Everybody knows the word "arthritis" and what it means—stiffness, pain and swelling in the joints, reduced range of motion, less flexibility and impaired mobility.
In comparison, rather few people in the West are familiar with the word "panchakarma"—a highly effective cleansing method used for treating both osteoarthritis (the common, "wear and tear" form of arthritis) and rheumatoid arthritis (an autoimmune disease that causes chronic inflammation of the joints) developed by Ayurvedic doctors in India sometime between 3,000 and 5,000 years ago.
Ayurveda is a Sanskrit word that translates to "science of life." In Ayurveda, health exists when five conditions are met: 1) the digestive fire (agni) is in a balanced condition, 2) the three dosha types (the energies of vata, pitta and kapha) are in equilibrium, 3) the three waste products (urine, feces and sweat) are produced and eliminated normally, 4) the body's tissues are functioning and 5) the mind and senses are working harmoniously together. When the balance of these systems is disturbed, the disease process begins.
Healing in the Ayurvedic system is based upon understanding how the five elements of creation—ether, air, fire, water and earth—work in, around and through us. These five fundamental life elements are understood as being foundational to the function and energy of everything in the universe—including us.
Instead of the Western medical approach of treating symptoms, Ayurveda places great emphasis on disease prevention and the maintenance of health and wellbeing by paying close attention to achieving balance in one's life—practicing the right thinking, right diet, right lifestyle and right use of herbs.
Getting to know one's unique dosha combination and its energetic qualities is a key to self-knowledge that helps you choose the best foods, activities and even the kinds of environments to work and live in that support rather than deplete you. Understanding your dosha—your constitutional type—gives you the information you need to manage your life and keep yourself in balance.
Unfortunately, very few people in the West are familiar with the doshas, and even if they are, our modern lifestyle doesn't lend itself to either moderation or balance. This means the vast majority of us end up out of balance and manifesting symptoms of various diseases, such as arthritis.
In the Ayurvedic view, arthritis is an underlying disease of imbalanced agni, or digestive fire. Agni mediates between the internal and external environments, transforming food into body tissue and eliminating the rest, discerning between nutritious material and waste product.
When the digestive fire is impaired through stress and emotional eating, improper food combining, eating the wrong kind of foods for your dosha or eating late at night, then a byproduct of uncooked matter called "ama" is produced.
The three doshas
In Ayurvedic medicine, the five elements—ether, air, fire, water and earth—manifest as three very different types of energies that give rise to our individual physiological and psychological/emotional constitutions called doshas. Most people's bodies reflect a combination of two or three doshas; rarely is someone a "pure" dosha type.
Here is a brief overview of the three doshas.
The vata dosha is aligned with the elements of air and ether. The main qualities of vata are highly mobile, quick, cool, dry, light, rough and subtle. These qualities show up in all areas of life: mentally, physically and emotionally. Vata- dominant people tend to have these qualities:
•Good at multitasking, can be scattered and have a nervous, fidgety constitution
•Cold hands and feet, seeks out warm places
•Dry skin, lips, hair and nails and "dry bones" that tend towards osteoporosis
•Light bones, lean frame
•Tends to insomnia and may often feel like a "space cadet."
"People with a strong vata constitution shouldn't go on a raw food diet," says Dr Ed Danaher, head of the Panchakarma Department at the Ayurvedic Institute in New Mexico. "But in the name of 'health,' people think raw food diets are going to be good for them. On the contrary, if there's any propensity for arthritis in the family and they're eating a lot of raw foods, there are many who will become impaired and experience arthritis symptoms."
The elements of fire and water make up the pitta dosha. The main qualities of pitta are hot, oily, sharp, fleshy, spreading and liquid, all of which express through one's mental, emotional and physical makeup. Pitta-dominant people tend to have these qualities:
•Reddish complexion, warm body, strong metabolism, possibly prone to heartburn and stomach ulcers.
•Might also display a hot temper.
•Oily skin, prone to acne and strong body odor
•Sharp intellect (possibly a sharp tongue)
•Energetically can "take over" other people, situations and geography, spreading like a rash
•Prone to excess sweating and stomach acid.
Dr. Danaher advises: "In summer months, pitta-dominant individuals should avoid or lessen their consumption of hot, spicy, sour and fermented foods lest their system becomes unbalanced and overly inflammatory."
Kapha is a combination of earth and water elements, and this dosha reflects earthy qualities: heavy, cool, slow-moving, unctuous/fatty, smooth, soft and stable. Kapha-dominant individuals exhibit:
•A sturdy, large-framed, grounded physique, good stamina and strong muscles. Can tend to be overweight and not to like change
•Cool skin and a laid-back, easygoing personality
•Slow measured gait
•Difficulty waking up in the morning
•Soft skin and gentle disposition
•Stable and loyal, possibly tending to stubbornness.
"With kapha, too much dairy and too many sweets and heavy meats, especially at night, can lead to weight gain and slowed metabolism," says Dr Danaher. "This can lead to ama entering into the joint spaces creating inflammation and a lack of mobility."
The stages of disease
"Ama is like soot clogging up a chimney," says Dr Ed Danaher, manager of the Panchakarma Department at the Ayurvedic Institute in Albuquerque, New Mexico. "It's uncooked matter that is sticky, gummy, slimy and heavy. And it becomes putrid if left long enough.
"Imagine putting a green log on a fire at midnight," he says. "Everyone wakes up to a house full of smoke and soot because that fire was not strong enough to cook that fuel. Ama is like that smoke and soot. The more it builds up, the more it begins to circulate in the system. Eventually it finds the spot or spots in your body that are weakest, and it gets deposited in those places."
Danaher says that rheumatoid arthritis is classically related to an accumulation of ama that has found its way to the joint spaces, causing inflammation and all the painful symptoms of arthritis. (In Ayurveda the condition itself is called "amavata.") The primary symptoms of amavata are: more severe pain in the morning, shifting pain, joint stiffness, increased temperature in the joints, joint deformity and lessening of movement.
In Ayurveda, the best way to rid the body of the accumulated toxins and to restore balance is by undergoing the cleansing process of panchakarma. Panchakarma is highly effective for eliminating or mitigating the symptoms of rheumatoid arthritis, an inflammatory condition of the joints.
It is also used to heal osteoarthritis, which is a degenerative condition that occurs when the synovial fluid in joints begins to dry up from genetic or aging factors. Anyone older than 60 is considered of "vata-age" in Ayurveda, subject to the drying effects of vata energy and a subsequent decline in tissue support.
Osteoarthritis can be caused by wear and tear on the body from general overuse. Unfortunately, by the time someone is experiencing symptoms of arthritis, it's harder to rectify the condition than it would be to simply correct an imbalance that might lead to symptoms.
"From an Ayurvedic perspective there are six stages of disease," says Dr Manisha Kshirsagar, an Ayurvedic doctor and one of the founding members of Ayurvedic Healing in Santa Cruz, California. "The first is accumulation, then provocation or aggravation, then spread, then localization, then manifestation and lastly differentiation.
In the West, people aren't able to seek medical help until they're in stage four, localization. The first question a doctor will ask you when you say you're in pain is, 'Where is the pain?' Until you're able to pinpoint and locate that pain, there's very little that Western medicine can do for you.
"From the Ayurvedic perspective, by the time there is localization, we know that the level of toxicity has spread and found a weak spot within the physiology where it now becomes a lot harder to reverse the stages of disease and imbalance."
Although it's impossible to say how long it will take to clear arthritis symptoms from the body using panchakarma, Kshirsagar says a general rule is that if you are relatively young and just diagnosed, you're looking at perhaps eight to ten weeks to become asymptomatic. For someone who's been dealing with arthritis for five or six years but only been taking over-the-counter pain meds, it will take about three months.
"For somebody who's been on prescription medication, NAISDs, steroid shots and who has increasingly high blood inflammatory markers, it takes a much longer time," he says. "At that point we're not just dealing with the arthritis, we're dealing with stress impacting gut inflammation, problems with the liver and all those other things. It could be up to a year where you are allowing them to heal and let the body regain control rather than drugging them."
What is panchakarma?
Panchakarma is an individualized cleansing and rejuvenation program for the body and mind. The word itself means "five actions" or "five treatments" based on the five traditional methods used to cleanse the body of toxins resulting from poor nutrition, bad food combining, environmental exposure and disease (see box, right). An individualized treatment program involving one or more of these methods is designed for each patient based on their unique dosha profile and personal history.
While scientific research on the use of Ayurveda is still quite limited, panchakarma has shown effectiveness for healing, or at least markedly reducing, the symptoms of arthritis.
Two clinical reviews by Ayurvedic doctors in India claim rheumatoid arthritis symptoms can be managed and even reversed with Ayurveda medicines and panchakarma, notably without any side-effects.1 A case report also describes the complete remission of rheumatoid arthritis in a patient in just four months.2
Ayurvedic oral medications, such as Yogaraja Guggulu and Ashvagandha Churna, both of which are routinely used in panchakarma protocols, have been shown to significantly reduce symptoms of osteoarthritis and provide a reliable alternative to NSAIDs.3 In one study, 10 weeks of treatment with the panchakarma herbs Rasaraj Rasa, Ashwagandha and Triphala Churna along with applying the herbal oil bala-ashwagandha taila (said to boost muscle strength) to affected joints improved osteoarthritis patients' pain and mobility levels.4
Another recent case study describes the effectiveness of Ayurvedic treatments and panchakarma for systemic lupus erythematosus, a debilitating autoimmune disease with some features in common with rheumatoid arthritis. The report describes a 39-year-old woman who was admitted to the hospital with severe pain and burning sensations in both legs, accompanied by ulceration and gangrene of the toes.
Diagnosed with lupus and vasculitis (inflammation of the blood vessels), her case was so severe she was advised to have one leg amputated. Instead she opted to undergo panchakarma, and her condition cleared up. Her leg was saved, and a year later she was still healthy with no issues in either leg.5
So, what's a typical panchakarma treatment like?
First there is a medical exam and assessment using pulse analysis and tongue analysis to determine if panchakarma is appropriate. All symptoms, emotional issues, lifestyle and eating habits are noted, and all the joints examined, including their temperature. There is a deep analysis of bowel function and an assessment of the level of ama that has been accumulating—often observed on the tongue or witnessed through foul body odor or foul breath.
Next, a pre-panchakarma cleansing diet of kichari (see box, right) and Triphala (an herb that helps correct the gastrointestinal tract) is initiated. Depending on the level of imbalance in the body, the cleansing diet can last up to two weeks.
"Each case is individual," says Danaher. "Each person's doshic evaluation is unique and so is their agni evaluation. You may have 10 arthritis patients, but they have 10 different doshic constitutions, and they each have to be approached slightly differently."
For both osteo- and rheumatoid arthritis, Ashwagandha (an herbal adaptogen that helps the body deal with stress) and Yogaraj Guggulu (a traditional Ayurvedic formula for balancing vata in the joints, nerves and muscles) are often taken internally. Turmeric and Boswelia (an herb that treats inflammation) are sometimes used as well.
Yogaraj Guggulu, the "king" of Ayurvedic herbs used in joint, muscle and blood vessel care, and Nirgundi Ghrita, a medicated ghee, might be rubbed topically on problematic areas. Herbal medicated oils are used in daily massages. Depending on the person's constitution, purgatives like castor oil may also be given.
"Castor oil is like the lion that roars through the jungle of ama," says Danaher. "So you have a jungle of ama with an arthritic condition, and castor oil taken in the right amount at the right time for the right person in the right medium, say, for example, in ginger tea, roars through the jungle of that accumulated ama and cleans it out."
Depending on the individual's constitution and the severity of their condition, some or all of the five stages of panchakarma are employed, usually for 10 to 14 days, but sometimes up to 30 days. Medicated sweats in saunas and steam rooms are also prescribed. After the panchakarma, the all-important post-cleanse period begins: getting plenty of rest, drinking plenty of fluids, doing yoga, meditating and eating foods specifically tailored to the individual's constitution.
Despite the complex nature of disease and panchakarma, sometimes effective treatment for arthritis can turn out to be amazingly simple.
"I see about 10 to 15 patients a month with rheumatoid arthritis," says Kshirsagar, "and the markers can be all over the place. I had one patient who was diagnosed later in life at age 56. She was experiencing minor pain, especially early in the morning, and she had seen her mother go through it. The genes were there. She was not on any medications, but she was getting prednisone shots and taking over-the-counter NSAIDs. After putting her on an Ayurvedic protocol, hot yoga turned out to be her savior.
"A lot of people think that hot yoga will increase heat in the body. And yes, it does. But you are also facilitating blood flow and helping the free flow of toxicity and movement. We did external medicated oil application before she did hot yoga five times a week, and within six weeks she was completely pain-free."
Kichari cleansing diet
Kichari (sometimes spelled kicherie) means "mixture" and is one of the go-to diets in Ayurvedic healing. Going on a kichari diet for a few days is a great way to give the body a break from toxic foods and bad food combinations. Used for a longer period of time as a precursor to panchakarma, it helps relieve the body of ama (toxins) that contribute to arthritis pain and stiffness.
Kichari is a simple meal composed of basmati rice, either white or brown (white is traditional), and yellow mung dal from whole mung beans that have been hulled and split. Basmati rice and mung dal together create a balanced, high-protein food that is very easy to digest.
The dish is tridoshic, which means it can be eaten by people with any combination of vata, pitta and kapha doshas. There are a lot of variations based on the specific seasonings, herbs and vegetables that are added to the basic dish. By varying the spices and vegetables, the dish can be designed to help balance the three doshas while cleansing the intestines, detoxing the cells and nourishing the tissues.
½ cup basmati rice
1 cup mung dal (split yellow mung beans)
6 cups (approx.) water
Up to 1 inch (2.5 cm) grated ginger root
¼ tsp mineral salt
2 tsp ghee
½ tsp turmeric powder
½ tsp mustard seeds
½ tsp coriander powder
½ tsp cumin powder
½ tsp whole cumin seeds
Pinch of asafoetida
1½ cups assorted vegetables (optional)
NOTE: Avoid nightshades (potato, tomato, eggplant and peppers)
For pitta-aggravated conditions, avoid mustard seeds
For vata- and kapha-aggravated conditions, add a pinch of ginger powder or grated ginger
1) Rinse the rice and dahl separately until the water runs clear. Add to the pot, together with 6 cups of filtered water. Cook covered for approximately 20 minutes.
2) Chop and add vegetables and cook for an additional 10 minutes.
3) Sauté the seeds in the ghee until they pop, and then add the rest of the spices. Stir into the rice mixture and serve.
A panchakarma case study
"Cynthia" was in her early 60s and overweight when she went for an Ayurvedic consultation and panchakarma with Dr Ed Danaher, the panchakarma director at the Ayurveda Institute in New Mexico.
She complained of symptoms of joint pain and inflammation in the hands, wrists, knees and hips; lack of mobility; long-standing constipation; mental fog; foul breath; foul body odor; a thick, white coating on the tongue; negative, critical thinking and general malaise.
"I gave her Triphala to help correct the constipation and help remove toxins and balance her doshas," says Danaher. "In addition, she was instructed to follow a 'kichari diet' [see box, page 47], which consisted of organic basmati rice, yellow split mung beans and certain spices—turmeric, cumin, coriander, fennel, asafoetida [also called "hing," a gum from a type of giant fennel, which creates a flavor similar to garlic], mustard seed—along with warm cooked vegetables for 10 consecutive days.
"For her choice of vegetables, I suggested that she avoid those in the nightshade family, such as tomatoes, potatoes, eggplant and bell peppers, as these are known to aggravate any rheumatic condition."
Danaher also advised Cynthia to avoid cold drinks and dairy products, to stop eating late at night and to take note of any emotional eating. Based upon her constitutional nature and imbalances, she was given an Ayurvedic herbal formula to be taken three times daily after meals.
"Cynthia did the 'pre-PK' [pre-panchakarma] protocol, which in addition to the kitchari diet, included ingesting daily increasing doses of ghee (clarified butter) for four consecutive days, followed on the last day with 2 tablespoons of castor oil in a mild ginger tea. This ripens and dislodges toxins and flushes them out through the GI tract."
After this preparatory protocol, Cynthia then started her two-week panchakarma program, which included the following daily practices: a two-person synchronized oil massage known as abhyanga, herbal sweat in a steam cabinet, Shiro dhara (warm oil poured onto the forehead for 20-25 min), an herbal enema, yoga, pranayama (controlled breathing exercises) and meditation.
"Upon completion of her two weeks of panchakarma, Cynthia noticed marked improvement in her overall health and outlook," says Danaher.
"Her mental fog was lifting, and she was more positive and hopeful with her condition. She had regular, daily bowel movements. Her joint pain and lack of mobility had markedly improved along with a reduction in gas, bloating and body odor. She was able to exercise with less pain and with greater vigor and vitality."
Cynthia continues to do phone consultations seasonally and complete an annual panchakarma to continue the momentum she has gained through this experience.
The Ayurvedic Institute, Albuquerque, NM:
Santa Cruz, CA:
To find an Ayurveda professional near you:
National Ayurvedic Medical Association USA:
Association of Ayurvedic Professionals UK:
International Society for Ayurveda and Health: www.ayurvedahealth.org