Ayurvedic Perspective of PTSD Part 2
By Anuradha Gupta, AD
If you haven’t read part 1, please do so here
War. Earthquakes. Witnessing an accident. Helping at a shooting. How does Ayurveda view trauma and PTSD that could result from manmade or natural disasters and how can it help us build resilience?
In Part 1 of this article, we explored the definitions, Ayurvedic approach and assessment of trauma and PTSD. In this section, we delve into their pathogenesis and management and discuss a couple of cases of PTSD.
Samprapti of Trauma and PTSD
How does trauma lead to PTSD?
When we discuss the Samprapti, we will see how and at what stage of the Shatkriyakala or stages of pathogenesis, Trauma has the potential to transform to PTSD (Refer Figure 3; this chart is truly my love’s labor)
Nidana or causes,
Agantuja Factors like Trauma/Stress,
Alpasattwa; or reduced Sattva. This could be as a result of overall health impairment, genetic propensity or Beej Dosha, or as a result of not following Sadvritta, certain Manobhavas could cause it, dominance of Rajas and Tamas,
Other disease factors - Prajnaparadha, Asatmiyaindriyarthasamyoga, Parinama, Dosha imbalance, depleted Ojas, Dhatu kshaya, Vata vitiation, Krimi, Vegadharan, Beej Dosha, Purvajanmakrita karma
This leads to imbalance of Sharirik and Manasik Doshas, Vata-Pitta vitiation aggravates Rajas and Kapha aggravates Tamas in Hridaya
Samprapti of Trauma - Within physiological limit it impacts Manasik Bhavas or entities of the mind like Anger (Krodha) and Bhaya (Fear).
Pathogenesis of PTSD (SthanSamshraya) – Beyond a certain limit, the Manasika Rogas and Dosha Vikruti lodge in Hridya, there is cascading Srotodushti, and PTSD Vyadhi develops.
Symptoms (Lakshan) – These are some of the symptoms that could result,
Impact on Intellect (Dhi Vibhramsha) - Negative thoughts, avoidance, hyper-arousal, reactivity
Will (Dhriti Vibramsha), fear, guilt, anger, loss of interest, numbing, devoid of joy & satisfaction.
Memory (Smriti Vibhramsha), reliving bad memories, flashbacks
Unmada - Satwa Pariplava (fickleness of mind), Pariyakula Dristi Adhiratha (unsteadiness of vision), Abaddha Vakyatwam (incoherent speech), Hrdayam Cha Sunyam (vacant mind), Sa Muda Na Sukham Na Dhukam Na Achara Dharmo (incapable of experiencing pleasure, sorrow)
Agantuja Unmada - Unnatural strength, enthusiasm, abnormal speech & perception, unexpected relapses.
SAMPRAPTI OF PTSD BASED ON SHAT KRIYAKAAL
(Fig 3 ©Anuradha Gupta)
Chikitsa of Trauma/PTSD
How is PTSD managed?
The management of Trauma and PTSD are illustrated in Table 3 and diet, lifestyle suggestions, Medhya rasayanas and different types of shodhana chikitsa have been discussed.
PTSD Chikitsa (Table 3)
Delving deeper into certain aspects of the management,
Dietary/Lifestyle Suggestions
a.Pathya Vihar/Aahar – food and lifestyle to be adopted include
Vihar - Sadvritta, Achar Rasayana, Dinacharya, Ritucharya, Exercise, Yoga, Pranayama, Meditation
Aahar - Sattvik Aahar, Dairy, Wheat (Godhuma), Navara Rice (shali), Ghee, particularly old ghee (Puranaghrit), Brahmi (Juice), Winter Gourd (Kushmanda), Jackfruit, Woodapple, Animal urine (Ashvamutra), Raisins (Draksha), Pointed gourd (Patola), Bird meat (Pakshi mamsa)
b.Apathya Aahar/Vihar
Vihar - Worry (Chinta), Grief (Shoka), fear (Bhaya), Anger (Krodha), Irregular sleep, Controlling natural urges (vegadharan)
Aahar - Impure and stale Tamasik food (apavitra padarth), Processed, fried, cold, raw, heavy food, overeating, Rajasic food (Spicy, caffeinated, alcohol), Sharp (teekshan), Heating (ushna), Bitter (tikta) Padarth, Incompatible foods (Viruddhahar)
2. Medhya Rasayanas (to be given by a trained Ayurvedic professional based on a personalized assessment and protocol) – Various dravyas have different actions in the specific Samptapti and Chikitsa. For instance, Guduchi is Tridosha pacifying Rasayana which is Grahi (could potentially help with diarrhea), is strengthening, helps with Deepana, Pachana, thirst, burning, diabetes, cough and anemia. Brahmi is Pitta Vata pacifying, has a laxative action, helps with the skin, toxicity, voice, anemia, diabetes, bleeding, cough and swelling. On the other hand, Vacha is Kapha pacifying, helpful for Deepana, constipation, bloating, colic, clearing urine, and helps with epilepsy, is anti-parasitic and anti-microbial. Here is a partial list,
a.Single herbs - Guduchi, Brahmi, Shankapushpi, Yashtimadhu, Ashwagandha, Mandukaparni, Jyotishmati, Shatavari, Bala, Kushmanda, Vacha, Jatamansi, Amalaki, Tagara, Tulsi, Haritaki
b. Formulations - Kalyanaka Ghrita, Brahmi Ghrita, Panchagavya Ghrita, Ashwagandhadhi Ghrita, Lasunadi Ghrita, Chyawanprasha, Manasamitra Vatakam, Kushmanda Rasayana, Saraswatarishtam, Saraswat Churna, Drakshadi Kwatham, Ashwagandha Aristam
3. Shodhana Chikitsa – Panchakarma and kaale samshodhana or cleansing from time to time (particularly during seasonal transitions) would help based on the bala of the Rogi and factoring in contraindications. Here are some useful therapies,
a.Moordha Thaila - Shiroabhyanga, Shirodhara, Shiropichu, Shirobasti (Ksheerbala, Bala Lakshadi, Brahmi, Ashwagandha Thailam) including Takradhara, Ksheeradhara, Kashaya Dhara– This helps with sleep, soothing the senses of Indriya Prashamana, Dosha Prashamana, Heals Marmas (reduces Chitta Nasha, Bhaya), revitalizing circulation, nervous system, relaxation in the pituitary/hypothalamus location and possible relaxation of the prefrontal cortex
b.Nasya (Ksheerabala 101, Jyotishmathi, Kalyanaka Ghrita), Vasti, Virechana (Eranda Thaila) – same impact as Moordha Thaila, Nasya crosses BB barrier, Vasti is Ardha Chikitsa and pacifies mainly Vata Dosha, Virechana pacifies both Pitta and Kapha (Vamana is not allowed in the US).
c.Abhyanga (Bala Ashwagandhadhi, Mahanarayan, Dhanwantaram, Mahamasha, Ksheerabala), Thalam with Mahachandanadi, Dhooma (Jatamansi, Tulsi), Anjana – Same benefits, Vata Prashamana, Thalam helps calm hyper-arousal/unmada
d. Full Panchakarma - Deeply therapeutic, Apunarbhava Chikitsa
Cases of Rogis diagnosed with PTSD
How have some cases of PTSD been managed successfully, over time? Here is casework related to a war veteran and a crisis counselor, shared with Rogi permission. These are brief summaries, without identifying the Rogis.
Case I: An 89-year-old infantry male veteran was also a refugee.
Rogi-Roga Pareeksha
Prakriti - PK
Vikrati - VKp
Agni - Vishama
Ama - ++
Ojo - Kshaya
Srotas - Anna, Rasa, Rakta, Mamsa, Medas, Asthi, Majja, Purisha, Mano
Sroto Dushti - Sangha, Vimarga Gamana
Vyadhi - Shoka, Manovikar (PTSD), Vata Rakta - Neuropathy, Malabadha (history - arshas), Sarvanga Vata, diagnosed with PTSD
Samprapti - Refugee, veteran trauma, mountain/border postings, injuries, PTSD, dhatu kshaya, vata vikruti, rooksha/sheeta aahar, vihar, shoka, vata rakta, kapha avarna, peripheral neuropathy – 15 years undiagnosed in allopathy, progressed-sarvanga vata, intensified post-COVID, resumed protocol
Chikitsa I - Ashwagandha Arishtam, Zandopa, Kaishore Vatakam, Guduchi, Ksheerabala 101, Rasona Ksheer Paka, Replace Triphala with Gandharvahastadi Eranda Thailam for Nitya Virechan, Abhyanga, Ksheerbala, Nasya (Ksheerbala 101), Sattvavajaya Chikitsa, SKY Meditation, Satsang
Chikitsa II - Ashtavargam Kwatham (3 weeks), Gandharvahastadi Kwatham, Ksheerabala 101, Brahmi Pearls, Moordha Thaila, Pratimarsha Nasya, Karna Poorna, Abhyanga, Pada Abhyanga, Matra Basti Compliance an issue, Pathya Aahar Vihar, Sahaj, Satsang
Result –Neuropathy stabilized but health deteriorated post COVID-19. Significant improvement in mood.
Case II: 22-year-old LGBTQ+ crisis counselor who had anxiety, knee pain after an injury, was a pre-nodular singer with dry cough and presented with symptoms of PTSD
Samprapti Ghatakas and Nidana Panchaka
Prakriti - V
Vikrati - Vk
Agni – Vishama (Jathargni and Dhatvagni with Agnijanya Ama)
Ama - +
Ojo – Kshaya
Dushya – Rasa dhatu
Srotas - Rasa, Prana, Mamsa, Medas, Asthi, Majja, Mano
Sroto Dushti - Sangha (Granthi)
Nidana – Chinta, Bhaya, Shoka, Ratrijagran,
Vyadhi - Manasika nidanas, Vata Pradhan Vikrati, Dhatu Kshaya, Kasa, Purva Roopa of Granthi – Pre-nodular (singer), Nidra-Nasha, Udvega, Mano-abhighata, Aadhija Manovikar, Agantuja Janu Shoola, diagnosed with PTSD
Samprapti - Vata Pradhan Vikrati, Dhatukshaya, Khavaigunya as Prana, Mano and Asthivaha Srotas, Beej Dosha leading to Manovikar, Chronic Dry Cough, Pre-nodular due to Asatmiyaindriyardhasamyoga, Aadhija Manovikar (grief, loss of friends, bullying), Ati-vyayam, Ratrijagran, Apathya, Dosha-dushya samoorchana in Hridaya, Sandhi, Stress related weight issue
Chikitsa Stage I - Shamana
Indukantham Kwatham 2-0-2
Dhanwantharam 101 2-0-2
Brahmi 1-0-1
Gargling with Triphala/Yashtimadhu, Pathya Aahar Vihar, Sattvavajaya Chikitsa, Local oil app (Mahanarayan/Myaxil), Abhyanga w/Mahanarayan
After a month, continue gargling and oil application, new herbal protocol.
Ashwagandha 1-0-1
Kaishore Vatakam 1-0-1
RG Forte 1-0-1
Indukantham Kwatham 2-0-2
Chikitsa Stage 2 – Shodhana
Day 1, 2, 3 - Abhyanga, Bashpa Sweda, Nasya
Day 4, 5 - Patrapotala Swedana, Pichu
Day 6, 7 - Shashtika Pinda Sweda, Shirodhara
Result - Significant improvement in mood, reduced knee pain, improved resilience, moved to a less stressful job
Conclusion – Ayurveda, Yoga and SKY Breath Meditation are promising complementary and alternative approaches in Trauma and PTSD Management. Ayurvedic Prevention addresses low Sattva Bala which creates the propensity (Khavaigunya) of mental illnesses. Ayurvedic epigenetics and prevention mitigate risk factors & prodromal symptoms of allied disorders. Ayurveda uses a Personalized Disease Management Approach. PTSD as a Vyadhi is Vata-Pradhan but Tridoshaja, impacting Rajo-Tamo Guna, causing Manovaha(Rasa, Majja and other) Sroto Dushti. It is a Manovikar or Manoabhighata which is caused by external factors and hence classified as Agantuja Unmada.
The Chikitsa involves Shamana with Medhya Rasayanas (for hyperarousal, dullness, both or alternating) and Pathya Aahar Vihar, combined with Shodhana Chikitsa/Panchakarma. Sattvavajaya, Daivyavyapashraya Chikitsa and Nidana Parivarjana are important in building resilience. There should be a tactful intake - gradual, empathetic, motivating, without overwhelming the Rogi. The approach should be long term, stabilizing Sattva Bala and strengthening the Rogi with regular follow ups. There is a great need for integrative approaches in the management of PTSD and Ayurveda helps bridge that gap.
Did you know more soldiers are diagnosed with PTSD than are wounded in action? This article is dedicated to those soldiers, and to my father, in the hope that we can make a difference to the lives of those afflicted by PTSD, other ailments and help heal the planet in any which way.
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(I gratefully acknowledge the guidance of Vaidya Princy Prasad and Vaidya Jayarajan Kodikannath, in understanding and outlining these concepts)
List of References
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment or Ayurveda advice, assessment or management. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition and seek the advice of your Ayurvedic practitioner for any disease management related queries using the Ayurvedic process. Any links to third-party websites are provided as a convenience only and neither the author nor CAAM is responsible for their content.
Author Bio: Anuradha Gupta, AD is an MBA, Engineer (MMS) and NAMACB Certified Ayurvedic Practitioner. She has been practicing at her own set-up, Ayurvedic Footprints since 2018. She is a Guest Faculty, AP Mentor and Writer/Content Specialist at Kerala Ayurveda USA. She served on NAMA’s DEI committee for a year and has written over a hundred articles on Ayurveda for Art of Living, Kerala Ayurveda, NAMA and other organizations. She is a dedicated volunteer for many causes and hopes to create a better world through Vedic practices. She has co-authored a primer on Ayurveda; Unveiling Health, Happiness and Longevity: A Primer on Ayurveda: Pandya, Ashish, Gupta, Anuradha: 9798329189360: Amazon.com: Books
