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A Simple Ayurvedic Case Study:

Pitta Woman with Anartava and Vata Vikruti

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Ayurvedic Medicine


Ayurvedic Medicine


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.






Moderate Bone Density




Pitta gives moderate bone density

5'7" and 122#




Average size

Skin is moderately thick. 




Pitta gives moderate skin thickness

Sleeps Well




Both Pitta or Kapha people can sleep well

Regular Appetite




Both Pitta or Kapha people can have regular appetites

Eats three meals a day consistently




Kapha is consistent, Pitta needs a lot of fuel

Occasionally snacks. 




Pitta people need to snack

Regular Periods, Light




Could be either, but more a Kapha tendency

Quick decisions 




Pitta gives a quick sharp mind

Critical of others




Pitta tends to make you critical

Enjoys Sex




Pitta gives passion, though all can enjoy Sex

Enjoys a Challenge




Pitta gives the passion to overcome challenges

Anger toward parents




Anyone can be angry, but Pitta is angrier faster

Finishes what she begins




Pitta and Kapha can finish things

Nice ordinary hair




Kapha tends to have the nicest hair, but Pitta as well

Her face is angular 




A classic Pitta sign

Eyes are deep set and penetrating




A classic Pitta sign

She has excellent musculature




Pitta gives good muscle tone

Her tongue is moderate in size




A Pitta sign

Rises at 7, sleeps at 1




Both signs of Pitta, who do well at Midnight.

So obvious to the most causal observer, this women has a Pitta Natal constitution.  I would estimate that

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.






A 24 year old 




Pitta is the dosha of mid-life, may drive a Vikruti





Complaining is often a Pitta event, likely is Prakruti

No Period for 5 months (Anartava) 




Amenorrhea is usually caused by Apana Vayu

Low energy




Usually caused by low Prana

Thinning Hair




Can be Vata or excessive heat in head

Excessive Gas and gas pains




Too much Vata

Occasional  constipation




Deranged Vata constipated

Crusty grayish vaginal discharge




Crusty (dry) and gray are both classic indicators of Vata

Painful intercourse 




Vata brings pain

Dry vagina




Excessive Vata tends to dry

Becoming a 'ditz'




Excessive Vata can make you forgetful

Lack of Concentration




Vata can move your mind disabling concentration

Very Slim, 107#  Loosing weight




She is loosing weight, a sign of Vata

Enjoys her petite figure




Could be normal, could be Vata induced insecurity

Dry, fine, scanty hair




All signs of High Vata

Thick Grey coating on tongue 




The Grey indicate Vata type toxins and Ama

No cracks




Indicates Vata may not be deep, doesn't make sense

No Scallops on tongue




Indicates good digestion, really an indication of Prakruti

Excessive running




Could be Vata or Pitta provoking

So again, clearly this woman has a Vata imbalance it seems.

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.
Determining which Subdoshas are affected

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.

Prana Vayu

Low energy, loss of concentration, ditzy

Udana Vayu

By association with the other vayu's Udana must be affected.

Samana Vayu

Coating on tongue, poor digestion

Vyana Vayu

Excessive running

Apana Vayu

Amenorrhea, excessive Gas and gas pains, dry vagina, constipation thinning hair (via asthi dhatu mala connection), gray vaginal discharge, excessive running

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.  

Rasa Dhatu

Dry Vagina, Amenorrhea, gray leucorrhea, gray tongue

Rakta Dhatu

Coating on tongue indicates blood is toxic

Mamsa Dhatu

Excessive running, weight loss

Medas Dhatu

Weight loss

Asthi Dhatu

Dry brittle thinning hair indicates her bones are not in great shape

Majja Dhatu

All her anger and criticism likely has made her nerves thin

Shukra Dhatu

Both her amenorrhea and the fact that her other dhatus are compromised indicate her shukra is compromised.  Also she seems to have low ojas, which can result from low shukra.

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. 

Pranavaha srota

Excessive Flow: She is feeling ditzy and can't concentrate

Annavaha srota

She has a coated tongue, something is wrong in there

Ambuvaha srota

Blocked Flow: Her Rasa is depleted, could possible be from an obstruction in the water channel

Rasavaha srota

Her rasa is depleted

Raktavaha srota

Thwarted: She has a lot of toxins trying to be released.  She is not menstruating

Mamsavaha srota

She has good muscles, but is loosing mass

Medovaha srota

Deficient Flow: She has too little fat on her

Majjavaha srota

Too much uncontrolled Vata in the system.  Vata and majja are always related

Asthivaha srota

Thwarted:Hair is in trouble which indicts problems with the flow in the bone channel, could be the agni.

Shukravaha srota

Low concentration, low energy

Mutrivaha srota

no indication here

Purishavaha srota

Blocked: Lot of Gas and gas pains, and constipation brittle hair, ama on tongue

Svedavaha srota

No indication here except that she seems dry overall

Manovaha srota

Feeling like a ditz, mind is spacy, she is loosing it, she is angry.

lactation srota

no indication

menstruation srota

Big indication, likely some sort of block in this channel caused by vitiated Apana vayu

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.  


no indication


The fact that she has toxic grey discharges on her tongue and vagina indicates her agni is low.


The fact that she has a good appetite and eats three meals a day and snacks indicates she has a sharp agni. If she really had sharp agni, no ama could generate.


The fact that it shows signs of slow and sharp indicates it is likely variable

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.  


Her Prana is vitiated, nothing is holding it.  It is out of control, which is not to say that it is high, it has just lost its buddy ojas, which is usually there to embrace it and calm it.  So now instead of controlled in a good way, Prana is excited in a sad way and races around the body drying up her colon and her menstruation.


Tejas is the source of trouble with her, or should I say the child of Tejas, Pitta.  It got too hot and burned out the Ojas and now Prana is a wild group of women, especially that earthy sister Apana.  Tejas once worked wonders for her allowing her to focus and overcome any challenge, but now it is being swayed left and right by Prana vayu, making her not able to see straight, causing her to be a ditz that can't concentrate enough to even choose which cereal to buy.


Poor Ojas.  It needs to get into some air-conditioning and definitely needs a nice bath and a massage. And then some good sleep and rest. 

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. 


Not quite yet, but maybe this lifetime if she really turns around. Talk about a challenge to face: Let's she if she can break through her Rajas and move into Sattva.


You got it! She is so active. Running all the time.  Judging people and situations constantly.  Wanting an active mind and life.  Working so hard to be perfect and then working so hard to make sure she beats herself up for not being perfect. Hmmm! Enough said.


Not yet, but if she burns herself out anymore, she just may land in a dark couch potato land, or worse.  The fact that she seemingly is holding a grudge against men is tamas.

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.


The fact that she has Ama and is constipated is enough indication to show that the maha vaha srota, the inner channel is getting blocked.


Her outer two doshas, rasa and rakta are definitely affected. 


Her imbalance is likely involving her inner 5 dhatus in a big enough way to be concerned.  For instance, the fact that her hair is affected indicates her bones are involved. and Her shukra is likely not so hot, no pun intended.

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.



No bitters, too cold, though it would help clear the anger in her liver and purify her blood.


No Astringents, she is already too contracted


Maybe a little pungent just to get the blood flowing and to move the blocks


A little to deal with the Vata, but not so much to throw her Pitta off




Here we work for now, using complex carbos and dravya that has the prabhava to increase Ojas



Organic: Basmati Rice, Oats, Wheat berries


In season and organic: Apricots, Avocado, Bananas, Berries, Coconut, Dates, Figs, Grapefruit, Kiwi, Lemons, limes, Mango, Melons, Papayas, Peaches, Pineapple, Plums, Rhubarb, Tamarind, Tangerines.


In Season and organic: Artichoke, asparagus, carrots, Daikon, Leeks, pumpkin, Sweet potatoes, Summer squash, Winter squash, Watercress


Organic: Almond, Brazil, Cashews, Chestnuts, Filberts, Macadamia, Peanuts, Pecans, Pine Nuts, Pistachios, Pumpkin seeds, Sesame Seeds, Sunflower, Walnuts


Organic: Ghee:  Increase agni while decreasing Vata and stabilizing Pitta, Almond, Sesame, Canola, Sunflower


Organic: Aduki, Mung, Tofu, Toor Dhal


Organic: Buttermilk, Cottage Cheese, Raw Cow's milk, Yogurt


Organic: Amasake, Brown rice Syrup, Dates, unheated Honey, Maple Syrup, sucanat, Sugarcane (Gur, Jaggery)


Organic: Anise, Hing, Basil, Bay Leaf, Black Cumin, Black Pepper, Caraway, Coriander, Dill, Fennel, Garam Masala, Kudzu, Mint, Orange Peel, Peppermint, Saffron, Sandalwood Chips, Spearmint, Tamarind, turmeric, Vanilla


Wildcrafted: Arame, Dulse, Hijiki, Kelp, Kombhu, Seaware, Wakame


Organic: Apricot Juices, Chicory Blends, Coconut Milk, warm Cow's milk, Date or fig shkes, Lassi, Sweet fruit juices


Organic: Bancha, Cardamom, Chamomile, Elder Flower, Fennel, Hops, Lavendar, Lemon Balm, Lemon Grass, Peppermint, Rose Flowers, Rosehips, Spearmint

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.

What kind of Herbs/Formulas are recommended

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



Anupan (vehicle)

Rajah Pravartini Vati

2-4 tablets TDS

Warm water or 
Decoction of fenugreek or 
Decoction of Das Mool

Boladi Vati

1-2 tablets TDS

Warm water

Hingvadi Vati

1-2 tablets BDS

Warm water

Nashat Pushpantak Ras

1-2 Tablets BDS

Warm water

For treating her Anartava (Amenorrhea) the herbs are:

Anartava Herbs

Herb Class





Carrot seed 

20 ml BDS

Its own Decoction


Powder of Krishan Til

5-10 gm BDS

5-10 gm Jaggery

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

Herb Class/Activity




Emmenagogue, clears channels, carminative, dispells Vata, warms uterus

Pennyroyal powder

1 part in formula

Aloe Juice, 2 ounces in 2 ounces of warm rose water and 20 drops of myrrh tincture made with the mantra 'Sitaram" and the Sri Yantra.

Tridoshic, sattvic, emmenagogue, nervine, induce Love, Feed Ojas

Rose petals

Use as rose water in anupan

As above

Tridoshic, sattvic, induce Love, tone her system, feed Ojas


1/2 part in formula

As above

Sattvic, Vata Tonic, demulcent, rejuvanative, harmonize formula, feed Ojas

Sesame seed powder

2 parts in formula

As above

Blood mover and cleaner, normalize colon, cleanse chakras and subtle body, improve metabolism, activate ovulation, purify liver emotions, activate agnis.

Turmeric powder 


1 part in formula

As above

Rejuvenate bodymind, emmenagogue, antispasmodic, dispel old blood, dispell old emotions, purify subtle body

Myrrh tincture

Use as tincture in anupan

As above

Emmenogogue, alterative, purify liver emotions, remove anartava

Manjishta powder

1/2 part in formula

As above

Demulcent, Female Vata Tonic, Calming, feed Ojas

Shatavari powder

1 part in formula

As above

Harmonize formula, demulcent, balance hormones, feed Ojas

Licorice powder

1 part in formula

As above

Activate formula, assimilate formula, increase agni, Universal tonic, Vata tonic, move blood, activate ovulation

Ginger powder

1/2 part in formula

As above

A sattvic, tridoshic, slightly cooling  blood purifier, alterative, nervine stimulant, to remove her 'ditzyness' and rebuild and purify her nerves.

Gotu Kola (Brahmi) 


1 part in formula

As above

Sattvic, tridoshic, emmenagogue, alterative, tonify agni without increasing Pitta, nutritive, rejuvenative, feed Ojas

Aloe Juice

Two ounces in Anupan

As above

For more information on these herbs see  The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine *
by Dr.Vasant Lad and Dr. David Frawley.

For more information on treating Amenorrhea and many other women's issues, see Ayurvedic Healing for Women by Atreya.  This formula above is my own and Atreya has several others in his fine newly released book.

Regarding nutraceuticals, I would encourage her to take Vitamin E oil and CoQ10 oil with flax seed oil to build her nerves, her Ojas, calm her Vata and strengthen her heart.  

What kind of Essential oils/Aromas are recommended
I would recommend Aldehydes for their sedative anti-Vata effects, Esters for their equilibrating effects, ketones for cell regeneration, lactones for mucolytic activity, and sesquiterpene
alcohols for their grounding calming quality.


Essential Oil






Lavendar, Clary sage, Geranium, Roman Chamomile

Clary sage has large C-20 molecules similar to estrogen and thus is effective for amenorrhea


Yarrow, Thuja, Anise

Anise has a special quality for curing amenorrhea




Sesquiterpene alcohols

Carrot seed, Cedar, Ginger, Vetiver, Frankincense

Interesting that Carrot seed oil is high in Sesquiterpene alcohols and is also a classic ayurvedic remedy for amenorrhea. 

These oils she could take internally as guided, or apply them directly to her abdomen or on the marma points as directed by the experienced practitioner.  For more information on the Science of Aromatherapy see
Advanced Aromatherapy: The Science of Essential Oil Therapy   by Kurt Schnaubelt

What colors are recommended
I would recommend for Vata- not too bright but warm like gold, orange, yellow, light green, deep blue, to warm and soothe her Pitta Vata, and nourish her sense of being.


What Pranayama are recommended
I would recommend Nadi shodana and Ujjai for general balancing, centering, cleansing and toning.  Two or three sessions of Nadi Shodana per day and Ujjai whenever she can think of it.  She can even do Kegels (Moolabandha) syncronized with the pranayama to activate her grounding force of her first chakra.  

What kind of Yoga Asanas are recommended
I would recommend yoga asanas for Vata at first, then for keeping her Pitta in balance.  For Vata:

  • Vata asanas: poses that compress pelvis, use lower back, thighs or pelvis all relieve excess Vata
  • slow w/ great focus on detail & body sensations
  • some Vata relieving poses: uttanasana, paschimottanasana, janu sirsasana,
  • meditative poses: virasana (supta virasana-fixed firm), padmasana (lotus), yoga mudra, dhanurasana (bow), savasana
  • avoid for Vata: surya namaskar (sun salut.), sarvangasana (shoulder stands), halasana (plow) and rapid flows

For more information on Ayurveda and Yoga see Ayurveda and Yoga by Vamadeva Dr David Frawley, OMD

How much exercise should she get and why
She should get exercise, but calming exercise as to not excite her Pitta or move her Vata to more imbalance.  So instead of running and racing against others and the clock and stressing over whether she is going to get hit by that car or twist her ankle on that curb, she can be calm and hike in nature with calm loving friends, taking in good prana. or she can do yoga in a calm cool friendly loving environment.

What Mantras are recommended
I would definitely recommend "SitaRam".

  • First, it is only beneficent, she won't hurt herself
  • It is balanced: Sita is cooling and Ram is warming
  • It is extremely sattvic
  • It can grant great meditation and even liberation
  • It promotes the peaceful union of the feminine with the masculine, something she needs
  • It is balancing
  • It can be sung to invoke Love of Love within and merge you with that Love

For grounding, she can also chant the seed syllable of the first earth chakra, "Lm" or of the second water chakra, "Vm".

Is Panchakarma recommended
I would recommend Panchakarma in about 4 months, after she builds herself.  She seems that she is on a downward spiral toward emaciation, so until she builds a little, we would use the Triphala to cleanse her instead of full on Panchakarma.


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