A guide for therapists and sufferers | by Ralph Steuernagel
I can't take any more. I'm burnt out. I'm always tired. I have no more energy. We always encounter these and many similar statements from clients in our daily Ayurveda practice.
The health, social and economic consequences of the coronavirus pandemic have been exacerbating the situation for two and a half years. Currently, fears and worries about the future are being compounded by the threat of war in Europe. Professional differential diagnostics and individualised therapy planning to increase energy levels are therefore of the utmost importance.
The first reaction of many therapists in the case history is: someone has overloaded themselves, their batteries are empty. This is a „Vata disorder“ and we counteract this with a sustainable build-up through food, medicinal plants and oil massages - ideally as part of a time-out.
Unfortunately, this action plan only rarely leads to sustainable therapeutic success. The issue is much more complex and requires several perspectives. The first and most important one is: Nidana Parivarjana.
Recognising and eliminating causes
Behind every exhaustion there are causes (nidana) that we must first research and understand. In my experience, these are rarely monocausal and are rather a complex of causes. They are made up of psychological and somatic, constitutional and acquired sources.
Start with the developmental history and the following questions:
- When did you start feeling exhausted?
- Were you previously full of energy or have you always been less resilient?
- Did the exhaustion start spontaneously or gradually?
- What were your private and professional living conditions like during this time?
- What state of health were you in at the beginning?
- Which symptoms did you notice first and which ones were added over time?
- What have you done to alleviate these complaints? With what results? What improved, what worsened?
In the next step, go into the current status:
- What symptoms and complaints are bothering you today?
- Do you feel physically or mentally exhausted? Or a combination of both? Where exactly can you localise your exhaustion? This concretising question is of paramount importance. Exhaustion is often only vaguely formulated. We need to know how we can recognise and measure the degree and the change in the future.
- Which influences intensify and which alleviate your complaints? Differentiate this question on the basis of five factors: diet, sleep, exercise, time of day and season, stressors (social, health, professional, economic, spiritual).
- So which of your daily habits continue to have a draining effect? The client now realises where exactly she is currently adding fuel to the fire. This realisation is very important, as we often act against our better judgement - and this Prajnaparadha is the most important cause of our suffering.
- Are you able to recover and recharge your batteries on days off or on holiday? This question helps us to get an idea of the degree of exhaustion and thus to make a prognostic assessment for the possible duration of our treatment.
Now that you have gained an initial impression of the possible causes of exhaustion, scrutinise all of the currently reinforcing influences: which of them can be removed immediately, which in the medium and long term? In Sanskrit this is called Parivarjana called.
This rule is sacred in Ayurveda:
First eliminate causes (Nidanaparivarjana), then initiate therapies through alleviating Shamana Chikitsa (diet, lifestyle changes, medication) and eliminating Shodhana Chikitsa (Panchakarma, manual therapy, surgery).
If this rule is not respected, the symptoms return after a short time despite extensive therapeutic measures.
Ask your client directly about her compliance:
If you continue to live the way you have been living, you will continue to be exhausted - we have both just realised that. Are you ready for a fundamental change in your unhealthy habits?
If she now gives you her OK, then agree an initial period with her in which the causes can be remedied and therapeutic measures introduced. Experience has shown that this should be at least four and a maximum of eight weeks. This is followed by the first evaluation and update.
Basic battery or rechargeable battery?
Our three sources of energy are food, breath and light. We gain ojas from food, prana from breathing and tejas from light.
I like to work with understandable images that stay with my clients even after a consultation and with which they can connect the reality of their lives. One such image is that of a basic battery and a rechargeable battery.
I have developed this model on the basis of the Ayurvedic Ojas teachings and would like to present it to you here in 8 steps:
- We all have two types of batteries inside us: a one-off Basic battery and a rechargeable Battery. The strength of both batteries is constitutionally determined and increases from the Vata to the Pitta to the Kapha prakriti. Give your client a white sheet of paper in landscape format and have her draw two batteries on it. Alternatively, you can use a flipchart or whiteboard in your practice - the large format will be even more powerful.
- The Basic battery We cannot recharge or replace them. It must be preserved. It is responsible for our longevity and allows us to survive in emergencies. Premature exhaustion leads to a shortening of our lifespan. You recognise parallels with the concept of Paraojas.
- Our Battery is replenished daily through food (which is optimised to build up Aparaojas breathing, light and sleep. We can and should influence this directly. Ask your client: Which of these sources do you feel you use optimally, which sub-optimally and which disastrously? Have them draw a smiley face on the battery for each of the three.
- Every physical and mental activity requires energy and therefore drains our battery. If these activities are also unhealthy (Mithyaharavihara), our mental balance is lacking and we are exposed to massive stressors, harmful substances such as alcohol and drugs are consumed or chronic illnesses sap our energy, this leads to a sudden discharge. Ask your client: Which activities drain your battery particularly drastically? Have them draw them into the battery again with arrows pointing downwards.
- You can now ask your client what state her battery is in - and hatch it on the drawing. Do you charge it every day just like your smartphone? Or do you start the day with a 10% charge level, even though you have big tasks waiting for you that require a lot of energy? If your battery is empty by lunchtime, you don't immediately fall over - but you are tapping into your basic battery, which is not actually intended for everyday tasks. Now your client realises (often painfully) how she is managing her energy. She recognises the imbalance between demand and available capacity. The capacity of the basic battery depends on the constitution: Kapha Prakriti has 100%, Pitta Prakriti perhaps three quarters and Vata Prakriti about two thirds. This is only an orientation. As you do not yet have a sufficient understanding of your client's constitution during the initial consultation, you should not make an assessment here.
- Ask your client now: What could you do to recharge your battery better and more sustainably?
- And then: What could you avoid to drain your battery less quickly?
- And finally: When would you like to start with what?
Pay particular attention to the feasibility of all planned changes. Ask the client individually on a scale of 0-10 how likely it is that she will a) start and b) stick with it.
0 means „definitely not“, 10 stands for „100% certain“.
If you don't get at least a 7, simplify the task.
The differential diagnostic evaluation
From a classical Ayurvedic point of view, both Functions as well as Structures of our body can be responsible for exhaustion.
Functionally, we consider the Tridosha and Agnibala:
- Exhaustion characterised by Vata aggravation can be classified as an emptiness pathology. It requires a nutritive diet, plenty of rest and sleep, sensory stimulation relief and restorative supplements. The primary therapeutic strategies are Brmhana, Nidrajanana, Balya and Rasayana Karma.
- Pitta aggravation leads to the proverbial „burnout“, which can also be categorised as an emptiness syndrome. Here, recovery, slowing down and reducing intensity are at the centre of therapeutic measures. The main therapeutic strategies are Balya and Rasayana.
- If a Kapha aggravation is associated with exhaustion, there is a fullness syndrome. Rest and build-up would exacerbate the problem, so reducing and stimulating measures are indicated. The most important therapeutic strategies are Langhana, Shodhana and Lekhana Karma.
- The two Agni states associated with exhaustion are weak Mandagni and changeable Vishamagni. In both cases, in addition to the necessary dosha reduction, we should specifically stimulate the Agni through appropriate Dravya and adjust the diet according to the agnistatus.
Structurally Excess tissue (especially Mamsa and Meda Dhatuvrddhi) and Tissue defects (especially Rasa and Raktakshaya) may be responsible for exhaustion. These can be regulated accordingly through opposing measures.
The condition of our Conductors (Srotamsi) plays an important role in the diagnosis of states of exhaustion. Both blocked pathways (srotorodha due to ama, high kapha or accumulated mala) and excessive loss (atipravrtti) of body substance can inhibit the supply and contribute to energy loss.
What role does our mind play in the development and maintenance of fatigue? An outstanding one! Both rajas and tamas have an exhausting effect as manasadosha; regeneration and a healthy energy balance are only possible in sattva guna. Which spiritual faculties are impaired, which life goals are pursued excessively, which inadequately? Sattvavajaya is essential for a sustainable increase in energy.
Breaking the vicious circle
„When I have energy again, I can exercise more, eat healthier, declutter and tidy my home and solve personal and professional problems.“ I hear this from my clients every day.
Looking at it the other way round: as long as I have no energy, I can't change anything. And it is precisely this mantra that prevents recovery. If I don't change my behaviour, my feelings won't change either.
Of course, we cannot overburden a chronically exhausted client. It is much more important to take small, sometimes even tiny steps. Start with 5 minutes of exercise a day and slowly increase this according to your capacity. Start with one warm, freshly prepared meal. With the first Dispose of unusable, stressful objects. And help your client to activate helpers if she can't do it on her own.
Don't look for the ultimate booster from the world of herbs to increase the energy levels of exhausted clients. Ashwagandha, Bala & Co. are great add-ons, but they have little effect on their own. Instead, think holistically Ayurvedic, recognise and avoid causes and support those seeking help in changing their lifestyle habits. The most important therapy pillar for recharging the battery is Vihara, behavioural medicine.
