Namaste everyone. Welcome to the Athreya Herbs practitioner podcast. My name is Vaidya Jay, and I am here to work with you and your cases like we do all the time. Our purpose in doing these podcasts is to have a healthy discussion and see how the rogi or the patient can be benefited from a collective approach of Ayurvedic practitioners. We share this information with you so that you can improve your clinical skills as well. For those of you who are just joining this time for the podcast, we do these podcasts regularly. If you want to continue receiving this podcast about clinical cases, please send us an email with your email address. Today we have Lisa Jacoby in our Podcast. Lisa has been there with us, and she started as a student at Southern California of Health Sciences. She graduated from practitioner-level education, and since then, she's been actively practicing here in the LA region. Without further delay, I welcome Lisa. Namaste, Lisa. 

January 27, 2022 |  37 minutes.
By Vaidya. Jay Parla. 

 

Lisa - Namaste, Vaidya Jay.

Vaidya - Last time, I had a wonderful time discussing your case, and this time too, I'm looking forward to listening to your case. After I chant, Would you mind presenting your entire case?

Lisa - Absolutely.

Vaidya - Om Namami Dhanwantrayam Aadi Devam, Surasura Vanditham Pada Padmam, Loke Jara Rugbhaya Mrityu Nashakam, Datharam Eesham Vividhaushadhinam.Om Shanti Shanti Shanti Hari Om. Let Lord Dhanvantari guide us in this discussion. Thank you, Lisa; please go ahead and present your case for us.

Lisa - Thank you so much, Namaste. I would love to present to you the case of a 25-year-old female with Gulpha Shoola and manovikriti. She has a heel injury, pain, and stress in her mind. The chief complaint is the long-lasting heel pain, and she also came to me because she's very interested in how Ayurvedic medicine works and wants to help balance. Her stress level is beyond her control right now, and she's a runner. Going back to her chief complaint, it's left heel pain that's been going on for two years. She was running in marathons, and then it started hurting once she started moving around from place to place. She moved from here to Texas, and the heel pain started when she started running again. It was alleviated by stopping running, and the stress increased when she stopped running. She feels like it's gotten worse after the Coronavirus and after she finished college about six years ago. In the last year, it's gotten worse, and she feels like she cannot go with the flow. She has control issues, with herself managing control in her life. She works for a company called Hana, copywriting branding. She is currently traveling for pleasure, and her boyfriend's parents are planning to come back to LA. However, they are making plans to move back to Texas. She has a boyfriend named Zack, and he has a problem with hearing. He's working with cochlear implant devices and now marketing in person. That's why she wanted to move to LA, and now she's concerned about not having a job working. She’s prone to depression, quote-unquote, coping mechanism is journalism, and recently started meditating. She said that she's very compliant with whatever I recommend. She's interested in becoming a holistic nutritionist, nutrition therapist, and anything that we have to offer Ayurvedic, especially. She Is a diet and bodyweight-oriented person. She is a very Pitta individual control. She wants to control her environment; her past and present are describing that. She has no major past injuries and illnesses except that she did have a little stress, thyroid induced hypothyroidism, but that was a six-month treatment. And she doesn't remember any medication, so no documentation on that. Otherwise, no past illnesses or injuries. No known drug allergies, except for seasonal allergies. She does describe some seasonal allergies, with changes of seasons, a runny nose when spring comes, etc. Right now, she's not taking any pharmaceuticals, except for Chyawanprash. She does take a certain Chyawanprash, and it’s called Hanah one. She takes it once a day and takes collagen in smoothies, amino acids,  Advil, and Alive. Recently, she's been taking up every day. Her menstrual cycle is normal, and the last menstrual cycle was on May 28, 2021. She claims that before her period begins, she gets very moody, gets acne around the chin. Heavy flow first day, the second day it's a brownish-red color and then turns red. Her libido is good. No awareness of any family history, past family history, hypertension, hyper cholesterol, anything like that was there. Her dad is a firefighter; that’s what I got from her family history. As far as her personal and social history, her normal daily routine is that she wakes up at 6:00 to 6:30 am every day. She takes coffee after she voids her bladder and does the bathroom routine, and does her journaling. At 7:30, she starts work, and at 9:30, she starts breakfast, a smoothie containing banana, almond butter, collagen peptides, blueberries, spinach, hemp seeds, almond, and oat milk. She works from 7:30 to 11:30. From 11:30 to 01:00, she works out and then takes a shower. She likes to run, but she does other cardiovascular exercises, such as push-ups and anything that can increase her heart rate since she can’t do that. She has lunch from about 1:30 to 2:00 pm that contains avocado toast salad, and maybe she has chicken, turkey sandwich avocado, lettuce, cheese, and goes back to work from 12:00 to 5:00. Then from 5:00 to 6:30 pm, she makes dinner, which is light. She does soups, meat, chicken, salads, or avocado, kind of a lot like her lunches. She eats a lot of raw foods and does meat every day. Then from 8:00 pm to 10:00 pm, she takes a shower and goes to bed, and relaxes. She has a good routine. She's in bed and reading by 10:00 to 10:30. Her rogi pariksha, her desire at mealtimes is yes, she has a strong appetite, and it makes it stronger when she works. When she has a lot of stress, it makes her appetite lower. She's had loose bowel movements since childhood. Now especially after eating or drinking coffee and eating a lot of veggies, she's sensitive to butter and fats. Urine is clear and normal, sweat is normal. When she works out, she sweats, sleeps normally, and goes to bed between 10:00 and 11:00 pm. The energy levels are pretty good. Emotional balance is up and down. She also quoted psychotic, learned not to react, meaning she has a lot of things that she reacts to strongly. When I asked her about that, it seemed like that was an emotional and physical response that she would tend to go into a manovikriti action. I checked the pulse of her left hand on an empty stomach and it was high in Vata, bouncy, stringy, but Pitta was predominant frog-like fast, and warm. On the right hand, there was a more rapid Vata. The presence of Pitta and Kapha was slow but consistent. Her blood pressure is 110 over 56, tongue pink on sides and mostly red, horizontal cracks on midline with zigzags near the tip and a red tip, probably indicative of sleep. Thin coating, brownish grey coating more towards the back with the teeth marks along the entire body of the tongue. So Ama was present in a brownish-grey color. When speaking, the voice is smooth, but when speaking emotionally, the voice becomes much faster. Touch: warm, smooth, wet, but not hot; vision: good, possibly myopic because she has some difficulty seeing distance. Her shape is medium, healthy appearance. She had trauma; when she was in college and was 19 years old, she was raped at a party. She was still a virgin, and the way she coped with that was alcohol, over-exercising, overstressed, and not knowing how to deal. She works part-time in May. She does a lot of people-pleasing assistant marketing, social media, a lot of side jobs. Her new job is going to start in Texas, in a brand marketing partnership in Hannah. She'll be moving to Texas on July 8th of 2021. My assessment was to go for Shoola, ankle pain, and manovikriti stress. That is what I have.

Vaidya - Great, Thank you. It is an interesting case. Let's look into it more deeply. It looks like the major issue here is what to do with the mind. She doesn't know what to do with her mind, and because of that, she runs away from her past. Even though you're young, you can't keep on pushing the body to its limits. So, the body is slowly showing the deficiency or lacking or overutilization of the dhatus leading to Vata increase. Now, the question is, it should be happening in every part of the body; why specifically here? One is running; the second thing is that it has something to do with her problems, that she feels like this. Whatever past and the strong mental impression she has is stuck to her like a nail in the heel. She wants to address that. You took a detailed history, and at some point, you said she also feels slightly psychotic, which is very interesting. State of that usually comes from the rajasic quality of mind, and psychotic quality comes from the rajasic state. As all of us know, Rajas triggers Vata, which makes perfect sense in her pulse. There is high Vata on both sides. High Vata makes sense because she is mentally triggering this Vata into her body. The body keeps being depleted by overrunning or overdoing things that are not reasonable because the mind is prone to psychotic states. As we started, we wanted to work on what to do with her mind, which is important. One thing that is good for her is having a routine. Routine is a good thing to balance a rajasic state of mind and also the Vata that is primarily increasing in her. All this has shown the udaka vaha srotas being depleted. The moolah of the udaka vaha srotas is in the throat and the upper palate, if you remember, the udaka vaha srotas ana moolam Talu, the upper palate and wapavaha or kloma. These two are the moolas of the udaka vaha srotas. She had a little bit of hypothyroidism in 2017. The body is losing udaka, which means she is causing the body to strain so much that vital fluids in the body are getting reduced. That's what we need to keep in mind. Her stress levels are high, and she's still willing to take another stressful higher-level job, which is not sustainable to her mental state. That may even add to this type of problem: stress and rajasic state of mind increase Vata. There was a trauma that resulted in a heel injury. Correct?

Lisa - She said there is no injury; it’s just a chronic, gradual heel, and the trauma was more emotional; when she was 19, somebody attacked her. 

Vaidya - If there is no injury, it's a good sign. If there was an injury, pathologically speaking, Vata would have gone even deeper. It looks like the fluids in the body are being depleted, and because of this depletion, the body is drying out. It starts with the lower part of the body, starting from the heel. When we talk about udaka, the fluids are distributed in different compartments. We know that there is a specific fluid that is in the synovial joints; we call it Shleshaka Kapha. The Shleshaka Kapha based in the udaka is reducing. Repeatedly running with a lot of stress and her mindset that she has to run away from this situation is not helping her. First, work with the mind and simultaneously with the heel. Internally, things for the mind, externally things for the heel, that will be bahirparimarjana and antahparimarjana. Bahirparimarjana means external treatments, and antahparimarjana means internal treatments. In this case, first, we'll start with the Herbs. Since Lisa has been with us for some time, she already would have got some ideas in her mind about what kind of aushadh will be useful. You would have thought about ashwagandha, didn't you?

Lisa -  Of course. Especially ashwagandha lehyam or gritham as well. 

Vaidya - In this form, you can combine ashwagandha with Shatavari because ashwagandha is brumhana, which means it increases the bulk or builds the tissue. It's just not building the tissue, but you want to bring the Shleshaka Kapha or the water component to be balanced, and that is done by Shatavari. You can give her Shatavari milk and ask her to take ashwagandha jam, or you can mix ashwagandha and Shatavari in equal quantities, then make that into a drink. Take one and a half teaspoons of ashwagandha and one and a half teaspoons of Shatavari, mix it into some hot water and then add a little bit of turmeric to it; warm almond milk can also be added. Drink that twice daily, once in the morning and once at night. 

Lisa - Maybe add some ginger?

Vaidya - Yes, you could add ginger. In these cases, Ama that is formed becomes stubborn and is localized in only one area. Turmeric can be used sometimes, and you can even use rasna, which is also good for this type of case. You can combine rasna with ashwagandha and Shatavari milk, and this can be taken twice daily, once in the morning and once at night. The second thing that you can do is Ashwagandha and Shatavari to look at the beauty of these two Herbs. Ashwagandha helps increase the ojas; we know that ashwagandha as a Rasayana increases the ojas in the mamsa and rebuilds the mamsa dhatu, and sends the nourishment to asthi dhatu. The Shatavari, which is also a Rasayana, has a direct action on rasa dhatu, and it can also work on the mamsa dhatu. So, rasa to mamsa and mamsa to asthi is the approach that we are taking. Drinking it twice will start bringing the necessary Ahara dravyas. That means the nutritional components that are necessary for building the tissues are depleted. That's not it, and we know that the Vata has gone in and is taking hold of this region. We want to drive the herbs deep, and Guggulu will do it. I would recommend Kaishore Guggulu because it can help the blood as a dhatu and take away the Vata present in the rakta. We did Shatavari for rasa and ashwagandha for mamsa; both of them help with asthi dhatu. Now rakta is left, and we need to take out the Dosha present in the rakta dhatu and Kaishore Guggulu does that. It is also specific to the joints. Two pills of Kaishore Guggulu once in the morning and two pills of Kaishore Guggulu once at night after food are advised. We did the Guggulu to make our Ayurvedic herbs, and went deeper into the sandhi to drive the Vata out. So These are the three things. Now go back again and think, did I do everything for the mind? Or should I do everything for the problem that the mind is causing? We did everything from the mind.

Lisa - Maybe mandukaparni or Brahmi?

Vaidya - Yes, exactly. You can suggest either Brahmi, as you said, or Mandukaparni. Also, I would do licorice. Brahmi or Mandukaparni with licorice. Licorice is medhya and is also good for udaka vaha srotas. The Madhur rasa of Yashtimadhu or licorice is great for helping the Rasa dhatu. It also helps to go to the heart of the person. Brahmi goes to the mind, and the licorice goes to the heart. Both of them together, one for the heart or emotional thoughts and the second for the rational thoughts because that's the conflict that she has with the mind. We will add the Brahmi one teaspoon and licorice quarter teaspoon, and then she drinks this as a tea about four times a day. Throughout the day, she is drinking a teaspoon of Brahmi and a quarter teaspoon of licorice in hot water.

Lisa - Just one combination that she'll put in a thermos and drink throughout the day?

Vaidya - Do what can be done, but Ideally, you want to make it fresh every time. Take the powder and put it in a teacup, mix the hot water and then drink it.

Lisa - That combination maybe twice a day?

Vaidya - Yes, that combination can be drunk three or four times a day. That will keep on replenishing her state of mind and the outcome of what the state of mind is doing to the body. We got everything that the mind is doing to the body, and now we have to think about what needs to be done externally. Pinda sweda can be done externally. Most of our practitioners know that it is tying the herbs in a cloth and turning it into a bolus, heating it on a pan with oil inside, and then you rub it against the heel or whatever part that is. Powder needs to be done with dill seeds, ajwain seeds, mustard seeds, sesame seeds, and a tiny bit of hing powder.

Lisa - Same formula that we can't that we typically use for the Pinda sweda.

Vaidya - This time, we are using hing, which we usually don’t use. The ratio will be a quarter of each of these seeds and a teaspoon of hing into it. That's for one bag, one bolus. If it's two, you need to multiply by two, and there'll be actually big-sized potlis.  Then you need to heat the oil, and the oil you can use is either Murivenna or Karpasasthyadi thailam. Both of them are equally good. When you use that, you will heat up and then keep the potli in the location and gently rotate the ankle in both directions, left and right. You keep rotating and massaging it at the same time. In the end, when you finish the treatment, mix a paste of Bala herb and Nirgundhi. Mix them in equal quantities and put it as a herbal paste around the ankle. Then ask her to cover it with a tin cloth and put on the sock on top, and let it stay in that location. She can go home with the paste on, which will be there for about two hours or so. Then she can take it off provided it's not itching or causing any irritation to the skin. This will be the ideal plan for her treatment right now. You also need to think about diet changes. I am sure that you will choose a Vata balancing diet. That would be good for her and make sure that she doesn't have a weight gain issue. Sometimes when we balance out Vata too much, then one starts gaining weight, so you need to be mindful of that. Otherwise, this will be the treatment protocol for this case.

Lisa - I love it. This is beautiful and mind-blowing. I have a question; after doing the Pinda sweda, what about doing gulpha dhara if it is in a lot of pain.

Vaidya - Gulpha dhara can be done. It is equally good. 

Lisa - Any oils now?. 

Vaidya -Pinda thailam will be good for her. You can use either Pinda thailam or combine Pinda thailam with Karpasastyasi thailam.

Lisa - Alternately, may be a Shirodhara for the mind?

Vaidya - Yes, we need to be very mindful of the costs that the patient can spare with us. The Shirodhara and the gulpha dhara will cost about $125 to $150 for one sitting if you do it locally. She can offer it maybe two or three times, but she will not want it beyond that.

Lisa - That's why I set up a GoFundMe for these things.

Vaidya - What you suggested is good, but I prefer the Pinda sweda because it has much more manual work. Where you're doing the heat and the Herbs with strong aroma can penetrate deep into the gulpha quickly.

Lisa - Yes, awesome. That's beautiful. When I finish off with any oil application, you said after doing the Pinda sweda send her home with a sock.

Vaidya - Yes, send her home with the sock on the lep that was applied.

Lisa - Okay, but should I leave the oil that I'm using for the Pinda sweda on? 

Vaidya - Yes, leave it on. In the long run, you need to tell her about the sustainable methods of relieving stress rather than continuously running.

Lisa - Yes.

Vaidya - Thank you so much, Lisa; we are grateful that you bring these wonderful cases, allow us to go through these cases, and give your input as well. I am so proud of you that you have taken this to your heart and brought these cases to us so that the entire community of Ayurveda practitioners can be benefitted from this. Thank you, we look forward to seeing you again with another case pretty soon. Namaste, everyone. 

Lisa- Namaste.