Mahabadata(Constipation) due to Vata Vikruti

Herbs and Supplements used - Gritham, Triphala Gritham, Kalyanaka Gritham, Chitraka, Haritaki, Aragvadha, Hingvashtak, Cumin.

Namaste everyone, welcome to the Athreya Family practitioner podcast series. We bring in cases from our community of practitioners. We talk about these cases in terms of a discussion where the practitioner and I would go through and see how we can improve our skills especially critical thinking skills, herb making skills, and diet and overall structuring program that is the purpose of these podcasts. Today I have Erica Harms back on our podcast- Case discussion. She is so generous to dedicate her time to come back here on our podcast, and she has some of the interesting cases that we try to dissect to see where we can help these patients. For those of you who do not know her, she is an Ayurvedic practitioner. She has graduated from the Southern California Institute of health sciences and is currently practicing in Oregon, building a community around herself to support those people who need Ayurveda. Namaste and welcome, Erica.

Erica- Thank you, Vaidya Jay, for having me on again.

Vaidya- Without any delay, we will go through this simple but very multilayered case. I think our practitioners will be intrigued by this case, it looks like a simple case that we all experience daily, but the patient doesn’t respond quickly.

Erica – Exactly, This is a wonderful patient I have had for quite a while. She is 40 years old, 5’8 tall, about 155 lbs. Her blood pressure tends to run about 100/70. For most of her life, as far as she can remember, she has always had digestive issues, specifically constipation, gas, low BP, low energy, but she is a very healthy person. She is a real estate agent, but she’s also a yoga instructor and as a daily practice. She’s a fantastic eater, and it’s mostly a Vata pacifying diet. She knows a lot about Ayurveda, yoga and she has excellent self-care practices. She is, however, someone who works a lot and has raised three kids by herself. She gets a little bit of support from their father-emotionally and likes to pick up and drop, but financially she is the breadwinner. As far as her allergies are concerned, she does not eat wheat or mangoes because she has sensitivity. She has had 2 Caesareans, has twins, and then another child. She had her tonsils and adenoids taken out at seven years old. When she was born, she had trouble with one of her eyes. I think it was like a wandering eye, and they did a few surgeries like a Lensectomy at two years old and another surgery several years later to straighten the eye, but essentially she has no vision in one eye. As far as medications, she takes Acyclovir for genital herpes, and then she takes a drug called Bisacodyl for constipation when she cannot handle it. She tries to do senna and teas but doesn’t get much success, sometimes she does melatonin for problems falling asleep, and she takes vitamin D. Her cycle tends to be heavy periods. Hence, she had an ablation in 2013, and she still has some spotting from time to time, but that is pretty much not an issue. She doesn’t drink alcohol, and as I said, she eats a healthy – Vata pacifying diet for the most part. Her home life growing up was pretty challenging. Her mother died relatively young from a stroke due to smoking, and I guess, drinking. Her grandmother was living with her until relatively recently because she’s 87 years old. Her dad had an issue with alcoholism and marijuana use, but they still have a reasonably close relationship even though she is more of the parent. When I was looking at her pulse on the left side, it was Vata- Pitta; on the right side, it was Pitta- Vata. It was like a shaky pulse, I haven’t taken it in a minute because I haven’t seen her, but that’s what I have in my notes here. Her tongue was purple; it had cracks and light white Ama present on the tongue. Her voice is clear, though. She’s cool to the touch, medium built, fairly tall like I said, she’s 5’8 and 155 lbs, so she is physically fit and very toned. She has always had this like prolonged digestion and what will happen is she won’t go to the bathroom and end up taking one of those drugs or the Senna Pills or something. She has diarrhea that is depleting; it’s kind of a bad cycle that she is dealing with. She’s also tired as she’s going to bed usually at 11 PM and getting up at 6:30 AM because she has teenage girls and a younger child that’s in- I think, grade 8. They have a lot of activities that she is doing, but in general, she has high energy, and her emotional well-being is excellent. She’s a delighted person, she seems very positive and not highly stressed about everything that is going on in your life because she’s pretty busy. She’s very successful at what she does. She’s single and has been divorced for seven years. She’s been doing this work as a realtor for a long time, and she’s successful and happy with it.

Vaidya - When you started, you said that she is pro- Health, doing the diet, and exercise right. You mentioned her body looks very toned and healthy, yet she has these digestive issues, especially constipation, as her primary complaint. This is happening for quite some time, is that right, Erica?

Erica- Absolutely since she can remember, she’s always had constipation.

Vaidya - Okay, so have you asked her whether she was breastfed or given the formula?

Erica- I think it was probably formula, but I have asked her.

Vaidya - That’s one thing; what happens in most of that age group is that in those times, the formula was pushed as the best nourishment, even better than the breast milk from the mother. The mothers thought it was very convenient to stick this formula into the baby’s mouth, and they would just suck on it and be full within no time, so when that happens, I think the Vata-Pitta- Kapha processing. The gut has the Kapha in the upper, the Pitta in the middle, and Vata in the lower region of these Doshas’ production can be impaired. There will be a constitutional Vata imbalance to start with, which begins in the gut. She has these symptoms from her childhood or even infancy, and then we need to think about using the formula. Now it’s long gone, and we don’t want to discourage her about this formula. That is not my intention here when I’m saying we want all our listeners to know that some kids can manage recipes and grow up okay. In contrast, the people who don’t have a strong enough Koshta or gut there is the right or production or formation of Vata-Pitta- Kapha in the gut would be impaired. Another thing that I found was fascinating is that she is constantly engaged in something. Hence, she is either taking care of her kids, taking care of her business, or working out or doing some exercise. She keeps herself busy, which for our understanding, is the Vata - that is aggravated. We need to keep in mind two things - Koshta is also Vata aggravated, and when we say Koshta here, we are talking about Apana Vata specifically. She is also very active, and it seems like Vyana Vata is also a little irritated. I wanted to see if she had any joint aches, muscle aches, or anything like that she mentioned to you, Erica?

Erica- She has from time to time, so we were doing Abhyangas and follow-ups.

Vaidya- How Long ago did her mother pass away?

Erica – I think it has probably been five years that her mother passed away.

Vaidya- I am asking because I am looking at the possibility of the drive that she has been fear-driven, even though she looks very active and running. All her activities are very well, but deep inside, there is an underlying current of Manas- the mind and the fear. Did you ever notice that she was acting like she was in control of everything but would you say that she had any underlying fear currents?

Erica- I definitely would say yes to that. I noticed that she talks about how she loved eating sweets and cake, but she doesn’t eat these things. She enjoys talking about it, and I think she does have a little bit, but she is very disciplined with that. It’s almost like a deprivation.

Vaidya- She has many cravings, but she is very strict with herself not to do it, and in a way, it may be okay. Is she in another relationship, or is she single now?

Erica- She’s single.

Vaidya- Yes, so one of the things is that she might have a point to prove that she is a great example of a working mother – everybody looks up to her and admirers that she does everything well and according to how a successful woman should be. There might be the drive she has, but underneath, I think all of that is being done with an undercurrent of fear. This is a disclaimer for all our listeners that I might just be speculating, but let us look at where we go with this case here. Has she had any hemorrhoids or fissures in the past because of constipation?

Erica- She hasn’t mentioned any of that.

Vaidya- She had twin pregnancy and another pregnancy. Is it something that she’s unaware of because of the lower part of the body- the Apana Vata being improperly managed and the fear factor affecting the lower part of the gut? Maybe they’re hemorrhoids that are causing these issues. Has she ever checked with the doctor about constipation?

Erica – I don’t believe so, and I think I am not familiar with the medication that I have mentioned, Bisacodyl is probably prescribed, so I would just assume that she mentioned that. That’s how they resolved that issue. I know she likes to do things naturally, so she is just trying to eat healthily and only relies on that when she needs it.

Vaidya- Yes, it’s a prescription medicine. Going back again, maybe there is internal Arshas -the hemorrhoids that may be causing this because she waits for about two or three days and then she takes the pill or the other prescription medicine, and then she will have diarrhea for a day or so?

Erica- Yes, that’s right.

Vaidya- Looking at its pattern, this stool may be formed there, but because of the Margavaroda or blockage or impediment to the normal bowel movement. When she has a bowel movement, she also has diarrhea, but she should have some pebble-like stool with diarrhea. Has she ever given you any detail about the type of bowel movements she has or how it looks when she has diarrhea?

Erica- She usually just tells me that she can’t, like nothing will come out.

Vaidya- Apana Vata, it needs to be aggravated until it is aggravated she has no bowel movement, there will be nothing coming out. Going back to the initial conversation that we started on-the original lacking proper formation of Vata in the gut itself, so the lower part- Katuvipaka creates the Vata, and Vata is generated in the colon region. It may not be formed at all, so you need to push Samana so much with these medications that she’s taking that it gradually turns into Apana and then starts pushing out everything. There is no existence of normally formed Apana Vata. She has to depend on something that pushes her bowel right from taking the help of Samana Vata from the upper GI. That is why she goes to the bathroom, and it’s diarrhea because it’s not pushing it from the colon. In that case, she will have only bowel movements, but it’s coming from the stomach down to the small intestine and then to the large intestine, so everything comes out in a liquid nature. The first and the foremost thing that we would like to do for this patient is to see how we can help the Apana Vata to be formed so that its normal function- Apano Apanagaha, It is in the lower part of the GI in the lower intestines, Koshta, lower Koshta, Media, Basti, Uru, in the external genitalia. I would like to find out if her divorce was for a specific reason or there was a conflict or not enough support?

Erica- She’s been married twice, and the first time she married someone who was older than her but very irresponsible and was having a hard time holding a job and was not very helpful with their children. She had to be the breadwinner. The other person that she married was a bit emotionally supportive, but with all her relationships (with her mother, grandmother, and father), she seems to be the one who is the caretaker and the breadwinner with a lot of responsibility.

Vaidya- That makes sense; she has to hold space for so many people. We had asked about her menstrual cycle, and you mentioned that her menstrual cycle is very irregular.

Erica- Her menstrual cycle was very heavy, and she had an ablation done seven years ago. Once you have an ability and you should not have a cycle anymore, but she does have a little bit of spotting.

Vaidya- So the reason she has bleeding even after the ablation is that Pitta is taking the space of Vata because Apana Vata is not there, which means it’s Ashayapakarshakahetu that is the displacement of Vata by Pitta. Even though it looks all about Vata as primary but Pitta takes over the location of Vata. I want to know if she experiences bloating or gas, or is she complaining about anything at all?

Erica- She does; she mentions that she has indigestion, constipation, gas, bloating, IBS symptoms.

Vaidya- She has IBS symptoms because Pitta is in Vata’s place Vata Sthana. Does she sleep all right?

Erica- She’s going to bed late. But she has these teenagers, so she is sleeping light and has had some issues with their behavior, so she’s been woken up a lot in the night as well.

Vaidya- We could say the sleep has been a little bit scanty if not scarce. Constitutionally, one Vata is not being formed, and two Apana Vata is not strong enough. She also has herpes which is a Pitta symptom, and she must be getting genital herpes?

Erica- She says she hasn’t because she’s been taking the antiviral – Acyclovir.

Vaidya- It’s another symptom showing that Pitta is in that location, so it’s another vital factor to consider that Pitta is increased. Pitta is taking the position of Vata, and Vata is unable to function due to non-formation and displacement by Pitta. Mentally, she is fear-based and constantly has to hold space for all these other family members. She’s having that to accomplish. So whenever space comes in, the Vata kind of gets into its hyper mode. I think we should start with Sneha in this case along with Deepana Pachana. We should give her some kind of internal Snehapana, and it can be Gritham, Triphala Gritham, or Kalyanaka Gritham. The reason I am choosing Gritham, It is capable of reducing both Pitta as well as Vata. Every night up to a teaspoon and a half of either of the Sneha, preferably the latter, because it has a mental effect. We’ll take Kalyanaka Gritham with either flax milk or almond milk or oat milk – you will warm it up, mix it, and to this mixture, I would use something to increase the Agni and digest the Ama. I would add Half a teaspoon of Chitraka and Haritaki (it may be a little strong in taste), and to make it tastier, we can add jaggery, maple syrup (which is Vata - Pitta reducing). This has to be taken every night – 3/4th or half a cup of this drink and then go to sleep. I wouldn’t use a Lepa but Sneha Sweda externally every night. We can even give her castor oil to apply on the lower GI region and keep a hot water bottle for about half-hour or so, and afterward, she can go to sleep. We are externally and internally doing Sneha - Vicharna Sneha, not for Virechana, so you can do both of these every day. It helps the displaced Vata to be pushed back into its original location that is the lower colon. I looked at some of your protocols, and Sneha was missing, so I thought maybe you should add that into her regimen. We also have to look at Guru, Manda, and Snigdha- as either doing Rechana effect or Anulomana effect. To help with that, I would do Aragvadha with Hingwashtak.

Aragvadha is Guru, Manda, Snigdha, Madhura Rasa, that will not purge but bring down both Vata and Kapha mobilizing all the toxins, bind them and bowel movement to move it out of the body along with that we are doing Hingwashtak. A teaspoon and half of Aragvadha and half a teaspoon of Hingwashtak after breakfast, lunch, and dinner would be great. In the nighttime, for her diet, I would do a large quantity of some kind of dark greens- kale and chard but cooked, boiled, and pureed. To this, she would add a sufficient amount of some sort of meat soup or meat broth or bone broth if she’s open to eating meat, not meat by itself but what we call Mamsa Rasa. Mamsa is boiled, and then you get the Rasa out of it. You mix it with a dark green to balance it but also promotes the bulk of the stool. You can administer that at night time as a daily soup prepared for the week, and she has to have about maybe 12 to 14 ounces of this liquid. You can give her a tea to sip on all day long, and the tea you should advise her should be like a spice-natured Tea - cumin powder or seeds boiled in hot water, just hot water, and cumin seeds maybe in a thermos. It would help with two things: first, the bleeding that is going on, and secondly, the Vata gets pushed down, which helps to convert Samana into Apana so both of them can work efficiently. I am also open to things that you can suggest that she could do or not do. What do you think is the program okay?

Erica-I thinks it sounds perfect, so how is this going to address the low BP? Is this going to bring the BP up?

Vaidya- Once the Aparna starts building, or it becomes routine, then there will be even distribution. Contributes to Vyana- Udana contributes to Vyana- Samana contributes to Vyana -Apana also contributes to Vyana Vata because Vyana is the one which goes horizontal or upwards and downwards. It is the one that is responsible for maintaining the Blood Pressure, so if the Apana Vata is missing, then Vyana will not be sufficiently working, so if we make the Apana build up in the lower part of the gut, then the blood pressure will start maintaining itself. So in terms of diet, I saw that you are doing an excellent job for her, and she’s also following everything accordingly. The missing piece of the puzzle is the Pitta aspect of this condition which seems to be not so obvious, but it is an undercurrent.

Erica- Right, I think that’s what I was probably missing is that issue.

Vaidya- Yes, and if possible, ask her to come for Shirodhara from time to time. Doing Abhyanga as well, but the combination would be better for her.

Erica- We did. The last treatment I gave her was a Shirodhara. She enjoyed it, and it was better and relaxing.

Vaidya- Yes, that relaxation is essential for her, and when you sit with her for counseling. You need to dwell and dig into her fears. You need to slowly start asking her because, in the long run, the fear factor of being relieved would be beneficial for her. You can even do Marma for her to do the following Marmas like the 2 Kshipra Marmas for her. They are in the hands and the feet in the web of the index and the thumb; there is a Kshipra Marma. It can be used on her whenever she does not have bowel movements. She can have that hot water pad on with the castor oil and then do the Kshipra Marma- You can teach her how to massage it to help with the formation and movement of Vata inside the body.

Erica- Yes, she’s a great patient. She is getting some benefits because I have been doing these things, but I was not doing them all together this way. It has been a little bit clunky. We did Aragvadha and Hingvashtak for a minute. I wasn’t able to quite get it right.

Vaidya- Yes, I saw your program. You had all the components. So that’s why I thought of taking those same Ayurvedic protocols that you had suggested and tried to tailor them to help remove her imbalances.

Erica- Yes, that’s very helpful, and the great thing is that she is stuck with it because she wants to get it resolved, and she does everything perfectly when I ask her, and I’m excited to do this with her.

Vaidya- You may ask her to do Virechana because it helps in bringing back their rhythm. Instead of taking the Senna pill or other prescription medication, she could do a clear and complete Virechana with Deepana Pachana, Snehapana, Abhyanga, Virechana, and some Sarjanakrama. It Will be helpful. Maybe down the line in June or July, you can prepare her to do the Virechana, but in the meantime, your program will be helping her to regulate her bowel movements.

Erica- This is super helpful; thank you.

Vaidya- You’re welcome. Thank you so much, Erica, for dedicating your time and bringing in all these cases. It looks like we might be getting all these cases all the time, and I get these types of cases in my practice. I have seen one case, which is why I suggested sipping on cumin tea all day long because I had done all the protocols, but the patient was not responding, and once I started, the cumin tea was ready to be sipped all day long it worked like a charm. Something to do with this constant stimulation of the gut to firm Vata, to push it down, is the key for this case.

Erica- Excellent, Thank you so much.

Vaidya- Thank you, all listeners, and we would love to have Erica back soon with interesting cases. At Athreya herbs, we want to support the Ayurvedic community and help practitioners find new critical analysis and practice ways. Also practicing the authentic Ayurveda and also using classical herbs as well as single herbs. We offer a wide range of organic herbs that we have-like the classical Grithams, Thailams, Avalehyams, etc., available for your patients. Please support us, and we look forward to seeing you again sometime soon on this practitioner’s podcast. Namaste.