Questions and answers with Dr Donn Brennan
Peter Brown: Doctor Brennan, how does Ayurveda deal with joint problems?
Dr Donn Brennan: For joint problems Ayurveda’s first consideration will be, are the symptoms due to imbalances within Vata (movement), Pitta (transformation) or Kapha (structure)? Also, is the toxic impurity called Ama a factor?
Vata in the joints
When there is too much Vata in the joint area, the Vata qualities of dryness and roughness will predominate. Vata tends to dry up and reduce the lubricating and protective tissue within the joints (known as Sleshaka Kapha, the subdosha of Kapha). As a result, joints become both less stable and less mobile. Deformity of the joints, osteoarthritis and also osteoporosis, where the bones become fragile and brittle and where there is a loss of tissue, are signs of a Vata imbalance.
Vyana Vata, is the subdosha of Vata that governs circulation and nerve impulses. Keeping Vyana Vata in balance supports circulation, metabolism, and the absorption of nutrients into bone tissue. Balancing Vyana Vata helps support the lubricating element of Shleshaka Kapha within the joints.
Pitta in the joints
When the joints become inflamed and hot, such as when someone has gout, it is due to an excess of Pitta within that area. You’ll sometimes also find that the patient can become fiercely angry, another symptom of excess Pitta. Because they are Pitta promoting, alcohol, coffee, red meat and hot curries will tend to exacerbate the condition, and should be avoided.
Kapha in the joints
When joints become swollen, an excess of Kapha is usually involved. The patient will have stiffness, as with Vata joint problems, but this time the stiffness will be due to swelling. In this condition you will find a build-up of Ama (incompletely digested food that settles into the body tissues and creates a blocking and toxic situation). The priority here, is to remove Ama.
Ama in the joints
One example of a common joint problems is arthritis. Arthritis is a complicated situation where the built up of Ama in the joints confuses the immune system and the immune system starts attacking the joints. As a result, the joints then become swollen and painful and can often become inflamed. So here we have Kapha, Ama and Pitta problems in the joints. In this case, even before you use oil on the joints, you have to remove the toxic Ama.
There is a saying in Ayurveda, “Don’t put oil into a dirty pot”. This is because oil will feed rather than reduce the toxic Ama. In cases where Ama is high, an Ama reducing regime, involving diet, light fasting and herbs, is necessary before any oil-based treatment is started.
With Vata joint problems, there is rarely a problem with Ama build-up. In these cases, direct oil treatment on the joints will always be beneficial, without any preliminaries.
Panchakarma treatment for the joints
Peter: What are the main Panchakarma treatments for joint problems?
Donn: A lot of heat and oil is applied during Panchakarma treatment. This has a balancing effect on Vata and it also balances the other Doshas – Pitta and Kapha. But in the case where there is a build-up of Ama in the joints – and this is usually the case where the joints are swollen – a fasting regime, along with Ama reducing herbs, is necessary before Panchakarma treatment commences. Before coming to a clinic for the main treatment, Virechana (Pitta purgative) treatment is usually also done at home.
Pindaswenada is a treatment for the joints and surrounding muscle tissue and that involves the use of lots of heat, milk-cooked rice and medicated oils. The oils add lubrication, balance Vata and encourage the tissues to release toxic Ama that has built up inside them. The heat helps to open up the purification and nourishment channels, or Shrotas, and helps break down and dissolve the Ama. The milk-cooked rice helps nourish and strengthen the joint tissues.
Pindaswenada is very suitable for many joint problems apart from gout, where we have to be careful not to use heat. With any Pitta joint problem, where the area is really red and inflamed, we should avoid the use of heat.
Pindaswenada is often given as a whole body treatment as it has a regulative effect our whole musculo-skeletal framework. It can also be given to specific areas of the body.
Gout and Panchakarma
Peter: If someone had gout, would you treat that before they came to the clinic for Panchakarma?
Donn: I would give the patient a strong Virechana treatment before they come for Panchakarma. Virechana is excellent at balancing the intestines, which is the main seat of Pitta and that is why Virechana is considered the primary treatment for removing excess Pitta.
The role of Virechana
Peter: So a person would be taking internal Ghee oleation, as part of Virechana?
Donn: Yes. Ghee is cooling and it is the best oil for removing excess Pitta. Virechana treatment is generally taken at home, before a patient comes to the clinic for the rest of their Panchakarma treatment.
Besides removing excess Pitta, Virechana is also very good at removing excess Kapha, which has its main seat in the stomach.
Basti (enema) is considered the most effective of all treatment
Peter: The word Basti has more than one meaning in Ayurveda, but in the present context we are using it to denote nourishing and detoxifying enemas. What is the role of Basti?
Donn: Vata is the moving element in the body and is considered the king of the Doshas. Ayurveda states that most health conditions are due to excess or disturbed Vata. Since the main seat of Vata is in the colon, enema, or Basti, is considered the most important treatment in the whole of Ayurveda.
In one ancient Vedic university there was a major debate as to the significance of Basti in the healing process. The conclusion was that Basti was 100% of treatment because all conditions can be handled through using the right kind of Basti.
Peter: So, even though you are applying the treatment through the colon, with the correct use of Basti you can also treat conditions within the joints?
Donn: Quite so. You can treat almost any condition through Basti.
Peter: Another Ayurvedic joint treatment is called Patra Pottali. In which situation would this be given?
Donn: Patra Pottali involves localised treatment for particular areas of the body. It is usually used to ease and soothe aching or sore joints, muscles and ligaments. The ingredients used, which both cleanse and nourish the areas they are used on, are placed in a bolus or cotton bag, and heated in a herbalised oil. The boluses are then massaged onto the specified affected area. The oil, herbs and other ingredients, lubricate, nourish, help clear the toxins and support the natural healing process.
Patra Pottali is particularly useful for removing Ama and excess Kapha and Vata from the joints.
As in the case with Pindaswedana, this heating treatment is not suitable for those with inflamed joints. Those with swollen joints would also benefit from both Virechana and an Ama reducing regime before this treatment is considered.
Diet for the joints
Peter: You have told us that, when it comes to the treatment of joints, the three Doshas need to be brought back into balance and toxic Ama needs to be eliminated. Are there any dietary recommendations that will help?
Foods that balance Vata
Donn: Most joint problems tend to be Vata related, so to help with Vata-based joint problems:
- Include all six tastes (sweet, sour, salty, bitter, pungent and astringent) in your meals but favour the sweet, sour, and salty tastes
- Eat less bitter, astringent and pungent foods.
- Favour a Vata-reducing diet which can include grains such as quinoa, rye, rice, wheat and amaranth. Cook the grains in water and add a little Ghee at the end of cooking
- Eat freshly cooked organic vegetables, well-cooked split mung dal soup, with Vata Aromatic Seasoning, and sweet, organic, juicy fruits
- Avoid raw, dry, rough and cold foods
- Favour a calcium-rich diet, and this can include non-homogenised, organic milk and vegetables such as asparagus, spinach, kale, and root vegetables
- Use Vata Aromatic Seasoning in your cooking
- Organic Vata Tea or warm milk with a little ghee and ginger will immediately balance
- Avoid caffeine and any highly acidic diet. They promote the excretion of calcium and magnesium into your urine and thereby deplete both valuable nutrients from your body and bones.
Foods that balance Pitta
A Pitta balancing diet is useful for inflamed joints:
- Favour sweet, bitter and astringent foods and eat less sour, salty and pungent foods
- Sweet and ripe fruits are to be favoured, such as apples, apricots, coconut, dates, figs, grapes, mangoes, melons, papaya, pears, prunes and raisins
- Pungent and bitter vegetable are to be favoured, such as artichoke, asparagus, beetroots, broccoli, brussels sprouts, cabbage, carrots, garlic and fennel
- Use Pitta Aromatic Seasoning in your cooking
- Reduce or avoid garlic, onions, vinegar, chilli, red pepper, over-spicy foods
- Avoid alcohol, coffee, chocolate, over-rich foods, processed food and refined foods
- Organic Pitta Tea or warm milk with a little ghee, cardamom and turmeric will help balance Pitta.
Foods that balance Kapha
For stiff, swollen joints favour a Kapha reducing diet:
- Favour pungent, bitter and astringent foods and eat less sweet, sour and salty foods
- Astringent fruits are useful, such as apples, lemons, limes, berries, pomegranates, peaches, pears, prunes, raisins and dry figs
- Sweet and bitter vegetable are to be favoured, such as artichoke, beetroots, broccoli, brussels sprouts, cabbage, carrots, cauliflower, celery, dandelion greens, fennel, green beans, artichoke, kale and leafy greens
- Reduce or avoid sugar, cakes, biscuits, heavy foods, vinegar, pickles, sweet chutneys and snacking between meals
- Avoid alcohol, coffee, chocolate, over-rich foods, processed and refined foods
- Organic Kapha Tea and Kapha Spicy Seasoning mix will help balance Kapha.
Daily routine to balance all three Doshas
- Go to bed before 10 pm, and rise before 6 am
- Less TV and reduce any other stimulating activity just before bed
- Eat your main meal at noon, and eat a light, nourishing dinner early in the evening
- Engage in regular mild exercise, such as yoga and walking for 30 minutes a day
- Practice Transcendental Meditation, an effortless but highly effective technique for dissolving stress and for developing consciousness. Once the mind and emotions are balanced, it is far easier to do and eat the right thing for your body
- Daily oil massage with sesame or coconut oil is very good for joint health and for overall good health. Follow the massage with a warm shower or bath. (If there is Ama in the joints and they are swollen, avoid the use of oil.)
Keeping your joints free from Ama
Peter: There is a saying that an ounce of prevention is worth a pound of cure. What can we do to not only help any existing joint condition but also prevent the build-up of toxins within our joins.
Donn: While it takes a little time and effort to remove Ama that is circulated throughout our body, once it settles into the joints, that Ama becomes far more difficult to remove. So that saying you quoted is very apt and it is wise to be vigilant about keeping the body free from Ama.
You will know if you have accumulated Ama if you:
- examine your tongue in the morning and it is coated
- lack good appetite at mealtimes
- experience post-meal fatigue after eating
- feel even a little stiffness or heaviness in your joints.
Foods and lifestyle habits that prevent or eliminate Ama
- Eat warm, light, dryer foods that are easy to digest
- Eat plenty of pure, organic foods such as sweet, juicy fruits like pears and ripe mangoes
- Reduce heavy foods such as meat, dairy products, leftovers and pre-prepared meals
- Cooked, bitter green vegetables, such as chard and kale, help remove Ama
- Cook with ginger, black pepper, garlic and cumin to stimulate joint metabolism
- Avoid carbonated, cold and iced drinks as they weaken the digestive fire
- Drink warm or hot water throughout the day to help flush impurities and keep nutrients and energy flowing smoothly
- Reduce stimulants, such as caffeine, chocolate and alcohol
- Stimulate digestion with nourishing soups and warm, freshly cooked grains and vegetables prepared with Kapha Spicy Seasoning mix
- A good breakfast is cooked apple with dried fruits, such as prunes, figs or raisins
- Use Digestive Seasoning Mix in your cooking
- You can prepare your own spice mix using 2 parts of turmeric, 6 parts of cumin, one part of ajowan, 2 parts of fenugreek, 1 part of black pepper, and 6 parts of fennel
- Keep your digestion working properly by avoiding day sleep and going to bed early, so you can rise before 6 am
- Eat only when you are truly hungry and stop eating before you are full
- Exercise for 30 minutes every day, and choose a type of exercise that you enjoy. Walking and yoga is ideal for most people
- Those who have a Kapha body-type usually need more vigorous exercise to stay in balance
- Don’t overexert. Make sure the intensity and duration of any exercise routine stays within your comfort zone
- Go to bed by 10 pm as the primary period for eliminating impurities occurs between 10 pm and 2 am
- Before any vigorous exercise, to reduce any potential muscle or joint strains, give yourself an oil massage.
You will feel more energetic and lighter just by making a few simple changes in your diet and routine – a little care will go a long way in helping your joints and muscles rejuvenate.
Purifying the joints using Ama Pachana water
A highly effective way to purify the joint is to drink plenty of Ama Pachana water (water that is infused with Ama-reducing spices). To make this water:
- Boil a kettle full of water and pour it into a flask and add
- 3 slices of fresh ginger
- 1/2 tsp cumin
- 1/2 tsp fennel
- 3 split black peppercorns (can split with a mortar and pestle)
- 3 leaves of mint
- Then let it steep for a while
- Drink this water throughout the day to help purify your joints and whole body.
Herbs that help keep your joints free from Ama
Joint Soothe Oil (MA929) lubricates the joints and keeps them free of impurities. It also supplies them with vital nutrients. This highly complex formula takes many days to prepare and contains two traditional joint remedies. One of these remedies is called Mahanarayana Oil and uses a blend of sesame oil, milk, and 56 herbs. In Ayurvedic texts, it is praised for its effectiveness in increasing circulation around the joints. The other remedy is Mahavishgarbha Oil. This sharp, heating oil penetrates the joints and helps keep them clear of sticky Ama impurities.
Joint Soothe tablets (MA3572) help keep your joints free from impurities and helps remove impurities that have been mobilised by the application of Joint Soothe Oil (MA929). Joint Soothe Oil and Joint Soothe Tablets are recommended to be used in combination.
Detox (MA1010) herbal supplement helps keep not only the joints but the whole body free from Ama. A useful strategy is to take Detox for three weeks and then start applying Joint Soothe Oil and taking Joint Soothe Tablets.
As each joint is supported by muscle tissue, it is important to maintain muscle health. Amlaberry (MA1) is designed to building healthy muscle and provide nourishment to the deepest levels of both mind and body.
When you have been very active, rub Sports Massage Oil (MA1201) on your muscles, especially around the joints. This will help muscles and joints stay loose and relaxed and will improve circulation.
For a more nourishing effect, use Maharishi Ayurvedic Balm (MA728). It is a deeply penetrating mixture and keeps the muscles relaxed and joints free.
Muscle Rest Aroma oil is also helpful. It is a blend of eight pure essential oils that helps you relax and recover your energy and strength.
Frankincense/Bhumi Amalaki complex (MA1673) is a herbal formula specifically designed to help maintain the normal lubrication of joints. By balancing both Vyana Vata and Shleshaka Kapha, it provides nourishment to both bones and joints and supports bone tissue.
Calciocare (MA925) helps maintain bone health by ensuring that you have an adequate supply of calcium. This supplement is not only a source of calcium but it helps your body absorb the calcium in your everyday diet.
NB. If you have severe joint problems always consult a physician. Any practitioner trained in Maharishi AyurVeda can help, by eliminating the problem at its source.