Herbs and Medicine - Yellow dock root, Vidarikanda, Bhumyamalaki, Bhunimba, Katuki, Bhringraj Tea, Punarnava Tea, Tikta Rasa, Punarnava Bhavati, Shankapushpi, Triphala Guglu, ginger- turmeric tea, Manjishta, Anantamul.

Namaste! Welcome everyone to the Athreya Herbs case discussion podcast.
We’re here to support and grow the practitioners in our own community so that we can become good in our practice and also get well informed on how to work with cases that are handled by our Ayurvedic community. I’m Vaidya Jay Parla and we’re here with Erica Harms Who has been on the practitioner case discussions podcast earlier too. She practices in Oregon, where she has a number of very interesting cases. She graduated as an Ayurvedic practitioner from southern California University of health sciences, she has been a long time follower of Ayurveda. Erica, I think it has been 10 to 12 years?
Erica - Honestly I can’t remember, it really heddles.
Vaidya - That started you off. Look at you now you are a practitioner. The thinking that if Ayurveda can help me, I can help others too is such a wonderful thing that you did in pursuing the studies of Ayurveda. Thank you for joining us and dedicating the time to Athreya’s practitioner community.

Erica- I am happy to be here, thank you for having me.
Vaidya-Great so, without any delay we are going to take a very interesting case that Erica has and we will at the end of the discussion entertain any question that our listeners have on our social media platforms for any clarifications, we will get back to you.

Erica- I wanted to share this case because it was such an interesting case for a number of reasons. I had a young woman about 22 years old come visit me, she’s 5’10, 135 lbs and she has had chronic skin issues like rashes, redness in her face, and raised bumps that you can visibly see. She has had a lot of skin issues throughout her life, she has had anemia since she was 13 and has struggled off and on with that. They have never been really able to pinpoint or manage it very well as to why that is happening. She knew a little bit about Ayurveda, she does intuitive readings and has a podcast. She does a lot of different things but a lot of them are in a spiritual arena. So she knew that she was feeling a lot of body disconnection like a lot of Vata in her body, lack of feeling grounded. She had chronic fatigue for most of her life. Also, she had been suffering from cystic acne and a lot of chronic dandruff but she was not presenting in that way when I saw her. She has seasonal allergies, allergy to cats, to a lot of nuts like peanuts, cashews, almonds as she definitely correlates skin irritation after having them. Currently, she does not take a lot of medication or supplements, she does an herbal iron pill and a yellow dock root tea to help with the iron because the medications they were giving her are hard on her stomach and a lemon balm that was just overall immunity support she said. As far as her cycles are concerned she has a very heavy cycle for three days and then one day it is light and that’s about it. A little bit longer than the average 30 day cycle she had had a pretty normal cycle since she started at 14 but in the last year she had a miscarriage and since then has had a lot of grumpiness and the cycles have gotten heavier. She doesn’t use alcohol or any kind of recreational drugs and she does like to exercise – she does crossfit, she is an aerialist. About her family history, her father and a few other people on his side of the family were type two diabetics but she attributes that more to his lifestyle as well as heart disease. Her mother had breast cancer and struggles with IBS. Additionally, the things that I thought were interesting are that she is a vegetarian, she does do a little dairy, she says her memory has been getting poor in the last six months, but she has also had a lot of anxiety and while eating she finds that the foods that are irritating her have too many ingredients. She has an unusual sleeping schedule because of the work she does so she tends to sleep till 9 am but not go to bed till 1 am. She kind of struggles with keeping her food, Sleep, work schedule, and food regimented and on a consistent basis because she does so many different things. As far as her pulse it had a lot of Pitta in the pulse but overall a very consistent and strong pulse – Vata, Pitta, Kapha. Her tongue looked white, grey (her Ama was white and grey) and it was swollen. She is cool to the touch and she says she does tend to get cold feet, cold extremities. She also goes from inconsistencies with her bowel movements like getting constipated or a soft bowel movement, she does not sweat. Struggles with energy so probably on a scale from 1 to 10 her energy tends to go anywhere from 4 to a 6 and by 3 to 7 in the evening she has no energy. Her emotional balance is on the same scale from 6 to 8. Her digestion is sometimes great but sometimes terrible so it is very inconsistent. She is very thin from being 510 and 135 lbs, has a Vata build, and a lot of Vata tendencies.

Vaidya- As you mentioned she has an unpredictable bowel movement, are the bowels hard or soft?
Erica - I think it tends to be none or soft.

Vaidya- Are there any other symptoms like headaches that you noticed in her?
Erica – In the past, she said she had some TMJ issues, digestive issues, she had struggled with depression but she felt like at this point it was a little more stabilized for her.

Vaidya- Is she on any medication for that? Is there anything else that you want to mention from her history?
Erica – Not anymore. Yes, she’s worn contacts since she was 9 years old. Her personality is very creative, intelligent, and articulate. She probably works a lot and is one of those people that forget to eat, she also does a lot of volunteer work so she has a very inconsistent schedule.

Vaidya- Any childhood trauma or issues in parenting that we should know about?
Erica- Yes, I would say that there is a lot of childhood trauma but she has worked through that.

Vaidya- Is she an only child or does she have siblings?
Erica - I can’t remember exactly but I think she does have siblings. She definitely mentions that she had a very different lifestyle and then her family because she was raised on a lot of junk food, a lot of neglect so with her volunteer work and even her diet and lifestyle –she is very concerned about her health and trying to help others.

Vaidya- What is her qualification or educational background?
Erica- I don’t know about that exactly but I do know that she has lived abroad in London and a few other places so she’s a very matured 22-year-old. She seems really well educated.

Vaidya- The primary complaint is the skin issues but underlying like you said there are multiple layers of symptoms or imbalances that she has. Let’s start with the first step that is the skin prone to cystic acne, mostly now turning into rashes and skin sensitivity is her primary complaint. What I found very interesting in this case was the underlying blood deficiency that is going on-Rakta being deficient so she’s taking a few things. Anemia or the Pandu Roga that she has, has been going on for some time it seems.
Erica- Yes, since she was 13 years old.

Vaidya- It probably is the same time as she started her menstrual cycle so there is a link between her menstrual cycle that is Artava to Rakta(blood) to the skin. That's one thing that we need to be aware of when we are working with this case. The second thing that I took notice of is because the Rakta is chronically deficient, maybe the upbringing itself had less nourishment, to begin with. The parents would not have given her the Prana or Ojas rich food which she mentions and it looks like she is also making up for all of it by being proactive about her health. In the beginning, she did not consume a lot of nutrition-rich food or Dosha balancing and Dhatu supporting food as a result to which she would have steadily aggravated Vata. The deficiency of the Rakta Dhatu Rakta is primarily required for Prana or its Jeevana action. Prana Needs to be circulated and once it descends into the chest and ascends from the digestive system both of these need to be distributed. That work as you know is done by Rakta (blood) which is deficient and Prana is chronically lacking in her body that is why even though her mind is very Rajasic that is very pro-to doing things but her body is constantly deficient of Prana and Ojas. We can relate to that because if Rakta is deficient, Prana is also deficient, if food is deficient Prana is also deficient so she is going through this prana deficiency and the third part is the mind that is anxious. It brings in even more Vata so we as practitioners would know that when prana does not circulate Vata takes its place. She is constantly increasing her Vata by being anxious, sleeping at odd times, eating is all over the place because she has so much life around her like she’s doing a podcast, helping people by volunteering that itself is a Vata driven Rajasic lifestyle she has chosen otherwise she would feel like she’s not doing anything. She’s constantly falling into this- she’s volunteering herself into some activity or some movement or otherwise she’d feel she is defeated from how she was raised so she always keeps herself busy and that further depletes prana because she is constantly carrying out activities. In this case, we see that she has a lot of prana deficiency. You correctly between 3 and 7 PM she has no energy because that is the time when the Vata kicks in. Whatever tiny amount of energy or prana she’s gathered from food and activity will be completely taken away by Vata and that is why she gets really quiet. What is puzzling is why is her pulse so strong and exhibiting a Pitta nature. The tongue has swelling, white and grey coating this all is taking place because of Vata displacing Pitta and Kapha. Especially, Pitta from the gut has moved to the blood because when Prana is deficient your body temperature will always tend to fall because anemic people or Pandu cases always feel cold because all the Rakta is used to nourish the vital organs. This little bit of Rakta keeps circulating in the major organs like the liver, kidney, spleen, heart, lungs but there is not much left to come to the periphery so the hands and feet tend to be cold. This helps Vata to gain some ground. In order to make up for the excessive cold because of prana deficiency, the Pitta is circulated in the blood so that a body temperature can be maintained otherwise she will always feel cold. That is why the pulse feels really strong even though she has all these Vata symptoms.
Erica-Yes actually this is going great so far because that is what I told her that the Vata is pushing the Pitta and Kapha so I am glad to know I was on the right track.

Vaidya- Pitta is Ashaya Apakashaka Hetu for those who have learned Ayurveda. Pitta is displaced from its location so one would see Vata symptoms in one part of the body and the Pitta symptoms in the other part of the body. The allergies, skin rashes because of Pitta being displaced from its position and going into the skin or Tvak, where she always lacks body temperature and Pitta has to make up for it because Pitta is not comfortable in that location in the skin. It produces rashes if the Pitta has left the gut and it is circulating in the Rakta and the Tvak. All the food she is consuming is turning into some sort of Kapha and Ama that is why the tongue has a greyish-white coating. It is swollen because she is not breaking down or absorbing food as her Agni is non-existent. This is an interesting scenario you see this happening in youngsters, they want to do so much but they never nourish themselves. I would say this patient has a driven mind, depleted body. Another part of it is the miscarriage she had about a year ago. It caused further Rakta depletion. To make up for the cold due to the Vata excess and Rakta, Pitta mechanism. She does cross-fit for work out so that she can feel a little bit of the warmth in her body so it is an interesting choice that she had made. Given all the patterns of this case, we need to work with her Prana and Agni first.
Secondly Vata and Pitta balance and lastly Ama-Pachana. As you mentioned she did sometimes have cystic acne.
Erica- She didn’t currently have cystic acne but yes in the past this has been an issue.

Vaidya- The Ama when it over-swells it goes into the Rakta and produces cystic acne but if it is somewhat managed it only stays in circulation and doesn’t come out.To understand and handle this case let’s first work with the Dosha. So how do we manage this Vata Dosha that is aggravated in her?
Start with something that is Snigdha, Ushna, Guru, Manda - these qualities are the opposite of that of Vata. Sheeta quality is balanced by Ushna, the Laghu quality is balanced by Guru, Ruksha quality is balanced by Snigdha, Chala quality is balanced by Manda. One would have to choose such herbs that have these qualities like we have an herb called Vidarikanda. When we consume such types of herbs one would definitely think that there is so much of Ama in this patient so why do we want to give them such heavy Guru Dravyas. We need to pay attention to the quantity- the Dravyas quantity should be minimal which means even though we are choosing Vidarikanda the quantity shall not exceed more than half a teaspoon in a single dose. We are trying to make Vata start reducing from the deeper Dhatus like Shukra, Majja, Mamsa so that the nourishment that is slowly going through Rasa gets stagnant or hoarded into Rakta. With this approach, I am trying to come from the retrograde that is Shukra Naresh, Majja Naresh, Mamsa Naresh. There isn’t much need to worry about deeper Dhatus so that is what I will do to reduce the Vata in the deeper Dhatus. Along with Vidarikanda, we can add another beautiful herb called Pippali. Pippali is good for the Rakta Dhatu, it works directly on it, Mula activates Yakrit (liver). It also brings the warmth that she is looking for to keep her body having circulation properly. Pippali is also indicated in Pandu Roga. Digestion is enhanced by Pippali. Half a teaspoon of Vidarikanda and a quarter teaspoon of Pippali. The last one that we will be doing for her is Amalaki. You enhance the Rasa by doing Amalaki, of course Vidarikanda also does increase a little bit of Rasa but Amalaki will be used for Pandu Roga because Amalaki is indicated for Pandu Roga. It is good for creating Rasa especially the Rasa that is going towards the uterus And helps with heavy menstrual flow. Half a teaspoon of Amalaki and the aforementioned quantities of Vidarikanda and Pippali so that this combination is taken with either almond or coconut or hemp or oat milk something like that which she drinks in the morning which works as a mild Deepana Rasayana. We are taking care of the raw material in the morning in the Kapha period so that by the time the Vata gets between 3 and 7 PM it is digested and she has energy. So she will start believing that whatever you are putting in is working. See people feel good when they have their energy back, we’ll work on that first. Now we have created the Rasa we do not want it to go towards Ama and create Ama inside the Rakta which is causing her skin to become aggravated. In order to clear the blood, we will be using something known as Ayurvedic bitters. If a patient is too lean and has a lack of nourishment as such, to begin with. When you use Tikta Dravyas (Bitter Dravyas) you need to be critically analysing and thinking whether it is okay or it isn’t. Let’s say in bitter herbs we have Bhumyamalaki (Gale of the wind) or Bhunimba or Katuki all these are working through the Rakta Dathu and helping to take the cleansing action on the blood. For Tikta Rasa to digest the Ama, it shouldn’t produce too much of Ruksha quality so if it produces too much of Ruksha then the patient will start feeling even more tired and exhausted because Vata keeps feeding on that Ruksha quality that comes in. I would rather do milder Tikta Rasas which are like Bhringraj and Punarnava. Bhringraj and Punarnava Tea to drink throughout the day like I would recommend in a thermos 1 1/2 teaspoon of Punarnava, 1 1/2 teaspoons of Bhringraj almost like a Paaniya that is a hot infusion but a very diluted hot infusion. What I am targeting here is that Punarnava helps to bring new tissue formation in the blood. As the name indicates Punarnavam Bhavati helps to make the new blood that is required for her skin condition and also for her Pandu Roga. Bhringraj is mild Tikta Katu Rasa, So both of them are Tikta Katu. Bhringraj also helps to reduce the Ama and increase the Rakta quality. So if she is drinking throughout the day little by little you can tell her if you are working have this tea two times a day, 1 1/2 teaspoons of each, About 20 oz of hot water, and then drink the same thing in the evening as well If she’s open to it. That will start helping her to build more Rakta and reduce the Ama. Another part is the mind part as we want to help with her mind a little bit so with this tea add a little bit of Shankhpushpi because she’s still 23 years old. Shankhpushpi will be better than Bhrami because when the power of reasoning is to be increased in young people Shankhpushpi is better. It will help her with what she’s doing, why she’s doing, if you will tell her she’s to sleep at 11 o’clock she won’t listen because she has a driven mind, she will just keep doing the same thing for example- oh I have this project to complete or I promised this person that I am going to give this. We have to help her with the mind that is able to think clearly and logically. About a teaspoon of Shankhpushpi can be added to this but not in the morning in the afternoon when she makes the second dose of this tea. This will help the mind to calm down and the anxiety to ease up. So when she goes to sleep she doesn’t have the anxiety to finish or furnish something for the next day.
Erica- How much should she take in the afternoon?

Vaidya- 1 teaspoon. Now given all of this we cannot go without addressing her skin. To improve the skin I would recommend something like Triphala Guggulu, It would take away the Ama that has been created. The first step is looking at the Whitish- grey coating of the tongue and start scraping the Ama up from the Amashaya (stomach) and Agnyashaya (small intestine). If you do not scrape out the Ama it keeps on circulating and will never be able to finish or digest itself. Triphala Guggulu 2 capsules in the morning and two in the night time along with the hot ginger- turmeric tea that is available anywhere and everywhere. you swallow the pills with warm ginger-turmeric tea. If she is not open to taking the tea because she is taking other health supplements and if it becomes too much then just take it with the hot water or a hot tea like Bhringraj and Punarnava that she’s already taking. It will start scraping the Ama out. Triphala Guggulu has Triphala, Guggulu, and Pippali and it’s processed in Guduchi’s Swarasa (Guduchi decoction). Here it will be the main thing with Guggulu that will scrape all the things away to move out. So now we have quite a bit of a prescription for her. A small amount of Rasayana - Start with Vidarikanda, Pippali, and Amalaki in the morning. Secondly tea with Punarnava and Bhringraj in the morning, and Punarnava, Bhringraj, and Shankhpushpi in the afternoon. Then Triphala Guggulu that she’s taking with hot water and by then the patient is already feeling that they have too much to take so you need to think about still addressing the skin issues. Ideally, you can do a Manjistha type of combination with Anantmool or Black cumin. It can be made into a honey paste that she takes in the night before bed, so half a teaspoon of Manjistha, half a teaspoon of Anantmool together with honey. I specifically chose honey here because honey is capable of scraping the Ama so instead of doing so many teas I could recommend honey at night time so that she can mix it with honey and use the Manjistha as it is great for purifying and improving the quality of blood. It is also a great tonic for healing skin rashes, acne. Anantmool is complimenting the Manjishta because Anantamul brings the best quality Rasa to the skin, you can only give it once a night. Vidarikanda, Amalaki, and Pippali in the morning and Anantamul and Manjishta in the night could be doable for her. She’ll think she’s taking it in the morning and the night because if you recommend 3 times a day these youngsters will say this is too much for them to take up. All these herbal combinations that she’ll be doing will be complemented with a very healthy diet. For the subsequent week or a month put her on the khichdi diet, I would recommend rice in the morning using a cooker or an instant pot. Everything can be put in there and then she can cook it in the morning. She can eat it at lunchtime and the same thing at dinner time if it is not boring for her. You can give her 4 or 5 options with vegetables, root vegetables, spices, quinoa - some options that she would have that she can turn on the switch and she doesn’t have to worry about the food being done so it is very ready to consume. Maybe in the morning, you could recommend non-grain or non-grainy breakfast like eggs with dark greens like arugula, dandelion, spinach together and she would scramble them and eat them. In this case, yogurt, cheese, cream cheese, bananas, oil fried food should be avoided. Also try to avoid peanuts, chilies, bell peppers, cashew nuts these things naturally aggravate Pitta. If you bring down the Pitta that is pushed by the Vata on the side then all these Rasayanas will start pushing the Vata down from the deeper Dhatus with Triphala Guggulu you’ll be able to gradually take Ama and Vata out. This would be a practical approach for the patient.
Erica- I started her on something very simple just about 2 to 3 things but it’s now time for me to see her again and I think at this point this would be something that she can manage. She is seeing a little bit of the results and she is excited about it but now I can transition her to something like this which is a little bit more sophisticated. I think she hadn’t ever been to an Ayurvedic practitioner so sometimes when I first see people I give them like two things. I try to do something easy like a Gritham or Arishtam. Something that is already prepared so they are not preparing anything so the next time I give them more of a powder and a mix- that is a little bit more work once they start seeing the initial results.

Vaidya- Yes, you’re totally correct. You need to walk these types of patients through because if they do not see the results in the first 2 or 3 months then they start doubting whether it’s working with them or not. So you have the right approach to start with a couple of things that are easy to do and when she starts to believe in this and the protocols she should be able to follow this a little more comprehensive program. We want to inform all our practitioners here that these types of cases are very common with the Ayurvedic practice. They do not have any other way to take care of their problems because if they go to a skin specialist they maybe will throw Accutane their way or If they go to a hematologist they’d recommend something else. They’d already be very frustrated when they come to us so hold their hands and walk them through because once they start seeing results they will be able to trust and follow through with all that you say.
Thank you Erica this was an interesting case that we just discussed. Thank you for your time and for sharing this with us. We look forward to welcoming you again with another interesting and critical case that you bring in.
Erica- Thank you for having me. I really enjoy it.

Vaidya - Namaste! to all our listeners.

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