Holistic approach of yoga for health

Published Date: 23 Mar 2015

In this modern era, we have all the material comforts due to advancements in technology; this rapid progress and technological development has changed the life style of the people, which in turn seems to pose many challenges. Today, one's life style has changed in all aspects, viz physical, mental & social. Mankind suffered from infectious & contagious diseases before 19th century. Thanks to all advances in modern medicine, this has helped us to get these infectious & contagious diseases under control. These are now replaced by psychosomatic ailments which are assuming epidemic proportions. Scientists are recognizing that the modern lifestyle has a major contribution for this. The modern medical science is recognizing its limitations in treating these psychosomatic ailments as evidenced by low success rates in the treatment, side effects of the medicine & continuing increase in the incidence of these life style problems. So, people are looking for some alternate remedy for their problems for effective management of their problems. In the past few years there is tremendous scope for the Complimentary & Alternative Medicines (CAM).

The aim of this report is to provide information about the positive benefits of an alternate system. Now is the time to review our approach in treating psychosomatic problems. A change in attitude and lifestyle is necessary to help us to cope with the problems and diseases. On the positive side, man has the potential to search for pragmatic and simple solutions. By finding realistic alternatives and by creating positive solutions, the problems can be resolved, and the world brought out of its present crisis.

Recent researches have shown that mind, the psyche plays a prime role in most of the psychosomatic diseases. The biomedical approach of modern medicine has looked at only (Physical) superficial aspect of one's existence, which in turn seems to have limited its treatment success. Vedas the treasure house of ancient Indian science, which includes Yoga & Ayurveda, may play an important role in treating these diseases with their holistic/ integrated approach. These two systems play a prime role in the expanded version of CAM. This science is more than 5000 years old. These are the major tools to achieve Chaturtha purusharthas (Dharma, Artha, Kama, and Moksha) which is a prime goal of all human being. In the classics they very beautifully explains that, we need long healthy life span to achieve chaturvidha purusharthas, ayurveda helps to achieve long healthy life span & yoga is to achieve a higher goal like Moksha(Liberation). As Yoga is known to calm down the mind, so in the modern era it has become an important tool to treat these psychosomatic diseases. Even though it is known for higher goal like Moksha, its need of the hour to successful conquering the challenges of these psychosomatic diseases. Through yoga, one can understand this root cause and take measures to establish peace and harmony. The approaches are integrated at all levels - Annamaya koÅ›a, Pranamaya koÅ›a, Manomaya koÅ›a, Vijñānamaya KoÅ›a and Änandamaya koÅ›a - promoting physical, mental, social and spiritual health.

Concept of health and Yoga

"Health is a state of well-being at physical, mental, social and spiritual levels and not merely an absence of illness or infirmity". This is the definition of Health as defined by World Health Organization (WHO). Prior to this latest definition the World Health Organization adopted only three components e.g. Physical, Mental and Social. The "spiritual" role played in making a healthy body was very newly recognized by this International Authority only after knowing the efficacy of yoga as a science in totality, so to say, an integrated and holistic science.

Sri Aurobindo emphasizes, health is an all-round personality development; at the physical, mental, intellectual, emotional and spiritual levels. It is a process by which the limitations and imperfections can be washed away resulting in a superhuman race. The new facilities of deeper perceptions of the world beyond the five senses emerge in this phase of superman existence. Further growth leads to man to unfold ever deeper layers of consciousness and widen the spectrum of his knowledge to move towards divinity or perfection. Yoga is a systematic conscious process for accelerating the growth of human being from his animal level and ultimately to divinity. It is a systematic methodology for all-round personality development on the physical, mental, intellectual, emotional and spiritual components of man. Thus, Yoga in its general methodology for the growth of man to divine heights includes techniques useful for therapeutic applications in making man healthier. Yoga way of life is characterized by peace and tranquility, harmony and health, love and happiness, precision and efficiency.

The aim of this report is to provide information about the positive benefits of an alternate system. Unlike conventional medicine where in the application of drugs treat only the surface level of the ailments and there are also dangerous side effects, which sometimes cause more problems the traditional yoga philosophy regards the human being as an indivisible entity. So it adopts a holistic approach. The root cause of the modern psychosomatic ailments is the stress. Through yoga, one can understand this root cause and take measures to establish peace and harmony. The approaches are integrated at all levels - अन्नमय कोश (annamaya koÅ›a ), प्राणमय कोश (prāṇamaya koÅ›a), मनोमय कोश (manomaya koÅ›a ), विज्ञानमय कोश (vijñānamaya koÅ›a) and आनन्दमय कोश(ānandamaya koÅ›a) - promoting physical, mental, social and spiritual health.

Recent research proved the efficacy of yoga in the treatment of psychosomatic diseases, but as it is comparatively new to treat these diseases, experts believe more research needs to be under taken.

Integrated Approach of Yoga Therapy (I.A.Y.T)

In ancient science yoga is known for higher goals like Moksha (Liberation). But as we know the need of the hour is to use Yoga for treating the psychosomatic ailments. From the last few decades yoga gained popularity as one of the Complimentary & Alternative Medicines (CAM) in all parts of the world. Different people are using it in different ways. It has also become a part of education with its multifold advantages. Yoga is used for developing memory, intelligence and creativity.

The modern medical system has replaced almost all the traditions system of medicine in different parts of the globe because of its relational basis. It has proved itself most effective in saving man from the fatal hands of contagious and infectious diseases. But many psychosomatic ailments and psychiatric problems pose a great disturbance to the modern medical system. It is here that yoga is making a vital contribution to the modern medical system.

Patanjali defines "YOGA" in his second patanjali's aphorism as; "Yogah Citta Vriti Nirodhah" Yoga is a continuous process of gaining control over the mind which helps us to reach over original state. Yoga helps us to remain calm and silent under a given situation and to think and act accordingly. As per yoga Vasistha, Yoga is a skilful trick to calm down the mind on the tend it is portrayed as

"Manah Prasamanopayah Yoga Ityabhidhiyate".

According to Bhagwad Gita, it is, "yogah karmasu kausalam" which says yoga is dexterity in action.

According to Sri Aurobindo, health is an all-round personality development; at the physical, mental, intellectual, emotional and spiritual levels. It is a process by which the limitation and imperfections can be washed away resulting in a super human race. Further growth leads man to unfold even deeper layers of consciousness and widen the spectrum of his knowledge to more towards divinity or perfection. In this march towards perfection, Yoga is a systematic conscious process for accelerating the growth of a human being from his animal level and ultimately to divinity. It is a systematic methodology for and all round personality development physical, mental, intellectual, emotional and spiritual components of man. Thus, yoga in its general methodology for the growth of man to divine heights includes technique useful for therapeutic applications in making man healthier. Yoga not only provides techniques for the growth of man from his animal level to heights of perfection it carves out a way of life for him. Yoga way of life in characterized by peace and tranquility, harmony and health, love and happiness, precision and efficiency.

Pancha kosa:

Pancha Kosa has been taken from Taittireya Upanisad. Human existence is made possible because of balance between five layers or Kosas. These Kosas are called Pancha Kosa, the 5 livered existence of human being. The fine Kosas are:

i) Annamaya Kosa: This is the physical layer, over physical body is made of 'anna' or matter. This matter based aspect of our physical personality is Annamaya Kosa. Annamaya Kosa consists of five elements are Panchabhutas namely - earth, water, fire, wind and space. Thus, Annamaya Kosa is the physical frame which is the grossest of the five Kosas.

ii) Pranamaya Kosa: It is prana - the vital force which is the basic fabric of this universe both inside and outside our body. A uniform harmonious flow of prana to each and every all of the Annamya Kosa keeps them alive and healthy. Prana flows through nadis which is called 'Pancha Prana' namely - Apana, Prana, Udana, Samana and Vyana.

iii) Manomaya Kosas: This is the mental layer where thoughts give rise to strong emotion. It is this emotion that is the root cause of all human joy and distress. When this emotion grows stronger, they govern against our right actions. This leads to imbalances called Adhi or stress. Long standing Adhis get pushed into pranamaya and annamaya Kosa causing Vyadhis.

iv) Vijanamaya Kosa: This is the discriminating faculty. It works on conscience which continuously guides the manamoya kosa to get mastery over the basic instincts. It is this component of the mind that was developed in human race that greatly differentiates man from animals.

v) Anandamaya Kosa: This is the bliss layer of our existence. This is the most suitable aspect of our existence which is derived of any form of emotions. Bliss is embodied in Anandamaya Kosa, the highest stage of emotion in the manifested existence. It is the subtest among the five layers of existence.

The science of illnesses:

In Anandamaya Kosa a man is healthiest with perfect harmony and balance of all his faculties. At Vijnanamaya Kosa the movements are channelized in the right direction. The imbalances start only in the Manomaya Kosa. This imbalance amplifies themselves resulting in mental illness called 'Adhi'. At this stage there are no symptoms at the physical level. The mental diseases percolate to the physical from because of the growth of wrong actions. These breed physical diseases are called Vyadhi which is divided into Adhija Vyadhi and Anadhija Vyadhi.

The Adhija Vyadhi is two fold- samanya and sara. The former includes diseases incidental to the body. These may be termed as psychosomatic ailments. But the latter is responsible for rebirth to which all men are subjected.

The second category of ailments is Anadija Vyadhi - those which are not originated by mind. These would probably include the infectious and contagious disease.

The disturbances in the Manomaya Kosa percolate into the physical layer through the Pranamaya Kosa. Hence in the treatment of these psychosomatic ailments it becomes mandatory to work at all the levels of pancha kosa. The integrated approach thus, consists is not only dealing with physical sheath, it also includes using technique to operate in different sheaths of our existence. A brief description is given below.

i) Annamaya Kosa: a healthy yogic diet, kriyas, loosing exercises and yogasanas are used to operate at the annamaya kosa level and to remove the physical symptoms of the ailments and also plays an important role in building the stamina.

ii) Pranamaya Kosa: Prana is the basic life principle. Pranamaya is a process for gaining control over prana. Through the practices of proper breathing, Kriyas pranayamas, we start operating on pranamaya Kosa. Thus, ailments are handled at this pranamaya Kosa level.

iii) Manomaya Kosa: A direct operation on this level is made possible by the last three limbs of Astanga Yoga of Patanjali-Dharma, Dhyana and Samadhi. A devotional session containing of prayers, chants, Bhajans, Dhuns, Stotras etc. help to build a congenial atmosphere to evoke, recognize, attenuate and dissipate the emotion. Therefore, the control over the manomaya kosa means control over the adhis and vyadhis.

iv) Vijnanamaya Kosa: we can come over all the miseries and obsessions by basic perception and right knowledge. Listening lectures, discussing and counseling of yoga philosophy; positives, and constructive topics offers the right attitude.

v) Anadamaya Kosa: The body of happiness can only be brought by working with a background of blissfulness the techniques used come under the heading of Karma Yoga the secret of action.

Thus the IAYT helps us for the total holistic health and humanity to build a divine society.

CHAPTER 8: DIABETES MELLITUS

Definition:

Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics and environmental factors. Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production. The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.

It is most common of the endocrine disorders. Being chronic it affects the metabolism of carbohydrates, protein, fat, water and electrolytes. The result is by effecting the eye, kidney and nervous system.

Classification:

Diabetes mellitus is classified into 2 major types.

Insulin Dependent Diabetes Mellitus (IDDM) or Juvenile Onset Diabetes (JOD)

Non-Insuline Dependent Diabetes Mellitus. (NIDDM)

1. Insuline Dependent Diabetes Mellitus (IDDM)

This is an Immune Mediated Diabetes which is caused by a phenomenon called "Auto Immune Mechanism". Here, the immune system goes wrong and produce antibodies. When autoimmune mechanisms are directed against the insulin producing B-cells of the pancreas (diabetes does not set in until 80% of B-cells are destroyed).saaaq Then, the pancreas stops producing insulin or producing insufficient qualities this prevents glucose from entering the body cells which results high level of food in the form of glucose in the blood stream, this type of diabetes must inject themselves daily with insulin.

Juvenile Onset Diabetes:

This subtype commonly occurs in childhood and adolescence but can occur in any age both sexes can be affected.

Idiopathic Diabetes is also type of IDDM. Here dietary plays an important part. There is no evidence of B-cell destruction. Episodes of rise in blood glucose and ketone accumulation may occur periodically. The patients may require insulin treatment for survival.

2. Non-insulin Dependent Diabetes Mellitus / Adult Onset Diabetes (AOD)

In this type an inappropriate secretion of insulin at the wrong time or the body issue becomes less responsive to the insulin. In this form of diabetes insulin release appear to occur too late in the cycle so the blood sugar level rises to a high level before insulin is secreted and when it is secreted then that there is a no enough to cope with the high blood sugar level. It is called "Non-Insulin Dependent DM" because it can usually be controlled without the use of insulin injection. This type was also referred as Adult Onset Diabetes since it occurs most often in adults, 40 years of age and older.

Other types of Diabetes.

a) Potential diabètes: Patients are having increase liability to develop diabetes due to genetic reason on child of diabetes parents.

b) Latent Diabetes:

Patients who have shown abnormal results under comparing a burden on the pancreatic all during pregnancy or infection.

Causes of Diabetes:

Type 1 Diabetes occurs due to heredity, and autoimmunity.

Type 2 Diabetes occurs due to heredity, overweight, sedentary life style and degenative

Heredity:

The heredity characteristics are:

If a parent has type-1 diabetes i.e. IDDM, a child has 2-5% change of developing DM. If a child has Type-1 DM, the changes of a brother or a sister developing DM is of the order of 5-10%.

If a person with one parent with type-II Diabetes has a chance of 25% of developing type-II diabetes during adult hood.

If both the parents have diabetes it increase to 50%

If a person has type-II diabetes the chances of a brother or a sister with develop in the order of 20-40%

Overweight: 50-80% of the people with type-II diabetes are overweight at the time of diagnosis.

Auto immunity: In this condition, the body's immune system mistakenly attacks and destroys of its own cells eg. Beta cells of the islets of langerhans in Type-1 diabetes.

Age: When there are two children of parents with diabetes and one becomes overweight during adulthood and the other does not one will be more likely to develop type II Diabetes

Signs and Symptoms:

Diabetes mellitus usually occurs with following sign and symptoms.

Dryness of the mouth and excessive thirst

Frequent urination

Weight loss

Weakness and inability to cope with the daily routine

Redness and Irritation of genitalia

Blurred vision

Fatigue

Painful limbs

Pain in fingers and toes

Cramps or numbers of feet may be present

Diagnosis:

Depends on history, examination supported by following investigations

Blood sugar test

Fasting blood sugar (FBS), Normal range - 50- 100mg% or (5-6-5mmol/l)

Post prandial blood sugar (PPBS), Normal range - 130-160mg% or (6-8 mmol/l)

Urine Test - Glucose appears in urine when the blood glucose level exceeds about 180mg%. This limit is called Renal Kidney threshold for glucose.

Methods of testing Sugar/Glucose.

Benedicts test

Paper strip test.

Glucose Tolerance Test:

Medical Management:

Diabetes mellitus cannot be cured completely but can be kept under control with the help of dietary changes, drugs or insulin.

Main object of Management:

To provide quality the life of diabetic patients

To relieve the symptoms of diabetes.

To establish good sugar control

To stop diabetes spreading for their complication.

Mode of the Diabetic Management

Diet

Exercise

Medicine

Acupuncture/Acupressure

Yoga

Magnet therapy

Principle of Diet-Planning: A DM patients diet should be able to Supply sufficient amount of energy giving nutrients like carbohydrates, proteins and fats.

-Supply sufficient amounts of vitamins and minerals.

To maintain ideal body weight.

To help in avoiding complications of DM.

Yogic Management:

According to yoga, the causes of diabetes are in the mind i.e. stress any percolate down to Pränamaya kosha and Annamaya Kosha. Hence it has got to be tackled at all the five koshas.

Annamaya Kosa:

Diet control is important; Sithilikarna Vyayama should be practiced to stimulate internal organs. Asanas brings flexibility suppleness to muscular system, help in removing tamasic behaviour. It also activates the vital internal organs Kriyas, Uddiyanabandha and Agnisara help increasing the blood flow to the region resulting in removing impurities and stimulating the pancreas

Pranamaya kosa:

Pranayama is gaining mastery over prana - the basic life giving force. It regulates the breath and balances prana. The following practices are very helpful.

Sectional breathing, Nadi Suddhi and Brahmari etc.

Manomaya Kosa:

The guided meditative practices described here under are easy to follow and highly beneficial in calming down and slowing down the mind.

OM Mediation

DRT

MSRT

QRT

Cyclic Mediation

Devotional Session

Vijnanamaya Kosa:

At the intellectual level, a national correction is imparted as to "What is real happiness?" i.e. Happy Analysis - 'Ananda Mimamsa" an effort to redeem the participants of all miseries and obsessions and attachments. This is done through counseling, satsangs, lectures, maitrimilian etc.

Anandamaya Kosa:

Everybody experienced that Ananda the blissful state beyond the time and space at least for a short time. May be by accident and may not be aware how to get that blissful state again and be in it for longer time if not forever participants are encouraged to be in touch with that blissful state through Karma Yoga and Happy Assembly.

Case History: Type 2 Diabetes Mellitus

Name : Mr. C. R.

Age & Sex : 73, Female

Occupation : Agriculture

Marital status : Married

Education : PUC

Date of Admission :

Date of Discharge :

Diagnosis : Diabetes Mellitus

Chief Complaints:

K/C/O- Diabetes and Hypertension since 15 years

Tingling numbness in feet

Delay in wound healing

BPH and Constipation since 4 years

Kidney stones since 2 years

History of Present Illness:

Patent was apparently normal before 15 years then he got to know that he is diabetic when his blood was checked. Later he was started with the medications. Gradually he developed the Prostate hypertrophy and constipation. Two years back he developed kidney stones.

Personal History:

Appetite : Normal

Sleep : Disturbed

Bowls : Constipated

Bladder : Frequent urination

Addictions : No

Menstrual/ OBG History:

Not specific

Past History:

Had the head injury in road traffic accident 4 year ago

He had the clot in the brain and operated in 2007

Family History:

Father and son having high BP

Treatment / Medication History:

Tab. Riotrill 5 Mg 0-0-1

Tab. Triptomen 0-0-1

Tab. Stamlo Beta 500 Mg 0-0-1

Tab. Glymet GP2 1-0-1

Tab. Plagerine -A 0-1-1

Tab. Storvas 10 Mg 0-0-1

Tab. Himplasia 1-0-1

Tab. Y- Lax Constipation

Social / Stress history:

Wife expired 2 years ago, she was also diabetic

Son is not co-operating

Examination

General Physical Examination:

Built: moderate

Pallor: +

Clubbing: NAD

Edema: Mild pitting edema in both legs

Vital Signs:

PR: 74/ min

RR: 24/ min

BP: 130/80 mm of Hg

Temp: Normal

Height: 5'6''

Weight: 77 Kg

Systemic Examination:

CVS: NAD

Investigations:

FBS : 90 mg/dl 1 week ago (Venous blood)

PPBS : 130 mg/ dl

Diagnosis:

Diabetes mellitus with neuropathy

Aim of Present Therapy:

Is to reduce the frequency of urination and to improve the quality of sleep.

To reduce the diabetic complications, bring down the medications.

To improve the overall quality of life.

Management & Progress:

The participant attended all the classes and found all of them to be enjoyable and enlighten. Out of all the class he liked CM, initially he found DM special technique a little too exhausting. After some time he was toned down to accommodate his physical condition. He enjoyed the lecture by Dr. Raghuramji found them relevant to his life.

Counseling Strategies:

The participant was completely understood the holistic approach of the IAYT. We encouraged him to abstain completely abstain from the sweets during his stay so that he may see clearly that blood sugar level is drooping by time of his discharge. We encouraged him to participate actively during special technique sessions and to practice his own diligently so that the effect of each exercise is felt more clearly

The participant responded positively when he started to noticing the improvement, he was more even more encouraged. We taught him the "sweet Meditation" and its theory.

The participant loved many of the lectures as they touched on the realities of day to day life. Gentle words of encouragement and praise worked very well with this participant.

Results:

General Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SYS BP (mm of Hg)

130

118

2

DIA BP (mm of Hg)

80

76

3

PULSE (cycles per min)

74

72

4

RR (cycles per min)

24

20

5

BHT(Sec)

8

11

6

WT(Kg)

77

76.1

Clinical Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

MEDICATION SCORE (MS)

8

8

2

SYMPTOM SCORE (SS)

4

1

Psychological Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SATVA

21

21

2

RAJAS

2

2

3

TAMAS

2

2

Specific Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

FBS(mg/dl)

90

90

2

PPBS(mg/dl)

130

114

CHAPTER 7: BACK PAIN

Definition

Any pain which occurs in the region between the neck and pelvic at any point on the Spinal column, is termed as Back Pain.

Back pain is not disease and therefore, it has no cure. But it can be controlled.

Causes:

Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many intra-abdominal disorders, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.

The most common causes of lower back pain are sprains and strains. Other conditions that can cause back pain include: disc injury, spinal stenosis, and osteoarthritis of the spine, spondylolisthesis, ankylosing spondylitis, osteoporosis and fractures of the lumbar spine, pregnancy, fibromyalgia.

Classification:

Several classifications are available. Feinstein described 3 major types of clinimetric indexes that are relevant to classification systems used for patients with LBP. These are the status index, the prognostic index, and the clinical guideline index.

Followings are some conditions with a symptom of back pain

Sciatica:

A severe shooting pain that radiates from the lower back along the back of the thigh down to the outer inner side of the foot.

Radiculopathy:

Pain in the area where the particular nerve has been distributed, because of nerve trap or compression, patient feels pain in that area.

Lumbar spondylosis:

Limited movements of the waist region.

Stiffening of the spine

Cervical spondylosis

Low back pain, neck pain, headache

Arm pain and neck movements are reduced

Tender spot in the trapezium muscles

Arms become weak and lose reflexes.

Coccydynia: Pain in the coccyx region

Ankylosing spondylitis:

Chronic stiffness in the hips and entire spine

Mild to moderate nagging pain in the lumbar region or hips

Lumbago: Acute pain to the buttocks or thighs

Signs and Symptoms:

Depends on type of Backpain

Diagnostic Criteria:

Asymmetrical straight leg raising

Asymmetrical movements of lumbar spine

Test for pain during movements

Test for neurology defect

Test for back pain on axial loading

Test for sensory loss

Imaging techniques i.e. CT and MRI

Medical management:

Depends on type of backpain.

Analgesics & anti-inflammatory.

Surgery

Yogic management:

Prevention is better than cure. Preventive measures include:

Awareness and correction of posture while standing, sitting and lying down

Regular exercises

Stress management

Yogic techniques involving slow body movements followed by practices of deep relaxation are useful in maintaining the strength and flexibility of the spine. Regular practice of a basic set of yoga practices of 45 to 60 min including sürya Namaskär, loosening practices, 8-10 āsana followed by deep relaxation, Prānānyāma and Meditation.

The different Yogic practices affects on Pancha kosha levels:

Annamaya kosha:

Asana, Physical movements, kriyas, and Yogasanas are used to operate at the Annamaya kosa level and to remove the physical symptoms of the ailments. Kriyās: It is a yogic process to cleanse the inner organs of the body and they bring the following effects: Activating and revitalizing the organs, toning up their functions

Desensitization

Development of the deep internal awareness Physical exercise and movement: Very simple physical movements to mobilize and activates, particularly, affected parts of the body are used. Some easy physical exercises are adopted to fulfill the needs of the particular ailments. Loosen the joints, stretch and relax the muscles, improve the forbearance power, & to develop stamina.

Yogasanas: Yogāsanas are physical postures often imitating the natural position of animal meant to tranquil the mind. Through postures the physical revitalization, deep relaxation and mental calmness are brought about.

Pranamaya kosha:

The sheath of prana is a process for gaining control over prana. Awareness and concentration on the painful parts give a control over the affected prana. Sectional breathing, Nādishuddhi, Cooling prānāyāma and PET are very helpful.

Manomaya kosha:

OM mediation, Bhajan, Satsanga and Nadanusandhana help in concentration and cultivating 'Sattvic' temperament which is a perquisite for any greater achievement in the practice of yoga.

Vijnanamaya kosha

A basic understanding is the key to operate with Vijnanamaya kośha. Notional correction through counseling forms the important thing here. Intellectual discussion and philosophy thinking help in the growth of viveka.

Anandamaya kośha

Happiness is the basis of everything. Placing oneself in this layer while performing actions is the key to happiness.

Spinal canal stenosis

Spinal stenosis is a condition where there is abnormal narrowing in the spinal canal. This narrowing limits the amount of space available for the spinal cord and nerves. As spinal stenosis becomes more severe there is compression or squeezing of the spinal cord and its nerves. Spinal stenosis can occur anywhere in the spinal canal, but it is most common in the cervical and lumbar spine.

Causes:

The most common reason to develop spinal stenosis is degenerative arthritis, or bony and soft tissue changes that result from ageing. Spinal stenosis is usually seen in patients over 50 years of age, and becomes progressively more severe with increased age. The normal "wear and tear" of ageing can cause arthritis in the spine that leads to spinal stenosis. This can be from bone spurs (osteophytes) forming, bulging and wear of the intervertebral discs, and thickening of the ligaments between the vertebrae.

Spinal Stenosis Symptoms

The symptoms of spinal stenosis depend on where the stenosis occurs in the spinal canal and how severe it is. Symptoms caused by compression of the spinal cord are called myelopathy. These can include: worsening balance, falling, dropping objects, difficulty buttoning buttons or picking up small coins, and loss of control of the bowel and/or bladder. Symptoms caused by compression of the nerves are called radiculopathy. These can include: pain, numbness, tingling, or weakness along the path of the nerve being compressed.

When stenosis develops in the neck (cervical spine stenosis) there can be compression of the spinal cord and the nerves that travel into the arms and hands. This can cause symptoms of: myelopathy, numbness, tingling, weakness or cramping in the arms and hands.

When the stenosis develops in the lower back (lumbar spine stenosis) there is compression of the nerves that travel into the legs and feet. This can cause: pain, numbness, tingling, weakness or cramping in the legs and feet, particularly progressively with walking and being relieved with resting. These symptoms are sometimes referred to as pseudoclaudication as they mimic the symptoms of inadequate circulation to the legs that is referred to as claudication.

Diagnosis:

Depends on history, physical examination and X ray, MRI, CT scan of spine

Management: There are various treatments available for spinal stenosis depending on how severe of symptoms.

Conservative treatment consists of medication (aspirin and non-steroidal anti-inflammatory drugs), orthotics (an effective thoraco-lumbar spinal brace which keeps the spine in some flexion); exercise (such as a stationary bicycle); and behavior modification (a pushcart when shopping, gentle leaning forward when sitting, avoiding prolonged standing, and avoiding sleeping on the back without pillows under the knees).

Surgery: If conservative treatments fail, surgery may be the answer. Using a procedure called decompression,

Case History: Disc prolapsed with canal stenosis

Name : Smt. S. C.N.

Age & Sex : 38 years

Occupation : Housewife

Marital status : Married

Education : Intermediate

Date of Admission : 9-10-09

Date of Discharge : 15-10-09

Diagnosis : Disc protrusion at L4-5

Chief Complaints:

Low back pain since 3 years

Pain in Rt. Lumbar region spreads to the both legs since 1 year

Pain increase by bending forward 1 year

Pain in heals since 6 months

History of Present Illness:

Patient was apparently normal 3 years back .Her weight was increased drastically within a year 5 Kg, one day while lifting a heavy weight in the home she felt slight pain in the back she consulted the doctor and took the pain killer for 3 days she felt good but after few days later her back pain again started and intensity of pain gradually increased. She consulted Neurologist in NIMHANS and underwent MRI report showed disc protrusion at L4-5. Undergone the traction therapy and painkillers from last 1 year.

Personal History:

Appetite : Normal

Sleep : Disturbed by LBA

Bowls : Normal

Bladder : Normal

Addictions : No

Menstrual/ OBG History:

Regular 2 Days in 30 days cycle,

Two children's (1 male & 1 female)

Past History:

Not specific

Family History:

Father - hypertension

Treatment / Medication History:

Tab. MAX Galin 1-0-1

Traction - not much relief

Social / Stress history:

Family stress

Examination

General Physical Examination:

Built: Moderate

Pallor: +

Vital Signs:

PR: 86/ min

RR: 22/ min

BP: 128/80 mm of Hg

Temp: Normal

Height: 159 cm

Weight: 75Kg

Systemic Examination:

Tenderness at Rt. Iliac joint.

SLR: left leg 250, Right leg 600

Forward bending limited to 900

Backward bending limited to 250

Investigations:

MRI: Shows mild disc protrusion at L4-5

Diagnosis:

Disc protrusion at L4-5

Aim of Present Therapy:

To reduce the pain,

To improve the mobility

To reduce her weight

Management & Progress:

She is taught

Counseling Strategies:

Results:

General Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SYS BP (mm of Hg)

120

120

2

DIA BP (mm of Hg)

80

80

3

PULSE (cycles per min)

86

72

4

RR (cycles per min)

22

16

5

BHT(Sec)

8

20

6

WT(Kg)

75.2

72

7

PFR(Ltr. Per min)

Clinical Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

MEDICATION SCORE (MS)

4

2

2

SYMPTOM SCORE (SS)

6

4

Psychological Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SATVA

12

14

2

RAJAS

10

10

3

TAMAS

2

0

Specific Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SLR

RT. LEG

60

90

2

LT. LEG

30

90

3

SIT & REACH(cm)

-4

+9.5

BIPOLAR DISORDER

Definition:

Bipolar disorder or manic-depressive disorder, which is also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations.

Causes:

There is known cause for Bipolar disorder, probable causes are

Childhood precursors

Life events and experiences

Neural processes

Melatonin activity

Psychological processes

Classification:

The disorder has been subdivided into bipolar I, bipolar II, cyclothymia, based on the nature and severity of mood episodes experienced; the range is often described as the bipolar spectrum.

Signs and symptoms:

Depends on type of episode,

Depressive episode: include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features.

Manic episode: Characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low, and a person in a manic state may be easily distracted. Judgment may become impaired, and sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behaviour may become aggressive, intolerant, or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen" and are "on a special mission" or have other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis or a break with reality, where thinking is affected along with mood. Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose. To be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required.

Hypomanic episode: Characterized by optimism, pressure of speech and activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning like mania.

Mixed affective episode: mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage).

Diagnosis:

There is no clear consensus as to how many types of bipolar disorder exist. In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists three specific subtypes.

Bipolar I disorder

One or more manic episodes, subcategories specify whether there has been more than one episode, and the type of the most recent episode. A depressive or hypomanic episode is not required for diagnosis, but it frequently occurs.

Bipolar II disorder

No manic episodes, but one or more hypomanic episodes and one or more major depressive episode. However, a bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.

Cyclothymia

A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning.

Medical Management:

There are a number of pharmacological and psychotherapeutic techniques used to treat Bipolar Disorder. Individuals may use self-help and pursue a personal recovery journey.  

Mood stabilizer,

Anti psychotic,

Anti depressants are commonly used.

Specific relaxation techniques should be targeted.

Hospitalization in case of severe episodes.

Psychotherapy

Behavioral therapy

Cognitive therapy

Re-education

Crisis Intervention

Yogic Management:

The integrated approach of Yoga therapy deals on individual at different levels of existence through different practices at each level.

Annamaya kosha: Initially one should start with loosening exercises which are body movements repeated with jerks and speed. This helps to distract the mind from loop of repeating anxiety producing thoughts. The dynamic practices help to reduce the physical unification of tremors of hands, palpitation. Once it is distracted by the first body movements, one can switch on to slower body, movements i.e. Yogasanas and 'Suryanamaskara'. Sāttvic diet of optimum quantity keeps them active and helps them to cope over tamasic nature. Kriyas is good for introverts and weak mind, as it helps to open up and to strengthen the will power and development of deep internal awareness.

Pranamaya kosha: Breathing practices involving slow deep breathing keeps a person stable the breathing and speed of the breathing also reduces which reciprocates at the level of mind by calming down the mind. Kapālabhāti and Bhastrika let out all the stagnation in the prana and cooling prānāyāma, nādi shuddhi reduces and balances metabolism respectively.

Manomaya Kosha: Mind can be set to further slowing down mode by actual Dharana and Dhyana, which is nothing but very slow effortless flow of single thought in the mind, sinking down into total inner silence for a few second. By this one gains better mastery over mind. A new habit of switching off the mind to silence and deep rest through a systematic training gives the capacity of not getting lost in the anxiety depression loop.

Vijnanamaya Kosha: The proper understanding of the present problem has to be brought about. The Yogic counseling, lecture on the concept of disease self-analysis are necessary to overcome the root cause of problem.

Anandamaya Kosha: At this level, they are helped to work in a blissful state by using karma yoga and haply assembly which is very useful and effective in bringing them out of thus shells. It is common to all psychological ailments characterized by morbid sadness, increased perception of physical plan and guilt consciousness. It is response to emotionally demanding situations.

Case History: Bipolar Disorder (BPD)

Name : Mr. A .N

Age & Sex : 18 years, Male

Occupation : Student

Marital status : Unmarried

Education : P U C

Date of Admission :

Date of Discharge :

Diagnosis : Bipolar disorder

Chief Complaints:

Mood swing since 2 years

Poor judgment

More fantasies

Gets angry quickly

Talks more in home

History of Present Illness:

Patient was apparently normal 4 years back when he came from residential school then he started going out from home more frequently and making more friends. Gradually he started getting angry on family members. Since two years he will be sitting quietly for some period and angry for some time. Then they consulted the psychiatrist medication started last March was attended the 21 rehab camp.

Personal History:

Appetite : Increased

Sleep : Normal

Bowls : Normal

Bladder : Normal

Addictions : Smoking since 1 month.

Menstrual/ OBG History:

Not specific

Past History:

Nothing significant

Family History:

Father has DM.

Treatment / Medication History:

Syp. Depakose 200mg BD

Tab. Aleanz 2.5 mg 0-0-1

Tab. Depalcote 250mg 1-0-1

Social / Stress history:

Examination stress

Future stres

Examination

General Physical Examination:

Built : Moderate

Pallor : NAD

Clubbing : NAD

Edema : NAD

Any other :

Vital Signs:

PR: 80/min

RR: 22/min

BP: 106/70 mm of Hg

Temp: Normal

Height: 167 cm

Weight: 72 Kg

Mental examination

Behavioral observation: not having insight

Speech: clear

Orientation: good

Thinking: Fast

Perception:

Mood: Swing

Investigations:

Not available

Diagnosis:

Bipolar disorder

Aim of Present Therapy:

To improve the concentration.

To reduce the mood swing.

To reduce weight.

Management & Progress:

During our initial interactions with the participant, we noted that he appeared lethargic was not very participative during the special techniques sessions. He explained that he is having joint pains. His mood swings. He was observed to go to sleep halfway through pranayama.

Sometimes he will be friendly and forthcoming whenever we talked to him. He felt good by the fact that we understood his predicaments and that helped him to open up more and more. Subsequently, he even confided in us some of his personal secrets opened up in front of us

Counseling Strategies:

The participant was counseled by Smt. Sabita who managed to draw out from his many lings that happened to and been troubling him since young. This helped him to resolve them, we always lent the participant a listening ear but refrained from giving him any advice". Instead, we asked her what he did and, or planned to do to overcome his problem and how he coped during each episode of manic/ panic attacks.

We all had a good laugh and told him that everything was fine and that she just needs to relax more. As we agreed with post discharge plans that would keep him mind occupied so that mid not start worrying unnecessarily, he felt encouraged that he is making the right he left Prashanti in a very positive mood, filled with hope.

Results:

General Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SYS BP (mm of Hg)

106

110

2

DIA BP (mm of Hg)

76

80

3

PULSE (cycles per min)

80

74

4

RR (cycles per min)

22

18

5

BHT(Sec)

13

20

6

WT(Kg)

77

74

Clinical Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

MEDICATION SCORE (MS)

3

3

2

SYMPTOM SCORE (SS)

2

0

Psychological Parameters:

S. NO

PARTICULARS

BY

AY

% CHANGE

1

SATVA

15

21

2

RAJAS

4

8

3

TAMAS

4

0