1. AYURVEDA : ANCIENT WISDOM FOR MODERN PSYCHIATRY Sudha Prathikanti, MD University of California, San Francisco www,prathikanti.com/teaching

2. AYURVEDA: SCIENCE OF LIVING FIVE GREAT BHUTAS THREE GREAT DOSHAS

3. AYURVEDA: THE THREE GREAT DOSHAS Each dosha has specific expression Each dosha has specific expression in every dimension of human being: in every dimension of human being: Vata moves ---> body, mind, subtle energy Vata moves ---> body, mind, subtle energy Pitta heats ----> body, mind, subtle energy Pitta heats ----> body, mind, subtle energy Kapha binds ---> body, mind, subtle energy Kapha binds ---> body, mind, subtle energy. There is implicit and explicit understanding that body, mind and spirit are manifestations of the same life-force.

4. AYURVEDA: IMPORTANCE OF INDIVIDUAL CONSTITUTION Each person has unique constitution of 3 doshas Constitution ascertained thru careful history & exam Pulse Pulse Body Build & Weight Body Build & Weight Tongue, Skin, Hair, Nails Tongue, Skin, Hair, Nails Circulation Circulation Climate Tolerance Climate Tolerance Speech / Motor Activity Speech / Motor Activity Emotional Tendencies Emotional Tendencies Memory & Cognition Memory & Cognition Eating / Elimination Patterns Eating / Elimination Patterns Sleeping Patterns Sleeping Patterns

5. . VATA VATA Lean, bony build Rapid walk and talk Erratic appetite & stamina Sensitive to wind & cold Quick, flexible mind Learn fast, forget fast Less willpower, resolve Easily anxious, unsettled Respond well to: Regular, long sleep Frequent meals: warm & rich Warm, moist climate.PITTA Medium build Forceful walk & talk Strong appetite & stamina Sensitive to heat Sharp, penetrating mind Like to plan & lead Great willpower, resolve Easily irritable, competitive Respond well to: Moderate sleep Regular meals: cool & sweet Cool climate AYURVEDA: CONSTITUTIONAL TYPES. KAPHA KAPHA Large, hefty build Slow walk and talk Steady appetite & stamina Sensitive to fog & cold Deliberate, steady mind Learn slowly, good memory Complacent, forgiving Easily depressed, clingy Respond well to: Less sleep Fewer meals: light & spicy Warm, dry climate

6. AYURVEDA: HEALTH AS HARMONIOUS LIVING Health: living in balance with basic constitution Illness: living out of balance with basic constitution

7. . VATA EXCESS -- Significant anxiety -- Insomnia -- Anorexia -- Weight loss -- Motor agitation -- Compulsive talking KAPHA EXCESS -- Profound anhedonia -- Hypersomnia -- Hyperphagia -- Weight Gain -- Apathy & Listlessness -- Paucity of speech AYURVEDA: DEPRESSION AS DOSHA IMBALANCE

8. AYURVEDA: REMEDIES FOR DOSHA IMBALANCE Purification Procedures Food & Spices Herbal Medicine Herbal Massage & Bath Yoga Asanas & Exercise PranayamaMeditation Sensory Experience Social Experience Attention to Nature Time Climate Environment Dosha-correcting remedies may be applied to every dimension, not just dimension where symptoms manifest

9. EVIDENCE BASE FOR AYURVEDIC REMEDIES IN PSYCHIATRY PANCHAKARMAHERBS HATHA YOGA MEDITATION

10. AYURVEDA RESEARCH WORLDWIDE India Britain Germany Australia

11. Photo 6

12. Steam chamber PANCHAKARMA: ABHYANGA & SVEDANA

13. PANCHAKARMA: SHIRODARA

14. Photo 4 PANCHAKARMA: NASYA

15. PANCHAKARMA STUDIES  Open controlled trial: Normal subjects undergoing panchakarma had reduction in depression, anxiety, overall distress compared to subjects taking didactic classes ()  Open controlled trial: Normal subjects undergoing panchakarma had reduction in depression, anxiety, overall distress compared to subjects taking didactic classes (Schneider, Cavanaughet et al 1990)  Open controlled trial: Subjects with Parkinson’s Disease receiving both panchakarma and an Ayurvedic herbal remedy exhibited more improvement in neurological symptoms than did a small control group receiving only the herbal remedy. (Nagashayana, Sankarankutty, et al 2000).  Many other panchakarma studies for medical conditions are summarized in “Scientific Basis for Ayurvedic Therapies” by Lakshmi Mishra (CRC Press: 2003)

16. Photo 5 AYURVEDIC HERBS

17. PSYCHOTROPIC HERBS IN AYURVEDA Bacopa Monniera Withania somnifera Valeriana jatamansi Convolvulus pluricaulis Rauwolfia serpentinaCentella asiatica Mandukparni Jatamansi Sarpagandha Ashwagandha Shankpushpi Brahmi Antipsychotic Effect -- Rauwolfia * -- Centella (in polyherbal) Anxiolytic Effect -- Valeriana -- Centella* -- Withania -- Convolvulus -- Bacopa * Antidepressant Effect --- Withania --- Convolvulus Soporific Effect -- Valeriana * -- Centella (in polyherbal) Cognitive Enhancement -- Centella* -- Withania * -- Convolvulus -- Bacopa *

18. SAFETY ISSUES WITH AYURVEDIC RMEDIES  Mass Production  Over-the-counter Availability  Plant Contaminants  Misidentification of Herbs  Circumventing De-toxification  Unorthodox Combinations  Herb-Drug Interactions

19. HATHA YOGA Randomized controlled trials Pranayama + asana reduces symptoms in depressed college students Pranayama + asana reduces symptoms in depressed college students Pranayama equivalent to tricyclic in treating depressed psych inpatients Pranayama equivalent to tricyclic in treating depressed psych inpatients Hatha yoga + methadone equivalent to psychotherapy + methadone in reducing relapse in opiate users Hatha yoga + methadone equivalent to psychotherapy + methadone in reducing relapse in opiate users Yoga breathing improves spatial memory learning in normal schoolchildren Yoga breathing improves spatial memory learning in normal schoolchildren Hatha yoga reduces anxiety & depression in normal adults Hatha yoga reduces anxiety & depression in normal adults Non-randomized controlled trials Hatha yoga equivalent to swimming in producing mood benefits in women, may be superior to swimming in men Hatha yoga equivalent to swimming in producing mood benefits in women, may be superior to swimming in men Hatha yoga superior to muscle relaxation and visualization in improving mood and alertness Hatha yoga superior to muscle relaxation and visualization in improving mood and alertness Hatha yoga related to higher life satisfaction, better overall mood, better coping with stress Hatha yoga related to higher life satisfaction, better overall mood, better coping with stress

20. MEDITATION  Chronic anxiety (TM, MBSR)  Chronic pain (RR, MBSR)  Chronic insomnia (RR)  Recurrent Depression (MBSR)  Overall emotional well-being (RR, MBSR) Less anxiety and depression Less anxiety and depression Increased sense of control Increased sense of control Increased empathy Increased empathy

21. INTEGRATIVE MEDICINE: THE BEST OF BOTH WORLDS Integrative Medicine might restore the soul to medicine… the soul being that part of us that is most important but the least easy to delineate. Richard Smith British Medical Journal January 2001