Ayurveda uses two main modalities in the treatment of disease, each with its own distinct purpose. Shamana therapy is used to palliate or manage the symptoms of disease, whereas shodhana therapy is used to eliminate the cause of disease. Each type of disease management has its own appropriateness depending on the patient, the time and the nature and stage of the illness.
SHAMANA CHIKITSA: Procedures for Alleviating the Symptoms
Shamana, which means “to suppress,” reduces or eliminates symptoms. Shamana treatments make the patient feel better by suppressing the effects of the body’s accumulated ama. When we take aspirin to alleviate headache or muscular pain, we are employing a shamana or palliative type of treatment.
However, shamana does not deal directly with root causes of the illness, and thus can never effect a complete cure. Its treatment methods can be compared to cutting weeds off at ground level. While the garden may temporarily appear to be free of weeds, they will inevitably grow back. Similarly, if we do not eliminate ama, the source of disease, and change the diet and behavior that created it, the symptoms will continue to manifest.
A childhood experience from my own life illustrates shamana therapy. When I was a small boy, I suffered from a case of persistent boils. My mother took me to a dermatologist, who gave me various treatments which eventually caused the boils to disappear. However, it wasn’t long before the boils returned as severely as ever.
Fortunately, at about this same time, my grandmother came to visit, bringing with her some valuable folk wisdom. She could not help but notice my condition and asked whether I was constipated. My mother quickly replied that I was lazy about going to the bathroom. Immediately my grandmother gave me a common herbal preparation called triphala in a dose large enough to act as a purgative.
Within twenty-four hours, my boils were gone. From that point on, my mother saw to it that regularity became a well-established habit first thing every morning and the boils never returned. My grandmother explained to my family that I did not have a skin problem, but was suffering from the effects of constipation. Waste matter and toxins had accumulated in my colon and were being absorbed into my body, thus producing the boils.
At the time, I could not comprehend how taking a purgative could cause skin problems to disappear, and I did not understand the significance of this event until many years later. Shortly after I began my clinical practice as an Ayurvedic physician, a patient came to see me with a serious skin problem. He told me that he had been suffering from boils for a long time and had noticed that whenever he took castor oil as a purgative, the boils went away for awhile. However, they always came back. I then remembered the incident from my own childhood and found the explanation in my Ayurvedic training.
The boils resulted from the body’s attempt to eliminate toxins through the skin. As long as the underlying problem was not addressed and ama remained in the dhatus, the body continued to try to expel the toxins with the boils emerging as a result.
When I was a small boy, one purgation, along with the establishment of regular bowel habits, was enough to cure my skin problems. However, for a thirty or forty-year-old adult, with many years of poor diet, weak digestion and incomplete elimination, purgation alone is not enough to rid the tissues of all the accumulated toxic material. My patient’s natural, homeostatic mechanisms persistently worked to help him regain optimum health. Each time the burden on the dhatus became too much, the body automatically attempted to bring the ama to the surface and expel it through the skin.
Purgation’s effectiveness as a symptomatic treatment demonstrated the connection between the mucous membranes of the digestive tract and the skin. The patient’s use of castor oil provides a good example of shamana, because it reduced the symptoms but did not remove the basis of the dysfunction.
SHODHANA CHIKITSA: Procedures for Eradicating Disease
The second means that Ayurveda uses to treat illness is called shodhana, which literally means “to go away.” In this form of treatment, the basis of the disease process is eradicated. Shodhana therapy rids the body of ama and mala and restores balance to the doshas. It pulls the weeds out by the roots. It is considered superior to shamana because it not only removes the symptoms of disease but also eliminates their cause.