India's National Magazine
From the publishers of THE HINDU
Vol. 15 :: No. 19 :: Sep. 12 - 25, 1998
The indigenous way
A Matter of Health: Integration of Yoga and Western Medicine for Prevention
and Cure by Dr. Krishna Raman; EastWest Books (Madras); pages 496 + XVI;
price Rs. 720.
WITH the increasing predominance of hospital-centred medical care over preventive medical care in the last 50 years, the Bhore Committee Report, which could have guided the country's health policy, has been largely forgotten. Discussions on health issues appear largely to cover the regional variations in the provision of medical care and its utilisation, expenditure patterns, public regulation of health services, the standards of health care in the public or private sector, access to health care and so on. The approach has generally been to view the receivers and givers of medical care as two separate groups that can be divided into smaller groups for purposes of analysis. Studies by and large relate to allopathic medical care on the assumption that allopathy is the preferred system. It is assumed further that medical care (or health care) is the responsibility of the state. Strangely enough, there is no sufficient realisation that except in the case of infectious diseases, chronic disease prevention or cure is primarily in the hands of the individual or his or her family.
Although India has fairly cost-effective indigenous systems of medicine, they have been given step-motherly treatment by successive governments. The patients/consumers are also to share the blame since they demand quick solutions that require no effort on their part. Equally intriguing is the neglect of traditional lifestyles and dietary regimens.
Over the last few decades, there has been impressive progress in medical technology, especially in diagnostics, surgical procedures and so on. In this process of increased dependence on equipment and "objective" diagnostic tests (of what is measurable), what appear to have been lost are compassion, intuition and the general "feel" a doctor can have about the patient's body and mind, and how the disease has emerged from these.
Over the last two decades, there has been a gradual emergence of a new paradigm in health care. Called "holistic approach", this respects the interaction between the body, the mind and the environment and lays emphasis on correcting the disharmony in the body, unlike the allopathic approach which is more Cartesian and which looks at pain and disease as negatives to be corrected by intervention - drugs or surgery. The new approach, a reversal of the traditional process of healing, sees the problem as one of disharmony, to be corrected by the individual with help from the doctor/healer, with minimal intervention by way of drugs or surgery - more through diet, exercise, psychotherapy and so on. The emphasis here is on the patient. This is a more integrated approach, with greater personal care from the doctor. The patient and the professionals work together as partners. The most critical aspect of this system is that the mind is given primacy in the treatment. There is also a greater emphasis on the appreciation of qualitative information on non-measurable factors - the connection between the mind and the body, especially the way in which the mind affects the body, its impact on blood pressure, pulse rate, immune responses and so on.
YOGA, one of the orthodox systems of Indian philosophy, was systematised by Patanjali in his Yogasutra. It is believed that Patanjali is also the author of Charakasamhita, a major work on Ayurveda. The aim of yoga was for the yogi to attain mastery over the body and the mind. Although yoga could have been an adjunct to Ayurveda, ayurvedic practitioners have not generally used yoga for therapeutic purposes.
In recent times, however, two masters of yoga used yoga for therapy - the late T. Krishnamacharya and his disciple B.K.S. Iyengar. A Matter of Health, a compendious book written by B.K.S. Iyengar's disciple Dr. Krishna Raman, is probably the most comprehensive attempt to integrate yoga and Western medicine.
As Dr. B. Ramamurthi, the distinguished neurosurgeon, points out in his introduction to the book, Dr. Krishna Raman, who studied modern medicine and was trained in yoga by B.K.S. Iyengar, "is a fit person to attempt this difficult task and he has done it well." In his preface, Dr. Raman explains the importance of physical and mental health and how yoga can help achieve this. He illustrates this with examples of how yoga, especially as taught by B.K.S. Iyengar, has been particularly useful in treating diseases. He has found that the application of 'Iyengar yoga' has resulted in enormous clinical changes in his patients. Dr. Raman says: "When one medically examines persons trained in other schools, their body parameters lag far behind students trained in the Iyengar system." He cites a number of cases to support his claim.
The book, both in its size and coverage, is almost encyclopaedic; it covers a wide range of subjects - nutrition, human physiology, lifestyles, various asanas and of course yoga as a medical system that can be applied in the management of various physical disorders.
The lifestyle of a person, including what one eats, how one lives and how one behaves, is crucial in treating illnesses that are typical of the modern age. Diet, exercise and mind control are not only critical for preventing cardiac diseases, but also help in reversing its effects.
Most of the first section of the book is appropriately on lifestyles and begins with a chapter on "Health and Food". In this chapter, Dr. Raman briefly discusses health as a process and writes about the roles of heredity, environment and nutrition. He defines carbohydrates as including glucose, canesugar, milk sugar and starch. It would have been more useful if a book of this kind had distinguished between complex and other carbohydrates. Grains and legumes are an important part of the Indian diet. They provide complex carbohydrates, vitamins and minerals, contain very little fat and have plenty of fibre. In addition, legumes provide a large amount of proteins. Fruits and vegetables could also have been covered briefly. Soluble and insoluble fibres and antioxidants found in grains, legumes and vegetables either help fight or prevent atherosclerosis, high blood pressure, diabetes and certain intestinal diseases. Since roughage is good for the heart and the gut, it should have been covered in brief.
Dr. Raman says that the minimum protein requirement of an adult is 1 gm per kg of body weight. According to an Indian Council of Medical Research (ICMR) expert group, about 60 gm would be required by an average Indian weighing 60 kg and who consumes about 3,000 calories a day. The United States National Academy of Sciences puts the protein requirement of a healthy adult at 0.5 gm per kg.
The problem of protein utilisation in the body can be limited by the availability of essential amino acids when the protein intake is mainly from plant sources. This has been resolved in the Indian tradition by combining rice or wheat with legumes, vegetables and dairy products since these complementary food sources increase protein utilisation. The standard coverage of the subject is diappointingly low when compared to the other sections, which are of a high order.
The sub-section on "The Growing Years, the Aged and Yoga" is excellent. The kind of food that children eat these days - processed, simple-starch, high-fat and high-sugar foods - will result in severe health problems in the long run. The advice on children's postures, habits, exercise and behaviour is essential reading for parents. For the elderly, the advice on how to acquire peace of mind, develop the ability to face illnesses and prepare for ultimate with equanimity, and discipline the body and mind to accept one's sunset days and age gracefully is replete with wisdom. How yoga can help the modern executive whose life is full of stress is covered well, especially the relevance of yoga for medical professionals. The sub-section on "Yoga and Sports" comprehensively conveys the need for sportspersons to practise specific asanas, which have preventive and curative effects. The sub-sections "Yoga for Artists" and "Yoga for Women" are probably unique and can be particularly useful.
The section on "Functional Anatomy and Physiology" is excellent with clear illustrations. The chapter on "Yoga as a Means of Preserving the Body", based on classical yoga texts combined with modern medical knowledge, goes back and forth between modern human physiology and yogic theory and practice to show how far yoga can help preserve the different parts of the body in very specific ways.
FOR well over a decade, cardiologists have emphasised the importance of exercise in the prevention as well as treatment of cardiovascular diseases. Dr. Ornish has proved comprehensively that heart disease is reversible. The two key elements of his programme are a vegetarian diet and the practice of yoga. But it is in Dr. Raman's book that one finds, in measured terms, what effects certain asanas have on blood circulation and how asanas contribute to cardiac fitness without resulting in any strain or side effects. The broad classification of asanas into seven types - standing, seated, forward or backward bending, inverted or twisted or balancing - and a description of their effects on the various body systems should satisfy most people who require proof of their efficacy. The chapter on pranayama is particularly illuminating. Some people may not agree with Dr. Raman's view that pranayama must be practised only after a certain level of mastery has been achieved over the asanas. Can we deny relief to a sick person, who can benefit from simple pranayama methods, asking him to master certain asanas? As a general principle, what Dr. Raman says is unexceptionable, especially when it comes to teaching pranayama or meditation to the young.
The sub-section on "Props" is innovative. Purists may scorn the use of props but for late beginners and those who cannot do certain asanas without props but have to do them for relief, props are invaluable. They are simple, ingenious and practical and make certain asanas doable. In any event, they are generally meant to be only of temporary use, until the student is able to do the "poses" without them. B.K.S. Iyengar pioneered the use of props and Dr. Raman advocates their use.
Before the last section on "Medical Disorders and their Management", Dr. Raman writes: "Yoga is a primary form of medicine. Integrating it with Western medicine enhances health care." Susruta had said: "A person who studies only one branch of learning cannot arrive at a proper conclusion. Therefore a physician should try to learn as many related sciences as possible." Both yoga and Ayurveda are based on the same concepts, principles and terminologies and see the well-being of a person as a process, in which diet control plays a critical role. Even in Western medicine, diet is becoming increasingly important. Similarly, there is an increasing dependence on stress relaxation techniques.
In the last section, which constitutes a substantial part of the book, Dr. Raman deals with different types of diseases such as cardiovascular, pulmonary, gastroenterological, metabolic, gynaecological and orthopaedic. He analyses the causes, symptoms, diagnosis and medical management of the diseases systematically. He then goes on to explain the yogic management needed for each type, how it would work in general and, more specifically, how certain asanas will not only give relief but help in eventual recovery. He repeatedly warns that one should learn the asanas only from a proper teacher, presumably following the practice of 'yukta siksana', that is, teaching what is appropriate to the person concerned. Relief through yoga can often be fairly quick but the process of treatment will take time. This is an admirable section, especially the part of orthopaedics. Dr. Raman conveys the quiet excitement of his own exploration and discoveries with a confidence that comes from his certainty in relating ancient intuitive wisdom to the scientific/medical exactness of his conclusions.
The production quality of the book is excellent. However, the editing could have been better. The sub-section "Understanding Yoga" (page 1 to 6) has been repeated with minor changes later (page 355-360). The quick reference list of asanas is good but a general idea about the duration of their practice required for therapy would have made it more useful. The glossary, a mixture of medical and other Sanskrit terms, should be replaced by separate lists of technical terms and Sanskrit words. The list of illustrations needs to be separated from the list of pictures of asanas. A good index will add to the book's utility.
In his foreword, B.K.S. Iyengar recommends this book to people who explore alternative approaches to health care and to teachers and students of yoga. It can be read with great benefit by physicians trained in Western or Indian systems of medicine and people involved in the making of health policy. By the time its next edition comes out, one can be confident that the book will be further enriched with more clinical experience.
Books such as this should catalyse a debate on policy issues.