A Study-Guide
of
Ten Clinical Consultations
in
Buddhist Ayurvedic Medicine
(For Case Study and Reference)
by
Brett S. Cantrell, Sr., A.A. (Sociology)
(Tib., Karma Sherab Zangpo)
Candidate for:
Diploma, C.A.T. (Clinical Ayurvedic Therapist)
and Ordination, Buddhist Pastoral Counselor (Upasaka)
Ven. Losang Jinpa, D.Ayur., M.A.H., Ph.D., Director
Ayurveda Healing Arts Institute
Medicine Buddha Healing Center
Berkeley, California
February 2007
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A Study Guide
Transference and Dedication of Merit and Blessings
By this merit, may all attain Enlightenment.
May the enemy of wrong doing be defeated,
From the stormy waves of old age, sickness and death.
May all beings be liberated.
At this very moment, for the peoples and nations of the Earth
May not even the names disease, famine, war, and suffering be heard;
But rather may their moral conduct, merit, wealth, and prosperity increase
And may supreme good fortune and well being always arise for them.
Just as the hero Manjushri Great Wisdom Bodhisattva gained Enlightenment
And Samantrabhadra Perfection of Conduct Bodhisattva exactly the same,
I dedicate this merit entirely (to the welfare of all)
So that I may train myself to follow Them.
Precious best mind Bodhicitta,
May it be born in those in whom it is not;
May it flourish in those whom it has arisen;
May it grow and grow, on and on.
May all of us who share a connection with the Medicine Buddha and Dhanvantari
Be inspired by illumination.
May the blessings of health and ease
Shower like fragrant blossoms from the Medicine Paradise.
May the Dharma increase.
May all beings be happy and realize the Great Perfection.
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A Study Guide
Introduction
While studying Ayurveda, particularly as a beginning student, I am
constantly looking for ways to test my knowledge, to learn by the “work smarter,
not harder” methodology. So, over time, I resorted to a variety of methods. . .
reading, flash cards, pounding terms into my head by rote, and yes, even
subliminal messages that would flash in milliseconds on my computer screen.
But there was one item that I kept wishing for. I wished there was a way to test
my knowledge, clinically. How would I learn to apply the information that was
now flooding my head? How would I recommend herbs and changes in lifestyle
for a patient? And what recommendations would I make, should I make, in a
variety of conditions?
It is to this end that I’ve developed this study guide.
These cases are from recorded sessions of my teacher’s, Ven. Losang
Jinpa’s, clinical consultations. I owe a deep debt of gratitude for his kindness, his
selfless and free giving in the promotion of Ayurveda and the Dharma.
I’ve chosen to present these case studies in a western-medicine SOAP note
style. During my 11 years of service as a US Navy Hospital Corpsman, I had
become quite accustomed to presenting medical information in this style. For
those of you who aren’t familiar with it, it stands for Subjective, Objective,
Assessment, and Prescription. The Subjective section is basically what the
patient tells you, their medical history, the nature of the illness as they experience
it. The Objective portion includes notes of the physical examination, the
observable condition of the patient. The Assessment includes the overall
assessment, or diagnosis, and possibly several diagnoses for consideration. And
the Prescription section is just that, the prescription, of how to treat the illness
presented.
Each case study begins with the presentation of the Subjective (what the
patient says) and the Objective (what is observed during the exam) of the session.
I’ve then offered a few questions to spark your thinking of how you might treat
each case. The actual Assessment and Prescription sections are included on a
following page(s) so that you can more easily test your knowledge before turning
to this section to see how Ven. Losang Jinpa analyzed and offered treatment.
And finally for each consultation I’ve added my response and any additional
information or explanatory material which I thought might be helpful.
Sometimes during an actual consultation, in the give and take of
conversation, certain points and explanations may be dropped or left unfinished.
I’ve endeavored to complete information and round-out the guidelines of chikitsa
(procedures and protocols) to the best of my Ayurvedic knowledge. My
additional comments and questions will be found in bold lettering in the case
notes themselves, and then in the Questions and Response sections of each
consultation.
While there is certainly the acknowledgement that there is more than one
way to skin a cat (I use the proverbial saying, not that I wish harm on any
sentient being,) there will, I am sure, be variances from the Ayurvedic treatments
and recommendations presented here, either Ven. Losang Jinpa’s or mine. There
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are no right and wrong answers, but in answering the questions and reasoning
your treatment, one should be able to clearly, logically, and with proper
documentation be able to back up your treatment recommendations. When
considering the many avenues of treatment, please bear in mind what Pandit Dr.
David Frawley and Dr. Vasant Lad say in their book, The Yoga of Herbs, that
“Remedies produced with love, even when not ‘therapeutically sound’, may work
wonders. Love is the true healing force; herbs and other means are merely
vehicles” (Frawley & Lad, 2001, p. 16).
The object here is to help train and enable the study of the up-and-coming
clinician, using basic principles and practices of Ayurvedic Chikitsa. I’ve
presumed a basic knowledge of Ayurveda and basic concepts such as Doshas. I’ve
also presumed a basic medical knowledge of western allopathic medicine and
terminology. The scope of this paper is not to teach the fundamental concepts
and terminology of these systems. There are plenty of fine introductory
textbooks on both Ayurvedic and Allopathic Medicine.
You’ll find each consult listed by number, as well as the filename of the
original audio recording (.mp3, .wma, or .wav file) for your reference.
Again, my special thanks to my teacher and Dharma guide.
May all realize Enlightenment,
Brett
Tadyata, Om Bhaisajye Bhaisajye, Bhaisajya, Samungate, Svaha. Om.
"More important than how many deities you visualize is to understand what you
are doing. And most important is to understand that by visualizing yourself as the
Medicine Buddha you are not pretending to be something that you are not...." Thrangu Rinpoche
"If one meditates on the Medicine Buddha, one will eventually attain
enlightenment, but in the meantime one will experience an increase in healing
powers both for oneself and others and a decrease in physical and mental illness
and suffering." -Lama Tashi Namgyal
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A Study Guide
Consult 1
Cons_Acid_Edema_1.wma
Subjective and Objective Examination
Subjective: Patient has never had her body constitution (dosha) determined
before.
States she has a problem with obesity, and additionally, water retention
and edema.
She has plantar fasciitis or heel spurs.
Patient has a history of acid reflux, though it is currently not as bad as it
has been in the past.
She complains that her hands go numb if she holds something, such as a
book or steering wheel for a period of time.
Her blood pressure is borderline high at 180/60 or 70.
She has nightmares where she is being chased in her dreams. She rests on
her back before sleep then turns onto her stomach to sleep.
She says that she takes in too much caffeine, consuming usually 2 cups of
coffee in the morning and 1 cup after lunch, all with cream. She tends to like
dairy products and salt.
She picks at spots on her skin, until they bleed.
When menstruating, the patient had menorrhagia or heavy bleeding, in
her later years. Her first onset of menstruation was at age 15.
Birthdate: 4/20/49, in Boston, at 9:34 AM. She was a medium sized child
as far as weight and height. Her weight, when she was about 25, was
approximately 130 lbs.
The patient is usually happy, but has had depression in the past. She
states that she learns fast and remembers.
Patient awakens to urinate during the night.
Objective: The tongue is reddish/pinkish – having more the appearance of a
Kapha tongue. The tongue appears good with only a small amount of whitish
coating.
She has a line on her earlobe, referred to in Chinese Medicine as the “Line
of Coronary Heart Disease.” Please note: although this line may be present it is
not indicative of an existing condition. It merely indicates the possibility that
such a condition may exist now or in the future.
Patient appears stable and slow at 5’0” and 190 lbs. Seems to have Kapha
qualities naturally.
Pulse is slow and Kapha.
She is missing all the moons on her fingernails, except on her thumbs.
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A Study Guide
Consult 1
Cons_Acid_Edema_1.wma
Questions
What would you consider this person’s Dosha to be? What are the indications for
your opinion?
What would you consider to be the primary illness requiring treatment? What is
the root cause of this illness? Remember to look at the root cause not just the
symptoms.
What would you consider to be the secondary illness requiring treatment?
Describe the significance of whitish coating on the tongue. What is it and
indicator of?
Describe the significance of visible moons on the fingernails. What is this
indicative of?
What lifestyle changes would you suggest?
What dietary changes would you suggest?
What herbal recommendations would you make?
Determine an herbal formula, by parts, for this patient.
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A Study Guide
Consult 1
Cons_Acid_Edema_1.wma
Assessment and Prescription
Assessment:
Patient is Kapha primary, but most likely Kapha-Pitta. In traditional
Ayurvedic medicine, there is no difference made in Kapha-Pitta/Pitta-Kapha.
They are both the same. In the United States and the West, where we are
concerned with measurement and percentages, a differentiation is now made
with Kapha being slightly higher and more important in the label Kapha-Pitta,
and vice-versa for Pitta-Kapha.
Of importance in all cases, the clinician should be aware of what time of
day the pain occurs. The time of day and its relation to the doshas, Vata, Pitta, or
Kapha time, can be indicative of the type and orientation of the pain.
Vata time is from 2:00 AM to 6:00 AM and then again from 2:00 PM to
6:00 PM. Pitta time is from 10:00 AM to 2:00 PM and from 10:00 PM to 2:00
AM. Kapha time is from 6:00 AM to 10:00 AM and from 6:00 PM to 10:00 PM.
Patient’s time of birth is Kapha time in Boston.
Obesity is a Kapha trait as are water retention and edema.
Plantar fasciitis or heel spurs is Kapha/Pitta.
Acid reflux is Pitta.
Numbness in hands is Vata disturbance.
Nightmares of being chased are Vata.
Coffee, with its caffeine and acidic tannins can be a cause for the acid
reflux.
Picking at skin, or causing bleeding, provides the patient temporary relief
from high Pitta.
Beginning menstruation at age 15 is a Kapha trait. Beginning early, at ages
8-11, is considered a Pitta trait. At ages 15-18 it is considered Kapha.
In America, when Kapha is out of balance, it’s responsible for the big
killers, such as Heart Disease, Diabetes, High BP, and Obesity (which leads to
other illnesses.) Depression and Hypersomnia are often a result of Kapha out of
balance. If Kapha can be balanced by regulating the metabolism, Kapha types
often live the longest lives of all the doshas.
Missing moons on the fingernails indicates decreased metabolism.
Prescription: According to Dr. Vasant Lad, herbs are only 5% of the cure. But
they are a start. The road to health also involves changes in diet, lifestyle,
spirituality, and a variety of other events that affect our health.
Ayurvedic wisdom says to never sleep on the stomach. It can create a
multitude of health disturbances. Sleeping on your back is the next worse. Since
this patient has mostly vata and kapha out of balance, mostly kapha, sleeping on
her left side would be very beneficial. Sleeping on the left side heats the body and
improves the metabolism. Sleeping on the left causes mucus to block the left
nostril, forcing breathing through the right nostril, which in turn nourishes the
left brain which heats up the body. This is solar sleeping as opposed to lunar
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A Study Guide
sleeping on the right side. Never rest or sleep with hand on belly or heart. This
creates a weight on the internal organs.
Until this patient eliminates dairy products from her diet, her weight,
metabolism, and slightly high blood pressure will not correct. It could worsen.
Dairy products have Kapha qualities, such as oily (snigdha.) Cheese is perhaps
the worst of all. If the patient desires cheese, she is encouraged to have goat’s
cheese (not Feta, because it is highly salted.) No white mucous-type foods. In
general, if it’s white, forget it. Additionally, butters are out, specifically nut
butters, peanut butters, almond butters, etc.
No salt. No oily foods.
Daily exercise is recommended.
Get a copy of The Ayurvedic Cookbook (Morningstar, 1990) and go on a
Kapha soothing (not Pitta provoking) diet.
Always eat at least 3 hours prior to bedtime. This allows for proper
digestion to take place before sleep.
Herbal treatment:
Chandra Prabha, 5 parts. Also called “Moonglow.” This is the most
important formula for this person.
Jatamamsi, 4 parts. Why Jatamamsi?
Brahmi, 3 parts. Why Brahmi?
Gokshura , 4pts. For urination at night. This is a Kapha weakness of the
kidneys.
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A Study Guide
Consult 1
Cons_Acid_Edema_1.wma
Remarks
I am listing the information on Chandra Prabha, because I have found
information on this compound relatively hard to find across various sources:
Chandra Prabha
Compound
Sanskrit Name: Chandra Prabha
Type of Herb: Ayurvedic
Effect on Doshas: Vata + Pitta+ Kapha+
Virya (Energy): Shita (cold), Ushna (hot)
Guna (Qualities): Laghu (light), Ruksha (rough)
Prabhava (Special Potency): meda ghana (antidiabetic), lekhana
(fat scraping), mutrala (diuretic)
Dhatu Affinity (Tissues Entered): urinary tract, reproductive
system, dhatu agni (tissue fire)
Pharmacological Action: antibacterial, disinfectant, stimulates
metabolism, decreases: cholesterol, obesity, lipomas, prostatic
enlargement, kidney, ureter, bladder stones
Indications: urinary tract infection, diabetes insipidis and
mellitis, hypothyroidism, sexual debility, urinary stricture,
premature ejaculation, spermatorrhea
Contraindications: emaciation
Constituents: cardamom, camphor, mineral pitch, chireta,
pippali, long pepper, black pepper, triphala, sandalwood, iron
ash, guggul, eye of bamboo, caleo pyrite, nitro hydrochloric acid,
piper cubeba, etc.
Jatamamsi is balancing for all Doshas, or Tridoshic. In this particular
case, Jatamamsi is indicated as a brain tonic, sedative, and anti-inflammatory.
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This herbs prabhava (special quality) is in the treatment of mental and
psychological diseases (Frawley & Lad, 2001, p. 244).
Brahmi or Manduka Parni is also Tridoshic and having effect on the
nervous, muscular, circulatory, and reproductive systems. Frawley and Lad
(2001) remark that this is perhaps the most important nervine herb in Ayurveda.
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A Study Guide
CONSULT 2
HRB108_Cons_V1P3K2_Diabetes
Short Consult
Subjective and Objective Examination
Subjective: Patient is currently on 2 of the newest insulins on the market. He
states that his body rejects the insulin most of the time. He sometimes has to
take insulin injections 4 or 5 times a day.
Experiences pain in the groin area and penis.
He states that he has asthmatic/respiratory problems. Patient spent 2
years on an iron lung as a child. Patient is a smoker. He found respiratory relief
while spending 6 years in the Caribbean eating fresh fruits and consuming lots of
coconut water.
Patient is of Native American heritage.
Memory is very poor. Forgets speaking with people and what they talked
about.
Born 6/22/52 in New York City, sometime in the early morning. Is 6’1”
and 190lbs.
Blood sugar in past has been up to 240 to 260.
Patient is out in the sun working frequently. Drinks approximately 4 liters
(16 to 20 cups) of water per day.
Objective: Pulse: Vata is felt in the heart pulse. Kapha was felt in the kidney
pulse.
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CONSULT 2
HRB108_Cons_V1P3K2_Diabetes
Short Consult
Questions
This was a short consultation, given during a limited amount of time after
a lecture. Given the available information:
What would you determine this persons doshas to be?
What is the Ayurvedic view and treatment of diabetes?
Should this person discontinue taking western medicines (insulin?)
Legally and ethically can you recommend this, why or why not?
What herbs would you consider for strengthening the lungs?
What does excess consumption of water cause in the body? Is there a
relationship to the pulse assessment of kapha being felt in the kidney?
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A Study Guide
CONSULT 2
HRB108_Cons_V1P3K2_Diabetes
Short Consult
Assessment and Prescription
Assessment: Ayurveda does not consider diabetes as a curable condition, but
rather as a manageable illness through exercise, diet, and use of herbal
medications.
Water intake is very high, but may be okay due to working in the sun
everyday.
Constitution is Pitta Kapha
Diabetes is called Prameha (Honey in Urine) or Madumeha (Sugar Urine.)
Prescription: This patient was given 25 tablets of Vasanskusama(sp?) which
contains purified gold. Take 1 tablet bid (twice daily) with water. Gold is a heart
tonic. The poor man’s version of this tonic is to take a 24kt gold ring, boil it for
10-15 minutes in water.
Exercise, watch the diet, and use herbal medicines.
Of an interesting note, in Ayurveda anything that has a negative side effect
is not a medicine.
Continue to drink water, but not as much as the patient is currently
drinking. Too much water can be energy depleting to kidneys.
Triphala in evening. Why Triphala? Who would you recommend
to take Triphala?
Brahmi – for memory.
Turmeric. Introduce turmeric into patient’s diet. Cook with it. Excellent
for diabetes.
Shilajit – Himalayan Mineral Pitch – grind it up and mix it with herbal
formula. Good for diabetes and Swas (Asthma.) Note: This is available from
Banyan Botanicals at www.banyan-botanicals.com.
Continue with diabetes medications. Patient should check his blood sugar
more often and more regularly than he is currently doing. Herbs could improve
the blood sugar and the patient may need to back off dosages of insulin.
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A Study Guide
CONSULT 2
HRB108_Cons_V1P3K2_Diabetes
Short Consult
Remarks
Legally, I would never advise a patient to discontinue a doctor’s prescribed
regimen. Most importantly, I’m not a medical doctor and, although I have
legitimate allopathic medical training, I would not even venture to put my advice
up against a practicing, board-certified, doctor. That, my friend, would be
practicing medicine without a license.
What I would offer is an alternative or complementary therapy. In a world
with patient’s rights, it is up to the patient to make an informed decision about
what treatment they wish to pursue for themselves, if the decision has to be an
either/or type of decision. What is more efficacious is for the patient to continue
on the treatment prescribed and designed by his medical doctor WHILE pursuing
Ayurvedic treatment as a complement to his current healing path. In this
manner, any improvements in the patient’s condition can be monitored by his
physician while the Ayurvedic practitioner remains aware of these changes and
can also adapt his therapies. It is not unreasonable then to see how Ayurvedic
and Allopathic medicine go hand-in-hand in caring for a person’s whole being.
Now, on to a mildly lighter subject.
Frawley and Lad (2001) recommend Pippali, or Indian Long Pepper, as an
herb of choice in the treatment of respiratory problems. It is indicated for
conditions such as colds, coughs, asthma, bronchitis, and laryngitis in regards to
upper respiratory symptoms. Since this herb is very heating, V-K-P+, it is
contraindicated in high Pitta or inflammatory conditions.
An interesting note is that Banyan Botanicals (2006) markets a Lung
Formula. Its listed ingredients are Licorice, Cane Sugar, Pippali, Elecampane,
Vasaka, Amalaki, Bibhitaki, Haritaki, Tulsi, Cardamom, and Cinnamon. Licorice
is a highly effective expectorant and one should be aware that Amalaki, Bibhitaki,
and Haritaki combined is the beautiful tridoshic rasayana (restorative) called
Triphala.
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A Study Guide
CONSULT 3
HRB108_Cons_V2P3K1_Kidney.wma
Subjective and Objective Examination
Subjective: Patient expressed that her main concern was her kidney problems.
Patient presents with history of kidney related illness.
In the past, the patient had mercury fillings in the teeth. Has had those
removed.
Patient has a basic knowledge of meridians in TCM (Traditional Chinese
Medicine.)
Patient still feels like she retains toxins and experiences kidney problems.
Patient is female, 29 years old, born on 4/19/74 at 8:35 AM in Los
Angeles, California.
She is 5’2” tall and approximately 115 to 120 pounds.
Began menstruation at about 11 or 12 years of age. Menstruation is
irregular. She uses birth-control pills to regulate her periods.
Memory lately has been poor.
Sleeps well.
Bowel movements are once or twice a day and normal.
Patient has normal urination, but sometimes may get dehydrated from not
drinking enough water. Maybe drinks 4 cups of water per day. First morning
urine is clear.
Lungs are also a problem. Patient coughs up clear mucus.
Patient has lots of teeth problems. Enamel is thin or non-existent, causing
severe decay and destruction of teeth. Almost all the teeth are involved.
Eyesight keeps getting worse.
Patient has an injury to the right abductor muscle from a past dance
injury.
Patient has to work on NOT gaining muscle mass when exercising. She
finds that increases in muscle mass will also increase her aggressive tendencies.
When pushed or confronted with aggression she will respond back with
aggression.
Objective: In Ayurveda, the Ashtavidha pariksha (the eight-fold examination)
is: nadi (pulse), jihva (tongue), shabda (voice), sparsha (palpation/touch), akruti
(form), drig (eyes), mutra (urine), mala (feces).
The Trividha pariksha (the three-fold examination) is: darshana
(observation), sparshana (tactile perception), prashna (questioning)
Patient looks off to the side often. This is Vata mind to look off into space
to pull thought out or retrieve it.
Bone structure is Pitta. Medium build and musculature.
Patient coughs up clear mucus, which is Vata. If the mucus was yellow, it
would indicate Pitta. If it was white, it would indicate Kapha.
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A Study Guide
The tongue is pointy, which is Pitta. There is a subtle white coating with
red dots on the periphery of the tongue. The tongue also has a tremor to it,
indicating Vata.
Pulse shows Kapha in the Heart. Other pulses are normal Pitta.
Fingernails show moons on the middle finger, index finger, and thumb.
Weight appears to be mostly pitta. Vata for that height would be about 105
lbs. or less. Kapha would be about 125 to 130 lbs. or more.
Drig – look at the persons eyes. Patient has Pitta eyes. Eyes are slightly
red. When talking she frequently looks off to the side.
Akruti – form. Patient is 5’2” and 115 lbs.
Mutra – first urine is clear in morning.
When the patient furrows her brow she has a distinct wrinkle on the
spleen line.
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A Study Guide
CONSULT 3
HRB108_Cons_V2P3K1_Kidney.wma
Questions
What guidelines might you suggest for healthy kidney function, aside from herbal
remedies?
What is a white coating of the tongue indicative of?
Coughing up clear mucus indicates what dosha?
In a fingernail examination, which fingers should have moons (the light areas at
the bed of the fingernail and cuticle,) and what are they indicative of?
First morning urine should generally be of what color?
Dental decay and lack of enamel on the teeth could indicate what?
What type of Ayurvedic oil is useful in massage to treat arthritic conditions as
well as muscular injuries?
What herb would you suggest for Vata mental disturbances?
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A Study Guide
CONSULT 3
HRB108_Cons_V2P3K1_Kidney.wma
Assessment and Prescription
Assessment: Pulse: Kapha in the heart indicates possible depression.
Subtle white coating on the tongue indicates possible beginning of toxins
accumulating in digestive tract.
Fingernail moons on the middle finger, index finger, and thumb are good.
These fingers are where the moons should be present. This is an indication that
at the present time the patient’s metabolism is in relatively good shape.
Looking off to the side to retrieve thought or information is Vata mind.
Pulling thought from space.
The fact that the first morning urine is clear indicates a vata disturbance of
the kidney. The first morning urine should be yellow. Deep seated fear and/or
anxiety harms the kidney.
The dental problem, lack of enamel, and decay indicate a kidney problem
as well.
Prescription: As a general given, herbal formulas are usually made to last one
month – equal to approximately 30 parts.
First thing in the morning drink 8-16 oz. of warm water, no colder than
room temperature. Then wait ½ hour before eating food or herbs. This flushes
the kidney.
Mahanarayan Oil - For muscle pain, massage with Mahanarayan Oil. This
is excellent for treating pain in the muscles and long-standing injuries. Apply it
each day. It is anti-inflammatory and analgesic (anti-pain.)
Brahmi – for Vata memory deficiencies. As a side note: Jatamamsi could
also be given if you wished to calm the patient.
Brahmi Guduchi – for calming Vata.
Herbal Formula:
Gokshura – 5 parts Why Gokshura?
Cumin Seed – 5 parts – for Agni
Chandra Prabha – 4 parts
Candana (White Sandalwood) – 3 parts Why Candana?
Kaishore Guggulu – 15 parts Why Kaishore Guggulu as the
predominant herbal mixture for this patient?
Brahmi – 10 parts Why, in this case Brahmi?
For formula take 1 teaspoon tid (three times per day.) Does not have to be
taken with food. Take with 3 tsp. Aloe Vera Gel or warm water as an Anupana
(vehicle, or carrier.)
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CONSULT 3
HRB108_Cons_V2P3K1_Kidney.wma
Remarks
Vata emotions weaken the kidneys (Frawley & Lad, 2001). Fear and
anxiety can cause health issues in this area. Recommending meditation or
specific Yoga asanas to reduce stress and stimulate the healing of the kidneys
would certainly be indicated in case such as this.
A white coating on the tongue is indicative of accumulated ama (or toxins)
in the digestive tract. A coating forward, towards the tip of the tongue, indicates
ama in the stomach and possibly small intestine. A coating in the center of the
tongue indicates ama in the small intestine, and a coating on the back of the
tongue indicates ama in the large intestine.
Gokshura is balancing for all doshas and is specifically indicated in
difficult or painful urination, kidney stones, nephritis, and hematuria (blood in
the urine.) Because Gokshura acts as a diuretic, eliminating excess water and
body fluids, care should be taken as this could lead to dehydration. Punarnava is
often added to a Gokshura formula and is another tonic for kidney ailments.
Candana is another herb which has an affinity to the urinary system. It is
V+P-K-. Michael Dick recommends taking Candana oil internally (1-2 drops with
½ teaspoon of sugar) for cystitis and dysuria (2001, sec. 19, pg. 15).
Kaishore Guggulu, for this patient, is an excellent treatment for pitta
inflammation due to her shoulder injury. Kaishore Guggulu’s main ingredient is
Guggulu, traditionally used in the treatment to expedite delivery to the joints, and
Guduchi which is Pitta decreasing.
Brahmi is the primary herb for emotional and anxiety disorders. This is
given due to the fact that the patient states that she has aggressive tendencies on
gaining muscle mass.
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A Study Guide
CONSULT 4
HRB108_Cons_V1P3K2_Weight_Asthma.wma
Subjective and Objective Examination
Subjective: Patient’s menstruation began late at age 15. Her Family Practice
Physician suggested that she has Cystic Ovarian Syndrome. She started on Birth
Control Pills to regulate her periods. On Birth Control Pills she gained weight
and was sick. She would wake up in the middle of the night with dry heaves and
dizzy spells. On waking in the morning she would black out. She stayed on Birth
Control Pills for 2 years and then quit. She now gets her period a little late with
medium to light flow. She finds it very hard to lose weight since she came off the
pill. She has been been off the pill for about 9 months now.
Her Grandmother and Aunt have had Breast Cancer.
Her Father has Asthma. Patient has had Asthma since she was 7 years old.
She has a lot of phlegm built up on awakening. Phlegm is yellow.
She has Allergies in the spring with runny nose and itchy watery eyes.
She is very active.
Patient has recently, late at night, had a sharp pain in her chest that made
her react.
Born 9/27/83 at 5:20 AM in Santa Rosa, CA. She is 5’6” tall and about 140
pounds.
She has a very muscular build like her father. She used to be involved in
Soccer and Dance, and did not worry about her weight during this time. She still
exercises but continues to have weight problems.
When asked, she likes sweet and hot tastes.
Has bowel movements 2 to 3 times per day. Stools are solid.
No specific urination problems.
Patient says that she has difficulty making decisions at times. She wants
to make everyone happy when she makes a decision, so she considers everyone
involved.
She finds it hard to get angry and feels like she takes other’s burdens.
Then, she explodes later when it gets to be too much.
Her long term memory is good, but her short term factual memory is not
good.
Because of a faster growth rate of her jawbone, patient had a dental jaw
break performed to ward off TMJ (Temporal Mandibular Joint Syndrome) later
in life. She felt very out of balance afterwards and, with inactivity, experienced
some weight gain. She had skin outbreaks after surgery which she attributes to
the type and amount of drugs in her system.
Patient has received Triphala as an herbal treatment recently with no
loosened stools noticed.
She has noticed feeling moderately hotter recently.
She wants to focus on weight loss primarily and, secondly, to establish
hormonal balance.
Patient will be traveling out of the country soon. Last visit in another
country patient developed digestive parasitic infection.
Cantrell 21
A Study Guide
Objective: Patient has Kapha body construction.
Pulse is slow Kapha pulse.
She is missing moons on her fingernails and has them on her thumbnails
only.
Patient has Pitta brow furrows.
Tongue on examination is square.
Patient has received Triphala as an herbal treatment recently.
Cantrell 22
A Study Guide
CONSULT 4
HRB108_Cons_V1P3K2_Weight_Asthma.wma
Questions
Describe a preventative treatment for Breast Cancer.
Yellow phlegm and mucus is associated with which doshic condition?
What is your advice about the sharp pain in her chest?
What is your advice for her short-term memory disorder?
Relate her skin outbreaks after surgery with common post-surgical
medications and their doshic effects.
Cantrell 23
A Study Guide
CONSULT 4
HRB108_Cons_V1P3K2_Weight_Asthma.wma
Assessment and Prescription
Assessment: Menstruation beginning late is Kapha.
Asthma is a Kapha problem.
Allergies: Runny nose is Kapha. Itchy eyes are Pitta. Watery eyes are
Kapha. Since allergies occur in the spring, this is a transfer from Kapha to Pitta
time. Basically she has Kapha allergies with secondary pitta symptomology.
Missing fingernail moons indicates sluggish metabolism.
Square tongue indicates that metabolism may be in disorder. Patient may
have an under active Thyroid due to square tongue and missing fingernail moons.
The attitude of wanting to please people is a Kapha trait which this patient
combines with Vata worry. Kapha, the earth, takes everyone’s burdens.
Prescription: As a preventative to Breast Cancer, rub Castor Oil over the
breast, starting at the sternum and massaging outward toward the arm pits.
Dance is very good for Kapha individuals. Kapha is naturally graceful but
loses this gracefulness due to weight. Earth-Mother would be a Kapha type.
Kapha types should stay active, moving, and warm. Coolness solidifies Kapha
oils.
With a Kapha constitution, patient needs to cut back on sweets and enjoy
spicy foods. This is very important – less sweets, more spicy. Patient needs to
watch her weight and metabolism.
Eat foods with less oil.
Avoid white foods.
Patients basic constitution is Pitta/Kapha.
To help with mental pressures, this patient would find meditation and
dance to be very important therapies.
Punarnava will help with the sharp chest pains at night.
Castor Oil Abhyanga of breasts.
Given an article on Physical Exercise and Yoga Asanas.
Given an article on Weight Control from an Ayurvedic Perspective.
Triphala – ½ tsp at night.
Formula:
Main herb is Punarnava – 15 parts – good for VPK, the lungs, and
strengthens metabolism. Punarnava is rejuvenative for Kapha. It helps in fat
metabolism, the lungs, and liver. It is a preventative for Breast Cancer and is
good for skin conditions.
Guduchi – 8 parts – Tinospora Cortifolia – good for VPK. It helps with
skin conditions and gives energy. It is good for the liver and fat metabolism.
Kutki – Katuka – 7 parts – for fat scraping. It is good for Kapha and Pitta.
It helps with the liver and anger, as well as the skin.
Cantrell 24
A Study Guide
Shatavari – 5 parts - is the Ayurvedic equivalent of Dong Quai. It helps
with polycystic ovaries, anger, and the skin. It also helps the patient to feel
cooler.
Brahmi – 4 parts – to help with the mind in staying clear and calm.
Ashoka – 8 parts – A Shoka (No Grief.) Useful for polycystic ovaries and
to help regulate menstruation.
Sitopiladi – 5 Parts – contains cinnamon, cardamom, Indian long pepper,
ginger, and black pepper. Useful in strengthening the lungs and improving
metabolism.
Abrak Bhasma – 1 part – Purified Mica. It strengthens the lungs and
heart. Useful in treating tuberculosis, asthma, and chronic diseases of any kind.
DOSAGE: WHOLE MIXTURE 1 tsp tid (three times per day.)
Add to the formula 6 parts of Vidanga. Dr. Lad says that Vidanga “kills
worms, sperms, and germs.” Use Vidanga for parasites, but it will also help
improve metabolism.
While out of the country, take Maha Sudarshan instead of Malaria pills.
Maha Sudarshan has been long used as a preventative of Malaria. It is bitter and
consequently almost never given to Vata people.
It is suggested that the patient buy a separate amount of Sitopiladi for use
in tea or in milk products. It is important for this patient with a history of
asthma, etc.
Patient was given a pitta soothing dusting powder – Neem/Manjista (a
blood purifier)/Sandalwood (a cooling a calming blood purifier)/ Rose Petals/
Chickpea Flower. Use this to wash the face instead of soap daily or twice daily.
Watch chocolate eating because of acne.
Cantrell 25
A Study Guide
CONSULT 4
HRB108_Cons_V1P3K2_Weight_Asthma.wma
Remarks
Abhyanga (self oil massage) is recommended to be done daily for all
individuals except Kapha individuals who should use a dusting powder instead of
oil due to the oily nature of their skin and systems. In the prevention of breast
cancer, massage is done with Castor Oil, massaging from the breast outwards
towards axillaries (arm pits.) This action provides nourishing oil to the breast
tissues while stimulating flow of interstitial, cellular, and lymphatic fluids
outward towards the larger lymph vessels in the armpits where it can be
circulated and cleansed.
Yellow phlegm and mucus, like pus, are colored by dead white blood cells
which have been used in fighting infection. In the bodies fight against an
infection there is also an increase of either localized or systemic heat. Wounds
with a localized infection will often feel hot to the touch. This condition, because
of the heat, is correctly identified as a Pitta disorder. Not that there is anything
wrong with the body increasing heat and “burning” off infection. That is the
body’s natural reaction. In Ayurveda, we see this as a Pitta increase. In cases
where there is discharge from the nose and sinuses, or the lungs, in which it is
yellow, we recognize as a Pitta disorder.
Any patient presenting with a pain in the chest, regardless, I would have to
refer to a western medical doctor. A quick simple and painless test called an EKG
(ECG, Electrocardiogram) can quickly detect any malfunction of the heart, which
should be your primary concern. Given that all is well with the EKG, the
Ayurvedic practitioner can then turn his attention to other possible root illnesses
including anxiety and improper breathing (pranayama.) If there is an illness of
the heart detected in the EKG, the medical doctor may begin his treatment with
any complementary medicine being provided by the Ayurvedic practitioner. The
EKG remains the key for symptomatic chest pain. In this case, it is much better
to play it safe, than sorry.
The herb of choice in treating memory disorders, anxiety, depression, etc.,
is Brahmi. Secondary to Brahmi is any herb that decreases Vata, as loss of
memory is a Vata disorder. But in this case, I might additionally advise
meditational practices that build concentration and single-pointed awareness.
Then as that practice progressed I would also advise meditational and daily living
practices that bring mindfulness and present moment awareness. By
strengthening the power of concentration and bringing the awareness to the
present moment the patient should find considerable increase in memory and, as
an aside, a reduction in anxiety. Spiritually, present moment awareness is the
most expedient path to realization of one’s true nature, that Cosmic
Consciousness, which manifests through us.
It is not unusual to see skin outbreaks, or other manifestations of an
increase in Pitta, in a post-surgery patient. Antibiotics, the staple for fighting
infection in western medicine, are Pitta increasing. Other side-effects of
antibiotics, such as diarrhea, are also increased Pitta induced.
Cantrell 26
A Study Guide
CONSULT 5
HRB108_Cons_Anxiety.wma
Subjective and Objective Examination
Subjective: Patient is a 24 year old female. Born on May 1, 1978 in California.
One year ago she was given anti-anxiety and sleeping medications (Ativan
and Ambien.) This resulted in chronic dehydration. This dried her eyes out. Her
eyes were almond shaped, now they’re round. This dehydration also resulted in
bone loss. She was 5’5” tall, but is now 5’3” tall.
She currently sleeps, but never wakes up refreshed. She had experienced
insomnia.
She used to have constipation for about 5 years, but does not anymore.
Drinks about 6 cups of water per day.
Has low blood pressure.
Has loss of muscle tone in face.
Objective: Pulse is Vata disturbed. Once her pulse is located, you can push on
it and make it disappear.
Cantrell 27
A Study Guide
CONSULT 5
HRB108_Cons_Anxiety.wma
Questions
What is indicated by a Vata pulse? How about this patients pulse? What
is indicated? Think along the lines of blood pressure and body hydration. How
are those two related?
Constipation is indicative of what doshic disturbance?
What would be normal water intake for a Vata person?
What major herbs would you prescribe in this case?
Is there another treatment, besides herbs, that may be more fitting?
Cantrell 28
A Study Guide
CONSULT 5
HRB108_Cons_Anxiety.wma
Assessment and Prescription
Assessment: Bone loss is a Vata condition.
She has kidney depletion, which is Vata.
Her water intake is way to little for Vata. She needs 10-12 cups of water
per day.
Pertaining to muscle tone loss in face, and bone loss: Loss of anything,
including relationships, job, weight, as well as dropping things, is always Vata.
Vata is catabolic or tissue destructive. Anabolic is tissue growth. Metabolic is
tissue maintenance and metabolism.
Prescription: The best way to soothe Vata is by daily oil massage. Use Sesame
Oil to massage the whole body. Take about 15 minutes to do the massage. Then
wait 5 to 10 minutes before taking a hot shower.
Oil massage is so important to Vata that, given between taking herbs or
taking oil massage, it would be better to do the oil massage. Oil use should be
about 1 quart of oil every 2 months due to the Vata nature.
On the face, due to loss of muscle, massage with Ashwagandha Bala Oil. It
is very strengthening to the muscles. Good for anyone who has illnesses of
wasting away. Babies who are born prematurely and are weak in their
constitution, and women who are Vata and premature in their delivery, are given
massages with Ashwagandha Oil.
Yogaraj Guggulu –Comiphora Mukul (a tree resin) - for massive bone loss.
Guggulu means it protects from diseases. How many parts should this be
in the preparation?
Jatamamsi for insomnia. How many parts should this be?
For dry, burning eyes use Rose Water. It must be organic rose water with
saline. It can be obtained from Mount Madonna Center over the internet.
Cantrell 29
A Study Guide
CONSULT 5
HRB108_Cons_Anxiety.wma
Remarks
My recommendation in the above herbal formula is to give 5 parts Yogaraj
Guggulu and 4 parts Jatamamsi. Although there are no strict rules in the
prescription of parts, I find the need for treatment of bone loss and the treatment
for sleep disorders to be nearly equal.
A Vata pulse is typically felt under the index finger, instead of the middle
or ring finger, in taking a pulse Ayurvedic style. I’ll refer readers to Dr. Vasant
Lad’s book, Pulse Diagnosis. With regards to this patient, Vata, or the air quality,
in the the brachial artery, allows the pulse to easily collapse with pressure and be
stopped. More realistically, there is not large amounts of air moving in the
circulatory system, as arteries, veins, etc., have some elasticity to allow for
fluctuations in blood pressure and volume. The amount of blood fluid volume is
low. Following this line of thinking, the artery is not filled with enough blood.
When there is not enough blood and plasma, blood pressure is going to be
lowered and is indicative of dehydration in the patient.
Constipation is another indicator of Vata disturbance. Literally, Vata or
air in the colon dries fecal material causing constipation, often hand in hand with
increased flatulence.
Additionally in this case, in the treatment of Vata increase and in
particular constipation, I would prescribe Triphala to act as a laxative with a
balancing effect on all Doshas.
Cantrell 30
A Study Guide
CONSULT 6
HRB108_Cons_V1P3K2_K3_Obesity.wma
Subjective and Objective Examination
Subjective: Patient had onset of menstruation at age 13. Menstruation is
currently regular.
Sleep is excellent and has been throughout her life. Patient says she sleeps
“like narcolepsy.”
Patient generally has cold hands and cold feet.
She feels nervous and anxious. She has a lot of anxiety with anger and
irritation. She is currently stressed because she runs 4 businesses. She has 2
grown children who both ill.
She was chubby as a child about age 9 or 10.
She has 2 to 3 bowel movements per day.
She learns fast and remembers.
Patient has NEVER been on a lot of medication in the past, but does take a
few herbs.
Her main concern is her obesity.
She has pressure in her ears. Acupuncture has worked for this in the past.
Patient has post-nasal drainage.
Patient has fibrocystic developments of the breast, uterus, and ovaries.
Her uterus has enlarged and is causing problems with her other organs as well as
pain in her back and pelvis.
Patient is diabetic.
She drinks about 80 ounces of water per day. This is about 10 glasses of
water per day.
Objective: Tongue show Vata disturbance by being squared off.
Pulse is Pitta Kapha.
Fingernail moons are slight.
She has the beginning of a line on her earlobe, called the Line of Coronary
Heart Disease.
Cantrell 31
A Study Guide
CONSULT 6
HRB108_Cons_V1P3K2_K3_Obesity.wma
Questions
Cold hands and cold feet are what?
What would you prescribe for nervousness and anxiety about her business and
children?
The patient has 2 to 3 bowel movements per day. Is this “normal?”
Is her consumption of 10 glasses of water per day adequate?
What herb would you prescribe for fibroid growths, and why?
Cantrell 32
A Study Guide
CONSULT 6
HRB108_Cons_V1P3K2_K3_Obesity.wma
Assessment and Prescription
Assessment: Sound, deep, sleep is Kapha.
Being chubby as a child is Kapha, possibly Kapha Pitta.
2 to 3 bowel movements per day is Pitta Kapha.
Learning fast and remembering is Pitta Kapha.
Slight fingernail moons indicate slower metabolism.
Considering the patient’s obesity and other findings, she is ranked as
V1P3K4.
Prescription: The patient should only drink 4 to 6 cups maximum of water
per day. If she feels that she wants more liquid, drink black tea without cream of
sugar.
Punarnava – 5 parts – helps liver metabolism.
Kutki – 4 parts – for liver metabolism.
Brahmi – 2 parts – good for anxiety and sleep.
Chitrak – 3 parts – for agni. Chitrak plumbago. Energy is V-P+K(There is a low supply of Chitrak at the pharmacy. Use Arogyavardini as a
replacement.)
Ashoka – 2 parts – for the fibroids
Musta – 2 parts – for fat scraping
Take the herb formula mixed with raw uncooked honey. Take 2
teaspoons. The honey acts as a catalytic agent to deliver the herbs into the
adipose tissue (fat tissues) and improve metabolism. Follow with 4 to 8 ounces of
either warm or hot water.
Introduce Turmeric into the diet. Cook with it. It is good for Diabetes
Use Fenugreek powder. The seeds are very had to grind. This is good for
diabetes. INTERACTION PRECAUTION: COUMADIN. Why the interaction
with coumadin?
Drink water from a copper cup. This improves metabolism. If a copper
cup was not available, what could be done as an alternative?
Cantrell 33
A Study Guide
CONSULT 6
HRB108_Cons_V1P3K2_K3_Obesity.wma
Remarks
Cold hands and cold feet are an indication of Vata.
Nervousness and anxiety can be effectively dealt with by dispensing
Brahmi in the patient’s formula. Additionally, I’d also suggest meditation aimed
at calming and centering the mind, and if the patient was receptive, mantra
recitation for mental and spiritual conditioning.
In health care, and particularly in Ayurveda, it’s important to remember
that there is no such thing as normal. There is a wide variation in the
constitutions of individuals, even though those constitutions are divided into the
three categories of Vata, Pitta, and Kapha. So, it’s not easy to say whether a
patient having 2 to 3 bowel movements per day is “normal.” The most generally
accepted idea of elimination is that a bowel movement is approximately once per
day.
Ten glasses of water per day is more than this Pitta (P2)/Kapha (K3)
individual needs. Four to six glasses per day is sufficient to support Kapha.
Ashoka (a tree; meaning “without sorrow”) is the herb recommended for
fibroid tumor growths. Acting directly on the muscle fibers of the uterus, it has a
stimulating effect on the endometrium (Ayurveda Herbs 8.htm).
Loyola University Health System reports that taking Fenugreek with
Coumadin (Warfarin), a blood thinner, may cause the blood to become too thin
(Loyola UHS mdx-amci0060.htm).
Taking water from a copper cup is often advisable. If a copper cup is not
available, several clean pennies can be placed in the glass of water overnight, or a
short length of copper tubing (available from your local home do-it-yourself
store) may be used in the place of pennies.
Cantrell 34
A Study Guide
Consult 7
HRB108_Cons_Mantra_Request.wma
Subjective and Objective Examination
Subjective: The patient requests a healing mantra.
Objective: No objective assessment required.
Cantrell 35
A Study Guide
Consult 7
HRB108_Cons_Mantra_Request.wma
Questions
Very simply, what would you prescribe as a healing mantra?
Cantrell 36
A Study Guide
Consult 7
HRB108_Cons_Mantra_Request.wma
Assessment and Prescription
Assessment:
Prescription: The patient was given a section of The Shurangama Mantra, the
longest mantra in Buddhism, as a healing mantra. This section, in particular, is
useful in healing Vata, Pitta, and Kapha illnesses and balancing for all Doshas, or
Tridoshic.
The section offered is from the “Sagely City of 10,000 Buddhas Daily
Recitation Handbook” page 12, lines 132 through 135, which read in
transliteration:
132) PE SHA SHE
133) SYI DAN LA
134) E JI NI
135) WU TWO JYA LA RAU SHE
Cantrell 37
A Study Guide
Consult 7
HRB108_Cons_Mantra_Request.wma
Remarks
I find the pronunciation of the transliteration to be slightly baffling at
times. If I had to further print it, as it sounds, I would print it:
132) PEE SHA SHEA
133) SHE DAN LAH
134) UH JEH NEE
135) WU TWOH JYAH LAH JAH SHEA
Additionally, for someone who has not taken Refuge in the Buddhist Triple
Jewels and/or has not vowed to keep the Five Precepts of 1) No killing, 2) No
lying, 3) No stealing, 4) No sexual misconduct, and 5) No intoxication, I would
recommend the short version of the Medicine Buddha Mantra. The Medicine
Buddha Mantra, and indeed even the Sadhana, because it is grounded in
Mahayana sutra, does not require an empowerment, or teaching from a Lama, to
perform. In the Sanskrit transliteration, the short version of the Medicine
Buddha Mantra is:
TADYATA, OM BHAISAJYE BHAISAJYE, BHAISAJYA, SAMUNGATE SVAHA.
In the Tibetan transliteration it is:
TAYATHA, OM BEKANDZE BEKANDZE, MAHA BEKANDZE (BEKANDZE),
RANDZE SAMUNGATE, SOHA.
Dr. David Frawley, in his book Ayurveda and the Mind, comments,
“Mantra is the main method of treating conciousness (Chitta) and is helpful for
healing all levels of the mind, inner and outer. . . For this reason, it is the main
Ayurvedic therapy for treating psychological disorders and can be very helpful for
physical problems as well” (p. 226).
Cantrell 38
A Study Guide
Consult 8
HRB108_Cons_V1P3K2_Pitta_Flu.wma
Subjective and Objective Examination
Subjective: Patient is Female.
Patient has had recent stomach pain along with acid reflux. Took Mylanta,
which relieved the condition.
She has had physical pain which radiated from the navel to mid-chest.
Patient has had normal stools. 2 bowel movements per day. Stools sink in
toilet.
Sleep is okay.
Has been having dizziness and nausea. On a previous day she had some
vomiting. Patient states she is dizzy a lot, even while sitting at rest.
Recently given antibiotics (about 1 ½ weeks ago) which increased nausea.
Patient was in the hospital for 5 days, with x-rays, CT scan, ultrasound.
Diagnosis of Diverticulitis.
No mucus in upper respiratory areas.
Patient has 235 cholesterol index.
Patient is already taking Guggulu to resolve arthritis.
In the past, she was given an herbal formula. The patient states that she
couldn’t take it because the Amla (Amalaki) content, with it’s inherent Vitamin C,
was resulting in heartburn and stomach upset. Patient also continued to
experience dizziness while taking the formula. This was another reason for
discontinuation.
The patient’s sister sent her Haritaki, which she added to the mixture. She
took the formula mixture for 2 days, then did not continue after that.
Patient’s current allopathic medications make her sleepy and tired.
Patient is Eastern Indian and does eat very spicy foods. But patient has
eaten a bland Kitchari diet and states that she has not been able to keep it down.
Patient states she is getting forgetful.
Objective: Tongue has tremors and fairly thick ama (tongue coating) indicating
toxins held in digestive tract. Dr. Lad ranks ama on the tongues of different
patients on a scale from 1 to 4. Ven. Losang Jinpa rates this patient’s tongue ama
at 3.
Earlobes have demarcation of long earring holes. This is not to be
mistaken for the Line of Coronary Heart Disease/Congestive Heart Failure.
Previous formula was:
Punarnava Guggulu – 3 parts – for thyroid, kapha metabolism, and heart.
Gokshuradi Guggulu – 3 parts – for urination, strengthening kidneys.
Brahmi – 2 parts – for memory.
Talisadi – 3 parts – which is Trikatu, Sugar, Cinnamon, Cardamom,
Himalayan Silver Fir Tree Needles (pharmacologically like Bay Leaves.) - for
cold and mucus symptoms. Can be removed from patient’s formula for now.
Guduchi – for dizziness, soothes Pitta, soothes irritability and anger.
Cantrell 39
A Study Guide
Jatamamsi – soothes nervousness, irritability, and anger.
Chandara Prabha – for weight and thyroid.
This formula would not cause or contribute to dizziness. Please evidence
that the patient continues now to experience dizziness after discontinuation of
previous formula.
Pulse is feeble with Vata in the heart.
Cantrell 40
A Study Guide
Consult 8
HRB108_Cons_V1P3K2_Pitta_Flu.wma
Questions
Nausea, acid reflux, and dizziness, are related to which doshic
disturbance?
Amalaki has the highest amount of natural vitamin C of all fruits.
However, in spite of the high content of vitamin C, Amalaki has another quality.
What is that quality?
Antibiotics cause an increase in which dosha?
Cantrell 41
A Study Guide
Consult 8
HRB108_Cons_V1P3K2_Pitta_Flu.wma
Assessment and Prescription
Assessment: Acid reflux is Pitta. The relief after using Mylanta shows it’s Pitta.
Sinking stools reveal toxins in the feces and consequently in the colon. 2
bowel movements per day is Pitta quality.
Dizziness is Pitta.
Nausea is Pitta.
Antibiotics can exacerbate nausea and vomiting. Antibiotics provoke
Pitta.
Studies have shown that Amalaki is indeed naturally high in Vitamin C.
However, Amalaki is NOT Pitta provoking. That is, it does not produce
heartburn or gastric distress as do dosages of processed Vitamin C such as found
in over-the-counter vitamins and supplements.
Shatavari and Bala are good Pitta reducing herbs, but this patient has too
much ama, as indicated on the tongue, to make these her primary herbs.
Normally Shatavari is the main herb for a Pitta person, but in her case it is not.
Prescription: Guduchi and Kama Duba for dizziness.
Patient could be given small amount of Kaishore Guggulu in formula.
Patient should not take the previous herbal formula given. The Chandara
Prabha may actually provoke some stomach upset. Patient may continue with
previous herbal formula after correcting the current set of symptoms. Currently
the patient needs to correct the excess Pitta.
Of note: Do not give Shilajit, Chandara Prabha, and Punarnava with
patient’s who are experiencing low-grade fevers.
Patient’s natural diet of Indian foods (very oily and very spicy) is
contraindicated in the symptoms she is experiencing. Patient should eat a fairly
bland diet, like a bland Kitchari diet.
Herbal Formula (Temporary for condition):
Guduchi is the main herb – 5 parts – Tinospora Cortifolia - soothes Pitta
Mahasudarshan (meaning: beautiful to look at.) – 2 parts - which contains
Guduchi and mainly bitter herbs. Is anti-viral. Is Ayurvedic antibiotic without
disturbing Pitta. 30 different herbs, all bitter. Classic bitters.
Kama Duba – 1 part - conch shell mixed with Guduchi Sattva (purified
starch of Guduchi), Red Coral, Cowry Shell, Oyster Shell. Antacid and Anti-Pitta.
Small amount it is quite potent. Only 1 to 2 tbsp in this formula.
Shatavari – 3 parts
Brahmi – 1 part – for memory
Cantrell 42
A Study Guide
Consult 8
HRB108_Cons_V1P3K2_Pitta_Flu.wma
Remarks
As a note in this case, about the use of Shatavari: Shatavari is indicated in
hyperacidity, and according to Frawley and Lad, “It is an effective demulcent for
dry and inflamed membranes of the lungs, stomach, kidneys and sexual organs.
As such, it is good for ulcers, and with its thirst-relieving and fluid-protecting
powers it is good for chronic diarrhea and dysentery.
Cantrell 43
A Study Guide
Consult 9
HRB108_Cons_V3P2K1_Constipation.wma
Subjective and Objective Examination
Subjective: Patient is 38 year old female.
Patient states problem with constipation. Has been using generic quality
Psyllium husk fiber in diet with no effect, except increased gas.
Patient’s finances are poor at this time.
She has just been diagnosed with Fibromyalgia.
Patient uses over-the-counter mineral oil.
Patient has history of eczema and asthma.
Menstruation is regular at about 25 days. Patient is currently
menstruating. Flow is medium, growing heavier with age.
Bowel movements are irregular with straining. May skip a day.
Patient takes Flovent for asthma and Bekanase for sinuses.
Patient has Carpal Tunnel Syndrome as well as some other tendonitis.
Memory is good most of the time, sometimes a little foggy.
Objective: Patient has very dry skin. Her hands are dry, even her palms. This
is a Vata quality.
Bone structure is Vata. Thin/skinny bones are Vata.
Pressure on pulse makes it disappear, which is Vata.
Cantrell 44
A Study Guide
Consult 9
HRB108_Cons_V3P2K1_Constipation.wma
Questions
Please comment on Abhyanga and its role in Ayurveda.
Cantrell 45
A Study Guide
Consult 9
HRB108_Cons_V3P2K1_Constipation.wma
Assessment and Prescription
Assessment: Dryness causes constipation, because you need liquidity and
lubrication in the colon to facilitate bowel movement. Constipation may be
caused by anxiety, a vata disturbance, which then manifests in the colon.
Fibromyalgia is often paired with Chronic Fatigue Syndrome. Both are
Vata disturbances/illnesses.
Psyllium husk can be habit forming, causing the body to rely on the
increased fiber in stool formation.
Carpal Tunnel Syndrome is a Vata condition.
Tongue is square shaped indicating metabolic disturbance.
Prescription: Best thing for the Vata condition is Abhyanga (daily oil massage
of whole body.) Do not use mineral oil. Use sesame oil instead. Sesame oil will
not clog the pores. Do oil massage before shower. Make sure to massage the
colon and whole pelvic area (belly, kidney area, vagina, anus, buttocks, and
thighs.) This is the most important treatment for the patient.
As the patient’s finances are a concern, she is encouraged to purchase
Mahanarayan Oil and combine it, 50/50, with sesame oil to stretch out its use.
Use 1 oz of oil per day in massage. Wherever the patient has fibromyalgia pain
apply Mahanarayan Oil full strength.
Herbal Formula:
Ashwagandha – 8 Parts– for general Vata disturbance.
Water Cress Seeds with Ashwagandha – called Bowel Care – 2 Parts.
Brahmi – 10 parts
Jatamamsi – 4 parts
Dashamula - “Ten Roots” – 4 parts - helps soothe Vata in mind and body.
Guduchi – 4 parts
Licorice – 3 parts - to increase pulse strength.
Triphala Guggulu - Triphala is the only herb in Ayurveda that your body
does not adapt and/or build tolerance to in its action. Triphala will additionally
help with allergies.
Take 1 tsp of mixture tid (three times per day.)
Additionally take 1 tsp of Triphala before bedtime. If patient does not get
good results from this, then also take 1 tsp of Triphala on awakening. Triphala
was modified by adding more Haritaki to aid in bowel movements.
Recommended water intake is 8-12 cups of water per day. Drink warm
water or at room temperature, never cold.
Cantrell 46
A Study Guide
Consult 9
HRB108_Cons_V3P2K1_Constipation.wma
Remarks
Abhyanga is a self-administered oil massage, most commonly done with
Sesame Oil. It supplies the skin, muscles, bones, and internal organs with needed
lubrication and softening by absorption through the skin. Abhyanga is relaxing
and beneficial as massage in itself, stimulating blood and lymph flow, loosening
muscles, and applying gentle motion to the internal organs. I find a five to ten
minute Abhyanga session, followed by about a twenty minute Yoga Asana
session, then a shower to be very beneficial. Those with a Kapha constitution are
advised to do a dry massage, using no oil, due to the natural oily tendencies of
Kapha.
Cantrell 47
A Study Guide
Consult 10
HRB108_Cons_V1P3K2_K2.5_Acne.wma
Short Consult
Subjective and Objective Examination
Subjective: Patient is female and presents with case of acne.
Patient has been washing her face with soap and then applying Pitta
Dusting Powder.
Patient is taking Turmeric and Manjistha orally by combining the mixture
in milk with ghee.
Memory is okay.
Sleep is very good.
Patient’s bowel movements depend on how much Triphala she takes. Days
that she doesn’t take Triphala she is constipated, but on days when she takes
Triphala she is regular.
Patient’s fingernail moons are returning.
Objective: (Because this was a short consult there was no physical exam other
than visual.)
Cantrell 48
A Study Guide
Consult 10
HRB108_Cons_V1P3K2_K2.5_Acne.wma
Short Consult
Questions
Explain the use of Manjistha in this patient’s treatment.
Cantrell 49
A Study Guide
Consult 10
HRB108_Cons_V1P3K2_K2.5_Acne.wma
Short Consult
Assessment and Prescription
Assessment: Patient’s fingernail moons returning shows an increase or
normalization of metabolism.
Prescription: Patient should use Pitta Dusting Powder. Do not wash the face
with soap, use the Pitta Dusting Powder instead, about once per day. The powder
contains: Neem, Manjistha, Rose, Turmeric, and Chickpea Flower.
Don’t use too much milk with K2 constitution.
Ideally this patient should have Triphala that contains more Amalaki for
her Pitta constitution: 2 parts Haritaki, 3 parts Amalaki, 1 part Bibhitaki.
Purnarnava – 2 parts - for skin and liver. Good for Kapha. Tridoshic.
V=P=K+
Shatavari – 1 part – Tridoshic. V-P-K- (K+ in excess)
Guduchi – 2 parts - for mind. Tridoshic. V-P-KKutki – 2 parts - affinities to liver and skin. V+P-K-. Very bitter.
Brahmi – 2 parts - for mind. V-P-KVacha – 1 part - V-P+K-. Helps Agni with affinities to skin.
Cantrell 50
A Study Guide
Consult 10
HRB108_Cons_V1P3K2_K2.5_Acne.wma
Short Consult
Remarks
Manjishta is indicated, among numerous other things, for skin problems.
Its energy is V+P-K-. Additionally it should be noted that Manjishta is
contraindicated in cases of high Vata or severe chills because of its cooling
properties. Since acne is a Pitta disturbance, manjishta is particularly suited for
this ailment.
Triphala (Three Fruits) is made up, usually of equal parts of Amalaki,
Haritaki, and Bibhitaki. Depending on the persons dosha, additional parts may
be added to more adequately balance with the individuals constitution. Such as
30% Amalaki, 30% Haritaki, and 40% Bibhitaki for Pitta/Kapha individuals.
Amalaki – PV- Kapha and Ama in excess
Haritaki – VPK= High Pitta in excess
Bibhitaki – PK- V+ in excess
Cantrell 51
A Study Guide
References
Ayurveda Herbs. (2007). Circle of Health. February 8, 2007
<http://www.ayurveda-herbs.com/8.htm>
Banyan Botanicals Fall/Winter 2007. (2006) Albuquerque, NM: Banyan
Trading Co.
Dick, M. (2001), Ayurvedic Herbology Handbook, Version VI. Palm Beach
Gardens, FL: Dhanvantari Ayurveda Center.
Frawley, Dr. D. (1996). Ayurveda and the Mind. Twin Lakes, WI: Lotus Press.
Frawley, D. & Lad, V. (2001). The Yoga of Herbs. Twin Lakes, WI: Lotus Press.
Loyola University Health System. (2006). Fenugreek – Alternative Medicine.
February 8, 2007 < http://www.luhs.org/HEALTH/kbase/htm/mdx/amci/0060/mdx-amci0060.htm>
Morningstar, A., et al. (1990). The Ayurvedic Cookbook. Twin Lakes, WI: Lotus
Press.