Supplements recommended by the Vaidya- Manjistha, Anantamul, Ushira, Musta, Mandukaparni, Brahmi, Kumkumadi Thailam

Supplements recommended by Lisa- Guggulu Tiktaka Gritham, CCCFT, Amalaki, Yashtimadhu, Haritaki, Chyawanprash, Triphala Guggulu, Avipattikar, Kanchanar Guggulu,

Namaste and welcome everyone to the Athreya herbs practitioner’s podcast. A genuine interest and effort are to support all the practitioners and discuss these cases, which our practitioner community brings in. We have Vaidya Jay Gopal Parla discussing these cases and giving practitioners some insights into these unique cases. Our goal is to strengthen Ayurvedic practice in the US with the limited resources we have. It is also to structure a program for various conditions that we come across, so today, we are excited to introduce you to Lisa Jacoby. She graduated from Southern California University of health sciences and finished the practitioner’s program to do extensive study for about 2000 hours with 350 hours of clinical training. She is excited about this Ayurveda journey and practices in El Segundo. She wanted to discuss a case where she did the Panchkarma and recently did a follow up so she wants to present this case to us to find out what would be a better protocol to apply. Namaste Lisa.

Lisa- Namastey Vaidya Jay. It is an honor and a pleasure to be here. Thank you so much for having me.

Vaidya- Let me chant, and then we shall start.

Let’s bring attention to our hearts. Let’s let Dhanvantari guide us into this discussion and help make us better practitioners. “Chant” Let us start with the details of your case.
Lisa- Today, I’ll be presenting A case regarding a 32-year-old female with Kshudra Kushta, more specifically Yavana Pidika(cystic acne) and Manovikriti(depression). I first saw this client in late October when she came in for a treatment- Shiro Abhyanga. At that time, we discussed some of the skin problems that she was having. We decided to do a consultation further, so we discussed what was going on, and that was cystic acne on the face, forehead, and chin. There was stress, little anxiety, low self-esteem, low energy, and overall fatigue. The history of her present illness began about five months before this visit around July and began to worsen. She had cystic acne on her face and one boil on her right lateral buttock, which was about 1-inch in diameter, and everything was just getting worse. She had acne since the age of 14, right around the beginning of her menstruation cycles, and once she realized that she was lactose intolerant in her mid-20s, she became a vegan. All of the skin issues disappeared after that but reappeared at the age of 32 because of the stress in her life. She went through a recent breakup with a roommate and had not been practicing her Ayurvedic diet and lifestyle. She was having smoothies for breakfast and took surfing lessons. She was exposed to cold water, which according to her, aggravated her skin issues. She was also going to bed late and waking up late as well. Overall her energy was low with intermittent depression and feeling like it was normal for people to feel this way. 2 years ago, she moved from Russia and was told that after 3 years, the depression should subside. I think this is normal is what she said. Other than that, her medical history has no serious surgeries or illnesses, and she was seeing an Ayurvedic doctor in Russia. She had several detoxes – about 6 Virechanas and 1 Vamana. She has no known drug allergies, certain food allergies to oranges, garlic, gluten, and lactose intolerance, so she became vegan and tried to become gluten-free. Her current medication includes vegan gummy capsules that she takes daily. Her menstrual cycle is normal and lasts 5 to 6 days with the heavy flow on the first day, and then it trickles off. Her symptoms included bloating, cramps, tender breasts, and some PMS symptoms before the detox. Her libido was low, and as far as her family history is concerned, there are no severe illnesses other than diabetes and hypertension. Her social history was a happy childhood and upbringing about the age of 8 when she moved to another city in Russia and started a new school. She felt lonely and did not engage or talk with her parents or develop a relationship with them, so she suppressed many of these feelings until about age 17, when she became friends with her mother. Her parents divorced when she was 14 even though they had many problems before then, but now she’s close to her mother and has a younger brother. They also did not have a good relationship until later on in life, like in her early 20s. She has never really had alcohol or uses drugs; however, she has suppressed those emotions by staying busy. She is a hard-working student who studied English and music, got good grades. She traveled a lot and has studied engineering. She has also worked as a tour and hotel guide. She spent some time in Greece and then came to California because she fell in love with it when she was here at the age of 19. In 2017 she decided to move to California and was doing well here – she was in a relationship, but that ended last January, a lot of her symptoms appeared around July. Right now, she has a pretty busy schedule; she would wake up not feeling ready for the day and had low energy, so her morning routine was kind of just attending to natural urges, eating smoothies, maybe having avocado toast but a lot of cold foods. Sometimes she would skip a meal, and sometimes she would just have granola and warm oat milk and coconut yogurt. Her appetite was kind of low. She liked to eat baked potatoes, salad, pomegranates, and lots of sweets as she is a vegan pastry chef, so her one default was eating a lot of chocolates. She typically skips dinner because she doesn’t have much of an appetite and doesn't drink coffee or take part in any recreational drugs. She does exercise, yoga, online dance classes, but this came to a halt when she hit a little bit of depression back in July. She’s 5’5 tall and 126 lbs. and her examination revealed Vishama Agni. Although she had a movement once a day, they varied. Sometimes they were a little harder, and sometimes they were a little looser most of the time. It would have a brown color, it would sink, long, but like a banana, it would be sticky and foul-smelling. She had no complaints of urine; it was normal and clear. Occasionally she would sweat with exercise, but her sleeping was not so good. She stayed up late and would wake up late. Low energy levels and her emotional balance were unstable. I could not perform her pulse at that initial consultation because I saw her for the treatment, and then we did the initial longline consultation. I did see her tongue at the time, and it was pale and pink. I would say pale pinkish, purple almost, red tip, teeth marks on the sides, and a deep crack along the midline. There was Ama- thick and located at the back of the tongue. Her voice was soft, high-pitched, and she talked real slow and calmly. Her touch was slightly cooler, oily around the face, but the rest of the body had a little bit of dryness. She had normal vision and overall a Pitta body shape. For her Virechana, we decided to proceed with Guggulu Tiktaka Gritham for the medicated ghee. The purgative oil Gandharvahastadi Thailam 3 oz also recommended CCCFT tea as a digestive tea for her to sip on, on the detox day and the days leading up to it. I have also given her a little take-home packet of laxative tea to get things rolling after she had drunk the oil on the eighth day. Everything went smoothly; day one started on November 1st where she took one tablespoon of Guggulu Tiktaka Gritham; Day 2 was two tablespoons up until day 7 to 12 tablespoons. She had no problems with taking the ghee, and she did well with that since she was experiencing nausea, but I had her make ginger tea in the meanwhile and again the CCCFT. On day five of her Purvakarma, the internal intake of the ghee, she reported that the cyst on her right buttock burst that day, and it had been building up for months. She said it had a foul smell, and she doesn’t pick at any of her acne, but it just burst on its own on Day 5. Moving forward to the main day, that is the detox day – she woke up early that morning, and she took 3 ounces of Gandharvahastadi Thailam. She had no problems right after she started internal Sneha with the Guggulu Tiktaka Gritham. I would have her take the medicated ghee in the morning between 6 AM and 8 AM on an empty stomach mixed with hot water and follow it with some warm water with ginger. She was doing very well with this as on day 2; she took 2 tablespoons of the Guggulu Tiktaka Gritham, day 3 was 4 tablespoons of Guggulu Tiktaka Gritham; Day 4 was 6 tablespoons, and day 5 was 8 tablespoons. She texted me about a cyst on her right buttock. She said it had burst and had a horrible smell. Now, this had been building for several months, and this boil was a fascinating surprise. She claims that it had a very foul smell. Then we moved onto day six, and she continued with her internal Sneha, ten tablespoons of Guggulu Tiktaka Gritham, and then she came in for her Abhyanga at 11 o’clock. On Day seven, she was up to 12 tablespoons of it, and she handled it like a champ. She came in for her Abhyanga, and she was feeling good. She reported little nausea after the Abhyanga but was doing well. At that meeting, I gave her her custom blend of laxative tea, and this was a great piece of advice that I got from Dr. Manjusha, and that was made up of Amalaki, Yashtimadhu, Haritaki, so I had that combination. I had her take one teaspoon of that with warm water to sip on for the morning after taking the oil. Day 8 was the main detox day. She woke up at about 6:30 AM and took the oil at 7 AM since orange juice wasn’t a choice because we want to aggravate the Pitta to get the digestive juices flowing. Since the patient liked apple juice, I allowed her to juice a sour apple with ginger to take after the oil. After sipping on the laxative tea, she took that oil. At 9 AM, the patient reported vomiting and thought it removed all of the oil. I had recommended the Avipattikar Churna packet that we also used for Virechana and advised her to sip on that tea and wait until things start flowing. Fortunately, it worked out because at 9:46 AM was her first bowel movement. It was a watery, orange, and oily stool which continued for about every few minutes; it was mostly oil and water. Later on, they became a little more mucousy. She had a little bit of gas and bloating. During her 12th movement, she started to feel weak and tired, wanting to take a nap, but I advised her that she can be a recliner, so she was bearing with it all and doing great. Then continuing with more bowel movements as they were all water at this point – it was all clear but awful smell. Her gas went away, and she had no quality pain after her 14th bowel movement up to her 19th bowel movement; she had her last bowel movement that smelled of castor oil and ghee. The last bowel movement was at 5:50 PM in the night, and it was pretty much like all the ghee had come out. After her appetite returned, she made the rice porridge with a little bit of Himalayan salt and rice crackers. Her appetite was pretty good when we spoke on the phone; she felt good but exhausted but already could feel energized. The next day she felt amazing; she reported that she felt terrific, like her face had already cleared up by taking the internal Sneha for seven days, and her energy levels would be good. She reported she had different experiences in the past. It was a good Panchakarma for her, so we both are very excited. What was interesting about this case to me was that since she was on Panchakarma, she had rice porridge for the first 2 days. She did not have a bowel movement for the first two days, and the coating on her tongue was pretty white and thick. I assured her that was a normal thing because I had learned from Vaidya Naomi, Vaidya Manjusha, and Vaidya Bharati. On day three, she had her first healthy bowel movement, well-formed and floating – it was like magic. Both of us felt great about it, and I prescribed some herbs to be taken 2 days after the Virechana. Her Agni and the digestive tract were rebuilding themselves after the cleanse, so I did not want to introduce anything new, but she did start to take the Chyawanprash after four days. At that point, we realized that she was allergic to it because she had a rash on her face, so I had her discontinue that. So she had Triphala Guggulu– 2 capsules once a day, Kanchanar Guggulu- 2 capsules once a day as well, as she continued her CCCFT tea. Everything was going well until about 15 November, which was less than a week after her detox. Her ex-boyfriend’s relationship had ended a while back, but he called her and returned to her life, bringing much new stress into her life. All of it was crashing down, so I reassured her to stay focused as she had all the tools, and she was already healing and doing well. It brought on a lot of high stress after the Virechana – the sadness and anger. There was also fear instilled back into her life, but she stuck with her Ayurvedic Ahara and Vihara and just took in a few herbs as above. We did a recent follow-up consult on the ninth of December – we did Abhyanga and Shirodhara. Before these, she had high levels of stress, 4 new pimples that had appeared since she had heard from her ex-boyfriend. They were around her left eye, eyebrow, and chin; also, they were very painfully red and big. They started at the end of November, and she was not taking the herbs quite as prescribed, but she was just taking a couple of the capsules. I said that that was okay, and we are going to continue it after Abhyanga and Shirodhara. The patient reported feeling well with all her energy back. We got a chance to talk about this experience and everything that had been the causative factor for her Kushta Roga(Skin Disease), the Nidhana Parivajana. We believe there were a lot of cold foods and drinks. It was like the cold ocean taking an excessive amount of sugar so, what I had with me were new complaints of these pimples. But she had some Agni and digested her food at the scheduled time without any difficulty. However, there was a little bit of a lack of desire to eat. She’s always had 1 bowel movement in the morning after the detox. They are well-formed with no foul smell; they float and are shaped like a banana. Her urine and sweating are normal, she is back to exercising, and her sleep has improved. She’s been going to bed early and has been waking up early. Her energy levels have improved significantly since the detox as she had this anxiousness, fear, and worry that kind of came back to her with her ex-boyfriend. I was able to check her pulse at this appointment, and she felt a little low Prana on her right, and I could feel that Vata and Pitta on her left as well. Maybe a little Ojashaya, even though she seemed happy after the treatment, I got her to realize that she might not be fulfilling her Dharma or the reason she came into the United States or her whole purpose of being here. She remains positive and is continuing school. She’s also really excited to be a part of Ayurveda again, and now I just want to know what you think about this Vaidya Jay?

Vaidya- Okay, so first of all, Lisa, I think you lucked out because a patient to take Guggulu Tiktaka Gritham up to 12 tablespoons is in itself incredible. There are four qualities of a patient Agya means they should have enough money and resources to complete the treatment, Bishagvashya means they should be able to follow the instructions given by their practitioners without any hesitation, so on that aspect, you lucked out. Some patients say it is unbearable- I cannot do anything, I cannot take that bitter Ghritam or the ghee or the Guggulu Tiktaka gritham. Having a great patient is always an advantage because when you start your practice, that is the confidence you need. If the patient is fussy and non-compliant, then you will have issues to juggle with, but this seems to be Dhanvantari sent to you. When I was listening to the entire detox process, the selection of Sneha seemed appropriate. Snehapana was on a good schedule, and the Virechana Dravyas used, which is the Gandharvahastadi Thailam, along with the Virechana tea(Special Blend) that you said like Haritaki, Amalaki, Licorice, or the Yashtimadhu. Hence, you give that as a Virechana Dravya in addition to the Gandharvahastadi Eranda Thailam. So what happens is when Dosha, especially the Vata Dosha, is being eliminated from the body because we call it Dosha Vilayana. The doshas are getting into the Koshta, and if the herb is trying to push the doshas out too quickly, then the Vata, instead of going downwards, sometimes turns upwards, so that is why Vamana happened. The Dravya was fast-moving the Vata in the downward direction, and the Vata could not go at the pace that the Dravyas were moving it. It is common for people to see a little bit of the Vamana first, and then you were wise to use the Avipattikar churna on top of the Virechana that you had done. That is why she got some good Rechana Vega almost up to 19. After the Virechana, she felt better, but what was the exact nature of these Mukadushika or the Kshudra Kushta and Yavana Pidika that she had? Is it red? You also mentioned that some of them are cystic, but is there anything else that you want to give me a little more information on so that our audience can also understand it?

Lisa- They feel deep around her hairline on her forehead and also the jawline. I can feel them deeply. The cysts are reddish, painful, apparent. She doesn’t pick at them at all, but they are very painful. She only wanted to talk about gratitude, and I had to reach her and ask what was going on. She was grateful like everything was perfect with her, and after the recent follow-up, I could see that as well.

Vaidya- This is my observation that till 14 years, she was okay. In the 14th year, when she started her menstrual cycle, she started having these Pidakas or lesions or pimples on her face, so it was discovered she was allergic to milk. The relationship between her mother, menstrual cycle, and a pimple has to do with letting go of the milk or the lactose. It is reminiscent of a mother. She got rid of all those lesions and pimples. She bettered that relationship at a psychological level; she got relief from the mother’s thought process not being good. It is something that I have observed that girls or younger women who have relationship issues with their mothers will break out very quickly during the menstrual cycles, and that could be something that our audience would be interested in learning. Secondly, because the boyfriend comes in, and then the same type of acne starts. Her stress levels are something I would like for you to look into. Keep performing Shirodhara post-Virechana. You could also think about helping with the Manodoshas, especially the Bhaya, underlying fear or anger as we are not sure what is involving the flare-ups. This Dosha aggravation initially starts from the Manas, and it may be ongoing. Pitta-Vata Dosha is because of the type of Mukhudushika, the pain that she’s been experiencing. When the Pitta increases, it goes into the Rakta, so the pustules or the small cyst also coming from the Rakta Dushti. Rakta Dushti and the Rajasic state of mind are involved, so in the future, this is something to look into how can keep her blood under Rakta Shuddhi or Rakta Shodhana. Rakta Shodhana Dravyas include Manjistha, Anantamul, Ushira, Musta. These are some of the herbs you can recommend to her, and you can evaluate the response when it comes to the herbs. Especially ask her to keep a log during the menstrual cycles because the breakouts during the menstrual cycle indicate that Rakta Dushti is there. Her keeping a log can confirm your next steps in the protocol. One point that you brought up I found exciting – the 4th day when you did the Chyawanprash Rasayana, you needed to space it at least two weeks after the Virechana. If you are doing the Rasayana therapy itself, then soon after the Virechana, you can start the Rasayana. But it wasn’t Rasayana therapy as you’re doing it in conjunction with other herbs and diets. You should at least wait a period of 10 to 14 days. That is something that we always have to keep in mind even though Rasayanas are so mild, but they can be hard to digest.

Lisa- Yes, that’s very helpful. Is that basically with any Rasayana?

Vaidya- No, that’s with every Rasayana that we would wait at least 10 to 14 days after Virechana, and then we can start.
Lisa- That is beautiful.

Vaidya- Continue on the Rakta Shuddhi protocol for her, and for the Rajasic state of mind, you should use Mandukaparni. Brahmi is also helpful, but Mandukaparni, in a way, is Sara; it’s not as tikta, and because of its sheeta veerya, it helps to keep the gut calm. I see a relationship between the gut, the blood, and the mind, so I would say we can always help her with adding some Mandukaparni. Brahmi can be used as an alternative to it. The day you’re going to prepare should have Anantamul, Manjistha, and Brahmi taken twice or thrice a day, which will help her. You can continue with what you are doing- Kanchanar Guggulu and Triphala Guggulu will be helpful for her. Triphala Guggulu will take away the Ama that is built in the Koshta. Kanchanar Guggulu will not allow the Rakta Dosha to go into Mamsa and Meda, where it becomes cystic. That is a good choice that you made. You can continue with it. The only thing I would like for you to think about is adding this tea that she drinks twice or thrice a day. That will give her some amount of relief, and you also need to think about Pranayamas.
Lisa- That is a good point because we did such a quick follow-up after Shirodhara and Abhyanga. I did not send her a protocol, but this is a beautiful opportunity for me to go further into her yoga and pranayama. I completely love Anantamul, Manjistha, and Brahmi. Would you recommend Musta as well in that herbal combination?

Vaidya- If you want to because Anantamul works at the Koshta, Rasa, and Artava level and Manjistha works at Koshta, Rasa, and Rakta level. If you want to do something just for Koshta itself, then Musta can be used, and for the Medhya aspect of it, we are using Brahmi. The quantities of Anantamul and Brahmi can be higher because of the Shuddhi of Rasa and Rakta. First, Rasa should be cleansed, and then you can go into Rakta. In the beginning, with half a teaspoon of Brahmi or Mandukaparni, half a teaspoon of Anantamul, and a quarter teaspoon of Musta and Manjistha. It can be done twice or thrice a day and finally, the Pranayamas. Why I’m suggesting Pranayamas is because she is physical and she looks very physically active, she’s doing all kinds of exercises-she surfs, she works out, has an active lifestyle, goes to college, so there is a lot of activity involved which is more bodily bound. In terms of pranayama, it brings more prana into her. It also shows that her Prana pulse is a little low; hence I would recommend, as you said, next sitting, spend some time with her doing abdominal breathing for about three minutes, then the Nadi Shodhana pranayama or in the alternate nostril breathing for three minutes, then Sheetali pranayama which is breathing through the tongue for three minutes. So every day, she dedicates about 9 minutes in the morning and 9 minutes in the evening towards helping the skin on her face and look radiant.
Lisa- You’re suggesting essential abdominal breathing for three minutes in the morning, then the alternate nostril breathing for three minutes, and Sheetali Pranayama in the morning and night.

Vaidya- Yes, as she has complained, she can do it twice but preferably in the morning before the day starts. I think she starts the day anxious, so I want her to be a little more relaxed when she goes into the day, and Pranayama is the best way to do it.
Lisa- I like the combination of those three.

Vaidya- In the future, when she comes to your Shirodhara treatment and when you do Abhyanga, you can use Kumkumadi Thailam for the face. You can also make a face pack for external applications like ‘Lepa.’ You can give it to her. Depending upon the internal treatment, you can decide the Bahi Parimarjana chikitsa, i.e., external applications.
Lisa-I could do something like Lodhra Haridra, Sandalwood.

Vaidya- Your choices are good. You can do a little bit of rose petal powder or even add Anantamul into it, which is helpful for the skin condition. Amalaki can also be used to bring Rasa to the skin. It can be used as a paste that you give her, and she can apply it in the evening and wash it off before she goes to bed.
Lisa- Would we use something like aloe vera as the base?

Vaidya- Yes, you could use aloe vera, but water is also acceptable. Rosewater is suitable for calming down the Pitta in the skin.
Lisa- Thank you so much, Vaidya Jay.

Vaidya- Your welcome, and I am happy that you had the opportunity to administer Virechana and get a good outcome. Now, all you need to do is select a proper Shamana Chikitsa, which we have discussed, and you will have a patient’s trust for life. She will believe in you and will be a patient for life.
Lisa- I agree she is the best patient. She gave me not only compliance but also constant gratitude.

Vaidya- Your welcome, and I am happy that you had the opportunity to administer Virechana and get a good outcome. Now, all you need to do is select a proper Shamana Chikitsa, which we have discussed, and you will have a patient’s trust for life. She will believe in you and will be a patient for life.
Lisa- I agree she is the best patient. She gave me not only compliance but also constant gratitude.