Duhkha Samyoga Viyoga Yogaha—
“Yoga is separating from identification with suffering”
The Yoga therapy presented in this book derives from an ancient tradition called Yoga cikitsa (cikitsa can be translated as therapy). This form of Yoga therapy is based on the ancient principles of cikitsa krama (therapeutic orientation), which derive from the Yoga tradition of Patañjali and the Āyurvedic system of health, both of which, in turn, derive from the Sankhya and Upanisadic traditions of Vedic India.
Yoga cikitsa is a remedial tradition, founded on a recognition that our physical condition, emotional states, attitudes, dietary and behavioral patterns, lifestyle and personal associations, and the environment in which we live and work are all intimately linked to each other and to the state of our health.
According to Yoga theory, we live within a frame-work of constant change (parināma), and, within this framework, develop conditioned patterns (samskāras) that are present in every dimension of our lives and that influence our perceptions, thoughts, attitudes, and behavior at every level. The good news is that because nothing is static, our condition will inevitably change. The salient question is, will it change for better or for worse? Our challenge is to influence the direction of change for the better. This challenge is complicated by those patterns, often operating beneath the level of our conscious awareness, that influence our action. We may heal the body through some medical or alternate healing modality, but, unless there is transformation at the level of our deep patterns, we may end up re-creating the same or similar conditions again.
Yoga cikitsa is the art of tapping the resources deep within us to heal ourselves. The belief that healing is a natural process goes along with a recognition that our attitudes and behavior can create conditions in our system—structurally, physiologically, and psychologically—that inhibit that natural process. The allopathic physician’s orientation is to treat the disease; the Yoga orientation is to treat the person. In Yoga therapy, therefore, we are first and foremost seeking to change attitudes and actions that inhibit the natural healing process. The ideal is to develop the mind so that it can lead us on a path to improve the quality of life. In fact, according to the ancient teachings, the main goal of Yoga is to influence the state of mind. My teacher has said that Yoga cikitsa is about helping people, not necessarily curing them. Our goal is first of all to help people feel better about themselves, gain more clarity about their lives, help them prioritize and become more effective in their actions, and—perhaps most important—contact a deeper source within themselves. I was taught, “To the extent that we influence the mind, we influence the entire system, and to that extent the person is better.”
There are two essential elements in this process: Viyoga and Samyoga. Viyoga literally means “separation.” In the context of Yoga therapy, Viyoga refers to the process of separating ourselves from whatever is undesirable in our lives. As an eliminative process, it involves the purification of both mind and body. It also involves letting go of unhealthy attachments, giving up self-destructive behavior, and breaking detrimental relationships.
Samyoga literally means “linking together.” In the context of Yoga therapy, Samyoga refers to the process of linking to whatever is positive and productive in our lives. It involves the development of mental qualities such as kindness, courage, patience, and compassion. It also involves establishing appropriate priorities, practicing virtues, and cultivating positive relationships.
The work of Yoga therapy can be called a kaya kalpa. This expression, coming from Āyurveda, is often presented as a science of immortality. In fact, kaya kalpa refers literally to the reorganization, reconstruction, and rejuvenation of our mind and body through our practice. It involves a progressive reintegration of the entire system and a creation of harmony in every aspect of our lives.
The ancient masters visualized the human system as a bird with five essential parts: a head, two wings, a body, and a tail. This bird, in turn, was visualized in five dimensions, each considered to be the “embodied soul” of the previous dimension. These dimensions are known as mayas—meaning “that which spreads” (to be distinguished from māyā, which means illusion). Each dimension, in turn, consists of five essential parts. Simplifying this complex model: The first dimension, anna maya, refers to our gross physical body. It includes the muscles, bones, organs, and tissues of our system. The second dimension, prāna maya, refers to the vital metabolic functions that sustain our life and health. It includes the operation of all of our physiological systems. The third dimension, mano maya, refers to our mental faculties of perception and cognition, and includes all the knowledge gained through our education and other external sources. The fourth dimension, vijñāna maya, refers to our inner and intuitive capacity to understand. It includes faith or ability to trust, values or sense of right and wrong, communication skills, state of mind, and patterns (samskāras) from our past that continue to influence our present attitudes and behavior. The fifth dimension, ānanda maya, refers to our spiritual or “heart” relationship to each moment and to life itself. It includes our longings, what pleases us, our sense of joy, our sense of fulfillment, and our focus on and union with whatever we most cherish.
Because these dimensions mutually interrelate and interpenetrate, a condition that manifests in one dimension will impact all others. For example, someone who has an accident and suffers long-term chronic low-back pain may begin to suffer from fatigue, troubled digestion, depression, and a negative attitude toward life. On the other hand, someone who suffers from low self-esteem may likewise progressively develop depression, fatigue, troubled digestion, and even joint pain.
The basic principle of Yoga cikitsa is that diseases are symptoms of imbalance; and, therefore, the orientation of Yoga cikitsa is to restore balance. According to the ancient masters, three main methodologies can be used to purify and strengthen our systems and so move toward health: āhāra (diet); vihāra (activity); and ausadhi (medicine). The teaching is that the first two methods are preferable and that the third should be used as a last resort. These three methods alone can work to transform the first three dimensions of our systems—physical, vital, and mental. The ancient teachings warn us that because our past patterns are a strong force, depending upon the seriousness of our condition, healing can take time. The only way to ultimately overcome dysfunctional patterns and thereby effect deep and lasting change in our lives is if our practice penetrates to the dimension of ānanda maya, the heart.
As we will see in the section on emotional health ahead, these traditional teachings are confirmed by our present understanding of the power of emotion to influence our physiology, thoughts, and behavior. Neuroscientists are becoming progressively more convinced that the emotional brain is able to override the rational brain and that, though we tend to consciously identify with our rational brain, we connect to life most deeply through our emotions.*
If we think about the times we have been touched deeply in our hearts, it is usually in the context of some relationship. This is easily seen in the relationship between a parent and a child. Of course, this relationship has the power to transform our lives for better or for worse. And when we are affected at that level, as we will see in more detail later in this book, everything else in our system is affected.
In the fourth dimension of our being (vijñāna maya), the head of the bird represents faith. Faith is a quality of confidence and trust, without a need for external confirmations. It is a deep and intuitive knowing that calms the mind and puts the heart at rest. Faith, according to the tradition, is the “ultimate medicine” for the emotional mind.
Our natural capacity for faith is linked to our past patterns but is strengthened or weakened by our associations. Thus the ancient masters taught that the most important aspect of healing was right association (sat sangha). For this reason they stressed the importance of relationship—to the divine (whatever that may mean to you), to the teacher (who represents our own potential to grow), and to the spiritual community. According to the tradition, the one-on-one relationship between a teacher and a student is the first Yoga and the basis from which to develop and sustain a personal practice. Of course, for this relationship to be most effective, there must be mutual confidence, trust, and openness. Such a relationship is between hearts and not simply at the level of information exchange. Thus the masters have said that sat sangha is essential for deep healing. With that as a foundation, the other methodologies (diet, activity, and medicine) will work powerfully to restore and revitalize our health and well-being.
Our health problems may be related to congenital factors; patterns acquired in childhood; the result of an accident, an unhealthy lifestyle, chronic stress; or any combination of these or other factors. At a practical level, many methods can be applied to help us in our journey to health, including postures and their adaptations, breathing techniques and ratios, sounds and associated meanings, meditations, visualizations, rituals, and prayers, relationships (sat sangha) with others, education and study, and dietary and other lifestyle changes. All these methods work to reinforce the commitment to ourselves required to bring our lives back into balance and to create a foundation for the development of our highest potential.
Although there are many means and methods for working to restore balance in the human system, the basic orientation of any treatment is either that of reduction or purification (langhana) or that of tonification or building (brahmana).
Reduction (langhana) therapy is called for when there is some kind of excess in the system that must be reduced: for example, excess weight, toxicity, hyperactivity, or anxiety. In Yoga practice, langhana techniques include exhalation, short hold after exhalation, forward bends, some twists, and headstand. Chanting, visualization, and meditation techniques can also be adapted to have a langhana effect. Langhana techniques are generally cooling (candra) and conserve energy. Because it is oriented toward eliminating conditions that may lead to further imbalance and disease, langhana therapy can also be preventative. In certain cases where it is necessary to increase the heat (agni) in the body in order to purify the system of toxins, brahmana techniques are used to produce a langhana effect.
Tonification (brahmana) therapy works to nourish the system. This is useful in conditions such as general weakness, low energy, specific debilities, or lack of confidence. In Yoga practice, brahmana techniques include inhalation, hold after inhalation, back bends, and shoulder stand. Chanting, visualization, and meditation techniques can also be adapted to have a brahmana effect. Generally, brahmana techniques increase heat (agni) in the body and build energy. Because tonification is oriented toward building the system back up, it is particularly useful during convalescence. In these cases, where cooling (candra) techniques help to nourish the system and conserve energy, langhana techniques are used to produce a brahmana effect.
These definitions are theoretical and overlapping. In practice, we often need to use both orientations and to mix a variety of methods. For example, in the sequence presented ahead for the chronic fatigue patient, we begin with a gentle brahmana approach to increase her energy; however, because too much heat will deplete her energy and leave her exhausted, we end with a gentle langhana approach to lower her body heat and conserve energy.
Among individuals, there are vast differences— physically, psychologically, and spiritually. The same long-term, stressful circumstances can create a complex of symptoms—anger, high blood pressure, elevated cholesterol levels, and Temporomandibular Joint Disease (TMJ) in one person, and depression, fatigue, loss of appetite, and poor posture in another. In fact, any number of different symptoms can result from the same cause; and any number of different conditions can result in the same or similar symptoms. Depression, for example, can cause loss of appetite, sleep disorders, and fatigue. Problems with digestive, endocrine, or nervous system function can cause the same symptoms. In addition, food allergies, heavy metal toxicity, nutritional deficiencies, Candida, chronic structural problems, and various forms of infections can lead to these same symptoms.
Theoretically, the Yoga tradition has practices that address any kind of condition, at any level of our system. At the same time, it should be clear that effective practice must respect the unique needs, interests, liabilities, and potentials of each individual by developing a practice that is adapted to that uniqueness. Further, every individual’s condition will change over time, and thus their own practice must evolve. This kind of teaching cannot be mass-marketed. That is its gift and, at the same time, its limitation.
Anyone can benefit from a personal practice, no matter their condition. Deep work usually requires a one-on-one contact with a qualified teacher over time to establish what should be practiced, how it should be practiced, and how the practice should evolve. Finally, however, the effectiveness of a practice is not guaranteed no matter how well it is adapted to your needs, because it is your own motivation, confidence in the practice, ability to understand your condition, and ability to sustain your practice that will ultimately determine its effectiveness.
Increased self-awareness will enable you to accurately assess your condition; and the commitment to a personal practice will enable you to break unconscious and self-destructive behavioral patterns and establish new ones that will lead to positive change. Understanding the nature and functions of your body’s various systems will enable you, over time, to experience directly the way they are affected by your attitudes, diet, and behavior. Through practice, you enter into a new relationship with yourself and your condition. On the one hand, you will build the energy required to break the habits and tendencies that you know to be self-destructive. On the other hand, you will be taking concrete and effective steps to reorganize your systems. The limiting factor in this approach, of course, is the necessity for personal practice. Without practice, there will be no results. But if we engage in simple practices consistently, we will be amazed at their capacity to change us deeply. Yoga therapy is an experiential process that requires and develops self-awareness and self-regulation as the foundation for healing.
Because of the interconnectedness of our various systems, we can initiate change in our overall condition by working through the body, the breath, and/or the mind. A process that leads to an alert and relaxed state of mind can also lead to increased control over what we normally think of as automatic functions. In the same way that the negative states of depression, anxiety, and anger—to name just a few—adversely impact our system, positive states of relaxation, joy, and love have a deeply restorative effect.
The specific methods and practices we choose will depend on our condition. As a general rule, we tend to begin all therapeutic practices by focusing on the spine and the breath. As we will see ahead, all of the fundamental systems of the body converge in the spine. And—as we have already seen—we can influence our state of mind, other aspects of our physiology, and our structure through the breath. In this process, linking the breath to the movement links the mind to the body and makes the movements conscious. As we increase our awareness of the body, we are better equipped to work with and regulate it.
Thus we begin with simple exercises of breath and movement, focusing on the spine, as a safe and effective start to our practice. We use various means to focus our attention and increase the flow of vital energy (prāna) to problem areas. As our practice develops, we will add other techniques, as appropriate, to deepen its effects and meet specific needs. The starting point for this work is variable also, and depends on the condition of each individual. We can see the graph below as an example of progression. Minus one represents someone with a very serious condition, and ten represents someone in optimal health.
Depending upon where the person is on the graph, we start at a different point on the scale. For serious diseases, we usually begin lying on a bed or seated on a chair, and bring awareness to the breath.
No matter our starting point, the goal is to deepen our self-awareness and to integrate body, breath, and mind. As we progress in our practice, we can shift our focus away from physical and/or mental limitations toward our higher potential; away from weakness toward strength; away from pain toward well-being; away from anxiety, anger, and depression toward relaxation, contentment, and joy. We can feel better about ourselves, stabilize and elevate our moods, develop clearer perception, increase mental energy and alertness, have a greater sense of physical well-being, and find a sense of direction and a deeper purpose in our life.
A final note before we move on to specific methods in the following sections: unless we are able to find a competent teacher, we should consider very carefully the choices we make in developing our own practice. Our intention may be clear—improving our condition through our activity—yet some practices we believe to be positive may actually be detrimental to achieving our intended goals. The great Yoga teacher Krishnamacharya, who brought the Viniyoga tradition into this century, had a wonderful expression for this kind of practice: anga bhanga sādhanā (literally, “limb-harmful-practice”), a sādhanā that is useful for one thing but harmful in some other way.
For example, Krishnamacharya considered running, for many people, to be an anga bhanga sādhanā. In that context, he said, “Running is for horses!” What he meant was that though running may be good for some parts of our body (such as the respiratory and cardiovascular systems), it can also be harmful for other parts (such as the ankles, knees, and hips). I have seen people jogging along the freeway in heavy traffic at midday under the hot sun without a hat. This is a classic anga bhanga sādhanā: refining the system and at the same time exposing it in some destructive way.
People take up this and other anga bhanga sādhanā practices in the belief that they are going to get more fit. They find encouragement to continue from the fact that they suddenly feel better. In the beginning and for some time thereafter, they may feel better, especially if they’ve been sedentary, but in the long run they are also doing themselves harm.
Although we strongly suggest that you make every effort to work with a well-trained and experienced teacher, the principles and practices in this book are meant to steer you away from this sort of activity. As you increase your self-awareness, proficiency, and understanding, you will become ever more readily able to recognize anga bhanga sādhanā practices for what they are. Any practice, even a Yoga practice, can become an anga bhanga sādhanā when wrongly applied: an important part of the continuing work of personal practice, therefore, will be monitoring yourself to determine whether the practice you are engaged in is right for you.
As you will see from the case studies that follow, the technology of practice is secondary to, and emerges out of, the relationship that develops in the environment of the session between the teacher and the student. Each case must be handled individually. In my work, I develop an active relationship with each student. In order to work out an appropriate practice and make lifestyle suggestions, I find out other aspects of the student’s character beyond the manifest symptoms. I repeat: because of the multiple variables between individuals suffering from the same condition, it would be inaccurate to suggest that we can prescribe a set practice for any condition.
In the sections ahead, we will present examples of Yoga cikitsa practices designed to work with specific chronic aches and pains, chronic diseases, and emotional health. The first section concerns common aches and pains. It contains a brief presentation of the skeletal and muscular systems to provide a foundation for understanding related problems, followed by a detailed discussion of three main aspects of these systems—neck and shoulders; upper and lower back; and sacrum, hips, and knees—and the common aches and pains that affect them. Each of these sections is followed by particular case studies and related practice sequences.
The next section concerns chronic disease. It contains a brief description of the functions of the eight main physiological systems, providing a foundation for understanding chronic related problems, and describes the various conditions of excess and deficiency that affect them. Each category is followed by a case study and related practice sequence.
The last section concerns emotional health. It contains a discussion on the brain; a discussion of the reciprocal relationship between our conceptual mind, our emotional states, and our physiology; and a discussion of the Yoga tradition’s view of emotional states and how to manage them. Also included is a description of three stressful emotional states: anger and anxiety, which are presented as states of hyper arousal; and depression, which is presented as a state of hypo arousal. Case studies of hyper and hypo conditions are followed by related practice sequences.