This case study has been a part of our educational series where we provide case scenarios to our Ayurvedic practitioners to get in-depth knowledge of Ayurvedic case management and look into diets, herbs, Panchkarma, and other aspects of wellbeing like yoga, breathing exercises, etc. Ayurvedic practitioners and professionals should feel confident while working with their clientele. Today we have Dario Ampudia from Tijuana who is a yoga teacher and an Ayurvedic practitioner.

Dario, thank you for being a part of this discussion for our Athreya Professional Solutions. This is an interesting case that Dario wanted to share with us. What happened when Dario was trying to self administer the treatment of Panchakarma for his health and well-being back in August 2019 and then later in September came to see me.

Vaidya- Dario, would you mind telling us what while you were trying to administer Panchakarma treatment.

Dario- I wouldn’t call it a full-on Panchakarma treatment. It was like a detox cleanse for my body to transition from summers and get rid of all the heat from my Pitta(biosystem of energy) to start new and fresh for the autumn.

Vaidya- Can you tell us what exactly happened while you were preparing for your Panchakarma or detox cleanse treatment?

Dario- The total cleanse was for 12 days. The first phase was of 4 days with only low-fat and unprocessed foods grains, or legumes, or fruits like apples, vegetables and seeds. Also a little bit of lean meat like chicken, no sugar, no dairy, no fats, no flour in the diet. I consumed herbs for a healthy liver function and good digestion, capsules like Manjishta with every meal, and some turmeric.

Vaidya- Were you sticking to some specific breakfast lunch and dinner or just the food articles you mentioned?

Dario- For the first 4 days my meals included having oatmeal cooked in water with ginger and cardamom for breakfast, for lunch I was having lentil stew and a beet salad with a little bit of lemon and ginger added to the light lunch, and for dinner, I had cream of vegetable soup without dairy.

Phase two was of 5 days with the addition of ghee to the diet. I took 3 teaspoons of ghee in the morning before breakfast on the first day, 6 teaspoons on the 2nd day, 9 teaspoons on the 3rd day, and the 4th day, 12 teaspoons on the 5th day. During this phase, I was only consuming steamed vegetables and ‘Khichadi’. On the final day, I did a final flush. This is where everyone should pay attention, I did Dashmula Kashayam and prepared a Bhasti (enema). I did it once and after the enema, everything seemed fine because half an hour later I went to the washroom.

The next day I started the 3rd and the final phase. 3 days of eating low-fat whole foods or grains, or legumes, or steamed vegetables, or lean meat. Throughout this process, I was taking a 12-ounce glass of water and 8 glasses of water in a day. Occasionally I was sipping on hot water so that it would help with my digestion. It started in August and ended in September.

After 2 weeks I went to a yoga workshop in Mexico, Guadalajara City. The temperature there was a little warmer than in San Diego so I felt a bit hot and itchy. I told my wife that I feel a bit itchy so I was looking for mosquito bites while I scanned my arms and feet but didn’t find any bite marks and the next day I started to feel a bit nauseous and still itchy.

Vaidya - By this time was your bowel movement regular?

Dario- Everything was normal, there was no appetite loss. But after I ate, I felt nauseous so I assumed that something I ate might’ve not settled well, since we weren’t home. After 3 days we went back and the itching persisted, it wasn’t normal as there were no insect bites also it was the first time it happened so I phoned you.

Vaidya- That was a very useful and informative narration. The first phase of the Panchkarma seemed alright but I wanna know how your bowel movement was by the end of the 2nd phase when you consumed 3 teaspoons to 12 teaspoons of ghee.

Dario - The waste was a little bit oily and supple with a shape to it but it wasn’t very soft.

Vaidya- Was the stool lighter in color?

Dario - Yes, it was lighter in color.

Vaidya - For all of our Ayurvedic practitioners here, it may mean that as Dario underwent this treatment the first phase would’ve helped him increase the Agni (fire) inside the body. ‘Deepana Pachana’ type of protocol was followed for attaining a healthy liver function and digestion through Manjistha and Turmeric to release the Pitta from the body, this was done in the fall season which may prove perfect. Then during the second phase, where he gradually started increasing the quantity of ghee consumed, he had a light diet of khichadi and the stool was also the color and consistency it’s required to be. The classical textbooks of Ayurveda say (Tila Pishta Niba Varchaha) Tila means sesame seeds( Tila Pishta means smashed paste of sesame seeds) that is the required color and consistency of the stool (Like Tahini). When a person is suffering from jaundice and the bile may not be flowing properly the same kind of color and consistency of the stool is observed.

Everything was alright till the 2nd phase because you were trying to mobilize all the toxins and the doshas from the gut, dhatus, and srotas.

In the third phase for the final flush, Dashamuladi enema(Dashamoola Tea Enema) was taken which could’ve been an inappropriate step. In the process of preparing yourself for the Panchkarma, the doshas may become aggravated and ready to be purged out. He administered enema instead of taking Virechana Aaradhya. Virechana Aaradhya can be like a big dose of Triphala, or Haritaki, or Aragvadha or Avipattikar powder which are meant for Adhogati or Adhobhagahara, which means they bring every dosha (Vata, Pitta, Kapha), Mala (a waste product) and move these downwards towards the intestinal direction. Herbs like Triphala, or Haritaki, or Avipattikar or Aragvadha even castor oil could work to cleanse. Moving the Doshas and Malas (Waste Product) outside of the body starting from the stomach or Amashaya down preparing to cleanse the gut from the Aamashayam. Enema would only cleanse from the Pakvashaya (Large Intestine) down which is from the large intestine. Hence administering enema may not help to relieve the aggravated Doshas in the Aamashaya region. It took almost 1 week for Dario’s body to distribute the Aama(Metabolic waste) and Doshas entirely for the symptoms to show up. If the symptoms would move into the ‘Rasa, Vaha, Srotas’ all the 3 doshas ( Vata, Pitta, Kapha) may become aggravated and behave in a similar fashion as that in Kushta a skin condition. There is the involvement of skin that is rasa dhatu (Twak), Rakta(blood), Mamsa(Muscle), and Lasika (skin secretion). Since the Doshas were not eliminated from the gut they would be secreted or excreted from the body through sweat and that could be the cause of the itching and bitten sensation in the body.

When Dario came to visit me, the first thing he said to me was that his body was itching. I asked him about the history of his panchakarma treatment.

answering to which he then gave me the piece of the puzzle. As we’ve discussed earlier enema was administered instead of purging which eliminated the Vata dosha but left the Pitta, Kapha, and Mala in the Amashaya(stomach) that’s what caused the itching. Do you remember what was suggested to you?

Dario- Yes, herbs to help purge the residual toxins were suggested. I was taking Aragvadha, Avipattikar for about 2 to 3 days, and on the third day, I purged.

Vaidya - I remember you not being able to sleep at night because of the itching so I suggested for you to take a tablespoon of both these products with warm water. The sensation and irritability persisted the first day, it underwent some alleviation so it was better the second day but it was the third day when it had all finally built up for you to purge. Did it give you immediate relief?

Dario- Yes, it was an immediate relief.

Vaidya - It takes time and in Dario’s case 3 days for the doshas to be aggravated in the Aamashayam (GI) again and the body to purge these out. But that didn’t solve the entire problem as you came back later and said you weren’t feeling entirely better, what happened?

Dario - The issue was that the itching had not completely gone and it would come back at certain times of the day. It would be aggravated especially at night while I was trying to fall asleep. And you suggested the preparation of a tea with Organic black cumin, Organic Cumin, Organic ajwain, Organic coriander, and Organic Fennel.

Vaidya - If you would recall, I did that specifically to re-establish the Agni in the body since there was the loss of appetite and a thick yellow coating at the posterior and a thick white coating in the interior of the tongue. The Agni was not in its position even though you had purged. The tea has black cumin and ajwain for Ama Pachana and the other 3 ingredients for increasing the Agni. You started feeling better after the consumption of the tea and your appetite was back since the Agni was reestablished in the body. I remember you were explaining to me that the itching at night felt like ants crawling on your skin.

Dario - Yes and you suggested 2 capsules of Kanchanar Guggulu, 3 times a day.

Vaidya- The following knowledge is especially for the purpose of the Ayurvedic practitioners observing this podcast. This was done because Kanchanar Guggulu took away Aama and Kapha from Mamsa and Medha dhatu (Adipose tissue) as we wouldn’t want the doshas aggravated in Mamsa and Rakta to move deeper into Mamsa and in Medha dhatu. Trikatu was suggested so that it may help improve the low Agni in your body. It was considered an Aama and Kapha imbalance instead of a Vata imbalance because there was itching and a thick coating on the tongue but there was no redness. These three products together act as a treatment that took us almost 3 weeks to reestablish your low Agni and help with the crawling sensation.

Dario - The itching seemed to have finally gone because I was consuming no oils.

Vaidya - Oh, we didn’t let you consume oil because the liver function test that you took showed SGPT and SGOT levels were raised and your gallbladder was swollen. All the Aama(Metabolic waste), Kapha(Earth and Water energy) came into the Rakta and started affecting the route organs of Rakta that are the Liver and Gallbladder. Since all the dumping was taking place in the gallbladder you began showing symptoms of a non-functioning liver and the blood tests confirmed my suspicions so I added the liver herbs Kutki, Bhumiamalaki, Bhunimba to help purge out the Aama that was acting up. After a month when the blood tests came back, the numbers were already down.

The case study merely aims at creating awareness that Panchakarma treatment should be followed diligently while you prepare your body and even if you have the right treatment for yourself you shouldn’t mix two procedures. If you’re to do the Vamana or Virechana, you should follow the one thoroughly. There is a section of Ayurveda Panchakarma Vyapat which means complications of Panchakarma. In this, the ancient Acharyas made clear observations of the cases that they administered and the consequences thereof to if it’s not properly followed or administered. Siddhi (accomplishment of Panchkarma) section of Charaka Samhita or Sushruta Samhita or Vagbhata Samhita informs on the complications that may result if someone doesn’t properly administer enema that would not come out. It also explains how to bring this all in balance when Virechna is given, what should an Ayurvedic practitioner do if it doesn’t properly result in a complete cleanse. I must say during this process you have been very patient for someone who is going through all of the itching and irritation all day for 3 weeks.

Dario - I even lost a lot of weight.

Vaidya - You may have lost a lot of weight because your Dhatu Agni came down as we unclogged the body of Aama. I guess it took us about 1 1/2 month for everything to come down to normal. It may also be great to experience it yourself before you could recommend or prescribe it to a patient going through the same. Thank you so much for being here with us discussing your case since and now we could establish that Panchkarma or any Ayurvedic treatment for that matter requires a Yojana that is proper planning to administer the treatment.

This Case study aims to aid Ayurvedic practitioners to assist their patients.