Thursday, 6 May 2010

from Srivasta Ramaswami's May 2010 Yoga and Bronchial Asthma

from Srivasta Ramaswami's May 2010 newsletter

In an earlier letter I referred to the use of Neti, Nadishodhana.
Kapalabhati, etc., for keeping the upper respiratory tract in good
condition and being able to deal with many upper respiratory ailments
like sinusitis, rhinitis, chronic sneezing, etc. Neti uses water or a
twine to cleanse the upper respiratory tract and Nadishodhana in a way
is neti using air as the cleansing medium. The lower respiratory tract
has its own idiosyncrasies. The air warmed and moistened in the upper
respiratory tract enters the trachea and flows through the bronchial
tubes to the lungs. The bronchial tubes are a sensitive pair and tend
to contract and dilate during the breathing cycle . Some yogis who
have one foot in yoga and the other in modern medicine have suggested
that the Kurma nadi mentioned in the yoga texts refers to the
bronchial section of the respiratory system—nadis are after all tubes.
This sensitive nadi causes problems in certain people. The bronchial
tubes tend to dilate and contract respectively during inhalation and
exhalation in normal people at normal times. But in certain people
they tend to contract during expiration but do not dilate sufficiently
or remain contracted even during inhalation restricting the free
passage of air. Because of the narrowing of this section of the
airway, we hear the unique whistling sound as we find among
asthmatics. These constrictions in certain advanced cases can be
continuous but with many asthmatics it is intermittent.

The cause of this is usually attributed to allergens. Some allergens,
like pollen, dust, peanuts, cat's hair or the spouse's dandruff,
produce a reaction in the respiratory center due to which the impulses
coming from the Vagus nerve which control the bronchial tubes tend to
produce bronchial spasm. While in most people this does not happen,
this overreaction takes place in asthmatics. The conventional approach
to deal with this problem is two fold. One is to find out those foods
and pollutants which produce this condition and develop vairagya
towards them. Avoidance, a yogic trait is recommended. .”Keep away
from the offending allergens” is the dictum. Another related approach
is to find out the various substances that one is allergic to and then
inject small doses of the allergens into the system. Hopefully over a
period of time the patient will develop some immunity to these
substances which she or he did not have. Related to this is to use
temporary medication to mainly dilate the bronchial tubes. Such
medications are available with allopathic doctors, ayurvedic vaidyas
and also as home remedies. My grandmother used to make a concoction of
several herbs (I do not remember the English names of them), turmeric,
black pepper, basil, cinnamon and a piece of dry date (to make it
palatable). So avoidance, developing artificial immunity and temporary
palliatives are the cures available for the millions of those who
suffer from the debilitating condition called bronchial asthma.

But the Yogis go one step deeper and say it is a functional disorder.
Even though allergens are the precipitating cause the root cause is
said to be sudden abnormal activity in the broncho-motor of the vagus
nucleus of the medulla. The external protein, the offending allergen,
excites reflectively in an asthmatic when the vagus motor nucleus is
irritable and unstable and produces the spasm of the bronchial tubes.
The lower tone of the sympathetic also contributes to this condition.
It is the malfunctioning of the respiratory center. In yogic parlance
it is the disturbance (prana prakopa) of the pranamaya kosa.

So rather than dealing with this problem empirically the yogic
procedures directly attempt to deal with and try to correct the
abnormality. One of them is a unique procedure called Ujjayi
breathing. In this the vocal cords are approximated using the deep
throat and vocal chord muscles and the subject breathes through the
constriction produced, creating a unique sound, the Ujjayi hissing
sound. Normally we do not use these muscles in this particular way.
While yogis are familiar with this breathing for many others it is
unfamiliar. But since we keep the vocal cords together for a
considerable amount of time, breathing in and out, we tend to gain
control over these muscles. Since the bronchial tubes are also
controlled by the same vagus nerve, one would gain control over the
muscles activating the bronchial tubes. In fact the effect is optimal
if one does the Ujjayi correctly by using proper jalandhara bandha. In
this the chin is brought way down and placed against the breast bone
and the whole rib cage pulled up by straightening the spine, giving a
very powerful bandha. In such a lock, one is able to breathe,
controlling the breathing way down in the respiratory tract, very
close to the bronchial tubes, the kurma nadi. A few days of attentive
practice of this unusual procedure will bring very good control over
the lower respiratory tract musculature. Ujjayi breathing will appear
very unusual for non yogis. Further the prolonged, deliberate
constriction of this area will also stimulate the sympathetic to send
impulses to open the bronchial tubes and tone of the sympathetic also
will be improved. A better tone of the sympathetic will help dilate
the bronchial tubes during normal breathing. Without getting much into
technicalities it may be said that this reprogramming done for a
sufficiently long time will help the asthmatic have improved breathing
and less severe and less frequent attacks, and in some cases complete
normalcy. With proper care of food, reduced stress levels and other
yoga friendly life style changes and regular practice one could,
hopefully, be free of the debilitating asthmatic attacks. Ujjayi
closely resembles asthmatic breathing. Another concomitant problem is
the dry chronic cough. For this Bhastrika, which simulates a cough,
should be practiced .

The other exercises that may be beneficial are, as you can guess, the
inversions, especially head stand. Once the patient is reasonably
healthy and strong the head stand or its variants with or without help
or props may be attempted. Headstand as it has been mentioned in
earlier articles, helps to direct the CSF into the ventricle in the
brain to stimulate the pituitary the secretions which help produce
adrenalin, a hormone which used to be given in the olden days for
asthmatics. Further it nourishes the spinal nerves which will help the
proper functioning of the autonomic nervous system thereby giving a
healthy control over the bronchial tubes. A short stay in Sarvangasana
also is helpful as it gives a natural jalandhaarabandha and the
quality of Ujjayi breathing is also good. Assisted
sarvangasanaViparitakarani) can also be attempted

It is also a good practice to work on the accessory muscles to
breathing. In an asthmatic the chest muscles tend to be rigid and
breathing shallow. Arm exercises and thoracic exercises are very
helpful to free the tightness of the chest. Please refer to the hasta
vinyasas and the Parsva bhangi vinyasas in the Tadasana sequence in my
book “The Complete Book of Vinyasa Yoga”. Many of these exercises can
be done even sitting, and some even lying down depending on the
condition of the patient. Singing (perhaps in the bathroom), full
throated chanting (prabalam adhiyita)and reading aloud (with or
without an audience) are also helpful.


Yoga can be very useful for asthmatics as an adjunct therapy, one may
continue with medical treatment one is undergoing like allopathic,
ayurvedic or any other. Normally it will be a good idea to start
treating an asthmatic during the season when the atmospheric
pollutants are the least troublesome and asthmatic attacks minimal.
One may start with the accessory muscle exercises and then teach
Kapalabhati, then Bhastrika and Ujjayi breathing with Kumbhaka withing
one's capacity. Some kind of assisted inversion can be attempted
after the participant feels more comfortable. Over a period of time
with regular practice almost everyone shows improvement. The
frequency and severity of the attacks come down.

When I started teaching way back in the mid seventies, with the
blessings of my guru, I taught yoga to a bunch of asthmatics in a
nearby hospital. The patients varied from about 8 years to about 60
years. I met each one individually once a week for about 8 weeks,
teaching them slowly and progressively. I did not keep any records but
later when I met the doctor he looked quite pleased. He mentioned that
many had shown improvements over a year and it was possible to reduce
and in one or two cases suspend medication. Their vital capacity
showed significant improvement. One important aspect of yoga therapy
is that the patient gets fully involved in it. When you give medicines
alone, the patient is a passive helpless participant. In yoga chikitsa
the patient is fully involved and when she/he sees improvement there
is a psychological boost-- a feeling of achievement is there which
will help them practice regularly and take care of themselves. They
are slowly able to overcome the despair and helplessness associated
with these attacks and start becoming more positive. They start
feeling equal to the challenge.

When anyone asks me if yoga cikitsa works for bronchial asthma, I say
yes. Because I was an asthmatic as a teenager. Since I started
studying with my Guru I have been—touch wood-- free of attacks, for 50
years now. Children from families who have asthmatic members may
benefit immensely from relevant yoga practice if they could start
appropriate yoga early in life.

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