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

Conditions
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.

Recommendations

Diet

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:
Favor:

• 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 

• 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

• 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:
Favor:

• 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

Lifestyle

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 (Photo credit: Wikipedia)

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.

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.

Image via Wikipedia

In previous issues of The Vine, we have discussed working with smokers and with pot smokers. In this issue, we will look at the much more difficult issue of working with alcoholics. In a typical Ayurvedic practice, we are unlikely to see the flagrant, rock-bottom alcoholic--unless one of our clients relapses after being sober for some time. Alcoholism is difficult to work with because it is so often covert. For purposes of this discussion, we will consider anyone who uses alcohol on a regular, daily basis as, at the very least, a mild alcoholic. Try a simple test--tell them that their Ayurvedic herbs will not be effective a long as they are using alcohol on a regular basis. The defensiveness and denial with which your suggestion that they give up alcohol is met will soon tell you of the hold the substance has over them.

 When a patient fails to improve despite appropriate treatment, if may be worthwhile to consider whether they are a closet alcoholic and are hiding this obstacle to their healing from you. One client we saw insisted that he has stopped his daily wine habit, yet failed to make progress with his complaints of hyperacidity and indigestion. Growing impatient with his lack of improvement, he sought out other practitioners, with no greater success. It was his wife, also a client, who alerted us to the fact that both of them were still drinking on a daily basis. Another patient failed to improve on her Ayurvedic regimen and had not admitted to any substance issues. The only indication of her alcoholism was a persistent habit of being late for her appointments or canceling at the last minute as well as a tendency to be sometimes warm and sometimes extremely cold and unapproachable.

Another tricky group of alcoholics are the sporadic users or binge alcoholics. These individuals may be sober during the week and drunk on the weekend or refrain from alcohol for extended periods of time, punctuated by bouts of intense binging. In this group of users, denial runs rampant, since they are always "sober" between binges. Yet, difficult as it may be, it is essential for the individual to admit their addiction, to themselves and to you, in order to start on the road to recovery.

Alcoholics who are on Antabuse offer a particular challenge to the Ayurvedic practitioner. We recommend that Ayurvedic herbal regimens be given to such individuals only by an Ayurvedic physician with a good grounding in Allopathic pharmacology or an Ayurvedic practitioner who is also a medical doctor. Herb-drug interactions are extremely complex and understanding them requires a knowledge of Pharmacodynamics--the science of how drugs and herbs are transported, distributed, metabolized and excreted. However, such clients can be helped by ancillary therapies such as diet and lifestyle counseling, abhyanga, shirodhara, marma point massage using Sandalwood oil, and herbal dusting.

The people most likely to be drawn to alcoholism are of course pitta individuals, although kapha may be strongly attracted to beer. Pitta seeks out alcohol to alleviate stress and tension. It is the quest of the mood altering effect that marks the difference between a harmless use and an addiction. It is particularly important to appreciate that pitta individuals suffering from depression or manic depressive disorder may self-medicate with alcohol.

 In general, Ayurvedic therapies will not be successful until the client is sober, as attempts to balance the doshas cannot be effective when a prajnaparadh, or crime against Ayurvedic wisdom, continues. Thus, as a rule, it is important to emphasize that sobriety is a precondition for Ayurvedic treatment. "You want to be rid of your allergies? Please return when you are ready to quit alcohol, and than we can definitely deal with your allergies."

The patient in question waited three months before returning to announce, "I'm sober. Now let's work on the allergies." However, in the case of the person self-medicating for depression or manic depressive disorder, it is usually necessary to institute treatment for depression prior to withdrawal of alcohol. This can be approached by giving Brahmi tea one teaspoon per cup three times daily or by using Mental Clarity Formula. This formula lends itself well to work with alcoholics since it contains not only Brahmi and Bacopa but also Shankhapushpi, an important liver herb which is also effective for depression.

For anyone who has used alcohol to the point of being blind drunk or having blackouts, the esoteric aspect of Ayurveda points to the danger of bhutas or elementals which may have attached to the aura of  during the episode of near-unconsciousness. Such energies may impact the individual's ability to reform and engage in genuine recovery, since it is in the interests of the energy for the alcoholism to continue. A simple way to remove bhutas from the aura is to mix Shankhapushpi in ghee and burn it in the presence of the affected individual. If the client concerned might think that talk of bhutas is hocus-pocus, they can be told, accurately enough, that Shankhapushpi smoke is a good remedy for depression and addictions.

As soon as the client has embarked on a course of sobriety, an Ayurvedic detoxification program should be instituted. For two weeks, the client should eat kitcheri for lunch and dinner, accompanied by a sabji (cooked vegetable dish) of carrots, beets, daikons and bitter greens, seasoned with cumin, turmeric and cilantro. Abundant cilantro should be used to balance the dish for pitta.  For breakfast and mid-afternoon snack they should have juice of carrot, beet, daikon, cucumber and cilantro. The amount of beet and daikon used in the juice should be small relative to the other ingredients, to avoid provoking pitta. Each morning, they should take a half teaspoon of Mahasudarshan mixed in honey, followed by warm water, or, if preferred, Mahasudarshan tablets.  This should be taken at least twenty minutes before breakfast. At bed time they should take half a teaspoon of Triphala steeped for ten minutes in boiling water and strained. If Triphala tea is not well tolerated, Amlaki tea or tablets can be substituted.  This detoxification program is not only effective in cleansing the liver; it is also dramatic enough to signify a passage to a new, sober, life.

Following the detoxification program, it is essential to rebuild the liver. Liver Formula, which includes cleansing herbs such as Musta and Manjista, hepato-protectives such as Kutki and liver rejuvenatives such as Bhringaraj, is an ideal choice for this situation. An excellent anupan to ensure the optimum effectiveness of Liver Formula is Aloe Vera, two tablespoons with each dose of Liver Formula. Mahasudarshan can be continued for up to a month after the detoxification program. If the client has a "beer belly" or has gained excess weight as a result of the alcohol habit, Trim Support could be used after a six week course of Liver Formula.  For those who have been heavy users of alcohol, a peri-diabetic condition may be observed, including weight gain, blood sugar swings and sweet cravings. In this case, Sweet Ease can be used along with Trim Support, or an individualized formula can be prepared using herbs such as Shardunika to regenerate the pancreas, Turmeric to balance blood sugar and Chitrak to kindle agni and improve metabolism. Brahmi tea or Mental Clarity formula can be continued for some months if mood swings or depression are an issue.  In some cases, alcoholism may have led to periodontal disease. This can be managed with organic sesame oil mouthwash.

Pancha Karma will be of great value for the recovering alcoholic, but timing is an important consideration. Unless the alcoholism was extremely mild, it is often wise to wait at least six months before initiating pancha karma. This gives the individual time to become stable in their sobriety. Nothing is more dangerous than an alcohol relapse during or immediately following pancha karma. Typically, Pitta Massage Oil could be used for abhyanga in this situation. If alcoholic liver damage is an issue, the client will not be able to do internal oleation. In this case, Panchamrit can be substituted for the usual internal oleation. Amlaki is the best substance for virechan and Guduchi for basti in this case.

Panchamrit Recipe

 ½ bowl fresh homemade yogurt                       

            1 tsp honey                                               

            1 tsp turbinado sugar

            1 tsp tulsi power                       

            2 Tbsp lukewarm milk                                   

            1 tsp ghee                                               

Alcoholism arises from a state of depression, emptiness, meaninglessness or stress. Hence it is important to introduce stress-reducing practices such as yoga and pranayama and to encourage pursuit of meaning through meditation and selfless service. Nurturing lifestyle practices are necessary to fill the empty space left by the alcohol. For example, marma point aromatherapy can be done using Champa or Jasmine attar, while for diffusion aromatherapy Sandalwood oil can be used. A bed-time foot massage with

Bhringaraj oil or coconut Brahmi oil, a cup of warm milk with cardamom and cinnamon or a dose of Stress Ease with some soothing rose and coriander tea can replace an alcoholic "nightcap". The former weekend alcoholic can substitute a weekend self-nurturing routine such as abhyanga and shirodhara.

Continuous support from the Ayurvedic practitioner is essential in the process of recovery. This should be supplemented by attendance at Alcoholics Anonymous or by individual counseling. Through herbal therapies and pancha karma the physical and mental aspects of detoxification and recovery can be effectively addressed, while through subtle therapies and rejuvenation practices, the client can be helped to fill the inner void and find new meaning in life.

Image via Wikipedia

When I was a child, a popular programme on BBC radio was Desert Island Discs, a show in which various celebrities chose the ten gramophone records they would want to have when marooned on a desert island.  I have often amused myself picking my ten Desert Island Herbs, and Punarnava is certainly among them. The name Punarnava means, quite literally, the Renewer, for local tribal folk observed that the dead, dry plant would spring again to new green life. On the theory of signatures, they took this to mean that the plant was rejuvenative--a fact now supported by rigorous scientific research.

Punarnava, boerhaavia diffusa in Latin, is known in English as Spreading Hogweed. It is an abundant weed, found growing in poor soil and native to both India and Brazil, where it is known as Erva tostão. It belongs to the Four o'clock family or Nyctaginaceae. The flowers are red, pink or white in colour. Supplies of Punarnava are often contaminated with a similar looking white flowered plant of the trianthema species, which does not contain punarnavine. For this reason, it is essential to be sure of obtaining certified organic Punarnava, as this will have a more reliable potency. Rasa is sweet and bitter, virya is heating and vipak is pungent. It reduces vata and kapha and may stimulate pitta in excess, though modest amounts will reduce pitta through sweet rasa. Active chemical components include flavonoids, alkaloids, steroids, triterpinoids, lipids, lignins, carbohydrates, proteins and glycoproteins. Some of the most important active components include puranavine and punarnavoside.

Punarnava is a folk medicine and super-food as well as a classical Ayurvedic Rasayana. In India, it is used by traditional tribal healers in Chhattisgarh, Bagbahera and Pithora regions. Healers apply Punarnava to the vagina to hasten delivery and also tie the roots, wrapped in red cord, around the woman's waist. They also apply Punarnava mixed in whey to breast abscesses. For eye sties they use Punarnava mixed in ghee, and for conjunctivitis, Punarnava in honey. They make Punarnava oil with Nirgundi to ease arthritic aches and pains. The Bhil tribal folk use Punarnava roots for blood dysentery.  Country folk plant Punarnava in their gardens to repel poisonous snakes and scorpions and in West Bengal and Assam, Punarnava leaves are eaten as a potherb and are understood to prevent renal calculi. In other areas, the entire plant, including the root, is eaten in curries and soups, while the seeds and roots are used in cereals and pancakes.

In South America, Erva tostão or Punarnava has long been used by traditional healers for maladies of the liver and kidneys.

In Ayurveda, Punarnava acts on the rasa, rakta and mamsa dhatus.It is used as a rasayana for lungs, heart, and kidneys as well as a diuretic, expectorant, and anti-diabetic. It reduces lung and peripheral oedema, is anti-rheumatic in painful and swollen joints, improves renal function, breaks up renal calculi, and is  valuable in nephrotic syndrome. As a bronchodilator and expectorant it is used in congestive cardiac failure, chronic bronchitis, bronchectasis and plural effusion. As an eye medicine, it is used in glaucoma and night blindness. Punarnava is frequently cited in the texts.  Dhanvanthari Nighantu states,

Punarnava Bhavedushna
Tiktaa rooksha Kaphaapaha
Sasopha Paandu hrid roga
Kaasorakshata Soolajit.

"Punarnava is bitter and heating. It is drying. It checks Kapha. It is useful in the treatment of diseases with swelling, anaemia, heart diseases, cough, blood spitting, and colic."

In skin diseases, a paste of the root with dadhimanda (water floating on curd) is used topically. (Chikitsa-Ch. 7. Charaka.) In urinary calculus, Punarnava decoction is recommended. (Chikitsa-Ch. 7. Sushruta). Sushruta also recommends milk boiled with Punarnava in fevers, and application of Punarnava paste in swelling of the testicles. In eye diseases, Bhavprakash says,

Dugdhena kandoom kshoudrena netrashravancha sarpisha pushpam, thailena thimiram, kanjikaena nisandhatam, Punarnava haratyaasu bhaskarasthimiram yatha.

"With milk in itching of the eyes, with honey in discharges, with ghee in white patches, with oil in immature cataracts, with rice washing water in night-blindness, Punarnava is useful in eye diseases."

In nephrotic oedema, a tea is made with Punarnava, ginger, khus and vetiver. In night blindness, a cup of cow's milk with a teaspoon of Punarnava is taken at bedtime. In enlarged spleen use one teaspoon Punarnava with Aloe Vera gel. In congestive cardiac failure give one teaspoon Punarnava and one teaspoon Arjun in honey.  In oedema a paste of Punarnava can be applied to the swollen areas. This is particularly useful in angioneurotic oedema of the face and eyes due to an allergic reaction, since Punarnava is anti-histamine and anti-inflammatory as well as reducing swellings. In itchy allergic eye conditions, bathe the eyes with Punarnava eyewash and in glaucoma use Punarnava eyedrops twice daily.

   In asthma, a teaspoon of Punarnava and half teaspoon Pippali can be given in honey. In epilepsy Punarnava can be combined with Vacha and Brahmi to reduce brain swelling and have an anticonvulsant effect. In allergic rashes, mix Punarnava with ghee and honey. In urinary tract infection, Punarnava tea is beneficial.

Compounds of Punarnava include Punarnavadyarishta, Punarnava Mandura and Punarnava Guggulu. Punarnavadyarishta, a medicated wine, is used in heart disease, anaemia, severe swelling, splenomegaly, fever, anorexia, cough and numerous other conditions. (Chikitsasthanam 12  37, Charaka). Punarnava Mandura, containing iron, is especially valuable in anaemia though it is also recommended for malaria, piles and intestinal parasites. (Chikitsasthanam 16 98, Charaka). More readily available in the US and of outstanding value is Punarnava Guggulu. This is the most valuable herbal compound for kidney stones and should be taken daily on a preventative basis by anyone with a history of kidney stones. It is also useful for obesity, goitre, water retention, glaucoma, diabetes and kapha type arthritis.

Punarnava has been extensively researched, with findings backing up its traditional uses. It has been demonstrated that punarnavoside is diuretic, (Gaitonde et al 1974)  anti-inflammatory, (Bhalla et al 1968) anti-fibrinolytic, (Jain and Khanna 1989)  antibacterical (Olukoya et al 1993) and anti-convulsant ( Adesina 1979). Punarnava has also been shown to be  hepatoprotective and choleretic, cardiokine, anti-cancer and anti-oxidant. It should always be considered in Hepatitis C because it has demonstrable hepato-protective action. Sony and Bhatt demonstrated effectiveness of an herbal mixture containing Punarnava in entamoeba histolytica (1995). It is also anti-fungal.

Pari and Sateesh ,2004, demonstrated the effectiveness of Punarnava in diabetes and its ability to lower blood lipids in diabetes, as well as showing the antioxidant impact  this  herb has in diabetes.  In cancer, Punarnava is anti-metastatic (Leyon et al 2005), as well as cancer preventive.

This immensely useful herb offers hope for many otherwise incurable or difficult to treat conditions including cancer, diabetes, obesity, kidney stones, renal failure and hepatitis C. It is also of great use in common conditions such as allergies and conjunctivitis. Hence, Punarnava is near the top of my list of Desert Island Herbs.

Image via Wikipedia

Among the most celebrated Ayurvedic herbs is Pippali, renowned for its benefits for the lungs but valuable in many other capacities too. Literature on Pippali can be found in both classical texts and contemporary peer reviewed journals. Pippali can be used in four capacities--as a culinary spice of rare distinction, as a home remedy, as a powerful medicinal herb and as a catalyst to potentiate the action of other herbs and drugs.

Pippali (piper longum,) is indigenous to India and Sri Lanka, although a very similar plant is found in Indonesia. A member of the family piperacae, Pippali is a perennial aromatic shrub. The flowers of Pippali grow in spikes, which are harvested and dried to form the Long Pepper. The root, Pippali Moola, is also a valuable herb widely mentioned in classical texts. It is important to note that, unlike cayenne pepper, and despite common misunderstanding, Pippali is not in the nightshade family and is perfectly acceptable to those who are unable to tolerate nightshades.

Pippali has as pungent rasa and sweet vipak. Its virya is anushnashita--neither hot nor cold, a fact the renders it invaluable for pitta.  It contains volatile oil, alkaloids piperin and piperlonguminine, terpenoids and N-isobutyl deca-trans-2-trans-4-dienamide, a waxy alkaloid.

Pippali regulates sroto- agni of pranavahasrotas, the respiratory tract. It acts as a bronchodilator, decongestant, expectorant, and lung rejuvenative. In annavahasrotas, the digestive tract, it also has powerful actions as carminative and deepan (agni kindler). Pippali kindles bhutagni in the liver, improving liver function, and is a metabolic stimulant, aiding the thermogenic response by increasing the level of thyroid hormone.

As a culinary spice, Pippali has been celebrated for its unique combination of pungent and sweet. It was an essential ingredient in Roman cooking and is used to this day in the cuisine of Morocco and Ethiopia, where it is an ingredient in berebere, a masala mix. Although its use in Indian cuisine has been replaced by the much harsher cayenne pepper introduced by the Portuguese, it is still used in certain traditional pickles.

As a home remedy, Pippali should be in every winter medicine cabinet. As always, choice of anupan will determine which aspect of the action of Pippali will predominate.  A pinch of Pippali in aloe vera gel will immediately relieve bronchospasm in an episode of bronchitis or severe cough. The same recipe can also be used before meals to help with intolerance to fats. In asthma, a quarter teaspoon of Pippali can be mixed in a teaspoon of honey and taken three times daily after meals. For hyperacidity, a quarter teaspoon of Pippali can be mixed with a half teaspoon of rock candy and a half cup of room temperature milk. A pinch of Pippali with a teaspoon of crushed rock candy is a good home remedy for hoarseness of the voice.

To enhance prana, a quarter teaspoon of Pippali can be mixed in ghee and taken in the morning. As a rejuvenative home remedy in chronic fatigue, a quarter teaspoon of Pippali can be taken daily with gritamadhu (a combination of ghee and honey) (1). As a carminative, a quarter teaspoon Pippali can be combined with a pinch of hing and a teaspoon of ghee and taken after meals. In haemorrhoids, make a Pippali yoghurt drink. Combine two tablespoons of yoghurt, a cup of pure water and a pinch of Pippali, blend together and drink after lunch and dinner. In obesity, combine a pinch of Pippali with a teaspoon of honey and drink in the mornings followed by hot water, for enhanced thyroid function and fat burning.

In chronic cough, asthma and low agni, Pippali milk can be used. Make a medicated milk by adding a quarter cup of water to a cup of milk. Add a pinch of Pippali and cook back down to one cup. Pippali is safe to use in pregnancy in small amounts. For asthma in pregnancy, a small amount of Pippali can be taken, mixed in ghee. A medicated ghee can also be made with Pippali, cooking a decoction of Pippali into ghee until all the water is absorbed. This is an excellent remedy for healing lungs that have been damaged by smoking.

As a medicinal herb, Pippali can be used to heal and rejuvenate pranavahasrotas. It is an excellent addition to any spring rejuvenative formula. As a powerful herb, it should be used in smaller proportions in the formula. It combines well with Punarnava in formulas for pranavahasrotas (respiratory conditions), with Shankhapushpi for chronic liver disease, with Ashwagandha in fatigue conditions and with Guggulu in rheumatoid arthritis.  It is also of value in anti-parasitical formulas.

In bronchial asthma, the famous Vardaman Pippali Rasayana can be used as described in detail in Charak Samhita. An increasing amount of Pippali is taken each day; with milk. Amounts of Pippali and their rate of increase are determined by the strength of the patient.  Once a peak is reached the amount of Pippali is slowly reduced each day (2). Meanwhile, a strict diet is followed. For Westerners, tolerance of Pippali is lower. It is best to find the point at which Pippali will cause hyperacidity, lower the dose to below that level, continue at that level for a week and then slowly reduce the amount.

There are a number of classical preparations featuring Pippali. These include Trikatu, Sitopaladi, Talisadi, Pippali Asavam and Pippali Prash. All these preparations make use of the powerful effects of Pippali on pranavahasrotas.

Recent research conforms the effectiveness of Pippali in a variety of situations. Several have shown immunostimulatory and antigiardial effects of Pippali (3). Pippali is similarly effective against entamoeba hystolytica. A 2006 study published in the Journal of Phytomedicine shows that Pippali inhibits liver fibrosis in animal studies. This provides support for the traditional use of Pippali in alcoholic liver disease and chronic hepatitis(4) A.K Agarwal et al demonstrated the protective effect of Pippali against gastric ulcers in rats.  "The antiulcerogenic effect seemed to be due to the augmentation of mucin secretion and decreased cell shedding rather than offensive acid and pepsin secretion which however, were found to be increased by them."(5). Pippali's anti-inflammatory and analgaesic effects may be equal to that of Ibuprofen, according to one animal study (6). "This indicates that P. longum root has weak opioid but potent NSAID( non steroidal anti-inflammatory) type of analgesic activity".

Another study demonstrated that Pippali is a useful anti-cancer agent. (7) "These results indicate the potential use of spices as anti-cancer agents as well as anti-tumour promoters." This study is very interesting in highlighting the usefulness of Pipplai both to recovering smokers, at risk for lung cancer, and to those with Hepatitis C, at risk for liver cancer.

Finally, in addition to its powerful effects as a medicinal herb in its own right, Pippali is also valuable as a catalytic agent to potentiate the actions of other herbs or drugs. The most important classical example of this usage of Pippali is of course Chyavanprash. In this formulation, Pippali functions as a catalytic agent to enhance the rejuvenative, anti-inflammatory, anti-cancer and lung infection-fighting capabilities of Amlaki, the chief herb in Chyavanprash. Pippali has also been shown to enhance the effects of antibiotics. (8) In this study, Pippali was found to be a phytochemical potentiator of Ciprofloxacin against Staphylococcus aureus, a common bacterium which can cause a variety of diseases including lung infections. This study points to the usefulness of taking sitopaladi alongside an antibiotic in serious bacterial infections such as bronchitis and pneumonia. It is important to note that in certain situations, the potentiating effect of Pippali may be dangerous in terms of herb-drug interactions. Neither Pippali nor black pepper should be used in individuals taking the beta blocker Propanalol, also known as Inderal, because piperine enhances the effects of this drug, with potentially dangerous consequences. It is also important to avoid Pippali when a patient is taking anti-coagulants.

Although Pippali is most famous for its rejuvenative impact on pranvahsrotas, ancient texts and contemporary studies point to wide-ranging effectiveness  of Pippali in respiratory, liver, digestive, metabolic, parasitic and malignant conditions.  In terms of Pippali's usefulness in pravavahasrotas, anti-infective, anti-inflammatory, anti-cancer and rejuvenative effects all synergize to create outstanding effectiveness in infectious and degenerative lung and upper respiratory diseases.

1. Chikitsasthan, Ch.1 v 32

2. Chikitsasthan, Ch.1 v36-40

3. Tripati et al Antigiardial and immunostimulatory effect of Piper longum on giardiasis due to Giardia lamblia. Phytother Res. 1999 Nov;13(7):561-5; Agarwal et al  Management of giardiasis by a herbal drug 'Pippali Rasayana': a clinical study.

4. Plant Products as Antimicrobial Agents. Marjorie Murphy Cowan^, Department of Microbiology, Miami University, Oxford, Ohio 45056. Clin Microbiol Rev. 1999 October; 12(4): 564-582.

5. J Ethnopharmacol. 1997 May; (3):233-6

6Phytomedicine. 2006 Feb;13(3):196-8. Epub 2005 Jun 24. Inhibition of CCl4-induced liver fibrosis by Piper longum Linn. Christina AJ, Saraswathy GR, Robert SJ, Kothai R, Chidambaranathan N, Nalini G, Therasal RL. Department of Pharmacology, KM College of Pharmacy, Uthangudi, Madurai, Tamil Nadu, India.)

7. Indian J Exp Biol. 2000 Oct; 38(10):994-8.

8. Indian J Exp Biol. 2003 Jun;41(6):649-51.

9. Unnikrishnan MC, Kuttan R; Cancer Lett. 1990 May 15;51(1):85-9.

10. Inshad Ali Khan, Zahid Mehmood Mirza, Ashwani Kumar, Vijeshwar Verma, and Ghulam Nabi Qazi, Antimicrobial Agents and Chemotherapy, February 2006, p. 810-812, Vol. 50, No. 2.

Image via Wikipedia

In this article, we will take a look at an extremely common cause of shoulder pain: rotator cuff injuries. We will look first at the normal anatomy and movements of the shoulder. Then we will consider the epidemiology and Ayurvedic management of rotator cuff injuries.

The human shoulder is a remarkable piece of engineering and one of the most mobile joints in the human body. Shoulder joints of different species are adapted to a variety of functions, from flying in the case of avian shoulders to quadripedal walking and running in the case of most mammals. Human shoulders reflect both our phylogenetic heritage as tree-swinging primates (arboreals) as well as the unique needs of our species such as spear throwing, tool making and enhancing speech with gesture. "The dorsal position of a highly-mobile scapula and the lateral orientation of the small, shallow glenoid fossa articulating with a medially-directed large round humeral head open up a nearly complete sphere of motion allowing the hand to be positioned almost anywhere around the body."  (1). The shoulder is a complex of several joints, including the sternoclavicular joint, acromioclavicular joint, glenohumeral ball and socket joint (GH) joint, and scapulothoracic (ST) joint or pseudoarticulation. These articulations work together to carry out normal shoulder motion. The majority of motion occurs at the GH and ST joints. (2,3).

Human shoulder joint movements include:

·      Scapular retraction (squeezing the shoulder blades together) using rhomboideus major and minor and trapezius

·      Scapular protraction (as in hugging yourself) using serratus anterior and pectoral muscles

·      Scapular elevation (shrugging shoulders) using levator scapulae and upper trapezius

·      Scapular depression (slumping shoulders) using pectoralis minor, latissimus dorsi and subclavius

·      Arm abduction, lifting arms away from body to 90',  (deltoid) followed by additional upward rotation of scapula to raise arms above the head (trapezius, serratus anterior).

·      Arm adduction, first bringing arms back down to 90' via downward rotation of scapula using pectorals, subclavius and latissimus dorsi; followed by true adduction, which additionally uses teres major and deltoid.

·      Arm flexion (reaching arm forward) using pectoralis major, coracobracialis, biceps, deltoid

·      Arm extension (pointing humerus backwards) using latissimus dorsi, teres major, triceps and deltoid

·      Medial rotation (turning upper arm in) using subscapularis,  latissimus dorsi, teres major, pectoralis major and deltoid

·      Lateral rotation (turning upper arm out) using infraspinatus, teres minor, deltoid

·      Circumduction (circular movement of arms up to 90') using pectoralis major, subscapularis, coracobrachialis, biceps, supraspinatus, deltoid, latissimus dorsi, teres muscles, infraspinatus and triceps. (3).

Some authorities suggest that on leaving our arboreal lifestyle, we fail to use our shoulder joint to full capacity, thus creating a tendency to osteo-arthritis of the shoulder (4). If this hypothesis is true, it provides a powerful justification for activities such as hatha yoga and chi gong in maintaining shoulder joint health through movement. Elderly subjects have been shown to have reduced shoulder joint movement after a lifetimes of under-use of some movements and over-use of others (5).

The rotator cuff is composed of four muscles whose tendons splay out and interdigitate to form a common, continuous insertion on the humerus, providing stability to the shoulder joint (6). The four main muscles of the rotator cuff are suspraspinatus, infraspinatus, teres major and subscapularis. Originating above the spine of the scapula, supraspinatus inserts on the greater tuberosity of the humerus. As the deltoid abducts the shoulder joint, supraspinatus fires to stablize the joint (7).  Infraspinatus, originating below the spine of the scapula, insets posteriorly on the greater tuberosity of the humerus and, as stated above, asssists in lateral rotation. Teres minor, originating on the lateral border of the scapular, inserts inferiorly on the greater tuberosity of the humerus and as we have seen, is involved in lateral rotation. Originating between the scapula and the ribs on the anterior surface of the scapula, subscapularis inserts on the lesser tuberosity of the humerus and is involved in medial rotation of the arm. However, although the rotator cuff muscles are associated with the above-mentioned shoulder motions, it is important to understand that their main function is to provide stability to the GH joint by compressing the humeral head on the glenoid (8).

Rotator cuff injuries are common in all ages and range from reversible tendinitis to massive tears involving supraspinatus, infraspinatus and subscapularis. Repetitive overhead movements such as pitching in baseball can cause rotator cuff injuries in younger people, or, less commonly, a trauma such as a fall or car accident can tear the rotator cuff (9). Older patients may present with a history of gradual onset of shoulder pain, with no clear history of trauma and yet are often shown on MRI to have significant partial or compete rotator cuff tears (10, 11). On cadaver studies, 39% of individuals over sixty were found to have full-thickness rotator cuff tears with an even higher incidence of partial tears (12). These injuries on elders are probably due to age related degeneration and compromised microvascular supply (13,14).

The main symptoms of rotator cuff injuries are shoulder pain and diminished range of motion; additional symptoms include weakness, swelling, instability and popping of the joint. In elders, a significant rotator cuff tear may present with insidious symptoms. Therefore, in patients over sixty-five, passive and active shoulder range of motion should routinely be examined, since rotator cuff injuries are prevalent in over a third of this population. When active elevation is less than passive elevation, this points to a rotator cuff injury.

Patients presenting with shoulder pain should have a full check up with a medical practitioner before proceeding ahead with Ayurvedic treatments for the rotator cuff. This is particularly important because both angina pectoris due to iscaemic heart disease and myocardial infarction (heart attack and its sequelae) are included in the differential diagnosis of shoulder pain. Additionally, the nature and extent of the tear can best be determined by imagining such as MRI.

While the most massive tears are usually referred for orthopedic surgery, most rotator cuff injuries are managed by conservative measures and can be addressed by systemic and localized Ayurvedic treatments. Therapy must address the cycle of pain/underuse/loss of conditioning/ joint laxity. First this cycle is broken by local and systemic measures to reduce inflammation. Then the shoulder muscles can be ongoingly conditioned to sustain maximum functioning.

 For reducing pain and inflammation, herbs, home remedies and Ayurvedic bodywork can be applied. Anti-inflammatory herbs such as guduchi, kaishore guggulu, tulsi, turmeric and licorice can be given orally to reduce inflammation, pain and swelling (15). Anti-inflammatory home remedies include ginger tea and Trinity Tea (tulsi, turmeric and ginger tea). Localized home treatments can be applied using anti-inflammatory oils such as castor oil and mahanarayan tailam (15) prior to a hot shower. Alternate hot and cold packs can also be given, using a bowl of ice water, a bowl of hot mustard seed tea and two cloths. First a hot pack is applied, then a cold pack, then hot, then cold for a counter-irritant impact. Bath therapy can also be used, first massaging the shoulder with castor oil and then taking a ginger-baking soda tub.

Many classical Ayurvedic body treatments can be applied to the shoulder to reduce the pain and inflammation of a torn rotator cuff. Mardana or pressure massage is recommended for snayugata vata or vata invading tendons (16). After applying mahanarayan oil the therapist gives vijayamala hasta (straight pressure massage on neck), viparita vijayamala hasta (oblique pressure massage on neck), shaila hasta (massaging front of shoulder), dheera hasta (circular massage on shoulder) and chakra hasta (rotary massage on shoulder (17). Valuka sveda using a hot sand bag is helpful to alleviate pain and swelling (18). Patrapinda sveda can be offered using leaves of datura, abundant in the United States as Jimson weed or Angel trumpet. The datura leaves are fried in oil and placed in muslin bags. Then mahanarayana oil is applied to the shoulder the shoulder and the comfortable hot pinda packs are massaged over the area. This treatment is effective for muscle and tendon injuries (19). Nadi svedan therapy using localized steam medicated with nirgundi is also extremely valuable in rotator cuff injuries (20). Taila dhara treatments with mahanaryana oil can alos be applied locally to the shoulder using the same setup as for shirodhara but adjusting the positioning (21).

After pain and inflammation have been managed, yoga therapy can be employed to strengthen the shoulder and restore range of motion. A qualified yoga therapist should perform this function. Improving posture, especially with regard to thoracic kyphosis, is important in preventing rotator cuff impingement. Modified dog poses against a wall help stabilize the scapula. Cat Bow can be utilized to strengthen shoulder extensors (22, 23). Modified cobra poses can be helpful in strengthen the rotator cuff, as can shoulder shrugs and shoulder circles. Use of yoga therapy, physical therapy or Chi Gong is a vital part of the care cycle, which necessarily involves both reduction of inflammation and restoratio of range of motion.

As we have seen, rotator cuff injuries are extremely common and require careful assessment. All but the  most severe cases can be well addressed by a combination of Ayurvedic treatment and skilled yoga therapy.

1.  Grine FE,  Fleagle JG, Leakey RE The First Humans: Origin and Early Evolution of the Genus Homo Vertebrate Paleobiology and Paleoanthroplology Springer Science 2009 p 64

2. Codman EA. The Shoulder. Boston, Mass: Thomas Todd; 1934.

3. Pronk GM, van der Helm FC, Rozendaal LA. Interaction between the joints in the shoulder mechanism: the function of the costoclavicular, conoid and trapezoid ligaments. Proc Inst Mech Eng H. 1993;207(4):219-29.

4. Alexander CJ, Utilisation of joint movement range in arboreal primates compared with human subjects: an evolutionary frame for primary osteoarthritis. Ann Rheum Dis 1994;53:720-725 doi:10.1136/ard.53.11.720

5. Chakravarty K, Webley M. Shoulder joint movement and its relationship to disability in the elderly. J Rheumatol. 1993 Aug;20(8):1359-61

6. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy J Bone Joint Surg Am. 1992 Jun;74(5):713-25.

7. Steindler A. Kinesiology of Human Body Under Normal and Pathological Conditions. Springfield, Ill: Charles C Thomas Publishing; 1984.

8. Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability. J Shoulder Elbow Surg. Jan-Feb 1998;7(1):43-52

9. Neer CS 2nd, Welsh RP. The shoulder in sports. Orthop Clin North Am. Jul 1977;8(3):583-91.

10.  Cailliet R. Shoulder Pain. 3^rd ed. Philadelphia, Pa: FA Davis Publishers; 1991:42-6.

11.  Baker CL, ed. Shoulder impingement and rotator cuff lesions. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Lippincott Williams and Wilkins; 1995:272-9.

12. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

13. Yamanaka K, Fukda H. Aging process of the supraspinatus tendon in surgical disorders of the shoulder. In: Watson N, ed. Surgical Disorders of the Shoulder. New York, NY: Churchill Livingstone; 1991:247.

14. hr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. May 1990;254:35-8.

15. Singh A, Malhotra S, Subban R Anti-inflammatory and analgesic agents from Indian medicinal plants Int. J. Integ. Biol., 2008, 3(1):  57-72

16. Shrinivasa Acharya G, Panchakarma Illustrated, Chaukhamba Sanskrit Pratishtan Delhi 2006 p167

17. ibid pp 169-171.

18. ibid pp 215-219

19. ibid 220-225

20. ibid p 226

21. Dash B, Massage therapy in Ayurveda, Concept Publishing Company, New Delhi, 1992 p 64

22. Hinnen BF Rotator Cuff and similar Shoulder Injuries Structural Yoga Therapy Research Paper

23. Stiles, Mukunda. Structural Yoga Therapy - Adapting to the Individual. Boston, Weiser Books, 2001

Last month, we looked at easily curable conditions of prana vaha srotas as well as those curable with difficulty.  This month, we will look at chronic (yapya) conditions of prana vaha srotas and also mention briefly how to be aware of potentially fatal conditions.

One extremely common yapya respiratory condition is chronic rhinitis, affecting as many as 40% of the US population. One of the world's most common chronic disorders, rhinitis affects the entire spectrum of life from infancy to old age (1). Sushrut discusses thirty-one diseases of the nose, including Apinasa (rhinitis) and pratishaya (nasal catarrh)(2). Apinasa is classified as a disease of vata and kapha (2). Pratishaya with dryness, hoarsenss, temporal headache and nasal obstruction arises from Vata (3), with thirst, yellowish nasal discharge and a feeling of hot smoky breath, pitta is involved (4) and with thick white or yellowish catarrh, swollen eyes, heaviness and itchy throat and palate, kapha is implicated.

 From a modern standpoint, classification of rhinitis is less based on clinical presentation and more on etiology. Rhinitis is either allergic or non-allergic. Allergic rhinitis results from IgE reactivity to both outdoor, seasonal allergens such as pollens and indoor allergens including moulds, house dust and animal dander. It is often associated with another chronic condition of prana vaha srotas, asthma. (See http://www.alandiashram.org/school/school_html/reviews/bronchial_asthma.html for a previous Vine discussion of asthma). While allergic rhinitis is common in infants, children and young adults (5), non-allergic rhinitis becomes increasingly prevalent in older adults and is more common in women (1). Although there are many etiologies of non-allergic rhinitis, some of the most common include chronic sinusitis, allergic fungal sinusitis, eosinophilic nasal polyps (6) and deviated nasal septum. For an in depth treatment of chronic sinusitis and allergic fungal sinusitis see archived Vine article http://www.alandiashram.org/school/school_html/reviews/chronic_sinusitis.html. Irritants such as dust, smoking and household cleaning agents can cause or contribute to rhinitis, as expressed by both Madhava and current medicine (7, 8). Hormonal causes of non-allergic rhinitis include pregnancy, menstruation, puberty and hormone replacement therapy as well as hypothroidism (8).

As we review the various ways of classifying rhinitis, we can see that the Western medicine classifications are more useful in terms of Western treatments. For example, allergic rhinitis would respond to anti-histamines whereas other kinds will not. By the same token, Sushrut's symptom based classification is more useful for Ayurvedic treatment since it points to the dosha involved and hence to the appropriate therapies.

Patients with chronic rhinitis frequently present for Ayurvedic treatment as an alternative to steroidal and non-steroidal nasal sprays and systemic antihistamines. Indeed, the persistent nature of this condition has led doctors, as well as patients, to look 'outside the box' for adjuvant therapies. As an example, a friend of mine recently visited National Jewish Hospital in Denver, one of the premier respiratory hospitals, only to be told to increase his use of the nasal rinse cup from once to twice a day! A number of studies have been done, demonstrating the effect of jala neti or saline irrigation using a nasal rinse cup.  As one abstract puts it, "The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. It is often prescribed as an adjunct to other treatments such as intranasal steroids or antibiotics. ...This review summarises the evidence for the effect of saline irrigations in the management of the symptoms of chronic rhinosinusitis. There is evidence that they relieve symptoms, help as an adjunct to treatment and are well tolerated by the majority of patients. While there is no evidence that saline is a replacement for standard therapies, the addition of topical nasal saline is likely to improve symptom control in patients with persistent sino-nasal disease....There are no significant side-effects reported in trials."     ( 9)

An earlier study also indicated that "Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis," (10) and an Australian study investigating nasal irrigation showed that neti, also known as nasal douche, was more effective than nasal sprays or nebulizers and effectively reached the maxillary sinuses and frontal recesses. The sphenoidal and frontal sinuses are not easily reached by irrigation methods. (11).

While local use of oils and herbs in the form of nasya have not been investigated to the same extent, some recent studies published by Gujerat Ayurved University indicate that nasya therapies are effective in both allergic and atropic rhinitis. Local (nasal) administration of herb via nasya was effective in giving immediate relief of signs and symptoms of allergic rhinitis and can best be paired with longer acting systemic herbs such as turmeric. (12). Nasya is also effective in atropic (non-allergic ) rhinitis (13).

Similarly, in terms of asthma, there has been a search for adjuvant therapies for this chronic condition. Steam inhalation, using natural mineral saline is one valuable adjuvant. The Ayurvedic use of steam and herbal smokes for administering medicines directly to the lungs is the precursor of today's asthma inhalers (14). Yoga therapy is also valuable in managing asthma. "Forty six young asthmatics with a history of childhood asthma were admitted for yoga training. Effects of training on resting pulmonary functions, exercise capacity, and exercise-induced bronchial lability index were measured. Yoga training resulted in a significant increase in pulmonary function and exercise capacity. A follow-up study spanning two years showed a good response with reduced symptom score and drug requirements in these subjects. It is concluded that yoga training is beneficial for young asthmatics." (15).

Herbal therapies of course are also effective for asthma, including Boswellia (16) and kapi kacchu (17). Ayurvedic and yogic therapies including neti, nasya, steam inhalation herbal smokes, yoga therapy and oral herbs can be of tremendous use in enhancing quality of life for patients with chronic prana vaha srotas conditions and reducing the amount of medications they need to use.

With regard to fatal conditions of prana vaha srotas, lung cancer remains the leading cause of cancer-related death both in the United States and throughout the world (18). Ayurvedic practitioners as well as primary care physicians should be highly suspicious in the case of any person with a history of smoking who presents with cough, breathlessness or wheezing or simply fatigue and malaise. A pneumonia or bronchitis may be more than it seems as lung cancer may frequently present as pneumonia or bronchitis. Swift referral for chest X ray is vital to avoid overlooking cancer. Patients with a history of coal mining or working in or living near an asbestos plant should also be treated with great caution in the event of a history of cough as they too are susceptible to lung cancer. And of course, one should not forget spouses of chain smokers, who may have been exposed to a lifetime of carcinogenic second and third-hand smoke. Tridoshic disturbance of overall vikruti, of the lung pulse or of the rasa dahtu pulse can lead the Ayurvedic practitioner suspect lung cancer, although these same pulse findings may also hold good in chronic obstructive pulmonary disease (COPD).  

To give some examples, some years ago a fifty-year-old woman presented with a non-specific complaint of "feeling unwell". She had never smoked cigarettes, although she was a marijuana smoker. However, her husband was a former chain-smoker. A few weeks later, she presented with cough and breathlessness and tridoshic disturbance in her lung pulse. Suspecting pneumonia, we referred her to her primary care practitioner, who diagnosed bronchitis and sent her home with antibiotics.  Days later she was admitted to hospital with for pneumonia and within three months she had died of advanced pulmonary adenocarcinoma.  This story serves to remind us of how nebulous the initial presentation of lung cancer may be.

A seventy five year old former smoker complained of chest pain during winter and was diagnosed with pneumonia and put on antibiotics. Bronchoscopy revealed Stage IV adenocarcinoma of the lungs and she presented for Ayurvedic adjuvant therapy alongside her chemotherapy. She went into remission for some time but recently, again in winter, developed cough and breathlessness and was found to have a pleural effusion, which may be malignant in origin. This case history too illustrates how difficult it is to diagnose lung cancer until a late stage of the condition and how closely its symptoms can mimic typical winter ailments.

Ayurvedic practitioners can facilitate considerable improvements in quality of life for patients suffering from chronic conditions of prana vaha srotas. When working with respiratory conditions, it is important to take note of lung cancer risk factors and to be aware that this condition can present as a typical winter chest infection.

1. John W. Georgitis  Prevalence and differential diagnosis of chronic rhinitis Current Allergy and Asthma Reports Volume 1, Number 3 / May, 2001

2. Su. Uttarasthan, XXII

3 ibid XXIV 6

4 ibid v 7-8

5 Quoc A Nguyen, MD Allergic Rhinits  http://emedicine.medscape.com/article/834281-overview

6. Maria Staevska and James N. Baraniuk Persistent nonallergic rhinosinusitis Current Allergy and Asthma Reports Volume 5, Number 3 / May, 2005

7. Madhava Nidhanam Ch 58 v 13-14

8. Vijay R Ramakrishnan, MD, Nonallergic Rhinitis http://emedicine.medscape.com/article/874171-overview

9. Richard Harvey, Saiful Alam Hannan, Lydia Badia, Glenis Scadding, Nasal saline irrigations for the symptoms of chronic rhinosinusitis  Otolaryngol Head Neck Surg. 2007 Oct;137(4):532-4.

10. G. Bachmann, Gerhard Hommel and Olaf Michel Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease European Archives of Oto-Rhino-Laryngology Volume 257, Number 10 / December, 2000

11. Peter-John Wormald, Tim Cain, Lyndell Oates et al, A Comparative Study of Three Methods of Nasal Irrigation The Laryngoscope Volume 114 Issue 12, Pages 2224 - 2227

12. Neha j Modha ,V.D. Shukla, MS Baghel Clinical study of Anurjata Janita Pratishaya (allergic rhinitis) and comparative assessment of nasya karma Ayur-vol 30 No 1 2009 47-54

13. BV DHARMENDRASINH, K SINGH, KN PANSARA, et al A clinical study of Vyoshadivati and Pathadi Taila Nasya on Apinasa-Atrophic Rhinitis Ayu vol 30 No 4 2009 475-47

14. Mark Sanders Inhalation therapy: an historical review Primary Care Respiratory Journal (2007) 16(2): 71-81

15. S. C. Jain; L. Rai; A. Valecha; U. K. Jha; S. O. D. Bhatnagar; K. Ram Effect of Yoga Training on Exercise Tolerance in Adolescents with Childhood Asthma   Journal of Asthma, Volume Issue 6 December 1991 , pages 437 - 442

16. Gupta I, Gupta V, Parihar A, Gupta S, Lüdtke R, Safayhi H, Ammon HP.Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study  Eur J Med Res. 1998 Nov 17;3(11):511-4

17. Mallaiah, GK | Thirupathi, K | Ganapaty, S | Rao, PT | Mohan, GK Phytochemical and AntimicrobialStudies on the Seeds of Mucuna Monosperma DC Current Trends in Biotechnology and Pharmacy. Vol. 2, no. 3, pp. 442-446. Jul 2008.

18. Syed Huq, http://emedicine.medscape.com/article/279960-overview

Image via Wikipedia

According to Vagbhat, "Prana vaha srotas' chief organs are hridaya (the heart) and mahasrotas (alimentary tract), it gets vitiated by dryness and depletion, suppression of thirst, hunger and other urges. Respiration being increased, decreased, difficult or interrupted, accompanied by pain or sound, are the chief signs of vitiation" (1). Nowadays the respiratory tract is seen as synonymous with the marga or pathway of pranavahasrotas, its root being in the left side of the heart, which receives oxygenated blood from the lungs.

Conditions of prana vaha srotas may occur in either the upper or respiratory tract and may be either easily curable, curable with difficulty, chronic incurable (yapya) or fatal.

Easily curable conditions of prana vaha srotas

Easily curable conditions of prana vaha Srotas include the common cold, hay fever, pharyngitis and laryngitis as well as many forms of influenza. Essentially these conditions fall into the category of abhaisaja sadhya or curable without medicine, since they are typically self-limiting viral infections which resolve within a few days to three weeks to allergies which dissipate when the allergen is absent. However, it is advisable to treat these conditions for two reasons; firstly, to help them resolve more quickly since they cause discomfort and inconvenience and secondly, to prevent complications. Easily curable conditions of prana vaha srotas may invade into deeper dhatus, as when rhinosinusitis localizes into asthi dhatu to create sinusitis proper. They may also move from the upper to the lower respiratory tract to cause conditions such as bronchitis. And they may progress through the stages of samprapti all the way to bheda, to create a dangerous condition such as a lung abscess.

Easily curable conditions of prana vaha srotas can often be managed with the use of home remedies, localized treatments and simple Ayurvedic medicines.  Provide your patients with a checklist of products they should have on hand and ways to use them.

Winter/Spring Checklist

(If you are pregnant, diabetic, have high blood pressure or are taking blood thinners, please consult your practitioner before using these remedies)

Nsal Rinse Cup: use for colds, sinus infections and allergies

Neem Soap: Use for hand washing especially during flu season

Natural mineral salt:

·      Use in tub to relieve coughs and colds

·      Use in neti pot for sinus conditions and allergies

·      Use with turmeric as gargle

·      Use in steam for coughs

Turmeric:

·      Use with hot water and salt as gargle for sore throats

·      Mix with honey and eat for allergies

·      Use with ginger and tulsi as a tea for coughs, colds and flus

Tulsi:  Use with ginger and turmeric as tea for coughs, colds and flus

Ginger:

·       Use with turmeric and tulsi as a tea for coughs, colds and flus

·      Use with baking soda in tub to promote sweating and relieve aches

Licorice: Use as tea for sore throat

Sitopaladi: Use for coughs, colds and flus, half a teaspoon three times daily.

Chyavanprash: Take to aid recovery after colds and flus; or as a preventative to support immunity

Conditions of Prana vaha srotas curable with difficulty

Many acute conditions of prana vaha srotas fall into the bhaisaja sadhya (curable with medicine) category. They can be cured completely but require the intervention of a practitioner to avoid serious complications or even the onset of life-threatening situations. One example is tonsillitis. Once the upper respiratory infection localizes in the tonsils, it may progress rapidly to the vyakti stage, with visibly enlarged and inflamed tonsils. The tonsils and tonsillar fauces (the passage from the mouth to the pharynx) may show either vesicles or yellow spots.  Typically vesicles indicate a viral tonsillitis, which usually resolves harmlessly, whereas a high fever, thickly coated tongue and yellow dots may point to a streptococcal throat infection (colloquially known as strep throat). Strep throat may have serious complications at the bheda level ranging from abscessed tonsils to septicemia, organ failure and death. Long-term complications of untreated streptococcal infections may include rheumatic fever (ama vata), rheumatic heart disease and renal disease (glomerulo-nephritis). Use a surgical mask when examining the throat with a tongue depressor. Tonsillitis should be referred to the primary care physician for a throat swab to determine whether there is a streptococcal infection. If so, antibiotics will be prescribed and Ayurvedic herbal therapies can be resumed after completion of the course of antibiotics. Ayurvedic herbs that are active against streptococcus include turmeric (2), ginger (3), and tulsi (4), rendering "Trinity Tea" -turmeric, tulsi and ginger--a good combination for strep throat as well as for viral tonsillitis. For added effectiveness, neem can also be used (5). Mahasudarshan will help clear Ama from the system, as will triphala. After the langhana phase of clearing toxins, Chyavanprash can be used to rejuvenate prana vaha srotas.

Another condition of prana vaha srotas classified as difficult to treat is pneumonia. Suspect pneumonia if a patient comes to you complaining of cough, fever, fatigue, malaise and difficulty breathing. Take careful notes of the respiratory rate. If it is elevated above the normal rate of 15 breaths per minute (in adults), pneumonia may be suspected and a medical referral made.  Atypical pneumonia or walking pneumonia may be more difficult to detect since its onset is insidious. I t should be suspected in a patient with malaise and a worsening non-productive cough.  In general, pneumonia will initially be managed with Western medical treatments such as antibiotics and may possibly even require a hospital stay to manage respiratory distress.     The work of the Ayurvedic practitioner will begin after the patient has been discharged and antibiotics have been discontinued.   

To give an example: Patient A is a sixty one year old pitta-kapha woman (V1 P3 K3) with a previous history of smoking, who was admitted to hospital with pneumonia following an overseas vacation where she was exposed to a lot of second hand smoke. She spent 24 hours in intensive care for respiratory distress and three additional days in hospital.  After discharge and cessation of antibiotics she sought out Ayurvedic support as she was still fatigued and coughing. She was given a formula that included punarnava as dosha pratyanika (against the dosha) for kapha, tulsi and pippali as vyadhi pratyanika (against the disease) for cough and cinnamon as an adjuvant for kindling prana vaha sroto-agni. She was placed on a kapha soothing and langhana regime but was encouraged to eat easily digestible soups, stews and kitcheris to soothe her provoked vata. After her cough resolved she was till feeling fatigued and drained and at this point was placed on a more rejuvenative regime for prana vaha srotas including twice daily Chyavanprash. As the weather was warming, her formula was changed to include shatavari as a strengthening and building herb as well as punarnava and licorice as lung strengtheners. She was also given an ojas drink which included raisins, well known as lung rejuvenatives.

Non-dairy Ojas drink

Ingredients

• 10 raw almonds
• 2 cups pure water
• 20 raisins
• 1 tsp ghee (rejuvenative)
• 1/32 tsp saffron (increases digestion and rejuvenative)
• 1/8 tsp ground cardamom (increases digestion)
• pinch of black pepper (helps control the Kapha)

Directions

1. Soak almonds in 1 cup of water overnight, and soak raisins in 1 cup of water either overnight or for several hours
2. In the morning, drain off the almond water and rub the skins off the almonds
3. In a blender, add the raisins AND their soaking water with the drained and peeled almonds
4. Add  ghee, saffron, cardamom, black pepper
5. Blend until smooth

Drink 3-4 times a week as directed.

Following this period of more intensive rejuvenation she took Lung Formula regularly for some months to continue to strengthen her lungs. 

As we have seen, Ayurvedic therapies and home remedies are valuable in easily curable upper respiratory conditions to help speed recovery and return to normal life as well as to prevent complications. In conditions like tonsillitis and pneumonia that are curable with difficulty, Ayurvedic management can be used following the recommended Western medical treatments, to help ensure optimal recovery. Following a serious lung infection requiring hospitalization, some months of treatment may be required to help the patient feel like themselves again. Next month, we will consider chronic conditions of prana vaha srotas and will also consider how to notice and refer potentially fatal respiratory conditions.

1. KR Srikantha Murthy, tr, Asthanga hridayam vol 1 pg 403 Chowkhamba Krishnadas Academy, Varanasi 2004 edition. (Excerpt from Asthanga Sangraha quoted in translator's notes)

2. Nadia Gul ; Talat Y. Mujahid ; Nayyar Jehan ; Samia Ahmad Studies on the Antibacterial Effect of Different Fractions of Curcuma longa Against Urinary Tract Infection Isolates Pakistan Journal of Biological Sciences 20047 12 p 2055-2060

3. Gur, S  Turgut-Balik, D  Gur, N Antimicrobial Activities and Some Fatty Acids of Turmeric, Ginger Root and Linseed Used in the Treatment of Infectious Diseases
World Journal of Agricultural Sciences [World J. Agric. Sci.]. Vol. 2, no. 4, pp. 439-442. 2006.

4. Reena Mukherjee^, PK Dash and G.C. Ram Immunotherapeutic potential of Ocimum sanctum (L) in bovine subclinical mastitis Research in Veterinary Science Volume 79, Issue 1, August 2005, Pages 37-43

5. Vanka, A : Tandon, S : Rao, S R : Udupa The effect of indigenous Neem (Adirachta indica) mouth wash on Streptococcus mutans and lactobacilli growth. Author: Indian-J-Dent-Res. 2001 Jul-Sep; 12(3): 133-44

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Image via Wikipedia

Many years ago, when living in India as a sadhvi (wandering renunciant) I met a Yogi who had taken a vow to wear white and eat only white food. While this Yogi was definitely pursuing sattva, he was omitting many important nutrients for the rakta dhatu. Iron, in particular, a key component of both hemoglobin and chlorophyll, imparts red or green colors to the foods that contain it. In this article we will look at a few important iron-rich foods and herbs and how they can be incorporated into daily routine to maintain healthy rakta.

First, it is important to note that iron in food occurs in two forms: heme iron and nonheme iron (1).  Heme iron is contained within a porphyrin ring structure and is found in hemoglobin (blood) and myoglobin (muscle). Hence heme iron occurs in meats, organ meats, fish and poultry. Nonheme iron may be either ferrous (Fe II) or ferric (Fe III) (1) and is found primarily in plant foods. Once iron is taken in as food, it must be hydrolysed from hemoglobin, myoglobin or the plant ligands that bind it (1). Iron absorption is extremely complex and absorption of ferric iron remains poorly understood to this day; however, well-functioning jatharagni including kledak kapha, pachak pitta ,prana vayu and samana vayu are vital for proper iron absorption.

Various food factors enhance iron absorption, including sugars, acids such as vitamin C  (ascorbic acid) and citric acid, as well as meat products. Acids chelate iron, rendering it more readily absorbed (1). Iron absorption is reduced by numerous lifestyle and dietary factors. Tannins in tea and coffee greatly reduce iron absorption (1) by acting as ligands binding the iron, so it is important that patients suffering from anemia do not drink tea or coffee after meals. Chocolate and other foods high in oxalic acid, such as spinach and chard, are well known to bind minerals--and iron is no exception. Phytates found in whole grains and legumes also bind iron, rendering it insoluble (1). And consumption of mineral supplements such as calcium and zinc after meals will result in interactions that will negatively affect absorption of both iron and the other minerals (1).

A typical vegetarian Ayurvedic diet, although iron-rich, is also high in tannins and phytins that reduce the absorption of iron. Pregnant women and those with low serum iron would be well-advised either to use husked dals (such as yellow rather than green mung dal or white rather than black urad) or to sprout legumes before making dals or kitcheris, as this practice greatly decreases the tannin content and so increases the levels of absorbable iron (2). Fermentation-- such as in a sourdough bread or idali--is another method to enhance bioavailability of iron in cereal-based foods (3). Cooking greens in an iron skillet has been found to enhance the biovailable iron content of greens. (4).

Since the liver is the root of rakta vaha srotas, it is not surprising to learn that the liver plays a key part in regulating iron absorption. When iron stores are adequate or excessive, the liver sectretes hepcidin, which both reduces absorption of dietary iron and sequesters the iron being recycled from dead erythrocytes (red blood cells) within the macrophages (1). Thus, through hepcidin secretion, the liver down-regulates iron absorption when iron stores are high and up-regulates it when stores are low.

So we need adequate iron intake and proper absorption and assimilation, but we also need proper transport to deliver the iron to the tissues. Iron in the body is bound to ferritin. Only oxidized ferrous iron can bind to ferritin. The copper- containing proteins hephaestin and ceruloplasmin oxidize iron, readying it for transport to the tissues (1). Hence copper deficiency can lead to impairment of iron delivery. Patients with iron deficiency anemia need a good copper intake via food sources such as leafy dark greens (kale, mustard, turnip, chard), molasses, sesame seeds, mushrooms, asparagus and summer squash (5).

Herbal supplementation plays a vital role in supporting healthy iron levels. An individual who is iron deficient is unlikely to make up all their depleted reserves from food alone, so supplementation is required. Bhringaraj (eclipta alba) is favored for treatment of anemia because it is an excellent iron source (6). Further, it is also a good copper source (7). Triphala is excellent for anemia since both haritaki and bibhitaki are very rich iron sources and are also rich in vitamin C, which aids iron absorption (6). The humble cumin seed rates as an excellent source of iron as well as zinc (8). In addition, cumin tea enhances the absorption of iron from food (9), creating a double benefit in using cumin tea as a remedy for anemia. Anise tea, mint tea and licorice tea similarly enhance iron absorption (9). Mint and licorice are also themselves excellent sources of iron and licorice is high in copper as well (10). Pippali is another good source of iron that also enhances iron absorption (11).

Understanding the food sources of iron, the factors that increase and decrease iron absorption, cooking methods to improve iron absorption within Ayurvedic and vegetarian diets, the importance of copper in iron utilization and the use of herbs and spice teas to supplement iron, we can create a well-reasoned treatment plan for iron deficiency.

1. Gropper, S et al, Advanced nutrition and human metabolism Wadsworth Cengage Learning (2008) ISBN 0495116572

  2. Rao, B. S. N. and Prabhavathi, T. (1982), Tannin content of foods commonly consumed in India and its influence on ionisable iron. Journal of the Science of Food and Agriculture, 33: 89-96. doi: 10.1002/jsfa.2740330116

3. Indumadhavi M. ; Agte V. Effect of fermentation on ionizable iron in cereal-pulse combinations Effect of fermentation on ionizable iron in cereal-pulse combinations 1992, vol. 27, n^o2, pp. 221-228 

4. Mamatha Kumari , Sheetal Gupta , A. Jyothi Lakshmi and Jamuna Prakash Iron bioavailability in green leafy vegetables cooked in different utensils Food Chemistry Volume 86, Issue 2, June 2004, Pages 217-222

5. http://www.whfoods.com/genpage.php?tname=nutrient&dbid=53 accessed 2 August 2011

6. Singh,v, Garg AN, Availability of essential trace elements in ayurvedic indian medicinal herbs using instrumental neutron activation analysis Applied radiation and Isotopes Volume 48, Issue 1, January 1997, Pages 97-101. N. GARG

7. Reddy SL, Fayazuddin Md et al Characterisation of bhringaraj and guduchi herb by ICP-MS analysis, optical absorption, infrared and EPR spectroscopic methods Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy Volume 71, Issue 1, 1 November 2008, Pages 31-38

8.  Muthamma Milan KS, Dholakia H, et al Enhancement of digestive enzymatic activity by cumin (Cuminum cyminum L.) and role of spent cumin as a bionutrient Food Chemistry 110 (2008) 678-683

9.  El-Shobaki FA, Saleh Z. A, Saleh N, The effect of some beverage extracts on intestinal iron absorption Chemistry and materials Science Volume 29, Number 4, 264-269, DOI: 10.1007/BF02023083

10. T.M. Ansari ; N. Ikram et al Essential Trace Metal (Zinc, Manganese, Copper and Iron) Levels in Plants of Medicinal Importance Journal of Biological Sciences 2004 4, 2 p95-99

11. Manoj, P., E.V. Soniya, N.S. Banerjee and P. Ravichandran Recent studies on well-known spice, Piper longum Linn. Natural Product Radiance 3, 4, 222--227 2004