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Part 1: The Practice and Principles of Iyengar Yoga During Pregnancy It is a privilege to introduce Dr. Rajiv Mehta. A student of Yogācārya B.K.S. Iyengar for four decades, she has taught public classes in Mumbai for the Light on Yoga Research Trust since 1986. Dr. Mehta is a reproductive biologist and scientist in the field of infertility and human in vitro fertilization, having earned her doctorate from the Indian Council of Medical Research’s National Institute for Research in Reproduction. She serves as an academic consultant to ORIGEO India and a scientific consultant to Trivector Biomed. She has been a lead teacher at International Iyengar Yoga Conventions across the UK, Europe, and Asia, and an invited speaker at ESHRE in Munich. She is also an advisor to the Ministry of Āyush. We are honored to have her speak on Iyengar Yoga during pregnancy. Good afternoon. First, I apologize to the earlier speakers, as I have encroached on their time due to a schedule change. The silver lining is that I will be quick. Our topic is Iyengar Yoga during pregnancy. We gather here knowing yoga is defined as union, from the root yuj. Speaking of "Iyengar Yoga" might suggest something separate. I begin with Yogācārya B.K.S. Iyengar’s own definition: yoga is one, like God is one; different people call it by different names. There is nothing like "Iyengar Yoga." However, in our tradition, knowledge is transmitted through the Guru-Śiṣya paramparā. Each ācārya’s understanding and methodology of teaching shapes the tradition. Thus, "Iyengar Yoga" refers to Yogācārya B.K.S. Iyengar’s interpretation of the Yoga Sūtras of Patañjali and other scriptures, and his method of imparting that knowledge. Students who learned from him said they studied "yoga as taught by B.K.S. Iyengar," which eventually shortened to "Iyengar." For many, especially in South India, this is amusing, as it is a name, not a form of yoga. Gurujī himself found it amusing. Each teacher interprets the sūtras uniquely. Consider Sthira sukham āsanam. Sthira means steady, firm; sukha is happiness, delight; āsana is posture, seat, or state. One can interpret it as "being delightful in any stable position." Another can see it as "being delightful and stable in any position." Both are valid, but they represent two ends of a spectrum: being comfortable in one’s comfort zone, or learning to be stable and delightful in any circumstance. This marks the difference in Gurujī’s interpretation. I judge no one; I simply present his view. If one must be stable in any condition, how is it achieved? Telling someone in pain, "Don’t worry, it will pass," is rarely effective. Gurujī’s methodology addressed this: how to give that stable, comfortable, delightful position regardless of an individual’s health, age, or status. This led to innovation. He realized that practicing āsanas with precision intensified their effects. While yoga is powerful and benefits everyone, accuracy deepens the impact. To help common people achieve this accuracy, he began using supports. As his students grew, he could not personally assist each one, so he devised props from common household items—tables, chairs, bolsters, blankets—to help students attain the correct āsana. Even the modern yoga mat originated from his need to provide stability on slippery Western floors; he used a carpet to prevent the mind from "slipping." The goal was always the experience. For instance, in Śīrṣāsana, a person with a cervical problem should not be told to do it regardless. Instead, props like a chair can give them the experience of the pose. The same applies to Sarvāṅgāsana for those with shoulder or neck issues. Yoga is experiential; without the experience, one cannot relish it. Props became a tool for the right experience. Interestingly, the Oxford English Dictionary defines "Iyengar" as a form of yoga, which remains amusing to us. It is a name, not a form, though it has become synonymous. Now, to the second aspect: research. We heard excellent presentations this morning on research-based experience: forming a hypothesis, using control and experimental groups, monitoring effects, and validating results for a larger population. Conversely, there is experience-based research: an individual’s practice is transmitted to students, and if a larger group reports similar experiences, that too forms research. In my talk, I will move between research-based experience and experience-based research. Now, to pregnancy. It is a beautiful time, yet its establishment relies on a hormonal orchestra: steroid hormones, pituitary gonadotropins, and hypothalamic gonadotropin-releasing hormones. If one element is out of sync, it creates cacophony. Hormonal changes in pregnancy are natural, but they bring other changes. We heard this morning about the psychoneuroimmunoendocrine axis—the mind affecting the endocrine system and vice versa. For example, premenstrual syndrome shows the endocrine system affecting mood. Similarly, anger connects to the adrenals. In pregnancy, hormonal shifts cause emotional changes for the woman, affecting those around her. Physiological changes occur as the fetus grows: breathlessness, heaviness, urinary incontinence, frequent urination, and leg swelling. Later, back pain arises, especially with multiple gestations. These physical issues affect mood, which in turn affects the fetus, creating a nexus. Yoga can play a role in different pregnancy stages. For convenience, we divide pregnancy into trimesters. The first trimester focuses on maintaining pregnancy, though many miscarriages occur here, often due to genetic abnormalities—nature’s way of preventing abnormal births. The second trimester is generally safe, while the third requires vigilance against premature birth. Yoga can help by strengthening the body and mind, ideally before conception, especially the back muscles. It aids fetal nourishment by ensuring what the mother eats reaches the fetus. It addresses pregnancy-associated issues like back pain, swelling, incontinence, and breathlessness. It prepares the woman for delivery, whether normal or cesarean, and helps manage stress. Stress pervades all life aspects, especially in pregnancy. Today, the average maternal age is rising, bringing fears of genetic abnormalities. As pregnancy advances, worries about the baby’s health persist. Studies show that nearly 20% of women experience depression during pregnancy, which may not have been present before. Stress, anxiety, and depression are particularly high in women undergoing assisted reproductive technologies (ART). India has an estimated 2,500 IVF clinics, so many women face stress before and during pregnancy. Maternal depression is linked to lower birth weight and head circumference in babies. While modern science offers antidepressants, their use in the second or third trimester raises the risk of ADHD in children. Thus, addressing stress, anxiety, and depression is crucial. I speak from the tradition I know: Yogācārya B.K.S. Iyengar’s. A UCLA study on yoga for depression showed that after three months of practice, positive mood traits increased while negative traits—stress, irritation, depression, anxiety, anger, pessimism—decreased. How does it work? Is it merely psychological? Dr. Chris Streeter’s work, presented this morning, explains that GABA levels are typically reduced in mood and anxiety disorders. She found a 27% increase in brain GABA after 60 minutes of yoga, indicating that the change is not just psychological but mediated by neurotransmitters—a physiological shift altering psychology. Subsequent studies compared yoga to walking, finding that walking did not produce the same GABA increase or reduction in anxiety and depression. Many studies document that yoga can lower stress, anxiety, and depression. The second aspect is strengthening body and mind for pregnancy through specific āsanas. Yogācārya B.K.S. Iyengar made practice accessible to all states. Visuals show Adho Mukha Śvānāsana with wall or rope support for those who cannot do it independently. Ardha Candrāsana strengthens legs and spine, preparing for pregnancy. Inverted āsanas like Śīrṣāsana and Sarvāṅgāsana are important for accessing the pituitary gland to release gonadotropins, which act on the ovaries to produce steroid hormones. Baddhakoṇāsana and Upaviṣṭakoṇāsana are advised only later in pregnancy, closer to the due date. These āsanas support emotional, physiological, and musculoskeletal health. Back pain is a common issue, especially with multiple gestations. A study on Iyengar Yoga for chronic lower back pain, in patients with pain for over 11 years, involved three months of sessions. Compliance was over 70%, likely due to the teacher’s motivation or the comfort props provided. Results showed decreased pain intensity, reduced functional disability, and an 88% reduction in pain medication use. This landmark study helped establish yoga as a first-line therapy for back pain. In advanced pregnancy, what can a woman do? Visuals convey more than words. Uttānāsana with full support prevents the lumbar from going concave, strengthening the legs and thus the spine. Ardha Candrāsana creates abdominal space. Supta Vīrāsana with supports allows comfortable rest, relieves leg fatigue, improves breathing, and quiets the mind through natural breath awareness. Mild twisting releases the back. However, certain āsanas should be avoided during pregnancy: Sūrya Namaskār cycles, jumping, and intensive twists. This conference focuses on what to do. Viparīta Daṇḍāsana, done on a bench or bed, lifts the chest, creating a feeling of elation and improving breath. Though a physical posture, it affects breath and mind. When agitated, breath becomes short and uneven; when posture supports breath, the mind quiets, diminishing earlier issues. Can pregnant women do inverted āsanas? Yes, under an experienced teacher’s guidance. They can perform Śīrṣāsana with ropes or Sarvāṅgāsana on a chair. There are instances where a woman practiced Śīrṣāsana in the morning and delivered comfortably that afternoon. However, a warning: one cannot simply replicate these pictures; trained guidance is essential. Part 2: The Role of Yoga in Pregnancy and Cancer Care Not just anyone can practice yoga during pregnancy without 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 year, when lying in Supta Baddha Koṇāsana, the breath becomes very soft. Practitioners develop a certain modulation of the breath, which aids during delivery. The practice concludes with total relaxation in 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, alleviating back pain. In this reclined position, she can practice Ujjāyī Prāṇāyāma as well as Viloma Prāṇāyāma, as sitting for Prāṇāyāma may be difficult. While lying down, she can still appreciate the modulations of the breath, inhale prāṇic energy, and gain its benefits. I must note that while I say this, I lack hard data to corroborate it. However, over the last 40–50 years, we have observed so many people practicing with positive outcomes. Sometimes we question the need to document such things. Yet, when I wear my scientist's hat, I believe there is a need to document and provide evidence for the claims we make. To summarize the benefits of practicing yoga during pregnancy: First, it reduces stress, anxiety, and depression. Second, it overcomes lumbar pain. Reports indicate it reduces pregnancy-associated hypertension, heaviness in the breath, and swelling in the legs. Further reports show yoga practice can reduce preterm labor, decrease labor time, lower the incidence of intrauterine growth retardation, and reduce the rate of caesarean sections. However, I must add a word of caution regarding this last statement. We are not claiming that practicing yoga guarantees a normal delivery. One must not be fanatical. If there is a breech presentation, a cesarean is needed. Yoga practitioners and teachers must work in tandem with modern obstetricians. We should collaborate to make a woman's life better. Nowadays, in our enthusiasm for yoga, we often dismiss modern medicine as negative, ineffective, or laden with side effects. Modern medicine too has a role, and it is time we work together rather than be at loggerheads, arguing one is better than the other. Studies are showing yoga is effective. Regarding the decreased time of labor, very renowned gynecologists in Mumbai, like Dr. R.P. Sunawala, have confirmed this. However, he also cautioned us not to proclaim this publicly, because women might then believe they will have a normal delivery and insist on one. As I said, one must accept the situation and proceed with what is required. Finally, I would like to conclude with a quote by Gurujī: "Āsanas are descriptions, not prescriptions." One cannot simply say, "Here are the āsanas, do them." It may not be effective. How they are done, and how they are done by a particular individual, is important. There is a format, a structure, and guidelines for practice, but at some level, it is individualized. In modern medicine, there are standard drugs for standard conditions, but a doctor is still needed to decide the individualized dose, etc. Similarly, in yoga, you need those guidelines. The practice is partly individualized within the framework of the guidelines and must be done under the guidance of an experienced teacher. That is very, very important. In our tradition, it is crucial that a student practices for three to five years before they can even dream of becoming a teacher. Yoga is an experiential subject. Especially when you are taking the life of another woman and an unborn child into your hands, it is vital to have that experience rather than play with two lives. Experience becomes paramount, and experience comes only from practice. With this, I end my presentation. Thank you very much to the organizers, my previous speakers, and my chairperson for facilitating my talk. Welcome back. It is my fortune to speak again. As Dr. Nagaratnā, our Gurujī, our beloved Didi, has said, whatever God plans is for the better. We are learning here, and whatever little bit of yogic science we have learned, she has been an instrumental figure whom I have looked up to for the last 15–20 years. It is truly an honor to talk. We were discussing stress and how it affects our lives. All of you will agree we are in a stress cycle leading to obesity, diabetes, cardiovascular disease, hypertension, and cancer as byproducts. We must look at genome health assessment as a whole, not just one or two single genes. The "stressome" refers to the genes activated, dysfunctional, or overexpressed during the stress response. I have covered these areas, and I look at the genome health index in patients, along with stress and the cell cycle. Every cell, from the time a zygote is formed in the mother's womb—where your father and mother have contributed half the genome each—starts dividing and continues throughout your life. It is a 24/7 process, balancing cell division and death. During the cell cycle, stress responses, aging, hypoxia, smoking, junk food, lack of sleep, and immunological imbalances are factors that affect cell division. DNA damage is increased by improper nutrition, radiation exposure, excessive alcohol, smoking, pollutants, pesticides, irregular lifestyle, long office hours, and stress. Most importantly, insufficient sleep is critical. If asked about the two most important things affecting the young generation, I would say insomnia and cell phone or social media addiction. A huge network operates within your cells constantly. Aging is the biggest carcinogen. Cancer is synonymous with death, and fear is an immediate part of the stress response. People often focus on the tumor or disease, but there is an enormous emotional burden underneath, alarmingly increasing worldwide. There are two reasons: our lifestyle and increased life expectancy. The world is aging, with life expectancy now around 75, leading to more older people and more cancer. There is a constant war between the host and the tumor genome. The tumor is not safe; it fights within the system, trying to alter the biological environment. A balance of DNA damage and repair occurs in your genome. Good repair leads to healthy, normal cells. No repair leads to programmed cell death, or apoptosis. Faulty or mismatch repair leads to mutation. Solid tumors do not grow in a day or two. They take months, years, or even decades to develop, progressing from normal hyperplasia to neoplasia to metastatic disease. It is an evolutionary process. Tumors undergo rapid evolution and cell division within the body, eventually acquiring significant size. Oral cancer is rampant in eastern India, where I come from, affecting young people primarily due to tobacco. Genes play a significant role. People now understand, as Angelina Jolie discovered, that BRCA1 and BRCA2 are responsible for hereditary breast cancer. She found mutations in her genes and underwent a mastectomy. Worldwide, it is understood that disease is not caused by one or two genes but by a group of genes and mechanisms. Scientists worldwide are playing a game akin to Whac-A-Mole, trying to inhibit one gene with a drug, only for another to emerge. Cancer cells are super smart, acquiring resistance. P53, discovered in the late 90s, was thought to be the "guardian of the genome." It is a tumor suppressor gene that regulates cell replication, genome duplication, and response to DNA damage. If P53 is mutated, tumors may develop. It also repairs the genome and can trigger cell death if repair is impossible. Its discoverer did not win a Nobel Prize. P53 is fundamental but not a druggable target. Other scientists, like Robert Weinberg (called the God of Molecular Oncology) and Bert Vogelstein, have immensely contributed to the study of oncogenes and cancer phenomena, yet they also have not won Nobel Prizes. This year, research reconfirmed that replication error, or DNA duplication, is the cause of 70% of cancers. My group researches how replication is controlled by telomeres. Telomere dysfunction causes segregation defects and genome instability. We found that telomere defects are responsible for head and neck cancer, and prognostication—determining how dangerous, aggressive, or metastatic a cancer is—is now possible by examining tumor specimens. We published this last year. Integration is key. We are in a technology revolution with genomics, proteomics, metabolomics, epigenomics, and environmental exposure data at our fingertips. We must integrate, just as yoga integrates body with mind. We are here assembling from all over the world, integrating our thoughts, expertise, and capabilities to find solutions for life. We are in the era of functional genomics, where it is possible to analyze hundreds of genes simultaneously. Soon, you may carry a genome card like an ATM card, a "genome selfie" that can be updated periodically to show how your genome interacts with the environment. We face technology dilemmas, such as whether to adopt liquid biopsies. Do not worry excessively; technology will take care of itself. About 10–11 years ago, we published a paper titled "Effects of Yoga, Integrated Yoga Program in Modulating Psychological Stress, Radiation-Induced Genotoxic Stress in Breast Cancer Patients Undergoing Radiation Treatment." This work was done collaboratively under the guidance of Dr. Nagaratnā. Among my thirty publications, this paper has the highest citations, downloaded and read daily worldwide. We observed that psychological stress, hospital anxiety, and radiation-induced DNA damage are all modulated by yoga practice. Yoga practice encompasses not just āsanas but entire meditation, yoga, and lifestyle modification. Yoga is a way of life, a change across the entire life spectrum, integrating your mind with universal consciousness. The five principles for a stress-free life are: proper diet, proper exercise, breathing, positive thinking, and meditation. Integrating these into your life leads to a stress-free existence. At the macromolecular level, some stress is necessary—positive stress, a positive push. For instance, when Dr. Nagaratnā asks for a paper by evening, we experience positive stress, integrating data productively. Chronic macromolecular disturbances translate to the cellular level if sustained over time, leading to disease. As Gurujī pointed out this morning, you must know the adhis (psychological afflictions), which lead to vyādhis (physical diseases). By adopting lifestyle changes, you create macromolecular harmony, which translates to micromolecular or genomic harmony. Disease becomes ease; the "dis-" is removed. I conclude with a take-home message from the Bhagavad Gītā: "Let a man lift himself by his own self. Let him not degrade himself, for the self alone can live in harmony with the self, and the self alone can be the enemy of the self." Thank you for your attention. Now, I would like to call upon our next speaker, Dr. Raghavendra Rao, a senior scientist in clinical research. First, we will hand over a memento. I request Dr. R. Nagaratnā to felicitate Brijesh Birendranath Banerjee. Our next speaker is from Healthcare Global Enterprises Limited, Bangalore. He holds a bachelor's degree in naturopathy and yogic sciences from Bangalore University. He has completed several research projects in rheumatoid arthritis, diabetes, and CVD risk prevention using yoga and naturopathy interventions at Swami Vivekananda Yoga University. He was a collaborator and Osher PSCRC NIH fellow at UCSF School of Medicine, San Francisco, from 2004 to 2006. He has 45 international research publications and one international book chapter. Please begin your lecture. Thank you. Good afternoon, everybody. I will try my best to keep you awake. I will share my experience over the last 20 years of working with cancer patients. I work at HCG (Healthcare Global Institute of Oncology) in Bangalore, the largest network of private oncology hospitals in India, with over 27 hospitals. I help manage the integrative oncology department and the clinical excellence department. We have integrated yoga and some aspects of Āyurveda into cancer care. I would like to share my research experience using yoga intervention with cancer patients. Approximately 40% of cancers are preventable, linked to tobacco, alcohol, lifestyle, lack of physical activity, obesity, and exposure to carcinogens and environmental pollution. The remaining 60% are of unknown origin. Patients often ask, "I am a vegetarian, I pray daily, I am physically active, I have a healthy lifestyle, I don't smoke or drink. Why did I get breast cancer?" There are no easy answers. This is due to chance mutations in critical genes, as Dr. Banerjee mentioned—perhaps a tumor promoter or suppressor gene mutated, leading to cancer. In 60% of cases, it is by chance; in 40%, it is lifestyle-related. Many women, especially breast cancer patients, ask: Does stress cause cancer? The answer is both yes and no. Studies in Western countries have shown that women with breast cancer often had a history of depression or melancholia. However, the evidence was not conclusive. A landmark experiment by Michael Anthony at Memorial Sloan Kettering Cancer Center in 2001 provided clearer insight. Three groups of mice were injected with breast cancer cells. The first group had no stress. The second group was subjected to restrained stress (e.g., electric shocks when approaching food). The third group received stress along with a beta-blocker (Perpetanol) that blocks sympathetic activation. Results: the first group had a 30% cancer rate; the stressed group had a 90% cancer rate with rapid spread; the group with the blocker showed reduced cancer spread by half. This demonstrated that stress may not cause cancer but certainly increases its progression. Subsequent studies in human and mouse models have delineated stress pathways that augment cancer progression. Meta-analyses in cancer survivors show that patients with depression or depressive symptoms have a three-fold higher mortality rate compared to those without such symptoms. This is conclusive evidence that stress increases cancer progression. We observe that patients who cope with cancer with a positive attitude survive longer and experience fewer distressing symptoms than those who feel helpless and hopeless. Thus, we examine how yoga plays a crucial role in coping with cancer. For many patients, a cancer diagnosis feels like a death certificate. They cry, feel devastated, and view it as a terminal, incurable illness, largely due to social stigma and phobia. When someone is diagnosed, there is often silence and over-sympathy, which can make the patient feel more vulnerable and helpless. Lack of education and courage exacerbates the situation. Yoga can help address these psychological burdens. Part 3: The Role of Yoga in Cancer Care and Holistic Health We wanted to observe patients from diagnosis through treatment. They undergo six months of intensive treatment for early-stage cancer: surgery, followed by six cycles of chemotherapy, and then radiation therapy. During these six months of continuous treatment, they experience severe side effects. Our aim was to see if adding a yoga intervention helps patients cope with these side effects. This is also part of my thesis. If you look at symptom burden and distress in patients, you can see fatigue affects 90% of them. Nausea and vomiting are seen in 90% of patients undergoing chemotherapy. Over 60% have anemia. They experience diarrhea and cognitive impairment. These are very common symptoms seen in almost all cancer patients today. We wanted to examine: 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? Does it change stress hormone rhythms, adrenaline hormone rhythms? Does it improve anti-tumor immune responses and NK cells? 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, starting from Cognitive Behavioral Therapy to Social Support, Biofeedback, Tai Chi, etc. In the last two decades, yoga has become very popular in cancer patients. What kind of yoga? There are many forms. In cancer literature, there is a lot of Iyengar yoga, various types of mindful yoga, restorative yoga—so many types exist. What is important here? Understanding yoga in the context of cancer: are we talking about flexibility of body or flexibility of mind? What we need in cancer is flexibility of mind—the ability to accept the diagnosis and cope with it. This is what is important for cancer patients. So, when we talk about yoga in cancer, we likely mean flexibility of mind. We all know the 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 keep ruminating. The moment they are diagnosed, they worry constantly: 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 makes them vomit. They cannot tolerate kitchen odors; going to the kitchen makes them feel nauseous during chemotherapy. These are anticipatory symptoms induced by anxiety. Such distressing anticipatory symptoms further aggravate the condition. So, we look at how to calm the mind, reduce stressful responses, and develop internal awareness. Most of the time, these patients are full of negativity—thinking about dying, death, worrying about their children, and so on. They are always in a negative frame of mind, ruminating. We want to distract the mind's attention from these problems. How do we do this? Through yoga. We started using yoga interventions in these patients. More importantly, breathing exercises are fantastic, wonderful, and very safe for patients. You must understand: these patients undergo chemotherapy, and sometimes cancer spreads to bones, making them brittle. You cannot give many āsanas, especially with spine metastasis or cancer spread to the femur bone, where fracture risk is high. With cancer spread to the lung and radiation to the lung lesion, hyperventilation or practices like kapālabhāti and bastrika can cause pneumothorax. Therefore, you must be very careful in knowing what sort of treatment to give these patients. This is very important. 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 the lungs. She was an avid follower of the Art of Living and regularly practiced Ujjāyī Prāṇāyāma and Bastrika Prāṇāyāma. When she came for consultation, I advised her to stop the practice for some days while undergoing radiation to her lung lesion, warning of pneumothorax risk. She did not listen. About a week later, her husband called frantically: she had collapsed while practicing Bhastrikā and was unable to breathe. I knew the problem: pneumothorax. I 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 right condition. Yoga can also cause 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, leading to a vertebral fracture and severe pain. She could not get up or walk. This happened because she did not inform the yoga therapist about her cancer, and she was unaware her back pain was due to metastasis from breast cancer. We need to be very careful when using yoga interventions with cancer patients. I will now discuss my study. We took new breast cancer patients, stage 2 and 3, undergoing surgery, radiation, and chemotherapy, and divided them into two arms. Most patients end up with mastectomy and axillary dissection, leading to lymphedema. We looked at post-operative outcomes. We wanted to see if the number of days for drain retention decreased. Fluid drainage improved when we started 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 decreased by one day, saving about 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: hypertension, tachycardia, catecholamines, 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 also examined immune outcomes: natural killer (NK) cell counts. NK cells are lymphocytes 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 started decreasing during treatment due to immunosuppression, but in the yoga group, levels remained almost higher or similar to baseline at the end of treatment compared to controls. We also looked at TNF-alpha, an inflammatory cytokine. After surgery, wound healing is expected within a month. In the yoga group, wound healing was faster because they had lower levels of TNF-alpha at four weeks. Prolonged high TNF-alpha indicates sepsis. Similarly, fatigue came down in the yoga group, and quality of life improved. Our results are similar to studies abroad where yoga has been used to reduce psychological distress, anxiety, and depression in cancer patients, indicating these results are viable and internationally reproducible. What is the mechanism of action of yoga? We saw a decrease in 6 a.m. cortisol levels in the yoga group. Usually, patients have high stress and high morning cortisol levels, which decrease by evening, aiding sleep and providing morning drive. In these patients, cortisol levels are high in the morning but remain flat or increase in the evening due to stress. In the yoga group, cortisol levels decreased drastically, and the slope level also decreased compared to controls. This has also been published internationally. We also examined how yoga helps reduce nausea and vomiting. We compared yoga with Jacobson’s relaxation in patients undergoing chemotherapy. A 25-minute yoga module given at the bedside showed nausea and vomiting decreased drastically in the yoga group. Yoga was able to manage and normalize gastric motility in cancer patients. During chemotherapy, vomiting leads to anti-emetics, which cause gastroparesis, nausea, and anorexia—a major problem with no solution until now. Using a yoga module, we can manage 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, everyone works together: palliative care specialists, physiotherapists, nutritionists, and yoga therapists. We have specific yoga modules for post-operative, radiation, and chemotherapy phases. We have about thirty full publications on yoga and cancer, and 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 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 receive inpatient referrals. I thank CCRN, the Department of Science and Technology, all oncologists, my mentors who have worked tirelessly with me for the last 20 years, and all patients kind enough to participate in our yoga studies and treatment. Thank you all for this opportunity.