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Part 1: Iyengar Yoga During Pregnancy: A Synthesis of Tradition and Experience Let me introduce Dr. Rajiv Mehta. Dr. Rajiv Mehta has been a student of Yogācārya B.K.S. Iyengar for four decades. She has been regularly teaching public classes in Mumbai for the Light on Yoga Research Trust since 1986. Madam is a scientist, a reproductive biologist working in the field of infertility and human in vitro fertilization, having attained her doctorate from the Indian Council of Medical Researchers, National Institute of Research in Reproduction. Currently, she is the academic consultant to ORIGEO India and scientific consultant to Trivector Biomed. Madam has been invited as a lead teacher at International Iyengar Yoga Conventions in the UK, France, Germany, Spain, Belgium, Switzerland, Ireland, China, and Israel, and has conducted workshops in Poland, the Philippines, Jordan, Dubai, and the USA. She was the invited speaker at ESHRE in Munich, Germany and is an advisor to the Ministry of Āyush for their various programs. It is a privilege to have her here. Now, I request ma’am to kindly deliver her lecture on the practice of Iyengar Yoga during pregnancy. Good afternoon, everybody. Firstly, I would like to apologize to the two speakers of the earlier session; I have invaded their time. Unfortunately, we didn’t know about the change in the program when we bought the tickets, and I need to rush. The advantage is that, because I need to rush, I may be quick. The topic is Iyengar Yoga during pregnancy. Friends, we have all gathered here. We know that the definition of yoga is all about union. The word originates from yuj, which is to unite. If I talk of Iyengar Yoga, it may seem as if I’m talking about something different. Having said that, I would like to start with the definition. I would like to start by saying what Gurujī B.K.S. Iyengar said about Iyengar Yoga himself. He said that yoga is one, like God is one; different people call it by different names. There is nothing like Iyengar Yoga. What really happens is that every system in our country was studied, or we had studied, by the Guru-Śiṣya paramparā. There are traditions and paramparās by which knowledge is transmitted from a teacher to a student and subsequently to the next generations of students. When that happens, it is basically each teacher, ācārya, master, and guru’s understanding of the subject. When I talk about Iyengar Yoga, it is basically Yogācārya B.K.S. Iyengar’s understanding of the Yoga Sūtras of Patañjali and the other yogic scriptures, and it is the methodology of teaching that becomes Iyengar Yoga. Since every teacher has his own essence of imparting knowledge, when students studied this subject, they would say, "We have studied yoga as taught by B.K.S. Iyengar." Then it became "as taught in the tradition of B.K.S. Iyengar." To make it short, it became an adjective. Sometimes now people say, "I study Aṅgar," which is quite amusing, especially for my friends from south India, as it was for Gurujī B.K.S. Iyengar himself, that Aṅgar is a form of yoga. It is just how each one looks at the Yoga Sūtras. I’ll give you an example. We have the Yoga Sūtras: "Sthira sukham āsanam." When we look at this sūtra, you can translate the three words: sthira as being steady, firm, fixed; sukha as a state of happiness, a state of delight; and āsana as a position, a posture, a sthiti, a state, a seat. How do you translate this? How can you understand this? Somebody can translate or understand this "Sthira Sukham Āsanam" as being delightful in any stable position. However, somebody can even look at it in another way and say it is being delightful and stable in any position as an āsana. Both these are right in their way of interpretation. But what it indicates are two extremes of a spectrum: I am comfortable in my comfort zone, so I am delightful in any stable position; or, whatever area I am in, whatever situation I am in, I learn to be delightful and stable. That marks the difference between how Gurujī B.K.S. Iyengar interpreted the yoga sūtras and what has been interpreted otherwise. I’m not sitting in judgment of any value, but I’m just saying this is the way he interpreted it. If you claim that, yes, whatever condition you are in, you need to be stable, the next question is: how? People have problems, and then you say, "Okay, don’t worry about the problem, it will go away." When a person is in pain, the person is in pain, and very few people are able to cut away from that pain. They said, "Yes, we are suffering." Then the methodology comes in. Among his many unique methods of teaching, one was this: how do I give that stable, comfortable, delightful position irrespective of the health, age, or status of the individual? That’s where he innovated a lot of props. He realized during his own practice that unless you did yoga with precision, or the āsanas with precision, the effects would not be as intense. The subject is very powerful, and whatever you do, you are going to get benefits. However, for the effects to be intense, you need to do it accurately. To bring about that accuracy, he could do it himself. But what about common people? It was difficult. So he started supporting them. It was important for him to give the experience rather than just the methodology. In the process, he found that, in case it was not possible for a person to do, he started using supports. As the number of students increased, you could not have photocopies of B.K.S. Iyengar helping each and every one. Naturally, he devised certain household items, like tables, chairs, bolsters, and blankets—what was available in every Indian house—to be utilized as a support to get the right āsana. Friends, many of you may not be aware that what has now become a yoga mat was, incidentally, Gurujī’s discovery, mainly meant for people in Western countries where there were wooden floors and they found it slippery. He decided, "Okay, if you are slipping, let your mind not be slipping." He found his mat under a carpet and utilized it and said, "Okay, now you are stable." That was just trying to get people to experience the subject. Subsequently, for example, Śīrṣāsana: if a person wanted to do Śīrṣāsana and had a cervical problem, it would be very difficult. The neck would be a problem. It would not be advisable to say, "Okay, do Śīrṣāsana, doesn’t matter what happens to your neck." Innovatively, let that person get an experience of what Śīrṣāsana feels like. Also Sarvāṅgāsana: sometimes people with shoulder or neck problems can use a chair to get the experience. After all, it’s an experiential subject, so unless you have an experience, you cannot really relish the subject. Incidentally, he started getting associated with these props. Props were just a tool to get the right experience. In fact, the Oxford English Dictionary defines Iyengar as a form of yoga. Again, for my friends from South India and even all of us in India, it’s quite an amusing definition because, after all, it’s a name. It is not a form of yoga; however, it just started becoming synonymous. Now, I come to the second aspect: research. We have been hearing excellent presentations in the morning on research-based experience, wherein you have a hypothesis, a control group, an experimental group, you put them through the process—whether it’s yoga āsanas, prāṇāyāma, or a combination—monitor and measure the effects, and then say, "Yes, the system works," possibly increasing it to a larger population. On the other hand, there is what I would refer to as experience-based research. That is, an individual has practices, tries to transmit that experience to students, and subsequently it goes to a larger number of students. If that entire group gets a similar, or at least a similar kind, or to some extent that kind of experience, it also forms experience-based research. During my next few minutes, I’ll be moving between research-based experience and experience-based research. Coming to the exact topic: changes during pregnancy. After all, we know that pregnancy is a beautiful time for a woman and the family. However, this establishment of pregnancy occurs because of the interaction and orchestration of hormones, even for the establishment of pregnancy. You have the steroid hormones, the gonadotropins by the pituitary, the gonadotropin-releasing hormones by the hypothalamus; all need to work together like an orchestra. If one of the members of the orchestra does not play with the symphony, it becomes a cacophony. So also in our body, if these hormones are not in sync, if there is no symphony, if there is no orchestration, things start getting troubled. In pregnancy, there are hormonal changes in the body. It is natural. But along with that, there are other changes. We heard in the morning of the psychoneuroimmunoendocrine axis, the psychoneuroendocrine axis. That means your mind affects your endocrine system. On the other hand, the endocrine system also affects your mind. Women know, or possibly even the men, that there are mood disorders prior to menstruation. Premenstrual syndrome is an established entity where some women experience mood changes. That is, again, the endocrine system affecting the mind. Similarly, we all know anger and the adrenal connection. During pregnancy, as there are hormonal changes, there are also emotional changes that the woman faces. If the woman faces emotional changes, the people around also have to face it, whether they intend to or not. Anybody close faces it. Then there are physiological changes, natural. There’s a fetus growing. There are going to be physiological changes. During these changes, some problems start coming in. For example, as the fetus grows, some women start feeling breathless. There is heaviness, urinary incontinence sometimes, and the frequency of urination increases. Swellings in the legs are some of the issues. Finally, as the pregnancy advances, there are physical changes. Women complain of back pain, especially with multiple gestation. This, again, will affect their moods, and these moods are going to affect the fetus. It becomes a nexus. That’s where I feel that yoga practices play a role during the different stages of pregnancy. Generally, for convenience, we divide pregnancy into three phases, the three trimesters. In the first trimester, it is all about the maintenance of the pregnancy. However, the largest number of miscarriages happen during the first trimester. Very often, these are genetic abnormal embryos or fetuses, which in a way is good because that is nature’s way of preventing an abnormal baby from coming to the world. As the pregnancy progresses, the second trimester is generally considered a safe phase by gynecologists and obstetricians. In the third trimester, one is very concerned that there should be no premature birth because the timelines of embryonic and fetal development need to be maintained. What happens during these different phases where yoga can play a role? First, the body and mind need to be strengthened once a woman gets pregnant, or even before. Especially the back muscles. Then there has to be good fetal nourishment. What the mother eats is fine, but it has to reach the fetus so the fetus has healthy nourishment and growth. Then there are pregnancy-associated issues like back pain, swelling in the legs, incontinence, breathlessness as the pregnancy advances. Then preparing the lady for birth, hopefully a normal delivery, or if it requires a cesarean—whatever it is, it’s finally for the obstetrician to decide—but one can help prepare the lady for delivery. Finally, to prepare the mental state and overcome stress. Stress pervades all aspects of our life, during pregnancy and before. For example, today the average age at which a woman gets pregnant is rising. Because of that, there is a constant fear in the mind of the couple: will the baby be normal? Women are now quite conscious that as age advances, the chances of genetic abnormalities are high. There is a high chance of chromosome abnormalities. There’s natural stress in the early phases: will the child be normal? As the pregnancy advances, there is also fear of whether the baby is going to be healthy. So there is ongoing stress, sometimes more, sometimes less. We do know, and there are enough studies documenting, that stress, anxiety, and depression—sometimes a part of it, sometimes the other—during pregnancy: nearly 20% of women experience depression. It could be mild or clinical depression. It is not essential that these women suffered from depression before pregnancy; it just comes into the pregnancy. The stress, anxiety, and depression are extremely high in women undergoing assisted reproductive technologies. Today, the number of women going for assisted reproductive technologies is extremely high and keeps increasing. Even in India, there is an estimate of nearly two and a half thousand clinics offering IVF. Naturally, these women are under stress before pregnancy and during pregnancy. If they have depression, does it matter? Yes. Studies have shown that when a woman is depressed during pregnancy, it leads to lower birth weight of the baby and also lower head circumference. If a woman is in depression, the child is going to be unhealthy. Modern science offers antidepressants, but the problem is, if they are given during the second or third trimester, there is a risk of ADHD in the children. So you have a child, but with attention deficit hyperactive disorder, which becomes quite difficult for parents to manage. All in all, we need to address stress, anxiety, and depression. Having said that, I’m talking of the system, the tradition of yoga of Yogācārya B.K.S. Iyengar, because that is what I’m familiar with and have worked with. A study done at UCLA looked at yoga for treating depression. If you see on the left, all the positive mood traits pre and post are increasing with only three months of practice. On the other hand, the negative mood traits—stress, irritation, depression, anxiety, anger, pessimism—all decrease with the practice of yoga. How does it act? Is it just a psychological tool? We had a wonderful paper in the morning by Dr. Chris Streeter explaining that GABA levels are generally reduced in mood and anxiety disorders. She found a 27% increase in brain GABA levels after 60 minutes of yoga practice, which clearly shows that the alteration in the depressed state is not merely psychological but mediated by a neurotransmitter. It is a physiological change which brings about changes in the psychology of the person. She has done subsequent studies comparing it with a walking group, showing that walking does not bring about the same change in GABA levels or in the state of anxiety and depression. There are many studies, but I’m just giving an example of a couple which clearly document that stress, anxiety, and depression can be lowered by yoga. The second aspect, moving from hard evidence-based, research-based evidence to experience-based research, is how to strengthen the body and mind for pregnancy. There are a series of āsanas that need to be done. Yogācārya B.K.S. Iyengar made it possible for everybody in any state to practice. Here you have visuals of somebody doing Adho Mukha Śvānāsana. If the person is unable to do it independently, we use supports of the wall or ropes. Then she is doing Ardha Candrāsana. These standing āsanas strengthen your legs and spine, preparing it for forthcoming pregnancy. The inverted āsanas, like Śīrṣāsana and Sarvāṅgāsana, play an important role because you have to access your pituitary gland for the gonadotropins to be released to act and produce the steroid hormones. That’s where inverted āsanas play a role. Then you have Baddhakoṇāsana and Upaviṣṭakoṇāsana, which are not advised during the first trimester but are done prior to the expected date of delivery. These āsanas help the emotional state, the physiological state, and the skeletomuscular body. Coming back to back pain, a very common problem, especially with more women having multiple gestations. In a study about 12 years ago on the use of Iyengar Yoga in chronic lower back pain—people with back pain for over 11 years—the yoga session was done for only three months. There was very good compliance, over 70%, which possibly means either the teacher is extremely motivating or the supports make it comfortable. There was a decrease in pain intensity, in functional disability, and an 88% reduction in the use of pain medication. This became one of the earliest landmark studies on chronic low back pain. Today, yoga is advised as first-line therapy for back pain. During the advanced stages of pregnancy, what can a woman do? Any amount of words will not depict what the visuals say. It’s like trying to describe a rasgullā or a gulāb jamun; you can never get its taste unless you eat it. However, here there is not an opportunity to give you the experience, but at least one can give a visual. Different āsanas that can be done by pregnant women: first, Uttānāsana. Here she is fully supported. All the time, the lumbar starts getting concave. The support helps her strengthen her legs; when the legs are strong, the spine gets affected. She does Ardha Candrāsana. In Ardha Candrāsana, in the second pose, a lot of abdominal space is created; the abdomen spreads out. Then there is Supta Vīrāsana. Here she can stay comfortably. If the legs are fatigued, they get relief. The supports help her breathe better. When she breathes better—we heard about breath awareness in the morning—natural breath awareness comes. If she breathes better, her mind gets quieted. A little bit of mild twisting, wherein, again, the back is released. However, there is a whole range of āsanas that should not be done during pregnancy. It appears to most people to be common sense. Obviously, you do not do a Sūrya Namaskār cycle, you don’t jump around, you don’t do intensive twisting āsanas. But in some rare incidences, we do see people doing those things. However, the objective of this conference is to say what has to be done, not what need not be done. Then we go to Viparīta Daṇḍāsana. This is done on a specific bench, but you can even use a bed at home. When the chest is lifted, there is a natural feeling of elation. When the chest is lifted, your breathing becomes better. That is the role of Viparīta Daṇḍāsana. Although I’m talking of a physical posture, the effect is on the breath, and along with the breath, on the mind. When you’re agitated, your breath becomes short, uneven, unrhythmic. When your posture is such, your breath becomes quiet, your mind becomes quiet, and naturally, all the issues I talked about earlier start diminishing. The inverted āsanas. The question is, can a pregnant woman do inverted āsanas? Yes, under the guidance of an experienced teacher, we do let pregnant women do inverted āsanas. They have done Śīrṣāsana with the help of the rope. They do Sarvāṅgāsana with the chair. We have had many incidents in class where a woman has done Śīrṣāsana in the morning, gone back in the afternoon, and when it was time for delivery, she delivered comfortably. The warning is: you cannot take these pictures and say, "I’m going to replicate it in my condition." You need trained people. Not anybody and everybody can do it. Part 2: Yoga and Pregnancy: A Balanced Approach Not everyone can practice yoga during pregnancy without the guidance of an experienced teacher. In preparation for delivery, specific āsanas are beneficial. Upaviṣṭa Koṇāsana, Baddha Koṇāsana, and Supta Baddha Koṇāsana, as common sense suggests, involve significant pelvic widening that can facilitate childbirth. These are practiced in the later stages of pregnancy. In the second trimester, when lying in Supta Baddha Koṇāsana, the breath becomes very soft. Practitioners develop a certain modulation of the breath—not control, but an ability to adjust it—which aids during the delivery phase. The practice culminates in a state of total relaxation through Śavāsana and Prāṇāyāma. Lying down straight is often very difficult for a pregnant woman, especially near her due date. Therefore, we have them lie down with bent legs so the lumbar region rests on the floor. This alleviates back pain. In this reclining position, she can practice Ujjāyī Prāṇāyāma as well as Viloma Prāṇāyāma, as sitting for Prāṇāyāma may be difficult. Even while lying down, she can appreciate the modulations of the breath, inhale prāṇic energy, and derive its benefits. While I state this, I must acknowledge I lack hard data to corroborate it. However, over the last 40–50 years, we have observed the effects through widespread practice. Sometimes we question the need to document such experiences. Yet, when I wear my scientist's hat, I recognize the need for documentation and evidence to substantiate our claims. To summarize, the benefits of practicing yoga during pregnancy include: 1. Reduction of stress, anxiety, and depression. 2. Alleviation of lumbar pain. 3. Reports indicate it can reduce pregnancy-associated hypertension, heaviness in the breath, and swelling in the legs. 4. Studies show yoga practice may reduce preterm labor, decrease labor time, lower the incidence of intrauterine growth retardation, and result in fewer caesarean deliveries. However, a strong word of caution is necessary regarding the last point. This is not a claim that practicing yoga guarantees a normal delivery. One must not be fanatical. Yoga practitioners and teachers must understand that if there is a breech presentation, a caesarean is necessary. We must work in tandem with modern obstetricians. Yoga and modern medicine should collaborate to make a woman's life better, rather than being at loggerheads. It is counterproductive to dismiss modern medicine as negative or ineffective; it too has a vital role. Studies are showing yoga's effectiveness, but we must maintain balance. Regarding decreased labor time, very renowned gynecologists in Mumbai, like Dr. R.P. Sunawala, have shared such observations with us. But he also cautioned against making this public, as women might then believe they are assured a normal delivery and insist on one against medical advice. We must accept each situation and proceed with what is required. I would like to conclude with a quote from Gurujī: "Āsanas are descriptions, not prescriptions." One cannot simply list āsanas and instruct to do them. Their effectiveness depends on how they are done by the particular individual. Therefore, while there is a format, structure, and guidelines for practice, at some level it must be individualized. Modern medicine also has standard drugs for standard conditions, but a doctor must decide the individualized dose. Similarly, in yoga, we need guidelines, and the practice must be partly individualized within that framework under the guidance of an experienced teacher. This is paramount. In our tradition, experience is crucial. A student must practice for three to five years before even dreaming of becoming a teacher. Yoga is an experiential subject. Especially when you are taking the life of a woman and her unborn child in your hands, it is vital to have that experience rather than play with two lives. Experience comes only from practice. With this, I end my presentation. Thank you. Part 3: The Role of Yoga in Cancer Care and Holistic Health From diagnosis through treatment, patients with early-stage cancer undergo six months of intensive therapy. This typically involves surgery, followed by six cycles of chemotherapy and then radiation therapy. Throughout these six months, patients experience severe side effects. Our research aims to determine whether adding a yoga intervention helps patients cope better with these side effects, which is also a part of my thesis. Examining symptom burden and distress, we see that fatigue affects 90% of patients. Nausea and vomiting are also seen in 90% of those undergoing chemotherapy. Other common symptoms include anemia (over 60%), diarrhea, and cognitive impairment. These are very common symptoms seen in almost all cancer patients today. We wanted to investigate: does yoga help alleviate these symptoms? How does it work? We also want to look at the mechanism of action. Does yoga help with symptom control? Does it alleviate mood, stress, anxiety, and depression? Does it reduce stress and change stress hormone rhythms, like adrenaline? Does it improve anti-tumor immune responses and Natural Killer (NK) cell activity? Does it have anti-inflammatory effects? Does it also protect the host from DNA damage? Over the years, many mind-body programs have been used in cancer care, from Cognitive Behavioral Therapy and Social Support to Biofeedback and Tai Chi. In the last two decades, yoga has become very popular among cancer patients. But what kind of yoga? There are many forms. Looking at cancer literature, there is Iyengar yoga, various types of mindful yoga, restorative yoga, and so many others. What is important here? Understanding yoga in the context of cancer: are we talking about flexibility of body or flexibility of mind? What cancer patients need is flexibility of mind—the ability to accept the diagnosis and cope with the disease. This is what is important. So, when we talk about yoga in cancer, we likely mean flexibility of mind. We all know the simple definition of yoga: the science of calming down the mind. You may use whatever tool you want—āsana, prāṇāyāma, breathing, sound, or music. If you are able to calm your mind, that serves as yoga. What happens in cancer patients is they ruminate constantly. The moment they are diagnosed, they worry incessantly: What will happen next? I will lose my hair. I will have severe nausea and vomiting during chemotherapy. The moment they enter the hospital, they start having anticipatory symptoms. The very smell of medicine can make them vomit. They can't tolerate kitchen odors; going to the kitchen makes them feel nauseous during chemotherapy. These are anticipatory symptoms induced by anxiety. Such distressing thoughts further aggravate physical symptoms. Therefore, we focus on how to calm the mind, reduce stressful mental responses, and develop internal awareness. Often, these patients are full of negativity, constantly thinking about dying, death, and what will happen to their children. They are in a negative frame of mind, ruminating. We want to help them get away from that, to distract the mind's attention from these problems. How do we do this? Through yoga. We found that breathing exercises are fantastic, wonderful, and very safe for patients. It's important to understand that these patients are undergoing chemotherapy, and cancer can spread to bones, making them brittle. You cannot give many āsanas, especially if there is spinal metastasis or cancer spread to long bones like the femur, where fracture risk is high. If cancer has spread to the lung and the patient is receiving radiation to a lung lesion, practices like kapālabhāti or bastrika (hyperventilation) could cause a pneumothorax. Therefore, one must be very careful in knowing what sort of treatment to give these patients. Understanding cancer itself, its side effects, and how to manage them is crucial. I had a case of a lady with breast cancer that had metastasized to her lungs. She was an avid follower of the Art of Living and regularly practiced Ujjāyī Prāṇāyāma and Bastrika Prāṇāyāma. When she came to me for consultation, I advised her to stop these practices while she was receiving radiation to her lung lesion, warning of a potential pneumothorax. She didn't listen. About a week later, her husband called frantically, saying she had collapsed while practicing Bhastrikā and couldn't breathe. I knew it was a pneumothorax and told him to take her to emergency immediately. She was saved, and my hunch proved correct. So, while yoga is safe, it must be used in the right way and under the right conditions. Yoga can also have problems. Another example: a lady with bone metastasis to the spine went to a regular yoga class. She did not inform the teacher she had cancer, only that she had back pain. The teacher gave her āsanas for back pain, which led to a vertebral fracture, causing severe pain and immobility. This happened because she hadn't informed the yoga therapist about her cancer and the metastasis causing her back pain. We need to be very careful when using yoga interventions with cancer patients. Now, regarding my study: we took new breast cancer patients (Stage 2 and 3) undergoing surgery, radiation, and chemotherapy, and divided them into two groups. Most patients end up with a mastectomy (breast removal) and axillary dissection, which can lead to lymphedema. We looked at post-operative outcomes. We wanted to see if the number of days for drain retention would decrease. We found that fluid drainage improved when we started patients on breathing exercises post-operatively. We began the intervention just before surgery and continued post-operative breathing exercises regularly, three or four times a day, along with prāṇāyāma and relaxation. We saw better drain retention. Hospital stay was reduced by one day, saving approximately 20,000 to 30,000 rupees. The interval for suture removal also decreased. Post-operative complications and duration came down. This has been published in an international journal. We also looked at post-operative outcomes like hypertension, tachycardia, catecholamine release, and edema due to wound healing. We saw decreased drain retention and edema, a decreased interval for suture removal in the yoga group, and a decreased duration of hospital stay by almost one day. We examined immune outcomes, specifically Natural Killer (NK) cell counts. These are lymphocytes in the blood that can directly kill viruses and cancer cells. If active, they are a powerful tool for eliminating cancer cells. We saw that NK cell levels typically drop during immunosuppressive cancer treatment. However, in the yoga group, these levels remained almost higher or similar to baseline levels by the end of treatment compared to controls. We also looked at TNF-alpha, an inflammatory cytokine. Normally, after surgery, a wound is expected to heal within a month. We found that wound healing was faster in the yoga group because they had lower levels of TNF-alpha at four weeks. Prolonged high TNF-alpha can indicate sepsis or poor healing. Furthermore, fatigue came down in the yoga group, and quality of life improved. Comparing our studies with international research, our results are similar to those from other countries where yoga has been used to reduce psychological distress, anxiety, and depression in cancer patients. This indicates our results are viable, internationally accepted, and reproducible. Regarding the mechanism of action, we saw a decrease in 6 a.m. cortisol levels in the yoga group. Typically, cortisol is high in the morning and decreases by evening, aiding sleep and providing morning drive. In stressed patients, this rhythm can flatten or even rise in the evening. In the yoga group, morning cortisol levels came down drastically, and the diurnal slope improved compared to controls. This has also been published internationally. We also investigated how yoga helps reduce nausea and vomiting. We compared yoga with Jacobson's relaxation in patients undergoing chemotherapy. A 25-minute bedside yoga module was given. Nausea and vomiting came down drastically in the yoga group. Yoga was able to manage and normalize gastric motility. Chemotherapy often causes vomiting, and anti-emetics given to counter this can cause gastroparesis, nausea, and anorexia—a significant, often unresolved problem in chemotherapy. Using our yoga module, we were able to address this nausea and anorexia. Yoga helps restore normal gastric motility. This paper won an American award at the American Society for Clinical Oncology in 2013. In our Integrative Medicine Department, we have everyone working together: palliative care specialists, physiotherapists, nutritionists, and yoga therapists. We have specific yoga modules for post-operative care, radiation, and chemotherapy. We have about thirty full publications on yoga and cancer and have received two awards: one from the American Society for Clinical Oncology and recently from the European Society for Medical Oncology. We are the first integrative oncology department in the country to be accredited by the European Society for Medical Oncology. The future of cancer prevention is ancient history—that is our hospital's slogan. We impart yoga on an OPD basis to almost all patients and also receive inpatient referrals. I thank the CCRN, the Department of Science and Technology, all the oncologists, my mentors who have worked tirelessly with me for the last 20 years, and all the patients kind enough to participate in our yoga studies and treatment. Thank you all for this opportunity. Concluding Remarks on Yoga and Cancer In this prayer, we pray to the Lord for an easy death. In Indian methodology, we pray for death—it should come as suffering came and went. Death will come; we know this. Indian people, from birth, know they have to die, but they also know they will be born again. "Jātas sahi dhruva mṛtyu, dhruva janma mṛtas sija." So, it is not a matter of worrying about death. At the onset, I want to share that through yoga, we can not only control and manage symptoms but also cure cancer. This is my opening remark for this concluding session, because one of our speakers, Dr. Srivastava, raised doubts that yoga cannot cure cancer. I am of the opinion—and I believe the whole dais shares this opinion—that yoga has a specific effect on the management of cancer. On behalf of Patañjali Yogpīṭh, I can very responsibly share with you that yoga and meditation can cure cancer itself. We have the documentation and can prove it. I will proceed with my slides due to limited time. You can see the cycle of cancer. As Dr. Rao, Dr. Banerjee, and Dr. Nayak shared, there is DNA. When damaging the DNA message occurs, cells can become cancerous. Modification in cells can cause cancer: DNA, chromatin, chromosome, nucleus, cell, human body, and finally death. This is the ladder. O2 free radicals, mutation, distorted messages, then malignancy (cancer), and finally the metastasis stage. I responsibly state that in primary cancer, and in the first and second stages, yoga can work very well and can cure cancer. In the third stage, we can manage the cancer, and in the fourth stage, we can relieve the symptoms. This is the responsibility of a yoga practitioner. Being an Āyurveda ācārya, a yoga ācārya, and a practitioner of T’ai Chi, I can say that through a yogic life, we can manage and cure cancer. We have conducted studies with many institutions, including major ones in the field of cancer like Johns Hopkins and MD Anderson Hospital. Their research on the impact of oxygen on cancer validates that oxygen has the ability to correct cellular distortion. This is the point: we can reverse DNA damage. The basic cause of cancer is the damaging effect on the cell, the damage of DNA. As my dear brother Rao said, "Samatvaṁ yoga ucyate." This is a renowned saying from the Bhagavad Gītā: "Yogasthaḥ kuru karmāṇi saṅgaṁ tyaktvā dhanañjaya, siddhy-asiddhyoḥ samo bhūtvā samatvaṁ yoga ucyate." Balance is yoga—the balance of body, mind, and soul; the balance of nature; the balance of the triguṇas; the balance of Tridoṣa; the balance of Saptadhātus. In Āyurveda, we have different definitions: "Samadoṣāḥ, samāgniṣṭhā, samadhātu malāḥ kriyā, prasanna ātmā indriya manaḥ, iti svastha abhidhīyate." The definition of health is there in Āyurveda. The definition of yoga is there in the Bhagavad Gītā. It is about balance. We have to concentrate on balance, on nature. We have to balance the three doṣas and the saptadhātus so that we can balance chemicals, minerals, hormones, amino acids, and vitamins. Who is at risk? Every human being has oncogenes in a dormant stage. Each person here and outside this hall has cancer cells in their body, but in a dormant stage. When oncogenes find a suitable environment for transformation, they turn into cancer cells. This begins with instability: instability of the three doṣas, instability of prakṛti, instability of the guṇas (the triguṇas). Then comes imbalance, followed by food habits. One of the basic causes of cancer is drug abuse and pollution. Some people ask, as Dr. Rao did: "We lead a very sāttvic life. How can we get cancer? We lead a happy life with no tensions or stress. We lead a pious life. Why cancer then?" The reasons are pollution in thoughts, pollution in food, and pollution in the soil. Fertilizer and pesticide-based agriculture is a major cause. Dr. Banerjee, a great microbiologist, told us there are 1.37 trillion cells in the body, each with DNA, and each DNA has 3.5 billion pairs of chromosomes. Given this intricate structure, we must take care of our soil and food. Fertilizer and pesticide-based agriculture is a major cause of cancer. A study in Bhatinda district, Punjab, found one in ten people was in the ambit of cancer. The specific reason was pesticides and fertilizers. The basis of acupuncture, yoga, and Āyurveda is vibrant health resulting from a balanced, unimpeded flow of energy through the body. According to Traditional Chinese Medicine, illness and pain are byproducts of energy blockage. A lady asked yesterday about her colleague suffering from cancer and crying in pain. My dear, it is all due to blockage of energy somewhere along one or more meridians. Each acupuncture point along a meridian acts like a pass-through or gate. Yoga means "Samatvaṁ Yoga ucyate." The final solution is there. Prāṇa Yoga is a super medicine. We are deliberating and focusing on medicine—Āyurveda, allopathy, naturopathy. Prāṇa is the super medicine where the limits of all other medicines end and the domain of prāṇa begins. I can say Aṣṭāṅga Yoga is a super medicine. This is the saying of the Ṛg Veda, which announces that prāṇa is the basic medicine and prāṇa can cure everything. Prāṇa can cure cancer. If you do prāṇāyāma, you can overcome cancer, cure cancer, and get rid of cancer. Thank you. Yoga for Menstrual Disorders Hari Om. I will start straight with the presentation, with Praṇām to Dr. Nagaratnā Didī, who has been an absolute role model in my life. My co-speakers, dear colleagues, and great masters in this field, I will be talking on yoga for menstrual disorders. I will rush through the presentation as I have to catch a flight to Mumbai, so please pardon me if I bombard you with information. We all know the word "woman" comes from the Sanskrit root "tru," which means to spread. So a woman is here to spread love, knowledge, everything. "Woman" also means "mahan" (great), and so she is called "mahilā." A woman’s body can be divided into two parts: anatomical and spiritual. The anatomical body, as gynecologists know, consists of the cervix, body of the uterus, fallopian tubes, and ovaries. The uterus can be anteverted or retroverted. The spiritual body of the woman, as yoga teachers know, can be divided into five kośas, but a sixth is described by Swami Niranjananda Saraswati: the ātmā māyā kośa. The other five are well-known: annamaya, prāṇamaya, manomaya, vijñānamaya, and ānandamaya. What is the menstrual cycle? It is the outward, visible sign of the periodic activity of the ovaries. Menstruation is the periodic and cyclic flow of menstrual blood from the uterus. It is a process dependent on complex hormonal and physiological changes that can be disturbed. Part 4: The Yogic Approach to Menstrual Health and Fertility A variety of factors influence the basic physiology of the menstrual cycle. The central nervous system, along with the external and internal environment, controls the hypothalamus, which is the center of emotions. The hypothalamus controls the anterior pituitary gland, which in turn controls the ovary. The ovary produces hormones like estrogen and progesterone. It is this estrogen which helps build the inner endometrial layer, resulting in the outward menstrual cycle. These processes involve neurohormones from the hypothalamus, pituitary, pineal gland, various brain peptides, endogenous opiates, and thyroid hormones, all of which influence the hypothalamic-pituitary-ovarian axis. What is the spiritual significance of the menstrual cycle? As Paramahaṁsa Swāmījī Satyananda Sarasvatī says, just as the body casts off substances it no longer needs, we too can throw out worn-out ideas and self-images and make the best of this opportunity for self-renewal. I personally like this definition. Menstrual disturbances are described by FIGO (the International Federation of Gynecology and Obstetrics) using the acronym PAM-COEIN: Polyps, Adenomyosis, Leiomyoma (fibroid uterus), Malignancy, Hyperplasia, Coagulopathies, Ovulatory dysfunctions, Endometrial causes, Iatrogenic causes, and Not yet classified. Among these, polyps (often from hormonal disturbances and hyperestrogenic conditions), malignancies, ovulatory dysfunctions, and not-yet-classified causes frequently fall under hormonal disturbances, which can often be corrected by yogic practices. Disturbances are generally described in terms of the frequency, duration, volume, and regularity of the cycle, and its variation over a 12-month period. They can also be described as abnormal uterine bleeding (AUB), resulting in heavy menstrual bleeding (HMB), intermenstrual bleeding, or chronic or acute uterine bleeding. What is the probable mechanism of stress? Hectic work schedules, faulty diets, lack of exercise, improper sleep, and emotional stress alter the sympatho-parasympathetic balance, disturbing the hypothalamic-pituitary-ovarian axis. Current evidence also supports that dysfunctional uterine bleeding (DUB) or AUB is associated with increased total prostacyclins in the uterus. These chemicals are powerful vasodilators and inhibitors of platelet aggregation. This increased vasodilation causes vessels to remain open longer, leading to excessive flow. Prostaglandin levels in the endometrial mucosa are also under the influence of estrogen and progesterone, which are directly controlled by the HPO axis. Thus, mental stress likely plays an important role in controlling the balance between vasodilation and vasoconstriction of endometrial vessels. The moral of the story is that a disturbed and stressful life cycle can lead to many changes. The hypothalamus-pituitary-ovarian axis becomes disturbed, resulting in imbalances in ovarian FSH, LH, TSH, ACTH, ADH, oxytocin, and growth hormone—which I call the Vishnu, or maintenance department, of our body. As we have heard, this can cause premature aging. Given this, we search for a method with no side effects, that is economical, highly beneficial, and useful for a lifetime. Could yoga provide an answer to alleviate menstrual trouble and help cope with stressful situations? Yes, of course. We face menstrual problems in adolescence, childbearing age (often PCOD-related), middle age, and the perimenopausal age. What is the present yogic knowledge for dealing with it? Many research reports show the role of yogic practices in reducing stress, obesity, hyperthyroidism, hypertension, and diabetes. Reports also prove the role of yoga on PCOD. Since factors responsible for DUB are benefited by yoga, we can infer that yoga may prove useful for AUB (here, DUB and AUB are used synonymously). What is the yogic concept of disease? As Swami Vivekananda says, a wave in the ocean must be at the cost of a hollow elsewhere. Similarly, a lack of prāṇic energy somewhere—probably ajīrṇatva, kujīrṇitva, or atijīrṇatva of the prāṇic energy—can bring about change in the menstrual cycle. Yoga is the science of harmony or balance, meaning physical reconditioning, mind controlling, emotion culturing, and spiritual evolving. Therefore, yoga can definitely be useful for menstrual disorders. A variety of gynecological disorders are benefited. The question is whether different sets of practices should be prescribed for different disorders. Does this sound logical? Once we understand yoga as a lifestyle and a methodized effort toward self-perfection, a few simplified yogic practices can be prescribed, common for all problems. The role of the pineal gland, which secretes melatonin, is extremely important. Melatonin maintains circadian rhythm and has been shown to increase estrogen receptors on the uterus. Hyper-estrogenic conditions can arise from a lack of melatonin due to disturbed sleep cycles, leading to increased incidence of fibroids and polycystic ovarian disease. In adolescence, āsanas included in our studies proved beneficial. Girls practicing these āsanas showed improved regularity of the cycle, reduced excessive flow, reduced pain, and reduced premenstrual tension syndrome. Associated problems like anemia, obesity, leucorrhea, and stress were also corrected. Why do these effects occur? Referring to the initial physiological diagram, compartment 4 (the hypothalamus) is affected by Prāṇāyāma, Śhavāsana, and meditation, which influence the neuroendocrine circuit. Compartments 1, 2, and 3 (the pituitary, ovary, and uterus) are affected by various āsanas that help shunt blood flow from the viscera, resulting in less pelvic congestion. Daily yoga abhyāsa also leads to better concentration and emotional stability. PCOD is of increasing, alarming incidence. It is a lifestyle-related disease. Modern treatment includes medicines and laparoscopy, but decreasing lifestyle-related stress is more important. Correcting hormonal status can result in spontaneous ovulation. We had a batch of girls with PCOD and infertility who showed a tremendous response; they started ovulating properly, with good results for fertility. In middle age, the main problems are again hormone-related. Dysmenorrhea is painful menstruation; pain is subjective and varies. The practice of Sūrya Namaskāra and selected āsanas like Bhadrāsana, Setubandhāsana, and Utthita Ekadvipādāsana helps relieve vascular congestion. Practice of Prāṇāyāma, Nāda Yoga, and especially Bhakti Yoga helps release endorphins, taking care of the brain. For premenstrual tension syndrome, symptoms increase during the luteal phase. CNS effects may result from abrupt withdrawal of beta-endorphins and can be corrected with bhāva sādhanā. Mantra japa can balance endorphin levels in the luteal phase, elevating mood. Emotional practices like nāda sādhanā (use of music and saptasvaras) help. Modern medicine offers symptom-suppressing treatment but does not tackle the root cause. Yoga gives us a holistic system to complement medical technology. A diagram correlates the sapta cakras with autonomic nervous system plexuses; these cakras happen to be the seat of important endocrine glands. Is this a coincidence, or something logical, much more beyond it? We must introspect. In the new millennium, let us realize and utilize yoga as a powerful component of scientific medicine to treat psychosomatic disorders. It is safe, economical, non-invasive, non-pharmacological, and an acceptable treatment modality. Then we can prove ourselves as the modern Kālī, Mahālakṣmī, and Sarasvatī. The Effect of Yoga, Meditation, and Counseling on Assisted Reproduction I started infertility management in 2006. It took eight years to convince the administration that we needed assisted reproduction techniques like an IVF center in the public sector. The question was always: "India is highly populated; why produce more?" Finally, it was started in 2006 at Maulana Azad Medical College in Delhi. Initially, we conducted routine IVF programs. But three years ago, I took a project on the effect of yoga, meditation, and counseling in assisted reproduction. My patients are not rich; 50,000 rupees for an IVF cycle, though a small amount in the public sector, is significant. I wanted the maximum success rate in the first cycle. Infertile patients look to the doctor with hope, thinking they have come to the right place for success. Infertility is a major stigma. Patients experience profound stress—socially, physically, and psychologically—with a detrimental effect on couples, especially women, even with a male factor. Convincing them to decrease stress is a difficult task. Stress affects the hypothalamic-pituitary-ovarian-uterine axis, causing a total hormonal imbalance. It increases maternal stress, decreases uterine perfusion (where the embryo implants), and can lead to poor placental perfusion if pregnancy occurs. We cannot assure a fully successful, full-term pregnancy if stress is high. Stress must come down for successful management. Urban modern women cope with a recurring cycle of hope, anxiety, and depression. There are numerous stress factors and personal questions asked repeatedly across cycles. They must balance careers with highly invasive, time-consuming infertility management, involving appointments on specific cycle days. Gonadotropin injections are costly, adding financial burden, and sometimes marriages break. The doctor's instruction to have sexual relations on specific days makes it a struggle to maintain romance; they are always counting calendar days. When the period comes, the cycle is failed, causing recurrent stress. With assisted reproduction like IUI, IVF, or ICSI, there is daily psychological distress over injections, follicle growth, egg retrieval, fertilization, cleavage, and implantation. Thirty to fifty percent of infertile women suffer from anxiety. Our 2011 study found 66% of women seeking treatment suffered psychological distress. A study by Domar et al. (2011) showed anxiety and depression in infertile women, though unseen from outside, is comparable to that in HIV, cancer, or heart disease patients. The mind-body intervention of yoga, an ancient Indian practice, should have been utilized earlier. But it is never too late. Hatha yoga-based stress management seems an ideal indigenous intervention. Yoga as psychological support reduces stress for IVF patients, who see it as a last resort to conceive. Our ICMR-funded project involved weekly group sessions with deep relaxation, āsanas, Prāṇāyāma (regulating respiration), meditation, chanting, and counseling before and after the IVF cycle. We used assessment tools and performed uterine Doppler studies pre- and post-yoga, up to oocyte pickup. I initially wondered if patients would come so frequently, but they wanted to come daily for group yogic āsanas. Uterine artery Doppler indices indicate uterine perfusion, crucial for implantation. The pulsatility index (PI) showed statistically significant improvement in the study group compared to controls, indicating better uterine perfusion. Patients who became pregnant in the study group had a far better PI. We used psychological counseling tools: the Cornell Medical Index (CMI) health questionnaire, Amritsar Depression Inventory, Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), a stressful life events scale (43 events), the SCAT for anxiety, and the FATICOL for quality of life. Pre-assessment showed control and study groups were comparable. Post-assessment in the study group showed statistically significant improvement, including in pregnant women. Out of 205 patients, 46% in the study group conceived, versus 27% in the control group—a significant difference. An ROC analysis found a minimum of 30 Hatha yoga sessions were needed to effectively reduce stress and achieve a better pregnancy rate. This is the first Indian RCT assessing yoga-based stress relief in assisted reproduction. It provides evidence that yoga-based stress relief effectively improves ART outcomes. Many IVF centers have since started yoga counseling. In conclusion, Hatha yoga-based stress management and counseling significantly reduce psychological distress and are associated with a better pregnancy rate in women undergoing IVF. It is an ideal mind-body therapy to improve ART outcomes in India. We should all involved in infertility management start using it, as these indigenous yogic lessons are underutilized here but used more in Western countries. Using yoga regularly in day-to-day practice will decrease the stress of daily life.