Empathy and Compliance

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          Reflections on the Clinic Experience

Lord of Ayurveda,Dhanvantari

Lord of Ayurveda,Dhanvantari (Photo credit: Wikipedia)

            Amid the vast swirl of new information I've been working and playing with during these first eight weeks studying Ayurvedic medicine at Alandi, the clinic experience has been the most profoundly affecting. 

Observing and interacting with patients on a regular basis provides grounding and human context for the timeless theory and Sanskrit vocabulary, which might otherwise tend towards academic abstraction. I have gleaned many useful facts and practical principles so far, but here I will focus on the broader issues that are making an impression on me.

One fundamental point I've observed (and experienced) in these sessions is that the presenting health concern is often a secondary or even tertiary issue. Many people are simply craving to be truly seen and heard.

It seems that a person's innate capacity for self-healing is activated by the attentive presence of the practitioner, through the exchange of deep listening and empathetic response. This process allows the more subtle causes of dis-ease to emerge and become self-evident to the patient. 

In being that clear mirror, the practitioner creates an opportunity for the patient to notice patterns and connections that were previously invisible to them. On its own, such awareness can stimulate positive shifts within a person.

IBM CIO Report: Key Findings

The other major issue I had not previously considered is that of compliance

In an imaginary, ideal world, healing is a clean process where expert diagnosis leads to a prescription for herbs and adjustments to diet and lifestyle. Then, we simply wait for the patient to return with reports of steady improvement.  

This obviously skips over the most crucial step -- that is, the patient actually doing what is asked. 

Ayurveda requires a certain level of dedication and willingness to do whatever it takes in order to be effective. By this measurement, not everyone is qualified for Ayurvedic treatment. 

Clearly, some individuals are more comfortable with their disease than with the procedures for treating it, and would therefore prefer to remain ill rather than venture outside their comfort zone.

This is mostly an unconscious choice. Deeply ingrained patterns of behavior are powerful forces. Just because a person is seeking healing on the surface doesn't necessarily mean they are able to comply with the changes prescribed. 

With this in mind, it has been valuable to observe Ma as she gently "coaxes" compliance from patients. Some people need more stern instructions, while others do well with some flexibility. Some folks are eager to do everything all at once, while others can only introduce one thing at a time. 

Knowing a person's mental and physical constitution is helpful, but coaxing is more art than science, and involves a good deal of intuitive feeling into the situation to know what is realistic, and what is asking too much.

Smoking Intuition

Smoking Intuition (Photo credit: Callt_o)

Finally, I will note how humbling it is to sit in clinic. It is a regular reminder that everyone is fighting unseen battles and should therefore be treated with the gentlest of care. 

It is a very powerful experience to have someone bare their deepest traumas, share their oldest secrets and express their greatest hopes and fears with the hope that you can help them. It is a responsibility not to be taken lightly, and serves as inspiration for me to learn as much as possible as fast as possible so as to actually be able to help. 

There is also a dampening effect as I realize that we can't possibly help everyone to the extent that we would like, that each person must take responsibility for their own healing, and all we can do is offer the best guidance we can and pray the rest will unfold in the most benevolent manner possible. 

This is heartbreaking, but then again, a heart must break in order to be open, and as we've seen, an open heart is truly the most potent medicine available to us.

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Thyroid Disorders

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)

An overview of thyroid diseases
The thyroid is an endocrine gland situated in the neck at the level of the cricoid cartilage at the base of the larynx and extending from the level of the fifth cervical vertebra down to the first thoracic. It is butterfly shaped with 2 elongated lateral lobes with superior and inferior poles connected by a median isthmus. The gland contains two hormones, L-thyroxine (tetraiodothyronine, T4) and L-triiodothyronine (T3). Affecting between one and two percent of the population worldwide, thyroid disease is among the most common endocrine disorders. Thyroid disorders and thyroid cancer disproportionately affect women.

Skin Inflammation

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)

Skin inflammations are quite common conditions, with atopic dermatitis or eczema affecting 10-20% of all children and 1-3% of adults (1) and psoriasis affecting between 2 and 2.6% of the US population. The prevalence of atopic dermatitis has doubled or tripled in industrialized countries during the past three decades. The visible and often disfiguring nature of skin inflammations leads to far greater levels of distress and depression than would be experienced with a more severe but less disfiguring condition. (2) Because a number of patients are suspicious of cortisone creams prescribed for them by their family practitioner or dermatologist, they may frequently present for Ayurvedic care as an alternative.

According to Ayurveda, skin has seven layers, corresponding to the seven dhatus. Similarly, in modern physiology, skin has been found to have seven layers, stratum corneum, on the surface, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale, the basement membrane and the dermis. (For a diagram of the seven layers of the skin, click here.) At the same time, the epidermis of the skin, as whole, is seen as an upadhatu of rasa dhatu, and the dermis as part of mamsa dhatu. Skin belongs to bahya marga, the external pathway of disease, and as such is very vulnerable to toxins carried by rasa and rakta dhatus during the prasara stage of disease, accounting for the relatively common nature of skin inflammations.

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Sinus Infections

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)

In the Ayurvedic approach to sinusitis, exposure to an infective agent such as pathogenic bacteria is just one factor in the development of the illness. Of far greater significance is the build up of excess doshas in the body, due to incorrect diet and lifestyle. Once excess doshas have built up and become prevalent due to repeated errors in daily regimen, they are readily carried by vata upwards to the head, where they lodge in any weak spot, creating acute illness. Unfortunately, due to today's polluted environment, the integrity of the mucus membranes of the nasal sinuses is under constant attack. Thus weakened, the sinuses are particularly vulnerable to invasion by provoked doshas. It is the unwholesome situation created by a combination of weakened sinuses, accumulation of doshas and build-up of ama or toxins in the body that provides a fertile ground for the multiplication of pathogens.

Sinusitis, as an inflammatory condition, always involves some component of pitta, the fiery humour. However, provocation of either vata or kapha within the sinuses can give rise to pitta irritation of the mucous membranes. Sinus infections thus can be regarded as either vata, pitta or kapha in nature, each type having specific causative factors and symptoms.

Silent Bladder Infections

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)

Silent bladder infections, also known as asymptomatic bacteruria, may result in generalized ill health or may lead to acute cystitis or to pyelonephritis, a potentially life-threatening kidney infection. Hence it is important to appreciate the groups affected by silent bladder infection, as well as how to make an Ayurvedic diagnosis of this condition and give appropriate chikitsa.

Tridoshic 'Yam' Kitcheri

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1cup split hulled mung beans
1 cup basmati rice
3 tbsp ghee
1 and half inches minced fresh ginger
2 tbsp shredded coconut
1 tsp turmeric 
1 handful cilantro leaves
8 green cardamom pods
8 whole cloves
11 black peppercorns
3 inch piece cinnamon stick
3 bay leaves Salt to taste
1 large yam, cubed (actually a golden sweet potato)

  • Rinse mung beans well with cold water and soak for a few hours 
  • Rinse rice well and soak while beans are cooking
  • Put ginger, coconut, turmeric, cilantro and some water in a blender or food processor and blend. Use enough water to blend well.
  • In a large pot, melt ghee over medium heat and sauté cardamom pods (split open first), cloves, peppercorns, cinnamon stick and bay leaves for a few minutes. Then add the blended spices and sauté for a few more minutes until lightly cooked
  • Next add beans and yams; cook for a couple more minutes. Add enough water to cover the beans with at least 3 inches of water and bring to a boil. Turn heat down to simmer. Cook for about 45 minutes or until the beans are completely broken down. Then add the rice and cook until the rice is broken apart. Add more water as needed Salt to taste and enjoy!

The White Powder: Ayurvedic Strategies for Sugar Addiction

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)

Addiction to sugar is a significant cause of overweight, obesity, diabetes, dental caries, candidiasis and adrenal deficiency. In addition, by lowering immunity, white sugar may contribute to the incidence of cancer and acute and chronic infections. Although white sugar as an addiction of choice affects all ages from infancy on, individuals born in the 1950s are particularly susceptible, due to the prevalence of sweetened infant formula at that period. All types of agni may be involved in sugar cravings, but the nature, consequences and management of sugar addiction differs depending upon the agni type.

Kapha Toxins: Candidiasis

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by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Candida, Liquid-based Pap

Candida, Liquid-based Pap (Photo credit: euthman)

In this article, we will consider candidiasis as a condition of kapha ama, reviewing the epidemiology, diagnosis and Ayurvedic management of this common condition.

Candida is a unicellular yeast whose cells reproduce by budding. A normal flora which can under certain circumstances become an invasive pathogen, it can flourish in most environments. Candida species frequently colonize the oropharynx, skin, mucous membranes, pranavahasrotas (lower respiratory tree), annavahasrotas (gastrointestinal tract) and mutravahasrotas (genitourinary tract). Candida can be found on foods, countertops, air-conditioning vents, and floors (6).

A discussion of candidiasis leads us to larger look at considerations of the ways in which epidemiology has changed from classical times until now. Many factors pertinent to the development of Candida overgrowths are relevant to modern industrial society and were not in effect in ancient times. These factors include a diet high in refined sugar and refined flour products, antibiotic therapy, environmental stresses that weaken immunity including EMFs (1), ELF radiation (2), chemical toxins and increased background radiation; sedentary lifestyles (3), epidemic obesity (4), development of immunodeficiency diseases such as HIV, and medical use of immunosuppressant therapies including inhaled corticosteroids. All these factors play a part in the frequency with which candidal conditions are seen in a typical Ayurvedic practice setting. Patients with endocrine disorders including diabetes, hypothyroidism and adrenal insufficiency are at increased risk for Candida overgrowth (6).

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Green Peas and Cancer

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Peas in pods.

Peas in pods. (Photo credit: Wikipedia)

I always eat my peas with honey;

I've done it all my life.

They do taste kind of funny

but It keeps them on my knife.

My father used to enjoy reading me this rhyme from the Penguin Book of Comical and Curious Verse. He also loved to grow peas in the garden of our Victorian house. We would shell them and eat them lightly steamed with butter and mint.

As a teenager I used to volunteer for Help the Aged by visiting a ninety year old widow, Mrs Scopes. She loved to tell me 'Old Wive's Tales'. One oft-repeated saying was "Peas give you cancer, my father said.' As it turns out, this adage could not be further from the truth. In fact a a unique constituent of green peas, coumestrol, is being investigated for its benefits in preventing cancer. A Mexico City study pointed to the potential of green peas in preventing stomach cancer (1). And the Prostate Cancer Sweden Study points to green peas as helpful in preventing prostate cancer (2). The antioxidant components of green peas may also be helpful in breast cancer (3) as well as in preventing heart disease.

According to Ayurveda, green peas are pitta soothing and laxative, beneficial for purisha vaha srotas or the colon. Enjoy green peas with rice, in kitcheri,in a sabji or vegetable curry with cauliflower and potato or in matar paneer. Or serve them like my father did, lightly steamed with butter and mint

1. Hernandez-Ramirez R, Galvan-Portillo M, Ward M et al. Dietary intake of polyphenols, nitrate and nitrite and gastric cancer risk in Mexico City. Int J Cancer. 2009 September 15; 125(6): 1424-1430. 2009.
2. Maria Hedelin, Åsa Klint, Ellen T. Chang, Rino Bellocco, Jan-Erik Johansson, Swen-Olof Andersson, Satu-Maarit Heinonen, Herman Adlercreutz, Hans-Olov Adami and Henrik Grönberg, et al.  Dietary Phytoestrogen, Serum Enterolactone and Risk of Prostate Cancer: The Cancer Prostate Sweden Study (Sweden) Cancer Causes and Control

Volume 17, Number 2 (2006), 169-180, DOI: 10.1007/s10552-005-0342-2
Pamela J. Magee* and Ian R. Rowland Phyto-oestrogens, their mechanism of action: current evidence for a role in breast and prostate cancer British Journal of Nutrition (2004), 91, 513-531

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Honoured guests, faculty, staff, graduates and students, each of you in your own way a part of our Alandi family-- today's graduation is a tender and triumphant moment.

It is a tender moment, as you, the candidates, graduate from student to practitioner, or from practitioner to doctor. Like the fledgling finches on the porch, you now leave the cozy nest of Alandi to find your wings, to sing and soar. Some of you are moving on to new levels of responsibility as graduates in our community, some to bring the light of Alandi into the wider world.

 It is a tender moment, as the founding students of our gurukula graduate and move on, stretching precious cords of love and friendship across distance and time. In myriad ways, all of us will miss our daily contact with these graduates, who helped lay the foundation stones of the gurukula. For four years we have chanted, meditated, eaten, studied, walked and served in clinic together. Now these bonds of love will be put to the test as our family matures to embrace the world.

It is also a triumphant moment for students, faculty and the gurukula. We did it! Heather has succeeded in graduating as a practitioner while raising her family and relocating from Evergreen to Boulder. Paula has crossed the finishing line after four years of patient part-time study. Annalise had upheld her commitment to Pancha karma and body therapies despite all obstacles. Bhavna has Skped into classes faithfully even as her young family moved from Texas to California. Ceci has surmounted myriad hurdles with great dedication to her studies. And Lauren, Kourtney and Heidi have stood the course through four years of demanding full time study, determined to be the best-trained practitioners of Ayurveda ever to be home-grown in America. Their thirst for learning and quest for excellence led us to create our advanced programme and bring the study of Ayurveda in America to new heights.

 Each of us--students, faculty, staff and ashramites-- have sacrificed much, enduring financial challenges, long work hours, and lack of privacy (in the case of Sadananda), to make this moment possible. With minimal resources, we have achieved great things. We have created a vibrant learning community, continually pushing the frontiers of pedagogy and practice--an environment where teachers and students alike grow continually. We have honoured the ancient roots of Ayurveda in the Gurukula system, creating an Ayurvedic family with deep spiritual roots.  Let us relish our accomplishment!

Dear graduates, as you step out as practitioners, pancha karma therapists and Ayurvedic doctors, you represent and embody not only Ayurveda, but also the lineage and teachings of Alandi, which has nurtured you for these past four years. Leaving our walls but not our family, carry with you our core teachings of love, simplicity and oneness.

In your time here, you have experienced radical simplicity in Alandi's capacity to do much with a little. As a visitor from Poland said recently, "What I love about this place is that in a small space you do great things." You have learnt to value authenticity over appearances and true richness over wealth. As you move on to your own practice, remember the basic lesson you have learnt here: do what you are here to do with what you have right now, without waiting for it to be bigger, better or more perfect. Or as Jesus, Peace upon Him, said, "Since you have been faithful in small things, I will give you charge over much."

If you want your dream to be
Build it slow and surely
Small beginnings greater ends
Heart felt work grows purely
If you want to live life free
Take your time go slowly
Do few things but do them well
Simple joys are holy
Day by day, stone by stone
Build your secrets slowly.

As members of Alandi's family, you have experienced on a daily basis the teachings of oneness and tolerance--sahishnuta. Ekam sat vipra bahuda vidanti. Truth is one, the wise call that by many names. Many rivers, one ocean, as Raghudas taught us.

Creation, like a prism
Fragments the pure white light of Truth.
People in different lands
Catching sight of different colors
Have taught that 'It is green'
Or 'It is gold!'
Today, from the seeds of light
Scattered over the Earth
We reap a rainbow harvest.


As healers, carry this understanding forth in your practice and your life, meeting each person where they are, honouring their beliefs, culture and life path while guiding them on the path to wellbeing through Ayurveda. This begins, every day, with meeting yourself where you are right now, including and accepting all the parts and aspects of yourself.


Above all, carry into the world the love you have received and shared here at Alandi. Love is the essential qualification of an Ayurvedic practitioner.


Maitri karunyam aarteshu

Shakye priti upekshanam

Prakruti shtheshu bhuteshu

Vaidyavritti chaturvidha

Friendliness and compassion towards the sick, joy in their recovery and equanimity towards those whose life is coming to an end; this is the fourfold attitude of the physician.


And love, compassion and friendliness are the most important core values you have received in your time at Alandi, which exists as a beacon of love for all beings. Let love permeate not just your Ayurveda practice, but the tiniest aspects of daily life. Love is the need of the hour, the urgent call of the Divine Mother. In all her manifestations, the divine feminine calls us to leave behind enmity, callousness and indifference and embrace the way of love and compassion. In the words of a great contemporary dakini, Yoko Ono, "Remember love!"

Remember love, remember love, Love is what it takes to know love.
Remember love, remember love, Love is what it takes sow love.
Remember love, remember love, Love is what it takes to grow love.
Remember love, remember love, Love is what it takes reap the fruits of love.
Remember love, remember love, Love is what it takes to be love.

 Remember love, remember love.

(Sadananda's version of Yoko Ono's song)




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