Nadishodhana pranayama: unveiling the healing power within

ISSN 2397-5628 Journal of Geriatric Care and Research 2024, Vol 11, No 1 Review Nadishodhana pranayama: unveiling the healing power within Suman Rawat, Apar Kaushik, Saamdu Chetri Abstract Various yogic texts delve into the intricacies of pranayama. Ayama, signifying "control" or "elongation," Background: Pranayama or yogic breathing exercises and prana, denoting "vital force" or "energy" coursing incorporate nadishodhana pranayama (alternate nostril through the body, facilitate optimal physiological breathing) helps purifying the body's energy channels and functioning.4 Prana also encompasses pranic capacity or ensuring optimal vital energy flow. Aims: It was intended length, with specific techniques known as kumbhaka to review the literature about the therapeutic potential of detailed in yoga scriptures. These include suryabhedana, nadishodhana pranayama in managing a range of chronic ujjayi, sheetali, sitkari, bhastrika, bhramari, moorcha, illnesses. Methods: A comprehensive search on PubMed, and plawani. Through pranayama, practitioners gain Google Scholar, and the Ayush Portal was conducted, insight into and mastery over the pranic processes within utilizing relevant terms such as nadishodhana the body. The breath serves as a conduit for prana intake, pranayama, anuloma-viloma, or alternate nostril emitting vibrations that impact the entirety of our being. breathing, and therapeutic effects, yielded 84 results A fundamental bodily function, breathing is intricately among 14 papers published between 2011 and 2022 were linked to the brain and central nervous system, with pertinent for inclusion. The selection process involved potential ties to the hypothalamus, responsible for meticulous scrutiny to identify the most relevant and regulating emotional responses.5,6 Given its purifying influential works in the field of yoga. Results: effects on the nadis (pranic channels), nadishodhana Nadishodhana pranayama favourably impacts the pranayama (alternate nostril breathing) is recommended autonomic nervous system, reducing sympathetic activity by Hatha yoga,7 before commencing the primary eight and increasing parasympathetic discharge. It demonstrates types of pranayama. Notably, nadishodhana pranayama therapeutic efficacy in various conditions, enhances exerts positive influences on the autonomic nervous oxygenation, reduces metabolic rates, and promotes system, evidenced by reduced metabolic rates, increased relaxation. Conclusion: Nadishodhana pranayama parasympathetic discharge, and diminished sympathetic emerges as a valuable tool for balancing the autonomic discharge.8 nervous system through its beneficial impact on the hypothalamus. With its broad therapeutic benefits, it can This review aims to summarize findings from seminal be safely integrated into treatment regimens for chronic papers and authentic yoga textbooks on how the practice ailments, provided proper technique is applied. This of nadishodhana pranayama can help in addressing and review underscores its significance as an adjunctive managing a wide range of illnesses and disorders such as therapy in managing various health conditions. sinusitis, asthma, premenstrual syndrome, hypertension, stress, depression, dysmenorrhea, stroke, migraine, and Keywords post-coronary artery bypass grafting rehabilitation. Anuloma-Viloma, Alternate Nostril Breathing, Nadishodhana Methods Pranayama, Therapeutic Effects We conducted a thorough literature review using databases including PubMed, Google Scholar, and the Introduction Ayush Portal to explore the therapeutic potential of nadishodhana pranayama. Keywords such as Yoga, a practice with a legacy spanning over 5,000 years, nadishodhana pranayama, alternative nostril breathing, encompasses intellectual, spiritual, and ascetic anuloma – viloma pranayama, and therapeutic effect of dimensions, comprising asana, pranayama, and nadishodhana or anuloma- viloma were employed in our meditation. With the rising prevalence of chronic illnesses search, yielding a total of 84 research papers. Through such as obesity, hypertension, coronary artery disease, careful screening of titles and abstracts, we narrowed and diabetes mellitus, yoga has gained traction as a down our selection to 35 papers that merited further complementary and alternative medicine (CAM) in recent examination. Among these, only 14 were deemed the years.1,2,3 Moreover, Hatha yoga is widely acclaimed for most pertinent and served as the primary basis for this its efficacy in addressing a broad spectrum of review (Fig 1). Additionally, we prioritized authentic physiological and psychological issues. textbooks in our review process. 21 Rawat et al, 2024 Results air from the lungs into the atmosphere; and kumbhaka, the breath-holding stage. However, the breath-holding stage The therapeutic effects of nadishodhana pranayama are has been eliminated in modern times. presented below by providing an overview of pranayama in general based on yogic texts. This is followed by a According to Swami Svatmarama, thorough cleansing of detailed description of nadishodhana pranayama, also the nadis is necessary for proper retention of air, or prana known as anuloma-viloma or alternate nostril breathing. vayu, to the essential degree. Thus, as per the text, then The role and applications of nadishodhana Hathayoga pradipika's exposition, the eight kumbhakas pranayama in managing various health conditions are should only be practiced after sufficient nadishodhana- systematically discussed in the core results section. The specific pranayama. Nadishodhana pranayama, also findings related to each condition are described, known as anuloma-viloma, is essential for this purpose. highlighting the specific benefits and therapeutic Nadishodhana pranayama/ anuloma-viloma or mechanisms. Relevant studies supporting the efficacy of alternative nostril breathing this pranayama practice across different ailments such as respiratory illnesses, gynaecological problems, It is a method for purifying the nadis, the pathways hypertension, mental health disorders, etc. are presented. through which prana flows. Traditionally, nadishodhana pranayama commences with a gentle exhalation from the left nostril, succeeded by puraka, or controlled inhalation, Fig 1. procedure for choosing research papers through the same nostril. Subsequently, practitioners engage in kumbhaka or breath retention. Following kumbhaka, exhalation through the right nostril ensues, as portrayed in Fig. 2(a), marking the completion of half of one cycle of nadishodhana pranayama. The second phase entails inhaling through the right nostril, initiated from the same nostril used for exhalation in the first phase. Once again, kumbhaka is practiced. Exhalation post-kumbhaka is directed through the left nostril, as depicted in Fig. 2(b). This concludes the cycle of nadishodhana pranayama. In certain medical contexts, kumbhaka or breath retention is omitted due to potential risks if not executed correctly. Hence, subsequent yoga literature refers to nadishodhana pranayama without kumbhaka as anuloma-viloma. Therapeutic effects The yogic breathing practice of nadishodhana pranayama has demonstrated beneficial effects on the autonomic nervous system, including a reduction in metabolic rate, decreased sympathetic discharge, and increased parasympathetic discharge.8 This rhythmic breathing technique facilitates thorough cleansing of the nasal passages and lungs, aiding in the healing of minor respiratory infections and optimizing blood oxygenation.11 Research findings indicate that slow breathing significantly lowers heart rate,12 with studies showing a substantial decrease after six weeks of consistent practice. Individuals who engage in yoga also exhibit lower heart rates.13 Moreover, practitioners can easily adjust the pace and rhythm of nadishodhana pranayama,14 which has been shown to correct neurological processes, alleviate Pranayama emotional tension, and promote feelings of rejuvenation Pranayama, as per Maharshi Patanjali, entails breath and and relaxation,15 exhalation control.9,10 The kumbhakas and pranayamas This review highlights the therapeutic potential of listed in the Hatha yoga Pradipika include suryabhedana, nadishodhana pranayama, also known as anuloma- ujjayi, shitali, sitkari, bhastrika, bhramari, murcha, and viloma pranayama, in treating various ailments, including plawani. Additionally, the Gheranda Samhita lists sahita, sinusitis, rhinosinusitis, premenstrual syndrome, suryabhedana, ujjayi, shitali, bhastrika, bhramari, hypertension, stress, depression, asthma, dysmenorrhea, murcha, and kevali pranayamas.10 The three steps of stroke, migraine, and post-coronary artery bypass grafting pranayama are puraka, involving a deep, slow, and (CABG). A summary of these findings is provided in prolonged inhalation; rechaka, the expulsion of unclean Table 1. 22  Journal of Geriatric Care and Research Fig 2 Cycle of nadishodhana pranayama: (a) first half (b) second half Role of nadishodhana pranayama in chronic in the pre-menstrual syndrome (PMS) group practicing rhinosinusitis anuloma-viloma pranayama, as well as in another group engaging in asanas.19 A comparative study evaluating the effectiveness of pranayama (anuloma-viloma and suryabhedana) and In a four-week comparative study, both yogasanas and nasal irrigation (jala-neti) in treating rhinosinusitis the anuloma-viloma pranayama technique were found to revealed significant improvements in symptom frequency be highly effective in adult women, reducing pain, and sinonasal outcome test scores. Nadishodhana alleviating the severity of dysmenorrhea, and enhancing pranayama was found to substantially alleviate symptoms quality of life (QOL).21 These studies underscored the such as nasal congestion, sneezing, runny nose, coughing, important role of anuloma-viloma or nadishodhana postnasal discharge, and thick nasal discharge associated pranayama in alleviating premenstrual syndrome, with chronic rhinosinusitis. When practiced in dysmenorrhea, and menstrual symptoms. conjunction with other therapies, anuloma-viloma pranayama strengthens the respiratory system and aids in Application of anuloma-viloma pranayama in the purification of the nadis,16 offering effective relief for hypertension chronic rhinosinusitis symptoms. In a case study on a 50-year-old male patient with Role of nadishodhana pranayama in asthma prehypertension and no other major health issues, it was observed that practicing anuloma-viloma pranayama led According to a study, practicing anuloma-viloma to a gradual reduction in both systolic and diastolic blood pranayama for four weeks has been identified as a potent pressure readings. The baseline elevated blood pressure in treatment for reducing the severity of dyspnoea (shortness the morning and evening, decreased to normal ranges in of breath); and is recommended for preventing acute both morning and evening readings by the 30th day of severe asthma,17 Similar results were obtained in a study practicing this pranayama technique. Alongside the where one month of anuloma-viloma pranayama practice reduction in blood pressure, the patient also experienced a significantly reduced dyspnoea in 20 patients with notable decrease in stress levels and an enhancement in bronchial asthma. The study found that practicing sleep quality.22 anuloma-viloma pranayama for one month significantly reduced dyspnoea and improved lung function in patients In another study, pregnant women at risk for pregnancy- with bronchial asthma. There was a notable decrease in induced hypertension (PIH) were divided into two groups: the dyspnoea scale score as well as a significant increase one practicing pranayama during the first trimester and in the forced expiratory volume in the first second (FEV1) the other without pranayama practice. Those in the score after the pranayama intervention.18 pranayama group exhibited a significant decrease in the luteinizing hormone/follicle-stimulating hormone (LF- Role of nadishodhana pranayama in mitigating pre- HF) ratio, a sensitive indicator of sympathovagal menstrual syndrome and primary dysmenorrhea imbalance, compared to those in the control group, who did not start pranayama until the second trimester.23 This A study revealed that all metrics indicating abnormally reduction was associated with a decline in high baseline sympathetic activity, including heart rate cardiometabolic risks and improved predictability of (HR), systolic and diastolic blood pressure (SBP, DBP), hypertension status. Hence, it may be concluded that electromyogram (EMG), galvanic skin response (GSR), anuloma-viloma is beneficial in managing hypertension and respiratory rate (RR) exhibited a significant decrease and is safe to practice. 23 Rawat et al, 2024 Table 1: Selected articles and findings Ref Study type Disorder Duration Intervention Variables Findings 19 Comparative PMS 7 days Group A – no SBP, DBP, There was a highly study intervention HR, EMG, significant Group B – GSR, RR, difference between anuloma viloma Temp the PMS sufferers Group C - asanas exercising yoga (uttanasana, activities (groups B adhomukha and C) and the svanasana) control (group A). While there was no significant change in RR across the groups, there was a highly significant difference in HR, SBP, DBP, EMG, GSR, and Temp. 17 Pre-post test Asthma 1 month Anuloma viloma FEV1, Anulom vilom pranayama Dyspnoea significantly reduced the severity of dyspnoea when practised for four weeks. 24 Pre-post test Stress in alcohol 10 days Anuloma viloma GSR After practising yoga dependence (with holding) breathing techniques, vs Control group both patients with chronic alcohol dependence and controls showed decreased stress levels as measured by GSR. 25 Quasi- Depression 3 months Anuloma viloma Geriatric Breathing exercises are experimental and bhramari depression not as helpful as design pranayama scale pranayama in reducing vs traditional depression. breathing such as deep breathing, pursed lip breathing 22 A case study Prehypertension 1 month Anuloma vilom BP Both the systolic and diastolic blood pressure measurements gradually dropped. 20 Experimental Primary 1 month Group A – Pain rating The three yoga asanas pilot study dysmenorrhea Yogasana scale, and anulom vilom Group B- severity, pranayama approach are Anuloma vilom QOL effective in alleviating Group C- pain, the severity of Combination of dysmenorrhea, and Asanas and improving QOL, with a pranayama significant increase in the group performing both methods 16 Comparative Chronic 1 month Group A – Jala Measure of Significant post- study rhinosinusitis neti followed by symptom intervention improvement kapalbhati severity, in the frequency of Group B – symptom symptoms and sino-nasal suryabhedana frequency outcome scores in both and anuloma the kriya and pranayama villoma groups. pranayama 24  Journal of Geriatric Care and Research Ref Study type Disorder Duration Intervention Variables Findings 23 Pre-post test Pregnancy- 12th week anulom viloma BMI, BHR, In the first trimester induced of pranayama (with SBP, DBP, recordings, there was a hypertension gestation kumbhak) v MAP and significant difference in to delivery control who did RPP BMI, BHR, SBP, DBP, not practice MAP, and RPP between pranayama the study group and control group. All the metrics were significantly lower in the study group compared to the control group in the second and third trimesters. Pranayama practised in pregnant women improved cardiovascular parameters. 26 Pre-post Stress 6 months anuloma vilom Expanded Stress levels of the nurses design Nursing were significantly Stress Scale reduced by the anuloma and viloma pranayama 18 Prospective Chronic asthma 1 month anuloma vilom Dyspnoea, After practising anuloma study pranayama FEV1 viloma pranayama for a month, there was a noticeable decrease in dyspnoea and an increase in FEV1. 27 Experimental Stroke 10 rounds nadishodhan Functional The ability to complete an study at one pranayama Mobility activity requiring time (without functional mobility was kumbhak) enhanced in stroke patients. 21 Randomized Primary 2 Group A- Pain, QOL Group A (nadishodhan) control trial dysmenorrhoea menstrual nadishodhan experienced significantly cycles pranayama better QOL and pain Group B- scores than Group B kapalbhati (kapalbhati). 28 Experimental CABG 6 months nadishodhan Depression, Nadi-shodhana study pranayama (with Anxiety, pranayama, when kumbhak) Stress, PEFR combined with traditional physical therapy, improves lung capacity and lowers stress, anxiety, and depressive symptoms in patients who have had CABG. 29 Randomized Migraine 3 months Intervention: Anxiety and The majority of migraine clinical trial nadishodhan migraine (ardhwabhedaka) pranayama symptoms complaints were (without kumbhak) alleviated in both groups; and dhyana, medication only 1st however, the intervention month group showed better Control: Yogic results. practice, no medication BHR: Bronchial hyperresponsiveness, BMI: Body mass index, BP: Blood pressure, CABG: Post Coronary Artery Bypass Grafting, DBP: Diastolic blood pressure, EMG: Electromyography, FEV1: Forced expiratory volume in first second, GSR: Galvanic skin response, HR: Heart rate, MAP: Mean arterial pressure, PEFR: Peak Expiratory Flow Rate, PMS: Pre-menstrual syndrome, QOL: Quality of life, RPP: Rate pressure product, RR: Respiratory rate, SBP: Systolic blood pressure, Temp: temperature 25 Rawat et al, 2024 Contribution of anuloma-viloma in mental disorders conditions like sinusitis,16 asthma,17,18 and improving lung function.18 The rhythmic breathing pattern facilitates the In a 10-day study, the stress levels of patients with cleansing of the respiratory passages and enhances chronic alcohol dependence were assessed before and oxygenation, making it a valuable adjunctive therapy for after anuloma viloma using galvanic skin resistance; respiratory disorders. which was compared with the control group. The stress levels of both groups decreased following the Nadishodhana pranayama has also shown promising intervention. Furthermore, the results of this research results in addressing gynaecological issues such as illustrated that regular pranayama practice positively premenstrual syndrome and dysmenorrhea.19,20,21 By impacts stress reduction and the development of reducing sympathetic activity and promoting relaxation, relaxation skills in patients undergoing rehabilitation and this practice effectively mitigates the associated treatment.24 symptoms and improves QOL. According to another study, pranayama (anuloma-viloma Furthermore, the review highlights the potential of and bhramari pranayama) were more effective than nadishodhana pranayama in managing hypertension,22,23 breathing exercises in reducing depression in a geriatric a significant risk factor for cardiovascular diseases. The population.25 A statistically significant stress reduction ability of this practice to modulate the autonomic nervous was observed in nurses after practicing anuloma-viloma system and reduce sympathetic discharge contributes to for six months.26 Another study demonstrated rapid its antihypertensive effects. improvement in functional mobility tasks among stroke patients who practiced nadishodhana pranayama.27 Mental health disorders, including stress, depression, and Patients who had undergone a coronary artery bypass anxiety, have also been targeted by nadishodhana graft (CABG) experienced less depression, anxiety, and pranayama interventions.24,25,26 The calming effects of stress after six months of nadishodhana pranayama in this practice on the nervous system and its potential to addition to traditional physiotherapy.28 influence the hypothalamus, a key regulator of emotional responses, underlie its therapeutic benefits in this domain. Role of nadishodhana pranayama in migraine Additionally, the review encompasses studies Nadishodhana pranayama and dhyana (meditation) have demonstrating the efficacy of nadishodhana pranayama demonstrated efficacy in alleviating symptoms of in stroke rehabilitation,27 post-coronary artery bypass ardhwabhedaka (migraine) by positively affecting the grafting recovery,28 and migraine management.29 These agya chakra (hypothalamo-cerebral system). Combining findings underscore the versatility of this practice and its nadishodhana pranayama with dhyana has been shown to potential as a complementary therapy across diverse significantly reduce migraine symptoms.29 clinical scenarios. Precautions and adverse effects Limitations Incorrect and unsystematic execution of yogic practices While the review presents compelling evidence for the may lead to increased physical disturbances, while proper therapeutic benefits of nadishodhana pranayama, certain and systematic practice activates greater pranic (vital life limitations should be acknowledged. Many of the force) capacity, thereby eliminating abnormalities and included studies have relatively small sample sizes, dysfunction in the physical body. Erratic or incorrect limiting the generalizability of the findings. Additionally, practice may result in conditions such as hiccups, some studies lack robust randomization and control wheezing, coughing, headaches, and discomfort in the groups, which may introduce potential biases. ears and eyes.30 If left unchecked, these conditions can become chronic, and conventional medicines may fail to Another limitation lies in the variability of intervention provide lasting relief unless the underlying disturbance in protocols and outcome measures across studies, making prana vayu (subtle energy) is addressed. direct comparisons challenging. Standardized protocols and validated outcome measures would enhance the Discussion interpretability and comparability of results. The present review systematically examined the Moreover, the mechanisms underlying the observed therapeutic potential of nadishodhana pranayama, a effects of nadishodhana pranayama on various yogic breathing technique, across various health physiological and psychological parameters require conditions. The findings suggested that this practice further elucidation. Future research should delve deeper exerts beneficial effects on the autonomic nervous system into the underlying neurophysiological and biochemical by reducing sympathetic activity and increasing processes to better understand the therapeutic mechanisms parasympathetic discharge.8 This modulation of the of the practice. autonomic nervous system contributes to the therapeutic efficacy observed in managing diverse ailments. It is also crucial to consider potential adverse effects or contraindications associated with nadishodhana Several studies have demonstrated the efficacy of pranayama, particularly in specific patient populations or nadishodhana pranayama in alleviating respiratory individuals with certain medical conditions. While the 26  Journal of Geriatric Care and Research review mentions precautions, more comprehensive safety Funding: None data are warranted. Received: 3 Mar 2024; Revised: 25 Mar 2024; Accepted: 26 Mar 2024 Lastly, long-term follow-up studies are needed to evaluate Copyright © 2024 The Author(s). This is an open-access article distributed the sustained effects of nadishodhana pranayama and its under the terms [CC BY-NC] which permits unrestricted use, distribution, potential role in disease prevention and health promotion. and reproduction in any medium, provided the original author and source are credited. Conclusion Citation: Rawat S, Kaushik A, Chetri S. Nadishodhana pranayama: unveiling the healing power within. Journal of Geriatric Care and Research, Based on the review, the major findings highlight the 2024, 11, 1: 21-28. therapeutic potential of nadishodhana pranayama across various conditions. This yogic breathing practice has References shown efficacy in managing respiratory conditions like 1. Jayawardena R, Ranasinghe P, Ranawaka H, Gamage N, sinusitis and asthma, alleviating gynaecological issues Dissanayake D, Misra A. Exploring the therapeutic benefits of such as premenstrual syndrome and dysmenorrhea, pranayama (yogic breathing): a systematic review. lowering hypertension and associated cardiovascular International Journal of Yoga. 2020 May;13(2):99-110. risks, reducing stress, depression, and anxiety, aiding in stroke rehabilitation and post-coronary artery bypass 2. Kuppusamy M, Kamaldeen D, Pitani R, Amaldas J, grafting recovery, and mitigating migraine symptoms. By Shanmugam P. 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