Ayurveda clinic manager
Prof. Shivenarain Gupta MD (Ayu) is a doctor and professor of Ayurvedic medicine from Nadiad (India). At the famous Ayurveda University of Jamnagar he received his doctorate. Today he is head of the Department of Internal Medicine at the P. D. Patel Ayurveda Hospital. As professor of the affiliated J. S. Ayurveda College he has succeeded in establishing one of the most respected pancakarma clinics in India, where patients from India and Europe receive help. He was awarded by IASTAM (India) for his achievements in teaching. At the European Academy of Ayurveda he has been one of the most important teachers and academic head of the training in Ayurvedic medicine for many years.
In last years until end of 2019, attention was paid more to non-communicable diseases, especially in relation to their management of Ayurveda. Communicable diseases were not an important issue. It was believed that Ayurveda is useful in non-communicable diseases but not in communicable diseases. Now suddenly paradigm is shifted to communicable diseases and immunity. People are concerned about immunity because Present pandemic has put the question mark on antimicrobial approach for which we have been proud of. Ayurvedic approach is not microbe oriented, for the prevention and treatment of infectious diseases. This is person oriented. In Ayurveda immunity is not limited to infections and neoplasia but a defense against all diseases. To understand the defense system, we may take example of defense system of a castle, which includes strong wall, watch guards at entry points and patrolling soldiers inside. Similar to that we have defense system in our body in which outer most barrier is our skin and mucous membrane, inner to that macrophages and complements etc. and the innermost level of antibodies and cellular defense.
In Ayurveda the equivalent word for immunity is vyadhiksamatva which is an outcome of strong bala which again is based on normal status of body components most particularly kapha, rasa and ojas. Science is emphasizing much on microbe related immunity which is now questioned. While in Ayurveda it is generalized and based on strengthening the barriers at every level. Moreover, Ayurveda considers immunity at different levels viz. universal level, social or familial level and personal level. To attain immunity there is no instant method. The measures consist of pro-nature behavior, planned progeny, wholesome daily routines (including food according to rules), seasonal regimen, periodic cleansing and rasayana.
Nutritional, pathogenic and therapeutic significance of amlarasa with particular emphasis on amlapitta as a clinical manifestation of it
Rasa (gustatory perception, or gustation) which is generally known as taste is the sensory perception of substances on the tongue and is one of the five senses. Modern science generally considers four basic tastes that are perceived by the taste buds such as sweetness, sourness, saltiness and bitterness. However, Ayurveda considers two more i.e. pungency and astringency. In fact, rasa is not mere a taste, but it is a total perception in buccal cavity when a substance is put into the mouth. Ayurveda considers six rasas viz. madhura (sweetness), amla (sourness), lavaṇa (saltiness) kaṭu (pungent) tikta (bitterness) and kaṣāya (astringent).
Amla (sourness) has dominance of prithivī and agni protoelements for its manifestation. This detects acidity. This shows a presence of some acidic components in a substance coming in the contact with tongue. This taste promotes salivary secretion in the mouth and produces a peculiar type of numb feeling on the teeth. Proper consumption of items with amla rasa supports in promoting agni and appetite, regulating vāta, pleases mind and satisfying the senses. However, an improper and excessive consumption may lead to inflammations, provocation of pitta, vitiation of rakta, looseness in the body, interference in wound healing.
As a clinical manifestation this is one of the clinical features of pitta provocation in the form of sour eructation. Amlapitta is a disease entity in which sour-bitter eructation is a presenting feature. This is mentioned first in carakasamhitā as a clinical consequence of āmaviṣa, produced due to indigestion and its association with pitta. However, later in mādhavanidāna this is described as a result of transformation of pitta due to pitta-provoking factors, in to vidagdha pitta (amla -pitta) which is sour in taste. Later bhāvaprakāśa had elaborated this further. It describes two clinical forms: adhoga and ūrdhvaga on the basis of primary descriptions of mādhavanidāna and madhukoṣa commentary on it. It also describes treatments in detail. In this way grossly the occurrence of amla -pitta would be in two forms. The treatment is to be planned according to that.
Pañcakarma - psychic status of patients during various phases of pañcakarma
Prof. Dr S.N. Gupta
Pañcakarma is a group of therapies meant for radical expulsion of harmful accumulations from the body those are not eliminated through routine excretory procedures. In this way, these therapies bring the body's environment to normal. Being delicate procedures they require special care and attentiveness at every level. They do not clean the body's atmosphere only but also influence at mental level as mind has to operate through body. The body is in highly turbulent state during all phases of pañcakarma. This is like cleaning a glass bottle by shaking vigorously after pouring a cleansing liquid in to it. Because of turbulence in body's milieu, mind is also in a shaky state. Therefore, patient needs a good support not only physically but mentally at every level. Then it may result into wonderful outcomes. Therefore, Ayurveda advices to take care of a patient like a tender egg, bowl brimful of oil or like a cowherd carrying a stick manages the cows (Ca.si.12/5)
Patients usually have some misunderstandings and confusions about pañcakarma procedures. They often compare them with some spa type of treatments. Therefore, when they encounter real pañcakarma, this is difficult for them to accept it easily and immediately. Moreover, they are not familiar with such situations. Patients have a common belief that Ayurvedic treatment consists of only pañcakarma, though it is not necessary to perform these procedures in every condition. In several conditions pañcakarma, especially the oleation is contraindicated. When the image about pañcakarma created by them is shattered they develop confusion, uncertainty and anxiety.
When it comes to internal oleation therapy, they develop anxiety because of their early information though unrealistic, about harms of the fatty substances especially ghee. Body's milieu is turbulent during the pūrvakarma. Doṣas are agitated and set to come out. It also influences the mental status of the patient which may give rise to certain emotional outbursts. When we think about mental reaction during pañcakarma (in which gut is the major operating organ), we have to keep in mind also the theory of gut-mind relation. These emotional reactions are observed when patient is alone in the room are while getting abhyaṅga etc.
Anxieties are observed during pradhānakarma also. Emotional outbursts have been observed sometimes during vamana. During virecana, frequency of stools may cause anxiety even though there is no dehydration. Forceful expulsion of colonic contents and straining during nirūha may sometimes cause vasovagal attack resulting into momentary fainting. This may also generate anxiety related to basti. During paścātkarma patient is weakened bodily which also influence his mental status. He has to observe absolute rest. He gets enough time to contemplate. This free contemplation is beneficial for the patient to see the mental problems clearly. However, if a proper support is not provided, he may be dragged in to anxiety and negative thinking.
Ojas - myths and facts with practical understanding about management of its disorders
Prof. Dr S.N. Gupta
As usually happens in samskrita language, the word Ojas has several meanings which results into its interpretations in different ways in different disciplines. Often these are mixed up with Ayurvedic concepts and put it into the category of some mystic entity. In Ayurveda it is clearly a material form which may be a substance or a cellular structure. This is again not a single substance. It is a term used for several entities possessing similar properties and functions.
In Ayurvedic field ojas, rasa, kapha and balam are sometimes used as synonyms as they are similar in functions and are supportive as well as responsible to each other. (Su.Su. 15/23-26,A.Hṛ.Su.11/8,Ca.Su.17/117,Ca.Ni.4/7, Dalhaṇa on Su.Su.15/19)
Ojas is described as a substance or structure with reddish pale color and guru, snigdha, picchila, śīta, madhura, mṛdu, ślakṣṇa, sthira, sāndra and prasanna properties. (Ca. Ci.24/31) This is responsible for immunity, vitality of the dhātus, body strength, mental strength, confidence, fearlessness, potence, tolerance, pleasure and brilliance.
There are two forms of ojas- param and aparam. (Cakrapāṇī commentary on ca.su.30/6-7)
Param ojas is most precious and inherited in the child from the mother, while apram is a final product of dhātupariṇāma. The amount of former is about half an Anjali while of the later is about eigth drops. Loss of former is fatal in consequences while of latter causes proneness for serious illnesses both physical as well as mental.
If we interpret the available classical descriptions about ojas, we may find that it may be substance essential for the cell membrane, substance essential for the health of heart, immune cells and the substances, and cells or substance promoting cell-reproduction and repair. Glycerophospholipids and coenzymes Q10 are also worth attention seeking substances in this context.
Head, Post Graduate Department of Kāyacikitsā
J. S. Ayurveda college & P.D. Patel Ayurveda Hospital, Nadiad, India
Head, Academic advisory board,
European Academy of Ayurveda, Germany
Cikitsā followed by a proper rogaparīkṣā which again based on a proper rogīparīkṣā is a recommended approach in Ayurveda. (ca.su.20/20; ca.su.10/21). Ayurveda duly emphasizes the consideration of deśa and kāla in every segment of clinical practice. Ayurveda is śāśvata and sārvabhauma (having all time and everywhere applicability) science. To experience these attributes one has to understand and apply the principles of Ayurveda in relation to deśa and kāla. Surprisingly in Ayurveda deśa denotes both patient as well as his land (his immediate and remote surroundings) and both are interrelated. This concept is described in detail in Ayurveda (Ca.vi.8/92-93) Success of cikitsā lies in knowledge about all the aspects of patient and his surroundings. Human-behavior is always influenced by his beliefs and that again are influenced by sociocultural environments. This is applicable also for patients, especially regarding their (mis)beliefs, understanding, approach towards their disease, its treatment, and their surroundings. If a clinician is not aware about the contribution of these factors in the disease process, he may be misled and cannot successfully treat a patient. In this presentation an attempt is made to analyse these factors which is not based on scientific research, but on a 25 years' observation on patients and health care providers and the information gathered from the students.
There are some false beliefs due to cultural influences always prevalent in every society and they affect the patient's mind set. For example, in India Dhāt syndrome is a quite prevalent problem which is basically related to some sex-taboos.
In Europe certain clinical conditions are observed which are believed by a patient without any evidence. Teeth-amalagam, intestinal fungus, liver problems and food intolerances are some presenting issues which do not often show any evidence but confuse a clinician in making a proper diagnosis. It does not mean that a patient may not suffer with such problems. A clinician has to ascertain after proper examination. There are some misconceptions about Ayurveda itself. A common belief that Ayurvedic treatments are unexceptionally safe or Ayurveda can cure any disease.
There are also certain common observed dispositions which may be named as Atlas syndrome, Space syndrome and world-managership syndrome. These dispositions of individuals towards surrounding, contribute in some of their psychic or psychosomatic issues. It is vital for a clinician to know all these facts before proceeding for a diagnosis as well as treatment of a patient.
jñānabuddhi pradīpena yo nāviśati tattavavit āturasyāntarātmānam sa na rogānścikitsati (Ca. Vi. IV.12)
(Even a knowledgeable physician if does not enter into the inner-soul of the patient by virtue of the light of his knowledge he will not be able to treat the disease)