Introduction

Meditation is a process of healing and restoration of wholeness of mind, body and spirit. The words meditation, medicine and medication, all share the same Latin root medicus, meaning “to cure”. Meditation is probably derived from the same root as the Latin word mederi meaning “to heal”. The word "heal" comes from the Indo-European root "to make whole". Studies have shown how the state of mind affects physical health. For example, anything that promotes a sense of isolation may lead to disease. The premise of meditation practice is that every individual has vast inner resources which, through meditation practice, can be mobilized to assist him or her in their healing.

One of the ancient health systems called Ayurveda, which is actively practiced in India, is a major promoter of meditation. The purpose of Ayurveda is to maximize human potential, defying sickness and aging through specific healing techniques, including the prescription of vegetarian foods, herbs, exercises, massages and meditation. Modern science is now beginning to accept what the ancient mystics and yogis have experienced through ages, concerning the latent healing and rejuvenating powers of man. Yoga, meditation and relaxation, when supplemented with natural foods and vegetarianism, have proven to increase the productivity of the mind and body, and create a state of well-being and inner peace.

Meditation has been practiced and perfected as a health enhancing technique for several thousand years in the Jain, Hindu and Buddhist practices. Meditation practices have also been used within the “Western” traditions, which include Judeo-Christian religious groups, as well as the Native Americans. “Traditional” meditation is based on theoretical and spiritual concepts rooted on ancient Eastern philosophies, while “modern” forms of meditation are concerned with efforts to explain meditation in terms of “western physiology”. The meditation practices that are without cultural or religious aspects were developed primarily for research purposes. Meditation gained widespread attention in the West after Maharishi Mahesh Yogi introduced Transcendental Meditation also known as TM to the United States in 1959. In 1972, Herbert Benson and Keith Wallace published an article in the Scientific American “The Physiology of Meditation” which gave scientific credibility to an ancient spiritual practice that changes the body’s metabolism, reduces stress and all its parameters and even offers a way of treating addictions. This search for healing of a problem, rather than control of symptoms, is one of the greatest draws of alternative medicine, and meditation is no exception to this effect (1,2,3).

The scientific study of meditation and its applications in healthcare has focused on three specific approaches: 1. Transcendental Meditation (TM); 2. The elicitation of the “Relaxation Response”, a generic approach to meditation formulated by Benson (4,5,6);and 3. Mindfulness Meditation, specifically the mindfulness-based stress reduction program developed by Kabat-Zinn (7,8,9).

This chapter is an overview of meditation as a complementary medical approach to the treatment and prevention of health-related problems and for promotion of health. This is intended to assist healthcare providers in giving advice to their patients about meditation. Unlike approaches in complementary medicine such as biofeedback and acupuncture, most meditation practices were developed within various religious and spiritual contexts. However, as a healthcare intervention, meditation can be effectively employed regardless of a patient’s cultural and religious background.

Why meditate?

The main objective of meditation is to bring steadiness to the mind, which, usually remains disturbed as the mind is constantly stimulated by the sense organs, sense objects and countless desires. In order for the mind to be relieved from the disturbance and confusion it needs to slowly move towards calmness, clarity and focus. To do this, one could sit in a solitary place, try to close doors of all sense organs and allow mental distractions to end.

One can make use of the following three key functions to meditation:

1. To curb the existing thoughts and prevent new thoughts from rising in the mind, in order to become thoughtless

2. To have only desired thoughts in the mind

3. To observe thoughts in the mind as a witness

These three functions of meditation are equally important. They are rooted in the roots to three different branches of yoga: Jnana (knowledge), karma (action) and bhakti (devotion).

What is Meditation?

The word meditation has an infinite variety of associations. In the English language meditation is used as a verb “to meditate about, or to meditate upon” implying meditation to be a mental or a cerebral activity. In that sense “to meditate” would be to focus one’s attention exclusively on anything predetermined by the person meditating. In English such activity is called concentration and in Sanskrit it is referred to as “Dharna”,meaning to hold, or sustain attention. Where as meditation, in Sanskrit referred to, as Dhyana is a state of being in which there is an effortless and choicelessawareness of what life is within and around. By this conception meditation is a state of being, not activity. Meditation can be said to be a non-cerebral activity, an activity of the consciousness, , not that part of the brain that is inhibited by conditioning through education, culture, civilization and socioeconomic contents of life. Meditation is the inner journey, the spiritual journey and the journey towards the absolute or the journey towards divine love (10,11). Meditation is a total way of living, not a partial or fragmentary activity. Meditation is not only ideally suited for optimum physical and mental health, but it confers a sense of self-reliance, a sense of harmony with laws of the universe, and an unfolding of one’s latent potentialities, as well as the unfolding of capacities for healing and regeneration.

Meditation includes different kinds of practices, and means something different to different cultures and traditions and includes both concentration and meditation practices. Some of the different forms include:

· Breath meditation

· Mantra meditation

· Vipassana or insight meditation

· Mandala/visual meditation

· Movement meditation, including T’ai Chi, Qigong and Hatha Yoga

· Classic Zen Buddhist meditation

· Classic yoga meditation

· Prayer

· Mindfulness meditation

· Medical meditation as used in stress-reduction clinics and for other medical problems (creativity meditation, or art as meditation (journaling, writing, drawing, sculpting, etc.)

· Guided imagery

· Sufi dance

· Centering prayer

There are three elements basic to most traditional meditation. These elements are:

· A comfortable or poised posture

· An object for attention-awareness to dwell upon

· A passive attitude

There are different meditation traditions and most systems can be grouped into two basic approaches: concentrative meditation and mindfulness meditation. Concentrative meditation focuses attention on the breath, an image, or a sound (mantra). These techniques use a focus of attention towards one point, so that thoughts are no longer scattered and undirected. These meditations use verbal tools, such as mantras, and visual tools, such as mandalas, prayer beads, rosaries or candles to help enhance concentration and focus thoughts. Mindfulness meditation involves opening of attention and awareness to sensations, feelings, images, thoughts, sounds and smells without thinking about them. In other words, practicing meditation is practicing the art of observation, not to interpret, not to analyze, not to compare, not to judge as good or bad but to be aware of the movement of the mind in the same way one is aware of the sunset. One can learn to observe the thoughts as they come by devoting some time to this, by sitting comfortably and quietly in an upright sitting position or lying prone. The core requirement is that the spine and the neck be straight, so that the rhythm of breathing and blood circulation are not disturbed.

We relax to meditate and not meditate to relax

Meditation is not relaxation alone. Relaxation is a necessary component of meditation and is a preparatory step towards meditation, as it becomes a gateway to deep sleep, rest and meditation. It helps to cultivate a restful, alert and focused mind, which then opens the flow of natural life force also referred to as prana, which is the subtlest form of biological energy. This life force is recognized in many cultural traditions; the Chinese know it as Chi and control its flow through acupuncture, meditation and specialized exercises, such as tai chi. In Japanese, this force is referred to ki. If you have seen the movie Star Wars, the Force is the same thing. Depletion or absence of prana is directly linked to aging and death. Prana includes intelligence and consciousness, the two vital ingredients that animate physical matter. Prana flows from spirit, or pure awareness, to bring intelligence and consciousness to every aspect of life.

Relaxation is usually equated with sleep or apathy, while meditation seeks to combine inner peace and awareness. Meditation restores energy and allows it to be used more effectively by causing one to be more mindful of what one is directing it to, thus fostering productivity while reducing tension. Being relaxed is not about avoiding responsibilities; rather, it is about developing skills and abilities to deal with responsibilities free of fears and tensions. The essence of meditation is to transform relaxation from a mechanical health chore to a reminder of personal beliefs, values and commitments conducive to increased calm. In the broadest sense, the art of meditation is to help a person discover a source of inner calm and tranquility in the midst of life’s activities. This quality of relaxation leads to transcendence.

Meditation is a process of harnessing the healing power

Hippocrates said, “The natural force within us is the greatest healer of disease”.

Meditation is a way of harnessing this natural force to maintain health and wholeness. Ancient sages have said that the atman (soul) is the source of all wisdom and from that source alone, streams of wisdom flow into the heart. This flow of wisdom can be achieved only to the extent that the mind remains peaceful and undisturbed.

The mind is a powerful ally in healing the body, and meditation keeps the mind primed. Yogis have believed and proven that our well-being depends on the energy fields within us that are far more subtle than the purely physical one. Of prime importance are the chakras or the spinning centers of etheric energy, which distribute the force throughout our entire being. The etheric energy field consists of a network of energy lines called nadis and where the lines intersect, the spinning energy centers are called the Chakras.

In the Indian tradition there are seven major Chakras, situated at different points on the spine, each spinning at its own rate. The seven are, in ascending order:

1. muladhara (coccygeal)

2. svadhishthana (sacral)

3. manipura (solar plexus)

4. anahata (heart)

5. vishuddha (throat)

6. ajna (brow)

7. sahasrara (head)

As shown in the table below, each of these chakras are associated with a particular physiologic system. For example, the heart chakra is associated with the physical heart and the circulatory system. The chakras are known to contribute energy to specific parts of the body. Meditation practices are known to open each of the chakras and allow the flow of prana or the healing force to circulate in the body, thus acting as energy transformers to distribute the prana energy to the major glands, nerves and organs of the body. The root or the base chakra is the storehouse for the prana energy, also called the kundalini. This kundalini energy has the potential to cultivate and align all of the major chakras with the higher centers; bringing illumination and spiritual enlightenment as the proper sequence of chakras unfold (10).

CHAKRA	PHYSIOLOGICAL SYSTEM	ENDOCRINE SYSTEM
COCCYGEAL	Reproductive	Gonads
SACRAL	Genitourinary	Leydig
SOLAR PLEXUS	Digestive	Adrenals
HEART	Circulatory	Thymus
THROAT	Respiratory	Thyroid
BROW OR THIRD EYE	Autonomic Nervous System	Pituitary
HEAD	Central Nervous System	Pineal

Components of Meditation

Physiotherapeutic breathing

The ancient yoga tradition dedicated to breathing exercises is called pranayama. According to the philosophy of yoga, breathing controls the flow of prana, the cosmic life force, into the body. The nose is believed to be the proper instrument for breathing rather than mouth. Yogic breathing methods teach breathing through the nose, rather than the mouth, and abdominal breathing in a slow and rhythmic pattern, rather than chest breathing. The followers of yoga believe that this form of breathing will facilitate the flow of prana. If you pay close attention to your breathing, you will notice that it varies according to your mood. One breathes differently, for example, when one is happy as opposed to sad, bored as opposed to excited, or calm as opposed to angry. Proper breathing can actually help to control destructive emotions, including anger, hatred, jealousy, grief and frustration.

In general, all meditation practices have the following in common:

1. Awareness of the nasal function and of nasal breathing; encouraged to breathe through the nose

2. Awareness of the rate and rhythm of his/ her breathing; encouraged to practice slowing the breathing process

3. Awareness of the difference between thoracic and abdominal breathing; encouraged to breathe by contracting the diaphragm, rather than by expanding the chest.

All Yogic techniques have certain outcomes, which include a state of deep relaxation in a short time; slowing of the body’s metabolism (physiological process of utilizing oxygen and nutrients) as the oxygen is consumed; and a decrease in carbon dioxide production, respiratory rate, heart rate and blood pressure. In addition, lactic acid, a substance produced by the metabolism of skeletal muscles and associated with anxiety and tension, is reduced. There is an increase in the intensity and frequency of alpha brain waves, which are present with deep relaxation, and a change in state of arousal and awareness (13).

Cognitive Processes

Cognitive processes are ways to assimilate information. Cognitive structures are the beliefs, values and commitments that underlie thoughts, speech and actions. Three cognitive processes are integral to initiating the process of meditation. 1. Focusing is the ability to identify, differentiate, maintain attention on, and return attention to simple stimuli for an extended period. 2. Passivity is the ability to stop unnecessary goal-directed and analytic activity. 3. Receptivity is the ability to tolerate and accept experiences that may be paradoxical, uncertain, or unfamiliar (14).

Manifestations of Meditation

Understanding the mind body connection

More than two thousand years ago, Galen observed that tumor growth was more pronounced in melancholy women than in sanguine women. Thus, the seed of the idea that mental processes and emotional status are linked with physical health and disease have long been planted. An important advancement in constructing a scientific framework for understanding the pathways came with Cannon (1914) and Hans Selyes’s (1934) description of the body’s responses to and defenses against a variety of stressful stimuli. Cannon coined the term ‘flight or fight’ response, which is associated with a series of physiological reactions triggered when faced with a threatening environmental situation, which includes dilation of pupils, increased blood pressure, increased respiratory rate, and heightened motor excitability. This mimics the increased sympathetic nervous system activity.

The terms “stress” and “stress syndrome” were first adopted some 66 years ago by Hans Seyle who, in an article in the science journal Nature, described a series of pathophysiological changes which typically develop in the rat following exposure to noxious stimuli as diverse as physical (cold, surgery), chemical (morphine, adrenaline) or emotional challenges (15).

The anterior pituitary gland and its control center in the brain, the hypothalamus, together constitute the classical neuroendocrine system, which play an important role in controlling the release of stress hormones, especially the powerfully immunosuppressive glucocorticoids, which can then communicate with the cells of the immune system whether they be moving within the circulation or static in the primary and secondary lymphoid tissues. The products of the immune system can “talk” to the neuroendocrine tissues. The hypothalamus is also a critical modulator of the behavioral responses to stress and of the autonomic nervous system, which is activated by stress and innervates tissues of the immune system. Stress hormones have a crucial role in maintaining body homeostasis in the face of an ever-changing external and emotional environment. If present at raised levels for prolonged periods, these hormones become immunosuppressive, thus predisposing an individual to a variety of diseases, including infection, autoimmune disorders, inflammatory diseases and cancers (16).

Relaxation response

Individuals possess an opposite, alternative response: the relaxation response that counteracts the effects of stress. The relaxation response is believed to be an integrated hypothalamic response that results in generalized decreased sympathetic nervous system activity and this response consists of changes opposite those of the fight or flight reaction. Hess called this response the “trophotropic response”. When he stimulated cats with electrical stimulation of the hypothalamic area, the response resulted in decreased blood pressure, decreased respiratory rate, and pupil constriction (17). The major physiological elements of relaxation response were first defined in humans during the practice of Transcendental Meditation: decreased oxygen consumption, carbon dioxide elimination, and changes in heart rate, respiratory rate, minute ventilation, and arterial blood lactate. Systolic, diastolic and mean blood pressures remained unchanged compared to control levels. Rectal temperature also remained unchanged, whereas skin resistance markedly increased and skeletal muscle blood flow slightly increased. The electroencephalogram demonstrated an increase in the intensity of slow alpha waves and occasional theta wave activity. These changes are consistent with generalized decreased sympathetic nervous system activity and are distinctly different from physiological changes noted during quite sitting or sleep. These changes occur simultaneously and are consistent with those noted by Hess.

Physiologic manifestations

Marked metabolic and circulatory changes accompany transcendental meditation, especially in long-term practitioners. Virtually none of the effects could be reproduced by sleep and unstylized eyes-closed rest. Jevning and others propose that the metabolic changes are probably mediated by circulating plasma effectors, and comprise an “integrated meditation response” (13). There appears to be a patterned physiological response of an overall decreased muscle mass, red cell metabolism, as well as decreased thyroid and adrenocortical hormone secretion. Electro physiologically, increased galvanic skin resistance, is inversely related to stress. These manifestations include increased cardiac output, probable increased cerebral blood flow, increased plasma rennin and prolactin, and decreased carbon dioxide generation by muscles. In brief, these findings emphasize that meditation may result in beneficial changes in physiologic parameters, such as levels of adrenal hormones, platelet aggregation, autonomic tone and balance, blood pressure brain biochemistry and cerebral blood flow.

Evidence based clinical usefulness

Reductions in arousal through meditation or relaxation can be manifested in at least three ways; behaviorally, physiologically and through self-report. Relaxation response based studies at the Mind/Body Medical Institute suggest that relaxation based techniques can reduce the nausea and fatigue associated with chemotherapy, decrease insomnia, ease hot flashes, and increase fertility in women with fertility problems. Studies by Benson and others have shown that meditation can lower blood pressure in hypertensive patients (18). Meditation may also be an effective complementary treatment for coronary artery disease (CAD). CAD patients practicing TM showed significant increase in exercise tolerance, maximal workload, and delay in the onset of ST-segment depression compared to controls. Dean Ornish’s programs on reversal of heart diseases include meditation as the central component (20).

Meditation has been effective in the treatment of chronic pain. Chronic pain patients have reduced their physician visits by 36 percent

. Mindfulness meditation facilitated significant reduction in pain symptoms, psychologic pain and pain-related drug use. The reduction in pain with meditation may be attributed to the hypo-arousal and cultivation of detached and decreased attention to the cognitive-emotional alarm reactions to painful sensations. The emotional and cognitive components of the pain experience are lowered, in patients trained in meditation resulting in less suffering and distress (21,22).

A variety of exercises were developed for these patients who suffer from chronic obstructive pulmonary disease (COPD), including emphysema and cystic fibrosis. , These included practicing pranayama (a special breathing technique) and other yogic meditative technique. These patients have demonstrated fewer asthma attacks, less shortness of breath, and greater control over their breathing (23).

Psychologic and Cognitive Manifestations

Meditation can help reduce symptoms of anxiety and anxiety- related disorders (24). Practitioners of all forms of relaxation, whether it be autogenic training, breathing, or Zen meditation, are essentially doing the same thing: honing and refining their ability to attend to a limited stimulus; ceasing unnecessary goal-oriented and analytic activity; and tolerating and accepting experiences that may be uncertain, unfamiliar and paradoxical.

Spiritual Benefits of Meditation

When individuals practice meditation for over six to seven weeks, they observe a shift toward personal and spiritual growth. Many individuals who initially learn meditation for its self-regulatory aspects find that as their practice deepens, they are drawn more and more into the realm of the "spiritual." The daily development of spiritual integration involves such factors as competent self care, stress management, clarification of spiritual beliefs and the discipline of spiritually enhancing practices. Being aware and respectful of one’s body by providing healthy food, exercise and rest supports the work of the physician. Meditation practices also gives one the power to change ones attitudes, beliefs, and therefore ones reaction in addition to making physical improvements. Meditation practices influence physical, mental, social and spiritual well-being. Joan Borysenko and Deepak Chopra, pioneers in the mind-body connection, have observed in many cancer and AIDS patients that most are interested in meditation as a way of becoming more attuned to the spiritual dimension of life. Borysenko reports that many die "healed," in a state of compassionate self-awareness and self-acceptance (25,26).

Meditation: Myths and Misconceptions

There has been a false impression in Western society that meditation is connected to Eastern mysticism, that by practicing meditation one might be doing something against God, that meditation is somehow a sin. It is true that meditation is embraced, professed and perfected in the East, but it can be found in all world religions, and it was this spiritual omnipresence that prompted Benson and Wallace to research it initially.

Prescription, Warnings and Precautions

It is recommended that concentrative meditation exercises should be avoided by individuals whose reality-testing function is poor, who are strongly paranoid, or who are likely to develop delusions of grandeur from the altered states of consciousness that these practices tend to produce. People with overwhelming anxiety should probably avoid insight meditations. Long periods of meditative practice (as in contemplative meditation) may precipitate psychotic episodes in susceptible individuals. Meditation practices may need to be closely monitored in patients with mental disorders. As emphasized throughout in complementary medicine, a patient’s health and well being encompasses more that just his or her physical health. Consequently, in order to treat the physical maladies manifested by psychological stress, one must consider the impacts on the patients’ mental, social, and spiritual health. Therefore, meditation and relaxation exercises are a valuable adjunct to our current therapies, and they are also useful as a preventive measure as these offer an appropriate solution that includes all aspects of health. These exercises are effective, readily available, and have no side effects; yet, their incorporation into medical practice is slow. Merely studying meditation as with exercise, will not produce the outcomes described here; practice and experience are essential . Familiarity with the simplicity and practice of these exercises tends to clear up misunderstandings, thus demystifying them. Probably the safest course for those in the healing professions is to experiment with meditation practices for themselves, and then share with clients and friends those they thoroughly understand. With all the advantages of meditation one of the challenges following the saying “time is money”, most people do not feel that they have time to meditate or relax. In this case the physicians could encourage the patients to consider the wisdom of Earl of Derby: “those who cannot find time for bodily exercise will sooner or later have to find time for illness.” (27)

APPENDIX

Relaxation Response

1. Pick a focus word or short phrase that's firmly rooted in your belief system. The repeat word could be a word, sound, prayer, phrase, or muscular activity. (You can use a religious or other word that means something to you or you can use a neutral word such as: one, ocean, love, peace, calm, relax).

2. Sit quietly in a comfortable position.

3. Close your eyes.

4. Relax your muscles.

5. Breathe slowly and naturally, and as you do, repeat your focus word, phrase, or prayer silently to yourself as you exhale.

6. Assume a passive attitude. When other thoughts come to mind, simply say to yourself, gently return to the repetition.

7. Continue for ten to twenty minutes.

8. Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then, open your eyes and sit for another minute before rising.

9. Practice this technique once or twice daily.

Source: Herbert Benson. Timeless Healing. New York, NY; Simon and Schuster, 1990.

Mindfulness Meditation

This stress reducing technique calls for meditating on different parts of the body to relax the mind. It can be done everyday. Set aside 30-45 minutes for this exercise.

1. Lie down on your back, with your legs uncrossed your arms along your sides, palms facing up. Close your eyes.

2. Become aware of your breathing, feeling your breath flow in and out of your body, noticing sensations at your nostrils, your chest or abdomen.

3. Now, start to focus on the toes of your left foot. Notice what you feel as you remain aware of your breathing. Continue for at least 1 to 2 minutes. If you get distracted, return here.

4. As you exhale, shift your focus to the bottom of your left foot as you continue to be aware of your breathing. Stay here for 1 to 2 minutes.

5. Now, move to the top of your left foot, and do the same as before. Eventually, move up your left ankle, lower leg, knee, thigh, and hip. Then, go back to the toes of your right foot, and start moving up from there.

6. Once you return to the hip, move up through hips, the genitals, the buttocks, and the rectum. Proceed up to the lower back, the abdomen, the upper back, ribs, chest, shoulder blades and shoulders.

7. From the shoulders, move out to the fingers and hands on both sides (you can do both hands at same time), and then move up to the wrists, forearms, elbows, upper arms, and return to the shoulders.

8. From the shoulders, move up to the neck, and then proceed to the head. Start with your face, focusing on the jaw, and move to the lips, teeth, gums, roof of your mouth, tongue, back of the throat, cheeks, nose, ears, eyes, eyelids, territory around the eyes, eyebrows, forehead, temples, scalp, and rest of the cranium.

9. Having reached the top of your head, imagine exhaling through it. Then, imagine inhaling through the bottom of your feet and again exhaling through the top of your head. Do this for a few minutes.

10. Let go of any focus on the body and be aware of breathing at no particular location.

11. Let go of the focus on breathing, and pay attention to whatever enters your awareness at the moment, whether thoughts, sensations of any sort, feelings, sounds, or silence. Perceive what they are, and let go of them, remaining in the moment.

Source: Kabat-Zinn J. Full catastrophe Living. New York, NY; Doubleday &Co, Inc; 1990.

GLOSSARY

Mindfulness is a form of meditation originally developed in Buddhist traditions of Asia but practiced today by many, from meditations in monasteries to physicians in stress-reduction clinics. Mindfulness can be defined as awareness of each moment as it occurs.

Yoga, from the Sanskrit root yuj, meaning “to yoke or join together,” is a 5,000-year-old method of mind-body health with a goal of enlightenment. It has many paths or methods:

· Karma yoga, which emphasizes action and service to others

· Bhakti Yoga, which emphasizes love of God

· Jnana Yoga, which emphasizes intellectual striving

· Hatha Yoga, which emphasizes balance through physical and mental exercise

· Raja Yoga, which emphasizes techniques for controlling mind and body, including exercises, breathing and relaxations techniques, and meditation

· Yama (moral commandments)

· Niyama (self-purification)

· Asana (posture)

· Pranayama (rhythmic breath control)

· Pratyahara (sense withdrawal)

· Dharna (concentration)

· Dhyana (meditation)

· Samadhi (higher unitive consciousness

Yogi is someone who practices yoga.

Chakras are psycho-physical-spiritual centers of energy that exist between the base of your spinal column and crown of your head, according to yogic thought. Chakras are often described as the centers where astral or subtle body and physical body converge, where mass is converted to energy and vice versa.

Mantras, wards chanted during meditation, resonate within the body and the Chakras. The chanted words evoke and release specific energies.

Prana, chi, ki are all names for life force energy that animates the body and the universe, and which when unblocked and properly directed, can help the body to heal itself.

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