Chikitsa (Treatment)

The classical management of tamaka svasa is the management of kapha dosha. Proper management requires an appreciation of the patients agni, ojas, and whether or not ama is present. Purification therapy should be performed in accordance with the patients strength. Following proper preparation, strong patients may undergo vamana, virechana, and niruha basti as well as nasya therapies. Agni can be improved with the use of dipana (pungent) herbs. These herbs allieviate kledaka kapha at the origin of the condition. Many pungent herbs also dry up excess mucous secretions in the pranavaha srota (respiratory system). Espeically effective are cloves and black pepper.

Weak patients require either tonification or palliation therapies. Tonification is required for the weakest patients whose ojas is depleted or where there is significant weight loss. Patients with moderate strength may undergo palliation therapy. All patients benefit by following the principles of samsarjana karma following any kind of purification.

Yogic Techniques for Managing the Breath
The practice of pranayama purifies the nadi. Depending upon the type of pranayama performed, the flow of pranic energy may be increased or decreased in either one or more of the major nadi: ida, pingala, or sushumna nadi. While Ayurveda understands the role of pranayama in regards to prana, tejas, and ojas and their corresponding effects on the mind, relaxation along with conscious breathing of almost any type will improve the functioning of the respiratory system. Simple diaphragmatic breathing increases the volume of air moving through the lungs on inhalation and exhalation. Experience with pranayama and meditation enables patients to take some control over autonomic function, offering the patient an opportunity to relax and dilate the bronchial passages at the onset of an asthmatic episode. This may also benefit patients with additional breathing challenges such as chronic bronchitis.

Common Herbs For Easing the Breath
Herbs that enhance the flow of breath come in two major categories; expectorants and bronchodilators. Expectorants soften or liquify accumulated mucous making it easier to expel. Bronchodilators expand the air passages allowing greater air flow. Bronchidilators are essential to the management of asthma and chronic bronchitis, which obstruct normal flow. Expectorants are beneficial for reducing mucous associated with colds and chronic bronchitis.

An important Indian herb in the management of kapha type respiratory complaints is Vasa (Adhatoda Vasica). Vasa is an important bronchodilator and expectorant, and has cool virya. Having a bitter and astringent rasa it is both rough and dry. These qualities make it best for pacifying pitta and kapha.

An additional herb of importance for those with vata type respiratory complaints is Bala (Sida Cordifolia). Bala is a respiratory tonic with a mild bronchodilating action. Bala has a sweet rasa, cool virya, and sweet vipaka. It has both oily and heavy qualities most suitable to vata. Bala has a multitude of additional actions making it one of the best rasayanas for people with a vata nature.

An important Chinese herb is Ma Huang (Ephedra Sinica, Ephedra Vulgaris). Ephedra is a strong bronchidilator and stimulant which dries up mucous secretions. It has a pungent, bitter and astringent rasa, warm virya, and pungent vikpaka. In additional to dilating the bronchial passageways it is a potent vasoconstrictor and cardiac stimulant. Hence, care must be used in its administration to patients at risk of cardiovascular disease and stroke. Ma Huang is best for those with kapha type respiratory disorders.

An important American herb is Mullein (Verbascum Thapu). Mullein is an effective astringent, expectorant and anti-inflammatory reducing the intensity of all mucousy conditions and respiratory allergies. With a bitter and astringent rasa, cool virya, and pungent vipaka, it is best for conditions of pitta and kapha nature. However, with a secondary sedative action, it will only aggrevate vata with long term use.

An important herb used in many parts of the world for kapha type respiratory conditions is Elecampane (Inula Helinum). Considered one of the best herbs for long term use, Elecampane is warming and dry and is an effective expectorant. Elecampane has the unique effect of strengthing respiratory tissue making them less susceptible to irritants of all kinds.

The common Indian spice, Long Pepper (Piper longum) is also important. With a pungent rasa, warm virya, and pungent vipaka, it is best for pacifying the kapha dosha. It also has a light, sharp, and surprisingly oily nature. Although best for kapha, it is also beneficial for pacifying vata. Long pepper is commonly used for preventing recurrent attacks of asthma. For this purpose, one peppercorn is taken on the first day of treatment. This is then followed each day for seven days by the administration of one additional peppercorn. (One peppercorn fills about two 00’ capsuls). Hence, by day seven, the patient is taking 14 capsules of peppercorn. The herbs are taken with hot water and the dose can be divided up during the day. This program continues for 6 more days as the patient reduces the dose by one peppercorn each day. Black pepper (Piper Nigrum) is less effective.

There are many additional beneficial herbs and spices to be considered by the practitioner. These include amalaki, ashwanganda, clove, cardamom and licorice.

Purva Rupa (Prodromal Symptoms)

Common purva rupa of svasa include chest, heart and flank pain, headaches, and gas.

Nidana (etiology) and Rupa (symptoms):

The presentation of Tamaka svasa (asthma) varies according to the doshic dominance of the condition. Vata type asthma is precipitated by physical or emotional stress along with a diet that is light, dry and cold. Vata type asthma presents with a dry cough following the asthmatic episode. There may also be accompanying weight loss which can be quite profound. Additional signs of vata vitiation may be present in any system of the body.

Kapha type asthma is the most common. The condition is precipitated by an excess of cold, heavy, moist foods, and over-eating. Attacks present with a moist, productive cough following an asthmatic episode. Mucous appears cloudy and white in color. Patients may be overweight and additional signs of kapha vitiation may present in any system of the body.

Pitta vitation may combine with either a vata or kapha type asthma. Attacks are precipitated by exposure to allergens or microbes. Inflammation of the bronchial passages reduces airway patency. Coughing following an asthmatic attack may produce yellow or green mucous. Additional signs of pitta vitation may be present in any system of the body.

Ayurveda and the Understanding and Management of Respiratory Disease

Introduction

Disorders of the breath affect almost every human being at some time in their lifetime. Whether due to a common cold resulting in bronchitis or something more serious such as asthma or emphysema, the ability of people to simply breath is not always as easy as it seems.

Ayurveda refers to breathing disorders (dyspnea) as “swasa”. There are five basic types. They are characterized by the type of breath they create, rather than the doshic disturbances that create them. The five types are called: ksudra, tamaka, chinna, urdhva and mahan.

Descriptions

Ksudra svasa is the name for heavy breathing such as might occur after exercise. However, the condition can also arise from anything that taxes the respiratory system resulting in increased respiration, including heavy eating.

Tamaka svasa is the name for forceful respiration that leads to great distress. The condition is due primarily to kapha doshs vitiation and results in the eyes opening wide and gazing in an upward direction during an attack. The condition term is used synonymously with bronchial asthma. Ayurvedic folklore attributes Tamaka svasa to past life karma resulting from the indiscriminant killing of animals.

Chinna svasa is the name for interrupted breathing such as that which is seen in the terminal stages of illness. The term is used synonymously with “Cheyne – Stokes”, respiration which occurs somewhat near the time of death. When Chinna svasa occurs the eyes gaze downward and one eye often appears red. Chinna svasa often preceeds the onset of coma.

Urdhva svasa is the name for prolonged expiration and an inability to inhale. Like tamaka svasa, patients eyes gaze upward and the eye balls may even roll back. Often times the mouth is covered with mucous. It should not be surprising that the patient is described as being in great fear. Urdhva svasa does not directly correlate with any one specific syndrome noted in the West.

Mahan svasa means “The Great Dyspnea” as this is the most serious of all breath disorders. The condition occurs shortly before death. The breath is described as being similar to a bull in heat. There is a sound which accompanies the breath which is high pitched. Patients with mahan svasa are usually delusional, there urine and feces are often obstructed, and death is impending.

Ayurveda and Massage

Ayurveda, the ancient science of healing from India has always utilized massage as a part of its regimens for healing. From an Ayurvedic perspective, different forms of massage are useful to different people. The form of massage utilized is based upon a person’s constitution and imbalance.

One’s constitution is the inborn or inherent balance of energies in his or her body and mind. In Ayurveda these are quantified in the understanding of the Doshas. There are three Doshas known as Vata, Pitta and Kapha. These three energies control the formation and functions of the body on the physical and emotional levels. In harmony the body is healthy but as the doshas move out of harmony the body expresses itself in the form of disease. Each individual has his/her own unique balance of these energies. As a result each individual expresses himself differently in the world. Each person has a different type of body frame, degree of oiliness in the skin, sensitivity to pain and many more characteristics that can be understood by knowing a person’s unique constitution. This is why Ayurveda sees all people as individuals recognizing that one person’s elixirs is another person’s poison.

As an example, people of Kapha nature have skin which is naturally oily, soft, and supple. They also tend toward being heavy, feeling cool and moving slowly. If these individuals use cooling oils like coconut, the cool and heavy quality of the oil will sedate them even more and may cause oozing skin conditions. On the other hand warm, lighter oils like safflower can be added to another warm oil like almond to make a much more balancing massage oil for Kapha individuals. In addition other warm, stimulating essential oils could be added. While other people of Kapha nature can do well with warm, stimulating oils, they also thrive with dry massage using powders.

In addition to the science of choosing or making oils for massage, Ayurveda recommends different forms of massage for different people. These principles can help a person understand why some people are drawn to polarity when others are drawn to deep tissue therapy and Rolfing. If a person is receiving the wrong form of massage for them, it can lead to greater imbalance physically and emotionally. Following our example above, people of Kapha nature who tend to be stocky, muscular, carry a little more weight and tend toward lethargy benefit from deep tissue massage which is more stimulating while gentle massage strokes like effleurage or polarity can add to their already sedate nature.

Massage is also used in the Ayurvedic therapy known as Pancha Karma. This is a therapy, which aids in detoxification. While massage with appropriate oils is only one part of this therapy, the knowledge of its role helps a person understand the effects of massage on their individual body type. During this form of massage called abyhanga, two practitioners participate in a rhythmic massage, which in conjunction with the oils used, liquefies toxins in the body so they can be easily expelled through other processes.

Finally, another area Ayurveda includes which is related to massage is the art of “Marma Point Therapy.” Marmas are special energetic points in the body with relationships to organ function, metabolism and emotional states. They bare similarities to Acupuncture points and many scholars hold to the view that Ayurveda is the foundation of Chinese medicine. Marma points are typically stimulated by hand pressure, massed with special oils or stimulated with medicated steam.

Dr. Marc Halpern is the founder and director of the California College of Ayurveda located in Nevada City, California. He is a nationally known lecturer on the subjects of Ayurveda and Yoga and has written numerous articles in newspapers and magazines.

Traditional Cancer Therapy

Traditional cancer therapies are based on two simple principles. Remove the cancerous cells when possible and destroy any cells that remain. To accomplish these goals, surgery is utilized when a malignant cancer is found that has not metastasized. Surgery may also be performed if there is metastasis if the removal of a tumor will increase the quality of life or if all surrounding lymph nodes are easily accessible.

Either in addition to or as an alternative to surgery, radiation therapies are employed. These therapies utilize gamma, neutron, proton, and electron radiation to destroy localized tumors. For some cancers such as Prostatic cancer and certain brain cancers, a radioactive seed may be implanted into the tumor to destroy the tumor from the inside out. Radiation may also be employed as an isotope injected into the blood if the cancer has a tendency to pick up the isotopes from the blood stream. This is common to thyroid cancers. While radiation damages or kills malignant cells it also causes damage to near by healthy cells.

Chemotherapy is the use of drugs to destroy cancer cells. Drugs are non specific and are spread throughout the entire body. These drugs are highly toxic and destroy both healthy and cancerous cells. As crude as it sounds, the success is dependant upon the ability of the drug to kill the cancerous cells before it kills the patient. Common side effects of chemotherapy include vomiting, mouth sores, hair loss and loss of appetite.

For some cancers, endocrine therapies are somewhat effective. Endocrine therapies involve altering levels of hormones in the body. In the management of prostate cancer, an orchietomy (removal of the testes) may be performed to decrease testosterone levels. In addition, estrogen may be administered. By decreasing testosterone and increasing estrogen the growth of prostatic cancer cells is slowed. Other cancers such as breast cancer respond positively to lower estrogen levels. A drug called Tamoxofin is sometimes used as a part of the treatment for breast cancer. It works by lowering estrogen levels. In addition, the ovaries are often removed to further reduce estrogen levels.

Biological Therapies are employed in the treatment of certain blood and lymph cancers. Interferon and Interleukins are anti-viral drugs. These slow down the progression of leukemia and lymphomas and in some cases leads to cure.

The Western approach to managing Cancer brings both opportunities for cure as well as great challenges. With early detection, prior to metastasis, Western Medicine can often offer patients excellent results. However, the long term prognosis for cancers which have metastasized is much less optimistic. In part two of this series, the Ayurvedic knowledge and approach to cancer will be explored as well as important nutritional and herbal therapies.

Ayurveda - Principles & Practice

Ayurveda which has been evolved around 600 BC, apart from treating ailments concentrated more in its prevention. This was followed by the Aryans & Dravidians who were inhabiting India and has been practiced ever since. In the 21st century, Ayurveda has become an indispensable branch of medicine due to its naturalistic approach, that depends on the diagnosis of ones physical base ie Vata, pitta and kabha, and to maintain a right balance.

One of the important principle of Ayurveda treatment is that , treatment is given not only to the ailments or the affected part, but to the person as a whole. This creates an enviornment for purifying your body naturally, which eliminates all toxic imbalances from your body, enabling you to regain natural resistance from diseases and attain good health.

Kerala's equable climate, natural abundance of forests, which caters to the demand for herbs and medicinal plants, and the cool monsoon season (June-November) are best suited for Ayurveda's curative and restorative packages. In fact, today, Kerala is the only State in India which practices this system of medicine with absolute dedication.

Every object-plant, animal or human - according to the Panchabhootha Philosophy (5 elements of philosophy), is constituted of Vata, Pitta, Kapha.

The concentration of these elements vary in each individual and therefore the time, place, duration and kind of treatment required to restore the balance also needs to change. This is why Ayurveda have a separate system of diagnosis and treatment for each patient. And a season for undergoing Ayurvedic programmes - the monsoon. The atmosphere remains dust-free and cool, opening the pores of the body to the maximum, making it most receptive to herbal oils and therapy.

Rejuvenative Programmes

The following are the major rejuvenational therapies practacied in Ayurveda.

Rasayana chikitsa

Tones up the skin and rejuvenates and strengthens all the tissues so as to achieve ideal health and longevity. Increases Ojas (primary vitality) and improves Sattva (mental clarity) and thereby increases the resistance of the body. Includes head and face creams, body massage with herbal oil or powder by hand and foot intake of rejuvenative medicines and medicated steam bath. Herbal baths are also used.

Kayakalpa Chikitsa

Prime treatment for retarding the ageing process, arresting the degeneration of body cells and immunization of the system. Includes intake of Rasayana (special Ayurvedic medicines and diet) and comprehensive body care programmes. Most effective for either sex if undertaken before the age of 50.

Sweda Karma

Medicine steam baths eliminate impurities from the body, improve the tone and complexion of the skin, reduce fat and are recommended for certain rheumatic diseases, particularly for pain. Precious herbs and herbal leaves are boiled and the steam is passed over the entire body for 10 to 20 minutes daily.

Hand massage with herbal oils or herbal powder improves blood circulation and tones up the muscles.

Meditation and Yoga

Mental and physical exercises meant to isolate the ego from the body and mind-designed to home your concentration, improve health and help attain peace of mind through 8 stages of training.

Disciplined behaviour yama Self purification niyama Bodily postures such as the lotus position asana.

Control of breathing Pranayama Control of the senses Pratyahara, fixing of the mind on a chosen object dharsana. Meditation dhyana and Samadhi - a state of being where you experience absolute tranquility and well being.

Beauty care

Herbal face pack, herbal oil massage, intake of herbal tea etc. improves complexion and beautifulness of the body.

Body Slimming

Medicated herbal powder and medicated herbal oil massages, and Ayurvedic diet of herbal juices etc. are part of the programme.

Overal Fitness

Panchakarma Treatment

A five fold treatment for mental and physical well being tunes the body, organs, mind, breath, nerves and purifies the blood.

Therapeutic Programmes

Treatment for chronic head-aches, insomnia, mental tension and cases of hysteria, hallucination and insanity.

Dhara: Herbal oils, medicated milk or buttermilk and decoctions are poured on the forehead/whole body in a special manner.

Variations include Oorhwanga Dhara (good for diseases of the eyes, ears and skin). Takra Dhara (for those suffering from memory loss, severe headache or insanity) and Sarvanga Dhara (for both head and body).

Treatment to alleviate osteoarthritis, leukemia etc.

Snehapanam: Medicated ghee is given internally in a gradually increased quality of specific periods.

Treatment for spondilosis, rheumatic diseases like arthritis, paralysis, hemiplegia, nervous weakness and nervous disorders.

Pizhichil: Lukewarm herbal oil is applied with fresh linen all over the body by trained masseurs in a rhythmic manner for a period of 1 to 11/2 hours daily for 7 to 21 days.

Treatment for diseases like hemiplegia, paralysis, obsety and certain rheumatic ailments.

Udvarthanam: Therapeutic massage with herbal powders.

Treatment for musculoskeletal ailments due to trauma or accidents.

Marma Chiksta: Treatment that works on the extremely sensitive vital points of the body (the 107 marmas).

Treatment for nasal ailments:

Nasyam: Inhalation of medicated herbal preparations, decoction oils, ghee etx. to eliminate the morbid factors from the head and neck area.

Treatment for ear ailments

Karnapooranam: Medicated oils are applied to the ear for 5 to 10 minutes daily to clean as well as treat specific ailments.

Preventing cataract and strengthening vision:

Tharpanam: A treatment for the eyes effective in preventing cataract and strengthening the optic nerve.

Treatment for wasting of muscles, all types or rheumatism, sports injuries, pain in the joints, emaciation of the body or parts of the body and certain kinds of skin diseases.

Navarakizhi: The whole body is made to perspire by the external application of medicated rice packs in the form of blouses tied in muslin bags.

Treatment for dryness of nostrils, mouth and throat, severe headaches, facial paralysis and burning sensation in the head.

Sirovasti: Lukewarm herbal oils are poured into a leather cap fitted on the head for specific durations as per physician's recommendation.

The Tridoshas

The Tridoshas (tri meaning three and doshas being the basic physical energies) are the primary and essential factors of the human body that govern our entire physical structure and function. Derived from the Panchmahabhutas, each dosha – which like the elements cannot be detected with our senses but their qualities can be – is a combination of any two of the five bhutas with the predominance of one. Called Vata, Pitta and Kapha in Sanskrit, these three are responsible for all the physiological and psychological processes within the body and mind – dynamic forces that determine growth and decay. Every physical characteristic, mental capacity and the emotional tendency of a human being can therefore be explained in terms of the tridoshas.

Most of the physical phenomena ascribed to the nervous system by modern physiology for example, can be identified with Vata. Just as the entire chemical process operating in the human body can be attributed to Pitta, including enzymes, hormones and the complete nutritional system. And the activities of the skeletal and the anabolic system, actually the entire physical volume of an organism, can be considered as Kapha.

Vata (Air and Space)	Pitta (Fire and Water)	Kapha (Water and Earth)
Light	Light	Heavy
Cold	Hot	Cold
Dry	Oily	Oily
Rough	Sharp	Slow
Subtle	Liquid	Slimy
Mobile	Sour	Dense
Clear	Pungent	Soft
Dispersing
Erratic
Astringent

Each dosha thus shares a quality with another (although there remain slight differences in the nature of shared quality), the third having just the opposite quality. Also, each has an inherent ability to regulate and balance itself, coming from the antagonistic qualities that arise from the doshas constituent elements.

When the doshas are in balance i.e. in a state of equilibrium, we remain healthy. As Charaka, the great ayurvedic sage, explained: "Vata, pitta and kapha maintain the integrity of the living human organism in their normal state and combine so as to make the man a complete being with his indriyas (sense organs) possessed of strength, good complexion and assured of longevity." It is only when that there is imbalance within the three that disease is caused. And since it is the strongest dosha in the constitution that usually has the greatest tendency to increase, one is most susceptible to illnesses associated with an increase of the same.

It is important to realise that these three are forces and not substances. Kapha is not mucus; it is the force that causes mucus to arise. Similarly pitta is not bile; but that which causes bile to be produced. And they are called doshas – literally meaning `faults’ or `out of whack’- as they indicate the fault lines along which the system can become imbalanced.

It is equally important to understand that the three doshas within any person keep changing constantly, due to the doshic qualities of specific lifestyle and environment, such as time and season. And that these three are not separate energies but different aspects of the same energy, present together in an infinite variety of combinations, wherein their qualities overlap and interrelate.

Ayurveda however considers only three types of constitution – in monotypes just one dosha predominates, in duo types two have near similar strength, and in the very rarely found third type all three are equally powerful. Within this broad classification, there are in the first category various sub-types that are listed below for easier reference.