CHAPTER 1
YOGA AS MEDICINE
Whether you are sick or weak, young, old or even very old,
you can succeed in yoga if you practice diligently.
—SVATMARAMA (HATHA YOGA PRADIPIKA)
If you are new to yoga, welcome. Yoga can change your life. If you are currently practicing yoga but want to learn more, you probably already know something of yoga’s life-changing potential. If you are sick, it can help you feel better. If you are depressed or anxious, tired all the time, addicted to drugs, or bothered by low back pain, yoga can set you on the path to recovery. For those with chronic health problems like arthritis, diabetes, multiple sclerosis, or HIV/AIDS, regular yoga practice can help you live better and, in all likelihood, longer. And for people suffering temporary symptoms—such as tension headaches, hot flashes, or sinus pressure—specific yoga postures, breathing techniques, and other practices can bring relief.
As someone who has been an MD for over twenty years, I can tell you that yoga is quite simply the most powerful system of overall health and well-being I have ever seen. Even if you are currently among what might be called the temporarily healthy, as preventive medicine, yoga is as close to one-stop shopping as you can find. This single comprehensive system can reduce stress, increase flexibility, improve balance, promote strength, heighten cardiovascular conditioning, lower blood pressure, reduce overweight, strengthen bones, prevent injuries, lift mood, improve immune function, increase the oxygen supply to the tissues, heighten sexual functioning and fulfillment, foster psychological equanimity, and promote spiritual well-being…and that’s only a partial list.
Yoga has a decidedly different view from Western medicine’s about what constitutes health—and this may be a big part of why it’s so effective. The absence of symptoms is in no way equated with health in yoga. Health to the yogi extends far beyond not having a headache or knee pain—or even being cured of cancer. It is about optimizing the function of every system in your body from the muscles to digestion, circulation, and immunity. It is about emotional well-being, spiritual resilience, and buoyancy, even joy. Yoga teaches that only when these elements are aligned can you maximize your chance for health and healing.
Yoga envisions a web of causation that is much more complex than the limited number of factors most doctors consider. In the case of heart disease, for example, it looks beyond cholesterol and blood pressure to stress and the role of the mind in perpetuating it, your emotional temperament, your connections to other people, and whether you are living your life in accordance with some larger purpose. The idea is that a wide variety of factors can affect your well-being, and the most efficient way to remedy health problems is to work on many areas simultaneously. This is precisely what the practice of yoga does.
In yoga, you do your spiritual work and it affects the body. You stretch and strengthen your muscles and that affects your circulation, digestion, and breathing. You calm and strengthen the nervous system and it affects the mind. You cultivate peace of mind and it affects the nervous system, the immune system, and the cardiovascular system. Yoga says that if you look clearly you will see that everything about you is connected to everything else. From a therapeutic standpoint, this provides the insight that you improve the functioning of any one organ or system by trying to improve all.
Thus a crucial difference between yoga as medicine and conventional medicine is yoga’s holistic emphasis on strengthening you throughout your body and mind. If you go to most doctors feeling out of sorts but without specific pain or other symptoms, with the exception of ordering a few tests to rule out the possibility of various diseases, they generally won’t have much to offer you. If you’re interested in making your nervous system more resilient, boosting immunity, or improving your ability to breathe, they’ll have little to suggest.
The opposite is true of yoga. But rather than being in competition with conventional medical care, yoga can complement it. Indeed, in my experience, yoga can help you get the most out of whatever other care you receive, alternative or conventional. As an adjunct to other care, yoga has an advantage over many other modalities that typically get labeled as alternative medicine. It can amplify the benefits and, since yoga can often allow you to use fewer drugs and herbs or use them in smaller doses, the chance of side effects is lessened. In addition, unlike other treatments, which can interfere with each other—the way vitamins can interfere with chemotherapy or some herbs with anesthetics—a properly chosen yoga practice is extremely unlikely to interact in a harmful way with any other treatments.
Yoga appears to be effective in the treatment of a wide variety of health conditions. We’ll be reviewing the scientific evidence later but, for now, let’s see what people who’ve tried therapeutic yoga have to say. In 1983–84, the London-based Yoga Biomedical Trust, run by Robin Monro, PhD, surveyed twenty-seven hundred people, most between the ages of thirty-one and sixty, who used yoga therapeutically. To be included, participants had to have practiced yoga for at least two hours a week for a year or longer. Though the number of people with some of the conditions in question was small, the results (see table 1.1) were impressive: 98 percent of back-pain sufferers found yoga helpful, 90 percent of cancer patients, 82 percent of people with insomnia, and 100 percent of alcoholics. The lowest success rate in the survey was for women with “menstrual problems,” two out of three of whom found that yoga helped.
Imagine how much you’d be hearing about a new drug that could accomplish even a fraction of this. Nevertheless, it’s my experience that few in the medical community or the general public have any conception of what yoga has to offer. Part of the problem, I’m convinced, is that many people who could benefit from yoga shy away due to misconceptions about what it is and isn’t, or who can do it and who shouldn’t. So before we get more deeply into the substance of how to use yoga as medicine, I’d like to address those subjects.
Common Misconceptions About Yoga and Yoga Therapy
YOGA ISN’T…ONLY FOR THE FLEXIBLE AND FIT
Some people avoid yoga because they think it’s only for people who can bend like Gumby. They think it’s for the young, strong, and athletic—and if you look at pictures in magazines or sample some vigorous yoga classes you could easily get that impression.
Interestingly enough, if you feel that you couldn’t possibly do yoga, then yoga might be especially helpful for you. It’s well-known among yoga therapists that people with no experience in yoga often make quicker progress with health problems than students with years of experience. Indeed, it is those who find yoga the most challenging, think they are terrible at it, and can’t seem to quiet their minds who have the most to gain.
YOGA ISN’T…ONLY FOR THOSE IN GOOD HEALTH
While I was researching yoga therapy in India, I visited centers that treated people with all kinds of physical, mental, and emotional problems: old people, stiff people, people with years of chronic disease, people in pain, people who were too depressed to get out of bed. Yoga has been used successfully on schizophrenics and on children with Down syndrome, cerebral palsy, and autism. Those who are bound to bed or wheelchairs can do yoga modified for their needs and abilities. There are people in their eighties, nineties, and beyond doing yoga, and I’m convinced that if you embrace the practice, you’ll increase your odds of making it that far and feeling good when you get there.
Yoga has helped cancer patients and people with heart disease so advanced that emergency surgery was recommended. In almost all instances, yoga therapists encourage their students to continue their coventional medical care. But many yoga students notice after a while they need less of it: medication may be reduced and some drugs become entirely unnecessary, surgery may be delayed and then canceled. In India, I spoke with patients in whom all signs of rheumatoid arthritis or type 2 diabetes disappeared with regular practice. This is not everyone’s experience, of course, but it shows what may be possible.
YOGA ISN’T…A RELIGION
Yoga is not a religion. Although yoga came out of ancient India it is not a form of Hinduism. In fact, yoga is happily practiced by Christians, Buddhists, Jews, Muslims, atheists, and agnostics alike (see Chapter 17). There is certainly a spiritual side to yoga, but you don’t have to subscribe to any particular beliefs to benefit from it. It’s probably more appropriate to view yoga as somewhat akin to Alcoholics Anonymous (AA). Like AA, yoga has a spiritual dimension that you can focus on or totally ignore, depending on what’s most useful to you. Like AA, yoga is compatible with any religion, or none, if that’s your preference.
Also like AA, yoga allows a “take what you can use and ignore the rest” approach. Meditation, which many people find effective for a variety of problems, originated in yoga and remains an integral part of it. (Although meditation is often thought of as a Buddhist practice, the Buddha himself was a yogi.) But if meditation seems too foreign to you, don’t do it. If chanting Om strikes you as weird, chant something else, a prayer to Jesus or Allah or for world peace, or don’t chant at all. In the thousands of classes I’ve attended, I’ve never once seen a teacher object to a student skipping it. I’ve also found that even those who aren’t the least bit interested in spirituality, or whose childhood religious experiences were traumatic, don’t have a problem with what goes on in most yoga classes or therapeutic settings. This is one of the beauties of yoga. There are so many practices and so many ways of modifying those practices that virtually anyone’s needs can be met.
What Is Yoga?
Yoga is a systematic technology to improve the body, understand the mind, and free the spirit. Yogis tend to be more flexible, stronger, more energetic, thinner, and more youthful than people who don’t do yoga. And what’s happening on the outside is a reflection of what’s happening to every system of the body. With the practice, you are strengthening and calming the nervous system. You are increasing the blood flow to internal organs and bringing more oxygen to your cells. You are clearing the mental clutter that can wreck your life, allowing you to see things more clearly. You are cultivating the spiritual muscles in a way that can make you happier, less anxious, more at peace.
Yoga has a number of tools that can help overcome one of the chief factors undermining the health and well-being of many in the modern world: an out-of-balance stress-response system. Since stress is a factor in a host of medical conditions—from heart attacks to infertility—yoga’s role in stress reduction helps explain why it is useful in so many situations. But stress reduction is good for everybody, not just the sick. One yoga class or even a single breathing exercise can leave you feeling calmer and more centered. Chapter 3, “Yoga for Stress Relief,” will cover this topic in detail.
Yoga is strong medicine but it is slow medicine. Don’t expect overnight cures with yoga (though for many people it does start to yield benefits right away). One major difference between yoga and many other approaches to healing is that yoga builds on itself, becoming more effective over time. This is not true of most drugs or of surgery, which often gradually diminish in effectiveness. In this sense yoga is something like learning to play a musical instrument: the longer you stick with it and the more you practice, the better you get and the more you will get out of it. A corollary to this is that yoga, by and large, is not the proper treatment for acute problems like broken bones, overwhelming infections, or surgical emergencies. These are best cared for in a conventional medical setting, and indeed the treatment of such acute problems is allopathic medicine’s strength.
Yoga’s health benefits can in part be explained by the fact that the various stretching, breathing, movement, balance, meditative, and strength practices—the elements of what’s known as hatha (pronounced HOT-uh, not HATH-ah) yoga—provide many of the benefits of other worthwhile activities like walking, weight lifting, or biofeedback, plus a whole lot more. And unlike such health-club standards as StairMasters, stationary bikes, and treadmills—where the minutes seem to go by painfully slowly—yoga can be fun. Most people who do it regularly discover that yoga gets more interesting over time. I don’t know anybody who feels that way about stomach crunches.
There is a continuum of effects from yoga. First, it can relax you. It can also, sometimes in fairly short order, lead to the relief of some symptoms of illness. With sustained practice, particularly of the stretching and strengthening exercises known as asana, and the breathing techniques known as pranayama, the body and breath become stronger. Posture and lung capacity improve, as does bowel function, lymphatic drainage, and the functioning of the immune system. Gradually one feels more balanced, better able to endure the slings and arrows of outrageous fortune.
In fact, yoga is all about balance. Many people have the impression that the physical practice of yoga is about being flexible, but physical flexibility is not the primary goal of asana practice; balance is. Some people who come to yoga, particularly some women, are very flexible; what they need is strength. Other people, including many men, are pretty strong when they first come to yoga, but lack flexibility. Some yoga students are debilitated by fear. Others have trouble staying motivated. Some people can’t relax. What the practice of yoga does is challenge you wherever you need it, transforming liabilities into strengths, making you a more balanced person. Asana practice is itself balanced because it involves doing different poses from each of the major categories (see Chapter 1). Ideally, if your condition allows, your practice will include some vigorous poses which are balanced with relaxation. This is one reason why yoga classes almost always end with Savasana (shah-VAH-sah-nah), the Deep Relaxation pose. Similarly, you can balance asana with pranayama, meditation, chanting, guided visualization, and other techniques.
Yoga is a series of practices that allow you to steadily gain discipline, strength, and self-control while cultivating relaxation, awareness, and equanimity. While it wasn’t originally invented to improve health or to facilitate recovery from serious illness—it was and still is, for those who choose to use it that way, a spiritual path, a way to find happiness and meaning in a chaotic and out-of-control world—there is a growing body of scientific evidence suggesting that yoga has serious therapeutic value. Let’s consider a real-world example of someone who is using yoga as medicine to help cope with a medical condition.
Dolores Johnson is a very attractive woman of African and European descent whose parents were first-generation emigrants from a tropical island nation. She looks almost a decade younger than her forty-two years. She’s warm, smiles broadly, and has a soft glow in her eyes. There’s something in her presence that I’ve come to associate with people whose lives have been changed by yoga: she seems calm, happy, grateful, and fully alive.
It’s very surprising to learn that despite her glow of health, Dolores has been infected with human immunodeficiency virus (HIV) for more than fifteen years. Dolores (not her real name because she can’t, as she says, “disclose,” at the high-tech corporation where she works, even though discriminating against those infected with HIV is illegal) has been using yoga as part of a comprehensive treatment plan to deal with her infection. When I first met Dolores in 2002, she’d been off all HIV drugs without any decline in her T-cell count—and with her doctor’s blessing—for more than a year. She was thriving on a combination of yoga, Chinese herbs, acupuncture, scripture reading, meditation, and prayer.
Besides HIV, some very bad things have happened to Dolores. At fifteen she lost her mother to a painful breast cancer death. Her dad went quickly from a brain tumor two years later. And then, in her late twenties, she learned that her boyfriend Steve (also a pseudonym) had unknowingly infected her with HIV. A letter arrived that informed him that his late wife had been infected by a blood transfusion during her long battle with Hodgkin’s disease.
When Dolores and Steve both tested positive for HIV, public ignorance and fear of AIDS was rampant. This was 1990, the year before Magic Johnson went public with his HIV status. They soon married. Because Steve had been infected years before and had gone too long without treatment, his immune system was so damaged that even significant advances in medication couldn’t save him. He died in 1999.
A year before Steve died, Dolores took a yoga class when a coworker invited her to come along. She figured it might help her to deal with the stress of nursing her ailing husband at home while continuing to work at a demanding job. At the end of that first class, which was a gentle practice, taught by a teacher trained in the Kripalu style of yoga, Dolores found herself in tears. “I wasn’t angry. I wasn’t upset,” she says. “This felt good.” After a while she moved on to more vigorous power yoga classes. She also began to practice at home a few times each week, sometimes with the aid of an instructional yoga video.
Dolores believes the poses have strengthened her muscles, and all the breathing and stretching exercises have helped her immune system. Beyond the physical benefits, though, she says yoga brings her joy. “As I kept taking yoga and learning more about it, I realized how much more power it was giving me to be more confident with myself, with my body and with my connection to the universe, and with my spirituality,” she says. “And I really liked that.”
Dolores’s story is still unfolding, and we will return to it later in the book. But even this much of it gives you insight into the power of yoga to change lives.
The Roots of Yoga as Medicine
India’s culture is among the oldest in the world, and yoga is a gift it has handed down to us. According to scholar Georg Feuerstein, yoga may date back to the seventh millennium B.C.E., though no one knows for sure how old it is. Yoga first came to the United States when Swami Vivekananda, a Hindu monk, gave a riveting address about yoga and the unity of purpose of different religions as part of the World’s Columbian Exposition in Chicago in 1893.
As science is beginning to validate many of the claims made by yoga practitioners and yoga therapists, you may wonder how such an ancient culture could have arrived at so many truths. The ancient yogis didn’t have fancy machines or advanced technology to study the internal organs or the nervous system. Instead, they used the observational powers of the body itself. They manipulated the body in every way they could think of and experimented with various techniques for channeling the breath, and as they did this they explored the effects. They believed that what they learned about themselves helped them better understand the world around them; the more they explored and observed, the more sophisticated their ability to perceive different aspects and subtleties of the body became.
Sitting in caves in the Himalayas, hideouts in the forest, and ashrams in the countryside, guided by the discoveries of the generations that preceded them, aspirants chanted, meditated, and experimented with the body in a dedicated and systematic way for centuries. They learned to stretch the muscles, open the joints, align the bones in various configurations, and observed what happened as a result. They stood on their heads and bent over backward. They mimicked the posture of animals (to this day many yoga poses carry the names of animals). They moved the joints through a much larger range of motion than most people ever use, creating a series of postures designed to systematically work every part of the body and create awareness where there was none.
By experimenting with the breath, the ancients noticed that certain practices could bring a sense of energy and warmth, while others calmed and balanced the nervous system. They figured out ways to raise or lower the temperature of their hands. They developed meditation techniques that allowed them to sit naked outside in freezing winter air and generate so much heat they could dry wet sheets placed over them. With greater awareness, they realized that humans tend to breathe primarily through one nostril at a time, flipping back and forth over the course of the day—a finding recently confirmed by Western science (see Chapter 3). The yogis learned to control the inhalation, the exhalation, and the pauses between, and through their experiments came to believe that when you control the breath you control the mind. Advanced yogis even achieved feats like stopping their hearts and restarting them or reducing their breathing rate and their need for oxygen to almost nothing. They invented various ways to cleanse the body such as swallowing long pieces of cloth and then slowly extracting them from the intestines. Although most of us would have little interest in trying these practices, in the course of their far-ranging experimentation they discovered things that even the most conventional Westerners would find useful and accessible. Following is a very simple exercise that shows how even a very simple movement can have an effect on the nervous system.
EXPERIENTIAL EXERCISE: Sit up straight in any comfortable seated position, either on the floor or in a chair. Bring the fleshy part of your palms onto your eyebrows and your fingers onto your scalp (figure 1.1). With the heels of your hands you should be able to feel the thick bony ridge above your eyes. Don’t put pressure on the eyeballs themselves. Close your eyes. Without actually moving your hands much, gently tug the skin on your forehead up so the eyebrows move slightly toward the hairline. Stay for fifteen to thirty seconds, tuning in to how you feel. Do you feel relaxed? Are you more alert? Do you notice any difference at all? Now with your hands in the same position, move your eyebrows slightly down toward your cheeks. Stay there for fifteen to thirty seconds, observing any differences. Did your breath slow down and get a little deeper? Was the relaxation more profound than when you were tugging the eyebrows up? Repeat these two exercises as many times as you wish.
Although the effect is subtle, what most people discover when they tug their eyebrows in an upward direction is that the experience is neutral or slightly stimulating. In contrast, almost everyone finds the second part of the exercise when the eyebrows move downward to be very relaxing. The breath slows and the nervous system starts to relax almost immediately. It’s pretty much automatic.
Now try another exercise that utilizes the relaxing effects of moving the eyebrow tissue down toward the cheeks. This is a simple restorative pose that can be used for such disorders as anxiety, headaches, and insomnia. You may notice that it’s a bit like what many children did in kindergarten, back when naps were part of the program.
EXPERIENTIAL EXERCISE: Sit in a chair facing a table. Place your forearms on the table, and cross your arms. Bend forward and rest your forehead on your hands or wrists so the inner edge of the forearm closest to you is just above your eyebrows (figure 1.2). Using your forearm, gently move the flesh between your eyebrows in the direction of your nose. Rest for one to five minutes in the pose. Notice if your breath deepens and slows. Try to let go of effort and pay attention, and not fall asleep. If you fall asleep it’s a sign that you need more sleep than you’re getting.
The direction of the “energy” of the eyebrow skin and its effects on the nervous system is just one of literally thousands of discoveries that yoga masters through the ages have made that many modern Western doctors still don’t know about. The yogis didn’t so much invent these effects as uncover them and then come up with practices that exploited this built-in circuitry. Thus yoga therapy takes advantage of innate body systems that can help you heal.
It is yoga’s ability to bring awareness to different parts of the body and use that awareness to influence autonomic functions—such as heart rate, brain waves, and blood pressure—that makes yoga such powerful medicine. You can use it to reduce your levels of stress hormones, like adrenaline and cortisol, which could have beneficial effects on conditions ranging from diabetes to insomnia to osteoporosis. You could lower your blood pressure and with it the risk of heart disease and stroke. You can learn to slow the mind down, lessening anxiety and depression. You can relax the muscles in the back and neck, potentially improving such conditions as headaches, carpal tunnel syndrome, and arthritis.
Although many Westerners (and these days, many Indians) come to yoga to reduce stress or improve their health, these were not the goals of the ancient yogis. They viewed yoga as a path to spiritual enlightenment. To them, better health was simply a side effect of treating your body as a sacred gift from God. Living a moral life, engaging in stretching and strengthening exercises, pranayama, and meditation were all part of the path to higher consciousness. Disease was seen as an obstacle to spiritual enlightenment and thus strengthening the body and ridding it of illness was part of that path.
The Yoga Therapy Toolbox
When people in the West refer to yoga they typically mean only the practice of the various physical postures. This misunderstanding is natural, since the asanas make for the most interesting photographs in books, magazines, and newspapers. But as Patanjali, the great codifier of yoga, defined it more than fifteen hundred years ago, yoga has eight constituent parts. The eight limbs of yoga, as found in Patanjali’s Yoga Sutras, are:
1. The Yamas: Ethical guidelines (see table below).
2. The Niyamas: Spiritual observances (see table below).
3. Asana: Physical postures. Asana constitute a systematic way to take the body through its entire range of motion. As they gradually increase the freedom of movement, the asanas build flexibility, strength, and balance in every area of the body. The postures themselves can be divided into several categories with differing effects. Included are standing poses, forward bends, backbends, side stretches, twists, inversions, meditative poses, and relaxation poses (figure 1.3).
An example of each of the major categories of asana:
a) forward bends, b) backbends, c) side stretches, d) twists, e) standing poses, f) balancing poses, g) inversions, h) relaxation poses, i) meditative poses.
Many poses combine these different elements. Parsvottanasana (figure 1.4), for example, is a standing pose that involves forward bending at the hips, twisting of the pelvis, and inverting the head relative to the trunk, challenging your balance.
4. Pranayama: Breathing exercises. These include a wide variety of practices that can either energize or relax you. Pranayama practices can quiet the mind, calm the nervous system, and set the stage for meditation. Here’s an exercise called Bhramari (BRA-mar-ee) that I first learned at the Vivekananda ashram in Bangalore, India. The literal meaning of the word Bhramari, according to the Tantric yoga teacher Rod Stryker, is “the sound of the bees.” According to the Hatha Yoga Pradipika, a classic Tantric text and the earliest known work on hatha yoga, as a result of this practice “the mind becomes absorbed in bliss.” Here is how Rod recommends doing Bhramari.
EXPERIENTIAL EXERCISE: BHRAMARI. Sit on the floor in a cross-legged position, with your spine straight. If you prefer you can sit up straight in a chair. Close your eyes and take a few slow, deep breaths. Then, after a full inhalation, begin making a gentle buzzing sound as you slowly exhale. The sound should come from as low in the throat as possible and should be soothing. As you’re exhaling, feel the vibration of the sound rising out of the back of your throat, through the roof of the mouth, and up to the brain itself. Gradually allow your attention to become completely absorbed in the sound of the vibration. As thoughts come up, relax more deeply into the sound. When you run out of air, inhale slowly and deeply. Repeat the cycle. If you feel short of breath at any time, return to regular breathing until you are breathing normally again. You can then resume the practice. If you’re comfortable doing so, you can gradually increase the length of exhalation. Continue the practice for one to five minutes.
5. Pratyahara: While often translated as “withdrawal of the senses,” pratyahara is perhaps more accurately thought of as turning the senses inward. It’s the ability to turn off the external messages from your eyes, ears, and other sense organs, and tune in to your internal environment. Instead of listening to the sounds in the room you’re in, for example, you focus on the internal sound of your breath as you just focused on the humming sound of Bhramari. Try this exercise of Ujjayi (oo-JAI-ee) breath. It can be used as a stand-alone pranayama, or practiced throughout a series of asana.
EXPERIENTIAL EXERCISE: UJJAYI BREATH. Sit in any comfortable position or lie on your back, supporting your head on a folded blanket or pillow. Inhale and exhale through your mouth while imitating the deep, sibilant breath sound that the character Darth Vader made in the movie Star Wars. If you are unsure of how to do this (or never saw the movie), imagine you are trying to fog your glasses before cleaning them. Keeping your mouth open, take several slow, deep breaths, making the sound on both inhalations and exhalations. Now close your mouth and continue to make the whooshing sound as you breathe through your nose. Feel the air as it passes the back of your throat. It’s the narrowing of your vocal cords that allows you to precisely control the amount of air moving in and out, the way a nozzle on a hose regulates the flow of water. Now close your eyes and focus your attention on the sound of the breath in your throat. Allow this attention to take you away from any sounds around you. Imagine that the breath is as loud as if you were in an echo chamber. When you first learn Ujjayi, you will breathe with an audible noise. But as you progress with the practice, the sound may become so subtle that someone sitting next to you would not hear it. Even with this quieter and more subtle version, you can still use the focus on the sound to keep your sense of hearing directed internally. Continue the practice for a minute or two.
6. Dharana: Concentration, the ability to maintain your focus. Most of what we call concentration in the West is a pale imitation of what happens in yoga. You may have noticed if you did the last exercise that you kept forgetting about the sound of your breath and your thoughts drifted elsewhere. Even in a minute or two you might have seen how much room for improvement you have.
7. Dhyana: Meditation; relaxed concentration where the stream of thoughts in the mind slows. Technically speaking, meditation can’t be taught. What is typically called meditation are concentration exercises, but if you practice concentration, meditation may occur spontaneously. That said, drawing the attention inward and focusing has value and measurable benefits on health even if from a technical standpoint you don’t achieve true meditation.
8. Samadhi: Blissful absorption. Yoga experts differ in their definition of samadhi (sah-MAH-dee). Some feel it is something that can be tasted, albeit fleetingly, in asana and pranayama and even in the course of everyday life, while others consider it to be the pinnacle of yoga, experienced only by masters. It is sometimes said that if you can follow twelve breaths from beginning to end without interrupting thoughts you will reach samadhi. As you’ve probably already experienced, following even one breath with absolute attention and no interrupting thoughts is not easy.
In addition to these eight limbs there are many other yogic tools that can be used in yoga as medicine. These will be discussed throughout the book.
| OTHER YOGIC TOOLS | |
| Chanting of Mantra | Diet |
| Yogic Seals and Gestures (Mudra) | Herbs |
| Energetic Locks (Bandha) | Community (Sangha) |
| Direction of Gaze (Drishti) | Props, like blankets, mats, and blocks |
| Geometric Designs (Yantra) | Hands-On Adjustments and Assists |
| Cleansing Exercises (Kriya) | Ritual |
| Selfless Service (Karma Yoga) | Yoga Philosophy (Jnana Yoga) |
| Devotional Practices (Bhakti Yoga) | Intention (Sankalpa) |
| Imagery | Faith |
All together, there are hundreds of different yoga tools. Indeed, there are hundreds of different asanas alone. The various tools have different effects and can be combined in a limitless number of ways. Different styles of yoga and different teachers vary in which tools they use, how they teach them, and how they combine the different tools.
Yoga as Medicine vs. Taking a Yoga Class
Yoga therapy is not the same thing as taking a yoga class. Indeed, if you have a serious medical problem and wander into a randomly chosen class, you could easily wind up worse off than when you started. Distinctions among styles of yoga and levels of expertise among yoga teachers are lost on many people, including a lot of physicians, which can be a problem. For example, a doctor who had read Marian Garfinkel’s widely reported study on yoga’s effects on carpal tunnel syndrome (CTS) in the Journal of the American Medical Association, and suggested that a patient try a yoga class, might do more harm than good. In many yoga classes, students do several repetitions of the sequence of poses known as a Sun Salutation. At several points during a Sun Salutation, you put much of your body weight directly onto the hands with your wrists cocked back—not a good idea if you’ve got CTS.
In her study, Garfinkel, a highly experienced teacher with many years of training, carefully chose the yoga postures subjects used and depending on how they responded, modified the protocol for each individual. In choosing the regimen, she avoided the many poses that could actually make CTS worse or modified them to make them safer (figures 1.5a & b).
In some ways, therapeutic yoga can be more like an appointment with a physical therapist or rehabilitation specialist than a yoga class, and as such is best taught by someone with a lot of experience. The average yoga teacher in a health club, where most Americans take yoga classes, isn’t likely to know enough to teach therapeutic yoga well, especially not in a group setting. Even some teachers in dedicated yoga studios won’t know enough about which poses present safety concerns. (For more on contraindications—medical reasons to avoid particular practices—see chapter 4 and appendix 1, “Avoiding Common Yoga Injuries,” as well as the chapters on specific conditions.)
The yoga pose Upward-Facing Dog, often taught as part of Sun Salutations, as it is usually performed. The weight on cocked wrists can exacerbate symptoms of carpal tunnel syndrome (figure 1.5a). The same pose adapted for Marian Garfinkel’s study on CTS. Notice the neutral position of the wrist (figure 1.5b).
For people with serious conditions, yoga therapy is generally taught one-on-one or in small groups. While general yoga classes may be great preventive medicine for people who are fit, many are too demanding for someone with a serious medical condition. If you have any doubts, be sure to speak with the teacher about what techniques she employs and whether she has experience in working with people who have had similar problems. If you have a medical condition and do take a general class, always try to err on the side of safety. If you’re not sure whether a pose is good for you, don’t do it. And certainly, if you notice pain, dizziness, shortness of breath, or other worrisome symptoms you should come out of the posture and tell the teacher. Good teachers will respect your decision to stop and will sometimes have suggestions on modifying the pose to make it safer for you.
Therapeutic yoga tends to be gentle and nurturing, though it also can be challenging. It places a heavy focus on bodily awareness, and in some systems on postural alignment, with movement tied to relaxed, rhythmic breathing. Much more than in physical therapy, students of therapeutic yoga are taught to tune in to subtle sensations of their muscles and joints, as well as the inner experience of the mind. Another difference is the heavy emphasis on relaxation. In fact, when patients are gravely ill, undergoing chemotherapy, or in the postoperative period, the entire practice may consist of breathing and relaxation until the patient gains enough strength to take on more.
The approach tends to be hands-on, tailored to the individual based on needs, abilities, and responses, as well as the teacher’s or therapist’s observations and any contraindications. Props such as blankets, bolsters, and straps may be employed to make postures more comfortable and safer, or postures themselves may be modified. Once students have begun to work with a yoga therapist, they are encouraged to develop a home practice, which appears to be critical to the effectiveness of the intervention.
Yoga as a Technology for Life Transformation
Although medical knowledge is constantly being refined, the basics of what we know about getting and staying healthy haven’t changed much in recent years. Just about everybody knows you shouldn’t smoke, and that you should eat lots of fruits, vegetables, and whole grains, get some kind of regular exercise, and keep your stress levels from spiraling out of control. The difficult part isn’t knowing what to do, it’s actually doing it.
In my medical practice, I saw that even patients who really wanted to change and made valiant efforts had a tough time sticking with the program. The more I’ve studied yoga, the more I’ve become convinced that it offers something doctors and public health authorities are missing: a way for people to implement the changes they want to make.
Yogis realized thousands of years ago—and what scientists are just now catching on to—that changing dysfunctional habits is largely a matter of the mind. The mind is a subject that yogis have studied systematically and that until recently medical researchers pretty much ignored. Yoga can make the critical difference in your health and well-being by giving you greater control of your mind, as well as greater understanding of the tricks it can play. This, perhaps more than anything, is what leads to life transformation.
Critical to understanding the mind’s contribution to perpetuating bad habits is what the ancient yogis called samskaras. Samskaras (sahm-SCAR-ahs) are habits of action and thought that get deeper all the time, like grooves in a muddy road. From a yogic perspective, every time you do or think something, you increase the likelihood that you will do or think it again. That’s true of both desirable and undesirable thoughts and actions.
When I was in medical school in the 1980s, we were taught that the brain wasn’t capable of much change in adulthood. The number of neurons was fixed early in life and declined from there on. Connections between different brain cells were formed during certain critical periods early in life and after that the architecture couldn’t be modified.
With advances in understanding and technology, scientists now talk about “neuroplasticity.” The brain, they have realized, is plastic, meaning it is capable of change. When you perform a new action, brain cells called neurons form new connections, and the more frequently you do it, the stronger these neural links become. This, in essence, is the neurobiological explanation of samskaras.
In the Yoga Sutras, Patanjali gives a formula for success in yoga: practice regularly without interruption over a long period of time. This sounds like the perfect formula to create deep new behavioral grooves taking advantage of neuroplasticity. The yogic model is that by creating new samskaras, and systematically strengthening them through repetition, you create habits so strong they can compete and replace older, dysfunctional ones. As Swami Vivekananda put it, “The only remedy for bad habits is counter habits.”
Even if you are too sick to do your yoga practice, yogis believe that there is value in simply imagining it in a step-by-step fashion. The more details you bring into the visualization the more effective it’s likely to be. The benefit of practicing in your mind’s eye is that any groove you’ve created through regular practice isn’t weakened by your absence from the mat; instead, it is deepened.
The Yoga of Action: Tapas, Svadhyaya, and Ishvara Pranidhana
Patanjali outlined a system of self-transformation that he called kriya yoga, the yoga of action. Kriya yoga comprises three elements: tapas, svadhyaya, and Ishvara pranidhana, which you’ll notice are also the final three niyamas.
Tapas is the Sanskrit word for heat and shares a root with the English word taper, a type of candle. To the ancient yogis, the human body without yoga is like an unbaked clay pot, and regular yoga practice is the kiln that gives the body the strength and resilience to withstand the wear and tear it is subjected to. The key, Patanjali said, is regularity of practice. Tapas, the fire, or dedication that fuels practice, is what keeps you going even if you don’t always feel like it.
If mustering the willpower to practice regularly seems like too much for you, don’t despair. One of the most amazing things about yoga is that it is both a discipline and a tool that promotes discipline. There’s something about doing yoga every day that makes you want to do it every day, and this tapas, which tends to grow over time, can be extended to other aspects of your life.
Certain yoga asanas are known to build tapas. If you aren’t feeling motivated, it’s often a good idea to begin your practice with some of these postures. Try the following exercise that I learned from my teacher, Patricia Walden.
EXPERIENTIAL EXERCISE: Stand with your feet hips’ width apart or sit up in a chair (figure 1.6a). Take a moment to notice the way you feel. Tune in to your body and your general level of energy. Now slowly inhale and lift both arms out in front of you, and then over your head (figure 1.6b). As you exhale, bring your arms back down. Repeat the arm movements, moving with your breath, five more times. Afterward, stand where you are or continue sitting, and close your eyes. Notice any warmth in your chest. Observe how your arms feel. Are they heavy? Do you feel life in your shoulders? Is there a tiny bit more awareness now when you tune in to your body? How about your energy level? Many people find that they’re energized even though they’ve just exerted themselves. If you experienced this, you have tasted tapas.
Another practice that’s known to build tapas is one of the most well-known postures of hatha yoga, Downward-Facing Dog (figure 1.7). If your enthusiasm is flagging, sometimes staying a minute or two in this pose (assuming you’ve built up the strength to do so) can give you enough tapas to want to continue your practice.
The ancient yogis realized that while tapas is a phenomenon of the body, it is also about the mind. Imagine you had already held Dog pose about as long as you felt you could and wanted to come back down. What if someone said that they’d pay you a million dollars to hold the pose for thirty seconds longer? It’s amazing how the strength can somehow be found when the mind wants something. Once you grasp that you have the ability to redirect your mind, you discover that even though your mind can make all kinds of excuses for not doing something, you can overrule those objections and decide to do it anyway. This is tapas.
Svadhyaya, or self-study, the second element of kriya yoga, is the growing ability to sense what’s happening in your body and mind when you do your yoga practice; this, too, can be extended off the mat. You begin to be able to feel when the hamstring muscles in the back of your thighs are being stretched in a forward bend, or if your breathing is getting a little strained in Dog pose. As you continue your practice, your ability to monitor the state of your body, breath, and emotions becomes progressively more refined. After a while, you may find yourself realizing that you always feel groggy or congested after eating certain foods, even if you like their taste, or that certain TV programs consistently leave you feeling more restless and unhappy. Once you really feel the effects of the choices you make in life, you may end up wanting to make different choices.
Ishvara pranidhana is the third element of kriya yoga. Its literal meaning is “devotion to God,” which can be interpreted as “faith in a higher power.” I like to think of it as “giving up the illusion of being in control of what happens.” Yoga says give your best effort but realize that you can’t control the result. That’s in God’s hands, as the Bhagavad Gita teaches.
Thus a yogic approach to weight loss would not be “I’m going to lose fifty pounds in the next two months,” but rather something like “I intend to walk every day for half an hour and eat slightly smaller portions, especially at dinner.” The first approach is results oriented, geared to an outcome that you can influence but ultimately can’t control, and can therefore become a formula for frustration and even fatalism. The second approach is the yogic tool of intention, or sankalpa. Setting an intention is formulating a plan of action. It’s what you tell yourself you’re going to do. “Take care of the present,” the twentieth-century yoga master Ramana Maharshi said. “The future will take care of itself.” For more on this topic, please see chapter 7.
Taking It Home
To deepen samskaras, the key is repetition. In the case of yoga, this means practice, ideally every day. This is what will most efficiently forge new neural pathways and strengthen grooves you’ve already begun to dig. Yogis find that setting an intention to practice daily for a specific amount of time can help it happen. Be realistic, though, and shoot for an amount that you are likely to be able to do, perhaps fifteen or twenty minutes a day to begin. While yoga classes can be valuable, I advocate a personal practice, usually done at home, as the best way to deepen the grooves because few people have more than a few hours each week they can dedicate to yoga. If it takes, say, half an hour to get to a class, half an hour to get home, and extra time to change your clothes, pack your mat, and whatever else you need to do, a single ninety-minute class could easily consume three hours. In that same amount of time you could do a twenty-minute practice six days a week and an hour-long session once a week. If you can afford the time, weekly classes combined with a daily home practice is ideal.
At first, a daily practice of even twenty minutes a day may seem like a lot. If so, why not try taking just a step in the direction of yoga? Could you try some of the exercises in this book? Could you commit yourself to a few minutes of yoga practice a day, even only to taking a single conscious breath, until the groove and your sensitivity to the benefits of yoga deepen? You may feel so much better that you’ll simply find yourself making the time you need, even wanting to increase it. That’s a sure sign that some kind of transformation is under way.
Keep in mind that despite your best attempts, you may be unable to live up to your intention. If so, that’s okay. The first step to life transformation is to see what is—to acknowledge, at least to yourself, where you are right now. You may not be able to create change immediately, but all change begins with seeing clearly. If your first attempt doesn’t work out, you might want to scale back your intention a bit or simply try again.
If you’re still not sure, consider what Dolores has to say. Keep in mind that yoga was completely foreign to her when she took her first class. Her advice: “Step out on faith. Try it. You might think it’s a risk, but there’s gain.” She adds, “Yoga feels good. Yoga makes you feel good. If I could tell somebody one thing, that’s it.”
As a doctor who has spent the last decade investigating the field, I’d add that when done with awareness and proper instruction, yoga is extremely safe. It’s fun. It’s surprisingly effective, and the more you do it, the more effective it becomes. Yoga can make your life better in so many ways, including some you might not predict.
But you don’t have to believe me. Try it for yourself and see what you think. That’s the yogic way.