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• We recommended 3,000-4,000 mgs. of Triphala BID to improve bowel function, reduce his abdominal discomfort and help gently detoxify the body.
• To protect prana, we also recommended that if possible, he do his heaviest farm work in the morning, rather than in the afternoon vata time slot (2-6 PM).
• We had Bob agree to choose morning whenever possible as the least disruptive time to run his airboats, and to wear protective ear muffs whenever the engines were on. (We also strongly encouraged him to wear protective ear muffs when he ran his woodworking tools.)
• Bob had already reduced his daily cigarette consumption by 1/2 when he first came to see us, but other than discussing with him the disruption of Prana etc., we did not recommended at this time that he quit smoking. In our experience, patients must have some balancing tools in place to be successful at smoking cessation.
• Farm work and heavy equipment work stir up tremendous amounts of dust and particulate matter. In addition, Bob’s woodworking hobby created large amounts of sawdust, and his smoking was drying to the nasal mucosa. We instructed him in the use a Neti pot twice a day to clean foreign matter from his nasal passages and reduce his stuffiness.
• We also gave Bob some instruction in a simple meditation technique as well as several Yoga asanas (Knee to Chest, Backward Bend, Cobra and Corpse) for supporting the colon and the central nervous system and suggested he practice them for a few minutes every day, preferably first thing in the morning. We taught him Bhramari, good for quelling anxiety quickly, recommending it as needed and before bed. And we advised him to share his treatment plan with his psychiatrist.

At a two-week follow-up, Bob was using the Neti Pot at least once a day. He was beginning to institute a large meal at noon on the days he was just at the farm (he felt that the old farmers had this right, anyway), but was still skipping food on the days he ran his equipment. His bowel movements had improved in consistency and he was having one per day. He seemed to be moving mucous in the upper respiratory tract. While his tongue still had exudate, it was less extensive than before and more uniform in thickness. He enjoyed practicing the meditation technique, but had only done it a few times.

• We advised him to continue practicing the meditation technique on a regular basis, as it would be helpful to him if and when emotional releases began to occur.
• We encouraged him to eat lunch on his heavy equipment days and had him increase the Trikatu to 500 mg. before the midday meal.
• We gave him some additional diet counseling and guidelines to help pacify Vata.

At six weeks, Bob reported a significant reduction of caffeine. From a high of 60 ounces per day he was down to 12 ounces first thing in the morning, though he reported some slowing of bowel function. He also reported that he had forgotten to take his medication one day during the previous week, but had been able to fall asleep that night without it. His was encouraged by this. A modest increase in weight was also observed (from 194 lbs to 196 lbs). He also reported that he was smoking less because he wasn’t drinking as much coffee.

• We reduced his Trikatu back to 250 mg. before his main meal .
• We added a small amount of haritaki to his Triphala regime to help overcome the loss of caffeine’s laxative effect.
• We had Bob do three days of internal oleation (about 2 oz. ghee first thing in the morning) for several days, followed by 3 consecutive days of abhyanga (including ear basti) and swedana treatments at our clinic, during which time he did his best to follow a mono diet of basmati rice and split yellow mung beans, and to reduce his activities as much as possible. He was also instructed in daily abhyanga with sesame oil. He did this at home for the next three days and concurrently was given dashmoola and sesame oil to self-administer basti. Following his three days of self-massage and basti, we told Bob he could slowly reintroduce steamed vegetables and other foods.

At one week after panchakarma, Bob reported minimal anxiety, more stable energy, no tinnitus and 1-2 soft to medium bowel movements per day. His skin was more supple and he seemed calmer. He had returned to a variety of foods, and his mealtimes were more regular. He was not taking any caffeine, cold or carbonated drinks. He had improved appetite and a weight increase to 198 lbs.

• We added Ashwagandha (1,000 mg BID) for its strengthening, adapotogenic and nervine qualities; Vacha, Brahmi (Hydrocotyle asiatica) and Jatamansi (in equal parts, for a total of 1,000 mg BID) for their ability to restore balance to the CNS and the Vata mind (Alakananda Devi on Prana Vayu in “Ayurvedic Specific Condition Review: ADD,” Protocol Journal of Botanical Medicine, II:1, 1996; Acharya Prakash, Lecture “Mental Disorders” Rishikesh, 2000).
• We also suggested some weekly shirodhara and abhyanga at our clinic, but cautioned Bob not to do any heavy equipment operation (or airboat or power tools) for several hours afterwards.

Bob had a follow-up with his psychiatrist after his limited panchakarma, and together they instituted a plan for gradual reduction of his amitriptyline. The intention was to get him to as low a maintenance dose as possible.


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