Research Article International Ayurvedic Medical Journal ISSN:2320 5091

A CRITICAL REVIEW OF CLINICAL APPLICATION OF YOGASANAS W.S.R. TO PAVANAMUKTASANA Alka Gupta1, H H Awasthi2 1Junior Resident, Department of Rachana Sharira, IMS, BHU 2Professior & Head, Department of Rachana Sharira IMS, BHU

ABSTRACT Objective- Stress is the outcome of every days overcomplicated lifestyle and lack of physical and spiritual support. After exhausted review of different literature, in regard to yogasana and pawanmuktasana, we found that according to hathyoga yogasana is first step of . Yogasana improve every aspect of life by counteracting stress through HPA axis and SNS down regulation. The purpose of this article is to provide a scholarly review of the literature regarding research studies for the effects of yogasana on a variety of health outcomes and health condi- tions.Method- Using different research database with the key word ‘‘yogasana” and “pawan- muktasana” a comprehensive search of the research literature from core scientific and nursing journals yielded studies that met inclusion criteria. These studies were included in this review. Yogasana searched through ancient literature and yoga literature fulfilled the aim of this ar- ticle.Result-In the studies reviewed Pawanmuktasana is one of 84 wordly described as air freeing exercise. Air means Vata which is the only motivating factor for all tridosha and in- ducing factor for all diseases according to Ayurveda. Pawanmuktasana remove Vata and act on all the system positively with proper breathing sequence it flow pranik energy with in kundalini and person can achieve extreme spiritual happiness.Conclusion-The studies comparing the ef- fects of yogasana seems to indicate that, in both healthy and diseased populations, yogasana may be as effective as exercise or better at improving a variety of health-related outcome measures. Pawanmuktasana is a dynamic series of asanas, which is extremely beneficial in number of sys- temic pathology in human body. Future clinical trials are needed to examine the definite mechan- ism of action particularly how these modalities may differ in their effects from exercise. Key- words- Yogasana, Pawanmuktasana, Kundalini, Vata.

INTRODUCTION Asanas are described as “sthira suk- main key of being healthy. Yoga is main ham asanas”1 that means stable, comfortable part of it and helps in coordinating mind state of body. Aasanas are the “subtle exer- with body; yoga put multidimensional being cises” that release physical and mental ener- into a state of reintegration that originally gy blockages and tone the body-mind for creates the feeling of wholeness6. deeper practices3. Ayurveda mainly com- Yogasana prises with mind body balance which is the Patanjali yoga have mentioned eight Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana branches –yama, niyama, , pranaya- siology and only skeletal muscle effected. In ma, pratyahara, dharna, dhyan, Samadhi so the yogasana process respiration and meta- asana is third limb1, while “” bolic rate slow down, consumption of oxy- given “asana” first place giving physical gen drop and body temprature decrease relaxation and steadiness most importance, that’s why yogasana tend to arrest catabol- in the way to reach extreme happiness. ism whereas exercise promotes it. So this “Ha”means sun indicates energy of solar takes some time to achieve beneficial stage plexus, “Tha” means moon indicates energy of yoga when it is practices in right posture of the emotions, located in the limbic system and right sequence of breathing.3,6 of brain and energy of both system come Asanas posture flows, vinyasas, (movement/ together in this system of yoga.2 position of limbs/ attitude- by Kavyad) ex- Yogasana and exercise plain the word) strengthen your mind by de- Yogasana and exercise both are part of that veloping continuity of awareness of breath. process of the development of good physical This in turn develops your capacity to sus- health by stretching, massaging, without it tain effort without producing stress. the muscles waste, the bones become weak, Generalised effect of yogasana- the capacity to absorb oxygen decreases, Main benefit of asana is when this insulin insensitivity can occur, and the abili- relaxation of effort and steadiness of body ty to meet the physical demands of sudden created, the resulting pleasurable sensation activity is lost. Among them yogasana also pervades all level of psychology, physiology stimulate the pranic channels and internal and consciousness. These asanas, if done organs, so asanas are complementary to ex- correctly, in a non-competitive and relaxed ercise. In addition, asanas are designed to atmosphere, not only relax the muscles of have specific effects on the glands and in- the body, but these relaxing impulses travel ternal organs, and to alter electrochemical back to the brain and relax the mind. By in- activity in the nervous system.6 tegrating the breath synchronization and Asanas are different from other exer- awareness, the attentive faculty of the mind cises as yogic posture are synchronous post- is made active and is not allowed to wander ure requiring minimum energy consumption into tension and stress. The nature of these and maximum rehabilitate effect on physio- asanas is thus more mental than physical. If logical organs and system and cultivate asanas are performed correctly they relax awareness, relaxation, concentration and the mind, tune up the autonomic nerves, meditation. This leads to an enhancement of hormonal functions and the activities of in- physiological efficiency without undue mus- ternal organs. These are benefits that make cular development alone, while in simple yoga unique. physical exercise is beneficial stress on the Stress is outcome of today’s over- body cause vigorous unstable muscular ac- complicated lifestyle and inducing cause of tion so the disproportionate loss of energy, all diseases. All these factors are compen- in brief it cause maximum energy consump- sated and counteracted by yogasana practic- tion, minimum rehabilitative effect on phy- es. There some article collected in this refer- 1088 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana ence dignifies this concept.

Figure showing Impact of stress inducing diseases gastric trouble and also mobilize all the ma- through various factor, yogasana shown significant jor joints. Swami Satyananda considered effect on all these factor through different them to be the very foundation of asana, mechanism. “subtle exercises” that release physical and This benefit is common to all asanas mental energy blockages and tone the body- utilized mind for deeper practices. Exercise stimu- benefit. The general benefits create mental lates the SNS, raising plasma epinephrine equilibrium, emotional health, calmness, and nor epinephrine. 25,26 Yoga on the other sensitivity to yourself and others and prepare hand, has been shown to lower sympathetic the mind for meditative introspection. With stimulation, significantly lowering levels of this understanding the early acharyas of yo- plasma nor epinephrine and epinephrine.9 ga advocated the mastery of one asana. Sec- improving perceptions of mood and anxie- ondary benefit is from practice of asanas ty.27,28 Yoga interventions in alleviating that related to specific movements of the symptoms and improving outcomes of pa- body and how positively they affect physi- tients with coronary artery disease,29,30 ology, this secondary effect are important from a health and curative point of view. Pawanamuktasana is series of the asana gives very much therapeutic effect in all the

Stress induced dis- Counteracting mechanism of yogasana ease producing fac- tor Hyperactive HPA 1) down-regulation of the hypothalamic– pituitary–adrenal (HPA) axis axis and the sympathetic nervous system (SNS)32 Atherogenic dysli- 1) yoga subjects experienced significantly lower levels of triglyce- pidemia rides and low density lipoprotein cholesterol, in addition to lower body weight34

1089 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana Increased glucose 1) cell stimulation increase insulin level so decrease glucose lev- level el.16 2) increase utilization and metabolism of glucose in peripheral tis- sues, liver, and adipose tissues through enzymatic process34 Behavioral effect 1) lowering levels of plasma nor epinephrine and epinephrine, im- proving perceptions of mood and anxiety9 Immunosuppressant/ 1) alleviate blood flow throughout body, improve metabolism and Inflammation increase immune response35 2) Decrease oxidative stress by significant improvements in BMI, 33 FPG, PPPG, HbA1c, malondialdehyde, glutathione, and vitamin C Enhanced sympa- 1) down-regulation of the hypothalamic– pituitary–adrenal (HPA) thetic nervous sys- axis and the sympathetic nervous system (SNS)32 tem response 2) Yogasana shown to lower sympathetic stimulation, significantly lowering levels of plasma nor epinephrine and epinephrine24 Increased blood 1) Forward bending asanas directly decrease blood pressure 9,19 pressure Biochemical changes and their effects on the microcirculation in vital organs and en- body through asanas docrine glands thus leading increased func- The practice of yoga specifically re- tional efficiency and in turn improved meta- habilitates the physiological organ and en- bolic sequence. docrine gland. A sustained evidence of in- Pavanamuktasana creased production and breakdown of adre- As the name suggest pavan-air, muk- nocortical hormone in the volunteer under- ta-release, asana-pose it regulate and release going yoga practice is found in most signifi- unwanted vayu (air) from whole body espe- cant observation. This increased adrenocor- cially gastrointestinal tract and joints. Our tical activity inhibit protein breakdown so bodies are composed of blood, flesh, bones, restore serum protein (show compatibility of marrow, water, wind, electricity, etc., and increased ACTH activity), decreased serum when we practice the pawanmuktasana se- cholesterol, and decreased fasting blood ries of exercises, we are definitely affecting sugar. Increased adrenocortical activity also these components of the body. However, the make subject competent for resisting more pawanmuktasana exercises are not only stress and also inhibit stress by inhibiting meant for the physical body. Of course we instantaneous metabolic and endocrinal perform these exercises through the physical change. These improved physiological, en- body and many of us practice pawanmukta- docrinal and metabolic sequence seen in sana to maintain or restore our physical these subjects. Simultaneously these practic- health, but as well as inducing positive ef- es induce a neurohumoral balance and im- fects in the physical body, our psychic cen- proved psychic function. All these changes ters are also influenced. Ayurvedic term va- are probably induced basically by improving ta, we can understand its meaning better and 1090 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana get a complete idea of how this series of randa samhita, Goraksha samhita etc) but asanas works. not many scripture described Pawanmukta- Vata is one of the three humors or sana in detail. tridosha in Ayurvedic system of medicine. In Asana Bandha These humors originated from the different by Swami Satyanand Saraswati described 3 elements and they constitute the basis of type of pawanmuktasana, 1st pawanmukta- human existence and our bio-psycho-social sana for joints, 2nd type for digestive system environment. Vata can be translated as 'that known as supta pawanamuktasana and jhu- which moves things'. It is comprised of the lana pawanmuktasana, 3rd type for improv- ether and air elements and it is related to the ing the energy flow within the body and energy or life-force. Vata is the motivator of breaking down neuro-muscular knots known the three humors and is considered to be the as Shakti Bandhasana..3 principle of movement or air principle. Its main site is in the large intestine 2,3 Pavanamuktasana -Review in different tradition-. Pawanamuktasana is described among 84 asanas by all yoga litreture(Hath yoga pradipika, Patanjali yoga sutra, Ghe-

(Type 1 Pawanmuktasana for joints -Asana Pranayama Mudra Bandha by Swami Satyanand Sa- raswati)

1091 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana (Type 3 Pawanmuktasana – Shakti bandh (Type 2 Pawanmuktasana – Supta pawanmukt -asana – Asana Pranayama Mudra Bandha asana -Asana Pranayama Mudra Bandha by Swami Satyanand Saraswati) by Swami Satyanand Saraswati)

In Krishnamacharya tradition pava- in GIT and so the various joints. Besides namuktasana is called as “apanasana”. this, with the practice of pawanmuktasana, Apanavayu- a downword moving inner the legs are brought higher than the heart energetic wind of body so pose is associated level, making the hydrostatic pressure work with anything need to exit from body from in favor of the blood flow towards the perineum, including waste from gastro intes- heart.29,30,31 tinal tract. Now a day’s many customs of yoga Some practitioner also are seen as Patanjali yoga, Hath yoga, Kun- termed pavanamuktasana as joint freeing dilini jagran yoga, Iyanger yoga, Krishna- asana. This asana is dynamic series for pur- macharya yoga etc. These different streams pose of limbering the joint, evaluating nor- somehow have the same aim to achieve ex- mal range of motion learning musculoske- treme spiritual and psychosomatic wellbe- letal anatomy, with regular practice freeing ing. subtle energy flow called nadis to permit to Effect of Pawanamuktasana on digestive the experience of meditation. system On regular practice asana stimulate Various asanas massages the abdo- “manipura chakra”. As the adhisthana of men and the digestive organs and is there- this chakra nabhi and peripheral anatomical fore very effective in increasing peristaltic structure related to it, are main pressing movement, regulate functioning of abdo- points by this asana and this chakra is stha- minal endocrine viscera, removing wind and na of agni which regulate all the gastro in- constipation. By massaging the pelvic mus- testinal functioning. Observation by many cles and reproductive organs this asana regu- researchers proved this asana to be effective late tone of pelvic viscera. By increasing in constipation, flatulence and other ga- peristaltic movement this asana is specially strointestinal trouble. suggested in patients with IBS and flatul- Effect of Pawanmuktasana on cardiovas- ance.3,8 cular system Effect of Pawanamuktasana on endocrine Pawanmuktasana is a forward bend- system ing asana and forward bending produce sed- `This asana type2 is specially benefi- ative effect also forward bending cause de- cial in digestive system related disease and crease in blood pressure. Except that pa- type 2 diabetes mellitus because this asana wanmuktasana stimulate stretching and directly affect abdominal viscera through lengthening reflex on abdominal muscle these mechanism (a) Rejuvena- which cause sudden rush of blood flow in tion/regeneration of cells of pancreas due to abdominal aorta and its tributaries and pro- abdominal stretching during yoga exercise, vide better perfusion of nutrition and oxygen which may increase utilization and metabol-

1092 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana ism of glucose in peripheral tissues, liver, might enhance insulin receptor expression and adipose tissues through enzymatic on muscles causing increased glucose up- process.10,11 (b) More active practices fol- take by muscles and thus reducing blood lowed by relaxing ones lead to deeper relax- sugar16 ation than relaxing practices alone, docu- The first part of the pawanmuktasa- mented by research from Swami Viveka- na series or anti-rheumatic exercises 3, we nanda yoga research foundation near Banga- can see how a great many muscles are used lore city and possibility of neuroplasticity and stimulated in a very systematic and re- bringing about changes in the hypo- laxed way. There is minimum contraction pituitary–pancreatic axis.12 (d) The im- (without tension) to tone up the lengthening provement in the lipid levels after yoga reflex, and when a group of muscles is con- could be due to increased hepatic lipase and tracting, the antagonists are stretching to lipoprotein lipase at cellular level, which stimulate the stretching reflexes. There is affects the metabolism of lipoprotein and also maximum stretching to develop flex- thus increase uptake of triglycerides by adi- ibility which affects the tone of the muscles, pose tissues.14,15 bringing them to the lowest possible state of Yoga postures can lead to improve- contraction and, in this way, releasing phys- ment in the sensitivity of the b-Cells of the ical tension that is reflected in a very high pancreas to the glucose signal and also the muscular tone. Pawanmuktasana series the improvement in insulin sensitivity in turn joints are mobilized safely to stimulate the can be due to the cumulative effect of per- circulation of synovial fluid, its secretion forming the postures.16 and absorption. This improves the process of Direct stimulation of the pancreas by lubrication and, at the same time, revitalizes the postures can rejuvenate its capacity to the tissues, improving nutrition and elimina- produce insulin.17 Regeneration of pancrea- tion of waste products and protecting them tic beta cells could occur by yoga exercises from degenerative changes due to normal or that promote blood circulation in the region abnormal activity.36 of the pancreas and yoga asanas that stimu- Effect of Pawanmuktasana on lymphatic late the meridian of pancreas also could as- system sist in some diabetic patients.18 The lymphatic channels also have Effect of Pawanmuktasana on muscu- valves that prevent the lymph from flowing loskeletal system downwards, following the hydrostatic pres- The muscle activity is very complex. sure. There is also an intrinsic lymphatic Therefore, in this paper, we will emphasize pump due to the presence of smooth muscle the effects of PMA on two important reflex- cells, but this intrinsic pump is helped very es: the stretch reflex and the lengthening ref- much by the extrinsic pump which is made lex, the tone of the muscle and its relation by contraction of the muscles, movement of with physical tension. the parts of the body and compression of the 20 Muscular relaxation, development tissues and arterial pulsation , All these and improved blood supply to muscles factors that form the extrinsic lymphatic 1093 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana pump are stimulated through regular prac- tion of the venous return from the legs, in- tice of pawamuktasana.36 creasing also the process of elimination. Effect of Pawanmuktasana on Central Apana is said to be the power of disease in- nervous system herent in the body, the force of devolution Pawanmuktasana like forward bend and limitation of consciousness. So by puri- usually have soothing effect on nervous sys- fying apana vayu, the body is protected tem and calm & quieting the mind. Medita- from the forces of degeneration 22,4. tive portion of this asana increase the con- Apana is also said to be the support centration and increase blood supply to the and control of all the other forms of vata, brain. In the localized effect of this asana and vata is said to be the root of the other produce stimulus to the pressure receptor on two humors 4. So through purification of the abdominal muscles and organs which apana, an overall effect is produced in the sends impulse to the autonomic ganglion in rest of the pranas and this reflects in the the region i.e. celiac ganglion, superior and humours or tridosha (Vata-gaseous content, inferior mesenteric ganglion, other autonom- Pitta- metabolic energy, Kapha- water, mu- ic plexus of organs. These stimuli further cus etc)-The aspect of energy, air, and water produce parasympathetic response as in- must be mentioned) which constitute the ba- crease blood supply and regulation of tone sis of human existence in the manifest of various organ.21 world. This is also responsible for the po- Relation of pawanmuktasana with werful healing effect of pawanmuktasana. Prana and Chakra The pranas are transmitted through- In the yogic system, pawan is also out the body by the nadis which are defined related to prana, as prana is defined as air. as channels or pathways of pranic current. In Ayurveda sometimes the concept of vata These energy channels make a complex and prana are used synonymously, although network of 'energy threads' that hold togeth- 23. this is not absolutely correct. If we under- er the energy field of the human body stand prana as the life-force or vitality 22, This asana influence a number of we can say that pawan represents this ener- energy centers and vital organs at the same gy principle. Then pawanmuktasana can be time, although the most important one is defined as the postures that liberate the life- Manipura chakra (Naval/ solar chakra). The force or vitality. We can also understand concept of Cakras is not generally consi- from this point of view how through the dered part of the acupuncture paradigm. Yet practice of this series of asanas a very po- like the acupuncture points of Chinese med- werful healing force is set forth. icine, the Cakras are energy nodes with spe- Part II of the pawanamuktasana se- cific functions and correlations. Cakra ries 3 has a direct influence on apana vayu. points can be integrated into specific meri- Its effect is very strong on the lower abdo- dian circuits, used as focusing points in a minal muscles, pelvic organs and large in- resonating triangle balance, utilized to facili- testine, which is also the site of vata. Blood tate Qi movement in the CV-GV circuit, in- irrigation is increased through the stimula- corporated into Zang-Fu tonification proto- 1094 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana cols, or used simply as Ah Shi or trigger creas, adrenal gland, kidney and celiac plex- points37. us and their tributeries.21 This chakra anatomically related to the pan-

(Dr Michael Greenwood is Medical Director of the Victoria were also observed suggesting positive ef- Pain Clinic, a residential facility in Victoria, British Co- lumbia, Canada PAGE 32 | MEDICAL ACUPUNCTURE | VOLUME SE- fect of yogasana. Yogasana used as adjuvant VENTEEN / NUMBER THREE / 2006) with diet and drug management of type 2 Pavanamuktasana-in modern re- diabetesmellitus.9 search view- Some modern researcher also ac- Another research by department of knowledged that these asana shown its ef- physiology, AIIMS stated beneficial effect fect on specific diseases. Department of of asanas in diarrhea dominant IBS. They physiology, Guru Tegbahadur Hospital col- applied various asanas on patients for 2 lege and university of medical sciences New month i.e. , pavanamuktasana, Delhi research shown effect of asana and along with suryanadi pranayama on type 2 diabetes mellitus-just pranayama twice daily and seen in result after asanas fasting and post prandial blood that significant decrease in bowel symptom sugar level is decreased significantly. Re- and anxiety. This was accompanied by an searcher applied 13 asanas and pranayama increase in electrophysiological recorded on type 2 NIDDM diabetes mellitus patients gastric activity in the convention and also i.e. padmasana, paschhimottanasana, pava- shows increased parasympathetic activity as 8 namuktasana, bhastrika pranayama, etc and heart rate parameter. seen that after yoga practice fasting blood CONCLUSION sugar decreased from 208 to 171±13 and Pawanmuktasana is a complete asa- post prandial blood sugar from 295 to na which not only fulfill materialistic re- 269±20. They formulated that exact me- quirements of human body but also enrich chanism of how these posture and controlled the spiritual level. Many research articles breathing interact with somatoendocrine described this with dignifying its effect on mechanism affecting insulin kinetics worked various diseases too. These beneficial effects out on glucose utilization and fat redistribu- are particular with specific asanas utilized tion in NIDDM. Yogasana used as adjuvant with concentrated glottal breathing. It was with diet and drug management of type 2 with this understanding that the early writers diabetes mellitus. A significant decrease in of yoga advocated the mastery of one asana. waist hip ratio and change in insulin level Further researches are needed to understand 1095 www.iamj.in IAMJ: Volume 2; Issue 6; November- December - 2014 Alka Gupta & H H Awasthi :A Critical Review Of Clinical Application Of Yogasanas W.S.R. To Pavanamuktasana exact mechanism of these asanas. 11. Sahay BK, Murthy KJR. Long term fol- low up studies on effect of yoga in di- REFERENCES abetes. Diab Res Clin Pract. 1988;5:S655. 1. Michel beloved/ Yogi madhvacharya, 12. McCall T. The Scientific Basis of Yoga Patanjaliyogasutra chaptor 2sadhana pa- Therapy.Accessed Jun 16, 2012. . da, verse 46,47,48 ;2009 13. 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CORRESPONDING AUTHOR Dr. Alka Gupta Junior Resident, Department of Rachana Sharira IMS, BHU, Varanasi. 21/1/c, Gangotri Nagar, Dandi ,Naini Allahabad,Uttar Pradesh, India Email: [email protected]

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