What is the yogic approach to cardiac patients and to heart disorders in general?
Well, the yogic management of the diseased heart is slightly different from that devised by the medical scientists, but in my experience, both systems can be used in conjunction for the patient's benefit. As you know, many yoga experts in India have appeared publicly from time to time and stopped the heart completely for some minutes, hours or even for many days. In earlier times, people either witnessed these events or believed in them, but in recent years, such feats as burial underground followed by resurrection have been carried out in the presence of physiologists and cardiac physicians, using laboratory monitoring equipment, and the results have been validated scientifically and widely publicized in medical journals and newspapers in India and other countries.
The clinical definition of death is stoppage of the heart for three minutes or more and a death certificate is issued on that basis. But these experiments on yogis have shown conclusively that the human heart can be voluntarily stopped and then induced to function again after more prolonged time periods, as a result of yogic training.
How is this relevant for cardiac patients?
In the first place, it leads to the conclusion that the heart is not an independent organ failing of its own accord, and that heart disease is an effect or result of an imbalance or loss of control occurring elsewhere. Where then does heart disease originate from? Surely, it is in the brain, where specific vasomotor centres have been isolated which control the rate, intensity and regularity of the coronary impulses. Therefore if someone is suffering from cardiac arrhythmia (uncontrolled, irregular heart beat), angina (pain due to cardiac insufficiency) or a slowly failing heart, we should really say that he has some malfunction in the coronary control centres of the brain, rather than something fundamentally and irreversibly wrong with the heart itself.
The most important factor leading to derangement in the coronary impulses emerging from the brain is a prolonged, excessive build up of anxiety and emotional conflict arising in domestic, marital or employment situations, coupled with a high level of subconscious intra-psychic stress arising from deeper unresolved and suppressed conflicts and memories from childhood and early life experiences. These cause fear and insecurity whenever they bubble up to the surface of the mind. When deep feelings of anger, competitiveness, jealousy, aggression, rejection and so on are not vented but are denied expression and suppressed back within the mind, the cardiac impulse becomes unsteady. This occurs when that tension and strain is relayed down to the heart as an excessive level of sympathetic nervous activity. As a result, the heart strains and labours excessively, and heart strain and failure is the end result. Therefore, our mental and emotional metabolism is directly reflected in the performance of our hearts, and this is why in yogic therapy we approach the problem here at its roots, whereas medical science, which focuses more upon the heart itself, relies on long term drug therapy to bolster up the failing heart mechanism, with little reference to the underlying causes on the mental and emotional planes.
If a yogi can stop and restart the heart through specific psycho-physiological training, then surely a cardiac sufferer can learn to recognize and gain control over the anxiety generating mental patterns which are constantly throwing his own heart mechanisms into revolt and disarray. We have found that lasting cardiac relief cannot be gained while the load of environmental and intra-psychic stresses remain suppressed and unresolved.
Approaching heart disease in this way, we follow a yogic treatment program which has proved tremendously effective for cardiac sufferers. Initiation into these practices of yoga brings immediate relief to the cardiac patient, and a new awareness of his situation soon emerges. He begins to recognize and understand his problem more objectively, in the light of this relaxation, as confidence in his ability to relax his mind is gained. By going beyond the constructive confines of his mental anguish into a refreshing realm of relaxation, a new, more joyful person begins to emerge spontaneously, confident of his abilities to live. He no longer feels confined in an impossible predicament in which he is estranged from his own failing heart, but sees that the root cause is his own thinking, and that he possesses the power to heal his own heart and mind through yoga.
Can you tell us briefly the yoga practices you use?
Yes, of course. First and foremost are the practices of yogic relaxation, but they must be administered by a skilled yoga therapist. This is because it is the whole concept of relaxation through yoga which must be conveyed to the sufferer, who is often completely beset by fears about his heart, his family, business and so many other things. It is an experience which has to be conveyed and then mastered by the sufferer himself so that he can confidently short circuit the enormous load of anxiety he carries with him, and enter into a more relaxed state of being. In some countries, yoga teachers prescribe yoga nidra and pranayama, while strictly avoiding asana, but in our Indian ashrams the approach is not like that. We prefer to teach these patients more dynamic methods of relaxation.
Yoga nidra is a wonderful relaxation practice, but it is a passive one. We prefer the practice of nada yoga, where you are aware of the mantra or sound and just that. You concentrate on the sound, tracing it to its source. As you know, sound vibration has a very powerful influence upon the mind because it is appreciated and understood at a purely intuitive, feeling level, without any intellectual analysis. In fact, it effectively renders the intellect incapable of its normal operation, and in a fearful, neurotic and tense mind this brings an instant release of tension which is soothing, relaxing and totally absorbing. Different mantras have different effects on the mind and the psychic centres, including the heart, and there is a whole science which can be applied very effectively.
Nada yoga can be practised from shavasana, and the musical scales of a harmonium can be used. The patient just lies down quietly, free of all restrictions, such as shoes, tie, tight belt etc, with lightly closed eyes and mouth. The legs of the patient should be a little elevated, so as to promote the return of the circulating blood to the heart. In this way the deepest experience of physical, mental, emotional and cardiac relaxation is experienced. An alternative is for the instructor to chant the mantra Om, asking the patient to let go of ail preconceptions and ideas and just follow the sound, absorbing himself within its vibration.
I have said that we do not teach pranayama, but I should qualify this. We do not teach conventional pranayama, but we definitely make use of the breath as a vehicle of relaxation. Our approach is that there is never any question of straining, withholding or resisting the breath. Rather, the patient learns to make friends with the spontaneous inflowing and out flowing breath, but makes no effort to control it in any way. He only witnesses it effortlessly, and gradually he chooses as his best vantage point the navel, which rises and falls spontaneously with the breathing cycle. No strain should be generated, but navel awareness grows gradually. This is found to automatically alter the filling pattern of the lobes of the lungs, and the chambers of the heart, and respiration becomes deeper and more efficient spontaneously. The heart rate slows and the cardio-respiratory efficiency increases automatically. This is a vital step for many anxious cardiac patients, firstly because they are often fast, shallow breathers, unconsciously confining the breath to the chest cavity, in parallel with their cardiac anxiety. This practice effectively unties the physiological, psychological and psychic knot in the heart region, where it has often been confined for many anxious years. Again, great relief is experienced.
Another practice we use is known as brahmari. This is actually both a pranayama and a practice of nada yoga which is practised in a sitting position. In the scriptures, the heart centre is termed 'the centre of un-struck sound' and also as 'the cave of bees'. In brahmari pranayama the humming sound of the bees is produced and traced towards its source. This produces deep mental and emotional relaxation and is extremely effective in cardiac disorders and in other diseases characterized by a high level of mental tension, such as epilepsy and asthma. However it must be learned correctly, because the whole process is very subtle. It is a process of inner absorption into the humming sound, which is produced with very gentle exhalation. The practice must take place effortlessly, without any strain to prolong the vibration unduly, or to make it loud. It should be spontaneous and it can be very soft. It is essentially an internal sound, and when the ears are blocked with the fingers, the patient is instructed to follow the inner vibration and discover its source.
Many doctors are very timorous about prescribing postures for cardiac patients. What is your experience?
I believe asanas can have an important part to play in restoration of cardiac function. They are very valuable, but of course one has to use common-sense and have some experience. For example, even the patient who has just endured a Myocardial infarction will gain relief if his legs are slightly elevated on a pillow so as to enhance venous drainage to the failing heart and that posture is known as uttan padasana. In his subsequent recovery, the pawanmuktasana series is a very simple way of promoting the circulation of blood and lymphatic fluid to the heart. In the beginning it will be no more than the movement of toes and ankles, but if practised with relaxed awareness, such simple exercises provide relief for the mind and comfort for the spirit. It is not just a matter of their physical effects. Of course, there should be no strain. After all, asanas are for enjoyment, and a few of them should be practised daily by everybody according to their needs and capacities. Cardiac patients are not exceptions, and they should not be excluded from these practices.
You have to remember that heart disease is a general term which includes many degrees of incapacity. We have been talking about the acute infarction situation, but yoga has a lot to offer those with long term cardiac disabilities such as angina, drug-controlled heart failure, arrhythmia, scarred Myocardial muscle from a prior infarct. Every case is slightly different, but they have in common a constant and fearful awareness that the heart is vulnerable, and usually so many precautions and restrictions have been recommended. Some doctors insist that asanas and regular exercise be avoided by this group, but I feel that this only serves to sustain the cardiac neurosis.
For example, in angina, it is our experience that an immediate improvement is experienced if we completely remove the patient from the family circumstances and situations. The family problems and business problems hurt the patient very much. They are far more important in causing angina than is physical effort. Emotional factors are more significant but they are underrated in medical circles, while the restrictions on effort and exercise are excessive. So we first change the environment. In our experience a few weeks in a yoga ashram provides the ideal setting for recovery and rehabilitation of such cardiac conditions. Here, the patient is instructed first in pawanmuktasana, a series of light exercises involving every part of the body. He learns both the anti-rheumatic and anti-gastric series, perfecting them carefully and in a relaxed, enjoyable manner which allows yogic self-awareness to develop spontaneously. Only a few of the more dynamic exercises are excluded from the program, and relaxation in shavasana is incorporated as a matter of course, so that the state of physical and mental relaxation can soon be effortlessly attained by the patient alone. This is an important step in cardiac disorders, because the cardiac personality is very often the tense, ambitious and aggressive one to whom relaxation in its deeper sense is an unknown experience.
Then major asanas are taught, beginning with the vajrasana series, and few limitations or restrictions are imposed. They perform matsyasana, bhujangasana, dhanurasana and so on, but in the beginning they usually avoid sarvangasana and paschimottanasana. Only the teaching must be correct. The postures are for relaxation and enjoyment, not to stress and strain the system, nor to compete or compare with anyone else. Nor do we impose severe restrictions on pranayama, but kumbhaka and bandhas are avoided. Nadi shodhana pranayama is practised with the breath just slightly deeper than normal. Bhastrika and kapalbhati are not contra-indicated, but they must be learned subtly and correctly. This is very important.
Do the cleansing kriyas of hatha yoga play any role in cardiac management?
Jala neti is a simple and refreshing practice which releases blocked energy from the autonomic nerve centres in the region of the hypothalamus and the eyebrow centre (ajna chakra) where psychic tension accumulates. Therefore, we recommend it daily for cardiac patients. In general, kunjal and shankhaprakshalana are avoided in the beginning, not because they are not beneficial, but because these practices, which demand that a large volume of saline water be taken into the body, can compromise the fluid and electrolyte balance of such patients. Certainly a patient with some degree of long standing circulatory failure, who is taking diuretic medications to help the kidneys eliminate excessive body fluid, is recommended to avoid these kriyas.
Sometimes, we find that chronic constipation and overtaxing of the digestive organs has been a major predisposing factor in genesis of the patient's present cardiac condition, and then it may be necessary to practise laghoo shankhaprakshalana (short form of intestinal cleansing). In this situation we use warm water with very little salt added and we supervise the patient very closely to avoid adverse reactions.
If you have an angina patient in your ashram, Is he personally attended or placed in a class situation?
As a rule, we have only individual classes. Placing two heart patients together in a class is not the best arrangement, because I believe that even though the name of the disease may be the same for two persons, their backgrounds, personalities and levels of physical resistance are never identical. For this reason, the yoga teacher has to deal with each patient individually.
Many people claim that by following the precepts of natural diet their cardiac health is assured. Is this enough?
It is not enough to seek to preserve cardiac health by dietary regulation alone. This is only part of the picture, because cardiac health depends on mental and emotional factors, as well as dietary ones. Here lies the mistake of many people who place undue emphasis on diet alone. Deeper blockages which demand release can be transcended only by following the spiritual discipline of meditation. To follow the natural life is commendable, but to really evolve beyond personal limitations and inadequacies, yoga is also necessary.