Supplements recommended - CCF tea, Buttermilk, Cumin, Himalayan salt, Coriander, Triphala Guggulu, Honey, Ghee, Chandanadi Thailam, Himasagara Thailam, Udichya, Chandana, Ushira, Ela, Musta, Amalaki, Dhanyaka Hima, Dhanyaka, Ksheerabala Thailam, Anu Thailam, Vidarikanda, Punarnava, Shatavari, Gokshura, Kalyanka Gritham, Sukumara Gritham.

Vaidya - Namaste everyone listening to the Athreya Herbs practitioner podcast. We welcome you to this continuing learning experience through Athreya Herbs. Our intention and thought process behind these podcasts is to help our practitioner community with quality Ayurvedic knowledge as far as the clinical management of Ayurveda cases is concerned. My name is Vaidya Jayagopal Parla, I go by Vaidya Jay. Today Cheri Michel is back on our podcast by popular demand. Cheri is a practitioner-level graduate of Southern California University of Health Sciences and is practicing in Southern California under Desert Ayurveda; that’s her healing and clive. Welcome again, Cheri, to this practitioner support podcast.

Cheri - Thank you, Vaidya Jay. It's a pleasure to be here. Thank you so much for having me back.

Vaidya - We have a wonderful case again. Every time Cheri brings these complex cases, our effort shows how Ayurveda can work with these cases. Cheri, first, I will chant and invoke the Dhanvantari, and then you can start narrating the case history.

Cheri - Okay.

January 17, 2022 |  51 minutes.
By Vaidya. Jay Parla. 

 

Vaidya - Om Namami Dhanwantrayam Aadi Devam, Surasura Vanditham Pada Padmam, Loke Jara Rugbhay Mrityu Nashakam, Datharam Eesham Vividhaushadhinam.Om Shanti Shanti Shanti Hari Om. May Dhanvantari guide us in this case management and discussion. Thank you, Cheri; please go ahead and present your case to us.

Cheri - Thank you, Vaidya Jay. This is a complicated case. I'm so grateful to have the opportunity to learn from this woman and to present it to you. Thank you again. The patient is a 61-year-old female, 5'6” and 98 pounds. She has struggled with anorexia since the age of 14. A doctor had told her that she's going to be fat and it's her destiny. It bothered her and was something she never forgot. I'm sure there are some other underlying issues as well because she traveled her whole life with this condition. She began long-distance running, working out seven days a week, and being anxious about skipping any kind of exercise. After exhausting all other options, she came to me and was referred to me by a doctor friend of mine, a chiropractor. She is at her wit's end and has chronic diarrhea, burning tongue-mouth syndrome since about 2003 - 2004, which came on after a stressful time in her life. She was experiencing burning tongue, and rest, sleep, and anti-stress activity seemed to be the alleviating factors. Any kind of stress seems to aggravate it. She can't pinpoint, but certain foods sometimes aggravate it and sometimes don't. The same food may or may not aggravate it. I think it depends on her stress level and the time of day she's eating; I am not sure. She experiences excessive thirst, has a lot of anxiety and fear around food, and eating. She fears that whatever she will eat might trigger the burning mouth and cause diarrhea. She experiences crampy and painful gas at times and suspects that there's some kind of a lower GI issue going on. She is often nauseous in the morning and told me that she's starving. She was in tears while telling me that she was starving and needed nourishment and was looking for a teacher to tell her what to do. She said she wants someone to hold her hand and support her. Ironically this woman has a master's degree in nutrition. She said that she helps people but can’t help herself, and that's where she needs someone to help and guide her. She has heard about Ayurveda before but claims that she wasn't ready, and now's the time when she's ready to do whatever it takes to feel better and become nourished. She has cravings for fat and salt; sometimes she just takes a spoonful of sour cream and eats that. She has had chronic diarrhea since the anorexia condition started. In the past couple of months, diarrhea has been occurring in the middle of the night. Sometimes she gets up four or five times and also urinates a lot. She gives herself coffee enemas once a month, and it's interesting that I didn't find this out until much later. I spent about three hours trying to get all the information and providing support to her because she was emotional and a little unstable. I just wanted to provide an opportunity by listening to her. I got this information towards the end and thought it's interesting that she gives herself coffee enemas once a month for headaches. She experiences a little bleeding, probably from the tear around the tissue, and sometimes has mucus in her stools. She has also had Lyme disease, but she wasn't too concerned about that at this time. She thinks she may have Ehlers Danlos Syndrome, which I never heard of, but it's a rare genetic connective tissue disorder. She also suspects that she has Reynaud syndrome, and her hands and feet are very cold with discoloration around her fingers. I did look at her hands, and they were quite discolored around the fingers, red around the fingertips. She said she has fungus on her toes that will not go away, and adrenal depletion, chronic pain, describes a fire feeling within like she's burning inside. She also feels empty, especially in the morning, and is hypersensitive to everything, and her body just has this overreaction to everything. She's done many tests, such as SIBO, H. pylori, and Candida; nothing seems to come of these tests. She’s still in the process of trying to find out what's going on. She's done some parasite testing and treatment even though she's not convinced that she has parasites. After going through all of this history with her, I was able to get her to my yoga class. I teach on a Saturday morning, and I said you should come and try yoga, do a lot of breathing, and a gentle practice on Saturday morning. I was happy to see that she came and she did the whole class. It was on Zoom, and I could see her getting up and coming back, again getting up and coming back; she was distracted, yet she kept coming back. She wants to apply whatever we give her because she's so anxious to have some kind of a solution to this. I don't know if I missed anything here about all those details, but I did get into the personal history. She has a master's in nutrition and is now retired. She is up all night, does not sleep, and gets up at 7. She says she wakes up in fear regarding food. She was on hormone therapy and isn’t now. She has a lot of fear around food and pain, and she feels empty. She is married and has a supportive husband, but they are platonic. They're friends. She has a difficult relationship with her mother, and there was a lot of emotion when we talked about her mother. Again, sometimes the food will trigger the mouth, the tongue burning, and sometimes won’t. Her tongue looked very dry right down the middle. She'll have breakfast, but sometimes she doesn't. She doesn't seem to eat it at regular times. Being in conversation with her for the past 3 or 4 days, I noticed that being her sounding board or someone she can reach out to has helped her a lot. Yesterday and today morning, she texted me that she just woke up feeling some hope because I gave her some things to try. I gave her CCCF tea, she was concerned about the spices burning her mouth, but then she did quite well with it and liked it. I was happy to hear that, and I talked about making Takra. I gave her the recipe, and she got emotional at the thought of drinking this buttermilk. I said, this might be good for you to try, and she immediately got fearful and said I don't know if I can. Even though inside she wants to eat it badly, she immediately goes to I don't think I can. I think she tried that and is doing okay with that so far. The trial and error, trying different things to see what works, is all I know to do with her right now. I was a little hesitant to prescribe any herbs because she needs more emotional support, and she needs to get on some kind of a feeding schedule and get her built up. She needs Brimhmana big time and to control diarrhea.

Vaidya - Thank you, Cheri. Any medications or supplements that she's taking?

Cheri - She brought a bag full of medicines.

Vaidya - That's what I thought.

Cheri - Yes, a bag full of different medications. She's taking medication for her thyroid. She's not big on medications, I should back up a little. She doesn't take medication,  she takes a lot of supplements—a lot of digestive enzymes. I took pictures because I could not write everything down; there were so many. The only pharmaceutical medication that she takes is for her thyroid.

Vaidya - Otherwise, it's all supplements and nutrients. I will get to the history in some aspects of it as we go; I may ask you a little more information. I got your complete intake to look at, but you will be a better person because I appreciate your patience in taking a three-hour intake with your patient. I say that because sometimes people have lost hope and reinstalling that hope may take even longer. All our practitioner friends should be ready to be disappointed sometimes in these types of cases because everything becomes very critical in terms of the patient's mind. If she was an ordinary person who did not have much clue about nutrition, it would have been easy for us, because she has a master's in nutrition, which makes our work harder. The first thing that I would say is to use only Ayurvedic terminology and explanation in this case. Using any bio-Medical language translates differently in this patient's mind. Always use Agni, Ama, Dhatu, Shaya dhatu Vriddhi. If she asks what that is, give her a broader comprehensive meaning or definition of what you're saying, it will help you to a great extent. I'm giving all our practitioner friends a clue how to work with complex cases, not in terms of herb and diet choices, but communication. Communication is important because the history and length of the condition go back to her teenage years, which is probably 50 years from now when she was about 11 to 13 years old. The next 45 to 50 years are spent proving a point. Her entire life the patient is proving that she will not look fat or gain weight, which she is destined to. The seed of her fear was planted when the doctor told her she was going to be fat. Bhaya janya has different types of Annabhilasha. Annabhilasha in the sense of lack of interest in food,  Annabhilasha developing her personality,  this challenge was thrown at her, and she's still proving that she won’t gain weight. It is not relevant, but she is fixated, and her life for the last 45 to 50 years has become a fight against the fat in her body.

Cheri - Yes

Vaidya - If you look at the Doshas in the long elongated history, there is a flow of Pitta and Vata doshas, one or the other is showing up. Nausea, connective tissue disorder, Reynaud's disease, sleep issues, these are all Vata Doshas, and chronic diarrhea, burning sensation, thirst, nausea are all going towards Pitta. The condition is gradually brought up from the mind (Manovaha srotas), and then it becomes a food attachment issue. Whenever she gets attached to any food, it becomes a trigger for fear. Maybe the same thing was with her mother, I’m not sure. If she gets too close. Is she fearful of her mom?

Cheri - Yes, she got emotional talking about her mother. She said her mother is very difficult to deal with and is judgmental.  She has had a hard time pleasing her mother her whole life, not feeling good enough.

Vaidya - There is an attachment towards food and mother. In the five elements, space, air, fire, water, and earth, the most attaching element is the water. This attachment has gradually gone into her Udaka Vaha Srotas, and talu (upper palate) the root or regulating organ of the Udaka Vaha Srotas, and that's why mouth burning, excessive thirst, and chronic diarrhea is happening. It's something to do with udaka vaha srotas and not with the annavaha srotas. The symptoms of annavaha srotas are nausea, diarrhea, bleeding in the stools, and mucus. Ultimately, the udaka vaha srotas involve annavaha srotas. This attachment is dealt with by a wise detachment that is anorexic in the beginning and then making hard choices, like her diet. She would have eaten a bowl of cereal or small shredded vegetables, and that would have been her meal for the day.

Cheri - She'll have a spoonful of sour cream, which was interesting.

Vaidya - Deal with it as a harsh detachment, say,” I'll give it to you, and this is it.” The udaka vaha srotas (fluid-carrying channels) are completely disrupted as she desperately tries this detachment. Even taking coffee enemas is to think that there is something attached to the gut. This is the mental framework or construct that she has going on with her gut, it is attached, and I need to remove it by any chance.  Take an enema and take it out attitude has become her way of perceiving detachment from the initial unhealthy attachment that she had. I don't think she has any parasitic issues, it can be H pylori or SIBO or something like that. It is mostly because the udaka is less, udaka is a huge srota and is responsible for supplementing other dhatus like Rasa to Rakta, Mamsa, Shukra dhatu. All of these get their fluid from the udaka vaha srotas.  The udaka vaha srotas is the STHANA SAMSHRAYA , which means dosha prakopa of Vata and Pitta doshas have increased, they have moved along with the Ama that was generated a long time ago and has created abnormal pathways into the udaka vaha srotas. The configuration or the healthy structure of the udaka vaha srotas is completely disrupted or destroyed. The water kind of leaks out from udaka vaha srotas like she is experiencing diarrhea especially between two o'clock and early morning she will go 4 to 5 times, which is around Pitta time. This entire process begins when Pitta and Vata consent. Pitta begins around 1 to 2 a.m. and continues until Vata, which occurs around 6:30 a.m.These 4 to 5 hours Vata and Pitta increase due to her sleeplessness, fear, and detachment issues,  will do sanchaya prakopa prasara and sthana samshraya udaka vaha srotas, which is because the primary attachment is the cause for this disease.  Am I making sense for our listeners here?  Cheri, are you getting the idea of what I'm trying to communicate?

Cheri -  Yes, she needs counseling.

Vaidya - Counseling may not be the thing, Cheri. She needs a multi-pronged approach. You said that she can have takra, which is made from yogurt, by churning the fat out and adding Himalayan salt, cumin, and things like that. She may drink it for one week; afterward, she will have that attachment issue, again, to this buttermilk. You suggested the CCF tea, she will drink it for about 15 days, and then again, the attachment issue will pop up. This attachment is what you need to deal with by constantly changing her horrible recommendations. Then the attachment issue will not show up that quickly. Also attachment to you now.

Cheri - I feel that she's texting me in the morning. I want to help and support her and hopefully, guide her but oh my goodness.

Vaidya - It will be difficult to deal with, and if you don't respond in time, she will start detaching from you. Just be aware, that's what I said to all of our listeners today. This is a case where you may be put into a challenge, you should not be discouraged by these cases. It's such a long-hard pathology that has taken place over 45 to 50 years, and to reverse it with a few Ayurvedic herbs is not possible. You need to involve the patient in multiple areas, "I'm doing a yoga class; come join me." I'm doing a cooking class or public talk; come join me." "These are your resources; read through these." Things like that will keep the person a little more informed and involved in the healing process. Where do we start in this type of case? Even though there is no direct correlation to the purisha vaha srotas and diarrhea. In Ayurveda, diarrhea is a udaka vaha srota of vyadhi coming from fluid metabolism diseases or pathways. Start with an approach to balance out on purisha vaha srotas, that is colon and intestines, simultaneously udaka vaha srotas. The great Acharyas said that the Udaka vaha srotas tend to dry and accumulate heat. Dry tongue, dry mouth, burning mouth, and even the constant thirst, are indicative of udaka vaha srotas being abnormally affected by Pitta. Okay. You said that she underwent menopause, and she tried the HRT (Hormone Replacement Therapy). How long did she try it, or is she continuing it?

Cheri - She is continuing but currently is not on anything because she ran out and is waiting to get her prescription refilled, but that's not something she's planning on stopping.

Vaidya - This is one thing that you need to educate her on because the more estrogen is given the more burning sensation will increase. Recently, burning mouth syndrome has been in the limelight and is considered an autoimmune disease. I have a few patients who have burning mouth syndrome, and sometimes people will respond within 2 to 3 weeks, and it's gone forever. Sometimes, even if you try all methods, the issue persists and frustrates the practitioner and the patient because it is an autoimmune disease causing the Ojas based in the udaka vaha srotas to deplete. We want to start helping the fluid to remain in the body, especially being absorbed from the annavaha srotas (gut). An easy way of getting to the udaka vaha srotas is to have cold infusions. Cold infusions of Amalaki, Musta, Dhanyaka, Ela, Ushira are the things you should recommend. In the morning, ask her to have six glasses of water, in the first glass, put 1 teaspoon of Musta, in the second glass 1 teaspoon of Amalaki, and in the other glasses 1 teaspoon of Coriander, 1 teaspoon Ushira, and 1 teaspoon of Cardamom. During the day, she would make it and drink only the water, not the powder. Only sheeta veerya dravyas are beneficial for Daha, Trishna, and Annabhilasha (lack of interest in eating). We can make the Himas by soaking them over a period, ideally six hours. The water and the herb should be in the ratio of 1:6. You will add 1 part of whichever powder you intend to use, and, then add the water, you leave it for six to twelve hours, then mix, strain, and drink it. Every day six types of udaka vaha srotas balancing Himas (cold infusions). The external treatment (bahirparimarjana chikitsa) is going to work for this patient. Take the Thailam, that is sheeta guna pradhan. Even coconut oil will work, but one can use Himasagara thailam. Chandanadi thailam is difficult to get, Chandana itself is not available in large quantities, or it is not legal to get white sandalwood. You can use Himasagara thailam or Jathyadi thailam made from Jasmine leaves. Every night before going to bed, these oils must be applied, and the patient should soak or sit in the steam for around 8 to 10 minutes in a good hot tub. It balances the udaka vaha srotas, Udaka refers to water elements as well. The warm oil and warm bath will externally help udaka vaha srotas. In the same scenario, you suggested takra, and I appreciate your bravery; usually, people are not comfortable with these health conditions, and as a practitioner, you will have to think twice before suggesting something made from dairy products. If the dairy product is not digested, it can become much more hindrance to the udaka vaha srotas. The takra can be used as Cheri suggested or something which is made from almond milk or coconut milk or even oat milk. These things can also be used with female nourishing herbs when I say female nourishing herbs, which include Vidarikanda,  Punarnava, Shatavari, Gokshura. These powders can be boiled with milk, then strained and administered once in the morning and once at night. This is to bring in the poshana. Poshana is a word used in Ayurveda to bring suitable nourishment or suitable nutrients for udaka vaha srotas. You boil it with milk and drink it once in the morning, and once at night is recommended. The patient will feel a little more grounded, and herbs, like Shatavari and Vidarikanda, are good for balancing hormones. You're looking at a good type of healthy attachment, and once you do that, give her a good amount of literature to read through. What is Shatavari, Punarnava, Gokshura doing? Online, you will find some information that is suitable for these common Ayurvedic herbs. You have the milk concoction, cold infusion, and you can also use Guggulu preparation, not in large quantities because she's only 98 pounds, any Guggulu will be a little stronger. You have to use it in small quantities. The quantity and type of Guggulu that you can use are Triphala Guggulu. It will help with diarrhea and in the burning, bleeding after the bowel movements because of continuous wiping. A condition like Reynaud's disease, toenail fungus, will improve when you take the Triphala Guggulu. Triphala Guggulu can be taken, 1 in the morning, and 1 at night with the food. Having said all of this, we can never forget how to structure her diet. The suggestion is don't put a huge diet program for this patient, these types of patients are super-critical, and if you give something, they will do research and get back to you saying, is this what I'm supposed to have? 

Cheri - She's already doing that.

Vaidya - Be ready for more of those. If you're confident, take her confidence in your hand and guide her, so that whenever she is confident, she develops hope. The two times she did something that you suggested, she woke up with the notion) of something hopeful. That's why in Ayurveda, we have three types of Satva: Avara satva, Pravara satva, Madhyama satva . Mind is meek and weak and depends on others to make choices, to help, and to guide. The second one, Madhyama looks at people and thinks, if they can do it, I can do it. The Pravara satva people you can suggest anything, they will come through. She's Avara satva, which means she has mild mental strength. Lastly, the important thing for us is to hold liquid in the mouth first thing in the morning and last thing at night. Liquid can be Kavala and Gandusha, either mouth fill or mouth Gargle can be done. If you do this, you need to choose the barks of the Banyan tree, which is Vata, Udumbara, Ashvatha, Udumbara. Not all of them are available in the US, but at least you can get the wild fig (Udumbara), and the Ficus religiosa (peepal tree). Barks can be boiled and held in the mouth, you can even put it in hot water and soak it and once it is soaked in, then strain it and put it in the mouth thrice daily. You can add Ghee and honey to this holding in the mouth since the patient is not going to swallow it, she has to hold it in her mouth. You can add half a teaspoon of ghee and one teaspoon of honey. Honey helps to scrape away the Ama, whereas ghee helps to bring in the Vata balance. You can continue this for 2 to 3 months and, in the meantime, ask her to come for Nasya and Shirodhara. In the first week, do the Nasya treatment, and the next week, do the Shirodhara treatment. Alternating between Nasya and Shirodhara for about 45 days. A month and a half will be best for her to recover from the long-term impressions of attachment and discouragement that she is getting from all the diet programs she has followed.  

Cheri - Vaidya Jay. Can I use Ksheerabala for Nasya?

Vaidya - Yes, Ksheerabala will be good. It will balance both Vata and Pitta. If you don't have Ksheerabala, you can use Anu thailam. You can even use both thailam on alternate weeks. Nourishing and cleansing can be done alternatively.

Cheri - What about Abhyanga with steam? 

Vaidya - It would be beneficial. I think cleansing will be good. Anyway, she will be applying the Himasagara thailam or Chandanadi thailam and lying in the bathtub so that externally the water gets influenced by her body. On top of it, if you want to do Abhyanga, that's ok.

Cheri - I have her schedule for Shiro next week. That's what I had planned.

Vaidya - You can do Shiro for one week. She can come once a week for Shirodhara, and the next week you can do Nasya with Anu thailam or Ksheerabala thailam. Either one of them.

Cheri -  Do you mind going back to the cold infusion just for a moment.

Vaidya - For cold infusion, you can use 1 teaspoon of Amalaki in 1 glass of water. Amalaki, Musta, Ela (Cardamom), Ushira (Vetiver grass-root), Dhanyaka Hima (Coriander), Chandana (Red Sandalwood), Udhichya can be used.

Cheri - All of them in 1 day?

Vaidya - You can divide them into six glasses in which you add powder and water, keep it covered, and drink in the morning. If she keeps it in the night, the next morning, she will mix, strain, and drink all six of them.

Cheri - Ok, all six in the morning?

Vaidya - No, throughout the day.

Cheri - She will have these cold infusions (Himas) to drink throughout the day.

Vaidya - Yes.

Cheri - In between her meals?

Vaidya - She can have them in between her meals, during the meals. It can be drunk cold as well.

Cheri - I had a question about ghee or Gritham that you recommended for a different case. You take that right in the middle of the meal because it helps where Bhrajaka Pitta is most active and helps with calming the Pitta. Would that be helpful in this condition?

Vaidya - If you are doing Gritham, do it as a Ushapana (Morning drink). In the morning, she has to take Kalyanaka or Sukumara Gritham and drink it with warm water or warm almond milk. Remember Cheri, too many things will also not be beneficial for her. Just streamline it in a way that is effective for her treatment.

Cheri - The milk concussion is Gokshura, Shatavari, Punarnava, and Vidarikanda all together?

Vaidya - Yes, altogether, each one of them Half a teaspoon. It makes 2 teaspoons of the powder that you will concoct with Almond milk and drink it.

Cheri - That's good. I was afraid to go with herbs and thought more of her diet, but this will give her something to do and focus on.

Vaidya - When she comes for Shirodhara, subtly explain to her generally, we have to move towards the light and leave the past behind. You have to slowly diffuse the Satvavajaya's mind-winning or mind consolidating type of treatment.

Cheri -  That's what I thought if she came to take my Yoga class, I could drop little things throughout the class. 

Vaidya - Shirodhara is one of the best times for that.

Cheri - One more question about healing her relationship with her mother because that seems to be a big factor. There was a meditation group that I have been involved with; it says you should give thanks and gratitude to the sun and your parents first thing in the morning. Regardless of the relationship, we should thank our parents. It helped me heal my relations with my parents, and it might help her.

Vaidya - You can tell her if you can't feel it, fake it. Permit her. It will be useful, and we'll all be waiting to listen to your input on what happened to the patient when she came back the fourth or fifth time to you. What changes you observed, what changes did she feel?

Cheri -I am going to send her to you. 

Vaidya - That's not the purpose. The purpose of this podcast is to empower you to do what I do. 

Cheri - I am going to do my best with the advice that you have given. I appreciate it.

Vaidya - That's what Athreya Herb does. We want our practitioners to have confidence and thrive in their practice.

Cheri - This is a blessing that you are offering for us practitioners. I am incredibly grateful. Thank you.

Vaidya - Thank you for bringing in these wonderful cases and enriching our knowledge. We look forward to having you soon on this practitioner support podcast. Namaste.

Cheri - Namaste, Thank you.