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A Simple Ayurvedic Case Study: Pitta Woman with Anartava and Vata Vikruti

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.

• constipation
• Gas and gas pains

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."

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.

• Vata
• Pitta
• Kapha
• overweight
   

 
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.
 

 
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.

• Vata
• Pitta
• Liver Flush
• Kapha
• overweight

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

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. 
 

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.  

• 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.

• Vata
• Pitta
• Kapha
   

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.

• constipation
• Liver Flus
• Sweating

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

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

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.

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.

• Liver Flush
• Vata 
• Pitta

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.

• Liver Flush
• Panchakarma