In Ayurveda this imbalance is classified as an imbalance of one of the three vital parts. These are head (sira), heart (hrydara) and pelvis (vasti). This disorder of the pelvis (vasti) is further classified into a type of disorder called Udavarta which means the reverse direction of vata. More specifically, the apana vata in the colon and reproductive organs gets aggravated and rises upwards, leaving the reproductive organs, or prostate in this case, depleted.

Caraka Samhita points out a few of the major causes of this condition: suppression of natural urges, fasting, excessive exercise, excessive intercourse, too much astringent, bitter, and pungent foods, wine and meat in excess. This obstruction and rising of the apana vata will cause Mutrakrachra or dysuria where there is pain and difficulty in urination and Mutraghata where there is retention of urine.

Several srotas are involved in this process. They are the Udakvaha and Utra vaha srotas (water-carrying channels). They will become involved at the level of the kidney and urinary bladder when the enlarged prostate blocks urinary flow and the apana vata is in its normal downward motion.

The Rasavaha srotas, which primarily control plasma and lymphatic flow, are directly responsible for any sexual debility. This lymphatic blockage in the femoral area is directly responsible for the back up of lymph and thus the enlargement of the prostate.

The final srotas involved are the Shukra vaha srotas, which control all the reproductive organs, the supply of ojas (see below), and specifically the prostate. Blockage in these srotas can cause pain in testicles or the penis, painful intercourse, premature ejaculation, excessive sex drive, and an enlarged prostate. When these are blocked then they will in turn block the lymphatic and water-carrying srotas, leading to retention and difficulty in urination.

Probably the most common reason for this disorder in such large numbers in the West is the excessive amount of sexual activity which is considered to be normal. Too much sex and the resultant depletion of semen will deplete the ojas. Ojas is considered to be the physical expression of consciousness in the body and is used for immunity and procreation. It takes thirty days to replenish the ojas reserves in the body. During this time one must abstain from sexual activity. Without an adequate reserve of sperm and ojas, the prostate inflames as the demand for sperm is excessive. This inflammation blocks srotas which are the normal channels of circulation leading to the chronic condition of prostatic hypertrophy.

In Udavarta, the apana vata rises into the liver, creating a pitta imbalance in the ranjaka pitta. This Udavarta siphons ama or impurities from the intestinal tract into the liver and ultimately into the blood (rakta). This pitta-aggravated blood circulates and will accumulate in any weakened areas (i.e., the apana vata). In the case of prostatic hypertrophy, the reproductive organs are where the body dumps the impurities of the blood. Because of the lymphatic and urinary srota blockages, the impurities have no way out through normal channels, and thus deposit into and inflame susceptible organs. Depending on body type, diet, and genetic predisposition, the prostate can commonly be affected.

Treatment

Dietary Guidelines

In general, one suffering from BPH should avoid garlic, onions, and alcohol. Because of both the udavarta, ranjaka pitta, and ama rakta (impure and hot blood), treatment would have to incorporate both a vata- and a pitta-balancing approach. If the constitution and season were both pitta (i.e., summer season), then refer to the pitta-reducing diet (see The 3-Season Diet); if the body type is vata in the vata (winter) season, then refer to the vata-reducing diet. If neither of these is the case then you must determine which imbalance is primary: vata or pitta.

Follow the pitta diet if the following associated factors apply: heartburn, acidity, yellow urine and stools, reddish whites of eyes, anger, skin rash, crave sugar, loose stools, and an aversion to heat.

Follow the vata diet if the following factors apply: low back pain, constipation or incomplete elimination, dry skin, sleep disturbance, fear and anxiety.

Herbal Medicine

For the Apana Vata

1. Equal parts ashwaganda (Withania somnifera), shatavari (Asparagus racemosa), and gokushura (Tribulis terrestris). Take 1 teaspoon with hot water, 3 times per day anytime.

2. Oleation and purgation. Take increasing amount of ghee each day for four days (2-4-6-8 teaspoons) first thing in the morning, with hot water. On the evening of the fourth day take 6 teaspoons of castor oil. This will produce a laxative effect and anchor the apana vata. Do this once a month for three months. During this time eat lightly and sip hot water every 1⁄2 hour for up to one week after laxative.

3. Purnavarna. 1⁄2 teaspoon twice per day with hot water or ghee anytime.

4. Equal parts amalaki (Emblica officinalis) and gokshura (Tribulis terrestris) and 1⁄2 part cardamom powder and pinch of saffron. Take 1 tsp 3 times per day with hot water or rose water.

For the Ranjaka Pitta (inflammatory process)

1. Equal parts shilajit (Asphaltum) and guggul (Commiphora mukul). Take 1 teaspoon with honey 2 times per day after meals.

2. Three cups of neem tea per day.

3. Equal parts turmeric (Curcuma longa), shatavari (Asparagus racemosa), amalaki (Emblica officinalis) and gokshura (Tribulis terrestris). Take 1 teaspoon with hot milk and honey before bed.

4. 1 teaspoon of psyllium husk with 8 ounces warm water in the morning.

5. Equal parts trifala (combined Emblica officinalis, Terminalia chebula, Terminalis belerica), trikatu (Piper nigrum, Piper longum, and Zingiber officinalis) and gokshura (Tribulis terrestris). Take one teaspoon with warm water and 1⁄4 teaspoon raw sugar twice per day morning and evening on an empty stomach.

The Vata-Pacifying Diet Simplified

1. Favor foods that are warm, heavy, and oily. Minimize foods that are cold, dry, and light.

2. Favor foods that are sweet (e.g., wheat, milk, rice), sour (e.g., yogurt, tomatoes, citrus fruit), and salty. Minimize foods that are spicy, bitter (e.g., green leafy vegetables), and astringent (e.g., apples, beans).

3. Some specific recommendations:

A. Eat larger quantities of food, but not more than you can digest easily.
B. Dairy: All dairy products pacify vata. Always boil milk before you drink it, and drink it warm. Don’t take milk with a full meal.
C. Sweeteners: All are good for pacifying vata (but don’t overdo).
D. Oils: All oils reduce vata.
E. Grains: Rice and wheat are very good. Reduce intake of barley, corn, millet, buckwheat, rye, and oats.
F. Fruits: Favor sweet, sour, or heavy fruits, such as oranges, bananas, avocados, grapes, cherries, peaches, melons, berries, plums, pineapples, mangoes, and papayas. Avoid or reduce dry or light fruits, such as apples, pears, pomegranates, cranberries, and dried fruits.
G. Vegetables: Beets, cucumbers, carrots, asparagus, and sweet potatoes are good. They should be cooked, not raw. The following vegetables are acceptable in moderate quantities if they’re cooked, especially with ghee or oil and vata-reducing spices: peas, green leafy vegetables, broccoli, cauliflower, celery, zucchini, and potatoes. It’s better to avoid sprouts and cabbage.
H. Spices: Cardamom, cumin, ginger, cinnamon, salt, cloves, mustard seed, and small quantities of black pepper all help reduce vata.
I. Nuts: All nuts are good.
J. Beans: Avoid all beans, except for tofu and mung dhal.
K. Meat and fish (for nonvegetarian): Chicken, turkey, and seafoods are fine; beef should be avoided.

The Pitta-Pacifying Diet Simplified

1. Favor foods that are cool and liquid. Minimize foods that are hot.

2. Favor foods that are sweet, bitter, or astringent. Minimize foods that are spicy, salty or sour.

3. Some specific recommendations:

A. Dairy: Milk, butter, and ghee are good for pacifying pitta. Avoid yogurt, cheese, sour cream, and cultured buttermilk; these sour tastes aggravate pitta.
B. Sweeteners: All sweeteners are good except for honey and molasses.
C. Oils: Olive, sunflower, and coconut oils are best. Reduce sesame, almond, and corn oil, all of which increase pitta.
D. Grains: Wheat, white rice, barley. Reduce corn, rye, millet, and brown rice.
E. Fruits: Favor sweet fruits such as grapes, cherries, melons, avocado, coconut, pomegranates, mangoes, sweet, fully-ripened oranges, pineapples, and plums. Reduce sour fruits such as grapefruits, olives, papayas and persimmons, and sour, not-yet-ripened oranges, pineapples, and plums.
F. Vegetables: Favor asparagus, cucumber, potato, sweet potato, green leafy vegetables, pumpkins, broccoli, cauliflower, celery, okra, lettuce, beans, green beans, zucchini. Avoid hot peppers, tomatoes, carrots, beets, onions, garlic, radishes, and spinach.
G. Beans: Avoid all beans except for tofu and mung dhal.
H. Spices: Cinnamon, coriander, cardamom, fennel, and small amounts of black pepper are all right. But the following spices strongly increase pitta and should be taken in moderation: ginger, cumin, fenugreek, clove, celery seed, salt, and mustard seed. Chili peppers and cayenne should be avoided.
I. Meat and Fish (for nonvegetarians): Chicken, pheasant, and turkey are preferable; but beef, seafood, and egg yolk increase pitta.