A Study-Guide



A Study-Guide

of

Ten Clinical Consultations

in

Buddhist Ayurvedic Medicine

(For Case Study and Reference)

by

Brett S. Cantrell, Sr., A.A. (Sociology)

(Tib., Karma Sherab Zangpo)

Candidate for:

Diploma, C.A.T. (Clinical Ayurvedic Therapist)

and Ordination, Buddhist Pastoral Counselor (Upasaka)

Ven. Losang Jinpa, D.Ayur., M.A.H., Ph.D., Director

Ayurveda Healing Arts Institute

Medicine Buddha Healing Center

Berkeley, California

February 2007

Transference and Dedication of Merit and Blessings

By this merit, may all attain Enlightenment.

May the enemy of wrong doing be defeated,

From the stormy waves of old age, sickness and death.

May all beings be liberated.

At this very moment, for the peoples and nations of the Earth

May not even the names disease, famine, war, and suffering be heard;

But rather may their moral conduct, merit, wealth, and prosperity increase

And may supreme good fortune and well being always arise for them.

Just as the hero Manjushri Great Wisdom Bodhisattva gained Enlightenment

And Samantrabhadra Perfection of Conduct Bodhisattva exactly the same,

I dedicate this merit entirely (to the welfare of all)

So that I may train myself to follow Them.

Precious best mind Bodhicitta,

May it be born in those in whom it is not;

May it flourish in those whom it has arisen;

May it grow and grow, on and on.

May all of us who share a connection with the Medicine Buddha and Dhanvantari

Be inspired by illumination.

May the blessings of health and ease

Shower like fragrant blossoms from the Medicine Paradise.

May the Dharma increase.

May all beings be happy and realize the Great Perfection.

Introduction

While studying Ayurveda, particularly as a beginning student, I am constantly looking for ways to test my knowledge, to learn by the “work smarter, not harder” methodology. So, over time, I resorted to a variety of methods. . . reading, flash cards, pounding terms into my head by rote, and yes, even subliminal messages that would flash in milliseconds on my computer screen. But there was one item that I kept wishing for. I wished there was a way to test my knowledge, clinically. How would I learn to apply the information that was now flooding my head? How would I recommend herbs and changes in lifestyle for a patient? And what recommendations would I make, should I make, in a variety of conditions?

It is to this end that I’ve developed this study guide.

These cases are from recorded sessions of my teacher’s, Ven. Losang Jinpa’s, clinical consultations. I owe a deep debt of gratitude for his kindness, his selfless and free giving in the promotion of Ayurveda and the Dharma.

I’ve chosen to present these case studies in a western-medicine SOAP note style. During my 11 years of service as a US Navy Hospital Corpsman, I had become quite accustomed to presenting medical information in this style. For those of you who aren’t familiar with it, it stands for Subjective, Objective, Assessment, and Prescription. The Subjective section is basically what the patient tells you, their medical history, the nature of the illness as they experience it. The Objective portion includes notes of the physical examination, the observable condition of the patient. The Assessment includes the overall assessment, or diagnosis, and possibly several diagnoses for consideration. And the Prescription section is just that, the prescription, of how to treat the illness presented.

Each case study begins with the presentation of the Subjective (what the patient says) and the Objective (what is observed during the exam) of the session. I’ve then offered a few questions to spark your thinking of how you might treat each case. The actual Assessment and Prescription sections are included on a following page(s) so that you can more easily test your knowledge before turning to this section to see how Ven. Losang Jinpa analyzed and offered treatment. And finally for each consultation I’ve added my response and any additional information or explanatory material which I thought might be helpful.

Sometimes during an actual consultation, in the give and take of conversation, certain points and explanations may be dropped or left unfinished. I’ve endeavored to complete information and round-out the guidelines of chikitsa (procedures and protocols) to the best of my Ayurvedic knowledge. My additional comments and questions will be found in bold lettering in the case notes themselves, and then in the Questions and Response sections of each consultation.

While there is certainly the acknowledgement that there is more than one way to skin a cat (I use the proverbial saying, not that I wish harm on any sentient being,) there will, I am sure, be variances from the Ayurvedic treatments and recommendations presented here, either Ven. Losang Jinpa’s or mine. There are no right and wrong answers, but in answering the questions and reasoning your treatment, one should be able to clearly, logically, and with proper documentation be able to back up your treatment recommendations. When considering the many avenues of treatment, please bear in mind what Pandit Dr. David Frawley and Dr. Vasant Lad say in their book, The Yoga of Herbs, that “Remedies produced with love, even when not ‘therapeutically sound’, may work wonders. Love is the true healing force; herbs and other means are merely vehicles” (Frawley & Lad, 2001, p. 16).

The object here is to help train and enable the study of the up-and-coming clinician, using basic principles and practices of Ayurvedic Chikitsa. I’ve presumed a basic knowledge of Ayurveda and basic concepts such as Doshas. I’ve also presumed a basic medical knowledge of western allopathic medicine and terminology. The scope of this paper is not to teach the fundamental concepts and terminology of these systems. There are plenty of fine introductory textbooks on both Ayurvedic and Allopathic Medicine.

You’ll find each consult listed by number, as well as the filename of the original audio recording (.mp3, .wma, or .wav file) for your reference.

Again, my special thanks to my teacher and Dharma guide.

May all realize Enlightenment,

Brett

Tadyata, Om Bhaisajye Bhaisajye, Bhaisajya, Samungate, Svaha. Om.

"More important than how many deities you visualize is to understand what you are doing. And most important is to understand that by visualizing yourself as the Medicine Buddha you are not pretending to be something that you are not...." -Thrangu Rinpoche

"If one meditates on the Medicine Buddha, one will eventually attain enlightenment, but in the meantime one will experience an increase in healing powers both for oneself and others and a decrease in physical and mental illness and suffering." -Lama Tashi Namgyal

Consult 1

Cons_Acid_Edema_1.wma

Subjective and Objective Examination

Subjective: Patient has never had her body constitution (dosha) determined before.

States she has a problem with obesity, and additionally, water retention and edema.

She has plantar fasciitis or heel spurs.

Patient has a history of acid reflux, though it is currently not as bad as it has been in the past.

She complains that her hands go numb if she holds something, such as a book or steering wheel for a period of time.

Her blood pressure is borderline high at 180/60 or 70.

She has nightmares where she is being chased in her dreams. She rests on her back before sleep then turns onto her stomach to sleep.

She says that she takes in too much caffeine, consuming usually 2 cups of coffee in the morning and 1 cup after lunch, all with cream. She tends to like dairy products and salt.

She picks at spots on her skin, until they bleed.

When menstruating, the patient had menorrhagia or heavy bleeding, in her later years. Her first onset of menstruation was at age 15.

Birthdate: 4/20/49, in Boston, at 9:34 AM. She was a medium sized child as far as weight and height. Her weight, when she was about 25, was approximately 130 lbs.

The patient is usually happy, but has had depression in the past. She states that she learns fast and remembers.

Patient awakens to urinate during the night.

Objective: The tongue is reddish/pinkish – having more the appearance of a Kapha tongue. The tongue appears good with only a small amount of whitish coating.

She has a line on her earlobe, referred to in Chinese Medicine as the “Line of Coronary Heart Disease.” Please note: although this line may be present it is not indicative of an existing condition. It merely indicates the possibility that such a condition may exist now or in the future.

Patient appears stable and slow at 5’0” and 190 lbs. Seems to have Kapha qualities naturally.

Pulse is slow and Kapha.

She is missing all the moons on her fingernails, except on her thumbs.

Consult 1

Cons_Acid_Edema_1.wma

Questions

What would you consider this person’s Dosha to be? What are the indications for your opinion?

What would you consider to be the primary illness requiring treatment? What is the root cause of this illness? Remember to look at the root cause not just the symptoms.

What would you consider to be the secondary illness requiring treatment?

Describe the significance of whitish coating on the tongue. What is it and indicator of?

Describe the significance of visible moons on the fingernails. What is this indicative of?

What lifestyle changes would you suggest?

What dietary changes would you suggest?

What herbal recommendations would you make?

Determine an herbal formula, by parts, for this patient.

Consult 1

Cons_Acid_Edema_1.wma

Assessment and Prescription

Assessment:

Patient is Kapha primary, but most likely Kapha-Pitta. In traditional Ayurvedic medicine, there is no difference made in Kapha-Pitta/Pitta-Kapha. They are both the same. In the United States and the West, where we are concerned with measurement and percentages, a differentiation is now made with Kapha being slightly higher and more important in the label Kapha-Pitta, and vice-versa for Pitta-Kapha.

Of importance in all cases, the clinician should be aware of what time of day the pain occurs. The time of day and its relation to the doshas, Vata, Pitta, or Kapha time, can be indicative of the type and orientation of the pain.

Vata time is from 2:00 AM to 6:00 AM and then again from 2:00 PM to 6:00 PM. Pitta time is from 10:00 AM to 2:00 PM and from 10:00 PM to 2:00 AM. Kapha time is from 6:00 AM to 10:00 AM and from 6:00 PM to 10:00 PM.

Patient’s time of birth is Kapha time in Boston.

Obesity is a Kapha trait as are water retention and edema.

Plantar fasciitis or heel spurs is Kapha/Pitta.

Acid reflux is Pitta.

Numbness in hands is Vata disturbance.

Nightmares of being chased are Vata.

Coffee, with its caffeine and acidic tannins can be a cause for the acid reflux.

Picking at skin, or causing bleeding, provides the patient temporary relief from high Pitta.

Beginning menstruation at age 15 is a Kapha trait. Beginning early, at ages 8-11, is considered a Pitta trait. At ages 15-18 it is considered Kapha.

In America, when Kapha is out of balance, it’s responsible for the big killers, such as Heart Disease, Diabetes, High BP, and Obesity (which leads to other illnesses.) Depression and Hypersomnia are often a result of Kapha out of balance. If Kapha can be balanced by regulating the metabolism, Kapha types often live the longest lives of all the doshas.

Missing moons on the fingernails indicates decreased metabolism.

Prescription: According to Dr. Vasant Lad, herbs are only 5% of the cure. But they are a start. The road to health also involves changes in diet, lifestyle, spirituality, and a variety of other events that affect our health.

Ayurvedic wisdom says to never sleep on the stomach. It can create a multitude of health disturbances. Sleeping on your back is the next worse. Since this patient has mostly vata and kapha out of balance, mostly kapha, sleeping on her left side would be very beneficial. Sleeping on the left side heats the body and improves the metabolism. Sleeping on the left causes mucus to block the left nostril, forcing breathing through the right nostril, which in turn nourishes the left brain which heats up the body. This is solar sleeping as opposed to lunar sleeping on the right side. Never rest or sleep with hand on belly or heart. This creates a weight on the internal organs.

Until this patient eliminates dairy products from her diet, her weight, metabolism, and slightly high blood pressure will not correct. It could worsen. Dairy products have Kapha qualities, such as oily (snigdha.) Cheese is perhaps the worst of all. If the patient desires cheese, she is encouraged to have goat’s cheese (not Feta, because it is highly salted.) No white mucous-type foods. In general, if it’s white, forget it. Additionally, butters are out, specifically nut butters, peanut butters, almond butters, etc.

No salt. No oily foods.

Daily exercise is recommended.

Get a copy of The Ayurvedic Cookbook (Morningstar, 1990) and go on a Kapha soothing (not Pitta provoking) diet.

Always eat at least 3 hours prior to bedtime. This allows for proper digestion to take place before sleep.

Herbal treatment:

Chandra Prabha, 5 parts. Also called “Moonglow.” This is the most important formula for this person.

Jatamamsi, 4 parts. Why Jatamamsi?

Brahmi, 3 parts. Why Brahmi?

Gokshura , 4pts. For urination at night. This is a Kapha weakness of the kidneys.

Consult 1

Cons_Acid_Edema_1.wma

Remarks

I am listing the information on Chandra Prabha, because I have found information on this compound relatively hard to find across various sources:

|Chandra Prabha |

| |

|Compound |

|Sanskrit Name: Chandra Prabha |

|Type of Herb: Ayurvedic |

|Effect on Doshas: Vata +  Pitta+   Kapha+ |

|Virya (Energy): Shita (cold), Ushna (hot) |

|Guna (Qualities): Laghu (light), Ruksha (rough) |

|Prabhava (Special Potency): meda ghana (antidiabetic), lekhana (fat scraping), mutrala (diuretic) |

|Dhatu Affinity (Tissues Entered): urinary tract, reproductive system, dhatu agni (tissue fire) |

|Pharmacological Action: antibacterial, disinfectant, stimulates metabolism, decreases: cholesterol, obesity, |

|lipomas, prostatic enlargement, kidney, ureter, bladder stones |

|Indications: urinary tract infection, diabetes insipidis and mellitis, hypothyroidism, sexual debility, urinary |

|stricture, premature ejaculation, spermatorrhea |

|Contraindications: emaciation |

|Constituents: cardamom, camphor, mineral pitch, chireta, pippali, long pepper, black pepper, triphala, sandalwood, |

|iron ash, guggul, eye of bamboo, caleo pyrite, nitro hydrochloric acid, piper cubeba, etc. |

| |

| |

| |

| |

| |

Jatamamsi is balancing for all Doshas, or Tridoshic. In this particular case, Jatamamsi is indicated as a brain tonic, sedative, and anti-inflammatory. This herbs prabhava (special quality) is in the treatment of mental and psychological diseases (Frawley & Lad, 2001, p. 244).

Brahmi or Manduka Parni is also Tridoshic and having effect on the nervous, muscular, circulatory, and reproductive systems. Frawley and Lad (2001) remark that this is perhaps the most important nervine herb in Ayurveda.

CONSULT 2

HRB108_Cons_V1P3K2_Diabetes

Short Consult

Subjective and Objective Examination

Subjective: Patient is currently on 2 of the newest insulins on the market. He states that his body rejects the insulin most of the time. He sometimes has to take insulin injections 4 or 5 times a day.

Experiences pain in the groin area and penis.

He states that he has asthmatic/respiratory problems. Patient spent 2 years on an iron lung as a child. Patient is a smoker. He found respiratory relief while spending 6 years in the Caribbean eating fresh fruits and consuming lots of coconut water.

Patient is of Native American heritage.

Memory is very poor. Forgets speaking with people and what they talked about.

Born 6/22/52 in New York City, sometime in the early morning. Is 6’1” and 190lbs.

Blood sugar in past has been up to 240 to 260.

Patient is out in the sun working frequently. Drinks approximately 4 liters (16 to 20 cups) of water per day.

Objective: Pulse: Vata is felt in the heart pulse. Kapha was felt in the kidney pulse.

CONSULT 2

HRB108_Cons_V1P3K2_Diabetes

Short Consult

Questions

This was a short consultation, given during a limited amount of time after a lecture. Given the available information:

What would you determine this persons doshas to be?

What is the Ayurvedic view and treatment of diabetes?

Should this person discontinue taking western medicines (insulin?) Legally and ethically can you recommend this, why or why not?

What herbs would you consider for strengthening the lungs?

What does excess consumption of water cause in the body? Is there a relationship to the pulse assessment of kapha being felt in the kidney?

CONSULT 2

HRB108_Cons_V1P3K2_Diabetes

Short Consult

Assessment and Prescription

Assessment: Ayurveda does not consider diabetes as a curable condition, but rather as a manageable illness through exercise, diet, and use of herbal medications.

Water intake is very high, but may be okay due to working in the sun everyday.

Constitution is Pitta Kapha

Diabetes is called Prameha (Honey in Urine) or Madumeha (Sugar Urine.)

Prescription: This patient was given 25 tablets of Vasanskusama(sp?) which contains purified gold. Take 1 tablet bid (twice daily) with water. Gold is a heart tonic. The poor man’s version of this tonic is to take a 24kt gold ring, boil it for 10-15 minutes in water.

Exercise, watch the diet, and use herbal medicines.

Of an interesting note, in Ayurveda anything that has a negative side effect is not a medicine.

Continue to drink water, but not as much as the patient is currently drinking. Too much water can be energy depleting to kidneys.

Triphala in evening. Why Triphala? Who would you recommend to take Triphala?

Brahmi – for memory.

Turmeric. Introduce turmeric into patient’s diet. Cook with it. Excellent for diabetes.

Shilajit – Himalayan Mineral Pitch – grind it up and mix it with herbal formula. Good for diabetes and Swas (Asthma.) Note: This is available from Banyan Botanicals at banyan-.

Continue with diabetes medications. Patient should check his blood sugar more often and more regularly than he is currently doing. Herbs could improve the blood sugar and the patient may need to back off dosages of insulin.

CONSULT 2

HRB108_Cons_V1P3K2_Diabetes

Short Consult

Remarks

Legally, I would never advise a patient to discontinue a doctor’s prescribed regimen. Most importantly, I’m not a medical doctor and, although I have legitimate allopathic medical training, I would not even venture to put my advice up against a practicing, board-certified, doctor. That, my friend, would be practicing medicine without a license.

What I would offer is an alternative or complementary therapy. In a world with patient’s rights, it is up to the patient to make an informed decision about what treatment they wish to pursue for themselves, if the decision has to be an either/or type of decision. What is more efficacious is for the patient to continue on the treatment prescribed and designed by his medical doctor WHILE pursuing Ayurvedic treatment as a complement to his current healing path. In this manner, any improvements in the patient’s condition can be monitored by his physician while the Ayurvedic practitioner remains aware of these changes and can also adapt his therapies. It is not unreasonable then to see how Ayurvedic and Allopathic medicine go hand-in-hand in caring for a person’s whole being.

Now, on to a mildly lighter subject.

Frawley and Lad (2001) recommend Pippali, or Indian Long Pepper, as an herb of choice in the treatment of respiratory problems. It is indicated for conditions such as colds, coughs, asthma, bronchitis, and laryngitis in regards to upper respiratory symptoms. Since this herb is very heating, V-K-P+, it is contraindicated in high Pitta or inflammatory conditions.

An interesting note is that Banyan Botanicals (2006) markets a Lung Formula. Its listed ingredients are Licorice, Cane Sugar, Pippali, Elecampane, Vasaka, Amalaki, Bibhitaki, Haritaki, Tulsi, Cardamom, and Cinnamon. Licorice is a highly effective expectorant and one should be aware that Amalaki, Bibhitaki, and Haritaki combined is the beautiful tridoshic rasayana (restorative) called Triphala.

CONSULT 3

HRB108_Cons_V2P3K1_Kidney.wma

Subjective and Objective Examination

Subjective: Patient expressed that her main concern was her kidney problems. Patient presents with history of kidney related illness.

In the past, the patient had mercury fillings in the teeth. Has had those removed.

Patient has a basic knowledge of meridians in TCM (Traditional Chinese Medicine.)

Patient still feels like she retains toxins and experiences kidney problems.

Patient is female, 29 years old, born on 4/19/74 at 8:35 AM in Los Angeles, California.

She is 5’2” tall and approximately 115 to 120 pounds.

Began menstruation at about 11 or 12 years of age. Menstruation is irregular. She uses birth-control pills to regulate her periods.

Memory lately has been poor.

Sleeps well.

Bowel movements are once or twice a day and normal.

Patient has normal urination, but sometimes may get dehydrated from not drinking enough water. Maybe drinks 4 cups of water per day. First morning urine is clear.

Lungs are also a problem. Patient coughs up clear mucus.

Patient has lots of teeth problems. Enamel is thin or non-existent, causing severe decay and destruction of teeth. Almost all the teeth are involved.

Eyesight keeps getting worse.

Patient has an injury to the right abductor muscle from a past dance injury.

Patient has to work on NOT gaining muscle mass when exercising. She finds that increases in muscle mass will also increase her aggressive tendencies. When pushed or confronted with aggression she will respond back with aggression.

Objective: In Ayurveda, the Ashtavidha pariksha (the eight-fold examination) is: nadi (pulse), jihva (tongue), shabda (voice), sparsha (palpation/touch), akruti (form), drig (eyes), mutra (urine), mala (feces).

The Trividha pariksha (the three-fold examination) is: darshana (observation), sparshana (tactile perception), prashna (questioning)

Patient looks off to the side often. This is Vata mind to look off into space to pull thought out or retrieve it.

Bone structure is Pitta. Medium build and musculature.

Patient coughs up clear mucus, which is Vata. If the mucus was yellow, it would indicate Pitta. If it was white, it would indicate Kapha.

The tongue is pointy, which is Pitta. There is a subtle white coating with red dots on the periphery of the tongue. The tongue also has a tremor to it, indicating Vata.

Pulse shows Kapha in the Heart. Other pulses are normal Pitta.

Fingernails show moons on the middle finger, index finger, and thumb.

Weight appears to be mostly pitta. Vata for that height would be about 105 lbs. or less. Kapha would be about 125 to 130 lbs. or more.

Drig – look at the persons eyes. Patient has Pitta eyes. Eyes are slightly red. When talking she frequently looks off to the side.

Akruti – form. Patient is 5’2” and 115 lbs.

Mutra – first urine is clear in morning.

When the patient furrows her brow she has a distinct wrinkle on the spleen line.

CONSULT 3

HRB108_Cons_V2P3K1_Kidney.wma

Questions

What guidelines might you suggest for healthy kidney function, aside from herbal remedies?

What is a white coating of the tongue indicative of?

Coughing up clear mucus indicates what dosha?

In a fingernail examination, which fingers should have moons (the light areas at the bed of the fingernail and cuticle,) and what are they indicative of?

First morning urine should generally be of what color?

Dental decay and lack of enamel on the teeth could indicate what?

What type of Ayurvedic oil is useful in massage to treat arthritic conditions as well as muscular injuries?

What herb would you suggest for Vata mental disturbances?

CONSULT 3

HRB108_Cons_V2P3K1_Kidney.wma

Assessment and Prescription

Assessment: Pulse: Kapha in the heart indicates possible depression.

Subtle white coating on the tongue indicates possible beginning of toxins accumulating in digestive tract.

Fingernail moons on the middle finger, index finger, and thumb are good. These fingers are where the moons should be present. This is an indication that at the present time the patient’s metabolism is in relatively good shape.

Looking off to the side to retrieve thought or information is Vata mind. Pulling thought from space.

The fact that the first morning urine is clear indicates a vata disturbance of the kidney. The first morning urine should be yellow. Deep seated fear and/or anxiety harms the kidney.

The dental problem, lack of enamel, and decay indicate a kidney problem as well.

Prescription: As a general given, herbal formulas are usually made to last one month – equal to approximately 30 parts.

First thing in the morning drink 8-16 oz. of warm water, no colder than room temperature. Then wait ½ hour before eating food or herbs. This flushes the kidney.

Mahanarayan Oil - For muscle pain, massage with Mahanarayan Oil. This is excellent for treating pain in the muscles and long-standing injuries. Apply it each day. It is anti-inflammatory and analgesic (anti-pain.)

Brahmi – for Vata memory deficiencies. As a side note: Jatamamsi could also be given if you wished to calm the patient.

Brahmi Guduchi – for calming Vata.

Herbal Formula:

Gokshura – 5 parts Why Gokshura?

Cumin Seed – 5 parts – for Agni

Chandra Prabha – 4 parts

Candana (White Sandalwood) – 3 parts Why Candana?

Kaishore Guggulu – 15 parts Why Kaishore Guggulu as the predominant herbal mixture for this patient?

Brahmi – 10 parts Why, in this case Brahmi?

For formula take 1 teaspoon tid (three times per day.) Does not have to be taken with food. Take with 3 tsp. Aloe Vera Gel or warm water as an Anupana (vehicle, or carrier.)

CONSULT 3

HRB108_Cons_V2P3K1_Kidney.wma

Remarks

Vata emotions weaken the kidneys (Frawley & Lad, 2001). Fear and anxiety can cause health issues in this area. Recommending meditation or specific Yoga asanas to reduce stress and stimulate the healing of the kidneys would certainly be indicated in case such as this.

A white coating on the tongue is indicative of accumulated ama (or toxins) in the digestive tract. A coating forward, towards the tip of the tongue, indicates ama in the stomach and possibly small intestine. A coating in the center of the tongue indicates ama in the small intestine, and a coating on the back of the tongue indicates ama in the large intestine.

Gokshura is balancing for all doshas and is specifically indicated in difficult or painful urination, kidney stones, nephritis, and hematuria (blood in the urine.) Because Gokshura acts as a diuretic, eliminating excess water and body fluids, care should be taken as this could lead to dehydration. Punarnava is often added to a Gokshura formula and is another tonic for kidney ailments.

Candana is another herb which has an affinity to the urinary system. It is V+P-K-. Michael Dick recommends taking Candana oil internally (1-2 drops with ½ teaspoon of sugar) for cystitis and dysuria (2001, sec. 19, pg. 15).

Kaishore Guggulu, for this patient, is an excellent treatment for pitta inflammation due to her shoulder injury. Kaishore Guggulu’s main ingredient is Guggulu, traditionally used in the treatment to expedite delivery to the joints, and Guduchi which is Pitta decreasing.

Brahmi is the primary herb for emotional and anxiety disorders. This is given due to the fact that the patient states that she has aggressive tendencies on gaining muscle mass.

CONSULT 4

HRB108_Cons_V1P3K2_Weight_Asthma.wma

Subjective and Objective Examination

Subjective: Patient’s menstruation began late at age 15. Her Family Practice Physician suggested that she has Cystic Ovarian Syndrome. She started on Birth Control Pills to regulate her periods. On Birth Control Pills she gained weight and was sick. She would wake up in the middle of the night with dry heaves and dizzy spells. On waking in the morning she would black out. She stayed on Birth Control Pills for 2 years and then quit. She now gets her period a little late with medium to light flow. She finds it very hard to lose weight since she came off the pill. She has been been off the pill for about 9 months now.

Her Grandmother and Aunt have had Breast Cancer.

Her Father has Asthma. Patient has had Asthma since she was 7 years old. She has a lot of phlegm built up on awakening. Phlegm is yellow.

She has Allergies in the spring with runny nose and itchy watery eyes.

She is very active.

Patient has recently, late at night, had a sharp pain in her chest that made her react.

Born 9/27/83 at 5:20 AM in Santa Rosa, CA. She is 5’6” tall and about 140 pounds.

She has a very muscular build like her father. She used to be involved in Soccer and Dance, and did not worry about her weight during this time. She still exercises but continues to have weight problems.

When asked, she likes sweet and hot tastes.

Has bowel movements 2 to 3 times per day. Stools are solid.

No specific urination problems.

Patient says that she has difficulty making decisions at times. She wants to make everyone happy when she makes a decision, so she considers everyone involved.

She finds it hard to get angry and feels like she takes other’s burdens. Then, she explodes later when it gets to be too much.

Her long term memory is good, but her short term factual memory is not good.

Because of a faster growth rate of her jawbone, patient had a dental jaw break performed to ward off TMJ (Temporal Mandibular Joint Syndrome) later in life. She felt very out of balance afterwards and, with inactivity, experienced some weight gain. She had skin outbreaks after surgery which she attributes to the type and amount of drugs in her system.

Patient has received Triphala as an herbal treatment recently with no loosened stools noticed.

She has noticed feeling moderately hotter recently.

She wants to focus on weight loss primarily and, secondly, to establish hormonal balance.

Patient will be traveling out of the country soon. Last visit in another country patient developed digestive parasitic infection.

Objective: Patient has Kapha body construction.

Pulse is slow Kapha pulse.

She is missing moons on her fingernails and has them on her thumbnails

only.

Patient has Pitta brow furrows.

Tongue on examination is square.

Patient has received Triphala as an herbal treatment recently.

CONSULT 4

HRB108_Cons_V1P3K2_Weight_Asthma.wma

Questions

Describe a preventative treatment for Breast Cancer.

Yellow phlegm and mucus is associated with which doshic condition?

What is your advice about the sharp pain in her chest?

What is your advice for her short-term memory disorder?

Relate her skin outbreaks after surgery with common post-surgical medications and their doshic effects.

CONSULT 4

HRB108_Cons_V1P3K2_Weight_Asthma.wma

Assessment and Prescription

Assessment: Menstruation beginning late is Kapha.

Asthma is a Kapha problem.

Allergies: Runny nose is Kapha. Itchy eyes are Pitta. Watery eyes are Kapha. Since allergies occur in the spring, this is a transfer from Kapha to Pitta time. Basically she has Kapha allergies with secondary pitta symptomology.

Missing fingernail moons indicates sluggish metabolism.

Square tongue indicates that metabolism may be in disorder. Patient may have an under active Thyroid due to square tongue and missing fingernail moons.

The attitude of wanting to please people is a Kapha trait which this patient combines with Vata worry. Kapha, the earth, takes everyone’s burdens.

Prescription: As a preventative to Breast Cancer, rub Castor Oil over the breast, starting at the sternum and massaging outward toward the arm pits.

Dance is very good for Kapha individuals. Kapha is naturally graceful but loses this gracefulness due to weight. Earth-Mother would be a Kapha type. Kapha types should stay active, moving, and warm. Coolness solidifies Kapha oils.

With a Kapha constitution, patient needs to cut back on sweets and enjoy spicy foods. This is very important – less sweets, more spicy. Patient needs to watch her weight and metabolism.

Eat foods with less oil.

Avoid white foods.

Patients basic constitution is Pitta/Kapha.

To help with mental pressures, this patient would find meditation and dance to be very important therapies.

Punarnava will help with the sharp chest pains at night.

Castor Oil Abhyanga of breasts.

Given an article on Physical Exercise and Yoga Asanas.

Given an article on Weight Control from an Ayurvedic Perspective.

Triphala – ½ tsp at night.

Formula:

Main herb is Punarnava – 15 parts – good for VPK, the lungs, and strengthens metabolism. Punarnava is rejuvenative for Kapha. It helps in fat metabolism, the lungs, and liver. It is a preventative for Breast Cancer and is good for skin conditions.

Guduchi – 8 parts – Tinospora Cortifolia – good for VPK. It helps with skin conditions and gives energy. It is good for the liver and fat metabolism.

Kutki – Katuka – 7 parts – for fat scraping. It is good for Kapha and Pitta. It helps with the liver and anger, as well as the skin.

Shatavari – 5 parts - is the Ayurvedic equivalent of Dong Quai. It helps with polycystic ovaries, anger, and the skin. It also helps the patient to feel cooler.

Brahmi – 4 parts – to help with the mind in staying clear and calm.

Ashoka – 8 parts – A Shoka (No Grief.) Useful for polycystic ovaries and to help regulate menstruation.

Sitopiladi – 5 Parts – contains cinnamon, cardamom, Indian long pepper, ginger, and black pepper. Useful in strengthening the lungs and improving metabolism.

Abrak Bhasma – 1 part – Purified Mica. It strengthens the lungs and heart. Useful in treating tuberculosis, asthma, and chronic diseases of any kind.

DOSAGE: WHOLE MIXTURE 1 tsp tid (three times per day.)

Add to the formula 6 parts of Vidanga. Dr. Lad says that Vidanga “kills worms, sperms, and germs.” Use Vidanga for parasites, but it will also help improve metabolism.

While out of the country, take Maha Sudarshan instead of Malaria pills. Maha Sudarshan has been long used as a preventative of Malaria. It is bitter and consequently almost never given to Vata people.

It is suggested that the patient buy a separate amount of Sitopiladi for use in tea or in milk products. It is important for this patient with a history of asthma, etc.

Patient was given a pitta soothing dusting powder – Neem/Manjista (a blood purifier)/Sandalwood (a cooling a calming blood purifier)/ Rose Petals/ Chickpea Flower. Use this to wash the face instead of soap daily or twice daily.

Watch chocolate eating because of acne.

CONSULT 4

HRB108_Cons_V1P3K2_Weight_Asthma.wma

Remarks

Abhyanga (self oil massage) is recommended to be done daily for all individuals except Kapha individuals who should use a dusting powder instead of oil due to the oily nature of their skin and systems. In the prevention of breast cancer, massage is done with Castor Oil, massaging from the breast outwards towards axillaries (arm pits.) This action provides nourishing oil to the breast tissues while stimulating flow of interstitial, cellular, and lymphatic fluids outward towards the larger lymph vessels in the armpits where it can be circulated and cleansed.

Yellow phlegm and mucus, like pus, are colored by dead white blood cells which have been used in fighting infection. In the bodies fight against an infection there is also an increase of either localized or systemic heat. Wounds with a localized infection will often feel hot to the touch. This condition, because of the heat, is correctly identified as a Pitta disorder. Not that there is anything wrong with the body increasing heat and “burning” off infection. That is the body’s natural reaction. In Ayurveda, we see this as a Pitta increase. In cases where there is discharge from the nose and sinuses, or the lungs, in which it is yellow, we recognize as a Pitta disorder.

Any patient presenting with a pain in the chest, regardless, I would have to refer to a western medical doctor. A quick simple and painless test called an EKG (ECG, Electrocardiogram) can quickly detect any malfunction of the heart, which should be your primary concern. Given that all is well with the EKG, the Ayurvedic practitioner can then turn his attention to other possible root illnesses including anxiety and improper breathing (pranayama.) If there is an illness of the heart detected in the EKG, the medical doctor may begin his treatment with any complementary medicine being provided by the Ayurvedic practitioner. The EKG remains the key for symptomatic chest pain. In this case, it is much better to play it safe, than sorry.

The herb of choice in treating memory disorders, anxiety, depression, etc., is Brahmi. Secondary to Brahmi is any herb that decreases Vata, as loss of memory is a Vata disorder. But in this case, I might additionally advise meditational practices that build concentration and single-pointed awareness. Then as that practice progressed I would also advise meditational and daily living practices that bring mindfulness and present moment awareness. By strengthening the power of concentration and bringing the awareness to the present moment the patient should find considerable increase in memory and, as an aside, a reduction in anxiety. Spiritually, present moment awareness is the most expedient path to realization of one’s true nature, that Cosmic Consciousness, which manifests through us.

It is not unusual to see skin outbreaks, or other manifestations of an increase in Pitta, in a post-surgery patient. Antibiotics, the staple for fighting infection in western medicine, are Pitta increasing. Other side-effects of antibiotics, such as diarrhea, are also increased Pitta induced.

CONSULT 5

HRB108_Cons_Anxiety.wma

Subjective and Objective Examination

Subjective: Patient is a 24 year old female. Born on May 1, 1978 in California.

One year ago she was given anti-anxiety and sleeping medications (Ativan and Ambien.) This resulted in chronic dehydration. This dried her eyes out. Her eyes were almond shaped, now they’re round. This dehydration also resulted in bone loss. She was 5’5” tall, but is now 5’3” tall.

She currently sleeps, but never wakes up refreshed. She had experienced insomnia.

She used to have constipation for about 5 years, but does not anymore.

Drinks about 6 cups of water per day.

Has low blood pressure.

Has loss of muscle tone in face.

Objective: Pulse is Vata disturbed. Once her pulse is located, you can push on it and make it disappear.

CONSULT 5

HRB108_Cons_Anxiety.wma

Questions

What is indicated by a Vata pulse? How about this patients pulse? What is indicated? Think along the lines of blood pressure and body hydration. How are those two related?

Constipation is indicative of what doshic disturbance?

What would be normal water intake for a Vata person?

What major herbs would you prescribe in this case?

Is there another treatment, besides herbs, that may be more fitting?

CONSULT 5

HRB108_Cons_Anxiety.wma

Assessment and Prescription

Assessment: Bone loss is a Vata condition.

She has kidney depletion, which is Vata.

Her water intake is way to little for Vata. She needs 10-12 cups of water per day.

Pertaining to muscle tone loss in face, and bone loss: Loss of anything, including relationships, job, weight, as well as dropping things, is always Vata. Vata is catabolic or tissue destructive. Anabolic is tissue growth. Metabolic is tissue maintenance and metabolism.

Prescription: The best way to soothe Vata is by daily oil massage. Use Sesame Oil to massage the whole body. Take about 15 minutes to do the massage. Then wait 5 to 10 minutes before taking a hot shower.

Oil massage is so important to Vata that, given between taking herbs or taking oil massage, it would be better to do the oil massage. Oil use should be about 1 quart of oil every 2 months due to the Vata nature.

On the face, due to loss of muscle, massage with Ashwagandha Bala Oil. It is very strengthening to the muscles. Good for anyone who has illnesses of wasting away. Babies who are born prematurely and are weak in their constitution, and women who are Vata and premature in their delivery, are given massages with Ashwagandha Oil.

Yogaraj Guggulu –Comiphora Mukul (a tree resin) - for massive bone loss. Guggulu means it protects from diseases. How many parts should this be in the preparation?

Jatamamsi for insomnia. How many parts should this be?

For dry, burning eyes use Rose Water. It must be organic rose water with saline. It can be obtained from Mount Madonna Center over the internet.

CONSULT 5

HRB108_Cons_Anxiety.wma

Remarks

My recommendation in the above herbal formula is to give 5 parts Yogaraj Guggulu and 4 parts Jatamamsi. Although there are no strict rules in the prescription of parts, I find the need for treatment of bone loss and the treatment for sleep disorders to be nearly equal.

A Vata pulse is typically felt under the index finger, instead of the middle or ring finger, in taking a pulse Ayurvedic style. I’ll refer readers to Dr. Vasant Lad’s book, Pulse Diagnosis. With regards to this patient, Vata, or the air quality, in the the brachial artery, allows the pulse to easily collapse with pressure and be stopped. More realistically, there is not large amounts of air moving in the circulatory system, as arteries, veins, etc., have some elasticity to allow for fluctuations in blood pressure and volume. The amount of blood fluid volume is low. Following this line of thinking, the artery is not filled with enough blood. When there is not enough blood and plasma, blood pressure is going to be lowered and is indicative of dehydration in the patient.

Constipation is another indicator of Vata disturbance. Literally, Vata or air in the colon dries fecal material causing constipation, often hand in hand with increased flatulence.

Additionally in this case, in the treatment of Vata increase and in particular constipation, I would prescribe Triphala to act as a laxative with a balancing effect on all Doshas.

CONSULT 6

HRB108_Cons_V1P3K2_K3_Obesity.wma

Subjective and Objective Examination

Subjective: Patient had onset of menstruation at age 13. Menstruation is currently regular.

Sleep is excellent and has been throughout her life. Patient says she sleeps “like narcolepsy.”

Patient generally has cold hands and cold feet.

She feels nervous and anxious. She has a lot of anxiety with anger and irritation. She is currently stressed because she runs 4 businesses. She has 2 grown children who both ill.

She was chubby as a child about age 9 or 10.

She has 2 to 3 bowel movements per day.

She learns fast and remembers.

Patient has NEVER been on a lot of medication in the past, but does take a few herbs.

Her main concern is her obesity.

She has pressure in her ears. Acupuncture has worked for this in the past.

Patient has post-nasal drainage.

Patient has fibrocystic developments of the breast, uterus, and ovaries. Her uterus has enlarged and is causing problems with her other organs as well as pain in her back and pelvis.

Patient is diabetic.

She drinks about 80 ounces of water per day. This is about 10 glasses of water per day.

Objective: Tongue show Vata disturbance by being squared off.

Pulse is Pitta Kapha.

Fingernail moons are slight.

She has the beginning of a line on her earlobe, called the Line of Coronary Heart Disease.

CONSULT 6

HRB108_Cons_V1P3K2_K3_Obesity.wma

Questions

Cold hands and cold feet are what?

What would you prescribe for nervousness and anxiety about her business and children?

The patient has 2 to 3 bowel movements per day. Is this “normal?”

Is her consumption of 10 glasses of water per day adequate?

What herb would you prescribe for fibroid growths, and why?

CONSULT 6

HRB108_Cons_V1P3K2_K3_Obesity.wma

Assessment and Prescription

Assessment: Sound, deep, sleep is Kapha.

Being chubby as a child is Kapha, possibly Kapha Pitta.

2 to 3 bowel movements per day is Pitta Kapha.

Learning fast and remembering is Pitta Kapha.

Slight fingernail moons indicate slower metabolism.

Considering the patient’s obesity and other findings, she is ranked as V1P3K4.

Prescription: The patient should only drink 4 to 6 cups maximum of water per day. If she feels that she wants more liquid, drink black tea without cream of sugar.

Punarnava – 5 parts – helps liver metabolism.

Kutki – 4 parts – for liver metabolism.

Brahmi – 2 parts – good for anxiety and sleep.

Chitrak – 3 parts – for agni. Chitrak plumbago. Energy is V-P+K-

(There is a low supply of Chitrak at the pharmacy. Use Arogyavardini as a replacement.)

Ashoka – 2 parts – for the fibroids

Musta – 2 parts – for fat scraping

Take the herb formula mixed with raw uncooked honey. Take 2 teaspoons. The honey acts as a catalytic agent to deliver the herbs into the adipose tissue (fat tissues) and improve metabolism. Follow with 4 to 8 ounces of either warm or hot water.

Introduce Turmeric into the diet. Cook with it. It is good for Diabetes

Use Fenugreek powder. The seeds are very had to grind. This is good for diabetes. INTERACTION PRECAUTION: COUMADIN. Why the interaction with coumadin?

Drink water from a copper cup. This improves metabolism. If a copper cup was not available, what could be done as an alternative?

CONSULT 6

HRB108_Cons_V1P3K2_K3_Obesity.wma

Remarks

Cold hands and cold feet are an indication of Vata.

Nervousness and anxiety can be effectively dealt with by dispensing Brahmi in the patient’s formula. Additionally, I’d also suggest meditation aimed at calming and centering the mind, and if the patient was receptive, mantra recitation for mental and spiritual conditioning.

In health care, and particularly in Ayurveda, it’s important to remember that there is no such thing as normal. There is a wide variation in the constitutions of individuals, even though those constitutions are divided into the three categories of Vata, Pitta, and Kapha. So, it’s not easy to say whether a patient having 2 to 3 bowel movements per day is “normal.” The most generally accepted idea of elimination is that a bowel movement is approximately once per day.

Ten glasses of water per day is more than this Pitta (P2)/Kapha (K3) individual needs. Four to six glasses per day is sufficient to support Kapha.

Ashoka (a tree; meaning “without sorrow”) is the herb recommended for fibroid tumor growths. Acting directly on the muscle fibers of the uterus, it has a stimulating effect on the endometrium (Ayurveda Herbs 8.htm).

Loyola University Health System reports that taking Fenugreek with Coumadin (Warfarin), a blood thinner, may cause the blood to become too thin (Loyola UHS mdx-amci0060.htm).

Taking water from a copper cup is often advisable. If a copper cup is not available, several clean pennies can be placed in the glass of water overnight, or a short length of copper tubing (available from your local home do-it-yourself store) may be used in the place of pennies.

Consult 7

HRB108_Cons_Mantra_Request.wma

Subjective and Objective Examination

Subjective: The patient requests a healing mantra.

Objective: No objective assessment required.

Consult 7

HRB108_Cons_Mantra_Request.wma

Questions

Very simply, what would you prescribe as a healing mantra?

Consult 7

HRB108_Cons_Mantra_Request.wma

Assessment and Prescription

Assessment:

Prescription: The patient was given a section of The Shurangama Mantra, the longest mantra in Buddhism, as a healing mantra. This section, in particular, is useful in healing Vata, Pitta, and Kapha illnesses and balancing for all Doshas, or Tridoshic.

The section offered is from the “Sagely City of 10,000 Buddhas Daily Recitation Handbook” page 12, lines 132 through 135, which read in transliteration:

132) PE SHA SHE

133) SYI DAN LA

134) E JI NI

135) WU TWO JYA LA RAU SHE

Consult 7

HRB108_Cons_Mantra_Request.wma

Remarks

I find the pronunciation of the transliteration to be slightly baffling at times. If I had to further print it, as it sounds, I would print it:

132) PEE SHA SHEA

133) SHE DAN LAH

134) UH JEH NEE

135) WU TWOH JYAH LAH JAH SHEA

Additionally, for someone who has not taken Refuge in the Buddhist Triple Jewels and/or has not vowed to keep the Five Precepts of 1) No killing, 2) No lying, 3) No stealing, 4) No sexual misconduct, and 5) No intoxication, I would recommend the short version of the Medicine Buddha Mantra. The Medicine Buddha Mantra, and indeed even the Sadhana, because it is grounded in Mahayana sutra, does not require an empowerment, or teaching from a Lama, to perform. In the Sanskrit transliteration, the short version of the Medicine Buddha Mantra is:

TADYATA, OM BHAISAJYE BHAISAJYE, BHAISAJYA, SAMUNGATE SVAHA.

In the Tibetan transliteration it is:

TAYATHA, OM BEKANDZE BEKANDZE, MAHA BEKANDZE (BEKANDZE), RANDZE SAMUNGATE, SOHA.

Dr. David Frawley, in his book Ayurveda and the Mind, comments, “Mantra is the main method of treating conciousness (Chitta) and is helpful for healing all levels of the mind, inner and outer. . . For this reason, it is the main Ayurvedic therapy for treating psychological disorders and can be very helpful for physical problems as well” (p. 226).

Consult 8

HRB108_Cons_V1P3K2_Pitta_Flu.wma

Subjective and Objective Examination

Subjective: Patient is Female.

Patient has had recent stomach pain along with acid reflux. Took Mylanta, which relieved the condition.

She has had physical pain which radiated from the navel to mid-chest.

Patient has had normal stools. 2 bowel movements per day. Stools sink in toilet.

Sleep is okay.

Has been having dizziness and nausea. On a previous day she had some vomiting. Patient states she is dizzy a lot, even while sitting at rest.

Recently given antibiotics (about 1 ½ weeks ago) which increased nausea. Patient was in the hospital for 5 days, with x-rays, CT scan, ultrasound. Diagnosis of Diverticulitis.

No mucus in upper respiratory areas.

Patient has 235 cholesterol index.

Patient is already taking Guggulu to resolve arthritis.

In the past, she was given an herbal formula. The patient states that she couldn’t take it because the Amla (Amalaki) content, with it’s inherent Vitamin C, was resulting in heartburn and stomach upset. Patient also continued to experience dizziness while taking the formula. This was another reason for discontinuation.

The patient’s sister sent her Haritaki, which she added to the mixture. She took the formula mixture for 2 days, then did not continue after that.

Patient’s current allopathic medications make her sleepy and tired.

Patient is Eastern Indian and does eat very spicy foods. But patient has eaten a bland Kitchari diet and states that she has not been able to keep it down.

Patient states she is getting forgetful.

Objective: Tongue has tremors and fairly thick ama (tongue coating) indicating toxins held in digestive tract. Dr. Lad ranks ama on the tongues of different patients on a scale from 1 to 4. Ven. Losang Jinpa rates this patient’s tongue ama at 3.

Earlobes have demarcation of long earring holes. This is not to be mistaken for the Line of Coronary Heart Disease/Congestive Heart Failure.

Previous formula was:

Punarnava Guggulu – 3 parts – for thyroid, kapha metabolism, and heart.

Gokshuradi Guggulu – 3 parts – for urination, strengthening kidneys.

Brahmi – 2 parts – for memory.

Talisadi – 3 parts – which is Trikatu, Sugar, Cinnamon, Cardamom, Himalayan Silver Fir Tree Needles (pharmacologically like Bay Leaves.) - for cold and mucus symptoms. Can be removed from patient’s formula for now.

Guduchi – for dizziness, soothes Pitta, soothes irritability and anger.

Jatamamsi – soothes nervousness, irritability, and anger.

Chandara Prabha – for weight and thyroid.

This formula would not cause or contribute to dizziness. Please evidence that the patient continues now to experience dizziness after discontinuation of previous formula.

Pulse is feeble with Vata in the heart.

Consult 8

HRB108_Cons_V1P3K2_Pitta_Flu.wma

Questions

Nausea, acid reflux, and dizziness, are related to which doshic disturbance?

Amalaki has the highest amount of natural vitamin C of all fruits. However, in spite of the high content of vitamin C, Amalaki has another quality. What is that quality?

Antibiotics cause an increase in which dosha?

Consult 8

HRB108_Cons_V1P3K2_Pitta_Flu.wma

Assessment and Prescription

Assessment: Acid reflux is Pitta. The relief after using Mylanta shows it’s Pitta.

Sinking stools reveal toxins in the feces and consequently in the colon. 2 bowel movements per day is Pitta quality.

Dizziness is Pitta.

Nausea is Pitta.

Antibiotics can exacerbate nausea and vomiting. Antibiotics provoke Pitta.

Studies have shown that Amalaki is indeed naturally high in Vitamin C. However, Amalaki is NOT Pitta provoking. That is, it does not produce heartburn or gastric distress as do dosages of processed Vitamin C such as found in over-the-counter vitamins and supplements.

Shatavari and Bala are good Pitta reducing herbs, but this patient has too much ama, as indicated on the tongue, to make these her primary herbs. Normally Shatavari is the main herb for a Pitta person, but in her case it is not.

Prescription: Guduchi and Kama Duba for dizziness.

Patient could be given small amount of Kaishore Guggulu in formula.

Patient should not take the previous herbal formula given. The Chandara Prabha may actually provoke some stomach upset. Patient may continue with previous herbal formula after correcting the current set of symptoms. Currently the patient needs to correct the excess Pitta.

Of note: Do not give Shilajit, Chandara Prabha, and Punarnava with patient’s who are experiencing low-grade fevers.

Patient’s natural diet of Indian foods (very oily and very spicy) is contraindicated in the symptoms she is experiencing. Patient should eat a fairly bland diet, like a bland Kitchari diet.

Herbal Formula (Temporary for condition):

Guduchi is the main herb – 5 parts – Tinospora Cortifolia - soothes Pitta

Mahasudarshan (meaning: beautiful to look at.) – 2 parts - which contains Guduchi and mainly bitter herbs. Is anti-viral. Is Ayurvedic antibiotic without disturbing Pitta. 30 different herbs, all bitter. Classic bitters.

Kama Duba – 1 part - conch shell mixed with Guduchi Sattva (purified starch of Guduchi), Red Coral, Cowry Shell, Oyster Shell. Antacid and Anti-Pitta. Small amount it is quite potent. Only 1 to 2 tbsp in this formula.

Shatavari – 3 parts

Brahmi – 1 part – for memory

Consult 8

HRB108_Cons_V1P3K2_Pitta_Flu.wma

Remarks

As a note in this case, about the use of Shatavari: Shatavari is indicated in hyperacidity, and according to Frawley and Lad, “It is an effective demulcent for dry and inflamed membranes of the lungs, stomach, kidneys and sexual organs. As such, it is good for ulcers, and with its thirst-relieving and fluid-protecting powers it is good for chronic diarrhea and dysentery.

Consult 9

HRB108_Cons_V3P2K1_Constipation.wma

Subjective and Objective Examination

Subjective: Patient is 38 year old female.

Patient states problem with constipation. Has been using generic quality Psyllium husk fiber in diet with no effect, except increased gas.

Patient’s finances are poor at this time.

She has just been diagnosed with Fibromyalgia.

Patient uses over-the-counter mineral oil.

Patient has history of eczema and asthma.

Menstruation is regular at about 25 days. Patient is currently menstruating. Flow is medium, growing heavier with age.

Bowel movements are irregular with straining. May skip a day.

Patient takes Flovent for asthma and Bekanase for sinuses.

Patient has Carpal Tunnel Syndrome as well as some other tendonitis.

Memory is good most of the time, sometimes a little foggy.

Objective: Patient has very dry skin. Her hands are dry, even her palms. This is a Vata quality.

Bone structure is Vata. Thin/skinny bones are Vata.

Pressure on pulse makes it disappear, which is Vata.

Consult 9

HRB108_Cons_V3P2K1_Constipation.wma

Questions

Please comment on Abhyanga and its role in Ayurveda.

Consult 9

HRB108_Cons_V3P2K1_Constipation.wma

Assessment and Prescription

Assessment: Dryness causes constipation, because you need liquidity and lubrication in the colon to facilitate bowel movement. Constipation may be caused by anxiety, a vata disturbance, which then manifests in the colon.

Fibromyalgia is often paired with Chronic Fatigue Syndrome. Both are Vata disturbances/illnesses.

Psyllium husk can be habit forming, causing the body to rely on the increased fiber in stool formation.

Carpal Tunnel Syndrome is a Vata condition.

Tongue is square shaped indicating metabolic disturbance.

Prescription: Best thing for the Vata condition is Abhyanga (daily oil massage of whole body.) Do not use mineral oil. Use sesame oil instead. Sesame oil will not clog the pores. Do oil massage before shower. Make sure to massage the colon and whole pelvic area (belly, kidney area, vagina, anus, buttocks, and thighs.) This is the most important treatment for the patient.

As the patient’s finances are a concern, she is encouraged to purchase Mahanarayan Oil and combine it, 50/50, with sesame oil to stretch out its use. Use 1 oz of oil per day in massage. Wherever the patient has fibromyalgia pain apply Mahanarayan Oil full strength.

Herbal Formula:

Ashwagandha – 8 Parts– for general Vata disturbance.

Water Cress Seeds with Ashwagandha – called Bowel Care – 2 Parts.

Brahmi – 10 parts

Jatamamsi – 4 parts

Dashamula - “Ten Roots” – 4 parts - helps soothe Vata in mind and body.

Guduchi – 4 parts

Licorice – 3 parts - to increase pulse strength.

Triphala Guggulu - Triphala is the only herb in Ayurveda that your body does not adapt and/or build tolerance to in its action. Triphala will additionally help with allergies.

Take 1 tsp of mixture tid (three times per day.)

Additionally take 1 tsp of Triphala before bedtime. If patient does not get good results from this, then also take 1 tsp of Triphala on awakening. Triphala was modified by adding more Haritaki to aid in bowel movements.

Recommended water intake is 8-12 cups of water per day. Drink warm water or at room temperature, never cold.

Consult 9

HRB108_Cons_V3P2K1_Constipation.wma

Remarks

Abhyanga is a self-administered oil massage, most commonly done with Sesame Oil. It supplies the skin, muscles, bones, and internal organs with needed lubrication and softening by absorption through the skin. Abhyanga is relaxing and beneficial as massage in itself, stimulating blood and lymph flow, loosening muscles, and applying gentle motion to the internal organs. I find a five to ten minute Abhyanga session, followed by about a twenty minute Yoga Asana session, then a shower to be very beneficial. Those with a Kapha constitution are advised to do a dry massage, using no oil, due to the natural oily tendencies of Kapha.

Consult 10

HRB108_Cons_V1P3K2_K2.5_Acne.wma

Short Consult

Subjective and Objective Examination

Subjective: Patient is female and presents with case of acne.

Patient has been washing her face with soap and then applying Pitta Dusting Powder.

Patient is taking Turmeric and Manjistha orally by combining the mixture in milk with ghee.

Memory is okay.

Sleep is very good.

Patient’s bowel movements depend on how much Triphala she takes. Days that she doesn’t take Triphala she is constipated, but on days when she takes Triphala she is regular.

Patient’s fingernail moons are returning.

Objective: (Because this was a short consult there was no physical exam other than visual.)

Consult 10

HRB108_Cons_V1P3K2_K2.5_Acne.wma

Short Consult

Questions

Explain the use of Manjistha in this patient’s treatment.

Consult 10

HRB108_Cons_V1P3K2_K2.5_Acne.wma

Short Consult

Assessment and Prescription

Assessment: Patient’s fingernail moons returning shows an increase or normalization of metabolism.

Prescription: Patient should use Pitta Dusting Powder. Do not wash the face with soap, use the Pitta Dusting Powder instead, about once per day. The powder contains: Neem, Manjistha, Rose, Turmeric, and Chickpea Flower.

Don’t use too much milk with K2 constitution.

Ideally this patient should have Triphala that contains more Amalaki for her Pitta constitution: 2 parts Haritaki, 3 parts Amalaki, 1 part Bibhitaki.

Purnarnava – 2 parts - for skin and liver. Good for Kapha. Tridoshic. V=P=K+

Shatavari – 1 part – Tridoshic. V-P-K- (K+ in excess)

Guduchi – 2 parts - for mind. Tridoshic. V-P-K-

Kutki – 2 parts - affinities to liver and skin. V+P-K-. Very bitter.

Brahmi – 2 parts - for mind. V-P-K-

Vacha – 1 part - V-P+K-. Helps Agni with affinities to skin.

Consult 10

HRB108_Cons_V1P3K2_K2.5_Acne.wma

Short Consult

Remarks

Manjishta is indicated, among numerous other things, for skin problems. Its energy is V+P-K-. Additionally it should be noted that Manjishta is contraindicated in cases of high Vata or severe chills because of its cooling properties. Since acne is a Pitta disturbance, manjishta is particularly suited for this ailment.

Triphala (Three Fruits) is made up, usually of equal parts of Amalaki, Haritaki, and Bibhitaki. Depending on the persons dosha, additional parts may be added to more adequately balance with the individuals constitution. Such as 30% Amalaki, 30% Haritaki, and 40% Bibhitaki for Pitta/Kapha individuals.

Amalaki – PV- Kapha and Ama in excess

Haritaki – VPK= High Pitta in excess

Bibhitaki – PK- V+ in excess

References

Ayurveda Herbs. (2007). Circle of Health. February 8, 2007

Banyan Botanicals Fall/Winter 2007. (2006) Albuquerque, NM: Banyan Trading Co.

Dick, M. (2001), Ayurvedic Herbology Handbook, Version VI. Palm Beach Gardens, FL: Dhanvantari Ayurveda Center.

Frawley, Dr. D. (1996). Ayurveda and the Mind. Twin Lakes, WI: Lotus Press.

Frawley, D. & Lad, V. (2001). The Yoga of Herbs. Twin Lakes, WI: Lotus Press.

Loyola University Health System. (2006). Fenugreek – Alternative Medicine. February 8, 2007 < >

Morningstar, A., et al. (1990). The Ayurvedic Cookbook. Twin Lakes, WI: Lotus Press.

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