, immune weakness, constipation, cold hands and feet, and anxiety or nervousness. For these people, calming and grounding yoga poses are best. Standing postures such the tree pose (Vrksasana) and mountain pose (Tadasana) root the feet into the ground and reduce anxiety and nervousness. Poses which compress the pelvis such as seated forward bends (Pascimottanasana) aid in reducing constipation while strength poses such as the crane (Bakasana) aid circulation. Fastpaced poses such as repetitive sun salutations (Surya Nanaskar) performed rapidly, for example, may increase nervousness over time and poses performed without attention to detail in position may injure the joints. While the proper poses bring about balance, improper poses can cause greater imbalance. Those people with an imbalance in the Pitta dosha tend to suffer from excess heat in their bodies. They feel warm and may have a multitude of skin conditions such as acne or psoriasis. They may also suffer from diarrhea, burning eyes, and liver weakness. Calming and cooling poses which compress the solar plexus help balance them, while poses which extend the solar plexus help dissipate heat in the body. Poses such as the cobra (Bhujangasana) and the bow (Dhanurasana) are examples of poses which dissipate excess heat. Those people of pitta imbalance need to avoid overheating themselves with their Yoga practice. Aerobic forms of Yoga causing profuse sweating should be avoided as should inverted poses which increase the heat in the head. Those with a Kapha imbalance tend to experience excess heaviness, sluggishness, coldness, and dampness in their body. They suffer from congestion, weight gain, and lethargy. Stimulating, heating forms of Yoga suit their needs well. Aerobic forms are recommended though they should begin slowly and work their way up in aggressiveness. The sun salutation, as the name suggests is quite heating and performed with repetition, is perhaps the best Yoga sequence for Kapha imbalance. Its aerobic nature alleviates lethargy and assists with weight loss. Poses which extend or open the chest reduce congestion and aid breathing. These include the upward bow pose (Urdhva Dhanura) and the bridge pose (Setu Bandha Sarvangasana). While meditative poses can be performed by those of Kapha nature or imbalance, they must always be balanced with active postures to avoid an increase in lethargy. Yoga poses themselves are not a complete healing program. They are a part of a complete regimen for balancing the body and mind utilizing all of the components of Ayurveda. This includes proper diet, herbs, aromatherapy, color therapy, sound therapy, meditation, detoxification, rejuvenation and creating a harmonious lifestyle. The individual who follows an Ayurvedic program is assured of creating an optimal environment in their body for healing to take place. In an optimal environment, the body can reach its greatest potential. We say in Ayurveda that where there is harmony there is health, where there is disharmony there is disease. Ayurveda and Yoga combine to lead a person on the path to perfect harmony and optimal health. Patanjali, author of the Yoga Sutras , laid out the path for using Yoga as a guide to enlightenment. He said: "We must proceed gradually through all of the steps of yoga practice." Yoga postures are just one step of the process of preparing the body to be able to manage both the increase and the heightening of energy that occurs with spiritual practice. Asanas, along with proper lifestyle (including proper diet, disciplines, and restraints), are the foundations upon which spiritual growth can occur. Once the proper foundation has been achieved, the deeper practices can begin. http://www.ayurvedacollege.com/book/export/html/2
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Both Yoga and Ayurveda incorporate meditation and breathing techniques in their practices. Meditation as a tool can be used both for healing as well as for spiritual awareness. While Ayurvedic techniques focus on the healing component of meditation, Yoga focuses on its spiritual components. Regardless of one's focus, meditation clears the mind and relaxes the body resulting in both healing and spiritual awareness. There are many forms of meditation which act like tools helping the practitioner to achieve their desired end result. While some individuals resonate with one particular type more than others, for the most part meditative techniques are tools and all of them have value for the right person. Healing ourselves with Yoga and Ayurveda is indeed a journey. It is not a quick fix or a magic pill. It heals us at the core of our nature, in essence, through the transformation of consciousness. It is a discipline in harmony with all of nature. As we practice, we grow and evolve as people. Stress is reduced, harmful emotions dissipate, sorrow is no longer, joy and peace return to our lives. Our internal energy builds and our eyes shine radiating the light that is life itself. Namaste. "Who burns with the bliss and suffers the sorrow of every creature within his own heart, making his own each bliss and each sorrow. Him I hold highest of the yogis." Bhagavad Gita translated by Swami Pravhavanada.
The three doshas in Ayurveda (vata, pitta, kapha) Tridosha: The Science Of Ayurveda and the three doshas (vata, pitta, kapha) The ancient science of Ayurveda is the oldest known form of health care in the world. Often called the mother of all healing, it originated in India some 5000 or more years ago. Recently Ayurveda has been having a profound impact upon the world of health care. Popular books by Deepak Chopra, M.D. and Andrew Weil, M.D. have called attention to the potential of this ancient healing system to bring healing to those suffering with chronic disease. In addition, Ayurveda promises to improve the health and longevity of just about everyone. Ayurveda is a science of Self understanding. By understanding your own unique nature or constitution you can begin to understand how you interact with your environment and thus make choices that will lead you toward greater health. Ayurveda defines disease as the natural end result of living out of harmony with one’s constitution. Our constitution is the inherent balance of energies within our bodies and our minds. It describes who you are on the most fundamental level. This unique balance of energy determines everything from our bone structure to our predisposition toward certain health challenges. In fact, our constitution defines what we are naturally attracted to as well as what repels us. It defines what is in harmony with our nature and what will cause us to move out of balance and experience sickness and disease. Because we all have a different balance of energy, Ayurveda shows that the path to optimal health is different for each person http://www.ayurvedacollege.com/book/export/html/2
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depending upon their constitution. The science of understanding our nature or our constitution is the science of Tridosha. Tridosha defines the three fundamental energies or principles which govern the function of our bodies on the physical and emotional level. The three energies are known a Vata, Pitta, and Kapha. Each individual has a unique balance of all three of these energies. Some people will be predominant in one while others are a mixture of two or more. Lets look at each of these now. Vata The Vata dosha is said to be made up of the air and ether elements. This means that it has qualities which are similar to these elements. Vata is very much like the wind it is light, cool, dry and mobile. In the body, those people with a Vata nature experience more of these qualities. Their bodies tend to be light, their bones thin, and their skin and hair dry. They often move and speak quickly. When out of balance, they may lose weight, become constipated and have weakness in their immune and nervous systems These qualities also reflect in their personality. Those with a Vata nature tend to be talkative, enthusiastic, creative, flexible and energetic. Yet, when out of balance they may also become easily confused and overwhelmed, have difficulty focusing and making decisions and have trouble sleeping. This becomes more apparent when they are under stress. Emotionally they are challenged by cool emotions like worry, fear and anxiety. In order to bring balance to Vata, programs are designed which emphasize the opposing qualities of warmth, heaviness (nourishment), moistness and stability. In the diet, this is reflected in the consumption of cooked grains such as rice and cooked vegetables as well as the intake of warm milk with spices. Pungent herbs like ginger which increase internal heat and nourishing herbs like ashwagandha bring balance to Vata. Ayurvedic programs include not only herbs and diet but also color and aroma therapies, detoxification, yoga and meditation. Pitta dosha The Pitta dosha is said to be made up of the fire and water elements. Fire is more predominant and those people with a predominant Pitta nature have many of the qualities of fire within them. Pitta tends to hot, sharp and penetrating. It is also somewhat volatile and oily. The oily nature of Pitta is related to the secondary component of water. People with a Pitta nature reflect these qualities. They tend to feel warm, have somewhat oily skin, penetrating eyes and sharp features. They tend to have moderate weights and good musculature. When out of balance they tend toward diarrhea, infections, skin rashes and weakness in the liver, spleen and blood. These qualities also reflect in their personalities. Pitta people tend to be highly focused, competitive, capable, courageous, energetic and clear communicators who get right to the point. They like to solve problems and when under stress they dig in their heels. They can however also become overly intense and speak with a sharp tongue. They make great friends but feared enemies. Emotionally they are challenged by the heated emotions of anger, resentment and jealousy.
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In order to bring balance to Pitta, programs are designed to emphasize the opposing qualities of coolness, heaviness (nourishing) and dryness. Cool spices like fennel are recommended in the diet along with foods such as raw vegetables, cooked rice and wheat as well as most beans. Sweet herbs like shatavari are used to nourish the body while bitters like dandelion root temper the fire. A Clinical Ayurvedic Specialist puts together programs that not only include foods and herbs but also aromas, colors, massage, detoxification, yoga and meditation. Kapha dosha Within the Kapha dosha there is a predominance of the water and earth elements. Like these elements Kapha tends to be cool, moist, stable and heavy. In the body these qualities manifest as dense, heavy bones, lustrous, supple skin, low metabolism, and large, stocky frames. In addition, those with a Kapha nature tend to feel cool. When out of balance, Kapha individuals are prone to gaining weight and tend to have weaknesses in their lungs and sinuses where there is an accumulation of mucous. Those of Kapha nature are also most prone to noninsulin dependent diabetes mellitus. The elements of water and earth also reflect in the personality. The heavy, stable nature of Kapha reflects in a stable personality which is not prone to quick fluctuations. Those with a Kapha nature handle stress very well, often not even noticing that it exists. They don't like change, are generally conservative and would prefer to keep things just the way they are. Those with a Kapha nature are also comfort seekers. This relates to the soft watery nature of Kapha. Too much comfort however can lead to a lack of motivation and feeling of becoming stuck. When Kapha is out of balance, the heavy emotions of depression and lethargy result. In order to bring balance to a Kapha nature the opposing qualities of lightness, dryness and warmth are recommended. These qualities are integrated in dietary and herbal programs as well as aroma and color therapies, detoxification, yoga and meditation. Grains such as quinoa and amaranth are recommended as well as hot spices like cayenne pepper. Lots of vegetables and very little nuts or dairy are prescribed. Cleansing herbs like guggul and pungents like clove bring balance to Kapha. We must remember that we are all a combination of the three doshic energies. On the most fundamental level, Pitta is our metabolism, Kapha our structure and Vata the mobility that brings action and life into creation. Without all three energies, we simply could not exist. To determine a person’s constitution, a Clinical Ayurvedic Specialist conducts a two hour consultation taking a look at every aspect of a person. This physical, emotional, and spiritual evaluation identifies the balance of energies in a person's body as well as areas of imbalance. Once the nature of the person and the imbalance are identified, the Clinical Ayurvedic Specialist can then put together a treatment program utilizing the appropriate diet and herbs, aromas, colors, yoga and meditation aimed at restoring or maintaining balance. Optimal Health is achieved through Ayurvedic Medicine when we are living in complete harmony with our environment. In order to live in harmony we must first understand our own natures. Only then can we intelligently make choices which support us on our journey. Good luck on yours!
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What is Vata Dosha? Tips and diet for balancing vata The word vata means to blow or move like the wind. Consisting of the elements air and ether, it is the principle force of motion in the body and mind. When vata dosha is healthy, the movements of the body are graceful, unimpeded, and yet controlled. When out of balance, the movements become erratic, excessive, decreased, or blocked. To understand the vata dosha, it is important to understand its qualities.Vata dosha is light, dry, mobile, cold, hard, rough, sharp, subtle, flowing and clear. A body and mind in which the vata dosha predominates expresses or reflects these qualities. Vata dosha is best understood in terms of its component parts, its subdoshas, which are the five types of vata or five types of movement. Each subdosha defines a direction of movement and governs specific actions in the body. Prana Vayu: Prana vayu represents the force that draws sensory experience to us. It is the force of attraction and has a magnetic nature. The way it functions determines the types of impressions we expose ourselves to. Prana vayu resides in the head and heart (chest) where desire dwells, choices are made, and sensory experience is processed. When it is healthy, we are drawn toward that which is harmonious and which brings us health and wellbeing. When prana vayu is out of balance, we misuse our senses and bring inside of us that which will cause disease. Samana Vayu: Whereas prana vayu represents the force of attraction, samana vayu represents the force of absorption, pulling the impressions we are drawn to toward the center of our being. For example, samana vayu carries nutrients from the intestines into the circulatory system, and the sensations of things we touch are carried from the skin to the central nervous system. When samana vayu is functioning properly, impressions are properly absorbed. When it is in a state of dysfunction, absorption becomes difficult,and malnourishment and numbness may occur (respectively). Vyana Vayu: Once absorbed, animpression must be acted upon. This is the role of vyana vayu, which is the force that circulates the response, moving it from the center toward the periphery. Following our examples, in the digestive system blood carries the nutrients throughout the body so that each cell receives its proper supply. In the nervous system, a signal is sent from the central nervous system toward a muscle or organ. Udana Vayu: Udana vayu is responsible for action and expression, which means putting the energy received to work. . Cells take the energy received and perform their unique functions. Nutrients are used for cellular energy and for building proteins. The nerves instruct muscles and organs to act properly. Apana Vayu: Cellular activity produces both work and waste. While udana is responsible for the work, apana vayu is responsible for cleaning up the waste. Apana vayu eliminates waste primarily through the functions of urination, defecation and menstruation. However, it is responsible for all the downward flowing energy of the body and as such is also responsible for the energy needed for carrying the child out of the womb and into the world.
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The Qualities and Presentation of Vata Dosha The natural expression of vata dosha in the constitutioni of the body and mind reflects the qualities inherent in the dosha. Examples of the way these qualities manifest are as follows: Light: The bones of the body are narrow Cold: A person tends to become chilled easier than others Dry: The skin or eyes have a tendency to become dry Mobile: A person moves quickly, often with a lack of focus Subtle: The mind is open to new ideas, is expansive and interested in the esoteric Hard: If the tissues of the body become dry, they will then become hard;this is easiest to see as an imbalanceFlowing: The mind flows easily from one idea to the next Sharp: The bridge of the nose is thinner and sharper than in other constitutional types Rough: As the skin becomes drier, it becomes rougher; whichhis is easiest to see as an imbalance Clear: The eyes are clear When vata dosha is out of balance, there is an excess of the qualities that define the dosha. The specific symptoms produced as a result of the imbalance depend upon which srota (channel system) and which dhatu (tissue) inside that channel are affected. Generalized examples of excess vata qualities (imbalances) in the body are as follows: Light: The body loses weight Cold: A person feels chilled Dry: The lips become chapped Mobile: The voice becomes too quick and rambles Subtle: A person is too easily affected by the feelings of others http://www.ayurvedacollege.com/book/export/html/2
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Hard: The stools become hard and difficult to eliminate Flowing: There is an inability of the mind to focus Sharp: Pain in the body is sharp like the prick of a needleRough: The skin becomes rough Clear: The eyes and the mind become vacant Managing Vata Dosha Ayurvedai offers many approaches to bringing vata dosha into balance. Whether the tools used are dietary, herbal, colors, aromas, mantras, massage oils or lifestyle, the principles used to return to balance are the same. It is necessary to increase the qualities opposed to the imbalance. Where there is an excess of lightness, we increase heaviness. Where there is an excess of coldness, we increase heat. Where there is an excess of hardness, we increase softness and so on. While each of the treatment tools noted above are valuable, by far the most important tool is lifestyle. Only through adopting an appropriate lifestyle can the vata dosha remain in balance and the cause of disease be removed. One of the most important lifestyle tools for maintaining health and for supporting healing in the vata individual is the adoption of regular healthy routines that are in harmony with the rhythms of nature. Stability is greatly improved through eating and sleeping at the same times every day. It is best to arise within a half hour of the sun rising. The morning routine should include time for self abhyanga (oil massage), meditation and yoga asana practice in addition to proper daily hygiene. Meals should be taken regularly throughout the day; as many as five small meals per day taken every three hours would be appropriate. These meals should be taken at the same time each day. This increases both the heavy and stable qualities. The foods should be somewhat oily (moist), cooked when possible (warm) and moderately spiced (warm). Bed time should occur at about 9:00 or 10:00 , though this depends somewhat on the rhythm of the sunset and varies season to season and by latitude. Waking and sleeping times should be consistent from day to day (stability). Specific treatments are available for almost every known condition in the body as such symptoms can be understood in terms of the ten pairs of opposite qualities. Once the qualities of the patient's constitution and condition are known, the experienced practitioner, knowing the qualities of the remedies, is able to design a treatment program that brings these opposite qualities into harmony. These qualities provide the body with the fundamental energies and raw material needed to support the healing process.
The Way of Success? Vata Style! There are many roads to success. One of those is the path of inspiration. The inspired individual is one who draws inspiration from above and brings it down through their crown chakra into their heart where it gestates till ready to emerge through the organs of action and take form in the http://www.ayurvedacollege.com/book/export/html/2
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world. Left unobstructed, success is guaranteed and the creation is one of divine beauty. Through the unencumbered mind, the divine river flows effortlessly. Action is guided by a higher power and the actor is its tool. Inspiration is a fragile moment for many. A glimpse of the divine is often fleeting, as allowing it to flow continuously can be too much for many. For most, the wind of mind causes ripples in the stillness that distorts the perception of divine intention. This creates doubts, fear and subsequent overwhelm. Do not doubt the moment. The moment of genuine inspiration will leave an imprint upon your consciousness. Within the ripples of confusion, the imprint remains like an echo. Move forward and jump in the water. Let go and allow the divine flow to carry you off. But how will you swim? That, you can figure out later. You may not have to. The river will carry you to where you need to be. All you need is to surrender and trust in the divine. As its waters flow over and around you, comfort will replace fear as you are lifted up and over the rocks. And should you drown, you will do so with a smile radiating from your heart and you will be reborn anew for we never really were. With true inspiration, there is no real choice. We are drawn to the river. The next step is to jump in with joy!
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