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In working with addicted patients, the practitioner must be clear not to be an enabler, helping the addict to have an easier time while he or she continues to pursue a self destructive lifestyle. In the next few editions of the Vine, we will offer a series on working with addictions.
Social acceptance has for long dogged efforts to reduce the incidence of smoking. Today, with an appreciation of the harmful effects of second hand smoke, social acceptance of smoking is finally giving way to widespread efforts to limit smoking, with even such unlikely venues as restaurants in Italy and pubs in Ireland banning smoking.
Cigarette smoke leaves tarry deposits on the lungs. The pink, elastic lung tissue becomes stiff and blackened, losing its elasticity and oxygen exchange potential, eventually leading to obstructive airway disease. Vata individuals are particularly prone to dry cough, raspy throat, poor circulation and peripheral vascular disease as a result of smoking. Smoking also reduces their appetite leading to visham agni and underweight. In the worst case, smoking can lead to gastric ulcers. Pitta individuals are the most likely to suffer from smoking-induced heart disease and hypertension, while sinus problems, post-nasal drip, chronic bronchitis and emphysema will affect kapha smokers. Lung cancer or increased incidence of bladder cancer may affect all doshas.
In working with a smoker, it is essential to address the underlying cause of the addiction. Vata smokes out of nervousness and pitta out of self-hate and self-destruction, but it is kapha who is the most vulnerable to the emotionally suppressive effect of smoking. Kapha uses smoking as a strategy to suppress deep-seated grief, which is held in the lungs. Other doshas may also adopt this strategy if they have been subjected to great grief, such as bereavement. Hence in seeing a smoker it is important to take a full emotional history including all childhood traumas as well as more recent events.
Because of the enabling issue, it is often best to offer minimal herbal support to the smoker initially. The best tactic is to explain to the smoker all the ways in which their habit is causing their current health concerns. As well as direct effects of smoking listed above, this also includes the indirect effects that result from provocation of the doshas as a result of the smoking habit, which falls into the category of prajnaparadh or crimes against innate wisdom. The smoker should then be offered herbs such as Brahmi to help address the underlying grief, depression or anxiety. In addition, appropriate counseling should be recommended to deal with childhood or recent traumas.
Vata must be spoken to very gently, as if one were trying to coax a child. Discourage vata from quitting smoking suddenly, as this will lead to immense vata provocation. Also, smoking is a habit that is all too easy to quit--again and again. Slow steady, sustainable changes are best. It is wise to follow the Ayurvedic tobacco withdrawal protocol outlined below. Pitta should be reasoned with. It can be helpful to have materials in your office showing the difference between a smoker's lungs and a non-smoker's lungs. Encourage pitta to get online, do the research and appreciate the immense risk they are running. Appeal to their pride, encouraging them to access their will power and help them to see how quitting smoking will help them succeed in their goals in life. As for kapha, threaten them with the dire consequences of continuing to smoke. Point out how their lung pulse looked. If there are two doshas present in the lungs it is imperative to tell them that they are already developing obstructive airway disease. All too often, kapha will quit smoking only after a life-threatening bout of pneumonia.
Awareness is the greatest tool in dealing with smoking. Conscious smoking is the first step in quitting. In conscious smoking, the patient agrees to smoke only when they are not doing anything else at the same time. Instruct them to smoke as a meditation, bringing awareness to their thoughts, feelings and body sensations before, during and after smoking. This can result in some amazing discoveries. One patient reported that she realized she was trying to kill herself by smoking, another said that he became aware of the grief over his mother's death that he was suppressing by smoking.
As soon as the individual is ready to begin the process of releasing their habit, they can begin the tobacco withdrawal protocol. A typical Ayurvedic smoking mix and client handout is shown below.
30% red clover
30% calamus root--ground, not powdered
10-15% marshmallow root
5-10% osha root--broken up well
"If you are trying to cut out tobacco, start out with 60% herbal mixture, 40% tobacco, then gradually cut down the amount of tobacco weekly.
You need to buy rolling paper and roll your own cigarettes.
This mixture is rejuvenating for the lungs and clears the mind and sharpens concentration."
It is important to explain to the client from the outset that herbs can be given to rejuvenate the lungs, balance the doshas and address their current health concerns, but that these herbs will not be effective as long as the smoking habit is continued. In particular, lung rejuvenatives should not be given until tobacco smoking has stopped. Healthy lung tissue cannot be built until smoking is discontinued. Once the client has stopped smoking, lung rejuvenatives are essential. Liquorice is a good choice to help with lung rejuvenation as well as raspy throat and pre-ulcerative conditions of the stomach or duodenum. Punarnava helps strengthen the lungs and is also anti-cancer in traditional usage. Ideally, first carry out the tobacco withdrawal, then give some shamanam herbs to begin to balance the doshas. Next give cleansing herbs in preparation for pancha karma and carry out a thorough cleanse. Although vaman, therapeutic emesis, is a far from popular process, it will be invaluable for kapha in the process of recovering from smoking. Once pancha karma has been done, there is the optimum situation to rejuvenate the lungs using Chyavanprash as well as the herbs discussed above. It takes as year or so of not smoking to return the lungs to the pink, clean condition of a non-smoker. Hopefully, pancha karma and rasayana could greatly accelerate this process.
Pranayama is another beneficial process that should be commenced only after quitting smoking. Especially when someone is healing from pneumonia, asthma or obstructive airway disease, it is imperative for them to learn to breathe properly, filling the lung bases and bringing air all the way into the upper lungs. In addition, surya namaskar and chest-opening asanas such as cobra and camel pose will be of great benefit in healing the lungs and restoring a normal breathing pattern. Finally, the root cause of the smoking habit can be best addressed by a meditation practice, with a focus on basic mindfulness and breath awareness. A practice such as the Empty Bowl Mediation taught by Dr Vasant Lad is ideal in bringing in a more refined awareness of the breath and That which lies beyond breath.