“You can only cure retail, but you can prevent wholesale.”
Brock Chisholm
When I was a medical student, I would sometimes hear people discussing the possible presence of toxins in their bodies. At that time there were a number of alternative health procedures that promised to eliminate putrefying matter from the system, and adventurous souls were beginning to try liver flushes, high-colonic enemas, and a variety of herbal cleanses. It was easy to visualize plaques of toxic matter lining the intestines like mud caked on the exhaust pipe of an off-road vehicle. By flushing out this fetid material, the various remedies offered more energy, greater happiness, and a new lease on life. I found it difficult to believe any of this, however. In my gastrointestinal service rotations I had peered into dozens of digestive tracts through fiberoptic scopes, and I had seen remarkably little evidence that our intestines were lined with pockets of compost heaps.
As a result of my clinical experience, I was initially skeptical about Ayurvedic descriptions of ama, and the attendant recommendations for eliminating these toxic residues. Since then, however, I’ve come to appreciate the subtlety of the concept of incompletely digested experiences, and I’ve also seen the benefits of taking steps to metabolize them more fully.
Ayurveda describes disease as the final expression of toxic accumulations in the mind body physiology. If we think of our bodies as systems that ingest, transform, and release energy, we can then envision situations in which the energy that enters the system overloads the capacity to either transform or release it. This indigestible energy destabilizes the system’s balance, while procedures for releasing these accumulations can help us reestablish a healthy homeostatic state.
In order to clarify the cause and the treatment of these toxic accumulations from an Ayurvedic point of view, we should first briefly review the concepts of agni and ama. Agni, or “digestive fire,” is the principle of conversion that metabolizes nourishment from the environment. When our agnis are strong, the packages of information and intelligence that we take from the environment are digested into their fundamental elements. These elements are absorbed into the mind body physiology, where they eventually become our cells and tissues. If we are healthy, any part of the digested material that is not useful is eliminated from the body.
The principle of agni is usually applied to the digestion of food, but it can apply to the metabolism of anything that enters into us from the environment. We can speak of intellectual agnis as the process of digesting new ideas, or emotional agnis whereby we metabolize feelings, or sensory agnis that process all sensory input. When we are exposed to a new theory or concept, for example, our mental agnis break it down into fundamental bits of information, process the conceptual elements, assimilate those that are nourishing to our “intellectual body,” and eliminate those aspects that are not nourishing. All sensory input—sound, touch, sight, taste, or smell, as well as our emotional experiences—is processed in a similar way.
When agni is not functioning efficiently, toxins and impurities can accumulate. Ayurveda refers to these incompletely metabolized materials as ama, and their presence in the body’s cells and channels of circulation disrupts the free flow of nourishment. Ama is described as heavy, thick, cold, and foul, while agni is light, clear, hot, and pure. Thus, there is a fundamental opposition between the two concepts, and the strengthening of agni will automatically diminish the presence of ama.
If ama has accumulated over a period of time our mental and physical functioning is diminished, because significant energy is required to overcome the obstructive effects of the toxicity. People with significant ama accumulation are often mentally fatigued, and they may experience generalized physical pain as well. Since the condition of the tongue reflects the presence of ama in the system, there is frequently an unpleasant white coating on the tongues of people with significant ama accumulations, which is particularly noticeable in the morning.
Since ama is usually associated with one of the three doshas, it’s possible to have Vata, Pitta, or Kapha imbalances either with ama or without it. In any case, if there is significant toxicity in the system, it is difficult to restore balance to the doshas until the impurities have been eliminated. Ayurveda refers to this process of transformation as moving from a state of Sama (with ama) to one of Nirama (without ama.) Once the ama is reduced, more specific measures for balancing the doshas can be effective.
A healthy diet is one of the most important tools for reducing ama accumulation. If you feel that you have accumulated toxicity due to poor nutrition or the use of alcohol, cigarettes, or drugs, following an ama-reducing program for a few days or weeks can be a good start to a healthier lifestyle. Try following these recommendations, and notice any effects on your energy levels and general well being.
• Eat foods that are freshly prepared, nutritious, and appetizing; minimize canned foods and leftovers.
• Take foods that are lighter and easier to digest, such as rice, soups, and lentils.
• Favor freshly steamed or lightly sautéed vegetables.
• Avoid fried foods.
• Avoid cold foods and drinks.
• Temporarily reduce your intake of dairy products.
• Minimize fermented foods and drinks, including vinegar, pickled condiments, cheeses, and alcohol.
• Favor the lighter grains, such as barley or basmati rice.
• Reduce highly refined carbohydrates such as white flour and sugar.
• Reduce oily, heavy, or salty nuts; sunflower, pumpkin, or sesame seeds may be taken in small amounts.
• If animal products cannot be eliminated entirely, favor the white meat of turkey or chicken; minimize red meats.
The ancient procedures for eliminating accumulated impurities from the physiology are known in Ayurveda as panchakarma. Pancha, in Sanskrit, means “five,” and karma means “action.” Panchakarma, therefore, refers to the five actions that are considered the most powerful, purifying, and rejuvenative procedures in Ayurveda. In the ancient Vedic cultures, panchakarma was available only to the nobility. But now Ayurvedic centers are springing up around the world, providing unprecedented access to these powerful rejuvenative processes.
Traditionally, a few days of panchakarma are recommended at the change of seasons. Since the changing annual weather periods foster accumulation of a specific dosha, cleansing yourself at seasonal transitions can be very helpful for reducing or eliminating those accumulations. Thus, at the end of a cold, dry fall and early winter, Vata accumulates; at the end of a wet, cold spring, Kapha builds up; and by the end of a warm, humid summer, Pitta levels have significantly increased. These are the ideal times to undergo panchakarma to restore balance in the physiology.
Panchakarma is also a beneficial, powerful process for people who have manifest illness. At The Chopra Center for Well Being, many people facing serious diseases arrive filled with anxiety, fear, and pain; but after a week of these powerful cleansing and rejuvenative procedures their view of their problem is dramatically transformed. They begin to sleep better, their appetite improves, pain is reduced, and they are able to reach a higher level of well being. This shift, of course, occurs in both the mind and body of the individual.
Ayurveda emphasizes an active role for the patient in the care of his or her health. Panchakarma, however, is unique among Ayurvedic procedure in that the patient passively receives the therapeutic approaches of trained caregivers. The entire process is designed to facilitate the deep-rooted release of stress, and to encourage the patient to surrender to the healing process. There are three integrated components of the panchakarma process: the preparation phase, the principal procedures, and the post-procedure phase. In Sanskrit these are known as Poorva karma, Pradhana karma, and Paschat karma.
Poorva karma, which is designed to prepare the body for the elimination of imbalances, has two aspects: Snehana, or oleation, and Swedena, or heat treatment. Snehana includes both internal and external oiling of the system. According to Ayurveda, pure herbalized oils are able to permeate the cells and tissues, encouraging the release of stored toxicity. During the preparation phase, patients are instructed to take increasing quantities of herbalized oils by mouth, which are designed to lubricate the digestive system and mobilize toxicity so it can be eliminated. The clarified butter or ghee is herbalized with bitter Ayurvedic herbs; these enhance its ama-reducing qualities and also reportedly reduce its effect on cholesterol levels. If an individual has high cholesterol, however, ghee should be used very sparingly. As an alternative, chewing raw sesame seeds with raisins can provide useful internal Snehana and will not effect cholesterol.
Regardless of which oleating substance is used, the Ayurvedic therapeutic principle is always the same. The oils move from the gastrointestinal tract into the tissues. As they travel through the cells, they extract the accumulated ama, allowing it to be moved into the circulatory channels for elimination.
Oleation is also provided externally through massage. Ayurveda describes hundreds of massage therapies designed to loosen impurities from the tissues. The type of oil, the herbs used to prepare the oil, and the massage techniques all have specific effects. In panchakarma, massage serves principally as a technique for providing oil to the tissues, thus loosening impurities and allowing them to move into the gastrointestinal tract or the circulatory system for removal.
Swedena, or heat treatment, is the second component of the preparatory phase. It is also sometimes translated as fomentation therapy. The English word sweat is derived from the Sanskrit word sweden, and heat is an important preparatory aspect of panchakarma.
Many cultures have used heat therapeutically. Sweat lodges among Native American tribes provide a ritualized opportunity for physical and spiritual purification. Dry and wet saunas have been a standard feature of European health spas for centuries. Anyone who has experienced the relaxing pleasure of a steam room understands the benefit of therapeutic heat.
Ayurveda teaches that heating the system has two principle detoxifying effects: It facilitates the mobilization of ama, and it dilates the channels of circulation, thus speeding the elimination of impurities that have been loosened by oleation. Swedena techniques include hot baths, herbalized steam treatments, dry heat, hot-water bottles, very warm oils, exercise, exposure to the sun, pungent herbs taken internally, and the application of herbalized poultices. Particularly for people with Vata problems such as arthritis, chronic low back pain, or abdominal bloating, heat can provide prompt symptomatic relief.
To my knowledge, there is no scientific evidence that these elaborate oleation and heat treatments actually mobilize measurable toxic substances. It is, however, clearly obvious that these procedures create a profound state of relaxation in our patients. The rhythmic massages performed by paired Ayurvedic therapists provide synchronized nourishing stimulation to the nervous system, and the herbalized heat treatment provokes controlled sweating that is very purifying to the skin.
Once the preparatory therapies have loosened and mobilized impurities, the principal procedures are begun in order to eliminate the toxins from the body. There are five classical elimination procedures, and these are known as panchakarma. At present, we are not using all five of these at The Chopra Center, but we will review them all here in the interest of providing a complete description.
Vamana is therapeutic emesis, or carefully controlled vomiting. It is traditionally used in severe Kapha conditions such as recurrent asthma, bronchitis, and sinus congestion. Because the stomach is one of the major sites of Kapha in the physiology, cleansing this region reduces the accumulation of ama associated with Kapha. The patient is prepared with oleation and heat, and is then given a large volume of herbalized tea to drink. Finally, a small quantity of a potent herbal emetic induces a smooth emesis, and the volume is recorded.
Although the induction of vomiting is not a major component of Western medicine, it is occasionally used when a noncaustic poison has been consumed. The most commonly used agent in the West is emetine, also known as Brazil root, an alkaloid derived from ipecac. Animals in the wild often eat plants and grasses to induce vomiting if something is upsetting their digestion, and this is occasionally seen in household cats and dogs as well.
Virechana means purgation. In the context of panchakarma it refers to the movement of gastrointestinal contents out through the colon. Most of the important Ayurvedic purgatives act principally upon the small intestine, which is a major site of Pitta. Virechana, therefore, is one of the most effective modalities for removing ama that is associated with a Pitta accumulation.
Before receiving an herbal laxative, the patient is prepared with oleation and heat. Increasing quantities of herbalized oil are provided for four to seven days, and a hot bath is recommended before the purgative is given. At The Chopra Center we tend to use either castor oil or senna, which stimulates several movements within four to eight hours after taking the dosage. The laxative is usually taken before going to bed so it will have an effect early the next morning.
We do not recommend taking laxatives on a regular basis as they can create laziness in elimination. We recommend that Virechana only be performed under the supervision of a trained health provider. It is traditionally used for relieving Pitta accumulations in people with certain skin rashes, inflammatory arthritis, migraines, or chronic irritability, and in women with severe premenstrual discomfort.
Nasya refers to the application of herbalized substances through the nasal passages. Many different herbs are used and for the most part are enjoyable to receive; they are very useful in cleansing the sinuses and in calming or clearing the mind. To begin, a vigorous head-and-neck massage with herbalized oil is provided. Then heat is applied in the form of herbalized steam and hot packs, which are placed over the sinus areas. Finally, drops of herbalized oil are gently introduced into each nostril, and the patient sniffs the oil back into the nasal pharynx.
Nasya can be very effective in the treatment of chronic sinus congestion and allergic rhinitis. Conditions such as anxiety, insomnia, and headaches can also be relieved with the appropriate application of Nasya, and the procedures can be easily performed at home to alleviate mild upper-respiratory symptoms. At the onset of a cold, inhaling the steam of boiling water to which a few drops of eucalyptus oil has been added can provide rapid temporary decongestion. If this is done several times a day, sedating over-the-counter remedies may be avoided.
Basti is the administration of herbalized enemas. According to Ayurveda, the colon is one of the major sites of Vata in the mind body physiology, and the application of herbs through the large intestines is the most effective way to balance Vata and remove impurities.
There are two types of Basti: Anuvasana and Niruha. Anuvasana Bastis are oil-based and are primarily pacifying to Vata. The oil-based preparations usually use sesame oil and are administered in quantities of approximately eighty cc’s. They are lubricating to the rectal area and are very soothing for hemorrhoids and mild constipation. Niruha Bastis are water-based decoctions and are primarily eliminative. They are decoctions of five to fifteen herbs and are administered in volumes of about a cup. In addition to facilitating elimination, the water-based decoctions also have a nutritive effect.
Ayurvedic texts devote a great deal of attention to Bastis. In ancient times, administering medicinal herbs via the colon was a very effective means of making the healing herb available to the system, particularly if the patient was unable to take things by mouth. Preparing the herbs in water- and oil-based solutions significantly enhances their absorption. In modern practice, medications are sometimes applied rectally because they cannot be given intravenously. Valproic acid, for example, is an anti-epilepsy medicine that is sometimes administered via an enema in patients with uncontrolled seizures, and it has been shown to achieve therapeutic blood concentrations.
The fifth and final purifying procedure is Rakta Mokshana, or therapeutic blood cleansing. Although historically this has involved the removal of small quantities of blood, this has not been routinely practiced in India for centuries and is not an acceptable method in the West. We apply the principles of these purification procedures by using natural herbal formulas that are considered alteratives, or blood cleansers.
Interestingly, although bloodletting sounds very primitive, modern medicine does make use of the practice in a number of conditions. Hemodialysis for renal disease, and plasma exchange for a host of neurological conditions, can be considered forms of blood detoxification; in certain hematological conditions such as polycythemia, where there is excessive production of the red-cell line, regular removal of blood is performed. Regular removal of blood is therapeutic for hemochromatosis, a condition in which excessive iron accumulates and results in liver damage. There is even a revival of the use of leeches to remove toxic blood and enhance revascularization after limb-amputation surgeries.
Because Rakta Mokshana is so rarely used, even in India, some authorities consider the five karmas to be: Vamana, Virechana, Nasya, Anuvasana Basti, and Niruha Basti. With these five procedures, ama can be eliminated and all three doshas can be balanced using the appropriate combination of herbs and oils.
What do I, as a scientifically trained physician, make of these rather esoteric approaches? As medical director of our center, I have supervised almost a thousand people going through the panchakarma program, and I’ve been consistently impressed with the normalization of basic biological functions that I’ve observed. Patients’ digestive and elimination problems improve, healthier sleep patterns are restored, and emotional well being is consistently enhanced. Is this due to a specific effect of the panchakarma treatments, or to the more general benefits of total immersion in a nurturing, loving, healing environment? I don’t know for sure, but I suspect that both influences are at work.
Mrs. Sterling was going through a rough year. Ten months ago her husband of forty-five years passed away from cancer and last month her only daughter had a second miscarriage. She recently moved from her large house into a more manageable apartment but was missing her familiar neighborhood. Her rheumatoid arthritis, which had been under good control, flared up, requiring higher doses of anti-inflammatory medications. Her sensitive stomach acted up, requiring new medications to treat the side effects of the other drugs. Her appetite was affected and she was sleeping poorly.
During her week with us, she was taught meditation, participated in yoga classes, and underwent two-hour daily panchakarma treatments. The Ayurvedic name for arthritis is amavata, which means “the deposition of ama into the joints responsible for movement.” The massages, heat treatments, and herbalized therapies were designed to eliminate toxicity and reestablish balance in her mind and body. By the end of the week, she was sleeping better and her joints were less swollen. Within a month, her rheumatologist was able to reduce her medications and she felt she was establishing a new rhythm in her life.
I have seen benefits from these intensive treatments in a variety of health conditions. For people with common digestive disorders, the procedures directed toward the gastrointestinal tract, combined with a simplified diet, seem to have a “resetting” effect, normalizing digestion and elimination. The Nasya treatments seem to help clear the nasal and sinus passages in people with allergic rhinitis and sinus congestion. People with a host of chronic-pain disorders benefit from the massage and heat treatments. There is no question that being touched and cared for in a sensitive, ritualized way simply feels great and almost certainly enhances production and release of our intrinsic healing chemicals such as endorphins.
Over the past few years, I’ve met growing numbers of health-care providers who consider themselves holistically oriented. These are people who accept the existence of a mind body connection that can be useful in the healing process, and certainly this shift in awareness is critically important. But I also believe it’s essential that we have a systematic means for providing patients with the experience of substituting nourishing experiences for toxic ones, and for allowing them to see how this can benefit their mental and physical health. Panchakarma therapies meet this need. They offer a way to directly and powerfully influence a patient’s sense of well-being.
After the preparatory procedures and the principal elimination processes, Ayurveda recommends a systematic rekindling of the agnis to prevent unhealthy accumulation. This is accomplished through nutritional herbs such as fresh ginger or trikatu (three pungent spices) to stimulate digestion. The diet in general should be primarily ama reducing, with a minimum of fermented, raw, or heavy foods. Meditation, daily oil massage, Pranayama, and yoga can all help to keep the channels of the mind body constitution clear, and to prevent the reaccumulation of toxins.
Panchakarma treatments are powerful procedures for eliminating deeply stored toxins and impurities from the mind body physiology. Each of the three doshas can be influenced, depending upon the procedure and the nutritional herbs that are used: the Kapha zone, which is from the diaphragm upward, is best treated with Vamana and Nasya; the Pitta zone, between the diaphragm and the navel, is addressed with Virechana; and the Vata zone, below the navel, is best treated with Bastis. In all cases, the mind body system must be carefully prepared with oleation and heat to gain maximal benefit from the main procedures; then, after the elimination process has taken place, digestive power must be reconstituted. Lastly, but of great importance, the patient should be provided with information for making healthy life choices that will prevent the reaccumulation of impurities.
Herbs are an important component of an Ayurvedic program to reduce and digest ama. Bitter herbs help to separate ama from the tissues, as their dry, light nature helps to reduce the heaviness associated with toxicity. Examples of readily available Western bitter herbs include aloe vera, barberry, golden seal, and echinacea, while the classical Ayurvedic bitter herbs include manjishta and neem. Pungent herbs are also useful for digesting ama, but they must be used carefully so as not to aggravate Pitta. Agni-stimulating spices include ginger and cayenne; fresh ginger and long pepper are especially valuable as they stimulate agni but do not exacerbate Pitta.
Gentle liquid fasting can also be valuable in reducing accumulated toxicity. Kapha-type individuals can tolerate several days of liquefied diet each month, but Vata types should fast sparingly. Fresh fruit and vegetable juices encourage the cleansing process without creating any deficiency of essential nutrients. Apples, carrots, and grapefruit are very commonly used, but almost any fruit or vegetable is appropriate. You can also make very thin, blended vegetable soups, which are purifying and nutritious. A liquefied regimen usually begins after dinner, continues through the next day, and ends at breakfast the following morning.
Rasayanas are nutritional herbs that have a rapid rejuvenative effect on tissues. The word rasayana in Sanskrit means “that which enters rapidly into the essence of the physiology.” Rasayanas penetrate rapidly and nourish the subtlest aspect of our psychophysiological being. Their purpose is to enhance the functioning of cells, tissues, and whole systems in order to support the highest level of awareness.
Many formulas have been used for thousands of years in Ayurveda. In the chapter on herbs, I discussed Chyvan prash, derived from the amalaki (Emblic myrobalan) fruit. Considered among the most valuable rasayanas, one hundred grams of the fresh pulp has over seven hundred milligrams of vitamin C, which is more than fifteen times that found in an orange. Reputed in the ancient texts to enhance immunity, Chavan prash’s strong antioxidant properties have been confirmed in modern studies. One to two spoonfuls of the Chavan prash jam twice per day is recommended. It can be mixed in hot milk or water.
Brahma rasayana is another classical herbal nutritional formula that nourishes the mind and nervous system and enhances mental clarity. The principle ingredient is brahmi (Centella asiatica). This is said to awaken the highest energy centers and is useful before meditation.
Although rasayanas can be viewed as tonics with general benefit, specific nutritive herbs are also used for individuals with a predominance of certain doshas. Some of these are listed below:
VATA: Ashwagandha (Withania somnifera), Guggulu (Commiphora mukul), Haritaki (Chebulic myrobalan)
PITTA: Amalaki (Emblic myrobalan), Brahmi (Centella asiatica), Shatavari (Asparagus racemosus), Kumari (Aloe vera)
KAPHA: Bibhitaki (Beleric myrobalan), Guggulu (Commiphora mukul), Pippali (Piper longum)
Once the toxic accumulation has been reduced, steps can be taken to help cells and tissues return to their optimal state. This rejuvenating process involves choosing nourishing behaviors as well as nourishing foods. Thus, the regular practice of meditation is an essential component of any rejuvenation program. Yogic breathing exercises and postures energize and balance the mind body physiology, and a daily oil massage assists in the elimination of toxins and stimulates the release of healing chemicals from the skin. It is also extremely important to recognize the extent to which nourishing and supportive relationships provide mirrors of our own nature, allowing us to recognize and take appropriate responsibility for the conditions that we have created for ourselves.
A subtle but very enjoyable way to derive nourishment from the environment is to consciously allow your attention to go to the five natural elements. These life-force-enhancing exercises are rejuvenating and fun to do on a regular basis.
• Walk barefoot on the earth for at least ten minutes every day. Have your attention on your feet and the earth with the intention to absorb nourishment from Mother Earth.
• Walk along natural bodies of water. Allow the cooling, coherent influence of water to infuse your being.
• Allow the light and warmth of the sun to permeate you. Acknowledge the energy-giving force of the sun, the source of all life on earth.
• Take a walk where there is abundant vegetation and deeply inhale the breath of plants. The ideal time to receive the life force of plants is right before dawn and right after sunset.
• Gaze into the heavens at night. Let your awareness touch the stars and the furthest reaches of the cosmos.
• Eat locally grown, fresh, and lovingly prepared fruits, vegetables, and grains, which imbibe the life force of all five elements.
Ayurvedic techniques of purification and rejuvenation can be studied in great detail, but the most important principles can be expressed in just a few words: We can improve our health by changing the material that we bring into our bodies and our minds, and by strengthening our ability to digest that material. By being fully present in all aspects of our lives, we can metabolize the gifts of nature into a sublime essence, a nectar that will bring us well being and joy.