AYURVEDA : ANCIENT WISDOM

FOR MODERN PSYCHIATRY

Sudha Prathikanti, MDUniversity of California, San Francisco

www,prathikanti.com/teaching

AYURVEDA:AYURVEDA:SCIENCE OF LIVINGSCIENCE OF LIVING

COSMOS

VATA PITTA KAPHA

moves transforms binds

SPACE AIR FIRE WATER EARTHFIVE GREAT BHUTAS

THREE GREAT DOSHAS

AYURVEDA: AYURVEDA: THE THREE GREAT DOSHASTHE THREE GREAT DOSHAS

Each dosha has specific expression Each dosha has specific expression in every dimension of human being:in every dimension of human being:

Vata moves ---> body, mind, subtle energyVata moves ---> body, mind, subtle energy

Pitta heats ----> body, mind, subtle energy Pitta heats ----> body, mind, subtle energy

Kapha binds ---> body, mind, subtle energyKapha binds ---> body, mind, subtle energy

..

There is implicit and explicit understanding that There is implicit and explicit understanding that

body, mind and spirit are manifestations of the same life-force.body, mind and spirit are manifestations of the same life-force.

AYURVEDA:AYURVEDA:IMPORTANCE OF INDIVIDUAL CONSTITUTIONIMPORTANCE OF INDIVIDUAL CONSTITUTION

Each person has unique Each person has unique constitution of 3 doshas constitution of 3 doshas

Constitution ascertainedConstitution ascertainedthru careful history & examthru careful history & exam

PulsePulse Body Build & WeightBody Build & Weight Tongue, Skin, Hair, NailsTongue, Skin, Hair, Nails CirculationCirculation Climate ToleranceClimate Tolerance

Speech / Motor ActivitySpeech / Motor Activity Emotional TendenciesEmotional Tendencies Memory & CognitionMemory & Cognition Eating / Elimination PatternsEating / Elimination Patterns Sleeping PatternsSleeping Patterns

..

VATAVATA

Lean, bony buildLean, bony buildRapid walk and talkRapid walk and talkErratic appetite & staminaErratic appetite & staminaSensitive to wind & coldSensitive to wind & cold

Quick, flexible mindQuick, flexible mindLearn fast, forget fastLearn fast, forget fastLess willpower, resolveLess willpower, resolveEasily anxious, unsettledEasily anxious, unsettled

Respond well to:Respond well to:Regular, long sleepRegular, long sleepFrequent meals: warm & richFrequent meals: warm & richWarm, moist climateWarm, moist climate

..

PITTAPITTA

Medium buildMedium buildForceful walk & talkForceful walk & talkStrong appetite & staminaStrong appetite & staminaSensitive to heatSensitive to heat

Sharp, penetrating mindSharp, penetrating mindLike to plan & leadLike to plan & leadGreat willpower, resolveGreat willpower, resolveEasily irritable, competitiveEasily irritable, competitive

Respond well to:Respond well to:Moderate sleepModerate sleepRegular meals: cool & sweet Regular meals: cool & sweet Cool climateCool climate

AYURVEDA: CONSTITUTIONAL TYPESAYURVEDA: CONSTITUTIONAL TYPES

..

KAPHAKAPHA

Large, hefty buildLarge, hefty buildSlow walk and talkSlow walk and talkSteady appetite & staminaSteady appetite & staminaSensitive to fog & coldSensitive to fog & cold

Deliberate, steady mindDeliberate, steady mindLearn slowly, good memoryLearn slowly, good memoryComplacent, forgivingComplacent, forgivingEasily depressed, clingyEasily depressed, clingy

Respond well to:Respond well to:Less sleepLess sleepFewer meals: light & spicy Fewer meals: light & spicy Warm, dry climateWarm, dry climate

AYURVEDA:AYURVEDA:HEALTH AS HARMONIOUS LIVINGHEALTH AS HARMONIOUS LIVING

Health: Health: living in balance living in balance with basic constitutionwith basic constitution

Illness: Illness: living out of balance living out of balance with basic constitutionwith basic constitution

..

VATA EXCESSVATA EXCESS

-- Significant anxiety -- Significant anxiety -- Insomnia-- Insomnia-- Anorexia-- Anorexia-- Weight loss-- Weight loss-- Motor agitation-- Motor agitation-- Compulsive talking-- Compulsive talking

KAPHA EXCESSKAPHA EXCESS

-- Profound anhedonia-- Profound anhedonia-- Hypersomnia-- Hypersomnia-- Hyperphagia-- Hyperphagia-- Weight Gain-- Weight Gain-- Apathy & Listlessness-- Apathy & Listlessness-- Paucity of speech-- Paucity of speech

AYURVEDA: AYURVEDA: DEPRESSION ASDEPRESSION ASDOSHA IMBALANCEDOSHA IMBALANCE

AYURVEDA:AYURVEDA:REMEDIES FOR DOSHA IMBALANCEREMEDIES FOR DOSHA IMBALANCE

Purification Procedures Purification Procedures Food & SpicesFood & SpicesHerbal MedicineHerbal MedicineHerbal Massage & BathHerbal Massage & BathYoga Asanas & ExerciseYoga Asanas & ExercisePranayamaPranayamaMeditationMeditationSensory ExperienceSensory ExperienceSocial ExperienceSocial ExperienceAttention to Nature Attention to Nature

TimeTime ClimateClimate EnvironmentEnvironment

Dosha-correcting remedies may be applied to every dimension, Dosha-correcting remedies may be applied to every dimension, not just dimension where symptoms manifestnot just dimension where symptoms manifest

EVIDENCE BASE FOR AYURVEDIC EVIDENCE BASE FOR AYURVEDIC REMEDIES IN PSYCHIATRYREMEDIES IN PSYCHIATRY

PANCHAKARMAPANCHAKARMA

HERBSHERBS

HATHA YOGAHATHA YOGA

MEDITATIONMEDITATION

AYURVEDA RESEARCHAYURVEDA RESEARCH WORLDWIDE WORLDWIDE

India BritainGermanyAustralia

Photo 6Photo 6

Steam chamberSteam chamber

PANCHAKARMA:ABHYANGA &SVEDANA

PANCHAKARMA:SHIRODARA

Photo 4Photo 4 PANCHAKARMA:NASYA

PANCHAKARMA STUDIESPANCHAKARMA STUDIES

Open controlled trial: Normal subjects undergoing Open controlled trial: Normal subjects undergoing panchakarma had reduction in depression, anxiety, panchakarma had reduction in depression, anxiety, overall distress compared to subjects taking didactic overall distress compared to subjects taking didactic classes (classes (Schneider, Cavanaughet et al 1990))

Open controlled trial: Subjects with Parkinson’s Open controlled trial: Subjects with Parkinson’s Disease receiving both panchakarma and an Disease receiving both panchakarma and an Ayurvedic herbal remedy exhibited more Ayurvedic herbal remedy exhibited more improvement in neurological symptoms than did a improvement in neurological symptoms than did a small control group receiving only the herbal remedy. small control group receiving only the herbal remedy. (Nagashayana, (Nagashayana, Sankarankutty, et al 2000).Sankarankutty, et al 2000).

Many other panchakarma studies for medical Many other panchakarma studies for medical conditions are summarized in “Scientific Basis for conditions are summarized in “Scientific Basis for Ayurvedic Therapies” by Lakshmi Mishra (CRC Ayurvedic Therapies” by Lakshmi Mishra (CRC Press: 2003)Press: 2003)

Photo 5Photo 5

AYURVEDIC HERBS

PSYCHOTROPIC HERBS IN AYURVEDAPSYCHOTROPIC HERBS IN AYURVEDA

Bacopa MonnieraWithania somnifera

Valeriana jatamansi

Convolvulus pluricaulis

Rauwolfia serpentina Centella asiatica

Mandukparni

Jatamansi

Sarpagandha

AshwagandhaShankpushpi

Brahmi

Antipsychotic Effect

-- Rauwolfia * -- Centella (in polyherbal) Anxiolytic Effect

-- Valeriana -- Centella* -- Withania -- Convolvulus -- Bacopa *

Antidepressant Effect

--- Withania --- Convolvulus

Soporific Effect

-- Valeriana * -- Centella (in polyherbal)

Cognitive Enhancement

-- Centella* -- Withania * -- Convolvulus -- Bacopa *

SAFETY ISSUES WITH AYURVEDIC RMEDIESSAFETY ISSUES WITH AYURVEDIC RMEDIES

Mass Production Mass Production

Over-the-counter AvailabilityOver-the-counter Availability

Plant ContaminantsPlant Contaminants

Misidentification of HerbsMisidentification of Herbs

Circumventing De-toxificationCircumventing De-toxification Unorthodox CombinationsUnorthodox Combinations

Herb-Drug InteractionsHerb-Drug Interactions

HATHA YOGAHATHA YOGA

Randomized controlled trialsRandomized controlled trials Pranayama + asana reduces symptoms in Pranayama + asana reduces symptoms in

depressed college students depressed college students Pranayama equivalent to tricyclic in treating Pranayama equivalent to tricyclic in treating

depressed psych inpatientsdepressed psych inpatients Hatha yoga + methadone equivalent to Hatha yoga + methadone equivalent to

psychotherapy + methadone in reducing psychotherapy + methadone in reducing relapse in opiate usersrelapse in opiate users

Yoga breathing improves spatial memory Yoga breathing improves spatial memory learning in normal schoolchildrenlearning in normal schoolchildren

Hatha yoga reduces anxiety & depression Hatha yoga reduces anxiety & depression in normal adultsin normal adults

Non-randomized controlled trialsNon-randomized controlled trials Hatha yoga equivalent to swimming in Hatha yoga equivalent to swimming in

producing mood benefits in women, may producing mood benefits in women, may be superior to swimming in menbe superior to swimming in men

Hatha yoga superior to muscle relaxation and Hatha yoga superior to muscle relaxation and visualization in improving mood and alertnessvisualization in improving mood and alertness

Hatha yoga related to higher life satisfaction, Hatha yoga related to higher life satisfaction, better overall mood, better coping with stressbetter overall mood, better coping with stress

MEDITATIONMEDITATION

Chronic anxiety (TM, MBSR)Chronic anxiety (TM, MBSR) Chronic pain (RR, MBSR)Chronic pain (RR, MBSR) Chronic insomnia (RR)Chronic insomnia (RR) Recurrent Depression (MBSR)Recurrent Depression (MBSR) Overall emotional well-being Overall emotional well-being

(RR, MBSR)(RR, MBSR) Less anxiety and depressionLess anxiety and depression Increased sense of controlIncreased sense of control Increased empathy Increased empathy

INTEGRATIVE MEDICINE:INTEGRATIVE MEDICINE:THE BEST OF BOTH WORLDSTHE BEST OF BOTH WORLDS

Integrative Medicine might restore the soul to medicine…

the soul being that part of us that is most important but the least easy to delineate.

Richard Smith

British Medical Journal January 2001