Yoga

Yoga is primarily a philosophical science, born out of man's need to fathom the
meaning of existence. Patanjali, the father of yoga, states in the second sutra, (the
yoga sutras):"Yogah cittavrtti nirodhah." (yogah = integration of all levels of our
being; citta = consciousness; vrtti = fluctuation or state of mind; nirodhah =
restraint) - meaning, "Yoga is the cessation of consciousness." The ultimate aim of
yoga is self-evolution. In ancient times, when people lived the yogic way, good
health was the natural result of their lifestyle. But, as health deteriorated with man's
changing values, yoga gained ground in its use as therapy.

Patanjali explained that uncertain action, giving rise to violence, whether done
directly or indirectly, or condoned, is caused by greed, anger, or delusion in different
degrees. This causes endless pain and ignorance. Through introspection comes an
end to pain and ignorance. This sutra explains the essence of the genesis of ill-health
in today's world and also the method of management. Diseases are due not just to
physical reasons but to decay in moral standards also. So the curative methods,
should not be confined to the material plane alone.

 Yoga and Modern Medicine - A Comparison

 Power of the Human Mind
 Yogic Approach
 A Diagnostic Tool
 Preventive Care
 Yoga Sutras
 Ashtanga Yoga
 Professional Life
o Executive Health
o Yoga's aid to the executive
 Targeting Diseases
o Bronchial Asthma
o Chronic Bronchitis and Ephysemia
o Peptic Ulcer
o Gastric Ulcer
o Duodenal Ulcer
o Yogic Management of Ulcers
o Diabetes Mellitus
 Yogic Management
o Cervical Spondylitis
 Asanas
 Yoga and Modern Medicine - A Comparison

The fact that yoga can prevent and cure many ailments is well known. Yoga should
not be viewed as an alternative system of medicine but as a primary form of cure in
those areas in which yoga alone can cure ill-health. Yoga can tackle many major
illnesses non-invasively; it is not just a stress-reliever or a panacea. This places yoga
in a different dimension altogether. Modern medicine uses bio-feedback as a stress-
relieving technique, but yoga works on the inner senses and mind in a conscious
process and is more direct in its approach. It is an automatic feedback system.

Modern medicine undergoes constant change. Theories alter by the minute.

Terminologies are modified in each national or international conference. Newer drugs
are being discovered to tackle old and new illnesses; old illnesses are vanishing and
new ones taking their place.

The science of yoga however, has remained unchanged, as the yogic procedures
have been researched on and determined by our ancient seers. There are clear-cut
guidelines for both prevention and cure. Today when, in despair at the failure of
Western medicine to deliver every time, we are turning to natural remedies, yoga is
coming into its own.

The ancients said that the mind is the cause of all diseases, physiological or mental.
Modern medicine has corroborated this with the word `psychosomatic'. Now there is
clear proof that mental stress produces many diseases coronary and respiratory
illness, peptic ulcers, weak immune systems. Mental stress is due to disorganised
behavior inside the psyche. The soma or body is influenced by the sense organs
(which are the agents of the mind). On coming into contact with a pleasurable
situation or object for example, a cigarette they give feedback to the mind. The
organs of action pursue the same object to perpetuate the experience.

Thus, the mind and senses are caught in a vicious cycle each reinforcing the other,
being themselves reinforced by the experience. Patanjali emphasised that the cause
of pain lies in the identification of the seer with the seen, and the remedy lies in the
disassociation. If the mind is silenced by the practice of asanas and pranayama and
the senses are quietened, one's perception is altered, leading to a sense of
detachment in observation. The senses are not stimulated. The person uses innate
intelligence to remain unaffected by pleasurable situations. In other words, realising
the transient nature of everything, he or she is equanimous in all situations.

The relation between the psyche and soma is harmonized by the practice of yoga.
Drugs may cure illnesses, but the basic inner foundation for achieving health, the
harmonization of the inner psyche, is not established. Yoga is of most value in this.
Power of the Human Mind

With regard to many of the benefits of yoga, the mechanisms are at very subtle
levels. The concepts of treatment in Yoga are different from those of western
medicine. Sometimes, we in the medical profession, having been tuned to a
particular way of approaching the human body, find it difficult to accept other
systems of cure. It is a fact that the human mind is the source of immense energy.
We use only one-tenth of our brain cells, the remainder being inactive. In a yogi,
with accomplished capacity for supernormal healing, it is postulated that much more
of the brain is active. Yogis have demonstrated their healing powers time and again;
but this cannot be as objectively studied as western medicine would like it to be.
There are no medical yardsticks to measure many of the effects of asanas and
pranayama. There is no way of studying the workings of the mind in the material
plane. Mind is energy, and energy can heal or destroy, depending on the proper
balance in and around us.

Life is an offshoot of the basic energy in all living things, and when this is depleted,
there is a state of death. This energy balance is disturbed in many illnesses. When a
drug is administered, it is not that alone which cures; the inner strength of the body
also aids it. If this fails, in spite of the medicine, the patient can die. The human will
has been recognized as a considerable force in overcoming many illnesses. Beyond
this, western medicine refrains from comment. But, yogic science has explored this
and has realised that it is possible to achieve a state where the mind triumphs over
matter.

A simple example is the ability to shut off pain. It is possible to avoid experiencing
severe pain physically by intensely repositioning the mind in a different direction. In
this respect, yogis have always demonstrated the supreme capacity of mind over
matter. A telling example is that of the very famous sage, Sri Ramana Maharishi of
Tamil Nadu in India. When sarcoma was diagnosed, and an operation was imminent,
he refused an anaesthetic and felt no pain at all.
 Yogic Approach

The yogis had precise concepts that were ratified by their methods of treatment. For
example, according to the Yoga Upanishad, there are ten vital principles that have
specific functions in the body. A dyspepsia problem is, according to yoga, governed
by vital principles known as apana and naga. The former regulates build-up of air in
the gastro-intestinal tract and the latter governs the act of belching. Asanas like
twisting poses, forward and back bends, regulate the vital principles in the abdominal
organs. When the patient practises twisting poses, the problem of excessive wind
formation and belching is controlled. This is due to the regulation of the mechanisms
that govern the orderly functioning of the cells. Obviously, such situations have to be
experienced and cannot be explained by theory.

Doctors are disinclined to accept drugs or surgery for their own chronic conditions
knowing, as they do full well, the limitations of `symptomatic therapy'. They would
much prefer a permanent solution. Like yoga. Typical examples are low back pain
and essential hypertension, where the role of drugs is limited if yoga therapy is
begun early.

In the case of blood pressure, only the elevated blood pressure is neutralised by
drugs. The exact cause for the malfunction is untouched. Of course, the general
advice to `reduce stress' is given. To reduce stress is easier said than done. Yoga
boosts and strengthens the enormous inner defensive energy to control the offensive
forces and offers an alternate method that is non-invasive, and non-drugging.

Yoga uses postures to correct inner malfunction according to natural principles. It is

important to minimise the use of drugs whenever possible and employ natural
methods that, in the long run, preserve the sensitivity of the body. Such a body will
be more responsive to treatment than one that has been constantly exposed to
drugs. Take the case of recurrent sore throats in children. Often, repeated doses of
antibiotics are prescribed. Yet, the infection recurs. Sarvangasana and half halasana
are very useful in such cases.

Patanjali has said that the disease process can be “dormant, attenuated, interrupted,
or fully active”. Yoga treats diseases using the process in reverse - the active disease
is first rendered interrupted, then attenuated, and then made to disappear after
passing through a stage of being dormant. The yogic approach is step by step, and is
never in a hurry. It works along the principles of evolution of a disease.
 A Diagnostic Tool

Yoga is a useful tool in diagnosing many problems in clinical medicine. Yoga has its
own logistics in this. Medicine, too, trains us to look for certain signs in the patient,
both on the surface and internally. The investigations are correlated with the clinical
diagnosis. Nowadays, bio-medical engineering has produced a vast array of
diagnostic tools that are used for accurate and fast investigations. Unfortunately, we
tend to rely more and more on them, often unnecessarily and expensively. Our
innate skills and intelligence in diagnosis are being lost in the process. It is important
that a right balance is maintained for, as an eminent doctor has put it: With all our
varied instruments, useful as they are, nothing can replace the watchful eye, the
alert ear, the tactful finger and the logical mind.

Yoga identifies diseases at the embryonic stage, several years before the symptoms
become obvious. An easy example is the orthopaedic disorder of low back pain.
Medicine has no method to predict who will suffer from this problem. Yoga analyses a
person in terms of the ability to perform certain postures, and predicts the
probability of the person suffering from low back pain in the future. It is difficult to
understand this further unless one has practised yoga for many years. No doubt we
medical professionals understand anatomy and physiology, but there is much more
to be learnt. Yoga fixes different parameters to determine which body is a fertile
breeding ground for ailments.

Another example is that of a person sitting in a chair, with the spine doubled up and
with the rib cage compressed. Medical science does understand that such persons
will suffer from back pain; but yoga states that because the heart and major blood
vessels are compressed in such a posture, healthy and pure blood cannot flow into
the muscles of the heart itself. Just as sitting in a chair for prolonged periods will
reduce blood supply to the pressure points, the inner organs also suffer the same
fate if the posture is incorrect, says yoga. Sure enough, all these can be proved by
diagnostic tests.

Many such examples can be given. A blend of yoga and medicine is the best.
Western medicine and its investigational facilities help diagnosis; treatment can be
either by yoga or medicine or both, depending on the ailment.
 Preventive Care

Today, more than ever, the need for preventive systems of medicine is being widely
realised. Sophisticated diagnostic tools prescriptive drugs that come in complicated
combinations, and a high level of specialization are making medical care expensive.

There are many public health measures that have been introduced to prevent
disease. Some of them, like the eradication of plague and small pox, have proved
successful. Health education for the masses has clearly demonstrated that clean
surroundings, boiled water, childhood immunisations, and family planning have their
place in preventing infectious diseases. Early and regular screening for diseases like
tuberculosis and cancer have been useful in diagnosis and treatment. There has been
much propaganda about the evils of alcohol, nicotine, drugs and permissive sexual
habits.

Yet, all this has not been enough. Illnesses are on the rise. Newer, dreaded ones like
AIDS are cropping up. We are in this unenviable situation because the individual has
not shown enough discipline in taking care of himself or herself.

This is where yoga comes in. Patanjali's sutras lay the foundation for a healthy life.
That the mind is the root of most physical problems is brought out and guidelines for
healthy living are given. The Yoga Vasishta points out that the course of events or
destiny is according to thought. Whatever thought has commenced, in whichever
manner, that is established in that manner alone. (Samvid, The Vision and the Way
of Vasishta, Indian Heritage Trust, Madras, 1993, verse 684) For example, though it
has been proved that smoking is injurious to health, the manufacture and
consumption of cigarettes have not stopped. The body does not need nicotine, only
the mind does.

Yoga lays great emphasis on asanas and pranayama to prevent illness and, more
important, to preserve health. A regular routine of physical exercises, from a young
age, has been shown to be of preventive value in many medical disorders like
coronary, respiratory and orthopaedic problems. Any kind of exercise is good, but
yoga is the ideal form as it is totally non-invasive, gentle and soothing. Also, it is the
most cost effective. There is no equipment needed, and even the props
recommended for some patients are not expensive. The practice of yoga instills
confidence in a person, especially when recovering from an illness. Yoga is
particularly valuable as one grows older. As most ailments are degenerative in
nature, asanas keep the geriatric person active and, therefore, healthy. Apart from
the asanas and pranayama, the other precepts for good living laid down by Patanjali
reinforce a healthy body and mind.

Gandhiji said: “Health is wealth, and the basic requisite for every kind of happiness”.
The World Health Organisation has defined health as a state of complete physical,
mental and social well-being, and not merely an absence of disease or infirmity. It is
obvious that yoga, which so amply fulfils the criteria for a system of health care, has
come to stay.
 Patanjali's Yoga Sutras

We owe our knowledge of yoga to the teachings of Patanjali. The word yoga is
derived from the root yuj, which means to bind or yoke. It also means to apply
oneself to, or direct one's concentration upon. Yoga has been codified by Patanjali
into his classic work, the Yoga Sutras, which contain 196 terse aphorisms. The entire
life of man is contained in these, provided we know how to interpret them in our
daily life. The Kathopanishad says: When the senses are stilled, the mind is at rest,
and the intellect does not waver, the wise say that the state of yoga has been
reached.

Patanjali lived in India, around 300 BC. It is said that he was an incarnation of
Adisesa, the serpent protecting Lord Vishnu. He was born to a tapasvini by name
Gonica. As she was offering oblation to Surya, the Sun God, a small snake appeared
in her hands and took human form. It prayed to Gonica to accept him as her son,
which she did, naming him Patanjali. (Pata means fallen and anjali means prayer.
The method of birth explains Patanjali's name).

Patanjali was the author of classics in three important fields. He wrote a treatise on
grammar, the Mahabhasya. He was the author of a major work on ayurveda, the
holistic Indian system of natural medicine comprising medicine, surgery, personal,
social and environmental hygiene, as well as psychological and spiritual health. And,
what interests us most, he compiled the Yoga Sutras. The word sutra means a
thread. Says Alistair Shearer in his translation of the Yoga Sutras: "Each sutra
resembles a knot of the finest thread that must be teased and unravelled, so that
every inch of its meaning is displayed. Only then can the whole fabric of the teaching
be woven together."

Patanjali's 196 aphorisms, divided into four sections, are of extreme brevity, each
self-contained in its teaching, yet part of the greater whole. They are: (i) Samadhi
Pada, on contemplation; (ii) Sadhana Pada, on the practice of yoga; (iii) Vibhuti
Pada, on properties and powers in the yogic path; and (iv) Kaivalya Pada, on
freedom and liberation.

As the goal of any dharmic law is liberation, Patanjali speaks of this in detail as the
eight-fold path of yoga.
 Ashtanga Yoga

The eight limbs of Yoga

Patanjali calls his advice 'ashtanga yoga', or the eight limbs of yoga. These are steps
towards the goal, not sequential but fully interrelated, each reinforcing the other.
Patanjali has significantly described them as limbs because, in any body, the limbs
that constitute it grow in an organic, proportionate and concurrent manner till full
development is reached. The disciplines are yama (moral commandments), niyama
(observances of conduct), asana (posture), pranayama (breathing exercises),
pratyahara (withdrawal of the senses), dharana (concentration), dhyana
(meditation) and samadhi (the settled mind or total -absorption).

YAMA - The five commandments

The yamas are five universal laws.

Ahimsa or non-violence extends way beyond its usual physical connotation. True
non-violence, which is really freedom from fear and anger, is an inner state of
quietitude, producing pure, unprejudiced action.

Satya is truth in thought, word and deed.

Asteya means `not stealing' which, in a wider sense, is not claiming anything that
does not belong to us. To put it differently, we, as fully evolved spiritual selves,
should not hanker after mundane objects.

Brahmacharya is again misunderstood as just physical celibacy. It is much more than

that: it is the transcendence of all desires, thus leading to an enormous store of
energy that has not been dissipated.

Aparigraha is living in a state of non-attachment, without coveting anything. As

Shankaracharya points out, it is a difficult achievement: "The body has become old,
the sight feeble, the bones weak, the flesh weak, the spirit dull, but man still does
not give up desires."

NIYAMA - The right conduct

The niyamas are rules for living, also five in number.

Saucha is cleanliness or purity: both physical, to maintain the body and mind at their
optimum best, and spiritual, to achieve a simple and unsullied awareness.
Santosa is contentment. The content man knows what he wants and how to achieve
it and, therefore, is undisturbed by internal and external factors.

Tapas means blaze or fire. It is the burning commitment or desire to reach the
pristine state. It is often described as the purification of desires by self-discipline and
austerity.

Swadhyaya is the study of oneself, not in any narrow narcissistic manner, but as
being conducive to reaching one's inner spiritual being.

Ishwarapranidhana is total, unconditional devotion and surrender to a higher infinite

power. Sri Aurobindo says: "The manifestation of the higher forces takes place only if
there is total humility and surrender."

Postures and Breathing Exercises

Asana
Asana or posture is what everyone generally takes yoga to mean. However, asanas
are not just a set of exercises or positioning of the body. They are the complete
relaxation of the cells of the brain and activation of the cells of the bodily organs. It
takes years of sustained effort to master asanas and the concentration and balance
needed make the mind razor sharp. When once the asanas have been perfected,
being becomes effortless and the yogi loses himself in the pose.

Pranayama
Prana means all forms of energy - cosmic energy, mental energy, sexual energy and
physical energy. It is loosely translated as breath. Ayama is control; so, pranayama
is control or discipline of breathing. If the breath is controlled and calm, the senses
are stilled and the mind is settled. Pranayama raises the practitioner to that state of
silence rarely experienced in normal, everyday life.

PRATYAHARA - Yoga for the mind

Pratyahara, the withdrawal of the senses, is the link between yama, niyama, asana
and pranayama and the last three steps - dharana, dhyana and samadhi. Following
the rules of living, and practising asanas and pranayama, the yogi finds himself able
to turn his senses inward and achieve complete quietitude. He is now ready for the
ultimate in yoga.

Dharana
Dharana is `one-pointedness', the state of total absorption. The longer the mind
remains in this state of focus, the more powerful it becomes.

Dhyana
Dhyana is the stage of meditation, the culmination of uninterrupted concentration.
The meditative mind lives in the eternal present, in a state of choiceless awareness
and sureness, in which there are no ambiguities.
Samadhi
Samadhi is the peak of yogic achievement, a true sense of communion and peace.
This settling of the mind is the heart of yoga, where the senses have been
transcended by complete refinement of the body and mind.

Yoga is not just a set of esoteric exercises to keep physically fit. It is a complete
system of life, with our bodily afflictions and mental fluctuations under control by the
practice of concrete rules of conduct.

These are universal rules, applicable to every human being, irrespective of creed and
colour. For whether you are American or Chinese or African or Indian, whether you
are a Muslim, Buddhist, Christian, Hindu or Jew, you have the same physical and
mental organs as everyone else.
 Yoga in Professional Life

Every job has its 'occupational hazards'. Some executives travel constantly, others
are desk-bound. Most keep long working hours, with family life and leisure playing
secondary roles.

The physical ailments of executives have origins in the stress of their jobs.

A very good method to achieve equanimity and relaxation is to get away from the
pressures of work every now and then. This can be done by taking impromptu
breaks (for even just a weekend, though longer holidays would be much better), in
peaceful and natural surroundings, with the family.

A woman's body is more likely to be damaged by stress than a man's because of

hormonal differences. Stress changes the rhythm of the menstrual cycle, and pre-
menstrual tension (PMT) is more evident.

Regular practise of yoga brings stress relief, greater concentration and a harmony in
mind and body that is so essential for better professional performance. It may be
argued that all human beings cannot fully follow Patanjali's advice and evolve into
perfect yogis. This is, naturally, an impossible expectation. But his guidelines can be
structured to suit our lifestyles; in our daily lives, we can practise yama, niyama,
asana and pranayama, (see Ashtanga Yoga) keeping ourselves healthy in body and
mind.

We would then be able to give the best of ourselves, with concentration and
commitment, to whatever field we are involved in — as sportsperson, medical
professional, business executive, teacher, wife and mother, artist. The world would
be the better for it.

Smoking and drinking are the two principal causes of preventable disease and
premature mortality. Exercises of any nature will give inner stimulus to stop these
bad habits. The practice of yoga helps nullify the ill effects of nicotine and alcohol,
but first the habits have to be stopped. One cannot practise pranayama while
continuing to smoke.

 Executive Health
 Yoga's aid to the executive
 Executive Health

According to yoga, there are basically three types of diseases

 Adhibhautika roga: diseases due to imbalance of the five elements in the

body
 Adidaivika roga: genetic and allergic diseases
 Adhyatmika roga: self-inflicted diseases

The executive is prone to suffer from all these types of diseases. Let us analyse the
diseases that executives are specially prone to and see how yoga can help in their
prevention and cure.
The muscles and joints
Many executives suffer from cervical spondylitis, low backache and knee disorders.
'Executive' chairs push the cervical spine into an awkward position. Premature
degeneration of the thoracic spine is caused, resulting in spondylitis of the dorsal
(thoracic) spine.
The lumbar spine also suffers. If the executive has to sit for long hours at a 'desk'
job, the muscles of the lower lumbar become stiff. Lack of flexibility in this area leads
to a chronic low back problem.
To ensure the health of the back, regular exercises for the entire spine and proper
maintenance of posture at all times is needed. All the yogic asanas strengthen and
tone the joints and muscles very well. The strain of using poorly designed chairs and
mattresses is balanced by the standing poses which strengthen the lateral part of the
spine and the forward bends which give maximum elasticity to forward movement of
the spine. One of the basic prerequisites for spinal health is to be flexible in the act
of bending forward. Any mechanical disorder can be prevented or cured by asanas.

The heart and circulation

Excessive nervous discharge from the cerebral cortex raises the tension of the
arteries of the body - this is Essential Hypertension.
High levels of stress increase the discharge of chemicals which block the lumen of
the coronary arteries and this, when critically narrowed, results in a heart attack.
Irregularity in the rhythm of the heart is a stress-related problem. Unhealthy habits
of drinking and smoking thicken the arteries of the body, leading to elevated blood
pressure.
Many executives work on the treadmill and the stationary bicycle in the mistaken
belief that, by boosting the heart rate and pulse beat, the cardiovascular system
remains healthy. This is erroneous. Jogging is another inappropriate exercise to the
already hyper-stressed system of the executive.
What is needed is a procedure to soothe the mind and body of the person and for
this, yoga is most ideally suited. It establishes quietitude, the heart is energised. In
the usual exercises the system is only exhausted. Waste products are built up. In
yoga there is no accumulation of waste ; rather, the body's daily production of toxins
and those acquired due to stress are efficiently removed.
In this process, energy is built up. Yoga is `restful exercise' which refreshes the
body. This is precisely what the executive needs. The massaging action of the asanas
on the blood vessels prevents blockage of the arteries. It maintains a state of
healthy circulation even at the age of seventy-five. The greatest advantage of asanas
is that any defective part of the heart and the circulatory system can be tackled, as
they have a precisely directed action on the body. They tone up the circulation to the
bone marrow, thus improving the supply of healthy blood cells.
The skin is exposed to varying temperatures. Asanas maintain healthy blood flow to
the skin, tone up the tissues and prevent the effects of climatic changes. Asanas
improve the blood flow to different parts of the body and prevent blockages in the
circulation. Thus, the heart is kept free of obstruction. Fluctuations in blood pressure
are prevented, as the asanas reduce the stress on the nerves.
All asanas are useful for cardiac toning, particularly the back bending asanas like
urdhva dhanurasana, viparita dandasana and kapotasana. These can be done with
props to make it easy and save time for the busy executive. Regularity of practice
can thus be maintained.

The lungs
The lungs are well toned up by asanas. Asanas hasten the excretion of smoke and
other pollutants that weaken the lungs. Back bending and inverted asanas are
invaluable for this purpose. Standing poses elasticise all parts of the lungs. The
practice of pranayama is useful to prevent allergic disorders. Pranayama tones up
the functions of the heart and lungs together. It also protects the lungs against the
harmful effects of passive smoking.
Pranayama, even more than asanas, is valuable in harnessing the large amount of
energy the executive's -lifestyle needs, as it works on the mind and the senses. A
minimum of fifteen minutes of practice will suffice.

The digestive and excretory systems

Unhealthy eating habits affect the metabolism of the body, the results being
diabetes, hypertension, problems of weight regulation and so on. Eating late in the
night affects the digestive organs, as the nervous system, which is supposed to rest,
continues to regulate the flow of digestive juices. Headaches on arising in the
morning, or indigestion, is the outcome. Smoking, alcohol, and a faulty diet high in
fat and protein can cause an overload in the cells of the kidneys and lead to
premature deterioration.
For the executive, the most common problem in the digestive system is peptic ulcer.
This is due to either a bacterial infection or excessive stress, promoting excessive
hydrochloric acid and pepsin secretion which irritate the stomach wall and create an
area of inflammation. Pain occurs.
The drugs used to treat peptic ulcer inhibit acid secretion in the cells of the stomach.
It is possible to live without drugs if a basic change is made in one's lifestyle. This
should include enough time every day for adequate relaxation of the mind, not just
by playing golf or listening to music, but by -exercise which is more concrete in
improving the health of the inner organs.
Acquired diabetes is due to abuse and neglect of the body. A high calorie diet, no
exercise, alcohol and smoking are the key factors that irritate the pancreas, destroy
the cells and decrease the levels of insulin. Mental and physical stresses increase
blood sugar levels. Drugs used to treat diabetes do reduce sugar levels, but unless a
parameter like exercise is added, the organs are not protected against microcellular
damage.
The gall bladder and the colon suffer if the diet is excessively high in fat, which is a
known cause for colon cancer. The digestive organs are massaged by forward bends
and twisting asanas. Healthy blood flowing in helps proper digestion. Supta virasana
which is one of the few poses that can be done after food, ensures good digestion.
Twisting poses correct any defect in absorption and digestion by massaging the
intra-abdominal organs, and back bends reduce acidity and wind formation.
Asanas control problems of hyperacidity by soothing the cells in the lining of the
stomach. In preventing peptic ulcers, sense control and meditation are highly
valuable.
Yoga automatically corrects unhealthy eating habits, as the practitioner progressively
finds that he or she prefers a simple diet and cannot tolerate very 'rich' food.
The kidneys are well massaged in back bending asanas and their functions
stimulated. Asanas avert cellular malfunction in the kidneys, preventing
hypertension. Twisting and back bends, forward bends and inversions are all
valuable for this purpose. Pranayama regulates the response of the kidneys to
neuro-endocrine messages from the pituitary. Twistings and back bends protect the
kidneys against the microcellular damage of diabetes. The arteries in the kidneys are
very delicate and the action of the yogic poses is highly suited to maintaining the
softness and delicacy of the structures.
The intestines are stimulated and massaged so that absorption and elimination
functions are well maintained. The liver, gall bladder and pancreas are toned up by
twisting postures and toxins are removed.

The nervous system

The nervous system is most easily affected by hectic lifestyles. Regular, daily
exercise provides extra energy to tide over the day's strain, both mentally and
physically. The nervous and glandular systems become more resilient. The hormonal
discharge in the brain controls ovarian functions in the woman's body. Excess stress
changes the rhythm of the menstrual cycle, affects ovulation, and damages the
biological functions of the woman. This damage is microcellular, taking years to heal.
The executive is prone to headaches. The only solution for this disorder is to
incorporate exercises which calm the nerves. Painkillers are not advisable unless the
situation is really out of control.
Yoga is non-stressful. If the brain gets exhausted by overwork, half halasana
removes the fatigue
Forward bends prevent fatigue. Viparita karani is excellent for tired executives.
Passive back bends and inversions with the facial bandage also relieve exhaustion.
Yoga strengthens immunity, as the nerves are made strong by all asanas.
Particularly useful are the forward bends as they remove the sympathetic overdrive.

The Glandular System

Men and women have some common problems in the glandular system. In addition,
women suffer disorders in the reproductive system due to high levels of stress. The
most common organ to be affected is the adrenal gland which pours out the energy-
giving chemicals — the steroid hormones and the catecholamines, adrenaline and
noradrenaline. Constant travel and late nights are some of the factors that alter the
bio-rhythm of cortisol, which is at the highest level at 8 a.m., and lowest in the
evening. Proper rest at the right time rejuvenates the cycle. It is important to retire
to bed at around 10 p.m. and rise at about 5:30 a.m. Optimum recharging of energy
levels is thus ensured.
Inverted poses refresh the endocrine glands by bathing them in fresh blood. These
poses prevent jet lag as extra energy is available to the mind and the brain. Head
stand and shoulder stand just before boarding a long distance flight give maximum
benefit. The health of the glandular system depends on the nervine stimuli and, if
the nervous system is healthy, the glands are stimulated properly. Back bends
energise the system in a stimulative manner. Age-related weakening of the
endocrine glands does not affect the executive who practises yoga regularly.

The Immune System

The immune system is vulnerable to malfunctioning. Lack of sleep is one of the most
potent forces generating stress on the immune system, weakening the functioning of
the cells.
Improper diet is another cause for ill-health of the immune system. High
polyunsaturated fat content in the diet affects the genesis of the lympho-cytes in the
bone marrow. It is preferable to stick to a vegetarian diet as it is low in fat. Studies
have shown that, in vegetarians, the killer cell activity of the immune system is twice
that of omnivorous controls. Emotions also affect the immune system. High levels of
noise are also known to affect the immune system. Nicotine and alcohol hamper the
production of healthy cells in the bone marrow, and immature cells that function
ineffectively are released into the circulation.
A wave of stress releases large amounts of adrenaline and nor-adrenaline which can
either stimulate or inhibit the functions of the immune system. There is a difference
between healthy and unhealthy stress. The former is necessary and tones up the
immune system, while the latter wears out the immune functions. Such a healthy
stimulus is exercise. All asanas are helpful. Pranayama is valuable for the immune
system.
Pranayama stimulates and regulates the healthy functioning of all the organs
through the nervous system. In pranayama, the facial muscles are relaxed. This
pacifies the organs of perception (smell, touch, sight, hearing and taste) and allows
the mind to withdraw inward into relaxation.
 Yoga's aid to the executive
Yoga is a way of life. It is not just asanas and pranayama alone, as is commonly
assumed. Patanjali's sutras cover the entire gamut of living, giving us procedures by
which we can get the maximum out of our lives. This does not refer to materialistic
gains, but to those intangible rewards that make our lives meaningful. The executive
would do well to follow the yamas and niyamas in his or her daily life and work.
Ahimsa (non-violence), satya (truth), asteya (non-stealing), brahmacharya (control
of the senses), and aparigraha (non-covetousness) can all be exercised.

Ahimsa is not just against physical violence, it can also apply to standards of
business conduct. Advertisements detrimental to health are a travesty of satya.
Cigarette companies advertise extravagantly and, though advertising alcohol is
banned in India, thinly veiled advertisements for it are quite common. Ego,
competition, and the desire for easy success lead to the practice of unethical
methods that go against the teachings of Patanjali.

While the executive has to be committed and dedicated to work, drawing upon his
powers of tapas, he has also to practise saucha and santosa. Saucha or hygiene goes
beyond bodily hygiene to that of the inner organs. The busy, hyperactive executive
must learn to look out for and act fast upon the signals that convey deterioration in
health. In fact, if yoga is practised regularly, he or she can stop such signals from
occurring.

Contentment (santosa) is a state of mind. It is the constant longing for more and
more that exhausts the mind, not the object itself. The Yoga Vasishta says: "Not
wishing for the objects of enjoyment that have not arrived, and enjoyment of those
that have arrived spontaneously, is the characteristic of a wise man. He is called a
great enjoyer who does not hate anything and does not long for anything, and who
enjoys everything on hand."

Swadhyaya or self-study is illustrated by the saying that you are actually three
people in one body - the one you think you are (a self-assumed image), the one
others think you are (that which is projected), and the one you actually are (the
atma within, but covered by the dust and dirt of worldly motives). Introspection of
one's thoughts and deeds will stand the executive in good stead on many occasions.

Iswarapranidhana is to do one's job to the best of one's ability and leave the rest to
Providence. The message of the Bhagavad Gita is: "Work alone art thou entitled to,
and not to its fruit." The belief that there is a higher power that will ensure fruit to
hard and honest labour is very essential, particularly in today's world, to provide
solace and equanimity to workers in any field.

With the practice of the yamas and niyamas, pratyahara controls the senses and the
mind. This de-stresses the nervous system. Dissipation of energy is controlled,
leading to a rise in the levels available to the executive. Dharana, dhyana and
samadhi are psycho-spiritual processes which bring about steadiness of mind, and
subtlety and refinement of consciousness. Complete tranquillity is the result. For the
executive, this can be interpreted as releasing the tensions of work and engendering
a much needed state of composure and serenity.
Thus, it is very clear that the executive has to create a lifestyle around healthy
habits. The time has arrived for executives to take the lead, to be forceful about their
health, physical and spiritual, as they would be in their work. Swatmarama, the
author of Hatha Yoga Pradipika, has specified no particular age for the practice of
yoga; whether one is young, old, infirm or sick, one can begin to practise yoga so
that the body is fit. Modern medicine has been successfully challenged by situations
where, as catalogued in Howard Murphet's book, Sai Baba — Man of Miracles, cures
of seemingly impossible conditions have taken place by methods that cannot be
understood by science.

The discipline of yoga in all its aspects will help the executive attain what an
individual needs most in life - trikarana shuddi, which is the integration of thought,
word, and deed.
 Targeting Diseases

Pulmonary Diseases

 Bronchial Asthma
 Chronic Bronchitis and Emphysema

Gastro Intestinal Diseases

 Peptic Ulcer
 Gastric Ulcer
 Duodenal Ulcer
 Yogic Management of Ulcers

Metabolic Diseases
 Diabetes Mellitus

Orthopaedic Diseases
 Cervical Spondylitis
 Pulmonary Diseases

Pulmonary diseases are on the rise today due to the extensive iatrogenic pollution in
our world. Unless a global commitment is undertaken to control pollution, the
incidence of pulmonary diseases will be on the rise.

Bronchial Asthma
 Cause
 Symptoms
 Medical Management
 Yogic management
 Role of Pranayama

Causative factors

The essential feature is widespread inflammation of the airways. This is in response

to a multiplicity of stimuli: drug-related, allergic, environmental, occupational,
infectious, food-related, exercise-related and emotional.
A variety of drugs like aspirin, beta blockers (as beta stimulation dilates airways) like
those used to control hypertension, some colouring agents, an assortment of food
products like sea food, salads and fresh fruit contain preservatives and other
chemicals that cause wheezing. Environmental airborne factors irritate the lining at
any time of the day. Smoking is one of the principal irritants. During intense aerobic
exercise, a person often breathes through the mouth and the humidification of the
inhaled air by the nasal passages and the sinuses is lost. This results in thermal
cooling of the air that reaches the distal airways, causing wheezing. Occupational
factors like exposure to strong smells, leather, cotton, etc., are all well-known agents
that provoke wheezing. Virtually any agent can cause wheezing. Infections cause
wheezing and this is due more to viruses than to bacteria. Emotional stress increases
the parasympathetic tone and provokes wheezing.
The mechanism by which the spasms are triggered is not fully understood, but there
is an antigen antibody complex which releases the chemical mediators of
inflammation and hypersensitivity, bypassing the cellular defense mechanisms. Such
chemicals include histamines, prostaglandins and a variety of other substances. This
allergic response is mediated by T and B lymphocytes. The hallmark is reduction in
airways diameter due to oedema, mucus plugs, and smooth muscle constriction. Air
trapping occurs. Hypoxia is a universal finding during acute attacks. There is carbon
dioxide retention and metabolic acidosis results.
Symptoms

The disorder can be acute or chronic. An acute exacerbation of a chronic condition is

also possible. The symptoms consist of cough, wheezing and breathlessness
(dyspnoea). They can be present singly or in varying combinations. A small amount
of sputum, typically sticky, is produced. Ventilatory assistance may be required if the
spasms worsen. Occasionally, death supervenes.
No single test is conclusive of asthma; but a clinical conclusion is well assisted by
pulmonary function tests. This shows reduction of various parameters. An adult can,
for the first time, suffer the problem in middle age — the so-called adult onset
asthma. Hence it is good to practise yoga to keep oneself fit all the time.

Medical Management

The treatment consists of oral drugs or the use of different systems of inhalers which
deliver the drug by a fine mist into the airways. The oral drugs stimulate the beta
receptors in the lining of the bronchial tree. They dilate the airways by chemical
changes through the sympathetic nervous system. Since the sympathetic tone is
reduced in asthma, drugs that provoke this system are necessary. Drugs like the
methylxanthines (theophylline) produce dilatation through certain chemical
mediators. Salbutamol is a drug that works along the sympathetic nervous system,
stimulating the beta receptors. Cromolyn sodium prevents the mast cells from
releasing the chemicals of an allergic reaction. It is preventive, not curative, in
action. Newer drugs which provide quicker relief are available now, but none is
natural in its mode of action. At the end of the drug list are steroids which reduce
airway blockage by their anti-inflammatory action. Intravenous therapy is used,
depending on the clinical condition.
Most of the drugs have side effects like tremors, palpitations, sweating, ectopic beats
and gastric disturbances. This is related to the severity of the disease and, therefore,
the frequency of drug usage. It is not possible to predict whether the disease will
worsen or not, as the aggravating conditions are multifactorial. Moreover, if the
patient is in a state of tense anticipation of an attack, it is difficult to reduce the
dosage. Regardless of the pattern of attacks, an asthmatic must be taught how to
relax the mind. Asthma is described as psycho-somatic as the mind is linked to the
respiratory tree, and stress upsets its delicate chemical balance.
The tremors are due to over stimulation of the sympathetic system through the beta
receptors. The gastric irritation is due to a direct effect on the lining of the stomach.
The incidence of side effects also depends on the individual susceptibility of the
patient to the drug. However, the usefulness of drugs in dealing with a problem like
asthma cannot be understated.
Though an asthmatic can never be completely free of the disease, it is possible to
strengthen the system by the addition of the parameter of yoga to the regimen of
treatment. In some cases, the practice of yoga should be continued along with
medication for many months. In others, it may be possible to discontinue medication
in a short while. If an asthmatic is able to ensure stability with minimum dosage of
the drug aided in the greater part by the practice of yoga, it is certainly an
achievement in today's polluted world. Many asthmatics feel better if they change
their place of living. This may be migration to a different climate in the same or a
different country. So long as they live in a different place, their attacks are highly
infrequent. For example, when an Indian asthmatic goes to reside in the West, the
attacks reduce and almost disappear. When they return to India, the moment they
alight from the aircraft, the spasms begin due to the high humidity and pollution in
some states.

Yogic Management

Yoga is very useful in the treatment of asthma as it primarily works by stabilising the
autonomous nervous systems. According to yoga, quietude in the body always
stabilises irritable responses. The parasympathetic tone is in excess in asthma;
exercises always help balance the autonomic tone by raising the sympathetic. It is
possible to change the very responsiveness of the body. It is a matter of training.
Asanas do their part by helping to ease the congestion in the lungs. This promotes
relaxation of smooth muscle and better oxygenation. The change, however, does not
happen overnight, as asthma is a chronic disorder and irritable responses take time
to stabilise. The earlier the asthmatic begins yoga the better the response. Constant
practice is required to change the sensitivity of the body. The practice of asanas
during an attack is different from when the patient is free of symptoms. All asanas
are useful. If the patient is stable, standing poses can be practised. Back bends are
very helpful to open the frontal lungs and relax the bronchial muscle. Props may be
needed. Immediate improvement in oxygenation occurs. The cells lining the
bronchial tree are soothed by the improved blood flow and breathing mechanics of
back bends. The sympathetic system being stimulated, the bronchi dilate.
Constrictive activity is reduced with the lowered parasympathetic tone. During acute
attacks such poses cannot be done by some patients. For such people forward bends
are helpful. Forward bends are useful during an attack, but the requirement varies
from person to person. The posterior lungs are made to open out or supported and
rested, the secretions squeezed out and the nervous tone altered, relieving the
stress on the lungs. Inverted poses condition the lungs for exertion of a particular
kind. They flush the lungs free of accumulated toxins and enhance fresh blood flow,
healing the irritated areas. The circulation of the bronchial tree has to be soothed
and refreshed to prevent an allergic response. Props are usually needed.

Role of Pranayama

Pranayama is of direct help in this situation. The sympathetic tone is raised and
vagal tone lessened; in other words, a balance is obtained. The effect can be felt
soon after the practice of pranayama is over. A single long inhalation has been
shown to enhance airways relaxation. The resistance to air flow in asthma occurs in
medium sized airways. The slower and longer the inhalation, the better the
relaxation. The exhalation in yoga is never forced as it would narrow the bronchi. It
is rather a slow, very deliberate process. It can take as much as one minute to
complete an inhalation and exhalation. The normal respiratory rate is 16 to 17 per
minute. In pranayamic practice this is brought to one or two per minute. One can
well imagine the relaxation of the bronchial tree. Regular practice improves ventila-
tion, better control of smooth muscle as the process of breathing helps in voluntary
opening of airways. There is a gradual change in the frequency of attacks and then a
reduction in their severity. The breathing soothes the lining of the bronchial tree and
prevents hypersensitivity to external allergens. Hence the chemical irritation of the
lining is less. In pranayama, the varying rates of inhalation and exhalation give
added benefits. As pranayama works at the microcellular level, stabilisation occurs
over a prolonged period of time.
All asthmatics cannot start with pranayama. When they are breathless most of the
time, how can they practise pranayama which demands slow breathing? First, the
lungs need to be rested before breathing is done. Some need to practise asanas to
stabilise the lungs and relieve the strain, before pranayamic practice can be initiated.
Pranayama is done lying down on pillows to promote deep breathing. Simple ujjayi
breathing may be used at first; and, as the condition improves, strenuous
pranayamic techniques which have better effects can be taught.
If pranayama is practised regularly the patient will most certainly feel a marked
difference. Nevertheless, spasms may continue to occur and the patient should never
stop practice in despair but persevere. Drugs may still be needed, but the patient will
do better with yoga and medication than with medication alone. In some cases, yoga
alone will suffice. As the disorder is one of a hypersensitive nature, relapses are
common. Yet, in the long run, stabilisation does occur. Many so-called yoga camps
conducted for asthma wrongly claim relief or cures in a short period. Asthma, being a
chronic disorder, requires many years for stabilisation, not to speak of a total cure.
Resting poses like supta virasana, setu bandha sarvangasana, half halasana, viparita
karani and viparita dandasana are the asanas recommended in the treatment of
asthma. During an attack, the use of back or forward bends depends on the patient's
needs. All the asanas are done on props to help avoid strain and not provoke
wheezing. As the condition improves, props can be dispensed with.
 Pulmonary Diseases

Chronic bronchitis and emphysema

Chronic bronchitis is a condition where there is excessive mucus production in the

airways for at least three months in a year. This can be with or without pus in the
sputum. Associated with this is wheezing. Emphysema is defined as distension of the
air spaces distal to the terminal bronchiole, with destruction of the alveolar septae.

In chronic bronchitis, there is increase in the size and number of mucus-secreting

glands. In emphysema, the cells of the lungs are permanently destroyed.

 Cause
 Symptoms
 Medical Management
 Yogic management
 Role of Pranayama

Causative factors

Again, for both the diseases, the causative factors are smoking, air pollution,
occupational hazards, infection, etc. In emphysema, there can be a deficiency of an
enzyme inhibitor that normally prevents the cells of the lungs from being eaten away
by certain other enzymes. Lack of this inhibitor can be a genetic problem.
On the functional level, there is airways obstruction in both the diseases. In
emphysema, there is loss of elastic recoil of the airways and the cells of the lungs.
As the alveoli are inelastic and overstretched, drawn in air is not easily pushed out,
resulting in air being trapped in the lungs. This makes the patient gasp as the lungs
are over-distended. Poor oxygen exchange and expulsion of carbon dioxide, poor
circulation of blood, and stagnation of secretions leading to easy infection, occur. The
heart is constantly strained as breathing is laboured.
In the bronchitic patient, there is carbon dioxide trapping, with the patient becoming
markedly blue in some cases; respiratory failure can result. The heart is overloaded,
leading to cardiac failure. In contrast, patients with emphysema manage to maintain
the carbon dioxide and oxygen levels in balance fairly well.

Symptoms

Bronchitis
There is a history of recurrent mucopurulent cough with expectoration. This is often
of long duration. The strain on the heart is greater in this disorder. The back
pressure creates cardiac or, more often, cardio-respiratory failure. Because of mucus
plugging, it is more exacting for the blood to flow into the lungs; and the right
ventricle finds it increasingly difficult over the years to pump blood. Carbon dioxide
levels are high. Hypertension develops in the pulmonary vessels.
Emphysema
Breathlessness (dyspnoea) is the cardinal factor. This is associated with varying
degrees of wheezing and cough. Chronic hyperventilation and exertion of breathing
keep the chest constantly elevated, giving the appearance of a puffed-up chest. The
increased effort in breathing is due to deficient elastic recoil of the lungs which retain
air and become over-distended. The diaphragm is always kept in the lowest possible
position. The constant struggle often tires the patient. The accessory muscles of
respiration in the neck are prominent.

Medical Management

The principles of management in both the disorders are somewhat similar. Oxygen is
of prime value in both. In emphysema, it is beneficial for the patient to use oxygen
for at least ten hours daily, especially in advanced cases. This helps to maintain the
saturation of oxygen at near normal levels. In bronchitis, the infection should be
treated with antibiotics, and oxygen if necessary. The emphasis here should be on
preventing episodes of infections. In both disorders bronchodilators are useful to
open the airways and push out the secretions. Sputum liquefiers are valuable to help
expectorate. The goal in treating both the diseases is to maintain near normal
respiratory function to help the patient carry on with daily activities. The pollution in
the atmosphere today makes life miserable for both types of patients.

Yogic Management

Antibiotics remove infection, bronchodilators dilate, but to maintain the health of the
respiratory system after recovery or before unhealthiness sets in, exercise is the only
viable tool. Exercise is the only way to help improve the mechanical efficiency of the
lungs. The usual repertoire of exercises is too strenuous for the lungs, especially in
emphysema. Exercises that do not raise the respiratory rate and yet help excretion
of the sputum, increase oxygen levels in the blood, increase the elastic recoil of the
lungs, prevent recurrent infections, and aerate the whole lungs, invigorating the
patient at the end of the session, are necessary. Yoga stands out as the only system
eminently meeting all these requirements.
Asanas are very valuable in treating both disorders. Props are needed to prevent the
patient from becoming breathless as the lungs are already unhealthy, particularly for
the patient with emphysema. Asanas, especially inversions, are useful in promoting
better drainage from the basal parts of the lungs. The steady pressure of the
abdominal organs on the diaphragm develops endurance. But for the patient, head
stand is done on the ropes. This does not create pressure on the lungs. As these
disorders are due to clogging, poor clearance, fatigue of the lungs and spasms, yoga
works very well in all these parameters and also at the micro level, improving
oxygenation to the cells. The principal point to remember is that while other
exercises exhaust the lungs, yoga gives rest and rejuvenation. Asanas and
pranayama work by gentle and steady methods, wafting the air into the lungs; other
exercises are harsh and strenuous.
Back bends help clear the bronchial tree of mucus by massaging the lungs. These
poses give rest to the lungs and improve stamina. Effort tolerance improves. The
heart is made strong in the bronchitic. The opening of the thoracic cage in back
bends creates negative pressure in the lungs, allowing blood from the right ventricle
to enter without strain. As back bends improve vital capacity, the emphysematic
benefits. For the bronchitic, excellent oxygenation occurs. These poses are very
valuable as they invigorate the lungs.
In forward bends, the posterior lobes of the lungs are massaged and blood flow is
improved. For the emphy-sematic, this position relieves constant strain on the heart.
Twisting asanas squeeze the lateral parts of the lungs, improving their function. The
asanas help better expulsion of trapped air in the emphysema patient. Resting poses
such as supta virasanaand viparita karani are very useful to remove strain on the
heart and reduce the respiratory rate in the emphysematic.
All standing poses improve the endurance of the patient in a manner similar to that
of other exercises, but without the added strain. The vascularity of the lung, its
mechanical components, its exchange capacity for gases, and the softness of the
lung are all preserved by the practice of asanas and pranayama. The drainage of
mucus helps prevent recurrent infections. This benefit is of a significant nature for
both conditions.

Role of Pranayama

Pranayama improves mucociliary clearance and stamina. The practice of kumbhaka

(breath retention) facilitates better percolation of oxygen into the lungs. In the
process of retention, the partial pressure of gases (in this case, oxygen) increases,
which facilitates better and deeper entry as there is enough time for percolation. The
improved uptake creates better adsorption onto haemoglobin, thus enriching the
quality of cellular food. This gives greater energy. To begin with, ujjayi pranayama is
introduced as it does not strain the lungs. Later, other varieties are more beneficial.
A minimum time of 15 minutes of daily practice is essential.
All the asanas are done on props. This gives rest to the lungs, especially in the
emphysematous patient. As the lungs recover faster from breathlessness, fatigue is
relieved. The benefit of easier breathing is appreciated more in bronchitis as the
mucociliary clearance mechanism is activated. In emphysema, the need is to reduce
the strain on the lungs by using a prop while practising pranayama which allows
more complete evacuation of the trapped air in the alveoli. With regular practice, the
lungs empty and fill in a coordinated manner. The normal medical instruction for
patients with emphysema, to press the abdominal area to squeeze more air out of
the lungs and through the mouth, is a strain on the system. The dorsal spine must
be supported by a prop. Only then must breathing begin. The accessory muscles of
respiration in the neck are already strained in emphysema. Forcibly using them by
pressing the diaphragm which, in turn, tenses the neck muscles, must be avoided.
Moreover, with the abdominal area compressed, the heart is also strained. There is
also no time to prevent recurrent infections (by enhancing clearance mechanisms) if
breathing is done fast. The moment the patient lies down on the prop, the strain on
the accessory muscles of respiration reduces and he or she can make a `relaxed
effort' to empty the lungs. The benefits depend, of course, on how much of healthy
lung tissue remains.
All passive poses are good for emphysema. As the patient improves, active asanas
can be practised. In chronic bronchitis, both active and passive asanas can be done,
depending on the condition of the patient. As the strain on the heart is relieved (by
the lungs functioning better), premature failure of the heart can be avoided. The
asanas are modified according to the condition and age of the patient. Continuous
follow-up is essential.
The relevant asanas for the three conditions mentioned above include supta
virasana, setu bandha sarvangasana on pillows, dog pose with the rope,
purvottanasana on pillows, head stand on the ropes, viparita dandasana on the rack,
urdhva dhanurasana on the stool, sarvangasana on the chair and viparita karani
against the wall. All other asanas can be done as the condition improves. Pranayama
is instituted when the frequency of attacks decreases, the spasms lessen, and the
intercostal muscles function well.
 Gastro Intestinal Diseases

Peptic Ulcer

This is probably the most common stress-induced disorder today. Anyone who is
prone to tension is a potential patient. This disorder is an excellent example of how
Western medicine and yoga can work together. A good deal is known about its
mechanisms and management.

Etiology

Cells in the gastric lining secrete acid. There is a chemical pump mechanism that
makes for acid flow. Multiple factors influence this secretion: chemical, neural and
mental. Gastrin, present in one of the regulatory peptides, stimulates acid flow. This
is also present in the duodenal mucosa. Histamine is a chemical present in the
gastric mucosa. This also stimulates acid flow by binding to certain receptors, called
H2 receptors. Food in the stomach, principally the protein content, stimulates release
of acid. Other substances like alcohol, non-steroidal anti-inflammatory drugs like
aspirin, caffeine and oral calcium also stimulate acid flow.

Inhibition of acid flow can occur by other chemicals present in the antral mucosa.
Somatostatin is one such chemical. Fat in the duodenum also inhibits acid flow.
Stimulation of the vagus nerve is responsible for acid flow.

Pepsinogen is an enzyme in the stomach responsible for the formation of pepsin.

Both acid and pepsin can corrode the gastric mucosa. Secretion of mucus is a potent
inhibitor of the corrosive effects. Bicarbonate ion secreted from the gastric mucosa is
another. Once acid is secreted it cannot flow back into the cells as there is an
effective barrier to this back flow. If this barrier is broken, cellular injury may result.
Maintenance of normal mucosal blood flow is an important component of mucosal
resistance to acid injury.
 Gastro Intestinal Diseases

Gastric Ulcer

This generally occurs when a person is in his or her sixties, and usually ten years
after duodenal ulcer. Gastric ulcer can be benign or malignant. About 55% of ulcers
occur in males.

 Cause
 Symptoms
 Diagnosis
 Medical Management

Causative factors

Acid and pepsin are important in the pathogenesis. Some patients have duodenal
ulcers in addition. The exact mechanism is uncertain but damage to the mucosal
lining occurs. Regurgitation of bile from the duodenum can be a factor in genesis.

Symptoms

The most characteristic is that of pain in the epigastric area (where the ribs diverge
at the bottom of the sternum). The pain can be relieved or precipitated by food.
Other symptoms are nausea, vomiting, bloating and fullness after meals. Gastric
ulcer is less frequent than duodenal ulcer. Weight loss is common as many avoid
eating because of the pain. Gastric ulcers can heal and recur in the same location,
mostly in the antral region of the stomach. Haemorrhage is present in 25% of cases.
Mortality, if perforation of the stomach occurs, is greater than in duodenal ulcers as
the patients are older. There may be gastric outlet obstruction if the ulcer is in the
pyloric area.

Diagnosis

Endoscopy and barium meal are the two diagnostic methods. The latter gives an
accuracy of almost 90%. Larger ulcers are often malignant (about 5% of ulcers are).
A biopsy is needed to confirm malignancy. Endoscopic assessment allows cytological
studies.
Medical Management

Antacids are the mainstay. Though acid hypersecretion is not the feature of this
disease, drugs like ranitidine, cimetidine and famotidine are useful in healing the
ulcers as they inhibit acid secretion, allowing the area to heal. Side effects to these
include rash, breast enlargement in males (gynaecomastia), reduction in sperm
count, and impairment of mental status in elderly patients. The drugs need to be
taken twice daily. The patient should follow a bland diet. Carbenoxelone, a drug from
the liquorice plant, is effective in healing ulcers. It increases the life span of mucosal
cells and the secretion and viscosity of mucus. Side effects include salt and water
retention. Failure to heal in three months should suggest malignancy. Surgery is
reserved for refractive medical therapy. With effective medical treatment this can be
avoided.
 Gastro Intestinal Diseases

Duodenal Ulcer

This is more classical and common. The ulcer penetrates deep into the mucosa. More
than 95% occur in the first part of the duodenum. About 60% of ulcers recur within
one year and 90% within two years.

 Cause
 Symptoms
 Diagnosis
 Medical Management

Causative factors

These are not known for sure. The number of acid-secreting cells is high, with
greater outpouring of acid. Excessive acid flow is consequential, in comparison to
gastric ulcer where defective mucosal resistance is the cause. Genetic factors appear
to be important. Alcohol and cigarettes are potent causative and aggravating factors.
Others are chronic usage of painkiller drugs, poor lifestyle, a bacteria known as
helicobacter pylori found in a number of patients with DU, skipping meals (which
allows acid to irritate the lining, the outflow being aggravated by stress on an empty
stomach) and, most important, the mind. Stress produces and aggravates duodenal
ulcer in any situation. Of this there is no doubt. All patients experience increase in
pain with stress.

Symptoms

The classic symptom is pain in the epigastric area present two to three hours after a
meal. It is a burning, painful, gnawing or aching sensation, with fullness or bloating,
even awakening the patient from sleep. It is relieved by intake of food or antacids.
The severity of the pain varies, and recurrence is common with periods of remission.
Any change in the pattern of the pain may herald complications — constant pain
unrelieved by any agent may suggest perforation, or adherence to the pancreas
behind. Many patients with DU have no symptoms. There is often poor correlation
between symptoms and healing. Surprisingly, duodenal ulcers never turn malignant.
Complications are similar to gastric ulcer.
Diagnosis

Pain in the epigastric region and a little to the right side and below it, if relieved by
food or antacids, is in favour of DU. Double contrast barium and endoscopy are
helpful in diagnosis. Small ulcers missed by barium can be picked up by endoscopy.

Medical Management

Healing of ulcers and relief of pain are the two objectives. Antacids like aluminium
hydroxide and magnesium hydroxide are most commonly used. The former produces
constipation, and the latter diarrhoea in some patients. Antacids could be taken one
hour after each meal and at bedtime. Agents preventing the binding of histamine to
receptors are very helpful. Acid secretion is lowered. They are taken with meals. Side
effects are minimal, though they include rash, gynaecomastia, mental confusion and
increasing the action of other drugs. Ranitidine, nizatidine and famotidine are
effective. Omperazole is a promising drug. Prostaglandins, which are chemicals
present in the body, help ulcers. They reduce acid secretion, enhance mucosal
resistance, stimulate blood flow, increase bicarbonate secretion and stimulate cellular
regeneration. Other important measures include cessation of smoking and drinking,
lifestyle changes to reduce stress (which is probably the most important) and
avoidance of painkiller drugs. Within four to six weeks of therapy, most duodenal
ulcers heal.
If surgical procedures are undertaken, the area is resected and the remainder
sutured for gastric ulcers. In duodenal ulcers, the duodenum is bypassed and the
stomach joined with the small intestine (gastro-jejunostomy). There are many side
effects: diarrhoea, as the vagus nerve is cut to reduce acid secretion (the vagus
nerve controls gastric emptying), nausea, alteration in blood glucose due to the
altered anatomy, and anaemia due to malabsorption. The frequency of surgery for
both conditions has decreased after advances in medicine.
 Gastro Intestinal Diseases

Yogic Management of Ulcers

Yoga works along four principal mechanisms. First is that of intra-organ massage,
improving blood flow and allowing better healing; second is by better glandular
secretion of mucus; third is acid reduction by specific poses; and the last, and most
important, control of the mind and senses.

The quality of massage is such that in specific asanas like supta virasana,
purvottanasana and back bends done on props, blood circulates healthily in the
gastric area. This helps healthy healing of ulcers and digestion which is hampered in
such patients. Healthy absorption follows, with good energy levels. This reduces
stress on the nerves. Each asana is held for a period of five minutes at least. Props
are used, without which it is difficult to maintain timings. As healthy blood flow
occurs, the glands secrete mucus which coats the lining of the stomach or
duodenum.

The stretch of the vagus nerve is probably the most important mechanism in back
bends which reduces acid flow. Hunger decreases. The normal effect of stimulation of
the nervous system and mind by back bends does not occur as the poses are done
with props and with the bandage on the eyes. A particular property of an asana is
nullified, yet the asana is used.

Inversions promote a feeling of lightness in the organs at once. They also help good
absorption of food and elimination of excess wind in the system. Forward bends,
though they quieten the mind, are contra-indicated, as they increase acidity with the
vagus nerve being stimulated. They may be introduced after healing has occurred
and the condition is under control with yoga alone. If drugs are still being used,
forward bends should not be introduced.

To relieve bloating, belching, fullness and acid burn after meals in both conditions,
some asanas can be performed after food. These are supta virasana on pillows and
purvottanasana. They can be repeated any number of times in a day in addition to
the morning and evening practice sessions. The effect is just like ingestion of
antacids, and even faster as lightness is perceived in the organs at once. This feeling
cannot be achieved by cimetidine and other drugs. It is a very good policy to start
treatment with drugs and simultaneously ensure asana practice. The effect is
additive. The drugs can be tapered off as the condition improves. If the person is
patient enough and the disease is in the early stages, yoga alone is sufficient.

Drugs work at the cellular level, inhibiting acid flow by antagonising some receptors.
The peripheral effects are controlled but the crux of the problem is not tackled. If
medication is discontinued, it recurs. Asanas prevent this, as yoga works on the
vagus nerve itself, reducing acid flow. This is healthier, especially in the long run.
Yoga also quietens the entire system, inducing hibernation, so that all cellular
responses are quietened. Drugs can be discontinued fully, if a patient combines yoga
with medication in the early stages of disease management. Moreover, asanas
maintain acid flow in old age, preventing invasion of the stomach by pathological
-organisms.

It is also important for the person to make lifestyle changes by delegating work,
practising a little detachment emotionally from the work scenario, not being a
perfectionist, adhering to meal timings strictly, and ensuring good sleeping hours.
Keeping the mind in control is very important for patients with duodenal ulcer. The
value of pranayama along with pratyahara has been repeatedly emphasised. The use
of the bandage in asana practice cools the senses. Tranquility occurs, reducing acid
flow further. This allows healing of ulcerated areas. Pranayama reduces sympathetic
stress on the mind and the body, and thus acid flow is reduced. Again, the cells are
not antagonised, it is along natural principles. Acid pain and other symptoms reduce
very fast, if pranayama is done with total involvement and sense withdrawal. The
contemplative type of nadi shodana is the best as it brings the mind to focus on the
breath and produces withdrawal of the senses. The use of the bandage on the face is
essential.

The asanas useful for both gastric and duodenal ulcers include supta virasana,
purvottanasana, setu bandha sarvangasana on pillows, dog pose with the rope,
inversions on the ropes (which drain and allow fresh blood for healing the ulcerated
areas), half halasana (which removes stress on the mind), setu bandha
sarvangasana on the box and viparita karani. The gastric fire which is overstimulated
is quietened by back bends.

The question of how the same asanas work for both diseases may be raised. The
reason is that, in both, healing is needed, acid flow is to be decreased, mucus
secretion is necessary, digestion is to be optimised. In the case of gastric ulcer, the
stomach is kept comfortable after a full meal by these asanas and in the case of DU,
the stomach and duodenum are kept non-irritated by the soothing of the vagus
nerve.

Acid peptic disease is a classic example of the breakdown of mind and body
connections. It is interesting to note that persons who practice yoga from a young
age never develop peptic ulcer disease as the training of the mind and body is
already instilled. Yoga philosophy teaches the right way to live, and asanas and
pranayama protect the system.

Even if there is mental stress, so long as the person is practising yoga, the body
does not feel the impact. It is easier to protect the body than the mind. Hence the
ancients advised us to practice yoga so that at least the body is kept healthy and
gradually, some day, the mind that is under stress can also be made likewise.

Our ancient preceptors had no facility to measure acid flow in the stomach, no
endoscopic facilities, no barium facility, and yet they analysed the problem in their
own way according to the theory that our body is made up of five elements, and the
fire element is aggravated in such disorders. They even prescribed the correct
asanas to alleviate them. How, one may ask, did they understand so much and even
prescribe? Intuition? The silence that touches your mind when asked these questions
will provide the right answer.
 Metabolic Diseases

Diabetes Mellitus

Diabetes mellitus (DM) is the most common and possibly one of the oldest metabolic
disorders in the world. It is characterised by multi-system dysfunction due to an
elevated blood sugar level. Susruta has described this disorder in his medical text.

 Types
 Symptoms
 Complications of diabetes
 Long term complications
 Causes of complications
 Medical Management
 Yogic Management

Types of Diabetes

There are two broad types of diabetes mellitus:

i. Primary or type I Insulin Dependent Diabetes Mellitus (IDDM), which develops
before the age of forty.
This is often seen in children too. It is almost certain that the disease is auto-
immune in nature and that there is a genetic predisposition. The body's defense
mechanism attacks the pancreas and destroys the islets, and the level of
endogenous insulin is very low. The situation is similar to rheumatoid arthritis. An
environmental factor of viral etiology is also thought to play an important role in the
genesis of the disease. The situation can be summarised as: genetic predisposition
-->> environmental insulitis -->> activation of auto immunity -->> destruction of
the cells of the pancreas -->> diabetes.
ii. Type II Non-Insulin Dependent Diabetes Mellitus (NIDDM), which is the most
common form of the disease and accounts for 90% of all diabetics.
This usually begins after middle age. There are three sub-types: non-obese, obese,
and maturity-onset diabetes of the young (MODY). Endogenous insulin is adequate
but, in the face of stress, may fail. The defect here can be either one of the beta cells
failing to produce enough insulin or an impaired tissue sensitivity to insulin.
There can also be secondary diabetes which is caused by (i) pancreatic disease due
to damage to cells of the gland; (ii) drugs like diuretics and steroids which can
increase the blood sugar level; (iii) hormonal abnormalities — over functioning of the
pituitary and adrenal glands; (iv) insulin receptor abnormalities; and (v) genetic
disorders.
In IDDM, by the time diagnosis is made, 90% of the beta cells are destroyed. Little
progress has been made in the pathogenesis of NIDDM.
Symptoms

The patient usually complains of passing a larger than normal volume of urine, with
increasing frequency every day. The osmotic effect of increased levels of blood
glucose causes more thirst and hunger. These classic symptoms, however, are not
the normal presentation. Usually the disease is discovered on routine examination.
Sometimes the patient suffers a frozen shoulder and this can be a manifestation of
diabetes. Lethargy, weight loss and easy susceptibility to infections, particularly of
the skin (like a simple boil or a fungal infection), excessive hunger, craving for
sweets and sweating are some of the other symptoms.
Diabetes may co-exist with other disease states. In this situation, it might be the
diabetic condition that has made the patient prone to infection. Tuberculosis is the
most common clinical condition which may also be present. Some others are
malignancy, HIV infection, surgical stress, a heart attack, febrile illnesses and renal
disease.
Normally, the fasting level of blood glucose is less than 90 mg/dL and the post-
prandial (2 hour) level is less than 120 mg/dL. If the post-prandial sugar level is
between 150 and 200 mg, the condition is labelled as an impaired tolerance and, if
above 200, it is frank diabetes.

Complications of diabetes

Acute complications include ketoacidosis, a state of metabolic stress with

overproduction of chemicals called ketone bodies. The patient suffers nausea,
vomiting, dehydration and, if untreated, coma supervenes. This is always treated
with insulin and replacement of electrolytes. The fluid deficit is around three to five
litres. Any kind of stress — mental tension, a major infection or even a mere boil,
fever, etc. can precipitate an acute increase in blood sugar level. Mental stress is the
commonest situation that raises blood sugar level. Stress drives the adrenal glands
and this raises the blood sugar. Stress also prevents orderly secretion from the
pancreas, which is unable to handle the extra load. Eventually, the majority of
diabetic patients suffer long-term complications which can be prevented if adequate
precautions are taken to stem the disease in the early stages by a healthy diet and,
more importantly, by the inculcation of a daily exercise schedule.

Long term complications of diabetes

Cardiovascular problems: The rate of progression of atherosclerosis is rapid due to

the elevated blood sugar. Blockage of peripheral blood vessels creates intermittent
claudication (pain when walking, which varies from patient to patient) in the legs.
Silent heart attacks (due to narrowed coronary vessels) are the rule because of
damage to the cardiac nerves that normally transmit the pain sensation of angina.
Sudden rhythm changes in the electrical conduction of the nerves of the heart can
cause what are known as arrhythmias. These may manifest as a medical emergency
with the heart coming to a total standstill. Sudden death due to autonomic cardiac
dysfunction is well known. Hypotension and sudden fainting due to autonomic
imbalance are also common.
Eye complications: Diabetic retinopathy is one of the leading causes of blindness.
The basic reason is hypoxia to the blood vessels which causes the various forms of
retinopathy. The eye lesions are classified into background retinopathy and
proliferative type. Because of hypoxia, there occurs increased capillary permeability,
venous dilatation, leakage of protein and lipids, infarcts in the retina called `cotton
wool spots' which are nothing but areas of dead tissue, bulging of the lining of blood
vessels and haemorrhages.

New vessels may form due to hypoxia. The stimulus for new vessel formation is lack
of oxygen. These new vessels affect vision and cause traction on the retina and
subsequent retinal detachment. Photo-coagulation is the treatment for neo-
vascularisation. Some loss of peripheral vision may occur. About 85% of patients
develop eye -complications.
Diabetic Nephropathy: Renal disease due to diabetes is a leading cause of mortality.
The minute blood vessels undergo thickening and deposition of albumin and globulin
material occurs. Atherosclerosis is rapid in the diabetic kidney. The cells of the
kidneys shrink due to loss of blood supply, resulting in an ischaemic shrunken
kidney. There is loss of albumin in the urine to the extent of more than 30 mg to 300
mg per day. Recurrent kidney infections are also common. There is no specific
therapy for diabetic renal disease. Renal transplantation offers a solution if renal
failure occurs, but there may be other associated complications that may offer poor
results. Associated hypertension has to be aggressively treated.
Diabetic Neuropathy: This affects every part of the nervous system with the
exception of the brain. There is de-myelination of the nerves due to ischaemic
changes in the minute blood vessels that supply the nerves. Loss of nerve function
causes symptoms like sensory and motor disturbances, severe pain, and altered
sensation in the area of the nerve, the so-called diabetic polyneuropathy. The nerves
innervating the joints are damaged. Pain in the joints due to wrong usage goes
unnoticed as the nerves that transmit such pain to the cerebral cortex and spinal
cord are damaged by excess blood sugar. This results in trauma to the joints, with
the affected joints becoming deformed and 'dead'.
Sudden paralysis of any of the cranial nerves can occur. Spinal nerves are also
affected, leading to pain in the muscle innervated (diabetic amyotrophy). Sometimes
the affected area can also burn like fire.

Gastrointestinal Conditions: Autonomic dysfunction (imbalance between sympathetic

and parasympathetic systems) affects the gastro-intestinal tract, resulting in delayed
gastric emptying, constipation or diarrhoea. The impaired colonic motility causes
stagnation of bowel contents and colonisation by pathogenic bacteria and infection.
This diarrhoea responds to the antibiotic tetracycline but the mechanism is ill
understood. Bladder dysfunction or impotence can occur.
Skin Disorders: Diabetic foot ulcers are a dreaded problem. The elevated blood sugar
leads to altered and defective protein synthesis and abnormal collagen formation,
and the tissue formed is easily susceptible to trauma. Blockage to the minute blood
vessels also causes ischaemic necrosis of the skin and gangrene can result with
added infection. This leads to easy breakdown of skin and formation of ulcers; and,
since the nerves are damaged, the pain is not noticed even if there is gross infection.
Healing of wounds is delayed due to poor circulation and low resistance of the tissues
in a high sugar medium. The skin on the surface of the shin is affected by certain
specific lesions. The deposition of lipid-laden macrophages on the buttocks, back of
the elbows and knees constitute what are known as xanthomas.

Causes of complications

This is not known for sure. A substance called sorbitol, a metabolite of glucose
formed by activation of different chemical reactions, acts as a tissue toxin and is
thought to be responsible for all lesions. A second mechanism is the formation of
altered proteins in the body. The lipoproteins are also affected. Altered collagen traps
this changed lipoprotein in the vessel walls. Thus blockage of vessels is accelerated.
The lipid fractions in the blood are raised. Hyperviscosity, with abnormal aggregation
of platelets, occurs.

Medical Management

Patient education is very important. Physicians must spend time to explain that this
is a controllable situation and one need not despair. Patients too often do not
comply. They abuse their diet and yet expect the blood sugar to remain under
control. Firstly, a strict dietary regimen is very important. Secondly, exercise is very
valuable. A diabetic may manage without medication, but he or she cannot manage
without exercise and a healthy diet. Exercises like jogging and cycling increase the
rate of entry of sugar into the cells and improve insulin sensitivity. As the cells are
metabolically very active during exercise, they consume greater amounts of sugar
and the blood levels of sugar reduce. The quantity and type of exercise needed
varies from patient to patient and has to be monitored.
The goal of therapy is to maintain blood glucose to as near normal as possible. This
is associated with fewer complications in the long run. The danger of low blood sugar
during therapy has to be carefully tackled. Self-monitoring of glucose is convenient
though regular hospital check-ups are important. There are a variety of user-friendly
gadgets for home monitoring. Periodic laboratory check-ups are essential for counter
checks.

Control through diet

Dietary modification depends upon the type of food the patient is exposed to; and
the correct balance of proteins, fats and carbohydrate is to be taught. Generally, a
low fat, high protein diet with normal carbohydrate intake is advised. If the patient
does not exercise regularly, carbohydrate content is to be reduced. Protein is
important unless renal disease is present. A young active diabetic needs around
1800 to 3000 kcal per day. The elderly diabetic needs around 1000 to 1800 kcal, and
an obese middle-aged patient needs 1000 to 1600 kcal.
In most diabetic diets, calories derived from carbohydrate is around 45% to 55%,
from protein 15% to 20%, and from fat 30% to 35%. This is not a strict classification
and there are any number of modifications possible from patient to patient. The
intake of protein may be around 60 to 110 gm. That of fat is around 50 to 150 gm
and of carbohydrate around 200 gm. For obese patients, reduction in weight is
important as blood sugar level improves with loss of weight.
Strict monitoring of this regimen is necessary. A measured diet is healthier than an
unmeasured one. Fibre lowers the absorption of sugar from the intestine and reduces
post-prandial increase in blood sugar. Beans, legumes, guar gum and bran help to
control and reduce absorption of the LDL type of cholesterol. Though artificial
sweeteners can be used, they are better avoided as they are chemicals. Non-
vegetarian food, with its high fat content, is not recommended. Alcohol is strictly
prohibited.

Medication
The treatment of IDDM is primarily by insulin. There are several kinds of insulin —
short-acting, ultra short, intermediate and long-acting — which are used as the
situation warrants. For example, if the sugar has to be normalised very rapidly,
short-acting types may be used. Insulin lowers sugar in all kinds of diabetes. This
delivery should be similar to endogenous natural pancreatic insulin; but then, man
can never duplicate nature. At best a mechanical pseudo-imitation can be
manufactured. The release of insulin is influenced by the state of mind which, in
turn, influences sleep and so many other mental and physiological factors which
regulate insulin release which no machine can sense and adjust.
The delivery of insulin can be by a syringe, by a jet injection or by portable infusion
pumps. Treatment with insulin does have problems. Hypoglycaemia is the most
common dysfunction. Each method of delivery has its inherent problems. For
example, when portable infusion pumps are used, signs of infection must be carefully
watched for. The areas where insulin has been injected can atrophy, causing skin
problems. The body can develop allergy, resistance, antibodies to the insulin
delivered; and increased dosage of insulin may be needed as the disease progresses.
Insulin from human sources is less irritative to the body, less stimulative to antibody
systems and is better tolerated than most other kinds.
Drugs used to treat diabetes, like tolbutamide, glibenclamide, glipizide, glyburide,
glicazide, etc (the sulphonylureas), lower blood glucose in patients capable of
endogenous insulin production. These are indicated for type II diabetes and in non-
pregnant adults and most types of secondary diabetes. They stimulate the islets to
release insulin and possibly decrease insulin resistance. Side effects include
hypoglycaemia, rash, nausea and an increased risk of cardiovascular mortality.
Drugs are the first line method of treatment if the situation allows it. In the elderly,
who cannot try other modalities of treatment, these are very helpful.
Even for the middle-aged with maturity onset diabetes, it might be easy to reduce
the sugar levels with a drug or insulin and then switch over to, or add, the important
component of exercise. In the long run, unless the tool of exercise is introduced,
metabolic control is not satisfactory in all the types of diabetes.

Role of exercise
The effect of exercise in IDDM and NIDDM stems from the fact that exercising
muscles increase their uptake of glucose 10 to 20 times, depending upon the
duration and intensity. High intensity exercise reduces blood glucose and fatty acids
are used for energy. Exercise training enhances the action of drugs and increases
insulin sensitivity. If the patient is obese, the development of such sensitivity takes a
longer time. Blood sugar must be fairly under control before this is begun.
Vigorous exercise training helps normalise blood sugar, either alone or in
combination with dietary modification and drugs. For type I diabetics, regular
exercise is important. This improves cardiac function and lowers excess lipids.
Individual monitoring of the response to exercise is important. If exercise sessions
are intense, it is advisable to decrease insulin dosage and raise carbohydrate
content. If any complication is present, like peripheral neuropathy, irritative
exercises like jogging which can cause foot damage should be avoided as the patient
cannot feel the pain due to the nerves being damaged by excess blood sugar.
Heavy meals should be eaten one to two hours before strenuous physical activity.
This avoids the coincidence of meal and insulin effect. If the patient has any other
existing complications like retinopathy or renal disease, he or she should avoid
strenuous exertion to prevent rise in systolic blood pressure which can damage the
weakened arteries.
 Diabetes Mellitus

Yogic Management

 Circulatory system, heart and lungs

 Digestive system
 Renal system
 Nervous system and special senses
 Skin
 Role of pranayama

Yoga is ideally suited for both types of DM. In insulin dependent DM, asanas help
prevent an increase in insulin requirement over the years. In NIDDM, asanas help
normalise blood sugar due to the high intensity workout. Yogic exercises can either
be high or low intensity, depending on the clinical condition. A young active diabetic
can be made to practise very intense asanas in a dynamic manner, which will
increase the cellular activity of the muscle which needs more sugar. The advanced
asanas require a lot of energy and this helps normalise blood sugar. But, if the
person is obese, asana practice is difficult and it is easier to reduce weight by other
means and then take up yoga.
Yoga increases the practitioner's sensitivity to body movements and cellular changes.
There is no pounding, flogging or forcible action in asana practice. The action on the
cells is gentle and soothing and relieves the modified pathology by better blood
perfusion, thus healing the area. Depending on the need the asanas can be modified.
In yoga, it is possible to create a selective uptake of sugar depending on the group
worked. Other exercises increase the general sugar uptake by the cells. Yoga selects
the cells to absorb sugar. This is due to the wide variety of the geometric shapes of
the asanas. The intensity of workout is total or regional.
The single advantage of the asana system is that the internal organs are directly
affected by the geometric shape of the asana itself; in other exercises the results are
indirect. The danger of hypoglycaemia in yoga is not so much as in other exercises
because of the conscious control over the cellular systems. The advantage in the
asana system is that even an elderly diabetic can practise it without any danger.
Other systems might aggravate autonomic neuropathy and sudden death is possible.
The emphasis in yoga is on controlling the autonomic dysfunction by means of
pranayama. A prolonged observational follow-up of practitioners of yoga has shown
that the incidence of DM is very low, if at all. This is so only if yoga has been
practised from a very young age or very regularly. In fact, the incidence of most
health disorders is very low in practitioners of yoga.
Circulatory system, heart and lungs

All the asanas are useful to prevent circulatory disease. Asanas impart strength to
tissues, helping them resist cellular alteration in pathological states. Because of
intra-arterial massage, the lining of the vessel wall is kept free of blocks. Moreover,
the force of arterial flow can be increased and directed to any organ, which is of
immense use in the diabetic state. In standing poses, the skeletal muscles increase
their uptake of sugar. Hence, the tissues retain insulin sensitivity. Capillary changes
are easily prevented by yoga as the action is on the vessel wall.
Foot injuries are avoided because of neural and soft tissue massage and retention of
healthy blood flow along with fresh oxygen; the last is so vital to diabetic tissue in a
particular area. For the patient with a diabetic foot lesion in the early stages, asanas
do not harm the sensitivity of the foot as the practice is slow and reflective. Injuries
are less likely to occur in comparison with other systems. In early cases, the
situation of a diabetic foot can be reversed. Virasana is particularly useful for this
purpose.
Peripheral blockage of arteries never happens if the patient is regular in asana
practice. Hence vascular disease, which is so common in diabetics, can be prevented
by instituting yoga as soon as the diagnosis has been made. Of course, the damage
may have already occurred; yet, more can be controlled after proper assessment of
peripheral flow by investigational procedures. The use of the foot rest for improving
blood in the calf muscle area is very important. This prevents neuritic pain in the
extremities. Peripheral neuritis is prevented and benefited by standing poses.
Back bends are very useful in averting blockage of coronary arteries. The maximum
benefits are derived only with an early diagnosis and asana practice instituted as
soon as possible, for atherosclerosis may have already progressed to a considerable
extent. Angiographic evaluation of the quality of blood flow to the coronaries will
provide baseline information of the status of the arteries. It is then possible to totally
prevent future cardiac problems. As the autonomic systems are balanced,
irregularities in heart rate and rhythm are controlled. Hence the chances of a sudden
collapse of a diabetic patient due to a cardiac lesion are much less.
Asanas tone up the lungs also. Back bends, forward bends, standing poses, are all
useful. Props may be needed for the elderly who have poor vital capacity. In this
respect pranayama is highly useful. Oxygenation being better, tissue hypoxia never
occurs.

Digestive system

Yoga is microcellular in its action. As the internal organs are massaged, sensitivity to
insulin and uptake of sugar are enhanced. Gastric and intestinal activity is regulated
and diarrhoea or constipation due to autonomic malfunction does not occur. As the
villi are massaged, absorption is better and sugar uptake is regulated. Twisting poses
squeeze the intestines and massage them. Hence, stagnation of colonic contents due
to autonomic dysfunction cannot occur. Asanas also pressurise the pancreas in an
effort to improve the secretory status. The massage of the pancreas by forward
bends and twistings help release more insulin in response to food.
Backward bends, being very strenuous, help reduce blood sugar due to the intense
work out given; yet in a different manner than that of aerobic exercises. Back bends
improve blood supply to all abdominal and pelvic organs. This ensures healthy
cellular integrity and due to the massage no deposits are formed. Forward bends
increase the gastric fire and help healthy digestion of food. This prevents fluctuations
of sugar levels in a diabetic. Hypoglycaemic reactions are suppressed. Burning up of
excess sugar is promoted by the stimulation of gastric fire.

Renal system

In renal disease, the increased systolic pressure in the renal artery and the protein
load during aerobic exercises might further damage the kidney. Yoga makes arterial
flow easier without an increase in systolic pressure. In yoga it is possible to control
the velocity of blood flow to internal organs; in other exercises there is no control
over the exercise process once it has begun.
In yoga there are asanas to shut off blood flow or promote flow without velocity if
necessary. Intra-renal massage prevents deposits in the microcellular areas that
damage renal tissues. Back bends are valuable tools against progression of renal
lesions. They squeeze the kidneys and prevent stagnation of circulation and
deposition of material that blocks blood flow to the cells. Hence, organ atrophy is
prevented. In the early stages of a renal lesion, asanas can be very helpful. Even
after a renal transplant, practice of asanas is very important to promote fresh blood
supply to the donor kidney. If a diabetic patient who has no evidence of nephropathy
practises yoga, he or she will never suffer the disorder. Passive back bends improve
blood flow in the renal artery without increase in pressure, while active poses
enhance pressure; thus both are needed.

Nervous system and special senses

Inverted asanas prevent blockage of cerebral arteries. Most important of all, they
prevent the development and progression of retinopathy by enhancing microcellular
perfusion of blood and oxygen into the retina without rise in systolic pressure. This
also prevents further complications as oxygen supply to the tissues is maintained
and enhanced. Forward bends soothe the nerves of the eye. They are preparatory to
inverted poses. The retinal vessels are gently massaged and strengthened by
forward bends. Standing inverted poses, like uttanasana with the head on the stool,
dog pose, prasarita padottanasana and viparita karani, have to be done with a
bandage on the eyes which acts like a pressure bandage, preventing rise in pressure
in the retina. Half halasana is valuable to rest the retina. If the retinopathy is very
advanced, much relief cannot be obtained. Competent guidance is essential to learn
yoga if the patient has eye lesions.
If standing poses prevent peripheral neuropathy, back bends prevent central
neuropathy; that is, afflictions of the autonomic plexuses and sympathetic and
cranial nerves. If diabetic neuropathy exists (whether in the distal or proximal parts),
practice of other exercises may be harmful as any injury to the tissues may go
unnoticed by the patient. But yoga is very gentle in its action and the patient can
restrain the intensity to any level. This prevents overstretching and injury. Moreover,
the movements are very slow in comparison to other exercises.
In an early diabetic state, asanas prevent damage to the nerves. All asanas should
be practised to prevent neuropathy. Standing poses, back and forward bends
preserve the integrity of the spinal nerves and the plexuses. In a well established
case of diabetic neuritis, it might be difficult to abolish the symptoms. This is why
yoga should be started as soon as the diagnosis is made. Asanas prevent damage to
the minute blood vessels which supply the nerves that normally get occluded due to
the pathological state. As healthy micro-circulation and massage are provided by
asanas, formation of new nerve sheaths are of a healthy nature.

Skin

The skin is massaged and blood supply preserved. As fresh blood flows through,
resistance to infections is built up. The skin does not become waxy and -unhealthy
as it would usually be in a diabetic. Elasticity is retained. Certain specific diabetic
skin lesions are prevented if regular yogic practice is resorted to. Standing poses,
virasana, padmasana, mula bandhasana, inverted poses, are all helpful in preventing
diabetic foot lesions.

Role of pranayama

Pranayama is highly valuable for improving oxygen perfusion to the tissues. As it

also removes stress on the system, progression of blockage is arrested. Oxygen
delivery to the tissues is systematic and sure. Tissue hypoxia never occurs.
Sympathetic and parasympathetic stabilisation prevent autonomic dysfunction. Even
in an established situation of imbalance, depending on the individual merits of the
case, relief can be provided. Prevention, relief or arrest of further progress of many
forms of autonomic dysfunction can occur through pranayamic practice. It is very
useful for all complications of the diabetic state, particularly cardiac autonomic
dysfunction, retinopathy and peripheral arterial occlusive conditions.
 Orthopaedic Diseases

Cervical Spondylitis

A very common disorder, normally seen in the elderly from the age of 55 onwards,
cervical spondylitis today is increasingly frequent in the younger age group from 35
to 45 years of age. There are several reasons for this. Before coming to the
pathophysiology, let us understand the developmental concepts.

 Causes
 Pathology
 Symptoms
 Medical Management
 Yogic Management

Causes

This is basically a mechanical disorder.

 Very stiff muscles in the cervical region can, over the years, cause a kinking
of the cervical spine to the front.
 Bad posture and lack of exercise to the cervical region are the key factors
which are responsible in a majority of the patients.
 Lying in bed with several pillows propping up the neck into an unnatural
position can affect the alignment of the cervical column, causing a forward
inclination.
 Reclining on sofas with the spine hunched and the neck pushed forward is bad
for cervical alignment.
 Hunching over the computer for many hours, occupational hazards such as
those of a writer, an illustrator or a painter, all cause the spine to be bent
forward all the time.
 Positioning the body to the same side during sleep, with the shoulder muscles
and the neck compressed, also develops faulty alignment in the cervical
spine. In due course the spine is bent, the front surface of the bones and disc
are excessively pressurised and damage occurs.
 The so-called executive chairs are ill-designed and push the neck out of
alignment. No chair should reach over the head. The level should be up to the
shoulder blades so that the chest can stretch over the edge keeping the body
upright.

In India, railway porters carry heavy loads on their heads but they do not suffer from
cervical pain (as one would expect) from the heavy load they carry every day. Only
in the group of people who never exercise their bodies does this occur most
frequently.
Pathology

Essentially, the pathology consists of:

1. Narrowing of the cervical vertebrae with disc space reduction.
2. Friction between two vertebral bodies created by this narrowing, with an
osteophyte (bony spur) formation.
3. Loss of normal concavity in the cervical region, i.e., loss of lordosis.
4. Symptoms of vascular insufficiency.
5. Numbness and tingling sensation in the hands or feet due to the compression
of the cervical nerve roots.

The problems of vascular insufficiency consist of vertigo, giddiness, occasional

tinnitus (a ringing sensation in the inner ear), a sense of unsteadiness, etc. In a
severe case, there is transient loss of consciousness. The vertebro-basilar vessels are
important arteries coursing along the cervical column to the back of the brain There
are areas here that subserve balance and posture. If the blood flow is affected, the
corresponding function is also affected. As the anatomical arrangement is intricate,
any movement in the neck affects the flow of blood in the arteries. This syndrome is
known as vertebro-basilar -insufficiency.

Symptoms

The most common symptom is pain in the neck, worsening with exertion and
relieved, in the early stages, by rest. This pain often radiates down to the hand, with
the fingers becoming numb due to compression of the nerves that innervate the
upper extremity. The brachial plexus is affected. The trapezius area becomes tender
and painful. A nodule can form in the muscle due to chronic pressure. The symptoms
of cervical cord compression can sometimes be severe. The pain radiates down the
right or left arm to the fingers, to the chest and shoulder blades depending on which
side the nerve root is involved. It can become continuous, making movements
painful and limited. If the cervical vertebrae become unstable, the danger of cord
compression is imminent and, in some cases, fusion of the bones may be warranted.
But this is rare.

Medical management

Medical science accepts cervical spondylitis as a normal degenerative aging change.

Painkillers are prescribed. In order to prevent the symptoms of vascular
insufficiency, anti-platelet drugs are given to maintain cerebral blood flow. This
makes the platelets less sticky, the blood thinner and helps better flow. But this is
illogical. The essential change is of a mechanical nature. If the cervical spine could
be realigned and the intervertebral spaces widened, a normal state of blood flow
would be restored. Physiotherapy can, at best, only offer marginal relief. sometimes
the condition may even be aggravated. It is better avoided.
In situations where the patient suffers acute giddiness, it is useful to restrict the
movement of the neck with a soft collar. Sudden neck movements cause the spur to
impinge on the cervical nerves and blood vessels and reduce the blood to the brain.
This creates a situation where the patient, sometimes becomes afraid of moving the
neck. In the long run, of course, a collar is to be avoided as it stiffens the neck
muscles and pushes the neck out of alignment. The problem is worsened as, for
health, the muscles and bones have to be aligned and stretched rather than made
stiff.
Cervical traction, where the skull is lifted up, has its value in a few cases. But, in due
course, the weight of the skull makes it settle down on the cervical column and the
symptoms recur. Though, obviously, the osteo-phytes cannot be removed, one can
adjust and realign the spine so that compression of the vertebral arteries and
cervical nerves does not occur.

Yogic management

All patients with cervical spondylitis have stiff neck and trapezius muscles and are
unable to stretch the neck backward. This is an inherent problem and not a muscle
spasm. As the anterior surfaces of the vertebrae are compressed causing pain, spinal
extension (stretching the spine backward) relieves the problem, though the
movement might initially cause vertebro-basilar insufficiency in some cases.
Vertebro-basilar insufficiency is prevented because of the resultant elasticity of the
cervical muscles and vertebral arteries.
It is essential to make flexible the trapezius, cervical and shoulder muscles. Patients
with cervical spondylitis cannot stretch the dorsal spine. Once this can be
accomplished, cervical spondylitis ceases to be a problem as extension movements
reduce pressure on the cervical nerves. Again, by regularly practising back bends,
this disorder can be averted.
In yoga, the intervertebral spaces are widened by pulling the trapezius and other
muscles downwards. This is yogic traction. This lengthens the trapezius for it is along
the line of gravity . Very little is achieved by conventional traction, where the
muscles will telescope into each other again.
There are various asanas which prevent and give relief to this problem —
sarvangasana, halasana and back bends are significant. Standing poses help align
the cervical and dorsal vertebrae. Inverted poses like head stand and shoulder stand
strengthen the cervical muscles and shoulder area. But the technique used in these
cases is quite different from the normal.

In head stand the forehead, and not the centre of the skull, is placed on the ground.
This lengthens the cervical column and helps weight bearing. Hence the concept that
persons with cervical ailments should avoid head stand is incorrect. The correct
method should be learnt, taking the ailment into account. As the condition improves,
normal practice methods can be introduced. Thus elasticity of the cervical muscles is
ensured. Shoulder stand is done with the help of the chair. This releases tight
trapezius muscles and frees all the structures along the cervical spine. If the normal
method of shoulder stand is practised by the patient, injury can occur to the cervical
spine. A rolled blanket may help the neck if stiffness is excessive.
In halasana, the cervical column is elongated and given strength and alignment. The
dorsal spine is strengthened and made supple. In back bends like urdhva
dhanurasana and viparita dandasana, maximum freedom is given to the anterior
surfaces of the cervical column and the dorsal spine. Nerve compression is released.
For a patient with cervical spondylitis these poses are modified. A simple exercise is
to suspend the neck on the rope, This helps even aged persons get relief. This single
position provides relief from the symptom of vertebro-basilar insufficiency as the
spine is made to fall into the anatomical line and blood courses normally into the
back of the brain. Belts are used to make the shoulder and cervical muscles supple in
a passive manner. This relieves nerve root compression in certain areas.
Elasticity of the backward movements of the hands is very important. This releases
compression of the cervical nerves. The hands are made to hold bars with the palms
facing downwards This opens out the sternum and dorsal spine. If the dorsal spine is
well elasticised, the symptoms are controlled.
Twisting asanas are very useful to loosen the dorsal and cervical spine. In many, the
rotators of the spine are very stiff and the neck is hardly able to perform normal
everyday functions. These asanas help relieve stiffness and pain, and make the
rotators of the neck soft and supple. In summary, the entire cervical column is made
mechanically sound, so that movements are free and the symptoms are relieved.
The specific asanas recommended for the treatment of cervical spondylitis are
bharadvajasana on the stool, the double rope back bend, cervical extension with the
rope, shoulder stand with the chair stretching the trapezius muscle towards the
chair, holding the window grills behind the body, trapezius traction and strapping the
hands behind the back. The last relieves pain in the trapezius, cervical and mid-
dorsal muscles, regardless of whether the pain is a referred pain or a localised one.
Later, as recovery occurs, all asanas can be done. Back bends are very useful along
with hand and elbow stand in younger patients. Click here for some of the useful
asanas.
 Asanas

Padmasana Double ropes

Viparita Karani Dog pose with rope

Pawana Mukta Virasana with pillows Urdhva Dhanurasana on stool

 Asanas (Continued)

Savasana with weight on Setu Bandha Sarvangasana on box and

forehead bench

Setu Bandha Sarvangasana on little Cross legged forward bend with

horse pillow

Supta Virasana Supta Virasana with pillows

Viparita Dandasana on chair Viparita Dandasana on rack

 Asanas (Continued)

Dog Pose Half Halasana

Purvottanasana Prasarita padottanasana

Uttanasana Headstand on ropes