by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Within Ayurveda, every aspect of life is governed by the interplay of the three doshas (body humors), vata, pitta, and kapha. Throughout the hours of the day and the seasons of the year, these doshas predominate in a rhythmic and cyclical manner. Similarly, throughout an individual's lifetime, each dosha has its time of predominance. Kapha governs childhood; pitta, maturity; and vata, old age. Thus, during the latter years of life, there is a tendency towards vata imbalances, such as memory loss, disorientation, paranoia, tremors, rigidity, cracked and quaking voice and stooped spine. The condition known to Western medicine as Alzheimer's disease constitutes, according to Ayurveda, a drastic and accelerated form of this vata provocation of old age.
In Alzheimer's disease, the vata is severely provoked in the majja dhatu, the tissue layer which includes the central nervous system and all other tissues which are contained within bone. The vata dries and thus degenerates the brain. In addition, the vata passes from the majja dhatu to the mano vaha srotas, or "mind-carrying channels," causing thought disorders such as paranoia and delusions as well as memory loss and confusion.
The causes of this severe vata provocation within majja dhatu and mano vaha srotas are both hereditary and acquired. Susceptible people are those who have a hereditary weakness of the majja dhatu. Once vata is provoked, it follows the line of least resistance, moving into the weakest tissue layer, in this case, the majja dhatu. Acquired causes are those which serve to aggravate the vata dosha sufficiently to bring about the onset of the disease in susceptible subjects. Unfortunately, our stressful, fast-paced, coffee-driven lifestyle provides abundant opportunities for such provocation. In addition, we are exposed to a number of environmental toxins which specifically weaken the majja dhatu, causing greatly increased susceptibility to Alzheimer's disease. Aluminum, pesticides, herbicides, agent orange, lead, and other toxins have a specific action in weakening the majja dhatu agni, the metabolic fire of the central nervous system.
One particularly important factor in the causation of Alzheimer's disease is the increased rate of change and increased population mobility. A person born before the first World War has witnessed changes more rapid than those experienced previously by many generations. Change provokes vata, as does movement. Relocation, movement of family members, and other such shifts present a much more vata-provoking situation than does the old village life, where people were born and died in the same house, surrounded by familiar family members.
Prevention, mitigation, and treatment of Alzheimer's disease requires that we create more stable, calming, vata-soothing lifestyles for ourselves and our elders. Regular routines, calm family mealtimes, daily rituals, and a slower pace of life will help to reduce the vata-provoking effects of our exponentially increasing rate of technological change. The old tribal or extended family systems must be replaced by stable and committed support networks. This is particularly important since, according to Ayurveda, a person with Alzheimer's disease is best nursed at home whenever possible. Relocation to the unfamiliar environment of a nursing home is drastically vata-provoking. However, homecare cannot realistically be provided by a single care giver, and is possible only when a solid and reliable support network is available.
From an Ayurvedic standpoint, it is recommended that health departments and health insurance companies focus on providing in-home services for patients with Alzheimer's disease, rather than nursing home care, since patients have a much greater chance of retaining a higher level of functioning when as little change as possible is made in their way of life.
General and Specific
General vata pacifying measures should be introduced as soon as the onset of symptoms appears, or, better still, as soon as susceptibility is suspected. These include daily oil massage (or self massage) before taking a warm shower; taking a vata-soothing diet; and drinking, at bedtime, a cup of warm milk with a teaspoon of ashwaganda (Withania somnifera) and a half a teaspoon of ghee (clarified butter). If the cholesterol level is high, the ghee can be omitted, and skim milk can be used.
When older people live alone, they may consume an inadequate diet consisting of, for example, bread and coffee or frozen dinners. As much as possible, caffeine, frozen foods, and dry foods should be eliminated from the diet to prevent the development of vata provocation. In severe or advanced cases of Alzheimer's disease, a khichari diet could be given. This consists of Basmati rice, mung dal, well-cooked vegetables, and mild digestive spices such as cumin, coriander, fennel, turmeric, and ginger. At bedtime, the soles of the feet should be massaged with warm sesame oil.
In younger patients and in milder or earlier stages of the disease, cleansing practices may be indicated. These are svedan (sweating), basti (Ayurvedic enema), and nasya (nasal medication). Sweating is applied after oiling with sesame oil. A simple form of sweat that can be done at home consists of taking a bath at a comfortable temperature with one-third of a cup of dry ginger powder and one third cup baking soda in the tub. The ginger will promote sweating, so that after taking the tub, and remaining in a warm place, sweating should occur.
Recommended basti recipes are as follows:
Madhu tail basti
1 1/2 pint pure water
1 oz. anise seeds
1 oz. ashwaganda (Withania somnifera)
1 oz. brahmi (Bacopa monniera)
Simmer, with lid on, for 20 minutes, then add:
2 oz honey
2 oz sesame oil
1 t salt
Strain and cool to slightly above blood heat and use as enema.
Vata-soothing basti (indicated in severe vata provocation; contraindicated in pitta provocation)
Mustard seed decoction
Soured rice gruel
Use as an enema.
In the case of unavailability of certain ingredients (e.g., organic cow's urine), mustard seed decoction alone may be used with good effect.
3-4 oz warm sesame oil, retained if possible for about half an hour.
Basti treatment should not be used with very old or very frail people, although a 2- oz oil basti may still be used if constipation is a significant issue.
Indicated nasyas for Alzheimer's disease:
Brahmi (Bacopa monniera), ghee nasya — best if there is any pitta provocation
Vacha oil nasya (Acorus calamus) in sesame oil — best for severe vata provocation without any concurrent pitta provocation.
Nasya should not be used in very old, very frail or severely confused subjects, but only for those who are capable of understanding how to use the nasya correctly.
Specific treatment for Alzheimer's disease consists of the use of herbs which act upon the majja dhatu and mano vaha srotas. Chiefly, these are brahmi, vacha, jatamansi (Nardostachys jatamansi; ssp: grandiflorum), and Akar karabha (Anacyclus pyrethrum). Generally, the most useful remedy for Alzheimer's disease is sarasvati churna, which is highly effective in presenting and enhancing memory and intellect. Sarasvati churna can be taken in doses of one quarter to one-half teaspoon twice daily after meals. In severe cases, it can be taken three times daily. In cases where there is a bleeding disorder, ulcer, or bleeding hemorrhoids, brahmi and jatamansi may be used, but vacha should be omitted completely, since it is contraindicated in bleeding disorder.
Akar karabha, which contains the active ingredient anacycline, is extremely important in the treatment of Alzheimer's disease. Unfortunately, it is currently unavailable outside India. It may be used as a medicated milk:
1/2 teaspoon Akar karabha
1/2 teaspoon Brahmi
I cup milk
Boil together and drink at bedtime. It may also be used as a tea, using 1/2 teaspoon Akar karabha and 1/2 teaspoon shankapushpi (Evolvulus alsinoides). Steep 10 minutes in I cup boiling water and drink 2-3 times daily.
Despite the great usefulness of these general and specific measures in the treatment of Alzheimer's disease, regularity and stability remain the most important factors in treating this condition. Meals and remedies must be given at regular times, treatments such as oil massage must be administered according to a fixed schedule, whilst familiar faces and familiar surroundings are also of great importance. Any conditions that are haphazard, irregular or unexpected will serve only to provoke the vata still more. To be useful at all, Ayurvedic treatment of this condition must be both regular and prolonged.
Peer-reviewed article first published in the Protocol Journal of Botanical Medicine.
Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.