As we continued working together, I introduced Howie to the Ayurvedic guidelines for healthy eating, helping him transform his eating into a form of sadhana. Howie’s symptoms improved over the first few weeks, as the weather warmed, he began a month-long khichadi mono-diet to clear the remaining ama and rejuvenate the liver. Khichadi mono-diets are ideal for those that do not have the financial resources to go through a full Pancha Karma. In fact, there are few that would not benefit from at least a short khichadi fast at the onset of spring. Howie’s khichadi included a good deal of turmeric and greens to aid in clearing the liver. I supported Howie through the normal initial fluctuations in energy that come with a khichadi fast.

I usually teach patients a form of pranayama using a double inhalation double exhalation, as well as focusing on drawing in prana from the sun and using affirmations that support the mind to let go of its addiction to getting life “from bread alone.” Howie did a marvelous job and was fully compliant.

After the first week, Howie was feeling wonderfully light and his symptoms were entirely relieved. By the third week, Howie went to have his liver readings and cholesterol levels checked again. His doctor was amazed with the results. Not only was it quite rare to see these high readings drop so much, but he had never seen them drop so quickly! Howie was thrilled.

I instructed Howie to take a month to return to the Pitta-Vata diet, starting with the most easily digestible foods. The following are some good guidelines to follow for a post-fast samsarjana krama:

• Spend the same length of time returning to a normal diet as the length of the fast.
• The first foods after the fast should have the same ingredients, but in different forms. For example, instead of khichadi the meal may be rice, steamed vegetables with ghee, and spiced mung dal.
• The portions should be small.
• Digestive herbs should be continued, increasing the dosage if there is any gas.

I continue seeing Howie occasionally and he continues to look and feel increasingly better. At the last visit I introduced color therapy to him. As he continues to integrate the healing principles of Ayurveda into his lifestyle and his knowledge of self-healing deepens, I am deeply inspired and grateful for the opportunity to share the science of Ayurveda. I am reminded of the intentions of our ancient rishis when they sat together in the Himalayan Mountains and sent Bharadvaja to ask of Lord Indra the principles of Ayurveda; the rishis were seeking to relieve the pain of suffering humanity, and to support our health on the path of Self-realization. May their light continue to guide us always as we practice with these goals in our hearts and minds.

Jacob Griscom, CAS is a Clinical Ayurvedic Specialist with an Ayurvedic practice at the Peaceful Living Holistic Healthcare Center in Nevada City, CA. He is also a teacher and intern supervisor at California College of Ayurveda, and serves as secretary of the California Association of Ayurvedic Medicine. Tel: (530) 478-0729. Web site: www.peacefullivinghhc.com
Email: jacob@peacefullivinghhc.com

References:
(1) Dash, B. and Sharma, R.K. Caraka Samhita. Volume I, Chpt.VII (Navegandharaniya), v.37. Varanasi, India.

Extreme Vata: A Case Study

by Debbie Mathis, MA, D.Ay.

Bob, a 52 year-old male with a history of anxiety, was under a psychiatrist’s care for bipolar disorder. He came to our practice because he needed a physical and because he had heard we had a “different approach to things.”

He was first evaluated, as are all of our new patients, via lab work and physical exam. Lab work included CBC, a comprehensive metabolic panel, urinalysis, lipid panel, GGT, serum iron, Thyroxine (T4) sedimentation rate, and prostate-specific antigen. He had a slight elevation of polymorphonuclear cells, urine pH of 8.0 (normal is 5.0-7.5) and an elevated cholesterol of 208 (normal is 100-199). His HDL was 37 mg/dL (normal is 40-49) while his LDL was 146 (normal is 0-99). White blood cell count was at the upper reaches of normal at 9,900. All other lab results were within normal limits.

Objective findings on his physical exam included height of 6’5’’, weight of 194, blood pressure of 134/80, pulse of 85. He had male pattern baldness and light brown hair, hazel eyes, deeply tanned dry skin and roughened hands and feet. Tongue exam showed extensive white/yellow exudate with heavier patches paralleling the lateral anterior borders (the area corresponding to the lungs). Bob’s tongue moved constantly on extension. Pulse exam suggested Vata 3, Pitta 1, Kapha 0, with both Prana and Udana Vata disruption.

Medical history revealed several rehabilitation hospitalizations for alcoholism and 2 for manic episodes (one of which was violent), and an electrocution while hanging cable from trees in 1975 with subsequent abnormal electrocardiograms. His recent EKG was normal.
Medical history also included mild hearing loss and tinnitus, respiratory allergies, (stuffiness and shortness of breath around mold and fungus). His medications: 150 mg daily of amitriptyline (antidepressant) and a nasal decongestant prn.

Unmarried, Bob had worked for some years as a “tree climber” hanging cable for film companies, and as a construction worker on high rise buildings. His current occupations included operating heavy equipment for his water management company, and running his 61-acre farm. In his spare time he did woodworking and built airboats, running them on a river near his farm, and occasionally on the ocean.

Bob’s habits included smoking for thirty years, regular use of marijuana, and heavy caffeine consumption (at least 60 ounces of coffee per day). He had achieved sobriety 8 years before his first visit to us. His diet was irregular. He often didn’t feel like eating and might not take any food for “a few days.” Other than coffee and caffeinated colas, he favored cold water (60-100 oz. per day), craved chocolate, eating several candy bars in the evening, and loved hot pickled habanero peppers and hot red pepper sauce. He normally did not eat during the day and had his only meal in the evening. Bob said he had to fight to stay near 200 lbs. He had 5 dry bowel movements per week with difficulty and occasionally abdominal cramping. Constipation was exacerbated by travel.

Except for his hazel eyes and male pattern baldness, Bob presented as classic Vata, very tall, quite thin for his height, cold extremities, extremely dry, rough skin, variable appetite, difficulty in maintaining weight, and constipation. Constantly talking, having difficulty staying on track, Bob told us that although he had graduated from college, he was labeled “stupid” in elementary and high school. (Though he was never diagnosed with ADD/ADHD, it would be in keeping with disruption of Prana Vata.)

While Bob had overcome his addiction to alcohol, he still had addiction to smoking and marijuana. Smoking directly disrupts Prana Vata, while Marijuana is additionally ungrounding. In general, addictions are quite Vata unbalancing.

Bob was also addicted to height and speed. He had been nicknamed “Squirrel” by coworkers because of his agility and affinity for tree climbing, and he had a self-avowed love of racing his jet engine airboats. Added Vata derangement came from the unbalancing effect of the high decibel levels he experienced several days a week from his operation of heavy equipment (he could not wear ear protection, he said, because he could not hear people or other equipment at the work site).

One of Bob’s more pressing problems was the imbalance created by his medication and his attempts to remedy that with caffeine. Bob told us that his psychiatrist had prescribed the amitriptyline to help control his bipolar disorder, and while he claimed his bipolar disorder was more manageable with the antidepressants, it had “a pretty big kick.” In order to counter its sedative effect, he needed plenty of coffee to get going and stay alert during the day. He took the amitriptyline around 4 PM, in order to get to sleep by 10 PM. If he forgot to take it, he could not sleep. If he didn’t sleep, he couldn’t operate his equipment safely.

Our assessment of Bob was that he had obvious signs of Vata derangement, due in part to his genetic predisposition (mother and maternal grandmother were bipolar, maternal grandfather was alcoholic and committed suicide and father was alcoholic) and exacerbated by his addictions, life-style and diet choices. We also suspected a childhood history of sexual abuse, based on other bipolar patients we have seen. Bob confirmed this on a subsequent visit.

We did not want to reduce his medication, nor did Bob, because of the possible exacerbation of his bipolar disorder. While the medication “masked” his bipolar symptoms and did not address the underlying imbalances, it was keeping him functional. Instead, we first approached some of the habits and life-style issues which were contributing to his Vata disruption. David Frawley has suggested that bipolar disorder is an example of extreme Vata imbalance (lecture, Southwest Yoga Conference in Austin, Texas, November 2000), and for Bob, this certainly seemed to be the case.

• We gave Bob 250 mg. of Trikatu before meals to help stimulate appetite, improve digestion and reduce ama. We set up a weekly schedule of mealtimes. For the 4-5 days he was on his farm, we encouraged him to eat his evening meal in the middle of the day, thereby taking advantage of stronger agni, and reducing the deleterious effects of his less than optimal food choices. On the days he ran his heavy equipment, he had to follow the job site schedule and would often have to work during the lunchtime of some of the other operators in order not to be in the way of their machinery. We suggested he try to eat his lunch around 10:30 or 11:00 am, a time which had previously been his customary coffee break.

• To further reduce ama, we had him begin the simple practice of drinking hot water rather than cold (he was accepting of the suggestion: an uncle had followed the practice and had lived well past ninety)

We suggested a gradual withdrawal from caffeine and carbonated beverages. We told Bob that if his nervous system weren’t so jagged on caffeine, eventually, he wouldn’t need as much amitriptyline to calm it down, but it was best to proceed slowly. Hot water would be able to replace some of the coffee “habit.” Improved appetite and increased food intake would give him more energy so coffee wouldn’t be needed. We also told him that one likely benefit of reducing or eliminating caffeine would be a decrease in his LDL cholesterol. (Caffeine is implicated in elevated cholesterol.)