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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.

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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Late Spring - April & May (Colorado, USA)

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Cherry Blossom 21st April and the cherry bloss...

Cherry Blossom 21st April and the cherry blossom is flourishing. (Photo credit: Wikipedia)

By Kourtney Nelson

Zodiac Signs: Taurus & Gemini

Dosha Accumulation: Kapha & Pitta primarily, some Vata

Dosha Provocation: kapha during wet, cloudy weather, pitta with hot clear days, vata with large or frequent weather changes and windy days

Gunas Involved: cold-sita, hot-usna, snigdha-oily, heavy-guru, mobile-cala, clear-visada, picchila-cloudy, dry-ruksha, light-laghu

April - Average sunrise - 6:30am, average sunset - 7:45pm; Temperature range 62-34, average 53.
May - Average sunrise - 5:45am, average sunset - 8:00pm; Temperature range 71-44, average 61

Weather - Wide range of weather patterns, and large temperature changes. Can be very warm and sunny, or cold. April and May are often some of the wettest months in the year, with snow storms or thunderstorms. May experience windy periods as well.



Kapha - during late spring Kapha has accumulated is liquefied by the increasing heat, which can disturb the digestive system. Kapha can become provoked during precipitation, snowy days and cloudy rainy days

To minimize Kapha:

  • warming, drying, and activating foods
  • Pungent, bitter, and astringent tastes
  • Honey and hot herbal teas
  • Vegetarian, low-fat diet
  • Limit oils - Sesame oil and flax seed oil can be used minimally
  • Vegetables, grains, and beans, cooked and well-spiced
  • One salad per day
  • Whole grain crackers and toasted breads of millet, quinoa, and corn
  • Pungent spices: cinnamon, ginger, black pepper, mustard, cloves, celery seed, dill, radish,
  • Spiced, cooked fruits
  • Cranberry, pomegranate, carrot, grapefruit, and spinach juices can be used in moderation
  • Herbal teas 
 Reduce or Avoid:

  • Cold, wet, bland foods
  • Excessive use of oils, sours, salty
  • Too many dairy products (especially yogurt)
  • White sugar and too many sweets
  • Wheat, oatmeal, unless toasted
  • Too many cooling fruits such as banana, dates, mangos, apples and apple juice, especially in winter 

Pitta - During late spring Pitta begins to increase in the body. Pitta can increase or be provoked on warm clear days

To minimize Pitta:
  • Astringent, bitter, and sweet tastes
  • Moderate use of oils: Olive oil, coconut oil, and ghee
  • Spices: cumin, coriander, fennel, anise, and cardamom.
  • Organic milk, cottage cheese,
  • Basmati rice, barley, millet, quinoa,
  • Cucumber, lettuce, winter squash, yams, tofu, avocado
  • Sweet fruits (e.g. figs, grapes and raisins, dates, blueberries, red raspberries, Babcock peaches, apples, pears, mango, and coconut.)
  • Bitter and astringent herbal teas and nonalcoholic beers and wines
  • Whole grains 
 Reduce or avoid:
  • Excessive sour, oily, salty, and fried foods
  • Red meat, shellfish fish
  • Alcohol, caffeine, and soda pop
  • Excessively hot spices, such as cloves, mustard, onion, garlic, chilies, radish, and cayenne.
  • Frequent use of acidic fruits, juices, and vegetables: tomatoes, beets, eggplant, corn, carrots, hot leafy greens, papayas, pineapple, citrus (except limes), and vinegar.
  • Cashews, peanuts

Vata - During late spring Vata can be aggravated by the highly changeable conditions and dry windy days

To minimize Vata:

  • Cooked, warm, soupy, moderate to heavy foods, soothing and satisfying
  • Plenty of healthy oils (monounsaturates, sesame oil, ghee, butter, nut butters, and EFAs) - avoid hydrogenated oils, other saturated and polyunsaturated oils
  • Natural sweet, sour, and salty tastes and flavorful sauces
  • Carminative spices such as basil, oregano, ginger, cardamom, cinnamon, cumin, pippali, coriander, and dill.
  • Protein-rich diet of animal products: ghee, warm milk, yogurt, cooked cheese, buttermilk, kefir, eggs, etc, as well as the grains like quinoa, corn, and basmati rice, and easily digested nuts and sesame seeds
  • Best fruits and juices: tomato, pomegranate, carrot, fresh-squeezed orange and grapefruit, apricot, peach, strawberry, raspberry, and vegetable juices
  • Lots of fresh veggies (cooked are easier to digest for Vata): pumpkin, carrots, beets, green leafy veggies, avocado, broccoli, baked potato, winter squash, tomatoes, etc. 
 Reduce or Avoid: 

  • Caffeine, white sugar, and soda
  • Excessive use of beans and heavy grains (prepare them with ghee and spices)
  • Dry foods taken alone, large amounts of raw vegetables
  • Taking foods and drinks colder than room temperature  Red meat


Late spring is a time of changing weather and release of accumulated kapha in the body, so digestion can be especially delicate, it can be especially important to follow agni rules at this time

Agni Recommendations:

  • Follow agni rules
  • Proper food combining
  • Drink ginger tea in the morning (fresh for vata and pitta, dry for kapha)
  • Take Agni kindler before meals
  • Drink CCF tea after meals

For Kapha:

  1. Movement: vigorous exercise daily (ex. jogging, aerobics etc), strength training, engage in new activities and mental challenges
  2. Do not skip meals, and do not fast. The Kapha digestive agni tends to be low, as does appetite, and not eating on time slows down the metabolism even more. Start your day with a light breakfast. Eat a sustaining meal at lunch, and a lighter meal for dinner.
  3. Vigorous oil massage with warming oil
  4. Protect yourself from the damp and cold. Drink lots of warm water, infused with warming spices such as turmeric, dried ginger and black pepper. At-home steam therapy can help open clogged channels.
  5. Go to bed early and wake up really early in the morning, 90 minutes before sunrise, do not indulge in daytime snoozes.

For Pitta:

  1. Stay cool--both physically and emotionally. Avoid going out in the heat of the day, especially on an empty stomach or after you have eaten tangy or spicy foods. Avoid exercising when it's hot. Walk away from situations that make you see red.
  2. Do not skip meals, do not fast and do not wait to eat until you are ravenously hungry. You want to keep the fire burning at a moderate temperature, you don't want to put the fire out or to stoke it too high.
  3. Daily oil massage with moderate to cooling oil
  4. Water-based activities are ideal exercise for Pitta-dominant people. Try swimming or aqua-aerobics to stay fit but cool. Strolling after sunset, especially along a waterfront, is also a soothing way to fit some leisurely activity into your day.
  5. Go to bed early, rise 60 minutes. Make sure to turn off the computer or TV by 10pm and turn the lights out. A cup of warm milk, with some cardamom, can be helpful before bedtime.
  6. Balance work and play. Set aside some time for R&R everyday, and do not get so absorbed in a project that you are unable to detach from it.

For Vata:

  1. Establish a daily routine. Go to bed and rise at same time (30 min before sunrise). Regulate meal times, eat even if not hungry to establish routine. Don't skip meals.
  2. Foods and drinks that nourish
  3. Daily oil massage with warming oil such as sesame
  4. Light to moderate daily activity (don't over do and exhaust self) - slow classical vinyasa, swimming, dancing, bike riding
  5. Keep warm, stay out of wind.

Flatirons with Spring flowers

Flatirons with Spring flowers (Photo credit: Wikipedia)

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English: A bowl of white granulated sugar. The...

Image via Wikipedia


 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.


Visham Agni and Sugar

The individual with visham agni has cravings for sweet, salty, sour, spicy and oily foods. They are just as likely to indulge in tortilla chips and salsa, potato chips, French fries and ketchup, salted peanuts or crackers as in sugar. To complicate matters, manufacturers frequently include sugar in savory items such as crackers, chips or peanut butter. Often, such individuals may realize that sweet baked goods such as cookies upset their digestion. Instead, they will use M&Ms or chocolate peanuts, seeking the combination of sweet, fat and crunch.

 The impact of white sugar on such an individual can be devastating to the adrenals. Vata-provoked clients with visham agni are prone to under-eating and random meal plans. Breakfast could be a few Twinkies or a Power Bar in the car on the way to work. Feeling hungry while at work, they may snack on chips, crackers, doughnuts or whatever is in the office or the vending machine. After a salad for lunch, they are hungry again by mid afternoon and begin consuming chocolate and other munchies. By dinner time, they have no appetite left, having wasted their available agni on junk foods. Each time sugar is eaten, it stimulates an adrenal-type energy rush, gradually leading to adrenal exhaustion, especially if combined with caffeine. As the adrenals become increasingly exhausted, the urge to eat sugar grows stronger, in response to the need to "get some energy". As much as sugar may be a cause of overweight in other agni types, it  can contribute to chronic underweight in the person with visham agni. Yet despite being underweight, the junk-food junkie may have more toxic hard fat in the system than the pitta with a chubby little belly.


A young woman with this agni condition worked at a residential elder care facility. When at home, she followed a strict diet of brown rice, steamed vegetables and carrot juice. At work, she indulged in big portions of lasagna and stacks of Oreo Cookies. After explaining to her that there was in fact nothing wrong with lasagna for her constitution, we encouraged her to stash healthy treats at the elder care facility, so that Oreo Cookies would not tempt her.  This strategy works well for both visham agni and tikshnagni.  Creating a stash of suitable treats made with whole sugars or other natural sweeteners gives an outlet for the desire stimulated by the presence of poor quality sweets.

A good remedy to balance sweet cravings for vata can be prepared using Ashwagandha. Roast an ounce of Ashwagandha in ghee and add a tablespoon of date sugar. Store in a screw top glass jar in the refrigerator.  This can be eaten in the morning about twenty minutes before breakfast, in the mid afternoon-- if sweet cravings arise-- and at bed time with a cup of hot milk. To help reduce the stress levels that exacerbate sweet cravings, tulsi tea can be used as a general beverage or Tranquil Mind formula can be taken three times daily. For adrenal exhaustion, Stress Ease can also be taken.


Tikshnagni and Sugar

The individual with tikshnagni craves sweet, bitter and astringent foods. A sugary cup of black tea satisfies the desire for a mixture of sweet with astringent, a cup of sweet latte or a rich dark chocolate meets the need for a mixture of sweet and bitter. Unfortunately, caffeine and white sugar provoke pitta, intensifying tikshnagni. Thus, the more the pitta individual indulges in white sugar, coffee, tea and supermarket chocolate, the worse their tikshnagni becomes and the more strongly they crave sweets. Next, they begin to crave yeasted breads and sweet baked goods in an attempt to diminish their raging inner fire. Yeast, being sour, further provokes pitta, worsening tikshnagni.  People with tikshnagni need extra protein, a slower burning fuel. Thus the empty calories of muffins, cookies, cupcakes and brownies only serve to make them hungrier. Soon they are twenty to thirty pounds overweight while being essentially malnourished.

A fifty year old real estate agent with a pitta prakruti presented with a lifelong history of tikshnagni and compulsive overeating. She came from an alcoholic family and had been an active alcoholic herself for ten years, a typical finding with tikshnagni and sugar addiction. She had a set of very strict diet guidelines that inevitably fell apart each evening. Until that point each day she perceived herself as a person who ate healthily and avoided dairy and processed flours. She took fruit for breakfast and typically ate a business lunch with her clients. Feeling remorseful about the size of her stressful lunch, she took only fish and salad for dinner. Like most stressed out individuals with tikshnagni, she began craving chocolate around four in the afternoon, but held back, determined to be 'good.' By the end of her austere dinner she was ready to spend the rest of the evening consuming chocolate, ice cream and cookies. She was about forty pounds overweight.

Her troubles each day began with her fruit breakfast. Although this may be a good strategy for a healthy pitta with a tranquil life, fruit was not advisable for breakfast given her tikshnagni and the competitive nature of her job, with its stressful lunches. Instead of starting the day with the sweet taste, she could begin with bitter.  A half teaspoon of Mahasudarshan in a teaspoon of honey works well for most people to diminish cravings for breads and sweets. This can be followed, twenty minutes later, by a breakfast containing protein. It is better to avoid a sweet breakfast altogether in this situation and to start the day with a small but complete meal such as a bowl of kitcheri and a whole wheat chapatti.   

To regulate tikshnagni she could prepare Shatavari Kalpa.  Roast an ounce of Shatavari with ghee and add a tablespoon of sucanat or turbinado sugar. This can be taken mid-morning and mid-afternoon to prevent hypoglycemia and to regulate tikshnagni. For stress and addictive tendencies she should drink Brahmi tea three times daily. She could also take Stress Ease three times daily.

Mandagni and sugar.

For the kapha individual with mandagni, sugar addiction is truly a   life or death situation. Waking sluggish and dull, kapha seeks energy from a donut or sugary cereal with cold milk. Although this gives a short burst of adrenal energy, these foods, to which a majority of individuals with mandagni are allergic, serve only to make him more sluggish and sleepy. Worse still, in kapha individuals, the insulin response is easily over stimulated. Whereas vata will burn all the sugar they consume in a frenetic rush of adrenal energy, kapha's body will immediately respond by storing sugar as fat. Gradually, the pancreas becomes more and more oversensitive, leading to a peri-diabetic condition of obesity, low energy and constant cravings for sweets and refined flours. White sugar and refined flour do not contain enough chromium for their own metabolism and thus deplete the body of chromium, essential to metabolism and to the functioning of the pancreas. Continued over-consumption of such refined foods will tip the kapha individual from peri-diabetes to diabetes proper, complete with retinopathy, neuropathy, arterial disease and diabetic ulcers. This is truly a high price to pay for a bowl of cereal and a Snickers Bar a day.

A forty year old financial planner had reached a level of mandagni so severe that not only wheat, dairy and sugar but even brown rice made him nauseated, tired, heavy and dull. He was sixty pounds overweight and lived on an energy roller-coaster, consuming caffeinated soda and sugar to get a burst of energy and then breads and cereal to calm him down. The breads made him tired and lethargic, so then he needed sugar and caffeine, which wired him, after which he needed more bread. In a few short years, if he did not change his ways, he would be diabetic.

He could be helped by taking a teaspoon of Shardunika after each meal or Sweet Ease formula three times daily. This would help balance his insulin secretion and reduce his craving for sweets. As with tikshnagni, a morning dose of Mahasudarshan would help with his craving for breads. Ten minutes before each meal he could take a half teaspoon of organic turmeric powder to aid in balancing the blood sugar load from that meal. To help reduce weight and kindle agni, he could use Trikatu. For stress he could take Bacopa tea three times daily or Mental Clarity formula, which would help with the sluggishness and lethargy that drove him to drink Pepsi-Cola.

In accordance with the basic principles of Ayurveda, although white sugar is a poison for all three doshas, its use must be handled very differently depending upon agni type. It is essential, as we have seen, to provide dietary counseling and to offer appropriate stress- reduction strategies, as sugar consumption is a manifestation of mental stress and a cause of physiological stress. Because of the importance of stress in the overall picture, it may often be wise to begin the treatment program with the appropriate stress-reducing herbs and to hold the other suggestions for a later appointment.



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Manet Smoker

Image via Wikipedia


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.


Smoking Mixture


30%             red clover

30%             calamus root--ground, not powdered

10-15% marshmallow root

5-10%             osha root--broken up well

5%       mullein


"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.


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