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Jesal Parikh

TSY 300-hour TT
March 2014

Yoga for the Treatment of Psoriasis


Defining Psoriasis

According to the National Psoriasis Foundation, Psoriasis is a


chronic, noncontagious autoimmune disease that appears on the skin. It
occurs when the immune system sends out faulty signals that speed up the
growth cycle of skin cells.[1] This process of rapid skin cell reproduction
eventually manifests on the surface of the skin in one or more of five
uncomfortable and sometimes debilitating forms: plaque psoriasis, guttate
psoriasis, inverse psoriasis, pustular psoriasis and erythrodermic psoriasis.[2]
Furthermore, each case of psoriasis can be also classified as mild (affecting
less than 3% of the body), moderate (affecting 3%-10% of the body) or
severe (affecting more than 10% of the body).[3]

Psoriasis is estimated to afflict as many as 7.5 million people in the


United States and 125 million people worldwide.[1] While onset of this
disorder is common between ages 15 and 35, psoriasis can develop at any
age.[1] Neither race nor gender seem to be risk factors and although genetics
plays a part, the cause of onset is yet to be determined. Treatments of the
condition are usually aimed at the processes of the skin and/or the immune
system.[4] Psoriasis is generally considered by the medical community to be a
life-long condition with no cure.

Symptoms

Though itching, burning sensations and discomfort are often associated


with all types of psoriasis, each of the different types manifest on the skin in
unique ways.

Plaque Psoriasis (psoriasis vulgaris): It is characterized by raised,


inflamed, red lesions covered by a silvery white scale. It is typically
found on the elbows, knees, scalp and lower back.[5] It affects the
majority of psoriasis patients (about 80%).[5]
Guttate Psoriasis: A form of psoriasis where small, red drops or
spots appear on the skin, often on the trunk and limbs.[2, 5-7]
Inverse Psoriasis: Appears as smooth, shiny, bright-red patches of
skin that occurs where skin touches skin (skin folds) and can
sometimes make the skin appear raw.[2, 5,6]
Pustular Psoriasis: Develops as white-pus filled bumps (non-
infectious) surrounded by red, inflamed skin.[2, 5-7]
Erythordermic Psoriasis: Is a form of the condition where most or all
of the skin becomes severely inflamed and red. It can be extremely
painful and itchy and even potentially life-threatening.[2, 5,6]

Psoriasis can develop on virtually any part of the skin. Some of the most
uncomfortable and debilitating locations psoriasis can occur include: under
the nails, on the genitals, on the face, on the hands and feet, and on the scalp.

Triggers

As previously indicated, no one knows the exact cause of psoriasis.


However, a genetic component is associated with onset of the condition. The
National Psoriasis Foundation claims:

Scientists believe that at least 10 percent of the general population


inherits one or more of the genes that create a predisposition to
psoriasis. However, only 2 percent to 3 percent of the population
develops the disease. Researchers believe that for a person to develop
psoriasis, the individual must have a combination of the genes that
cause psoriasis and be exposed to specific external factors known as
triggers.[8]

Some of the known triggers include stress, strep throat and upper
respiratory infections (especially in the case of guttate psoriasis), injuries to
the skin (known as the Koebner Phenomenon), specific medications (lithium,
antimalarials, Inderal, quinidine, Indomethacine) and cold, dry weather.[8-10]

Among those who are involved with psoriasis, some believe that psoriasis is
strongly linked to diet and allergies but these links are not yet conclusively
proven.[7,8]

Current Medical Approach to Therapy

The current medical approach to psoriasis is that it cannot be cured,


but rather, it can be managed through the use of various therapies. These
therapies are comprised of four main categories: topical treatments,
phototherapy, systemic medications and alternative treatments.[7,11,12]

Topical Treatments

Some topical treatments are aimed at soothing the skin and reducing the
dryness associated with the condition. These treatments include the use of
Epsom salts baths, mineral oil and other moisturizers. [7,12] Further
treatments include:

Salicylic Acid: Promotes smoothing of skin by helping the scales to


shed. Prolonged use of this treatment can lead to skin irritation and
hair loss. The effectiveness of this treatment is considered modest at
best.[11,12]
Steroid-based Creams: Steroid creams decrease inflammation,
relieve itching, and block the production of cells that are
overproduced in psoriasis. Stronger preparations, which are more
effective than milder ones, can cause side effects that include burning,
dryness, irritation, and thinning of the skin.[13]
Calcipotriene Ointment: A vitamin D3 analogue containing ointment.
The exact mechanism of action is unknown but it is believed to be
related to the immune system, specifically T cell receptors.[7,11-14]
Dithranol: A synthetic compound that slows cell reproduction and is
therefore used on lesions to slow the formation of scales. It may cause
burning and itching and this treatment also temporarily stains the
skin yellow-brown (it permanently stains clothing).[11,15,16]
Coal-tar Ointments and Shampoos: These products also help to slow
cell growth, however the side effects include folliculitis a pimple-
like rash affecting the hair follicles.[11,12,13]
Topical Retinoids: Retinoids are Vitamin A derivatives that also help
normalize skin cell reproduction and reduce inflammation. Side
effects include dryness, skin irritation and sensitivity to sunlight.
[11,12,13]

Phototherapy

Also known as light therapy, this treatment usually involves exposure


to UVA light (PUVA therapy), which has a positive effect on the immune
system while also initiating other mechanisms of actions. PUVA therapy can
be effective but is shown to increase a patients risk of developing melanoma.
Therefore, doctors are increasingly prescribing a more targeted UVB light
box therapy, which is shown to be almost as effective but can cause more
severe/longer lasting burns. Exposure to natural sunlight has also been
shown to help alleviate the symptoms of psoriasis.[7,11,12,13,17]

Systemic Medications

When patients are resistant to topical or photo- therapies, they may


be prescribed oral or injectable medications with internal mechanisms of
action. These therapies usually interrupt immune system activities. Though
these therapies can be effective, they can also be toxic to the system. Patients
who see results with these therapies often see a recurrence (usually more
severe) once the treatment is discontinued. [7,11,12,18] There are four major
types of systemic medications:

Oral Retinoids: An oral form of synthetic Vitamin A. The exact


mechanism of action is unknown. Oral retinoids, though effective, can
also have a laundry list of side effects including dryness (skin, eyes,
feet, lips, dry mouth, etc.), hair loss, nose bleeds, bleeding gums, joint
pain, headaches, depression, aggressive/self-destructive thoughts and
many more.[7,11,19]
Methotrexate: An immunosuppressant drug that is also used to treat
cancer. Side effects can include nausea, headaches, hair loss, skin
pigmentation, liver damage and reduced white blood cell
count.[11,20,21]
Cyclosporine: Another immunosuppressant drug that interferes with
T cell activity. Potential side effects include decreased kidney function,
headaches, high blood pressure, high cholesterol, excessive hair
growth, flu symptoms, upset stomach, join or muscle pain and many
more.[11,22]
Biologics: Protein-based drugs that are given either intravenously or
by injection. Biologics are also targeted at suppressing the immune
system but they do so by targeting specific proteins and cells (T cells)
rather than involving the entire immune system. These proteins are
thought to be the major players in causing the inflammation
associated with psoriasis. Potential side effects of biologics include
respiratory infections, flu-like symptoms and injection site reactions.
Rare side effects include serious nervous system disorders, blood
disorders, inflammation of nerves in the eye and cancer.[7,11,23]

An Alternative Approach

The traditional medical attitude towards the role of alternative


medicine in the treatment of psoriasis has been quite dismissive.[12] Though
many patients suspect and some studies confirm the role of diet, exercise and
lifestyle, no substantial research has been done to produce conclusive
evidence.[24,25,26,27] The medical website WebMD purports:

Diet therapies are of almost no benefit in the treatment of


psoriasis. Starvation has been shown to be associated with fewer
symptoms, but this is hardly practical. While natural remedies may
play a role in psoriasis treatment, it's important to know that they,
too, can have risks.[12]

It might be important to note that, at least in part, WebMD is financed


by advertising, third-party contributions and sponsorships. [28,29] Until
further research on the role of diet and lifestyle is done, alternative theories
will remain inconclusive. Yet that does not mean there is no merit to these
ideas. Preliminary studies as well as anecdotal evidence support the notion
that alternative therapies, including yoga, can significantly improve the
symptoms of psoriasis.[24,25,26,27,30,31,32]

Yoga and the Leaky Gut Syndrome

In this physical body, the various organs and systems all have their
own functions to carry out, but there should be coordination between
them. If any of the organs or systems of the body are not able to
coordinate with each other, it means that not one but all systems and
organs are unbalanced. Thus, in any sickness, whether physical or
mental, every system is out of coordination.[33]

- Swami Mutkibodhananda, Hatha Yoga Pradipika

According to Yoga, the systems of the body are interrelated and a


disease in one area of the body cannot be seen in isolation. Skin diseases like
psoriasis are generally considered an effect of toxicity throughout the entire
body and the entire body must be detoxified in order to correct any
imbalances leading to psoriasis.[31] The modern-day theory that psoriasis is
rooted in a leaky gut syndrome, directly aligns itself with this type of yogic
and thinking.
Leaky gut syndrome is controversial condition in which it is thought
that mucosal lining of the gut lack integrity, rendering a portion of the
intestines hyperpermeable.[34,35,36,37,38,39] It is believed by some that this
increased permeability allows toxins (from food, parasites, infection,
medication, etc.) that would normally be eliminated by the body to be
reabsorbed. These out-of-place waste materials enter the blood stream
through the lymphatic system, triggering all sorts of responses in the body.
To deal with these toxins, many of the other systems in the body then try to
take on the job of elimination. 36,37,38,39,40] The liver and kidneys take on some
of this role through their normal function of purifying the blood stream, but
the immune system is also triggered by these toxins (approximately 70% of
the immune system is located in and around the digestive system).[41] Part of
the immune response is to signal the skin (the bodys largest organ) to take
over the job of elimination.[38] Given what we know about how psoriatic skin
cells function that is to say overly rapid skin cell reproduction - we may be
able to deduce that the skin attempts to rid the body of these substances by
absorbing them into the newly forming skin cells and then rapidly reproduce
more skin cells until these toxic skin cells can come to the surface to fall
away from the body. Whether or not this is the exact process in which
psoriasis occurs, we can conclude that the skins interaction with the waste
material interferes with normal skin functioning, eventually producing
lesions on the surface layer of the skin.[7,38]

In the words of John O.A. Pagano, D.C., the author of Healing


Psoriasis: The Natural Alternative,

The skin is not ordinarily designed to remove waste matter to any


great extent, but, due to the toxic overload produced by a leaky gut, it
acts as a backup system and takes on the task of removing toxins
thus the rash, irritation, and lesions.[38]

To rid the skin of psoriasis, the modern holistic view and the
yogic/ayurvedic* views are much the same: the entire body must be cleansed
with emphasis on cleansing and then regulating the digestive system. The
initial cleansing will help to immediately alleviate the toxin toll on the body
and let the organs resume normal functioning. Once balance is restored to
the entire body, the attention can shift to maintaining that balance. The
following sections take a look at determining which yoga and ayurveda
practices are helpful to cleaning the body and keeping psoriasis at bay for the
long-term.

*Yoga and ayurveda are sister systems of understanding the body, both
stemming from the Vedas.[42]

Kriyas

The Hatha Yoga Pradipika and the Gheranda Samhita are two
foundational texts that form the basis of modern-day yoga. In his version of
the Hatha Yoga Pradipika, Swami Muktibodhananda combines the
information from both texts to give a more in-depth explanation of the
practices described in the Hatha Yoga Pradipika. Together the two texts
outline a system of purification practices (kriyas) for almost all diseases in
the body. These practices are designed to purify the doshas, or constitutional
humors of the body.[43] According to the systems of yoga and ayurveda, the
imbalance of these doshas is the root cause of most illnesses. [33] In order to
correct these imbalances, The Hatha Yoga Pradipika outlines a system of six
practices known collectively as shatkarma. Individually, there are: dhauti
(internal cleansing), basti (yogic enema), neti (nasal cleansing), trataka
(concentrated gazing), nauli (abdominal massaging) and kapalabhati (frontal
brain cleansing breath).[33] Some of these practices overlap with the
ayurvedic system of five practices known as panchakarma, which will be
referred to in-depth at the end of the section.[44] Each kriya, whether it is
described as part of shatkarma or panchakarma may have several
contraindications and/or may require pre- or post- procedural care.
Therefore, neither shatkarma nor panchakarma should be practiced without
the guidance of a guru, experienced practitioner or medical professional who
is qualified to prescribe and oversee these practices.
The first practice of shatkarma is dauti. Dhauti consists of the
practices of cleansing the body internally. There are four subcategories of
dhauti: antar dhauti (internal cleansing mainly dealing with the digestive
system), danta dhauti (teeth cleansing), hrid dhauti (cardiac/chest cleansing)
and moola shodhana (rectal cleansing). Each of these categories, in turn,
describes several practices utilizing different tools for cleansing.[33]
Anatar dhauti, for example, consists of vatsara dhatui swallowing air
into the stomach and passing it through the large intestine, varisara dhauti
(shankhaprakshalana) drinking up to sixteen glasses of salty water and
passing it through the digestive system, vahnisara dhauti pushing the
abdomen in and out rapidly, and bahiskrita dahuti standing navel-deep in
clean water, pushing the rectum out of the body and cleaning it physically
with the hands.[33] Among the practices of antar dhauti, varisara dhauti is
considered the easiest and least advanced practice. While varisara dhauti
must still be practiced under the guidance of an experienced practitioner, it is
the most accessible practice to the average, healthy person.
Danta dhauti generally refers to the cleaning of teeth with a stick of
neem or babool. Other types of danta dhauti include jihva dhauti cleaning
the tongue by rubbing it the first finger and thumb joined together in a circle,
karna dhauti cleaning the ears with the middle finger, kapalrandhra dhauti
cleaning the forehead and face, and chakshu dhauti bathing the eyes with
lukewarm saline water.[33, 45-47] All of these practices are simple and many
can even be replaced by modern day practices such as tooth brushing, using a
tongue scraper, and cleaning the ears with a cotton swab.[46] The other
practices can be learned by anyone and all of them can be practiced regularly.
Hrid dhauti consists of danda dhauti inserting a stick (soft banana
stem, turmeric root, sugarcane stick or catheter) into the stomach to clean
the esophagus, vaman dhauti induced vomiting aimed at cleaning out the
stomach, and vastra dhauti swallowing a long, sanitized piece of cloth
followed by practicing nauli (abdominal exercises).[33] The most basic among
these three practices is vaman dhauti.
Lastly, mool shodhana involves inserting a clean middle finger or a
turmeric root into the rectum and rotating both clockwise and anti-
clockwise.[33]
Dhauti practices are used to clean the digestive and respiratory tracts.
They remove toxic waste that has built up in the body, including but not
limited to old bile, mucus buildup, infectious bacteria, excess fatty tissue,
fecal buildup, flatulence, etc. Dhauti helps to restore the bodys optimal
chemical balance, stimulate healing, and regulate digestion. Each practice of
dhauti has its own contraindication and should only be practiced if
prescribed by a qualified expert.[33]
The second practice of shatkarma is basti. Basti is the practice of yogic
enema. There are two main variations of basti: jala basti (with liquid) and
sthala basti (dry, with air). Jala basti is the easier and more common of the
two variations. Traditionally, jala basti was performed by squatting in a river
and using a bamboo tube. These practices are no longer practical for the
most part, and rather, a recommended method is to insert a gently lubricated
catheter or plastic tubing part way up the anus while one squats over a
bucket of water (or sometimes medicated oil) in which rests the other end of
the catheter. By performing uddiyana bandha (abdominal retraction lock)
and/or madhyama nauli (central abdominal contraction) the water should be
sucked up the tube into the anus. The breath should be held in and when it
cannot be held any longer, the tube should be removed and exhalation should
occur while one sits on a toilet. The contents of the anus should be expelled
during this time. After the practice, pashinee mudra, savasana and
bhujangasana should be performed to expel any remaining water and air.
Sthala basti is performed with the practitioner laying on their back and
sucking in air into the rectum.
Basti cleanses the bowel to remove unsuitable or excess bacteria, old
stool, threadworms, and excessive heat from the lower intestines. It cures
digestive disorders, relieves constipation, stimulates sluggish digestion and
strengthens the solar plexus. Basti also has a positive effect on ones
emotional state. Because of the advanced nature of basti, many practitioners
will use and enema kit to assist in the performance of jala basti.[33,48,49]
Neti is the practice of nasal cleansing. There are two types of neti: jala
neti and sutra neti. Jala neti is the practice of streaming warm saline water
through the nasal passage with the use of a special pot. The spout of the pot
is held up to the right nostril while the practitioner tilts his or her head to left
breathing through the mouth, and the saline water flows up and out the left
nostril. The practitioner then brings their head back up to center, closes off
the left nostril and gently blows out any remaining water. This is then
repeated on the other side. While the use of saline water is standard practice,
warm milk or warm ghee (clarified butter)/oil can also be used. These
practices are called dugdha neti and ghrita neti, respectively.[33] Sutra neti is
the practice of using a special cotton thread or a rubber catheter to cleanse
the nasal passages. In this practice, the head is tilted slightly back while the
thread or catheter is gently pushed up the right nostril until it can be felt in
the back of the throat. The practitioner then puts his first two fingers into the
back of the throat to pull the thread through the mouth. It is recommended
that the string be pulled back and forth through the nostril and mouth,
however this is not necessary. Finally the string is pulled completely out
through the mouth. This is repeated for the left nostril. To aid in this process,
the thread or catheter can be either dipped in saline water or coated gently in
ghee. It is recommended that sutra neti follow jala neti, and that both are
followed by pranayama to completely dry the nasal passage.[33]
The neti practices are said to create resistance to certain diseases of
the eyes, ears, nose and throat. These include but are not limited to myopia,
eyestrain, glue ear, middle ear infections, nasal polyps, and inflammation of
the adenoids. Neti is also said to increase memory, concentration, creativity,
intuition and youthfulness of complexion and it is said to be beneficial for
those suffering from anxiety, depression, epilepsy and hysteria. But most
importantly to the psoriatic, neti is said to bring balance to the entire central
nervous system as well as to the systems governing respiratory, circulatory,
digestive and excretory functions.[33]
Trataka is the fourth practice of shatkarma. It is the practice of
concentrated gazing. There are two varieties of trataka, the simplest of which
is known as bahiranga trataka or external gazing. The practice involves
steadfastly gazing at an external object with full concentration, clearing the
mind of any other thoughts, for at least 5 to 10 minutes while blinking as
little as possible. While any object or symbol can be used, the easiest and
most common is a candle flame (one that is steady and not disturbed by
drafts, movements, etc.) because it lends itself to the goal of the practice: an
internalization of the image so that one can practice antaranga trataka or
internal gazing. In this second practice, the practitioner focuses on a clear
and stable internal visualization with closed eyes.[33]
Trataka is beneficial not only to the eyes, but also to psychological and
mental functions. It is useful in the treatment of depression and anxiety
something psoriasis patients can be overcome by. Trataka is a powerful tool
in a spiritual sense because it is said to cause the brain to withdraw from
external stimuli while keeping awareness alert. Over time, this translates into
a spiritual awakening that can give one the feeling of a connection to a
higher spirit.[33] From the psoriatics point-of-view, a spiritual connection can
be beneficial in overcoming anxiety and depression as mentioned previously,
but also in ridding the mind of negative thoughts and emotions: an effect that
can have proven repercussions on the physical body, especially in the case of
psoriasis.[38, 50-53]
The next practice of shatkarma is nauli, or abdominal massaging. It
can more accurately be described as the art of abdominal muscle isolation,
namely the rectus abdominis with the help of the external oblique and
traverse abdominis. Nauli can be practiced in two variations: muscles
contracted in a circular pattern (vama nauli is clockwise in motion while
dakshina nauli is counterclockwise in motion) and central abdominal
contraction. The circular version of nauli is typically mastered before moving
onto central abdominal contraction. The action of abdominal muscle isolation
in this manner gives a massage to the central internal organs. In turn, the
massage of the organs gives rise to many benefits: it stimulates digestion;
tones the abdominal muscles, nerves, intestines, reproductive, excretory and
urinary organs; generates energy, especially in the digestive and excretory
systems; generates heat in the body; balances the endocrine system,
balancing hormones and mood; and can help to strengthen ones
willpower.[33] These benefits are especially relevant to a psoriatic who is:
experiencing constipation or malabsorpbtion due to leaky gut syndrome,
having trouble losing extra weight, having negative thoughts or associated
depression, dealing with a weakened immune response and/or experiencing
lack or willpower or a feeling of helplessness.
The final practice of shatkarma is kapalabhati. Kapalabhati is a
practice of forceful exhalation and passive inhalation. It is performed while
sitting in a comfortable position with the spine erect. The abdominal muscles
are then contracted into the body to exhale the lungs completely. Inhalation
is a result of the exhalation and occurs spontaneously and passively.[33] It is
advised to begin the practice of kapalabhati by exhaling one breath per
second for 10 breaths. This can gradually be increased to two breaths per
second and the amount of breaths can be increased by 10 until eventually
120 breaths are reached in one sitting. If any dizziness occurs, the practice
should be stopped and then resumed with more awareness and less
exertion.[54]
Kapalabhati cleanses the respiratory system, nasal passages, and rids
the body of a greater amount of gaseous toxins (carbon dioxide along with
methanol, acetone, ethanol, other alcohols, ketones, and some hydrocarbons
to name a few). [33,54, 55] It allows the tissues and cells absorb a greater
amount of oxygen. It massages the internal organs and helps to relieve
constipation. It also helps to increase metabolic rate and regulate weight
imbalances. [55] All of these benefits are relevant to a patient of psoriasis who
is experiencing greater toxicity in the body.

It is worth mentioning that ayurveda, the sister science of yoga, also


recommends clearing the system of toxins (knowns as ama) as the first step
towards ridding the body of psoriasis. [42] Similar to shatkarma in yoga,
panchakarma is a system of five categories of cleansing practices. These
include vamana, virechana, basti, nasya, and raktamokshana.[44,56-58]
Many of these are extremely similar to yoga shatkarmas. For example,
vamana is a similar if not the same practice as vaman dhauti described
earlier.[58,59] Nasya is similar to jala neti in that they both clear the sinuses.
However, instead of letting liquid flow in one nostril and out the other, nasya
involves administering small quantities of warm, medicated oil or medical
powders into the nasal passage by way of cotton swab, finger or dropper, and
letting it absorb into the sinuses. Additionally, nasya can be preceded by
oleation and sweating and followed by massage of the head, neck and
shoulders.[60-62] In ayurveda, basti (also called vasthi) is similar to jala basti in
yoga, however, medicated oils are often used in place of water or a second
basti is performed: the first with oil and the second with tea and oil.[48, 49,63,64]
The reasoning for this is that, while basti can be used to clean out the bowels,
it can also serve to administer medication in a more efficacious way (faster
onset, more potency, etc.) versus oral administration of medication.[49,64]
Virechana and raktamokshana, while not the same as the practices of
shatkarma, are worth mentioning as practices than can benefit patients of
psoriasis.[32,66-69] Virechana is the ayurvedic form of medical purgation, or
cleansing the entire gastrointestinal tract with the use of oral, herbal
medication. Virechana helps to increase digestive powers, cleanse the blood
of toxins, clear the sweat glands, the kidneys, the stomach, the small
intestines, the liver and the spleen.[70] Virechana, in its pure ayurvedic form,
should only be practiced three days after vamana and under the guidance of
an ayurvedic specialist who can determine whether the practice should be
done in conjunction with internal oleation, external oleation, steam bathing
or should not be done due to contraindications.[71] The frequency of the
practice and determination of which herbal medications should be used
should also be prescribed by a specialist. Typically, a very light diet should be
assumed during the practice of virechana.
Raktamokshana is the practice of blood letting that is often indicated
for those with skin diseases.[67,72,73] It can be performed with sterile surgical
instruments or it can be done with the help of leeches, deer horn or
cupping.[72,73] In a clinical trial for eczema (related condition to psoriasis), the
use of leeches was found to be more effective than the use of surgical
instruments (syringe).[67] Raktamokshana should always be done by a
qualified ayurvedic specialist and no more than 10-40 mL of blood should be
removed at one time.[72]
While all of the practices of shatkarma and panchakarma are relevant
and beneficial for patients of psoriasis, it cannot be emphasized enough that
each practice has its own contraindications (ex. pregnancy, heart conditions,
high blood pressure, etc.) and should only be practiced with the prescription
of, and under the supervision of an experienced yoga practitioner along with
the permission of a medical health professional.

Though not traditionally referenced or understood through the lens of


yoga or ayurveda, many of the practices recommended by John O. A. Pagano
in his book are extremely similar to the practices of shatkarma and
panchakarma. While in yoga, the practices of shatkarma should be overseen
by a guru with experience, and in ayurveda the practices of panchakarma
should be performed by an experienced practitioner, the holistic practices
outlined by John O.A. Pagano represent a combination of the yogic and
ayurvedic practices, modernized so that they can be practiced by a patient in-
home, as long as a physician is consulted beforehand and periodically
throughout the process. Therefore, it is worth mentioning these practices as
they may be viewed as the modern-day parallels to their ancient
counterparts.
Similar to the concept of virechana in ayurveda, Pagano recommends
the use of natural purgatives. However, unlike a short-term regime
recommended in ayurveda, Pagano recommends incorporating at least one
form of cathartic into a psoriatics every day routine. Firstly he recommends
incorporating foods like raw fruits and vegetables, stewed fruits (which are
high in fiber), seedy fruits (which stimulate bowel movements), and foods
high in Vitamin B (which also helps with stimulating the bowel) into a
patients everyday diet.[38]
Other cathartics that are recommended include
Senekot from the senna leaf (in tea, pill, or granular form)
Fletchers Castoria combined with syrup made from California figs
Castor oil, taken with orange or apple juice if necessary
Pysillium husks
Milk of magnesia
Eno salts not suitable for diabetics
Olive oil not suitable for those with a gallbladder condition
Lecithen
Suflax tri-salts (a combination of sulfur, cream of tartar and Rochelle
salts) to be used under direction of a doctor or osteopath
Pagano recommends alternating cathartics for best results and to avoid any
chance of over-reliance on any one method. However, he states that daily
bowel movement is of the utmost importance to clear out toxins from the
body in the case of psoriasis.[38]
While in ayurveda, steam bathing and oleation are considered
preparatory practices for virechana, vamana, etc., Pagano refers to them as a
separate practices.[38,44,56] Steam bathing is recommended as often as
possible, especially in severe cases of psoriasis, where he recommends
investing in a steam cabinet for use at home. The steam opens up the pores of
the skin, allowing a greater flow of toxins through the sweat glands out of the
body. If a patient is able to purchase a steam cabinet for home use, he
recommends filling the reservoir with one tablespoon of witch hazel mixed
with a half pint of water. Whether one steams at home or in a public steam
bath, he recommends drinking plenty of water, drinking a cup of American
saffron tea thirty minutes to an hour before steaming, having a glass of water
with a pinch of salt both before and after the steam bath and drinking one to
two glasses of water during the steam. He also recommends eating foods rich
in potassium and calcium before steaming to prevent excessive mineral loss.
The period of steam bathing should be between fifteen and thirty-five
minutes, depending on each individuals steam tolerance. Afterwards, it is
advised to shower with plain, warm water and to avoid using soap. Pagano
cautions that an assistant should always be on hand to watch the reaction
and be prepared to administer assistance if necessary. Cool towels and water
should be kept nearby. Those with heart problems, high blood pressure,
cardiovascular issues, extreme sensitivity and other questionable systemic
conditions should avoid this practice. It is advisable to practice steam bathing
only after consulting a doctor.[38]
According to Pagano, Epsom salt baths (or Dead Sea salt baths) have a
similar, if not more effective, therapeutic effect. As mentioned previously, the
benefits of Epsom salt baths include aiding in the removal of toxin through
the body, relieving constipation, reducing inflammation and improving
circulation in the body. [7,12,38,74,75] For each bath, he recommends using four
pounds of Epsom salts (or a cup and a half of Dead Sea salts). He advises
taking these baths at least twice a week until symptoms are relieved for
twenty to thirty minutes, reheating the water so the temperature remains
106 to 108 degrees Fahrenheit (if tolerable to the patient). Just like with
steam bathing, he insists that the patient have an assistant on hand in case of
dizziness or other adverse effects. Patients with heart or blood pressure
problems, cracked or extremely sensitive skin, or without an assistant
(especially in the case of geriatrics or severe arthritis), should not take
Epsom baths.[38]
Much like with the practices of ayurveda, Epsom salt baths should be
followed by oleation. Additionally, he advises that external oleation be done
daily as well. While ghee and sesame oil are typically used in ayurveda,
Pagano recommends an equal mix of olive oil and peanut oil. In the case of
peanut allergies, pure, organic coconut oil can be used instead. In cases of
very thick scales, castor oil can be used, though this is not recommended for
the scalp, as it is difficult to remove.[38]
Another overlap between the practices indicated in yoga/ayurveda
and the suggestions listed in Paganos book are the recommendation to clear
out the intestines through irrigations. While in yoga and in ayurveda this
practice is called basti, Pagano refers to high colonic irrigation and enemas. A
regimen of high colonic irrigations are recommended toward the beginning
of the cleansing process and periodically throughout as they clean up to five
feet of intestine. However, high colonics can be prohibitive as they are costly,
require an experienced and qualified technician and have more
contraindications than an enema. Therefore, Pagano also outlines a regimen
of enemas that can be done by a psoriatic at home without supervision (as
long as a physician has cleared the individual for such a practice ahead of
time).[38]
There are two more areas where Paganos recommendations for a
psoriasis patient overlap with those of yoga. While he calls them exercise and
right thinking, in yoga they are referred to as asana and meditation. The
corresponding sections below will address each of these.

Asanas

With regards to exercise, John O.A. Pagano writes, It stimulates the


internal structures of the body, increases circulation, activates the glands,
oxygenates the blood, opens the pores, pumps the lymphs and filters the
blood through the liver and kidneys.[38] He further goes on to say that
stretching in particulars aids the body in eliminating waste matter more
effectively.[38] In there respective books, Yoga: The Path to Holistic Health
and Dr. Yoga: A Complete Program for Discovering the Head-to-Toe Health
Benefits of Yoga, yoga master B.K.S. Iyengar and hatha yoga cardiac
therapist Nirmala Heriza explain which yoga poses or asanas can optimally
provide each of those benefits and more. Below is a list of asanas that could
be propitious for a psoriactic* based their ability to aid in waste elimination
and address the other issues plaguing those suffering from psoriasis.
Trikonasana (Triangle Pose): Relieves gastritis, indigestion, acidity,
and flatulence.[76]
Utthita Parsvakonasana (Extended Side Angle): Improves digestion
and helps with the elimination of waste.[76]
Parsvottanasana (Pyramid Pose): Improves digestion, and tones the
liver and spleen.[76]
Uttanasana (Forward Fold): Tones the liver, kidney and spleen.[76]
Virabhadrasana I (Warrior 1): Relieves acidity and improves
digestion.[76]
Baddha Konasana (Bound Angle Pose): Keeps the kidneys healthy.[76]
Trianga Mukhaikapada Paschimottanasana (Three Limbed Forward
Bend): Assists in digestion, counters the effects of excess bile
secretion, and reduces constipation.[76]
Paschimottanasana (Seated Forward Fold): Tones the kidneys,
bladder and pancreas; activates a sluggish liver; improves the
digestive system; and regulates the supply of blood to the endocrine
glands, activating the adrenal glands and relaxing the thyroid
gland.[76] Also, stimulates and massages pelvic floor.[77] When
performed restoratively with props, the pose cools the temperature of
the skin.[76]
Marichyasana (Posed dedicated to Sage Marichi): Improves the
functioning of the liver, spleen, pancreas, kidneys and intestines.[76]
Sirsasana (Headstand): When practiced along with shoulder stand, it
brings relief from digestive and eliminatory problems.[76]
Salamba Sarvangasana (Shoulderstand): Improves bowel movements,
relieves colitis, stimulates the thyroid and thymus glands, stabilizes
the metabolism, reduces abdominal fat, enhances circulation of the
entire lymph system, increases blood supply to pancreas, liver and
spleen, draws blood into the abdominal plexus, helping to promote
digestion, and balances sympathetic and parasympathetic nervous
systems.[76.77]
Supta Virasana (Reclining Heros Pose): Aids digestion after a heavy
meal. Soothes acidity and stomach ulcers.[76]
Ardha Chandrasana (Half Moon Pose): Relieves gastritis and
acidity.[76]
Prasarita Padottanasana (Wide-Legged Standing Forward Fold):
Reduces depression and boosts confidence, energies the heart and
lungs, tones the abdominal organs, and neutralizes acidity in the
stomach.[76]
Adho Mukha Svanasana (Downward Dog): Relieves chronic
constipation, indigestion, and excess bile formation.[76]
Dandasana (Staff Pose): Improves digestion and tones kidneys.[76]
Navasana (Boat Pose): Relieves indigestion and flatulence, increases
metabolic rate, tones kidneys and abdomen muscles, and improves
circulation to the abdomen.[76]
Bhujangasana (Cobra Pose): Stimulates thyroid gland, gently
massages the abdomen (especially the kidneys and adrenal glands)
relieves constipation, improves circulation, improves oxygenation of
lungs, and stimulates thymus gland to aid in strengthening immune
system. [77]
Salabhasana (Locust Pose): Provides therapeutic massage to digestive
system, promoting elimination and preventing constipation. Promotes
circulation and lymph drainage especially in the heart and lungs.[77]
Dhanurasana (Bow Pose): massages abdominal organs and digestive
tract, improves circulation and increases nervous response to the
digestive system, helping to prevent and treat constipation.[77]
Janu Sirsasana (Head-to-Knee Pose): Prevents and relieves
constipation, improves circulation to and massages the bowel, repairs
muscles and lining of the bowel, and stimulates parasympathetic
nervous system.[76,77]
Halasana (Plow Pose): Tones the thyroid gland and applies gentle
pressure to the stomach to massage and increase circulation into the
Increases energy and blood flow to the liver, spleen, and pancreas.[77]
Matsyasana (Fish Pose): Increases lung capacity, improves circulation
to and regulates the thyroid, stabilizes the metabolism, and increases
circulation to the thymus, spleen, lungs and heart.[77]
Pavanamuktasana (Wind Release Pose): Applies pressure to the
abdominal organs and digestive tract, pushing contents of the bowl
along, and stimulates the colon and small intestines.[77]
Ardha Matsyendrasana (Half Lord of the Fishes Pose): The twisting
action of this pose massages the torso, increasing circulation into the
liver, spleen, kidneys, gallbladder, pancreas, adrenal glands, colon and
small intestines. It also helps to relieve constipation and aids in the
treatment of obesity.[77]
Mayurasana (Peacock Pose): This is an advanced pose that
strengthens the abdominals and increases circulation to that area. It
also aids in digestion, prevents constipation and alleviates emotional
stress.[77]
Yoga Mudra (Yogic Seal): Relaxes the nervous system connected to the
digestive system, while at the same time massaging the stomach and
lower bowels (preventing and alleviating constipation). Rebalances
immune system and aids in stabilizing thyroid.[77]

Asanas can be synergistically combined to form a sequence that can amplify


the effects of the poses by elevating the heart rate for a longer period of time,
causing the body to sweat, increasing metabolism, forcing the mind to focus
for longer bursts of time, and much more. Two such sequences are outlined
below.
Sun Salutation Sequence: this sequence is the most common of all
asana sequences. There are several variations of this sequence, but as
outlined by Nirmala Heriza, the poses are as follows:

(1) Tadasana, (2) Urdhva Hastasana, (3) Uttanasana, (4) Anjaneyasana, (5)
Adho Mukha Svanasana, (6) Kumbhakasana, (7) Ashtanga Namaskara, (8)
Bhujangasana, (9) Adho Mukha Svanasana, (10) Anjaneyasana, (11)
Uttanasana, (12) Urdhva Hastasana, (13) Tadasana. [77]

According to Heriza, this sequence:

Stretches the entire body, increasing circulation to the heart, lungs


and all the major organs and muscles and joints. It tones all the major
muscle groups and promotes spinal flexibility, rejuvenating the
nervous system. It stimulates the endocrine system, helping to
support the immune function. It is beneficial to the prevention and
treatment of arthritis by promoting the secretion of synovial fluid in
the joints.[77]

It also circulates blood and lymph throughout the entire system, helping to
energize the digestive system and helps relieve constipation.[76,77]

Iyengars Psoriasis Sequence: In his book, B.K.S Iyengar outlines a sequence


of poses he recommends for psoriasis. It is as follows:

(1) Uttanasana, (2) Adho Mukha Svanasana, (3) Uttanasana, (4) Adho Mukha
Svanasana, (5) Ardha Chandrasana, (6) Baddhakonasana, (7) Upvasita
Konasana, (8) Sirsasana, (9) Viparita Dandasana, (10) Supta
Baddhakonasana, (11) Sarvangasana, (12) Halasana, (13) Supta
Padagusthasana I, (14) Supta Padagusthasana II, (15) Paschimotanasana,
(16) Janu Sirsasana, (17) Setubandha Sarvangasana, (17) Viparita Karani,
(18) Savasana, (19) Ujjayi Breath (see Pranayama).

* Each asana has unique contraindications. A certified yoga instructor should


be consulted before attempting any asana or sequence of asanas.
Additionally, those with severe psoriasis should be careful to not overstretch
areas that are sensitive or chapped and cracking.

Meditation: The Mind Body Connection

In yoga, the connection between the mind and body has long been
established. The mind is the middle layer of the five sheaths or koshas that
make up the Self,* and it has the capability to affect our energy and our
physical body. By controlling our mind, we can control our body and let our
inner perfection or bliss show in our bodies. For this reason, meditation is
considered one of, if not the most important practice of yoga.
While in yoga it is accepted as fact that our thoughts affect our
emotional well-being as well as our physical well-being, this concept is
slowly finding scientific backing. For example, scientists have found that
meditation is associated with sensitivity to positive emotion and can have a
positive impact on mood.[78,79] Another study found changes in
neurochemistry that suggest a positive mental impact for the subjects in the
study.[80] And perhaps most profoundly, studies have confirmed both the
placebo and nocebo effects.[52, 81-83] What this means is there is scientific
evidence backing the notion that if you think positive thoughts, you can help
your body heal and conversely, if you think negative thoughts, you can
contribute to your own state of poor health.
For a psoriasis patient this is a powerful notion as it means that
accepting the condition and choosing to think positive thoughts can have a
significant impact on healing the condition. In fact, one study concludes that
mindfulness meditation can help patients clear their psoriasis.[84]
So how does one actually meditate? There are a plethora of
meditation methods to choose from, but these suggestions might be among
the most helpful for patients of psoriasis:

Third-eye Gazing: Sit comfortably with the spine erect. Close


the eyes if possible. Bring the attention to the space between
the eyebrows. Concentrate on this place and allow the eyes to
move towards this spot. Allow any thoughts to flow through
without attaching the attention to any of these thoughts. If the
attention shifts, bring the attention back to the third eye
without any harsh feelings. Do this for five minutes or more.[85]
Mantra Meditation (Positive Affirmations): Mantra meditation
means fixing ones attention on a special word or group of
words, usually by repeating this word out loud or in the mind.
While in yoga, sacred Sanskrit words are usually passed to a
practitioner by his or her guru, a psoriasis patient can use a
positive affirmation as a point of focus. Examples include:
o My skin is naturally healthy.
o Everyday, my skin becomes clearer.
o With every inhale, my skin is healing and with every
exhale, my symptoms exit my body.
o So Hum or I am that [which is also the universe].
o I am healthy. I am happy.
White Light Visualization: In this meditation, one visualizes a
white, healing light, entering the body and slowly growing to
take over the body. As it expands, healing expands. By the end
of the meditation, one should visualize the entire body
surrounded by this healing, white light.
Thought Observing Meditation: Sit comfortably with the spine
erect. Close the eyes if you can. Begin to bring awareness to
your thoughts. Allow each thought to come and go. Do not hold
on to any one thought. Do no pass judgment on any one
thought. Be strictly an observer and simply witness the
thoughts come and go. If it helps, you can pretend they are the
thoughts of someone else. Or you can pretend that the thoughts
are on a river before you, coming into attention for just a
moment and then passing downstream. If you get caught up in
any one thought or judgment, actively let it go down the river.
Mindfulness Activity: Perform one activity with extreme
mindfulness. For example:
Sit down to eat a healthy lunch. Before taking a bite,
close your eyes and observe how you feel. Do you feel
energetic or tired? How hungry do you feel? How thirsty
do you feel? Make any observations you can and then
open your eyes. Observe your lunch. What colors are in
your meal? Does it have a pleasant smell? Take a bite
and chew slowly. Describe the taste and texture to
yourself. How does eating this meal make you feel? Is it
providing you with health and nourishment? After you
finished the meal, close your eyes again and observe
any changes. How full do you feel? Do you feel energetic
or tired? Is this meal healing to your condition? Etc.
Mindfulness meditation of this sort can be practiced with any
activity like brushing teeth, breathing, walking, watching TV, or
any of the yoga practices outlined in this paper.
While most of these methods of meditation suggest sitting, they can
also be done standing, walking, or even lying. The most important thing is
that the spine is as erect as possible and the position is sustainable for at
least several minutes without causing fatigue or sleep. A meditation can be
suggested by a guru or spiritual teacher, but the internet can also be a good
resource for meditation practices. Many guided meditation recordings can be
found. The Chopra Center (Deepak Chopras website) and the UCLA Mindful
Awareness Research Center are two good resources.[86,87]

* From inner to outer they are anandamaya kosha (bliss sheath a.k.a. the pure
soul), vijanamaya kosha (knowledge sheath), manomaya kosha (mind
sheath), pranamaya (energy sheath), and annamaya kosha (physical body
sheath).[88]

Pranayama

Pranayama literally translates to vital force extension. Because it is


believed that the breath is the conduit of this vital force, pranayama is the
practice of using the breath to affect both body and mind. There are several
different ways to use the breath to achieve benefits for the body and mind.
Referenced below are the best pranayama practices for psoriasis patients.

Deerga Swasam: This practice is a three-part deep breathing exercise.


It involves keeping the spine erect in either a seated or standing
position, exhaling completely and then beginning an inhale by
breathing first into the abdomen, then into the ribcage and finally into
the collarbone area. Exhalation is done by releasing the collarbone,
then the ribcage and then by pulling the abdomen toward the spine.
The three areas of the breath (abdomen, ribcage and collarbone)
pertain to the three parts of the lungs: superior lobe, middle lobe and
inferior lobe. Over time, this practice increases lung capacity,
allowing a greater exchange of oxygen for carbon dioxide and other
gases.[54,77,89] Deerga swasam massages the abdominal organs and
digestive tract, improving circulation and thus assisting the
gastrointestinal system in achieving optimal nutrition, maintenance
and repair.[77] Deerga swasam is the most basic practice of breath
control and forms the basis for learning other pranayama.
Ujjayi: This breath, known as the victorious breath, is a variation of
deerga swasam where the glottis muscle in the throat is partially
contracted to create a rush of air in the throat that produces an ocean
sound. There are variations of this breath that involve retaining the
inhalation or exhalation, creating locks in the body, etc. This breath
can be done in any position and can accompany any asana. The
benefits of this breath includes: the removal of phlegm, stimulation of
the digestive system, increasing concentration, reducing mental
tension and generally keeping the body healthy and free of
diseases.[33,54]
Nadhi Suddhi (a.k.a. Nadi Shodhana): This is the practice of alternate
nostril breathing. The student inhales through both nostrils, then
gently closing off the right nostril with the right thumb, exhales
through left nostril. Then the student inhales through left nostril,
releases the thumb and gently closes of the left nostril with the ring
finger (still using the right hand), and exhales through right nostril.
Again inhaling through right, exhaling through left. This can continue
for several rounds until the final exhalation is performed with right
nostril and regular breathing resumes. This breath is extremely
calming to the nervous system and creates a deep sense of relaxation.
It is good for anxiety, depression, anger and fear. The breath is also
supportive to the gastrointestinal tract and to the immune system.[77]
Kapalabhati: This is the same practice that is described previously, in
the Kriyas section. Though it is technically a kriya (cleansing
practice), because it involves manipulation of the breath, it is often
practiced along with pranayama. In addition to the benefits
mentioned before (cleansing the respiratory system, allowing a
greater exchange of gases for oxygen, massaging the internal organs,
increasing metabolism, regulating weight imbalance, and relieving
constipation), kapalabhati also rapidly increases circulation, helps to
alleviate depression, enhances immune function, and increases energy
to all the organs and the entire body and mind.[54,55,77]
Bhastrika: Bhastrika is a bellowing breath that is a combination of
kapalabhati and ujjayi (it is advised to practice those two pranayamas
first). It requires gentle force for both inhalation and exhalation. This
breath relieves inflammation, destroys phlegm, accelerates circulation
and therefore rate of gas exchange, massages the internal organs,
improves digestion, increases metabolism, increases clarity of mind,
aids in weight loss, invigorates the mind and body, increases
willpower, keeps body free from disease and increases inner
happiness and peace.[33,54,90]
Sitali: Sitali is a cooling breath that is done by protruding the tongue
outwards, rolling the tongue into a tube, inhaling, then closing the
mouth and exhaling normally. This can be practiced for several
rounds. This breath calms inflammation of various chronic diseases,
calms the mind, purifies the blood, and improves digestion. Sitali
should be performed after heating asanas and pranayama and should
not be practiced in a polluted or excessively cold atmosphere.[33,54]
Like kriyas and asanas, pranayama should only be practiced if prescribed
by and first taught by an experienced yoga teacher. Some pranayama have
contraindications and/or should only be practiced under strict guidance of a
guru. Please check with an experienced yoga practitioner before beginning
any pranayama practices.

Diet

For those who have experienced the benefit of a change in diet, it is


undeniable that the role of diet plays an extremely significant part of
managing and overcoming psoriasis. However, different sources often list
varying and sometimes conflicting information about which foods should be
eaten and which should be avoided. Diet should really be prescribed on an
individual basis and should be altered with the guidance of a physician or
nutrition expert. However, there are some general guidelines that can help to
shape an individuals psoriasis-friendly diet. Currently, there is evidence that
supports various anti-inflammatory diets, and there are recommendations in
John O.A. Paganos book based on his experience.[38, 91-93] However, the yogic
diet can offer some benefits as well. All of these have some commonalities,
but the yogic diet is distinctive in some ways.

Where all the diets recommended for psoriasis agree are in the following
areas:

Eating in moderation. This is the most important rule in yoga for


maintaining health as it means the digestive system can work
efficiently and can easily eliminate the anything thw body does not
need or want. The rule of thumb is that when eating, the stomach
should be half full with food, one quarter filled with water and one
quarter filled with air. Additionally, no one particular food should be
eaten in excess.[33]
Avoiding processed food. The yogic belief is that only freshly
prepared, whole foods with some natural water content are good for
the body. In yoga this means avoiding reheated food as well. Though
in modern times, avoiding processed food means avoiding
preservatives, genetically modified ingredients, foods adversely
affected by storage and mishandling and additives such as excess of
sugar, fat and salt. Which leads to...[94-97]
Avoiding foods high in sugar, fat, and salt. While these three things
are fine (and even good) in moderation, the modern Western diet is
much too high in all three of these things. Thus it is better to avoid
foods with sugar, fat and salt at least until psoriasis has improved and
then resume eating these things only in moderation.
Eating easily digestible food. In order to create and maintain health,
energy in the body should be available for activity more so than for
digestion. Eating easily digestible food not only allows the digestive
system to work efficiently (absorbing greater energy from the food
eaten and easily getting rid of what is not needed), the body can
redirect energy towards other activities that may be need to be done.
For example, when one eats heavy food, one is prone to food coma
because all the energy is redirected towards digestion. If easily
digestible foods are eaten, then the body has more energy for
healing.[33]
Avoiding alcohol. Alcohol is a toxin to the body and damages the
brain and liver. While an optimally healthy person can process a
moderate amount of alcohol infrequently without too much harm, a
psoriatic is not an optimally healthy person. Therefore all alcohol
should be avoided so the body (and mind!) can focus on detoxifying
and healing.[33]
Additional elements of the yogic diet include:

Fasting to kick-start healing. In yoga, fasting is a tool that can be


used for healing. For example, when performing kriyas, it is
recommended that the practitioner eats very few, nutritionally dense,
small meals. This is because the healing process is helped when most
of the bodys energy is directed towards healing and restoring balance
to the body rather than fueling digestion.[33] This idea has been
corroborated by the study that says fasting, vegetarianism, and low-
energy diets can help to clear psoriasis.[92,93] While a low-energy
diet is not sustainable long-term, one can infer that this type of diet
can be followed short-term to boost the initial healing of psoriasis.
Eating a vegetarian diet. In yoga, there are several reasons why
eating meat is considered unhealthy. Firstly, it is considered one of the
foods that create toxins and putrefy in the intestines. Secondly, it is
considered energetically inefficient as it requires much more digestive
power (and time in the system) than most vegetables, pulses and
whole grains. Therefore, it is a food that is avoided in yoga.[33]
Eating (and sleeping) at regular times. Maintaining a regular
schedule of mealtimes (as well as a sleep schedule) helps the body to
run efficiently and smoothly. The body is able to anticipate when the
greatest amount of energy is needed and signal when food is needed.
If there is no schedule, the signal can get confused and lead to
overeating or undereating at the wrong times and ultimately lead to
imbalance (i.e. disease) in the system.[33]
Eating only simple and bland foods. According to the yogic
understanding of the body, eating any foods that are concentrated,
such as greasy, spicy or stale foods, causes acidity in the body and
overheats the whole system. This includes foods with too many
different vegetables, as digestion of this type requires too many
different chemical reactions to break down the various foods. It also
includes foods that have too much garlic or asafoetida as they can
overstimulate sex hormones. Instead, the following foods are
recommended: whole grains, rice, fresh milk, ghee, honey, ginger
(both fresh and dry), vegetables, easily digestible pulses and pure
water. Of course, the caveat is that each of these things should be
agreeable to the environment and individual (for example, someone
with a rice allergy should not consume rice). For a psoriasis patient,
milk and ghee should only be consumed after the shatkarmas have
destroyed the old mucus in the body, since milk and ghee will help the
body to form a fresh mucosal lining.[33]
While the yogic diet isnt prescribed specifically for the treatment of
psoriasis, the general outlook of the diet is one that creates and maintains
optimal health, and this can be very beneficial to someone suffering from
psoriasis. However, for particularly stubborn psoriasis, it may be advisable to
temporarily take specific oral remedies or dietary supplements until optimal
health is reached. These remedies and cures are not found in yoga, but rather
in ayurveda. Whether following a strictly yogic diet or including ayurvedic
remedies, it is understood as a principle of both schools of thinking that diet
should be individualized to the practitioner according to his or her needs and
metabolic reactions.

Conclusions

Though traditional Western medicine can offers some solutions for


managing the condition of psoriasis, it cannot yet offer a complete cure for all
sufferers. In part, this is because science has not yet fully understood the root
cause of the condition and so treatments focus on managing symptoms
rather than eradicating the condition completely. Furthermore, the side
effects of many of these treatments can be worse than the condition itself.
Complementary alternative therapies such as yoga can offer relatively low-
risk solutions that can fill in the gaps where traditional Western medicine
fails.
Yoga is particularly useful to patients of psoriasis because, unlike the
isolationist treatments of symptoms offered by traditional Western medicine,
yoga focuses on the interconnectedness of the all parts of human being,
bringing health to the mind, body, and spirit, and thereby targeting the
known, unknown, proven and unproven causes of psoriasis. One such cause
is the leaky gut syndrome a controversial condition where the mucosal
lining of the intestine is compromised and allows waste and toxins to re-
enter the blood stream. Though this condition is not yet fully embraced by all
members of the medical community, there are many who feel this condition
is not only real, but also responsible for several autoimmune conditions
including psoriasis. Yoga offers practices that can bring health and vitality to
the gut, as well as the immune system, respiratory system, endocrine system
and so on. It offers a range of practices: kriyas, asanas, meditation,
pranayama and diet. These practices can be used solely in the short-term or
can be used as part of a lifelong health-focused lifestyle. And most
importantly, yoga recognizes the individual needs of each patient and can be
tailored to fit those needs. Thus, sufferers of psoriasis should seek out an
individualized regime of yoga practices to complement traditional therapies,
and by doing so, adopt a lifestyle more conducive to total health and
wellness.
Yoga for Psoriasis: Reference List
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3. National Psoriasis Foundation [Internet]. Portland, OR: National Psoriasis


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5. AbbVie [Internet]. North Chicago, IL: AbbVie; Date unknown [cited: 2014
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--p/psoriasis/signs-symptoms

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8. National Psoriasis Foundation [Internet]. Portland, OR: National Psoriasis


Foundation; Date unknown [cited: 2014 March 13]. Available from:
http://www.psoriasis.org/about-psoriasis/causes

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