By John Douillard, DC, PhD
IntroductionPremenstrual syndrome falls under the general Ayurvedic heading of Yonivyad: diseases of the female genital tact. PMS is usually associated with mood swings, nervous tension, and emotional disturbances, and it often is accompanied by a set of physical complaints. The symptomatic presentation will be determined in part by the prakriti, or body type, of the individual. The remaining factors predicting associated symptoms will be the vikriti, or imbalance of the individual. Because the imbalance has to be determined by a pulse diagnosis and on physical exam, this discussion necessarily must concern body type only.
The premise of Ayurveda is not based on the removal of symptoms; rather, it empowers the body’s ability to heal itself. In this regard, the focus of the treatment identifies and addresses the initial cause of PMS. The root cause of most cases of PMS starts early in the lifestyle of a menstruating young woman. Caraka and the other Ayurvedic authorities state that the suppression of natural urges, excessive sex and excessive physical exercise, along with an improper diet, are linked to the cause of female reproductive disorder. But here in the West the average female strays from following some of the major feminine health guidelines that are taken for granted in the culture of India’s Ayurveda. The causes of some of our modern diseases which did not exist as such in Vedic times have to be reinvestigated from a modern perspective of lifestyle and behavior.
Understanding the Cleansing CycleThere is a general consensus among Ayurvedic physicians, who come from India to tour the country, as to why the excessive amount of female disorders plague the West and not the East, and it has much to do with honoring the cycle itself. In India, the menstrual cycle is a highly respected cycle that is an expression of the female connectedness to the cycles of the moon. This cycle regulates the tides, migrations, mating times, and, of course, the twenty-eight day cycle of menstruation. Menses is a time when the female body is providing extra energy to insure an effective and complete sloughing of waste products. It is a natural time of cleansing and rejuvenation, traditionally accompanied by a time of rest or light duty. It is understood that in traditional cultures there were extended families which supported women during their monthly cycle and through menstruation. Here in the West, this is not the case. However, this does not mean that modern working women cannot respect this time of the month, taking a lighter load or scheduling around their time of the month.Basically, the Ayurvedic recommendation is to act in accord with how one feels. Ignoring this cycle is often at the root of the premenstrual syndrome. If there is some desire to rest during menstruation and this is not provided, then symptoms of some sort are sure to come. This resting is not a sign of weakness: it is a time of pulling back the bow so that one can later engage in more dynamic activity. Some of the Ayurvedic doctors comment that the menstrual cycle and monthly cleansing is one of the factors that leads to the generally longer life span of women [vs. men].
The Apana and Prana VatasThe controlling dosha in premenstrual syndrome is vata. More specifically, it is the Apana vata that governs the flow of Prana (life force) into the reproductive organs; this Apana vata provides the energy for the birthing process and the monthly cycle of menstruation. For the Apana Vata to do its job effectively it is necessary for the Apana (downward force of energy) to do so without distractions. If the lifestyle of the women is such that there is no change in one’s hectic lifestyle, particularly during the menstrual cycle, then the Apana will not have available all the energy necessary to perform a complete menstruation. Often times the physical and mental workload during this time is so great that the Apana vata downward flow of energy turns upwards in an attempt to support the Prana vata in accomplishing the task at hand. This lifestyle stress on a monthly basis for ten to twenty years can create a formidable depletion of the integrity of the Apana vata.The next stage in the PMS symptom picture happens when the depleted Apana vata is called upon to menstruate and there is not enough vitality available to support this process. Now it is the Prana vata (mental energy) which is called upon to support the Apana vata in order to complete menses. The Prana vata is the main vital upward force of energy that stabilizes moods, emotions, and energy. When Prana vata is imbalanced, severe psychological or neurological disorders result. When this kind of drain in the Prana vata continues for ten to twenty years, there occurs with ovulation the demand for Apana downward vata support. This brings the upward moving Prana down to the pelvis, leaving the mind and its emotional stability to suffer. Premenstrual syndrome results. The litany of physical symptoms associated with PMS, discussed in the pages that follow, is also the result of insult to both the Prana and Apana vata.
Beware of the common cures of PMS, such as the recommendation for exercise. Although it is a proven asset in removing the PMS symptoms, it will often further aggravate the cause. For example, if the cause of PMS is in fact a depletion in the Apana vata, which then drains Prana vata from the head, exercise will clearly drive the Prana back up into the head because now the Prana is needed there in order to perform the actual activity of exercise. This will result in symptoms typically categorized as “of the mind,” i.e., tiredness, mood swings, and emotional sensitivity, and these symptoms will further deplete the Apana vata, making the cause of the problem even worse. In an attempt to remove the symptoms, the cause is driven deeper and more permanently into the body.
Treatment According to DoshasPMS - Vata TypeSymptoms of vata imbalance as they manifest in relation to the menstrual cycle include:
Premenstrual
Nervous tension
Mood swings
Anxiety/Depression
Insomnia
Forgetfulness/confusion
Constipation
Light amount of flowMenstrual
Pain/Cramps/Backache
Extended length of period with dark, clotted flow
Irregularity of periods or flow
General Treatments• Diet
• Vata-Pacifying Diet (below)
• Avoid coffee, tea, tobacco, drugs, and extremely spicy foods
Vata-Pacifying Diet (simplified)Favor foods that are warm, heavy, and oily. Minimize foods that are cold, dry, and light.
Favor foods that are sweet (e.g., wheat, milk, rice), sour (e.g., yogurt, tomatoes, citrus fruit), and salty. Minimize foods that are spicy, bitter (e.g., green leafy vegetables), and astringent (e.g., apples, beans).
Eat larger quantities of food, but not more than you can digest easily.
Dairy: All dairy products pacify vata. Always boil milk before you drink it, and drink it warm. Don’t take milk with a full meal.
Sweeteners: All are good for pacifying vata (but don’t overdo).
Oils: All oils reduce vata.
Grains: Rice and wheat are very good. Reduce intake of barley, corn, millet, buckwheat, rye, and oats.
Fruits: Favor sweet, sour, or heavy fruits, such as oranges, bananas, avocados, grapes, cherries, peaches, melons, berries, plums, pineapples, mangoes, and papayas. Avoid or reduce dry or light fruits, such as apples, pears, pomegranates, cranberries, and dried fruits.
Vegetables: Beets, cucumbers, carrots, asparagus, and sweet potatoes are good. They should be cooked, not raw. The following vegetables are acceptable in moderate quantities if they’re cooked, especially with ghee or oil and vata-reducing spices: peas, green leafy vegetables, broccoli, cauliflower, celery, zucchini, and potatoes. It’s better to avoid sprouts and cabbage.
Spices: Cardamom, cumin, ginger, cinnamon, salt, cloves, mustard seed, and small quantities of black pepper all help reduce vata.
Nuts: All nuts are good.Beans: Avoid all beans, except for tofu and mung dhal.
Meat and Fish (for non-vegetarians): Chicken, turkey, and seafoods are fine; beef should be avoided.
Food Supplements1. Take 1 teaspoon castor oil (Ricinus communis) every night for one month. Take less if there is a laxative effect.
2. Take 2 tablespoons pure (no preservatives) aloe juice (Aloe littoralis) after meals b.i.d., but not within three days of the end of menstrual flow.
3. Take fennel (Foeniculum vulgare) and licorice (Glycyrrhiza glabra) tea, as desired.
Specific Herbal Supplements1. For Apana vata, combine:2 parts shatavari (Asparagus racemosa)2 parts musta (Cyperus rotundus)1 part licorice (Glycyrrhiza glabra)1 part punarnava (Boerhaavia diffusa)Mix 1 teaspoon of the resulting combination with sugar and ghee and take t.i.d., anytime.
2. For Prana vata, combine equal parts:brahmi (Bacopa monnieri)jatamansi (Nardostacys grandiflora)ashwaganda (Withania somnifera)gudduchi (Tinosporia cordifolia)Mix 1 teaspoon of the resulting combination with water and take t.i.d.ActivityEmphasize the importance of maintaining the proper balance of rest and activity throughout the month. Rest during the period, and practice daily abhyanga (see below) and exercise.Specific Home Treatments1. Daily abhyanga (see below) with sesame oil.2. 7 to 10 days before your period, one hour after your abhyanga, take a hot tub bath. Massage the abdomen in a clockwise motion during the bath.
3. 7 to 10 days before your period, follow your abhayanga and bath with the following laxative therapy: On an empty stomach, take four tablespoons castor oil mixed with 1⁄2 cup juice (any juice except grape juice). Do not eat until the majority of the laxative action has occurred (4 to 6 hours). Usually this procedure results in 2 to 3 bowel movements. You may repeat this monthly for up to 6 months.
4. Pitu: soak a 1"x3" clean cotton cloth in sesame oil and place in the vagina overnight or for a few hours each day for 3-5 days before your period begins. Do not do pitu during the period of if you are prone to vaginal infections or have a vaginal infection, or if you have a kapha imbalance. Be sure to remember to remove the pitu in the morning.
5. For pain experienced during the period, application of heat externally to the lower abdomen is advised. This may be accomplished by rubbing ripened sesame oil on the abdomen followed by the application of a hot water bottle directly to the oiled skin or placed on tip of a cotton cloth soaked in fresh ginger juice or on top of a paste made from ginger powder and warm water.For persistent or severe cases take an extended panchakarma treatment (5 to 7 days) as soon as possible.
PMS - Pitta TypeSymptoms of pitta imbalance as they manifest in relation to the menstrual cycle include:
Premenstrual and menopausal
Irritability/anger
Increased appetite
Headache (especially migraine)
Excessive body heat or sweating
Diarrhea or increased bowel movements
Skin rashes/acneMenstrual
Excessive bleeding
Increased frequency of periods
Bright red flow
General TreatmentsDiet
• Pitta-pacifying diet (see below)
• Ghee (clarified butter) and raisins daily
• Avoid alcohol, coffee, tea, chocolate, cheese, yoghurt, and animal products
• Avoid delaying or skipping meals when you are hungry
• Avoid sour, salty, and pungent foodsPitta-Pacifying Diet (simplified)
Favor foods that are cool and liquid. Minimize foods that are hot.
Favor foods that are sweet, bitter, or astringent. Minimize foods that are spicy, salty or sour.
Dairy: Milk, butter, and ghee are good for pacifying pitta. Avoid yogurt, cheese, sour cream, and cultured buttermilk; these sour tastes aggravate pitta.
Sweeteners: All sweeteners are good except for honey and molasses.
Oils: Olive, sunflower, and coconut oils are best. Reduce sesame, almond, and corn oil, all of which increase pitta.
Grains: Wheat, white rice, barley. Reduce corn, rye, millet, and brown rice.
Fruits: Favor sweet fruits such as grapes, cherries, melons, avocado, coconut, pomegranates, mangoes, sweet, fully-ripened oranges, pineapples, and plums. Reduce sour fruits such as grapefruits, olives, papayas and persimmons, and sour, not-yet-ripened oranges, pineapples, and plums.
Vegetables: Favor asparagus, cucumber, potato, sweet potato, green leafy vegetables, pumpkins, broccoli, cauliflower, celery, okra, lettuce, beans, green beans, zucchini. Avoid hot peppers, tomatoes, carrots, beets, onions, garlic, radishes, and spinach.
Beans: Avoid all beans except for tofu and mung dhal.
Spices: Cinnamon, coriander, cardamom, fennel, and small amounts of black pepper are good, but the following spices strongly increase pitta and should be taken in moderation: ginger, cumin, fenugreek, clove, celery seed, salt, and mustard seed. Chili peppers and cayenne should be avoided.
Meat and Fish (for non-vegetarians): Chicken, pheasant, and turkey are preferable; but beef, seafood, and egg yolk increase pitta.
Food SupplementsFennel (Foeniculum vulgare) and/or coriander (Coriandrum sativum) tea
Pure aloe vera (Aloe littoralis) juice (no preservatives). Take 2 tablespoons after meals twice a day, but not during or within 3 days of the end of menstrual flow.
Specific Herbal Supplements1. For both Prana and Apana vata, combine:2 parts shatavari (Asparagus racemosa)1 part tumeric (Curcuma longa)1 part brahmi (Bacopa monnieri)Take 1 teaspoon, with water, t.i.d.
2. To decrease pitta and Apana vata, take 2 tablets manjistha t.i.d. after meals.
3. As a uterine tonic and for the Apana vata, make tea from kumari (aloe barbadensis) leaves and drink 3 cups per day.ExerciseThose experiencing pitta-type PMS symptoms should be encouraged to stay active and focused during the premenstrual phase. Overheating, however, should be carefully avoided.Specific Home Treatments1. Daily abhyanga (see below) with coconut oil.2. Each day for seven days before the period begins dabhyanga with coconut oil, followed by a hot tub bath one hour later. Massage the abdomen in a clockwise motion during the bath.
3. 7 to 10 days before your period, follow your abhyanga and bath with the following laxative therapy: On an empty stomach, take 4 teaspoons of castor oil mixed with 1⁄2 cup of any juice (except grape). Ideally, you should also take a tea - HP 908 - 15 to 30 minutes before taking the castor oil. Do not eat until the majority of the laxative action has occurred (4 to 6 hours). Usually, this procedure results in 2 to 3 bowel movements. You may repeat this monthly for up to 6 months.
4. Pitu. Soak a 1"x3" clean cotton cloth in coconut oil and place in the vagina over night or for a few hours daily each day for 3 to 5 days before your period begins. Do not do pitu during the period if you are prone to vaginal infections or have a vaginal infection, or if you have a kapha imbalance. Be sure to remember to remove the pitu in the morning.
Other Specific Recommendations1. Rinse the external genital area twice daily with cool water. You also may splash cool water on the eyes twice daily.
2. Apply coconut oil to the head and feet at bedtime for more restful sleep and headache prevention.
3. Sniff ghee daily for one week before the period.
4. Avoid overheating, hot water on the head, and overexposure to sunlight.
5. When irritable or out of sorts, it is important to ensure that you are getting adequate rest. Also, try to stay focused on specific projects.
6. Be sure not to take long hot showers or hot baths during your heavy flow days, as these tend to increase flow. Take a short shower or sponge bath instead.
For persistent or severe cases, take an extended panchakarma treatment
PMS - Kapha TypeSymptoms of Kapha imbalance as they manifest in relation to the menstrual cycle include:
Premenstrual
Weight gain
Fluid retention
Breast enlargement
Abdominal bloating
Acne
Menstrual
Stiffness in back, joints, etc.
Pale, mucousy menstrual flow
General Treatments• Diet
• Kapha-pacifying diet (see below)
• Avoid salt, cheese, yogurt, chocolate, and refined sugars and flours for one week before and during the period.
• Lassi (1⁄2 cup yogurt, 1⁄2 cup water) and hot boiled milk are okay.
• Avoid overeating, especially at night.
• Do not eat when you are not hungry.
• A primarily vegetarian diet is highly recommended.
• Include ginger in your daily diet: take a pinch of fresh ginger root with a few drops of lemon juice before each meal.
Kapha-Pacifying Diet (simplified)Favor foods that are light, dry, and warm. Minimize foods that are heavy, oily, and cold.
Favor foods that are spicy, bitter, and astringent. Minimize foods that are sweet, salty, and sour.
Dairy: Low-fat milk is better. Always boil milk before you drink it (making it easier to digest) and take it warm. Do not take milk with a full meal, or with sour or salty food. You might add one or two pinches of turmeric or ginger to whole milk before boiling it to help reduce any kapha-creating properties in the milk.
Fruits: Lighter fruits, such as apples and pears, are better. Reduce heavy or sour fruits such as oranges, bananas, pineapples, figs, dates, avocados, coconuts, and melons, as these fruits increase kapha.
Sweeteners: Honey is excellent for reducing kapha. Reduce sugar products, as these increase kapha.
Beans: All beans are fine, except tofu.
Nuts: Reduce all nuts.
Grains: Most grains are fine, especially barley and millet. Do not take too much wheat, rice, or oats, as they increase kapha.
Spices: All are fine, except for salt. Salt increases kapha.
Vegetables: All are fine, except tomatoes, cucumbers, sweet potatoes, and zucchini, all of which increase kapha.
Meat and Fish (for non-vegetarians): White meat from chicken or turkey is fine, as is seafood. Avoid or reduce red meat.
Food Supplements1. Spice food with turmeric, ginger, black pepper, and cinnamon.
2. Take 2 tablespoons pure aloe vera juice (no preservatives) after meals b.i.d., but not during or within 3 days of the end of the menstrual flow.
Specific Herbal Supplements1. For Apana vata, combine equal parts:shatavari (Asparagus racemosa)ashwaganda (Withania somnifera)trikatu (Zingiber officinalis,Piper longum, Piper nigrum)Mix with honey into a paste and take 1 teaspoon t.i.d.
2. For Prana vata, prepare a calamus nasya:Combine 1⁄2 teaspoon calamus with 1 ounce sesame oil. Sniff 10-15 drops into each nostril, t.i.d.
3. For Apana and Prana vata:Mix 1 teaspoon dashmula in 2 cups water and boil down to 1⁄2 cup; drink 1⁄2 cup b.i.d. Dashmula, a.k.a. dashamoola, or ten roots, is a compounded formula containing the following, although this formula may be modified by some practitioners: salaparni (Gmelina arborea), agnimantha (Premna obtusifolia), brhati (Solanum indicum), kantakari (Solanum xanthocarpum), praniparni, gokshura (Tribulus terrestris), patala (Clerodendron phlomoides), syvnajka, bilua (Aegle marmelos), gambarai.
ExerciseIt is especially important to get daily exercise. A brisk walk for 30 minutes is the minimum exercise required. Perform deep nasal breathing during exercise.
RestDo not sleep during the day unless illness or unusual circumstances cause exhaustion. Always try to avoid sleeping within 2 hours after a meal.
Specific Home Treatments1. Daily abhyanga with sesame oil.
2. 7 to 10 days before your period follow your abhyanga with a hot tub bath one hour later. Massage the abdomen in a clockwise motion during the bath.
3. 7 to 10 days before your period, follow your abhyanga and bath with the following laxative therapy: on an empty stomach, take 4 teaspoons castor oil mixed with 1⁄2 cup any juice except grape juice. Do not eat until the majority of the laxative action has occurred (4 to 6 hours). Usually this procedure results in 2 to 3 bowel movements. You may repeat this monthly for up to 6 months.For persistent or severe cases take an extended panchakarma treatment (5 to 7 days) as soon as possible.
Abhyanga:Ayurvedic Oil MassageOur skin is the largest organ of our body. It weights about 6 to 10 pounds and is about 16% of our body weight. Biologically it is a very active organ: it is alive, it breathes, it self-repairs, and it gets rid of toxins. But most important, what scientists are finding out is that the skin is the riches source of all hormones that we can find anywhere, including the hypothalamus in the brain. Also, when we stimulate the skin we can literally cause a shower of healing chemicals into our bloodstream. The most important of these are growth factors or growth hormones. If our skin is the riches source of growth factors, then we can cause these growth factors to be released into our bloodstream by simply stimulating the skin.It is important to realize that touch is about ten times stronger than verbal or emotional contact. Like the other organs, the skin is also a seat of emotions. We can influence emotions, feelings, and desires through our skin as a result of the release of these hormones. A 5-minute oil massage from head to toe harmonizes mind and body and creates a sense of energy and buoyancy throughout the day.A scientific study on post-coronary patients (patients who have had heart-attacks) is indicating that if after the heart attack they receive a massage in the coronary care unit, then growth factors are released into the bloodstream. This release opens up coronary vessels and also opens up collateral blood vessels, increasing the blood supply to the heart. You can cause the same release of these growth factors through you skin by giving yourself a massage. The Ayurvedic oil massage is said to strengthen and balance the whole physiology, improve circulation and vitality, and rejuvenate the skin.We recommend to all our patients that they give themselves a daily oil massage before bathing in the morning. When we sleep at night, fatigue is dissolved and toxins are produced which are deposited in the colon and skin. That is why the first thing we do in the morning for personal hygiene is eliminate and bathe, preventing these toxins from backing up into the system. The instructions for how to do the massage are listed below.Sesame oil is the recommended oil because it doesn’t allow bacteria to grow and it gets absorbed through the skin. Current research indicates that sesame oil decreases free-radical and thereby prevents aging. Sesame oil can be purchased at any grocery store. It is recommended to use unprocessed, cold-pressed sesame oil. If sesame oil is unsuitable, you can use olive oil or coconut oil. Coconut oil doesn’t have to be cured or heated because it is used for its cooling properties.Instructions1. Use comfortably warm sesame oil that has been cured. Keep a portion of your oil in a plastic flip-top bottle, and warm it each day.Curing oil, a one-time process, causes the molecular structure of the oil to alter just enough so that the oil is better absorbed by the skin. Curing is done with heat.
One is cautioned never to burn the oil: curing is finished when a drop of water, dripped onto the hot oil, jumps.
2. Once you are undressed, apply a small amount (to 1⁄2 cup) of warm oil to your entire body, allowing the oil to have maximum time of contact (10 minutes is good).
3. Using the flat of the hand, do a brisk massage. It is not a deep, kneading massage. Apply moderate pressure over most of the body and light pressure over abdomen and heart.
4. Use circular motions over rounded areas (joints, head) and straight strokes up and down over straight areas (arms and legs).
5. Follow the oil massage with a 10- or 15-minute warm bath or shower.
6. If you don’t have time to do the whole massage, at least put the oil on and get in the shower and wash it off. A little bit every day is better than a whole lot every other day.
References-Sharma, P.V. Cakradatta, Chaukhambha Orientalia. New Delhi, India. 1994.
-Atha Vale, V.B. Basic Principles of Ayurveda. Bombay, India Town Pinery. 1980.
-Bhishagratna, K.L. Shushruta Samhita, Vol 1 and 2. Varanasi, India. Chowkhamba Sanscrit series. 1981.
-Sharma, P.V. Caraka Samhita, Vols. 1 and 2. Varanasi, India. Chaukhanbha. 1981.
-Devaraj, T.L. The Panchakarma Treatment of Ayurveda. Dwanwantari Orientalia Publications, Bangalore India. 1986.
