In my previous two columns, I explored ways to potentially integrate Chinese and Western medicine in the treatment of respiratory issues. I would like to finish our discussion on respiratory issues by introducing treatment methods from the Indian medical system, including ayurveda and its sister science, yoga. Both of these traditions have much to offer when addressing respiratory complaints and easily can be integrated into standard TCM protocols in order to hasten recovery and empower patients to assume an active role in the healing process.
Ayurveda has an extensive materia medica and differential diagnostic system, similar in scope to TCM. Before an herb, food or lifestyle modification is prescribed, the patient's specific constitution or prakriti is taken into consideration. Also taken into account is the patient's unique disease expression or vikriti. The prakriti is set at birth and the vikriti is the body's symptom expression in relation to changes in climate, season, diet, emotions and lifestyle. With this in mind, I plan to introduce ayurvedic medicinals that can, for the most part, be safely used for all body types and can easily be integrated into a TCM herbal protocol.
One of the safest and most effective ayurvedic medicinals for respiratory complaints is tulsi or holy basil (Occimum sanctum). The ayurvedic materia medica Dravyaguna Vijnana states the following for tulsi: Rasa or taste is pungent and bitter, energy or virya is heating, and post-digestive effect is pungent. It lists the actions of tulsi as anti-pyretic, carminative, diaphoretic and expectorant. Tulsi acts as a carrier or "anupan" to guide the actions of substances to the respiratory tissues, much like the TCM medicinal jie geng, and can be used in both acute and chronic presentations. Its pleasant taste makes it especially useful in pediatric cases, particularly when combined with honey and licorice root (yasthimadhu/gan cao).
Tulsi's bitter and pungent tastes can clear heat and stimulate diaphoresis (release the exterior), making it a useful medicinal during an acute cold or flu. Its gentle expectorant and guiding actions allow tulsi to easily be integrated into more complex TCM respiratory formulas as per pattern presentation. Modern research on tulsi has revealed COX-2 anti-inflammatory actions, as well as a cortisol-lowering, calming "adaptagenic" action.
The vipaka or post-digestive effect is a concept unique to ayurveda. This means the taste or rasa of an herb will be modified during its "journey" through the digestive system. Vipaka also describes the end result or delayed effect that an herb will produce in the body, especially after long-term use. Therefore, tulsi's pungent vipaka will produce its carminative effect in the last part of the digestive tract or intestines. Another concept, unique to ayurveda, is the idea of prabhava or special potency. This is a subtle and unique action of an herb that is not expected to occur based solely on its basic energetics. For example, tulsi, while classified as pungent in virya or energy, can help lower a fever regardless of the cause. Why? Because this is tulsi's prabhava or unique and subtle expression. These two ideas of vipaka and prabhava offer some stimulating ideas for TCM practitioners to explore when using and studying the clinical effects of herbal therapies.
Another useful ayurvedic remedy for respiratory problems is the formula "chyavanprash." The following is an excerpt from the ayurvedic text Ashtanga Hridayam that lists the medicinal uses of chyavanprash:
"Cures cough, dyspnea, fever, consumption, heart disease, gout, diseases of the urinary tract and disorders of speech; helps the growth of the body of children, the aged, the wounded and emaciated; bestows great intelligence, memory, complexion, long life, digestive fire, strength of body and desire for women, if used in the proper manner."
Typically, chyavanprash consists of around 20 herbs cooked and prepared together in a base of ghee and honey and is taken as a paste. It's considered a potent rasayana or rejuvenative medicine in ayurveda, and modern research has shown it to be a powerful antioxidant and immune system supplement.
Chyavanprash can be taken by the tablespoon at the first sign of a cold or flu and is especially effective when taken with tulsi tea to carry its actions to the lungs. One of its main ingredients is amalaki (Emblica officinalis). Amalaki energetics are said to express all tastes except salty, but are predominantly sour and cooling with a sweet vipaka. Modern research has shown significant antiviral and antioxidant actions and its prabhava is said to bring good fortune to all who consume it. Amalaki can effectively clear heat, while at the same time strengthen the digestive fire or agni, boosting the body's inherent vitality.
Another important ingredient in chyavanprash is pippali (Piper longum). Pippali also is a medicinal in the TCM materia medica known as bi-ba. It's interesting to compare indications between ayurveda and TCM in reference to pippali. Both traditions state pippali to be pungent and hot, yet ayurveda lists its unique vipaka or post-digestive effect as sweet. This vipaka effect is the main reason why ayurveda lists pippali as a powerful rejuvenator or rasayana for the respiratory tissue and digestive system. TCM does not list sweet as an indication for bi-ba or pippali and reserves its use for cold patterns. Ayurveda considers the sweet taste to be deeply nourishing in the proper amount and setting, and traditionally uses pippali in milk decoctions or in chyavanprash for long-term use or to guide its actions to the lungs. Modern research has shown pippali to be antibacterial, anti-amoebic, immunostimulant, and have the ability to improve bio-availability of substances taken concurrently. Pippali also has been shown to improve the ability of the bronchial tissues to absorb oxygen, hence its specific use in respiratory issues. Its addition to chyavanprash helps improve the absorption of the formula and helps guide its actions to the respiratory tissues.
Ayurveda's sister science of yoga also has much to offer in cases of respiratory distress. In the West, yoga is mostly viewed as a type of "physical therapy" and its asana aspect tends to assume center stage. It's true there are many helpful asanas that can open the chest area to help improve the elasticity of the pleural cavity and its accessory muscles, which can improve breathing capacity and respiratory challenges. However, yoga's limb of pranayama or breathing practices has just as much, if not more, relevance to the clinician in respect to respiratory issues than typical asana therapy. It's much easier for most patients to sit down and learn breathing exercises than it is to teach asana positions. Many patients have physical issues which might prevent them from practicing a physical therapy, or they might lack the motivation to integrate an exercise into their therapy. Yet most patients are willing to slow down, sit down, relax and learn to breathe.
The study of pranayama is a complex subject beyond the scope of this short article. However, we can introduce a safe and basic yoga technique that easily can be integrated into any TCM or allopathic protocol when dealing with respiratory challenges. The best pranayama technique to start with is nadi shodhana or alternate nostril breathing. This is a very safe, easy and calming technique which can help clear the lungs of phlegm while at the same time improving the flow of qi or prana throughout the respiratory system. The basic technique is to sit down and relax into a comfortable position with the back supported and straightened. The right nostril is gently closed with the right thumb and one gently inhales through the left nostril. One then gently releases the right nostril while, at the same time, gently closing the left nostril with the right ring finger and exhaling through the right nostril. Then one reverses the process by inhaling through the right nostril and then exhaling through the left. (It's best to limit nadi shodhana to two minutes when first starting the practice.)
There are many variations on this method, but it's best to start with this basic sequence for at least two months before attempting any more complex methods of pranayama. Also, pranayama should be learned from a properly trained practitioner and should not be attempted if the sinus cavities are blocked or congested. Nadi shodhana also is an extremely calming practice which is an excellent adjunct therapy for stress-induced respiratory problems. Any patient with liver depression qi stagnation as a complicating factor can benefit from nadi shodhana as well.
I hope this short article on ayurveda and respiratory health has stimulated interest in the potential for the integration of ayurveda and yoga into TCM modalities. Ayurveda and yoga are immense subjects and I plan to cover these topics in greater depth in future columns. We can learn much from studying other healing traditions, much like how we change our perceptions after visiting a foreign country. When this occurs, our minds broaden and our visionary scope is widened, allowing us to add new flavor to the ongoing evolution of herbal medicine in this planetary age.
Take care and namaskar!
