Case 10: Thrush – Ayurvedic Case Presentation

UTI: According to Ayurveda, UTIs are caused by an imbalance of the pitta dosha, which can be caused by:

• Eating too much hot, sour or spicy food
• Excessive exposure to heat or sunlight and exercise
• Not drinking enough water
• Working with chemicals or fire
• Consuming to much alcohol
• Retaining urine in the bladder and suppressing the need to urinate.
• Intake of food or medicines that are excessively pungent and harshly drying in nature
• Excessive intake of meat
• Chronic indigestion
• Hot emotions, and anger can also play a role

• Pathway (Internal, external, middle): Middle and internal
• Kriyakala (Accumulation) (Sanchaya); Aggravation (Prakopa); Overflow (Prasara); Relocation (Sthyana Samsraya);
• Manifestation (Vyakti); Complications (Bheda): Manifestation
• Dosha gati (Direction): Downward Pitta, triyag vata, linear pitta
• Purvaroopa (Prodormal Signs and symptoms): Burning sensations, changes in vaginal secretions (creamy, smell), blood in urine.
• Roopa (Disease Manifest Signs and symptoms): UTI recurrent, thrush, depression

Prana, Tejas, Ojas:

• Tejo visramsa (pitta conditions, burning sensations)
• Tejo vruddhi (increased pitta, skin rashes)

Srotas (Annavaha) {Digestive}, Pranavaha {Respiratory}, Udakavaha {Fluid}, Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Sukravaha, Swedavaha, Purishsvaha, Mutravaha, Manovavaha, Arthavavaha {Menstruation}, Stanyavaha {Lactation}:

• Rakta vaha sroto dushti (skin rashes, pitta disorders)
• Artava vaha sroto dishti (leukorrhea)
• Mutra vaha sroto dushti (blood in urine, UTI, burning sensations while urination)

Dhatus (Rasa, Rakta, Mamsa, Meda, Asti, Majja, Shukra):

• Rasa vruddhi (low agni)
• Rakta vruddhi (skin conditions)
• Rakta dushti (skin conditions)
• Majja dushti (depression)
• Artava vrudhi (skin rashes, thrush)
• Mutra dhatu dushti (blood in urine, UTIs)

Sub dosha Kapha (Tarpaka, Bodhaka, Kledaka, Sleshaka, Avalambaka):

• Tarpaka kapha (depression)
• Kledaka kapha (mandagni)

Sub dosha Pitta (Sadhaka, Alochaka, Pachaka, Bhrajaka, Ranjaka):

• Packaka pitta (mandagni)
• Bhrajaka pitta (skin rashes)

Sub dosha Vata (Prana, Udana, Samana, Vyana, Apana):

• Prana Vayu (involved in all disease conditions to some extent)
• Apana vayu (thrush, UTI)

• Prakruthi: PV
• Vikruthi: P with Vata and Kapha also involved to some extent
• Agni: Mandagni

Physical Examination

Nadi Pariksha (Pulse Examination)

• PV

Mutra Pariksha (Examination of Urine)

• Recurrent UTIs
• Can have blood in urine

Mala Pariksha (Stool Examination)

• Normal

Jihwa Pariksha (Tongue Examination)

• Very slight coating

Shabda Pariksha (Voice Examination)

• Normal

Sparsha Pariksha (Touch Examination)

• Normal

Drik Pariksha (Eye Examination)

• NAD

Akrti Pariksha (Physical Appearance Examination)

• NAD

Akruti (volume and tension of pulse)

• PV

Social History

• Non-smoker
• 1 x month a drink
• No drugs

Family History

• Hypertension

Medications

• Vit D
• Iron
• Hair nutrition for women
• Canesten
• Alprim

Surgical History

• NIL

Past Medical History

• Kidney stones 5 years ago

History Of Presenting Complaints

• History of recurrent and ongoing UTI
• Thrush commenced since started sexual intercourse a few months ago
• Stressed and depressed
• Can see blood in the urine
• Low Iron
• Low Vit D

Background

24-year old female presenting for an initial consultation for thrush. She has just become sexually active over the last few months with the same partner. She has also had ongoing issues with an UTI. She was prescribed antibiotics, but she did not like the side effects. She has been to her GP and all relevant tests have been undertaken, including for STD’s. All have come back normal. Her GP can only put the condition down to friction during intercourse. She has been checked by a gynacologist twice and the specialist also cannot establish the cause. She has been using Canesten for some time for the thrush and Alprim for the UTI. When she is prescribed Trimethoprim, the UTI normally clears up for a while. She also suffers bleeding in the vagina from intercourse. He has also been medically checked, with nothing found/established from the results. She also finds that she can have blood in her urine at times. Her iron is low, her Vit. D is low, with full bloods done 6 months ago – which all came back within accepted ranges. She says that she is quite stressed and can suffers from depression. She sleeps well, does not suffer from constipation. Vaginal discharge is creamy.

Following Ayurvedic classical literature, UTIs have several etiologies. Various unhealthy food and lifestyle activities lead to the aggravation of Vata, Pitta, and Kapha in the body. The vitiated state of tridosha, along with mandagni, sets up the production of Ama (undigested food particle). Ama then mixes with dosha and becomes sama, which subsequently affects the mutra vaha srotas (urinary tract) and gives rise to mutrakrichhya.

Thrush: Aggravating diet and lifestyle lead to with Mandagni. This low digestive fire then leads to deficient and incomplete digestion of food, and formation of ama. Ama is then absorbed into the blood stream (amarasa), and redistributed to moist and viscous tissues of the body (intestinal tract, vagina, oral cavity, skin folds, etc.). In the small and large intestines, it will putrefy and ferment, thus inhibiting the growth of a healthy intestinal bacterial flora. In other extra-intestinal sites, it will disrupt tissue immunity, thus permitting candida overgrowth. Once the disease progresses to the point where dhatvagnis are disrupted and saptadhatu formation becomes defective, deficient ojas will occur – lack of vitality, immunity and multiple system dysfunction.

Ayurveda sees that there are different aspects to thrush depending on which dosha is involved.

Vata: Caused by an excess of pungent, butter and astringent foods, too much cold. Excessive travel, the supression of natural urges, excessive intercourse and irregular eating and sleeping habits.

Pitta: can be caused by an excess of pungent, uncooked, burning, sour and alkaline foods.

Kapha: can be caused by the intake of foods that are too heavy, oil and cold. In addition, overeating sleeping during the day.

Tridoshic: Can show all of the above symptoms.

UTI: A urinary tract infection is an infection in any part of the urinary system, including the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract, and involving the bladder and the urethra. Women are at greater risk of developing a UTI than men. Infections need to be treated quickly as serious consequences can occur if a UTI spreads to the kidneys. UTIs typically occur when bacteria enters the urinary tract via the urethra and multiply in the bladder.

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

• Kidneys (acute pyelonephritis): Back pain or side (flank) pain, High fever, Shaking and chills, Nausea, Vomiting
• Bladder (cystitis): Pelvic pressure; Lower abdomen discomfort, Frequent, painful urination, Blood in urine
• Urethra (urethritis): Burning with urination, Discharge

The most common UTIs occur mainly in women and affect the bladder and urethra.

• Infection of the bladder (cystitis).
• Sexual intercourse may lead to cystitis,
• Infection of the urethra (urethritis).

Risk factors include: Female anatomy, sexual activity, certain types of birth control, urinary tract abnormalities, blockages in urinary tract, suppressed immune system, catheter use, recent urinary procedure.

The first line of treatment for a UTI is antibiotics.

Thrush: Vaginal thrush is an infection caused though an overgrowth of the yeast Candida albicans. This yeast lives naturally in the bowel and in small numbers in the vagina. This overgrowth may occur due to recent antibiotic use, oral contraceptive use, pregnancy, menstrual cycle changes

general illnesses like diabetes, iron deficiency and immune system disorders, associated vulval skin conditions. Sometimes, the reason can’t be identified.

• Vaginal discomfort – itching or burning
• Thick, white discharge with a ‘cottage cheese’ appearance and yeasty smell
• Redness or swelling of the vagina/vulva
• Splits in genital skin
• Stinging or burning while urinating or during sex.

Treatment can include: antifungal creams and /or vaginal pessaries or oral medication.

Prescribed Herbs For This Client:

• Replens vaginal cream
• Triphala decoction – douche 1tsp triphala with 500ml water and boil for 5 minutes on low. Douche vaginal externally with decoction and wash with water after this.
• Revive_M 1 — 1
• Triphala 1 — 1
• NRG Biotic 1 — 1
• Dashamoola and punarnava decoction herbal mix. 15ml — 15ml

Also, client is to undertake pelvic floor exercises daily.

Continue also with:

• Vit D
• Iron supplement

Thrush:

• Vata Pitta Balancing: guduchi, tripahala, lodhra
• Vata Kapha Balancing: chitraka, trikatu, guduchi, tripahala, ashwaganda, vidanga, moringa
• Pitta Vata Balancing: guduchi, tripahala, lodhra,
• Pitta Kapha Balancing: kutki, musta, neem, guduchi, tripahala
• Kapha Vata Balancing: chitraka, trikatu, guduchi, tripahala, ashwaganda, vidanga, moringa
• Kapha Pitta Balancing: kutki, musta, neem, guduchi, tripahala

UTI:

• Vata Pitta Balancing: gokshura, guduchi, coriander, triphala, shatavari, punanarva, sandalwood
• Vata Kapha Balancing: gokshura, guduchi, coriander, triphala, ashwanganda, punanarva, sandalwood
• Pitta Vata Balancing: gokshura, guduchi, coriander, triphala, shatavari, punanarva, sandalwood
• Pitta Kapha Balancing: gokshura, guduchi, coriander, triphala, punanarva, sandalwood
• Kapha Vata Balancing: gokshura, guduchi, coriander, triphala, ashwaganda, punanarva, sandalwood
• Kapha Pitta Balancing: gokshura, guduchi, coriander, triphala, punanarva, sandalwood

Ayurvedic treatment approach for UTI:

This is achieved through a personalized regimen of diet and lifestyle modifications, herbal preparations and cleansing therapies in order to flush out infection with detoxification, cleaning out blockages of the urinary tract, along with herb that tone the kidneys and normalize the functioning of the Apana Vayu, and strengthen the immune system, and increase Agni.

• Cleansing therapies include (a) localised and include douching with medicated decoctions and (b) systemic (panchakarma detoxification).
• Herbal (orally ingested) medicines
• Diet and lifestyle modifications
• Avoiding causative factor
• Build Jataragni
• Rasayana

• Restore Agni
• Build up the immunity
• Use natural herbs and supplements to rebalance bacteria
• Detoxification
• Rasayana
• Diet and lifestyle modifications
• Avoid all causative factors

There are differences in Ayurvedic circles (practitioners and schools) as to what diet to eat with respect to thrush. As candida albicans are facultative anaerobes, they can utilize sugars via the alcoholic fermentation pathway to derive energy. Therefore, sugar—glucose, sucrose, fructose, maltose, dextrose—need to be avoided. This includes fruits. In addition, yeast-containing foods should be eliminated as well as fermented foods, cheese, mushrooms, and wheat. Ideally, a gluten-free diet is recommended.

For Vata thrush treatment: avoiding dairy, sugar, breads and mucus producing foods. Cold and raw foods need to be avoided, Drink lots of warm water throughout the day. Avoid concentrated fruits juice and have fruit in moderation. Use asafoetida, ginger, basil, fresh ginger and garlic to spice food. Drink a triphala decoction in the evening before bed.

For Pitta thrush treatment: Intake of green leafy vegetables, pomegranate, bitter herbs, and spices that tend not to aggravate pitta. Also, one should avoid sugar and concentrated fruit juices.

For Kapha thrush treatment: Avoid all mucus producing foods, and foods that are oily, greasy, salty or sweet. 1.2 tsp of trikatu can be taken along with warm water before aa meal.

• Client needs to be on a diet that minimises sugar intake. Therefore, sugar—glucose, sucrose, fructose, maltose, dextrose—need to be avoided. This includes fruits. In addition, yeast-containing foods should be eliminated as well as fermented foods, cheese, mushrooms, and wheat. Ideally, a gluten-free diet is recommended. Avoid starchy vegetables (potato, yams) and sugary vegetables (carrots, beets). All dark leafy vegetables are fine. Beans, legume, unprocessed seeds and nuts are OK (avoid peanuts and pistachios). Avoid milk as much as possible, instead use nut or soy milk. Small amounts of goat milk are OK. Chicken and egg whites are OK. Cranberry and pomegranate juice is also beneficial to have one glass per day.
• Drink buttermilk after each meal.
• Avoid fermented foods, mushrooms, yeasted breads, carbonated drinks, alcohol as well.
• Spices to use include dill, lemongrass, turmeric, cumin, cardamon, cinnamon, fresh ginger.
• In general, you need to eat on time, keep eating healthy food, eat warm food, wholefoods, cooked food, steamed veggies, boiled eggs or whites, soaked almonds, soaked walnuts. Keep aggravating spices to a minimum and do not over-spice meals. Keep food combinations and preparation methods simple and nutritious.
• Use small amounts of ghee in cooking.
• Upon waking: Drink a glass of warm water with 15ml of pure aloe vera juice.
• (Allow 6 hours between meals and snack 3 hours after a meal, and only if hungry).
• Avid: Cold foods, raw foods, leftover foods (24 hours), frozen foods, cold water, processed and packaged foods, soft drinks, alcohol, coffee, wine, high fat foods, greasy foods, potatoes. No rice, no wheat, No sugar. No milk.
• Water Intake: Drink 2-3 litres warm water during the day. This will also help to keep system clear of toxins and allow for flushing of bacteria.
• Use all of the five senses at mealtimes. Create a ritual of eating to bring back the sacredness of eating. Stop eating when ¾ full.
• Eat in a pleasant environment. Eat seated. No TV, no electronic devices.
• Eat slowly, eat with respect/reverence for what you are eating, chew thoroughly. Savour the food. This helps prevent overeating and helps to retrain the brains wrings in relationship to food.
• Avoid excess eating (emotional eating), eating during indigestion and eating while previous meal is being digested.

• Wipe bottom from front to back after going to the toilet.
• Avoid using soap to wash the genital area.
• Empty the bladder after intercourse.
• Avoid using chemical antiseptics, douches or perfumed sprays in the genital area, and use sanitary pads over tampons.
• Avoid using perfumed toilet papers and menstrual products. Also, use unperfumed and natural laundry products, and avoid chemical or perfumes feminine products.
• Wear loose fitting clothing of natural fibres that allow the area to breathe. This includes underwear.
• Diaphragms, or unlubricated or spermicide-treated condoms, can contribute to bacterial growth.
• Regular daily routines are essential – and stick to them.
• Daily exercise is important (yoga, gym, swimming, walking, tai chi etc.). At least 30 minutes of walking a day is essential.
• With work and family life, stress is a part of your life. Therefore, it is important to learn better skills and tools to be able to build more resilience to stress. You may wish to see a holistic counsellor or life coach to help you learn stress and anxiety management techniques for daily life. This may also be beneficial with the depressive tendencies.
• Look at introducing meditation into your daily lifestyle to help combat stress.
• Make sure to be in bed by 10pm and get sufficient sleep and wake at a regular hour.
• Avoid all allergens and immune weakening products.
• Take a warm water bath (if needed to reduce pain) with Epsom sales or baking soda.

Review: 2 weeks

Note: It is always advised to continue any and all prescribed conventional medicine as advised by one’s healthcare practitioner. Should one use Ayurvedic herbs alongside conventional medicines, be sure to consult with your GP and/or medical specialist and your qualified Ayurvedic practitioner about any possible drug interactions and potential side effects.