Nov 18, 2012

Ayurvedic Medicine: Anti-toxification vs. Detoxification

Ayurvedic Medicine: Anti-toxification vs. Detoxification     by Dr. Scott Gerson

© 2011 Scott Gerson, M.D., M. Phil. (Ayu), Ph.D. (Ay)
Medical Director, National Institute Of Ayurvedic Medicine
Associate Professor, Tilak Ayurved Mahavidyalaya, Pune India
Clinical Assistant Professor, New York Medical College, Dept. Family and Preventive Medicine

According to Ayurveda, youth ends at 60. Thereafter, if proper measures are continued which slow and prevent the degenerative changes that can accompany aging, one can achieve a long and disease-free old age. There are two aspects of these proper measures.  The first is known as panchakarma, which includes both a sophisticated series of massage and other physical procedures to open the channels of the body and promote elimination of toxins. The second aspect involves an array of natural herbal medicines which up-regulate innate physiological cleansing processes in the body.

Here in the West, Ayurveda has become famous for these cleansing methods which have been dubbed as the “detoxification” procedures of Ayurveda.  However, Ayurvedic physicians do not agree with the term detoxification.  We interpret the term detoxification as a solution to a problem which has already occurred.  It would be analogous to waiting until your car was spewing thick, black smoke and overheating before you finally decide to change the motor oil. In contrast, the Ayurvedic approach to health utilizes what could be aptly described as “anti-toxification”--a continuous process of internal care and hygiene fueled by appropriate nutrition and carefully selected natural herbal medicines.

Anti-toxification is preventative maintenance which prevents decay and periodically revitalizes our physiology so that detoxification is never required.  Longevity is not equated with merely a long life; it means achieving a long life filled with pleasure and meaning and free from disease and misery.  It is within every human beings’ power to maximize their longevity, however we must follow some simple measures to preserve the youthful vigor and vitality of our minds and bodies.  Remembering our oil-burning car analogy, the time to act and invest in our health is now.  One does not begin digging a well upon feeling thirsty.

What Constitutes Toxicity

Polychlorinated biphenyls (PCBs), DDT and its metabolites, dioxins, dibenzofurans, polybrominated diphenyl ethers (PBDEs), radiation, and heavy metals are among the exogenous toxins many of us are becoming aware of that negatively impact our health in significant ways. The list of these substances is frightening long.

However, Ayurveda also offers an enlightening explanation of how endogenous toxic substances, which have equally devastating health effects, are engendered within the body itself. In order to understand this it is important to be familiar with two simple Ayurvedic concepts: agni and ama.

AGNI

Agni corresponds to the myriad heat- and energy-producing chemical reactions in the physiology which powers all the biological processes of life. The classic example is the energy which is released when the chemical bond between two phosphate atoms is broken. This energy is vital to the life function of the human being. Everything depends on it:  a person's intelligence, understanding, awareness, one’s health, energy, appearance, life force, core body temperature, autoimmune system, digestion ... life.

One of the main functions of Agni is to serve as the digestive fire and transform the foods we eat into assimilable forms. Many diseases arise from improper functioning of our digestive systems and this is often traceable to a disruption of Agni, the digestive fire. Agni is not only responsible for the breakdown of food substances, but also for destroying undesirable bacteria, viruses, and toxins in the body which could impair our autoimmune systems. In the recognition, capture, and eventual destruction of a foreign antigen by the body's own antibodies, it is Agni that powers the cascade of steps to protect our lives.

In order to maintain and improve our health, it is essential that we nourish and care for Agni so that it can properly transform our foods and provide nourishment for all the Dhatus (tissues). When Agni is functioning well there is excellent digestion, normal elimination, good circulation, abundant energy, strong resistance to disease, good complexion, pleasant body odor and breath, and an enthusiasm for life. When however Agni is disturbed, digestion is incomplete, and the metabolism and physiology of the entire mind-body is impaired. Improperly digested foods form a toxin called Ama which then ferments and putrifies in the stomach and intestines.

This gives rise to poor complexion, offensive breath and body odor, constipation, intestinal gas, reduced vital energy, impaired circulation and a decreased ability to discriminate Truth from untruth. Thus we see that, without exaggeration, the treatment of Agni is a fundamental measure for most disease states.

There are thirteen forms of Agni the most important of which is Jathara Agni which presides over all the other Agnis. It rests in the region of the stomach and duodenum and catalyzes the production of digestive enzymes and the initial stages of digestion of all foods. It plays a major role in the transformation of foods into chyme, from which all the tissues arise and are sustained. Five additional Agnis are called the bhutagnis and they each are responsible for the further digestion of one of the five basic elements (Mahabhutas) contained in the ingested foods. They operate mainly in the liver. There are also seven dhatvagnis which are located in each of the seven Dhatus of the body which regulate the physiological processes of each tissue.

The Ayurvedic scriptures mention specific factors which disrupt the functioning of Agni. Among these are over eating, under eating, eating at inappropriate times, eating foods that lack nourishment, and eating before a previous meal has been digested. Other factors are excessive sleep, excessive sexual activity, extremely hot or cold climates, anger, rage, prolonged bereavement, crowded or inhospitable living arrangements, acting contrary to accepted moral or social conduct, and drastic changes in dietary habits.


AMA

If Agni becomes impaired due to one of the mentioned factors, the first consequence is that the digestion will be significantly affected. Depending upon which bhutagni is most disturbed, certain food components will not be completely digested and will remain partially unassimilated. If Jatharagni is affected this will be true of all foods which are eaten. This mass of undigested food eventually accumulates in the colon where it putrifies into a very sticky, white, foul smelling substance. This substance is called ama. Ama initially forms and accumulates in the digestive tract but then can enter other srotas (channels) of the body such as the blood vessels, capillaries, and lymphatics where it can cause obstruction. In addition to grossly visible physical effects on the body, Ama also has subtler consequences on the vital energies which flow through the individual. If allowed to remain, Ama eventually undergoes further deterioration and produces toxic substances which circulate throughout the body via the srotas. Theses substances will accumulate in regions and tissues of the body in which a given individual has a predilection for disease. There, they reduce the body's natural mechanisms for maintaining the health of the tissues and create a blockage, contraction, and loss of vital energy in that region. As a consequence a "disease" condition becomes manifest after a given amount of time and we then give it a name: gallstone, bronchitis, cancer, depression, and so forth.

In Ayurveda two general forms of disease are recognized: exogenous, caused by factors originating outside the bodv, and endogenous, due to factors inside the body. Ama is the root of all endogenous disease. When Ama accumulates in the digestive tract it can be diagnosed by various means of physical examination the most important of which is examination of the tongue, which will exhibit a whitish, yellowish, or brownish coating. Depending upon the appearance of that coating and its location on the tongue, much can be known about the degree of Ama accumulation throughout the body. Ama is viewed, in Ayurveda, as the harbinger of misery, the cause of disease. The recommendation is to be relentless in our efforts to help the body rid itself of this venomous substance by means of the interventions discussed below.
Panchakarma Chikitsa

In Ayurveda we can discover practical and reliable knowledge about the prevention and treatment of disease, the maintenance of health, and the promotion of longevity.  Ayurveda defines health not only in terms of a balanced physiology of the physical body, but also as a state of harmony and contentment in every aspect of life. Thus, not only is it a medical approach to health--Ayurveda can also be the foundation for the spiritual evolution of humankind.

A principle concept in Ayurveda is that of internal hygiene, or preservation of a toxin-free physiology.  This is because one of the earliest stages of disease involves the obstruction of the body’s various channels (shrotas) by accumulated impurities. Panchakarma is comprised of five (“panch”) actions (“karma”)--or less literally five therapies--which promote a clean physiology.  These therapies are physical therapies such as various massages, enemas, and other procedures described below which correspond to the body’s own natural cleansing functions.  Normally, the body can cleanse itself without assistance; however these innate functions often become dysfunctional due to modern dietary, environmental, and emotional stresses.  Panchakarma therapies are designed to loosen and eliminate accumulated impurities in the shrotas to create a profound internal cleansing.

These treatments are extremely enjoyable and can be described as a cross between a spa treatment and a medical procedure--there are aspects of both.  Each individual Panchakarma session requires between two and four hours and patients may be advised to have two, four, eight, or more sessions depending on the individual’s state of health.

The therapies are available in two settings.  One option is for patients to attend a Panchakarma Retreat at the National Institute Of Ayurvedic Medicine in Brewster, New York, one hour north of Manhattan, or at another authentic center.  The advantage of retreat-based panchakarma is that the food is specially prepared, yoga and meditation sessions are provided, exercise periods are individualized, and a senior vaidya is always present for questions and support.  The serene and peaceful surroundings reduce stress and promotes the emotional aspects of anti-toxification.

The second option for receiving Panchakarma treatments is to do them on an outpatient basis in a qualified physician’s fully-equipped panchakarma office facility.  The treatments one receives in an office are identical to those at the retreat center, with the difference of being able to go home after each session.  The patient simply returns the next day to receive the next treatment.  Instructions are provided on how to eat, exercise, and rest during the time of your treatments.

A description of several of the more common Panchakarma therapies follows below.  Not all individuals will require all procedures.

Nasya

The application of specially herbalized nasal drops which cleanse the sinuses and removes impurities from the throat, facial, and supraclavicular areas.

Vamana

The use of emetic herbs to induce a therapeutic vomiting of the stomach contents.  Preceded by the consumption of cool water or specific teas to fill the stomach. Excellent in treating all kapha-type conditions including asthma, bronchitis, allergies, depression, and many digestive problems.

Snehana-Virechana

A two-part procedure which involves an initial consumption of an oily or unctuous substance followed by the administration of an herbal laxative.  The oleation acts as a solvent and mobilizer for certain toxins in the body and also promotes strength, good complexion, efficient digestion, and proper function of the sense organs.  The subsequent laxative therapies eliminates the toxins loosened by the oleation and causes a maximal dilation of the hepatic, biliary, and other channels which allows for the removal of lipid-soluble impurities.

Basti

Gentle, herbalized enemas which cleanse the rectum and lower colon and eliminate excess vata dosha from the physiology.

Raktamokshana

The removal of a small quantity of blood from the patient using modern sterile techniques; traditionally this was accomplished with special jaluka, or leeches.  This procedure is valuable if there is toxicity in the blood; it also stimulates production of fresh blood cells from the bone marrow.

Abhyanga

The body is massaged with warm, herbalized oils by one or more therapists working in perfect unison.  This promotes deep relaxation and gently stimulates the marma points leading to a state of mental balance and heightened awareness.  This is the renowned “oil massage” of Ayurveda.

Swedana

An herbalized steam treatment promotes perspiration and elimination of toxins from the fatty tissues and nerves via the sweat glands.  This treatment also optimizes the circulation and dissolves impurities.

Shirodhara

A continuous stream of warm, herbalized oil flows from an overhead vessel through a small aperture onto the forehead.  This treatment is said to purify the mind-body, and profoundly relax the nervous system.  Individuals experience twilight states of consciousness between waking and dreaming. Very meditative and pleasurable.

Udvartna

A general term for therapies in which herbal pastes (or muds) are applied to all parts of the body.  patients are wrapped in warm blankets and the paste removed when dry.  This treatment exfoliates the skin, penetrates to the muscles and fat tissues, and removes impurities.  Useful in stimulating weight reduction.

Additional specialized therapies are administered when medically indicated.

Herbal Medicines

Normally the body has the natural ability to efficiently process and eliminate toxins and products of metabolism.  If one is careful about diet, stress management, and exercise Panchakarma alone can prevent the bioaccumulation of toxins, maintain your vital energies, and prevent the occurrence of disease.  However, many of us are prone to repeated dietary indiscretions, poor exercise patterns, environmental stresses, and modern lifestyles which upset the homeostasis of the body and result in accumulation of waste products.  This situation may be beyond the point of repair by Panchakarma therapies alone.  This is when Ayurvedic herbal medicines can often be useful.

There are many, many tissues and organs in the human body which are important for the removal of toxins:  liver, spleen, kidneys, lymphatics, intestines, skin, and mucous membranes to name a few.  Ayurveda recognizes each of these and prescribes an array of plant-derived medicines to assist each in their cleansing function.  Because of space, we will limit our discussion to herbs which support the liver--the master un-toxifier.  To appreciate the importance of the liver’s role in purifying the body, consider the following modern example.

You eat an (non-organic) apple treated with a pesticide. The chemical is absorbed into the bloodstream and eventually arrives at the liver where it undergoes two biochemical processes known as functionalization and conjugation.  These processes convert the pesticide from a lipid-soluble to a water-soluble form which can be eliminated in the urine or feces.  Furthermore, for these important processes to proceed effectively, many specific complex enzymes are required in proper proportion and release sequence.  If the liver is properly nourished and in a clean state, the pesticide will be eliminated from the body before it can exert its neuro- or immunotoxic effect.  The ancient vaidyas were not aware of these details, but fully understood the importance of the liver in maintaining health and avoiding premature mortality.

Three herbal medicines in particular were, and still are, found useful in maintaining liver function:  Andrographis paniculata, Picrorhiza kurroa, and Phyllanthus niruri.

Andrographis paniculata  (Nees)   Family:  Acanthaceae    Sanskrit name: Kalmegh
The ancient Ayurvedic medical texts describe the use of the leaves of this common and ubiquitous plant in the treatment of jaundice and other liver ailments. The leaves and leaf juice have also been traditionally used as a remedy for flatulence, loss of appetite, children’s bowel complaints, dyspepsia, and general debility. The hepatoprotective action of A. paniculata  and its acive principle, andrographolide, has been studied.

These studies show that the leaf water extract significantly reduced the expected liver damage from carbon tetrachloride, a known hepatic toxin.  Free radical formation via microsomal lipid peroxidation was also shown to be reduced.

A leaf decoction of A. paniculata was studied in twenty patients with viral hepatitis. After twenty four days complete clinical improvement was observed in 16 patients (80%) and significant improvement in four patients. SGOT, SGPT, and bilirubin returned to normal levels within one month.
Picrorhiza kurroa  (Royle ex Benth)   Family:  Scrophulariaceae    Sanskrit name: Kutki

This perennial woody herb with its greyish, irregularly curved roots has been used for centuries as a liver stimulant, laxative, appetite stimulant, febrifuge, and treatment for bronchial asthma and arthritic pain.

Recent studies have isolated a bitter glycosial principle, kutkin, which has demonstrated both protective and therapeutic effects against diverse models of liver damage.  The crude root extract has shown hepatoprotective activity against carbon tetrachloride, paracetamol, galactosamine, and alcohol.

The powdered root given in divided dosages of 4 gm/day to fifty-five patients with documented infectious hepatitis for six weeks resulted in complete clinical resolution in fifty patients (91%), satisfactory response in 3 patients, and no response in 2 patients.  The conclusion was that P. kurroa root powder appeared to be a useful agent in the treatment of jaundice in infectious hepatitis.  This very well-researched herb is useful not only in liver disease, but also in promoting routine liver protection and immunocompetence.

Phyllanthus niruri   (Hook f.)   Family:  Euphorbiaceae     Sanskrit name: Bhumi amalaki

The aerial parts of this plant have been found to contain principles known as lignans, which are known to modify the immune system. Five flavonoids with known antioxidant activity has also been isolated including:  quercitin, quercitrin, isoquercitrin, astralgin, and rutin.

In what has now become a classic and much-quoted collaborative study at the Madras Hospital For Children and the Madras Government General Hospital (The Lancet, October 1, 1988, 764-766) Thyagarajan, et al treated carriers of hepatitis B with extracts of P. niruri for thirty days.  Three weeks after the herb was discontinued 59% of the patients sero-converted to non-carrier status ,i.e., neither the virus itself nor antibodies to it could be found in their serum. Blumberg et al found that the extract inhibited hepatitis B DNA polymerase and also had a viral-agglutinating activity.

Other detoxifying herbs of great value are: neem, guggulu, punarnava, red clover, chaparral, burdock root, dandelion, thistles, barley grass, Oregon grape root, aloe vera gel and many others which are native to all parts of the world.

It seems clear that with the help of Ayurvedic treatments like Panchakarma and the protective and purifying effects of herbs like those mentioned above, we have all the necessary tools to remain “anti-toxified” and preserve our health.

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