Principles and practice of Clinical Yoga

Dr.K.V Dilipkumar, Professor  of Ayurveda, Peoples Friendship University of Russia, Moscow

World has achieved a tremendous growth with the advancement in science. Modern medicine is an offshoot of Modern science. Despite many great innovations made in curing and preventing some dreaded diseases people are not happy with the quality of treatment that is available today. Survey studies conducted in America and England have shown that 80 percent of patients are unsatisfied with treatment for those complaints presented to their doctors. They expressed that though the symptoms subsided with treatment a feeling of morbidity persist for long. Apart from this new diseases are emerging and some are reemerging.  Scientists could not find appropriate remedies for many diseases. Need for alternative medical systems are badly demanded at this juncture. Clinical Yoga is a widely discussed therapeutic tool in this context. Major difference between Modern medicine and Yoga is that the Modern medicine is a matter based science whereas Yoga is a consciousness based science. Hence to have an in-depth understanding of Yoga and its therapeutic applications one has to transcend beyond the material boundaries.

Our concern of health is largely limited to physical well being. According to Yoga, physique or body is a manifested component of a complex system. It is analogous to a cinema performed in the screen. During the performance of cinema we are only aware of the artists on screen. In fact cinema is a collective effort of a group of people starting from light boy to the director. In a human being apart from the body there are Prana or energy, mind, intellect and soul existing invisibly. These different components are tangled each other. They are not compartmentalized components. They are manifestation of the same principle at different subtlety. They are mutually interrelated. A minute change in any of the component will have a repercussion in others. Hence when we think of health we should have a comprehensive awareness of all. It is a positive gesture that in 1945 at the time of formation of WHO the Allopathic medicine has agreed to include the mental and social aspect of well being in the definition of health deviating from the earlier stand that the health is merely an absence of disease. Allopathic medicine is yet to convince the spiritual component of health and incorporate in the definition officially.

Studies in neurobiology unraveled the mysteries of mind-body relation to some extent. It is demonstrated that how a spark of thought at the mind trigger a series of after effects in the body and vice versa. For example when you encounter a threatening situation the information is passed to visual centre through the optic nerve. Then the information passed to Amygdala, a portion of gray cortex situated in the lower end. Amygdala takes a decision by analyzing the emotional memory stored in it and passes information over to the hypothalamus.  Subsequently the Corticotropin-Releasing Hormone (CRH) secreting from hypothalamus gives directions to pituitary gland for the secretion of Adrenocorticotropic hormone (ACTH). This hormone causes the secretion of corticosteroid from adrenal cortex stimulate gluconeogenesis (formation of carbohydrate from proteins and some other substances) by the liver. Another set of hormones called Epinephrine and Norepinephrine that are secreted from medulla of the kidney stimulate autonomous nervous system functions. As a result various neurotransmitters are secreted at the synaptic junction of the neurons. These neruotransmitters help to communicate the information to the internal organs like heart, lungs, stomach, kidney and entire musculature to respond immediately to cope up with the situation. In turn heart start palpates, respiration enhances, musculature contracts, sweat generates and so on. Similarly when somebody pricks the body of another person a series of reaction takes place and finally the person becomes angry. Here a bodily sign converts into a mental response. This shows the influence of subtle mind on gross body and vice versa. When these changes are within a normal range it is considered as Health. If changes goes beyond normal that state is called disease. Health is a dynamic state. We cannot fix a single digit as an indicator of normal function of an organ. Only a range of value is possible. Every thought of mind and every act of the body cause slight fluctuation in the normal value.

Unity in diversity

Each of the 100 trillion cells in a human being is a living structure that can survive for months or many years.

Recent studies have shown that few cells live as long as the individual they belong to without renewal. A majority, if not all, the cells making up the cerebral cortex belong to this small group. The life span of some other human cells are as follows: 


Lifespan of select human cells:


Cell Type — Lifespan

  • Granulocytes — 10 hours to 3 days
  • Stomach lining cells — 2 days
  • Sperm cells — 2-3 days
  • Colon cells — 3-4 days
  • Epithelia of small intestine — 1 week or less
  • Platelets — 10 days
  • Skin epidermal cells — 2 — 4 weeks
  • Lymphocytes — 2 months — a year
  • Red blood cells — 4 months
  • Macrophages — months — years
  • Endothelial cells — months — years
  • Pancreas cells — 1 year or more
  • Bone Cells — 25 — 30 years

There are different types of cells in our body. All of them are capable of controlling themselves by the genes in it. Genes carry a programme for its individual duties and social duties. Most of the time cells work collectively for the well being of person in which it resides. It is possible that some cells choose to work less efficiently and some others work with over enthusiasm. It is also possible that there can be harmony or disharmony between different groups of cells. This can be equated to that of millions of people living in a country and having individual intelligence forms separate groups on the basis of religion, language, geographic region, profession etc. Despite all these diversity there is one common factor for unity is that they are all citizens of that country. Health is a state of harmonious existence of trillions of cells to serve one human being with a single goal. Disease is a state of disharmony in which the cells are functioning independently and fighting each other.


Who coordinates?


                It is interesting to find that who is coordinating the 100 trillion cells?  Psychologists are trying to attribute it to the Mind. Neurologist says that Brain is the key controller. There are also efforts to identify the coordinator in Immune system, Endocrine system, Genes, DNA and RNA. Yoga says it is the ‘I’ or the self is the coordinator. Hence self is ultimately responsible for health and diseases. So who is this ‘I’?  Materialist considers Body as ‘I’. One can say that “This is my right hand”. But he will not say “I am right hand”. Similarly we realize that Body is mine. But I am not body. Mind is mine. But I am not mind. Intelligence is mine. But I am not Intelligence. Therefore ‘I’ or SELF is beyond Body, Mind, and Intelligence. SELF is also known as Atman or consciousness. Therefore human being is a complex of body, energy, mind, intelligence under the leadership of Atman. Hence a Holistic perspective of human being is essential to understand the health and disease.

Theory of Panchakosa

        Indian philosophers investigated the human being through five levels of subtlety varying from the gross layer, such as the physical layer which they called the annamayakosa, to the subtlest layer of man's true nature of bliss i.e., Anandamayakosa. Atma or Consciousness stays at the level of Anandamayakosa.


Anandamayakosa is most subtle of all kosas. When Atman exists in this kosa we will have highest state of health. Anandamayakosa is prone to get afflicted with some factors of ill health. They are the resultant drive of the seed of residual potencies or impression of previous birth (karmaphala). This may be correlated to the present understanding of genetic transcription. These congenital factors determine our personality, attitude and aptitude. These carried over impressions of previous birth influence the intelligence to come to wrong conclusions on reality. Subsequently mind gets vitiated and attracted to sensual objects for pleasure. This causes the loss of awareness of Atman.    Whenever Atman stays at Anandamayakosa and maintain the awareness of other layers, they are in perfect harmony. In the absence of this awareness cells are prone to lose their direction and develop disharmony. Accordingly diseases occur. This is analogous to that of a lower class room where in the absence of a teacher students are undisciplined.  As soon as teacher enters the classroom everybody come in an order.  At every point of time we are prone to get attacked by disease. For example Cancer cells are occurring in the body very often by mutation or by some other abnormal activation of cellular genes. The abnormal genes are called oncogenes. Also present in all cells are antioncogenes, which suppress the activation of specific oncogenes. Therefore we are in the midst of health and disease. All these can be controlled ultimately by the Atman.


        Vijnanamaya includes our intellect and also the sense faculties (jnanendriya). This level is the collection of all inherited and acquired knowledge. Knowledge is our understanding and appreciation of the fundamentals of life, real source of joy and happiness, the reality of things outside etc. We undertake a lot of analysis at this level and finally discriminate what is right and what is wrong. Vijnanamayakosa is dealing with the present i.e., here and now. Whenever vijnanamayakosa misunderstands itself as “I’, that state is called Ego. Ego cannot take an impartial stand because it always attached to desires and aversion. In an effort to satisfy the Ego mind wanders externally resulting to a lot of negative emotions. This considered as the seed of diseases.


        Mind is the seat of emotions. Thoughts which are attuned to our likes invoke positive feelings, while thoughts pertaining to our dislikes invoke negative emotions. The modern day epidemic of stress is basically a problem at the level of mind. During stress a number of negative emotions are accumulated without giving it a vent. This causes many psychological ailments like depression, anxiety, schizophrenia etc. Further it is also indentified as the layer that originates psychosomatic diseases.


        The word ‘prana’ roughly means energy. We can experience the existence of an energy-providing layer for all our physical and mental activities. Every bit of physical and mental activities requires energy. Breathing, heart beats, circulation, digestion, etc. can be considered as evidence of the presence of prana. The moment prana leaves the body; all activities come to an end. This physiological system which gives us energy backup is the Pranamayakosa.  An imbalance of Pranayama is evident in the form of reversible diseases like asthma, hypertension, epilepsy and migraine.  We also experience that proper regulation of prana helps to cure many physical ailments.


        Annamayakosa is the only directly perceivable component of living being. Whatever we perceive as gross physical body through our sense faculties are part of annamayakosa. All the symptoms of diseases are manifested in the body and become obvious as change of normal structure. Investigations like MRI, X-ray, CT scan, blood bio chemistry, Endoscopy, proctoscopy can identify the changes. Fracture, injury, tumour, skin lesions, ulcer and degenerative changes of different tissues are some of the examples of Annamayakosa disorders.

Management at different kosa


        A manifested structural lesions need to be treated either by eliminating through surgical measures, Panchakarma or medicaments. All the conventional medical systems have developed mainly to cure the physical manifestations of disease. Here yoga can play a role of a complementary medicine by promoting innate healing power. Yoga practices like Sithilikarana vyayama, asana, sookshma vyayama, Sudhikriya and dietary modifications address the imbalance of annamayakosa. All the physically oriented Asana and suddhikriya practices promote the bodily awareness. During the practice of Yogasanas one has to have full awareness of all the changes in the body. That is the one important aspect of Yoga that differentiates from other exercises. Suddhikriya could remove the impurities accumulated in the channels and expand the awareness of internal organs. Asana practice helps to stretch all the musculature connected to the circulatory channels so as to promote the transportation of nutrients and waste in Elementary system, blood vessels, lymphatic system.  Asana synchronizes the activities of mind and body. Hathayoga is the yoga stream that considers body as prime concern.


        Pranayama is the practice which is meant to tackle the imbalances of Pranamayakosa. Breathing is the visible indicator of all the functions of the body. Pranayama is a process of regulating the breathing through a voluntary practice. Subsequently all the functions in the body are coming under the voluntary control of the practitioner. Thus Pranayama could correct the functional imbalances like haphazard breathing, hypertension, palpitation, tremor, hypersensitive reaction, over activity and auto immune reaction.


        Narrowness of the mind is the reason for majority of the negative emotions that leads to stress. Dimension of perception of a problem determines mostly its response in the emotional parlance. Hence the ability to expand the awareness and change of attitude are considered as good measures to reduce stress. Yoga teaches the technique of expansion of awareness. The expansion of awareness is emphasized in dhyana. One need to learn the techniques of expanding the awareness from pointed awareness to linear awareness, from linear awareness to surface awareness, from surface awareness to three-dimensional awareness, from three-dimensional awareness to group awareness and finally from group awareness to all pervasive awareness.   As the awareness is expanding, ego reduces and stress disappears. Dhyana, devotional sessions and group activities help to expand the awareness. An expanded mind will seldom embraces any negative emotions like irritability, anxiety, fear, anger, sorrow and depression.


        Removal of ignorance to unravel the real Self will help to eliminate the entire stress. It is crucial to appreciate ourselves that all the materialistic comforts and mundane pleasures are not the ultimate source of happiness. All our efforts to satisfy our ego is finally end up with stress and stress induced diseases. The intellectual analysis in a deeper level reveals the innate source of knowledge. This is the path of jnanayoga. The upanishats are dealing this knowledge at great length. Spiritual discourses, health awareness, psychotherapy and counselling are some of the useful tools to clear the imbalance of vijnanamayakosa.


        The goal of treatment at anandamayakosa is to attain a state of absolute awareness of the Atman. Longer the Atman maintains the awareness the renunciation of the accumulated fruits of action (karmaphala) of past and present births occurs. Ultimate goal of all the different yoga streams are to train an individual to attain the state of absolute awareness. This state is known as Samadhi. This considers as the measure of an absolute removal of stress induced diseases. As soon as the person enters into Samadhi he experiences removal of all negative thoughts and feels recharged with positive energy.

                Clinical Yoga aims at promoting the innate healing. Both prevention and cure is possible by expanding the awareness of body, prana, mind, Intelligence and Atman.