Ayurveda, or the ‘science of life,' is one of the oldest and most alive healing traditions. It is a healthy lifestyle system that people have used for more than 5,000 years. The primary goal of Ayurveda is to sustain a healthy person's health and eradicate sickness in the sick. The concept of SANKARA is explained at the end of Nidana Sthana and is a unique contribution of Charaka Samhita. Sankara is classified into four categories: Hetu, Linga, Chikitsa, and Vyadhi.

Today, we will discuss the case of Vyadhi Sankara, which means a mixture or combination or group of two or more diseases. So let’s first discuss the case history of the patient.

October 20, 2021 |  39 minutes.
By Vaidya. Jay Parla. 

 

Namaste everyone listening to the podcast series, which is for the Athreya practitioners and the community of practitioners. As you all know, this is an initiative through Athreya herbs to bring cases or case studies from our community to discuss and evaluate how we can improve our skills, especially critical thinking skills, clinical skills, and herbal prescription skills. My name is Vaidya Jay Parla. I am here with our dear practitioner Cheri Michelle, Namaste.

Cheri - Namaste Vaidya Jay, thank you.

Vaidya -  Of Course, thank you for joining us. Cheri is a practitioner who has graduated from the Southern California University of health sciences. A voracious learner, as I know from teaching her. She is passionate about Ayurveda and practices in the Palm Springs area. Her practice is Desert Ayurveda, and she has a lively narration, so without any further delay, I will first chant, and then we’ll have her present. We shall chant now. May Dhanvanthri guide us through this clinical discussion, and I am glad Cheri that you are right away practicing and then getting these interesting cases; please go ahead.

Cheri - Okay, thank you so much, and I just want first to say that I so appreciate you doing this for us; this is such a gift for our continuing education and learning from each other. So I’m just thrilled that you’re doing this. 

Vaidya - We also appreciate every practitioner who brings in cases to improve our clinical skills. Thank you.

Cheri - The interesting case that I came across is a 52-year-old female who didn’t know anything about Ayurveda, and she’s a friend of mine, so she knows what I have been up to the last couple of years and did not know a lot about Ayurveda. We visited and got into the details, and she became more interested as I continued to speak about Ayurveda, and it evolved. We talked about her diet and the different things she was doing that might help her change and adjust slightly. I progressed and said, let me take a look at your tongue. She thought that’s so weird, and I was like, I know, but let me just look at it. She sticks out her tongue, and I had to stop myself from being so shocked. It was a fascinating tongue because it had a little growth or papules or bombs in the area representing the reproductive organs and the digestive system. So I asked her when was the last time she had been to the doctor or when was the last time she had a check-up, and she said it’d been a while. So I suggested that it might be a good idea to go in because you’re at the age where you can probably get a colonoscopy and get a full workup to make sure that everything is good. In the meantime, I’m just going to see if you want to go on this herb called Kanchanar Guggulu and she was very open to it, and she started immediately. She went home and right away followed my advice. She went to the doctor, and they did a complete exam on her. They found something suspicious in her left ovary, and so she called me and said, wow, you were right. Something is going on, and they will take a second look in a couple of weeks. Meanwhile, she is continuing Kanchanar Guggulu, and when she went back in, they said that it had shrunk, and this was a surprise to her. she came back to me and said, alright there’s something to this, and I want to do a full workup with you so what do I need to do? Then I made her whole history, and we did discover that she suffers from chronic migraines and tension headaches, and then there was a whole slew of things that came out. It’s quite the case.

Vaidya - Yeah, these cases are interesting because they tumble upon Ayurveda without knowing what it is. Suddenly they are so encouraged and astonished that their doctors or nobody said anything to check this same part of my body. There was this precise instruction from you to look and go to a workout about your colon or reproductive tissues. It is fascinating, and I am so proud of you that you just looked at it and said there must be something going on with their digestive system or the reproductive system. Let us get into the details of the case that you have taken to share with us. Then we will address the issue of her headaches.

Cheri - I discovered that she has migraines and chronic tension headaches. She also suffers from severe sugar addiction. For the last year, she’s been having extreme drying in the sinuses, eyes, scalp, and mouth. She’s also been experiencing an itchy anal area and lower back pain if she sits for too long. She has a bulging L4 and L5 from pregnancy. But that is not her concern too much, and she manages it pretty well with Yoga. She's a Yoga teacher, and she suffers from what she believes are chilblains. She suffers from hands and feet that are always cold, and sometimes her toes turn red and puffy. Usually, she runs cold except for possible menopause lately, but she’s not sure because she does have an IUD with hormones, and it does have a tendency to stop your menstrual flow. She’s also had an ovarian cyst in the past, which was interesting, but I did not know any of this when I saw the tongue. Her tongue, I would say, did show that, and the history of her present illness, or the patient suffers weekly from headaches, migraines and has most of her life. They started back when she was in her 20s, and it got worse in her 40s. The only time she felt that she had real relief from these headaches was during her two pregnancies. She said that life was great at that time and she was less stressed on every level. She was a lot happier, her marriage was great, and they had money, so they felt secure and happy. Then she entered her 40s along with that came a lot of transition in her life. They made a big move and a cut in finances, marital stress, and the added stress of going back to school. It made her feel more of the financial load was on her shoulders, which increased stress as she had to handle everything. Although she does enjoy school and the children, it was a lot for her. She is susceptible to sound, which I thought was very interesting in these debilitating headaches. They seem to stem from the base of the neck and around the occipital area. She did say that ponytails, hats, and wearing glasses can trigger these headaches. She switched to contacts which did seem to help a little bit. This is how she has been treating these headaches by receiving Botox for 3 to 4 months for ten years or so. All around her head, neck, and trapezius. It seems to help but doesn't take away the headaches. If anything, she feels like the Botox treatment is interfering with the muscle tone in her shoulders because maybe it freezes that area. She has also tried meditation which helps a little, and has also tried autogenic training, which I didn’t know anything about, so I had to look it up. I’m not sure, but I think it is a form of meditation, and she did experience relief when she was doing that. She has also tried changing her diet and eliminating sugar, and this has also been hard for her because it’s a real problem as she does have a sugar addiction. She does try to eliminate sugar and eat gluten, which did not help but did not fix the headaches. Although sugar does seem to be a significant trigger, she has figured that out. In her 40s, when the headaches were out of control, she admits going through bottles and bottles of Indomethacin as a medication. Now she has found out that Xcyterin helps the most for her, and she sometimes takes that daily. She has been taking some sort of NSAIDs for the past 12 years consistently. Since childhood, the patient battles with sugar addiction and tries to avoid sugar, which makes her feel better overall with fewer headaches; however, she inevitably falls off the wagon, which is a huge struggle. For the past six years, she has been experiencing a severely itchy anus, and sometimes it is so severe that it wakes her up in the middle of the night. She feels it’s way worse when she’s eating sugar, and the doctor prescribed Cortisone seems to help. As I mentioned, she suffers from chilblains mainly in her feet and can stop it from progressing by applying oil to her feet and massaging. She’s also been experiencing pretty severe dryness in the sinuses, mouth, eyes, and scalp for the past year, and the doctor has ordered a test to check for Sicca syndrome. I have never heard of it, but she hasn’t gotten those results yet, so that we will see.  She has experienced ovarian cysts in the past, and when she came to me for guidance the first time, I went into the whole story. She is still taking the Kanchanar Guggulu now until I hear more about this from the master.

Vaidya - Thank you, this is a Vyadi Sankara in Ayurveda. It means a few diseases all attacking the patient‘s different areas. What are her weight and height?

Cheri - She’s 5 '4-5' 5 maybe and 110 lbs in weight. She has a hard time keeping the weight on.

Vaidya - Exactly, so that is the point I was getting; her Dathu is getting Kshaya. Dhatu Kshaya means the Dhatu is not having the either qualitative or appropriate quality or quantity. It would have been her underlying pathology or imbalance. When the Dhatus are not nourished, they feed to 1 Dosha that is Vata. So whenever these are depleted, Vata keeps on increasing. That makes sense. After all, she wants to eat sugar all the time because she feels this lack of nourishment. As Ayurvedic practitioners, we know that Madhura or Sweet is the most nourishing taste, but if this sweet is made from sugar instead of natural sources like jaggery or honey or maple syrup, or coconut’s nectar. Sugar is (Sheeta Veerya) cold in potency. So the more sugar she eats or the more sugar preparations that she eats may create a sense of the nourishment that is lacking, but it also feeds the Vata because of its cold quality. So she keeps on adding, and that is why she has cold hands and feet. I wanted all our listeners to know that you did send me the picture of her tongue to look at, and I can completely agree that it’s a very interesting thing like your eyes might pop out. When you look at it, it’s a tongue that shows overall Dhatu Kshaya, not only The Rasa Dhatu but also Rakta, Mamsa, and Meda. How is her libido?

Cheri - She says that the desire is there; however, it feels exhausting. She thinks that she has got the kids around and doesn’t have any time.

Vaidya - So mentally,  she may be inclined, but physically, I don’t think she has any support for a good sexual life.  I’m just looking at Rasa, Rakta, and Mamsa for sure. That’s why the Trika Sthana is the neck, shoulders, and nape of the neck. These are the regions where muscles are being depleted, and that is why she has the headaches starting from the neck, and Botox helps, which makes sense because it numbs the Vata that was aggravated in that region. Given that, why would she develop a cyst in the ovary or some uterine problems? She also has constipation, right? 

Cheri - She had a hard time talking about her bowel and got kind of embarrassed about it, so I had to drag it out of her, but she doesn’t seem to have constipation. She said she goes, and sometimes it’s dry or loose, but I wasn’t sure.

Vaidya - She must be helping it by taking supporting laxatives like milk of magnesia or sometimes taking Senna. So something must be taken; otherwise, I don’t think after much of Vata’s aggravation and the tongue you showed me, she has healthy and regular bowel movements. I think the Vata influences them, and there is no question about it; maybe that’s why she hesitated to tell you. I’m just speculating here, but I think there is something to do with the bowel movement. The Apana Vata is increased and has moved along the spine. She does have back pain which she manages with yoga, and now it is going towards the head and neck region, also causing the headache. It is secondary to Vata being excessive due to the lack of tissues and nourishment, especially Mamsa and Meda. Is there any joint pain complaint she had, as I did not get that from her history? 

Cheri - I did not get that from her, but I feel that she feels achy in her joints, and I gave her a treatment. The back of her neck was super rigid and tight, and she does experience it in her fingers and toes.

Vaidya - That is because it should start from the fingers and toes as Vata is predominant to the cold and discoloration, which could be one reason why the joints would ache. Sandhi is involved, Asthi is involved, but most importantly, Mamsa is involved, and is her period regular? Cheri- well, now that she has the IUD, she doesn’t have her period. 

Vaidya - What about before the IUD? 

Cheri - Before the IUD, she said it was pretty regular and lasting three days.

Vaidya - Alright, so the bottom line for this patient is that there is a lack of nourishment of the tissue, Vata in the Apana area has increased. There is a history of some Ovarian cysts in the past. In contrast, now they suspect another possible abnormality, so the Vata does not allow the regular eggs to mature; instead, it stagnates and makes the Kapha accumulate and displace the Kapha in that region. Apana influence is seen all along the pelvic region then the Vata that is generated is going towards the head and neck region. It is Vata Janyeshiroshola and Dhatu Kshaya Janyeshiroshola due to tissue or Mamsa especially lacking muscle tone and muscle strength. She’s a yoga teacher, so she must be helping herself by moving and keeping her neck and shoulders flexible otherwise if anybody else would have had such a dislocation or disk herniation in the neck region, the Vata keeps increasing what it would do finally is displaced, that could have also happened in her case. In Ayurveda, the migraine headache is called Ardhava Bedheka. It is a partial headache that involves one side of the head and increases at specific times. We would go for the simplicity of our listeners, head towards-, how to approach this case. The most important thing is you gave her the Kanchanar Guggulu, which will help with the aggregation of the Artava or the stagnant menstrual flow and make the ovaries swell and become abnormal tissues. It’ll break the possible stagnation of Artava and Dasthi Shukra that is stagnant and needs to be mobilized for no complications, and that is the good part of what you have done. What should we do in terms of Vata Anulomana? Vata should be eliminated in the downward direction. Anulomana is to follow the direction of the spine and the direction of the Cauda Equina going down. How do we do that? It can be done with a few herbs as simple as Haritaki because it’s one of the best Anulomanas that we can get. It can be mixed with Hingvashtak, ‘Hing’ also is a downward propeller of Vata. Hingvashtak also has Ajamoda, Krishna Jeeraka, Trikatu, Sendhava. All these help correct the Koshta(gut) where the Vata is getting formed. Take Hingvashtak about 3/4th of a teaspoon and then add half a teaspoon of Haritaki, take it twice- once in the morning and once at night. We will mix it with the hot water and not as the first morsel of the food. Usually, that’s how it’s taken, but we don’t have to do that. We can just take about 3/4 of a teaspoon and mix it into a quarter cup of warm water and mix half a teaspoon of Haritaki to give to her. Whatever help she needs for going to the bathroom regularly and directing the Vata is done by this. The critical point is that you have to do internal Snehana for her. The tissues if they’re dry, like the tongue, which looks quite dry and cracked. The tongue almost looks like a dry lake bed. That shows  Sneha is missing, and we need to put the Sneha back into its place, we can use goods Sneha like Triphala Sneha, or we can use Kalyanaka Ghritam. Triphala Gritham will be better, and you can give 1 1/2 teaspoon every night. It is about half a tablespoon, and we can do that only at night; you mix it with a bit of warm flax milk, and then you can administer it. You recommend it to her as a before-bed kind of a thing.  If the test is not interesting enough, she can add a little ginger and blend it all to drink it. What does it do? Sneha in the form of Pana. It means drinking. Drinking the Sneha is highly recommended in Vatavyadhi. You should do it with Thailam. It will be very hard to take. Sneha in the form of Ghritam is straightforward. Triphala being such a useful Ghrita for digestion, she can take Triphala Gritham and then go to sleep. Our primary focus is to correct the flow of Vata to Ruksha quality, which is showing up on the tongue and can be reduced. The Triphala Ghrita pana also addresses this quality that is also making the ovaries stagnate. Once the Vata starts going down and out, we must think about strengthening the muscles in the back and the neck. One of the things that she can do is use Sneha or external oil, Karpasastyadi Thailam. It is cottonseed oil that is good for spine conditions, and also, you can use Bala Ashwagandhadi Thailam, which is soothing, and you can mix them. Like maybe 4 ounces Karpasasthyadi and Bala Ashwagandhadi. Mix them and apply them on the neck so she would lie down on a hot water bottle or a heating pad in the evening time for about 10- 15 minutes on this hot surface. What happens with that is that the locally settled Vata will start moving. She doesn’t have to depend on Botox for a long time.

Cheri - Beautiful!

Vaidya - that she will do as her external treatment. Now we need to think about the Mamsa Dhatu, and we cannot forget about it because Vidarikanda is a great remedy for this. For women to improve their muscle tissue, you can also add Ashwagandha, which is also possible, but Vidarikanda is the herb of choice for this patient. You can give that as a milk concoction or a latte, or she can cook it with oatmeal, or if she’s drinking some kind of morning hot or warm tea, she can also add it. We can, either way, introduce Vidarikanda. I would recommend up to 1 1/2 teaspoon of Vidarikanda during the morning, once a day. Mix it with warm milk, or she can blend it with flax milk, etc., or a hot tea. It has a Bruhmna quality, Snigdha and Guru Pichila. These qualities will help to rebuild the muscle tissue by nourishing it. We have Bruhmna Chikitsa, Anulomana Chikitsa, Snehana Chikitsa (internal and external) Snehana. Moving towards Shoola, that is the pain. You did everything around it, and now you had to target the pain. It is because of Vata being aggravated. The best thing for that is using herbs that can Shoola Prashamana so that the choices will be using either Yogaraj Guggulu one in the morning, noon, and night along with Kanchanar Guggulu. One pill three times a day because the Vata is deep-seated, and to remove it, we want to use Guggulu because it drives itself deep into the tissues. You can also later ask her to take this combination for three weeks. She can come back and then tell you how her pain is. Also, she can keep a log of how many times she has headaches while she’s on this program when she comes back after three weeks and says that she feels better, but the frequency of her headaches is still like twice or thrice a week. Has she complained about headaches, so we get at least twice or thrice a week?

Cheri - Atleast, weekly.

Vaidya - If in three weeks it is reduced to a maximum of one or two events, then you can be assured that your treatment protocol is working. If not, then you need to increase the Snehana. You can do this by using oil in the ear Bruhmana Nasya Everything, nourishing the tissues, and getting the Vata out. You can use Ksheera Bala oil in the nose. To make sure all these areas are dried out and emaciated due to Vata, start getting some kind of nourishment.

Cheri - I told her to do daily Abhyanga for herself and nourish her five senses. I felt like maybe swishing, but I could be wrong. I got her started on Nasya.

Vaidya - Anu Thailam may be okay, but I would do more Bruhmana Nasya using either Mahanarayana oil or Ksheerbala oil in the nostrils. If the pain continues after this, you can switch to the general pain-reducing herbs that we have like you can use Nirgundi, Rasna, and some amount of Ajamoda. This protocol will help to nourish the Dhatus and eliminate the Vata at the same time. And filling up the ears and the nasal with oil drops will go towards the head and neck region to even drive the deep-seated Vata out. You have Yogaraj Guggulu, which is also helpful in reducing the pain and taking the Vata out from the Majja Dhatu. Next time you come to us for another podcast, Cheri, we would love to input this.

Cheri - Excellent I’m so excited to present this to her.

Vaidya - Thank you, I think it was very complex but, at the same time, a case that we often encounter all the time. The patients come to us, and their problems have a complexity like headaches, constipation, skin rashes, sometimes even sinus issues or lower back pain, and one has to know where to start. Also, to understand the major phenomena so you can cast out the problem from the root and then start working towards the other branches. This case was like that, and I think our listeners and our practitioner family should know that these cases are widespread because they don’t have an answer in other systems. The patient is inclined towards Ayurveda, thinking it could help. There is help in Ayurveda, no question asked, provided you plan your treatment well, you know where to streamline your therapeutic protocols, and the patient will get relief. I hope that you will give us some positive feedback next time you’re here. Thank you so much for sharing all this information, and it was a very interesting case that I enjoyed discussing with you.

Cheri - Thank you, Vaidya Jay. Namastey and Will come back with a new case. If you have a case that you want to discuss, please bring it to our attention by emailing us at info@athreyaherbs.com or calling us at 323 909 2981. We’ll be looking at the cases according to whoever is first, but we will also be giving priority to the cases that need urgent attention. So it may not be necessary that you have to wait. Thank you, everyone; we look forward to seeing you again.

Cheri- Namastey.