Cardiovascular Management Using Yogic Techniques

Following the recent publication of 'Yoga and Cardiovascular Management', a series of questions was raised for discussion by one of India's leading cardiologists, Hon. Brig. Dr. K.K. Datey of Bombay. It is hoped that this dialogue will serve as an inspiration for all those who are working towards an alliance between the yogic and medical sciences.

It was a pleasure to read your book on 'Yoga and Cardiovascular Management'. There are certain points on which I would like to have some clarification. In the text you have frequently made reference to pawanmuktasana parts I and II. Can you specify exactly what these two parts are?

Pawanmuktasana is a series of 22 preliminary asanas specifically designed for beginners in yoga and especially for use in yoga therapeutics. These are simple yet highly effective exercises which can be performed readily by debilitated or convalescing patients, and are extremely effective in chronic, long term and degenerative conditions, where conventional yogic postures are contra-indicated or too difficult to be performed.

The series is divided into 2 parts. Part I is termed 'anti-rheumatic series', and consists of 16 exercises. These are most effective in rectifying underlying circulatory, rheumatic and neuroendocrine imbalances.

Here, pawan refers to 'wind', meaning the state of pranic blockage or physiological congestion which occurs in various joints, tissues and glands, resulting in pain, stiffness, altered function, etc. In modern terms it includes factors such as uric acid crystallization, immune complex deposition, fibroblastic infiltration, synovial erosion, vascular stasis and thrombosis, etc. Pawanmuktasana part II comprises 5 further exercises termed the 'anti-gastric series'. These are indicated in restoring proper digestion, which is usually, impaired in chronic degenerative conditions. Indigestion, colitis, obesity, constipation, diabetes, hepatic disturbances and arthritis as well as asthma and coronary ischemia are common indications for this series of postures.

For further information on pawanmuktasana, which is one of the major components of the simplified system of practical yoga therapeutics devised by Swami Satyananda, and now being taught with great success in hundreds of ashrams and yoga centres around the world, please refer to the Bihar School of Yoga training manual 'Asana Pranayama Mudra Bandha'.

You have mentioned that kapalbhati pranayama is contra-indicated in coronary heart disease, including hypertension. Why is it contra-indicated if the patient is otherwise well compensated?

Kapalbhati (the frontal brain bellows), which is not strictly a pranayama but one of the shatkriyas of hatha yoga, acts to restore balance between excitatory and inhibitory neuronal influences in the frontal cerebral cortex. In terms of hatha yoga there is a balancing of the vital (solar) energy flowing in pingala nadi and the mental (lunar) energy in ida nadi.

In modern medical science, it is recognized as restoring autonomic psychosomatic balance by damping down excessive sympathetic (adrenergic) activity and stimulating parasympathetic (cholinergic) activity within the brain and autonomic nervous systems. This effect is relayed to the heart via the vagus nerve and to the peripheral blood vessels via the sympathetic nerves. The result is a physiological lowering of blood pressure and normalization of cardiac behaviour.

We have suggested that kapalbhati is contra-indicated in coronary disease and hypertension precisely because the practice can prove too powerful and even dangerous for a patient who seeks a cure and whose condition is not being currently compensated by a daily drug regime.

In a patient whose symptoms are being damped down or held in check by therapeutic drugs such as diuretics, beta blockers and peripheral vasodilators, either alone or in combination, kapalbhati may not be contra-indicated, but its efficacy is also reduced. This is because therapeutic drugs often buffer or counteract the desirable normalizing influence of yogic techniques. The whole area of potentiating and inhibiting interactions between yogic and pharmacologic therapies has as yet not really been considered by researchers.

Several studies have shown that various pranayamas, including kapalbhati, lead to improved cardiorespiratory performance with marginal extra cardiac demand in healthy subjects. As a general rule we have found that equal improvement can be gained from ujjayi, nadi shodhana or mild bhastrika pranayamas, which demand less coronary reserve at the outset and so provide less opportunity for mishap through cardiac strain, exaggerated tachycardia or elevation of blood pressure. In this regard, we consider each of the pranayamas, if learned and practised correctly, will prove effective in steadying the mental and emotional fluctuations to provide reflex cardiovascular relaxation. We are well aware that there is a real risk in yoga therapeutics, where powerful techniques can precipitate negative reactions through misinterpretation or lack of guidance, just as modem medicines and drugs can be misused with serious consequences. This is why we always take great care to recommend that yogic initiations occur in a suitable environment, such as a yoga ashram or therapeutic centre, under qualified guidance.

You have mentioned that abdominal breath awareness is found to exert a profound physiological influence. It automatically alters the filling pattern of the lobes of the lungs and also the chambers of the heart so that respiration becomes deeper and more efficient. Have any studies been carried out to verify this?

The profound influence of this practice can be readily intuited and experientially verified for yourself should you ever develop transitory coronary angina or shortness of breath due to emotional factors or exertion. Working from first principles, it is clear that alteration of the depth and rate of breathing, which becomes deeper and slower spontaneously during the practice of abdominal breath awareness, corresponds to a deeper diaphragmatic descent, a more negative intra-thoracic pressure and enhanced filling of the lower lobes.

Similarly, because of their intimate proximity, these changes in rhythmic expansion of the lobes of the lungs exert a direct appositional influence upon the heart in the form of a coronary massage, which influences the filling and ejection cycles of left sided and right sided chambers of the heart, influencing both the arterial and venous circulatory systems. Clearly, this effect can be agitating or calming, according to the pattern of breathing. For example, in cardiac neurosis or chronic anxiety states, the accelerated, irregular rate and randomly fluctuating respiratory rhythm will produce an irregular, detrimental coronary massage.

On the other hand, each of the various pranayamas, including the abdominal breath, exerts a specific form of calming, relaxing or stimulating influence directly upon the pumping cycle of the heart. In this way we can even suggest that the direct mechanical influence of the respiratory cycle is a far more important medium of influencing and altering cardiac behaviour and performance than has been previously acknowledged. This will be especially important in future considerations of voluntary control of angina and impending infarction.

To our knowledge, no investigations of the selective influence of the various pranayamas upon lobar expansion of the lungs, and the resulting mechanical influences upon the filling patterns of the chambers of the heart, have as yet been carried out. Perhaps it is because of the complex instrumentation which would be required. However, it is certainly a promising area for cardio-vascular research, which in recent years seems to have become more a pharmacological than a physiological quest. Perhaps government research agencies such as the National Heart Council can be inspired to help with a research grant or other facilities.

The other frontier of research is the subjective, experiential one which can be encountered directly through yogic sadhana. It is in this way that the process of internal cardiac massage can be definitely initiated and experienced by the yogi.