Mastitis

By John Douillard, DC, PhD

Mastitis, or inflammation of the breast, is caused by a blockage of one of the thirteen srotas or channels of the body. These channels move nutrition and energy, both subtle and non-subtle, throughout the body. In the case of mastitis, the rasa vaha srotas, plasma- and lymph-carrying channels, become blocked. The cause of these blockages is often due to the improper formation of the dhatus or tissues of the body. There are seven tissues or dhatus in the body that are converted by dhatu-agnis (enzymes) from more basic to more complex bodily tissues. This process begins with rasa (plasma, lymph) to rakta (blood) to mamsa (muscle) to meda (fat) to ashti (bone) to majja (bone marrow) to the final dhatu of shukra (reproductive tissue). If this process is interfered with anywhere along the way, then the shukara dhatu is not formed and procreation is halted.

In the case of mastitis, the interruption of this process is at the level of rasa agni, which converts rasa dharau into rakta dhatu. In the transformation process of the dhatus, there are waste products produced along the way. Kapha (ama) which is heavy, sticky, slow-moving and cohesive, is the mala, or waste product, of rasa dhatu. Each of these seven dhatus have a set of upadhatus, or subordinate dhatus, which are nourished by the major dhatus. In the case of rasa, there are two upadhatus: stanya, or breast milk, and artava, or menstrual blood.

When the dhatus are not properly formed, an excessive amount of waste product will be produced and the upadhatus will not be nourished. In the case of a lactating mother, the breast milk would be imbalanced and most likely an inadequate supply for the infant would be produced. The rasa vaha srotas would become blocked by the excessive mala of kapha (ama), and the updhatu would be inadequately nourished. In the case of a non-lactating woman, the same srotas would be blocked. The result would be that the lymph or waste-carrying vessels in the body would be blocked by the rasa dhatu mala of kapha (ama), and the natural cycle of nutrition in waste out , would cease. This lack of circulation and build up of ama (impurities) would irritate breast tissue and, over time, inflame it and render the breast swollen, hard, and tender.

General Etiology

Although this condition may appear acute, it is always a result of an underlying chronic imbalance. Vata is usually the cause of rasa vaha srota blockage. The production of ama (mala of rasa dhatu) will aggravate kapha and soon both vata and kapha are unbalanced. Whenever there is a vata-kapha imbalance, there will always be an underlying chronic condition.Vata and kapha are opposites and as the body tries to correct one, it will imbalance the other, finding it very difficult to correct itself. More specifically, it is the samana vata subdosha of vata that is at the root of the rasa vaha srota blockage. Samana vata is the vata aspect of digestion which means it relates to the quality of the nervous system during digestion that will determine proper function. Any nervous system tension or stress during the meals will aggravate the samana vata and initiate the manufacturing process of ama. This ama moves specifically into the lymphatic system, making the rasa vaha srotas susceptible to blockage. The breast, which is a major site for lymphatic vessels, is often a target for such a lymph stasis and resultant inflammation or mastitis.

General Treatment

In the case of a samana vata imbalance, the first line of treatment must be behavioral: if the vata continues to be aggravated in relation to digestion then ama will continue to be produced and the cause of the problem will not be addressed. Because samana vata has to do with the vata aspect of digestion then what the nervous system is doing during digestion will play an important role in this treatment. There are three aspects of eating that must be addressed for samana vata to be balanced. These three factors are: how, when, and what you eat. Each of these are equally important and must be taken seriously. In the West, we put an excessive amount of attention on what we eat, but rarely are we concerned with how and when.

When To Eat

The Ayurvedic clock tells us that between 10 AM and 2 PM is the pitta time of day. This is the hottest part of the day and has traditionally been when families gather to eat their biggest meal. This is the time of day when digestion is the strongest and is the only time that the body can properly nourish itself to get enough energy to carry it through a long, hectic day. If meals are not taken at this time, then vata gets aggravated and the body often craves sweets, caffeine, or rest, in the late afternoon. Food eaten after the sun goes down is very difficult to digest, and will produce ama and aggravate the rasa vaha srotas in the case of mastitis.

How To Eat

In Western societies, eating in front of the TV, while opening mail, or while reading the newspaper has become accepted as the norm. In Ayurvedic medicine, this is an extreme violation and can lead to a litany of imbalances and diseases. Eating is a sacred time when we nourish our minds, bodies, and emotion. It is not a time to rid ourselves of a hunger pain and move onto the next activity. Here are some eating habit reminders:
• Eat in a settled atmosphere.
• Never eat when upset.
• Always sit down to eat.
• Eat only when hungry.
• Don’t talk while chewing.
• Don’t eat too slowly or too quickly.
• Eat only if previous meal is digested.
• Take a few sips of water with meal.
• Sit quietly for a few minutes after eating.
• Food should please all five senses.
• Put your fork down between bites.

What To Eat

In the case of mastitis, the diet has to be somewhat restricted in order to reduce the ama and move the lymphatic system and rasa vaha srotas. In this case, a light vata diet is recommended because the cause is samana vata and due to the heaviness of the ama the diet must be lightened.

Light Vata-Pacifying Diet

This diet pacifies vata with less of the oily, sweet, and rich foods that are recommended in the regular vata diet. Food should be fresh, well-cooked, tasty, and satisfying. Do not overeat.
Grains: Wheat, rice, and oats, prepared as follows:
Wheat: Finely-ground whole wheat flour, in foods such as crackers, biscuits with low-fat and sugar, toasted light bread, unleavened flat breads (chapati, pita bread, tortillas), cous¬cous, semolina, and cream of wheat.
Rice: Basmati rice (or other white rice), rice flour, puffed rice, and cream of rice. You can fry the rice in a pan without oil, then steam or boil it into a soup.
Oats: Cook with water to make a light porridge.
Legumes: Green or yellow mung beans or lentils (available in health food stores and Indian shops).
To prepare: boil 1 part legumes in 3 - 5 parts water. You can also boil beans with rice and a lot of water to make a thin soup. Adding a pinch of hing (asafoetida) while cooking will increase the digestibility of the beans.
Vegetables: Vegetables should be well-cooked, and prepared in soups, stews, and casseroles, with a high water content. Adding a pinch of hing (asafoetida) to vegetables increases their digestibility. Eggplant (peeled), zucchini, cucumber, asparagus, artichoke, tomato (peeled), celery (not the root), carrots, spinach, and tender white radish (prepared in oil). Almost all vegetables are acceptable.
Dairy Products: Low-fat milk, goat’s milk, buttermilk, lassi (2-3 parts warm water blended with 1 part yoghurt, taken after the meal), and ghee (clarified butter).
Sweeteners: All are acceptable in small amounts, but do not heat or cook with honey.Oils: All are acceptable in small amounts, except coconut oil.
Spices and Condiments: Cumin, ginger, fenugreek, hing (asafoetida), mustard seeds, black pepper (in small amounts), cinnamon, cardamom, anise, fennel, cloves, salt, lemon juice, tamarind. Small amounts of all other spices.
Fruits: Fruits should be sweet, ripe, and in season. Grapes, pomegranates, papayas, pineapples, figs, oranges, and fresh apricots. The juice of these fruits is also good. Raisins are fine in small amounts, if pre-soaked and chewed well.

Cleansing Diet for Rasa Vaha Srotas

This traditional Ayurvedic programs helps to eliminate impurities (ama) which result from inefficient digestion and metabolism, and strengthens the digestive and metabolic fires (agni). It also corrects improper dietary habits which can lead to imbalances. Those with severe weakness of agni, or excessive ama, should follow these guidelines closely for three months and then continue on a more relaxed basis. Others should simply follow the major guidelines, whenever possible. However, the first rule of Ayurveda is to follow your own inner sense, and do what feels right for you.

Major Guidelines
1. Follow a regular daily routine of waking, eating, and sleeping.Wake between 5 and 7 AMLunch between 12 and 2 PMDinner between 5 and 7 PMBedtime between 9 and 10 PM
2. Lunch should be the main meal of the day, and dinner should be light. Breakfast should be very light, and is optional. Favor food that is freshly prepared, avoid leftovers and frozen, canned, or processed foods. Include fresh fruit and freshly made fruit juice or vegetable juice in your diet.
3. Do a sesame oil massage in the morning and follow with a warm bath or shower.
4. Sip hot water frequently throughout the day (every 1⁄2 hour, or as often as desired). This keeps the agni alive and flushes ama from the system. Sipping hot water also settles the nervous system when you feel anxious.
5. Get fresh air and regular exercise or physical activity (by taking a morning and/or evening walk, or by doing the sun salutation and other yoga asanas).
6. Practice meditation and pranayama (alternate nostril breathing) daily.
7. Take a liquid diet for one day a week. Soup, herbal tea, fresh fruit juice, fresh carrot, beet, or celery vegetable juice, and hot water are considerations.

Dinacharya (Daily Routine)

In the morning: Wake up at or before sunrise.Take warm water with a few drops of lemon juice and/or 1⁄2 teaspoon raw honey after rising.Promote regular elimination by sitting on the toilet at the same time each morning, after rising.Do skin brushing, oil massage, bath or shower, yoga, pranayama, and meditation before eating.

At mealtimes: Take lassi (yoghurt mixed with water – 1:1, 1:2, or 1:4) during lunch and between lunch and dinner, as needed to promote digestion. It is best to make lassi with freshly made yoghurt. Lassi can be sweet or seasoned, using:Honey, ginger, and cardamom, or Salt, ginger, and cumin. Avoid cold foods or drinks, especially foods and drinks taken directly from the refrigerator.Avoid heavy food at the evening meal, including heavy desserts, yogurt, cheese, oily food, fried food, root vegetables (carrots, beets, and radishes are alright).Take raisins, figs, dates, and almonds regularly (with warm milk, if desired).Raisins and almonds can be soaked overnight. Season your food to taste with any of the following:Cumin, ginger, turmeric, cardamom, cinnamon, cloves, mustard, seeds, asafoetida (hing), black pepper, rock salt, crystal or rock sugar, brown sugar.At lunchtime, you can include the following salad with your meal:Sprouts, grated carrot or beet, parsley, fresh basil, freshly-grated ginger, lemon juice and rock salt. Add seasoning to taste. If you have a weak digestion stemming from a vata imbalance, take a small amount and chew well.

Ayurvedic Food Combining

When there are several courses, meals can be eaten from heavier to lighter food, because the digestive fire is strongest at the beginning of the meal:Dessert (heavy sweets)Salad/raw vegetablesSoup/dal (lentils)/pasta/breadCooked vegetablesRice/lassiFresh fruit (sweet and ripe)
In the evening:Go to bed early when you naturally feel sleepy, between 6 and 10 PM.

Specific Herbal Combinations1. Trikatu (Piper longum, Piper nigrum, Zingiber officinalis). Mix 1⁄4 teaspoon combination with 1 teaspoon honey into paste before meals, to inhibit ama production during digestion.2. Avipattikar churna. Take 1⁄2 teaspoon during meals to inhibit ama production during digestion.3. Manjistha (Rubia cordifolia). Take 1⁄2 teaspoon after meals with water to destagnate blood and lymph.4. As an antioxidant, take equal parts ashwaganda (Withania somnifera), gud¬du¬chi (Tinosporia cordifolia) and brahmi (Bacopa monniera).5. Equal parts mahasudarshan, manjis¬tha, purnarnava (Boerhaavia diffusa), licorice (Glycyrrhiza glabra), 1⁄2 teaspoon t.i.d. with hot water, as a lymphatic cleanser.6. Soak wool cloth with castor oil and apply to breast 30 minutes t.i.d. with moist heat.7. Drink 3-5 cups fennel tea per day.8. Soak 1 teaspoon haritaki (Termina¬lia chebula) in 8 oz. water overnight. Strain off sediment and discard. Add 1 teaspoon honey to haritaki water, and drink in the morning. Do this once a day for one month. If a laxative effect occurs, cut back to 1⁄2 teaspoon haritaki or less.

References

-Sharma, P. Cakradatat. Chaukhambha Orientalia, New Delhi, India. 1994.
-Atha Vale, V. Basic Principles of Ayurveda. Town Pinery: Bombay, India. 1980.
-Bhishagratna, K. Shushruta Samhita, Vols. 1 and 2. Chowkhamba Sanscrit Series: Varanasi, India. 1981.
-Sharma, P. Caraka Samhita, Vols. 1 and 2. Chaukhambha Orientalia, New Delhi, India. 1981.
-Devaraj, T. The Panchakarma Treatment of Ayurveda. Dwanwantari Orientalia Publications. Bangalore: India. 1986.

Further Information

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