Spring can really hang you up…

Spring can really hang you up…

[pictured above, an alder (Alnus rubra) male catkin that releases pollen]

It’s officially Spring and many of you may be witnessing what some refer to as ‘yellow season’, the season of pollen dusting everything in it’s wake and wreaking havoc on our bodies. I’m reminded of one of the original bannock recipes, eaten by First Nations peoples, calling for cattail pollen, which grows in abundance for only a short few days in the spring. It’s one of the few examples of a pre-agrarian food that is comprised of tiny microparticles, and given its sticky, heavy properties, it’s probably a good thing that this special treat wasn’t available too often. In my book Food As Medicine, I make reference to research, which shows that a diet high in microparticles plays a role in gastrointestinal inflammation, which itself is a causative factor in the development of allergies and autoimmune disease. Of course, I don’t think that cattail bannock as a rare treat is the issue, but considering how high our diet is in microparticles, from highly refined flour products to additives such as titanium dioxide and mixed silicates, it’s no surprise that our immune systems are a little hyper-reactive.

There’s been a nasty cold going around as of late as well, and it seems like its one of those that seems to hang on. If that’s your experience, you might want to look at my post on how to properly deal with cold and flu. If you’re in the PNW, I expect that the high pollen count here has something to do with it, so you might also want to review my other post on the treatment of hay fever too. But if we want the high level perspective, we need to remember that spring is naturally a time of inertia and congestion. In Āyurveda, spring in northern temperate regions is associated with an increase in kapha, the aspect of the body that relates to its nourishment and structure, expressing the qualities of heavy, wet, stable, greasy, and cold. With the increasing presence of the sun during spring, the snow turning rain as the temperature begins to thaw, the primeval qualities of light, warmth and moisture initiates a gradual re-awakening of life. But this transition requires a break-through, a crisis, like a seedling which must take the risk and consume all its energy, to burst forth and penetrate through the heavy, dark soil to meet with the nourishing light of the sun. Some plants, like the Western Anenome (Anenome occidentalis), don’t even wait for the snow to melt before sprouting, rising up against all odds to commune with the meek rays of the early spring sun. It is perhaps no surprise that this plant is used medicinally (as the fresh plant tincture) – in small doses – to help reduce anxiety, ground and connect, particularly during difficult transitions.

According to Āyurveda, all living things naturally experience this obstructive element in the act of receiving abundance, and so it is true for us as well. As the weather becomes more spring-like, there is a natural congestion and saturation of the body, which increases our susceptibility to certain types of viral illness, overwhelming mucosal, metabolic, and lymphatic mechanisms, leaving you feeling tired and uninspired:

Spring this year has got me feeling
like a horse that never left the post.
I lie in my room
staring up at the ceiling.
Spring can really hang you up the most.

The solution for this of course, is found in the natural world. Like the struggle of the seedling, we need to marshal our energy and challenge ourselves to increase our physical activity. Exercise (vyāyāma) is an especially important practice in Āyurveda during spring, helping to decongest and expel the accumulated kapha, opening and clearing the channels of the body to sharpen and fine tune metabolic activities. Consider that from a physiological perspective, the only way to pump lymphatic wastes out of the tissues is through the regular contraction and expansion of skeletal muscle. Consider as well, all the research demonstrating that a lack of exercise impairs mitochondrial function, and increases insulin resistance in muscles, and along with this, an increase in the risk of diabetes, cancer, and cardiovascular disease. In this way, all these diseases are related to kapha and a state of excess nutrition, which when paired with the qualities of inertia, brings about ill health and disease. It is for this reason that Āyurveda articulates ṛtucaryā – the seasonal regimen – as a preventative strategy that provides the foreknowledge of how to best cope and adapt to the different seasons, as well as their transitions.

Thus the doctrine of ṛtucaryā tells us that when the kapha that accumulates over winter begins to ‘melt’ and flood the body during spring, just as a landowner clears the dry streams and creek beds of debris in preparation for the spring run-off, so too should the eliminative faculties of the body be prepared. The traditional practice in many cultures of a spring cleanse is an example of such a measure, best implemented just before the season has completely transitioned from winter to spring. In Āyurveda, a specialized technique called vamana (emetic therapy) is usually considered to be the most effective technique to reduce kapha, but other techniques such as virecana (purgation), vasti (enema), and nasya (errhines) may also be used. A simplified approach might consist of a course of kapha-reducing herbs such as Śuṇṭhī (ginger) rhizome, Pippalī (long pepper) fruit, and Dāruharidrā (barberry) root, taken with honey for 2-3 weeks. With regard to diet, light and easily digestible cereals such as barley, millet, amaranth and quinoa can be emphasized to reduce kapha, rather than heavier cereals such as wheat, rice, and oat. Meat with a light property such as goat, lamb, poultry and rabbit are appropriate to balance kapha, whereas heavier meats such as pork, beef, and duck should be limited. The emergent “green” energy of spring is particularly well-represented by the leafy green vegetables and shoots available at this time, consumed along with spicy herbs such as black pepper, ginger, mustard, and fenugreek. Many of the local herbs that are just starting to emerge, such as chickweed, dandelion, and nettle, all have a natural kapha-reducing activity, and are an excellent choice to prevent the congestion that frequently occurs with this seasonal transition.

As part of the kapha-reducing regimen mentioned above, I referred to a technique called nasya, which can be utilized to cleanse the nostrils, nasal cavity, sinuses and nasopharynx. Among the most commonly used preparations for nasya is either a plain sesame oil, or medicated oils such as Aṇu taila, two to three drops instilled into each nostril and inhaled back into the nasopharynx. Although it is oily (snigdha), another property of sesame oil is that it is tikṣṇa (‘sharp’), and when instilled into the nose, promotes a sensation of mild irritation followed by the liquefaction of kapha. This results in the draining of formerly congested mucus, which can then be expectorated out through the mouth. This type of nasya can be performed by most people, but is contraindicated in acute conditions of the nasopharynx, such as in a cold, fever or flu. For acute sinus congestion, two to three drops of a preparation made from equal parts Ārdraka (fresh ginger) rhizome juice, honey, and water can be instilled and inhaled into the nasopharynx. This medication is particularly effective to drain the sinuses and relieve pressure, and can be a godsend when you have an awful sinus headache. If you have particularly sensitive mucus membranes, however, you might coat the inside of your nostrils with a little bit of ghee first, before applying this remedy, in order to protect them.

Btw, here’s my favorite version of Spring Can Really Hang You Up:

Holistic medicine meets holistic learning

Holistic medicine meets holistic learning

Most of us who come to find Ayurveda have been searching for the deeper meaning behind our existence and wanting to add purpose to our lives. A lot of us have struggled against societal norms lacking in compassion and universal awareness so we take action by practicing humanitarian values in an effort to create a stronger relationship to ourselves, our families and to our community. We consistently evaluate the health of our communities, as well as our overall culture. In search of fulfilling this desire, we find a more holistic approach to our being and it feels true that holistic medicine is the anecdote to these concerns. It seems even more natural to begin to learn in environments where this philosophy is not only embraced, but also openly practiced.

With that in mind, Todd created Dogwood School of Botanical Medicine based upon this premise. We developed a video to share with you his mission in order to develop a deeper understanding of why we are not your average “online” school, but instead a more holistic model of learning that enriches you, the student, and the communities each of us serves. This model works not just to enhance your experience and produce better practitioners, but ultimately, works toward creating a greater sense of self-fulfillment. Please watch the following video as Todd shares his vision for our traditional model of education:

The Graduated Diet

The Graduated Diet

The ‘graduated diet’, or sansarjana krama in Sanskrit, is a measure utilized in Ayurveda to rekindle the digestive fire (agni). It is used for the purpose of amapachana: to enhance digestion and the processing of wastes, and remove the metabolic and immunological detritus (ama) that is generated with poor digestion.

The graduated diet can be utilized in a variety of situations, including whenever digestion is weak and in the treatment of diseases such as fever (jwara). The process of ‘rekindling’ the digestive fire (agni) is analogous to starting a fire in a wood stove, enkindling the agni with easily digestible foods as one would a fire with paper or kindling. Once the fire is established, in the form of a strong appetite, progressively denser and more energy-rich foods are introduced in a graduated fashion to feed the digestive fire, but never so much as to cause it to smolder or be extinguished.

How much to eat?
The graduated diet isn’t designed to provide a maximal source of energy. It is by nature a light diet, meant to encourage a strong appetite and to enhance metabolism. As such, it is important to limit physical and mental activity during this period, so there is more energy available for digestion.

The idea behind the graduated diet is to tease your appetite with small amounts of easily digestible foods. The amount of food recommended in this post is for a medium-sized adult, and should be adjusted accordingly. While having a strong appetite is a good thing, being constantly famished is not, so make sure to eat enough to satisfy your needs.

While on the graduated diet, try to eat mindfully and not too fast, and listen to what your stomach is telling you, rather than your tongue. As the saying goes, “control your tongue, control your life.”

Meal times
In Ayurveda, there are two basic times to eat a meal: once before noon (breakfast), and again before the sun sets (dinner). As such, the graduated diet follows this basic scheme of two meals a day consisting of breakfast and dinner. During the graduated diet specifically, snacks are not allowed, but ginger tea and room temperature water may be drunk freely. During this regimen, it is important to consume at least a liter of water on a daily basis.

Cautions and contraindications
While the graduated diet does contain nutrients and hence food energy, in the initial phases especially, the meals are quite small and will not provide enough energy for everyday activities. This means that during the first few days especially, you should plan to take time off of work, lighten your responsibilities, and significantly reduce your activity level. This is not a recommendation to ignore or take lightly! Please avoid driving or traveling during the graduated diet.

If you are diabetic, hypoglycemic, or are taking pharmaceutical drugs, the graduated diet may be contraindicated, so please check with your health care provider before undertaking this regimen.

The Components of the Graduated Diet

The basic components of the graduated diet include rice, mung bean, ginger root, salt, ghee, spice powder, fermented food, and meat soup. Apart from these items, one useful piece of equipment is a pressure cooker. Let’s explore all of these in some detail.

White basmati (left), red matta rice (right)

Rice
For the graduated diet, I suggest using either white basmati rice, or a partially milled red rice (red matta rice) that cooks in the same amount of time. Generally speaking, use one-half cup of dry rice per meal, per person. Thus, to make enough rice for one person for an entire day, use one cup of rice.

To prepare the rice, rinse in cold water to remove any foreign particles, and let it soak overnight in water. The next day, drain the rice, add the required amount of water, bring to a boil, and then simmer.

There are three basic types of rice preparations used in the graduated diet, called peya, vilepi, and odana. Each type of rice preparation is made with different amounts of water, as follows:

  • peya is prepared with one part rice and eight parts water;
  • vilepi is prepared with one part rice and four parts water;
  • odana is prepared with one part rice and two parts water.

To make enough peya for an entire day, use one cup of rice per person, and mix with eight cups water. Bring to a boil and simmer, partially covered with a lid, and stir periodically. When peya is ready, it should have the appearance of a thin porridge.

To make enough vilepi for an entire day, use one cup of rice per person, and mix with four cups water. Like the peya, bring this to a boil, reduce to a simmer, and partially cover the pot with a lid, stirring periodically. When vilepi is ready, it should have the appearance of a thick porridge.

To make enough odana for an entire day, use one cup of rice per person, and mix with two cups water. Bring this to a boil and simmer, covered with a lid. When odana is ready, the rice should be soft, moist, and firm, with no water left in the pot.

Mung beans, split and washed

Mung bean soup
For the purpose of the graduated diet, mung bean soup refers to washed, split yellow mung beans that have had their skins removed. Of all the beans mung bean is generally easiest to digest, and among the different types of mung, the washed/split mung bean is best for weak digestion. For a medium-framed individual, use ¼ cup of the dry beans, per meal. Thus to prepare enough mung bean soup for an entire day, use ½ cup per person.

To prepare the beans, soak them overnight in water, drain, and then add fourteen (14) times the amount of fresh water. For both meals for a single person, this would be equal to ½ cup of mung bean to seven cups water. To this mixture add a few thin slices of ginger root, bring to a boil, simmer, and cook uncovered until the beans are very soft and look blown apart. Stir frequently during cooking especially as it is coming to boil to prevent burning, and continue to stir periodically thereafter.

There are two types of mung bean soup: one that is unflavored and unsalted (akrita yusha) and another that is flavored with salt, spices and served with some fermented foods (krita yusha). When preparing akrita yusha do not add any salt, but with the krita yusha you can add ½ teaspoon of salt per person, per day.

Ginger root, fresh

Ginger root
Although technically a rhizome, or an underground stem, fresh ginger root (adrak) is an excellent medicine to prevent the gas-promoting property of any legume it’s cooked with, and is generally helpful for digestion. A few slices of fresh ginger root in water brought to a boil and then simmered makes for a pleasant, digestive-enhancing tea to drink throughout the day during the graduated diet.

Sendha namak, or pink salt

Salt
Generally this refers to sendha namak, also known as pink salt, or Himalayan pink salt. You can also use kala namak, or black salt, which is more warming in nature, as well as rich in both iron and sulfur, and is very helpful digestion is especially weak. Sea salt is a fine substitute for either pink or black salt, and over the long term, may be a preferred source of salt due to its natural iodine content.

Ghee, clarified butter

Ghee
Ghee refers to the pure oil extracted from unsalted, fermented (i.e. cultured) butter, sometimes known as ‘European’ or ‘Old-fashioned’ butter. The quality of the ghee will only be as good as that of the milk, and thus butter obtained from grass-fed cow milk is best. Cultured butter is made by fermenting the cream that naturally separates from fresh cow’s milk, and is very different from the bland, centrifuged ‘creamery’ butter that most people eat nowadays. Mostly notably, ghee made from creamery butter lacks the agni-giving property displayed by that made from cultured butter. Among the different fats, properly made ghee is perhaps best for digestion, but too much too soon will weaken digestion and promote ama, so use cautiously. In the graduated diet, use 1-2 teaspoons of ghee when stir-frying one tablespoon of the spice powder.

A chunk of raw Hing from Afghanistan.

Spice powder
In the graduated diet, the spice powder is a mixture (masala) of culinary herbs that have digestive-enhancing properties, called dipana-pachana in Ayurveda. One useful masala is the powdered herbal formula Hingwastak churna, which is easy to find at Indian grocery stores or online. This formula contains a stinky, garlic-smelling resin called hing (asafoetida) as its most potent ingredient. Hing is not only good for digestion, it helps to ease spasm and colic, and inhibits the activity of disease-causing bacteria and parasites. Hingwastak churna also contains trikatu (i.e. ginger, pippali, black pepper), as well cumin seed, nigella seed, ajwain seed, and pink salt.

While Hingwastak churna is a good choice, there are other herbs to consider too, particularly if the odor of the hing seems unpleasant, or if the formula seems too spicy. Less pungent and milder herbs to consider include the seeds of coriander (dhaniya), cumin (jeera), fenugreek (methi), fennel (sonf), caraway, and dill.

Use the spice mixture or masala by stir-frying one tablespoon of the freshly ground herbal powder in 1-2 teaspoons of ghee at medium heat for 1-2 minutes (do not burn), and use this to flavor both the mung bean and meat soups (krita yusha and mansa rasa).

Carrot pickle, before adding the brine

Fermented foods
Fermented foods refer to live culture vegetable pickles, which contain beneficial lactic acid bacteria that are essential to maintain good digestive health. A fermented food in the graduated diet can be any lacto-fermented pickle prepared without spices, made from any vegetable including carrot, cauliflower, daikon, or cabbage. This does not include any ferments made with fruit, sugar, or grains such as miso, tamari, kombucha, or alcohol. To get the best effect, make sure that the pickles are sufficiently aged (2-4 weeks, depending on season).

Meat soup, mansa rasa

Meat soup
Called mansa rasa (‘meat juice’) in Ayurveda, meat soup is a stated requirement for the traditional practice of sansarjana karma, but can be avoided in vegetarians. To make mansa rasa, fry one pound (half kilogram) of boney meat (e.g. goat, mutton, skinless chicken back) in one tablespoon of ghee, along with one tablespoon minced fresh ginger, one minced onion, minced celery (2-3 stalks), and one tablespoon of your chosen spice mixture. Add 12 cups of water, bring to a boil, secure the lid, and cook at a medium-simmer until the meat is falling off the bone. When done, strain the soup from the meat, and scoop off the fat. Initially, serve just the soup for the first meal of mansa rasa. If it is well-digested, small pieces of the cooked meat can be gradually added into the soup.

An example of a modern pressure cooker

Pressure cooker
A modern pressure cooker is an exceptionally useful piece of equipment that in my opinion should be in every kitchen. It is a wise investment, saving in both preparation time and dramatically reducing the energy cost of cooking. In former times, a failing rubber gasket might cause a pressure cooker to explode, and hence their bad reputation, but nowadays modern pressure cookers have long-lived silicone gaskets, and are very safe.

In ancient times, pressure cookers were big pots with very heavy thick lids, something that today would be a little unwieldy to use. The most practical and best-wearing pressure cookers are made of stainless steel, whereas cookers made with softer, more reactive metals such as aluminum – an established neurotoxin – releases metallic ions into the food during cooking. For regular use, a large and a small pressure cooker together is a versatile combination to feed several people quickly.

A pressure cooker is a quick way to make peya in under 30 minutes, whereas with a regular pot it might take up to two hours. Likewise, using a pressure cooker to prepare the mung bean soup saves about the same amount of time. Pressure cookers are especially useful to make the meat soup, which takes about 60-90 minutes, but up to 8-12 hours in a regular pot without pressure.

Implementation of the Graduated Diet

The graduated diet can be applied over a three, five, or seven day period, for a mild, moderate, or strong effect. It may be continued for even longer periods of time, although generally speaking, the graduated diet is not meant to be taken long term. In some cases it may be necessary to go backwards in the diet (i.e. simpler foods) if digestion is getting worse, and sometimes modifications may be required based on individual needs.

The five phases of the graduated diet
In Ayurveda there are five phases of the graduated diet, beginning with peya and ending with mansa rasa. Vegetarians, however, can avoid this last phase of the diet, and continue with krita yusha.

The graduated diet can be applied over a three, five, or seven day period, depending on the desired effect. A three day graduated diet has a mild effect, and is better for mild conditions, where digestion is only a little weak, and there is only a little ama. A five day graduated diet has a moderate effect, indicated when digestion is moderately impaired, with a moderate accumulation of ama. The seven day graduated diet is indicated for long-standing digestive weakness and a profound accumulation of ama. Each of these regimens is be applied as followed:

[table]Strength,Phase 1,Phase 2,Phase 3,Phase 4,Phase 5
Mild,Day 1 breakfast,Day 1 dinner, Day 2 breakfast, Day 2 dinner, Day 3 breakfast Day 3 dinner
Moderate,Day 1 breakfast Day 1 dinner,Day 2 breakfast Day 2 dinner,Day 3 breakfast Day 3 dinner,Day 4 breakfast Day 4 dinner,Day 5 breakfast Day 5 dinner
Strong,Day 1 breakfast Day 1 dinner Day 2 breakfast,Day 2 dinner Day 3 breakfast Day 3 dinner,Day 4 breakfast Day 4 dinner Day 5 breakfast,Day 5 dinner Day 6 breakfast Day 6 dinner, Day 7 breakfast Day 7 dinner
,,,,
[/table]

  • Phase 1: peya
    During this phase, only a thin rice porridge (peya) is eaten, prepared by cooking one part rice in eight parts water, without salt.
  • Phase 2: vilepi
    During this phase, only a thick rice porridge (vilepi) is eaten, prepared by cooking one part rice in four parts water, without salt.
  • Phase 3: akrita yusha
    During this phase, the rice is prepared as odana, prepared by cooking one part rice in two parts water, without salt. Taken with this rice is an unflavored mung bean soup (akrita yusha), prepared by cooking one part mung bean in fourteen parts water, without salt.
  • Phase 4: krita yusha
    This phase is identical to phase three, except that the mung bean soup is prepared with a little salt during cooking, and after it is ready, mixed with the spice powder that has been stir-fried in ghee. During this phase, a small amount of live culture vegetable pickle (2-3 tbsp) can be consumed with each meal.
  • Phase 5: mansa rasa
    For the final phase of the graduated diet, meat soup is eaten with odana (steamed rice, prepared at a 1:2), along with some fermented foods. Like the preparation of krita yusha, the stir-fried spice powder can be added to the soup, along with a little salt.

Coming off the Graduated Diet

After the graduated diet has been completed, succeeding meals are drawn from the same types of foods, so that as the process of graduation continues, and the graduated diet serves as the basic structure of the every day diet. After completing the graduated diet, the portion size may increase proportional to an increase in appetite and energy requirements.

Adding vegetables
As one comes off of the graduated diet, vegetables can be added back to every day meals. This includes both non-starchy and starchy vegetables. Non-starchy vegetables include leafy greens such as bok choy, chard, kale, cabbage, and collards, as well as green beans, zucchini, peas, and asparagus. When preparing non-starchy vegetables, use methods such as steaming or stir-frying, cooking until tender but maintaining the brilliant color of the vegetables. Starchy vegetables include carrot, rutabaga, winter squash, sweet potato, daikon, and parsnip. To prepare these dense, starchy foods, methods such as boiling, steaming or baking are optimal, cook them until tender and not crunchy.

Urad dal (black gram), split and washed

Increasing variety
After reintroducing vegetables successfully, other foods can be added back to the diet. For example, try mixing the mung beans with washed/split black gram (urad dal, kali dal), or trying a different legume altogether, such as washed/split red lentils (masoor dal) or washed/split garbanzo beans (chana dal). You can also vary the types of grains as well, substituting basmati and partially-milled red rice with safe alternatives such as quinoa, buckwheat, short grain brown rice, or wild rice. If whole cereals or legumes take on any significant role in the diet, they should be fermented during preparation to reduce the high levels of natural plant chemicals in these foods that actively inhibit digestion.

The issue of fatty foods
After the graduated diet is complete, slowly introduce more fatty foods into the diet. Although fat has been much maligned in recent years – a trend that now appears to be reversing – Ayurveda has long stated that the consumption of healthy, fatty foods is an important element to promote youthfulness and long life.

The problem with fat is that among the macronutrients it is the hardest to digest — and if digestion is weak — its consumption is most likely to result in the production of ama. Many people avoid eating fat because they can’t digest it well, but as the ability to digest fatty food diminishes, the entire body and especially the brain and nervous system becomes dry and deficient, promoting disease and aging. When digestion is strong, most people find that they function best when eating heavy, dense, fatty foods on a regular basis. These foods supply a dense source of nourishment that is slowly oxidized, nourishing the body and stabilizing the nervous system. Such heavy foods should be consumed during the early portion of the day – when digestion is strongest – saving lighter burning carbohydrate-rich food towards the end of the day.

Using the analogy of a wood stove, dense fuels like cherry, birch or fir are known to generate a lot of heat for a long time, something that might be added to the stove in the morning to keep the house warm during the day. But come evening, unless its really cold, it’s unnecessary to build a big fire when it’s time to go to sleep. In this same way do heavy, fatty foods eaten earlier in the day provide a more stable and prolonged supply of energy. Likewise, carbohydrate foods are best eaten when digestion and metabolic activity is decreased, towards the end of the day. This allows these lighter fuels to be burned at a slower metabolic rate, avoiding the peak and valley effect when carbohydrates are rapidly digested.

For vegetarians, fatty foods such as eggs and dairy should be introduced back into the diet. For example, fresh yogurt with a little honey can be taken in the morning on an empty stomach, or a cup of hot milk before bed. Unripened cheeses such as panir, cottage cheese, and feta cheese can also be introduced back into the diet, eaten with meals. In order to avoid inflammation, dairy products should come from A2 milk (e.g. Desi, or “Indian” cow), but if this is not available, goat, sheep, or water buffalo dairy can be used instead.

For non-vegetarians, prepare most or all of your meat by stewing, braising, or poaching methods. Grilling, roasting and baking, which cooks meat by drying it out, also makes it harder to digest by damaging both fats and proteins, resulting in the production of cancer-causing heterocyclic amines, lipotoxins, and glycotoxins.

To maintain proper digestion avoid eating raw and cold foods such as salads and ice water. Digestion requires a significant expenditure of energy, and raw foods require more energy for digestion, and many of these foods contain components that are inherently indigestible or even toxic. Physically cold foods such as ice cream, cold smoothies, and ice water serve to shock the digestive tract, forcing blood and circulation away from the epithelial surface, inhibiting chemical digestion and nutrient absorption.

Understanding all these factors, try to avoid extremes, listen to your body, and work towards maintaining a diet that is built upon this model of a graduated approach. Even with the best of diets, the reality of our constantly changing world means that digestion is affected regardless. Stress, infection, climate, and aging are only a few of the factors that affect digestive health, and are sometimes unavoidable. What the graduated diet provides for is a model of eating that allows you to adapt to the natural waxing and waning that happens with any fire, both resetting and fine-tuning your digestive fire whenever its required.

Ayurveda In Nepal: free lecture

Ayurveda In Nepal: free lecture

I was introduced to the Bajracharya medical tradition of Nepal by my colleague Alan Tillotson, author of the highly acclaimed One Earth Herbal Sourcebook. Alan had met the late Dr. Mana Bajra Bajracharya somewhat by chance when he traveled to Nepal in the early 1970s, suffering from the effects of poorly controlled type 1 diabetes. Through Dr. Mana’s skill Alan was restored to health, and since that time, Alan maintained an ongoing relationship with Dr. Mana until his death in 2001.

Known locally and internationally for his healing skills, Dr. Mana authored over 40 books on Ayurveda, and in 2000, Alan asked me to help with the publication of these works. In 2009, I finally traveled to Nepal to meet Dr. Mana’s son, Vaidya Madhu, and shortly thereafter we published the first of Dr. Mana’s work as Ayurveda In Nepal. This book is detailed compendium of the traditional theories and practices employed by Dr Mana, drawing from the 800 year old medical tradition that he inherited as part of the Bajracharya lineage.

Although Ayurveda is typically thought of as being a Hindu practice, during much of its development it was strongly influenced by Buddhism, and many notable teachers of Ayurveda including Vagbhata (author of the Ashtanga Hrdaya, c. 7th cent CE) and Nagarjuna (author of the Rasaratnakara, c. 10th cent. CE) had a Buddhist orientation. One major center of Buddhist Ayurveda was in Eastern India near modern-day Kolkata (Calcutta), at Nalanda university, which attracted scholars from all over the world. While Nalanda was eventually destroyed by invading forces in the 12th century, its teachings and practices have been maintained ever since by the Bajracharya lineage of Kathmandu, Nepal.

On March 8th, join me for a lecture that explores Ayurveda, Buddhism, and the Bajracharya medical tradition of Nepal, drawing from the work of Vaidya Mana Bajra Bajracharya. At the end of the lecture, I will discuss an opportunity to visit the Kathmandu valley in early 2017, to study the tradition and practices of Ayurveda in Nepal.

Register for this free webinar!

ayurvedainnepal_banner_6

Āyurveda, diet, and psychosis

Āyurveda, diet, and psychosis

After my recent post on Vegetarianism and Ayurveda, I received a question from a reader, who was curious about why I said that in Āyurveda, there is scant reference to the preferment of a vegetarian diet as a therapeutic tool, except for the disease of unmāda (psychosis). To explain myself better, I want to provide a little background on the disease to provide some more context.

The term unmāda is derived from the Sanskrit root words ud, meaning ‘upwards’, and mad, which refers to the capacity to ‘excite’ or ‘exhilarate’. According to Āyurveda the life force called prāṇa is received by the body not just through the lungs and digestive system, but also through the top of the head. This prāṇic energy descends downwards to guide the formation and maintenance of our bodies, connecting through our feet to the earth, from a state of etheric potentiality to one of physical manifestation. This energetic flow is symbolized by the downward-pointing triangle, representing the feminine principle. In Āyurveda, this downward moving energy relates to a subset of prāṇa (or vāta) called apāna vāyu, that roots itself in your abdomen after your first breath at birth, to become the ‘mother’ prāṇa, regulating all the other subsets of prāṇa.

yoniyantra

It is the downward-moving flow of apāna vāyu that promotes and regulates human consciousness, and a derivation of this pattern can promote disturbances of the mind. In an earlier post on anxiety I made reference to the idea that this condition is in large part caused by unexpressed creative energy. This creative energy is expressed by apāna vāyu, and a failure to properly release this energy over-excites it, causing it to rise upwards and disturb the heart. Although we like to think of the heart as nothing more than a simple pump, in both Āyurveda and Chinese medicine, as well as many other systems of traditional medicine, the heart is the seat of consciousness. By disturbing the function of the heart, the excitation and upward movement of apāna vāyu results in a disturbance to the manovaha srotas which allow for the expression of consciousness by the brain. By aggravating apāna vāyu, the pathology of anxiety in Āyurveda very much relates to the disorder of unmāda, and can even be a cause of a specific type of psychosis, called śokaja unmāda. While overt cases of schizophrenia are only thought to affect about 1% of the population, the prevalence of anxiety in our society appears to be increasing dramatically.

As a disease, psychosis or schizophrenia is a condition that exists independent of culture, religion, or race, and is found all over the world. The signs and symptoms appear to be equally distributed in both men and women, although the condition often appears earlier in men, usually in the late teens to early twenties, whereas for women the condition typically appears somewhat later, in the twenties to early thirties. There are several biological theories to explain the cause of schizophrenia, most built upon the concept that it is caused by physical abnormalities of the brain, and more specifically, neurochemical defects. This includes the idea that schizophrenia relates to a relative dopamine excess, or from the antagonism of NMDA (N-methyl-D-aspartate) receptors in the brain. While both these theories are conveniently structured so as to support the use of powerful antipsychotic drugs, such as as clozapine (which blocks dopamine) and cycloserine (an NMDA receptor agonist), there are other explanations too.

The single-carbon hypothesis is based on the observation that disturbances of the single-carbon folate pathway can lead to schizophrenic symptoms. This metabolic pathway provides carbon groups for a variety of chemical reactions in the brain, including the synthesis of the amino acid methionine. Several studies have shown that methionine metabolism is impaired in most schizophrenic patients, apparently caused by enzyme deficits in the folate pathway. While the relationship that these feature shave to neuronal transmission is entirely clear, it does support the work of practitioners such as Abram Hoffer who used B-vitamins such as folic acid and vitamin B12, that play a key role in methionine metabolism, to successfully treat schizophrenia. Likewise is there good evidence that deficiencies of other nutrients such as essential fatty acids (EPA/DHA), and vitamin D3 may play a role in psychosis.

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According to Caraka (Ci 9), Suśruta (Utt 62), and Vāgbhaṭa (Utt 6), the cause of unmāda (psychosis) is separated into two basic forms: that which arises innately to the body and mind (nijottha unmāda), and that which arises from external factors (āgantu unmāda). That which is arises from external factors is called devādikṛta unmāda, the term ‘deva’ referring to ‘possession’ by the graha (spirits), each type (e.g. deva graha, gandharva graha, yakṣa graha, etc.) exhibiting peculiar behaviors that allow it to be identified. Treatment for this particular form of unmāda comes under the purview of Bhūtavidyā tantra in Āyurveda, which delineates five separate types of treatments, each of which corresponds to a specific sense, i.e. smell (e.g. incense), taste (e.g. food), sight (e.g. yantra), touch (e.g. massage), and hearing (e.g. mantra). While certainly a foreign concept within modern medicine, this type of therapy has nonetheless been shown to have a powerful influence for what appear to be untreatable mental illnesses. In particular, as hereditary Buddhist priests of the Bajracharya lineage, my colleagues in Nepal have been practicing Bhūtavidyā tantra for 800 years, and have a record of their successes over the centuries.

Among those types of unmāda caused by innate factors (nijottha unmāda), there are five types: three for each doṣa, one for a combination of all three doṣa(s) (called sānnipātika), and one type caused by emotional disturbances (śokaja). There are, however, several factors that generally predispose one to become victim to unmāda. This includes failing to observe a proper dietary and lifestyle regimen, indulgence in alcohol and other inebrients, tāntrika practices, and disrespecting “gods, teachers and brahmins”. Certainly altered circadian patterns is a common finding among schizophrenic patients, as is a failure to obtain proper nutrition. Alcohol addiction and powerful psychoactive substances too can disturb the equanimity of the mind, and can lead to psychosis. Suśruta’s warning against improper tāntrika practices is germane, providing insight into the dynamic of a premature kundalini awakening, recently classified in the DSM IV as a “Religious or Spiritual Problem“. Lastly, while disrespecting “gods, teachers and brahmins” seems to be specific to Hindu culture, I believe that this simply refers to behaviors that are actively antagonistic to commonly held social values, leading separation and ostracization, and the emotional and mental stress that results.

Vātaja unmāda is identified when the patient has an unkempt appearance, speaks harshly, demonstrates breathing problems, is a picky eater, and exhibits symptoms of coldness, emaciation, and painful throbbing of the limbs and joints. The patient can often be seen to be clapping their hands repeatedly, singing, dancing, shouting, and wandering about. Patients suffering from pittaja unmāda complain of visual hallucinations, thirst, perspiration, burning sensations, an increase in appetite, and insomnia. They can be observed to retreat from hot or warm things, preferring the cold, shade, wind and water. Patients suffering from kapha unmāda complain of vomiting, poor appetite, aversion to food, lethargy, poor concentration/comprehension, sleepiness, and a desire for warm things. The sānnipātika type displays aspects of all three doṣa(s).

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Śokaja unmāda relates to emotional disturbances, caused from both within and without, both real and imaginary. As I made the point earlier, this type of unmāda relates to severe emotional stress, such as anxiety. In some cases, unmāda relates to the consumption of certain poisons, called viṣaja unmāda, noted by signs such as redness of the eyes, an alteration in perception, loss of bodily control, bluish discolorations, and a loss of consciousness. While considered a type of psychosis, the line of treatment for viṣaja unmāda concerns the specific use of antitoxin remedies described Agada tantra (agada, ‘antidote’), the branch of Āyurveda that concerns the treatment of poisoning.

The treatment for the various types of unmāda depend upon the etiological agent involved. For vātaja unmāda, the primary treatment is snehapāna, ‘oil-drinking’; and abhyaṅga, ‘massage’, followed by svedana (‘steam therapy’), utilizing gentle laxatives beforehand if the patient is constipated. For kapha and pitta unmāda, a course of panca karma is applied, consisting of snehana (oil massage) and svedana (sudation), followed by vamana (therapeutic vomiting), virecana (purgation), and vasti (therapeutic enema). Additional measures for psychosis include śiro virecana (‘head enema’), anjana (eye sales), avapiḍa nasya (nasal medication), dhūma (medicinal smoking), and rakta mokṣaṇa (blood-letting).

In the treatment of unmāda, Caraka, Suśruta and Vāgbhaṭa also mention the utility of aged ghee, called purāna ghṛta, which is stated to alleviate all three doṣa(s). Important herbal formulas mentioned in these texts include Mahākalyāṇa ghṛta, Lasunādya ghṛta, Brāhmi ghṛta, and Phala ghṛta. Individual herbs used in the treatment of unmāda, both internally and/or as incense, include brāhmī (Bacopa monnieri), hiṅgu (Ferula foetida), jaṭāmāṁsī (Nardostachys grandiflora), haridrā (Curcuma longa), guḍūcī (Tinospora cordifolia), vacā (Acorus calamus, śankhapuṣpi (Evolvulus alsinoides), and jyotiṣmatī (Celastrus paniculatus). Śokaja unmāda, or psychosis caused by emotional stress, is also addressed by reversing or ameliorating the underlying emotional state utilizing a variety psychological, behavioral and spiritual techniques.

With regard to the subject of diet, the instructions given by Caraka, Suśruta or Vāgbhaṭa are rather terse, and somewhat open to interpretation. Suśruta clearly states that a barley gruel prepared with the powder of parched barley grains should given to the patient every third day, but that otherwise, the diet should be palatable and appetizing to the patient. For the treatment of unmāda related to the doṣa(s), the application of the graduated diet is important to restore digestion before the application of panca karma, followed by doṣa-specific dietary regimens. While this isn’t specifically stated, this would logically include some animal products – particularly with regard to the treatment of vāta-type psychosis.

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There remains, however, some confusion in both Caraka and Vāgbhaṭa’s writings, with regard to the consumption of meat in the treatment of psychosis. On the one hand, there is clear reference by Caraka to the utility of meat, specifically following the application of rakta mokṣaṇa (blood-letting). Here Caraka states that after treatment, the patient should reside in wind-free location, and eat ghee and meat until satisfied – no doubt to restore the body after such an invasive treatment. A contradiction seems to arise, however, near the end of the section on unmāda, in which both Caraka and Vāgbhaṭa make the exact same statement:

निवृत्तामिषमद्यो यो हिताशी प्रयतः शुचिः|
निजागन्तुभिरुन्मादैः सत्त्ववान् न स युज्यते||९६||

nivṛttāmiṣamadyo yo hitāśī prayataḥ śuciḥ
nijāgantubhirunmādaiḥ sattvavān na sa yujyate

If you look for an interpretation of this verse, it is most frequently it is understood to mean that:

“A person who abstains from eating meat and drinking alcohol, eating only wholesome food, who is disciplined and pure, with a strong will, does not get afflicted by psychosis.”

One problem here is the word used for ‘meat’ (āmiṣa), which while it certainly can mean ‘flesh’, it also means something that we might ‘lust’ or ‘long’ for. Hence, the connotation here isn’t simply a reference to eating meat, but a ‘lust’ for meat. In this regard, lusting for anything disturbs the equanimity of the mind, and is a causative factor in mental illness. Nonetheless, I am well aware that this is my interpretation, and that others will probably disagree. And so if we stick to the conventional interpretation, then it is here in both Caraka and Vāgbhaṭa, but not in Suśruta, that we have this distinction around the role of meat consumption in unmāda. Hence, this is the source of my reference, in my earlier blog on Vegetarianism and Āyurveda, that there was some discrepancy around the use of meat in the treatment of psychosis.

If we peruse other important classical texts, however, such as the Cakradatta or the Bhaiṣajyaratnāvalī, we find specific recipes that call for the use of meat in the treatment of unmāda. The Cakradatta states the uncooked flesh of the sparrow pounded with milk and sugar is useful in unmāda, as is the use of the herbal formula daśamūla in a meat broth (māṃsa rasa). In the Bhaiṣajyaratnāvalī, the author Bhiṣagratna suggests the cooked flesh of the cuckoo bird restores memory and normal conscious in the patient suffering from unmāda.

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So what are we to make of the suggestions found in Caraka and Vāgbhaṭa that eating meat is a cause of psychosis? Considering that no mention of this is made in Suśruta, which in its current form is the oldest of all these texts, it could be that this verse was simply appended to these texts by later commentators. This type of thing is fairly common in Āyurveda and there are often a few different versions of these classical texts, some of which are still hidden away by family traditions. My Bajracharya colleagues in Nepal, for example, have a vast collection of palm leaf manuscripts, including that of the Caraka saṃhitā, that has never been carefully compared and contrasted to the existing sources.

As you can see, my mind struggles with the suggestion found in Caraka and Vāgbhaṭa, because it is contradictory, and, doesn’t conform to my empirical experience. As I stated previously, schizophrenia seems to exist independent of cultural factors such as diet, and is found in both vegetarian and non-vegetarian populations. Over the years, I have helped a number of people suffering from schizophrenia, and because the pathology most frequently involves the primary citation of vāta, a meat-based diet has almost always seemed helped to ‘ground’ the patient. Among the patients I have worked with, some have also been committed life-long vegetarians, contradicting the interpretation of the verse in question, that those who “abstain from eating meat… do not get afflicted by psychosis”.

As my earlier post indicates, the vitamin B12 deficiency commonly found in vegetarian populations is an important factor for the development of psychotic symptoms. Found in 81% of the Indian population, this deficiency leads to a functional folic acid deficiency, impairing the synthesis of S-adenosyl-methionine (SAMe), causing to widespread neurological damage. This is why among the typical symptoms of a vitamin B12 deficiency, such as diminished energy and pernicious anemia, there are often clear indications of mental changes, including depression, psychosis, and dementia. While a vitamin B12 deficiency is certainly not the only cause of unmāda, it can be easily remedied by following a wholesome, balanced diet. And I think we can all agree that this a prerequisite of both physical and mental health, whether you are vegetarian or not.