Yoga vs. Ach..choo and Yoga and Bronchial Asthma

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Yoga vs. Ach..choo Ramaswami’s March 2010 Newsletter

In a room full of people if one sneezes, there are smiling faces all
around and many have a pleasant “Bless You” to say. If there is second
sneeze, maybe one or two in the room will say “bless you” in a more
shrill voice. A third sneeze will bring frowns and a quick glance at
the exit door, indicating either they would like to go out of the room
or would want the multiple sneezer to vacate the room.

And quadruple sneeze bout is said to be one of the documented causes
of fatal road accidents!

The air we breathe day in and day out when it reaches the chest should
be lungs-friendly. It should be warm at about body temperature even
when we walk in freezing cold. It should be moist even if the humidity
is very low outside. It should also be bereft of much atmospheric
pollutants like dust and particulate matter. It should be reasonably
free of harmful bacteria and viruses.  So the respiratory tract should
not only add warmth and moisture to the inhaled air, but also prevent
the harmful substances and pathogens from reaching the lungs. And then
the Yogis of yesteryears insisted that the respiratory tract or the
nadis ida and pingala should be kept clean (nadI suddhi). Nadis are
tubular structures–blood vessels in the body are referred to as
nadis, so also nerves; they could also be air passages.

So how does the respiratory tract deliver the conditioned air to the
lungs and equally important how is the health of the tract itself
maintained and renewed continually?  The nostrils with those thick
short hairs (vibrissae) help to trap dust and some other offending
substances within the nostrils. Then the air enters the nose and goes
through the much narrower naso-pharynx.  The mucosa lining this tract
is supplied by nerves from the para sympathetic. It is said that the
nose secretes a viscous liquid continuously, but alternately. The left
part of the nose gets secretion for about 2 to 2 ½ hrs and then the
secretion switches to other side.  The wet secretions help the nose
trap dust particles and some offending organisms like virus/bacteria,
etc.  The cells of the respiratory epithelium have what are called
cilia which move the particulate matter towards the pharynx, which
passes into the esophagus and mostly this, the mucous with the
offending trapped material goes to the throat . When they reach the
throat, the tract changes and we involuntarily and periodically
swallow it to be neutralized by the powerful stomach acids. Sometimes
when the upper respiratory tract is congested due to infection etc.,
the cilia do not function well and sometimes we snort the secretions
and bring it to the throat, when it is normally coughed and spit out
After the two hour cycle there is the dry spell when one part of the
nose dries and periodically we blow out the scabs.

There are three yoga procedures that are designed to keep the
nasopharyngeal or the upper respiratory tract in good functional
health. Use of the  now popular neti pot helps to reduce the
congestion and wash down trapped debris so that the passage of air to
and from the lungs will be smooth. Clean warm water with a pinch of
salt helps to reduce naso-pharyngeal congestion and breathe freely.
This procedure may be followed for a short period of time until the
other more involved exercises, Kapalabhati and Nadishodhana
procedures, start giving more lasting benefits.

The Nadisodhana pranayama, as the name indicates, cleanses the nadis
and here we are concerned with the upper respiratory tract. According
to Yoga Yagnyavalkya, the two nadis ida and pingala, emanating from
the Kandasthana in the pelvic region, extend up to the tip of the left
and right nostrils respectively. When we breathe in, the hollow of the
nostrils first fill up letting the vibrissae and moisture trap some
pollutants. Then when the inhalation starts, the air goes through the
much narrower nasal passage at a significantly higher velocity. This
effect is enhanced  in Nadishodhana. In this pranayama we use the
Mrigi Mudra. In it one closes the right nostril with the thumb and
uses the little and ring fingers to partially close the nasal passage
on the left side, just below the ethamoid bone, giving more control
over the process of inhalation. The powerful flow of air over the
mucus membrane of the entire air passage when one sucks in or snorts
during inhalation phase of the nadisodhana pranayama helps to trap
much of the offending unfriendly pollutants and then evacuate into the
throat.

Further the area just beyond the ethanoid bone is considered very
sensitive (asthmagenic) and when allergens impinge on the membrane of
this area, histamines are produced which send signals to the sneeze
center (sneezing center) in the brain (medulla).  (Believe me I did
not make up the ‘sneeze center‘. It exists just as other centers such
as the cough center, respiratory center etc). Sternutation or sneezing
is a semi-autonomous convulsive expulsion of air from the lungs

The Kapalabhati is a procedure that has multiple benefits (For more
information on Kapalabhati, please refer to pages 190 to 194 in my
book “Yoga for Three Stages of Life“). It also helps to clear upper
respiratory passages  and remove congestion. Equally important is the
possible beneficial effects it has on sneezing, the sneeze center.
Come to think of it, Kapalabhati as one can see, simulates or closely
resembles the activity of ‘sneezing‘. So when one does Kapalabhati, a
few times at a time, and repeats it a few times a day, the procedure
presumably sends signals to the sneeze center and calms down the
overactive center of those who suffer from hay fever and those who
overreact to allergens and pollutants. In these people the sneeze
center is ‘on the edge’ so to speak. And they display a nervous
response to allergens, stress, etc. that is abnormal, usually
resulting in nasal congestion and multiple bouts of sneezing. This
Kapalabhati procedure if diligently practiced for a while should help
bring about considerable control over excessive sneezing. It is said
by medical doctors that some of the methods useful in the control of
sneezing would include deep exhalation of the air held in the lungs
and this is facilitated by both kapalabhati and deep exhalation in
nadishodhana pranayama. Holding the breath after a deep inhalation for
a count of 10 is another commonly known suggestion. It is actually
achieved while we hold the breath in antahkumbhaka after a deep
nadisodhana inhalation. Additionally, when we hold the breath the
sinuses are also filled with fresh air and are cleansed in the
process. Applying pressure to the nose is another commonly popular
remedy suggested with respect to sneezing. In fact that is exactly
what is done when one holds the breath in antahkumbhaka of
Nadisodhana. The nostrils are closed just below the ethanoid bones of
the nose by the thumb on the right side and the last two fingers on
the left side, using Mrigi Mudra. Hence these yogic procedures:
Kapalabhati followed by Nadisodhana breathing with the appropriate
occasional use of Neti could ensure the reduction and subsequent
prevention of recurrent cold, hay fever/ allergic rhinitis, and other
upper respiratory problems. One will not over-sneeze.

Yoga vs. Ach..choo

Thank you
Sincerely
Srivatsa Ramaswami

Yoga and Bronchial Asthma 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.

…

Best Wishes

Sincerely
Srivatsa Ramaswami