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Panchakarma, the ancient Ayurvedic protocol, aims to bring the body into balance through a series of individualized treatments and next-level detoxification therapies, specially prepared oils, herbs, and meals. It’s guided by the Ayurvedic principle to address the root cause of symptoms (as opposed to the symptoms themselves), and consider the bigger (or, rather, whole) picture. There’s a strong mental and emotional component to panchakarma—which can mean releasing some serious feels during treatment, in addition to more physical toxins.
Panchakarma is said to benefit people who are relatively healthy as well as those with a range of chronic health issues, including for some struggling with Lyme disease. Ally Hilfiger (read her Q&A on recovering from, and preventing, Lyme here) writes about her panchakarma experience with Scott Gerson, M.D., Ph.D., in her book, Bite Me. Gerson, the medical director of The Gerson Institute of Ayurvedic Medicine (located just outside of West Palm Beach in Florida), studied in both the States and India (where he completed his Ph.D. in Ayurveda, focusing on panchakarma), and still keeps a practice in NYC. He’s seen more and more Lyme patients every year for decades; here, he explains his approach to treatment, broader possible uses of panchakarma, and how the different disciplines within medicine can fit together:
A Q&A with Dr. Scott Gerson
In your wider practice, how does your background in both Western medicine and Ayurveda come into play?
I consider both approaches—sometimes they can be used simultaneously and sometimes one or the other approach is clearly the most rational way to proceed.
There is no question that allopathic medicine is a good approach for acute conditions, such as acute coronary syndrome, high fevers, bleeding, childbirth complications, and conditions which appear immediately life-threatening. I do not hesitate to engage in allopathic methods when it is appropriate. The majority of conditions afflicting modern mankind are chronic and multi-systemic in nature, though. The medical problems I generally see are a consequence of disequilibrium of the totality of an individual’s life—food, sleep, immunity, state of mind, exercise, relationships, the planets, even karma.
“There is a common misconception that the main difference between allopathic and Ayurvedic medicine is that Ayurveda uses natural treatments, instead of drugs, to treat disease.”
I often initially leave patients on their allopathic medicines, vitamins, and supplements for some period of time while I address the non-physical aspects of their disease as well as their diet. Then I carefully remove these medicines while monitoring them closely. I have found that patients who have been on synthetic medicines or so-called food supplements for periods of two years or greater have sustained metabolic imbalances as a result which must be corrected. Gentle yet thorough detoxification (shamana) through the up-regulation of hepatic, digestive, and renal function is an essential part of the process.
Most of my patients expect natural interventions and treatments. There is a common misconception that the main difference between allopathic and Ayurvedic medicine is that Ayurveda uses natural treatments, instead of drugs, to treat disease. While it is true that the Ayurvedic physician emphasizes the use of natural treatments over ones that are synthetic, it is an oversimplification of Ayurvedic philosophical foundations and a misunderstanding of our training to say the main difference is “natural vs. synthetic.” Ayurvedic physicians will from time to time employ condition-specific treatments for certain ailments, but our overall clinical objective is health optimization, rather than disease treatment. Furthermore, whereas allopathy excels in prescribing drugs to suppress the symptoms of a disease state, Ayurveda focuses on addressing the underlying cause, making symptomatic treatments unnecessary.
What does panchakarma consist of?
Panchakarma therapies are medical physiotherapies that promote intensified cleansing and bio-purification of the bodily tissues. Its main components include: (1) snehana, internal and external oiling of the body, (2) swedana, sweat therapies, (3) virechana, laxative therapy (4) nasya, nasal irrigation with herbal oils, (5) basti, herbalized enemas, (6) vamana, physician-supervised controlled vomiting, and (7) raktamokshana, removal of small quantities of blood.
Not all of these procedures are required for all patients. These procedures must be administered by trained therapists in a specific sequence for a specified period of time, usually six to fourteen days. In addition, although panchakarma is for the most part a delightful and comfortable—almost spa-like—therapy, there can be periods of discomfort associated with the profound release of toxins that does occur. Often, an emotional release accompanies the physical purification, too (which is also why it’s essential that the therapy be supervised by an expert).
Who is best suited for panchakarma?
The ancient physicians saw the importance of panchakarma treatments for overall healthcare. Charaka, the author of the first treatise on Ayurveda, wrote (in translation): “While doshas eliminated by gentler means (diet and herbs) may later recur, those eliminated with radical therapies do not recur. The doshas can be compared to trees; unless uprooted the tree will grow back despite its branches and leaves being removed.”
In Ayurvedic circles, it is considered important for almost everyone to regularly undergo these treatments, regardless of one’s state of health, with the exception of certain patients who are extremely fragile (and some other contraindications). If a person is suffering from acute or chronic diseases, panchakarma can promote healing by assisting the body in the removal of obstinate, stubborn waste that has become toxic. If one is in generally good health, panchakarma can prevent the accumulation of toxins, enhance your vital energies, and prevent the occurrence of disease.
“Panchakarma detoxification is perhaps the ‘missing link’ to restoring optimum function of our cells and tissues.”
This can become a high priority for individuals living in more stressful, polluted, and unnatural environments. In modern society, many of us are overworked and under‑rested, often eat unsatisfactory meals in a rushed manner, get insufficient exercise, sit at sedentary jobs under artificial light, breathe stale, oxygen‑depleted air, stare into cell phones, take synthetic medicines, and live surrounded by noise, electromagnetic fields, and harmful radiation, far removed from nature. The unavoidable consequence of this lifestyle is the formation and bioaccumulation of toxic substances and residues. They can take a myriad of forms including: senescent (dead) cells, mucous secretions, bacterial overgrowths, excessive fats and fatty acids, and many forms of toxins.
Panchakarma detoxification is perhaps the “missing link” to restoring optimum function of our cells and tissues. Whether undertaken to prevent or treat disease, most individuals who undergo authentic panchakarma will feel physically and mentally revitalized, with a decrease in symptoms of toxicity.
How did you begin tailoring treatments for people with Lyme?
Back in the 1980’s when I started to see my first Lyme patients, it became clear to me that the early, conventional treatment was not always effective. Borrelia burgdorferi and other spirochete co-infections can hide deep in the tissues of the body where antibiotics have a harder time reaching them, causing more severe symptoms and a more challenging prognosis. This persistent infection, coupled with an immune system weakened and corrupted by a long battle against the bacteria, meant patients could become chronic and untreatable through the gold-standard antibiotic therapy. Further, I observed that 10 to 20 percent of adequately diagnosed and treated patients progressed to have persistent or recurrent symptoms following even several courses of antibiotics.
By the 1990’s, it was widely known that deer ticks also carry many other pathogens and pass on more than one co-infection with a single bite. These co-infections increase the severity of the Lyme symptoms—or cause entirely different symptoms. Some do not respond to antibiotics, complicating diagnosis and treatment. What was needed was a more holistic approach, one that could up-regulate the body’s immune response to combat this complex multi-component disease. So I began to consider how Ayurveda, and panchakarma in particular, might be used to treat these patients and over time developed effective protocols.
What’s unique about the protocol for Lyme patients, and how can it help?
Chronic Lyme disease is a poorly defined condition that attributes various symptoms to protracted Borrelia burgdorferi and other co-infections. The treatment of chronic Lyme patients is controversial, and provokes strong emotions in both patients and doctors; the debates over how to treat Lyme have been more acrimonious than any other aspect of my medical career. Symptoms often lack the objective clinical abnormalities that are well-recognized in Lyme disease and there are many cases where the patient also lacks any serologic evidence of Lyme disease. In other patients, there is not even clear evidence of plausible exposure to the infection. The symptom complex usually diagnosed as chronic Lyme disease includes: chronic pain, fatigue, neuro-cognitive and behavioral symptoms, as well as a variety of atypical neurologic and rheumatological symptoms.
Infectious agents are not the cause of chronic Lyme disease; they simply initiate the disease in a predisposed individual. Ayurveda compares chronic infectious disease to a stick of dynamite with a long fuse. The spark is the not the cause of the explosion, it merely initiates the explosive potential of the dynamite. In this analogy, the spark is the spirochete, which initiates the epigenetic disease potential of the individual. But that epigenetic potential can be changed—and reversed.
“The treatment of chronic Lyme patients is controversial, and provokes strong emotions in both patients and doctors; the debates over how to treat Lyme have been more acrimonious than any other aspect of my medical career.”
Epigenetics is the process by which genes become expressed into proteins and other substances. Specifically, it’s the study of how our genes are modified by environmental exposures and influences. Epigenetic marks are not to be confused with genetic abnormalities, such as missing or mutated genes. Epigenetic marks involve an energetic imbalance. It means that our genes express themselves differently, and our cells behave differently, based on different environmental factors. And these environmental factors can include everything we bring inside our body through the five senses—and through the mind.
Everything we hear, touch, see, taste, smell, and feel can cause modifications in how our genes express themselves. Studies have shown that how you exercise, sleep, and behave can affect how your body transcribes your genes and translates them into either harmful or healthy substances. The modern Ayurvedic understanding of chronic Lyme disease is that the symptoms are caused by reversible epigenetic marks, which cause genes to malfunction and over-express or under-express vital proteins, cytokines, and substances that provoke an inappropriate autoimmune response.
So, panchakarma in the chronic Lyme patient is intended to reverse these epigenetic marks, restore normal gene expression, and eradicate the disease at its root.
What are nutritional genomics, and why might they also be relevant to Lyme?
Nutrigenomics and nutriepigenomics study the effects of ingested nutrients and other food components on gene expression and gene regulation. Since it is currently a rather reductionist field—it tries to identify and correct individual molecular targets—it is not exactly consistent with Ayurvedic holistic principles. But, nevertheless, some Lyme patients derive benefits from integrating this approach with Ayurvedic medicine. Nutriepigenomic marks are known to play a role in aging, alcoholism/substance abuse, cancer, cardiovascular disease, chronic fatigue, deafness, diabetes, obesity, immune disorders, macular degeneration, multiple sclerosis, neurological disorders, osteoporosis, Parkinson’s disease, and some psychiatric conditions. Some diet-modulated genes (and their normal, common variants) are likely to play a role in the onset, incidence, progression, and/or severity of chronic diseases.
However, epigenetic marks are, in my opinion, unlikely to be rectified through specific supplements or individual food components; epigenetic abnormalities represent bio-energetic (doshic) flaws in the body’s signaling “software,” which corrupts inter-cellular communication and bio-regulation systems of the body. A more holistic approach is required to effectively address these issues, and Ayurveda is one such approach.READ MORE ON LYME >>
Scott Gerson, M.D., Ph.D. (Ayu) is an Ayurvedic clinical physician and researcher. He’s the medical director of The Gerson Institute of Ayurvedic Medicine, based out of the West Palm Beach area of Florida, and open since 1982. (To contact the center, email firstname.lastname@example.org or call 561.510.3833.) Gerson is also Associate Professor at Tilak Ayurved Mahavidyalaya in India, Department of Kayachikitsa (Internal Medicine), where he earned his M.Phil. and Ph.D. in Ayurveda; a Clinical Assistant Professor in the Department of Community and Preventive Medicine at New York Medical College, and on the affiliate staff of Jupiter Medical Center; where he works on integrating Ayurveda and conventional medical approaches.
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