What's the hardest thing to heal?
When learning about Ayurveda, everyone eventually will ask me some version of the question, "What is the hardest condition for you to treat?"
I have been asked this question by my students, patients, and by non-Ayurvedic health professionals. I'm going to write today about my answer to this question, because I believe that it is important to enhance awareness of how the doshas can influence manifestations of illness. I can see five people with the same "diagnosis", and they may all require different treatment because of how the doshas are acting within each individual.
Please note while reading that this article is not written "about" any specific person. I often have people say things like, "I felt like you were talking directly to me!"
That's great, because it means that I am in tune with the Universal flow. I write whatever I feel needs to be written, and if it speaks to you that means it was written for you!
Alright, moving on...
What I have found over my years of practice is that there is a very specific kind of imbalance that is the most difficult to work with. That imbalance is IBS (irritable bowel syndrome), when it occurs in a person who is Pitta-dominant by nature, but who is presently experiencing a Vata-type imbalance manifesting with high anxiety. The difficulty in achieving good results is not due to any complexity with this type of IBS. In fact, the treatment is theoretically very simple.
IBS is very easy to treat from the Ayurvedic perspective. I have worked with countless individuals over the years who have healed IBS completely in a matter of months. In all cases, prior to my involvement, these patients had received many years of medical treatment for their condition with no significant improvement.
Thus far in my practice, most (not all) of the people who have been able to heal IBS have been Pitta folks with Pitta-type IBS. In Ayurveda, we describe this situation as "tikshagni", which broadly means overactive and acidic digestion with inflammation in the digestive tract. In a Pitta-type person with Pitta-type IBS, healing is easy because the perfectionistic nature of Pitta allows them to follow treatment recommendations to the letter. Their excellent follow-through usually results in rapid healing.
The most difficult type of IBS to heal is what we call "vishamagni" in Ayurveda, which means inconsistent digestion. This is the Vata-Pitta type of IBS. In these cases, sometimes a person will eat and feel fine, and other times they will eat and experience extreme episodes of bloating with severe discomfort. There is often chronic constipation or alternation between episodes of constipation and diarrhea. If symptoms proceed long enough without treatment, the person typically experiences severe weight loss and loss of appetite.
I typically see vishamagni occur in Pitta-type people who have developed Vata-type imbalances. These people are typically perfectionists by nature, have a love of learning, are competitive, enjoy taking action to solve problems, like to be physically active, respect those who they perceive as being intelligent, and tend to be harsh critics of themselves and/or others. In the unbalanced state, they will be frustrated, have angry outbursts, experience trouble sleeping, and feel anxiety. To self-heal, they will often engage in frequent fasting or strict dietary regimens, which are misguided attempt to seek balance. These are independent people who will spend hours reading online trying to find out how to heal themselves.
Healing becomes difficult for these folks with Vata-Pitta IBS because they tend to fall into a self-sabotaging pattern. This pattern is subconscious, and is consciously perceived as taking independent action towards healing or trusting in one's own body. When the doshas are unbalanced, the perception is not accurate. So although someone can trust that their healthy mind-body will guide them well, their unbalanced mind-body will not. In this subconscious sabotage pattern of Vata-Pitta IBS, the Pitta drive for independence and understanding interacts with the erratic nature of Vata, causing a characteristic cycle of self-diagnosis causing lack of follow-through with treatment recommendations. I will summarize below this pattern as I have seen it play out in all cases of Vata-Pitta IBS that I have treated in my practice so far:
1) The patient will usually self-diagnose. They come into the appointment telling me what they need and what treatments they think will work. This foundation makes treatment difficult because the patient is resistant to professional recommendations that are not aligned with their ideas about self-diagnosis and self-treatment.
2) There is typically an inability to control speech. The patient will often talk through most of the session, leaving little time for me to ask diagnostic questions or provide professional advice, and usually will interrupt me when I speak. In these cases, even when asked questions and instructed to "please answer only yes or no", the patient will give lengthy answers.
3) At the end of each appointment, we create an action plan together. The patient will subsequently do some form of self-analysis, reading, and/or Internet research. This activity is driven by the Pitta part of their nature wanting to learn and understand everything, and further unbalances Vata by creating anxiety and fear. The patient begins to question the validity of the action plan and may even become afraid that following it will exacerbate their digestive symptoms.
5) The patient contacts me repeatedly through various mediums to tell me why, based on their recent self-analysis and/or reading, they believe that they should not follow through with their action plan.
6) The patient decides that they can self-diagnose and self-treat better than any healing professional can guide them and they stop treatment entirely, OR they "jump practitioners" because the Pitta part of them is impatient for results and interacting with the Vata tendency to continually seek new things.
This is the 6-step pattern that I have observed over my years of practice. I hope that my sharing this doesn't sound like I am judging these folks. These are lovely and amazing people who unfortunately get stuck in a pattern of behavior that is not beneficial to them.
My hopes in writing this article are:
1) to provide helpful information so that those suffering from the Vata-Pitta type of IBS can better understand what is happening with them,
2) to help other health practitioners better understand the different types of IBS in order to provide better treatment.
The only way to successfully heal the condition of IBS with Vata-Pitta imbalance is for the patient to consistently follow through with the treatment recommendations. Consistent follow-through brings Vata back into balance, which allows anxiety to decrease and digestion to become more regular. Patients must also commit to the cessation of self-diagnosis and attempts to self-treat, as doing so will only heighten their Pitta imbalance, which in turn will fuel a further imbalance of Vata.
This cycle of suffering from Vata-Pitta type IBS is one that I have observed repeatedly. It is always challenging for me to deal with as a practitioner because I care so deeply about each one of my patients. When I know that someone would feel better if only they did not give up, and I watch them quit on their own healing process, it makes me want to cry every time. But part of my doing this work is to accept that I cannot do anyone's healing for them...even if I really wish that I could.
If anyone has questions about Ayurveda and IBS, I can be reached by email at email@example.com. Please understand that I cannot provide treatment recommendations for anyone without having a consultation, but I am happy to answer general inquiries.