Om namah shivaaya

Return to the Cave of the Heart

Ayurveda and Respiratory Health

The Role of Traditional Chinese Medicine and Ayurveda in Chronic Lower Back Pain. Part. I

The Role of Traditional Chinese Medicine and Ayurveda in Chronic Lower Back Pain. Part. II

Ayurveda and Liver Pathology

Return to the Cave of the Heart

There is in this city of Brahman an abode, the small lotus of the Heart, within it is a small space. Now what exists with that small space, that is to be sought after, that is what one should desire to understand.
— Chandogya Upanishad

Atman, smaller than the small, greater than the great, is hidden in the hearts of all living creatures.”
— Katha Upanishad

The Purusa, the size of a thumb, resides in the heart. He is the Lord of the past and the future and after knowing Him one fears no more.”
— Katha Upanishad

Everyone desires security. In our consumer driven culture most people seek this security outside themselves. The media perpetuates this insatiable pursuit by constantly bombarding individuals with images which claim to entertain and offers quick answers to all of life’s problems. Unfortunately this train of thought has also influenced the current and evolution of Yoga in the west. Yoga magazines are filled with ads of the latest fashions, articles claiming to allow one to age without wrinkles while losing weight effortlessly and endless discussions on the healing power of asanas. Yoga workshops claim to awaken Kundalini and the Chakras over the weekend regardless of the participant’s mental state or spiritual maturity. Yoga teachers claim enlightenment after visiting India and offer diksha in lieu of study, sadhana or commitment on the part of the student much like evangelical Christian churches promise instant salvation at revivals.

Kavyakanta GanapathiHowever when one examines the tradition of Yoga in India, a vastly different image is revealed. From the Rishis of the Vedas and Upanishads, from Krishna’s voice in the Gita and from Patanjali’s Sutras, the means of seeking personal as well as global security is traced upon a path that leads to a place the modern conditioned mind has forgotten: the Hridaya or spiritual Heart. Modern Rishis such as Yogananda, Ramana Maharshi and Sri Aurobindo have expressed this forgotten path as well. Yet how many Western Yoga teachers or magazines devote time or space to such important voices? If Yoga is to survive it transplantation from India into the West, a true Yogic vision must emerge within the Western world. The eternal flame of the Spiritual Heart must not be allowed to be stifled or suppressed by the Western conditioned consumer mind. An environment must be created where the Hridaya can burn and illuminate the perpetual day of Light that resides within each of us regardless of race, gender, status or culture.

For this to occur, the constant focus on the physical aspects of Yoga must be challenged and re-examined. Is the legacy of Yoga in the West to be a media driven image of a beautiful body or a trademarked sequence of asanas? Are we to prescribe Yoga asanas to address anxiety and existential malaise? The only true succor for our insatiable desires and fears is the realization that our essential Self is pure, unconditioned awareness and not a commodity to be bought or sold. Our Spiritual Heart never ages, never fatigues and desires nothing save Its revelation. To hear the quiet voice of the Hridaya we must silence the world and the conditioned chatter of our minds.

This requires the involution of attention. Our focus must be drawn away from the physical body and the external world. This requires pratyahara, dharana, dhyana, and samadhi over a new yoga mat or asana sequence. To envision a true evolution of Yoga in the West, we must practice and emphasize involution. The Western mind is not used to this type of thinking. The West views all evolution as an external phenomena. New trends of thought are constantly directed outside of ourselves and while dramatic technological advances can be seen in the external phenomenal world, the inner world of the West is becoming a vacuum.

The Western mind is also unable to hold its attention and focus for any substantial amount of time and is constantly jumping from one new trend or fad unto another. These characteristics of externalization and instability have taken hold of Yoga in the West as well. Yoga is marketed as a system of physical fitness or at best a method of relaxation. Yoga teachers scramble to put their unique spin on asana sequencing and avoid bringing up spiritual matters to avoid offending an audience of predominantly Judeo-Christian background. As a result, the Western Yoga tradition, despite glitzy and aggressive marketing, is becoming diluted and almost unrecognizable when contrasted with traditional Classical Yoga.

To realize a true evolution of Yoga in the West, we must use the spiritual methods of the Yoga tradition itself and not rely on Western pop-psychology to categorize or re-define Yoga into a exercise fad made more attractive to a palate used to bland and homogenized nourishment. Our attention must turn inward and this cannot be accomplished with a Western “Asana Yoga” but rather first requires the forgotten limb of Pratyahara or inversion of the mind and senses. If one does not take the time to sit down, which in actuality is the accurate definition of “asana”, one’s attention will be externalized. Pratyahara is the reversal of this natural tendency of the mind to externalize itself and seek fulfillment in transient emphemeral experiences. Such external seeking only leads to sorrow which in turn causes the mind to search at a more frantic pace for something to assuage its pain. This fruitless and blind search is essentially the root of all sickness. Therefore for true healing to occur, one must first stop the externalization of the mind and to accomplish requires Pratyahara.

One of the reasons for Pratyahara’s importance in the West is due to the virus-like spread of media driven consumerism. We are constantly bombarded with media images of beauty, success, psychological happiness and sex, all served up in 20-30 minute time slots. Is it any wonder that today’s children have trouble with concentration and focus? Is it any surprise that rates of anxiety and depression continue to rise despite the explosion of Yoga in the West? Even Yoga is market in 20 minute DVD’s with novel asana recipes that claim to provide a quick respite from the fast paced modern world. People claim to not have time for meditation yet will rarely miss their favorite television show which they cherish as some type of personal relationship. How can we expect an asana driven Yoga to provide a solution to this dilemma?

The Western mind is addicted to quick empty stimulation. Even if a person desires to change this conditioning process, the means to accomplish such a goal are rarely taught or discussed in a Western Yoga class. Even if the average person attempts to meditate, they are unable to achieve any true success due to the continual external stimulation of their conditioned mind. This is one of the reasons Eastern scholar Mircea Eliade chose the word “entasy” over “ecstacy” to describe the internal Yogic process as even language has been affected by the externalization process. This is where Pratyahara becomes the key turning point for breaking the cycle of external conditioning. Pratyahara becomes the doorway to the journey into our spiritual Heart, the only true source of sustenance and healing.

There are many methods of Pratyahara that can be used to facilitate the enstatic inversion process. With Western culture in mind, there are four important areas to consider removing our attention from: media exposure, speaking, sound / noise and artificial visual stimuli. These four areas have great potential to be used to manipulate the senses and are used extensively throughout the Western world. Even one who is diligent with a practice of an Asana based Yoga yet ignorant of the influences of these four areas and how they condition the mind will constantly be externalizing his or her awareness. Another important point to consider is how these four areas will impact medical therapies as well. Even if one is using prescribed allopathic or Ayurvedic therapies, if one is unaware of their constant entanglement in these four areas the prescribed therapies will not have a fertile environment to take root and flourish.

The first area to consider when utilizing Pratyahara is the exposure to mass-media. This is perhaps the hardest yet most relevant area to remove entanglement from for most Westerners. Most people begin and end their day sitting in front of the television absorbing images that stimulate and alienate rather than illuminate. Westerners are obsessed with dieting and fasting to lose weight yet rarely consider what they are consuming on a mental or emotional level. “Fasting” from the media is of primary importance if one desires to search inward and explore the spiritual universe that exists within the Heart. This media fast can be more powerful than drugs or herbs in cases of psychological and emotional disorders. Deeply embedded samskaras can be thawed and uprooted by the tapas of our sadhana, but only if we are not constantly feeding the samskaras with unwholesome and vapid images and trivial information via the media.

Pratyahara in relation to speaking and noise exposure is another powerful therapy and practice. Mauna or fasting from speaking can be a very effective form of Pratyahara. We are often unaware of the needless or mindless manner in which we use our voice. Sitting in silence, quieting our environment and our voices, we can start to hear the soft pulse of the unstruck sounds of the spiritual Heart. This also includes quieting the background “voices” of our mind with its ongoing conditioned dialogue. The tradition of Laya Yoga is a beautiful expression of this approach. Krisna states in the Gita “I am the silence of all hidden things” ( X.38 ). When we immerse ourselves in silence we can experience Krishna’s eternal message for ourselves. The more frequently we practice this sadhana the more natural it becomes. Ramana Maharshi often referred to this practice as “periodic dips into the Heart” and the in process of Atma Vichara or Self-Enquiry, this silence becomes the womb of our spiritual Heart. We can offer our fears, desires, and samskaras into the Flame of our Heart. This eternal Flame can transform our lives and deliver us to the Cosmic forces residing within. This is the Agni Yoga referred to in the Shvetasvatara Upanishad: “He has no disease, nor old age, nor death, who has attained a body born of the fire of Yoga.”

Sri RamanaFasting from unnatural and unwholesome visual stimuli is yet another important practice of Pratyahara. The images we gaze upon leave their imprints deep within our minds. We can use this to our advantage or disadvantage. Artificial and rajasic / tamasic images will plant seeds of discord and desire and will drain the mind. Natural and spiritual images have the potential to plant seeds of equanimity and peace leaving us feeling whole and renewed. Spending time in nature and natural environments is an excellent form of Pratyahara. We can gaze at a flowing stream or the open sky and feel the effect upon the “stream” of our thoughts or the “sky” of our minds. Just as we are polluting or external world, we are also polluting our internal world. We need involution not pollution to experience the spiritual Heart.

We can also use spiritual images such as Yantras or use the practice of Trataka or candle gazing as forms of Pratyahara. This also reveals the ways in which Dharana or concentration and Pratyahara are inter-related limbs of Yoga. Once the mind is focused on a single image, it is much easier to reverse the tendency for externalization. With repeated efforts we can cultivate Dharana as well as Tapas, both of which are necessary to successfully involute the awareness and allow Dhyana and Samadhi to spontaneously emerge. This emergence cannot be forced. We must spend time in silence and focus cultivating an environment conducive for the spiritual Heart to speak to us. This cannot be accomplished with asana therapy alone. We must listen to the Hridaya to awaken the new Rishis to allow the Yoga tradition to grow spontaneously in the West. This awakening will express its voice in our physical bodies but the source of Its growth will be the magnetic pull of our spiritual Heart drawing us inward to our true home in the cave of the Heart. Awaken Bhairavi!! Awaken Agni!!

Craig Williams, L.Ac., Clinical Herbalist AHG, Ayurvedic Practitioner, Veda Kovid,

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Ayurveda and Respiratory Health

Lotus FlowerIn my last two columns I explored ways to potentially integrate Chinese and Western medicinals 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 Ayurveda and its sister science Yoga. Both of these traditions have much to offer when addressing respiratory complaints and can be easily 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 in 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 am plan to introduce Ayurvedic medicinals that can, for the most part, be used safely for all body types and can be easily 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 if pungent. It lists the actions of Tulsi as anti-pyretic, carminative, diaphoretic and expectorant. Tulsi acts as a carrier or “anupan” to direct / 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 in acute colds and flus. Its gentle expectorant and guiding actions allow Tulsi to be easily integrated into more complex TCM respiratory formulas as per pattern presentation. Modern research on Tulsi has revealed COX-2 anti-inflammatory actions and 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 a 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 a 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 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 Ayurvedic text Ashtanga Hridayam lists the following actions for 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. “ Chyavanprash typically consists of around twenty herbs cooked and prepared together in a base of ghee and honey and is taken as a paste. It is considered a potent Rasayana or rejuvenative medicine in Ayurveda and modern research has shown it to be a powerful anti-oxident and immune system supplement.

Chyavanprash can be taken by the tablespoon at the first sign of a cold / 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 predominantly sour and cooling with a sweet vipaka. Modern research has shown significant anti-viral and anti-oxident 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 is also a medicinal in the TCM materia medica known as Bi Ba. It is 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 anti-bacterial and anti-amoebic, an immunostimulant, and have the ability to improve bio-availability of substances taken concurrently. Pippali has also 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 is true that 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 asasa therapy. It is 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 may prevent them from practicing a physical therapy or may lack the motivation to integrate an exercise into their therapy. Yet most patients are willing to slow down, sit down, relax and learn to breath.

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 can easily 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 improve the flow of Qi or Prana thoughout 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 closes the left nostril with the right ring finger and exhales through the right nostril. Then one reverses the process by inhaling through the right nostril and then exhaling through the left. It is best to limit Nadi Shodhana to two minutes when first starting the practice.

There are many variations on this method but it is best to start with this basic sequence for at least two month 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 is also 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!

Craig Williams, L.Ac.,Clinical Herbalist AHG, Ayurvedic Practitioner,

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The Role of Traditional Chinese Medicine and Ayurveda
in Chronic Lower Back Pain. Part. I

Chronic lower back pain is one of the most commonly encountered complaints in a student or professional clinic. The traditions of Traditional Chinese Medicine and Ayurveda offer a diverse array of effective therapies for addressing this painful condition. In this article I will discuss ways to manage chronic lower back pain more effectively in order to avoid patient dependency and poor clinical outcomes. I hope to elucidate ways to integrate Ayurvedic medicinals with TCM formulas and discuss potential combinations of acupuncture points with Ayurvedic marma points and medicinal oils.

One of the main TCM diagnostic errors I’ve seen in lower back pain scenarios is treating the condition as a sole pattern of Qi Stagnation / Blood Stasis. In any painful condition it is obvious that Qi Stagnation and Blood Stasis are present to some extent. However it is rarely a stand alone pattern in chronic lower back pain patients. Typically in these scenarios there are other factors involving some type of vacuity. Two statements of fact in Traditional Chinese Medicine are that the lower back is the mansion of the Kidneys and the Kidneys govern the low back and lower legs. It is important to keep these statements in mind when treating chronic lower back pain. One of the pathognomonic symptoms of Kidney vacuity is low back pain. Another statement of fact in TCM is enduring disease reaches the Kidneys. Therefore any chronic pain even if initially caused by Qi Stagnation / Blood Stasis will eventually damage the Kidneys. With this in mind it becomes obvious that only treating the stagnation aspect of low back pain will only provide temporary results. For lasting clinical results one must bank or supplement the Kidneys.

When using TCM formulas in low back pain presentations, it is helpful to have what I refer to as “skeleton” formulas that one can “flesh out” to address particular aspects of an individuals pattern. One such skeleton formula I frequently use and have on hand for low back pain is as follows: Du Zhong, Gu Sui Bu, Sang Ji Sheng, Bai Shao, and Gan Cao. The first three medicinals home to the Kidneys while the last two comprise an elegantly simple formula from the Jin Gui Yao Lue for spasms / pain in the legs, “Shao Yao Gan Cao Tang.” This skeleton can be fleshed out in numerous ways. For Qi Stagnation / Blood Stasis, one can add RuXiang, Mo Yao, and Yan Hu Suo. For Kidney Yin Vacuity add “Er Zhi Wan”: Nu Zhen Zi and Han Lian Cao. For Kidney Yang Vacuity add Tu Si Zi and Rou Gui. For Vacuity Heat, add Zhi Mu and Huang Bai. Since the Liver and the Kidneys share a common source, using a higher dose of Bai Shao with Dang Gui can soften and emoliate the Liver viscus enabling its Qi Mechanism to function smoothly and freely as well as supporting the Liver’s function of storing the Blood.

In TCM we know that Blood enriches and nourishes the whole body’s channels and network vessels. Therefore ensuring that the Liver is adequately nourished by Blood assists in any body pain scenario. TCM also states that enduring diseases enter the network vessels and that if the Liver and Kidney network vessels are empty, low back pain will not stop. This supplies another logical connection for adding Blood nourishing medicinals to a chronic pain formula vis a vis Blood nourishing the channels and network vessels.

Ayurvedic medicine can also be used to assuage the condition of chronic low back pain. The term for lower back pain in Sanskrit is “Kati Shula”, with “Kati” referring to the lower back and “Shula” referring to pain. Ayurveda differentiates low back pain into three basic subtypes or Doshas: Vata, Pitta, and Kapha. These categories are used to both classify a patient’s individual body type or Prakriti and the individual’s disease state or Vikriti. This type of differential diagnosis allows the practitioner to “treat the patient not the disease” ala Traditional Chinese Medicine. An individual’s disease state or Vikriti is very similar to a TCM pattern of disharmony. The Doshas represent psycho-physiological factors that maintain homeostasis or initiate disease if out of balance much like the delicate dance of Yin and Yang.

Like TCM, Ayurveda stresses the importance of an individuals intimate relationship with the universe. In Ayurveda, the five elements influence and interact with the body via the Doshas, each of which are comprised of two elements. Vata Dosha is comprised of Air and Either, Pitta Dosha is comprised of Fire and Water, and Kapha Dosha is comprised of Water and Earth. These elemental constituents influence the symptomatic expression of the Doshas in low back pain scenarios: in Vata presentations the pain is severe, migratory, and unpredictable much like Wind in TCM; in Pitta presentations, the low back feels hot, appears red, and pain is burning much like Damp Heat Bi in TCM; in Kapha presentations, the area feels cold, stiff, and pain tends to be dull, fixed, and constant similar to Wind Cold Bi in TCM.

Ayurvedic diagnosis states that there is no pain without Vata, no inflammation without Pitta, and no stagnation without Kapha.Therefore all lower back pain scenarios have Vata Dosha as a significant diagnostic factor.While low back pain can have multiple Doshic involvement, Vata Dosha is typically considered the catalyst. Ayurvedic theory considers Pitta and Kapha Doshas as “lame” and unable to move without the motivating force of Vata’s cold, dry and unpredictable winds. Also, one of the main symptoms of Vata vitiation is severe pain so commonly encountered in low back pain. It is in this theory where we can find an interesting connection between Ayurveda and Traditional Chinese Medicine. TCM states that wind is the initiator of the hundreds of diseases and wind has a predilection to movement and many changes. These TCM statements of fact clearly share an affinity with Ayurveda’s idea of Vata Dosha as the prime motivating force behind the Doshas and disease process. When we consider the power and unpredictability of Wind in our environment and its ability to cause drastic change in all the elements, it makes sense to use this analogy to express changes within the microcosm of our bodies.

Vata Dosha has five sub-types: Prana Vayu, Udana Vayu, Samana Vayu, Vyana Vayu, and Apana Vayu. Apana Vayu controls the entire pelvic cavity and its surrounding organs, bones and ligaments. The main site of accumulation for Vata Dosha is the large intestine and this organ is in the area of Apana Vayu’s windy domain. When Vata Dosha is provoked via poor diet, stress, traveling, emotions, or seasonal factors, Apana Vayu can possibly express itself as lower back pain. Vata can enter into the bone ( ashthi ) or muscle ( mamsa ) tissue and carry Pitta and Kapha along for the ride so to speak. It is this factor which will influence the particular individual disease expression.

One of the main herbs for balancing and calming a windy Vata Dosha is Withania Somnifera or Ashwagandha. This is one of the most commonly known Ayurvedic herbs and was renowned for its ability to impart the strength and virility of a horse to whomever consumed it. Ayurveda uses an herbal energetic system similar to TCM to classify and prescribe its medicinals. Ayurveda assigns an energy ( virya ), taste ( rasa ), and a unique post-digestive effect ( vipaka ) to medicinals. Ashwagandha has a mildly bitter ( tikta ) and astringent taste ( rasa ). The vipaka or post-digestive effect is sweet ( madhura ) and the energy or virya is warm ( ushna ). Ashwagandha has an anabolic ( brimhana ) and rejuvenating ( rasayana ) effect on the body’s tissues ( dhatus ) and has a special affinity to restore the nervous system ( medhya rasayana ), promote calmness and act as an analgesic. These unique characteristics reveal clues that can illuminate ways to integrate Ashwagandha into a TCM herbal protocol.

In TCM terms, Ashwagandha appears to have a unique ability to supplement Kidney Yin and Warm Kidney Yang. Its astringent and sweet tastes tend to nourish and consolidate tissues while its warm and heavy nature provides an anabolic supplementing effect. Scientific studies of Ashwagandha have demonstrated adaptagenic and anti-inflammatory effects. Therefore we have both traditional and modern support for potentially using Ashwagandha in chronic lower back pain protocols. For example, in a patient with chronic back pain with an underlying Kidney Essence Vacuity, Ashwagandha could perhaps be an excellent addition to “Jin Gui Shen Qi Wan”, “Zuo Gui Wan”, or “You Gui Wan” or a variation of the aforementioned “skeleton” formula.

Ashwagandha is an excellent medicinal in cases where the patient has trouble sleeping due to chronic pain or is suffering from fatigue due to sleep interruption. Deep restful sleep is critical for healing to occur. In TCM theory, during deep sleep the Blood homes to the Liver viscus. We also know that Blood and Essence share a common source and can mutually engender one another. If the Essence is not discharged it will gather in the Liver and be transformed into “clear blood.” This is an interesting idea when compared to the Ayurvedic theory of Ojas. Ojas is considered to be the surplus of the body’s tissues ( Dhatus ) and the deepest reservoir of vitality very similar to Kidney Essence. It is described in the Ayurvedic text Astanga Hrdayam as “ojas is the essence of the tissues” and “increase of ojas makes for contentment, nourishment of the body and increase of strength.” Ojas is greasy, watery, clear and when vacuous “loss of vitality and life is sure to happen.” This sounds remarkably similar to the surplus Essence / Clear Blood idea referred to earlier. Adequate amounts of Ojas in Ayurveda and Essence in TCM are crucial for deep restorative healing. Ashwagandha can assist in the production of Ojas or Clear Blood / Essence by assuring states of deep restful sleep and its action as a restorative medicinal or Rasayana.

I hope this first part of our discussion allowed a collaborative vision to emerge between the interface of TCM and Ayurveda when addressing chronic low back pain. In part II we will discuss a unique Ayurvedic diagnostic perspective on when not to use Ashwagandha in pain scenarios and explore the topical use of medicinals, Ayurvedic Marma points, and Yoga Asanas to assist in relieving low back pain. Until then, take care and Namaskar!!!

Best Wishes,

Craig Williams,L.Ac., Clinical Herbalist AHG,, Austin, TX

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The Role of Traditional Chinese Medicine and Ayurveda
in Chronic Lower Back Pain. Part II

In my last article I discussed avenues for integrating TCM and Ayurveda in chronic lower back pain and focused mainly on herbal therapies. In this article I wish to expand this topic further and discuss clinical scenarios where herbal medicine could potentially aggravate lower back pain, offer complementary Yoga therapies to assuage back pain, discuss similarities between Ayurvedic Marma points and TCM acupuncture points, and introduce novel ways to use herbal therapies topically to improve clinical outcomes.

Both Ayurveda and TCM agree that prior to any type of supplementation, the degree of stagnation present must be clinically evaluated. The clinician must “clear the way” so to speak before introducing heavy and cloying tonics like Shu Di Huang or Ashwagandha if large amounts of stagnation are present. Ayurveda uses the terms “Sama” and “Nirama” to address this issue. Sama means “with Ama” and Nirama means “without ama.” Ama is a unique idea in Ayurveda that is very similar to the TCM ideas of Food Stagnation, Damp, and Phlegm. The term Ama means roughly “undigested food mass.” Ama is sticky, wet, and cloying and by its very nature tends to clog up the channels or srotas thereby disrupting cellular intelligence and the flow of Prana or Qi throughout the body. This is very similar to the idea of Damp and Phlegm gumming up the Qi Mechanism preventing smooth flow throughout the body.

Signs of Ama include a wet and sticky tongue coating, fat plump tongue body with teethmarks, bad breath, constipation, depression and recalcitrant, chronic symptoms. These clinical signs share many similarities with the TCM presentations of Food Stagnation, Dampness, and Phlegm. The Ayurvedic herbal formula “Trikatu” can be used in these situations to help digest Ama, strengthen the digestive fire or Agni, and improve the bio-availability of herbal tonics. Trikatu is a simple formula consisting of Ginger, Black Pepper, and Pippali Pepper and is typically taken with honey as an “anupan” or vehicle to carry the herbs deep into the body. All the ingredients of Trikatu have shown anti-oxidant and anti-inflammatory actions in Western studies and have shown to dramatically improve the absorption of any substance taken concurrently. This has great clinical potential for use with heavy and hard to digest herbal medicines and could easily be added in small amounts to any TCM formula to improve its efficacy. Since Trikatu does have a heating action, literally “cooking” the Ama, clinicians should use cautiously when Heat signs are predominant or use very small amounts to avoid adding excess heat.

The TCM formula “Yue Ju Wan” ( Escape Restraint Pill ) is an excellent formula to use in chronic back pain scenarios where heavy, damp stagnation is present. Designed by Zhu Dan-Xi, “Yue Ju Wan” addresses the six stagnations of Qi, Blood, Fire, Food, Damp, and Phlegm. It can easily be combined with Trikatu and “Er Zhi Wan” ( Two Marvel Pill ) to avoid adding to the stagnation while still supplementing Kidney Yin and Ojas. The herb Tumeric could also be added to prevent stagnation and clearing the channels or srotas. TCM uses this herb as Jiang Huang while Ayurveda’s sanskrit name is Haridra. Both traditions use Tumeric to clear the channels and move the Qi and modern Western studies have shown numerous anti-inflammatory compounds present in Tumeric. When viewing both Western and Eastern views on Tumeric, one can easily see the potential for its use in chronic lower back pain presentations.

The herb Guggul is also used in Ayurveda to treat pain in situations presenting with stagnation and / or Ama. In my last article, I presented the Ayurvedic diagnostic maxim that there is no pain without Vata, no inflammation without Pitta, and no congestion without Kapha. With this in mind, the clinician can use Guggul based formulas to address the back pain at the root cause, the imbalaced Dosha. For Vata Dosha, Yogaraj Guggulu is used; for Pitta Dosha, Kaishor Guggulu is used; for Kapha Dosha, Punarnava Guggulu is used. It is very easy for all three doshas to be involved, or for Vata Dosha to be the main cause using its “windy” nature to push Pitta and Kapha out of balance. Therefore it is common to use the aforementioned Guggulu formulas in tandem or in rotation depending on the presentation or season. Triphala Guggulu can be used along with Trikatu in scenarios that are not responding to typical therapies or in difficult recalcitrant cases and can easily be used with “Shen Tong Zhu Yu Tang” to improve clinical efficacy.

Marma therapy or Marma Chkitsa is also a highly effective complementary clinical therapy for chronic lower back pain. Marma points are almost identical to TCM’s acupuncture points and can be used along the same lines as TCM meridian therapy. Marma means “vulnerable” or “sensitive” areas and can be used to affect a change in the body channels or srotas and deeper psycho-physiological systems or doshas. Clinicians trained in TCM can easily combine acupuncture or moxa on Marma points in conjunction with herbal medicines to see quicker resolution of pain. One of my favorite ways to use marma points is with the topical use of medicated oils and moxa.

Two of my favorite Ayurvedic medicated herbal oils are Ashwagandha / Bala oil and Mahanarayan Oil. These oils have been used clinically for thousands of years for relief of pain and to increase the healing capacity of the body. The healing aspect of touch is a crucial form of therapy in Ayurveda, and the use of massage or “Abhyanga” to stimulate the body’s innate healing intelligence can act as a powerful catalyst for rejuvenation in chronic pain scenarios. The Ayurvedic medical text Charaka Samhita states that Abhyanga can be used to decrease the effects of aging, nourish and rejuvenate the body, increase longevity, strengthen the body’s ability to adapt and recover from stress, stimulate the internal organs and circulation and pacify and harmonize Vata, Pitta , and Kapha. All of these attributes of Abhyanga can easily be tied into the idea of Banking or Supplementing the Kidneys and increasing the body’s reserves of Jing or Essence, and dispelling Blood Stasis in TCM.

The marma points I use most often in combination with medicated oils and moxa are Gulpa, Janu, and Parshvasandhi. Gulpa is nearly identical to Bladder 62, Janu is located in the center of the knee joint and Parshvasandhi is located in the lumbar area near the upper hips. After gently applying the medicated oil, gentle circular strokes are used for about five minutes and then moxa or a TDP lamp can be used to further stimulate the marmas. Care must be taken to not irritate the skin with the heat or to use to harsh of a touch. The skin is a Vata organ in Ayurveda so gentle, warm, consistent touch is crucial for effective results. I highly recommend the use of the text Ayruveda and Marma Therapy by Frawley, Ranade and Lele for reference and further reading on the applications of Marma therapy.

Ayurveda’s sister science of Yoga also has much to offer patients with chronic lower back pain. In the West, most view Yoga as primarily a form of physical therapy using various poses or Asanas to strengthen and stretch muscles and ligaments. Yoga however is not just a type of physical therapy. Numerous aspects of Yoga can be used to assist the patient in the healing process and include such methods as Pranayama or breathing exercises and meditation techniques or Dhyana. Asana therapy can play a crucial role in healing lower back pain, but it must be integrated into a larger Yogic paradigm to yield its fruits safely and consistently. Asanas by themselves are not Yoga. Gentle standing forward bends, gentle spinal twists, and standing poses used in a integrated way with Pranayama and Dhyana can dramatically help spinal and lower back issues but care must be taken when using these methods. It is important to consult a specialist trained in the proper integration of these therapies to avoid unneeded injury or aggravations.

I hope these articles on the care of lower back pain with TCM and Ayurveda have provided new insights or stimulated new avenues of interest for clinicians and patients alike. Both Ayurveda and TCM view health and healing as a delicate and dynamic balance. It is important that clinicians approach their patients and their studies with a sense of reverence, responsibility and respect. In many ways, the most powerful medicine is not herbs, needles or supplements, but kind words and a gentle touch which awaken the patient’s own healing intelligence.


Craig Williams, L.Ac., Clinical Herbalist AHG, Ayurvedic Yoga Therapist, Veda Kovid,

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Ayurveda and Liver Pathology

“Om tryambakam yajamahe
sugandhim pustivardhamam
urvarukam-iva bandhanan
mrtyor-muksiya mamrtat.”

“Om. We worship the three-eyed one,
who is fragrant and nourishment increasing;
Like the cucumber severed from its bondage to the vine,
may I release myself from death, not from immortality.”

The health of the liver plays a vital role in numerous pathological conditions. A person’s mental and physical well-being are dramatically impacted by a diverse array of metabolic and enzymatic processes originating in the liver organ. Consequently it is crucial to address and evaluate hepatic function in any clinical scenario whether acute or chronic in nature. Ayurveda offers unique diagnostic and therapeutic insights into liver pathology and can empower patients to assume an active role in the healing process. This article will examine Ayurvedic perspectives on liver health, discuss Ayurvedic dietary and herbal protocols, and elucidate ways in which Ayurveda can contribute to an integrative approach to understanding hepatic pathology.

GaneshOne of the first subjects to address when discussing hepatic disorders is the actual role the liver organ plays in Ayurvedic pathology. In Ayurveda, diagnostic emphasis is placed on the following factors: doshas, dhatus, and srotas. These are factors unique to Ayurveda and tend to take precedence over the actual liver organ per se. However, the state of the doshas, dhatus, and srotas are intimately connected to the functional and metabolic state of the liver. Doshas are psycho-physiological forces similar to the Greek “humors”, Dhatus are tissues affected by the doshas, and srotas are channels which carry and distribute doshas and various bodily substances.

The dosha most closely linked to the liver organ is the Pitta dosha or biological fire humor. Pitta means “that which digests things” and is responsible for all chemical and metabolic transformations in the body including such diverse roles as thermal regulation, digestion, visual perception, hunger, thirst, complexion and emotional states such as understanding, comprehension, courage, and will power. Pitta dosha has five subtypes: Sadhaka Pitta, Alochaka Pitta, Bhrajaka Pitta, Pachaka Pitta, and Ranjaka Pitta. The two subtypes most connected to liver pathology are Pachaka Pitta and Ranjaka Pitta. These sub-doshas are located in the small intestine, liver and spleen respectively. Ayurveda views the liver as a Pitta or fiery organ and the origin of many systemic inflammatory and digestive disorders. Ayurveda also views the liver as the site of “fiery” emotions such as jealousy, anger, irritability, will power and courage. In light of these viewpoints, treatment and diagnosis of hepatic pathologies in Ayurveda tends to address more aspects of a persons life than most therapeutic approaches.

As mentioned earlier, treatment of liver disorders in Ayurveda is focused on Pitta dosha rather than the liver organ itself. When the clinician targets and treats the Pitta dosha, the liver as a Pitta organ will consequently be affected. The Pitta subdoshas of Pachaka and Ranjaka Pitta are targeted as these are intimately connected to the liver organ and its role in the digestive process. Ayurveda views the process of digestion as the key factor in both treating and preventing disease states. The liver organ plays a key role in digestive health and can concomitantly be treated via Pachaka Pitta which is the basis and support of the digestive “fire” in all its psycho-physiological aspects in Ayurveda. The liver organ as a “fiery” Pitta organ is also the site of five metabolic “fires”, the five Bhuta-Agnis: Nabhasa Agni, Vayavya Agni, Tejo Agni, Apo Agni, and Parthiva Agni respectively. The Bhuta Agnis are specialized functions of Ranjaka Pitta originating in the liver organ which serve to enzymatically break down substances into their respective elemental factors ( either, air, fire, water, and earth ) and distribute them to the appropriate tissues or dhatus in the body.

These references to “fire” in the liver organ reveal clues as to the avenues of therapy that Ayurveda uses to target liver pathologies. The main goal of both herbal and dietary therapies is to clear excess heat or Pitta from the liver organ and balance the state of the digestive fire or “agni.” According to Ayurveda, the digestive fire is evaluated via the following states: high ( tikshna ), low ( manda ), variable ( vishama ), and balanced ( sama ). Remembering that the liver is a “fiery” organ, most pathologies are related to excess Pitta with a high ( tikshna ) burning agni. This agni burns “out of control” so to speak and will cause inflammatory conditions throughout the body’s tissues or Dhatus. Therefore most therapies seek to cool excess Pitta and clear excess heat systemically. This includes adherence to specific dietary, herbal , and lifestyle protocols to address the pathology in a truly wholistic fashion.

Dietary Protocol for Elevated Pitta Dosha

In elevated Pitta scenarios, the diet should focus on cooling, easy to digest foods. Heavy oils, fried foods, and excess spices should be avoided and meals should never be eaten under stressful conditions, late at night, or in a hurried manner. Most fresh fruit is acceptable, however care should be taken to avoid excess sour and acidic fruits as these can contribute more heat to an already overheated situation. Vegetables can be eaten raw or lightly steamed with small amounts of ghee if possible. Ghee is used to help regulate the Bhuta Agnis in the liver and help assist the digestive fires to burn cleanly and evenly. Most grains are acceptable especially Quinoa which can supply an easy to digest source of complete protein especially when combined with adzuki or mung beans. Often, a mono-diet of mung beans and basmati rice with cooling spices such as coriander and cumin can be used to support anti-Pitta herbal therapies. Roasted and salted nuts, heavy meats and excess dairy should be avoided as well. The best spices to use are cardamom, cilantro, coriander, cumin, dill, fennel, mint, saffron, and tumeric. These can all be used to creatively cook grains, vegetables and beans and assist in clearing heat or high Pitta in the liver. Pomegranate and blueberry juice and liquid chlorophyll are excellent adjuncts to the above dietary protocol as well.

Herbal Protocal

Many herbs can be used to address excess heat in the liver organ. The following herbs are simple, dependable and effective and can be combined with more intricate herbal formulas as needed.

Guduchi ( Tinosporia Cordifolia )

An excellent rasayana or rejuvenative for Pitta Dosha and the liver organ. Guduchi can help strengthen the digestive fire without causing it to burn too high and can be used long term without complications. Guduchi is specific for conditions in which excess heat has “burned out”the immune system. It is bitter and sweet which enables it to clear and strengthen at the same time making it a unique adjunct in liver pathologies.

Amalaki ( Emblica Officinalis )

Amalaki is also considered a superlative rasayana or rejuvenating medicinal and is balancing for all tissues or dhatus. It has the function of clearing heat while also strengthening agni much like the aforementioned Guduchi. It too can be taken long term and can be used in the medicinal jam “chyavanprash.”

Aloe Gel

Aloe gel can direct can act as a vehicle or “anupan” to carry or direct herbs to the liver organ. Aloe gel can easily be combined with Tumeric or coriander and taken along with Guduchi and Amalaki. The bitter and demulcent nature of aloe gel can assist in clearing and healing inflammatory conditions and compliments the actions of both Guduchi and Amalaki.

Kutki ( Picrorhiza kurroa )

The most commonly used bitter tonic in Ayurvedic medicine. Kutki strongly clears heat or excess Pitta from the liver organ and is best used short term or combined with Amalaki, licorice, or guduchi.

Arogya Vardhani

This is an excellent formula to use in excess Pitta scenarios especially when skin disorder are manifesting and / or Vata is pushing Pitta and Kapha into the Rasa and Rakta Dhatus; also useful in situations of Ama presentations.


This is an excellent formula to clear Pitta from the Rasa and Rakta Dhatus and is especially germane when fever is a main presenting symtom. Fever can also often manifest in high Ama situations whereby the body is attempting to “cook” the Ama.


This is perhaps the most crucial foundation in any Pitta excess situation as it targets the main site of Vata and the systemic state of Agni. Vata often pushes or “blows” on Pitta causing its “fires” to spread systemically. By targeting the main site of Vata, Pitta can be controlled more effectively.

Lifestyle Protocol

Along with dietary and herbal therapy, lifestyle modifications are a crucial adjunct in liver pathologies. Care should be taken to address emotional issues and provide appropriate outlets for release of “hot” emotions such as anger, aggression, frustration, and competitiveness. Yogic therapies such as meditation, awareness of the breath or pranayama, and asanas such as gentle forward bends and twists are effective therapies as well. Care must be taken during asana practise to avoid overheating the system further. Cooling pranayamas are crucial adjuncts to prevent this from occuring. It is also important to get adequate sleep ideally retiring before 9-10pm. Meals should be eaten slowly and calmly with an attitude of reverence and gratitude. Dhayana or meditation protocols are also important to allow the patient to calm the mind and cultivate Sattva and Ojas so crucial for long term healing to frucitfy.

Ayurveda clearly recognizes the entire individual when treating liver pathologies. It is important that clinicians not limit therapies to just the physical body or sheath. The physical, mental and spiritual shealths must all be addressed for effective and lasting healing to take root. Once the seeds for health are sown and an environment conducive for healing is cultivated, the body’s innate intelligence can flourish. This is the true goal of Ayurveda: to allow the body to heal itself.

Craig Williams, L.Ac., Clinical Herbalist AHG, Ayurvedic Yoga Therapist, Veda Kovid,

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"The misery which is not yet come can and is to be avoided."
 — Yoga Sutra of Patanjali