Author's Note: Part 1 of this article looks at breathing practice from the perspective of Chinese medicine; part 2 (next issue) recounts some of the exciting findings from modern breath research.
We all want to find ways to help our patients better navigate their health challenges, and offering them tools they can take away and make their own are especially desirable. One of the simplest and most powerful of these is slow, deep, lower abdominal breathing. It has been practiced in Asian self-cultivation traditions (for example, qigong, yoga and meditation) for millennia to enhance physical, mental and emotional well-being, and is the subject of ever-growing research in the modern world. It can easily be taught to patients, although as always it is best to practice it oneself for a while first.
Problem: Uprising Yang Qi
When I first studied in China in the early 1980s, one of my teachers laughingly said that the human body has two design faults – it is both vertical (rare in the animal world) and alive. Being alive, it has yang qi, whose natural tendency to rise is exacerbated by our narrow and upright frame. On a physical level, excessive uprising of yang can give rise to a host of symptoms and diseases; for example, headaches, dizziness, high blood pressure, strokes, sense organ diseases and more. At the same time, the lower body can become weak, uncoordinated and unrooted, leading to physical insecurity and a greater tendency to fall. This "fullness above and emptiness below" tends to increase as we age and our innate yin declines.
On a mental and emotional level, uprising of yang qi can easily agitate the heart-mind, leading to anxiety, restlessness, insomnia, worry, nervousness, fear, and an unstable and ungrounded shen. It can affect people at any age.
Solution: Descend the Qi
The solution in the Chinese self-cultivation tradition is to descend the qi. We do this physically during "internal method" practice (e.g., qigong) by lowering our center of gravity – releasing the knees and allowing the lower body to settle down into our "root" in the Earth. And we do it energetically by descending the breath to the dantian ("field of elixir") deep in the core of the lower abdomen. The effect is to pacify the mind and allow heart fire to sink into and rest in the cooling embrace of kidney water.
Engaging the Diaphragm
What is now called diaphragmatic breathing in modern medicine is increasingly widely taught. The conventional method is to sit in a chair and place one hand on the chest and the other hand on the abdomen below the navel. As we breathe in through the nose, we are encouraging the lower abdomen to fill and thus raise the hand while the chest remains still.
This can also be practiced lying down, and if you are in the habit of leaving the needles in during a treatment, patients can already start practicing as they lie there – enhancing the effect of the acupuncture.
Both these methods are helpful for beginners, but as soon as we become comfortable with breathing in this way, there is no need to expand the abdomen outward, as a deeper experience comes from feeling it fill internally.
Many of us only breathe into our upper chest, so the diaphragm barely descends; and when asked to breathe deeply, we simply do the same, but more so. This raises the qi, making us more prone to anxiety and stress, and reducing healthy oxygenation. Many years of chest breathing creates a pattern that can take time to change.
It is not unusual, therefore, for beginners to find it difficult to keep the chest (heart and lungs) quiet and descend the breath. It is common to experience tightness in the ribs when trying to do so; and the answer, as it is to many things in life, is reassurance that it will get easier through regular practice.
It may also help to combine slow, deep breathing with the most basic of qigong / tai chi movements, such as rhythmically lengthening through the body and allowing the arms to softly rise to shoulder height when breathing in, and allowing the body and arms to settle down when breathing out – all the while focusing on the feeling of filling the lower abdomen.
What we will see in part 2 of this article is that breathing in this way is the simplest, most effective and most direct way to shift our autonomic nervous system into parasympathetic dominance – characterized by deep rest, relaxation, cell repair, and an open and trusting response to the world. For many of our patients (and ourselves, of course), this can be a blessing, since so many of us are stuck in some degree of "fight or flight" sympathetic nervous system dominance.
Clinical Pearls
It is theorized (and clearly observed in daily life) that when we ourselves are in a calm and centered state, it is transmitted to those around us by our manner, facial expression, speech, friendliness and attentiveness. This can act as a rare invitation to our patients – many of whom face challenging economic, work, relationship and lifestyle stresses – to experience trust and safety; and so begin the healing experience even before a needle or herb is administered.
However, to do so, we need to be in a genuinely calm and friendly parasympathetic dominant state, since even the best attempt to pretend is likely to be picked up by the unconscious antennae of our patients.
A final caution: Conscious breathing is a powerful tool and should be approached with respect. The breath should never be forced or practiced more slowly than is reasonably comfortable. We need to remember always that the aim is to calm, not stress. With practice, the breathing will deepen and slow down over time, and we will start to experience the profound feeling of nourishment and repair that comes from taking the breath of life down into the dantian.
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