Ayurvedic Specific Condition Review: Constipation
Probably the most important imbalance commonly found in the human body falls into the category of constipation. It is not just the lack of, or difficulty in, elimination that supports the diagnosis of constipation, as many patients will report good elimination when they are in fact constipated. According to the classic ayurvedic definition, constipation occurs when elimination does not take place naturally, first thing upon rising. The stool should be fully-formed and floating. Upon flushing, the stool should break apart. One to three bowel movements each day (depending on the body type) is considered normal.
Most people develop constipation after years of either an imbalanced lifestyle or diet. In general there are a few contributing factors. The most common is the suppression of natural urges resulting in the subsequent disappearance of the normal eliminative urges. For example, first thing in the morning, typically at or before dawn there should be a natural urge to eliminate.
Our pets, for example, are let out first thing in the morning as an understood respect for this natural urge. We often find this natural urge inappropriate or inconvenient at certain times and force ourselves to suppress them. This habitual suppression can lead to a kind of psycho-social form of constipation whereby elimination may be regular but is not complete. If elimination does not naturally conform to the ayurvedic definition of normal, then the elimination cannot be complete and the colon is therefore constipated.
Diet can also be a leading factor. First and foremost is the lack of water consumption. Americans drink soft drinks, juices, and other beverages which may quench the thirst but do not properly nourish and lubricate the intestinal tract. Without enough water in the diet, ama, or toxins, will accumulate in the colon, creating a toxicity that is absorbed into the blood via the enteric cycle. This lack of water will also allow toxins to dry out and constipate the colon. This dryness encourages toxins to adhere to the intestinal wall, supporting further constipation and malabsorption.
The American diet is typically very mucous-forming and difficult to digest; both can slow down elimination. Stimulants such as tea and coffee may enhance peristalsis, presenting the illusion of better elimination – when in fact they progressively dry out the digestive tract, leaving the colon unable to properly eliminate.
Exercise is one of the simplest cures for a non-complicated constipation. Eighty percent of Americans do not exercise regularly. This sedentary lifestyle can be a primary factor in the etiology of constipation. From the ayurvedic perspective, exercise is primarily an activity to pump prana into every cell of the body. Deep nasal breathing during a brisk walk will provide the predicted benefits.
In ayurveda elimination is controlled by vata, the principle that governs movement in the body. The particular aspect of vata (or sub-dosha) is called apana vata. This is one of the five pranas or energies in the body which control normal function. Apana vata controls the vital force moving into the pelvis and controlling elimination and reproduction. Typically when apana vata gets out of balance it will first become dry. This dryness can cause the classic vata-based constipation where the colon is too dry and the stool can become hard and impacted. Treatment for this condition will be focused in removing the dryness by re-establishing the naturally moist and unctuous environment of the colon with demulcent and laxative herbs and tonics.
The next general form of constipation is caused by excess pitta, or too much heat. An over-abundance of heat in the colon can also dry out the colon, aggravating apana vata and lead to constipation. The body’s natural response to the dryness may be to form mucous and ultimately a kapha or mucous-based constipation. The digestive functioning of the stomach, liver and small intestine can also generate an excess amount of heat. The apana vata can provide additional air, or vata, to this fire of digestion, making the fire hotter and the apana vata weak and dry. The result is a pitta-caused constipation. Treatments for the pitta-based constipation will first cool as well as lubricate both the upper and lower digestive tracts with demulcent, alternative, and aperient herbs.
When there is excess vata or dryness in the colon, the body will defend itself by producing more colonic mucous to combat the dryness. When this happens in excess, then the colon can get clogged with mucous and cause a kapha-based constipation, the last general form of constipation. When this imbalance is combined with a mucous-forming diet, this condition could become chronic. Treatment for the kapha-based constipation will be geared to removing the mucous with drying, astringent, and pungent herbs – the exact opposite cure than the vata-based version.
How the constipation will manifest, whether it be vata, pitta or kapha will have a lot to do with the individual’s body type, the season, the geographical location, and of course the specific imbalances determined through a traditional ayurvedic pulse diagnosis.
The treatments of these three more common constipation types will vary from one individual to another. Laxatives and colonics are oftentimes recommended across the board, leaving the colon clean but weakened with aggravated vata. This kind of aggressive therapy, when regularly employed, will drain the integrity of the apana and if not corrected will begin to drain the prana vata which supports vital neurological and mental functions. When this happens constipation can grow into lower back pain, headaches, dizziness, chronic fatigue, anxiety, worry, insomnia, and depression. Before recommending aggressive laxative and colonic therapies, one should examine the strength of the individual and the kind of constipation he or she has.
Administering a laxative to stimulate elimination for the constipated patient will provide symptomatic relief at best. It is the goal of the ayurvedic approach, however, to establish why and how the constipation manifested and to restore balance specifically while enlivening the body’s natural ability to sustain normal elimination. With the proper diagnosis established, the treatment for constipation is relatively simple.
Recommendations: Vata Constipation
Avoid cold and dry foods. Eat heavier warm foods, emphasizing more oily foods like nuts, oils, and cooked grains.
Oleation and Purgation
A monthly oleation with ghee (clarified butter) followed by a castor oil purgation will provide an eliminative support as well as cumulatively reinstate a more unctuous environment in the colon. To ensure such an effect, moistening and vata-balancing herbs must be administered between oleations and purgations. This kind of therapy should not continue beyond three months.
- While eating lightly for days, start each day with progressively increasing amounts of liquid ghee (2-4-6 teaspoons), taken orally (Note: avoid this procedure if fat intolerant).
- On the eve of the third day, take a warm bath before retiring and drink 6 teaspoons of castor oil as a purgative.
- If there is any sign of weakness or fatigue then avoid the procedure above and simply take 1/2 to 1 teaspoon of castor oil every night for one month. This should not produce a laxative effect. If it does, then take less castor oil, as a continuous laxative effect can be depleting.
Spices and Herbs
- Fennel and licorice tea provide a lubricating and downward-balancing effect.
- Ghee with warm milk before bed.
- The juice of raisins and prunes soaked in water overnight will also provide both a mild eliminative and unctuous effect.
- One teaspoon of triphala taken three times per day is beneficial for vata-type constipation when taken in combination with castor flaxseed oil, making sure not to promote a laxative effect.
- Lavanbhaskar powder is a combination of ayurvedic salts to promote a mild laxative and carminative effect. Take 1 to 2 grams, 3 times per day.
- Hing or asafoetida can also be used as a spice with meals or during cooking.
Recommendations Pitta Constipation
Favor foods that are slightly oily and cooked, and avoid hot-spicy and pungent foods.
Oleation and Purgation
Purgation therapies will provide both a cooling, moistening, and eliminative effect, thus making it the treatment of choice for this type. Follow instructions for Vata Oleation and Purgation.
- 1 to 2 teaspoons aloe vera gel, 3 times per day.
- 1 teaspoon triphala mixed with ghee to make a paste, 3 times per day.
- Licorice, fennel, and coriander tea, 3 times per day.
- 1 teaspoon psyllium husk with 8 oz. water before bed.
- For severe cases, rhubarb root, senna leaf, and cascara sagrada can be taken individually or together as needed.
Recommendations Kapha Constipation
Avoid mucous-producing foods including cheese, sugar, yogurt, bread, and pastries. These foods should be particularly avoided at night. Foods rich in hot and more pungent spices are good, such as ginger, black pepper, and cayenne.
Oleation and Purgation
This therapy may be administered as above with the following additions. (Note: These additions should be taken during and between purgations.)
- 1 to 2 teaspoons pysllium husk taken with 8 oz. water, 3 times per day.
- 8 to 10 glasses of warm honey water each day.
- 1/2 to 1 teaspoon triphala taken with honey, 3 times per day.
- Aloe vera, rhubarb, and senna are bitter laxatives that will combat the intestinal kapha (kledaka) as well as provide an eliminative effect.
Special Note: In all therapies for vata, pitta, or kapha constipation there should not be a continuous laxative effect. If there is such an effect, then take less of the recommended therapy. If after two weeks of the therapy there is no natural improvement then the dosages can be increased.
Dr. John Douillard, Founder of LifeSpa Ayurvedic Retreat Center, Ayurvedic Practitioner and Author