Gastrointestinal.

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1. 2. DIGESTIVE DISORDERS YOGA FOR ACID PEPTIC DISEASE IRRITABLE BOWEL SYNDROME INTRODUCTION

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People are probably more aware of their digestive system than an of other system, not lease because of its frequent messages. Hunger, thirst, appetite, gas and the frequency and nature of bowel movements are all issues affecting daily life. Eating well, along with regular exercise, is one of the bedrocks of good health. Plenty of fresh vegetables and fruits, adequate fiber and restricted animal fats and salt are simple dietary guidelines that are essential for maintaining the well-being of all parts of the body, particularly the heart, blood vessels, bones and the digestive system itself.

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The digestive system consists of a long passageway, known as the alimentary canal or digestive tract and associated organs, including the liver, gallbladder, and pancreas. The digestive tract starts at the mouth and continues through the esophagus and intestines to the anus. Along its course food is broken down and nutrients extracted, while waste materials are disposed of. PATH OF FOOD MOUTH TO ANUS Path of food through the human digestive system includes the following organs and structures : Mouth pharynx esophagus peristalsis mucus sphincter muscles cardiac sphincter stomach pyloric sphincter small intestine (duodenum, jejunum, ileum) ileocecal valve large intestine or colon (cecum, appendix, ascending colon, transverse colon, sigmoid colon) rectum anus. STOMACH The stomach is a J-shaped muscular organ that receives and mixes food with digestive juices, and propels food to the small intestine. Stomach stores 2 pints (1.5 liters) or more of food from a meal and digests it both physically and chemically. Small intestine continues the chemical breakdown and is the main site for absorbing the resulting nutrients into the bloodstream. LIVER, GALLBLADDER & PANCREAS

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The liver is the bodys largest internal organ and has a crucial role in the manufacture, processing and storage of may chemicals. It produces the digestive fluid bile, which is then stored in the gallbladder. The pancreas secretes vital digestive enzymes. LIVER The reddish-brown liver, located in the upper right quadrant of the abdominal cavity, is the bodys largest internal organ. * Each lobe is separated into hepatic lobules consisting of hepatic cells radiating from a central vein. * Hepatic sinusoids separate groups of hepatic cells. * Blood from the hepatic portal vein carries blood rich in nutrients to the liver. * Kupffer cells carry on phagocytosis in the liver. * Secretions from hepatic cells are collected in bile canals that converge to become hepatic ducts and finally form the common hepatic duct.

8. 9. LIVER FUNCTIONS Most of the livers tasks are concerned with metabolism. They include: breakdown of digestive products; storage of the resulting products; circulation of substances such as vitamins and minerals; construction of complex molecules enzymes.

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Bile production - Liver cells secrete bile into small canals called bile canaliculi, which drain into bile ducts running between the lobules. These bile ducts coverage to form the common hepatic duct, which conveys bile to the gallbladder for storage. Nutrient processing - Liver removes nutrients from the blood. It converts simple sugars into glycogen a process called glycogenesis and synthesizes amino acids.

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Glucose regulation - The liver maintains blood glucose levels by converting fat and proteins into glucose glucogenesis. Detoxification - Harmful substances in the blood alcohol and some other poisons, are detoxified. Waste products and unwanted amino acids are converted into urea. Protein synthesis - Liver synthesizes blood-clotting proteins and proteins for the fluid part of blood (plasma).

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Mineral and vitamin storage - Liver is reservoir of minerals such as iron, copper, fat-soluble vitamins including A, B12, D, E and K Blood waste disposal - Bacteria and general foreign particles are eliminated. Recycling blood cells - Old red blood cells are broken down and their constituents reused.

14. GALLBLADDER Bile salts emulsify fats and aid in the absorption of fatty acids, cholesterol, and certain vitamins. 15. BILE TRANSPORT

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Bile assists the breakdown of fats (lipids) in the small intestine. Liver secretes up to 1 liter of bile daily. Bile passes along the left and right hepatic ducts from the livers two lobes, then along the common hepatic and cystic duct to the gallbladder. This sac holds about 50 mL of bile and concentrates it, ready for release after a meal. Bile flows along the cystic duct to enter the first part of small intestine, duodenum. Common bile ducts joins the pancreatic duct at the hepatopancreatic ampulla, which empties into the duodenum.

16. PANCREAS The pancreas has an exocrine function of producing pancreatic juice that aids digestion. It is closely associated with the small intestine. Cells that produce pancreatic juice, called pancreatic acinar cells, make up the bulk of the pancreas. Pancreatic and bile ducts join and empty into the small intestine, which is surrounded by the hepatopancreatic sphincter. 17. PANCREATIC JUICE Contains enzymes that digest carbohydrates, fats, proteins, and nucleic acids. Enzymes include pancreatic amylase, pancreatic lipase, trypsin, chymotrypsin, carboxypeptidase, and two nucleases. Protein-digesting enzymes are released in an inactive form and are activated upon reaching the small intestine. 18. SPLEEN Located in the upper left quadrant. Consists of white pulp (lymphoid tissue) and red pulp. Filters and stores blood. 19. SMALL INTESTINE The lengthy small intestine receives secretions from the pancreas and liver, completes digestion of the nutrients in chyme, absorbs the products of digestion, and transports the remaining residues to the large intestine. The small intestine consists of the duodenum, jejunum, and ileum. 20. 21. LARGE INTESTINES

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Large intestine is the final part of the digestive tract and comprises three main regions Cecum, colon and rectum. Cecum is a short pouch that links the small intestine to the colon, which is about 5 feet long. Colon changes liquid digestive waste products from the small intestine into a more solid form that the body excretes as feces via the rectum and anus.

22. The large intestine absorbs water and electrolytes and forms and stores feces. The large intestine consists of the cecum (pouch at the beginning of the large intestine), colon (ascending, transverse, descending, and sigmoid regions), the rectum, and the anal canal. The anal canal opens to the outside as the anus; it is guarded by an involuntary internal anal sphincter and a voluntary external anal sphincter muscle. 23. The large intestinal wall has the same four layers found in other areas of the alimentary canal, but lacks many of the features of the small intestinal mucosa. Fibers of longitudinal muscle are arranged in teniae coli that extend the entire length of the colon, creating a series of pouches (haustra). The large intestine does not digest or absorb nutrients, but it does secrete mucus. The large intestine absorbs electrolytes and water. 24. The movements of the large intestine are similar to those of the small intestine. Peristaltic waves happen only two or three times during the day. Defecation is stimulated by a defecation reflex that forces feces into the rectum where they can be expelled. 25. DIGESTION

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Digestive process involves a series of physical and chemical actions that break down the components of food into nutrient particles small enough for absorption. Feces are composed of undigested material, water, electrolytes, mucus, and bacteria. The color of feces is due to the action of bacteria on bile pigments. The odor of feces is due to the action of bacteria. FECES

28. ACID PEPTIC DISEASE 29. ACID PEPTIC DISEASE PROBLEM OF MODERN AGE

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AGE 20 - 40yrs DUODENAL.U. INDIA,USA 40 - 50yrs GASTRIC .U. JAPAN HUNGER PAIN CLOCK LIKE 3 AM 3 TO 4 Hrs AFTER MEALS

PAIN ABDOMEN BURNING, DISCOMFORT, GAS, DISTENSION 30. PEPTIC ULCER OR ACID PEPTIC DISEASE INFLAMMATION OF STOMACH DUE TO ACID PEPTIC DIGESTION 31.

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ELASTIC BAG DIGESTION OF PROTEIN BEGINS PROTECTION AGAINST GERMS & TOXINS

FUNCTIONS OF STOMACH 32. DIGESTED BY PEPSIN ENZYME PROTEIN DIGESTION PROTEIN IN FOOD IN CONCENTRATED HYDROCHLORIC ACID MEDIUM 33. PROTECTORS

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MUCUS COATING BICARBONATES BLOOD FLOW MUCUS CELL TURN OVER

WHAT PROTECTS STOMACH FROM SELF DIGESTION ? 34. o HIGH ACID

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PEPSIN SMOKING CHILLIES ALCOHOL

PAIN KILLER TABS

AGGRESSORS 35. IMBALANCE

PROTECTORS

AGGRESSORS APD 36. o ACUTE GASTRITIS

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CHRONIC GASTRITIS EROSION PEPTIC ULCER COMPLICATIONS

IMBALANCE LEADS TO 37. CAUSES OF A.P.D

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1. STRONG FAMILY HISTORY BLOOD GP O ARE PRONE TO APD 11. TRIGGERING FACTORS STRESS - TENSION NOT ABLE TO LET GO THE STEAM H. PYLORI ALCOHOL, CHILLI, STEROIDS, PAIN KILLERS

38. STRESS PARA SYMPATHETIC ACID BL. FLOW POOR MUCUS SLOW REPAIR EMOTIONAL CORTEX HYPOTHALAMUS GASTRIN ACID SYMPATHETIC 39. IRRITABLE BOWEL SYNDROME 40. 41. COMPLAINTS

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MIDDLE AGED WOMEN MORE THAN MEN ALTERNATE DIARRHOEA AND CONSTIPATION FEELING OF INCOMPLETE EVACUATION

- FORMED STOOL

42. IRRITABLE BOWEL SYNDROME

PERSONALITY:

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CLEAN

HYPER - REACTIVE

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NERVOUS INTROSPECTIVE FIXATION ON BOWEL CONCENTRATION ON THE BOWEL

43. IRRITABLE BOWEL SYNDROME OR FUNCTIONAL BOWEL DISORDER DEFINITION : -- IRREGULAR BOWEL MOTILITY AND PROPULSION ERROR 44. CONTROL OF BOWEL MOTILITY PSYCHE 45. EMPTYING NERVE CONTRACTS - COLON RELAXES - SPHINCTER SYMPATHETIC PARA SYMPATHETIC HOLDING NERVE CONTRACTS - SPHINCTER RELAXES - COLON 46. BOWEL MOTILITY IN IBS

MUSCLE TONE DISORDER -

ERRATIC EMPTYING OF BOWELS

HYPER REACTIVITY TO PARA SYMPATHO DRUGS PARASYMPATHETIC SYMPATHETIC 47. INFLAMMATORY BOWEL DISORDER ULCERATIVE COLITIS DEFINITION : EPISODES OF DIARRHOEA WITH BLOOD & MUCUS 48. PSYCHO NEURO IMMUNOLOGY STRESS & AUTO IMMUNITY THYMUS B T CAUSES AUTO IMMUNITY 49. 50. YOGA

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MASTERY OVER MIND & REST TO MIND DEEP REST TO BRAIN CELLS REST TO IMMUNE CELLS HIGHER FACULTY RESTORED

MASTERY OVER KILLER INSTINCT OF IMMUNE CELLS 51. nandamaya Ka Vijannmaya Ka PERFECT HEALTH Manmaya Ka Annamaya Ka Prnamaya Ka DHIJA VYDHIS Panchakosa concept 52. ANANDAMAYA KOSA ACTION IN RELAXATION

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ALL PRACTICES SHOULD TOUCH THIS KOSA DIFFUSE FROM NAVAL REGION DIFFUSE REGION OF PAIN BLISS IS MOKSA FREEDOM IS ANANDA

53. VIGNANAMAYA KOSA

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BASIC CONCEPT OF LIFE PURPOSE OF LIFE GOALS IN LIFE

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SEARCH FOR TRUTH SILENCE IS HAPPINESS

54. MANOMAYA KOSA STAGE I OF APD & IBS AS ADHIJA VYADHI DHARANA to DHYANA FOCUS to DEFOCUS NAVAL to EXPANSION EMOTIONS - JEALOUSY to ACCEPTANCE & APPRECIATION 55. MANOMAYA KOSA cont.

CM - DEEP CALMNESS

STRESS IS SPEED - MEDITATION DIVINE MOOD - CALM - REST 56. REDUCES STRESS DEVOTION - BHAKTI - SURRENDER MANOMAYA KOSA cont. JOY OF BEING IN THE PRESENCE OF THE BELOVED 57. EMOTIONS NONCOMPLAINING TOLERANCE ACCEPTANCE SURRENDER 58.

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STRESS - ACUTE CHRONIC SUPPRESSED HABITS, CRAVINGS, ALCOHOL, SMOKING MASTERY OVER MIND TO STRENGTHEN WILL POWER & CONFIDENCE

59. YOGA IS CAPACITY TO DO, NOT TO DO, OR DO IT OTHERWISE

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TO SMOKE, NOT TO SMOKE, REPLACE BY SIMPLER JOY SHIFT TO THE INNER COMPARTMENT (ANTHARRANGA) WHEN DISTRESSED. REPLACEMENT - SEETALI / SEETKARI, KAPALABHATI

HOW TO STOP SMOKING ? 60. Cigarette smoking contributes to a remarkable number of diseases, including coronary heart disease, stroke, chronic obstructive pulmonary disease, peripheral vascular disease, peptic ulcer disease, and many types of cancer. 61. General discomfort aches and pains STAGE - II OF APD / IBS AS ADHIJA VYADHI PRANA SAMANA APANA PRANIC IMBALANCE APD - ATIJERNATVAM TOO MUCH OF PRANA FOCUSSED IN SAMANA IBS - KUJRNATVAM TOO MUCH OF PRANA FOCUSSED IN APANA 62. PRANA SAMANA APANA PRANAMAYA KOSA PRANIC IMBALANCE PRANAYAMA SECTIONAL BREATHING STABILIZES SAMANA NS- 12 ROUNDS 4 TIMES A DAY 63. IAYT ANNAMAYA KOSA

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DO ANY POSTURES AGGRAVATE PAIN IN APD ? FORWARD BEND IN SITTING BLOCKS PRANA IN STOMACH

EMPHASISE : STANDING POSTURES BACK BENDING & DRT 64. VAMANA DHOUTI UDDIYANA BANDHA NAULI KRIYA AGNISARA KRIYA ANNAMAYA KOSA cont. KRIYAS IN APD 65.

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TO BRING HARMONY & BALANCE Avoid during episodes of diarrhea

Dynamic practices in standing position

ASANAS FOR IBS 66. o EMPHASIZE - INVERTED POSTURES

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VIPARETA KARANI WITH SUPPORT - DEEP ABDOMINAL BREATHING - AAA CHANTING - ASVINI MUDRA PRABHEDAS OF SARVANGASANA HALASANA, MATSYASANA SIRSASANA

DURING ACUTE ATTACKS 67. GID & IBS o Cause of concern is a reduction of H.C.L which increases with age, alcohol and smoking

Abundant mucus is produced to protect the stomach lining from being damaged by its own acid

68. CAUSES

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Life style Antibiotics High fat diets High sugar intake High intake of processed food Anti inflammatory drugs Fried foods Alcohol Soda Smoking Anxiety Depression Stress Etc.

69. CANDIDA

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Affects large number of people Faulty diet and lowered immunity is the cause Naturally present in GI track Mutates if immune system is affected or high sugar diets are taken

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Belching Excessive gas Abdominal cramps Can cause depression if not treated Insomnia Itchy ears Muscle pain Sore throat

70. DIETARY MANAGEMENT

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Water from boiled potato peelings Green leafy vegetables Ginger Soft fruits

for GID & IBS 71. COLITIS

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Villi flattened after coming into contact with gluten Can cause malnutrition Diarrhea Weight loss

72. DIETARY MANAGEMENT

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Avoid gluten containing foods like wheat, barley, oats, rye Increase fruits and vegetables specially green leafy vegetables well cooked and mashed Avoid high starchy foods

for COLITIS 73. DIVERTICULITIS

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Inflamed diverticula forming small pouches, which will be filled with waste. Causes pain SYMPTOMS Diarrhea constipation Tenderness Bloating Frequent need to go to toilet

74. DIETARY MANAGEMENT for DIVERTICULITIS

Objective to normalize motility and secretions

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Include more fluids into the diets High fibers Reduce carbohydrates More proteins (tofu sesame seeds, pumpkin seeds, chickpea, Soya beans) Include more juices vegetables as well as fruits

75. DIARRHEA

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Acute diarrhea is an infection Bloody diarrhea is a serious infection Intermittent bouts of diarrhea may be caused by food allergies / parasitic infection High intake of caffeine Increased stress SYMPTOMS Robs body of water and dehydration Excessive fatigue

76. DIETARY MANAGEMENT for DIARRHEA

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Increased fluids Mineral rich foods Low fiber or no fiber juices and fruits Green leafy vegetables Increased potassium intake After the attack include more green leafy vegetables Less of insoluble fibers Bland diet is preferable Fish is good it acts as anti inflammatory omega 3 essential fatty acid and vitamin E which has tissue healing properties

77. DIETARY MANAGEMENT for ULCERATIVE COLITIS

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Dietary management Lowered insoluble fiber (sweet corn, high starchy vegetables such as carrot, turnip) Avoid wholegrains Eliminate simple carbohydrates and sugars Bread, biscuits, cakes, pies, pasta Small frequent meals Increased fluids Vitamin E rich healthy foods

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Do not heat the oil Chemically thermally mechanically bland foods

78. OVERALL YOGIC MANAGEMENT o Satvik food

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Moderation in eating Special technique for GID Come out of strong likes and dislikes Come out of excessive desires Happiness analysis eg. Gulab jamoon Prayers Good postures Good yogic activities Food cooked and served in good atmosphere

79. INTEGRATED YOGA MODULE FOR GASTROINTESTINAL DISORDER

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Breathing exercises Ankle stretch breathing Tiger breathing Straight leg raise breathing Navasana breathing Instant relaxation technique (IRT) Sithilikarana Vyayama (loosening exercises) Jogging Forward and Backward bending Side bending Twisting Pavanamuktasana kriya Quick relaxation technique (QRT)

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Yogasanas Ardhakaticakrasana Padahastasana Parivritta Trikonasana Vakrasana/ Ardha-Matsyendrasana Bhujangasana Salabhasana

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Uddiyana Bandha / Agnisara Nauli kriya Viparitakarani kriya Deep relaxation technique (DRT)

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Pranayama Kapalabhati Vibhaga pranayama (sectional breathing) Nadisuddhi pranayama Sitali/ Sitkari/ Sadanta pranayama Bhramari pranayama Meditation (Dhyana Dharana) Nadanusandhana OM meditation Kriyas Jala Neti Sutra Neti Vamana Dhouti Laghu Sankhapraksalana

82. SPECIFIC PRACTICE

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Yoga aims at curing this problem by altering one's state of mind and helping the person to calm down physically and mentally. When stress does not stimulate excess secretion of gastric juices, the ulcers heal naturally. One also has to eat correctly so that wrong foods do not upset the digestive system. It recommends chewing the food slowly and concentrating on eating. Yoga recommends a high-fiber diet, regular exercise and avoid rushing in the morning.

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Ulcers (peptic or duodenal) General considerations : These problems are often related to stress and life-style. Contraindications : In acute problems we usually avoid the practices which may increase the pain such as Agnisara Dhauti, Kapalabhati, Mayurasana, Shalabhasana or Bhunjangasana. Dhauti (Kunjal) should be avoided because it removes the protective mucus membrane and may irritate the stomach during vomiting. Recommendations : General relaxation and relaxation of the abdominal area. Meditation and calming pranayama in Vajrasana.

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Pancreas (inflammation)

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General considerations : Acute inflammation of the pancreas (pancreatitis) is extremely painful and medical aid should be called immediately. Contraindications : A careful approach, especially with the practices increasing the pressure in the abdominal cavity, is advisable even in people with chronic pancreatitis. Recommendations : Relaxation and meditation practices.

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Colitis General considerations : It is the inflammation of the large intestine. Contraindications : Physically demanding practices strongly pressing or moving the intestines. Recommendations : Meditation and relaxation.

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Kidney and urinary tracts diseases General considerations : Medical advice about the ability to tolerate any exercise is advisable. Contraindications : People with serious kidney diseases and dropsy should avoid excessive intake of water (e.g. during Shankha Prakshalana). People with acute inflammatory diseases of the urinary tract should avoid strenuous physical exercises and inverted asanas. To stop the flow of urine repeatedly during urination may strengthen the sphincters, but it may somewhat increase the risk of an inflammation. To insert a catheter (even a sterile one) in the urethra increases the risk of inflammation more.

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Recommendations : Relaxation and Ujjayi in Shavasana for acute inflammations. Yoga tradition recommends Uddiyana, Agnisara Dhauti, Garudasana, etc. in non-acute problems.

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Gallbladder stones General considerations : Acute problems, especially if associated with inflammation, require medical aid. Contraindications : No practices pressing or moving this area (such as Nauli) are advisable. Recommendations : Proper medical care can be supplemented by relaxation which decreases most types of pain. Laghoo Shankhaprakshalana can be according to Yoga tradition used in non-acute problems.

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Recommended Asanas : Rechaka - Puraka Pranayama Uttanapadasan (Raising the legs) - exercises all abdominal muscles, corrects disorders of pancreas, cures constipation, wind troubles; takes away extra weight of abdominal area. Pawanmuktasan (Relieving the flatus) - activates pancreas; acts as wind reliever, loosens hip joints, and cures constipation. Bhujangasan (Cobra pose) - cures indigestion, constipation, stomachache, brings flexibility to spine.

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Salabhasan (Locust pose) - activates kidneys, liver, pancreas, helps in diarrhea, acidity and gastro-intestinal disorders. Paschim Uttaanasan (Head knee forward bend) - relieves stomach troubles, normalizes functioning of the nervous system. Vajrasan - helps in digestion; relieves pain of calves and knees. Can be done immediately after meals. Shavasan (Corpse pose) - relaxes all muscles, nerves and organs.

91. THANK YOU

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