Preface to the first Edition

I am happy to present herewith a monograph on "Disorders of Stress and their Management by Yoga" (A study of neurohumoral response) for the benefit of all those interested in the subject. This book is mainly based on our experience of managing these patients at the University Hospital, Banaras Hindu University. My interest in the subject dates back from about two decades when I myself was the victim of one of the stress diseases known at that time as "Cardiac Neurosis". The use of some of the tranquillisers at the initial stage followed by a regular practice of Yoga gave me complete relief. How such a change was brought about in my life from a state of nervous wreck to that of an active creative life by the use of Yoga was the subject of my enquiry in the subsequent years.

I read many medical books and monographs which gave vivid descriptions of most of the stress diseases from hypertension to migraine with no satisfactory answer to the question of their prevention. In the same way I read many books on Yoga too, from ancient authors to the modern scholars with no satisfactory answers. None of these books could give me a scientific explanation as to how these stress disorders are actually caused and why they are increasing at such a rapid rate all over the world. Hence I felt that there was a pressing need for further study of the various causative factors which are responsible for the development of these stress diseases. Similarly, there was also an urgent need to explore scientifically as to how 'Yoga' could act as an important measure with beneficial results to these patients from the preventive as well as the curative point of view.

It is because of these pressing considerations that we started working in this area. In fact the present monograph is the result of these studies carried out by myself and my colleagues for the last several years. In the beginning, when we started exploring the literature on the physiopathology of stress, we noted two distinct schools of thought One school working mostly on smaller animals believed that the hypothalamus and its neuro-endocrine apparatus are the highest centres for producing all the bodily disturbances of stress. But there was another group mostly belonging to the Pavlov school of physiology believing that it was the cerebral cortext which regulated all the abnormal symptoms manifested in stress. However, we are happy to state that our own studies of all the neurohumors indicated a complete integration of both the above hypotheses. Thus it is at first the cerebral cortex that is stimulated by stress. The hypothalamus and the entire neuroendocrine apparatus are stimulated subsequently to the cerebral cortex. It is also by the cerebral cortex that the autonomic nerves are stimulated via limbic system and hypothalamus which ultimately cause the disease proper in a given organ or tissue. From the above, one can say that it is the neurohumors which are the main connecting links between the cerebral cortex and all the bodily systems. It is surprising to note that all the modern neurohumoral theories to be described in this monograph closely resemble the one put forward about 2000 years ago by ancient medical authorities of the East and the West.

When we started investigating the effects of yogic practice on health and disease we followed several modern clinical, physiological and biochemical methods. However, we soon came to the conclusion that the neurohumoral studies are the most fruitful methods for finding out the efficacy of various yogic practices in the management of stress diseases.

The word 'yoga' is generally misunderstood by people. To some, it means a particular type of exercise, whereas to others it is meditation. As I understand the word, it means Patanjali's integrated type of yoga which includes yogic exercises breath holding practices and meditation. However, in the management of stress diseases one will have to make a selection and advise the type of yoga which is best suited to a patient to get over that particular disorders.

On the basis of the above stated principles, we carried on our studies on the use of various yogic practices in the management of some of the well known stress diseases, using neurohumoral studies as the main parameter for assessing the result. The results of these studies were very instructive and rewarding not only in the field of therapy, but also for understanding the pathogenesis and pathology of these stress diseases. Hence, a brief review of the pathogenesis and pathology of these diseases is also given after considering the various aspects of the Physiology Biochemistry of nervous system. Thereafter, specific disorders have been discussed briefly and our experience with the management of these cases by Yoga has been in some details.

From all these studies we are convinced that it is the cerebral cortex, specially the psychic centre, which is responsible for the initiation of all these stress disorders as a result of genetic susceptibility of a person receiving excessive environmental stimulation. Thus, the cerebral cortex in response to a strong stimulus initiates the changes in the whole body through the prompt liberation of neurohumors and hormones in an excessive quantity. It is at this stage that yogic practices would greatly help the patients to get over their trouble by decreasing their sensitivity to the environmental stimulation and thereby to these neurohumoral and hormonal changes. Because of the enormous benefits derived from so simple and inexpensive a measure as yoga in the management of these patients, who are otherwise destined to become neurotics or drug addicts, we have dealt with the subject in sufficient details. It is hoped that medical men and take effective measures so that they can provide a lasting relief to their patients based on these scientific studies. We hope the readers will take this monograph in the spirit with which is has been presented and will make the fullest use of it for conducting further studies on the subject.

Preface to the Second Edition

It is gratifying to note that scientists and scientifically minded people are now taking greater interest in exploring the truth of Yoga and its influence on the humanity as a whole. That is perhaps one of the reasons why there is more demand for books of this type, dealing with the physiological and biochemical aspects of Yoga.

Although the format of this book remains almost the same as that of the first edition, a few additions have been made at some places. The following are some of the important additions: (a) Kundalini Yoga: A new chapter on Kundalini Yoga has been added to explain the science and practice of this important branch of Tantra/Yoga: (b) Meditation: the chapter on meditation has been expanded to include recent trends in the study of consciousness and meditation: (c) Social aspects of Yoga: Lastly, as an Epilogue, social aspects of Yoga have been discussed in some detail because it is felt that apathy to conducting Yoga research on the part of scientists and medical men on the side and the traditional yogis on the other has greatly retarded the growth of this ancient science. Unless all these experts join their hands for conducting further studies, we will never be able to make further advances in the field of Yoga in the near future.

Further, in order to implement the Alma Mater declaration of "Health for all by the Year 2000 A.D.", specially for the promotion of mental health, Yoga and Meditation can play a great role provided proper scientific studies are conducted to establish their usefulness. Various scientific studies already conducted give sufficient proof in favour of the statement that the use of Yoga as a health promotive, preventive and curative procedure has provided enormous benefit to the people all over the world at a minimal effort and cost. Therefore let us pool all our resources to spread the message of Yoga for promoting universal health and happiness.

The purpose of writing this book will be fully served, if, in addition to providing guidance to the common man to attain better health, it also stimulates the elites of the society to dive deep into the subject. I sincerely hope that it will fulfill the purpose for which it has been written

Introduction

It is now well known that people of modern age suffer greatly from disorders of stress. In fact, they are the major causes of morbidity and mortality all over the world. Even now infective disorders take a great toll of lives in developing countries. But the disorders of stress and injuries are responsible for a large number of human tragedies in developed countries. Many of the accidental injuries are known to occur as a result of excess of stress and strain in life. Further, people undergoing too much of stress and strain are more liable to be affected by different types of infections than others because of poor immunological responses. If one considers all these matters together, one becomes convinced that the study of the causes and effects of stress would be one of the most important subjects of investigation for a modern medical man. Yet comparatively very few scientists and medical men have taken any interest in this subject. Hans Selye brought to the notice of the world about four decades ago cases of stress causing marked changes in the entire body in experimental animals, but very few attempts were made to apply this knowledge in solving the problems of human sufferings.

Selye, originally suggested that all the non-specific responses of stress such as hypertrophy of adrenal cortex, lymphopenia and gastro-intestinal ulcerations occurred as a result of excessive secretion of adrenocortical hormones. He further confirmed that such a response was mostly due to stimulation of anterior pituitary gland which regulated the function of the adrenal cortex through its secretion, adrenocorticotrophic hormone (ACTH). However, this was not fully accepted by most of the other physiologists. Waltor cannon had postulated earlier that adrenal medulla and its hormone adrenaline were responsible for the appearance of various physiological changes in the body after any type of psychosomatic stimulation. As a result of these two divergent views on the subject, not much progress could be made in the initial period.

Role of Neuroendocrines

In the meantime the extensive studies of the hypothalamus by Harris and also by Hess showed that it was the hypothalamus which regulated the function of the anterior pituitary gland. Therefore, one could say that stress caused the stimulation of the hypothalamus which through its corticotrophic releasing factor stimulated the anterior pituitary gland to secrete more of ACTH. This in turn stimulated the adrenal cortex to pour out excess of cortisol. It is this that caused all the bodily changes in stress, which Selye called Genera Adaptation Syndrome. The hypothalamus is also connected with sympathetic nervous system which also becomes activated simultaneously with the changes taking place in the neuroendocrine apparatus. The stimulation of sympathetic nervous system essentially causes excess of liberation of noradrenaline. Along with this, the excessive stimulation of adrenal medulla causes an outpouring of adrenaline.

It is said that initially the adrenal medulla pours out sufficient amount of adrenaline and also some amount of noradrenaline on receipt of stressful stimuli through the neural pathways. However, for the outpouring of both of them or a prolonged period, the presence of excess quantity of plasma cortisol is also essential. Thus, there is a close correlation between the secretion of catecholamines (adrenaline and noradrenaline) and cortisol in the appearance of the effects of stress in the peripheral organs and tissues.

Even after the full knowledge of the functions of hypothalamus, pituitary gland, adrenal cortex and medulla, it was not clear how the stressful situations could stimulate the hypothalamus specifically leaving out the rest of the cerebral cortex in a normal state.

Role of Cerebral Cortex

In the meantime the Russian Schools of Physiology proposed that all these bodily changes following stress originate in cerebral cortex. From there the stimuli reach the hypothalamic region through limbic system to produce the change in the autonomic nervous system and in the neuroendocrine apparatus. The cerebral cortex receives environmental stressful stimuli through the normal channels of sense organs (exteroceptors) and also from the viscera, blood vessels, endocrine glands and muscles through interoceptors. All these stimuli ultimately converge at the psychic centres in the frontal lobe, from where messages are transmitted to produce various specific responses of the whole body. However, it was not all clear as to how such a stress could produce many of the pathological lesions. It is here that our recent our recent study of neurohumors greatly helped us to understand the pathogenesis of different stress disorders.

GENETIC FACTORS
It has been stated that all stress disorders are caused by multifactorial responses. Amongst them genetic factor is the most important one. It is known that some sort of susceptibility to get a particular disease such as diabetes mellitus, hypertension or coronary artery disease runs in families for several generations. How such a susceptibility is transmitted from parents to children is still a matter of conjecture. After studying the catecholamine degrading enzyme Monoamine Oxidase (MAO) in the platelets it is now postulated that the deficiency of this particular enzyme in the body might predispose a person to have a prolonged and excessive action of catecholamines leading to many harmful effects. Similarly, the deficiency of the acetylcholine degrading enzyme cholinestarases may lead to the harmful effect of excessive action of acetylcholine in different organs and tissues. Although all these matters need further study and confirmation, one can certainly understand how possibly the genetic factors play their role in causing various disorders of stress.

In addition, the psychosomatic constitution of an individual can also become a genetically transmitted trait which can also predispose a person to certain stress disorders. Physical anthropologists have divided human physiques into three broad categories: Ectomorphs, Mesomorphs and Endomorphs. We have in our earlier studies observed that even the physical body constitutions have a neurohumoral basis and their susceptibility to certain diseases also has a biochemical explanation.

Similarly, psychologists have also observed that these are mainly two types of personalities which are genetically transmitted, Introverts and Extroverts. It was also noted that introverts were more susceptible to stress disorders than extroverts. Friedman and his colleagues divided personalities into two types, A and B. Type A personalities are more ambitious, hard working and restless. They are more liable to get stress disease then the others (Type B) who are relatively quiet, contented and satisfied with whatever they attain in their lives without much struggle.

It seems that all these genetically transmitted psychic and psychosomatic constitutions also have a neurohumoral basic and hence the subsequent development of different stress disorder also has a certain neurohumoral pattern.

ENVIRONMENT FACTORS
In addition to the genetic susceptibilities, various environmental factors such as age, sex, material status, family circumstances, childhood experience dietetic factors, nature and amount of daily work load, etc. may also play an important role in the causation of stress disorders. Normally, any type of stress and strain would lead to a series of changes in the body so as to make the person adapt himself efficiently to the changed environment. It is in the process of adaptation that various nonspecific change described by Selye, namely alarm reaction, stage of resistance and stage of recovery or exhaustion take place. If proper adaptation leading to full recovery does not take place, the persons goes into a stage of exhaustion leading to the development of one of the diseases of adaptation or stress disorder.

There has been considerable discussion as to whether there is any relationship between the type of stressful situation and the nature of disease process. For example, breakdown of love affairs in girls would lead to thyrotoxicosis, too much of frustration in life would lead to peptic ulcer or excessive marital tension or worry in life would lead to hypertension etc. However, recent studies have indicated that no such correlations can be established between the nature of stress and development of a particular type of disease.

STAGES OF DISEASE
It has now been observed that once a favorable stage has been set in for the development of a stress disease, a series of neurohumoral changes takes place leading at first to psychic changes, and then to psychosomatic changes, followed by somatic changes before it settles down to any one of the susceptible organs. Here, in the organ also at first the functional changes occur followed gradually by organic change leading to the development of disease in the form of known to modern pathology. It is now well established that this pathological changes occur as a result of disturbances in the microcirculation in that organ caused by local neurohumoral disturbance. This is especially so with regard to catecholamines leading to excessive vasoconstriction foe a prolonged period which would trigger off the development of autoimmune phenomenon in that organ. This usually gives rise to variable amount of chronic inflammatory process in that organ as we see in thyrotoxicosis which ultimately heals by fibrosis in favourable circumstances. On the other hand, if the circumstances are adverse, there is a breakdown of inflammatory process causing ulceration such as we see in peptic ulcer, which may deteriorate further causing haemorrhage or perforation or it may heal up if circumstances are found favourable.

From these observations, one can understand how the changes in the microcirculation which occurs as a result of local neurohumoral changes, can cause the entire pathological phenomenon in a given organ. In short it is these neuro-vascular changes occurring in a given organ which are responsible for the production of the diseases. These are primarily brought about by the effect of stress on the cerebral cortex especially its psychic center. This psychic centre regulates these neurovascular changes in a given organ by arranging to liberate appropriate neurohumors such as acetycholine, catecholamines, histamine etc, and transmitting them to that particular organ through limbic system. Surprisingly, such unified theory foe the causation of various disorders had been conceived centuries ago by the sages of ancient Indian medicine who postulated the presence of three humors foe the production of various psychosomatic changes in health and disease. The importance of such unified neurohumoral theory is that it greatly helps to plan effective therapeutic measures from the point of view of prevention and also that of cure.

YOGA THERAPY
Apart from the various specific psychotropic drugs which may directly act on the cerebral cortex either to reduce the activity or to increase it, there is one method whose sole purpose is to restore the function of the cerebral cortex either to reduce the activity or to increase it, there is one method whose sole purpose is to restore the function of the cerebral cortex to normalcy either by reducing its activity or by enhancing it. That method is Yoga which was well conceived and described by ancient Indian authors about 2500 years ago which proves to be of great value even today. Its unique contribution is that it directly affects the brain, especially the psychic center from where all the psychosomatic stress disorders are initiated. Hence, one can say that the practice of yoga can be a specific measure for the prevention and control of stress diseases.

Our studies have enabled us to demonstrate that these yogic measures produce their expected beneficial results by directly acting on the production of neurohumors. Hence, it seems that it is one of the most efficient and scientific methods for the management of stress diseases. It is this fact which made us study this problem in great details and we are happy that not only we could establish a therapeutic regimen for all the stress diseases on scientific lines, but also could advance adequate scientific explanations for all the phenomenon that occur in the disorder of stress. We, therefore, initiated our studies both in experimental animals and clinical cases with stress disorders. It is the results of these studies which become the basis of this monograph wherein yoga exercises are discussed in detail for the benefit of all those interested in this field.

About the Book

This monograph mainly covers our studies on the causes and management of the most common and disabling disorders of stress and strain of life. It is now well established that the brain with its known centres for sensory, intellectual and emotional functions plays the main role in maintaining a balanced condition of our body and mind by liberating required amount of neurohumors and hormones. Any disturbance of this homeostasis by genetic or environmental factors would ultimately lead to the development of the Stress Disorders. At first the changes are functional and later on bodily changes of Stress Disorders appear. In the treatment, during the acute stage, the use of tranquillizers and other drugs may help. However, if the disturbance persist, the practice of Yoga would help greatly to get over the neuro-humoral changes occurring in the brain. Hence the integrate practice of Yoga has an important role to play in the prevention and treatment of Stress Diseases. All these aspects have been dealt with in the book in sufficient detail with regard to each of the disorders of stress for the benefit of all concerned.

About the Author

Prof. K.N. Udupa (born 1920) has been working in the Institute of Medical Sciences, Banaras Hindu University for the last more than 24 years. Presently he is an Emeritus Professor in the University and also an Emeritus Medical Scientist of the Indian Council of Medical Research, New Delhi.

He was a Professor of Surgery and Principal of the Collage of Medical Sciences of this University from its very inception in the year 1960. He became the Director of the Institute of Medical Sciences in the year 1971 and the Rector of the University in the year 1981 for a year.

Throughout this period, especially during the last 12 years, he has been actively engaged in doing research on the scientific aspects of Yoga. His researches on the role of Yoga in the promotion of health and also for the treatment of various stress disorders have been widely recognized by the people all over the world.

Excerpts from reviews:

The information is gives about the cause, the growth and possible cure of dread diseases is almost clinical and yet understandable by common reader. It is a seminal work of a mature mind. 

M.P. Pandit, The mountain Path, January 1986

A monograph covering our studies on the causes and management of the most common and disabling disorders of stress and strain of life. 

B.J. Sandesara, ATC News, December 1985

...the work is an invaluable contribution to the existing literature on the subject, and as such will be received very well among knowledgeable circles. 

R.T. Vyas, Journal of Oriental Institute,
Vol. 36, No. 1-4

The book is intended to spread the message of Yoga for promoting universal health and happiness...... . We welcome this well written book.

K.K Raja
Adyar Library Bulletin,
Vol. 53, 1989

With the increasing recognition all over the world of the importance of Yoga in maintenance of health and well being, this book will be worth reading by all medical practitioners.

D.D. Banker 

This is an excellent book and is an important contribution to Yoga Therapy.

Alex Newell
The theosophical Jouranl,
Vol. 28, No. 2, USA, 1987

......... the book is a good attempt in the management of a very big list of stress disorders through scientific Yoga by a team of devoted medical persons.... The book shall be of great help to the medical practitioners and the students of Yoga.

Dr. H.S. Singh
Psychology Deptt.
G.K. University,
Hardwar
The Vedic Path, Vol. XLVIII, No. 384,
March 1986, Qua. Jour.: Indo. & Sci.
Research 

This book is useful for students, practitioners and for those who are seekers for knowledge.

Ayurveda Mahasammelan Patrika 

.... the book is a great achievement for the author and the publisher both of whom deserve our warmest congratulations.

V.N.V. Desikan
Review Projector (India),
Vol. 6, Nos. 1-3