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A Simple Ayurvedic Case Study: Pitta Woman with Anartava and Vata Vikruti
So, just the other day, a 24 year old woman comes to me complaining that she has not had a menstrual period in 5 months and that she does not feel as though she has as much energy as she used to. Prior to the last 5 months of her periods were regular and light with minimal discomfort. She has recently noticed a crusty grayish discharge from her vagina. She enjoys sex, however intercourse has recently become painful as she does not lubricate as much as she used to. She has also noticed that her hair appears to be thinning. Prior to five months ago she recalls having nice ordinary hair. Her history reveals that there have been no major illnesses or traumatic events that she can recall during her life. She is taking no medications. Further history reveals that she has excessive gas and occasional constipation have been present for about two years. She has always slept well, and her appetite is always regular. She eats three meals a day consistently and occasionally snacks. The emotional/psychological history reveals a person who makes quick decisions, finishes what she begins and enjoys a challenge. In observing her responses to questions about her social history I find her critical of the men she has been, and is, in relationship with. She also has an apparent anger toward her parents and one sibling. Additionally, she appears to be equally hard on herself as she accepts only her best and gets angry when she makes mistakes. Lately she has been making more mistakes than usual. "Its like I've become a ditz" she says. "Sometimes I feel like I'm dysfunctional where I can't concentrate." Upon examination of her routines, I find that she enjoys long distance running and in fact runs about 5 miles, 4 times per week. She has been doing this for the past year. In addition she wakes up around 7 and goes to bed around 1. This always been her adult pattern of waking/sleeping. Physical exam reveals a very slim woman with moderate bone density. She is 5'7" and weighs just 107 pounds. She has lost 15 pounds in the last 18 months and enjoys her petite figure. Her skin is moderately thick. Her hair is dry, fine, scanty. Her face is angular and her eyes are deep set and penetrating. She has excellent musculature. Her tongue is moderate in size and it has a thick grey coating. She has no cracks or scallops. So assuming this is
all the information we have to go on, let's see how we can move her
toward balance. First we have to determine her
Prakruti and
Vikruti.
There is a very key piece of information that is left out: IS she
pregnant? Assuming she is five months and still losing weight, we can
safely assume that she is not. If she was, the healing protocol would
be significantly different. Also, remember this is a simple case showing
just a few aspects of Ayurvedic diagnosis and healing. There are many
more levels I would attend to in an actual case.
Determining her Prakruti Natal Constitution The first step is to determine her Prakruti, her basic constitution. To do this we look at those aspects of her that are slow to change, like her body, bones, face, and tendencies she has carried her whole life. The following table lists the clues along with notes: The columns for Vata / Pitta / Kapha indicate it is a clue for Vata, Pitta, and Kapha dosha. Big X means more likely than little x.
Her Prakruti is 80% Pitta, 10% Kapha, and 10% Vata Determining her Vikruti Transient constitution Next we have to
find her transient constitution, her
Vikruti. To do this we look many
of the aspects of her being that are in flux over the last few months or
years. The following table list these.
Veritably, she has a Very Vata Vikruti But we must remember that it is likely Pitta emotions that are driving this, so one can say that she a Vata Pitta Vikruti. The first thing with Anartava, is that you have to rule out pregnancy. If she was overweight, she could be hiding a child, however, she is apparently not pregnant as she is thin and not showing. Having said that, I start intuiting that her Pitta dosha has burned up her water element, thereby leaving her air element, her Vata unchecked to wreak havoc, further drying her up. She has been physically and mentally hot and exhausting herself, literally burning and drying up her Kapha. So given the clues and intuition we have been given, I would say Her Vikruti is excessive Pitta leading to excess Vata and deficient Kapha
So we must calm her Vata, cool her
Pitta and build her Ojas, which is the essence of Kapha. Note that you don't want to build
doshas themselves, but minimize them. You do want to build the subtle
doshas of Prana, Tejas, and Ojas, which are the purified and stable
aspects of Vata, Pitta, and
Kapha, respectively. So in this case we want
to build Ojas, not Kapha.
Each of the doshas are divided into 5 sub-doshas, and actually there are minor doshas not included in these divisions. Since she has a Vata Vikruti, we will only look at Vata subdoshas. The table below lists these subdoshas and the clues as to which ones are out of balance. Definitely have to treat Apana soon.
Determining which Dhatus are affected Dhatus are the tissues of the body. To treat this woman we must know which tissues are affected. The following table lists the seven dhatus and the clues that indicate which dhatus are affected by her Vikruti.
Determining which Srota are affected
The Srotas are the channels within the body.
There are 16 of them in women, and 14 in men. The following table lists
these srotas and the clues which indicate that the srota is affected by
her Vikruti.
Determining the State of her Agni Agni is very important. It is the digestive power of the body, how well it can transform food and thought and sensory input and everything else that approaches it into something pure and usable for the Being. With a good agni you can cure and prevent most things. There are four states of agni as listed in the table below, along with...you guessed it, clues which indicate her state of agni.
Determining the State of her Subtle doshas The three subtle doshas are Prana, Tejas, and Ojas. The table below lists these three with my take on their state.
Determining the State of her Gunas The three gunas are Sattva, Rajas, and Tamas. The table below lists these three with my take on their state.
Determining the Disease Pathways
The three pathways of disease are Inner,
Outer, and Central. The table below lists these three with my take on
their state. I feel like I am repeating myself here.
Determining the Prognosis The prognosis is good. Though all three pathways are affected, the Vikruti and prakruti are not the same, and her Ojas still is in reasonable shape though I over dramatized its down-&-outness earlier. She is young and very strong and loves a challenge, so if we can get her into therapy to deal with her anger issues against men and her family, we will be able to stop her from running away from the issues that are burning her up. I would say that 12 therapy sessions over three months should do it. In the mean time we will work with body and energy ayurvedically and in the same three months, maybe four, bring her into a stabilized place. Then another two months to stabilize her inner dhatus. This all assumes, of course, stellar patient compliance. Now, since she is Pitta with Vata imbalance, we can't expect that, it can go either way. She may be way reactive and toss everything out. But it is possible if we can convince her of the beauty and necessity of the challenge at hand. What kind of Diet is recommended Since she has a Vata Vikruti and Pitta Prakruti, and seemingly low Ojas, we would want her to take foods that increase Ojas, which would naturally increase Kapha and decrease Pitta and Vata. The following tables lists the six tastes and the foods that would support her best. Tastes
Foods
What changes in her lifestyle are recommended Like I said before I would change the tendency to be angry and critical first. This is taxing her system and growing her old too quickly and seemingly shutting down her natural systems. Her body probably believes it is in a fight situation and thus knows that it is no time to get pregnant so isn't even allowing the option by shutting down her ovulation/menstruation. She needs to put her self in a situation where her body believes it is the perfect time to have a child, which isn't to say she must get pregnant, but that is the 'bhav' that she must envelope herself in. She needs to replenish her 'juice'. So she must be juicier, more loving and open hearted, cooler, less fighting and anger and much more ease. She must move from rajas toward sattva, from activity toward balance and peace. From criticism she must move to contentment in her life and her mind. She can replace judgment with acceptance, hate with love, anger with forgiveness. Moving her mind in this direction will cure her by itself, no doubt, no doubt, no doubt. For healing her anger she can read Ayurveda and the Mind: The Healing of Consciousness * by Dr. David Frawley or Healing Anger: The Power of Patience * His Holiness the Dalai Lama Replace her running on the streets with splendid walks in forests and beaches. In fact, just her running could be the cause of her Anartava, so just stopping the running could bring her periods back. This kind of exercise is infamous for stopping menstruation. So many athletic women lose their period for this reason. She should minimize sweating as to not sweat out all her juice, all her rasa dhatu. Her Sex is likely an aggressive horizontal bop, she can replace this with meditative union in the balanced Yabyum position. Instead of sleeping 1 to 7, she should sleep 10 to 6. This will be more sattvic and also give her liver a rest at midnight and help ease her Pitta emotions that are aggravated by staying up through liver regeneration time around midnight. I would also start her moving toward a wholesome Dinacharya, an Ayurvedic Daily Routine, as outlined at this linked page.
First of all she should take Triphala
for at least a year, every night as she goes to bed at 10, one to two
grams with warm water. This will gently normalize her Apana, remove the
constipation clean the blood and liver, build the Ojas, activate her
period, nourish her heart, and balance all three of her
doshas. Of
course, it will have other great effects, but these are the main ones
for her. Triphala alone may be able to totally
cure her if she has a
change of emotional heart, and in fact will support her changing
emotions. But to make the process faster, the following herbs are also
advised. For treating her Anartava
(Amenorrhea) the classic formulas are: Anartava Formulas
For
treating her Anartava (Amenorrhea) the herbs are:
Anartava Herbs
For treating her Vata Vikruti we want to nourish her with warming, soothing unctuous demulcent tonic herbs and tone her agni without increasing her Pitta, and we want to feed her Ojas. The following formula can be taken for at least one month before we would re-evaluate her situation. Then it could change, or she could continue it depending on her response and compliance. One can make the formula and take it as a powder or in capsules with the anupan, the vehicle, as described: A Vata Balancing/Kapha-Ojas building/Anartava Herb Formula
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