Formulation in Ayurveda Todd Caldecott

Rasa Shastra: Herbal Alchemy of the Nepali Bajracharya Tradition:

An Exploration of Simple and Complex Ayurvedic Formulas with Case Studies by Todd Caldecott

About 16 years ago, my fellow AHG colleague Alan Tillotson asked if I might be interested to working on a project and sent a manuscript written by his Nepalese teacher of Ayurveda, Vaidya Mana Bajra Bajracharya, aka “Dr. Mana.” Honored by

Alan’s request, I readily agreed, fascinated by this opportunity to connect with a tradition of Ayurveda that was totally new to me. As I learned more about the heritage of Dr. Mana and the indigenous Newar people of Kathmandu, it became clear that Nepal is a treasure-trove of ancient Indian culture, home to perhaps the oldest continuously practiced lineage of Ayurveda in the world.

Protected by the foothills of the Himalayas, for more than 2500 years the Kathmandu

Valley has served as a safe haven for peoples fleeing persecution and war.

Immigrants from the south brought with them the language of Sanskrit and their unique cultural practices, integrating with the indigenous Tibeto-Burmese population to create a cosmopolitan synthesis that is reflected in traditional Newar society. For many years, most of the authentic Sanskrit texts being discovered have been found in the Kathmandu Valley, where they have been preserved by different Newar families for centuries. Dr. Mana’s family alone has a huge library of ancient palm leaf manuscripts on Ayurveda and Buddhism that have never been seen or catalogued by

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott academic researchers.

The Bajracharya lineage can be traced back to the fall of the ancient Nalanda

University, which was sacked in the 13th century by the Turkic general, Muhammad bin Bakhtiyar Khilji. By this time, Nalanda had become a center of Vajrayana

Buddhism, a syncretic form of Buddhist practice that incorporates elements of Saivite philosophy and the elevation of the feminine principle (i.e. Shakti). In contradistinction to the earlier celibate tradition of Buddhism, Vajrayana led to the development of a householder tradition of Buddhist priests (vajracharya) and their married “consorts,” who passed along their knowledge in a hereditary fashion. After the destruction of Nalanda, and because Bakhtiyar Khilji ordered the death of anyone with a shaved head, it was this householder tradition, with its emphasis upon ritualism and secrecy, that kept the teachings of Nalanda alive.

Rasa Shastra

Among the important medical contributions associated with Nalanda are those of

Siddha Nagarjuna (c. 10th century), an abbot at Nalanda who was also a specialist in medicine and rasa shastra (iatrochemistry). As part of its spiritual heritage, Vajrayana claims the lineage of 84 different Mahasiddhas – many of whom might be described today as “crazy saints” – a collection of spiritual personages that lived on the fringes of society, challenging the normative socio-cultural values of the day in their search for the ultimate truth. Some of these Mahasiddhas sought to extend their lives

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott through the creation of powerful elixirs, developing complicated and sophisticated techniques, such as the use of specially purified minerals including gold, mercury, and arsenic. Siddha Nagarajuna is notable for many developments in the field of rasa shastra and Ayurveda, and through an unbroken lineage of Vajrayana hereditary priests, this medical tradition has been maintained by the Bajracharya medical tradition ever since.

The use of heavy metals in Ayurveda is a subject that has understandingly attracted a lot of negative attention. Partly the issue relates to contaminants and adulterants found in cheap commercial Ayurvedic products produced in India, reflecting all the typical problems you might find in a poor, overpopulated, and polluted country.

Some of these products, however, are a product of the rasa shastra tradition, and intentionally contain heavy metals. While this ancient tradition is much vaunted in

India, it doesn’t mean that all rasa shastra products are necessarily safe. As a secret tradition, the techniques of rasa shastra were never meant to be widely disseminated, and it was only a select few over the centuries that had a grasp of the advanced techniques required to prepare these remedies properly.

Since the 20th century, however, many esoteric texts on rasa shastra have been published, and are part of the curricula for Ayurveda training in Indian Government- approved colleges. The spread of this information has led to the widespread availability of alchemical products in the marketplace. Most of these products can be

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott obtained easily without prescription, often manufactured in such a way to make the traditional process more “efficient.” The problem is, however, that remedies prepared in this fashion aren’t authentic, and because of their improper manufacture and common use, are linked to several cases of documented toxicity. Despite the valid concerns raised by researchers, these same remedies have been safely used for hundreds of years by the Bajracharya lineage, and for the last 50 years with patients from all over the world. While there remains a lack of human clinical research on preparations made under traditional methods of processing in Ayurveda, experimental research on the purification of aconite and lead demonstrate that these techniques yield a profound difference between the crude (raw) drug and its purified form.

In 2006, I first began to use some of the authentic, hand-made remedies prepared at

Dr. Mana’s ancestral clinic, Piyushavarshi Aushadhalaya. Due to shipping costs, most of the remedies I use are compact, hand-rolled pills called vati, usually prepared in a base of Commiphora wightii (guggulu) resin as an excipient. Today I have these medications sent to patients all over the world, and I use them specifically in more complex conditions. Using these remedies has provided some insight into the nature of formulation in Ayurveda. Anyone familiar with Ayurveda, if not baffled by the

Sanskrit names, is usually confused by what appear to be impossibly complicated formulas that suggest an ‘everything-but-the-kitchen-sink’ approach. In some cases, it’s not uncommon for a single herbal formula in Ayurveda to contain upwards of 50

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott ingredients or more. This has led to the belief among some critics that Ayurveda is disconnected from its roots, preferring elaborate and complicated remedies to simple, honest herbal extracts. The reality is, however, that Ayurveda maintains a spectrum of remedies that can be applied in different contexts for different purposes, from simple ‘grandma’ medicine, to the highly complex polyherbal formulations of rasa shastra.

To fully understand the art of formulation in Ayurveda requires a nuanced appreciation of its principles and practices, including the basic concepts of tridosha

(three doshas), agni (digestive fire), and ama (toxin). Some formulas are very specific to certain doshas or combinations of doshas or used in specific disease states, whereas others have more general benefits. In almost every formula, however, there are herbs to ensure the proper function of digestion, even if to ensure the proper absorption and delivery of the formula ingredients themselves. Thus, the now- popular practice of mixing turmeric with Piper nigrum (black pepper, maricha) or P. longum (pippali), considered an imperative by some, is simply based on the general principle of dipana-pachana (stoking the digestive fire). This is particularly important when using bitter-tasting herbs such as turmeric, which can exert a suppressive influence on appetite and digestion.

Simple Formulas

Beyond the use of one or two herbs, Ayurveda maintains a collection of simple

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott formulas or samyoga aushadha (combinations of medicines). Each formula is denoted by a prefix, indicating how many herbs are in it, followed by a descriptive term. Thus the common formula Triphala is the “three fruits” formula (i.e., Terminalia chebula, T. belerica, Phyllanthus emblica), and Trikatu refers to the “three pungents” combination of Zingiber offcinalis (shunthi) rhizome, maricha fruit, and pippali fruit.

Likewise, Trijataka refers to the “three aromatics” of Cinnamomum zeylanicum (twak) bark, C. tamala (patra) leaf, and Elettaria cardamomum (ela) seed, whereas Trihima refers to the “three refrigerants” of Santalum album (chandana) wood, Pterocarpus santalinus (raktachandana) wood, and Berberis nepalensis (daruharidra) root bark.

Similarly there are combinations of four ingredients (e.g., Chaturjataka, the “four aromatics”), five ingredients (e.g., Mahatpanchamula, the “great combination of five roots”), six ingredients (e.g., Shaddharana, the “six supports”), eight ingredients

(e.g., Ashtavarga, the “group of eight”), and ten ingredients (e.g., Dashamula, the

“ten roots”). Once one becomes familiar with samyoga aushadha, rather than being a long disjointed list of ingredients, complex formulations in Ayurveda can be seen to be built upon a solid foundation of these sub-formulas.

Complex Formula 1: Chandraprabha vati

Among the more commonly used formulas in my practice is Chandraprabha vati, first described in a text called the Sharangadhara Samhita from the 12th century that reflects the developments of rasa shastra. This formula contains Cinnamomum camphora (karpura, chandraprabha) leaf, along with guggulu resin as a medicinal

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott excipient.

Non-herbal or specially-prepared ingredients include purified shilajatu, which serves as the primary ingredient of Chandraprabha vati, along with swarna makshika bhasma (purified copper/iron pyrite), yava kshara (calcinated barley grass, Hordeum vulgare), lavana trayam (rock salt, sea salt, and vida salt), sarjika kshara (purified natron, i.e., naturally mined sodium carbonate), lauha bhasma (purified iron), and cane sugar (Saccharum officinarum). A typical dose for Chandraprabha vati is two pills, taken twice daily before meals.

Table 1. Chandraprabha vati formula

Species Ayurvedic name(s) English name(s) Part used Cinnamomum camphora karpura, chandraprabha camphor leaf Commiphora wightii guggulu guggul resin Acorus calamus vacha sweet flag rhizome Cyperus rotundus mustaka nutgrass rhizome Andrographis paniculata bhunimba green chiretta herb Tinospora cordifolia guduchi heart-leaved stem moonseed Cedrus deodara devadaru Himalayan cedar wood Curcuma longa haridra turmeric rhizome Aconitum heterophyllum ativisha Indian aconite purified root Berberis nepalensis daruharidra Nepali barberry root bark Piper longum pippalimula long pepper root Plumbago zeylanica chitraka Ceylon leadwort root Coriandrum sativum dhanyaka coriander fruit Piper retrofractum chavya cubeb stem Embelia ribes vidanga false black pepper fruit Scindapsus officinalis gajapippali oriental cashew fruit Operculina turpethum trivrit turpeth root Baliospermum montanum danti wild croton root Bambusa arundinacea vamshalochana Indian thorny bamboo inner bark Mineral resin shilajatu shilajit purified shilajit Mineral swarna makshika chalcopyrite purified copper/iron pyrite Hordeum vulgare yava kshara barley calcinated grass

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott

Mineral and plant salts lavana trayam rock salt, sea salt, vida salts salt Mineral sarjika kshara sodium carbonate, purified, naturally natron mined mineral Mineral lauha bhasma iron purified iron Saccharum officinarum ikshu cane sugar concentrated sap Triphala combination (see above) Trikatu combination (see above) Trijataka combination (see above)

Chandraprabha vati is a rasayana, meaning that it can be used as a general remedy to promote long life and good health. Named after the aromatic and penetrating karpura leaf, Chandraprabha vati is an important remedy for dispersing kapha, heaviness, and inertia, and is thus one of the more important remedies used in the treatment of cancer. Almost all of the ingredients in the formula including chitraka, vacha, bhunimba, and yava kshara are traditionally used to reduce kapha. This formula helps to strengthen digestion, promotes the elimination of ama (wastes and toxins), and is very helpful in the treatment of digestive weakness and chronic food sensitivities.

Chandraprabha vati specifically benefits the liver and kidneys and is used for any disorder of these organs, improving lymphatic flow and decongesting the breast, uterus, prostate, and mucus membranes. Chandraprabha vati is especially helpful because it can be safely used to treat imbalances of all three doshas, and so can be of service in sannipataja (complex) conditions when all three doshas are active, which often results in contradictory and changeable signs and symptoms.

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott

Complex Formula 2: Kaishoraguggulu vati

Kaishoraguggulu vati is another important remedy in my practice, and mostly contains guduchi stem and guggulu resin as a medicinal excipient, along with smaller amounts of vidanga seed, danti root, trivrit root, Triphala, and Trikatu. A typical dose for Kaishoraguggulu vati is two pills, taken twice daily before meals.

Table 2. Kaishoraguggulu vati formula

Species Ayurvedic name(s) English name(s) Part used Tinospora cordifolia guduchi, amrita heart-leaved stem moonseed Commiphora wightii guggulu guggul resin Embelia ribes vidanga false black pepper fruit Baliospermum montanum danti wild croton root Operculina turpethum trivrit turpeth root Triphala combination (see above) Trikatu combination (see above)

Guduchi is a perennial climber with succulent stems that grows in the temperate and sub-tropical forests of India and Nepal. It is an exceptionally useful herb, also known as amrita (nectar) because it reduces all three doshas, eliminates ama, and is a rasayana to promote longevity. It is an important medicine in both inflammation and deficiency, and displays a “special power” (prabhava) called shamanam, meaning that it “restores balance” but never causes increase.

Kaishoraguggulu vati displays many of the same properties as guduchi but is more potent, and is specific to vitiations of pitta, useful in hepatitis and cirrhosis, kidney inflammation, joint inflammation, skin conditions such as psoriasis and lichen planus,

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott endometrial cancer, skin cancer, and leukemia. The trivrit root contained in this formula is a reliable and safe laxative, helping to clear excess heat from the digestive tract to relieve conditions such as constipation and ascites. Following the practice of

Dr. Mana, I commonly use this formula as an acute remedy along with another, long- term remedy called Yogarajaguggulu vati, in the treatment of inflammatory joint disease.

Complex Formula 3: Shambukadiyoga vati

Another common remedy in my practice is Shambukadiyoga vati, which contains

Turbinella pyrum (shankha bhasma, calcinated conch shell) among other ingredients.

A typical dose for Shambukadiyoga vati is two pills, taken twice daily before meals.

Table 3. Shambukadiyoga vati formula

Species Ayurvedic name(s) English name(s) Part used Turbinella pyrum shankha bhasma conch shell calcinated shell Coriandrum sativum dhanyaka coriander fruit Cuminum cyminum jiraka cumin seed Phyllanthus emblica amalaki Indian gooseberry fruit Ferula narthex hing asafoetida gum Phyllanthus emblica vida Indian gooseberry salt of fruit Hordeum vulgare yava kshara barley calcinated grass Mineral salt saindhava pink salt salt Trikatu combination (see above)

Shambuka is another name for conch shell, and in this formula refers to the calcinated ash (bhasma) of the giant conch shell, a calcium-rich anti-inflammatory remedy that is uniquely alkaline (kshara) in flavor. This additional flavor of alkaline, along with the six flavors already described in Ayurveda, is unique to the

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott preparations of rasa shastra and the process of calcination. The alkaline flavor generally exerts an acid-reducing effect, and on its own, shankha bhasma is used in the treatment of gastric and bowel inflammation, including ulceration and diarrhea, and is used externally as a plaster for acne and ophthalmological disorders.

As a formula, Shambhukadiyoga vati takes advantage of the cooling, anti- inflammatory, and neutralizing property of shankha bhasma, and combines this along with largely carminative remedies to enhance digestion. This particular remedy is very useful for weakness of digestion accompanied signs of inflammation and heat, such as ulcer, histamine intolerance, small intestine bacterial overgrowth (SIBO), and inflammatory bowel disease (IBD). If there is diarrhea, this formula is frequently used along with herbs that have a grahi (astringent, anti-diarrhea) effect that also helps to improve digestion. One common additional formula used here is Mustadi-bilwayoga churna, an herbal powder comprised of mustaka rhizome and bilwa fruit, along with dhanyaka seed, Pavonia odorata (hriverum) plant, shunthi rhizome, twak bark,

Pimpinella anisum (shatapushpa) seed, saindhava, and shankha bhasma.

Case History 1: Chronic Gastritis and Food Intolerances

In February of 2013 I met with “Cynthia,” a 28 year old single woman complaining of poor appetite with chronic gastritis, multiple food intolerances, abdominal pain, chronic constipation, anxiety, insomnia, chronic fatigue, body aches, and amenhorrhea. From reading my book, Food As Medicine, and based on her own

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott observations, Cynthia had put together a modified Paleolithic diet, with small amounts rice and buckwheat, and an avoidance of fruits, raw foods, egg white, fermented foods, beef, spicy foods, and FODMAP (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) foods. While this helped with some of her acute symptoms, she was by no means feeling completely better.

Initially, I prescribed the formula Triphala for Cynthia, and suggested a carminative tea of coriander, dill, and fennel seed. Along with this, I suggested two of my stock tinctures: one for liver and digestive support, containing Bupleurum sp. (chai hu) root,

Chionanthus virginica (fringetree) root bark, Curcuma longa (turmeric) rhizome,

Zingiber officinalis (ginger) rhizome, and Glycyrrhiza glabra (licorice) root; and the other comprised of relaxing nervines and medhya (intellect-enhancing) herbs such as

Bacopa monnieri (brahmi) leaf, Ganoderma lucidum (reishi) mushroom, and Withania somnifera (ashwagandha) root. I also suggested matra vasti (retention enema) at night, using two ounces of warm sesame oil, and had her use a footstool during defecation to relieve abdominal pressure. Other measures included abhyanga (oil massage), vitamin B complex, vitamin D (gained through UVB exposure), and creative release exercises.

After a few weeks, Cynthia noted some improvement in anxiety and constipation, but felt like she was “getting an ulcer.” The original formula was substituted by Robert’s

Formula, and it was suggested she also try chewing on deglycyrrhizinated licorice

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott

(DGL) lozenges. After some time the irritation discontinued, and because she expressed concern that she still wasn’t menstruating, I introduced a nourishing medicated herbal broth, prepared with lamb or chicken bones, along with Paeonia lactiflora (bai shao, white peony) root, Rehmannia glutinosa (shu di huang) prepared root, Panax quinquefolius (xi yang shen, American ginseng) root, Asparagus cochinchinensis (tien men dong, shatavari) root, Astragalus membranaceus (huang qi) root, and Codonopsis pilosula (dang shen) root.

After a week or so, her digestive issue again seemed to flare up, and she was finding herself becoming increasingly more intolerant of various foods. At this point, I suggested a six month course of three remedies from Piyushavarshi Aushadhalaya clinic:

§ Chandraprabha vati: two pills, b.i.d.

§ Shambukadiyoga vati: two pills, b.i.d.

§ Mustadi-bilwayoga churna: 2-3 grams, b.i.d., taken with water

Initially Cynthia found the Shambukadiyoga vati extremely intense, and I had her reduce the dose to one-fourth. Over the following weeks, however, her tolerance improved, and after a few months all of her digestive issues had resolved. By the end of the protocol, her menses had finally returned, and although she required additional support, in every respect felt that she had turned a major corner in her life.

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott

Case History 2: Travel Aggravation of IBD

In April of 2016 I met with “Jonathan,” a 68-year-old retired male that I had treated previously for asthma. Jonathan had a long history of IBD, an affliction also experienced by other family members. For the last several years the condition had been in remission, but while he was away in Mexico on holiday, he contracted a case of gastroenteritis. Upon returning to Canada, it seemed that the condition was starting resolve when he began to experience the sudden onset of eight to ten bouts of diarrhea daily, accompanied by severe cramping and bleeding. I initially suggested a simple diet of kitchari (easily digestible cooked grains and spices), oral rehydration, and two stock formulas that I prepare in my clinic: one comprised largely of anti- parasite herbs; and the other comprised of digestive restoratives, stimulants, and antispasmodics. After three to four days it was clear that this approach wasn’t working. I then ordered a three month protocol of:

§ Chandraprabha vati: two pills, b.i.d.

§ Shambukadiyoga vati: two pills, b.i.d.

§ Mustadi-bilwayoga churna: 2-3 grams, b.i.d., taken with water

While we waited for the shipment, I continued to try a number of other herbs, including Ulmus rubra (slippery elm) root bark, licorice root, Robert’s Formula,

Hyoscyamus niger (henbane) herb, Cannabis sativa (marijuana) flower, Rubus armeniacus (blackberry) root, and Geum macrophyllum (large-leaved avens) herb.

When none of these worked, I had him prepare a decoction of Chinese herbs

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott including Atractylodes macrocephala (bai zhu) root, dang shen, Terminalia chebula (he zi) fruit, Cyperus rotundus (xiang fu) root, Aucklanidia lappa (mu xiang) root, Punica granatum (shi liu pi) rind, Myristica fragrans (chao rou dou kou) fruit, ginger rhizome, and licorice root. Nothing made a difference in the symptoms.

Due to some customs issues, Jonathan received the medications about four weeks later, and initially found them to be very powerful. I suggested he start with just a quarter dose, and work his way up. Within a week he was at full dose, and in the last few days noticed a significant improvement in his symptoms, with much less diarrhea and cramping. Three weeks after this, Jonathan contacted me to tell me that the condition had resolved, and wanted to book another follow-up consultation to discuss preventative strategies.

Case History 3: Colon Cancer Treatment Sequelae

In November 2014, I met with “Fred,” a 54-year-old married male diagnosed with colon cancer (2013) and Lyme disease (2004). Before his cancer diagnosis, Fred was treated for five years with antibiotics for Lyme disease. In December of 2013, an acute abdominal mass was found, preceded by a chronic cough for four years. The client was treated with emergency surgery, eleven rounds of chemotherapy (5-fluorouracil, oxaliplatin, avastin, and capecitabine). His oncologist had stated that he would be on chemotherapy for the rest of his life. At the time of the consultation, however, the patient was currently off all drugs, as he was soon undergoing surgery to reverse the

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott ostomy.

When I saw him, Fred was taking an eclectic protocol, including Maharishi Ayurveda products (Amrit Nectar, Amrit Ambrosia), B-complex, benfotiamine, alpha lipoic acid,

CoQ10, Annona muricata (graviola) powder, ellagic acid powder, Camellia sinensis

(green tea), vitamin D3, probiotics, dehydroepiandrosterone (DHEA), Ocimum sanctum (tulsi), and a multivitamin. Since the diagnosis, Fred had avoided refined sugar and red meat, his diet consisting mostly of vegetarian foods, with a heavy reliance upon breads and cereals with small amounts of turkey meat and egg. Since conventional treatment, Fred had been experiencing chronic nausea and indigestion, diarrhea, neuropathy, low energy, pain in the rib cage behind the heart, chronic headaches, and osteoarthritis.

Colon cancer can be correlated with pratyasthila, a type of gulma (abdominal tumor) located in the colon, and is related to a vitiation of vata. As cancer is a complex, sannipataja disorder, the focus of the protocol was on maintaining the patient, rather than providing a cure, with a focus on supporting digestive function, which is a crucial element in the management of pratyasthila. To that end, I suggested that the client eliminate all flour products, avoid salads and raw foods, and obtain animal products from a more sustainable source to be prepared in an easily digestible manner (e.g., soups and stews). In addition, I prescribed the following herbal compounds as a six month protocol:

Journal of the American Herbalists Guild (November 2016) Formulation in Ayurveda Todd Caldecott

§ Chandraprabha vati: two pills, b.i.d.

§ Kaisaraguggulu vati: two pills, b.i.d.

§ Shambukadiyoga vati: two pills, b.i.d.

§ Shilajaturasayana vati: two pills, b.i.d.

Shilajaturasayana vati was prescribed specifically for the low energy and weakness, and contains purified shilajatu, along with amla fruit, swarna (gold) bhasma, and guggulu resin.

At follow-up in April of 2015, Fred reported significant improvement in almost all parameters, with much better digestion and energy, and decreased pain. A while after the protocol was complete, Fred noted that some of the earlier symptoms were returning, and an additional three month protocol was ordered for the patient. Since this time, the patient continues to do very well, free of symptoms and without any indication of metastasis.

Journal of the American Herbalists Guild (November 2016)