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CHAPTER - I

INTRODUCTION

1.1 LIFE

“Life is Beautiful and there is meaning behind everything. Everything in the

world is good, holy and beautiful”-Swami Vivekananda

“The purpose of our life is to be happy”– Dalai Lama

Human life is God’s genuine and a very precious gift. It is a combination of both

body and mind. A sound mind in a sound body is a very popular and wise saying. Each

and every moment of human life brings us an opportunity to act, develop and express our

virtues. Each moment opens a path to us. It is true that life gives us both positive and

negative situation. We have to face our difficulties in such a way that our actions purify

our spirit. Whenever we feel connected with the soul we realize everything is good. Our

body is our temple. We should keep it as a healthy vehicle for our spirit.

Those who continuously react negatively to various situations of life put their

health at risk. Opening ourself to others is a way to reduce stress and therefore

promoting healthy life. Acknowledging and sharing feelings of anger, fear sadness or

stress, hope, joy and happiness can lead to a healthier life. We all have the right to

live and we should not utilize the fact lightly with the through of violence, war, hatred

and death.

Numerous researches have been carried out world-wide to discover the factors

that make man-kind happier. The outcome of these findings indicate that happy-life is

a combination of many factors which include good nutrition, regular exercise and a

positive attitude as these factors keep diseases at bay thereby paving way for healthier

and happier life. The young stage of an individual may requires less attention on the

above factors, but the aged persons require more attention and care.

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1.2 AGED MEN

A man’s life is normally divided into five stages namely Infancy, Childhood,

Adolescence, Adulthood and Old age. In each of these stages an individual finds

himself in different situations and faces different problems. Old age is viewed as an

unavoidable undesirable and problem ridden phase of life. Problems of ageing usually

occur around 55 years.

Table I Elderly population in India aged 60 years and above India(in millions)

Source

Total

Rural Urban

Person Female Male

Census 1961 24.7 12.4 12.4 21 3.7

Census 1971 32.7 15.8 16.9 27.3 5.4

Census 1981 43.2 21.1 22 34.7 8.5

Census 1991 56.7 27.3 29.4 44.3 12.4

Census 2001 76.6 38.9 37.8 57.4 19.2

Census 2011 103.8 52.8 51.1 73.3 30.6

Source: Population Census Data (2016)

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Elderly Population in India (aged 60 years & above)

120

103.8

100

80

76.6 73.3

56.7

57.4

Person

60

43.2

44.3

51.1

Female

52.8

37.8

Male

40

32.7 34.7

38.9

27.3

29.4

Rural

24.7

30.6

27.3

12.4

16.9 22 Urban

20 21 21.1

12.4

15.8 19.2

12.4

8.5

5.4

0 3.7

Census Census Census Census Census Census 1961 1971 1981 1991 2001 2011

Figure 1

Status of Elderly Persons in Tamilnadu

Out of the 103.8 million total populations in India, Tamilnadu has

the third highest population of elderly at 10.4%.

30% men and 32% women above 60 years of age have reported to

have some form of Illness.

36.7% live with spouse and other family members.

26.9 % live with children.

31.7% elderly have their children and grandchildren outside the

village and town.

18.9% live with spouse against National average of 12%.

Highest number of elderly 10.9%, live alone against national average

of 5.2%

(Source: Elderly in India, Profile and programmes 2016)

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1.3 SOCIAL PROBLEMS IN OLD AGE

Indian societies are changing rapidly due to urbanization, the steep aspirations

of the youth and the increased number of women work force. All these factors have

led to a decline in the number of joint families and an increase in the concept of

nuclear families. The direct impact of this is the care and support of the elderly in

India is marginalized.

Again in cities, where there is only one older living spouse many problems

stem from properly ownership. The older people bear a lot of mental harassment to

transfer the property to their children. There is also lack of social security systems

where government machinery pays for food and health. As people get older, unless

they have the discipline of following a healthy regimented life, they can be in for a

long period of illness and suffering (Archana Jain and Shilpa Paranjape, 2013).

1.3.1 PHYSIOLOGICAL PROBLEMS OF AGED PERSONS

As long as, they are in service and feeling productive most elders aren’t

considering the risks to their health. Due to lack of health awareness from the previous

generations most elderly people have unhealthy habits that lead to medical problems like

cardio-vascular disease, tuberculosis, Alzheimer, asthma, etc. In addition there is a

malaise of ageing problems, the physical strength diminishes and mental stability

deteriorates. A small fall can lead to a fracture or breaking of the already fragile bone.

1.4 CALCULATION OF HEALTH STATUS

The Health Status is usually calculated in terms of life expectancy at birth,

infant mortality rate, fertility rate, crude birth rate and crude death rate. These control

points are displayed by various factors such as per capita income, nutrition, housing,

sanitation, safe drinking water, social infrastructure, health and medical care services

provided by geographical climate, employment status, government, incidence of

poverty and the like (Reddy and Selvaraju, Dadibhavi and Bagalkoti 1994).

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1.5 HEALTH

The World Health Organisation (WHO) defined health as, a state of complete

physical, mental, and social well-being and not merely the absence of disease or

infirmity.

A healthy life style means maintaining a balanced and nutritious diet as well as

engaging in fitness related activities. Time spent on Health activities is an investment

and not an expense. One of the most crucial factors on an individual’s life is his

health. Life is a weary burden to a person of broken health. Even a peasant with good

health is happier than the rich person with poor health. A person in the pink of health

enjoys all the good things in life. He finds vigor and strength in life to do his work.

Health is a condition of optimal well-being and it is the level of functional or

metabolic efficiency of a living being. In humans, it is the general condition of a

person's mind, body and spirit, usually meaning to be free from illness, injury or pain.

Total health is harmony between body, mind and soul. It is perfect

maintenance of the internal environment. Health is not a static state – it is dynamic,

ever-changing. We can never claim that we are always healthy, but only that we are

healthy at a particular moment. Health is not a commodity to be purchased in the

market. It has to be earned by the hard way, by trying to get every cell in our body

under our control (Krishna Raman, 1998).

The maintenance and promotion of health is achieved through different

combination of physical, mental, and social well-being, together sometimes referred

to as the “health triangle”. Health is not just a state, but also "a resource for everyday

life, not the objective of living. Health is a positive concept emphasizing social and

personal resources, as well as physical capacities”.

Generally, an individual’s health status and standard of life is determined by

the context in which an individual lives. It is increasingly recognized that health is

maintained and improved not only through the advancement and application of health

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science, but also through the efforts and intelligent lifestyle choices of the individual

and society. According to the World Health Organization, the major deciding factors

of health include the social and economic environment, the physical environment, and

the person's individual characteristics and behaviors.

In addition to health care interventions and a person's environment, a number

of other factors are known to influence the health status of individuals, including their

background, lifestyle, and economic and social status. These are referred to as

"determinants of health".

More specifically, key factors that have been found to influence whether

people are healthy or unhealthy include:

Social support networks

Health care services

Personal health practices and coping skills

Employment/working conditions

Biology and genetics

Gender

Income and social status

Education and literacy

Social environments

Healthy child development

Characteristic from parents due to heredity also play a role in determining the

health status of individuals and populations. This can encircle both the predisposition of

certain diseases and health conditions, as well as the habits and behaviors individuals

develop through the lifestyle of their family. For example, genetics may play a role in the

manner in which people cope with stress, mental, emotional or physical.

Data from the Alameda County Study suggested that, people can improve

their health by regular exercises, enough sleep, maintaining a healthy body weight,

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limiting alcohol use, and avoiding smoking. The ability to adopt and to self-

manage has been suggested as core components of human health.

1.6 HEALTHY PERSONS

Factors for good health include genetics, the environment, relationships, and

education. A healthy life includes diet, exercise, screening for diseases and lifestyle

changes.

Mental and physical healths are the two most commonly discussed types of

health. We also talk about "spiritual health", "emotional health", and "financial

health”, among others. These have also been linked to lower stress levels and mental

and physical wellbeing.

1.6.1 PHYSICAL HEALTH

Physical wellbeing involves pursuing a healthful lifestyle to decrease the risk

of disease and to maintain physical fitness. Physical health and well-being also help

reduce the risk of an injury or health issue. Examples include minimizing hazards in

the workplace, practicing safe sex, practicing good hygiene, or avoiding the use of

tobacco, alcohol, or illegal drugs.

1.6.2 MENTAL HEALTH

Mental health refers to a person's emotional, social, and psychological

wellbeing. Mental health is as important as physical health to a full, active lifestyle.

It is harder to define mental health than physical health, because, in many

cases, diagnosis depends on the individual's perception of their experience. A mental

illness such as depression or anorexia nervosa can affect body weight and function.

It is important to approach "health" as a whole, rather than its different types.

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Accordingly to ‘Hathyoga Pradipika’ a person enjoys good health when he

has: Slim (lissome) body, joyous face, sparking eyes, elegant voice, and positive good

thoughts, exuberance of vitality and radiance and purity of nervous system.

1.7 DISEASE

Diseases may be defined a disorder of structure or function in a human, animal

or plant especially one that proves specific symptoms or that affects a specific

location and is not simply a direct result of physical injury.

According to Oxford Dictionaries Medical Definition, disease is often

construed as a medical condition associated with specific symptoms and signs. It may

be caused by external factors such as pathogens or by internal dysfunctions,

particularly of the immune system, such as an immunodeficiency or by

hypersensitivity, including allergies and auto immunity.

As the human population is fast growing we need more space to dwell also

there is an increase in demand for food production which inturn increase the need for

more animals. As an impact of climate change, urbanization and globalization many

infectious diseases are fast emerging. All these environmental factors spread

communicable diseases as growing population leads to lack of water supply, poor

sanitation, mal-nutritious food etc. These diseases play a major role which cause

premature death in man-kind.

Remedies of communicable disease could be good hygiene and proper

sanitation. Direct contact with the infected person should be avoided keeping the

environment clean is one solution to numerous problems.

Another type of disease that affects human-folk in this modern era is a chronic

disease which is otherwise referred as life-style diseases. The underlying causes of

chronic diseases are lack of physical activity, stress, anxiety, poor-diet, intake of

alcohol, and use of tobacco etc.

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Among the life-style diseases diabetes comes first and foremost as world wide

number of cases of diabetes is fast increasing day-by-day.

As per the estimation of International Diabetic Federation (IDF) in 2017 about

425 million people throughout the world are affected by diabetes.

There are many remedies for diabetes among which yoga and varma play

crucial role. As far as life-style diseases are concerned they could be evaded by taking

nutritious food, managing stress and practicing regular exercise. Among the physical

activities yoga and varma play a predominant role in the intervention of disorders.

Countless researches have been carried out in the field of varma and yoga on various

aspects of diseases that influence mankind in this modern era.

As yoga and varma considered as Holistic approaches to treat ailments,

emphasis on yogic practices is gaining relevance at the present time.

Disease means loss of power and disorder in the body resulting in loss of

resistance caused by the blockage of the life carrier in their flow through the blood

stream and the tissues in the form of mucous or inorganic salts or both. It also reflects

the negative pole of waste deposits of solids, liquids gases and energy blocks in the

body.

1.7.1 CAUSES OF DISEASES

The causes for the Diseases are attributable to Poor diet, Lack of exercise,

Improper routine, Poisons, Lack of Fresh Air, Polluted Air, Hormonal Imbalance,

Lack of Sunshine, Tiredness, Improper Clothing, Pollution, Insufficient Sleep, Lack

of Elements (Tattvas), Disobeying the natural laws, Mental Disorders, Emotional

Maladjustment, Shocks, Excess of anything, wrong posture, Tension, Malfunction of

immune system, Bacteria, Fungi, Virus, Smoking and Alcohol, Hereditary, Narcotics,

Allergy, Suppressed Wishes, Obstructing nature call, Constipation, Pancha Kleshas,

Injustice against body, Lethargy, etc.

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1.8 DIABETES MELLITUS

Diabetes mellitus, commonly referred to as diabetes was first identified as a

disease associated with "sweet urine” and excessive muscle loss in the ancient world.

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar

(glucose) levels that result from defects in insulin secretion, or its action, or both.

Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the

urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone

produced by the pancreas. Insulin lowers the blood glucose level. Normally, after food

when the blood glucose elevates, insulin is released from the pancreas to normalize

the glucose level by promoting the uptake of glucose into body cells. In patients with

diabetes, the absence of insufficient production or lack of response to insulin causes

hyperglycemia. Diabetes is a chronic disorder, although it can be managed and

controlled efficiently through exercise and medication.

Diabetes mellitus is the disease which has plagued man for generations though

its incidence at present, especially in the more developed countries of the world, is

higher and it is only increasing year after year. With technological advancement, both

stress and affluence have become increasingly widespread, and people have

developed the tendency to avoid strenuous physical exercise and uncontrolled eating,

thus recent increase in diabetes can be considered to be a side effect of this century,

technological age, reflecting global pollution.

At present, modern science holds that there is no positive system of cure for

diabetes mellitus. The most it can offer is control of the symptoms through dietary

controls and daily use of insulin and other drugs. The disease itself, however, is

commonly not affected by this, and may even increase in severity.

It is based upon the internal readjustment of the physical organism through

stimulation of the body’s own regenerative process. The ancient science of yoga has

more successful method of management which is thousands of years old. After many

years of successfully dealing with sufferers of diabetes, by implementing the integral

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yogic system, it was desired to make the knowledge of these efficacious techniques

available to all interested sufferers and therapists of diabetes in the world (Swami

Shankaradevananda, 2002).

According to an estimate of International Diabetic Federation (IDF), in 2017

there are about 425 million people with diabetes throughout the world. It is also

estimated that there would be 629 million people with diabetes in the world in 2045.

The number of people according to IDF is estimated by taking the IDF diabetes atlas

prevalence estimate and applying it to the number of people aged 20-70 estimated by

the United Nations Population division. The estimate Includes both diagnosed and

undiagnosed diabetes (IDF Diabetes Atlas – 2017).

1.8.1 TYPES OF DIABETES

Insulin Dependent Diabetes Mellitus (IDDM) – Type 1: In this type of

Diabetes the capacity of pancreas to produce insulin had been partially

or even completely lost.

Non Insulin Dependent Diabetes Mellitus (NIDDM) – Type II: In this

type, it usually begins in middle age or after 40 years and also referred

as adult on-set diseases. The insulin resistance at receptor / post

receptor levels and increased hepatic glucose output production.

Maturity on Set Diabetes of the Young (MODY): This type develops

gradually in middle-aged owing to stressed, overweight, under

exercised persons, whose diet contains an excess of sugars, starches

and fats. The insulin secreting mechanism progressively deteriorates

and de-sensitises the body tissues to the insulin

Malnutrition Related Diabetes Mellitus (MRDM): The World Health

Organisation (WHO) has recently described this new form of diabetes

found in the age group of 14-30 in tropical countries. Pancreas fails to

produce adequate insulin and do not develop keto acid when insulin

injection are discontinued.

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Other types of associated with certain conditions and syndromes

Pancreatic diseases, Disease of Hormonal etiology, rig or chemical

induced conditions. Abnormalities of insulin or it receptor, certain

genetic syndromes.

1.8.2 TYPE I AND TYPE II DIABETES

The two types of diabetes mellitus are, insulin-dependent (IDDM) and noninsulin

dependent (NIDDM). First is due to low insulin-production by the pancreas and the more

common type, NIDDM usually starts after the age of 40 and has many contributory

causes such as obesity, heredity, lack of exercise, auto immunity and stress

(Robin Monro et.al., 1990).

1.8.3 SYMPTOMS OF DIABETES

Increased Urine Output

Excessive Thirst

Weight Loss

Hunger

Fatigue

Skin Problems

Slow Healing Wounds

Yeast Infections

Tingling or Numbness in the Feet or Toes

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Type I and Type II Diabetes

Pictorial representation of Type I and Type II Diabetes

Figure 2

1.9 HISTORY OF DIABETES

Thousands of years back people were aware of diabetes. For the past

thousands of years many Physicians and Scientists have been documenting the

conditions of diabetes. The first known mention on the symptoms of Diabetes was

done by Hesy – Ra, from Egypt who documented frequent urination which was called

as emaciation. Also it was observed by the ancient healers that ants were observed to

the urine of the persons who had this disease.

Sometimes in 150 AD When Greek physician Arateus started calling diabetes

as "the melting down of flesh and limbs into urine”. Physicians started getting a better

understanding about diabetes. In the latter stages diabetes was diagnosed by tasting

the urine of the people suspected to have it by, people known as “waster tasters”. To

acknowledge this condition the word “mellitus”, which means honey was added to the

name “diabetes”. After 1800, scientists developed chemical tests to detect diabetes

from the urine.

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1.10 EARLY TREATMENT OF DIABETES

When more about diabetes was learned by the physicians, they found various

methods to manage. Initial diabetes treatments involved exercises and often horseback

riding which was believed of relieving excess urination.

In the latter years of 1700s and 1800s, physicians understood the importance

of diet in managing and they advised their patients to eat suitable food to control

diabetes. In the early 1870’s during the Franco-Prussian War, the French physician

Apollinaire Bouchardat noted that due to war-related food rationing, his diabetic

patients' symptoms improved which encouraged him to develop individualized diets

as diabetes treatments. This paved the way for the fad diets such as oat-cure”, "potato

therapy”, and the "starvation diet” of the early 1900s.

In 1916, by creating the textbook The Treatment of Diabetes Mellitus, which

recommended, fasting diet combined with regular exercises, Boston scientist Elliott

Joslin established himself as one of the world's leading diabetes expert and he could

significantly reduce the risk of death in diabetes patients. Even today, doctors and

diabetes experts use these principles when counseling their patients about lifestyle

changes for the management of diabetes.

1.11 HISTORY OF INSULIN

Even though advances were made in controlling diabetes, before the discovery

of insulin there were premature diabetic death. In the early 1900s, Georg Zuelzer, a

German scientist, found that injecting pancreatic extract into patients could help

control diabetes.

Canadian Physician of Ontario, Frederick Banting, first had the idea of using

insulin to treat diabetes in 1920, and with his colleagues he tried out his theory in animal

experiments. Banting and his team finally used insulin to successfully treat a diabetic

patient in 1922 and finally a breakthrough was made in the treatment of diabetes. Banting

and his team were awarded the Nobel Prize in Medicine the following year.

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Over the years the evolution of Insulin has taken different dimension and the

following table shows the different types of insulin used during various period of time.

Table II History of Insulin

1922 First clinical use of insulin

1920s Short-acting bovine and pocrine extracts

1930s Improved purification

1940s Neutral Protamine Hagedorn (NPH) introduced

1950s Lente and ultralente insulin

1970s Highlypurified (monocomponent) insulin

1980s Premixed biphasic insulin

Insulin pumps for Continuous subcutaneous Insulin Infusion (CSII)

Biosynthetic human insulin

Pen injection devices

1990s Rapid-acting insulin analogues

2000s Long-acting insulin analogues

1.12 MORTALITY WITH DIABETES

Diabetes is a chronic disease associated with increased morbidity and

mortality, mainly from cardiovascular disease. Treatment of diabetes includes

normalizing hyperglycemia to attain glycemic targets and treatment of cardiovascular

risk factors such as hypertension and dyslipidemia. This multifactorial intervention

strategy has been shown to decrease cardiovascular and all-cause mortality among

patients with type II diabetes. Nevertheless, mortality in diabetes remains elevated.

A number of epidemiological studies have quantified the risk of death among

patients with diabetes and assessed the causes of death, with highly varying results.

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Overall, the studies to date have confirmed that diabetes is associated with an

increased risk of all-cause mortality, but the magnitude of this excess risk is highly

variable, with the relative risk ranging from 1.15 to 3.15 (Oriana Hoi Yun Yu and

Samy Suissa, 2016).

As per statistics of IDF (International Diabetic Federation), there is one death

in every eight seconds due to diabetes. This means roughly in 2017 4.0 (3.2-5.0)

million people aged between 20 and 79 years are estimated to die from diabetes.

In this age group the mortality in diabetes alone works out to 10.7% globally.

Out of this, 46.1% of deaths are due to diabetes in the age group of 20-79 years (IDF

Diabetes Atlas, 2017).

1.13 TOP 10 COUNTRIES WITH DIABETES (20-79 YEARS)

Table III Top 10 Diabetes Countries

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According to an estimate of IDF, in 2017 there are about 425 million people

with diabetes throughout the world. It is also estimated that there would be 629

million people with diabetes in the world in 2045. The number of people according to

IDF is estimated by taking the IDF diabetes atlas prevalence estimate and applying it

to the number of people aged 20-70 estimated by the United Nations Population

division. The estimate Includes both diagnosed and undiagnosed diabetes (IDF

Diabetes Atlas, 2017).

1.14 PREVALENCE OF PEOPLE WITH DIABETES BY AGE AND SEX

In 2017, there are 326.5 million people of working age (20-64 years) with

diabetes, and 122.8 million people 65-99 years with diabetes. The number of people

of working age with diabetes is expected to increase to 438.2 million, and the number

of people with diabetes 65-99 years will increase to 253.4 million in 2045. Likewise,

the economic burden of diabetes will increase in the next decades particularly among

elder age groups (70-99) with an increase of USD 104 billion from 2017 to 2045.

The prevalence of diabetes for women 20-79 years is estimated to be 8.4%

which is slightly lower than among men (9.1%). There are about 17.1 million more

men than women with diabetes (221.0 million men vs 203.9 million women). The

diabetes prevalence in men is expected to 10.0% in men. It is estimated that in the age

group of 65-79 years shows the highest diabetes prevalence in both women and men

(IDF Diabetes Atlas, 2017).

There are 326.5 million people of working age (20-64 years) with diabetes, and

122.8 million people 65-99 years with diabetes. The number of people of working age

with diabetes is expected to increase to 438.2 million, and the number of people with

diabetes 65-99 years will increase to 253.4 million in 2045 (Figures 3.1 and 3.2).

Likewise, the economic burden of diabetes will increase in the next decades particularly

among elder age groups (70-99) with an increase of USD 104 billion from 2017 to 2045.

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Table IV Diabetes by age and sex

Gender distribution the prevalence of diabetes for women 20-79 years is estimated to

be 8.4% which is slightly lower than among men (9.1%). There are about 17.1 million

more men than women with diabetes (221.0 million men vs 203.9 million women).

The diabetes prevalence in women is expected to increase to 9.7% in women and to

10.0% in men (Figures 3.1 and 3.2). The age group 65-79 years shows the highest

diabetes prevalence in both women and men.

1.15 CAUSES OF DIABETES

The exact causes of getting type II diabetes are not clear however, certain

things make some individuals more likely to get type II diabetes. These are called

predisposing factors that is, factors existing beforehand that predispose someone to, or

increase someone's chance of, developing the disease. These factors may not be the

real cause of diabetes rather the chances of getting it are high when one or more of the

following factors apply:

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1.15.1 GENETIC HISTORY

A person chance of developing type II diabetes is more likely if there exists

history of diabetes among the family members, including extended family those who

don’t have history of diabetes. The most common predisposing factor is a history of

Diabetes in the family. The factors of inheritance or genetic tendency that run in

families are stronger in type II diabetes than in other kinds. The chances depend on

how many in the family have it and whether it occurs on one or both sides of the

family. However, many people have the genetic tendency but never get diabetes.

1.15.2 OBESITY

It is observed that three fourth of persons who were found over-weight for

years together are diagnosed with diabetes. Being overweight seems to increase the

body's demand for insulin. In overweight people, even the individual cells that make

up the body fat are fatter, and it is thought that these larger fat cells do not respond as

well to insulin.

1.15.3 ETHNICITY

People of different racial and ethnic groups are more likely to develop type II

diabetes, heart disease, and stroke owing to their lifestyle. Environmental and lifestyle

changes resulting from industrialization and migration to urban environment from

rural settings may be responsible to a large extent, for this epidemic of type II

diabetes in Indians. Several studies show that the prevalence of type II diabetes is

increasing in migrant Indians. Today, the prevalence of diabetes in the urban metros

of India is approaching the figures reported in the affluent migrant Indians. Due to

overweight and high blood pressure, different races such as African Americans,

Mexican Americans, Indians, Native Hawaiians, Pacific Islanders and Asian

Americans have a higher risk for these deadly diseases. But it is very difficult to

separate racial and ethnic factors from genetic factors.

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1.15.4 SEDENTARY LIFE

Type II Diabetes is most commonly seen in older adults, but it is increasingly

seen in children, adolescents and younger adults due to rising level of obesity,

physical inactivity and poor diet. People who are active are less likely to get this kind

of Diabetes than people who are inactive. Physical activities seem to make the

available insulin work better.

1.15.5 STRESS

In these days people with high levels of stress are more likely to develop

Diabetes. For example, if someone has inherited the tendency, a stressful event such

as a death in the family, the loss of a job, or a physical illness may continue or it may

disappear for years and perhaps recur at another stressful time or in middle age.

1.15.6 HEREDITARY FACTOR

The heredity factor seems to be the highest factor that predisposes someone to

developing Type II Diabetes. An excess weight is by far the most common precipitating it

or brings it out, probably only if the underlying genetic tendency is there to begin with.

On the other hand, some diabetics may not have any of these factors.

1.16 SIGNS AND SYMPTOMS OF DIABETES

Individuals can experience different signs and symptoms of diabetes, and

sometimes there may be no signs. Some of the signs commonly experienced include

� Frequents Urination (Polyuria)

� Increased Hunger (Polyphagia)

� Excessive Thirst (Polydipsia)

� Weight Loss

� Always Tired and Sleepy

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Signs and Symptoms of Diabetes

Figure 3

� Blurry eyes or trouble seeing (focus)

� Tingling sensation or numbness in the hands or feet

� Delayed wound healing

� Dry and itchy skin

� Sexual problems.

� Nausea and Vomiting

� Infections of the bladder, skin and vaginal area

� Lack of interest and concentration

� Frequent infections

� Slow-healing wounds

� Vomiting and stomach pain (often mistaken as the flu)

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The development of type 1 diabetes is usually sudden and dramatic while the

symptoms can often be mild or absent in people with type II diabetes, making this

type of diabetes hard to detect.

1.16.1 FREQUENT URINATION

Glucose increases the osmolality of the glomerular filtrate and thus prevents

the re-absorption of water as the filtrate passes down the renal tubules. The patient

usually complains of passing a larger than normal volume of urine, with increasing

frequency every day. Glycosuria occurs when the blood glucose level is 180mg/dl.

1.16.2 DRY SKIN CONDITION

Diabetes may co-exist with other disease states. Some others are malignancy,

HIV infection, surgical stress, a heart attack, febrile illnesses and renal disease.

High Sugar levels in blood will lead to dry skin. When the blood glucose level

is high, the body attempts to remove excess glucose from the blood by increasing

urination. This loss of fluid from the body causes the skin to become dry. Dry skin

can also be caused by neuropathy (damage to the nerves) by affecting the nerves that

control the sweat glands. In these cases, neuropathy causes a decrease or absence of

sweating that may lead to dry, cracked skin. Cold, dry air and bathing in hot water can

aggravate dry skin.

Sometimes the patient suffers a frozen shoulder and this can be a manifestation of

diabetes. Lethargy, weight loss, easy susceptibility to infections, particularly of the skin

(like a simple boil or a fungal infection), excessive hunger, craving for sweet and

sweating are some of the other symptoms. These classic symptoms, however, are not the

normal presentation. Usually the disease is discovered on routine examination.

Normally, the fasting level of blood glucose is less than 90 mg/dL and the

post-prandial (2 hour) level is less than 120 mg/dl. If the post-prandial sugar level is

between 150 and 200 mg, the condition is labeled as an impaired tolerance and, if

above 200, it is frank diabetes.

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1.17 DIABETES RELATED HEALTH COMPLICATIONS

. In addition, people with diabetes also have a higher risk of developing infections

People with diabetes have an increased risk of developing a number of serious health

problems. Diabetes dramatically increases the risk of various cardiovascular problems

including heart attack, stroke, and coronary artery disease with chest pain and

narrowing of arteries. Other parts of the body affected by Diabetes are skin, sexual

organs, teeth and gum, nerves, eyes and kidney.

Complications of Diabetes

Figure 4

Maintaining blood glucose levels, blood pressure, and cholesterol at or close to

normal can help delay or prevent diabetes complications. Therefore people with

diabetes need regular monitoring.

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1.17.1 CARDIOLOGY (HEART PROBLEMS)

Persons with diabetic are having a higher-than-average-risk of getting heart attack

as there is a clear cut relation between Diabetes and heart diseases. As the blood glucose

levels are consistently high among diabetes they are prone to coronary artery disease and

stroke. Chronic complications occur over a long period of time and usually involve blood

vessels. Cardiovascular disease is the most common cause of death in people with

diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors

contribute to increasing the risk of cardiovascular complications.

1.17.2 NEPHROPATHY – (KIDNEY PROBLEMS)

One major cause of kidney failure is Diabetes Mellitus, a condition characterised

by high sugar levels. Over a period of time the high level of sugar in blood damage

millions of tiny filtering units in Kidney. Maintaining near normal levels of blood glucose

and blood pressure can greatly reduce the risk of kidney disease.

1.17.3 NEUROPATHY (NERVE PROBLEMS)

High blood sugar can cause diabetic neuropathy, which damages the nerves

that can cause numbness or tingling in your fingers, hands and feet. This can result

with indigestion, erectile dysfunction, and many other functions. Among the most

commonly affected areas are the extremities, in particular the feet. Nerve damage in

these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of

feeling. Loss of feeling is particularly important because it can allow injuries to go

unnoticed, leading to serious infections and possible amputations. People with

diabetes carry a risk of amputation that may be more than 25 times greater than that of

people without diabetes. However, with comprehensive management, a large

proportion of amputations related to diabetes can be prevented. Even when

amputation takes place, the remaining leg and the person’s life can be saved by good

follow-up care from a multidisciplinary foot team. As a preventive measure people

affected by Diabetes should do examination of feet on regular basis.

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1.17.4 RETINOPATHY (EYE PROBLEM)

Consistently high levels of blood glucose, together with high blood pressure

and high cholesterol, are the main causes of retinopathy. Retinopathy usually affects

people who have diabetes for significant number of years. Diabetic retinopathy, a

common complication of diabetes, affects the blood vessels in the retina causing

reduced vision or blindness. It can be managed through regular eye checks and

keeping glucose and lipid levels at or close to normal.

1.17.5 HEARING IMPAIRMENT

Hearing problems are more common in people with diabetes. Management of

this disease is crucial. When blood sugar levels aren’t well-controlled, your risk of

developing hearing loss may increase.

1.17.6 SKIN CONDITIONS

People with Diabetic must give due importance to skin care. Diabetes may

leave you more susceptible to skin problems, including bacterial and fungal

infections. Skin conditions can be more likely amongst diabetics, and reduced

sensitivity of nerves and circulation can often make it harder to spot emerging skin

problems. The skin on our feet need particular attention as the presence of diabetic

neuropathy can sometimes lead to skin issues not being identified until an advanced

stage, when they can cause serious problems. People with diabetes may experience

greater loss of fluid from the body due to high blood glucose levels, which can cause

dry skin on the legs, elbows, feet and other areas of the body. If dry skin becomes

cracked, germs can get into these areas and cause infection, meaning that taking care

of the skin is essential. If not checked regularly, even minor skin care problems can

evolve into serious diabetes complications, such as diabetic foot ulcers and even

amputation. Keeping the skin, particularly of your feet, in good condition should be a

priority for people with diabetes. As well as dry and cracked skin, a number of

specific skin problems are closely linked to diabetes. Diabetic Dermopathy is also a

common skin problem for people with diabetes. Sometimes known as shin spots, this

condition leaves round, raised lesions that can turn into ulcers.

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1.17.7 ALZHEIMER'S DISEASE

Type II diabetes may increase the risk of Alzheimer's disease. The poorer your

blood sugar control, the greater the risk appears to be. The exact connection between

these two conditions still remains unclear. The risk of dementia increases in persons

with Type II Diabetes due to the thinning of the cortex and more white matter

abnormalities. Overweight people with diabetes had more brain deterioration and the

risk of diseases of dementia, including Alzheimer’s is high (Derex Beres, 2017).

1.17.8 DKA (KETOACIDOSIS) AND KETONES

DKA - Diabetic ketoacidosis is a life-threatening condition that can lead to

diabetic, comaor even death. When your cells don't get the glucose they need for energy,

your body begins to burn fat for energy, which produces ketones. Ketones are chemicals

or fatty acids that the body creates when it breaks down fat to use for energy.

As there is inadequate secretion of insulin which is the normal source of

energy to the body reacts the other way. As the Ketones are acidic in nature it gives a

warning sign to the body indicting sickness. High levels of ketones can poison the

body. When levels get too high, you can develop DKA. Though it is a rare

phenomenon DKA may affect anybody having diabetes. Treatment for DKA usually

takes place in the hospital. But one can help prevent it by learning the warning signs

and checking your urine and blood regularly.

1.17.9 STROKE

Stroke is a condition which occurs due to poor blood flow in brain: either the

blood supply is blocked, or a blood vessel within the brain ruptures, causing brain

tissue to die. A stroke is a medical emergency, and treatment must be sought as

quickly as possible.

If one has diabetes, the chances of having a stroke are 1.5 times higher than in

people who don't have diabetes. But one can lower the risk by taking care of his/ her

health.

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1.17.10 HYPEROSMOLARHYPERGLYCEMICNONKETOTIC SYNDROME

(HHNS)

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) is a serious

health condition which normally affects the elderly. HHNS can happen to people with

either type 1 or type II diabetes is not being controlled properly, but it occurs more

often in people with type II. HHNS is usually brought on by something else, such as

an illness or infection. In HHNS, blood sugar levels rise, and your body tries to get rid

of the excess sugar by passing it into your urine. You have to urinate more often at

first and have to go to bathroom. Later on the urine will change very dark. Also there

may be very thirsty. Even if thirsty is not there, one need to drink liquids. If enough

liquid is not taken at this point, one can get dehydrated. Consequences of HHNS are

severe dehydration leading to seizures, coma and even death. HHNS may take days or

even weeks to develop. Know the warning signs of HHNS.

1.17.11 IMPOTENCY

A common problem faced by men, associated with diabetes is impotency.

High level of blood pressure; cholesterol and glucose are all associated with an

increased risk of erectile dysfunction. It is caused by neuropathy (nerve damage) and

reduced blood circulation typically as a result of less well controlled diabetes or long

standing diabetes.

Getting these under control, reducing consumption of alcohol and quitting

smoking can help to reduce the effects of impotency.

1.17.12 URINARY INCONTINENCE

Incontinence is defined as the loss of ability to control when you pass urine. The

main symptoms of incontinence are a loss of control of your bladder as the muscles in the

bladder that control the flow of urine relax or contract involuntarily. High glucose level

may lead to such a condition. Urinary incontinence is relatively common and affects

about 5% and 13% of men and women respectively. Causes of incontinence may include,

High blood glucose levels, Urinary tract infections, Autonomic neuropathy,

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certain medications, an enlarged prostate gland, Post-menopausal changes in

the bladder muscles.

1.17.13 URINARY TRACT INFECTIONS – UTIS

Urinary tract infection can be a particular problem for people with diabetes

as sugar in the urine makes a fertile breeding ground for bacteria. Urinary tract

infections may occur more often due to sugar in urine. A urinary tract infection is a

bacterial infection that grows within the urinary tract - anywhere from the kidneys,

the ureters, the bladder and through to the urethra. This is supported by data from the

American Diabetes Association (a report at the 73rd Scientific Sessions of the ADA),

which showed 9.4% of people diagnosed with type II diabetes had a UTI compared to

only 5.7% of people without diabetes.

1.17.14 COLON CANCER AND DIABETES

Various studies have shown that diabetes increases the risk of different forms

of cancer. Having cancer with diabetes can make achieving good diabetes control

much more difficult but this can be relieved to some extent. According to a theory,

high levels of insulin circulating (known as hyperinsulinemia) can promote the growth

of cancer cells which inturn stimulate the formation of new blood vessels that nourish

tumors. In type II diabetes, insulin resistance commonly causes the body to produce

more insulin than normal. Another reason is, a harmful lifestyle may lead to obesity

and therefore higher risks of both type II diabetes and cancer. The risks of contracting

the following cancers are shown to be doubled by the presence of type II diabetes. The

cancers with increased risk in type I diabetes are Colon cancer. It is a malignant tumor

arising from the inner wall of the large intestine (colon) or rectum. People with Type

II diabetes have even more reason to educate themselves about these deadly diseases.

1.17.15 EATING DISORDERS

Eating disorders means irregular eating habits which may include excessive or

inadequate intake of food in irregular timing which affects the irregular timing which

affects the well-being of individual adversely and diabetes tend to make the

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physiological effects, even more complicated. Eating disorders may vary from

overeating to under eating and some eating disorders, such as bulimia, may involve

alternating between the two. And Diabulimia is a term which has been used to

describe deliberate missing of insulin injections in an attempt to lose weight. When

people with type I diabetes skip insulin injections, it starves the body from getting

energy from food eaten. Diabulimia is particularly prevalent in teenage girls and

young women with type I diabetes. As high as 1 in 3 women with type I diabetes may

have deliberately missed injections to lose weight. Diabulimia is an especially

dangerous way to lose weight which greatly increases the risk of suffering diabetic

ketoacidosis in the short term and increasing the risk of developing complications

such as nerve damage and blindness later in life.

1.17.16 JOINT PAIN AND BONE DISORDERS

Complication of diabetes may led to bone and joint dis-order as diabetes

affects nerves and arteries which inturn affects joints and leads to joint pain. In terms

of the complications of diabetes, joint disorders tend to get mentioned less than the

likes of retinopathy and kidney disease but some of the conditions can be serious.

1.17.17 DENTAL HEALTH

Diabetes can affect the whole body, including mouth portion. One has to take care

of teeth and gums. It is of primary important to manage the blood sugar. Increased blood

glucose can put at risk of oral health problems. For example: Dry mouth can lead to

soreness, ulcers, infections and tooth decay and Inflammation in gums.

If one has diabetes, dental care is even more important, but it does not mean

that one has to adopt a new or different treatment regimen. Being aware of how best

to look after one’s teeth is an essential part of learning to live with both type 1 and

type II diabetes.

A diabetic patient should inform his / her Dentist about the intake of medication

for Diabetes, The dentist, may need to take this into account when they give advice or

recommend treatment. It can lead to hypos, such as insulin or sulfonylurea; let the

30

dentist or the doctor know that the diabetic treatment regime needs to be modified

before the dental work. High blood sugar levels may affect the time the teeth and

gums take to heal. If dental work is taking an unusually long time to heal, the diabetes

healthcare team or dentist should be contacted immediately for advice.

1.17.18 GUM DISEASE

Gum disease is a very common infection and occurs when bacteria within the

mouth begins to form into a sticky plaque which sits on the surface of the tooth. Over

time, if this is not removed by regular brushing using the correct technique, a gum

inflammation called gingivitis can develop. This will lead for red and swollen gums,

bleeding will often occur whilst brushing. Gum disease will stem from untreated

gingivitis, and in turn the teeth will begin to decay. One unfortunate side effect of

diabetes and high blood glucose levels is the fact that any infection in or on the body

will spread more easily. Keeping blood glucose levels under control reduces the risk

of infection spreading. Unfortunately, when the body begins to fight an infection,

blood glucose levels will usually rise in response and the infection in the mouth

become worse; food intake could be affected and further affects the diabetes.

1.17.19 THRUSH

Thrush of the mouth is also more common amongst people who have less

controlled blood glucose levels. Signs of oral thrush include white patches within the

mouth and cracking of the skin at the corner of the lips.

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Diabetes Risk Factors

Thrush

Figure 5

Several risk factors have been associated with type II diabetes, includes:

Unhealthy diet

Physical inactivity

High blood pressure

Ethnicity

Family history of diabetes

Overweight

Increasing age

1.18 ANATOMY OF THE PANCREAS

The pancreas is an elongated, tapered organ about 15cm long, in abdomen which

is a located behind the stomach across the back of the abdomen. The right side of the

organ (Head) is the widest part of the organ and lies in the curve of the duodenum (the

first section of the small intestine). The tapered left side extends slightly upward

32

(body of the pancreas) and ends near the spleen (also called as tail). The pancreas

is made up of two types of tissue.

Anatomy of Pancreas

Figure 6

1.18.1 EXOCRINE

The pancreatic juice is secreted by the exocrine part, which helps in the

digestion of carbohydrates, fats, and proteins. These enzymes are secreted into a

network of ducts that join the main pancreatic duct, which runs the length of the

pancreas. Exocrine glands include sweat, salivary mammary, ceromious, lacrimal and

mucous.

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1.18.2 ENDOCRINE TISSUE

The endocrine gland consists of a group of cells called the Islets of Langerhans.

This secretes hormones into the bloodstream. These cells produce hormones called

insulin and glucagon. These hormones influence the utilization of sugar in the body.

1.18.3 FUNCTIONS OF THE PANCREAS

The pancreas has digestive and hormonal functions. The enzymes secreted by

the exocrine tissue in the pancreas help break down carbohydrates, fats, proteins, and

acids in the duodenum. These enzymes travel down the pancreatic duct into the bile

duct in an inactive form. When they enter the duodenum, they are activated. The

exocrine tissue also secretes bicarbonate to neutralize stomach acid in the duodenum.

The endocrine glands, secrets hormones in the pancreas are insulin and

glucagon. It regulates the level of glucose in the blood and somatostatin, which

prevents the release of the other two hormones.

Best way is to lower the diabetes by practicing yoga which avoids risks of

developing complications later, slowing the progress of complications.

1.19 DIABETES AMONG AGED MEN

Aged men with diabetes have the highest rates of major lower-extremity

amputation, myocardial infarction, visual impairment, and end-stage renal disease.

Retinopathy, cardiovascular and peripheral neuropathy disease is significantly more

common among the old age with diabetics. Those aged above 75 years have higher

rates than those aged between 65 and 74. The rates of death due to hyperglycemic

crises also are significantly higher in older adults.

34

Although increasing numbers of individuals with type 1 diabetes are living

into old age. Older adults are at high risk for the development of type II diabetes due

to the combined effects of increasing insulin resistance and impaired pancreatic islet

function with aging. Age-related insulin resistance appears to be primarily associated

with adiposity, and physical inactivity. Healthcare burden of elderly diabetes is

immense and proper diagnosis and treatment alone can prevent further complication

(Sue Kirkmen M, 2012).

1.20 PREVENTION OF DIABETES

At present, type I diabetes cannot be prevented. However, type II Diabetes can

be prevented, if we have a systematic approach as under:

Reduce Sugar and refined carbohydrates from the diet: Eating food

high in refined carbohydrates and sugar increases blood sugar and

insulin level. Avoiding these foods may help reduce your risk.

Follow a regular work out: Physical activity on regular basis can

increase insulin secretion.

Drink Sufficient Quantity of Water: This will control blood sugar and

insulin levels.

If over Obese, advisable to lose weight: Having excess weight,

particularly in abdominal area increasing the risk of diabetes. Smokers

to quit smoking: It is strongly recommended to quit this habit.

Follow a Healthy Very Low Carb Diet: To keep the blood sugar and

insulin level under control, it is advisable to follow a ketogenic diet.

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Prevention of Diabetes

Figure 7

Keep an eye on the volume of food intake: Avoid large portion of size

intakes

Avoid Sedentary Behaviors like excessive sitting.

Eat a High-Fiber Diet at each meal can help

Vitamin D Level should be maintained at optimum level or taking

supplements

Intake of Processed Foods should be avoided / minimized

Other behaviors to consider include:

Smoking: Smoking increases risk of developing Diabetes and aggravates its

complications. As well as other harmful effects, smoking increases abdominal fat

accumulation and insulin resistance. All smokers should be encouraged to quit

smoking. However, weight gain is common when quitting smoking and therefore

dietary advice on avoiding weight gain should also be planned.

36

Depression, Anxiety and Risk of Type II Diabetes: The exact causes of type II

diabetes are still not clear. Since the 17th century, it has been suggested that

emotional stress plays a role in the etiology of type II diabetes mellitus. Many

research studies have mainly focused on depression and anxiety as a risk factor for the

development of type II diabetes mellitus. Chronic emotional stress is an established

risk factor for the development of depression and anxiety. The review of European

Depression in Diabetes (EDID) provides an overview of mainly prospective

epidemiological studies that have investigated the associations between different

forms of emotional stress and the development of type II diabetes mellitus.

Sleeping patterns: Both short (<6h) and long (>9h) sleep durations may be

associated with a higher risk of developing type II diabetes. Sleep deprivation may impair

the balance of hormones regulating food intake and energy balance. Long sleep durations

may be a sign of sleep-disordered breathing or depression and should be treated

appropriately. There is also a close association between obesity and obstructive sleep

apnea syndrome (OSA), the most common form of sleep disordered breathing.

1.21 ESSENTIALS OF YOGA

The word “yoga” is derived from the Sanskrit root “yuj”, which means to bind,

join, and union, attach and yoke”. Yoga is a practical aid, not a religion. Yoga is an

ancient art based on a synchronizing system of development for the body, mind, and

spirit. The continued practice of yoga will lead you to a sense of peace and well-

being, and also a feeling of being one with their environment. Yoga is a way of living.

Man is a physical, mental and spiritual being; yoga helps to promote balanced

development of all the three.

Total health is balance between body, mind and soul. The word Yoga comes

from Indian philosophy, it literally means union, and in this context refers to the union

of the individual's soul with the universe. Yoga is the only discipline - utilizes the

body, mind and spirit, all in one practice. Yoga is indeed a spiritual path that is based

on ancient sacred philosophy, but one does not need to make an ethical decision when

practicing yoga, rather finding your own path is wholly accepted.

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In Indian thought, everything is permeated by supreme universal spirit of

which the individual human spirit is a part. When one’s mind, intellect and self are

under control, free from craving or desire, the body is fit. Every disease begins in a

rudimentary manner. The inner focus as a means to enhance the sensory and human

ability is the root of all Yoga. The word can be split as a dis-ease lack of ease in body

and mind.

The holistic benefits of yoga are suitable for everyone whether young or old,

sick or well, with any religious background. The secrets of yoga are spiritualism,

concentration, and purification of mind and body with cleansing thoughts and food. It

is a perfect maintenance of the internal environment (Swami Shankardevananda,

2006).

Yogic Science is matchless gift to mankind. Yoga is the only way through

which mankind can rescue itself from its own destructive attitude and make further

progress. Yogic science is ultimate goal of this science is the realization of the

Absolute, in day to day life it is useful and necessary to maintain mental and bodily

health. Bodily exercises (asanas), breath control (pranayama) and mind control

(dhyana) are all helpful to conquer bodily and mental ills.

Saint Patanjali is remembered as a sage who gave us Yoga Sutras for

discipline of mind, medicines for health of the body and grammar for purity of the

tongue. Yoga is primarily a philosophical science, born out of man’s seeking to

fathom the meaning of existence. Patanjali has said in the second sutra: “Yogah

cittiavrtti nirodhah” (Yogah = integration of all levels of our being; citta =

consciousness, vrtti = fluctuation or state of mind; nirodhah = restraining) meaning.

“Yoga is the cessation of consciousness”.

Patanjali has explained that “uncertain action, giving rise to violence, whether

done directly or indirectly, or condoned, is caused by greed, anger or delusion in

different degrees. This causes endless pain and ignorance. Through introspection

comes an end to pain and ignorance”. This sutra explains the essence of the genesis of

ill health in today’s world and also the method of management.

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Yoga is widely accepted as a form of medicine which can prevent and cure

many ailments. Hence it should not be considered as alternative system by as a

primary form in those areas where Yoga alone can cure certain ailments. That it can

tackle many major illness non-invasively puts yoga in a different dimension from just

being a stress-relieving panacea. Yoga is a more direct approach than modern

medicine as it uses mind and inner sense as a conscious process whereas bio-feedback

is used as stress-relieving technique in modern medicine.

1.22 CLASSIFICATIONS IN THE CRONOLOGICAL AGE OF YOGA

The trace the origin of Yoga with accuracy is a difficult task. Some traces it

back to over 5000 years. But some speculate that yoga may be of up to 10000 years

old. Its traceable history can be generally divided into four broad periods as follows.

Vedic Period

Pre Classical Period

Classical Period

Post-Classical Period

1.22.1 VEDIC PERIOD

This period is marked by the emergence of the four Vedas, the Rig Veda Yajur

Veda, Saama Veda and Atharva Veda. The Vedas contain the oldest known Yoga

teaching called the Vedic Yoga. The Yogis led a healthy living in solitude and

seclusion became known in this age. These Rishis realised the ultimate truth through

their intense spiritual and meditative practices. In this period people followed the

dictates of the Yogis or Rishis and life was fixed on Divine harmony.

The Vedic Yoga, also known as Archaic Yoga, revolves around yoking of all the

powers of body, mind and soul to God; thus achieving or disciplining of the intellect, the

mind, the emotions, the will, which that Yoga pre-supposes; it means a poise of the soul

which enables one to look at life in all aspects evenly (BKS Iyengar, 1991).

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1.22.2 PRE-CLASSICAL PERIOD

The most central Yoga literature during this Pre-classic period is the

Upanishads which is a collection of texts revolving around meta-physical speculation.

This period in Yoga history spans about 5000 years. They are just like the Vedas,

considered as enigmatic revelations. As opposed to the public rituals of the Vedic

period, the Upanishads were secret scriptures. As Yoga and its secret teachings are

passed on from teacher to student or from guru to yogi, the concept of an individual

system of thought began to take shape.

Yoga was developed as a part of the tantric civilization which existed in India

and all parts of the world for more than 10,000 years ago. According to Indian

mythical tradition Shiva is said to be the founder of Yoga and Parvathi, was his first

disciple. The second set of yogic teaching was expounded by Lord Shiva to the sapta

Rishis or the first seven sages on the banks of karti Sarovar near Kedarnath,considered

as the world’s first collective yoga programme (ElangovanR, 2016).

1.22.3 CLASSICAL PERIOD

Patanjali Yoga is the eight-limbed Yoga described in the Sutras usually

referred to as Classical Yoga. The Yoga Sutras where most likely written around year

100-200 A.C. and consists of about 195 aphorisms (words of wisdom).

Here Yoga is presented in a systematic and approachable way, and many yogis

see it as an important source of yogic understanding. Almost all serious Yoga

practitioners will at some point study this literature and it has been published with

commentary many times since it was first published.

The first systematic and coherent presentation of Yoga was done by the sage

Patanjali in the Classical period when he brought out his Yoga Sutras. This is

generally understood to be dated between third and sixth century BC. Patanjali’s Yoga

propounds the Ashtanga Yoga or Yoga with eight limbs. It is also called as Classical

or Traditional Yoga.

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1.22.4 POST-CLASSICAL PERIOD

The great number of independent yoga schools that where developed, after

Sage Patanjali. A few hundred years after Patanjali, the evolution of Yoga took an

interesting turn - the potential of the human body now became an interesting field of

study. Yoga sutras, is usually referred to as post-classical Yoga.

Yogis of the past had not paid very much attention to the (physical) body, as

they focused all their energy on contemplation and meditation. Their goal was to leave

their bodies and the world, in order to re-unite with the shapeless reality - the soul.

Tantra Yoga came into picture with the aim of soul to attain enlightenment. From the

term Tantra Yoga and its physical-oriented practices emerged, what is today called as

Hatha Yoga.

1.23 MODERN YOGA

Modern Yoga is said to have begun at the World Parliament of Religions in

Chicago, 1893, where Swami Vivekananda introduced Yoga to Americans during his

stay in America and made ever-lasting impression in the minds of Americans. He

became the most popular among the delegates of the parliament of Religions, after his

historic speech on September 11th

1893 and he subsequently toured America and other

European countries and gave lectures on Yoga. Later, many Yoga masters crossed the

ocean and followed his footsteps and spread the Science of Yoga to all corners of the

world. Yoga schools were started and increasing number of people fell in love with

the yogic forms of exercise.

Yoga, in the form of Hatha Yoga, debuted in the consciousnesses of the west

masses when Russian born Indra Devi called "the first lady of Yoga", opened a Yoga

studio in Hollywood in 1947. She taught movie stars like Jennifer Jones, Gloria

Swanson and Robert Ryan, as well as educated hundreds of Yoga teachers. The most

influential yogi of all was Tiurmalai Krishnamacharya, who is responsible for the

incredible spread of asana practice in the west (Daniel Clement with Naomi

Clement, 2007).

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1.24 YOGA TODAY

Despite Yoga, having existed in India for many years, in the current scenario,

Yoga is the fast growing health movement. As people are looking for answers for

their daily problems, their attitude towards health, spirituality, way of life and our

place in society have changed drastically. We cannot always solve these problems,

but we can learn to face them. In these chaotic times, our environment is fighting for

survival and we humans suffer more and more from physical and psychological stress.

With new diseases developing, while the old ones, that we thought, could be handled

with antibiotics, returns with a vengeance in the midst of our society, and to this end,

Yoga is as good as an invention.

Yoga has gained tremendous popularity during the last few years and today, if

we take a look at the global population, 300 million people practice yoga.

If we look at the status of yoga in the world today, we can be reassured that

with its exploding popularity, the future looks to be a healthy and happy one. If the

same scenario continues, it is expected that Yoga practices will touch the life of over

one billion people by 2025.

1.25 YOGIC CONCEPT OF BODY AND HEALTH

According to Yoga, a human being is capable of experiencing five dimensions

of existence, which are called Panch Kosha or five sheaths. They are as follows.

ANNAMAYAKOSHA (food-apparent-sheath) is the first sheath or level of

experience is the physical body. The word anna means food and maya “comprised of

“this is the gross level of existence and is referred to as the food sheath due to its

dependency on food, water and air. It includes the five organs of perception (sight,

hearing, smell, taste, touch), and the five organs of action (apprehension, locomotion,

articulation, excretion, procreation).

PRANAMAYAKOSHA (air-apparent-sheath)is the second sheath, energy field of

an individual. The level of experience here is more subtle than the physical body.

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Five vital airs that correspond to five physiological functions of the mind and body

are called as five pranas.

Prana (in breath) -- affects faculty of perception: the functioning of

the five senses

Apana (out breath) -- affects faculty of excretion: eliminates,

"throws out" or evacuates the wastes of the body

Samana -- affects faculty of digestion; digests food received by

the stomach

Vyana -- affects faculty of digestion; distributes digested food

to different parts of the body through blood stream

Udana -- affects the faculty of thought-absorption: takes in fresh

knowledge

MANOMAYAKOSHA: Being the third sheath, is the mental dimension.

Level of experience is the conscious mind which holds the annayamaya and

pranayamaya kosha together as an integrated whole. . The mental sheath controls the

vital air and food sheaths.

VIJNANAMAYAKOSHA (Vijnana): Being the fourth sheath, gives the

psychic level of experience which relates to the subconscious and unconscious mind.

This sphere pervades the manomaya kosha but it is subtler than it. It analyses and

distinguishes between pairs of opposites. It controls the above three sheaths.

ANANDAMAYAKOSHA (Ananda):Being the fifth sheath, level of bliss and

happiness. This is the casual or transcendental body, the abode of most subtle prana.

The bliss sheath consists only of mental impressions or tendencies in seed form called

vasanas. When an individual is in deep dreamless sleep, he is encompassed by the

bliss sheath.

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Pancha Kosha

Figure 8

1.26 ADHI/VYADHI

The thoughts are transmitted to the body through the neuro-endocrine system.

Adhi (mental/emotional disturbances in the manomayakosha or astral sheath) cause

corresponding disturbances at the physical level (annamayakosha). These

disturbances are called vyadhi.

Physical disease is caused by disturbances/corruption and/or obstruction of the

nadis (psychic nerves) and energy patterns which have become disrupted, distorted,

and patterned into corruptive patterns causing degeneration, dissolution dis-ease, pain,

suffering, stasis, and death. By eliminating the source of through effective therapy

blocked pathways gets opened up rechanneling the energy flow (Swami

Niranjanananda Saraswati, 2009).

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1.27 YOGA THERAPY

According to yogic view, diseases, disorders and ailments are results of the

way we lead our lives, our ignorance in doing thing, lack of understanding education

or knowledge related to the individual. Therapeutic Yoga is basically a system of self-

treatment. The lifestyle diseases either temporary or prolonged malfunctioning of our

immune system is the major cause of diseases. This malfunctioning is caused due to

certain errors of the individuals. Since the root cause of a disease lies in the mistakes

of the individual, its cure also lies in correcting the mistakes by the same individual.

Thus it is the individual himself who is responsible in both the cases that is, for

causing as well as for curing the disease.

This being the basic assumption in this system about the nature of the trouble

and its remedy, there is total reliance on the effort of the patient himself. The yoga

expert shows only the path and works no more than a counselor to the individual.

Yoga-Therapy is an ingenious and useful by-product of the ancient Yoga-

Shastra. Both the main branches, namely Raja and Hatha are contributing to the

Material and Medical of treatment by Yoga Asanas (R K Garde, 1984).

1.28 YOGA – AN ASSET FOR PREVENTIVE CARE

Yoga can also be called as a form of medicine that can treat many ailments

and help us attain a state of equipoise. Yoga can be best used as a tool for preventive

care. It lays great emphasis on asanas and pranayama to prevent illness and helps to

maintain better health. Done regularly it prevents many illnesses. Performing Yoga

regularly is gentle, soothing and instills confidence and keeps us active and healthy as

we grow older.

If, any individual is looking for a wellness activity, yoga is a great option. Not

only is it a good form of physical exercise, there are also mental and spiritual health

benefits. Yoga involves a lot of mental focus, breathing control, meditation, and

simple poses which are meant to strengthen both the body and mind. Both men and

women can experience the following benefits while doing yoga.

45

Yoga does more than burning calories and toning of muscles. It's a total mind-

body workout that combines strengthening and stretching poses with deep breathing

and meditation or relaxation. It strengthens the muscles and holds up the body weight

and strengthens the muscle mass Cartilage and protects the Joints. It also increases the

flexibility and prevents arthritis. Increased flexibility results in better management of

back pain. Strengthens the Immune and Adrenal System and drains the lymphatic

system and thereby the toxic chemicals, cancer cells and infection can regulate the

adrenal glands and overall cortisol levels. By lowering the blood pressure it gives

health to the heart. Improved posture helps in eliminating the neck and back pain.

Concentration of asana can increase long and short term memory, focus,

concentration, problem solving skills and overall cognitive abilities. Increasing the

bone mass with yoga positions are weight bearing exercises. Higher level of serotonin

and dopamine in the body helps decrease the anxiety and depression. Yoga improves

Digestive System by stimulating body to process food which aids in proper digestion,

by including wellness program in an organization; it helps employees understand the

benefits of exercise.

Physical body undergoes birth, growth, change, decay and death which are very

normal. The yogi sees the life as a triangle; growth period reaches a plateau at about the

age of eighteen – twenty years. In the first years of life, the “youthful period”, the rate of

cell rejuvenation (anabolic) exceeds the rate of cell decay (catabolic). In the average

person, the body maintains equilibrium of these processes from the age of twenty until

around thirty five. Then the decaying, or catabolic process, begins to take precedence, and

the body starts its decline. This process later results in old age with its accompanying ills

and despair. However, yogis say that we were not born merely to be subject of pain and

suffering, disease and death. There is far greater purpose to life. But the spiritual

investigation of life’s purpose requires a keen intellect and a strong will; these are the

products of a healthy body and mind. For this reason, the ancient sages developed an

integral system to ward off or retard the decaying or catabolic process and to keep the

physical and mental faculties strong. This is the system of yoga, a simple and natural

programme involving five main principals:

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Proper Exercise - Asanas

Proper Breathing - Pranayama

Proper Relaxation - Savasana

Proper diet - Vegetarian

Positive Thinking and Meditation - Vedanta and Dhyana

Yoga is a life of self-discipline based on the tenets of simple living and high

thinking. The body is a temple or vehicle for the soul and has specific requirements

which must be fulfilled for it to function smoothly and supply the optimum mileage.

These requirements may be seen metaphorically in the relationship to those of another

vehicle.

Proper Exercise, Diet, Relaxation, Breathing, Thinking and Meditation helps

in lubricating joints, muscles, ligaments, tendons; provides correct fuel to the body.

Optimum utilization of food, air, water and sunlight is also essential. Breathing

Technique (Pranayama) energy is released for physical and mental rejuvenation. The

intellect is purified and with conscious mind, it controls steadiness and concentration

of mind.

1.29 ROLE OF YOGA IN CONTROLLING DIABETES

Regular practices of Yoga asanas assist in controlling type II diabetes to a

remarkable extend. As yoga is a physical mental and spiritual practice it is extremely

beneficial for physical and mental health. Diabetes may be manage without

medication, but cannot manage without exercise and healthy diet.

Hence definite forms of yoga meditation, asanas or postures can have a

curative impression upon the varied bodily parts both internal and external and also on

the glands. Chief among these asanas are Halasana translated as plough posture,

Bhujangasana also known as the snake or the cobra pose, Salabhasana are some of the

few backward postures that can cause the pancreas to stimulate and exercise the

abdominal muscles. Surya namaskar or otherwise called as Sun Salutation, is a form

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of yogic practice which is a combination of Asanas, Loosening exercises and

breathing practice which helps to supply blood to all parts of the body, indirectly

causes insulin improvement and assimilation.

1. Blood pressure and increased cholesterol levels play a great role in

development of diabetic and related complications; People suffering

from Diabetic have been benefited by yoga.

2. Muscular relaxation, development and improved blood supply to

muscles might enhance insulin receptor expression on muscles causing

increased glucose uptake by muscles and thus reducing blood sugar.

3. Weight loss induced by yoga is a well-accepted mechanism.

4. ‘Stress hormones’ such as adrenaline, noradrenalin and cortical in

blood are reduced through yoga practices. A good number of yogic

postures stretch the pancreatic region, which in turn stimulates the

function of pancreas.

5. Stress enhances the secretion of Glucagon’s in the body and Yoga

effectively reduces stress, thus reducing glucagon and possibly

improves insulin action.

6. When a regular exercise program is done the sensitivity of body cells

to the action of insulin increases. The increased sensitivity makes it

possible for the cells of our body to use glucose more easily.

1.30 VARMATHERAPY

Varma therapy is an ancient Tamil medicinal system practiced by the

Siddhars, and was written only in Tamil language. The Siddhars attained the Blissfull

state, called Siddhi by constant practice of certain Spiritual disciplines. Tamil

Siddhars developed this concept of Varma and have given treatment to the masses

besides having a record in manuscript form, thus proving the Varma Therapy is an

ancient medicinal science.

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Historically, Siddhars also refers to the people who were early age wandering

adopts that dominated ancient Tamil teaching and philosophy. They were

knowledgeable in science, technology, astronomy, literature, fine arts and provided

solutions to common people in their illness and advice for their future. Some of their

ideologies are considered to have originated during the First Sangam Period.

Typically Siddhars were saints, doctors, alchemists and mystics all in one.

They wrote their findings in the form of poems in the Tamil Language, on palm leaves

which are collected and stored in what are known as the “Palm Leaf Manuscripts”.

These are still owned by some families in Tamil Nadu and handed down through the

generations, as well as being kept in public institutions such as universities in India,

Germany, Great Britain and the United States.

Thus Siddha medicine is the one of the oldest medical systems originated from

South India. Varma is one the main streams within siddha medicine. If a patient is

suffering from pain in some part of the body, siddha medicine will be given to apply

the herbs externally, which after absorbed by the body, produce the cure. But based

on varma, certain pressure points are tuned to regulate the blood flow, which gives

immediate relief to the pain. In South India, Siddha doctors use this technique of

combined medication to give faster and better relief to the patients. In Ayurveda

system of treatment, Varma therapy is known as Varma therapy and it is followed

more in North India. However both Varma and Marma are one and the same.

Varmas are composed of all five basic components (mansa, sira, snayu, asthi,

and sandhi). Varmas are panchabhautika such as prithivi, jala, teja, vayu, akash (Sunil

Kumar Joshi 2010).

Siddhars have invented many therapy methods, out of which Varma Therapy

plays an important role. It stimulates vital energy of a particular point in the human

body and cures the problems in the affected area / region. Varma also represents

science of motion and function of the life-energy.

It is around 7000 years old that originated in Lemurian Continent also known

as Kumarikandam between BC 50,000-16,000 then followed by Chera, Chozha,

49

Pandiya and Pallava who have emphasized the Varma Therapy (Kannan Rajaram,

1993).

The Varma Therapy easily got spread across the globe through Buddhist

Monks. In particular, during AD 520, Bodhi Dharmar who went to China has

propagated the Varma Therapy. Besides spreading the Varma Therapy importance, he

has cured many ailments for the public in large (Shu Hikosaka et. al., 2007).

The healing application called Varma Vaidhiya is used to treat patients

suffering from Lifestyle Disease, Diabetes, Paralysis, Nervous Disorder, Spondylitis

and other conditions. Its combat application is known as Varma adi, meaning

“pressure point striking”.

This Varma Therapy has evolved in different forms like Accupuncture and

Accupressure also as per Medical Experts (S Mutharasan, 2003).

For the functioning of a Healthy and disease free body the fundamental need is

Prana sakthi or the vital energy. When the pranic energy flows throughout the body

uninterrupted, the body and mind will be functioning well. When there is an

abstraction or hindrance in the flow of Prana in the body various physical and

psychological disorders occur in the human body.

The Prana energy is stored in various centers throughout the human body, and

these centers are termed as varma points. By stimulating these varma points the Pranic

energy is made to flow throughout the body in a balanced manner which paves the

way for curing various health disorders.

In the human body across all the areas there are pressure points and they are

also available in joints, muscles, blood vessels, veins and vulnerable joints. Always

there is a prana energy flowing through the system. If there is any blockage in a

particular area of the human body at any point of time, then Varma Therapy helps in

regaining the original status.

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1.30.1 HISTORY OF VARMA THERAPY

It is believed that Lord Siva taught this art form. Varmakalai (the art of varma)

is considered to be very auspicious. Indians overwhelm by saying that all rare art

forms originate with roots from God.

According to the Dakshinamurthy Kaaviyam (778-780/1000), Lord Siva

taught varma to his wife Parvathi; later Parvathi taught varma to their son Lord

Murugan. Lord Murugan then taught Siddha Agathiyar. Agathiyar later gave a written

form that reached the masses. Through Agathiyar, the science of Varma Therapy

spread through other Siddhars like Bogar, Pulipaani, and Ramadevar. This

information is given in the following poem.

“Panbaaga Agathiyanaar, Ramadevar

Panivaaga Boga Munivar thaanum

Paruvamaai manidhargal pizaikavendru

Paangaaga sonnadhoru noolgal kandu

Paarthidave surukamai prithusonnen”

Kaimathirai Thiravukol-41

“Kumbayon soonna podhu gunamulla Kumaravelum

Anbaruku alladhe engu, yaarukum aagaadhendru Thanperu

beerangi noolai, thaan vaithu kandheduthu

Enperumaanukku endru enangi nool eduthu vaithaar paaru”

Varma Beerangi -3

The above poem explains that, Varma Science came into existence through

lord Shiva, and spread through Parvathi, Lord Muruga, Agasthiyar, Bogar and other

Siddhars (Shanmugam N, 2015).

Even though, VarmaTherapy is attributed to several Siddhars (sages) namely

Agastya, Bogar, Theriyar and Pulipani, only the Agastya School is commonly practiced

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in Tamil Nadu and in the neighboring state of Kerala. As a general rule, the vital

points in north India, Pakistan and Bangladesh are numbered at 107, while the schools

of south India and Sri Lanka recognize 108 points.

Hence, for the growth of varmakalai, mankind's capability, thinking process

and action played a dominant role. Our ancestors invented this art to help the

mankind. It is our duty to preserve this rare art (Kannan Rajaram, 2011).

1.30.2 VARMA AND YOGA

According to “Varmasara nool”, the origin of a Tamil text book on Varma

system of medicine describes Varma in the following poem.

“Udaluyir nadi thannil

Undhidum vaasiyadhaam

Oon odal maruviye

Oodaadum nilaye Varma” (Varma saranool) 7/16

The meaning of the above poem is, Varma points are the points (Sites / Stations

/ Centre) to control the life energy flow and they absorb the energy from one or more

organs or varma points and pump it to other one or more organs or varma points

systematically. Alternatively, it is an area in which energy is stored and conducted

through networking channel. The purpose of Varma Point is to increase the force

which will ultimately regulate the flow of life-energy through network channel.

Yoga is classified into two main streams. One based on breathing and another

based on body postures. They work in tandem and culminate to form today's yoga. If

yoga asanas (yoga postures) are properly practiced, it will result in good health. The

basic reason for that is yoga asanas which properly tunes the nerves system (along

with varma points present in the nerves system), resulting in regulated blood flow

throughout the body.

The practice of Asana has its effect on certain group of varma points enabling

proper flexibility, health, mobility, and physique. For example, if one practices

52

Sirasasana (headstand posture), it activates the varma points: Kondai Kolli,

Thilarndha Kalam, Patchi Varma, and Pidari Kalam. The Iddakala (Left) and a

Pingala (Right) nerve get tuned and strengthen the vertebral column. It increases

concentration, memory, serenity on one's face, etc.

1.30.3 CURRENT STATUS OF VARMA SCIENCE

The science of Varma, which was confined to the Siddhars, and saints of south

India has gained the faith of the people and is becoming popular among the masses.

Now it has become more academic oriented and many universities have started degree

courses in Varma therapy. The ancient traditional manuscripts pertaining to Varma

science has been published by many Government and private publishers. Many

Government and private Hospitals have started giving Varma Treatment through their

specially appointed qualified Varma experts. In Tamilnadu all District Head quarter

Government hospitals are having Varma treatment facilities under the Department of

Siddha and Ayurveda. Many research scholars have done exclusive research work in

Varma and Varma science and have submitted their papers in many National and

International journals. In addition to this, many research works is in progress in the

field of Varma therapy.

1.30.4 METHODS OF VARMA THERAPY

There are various methods of Varma Therapy to treat a patient according to

the type of illness and body condition. Following are a few methods

Stimulating Method (Thoondal Murai)

Manipulating Method (Elakkal Murai)

Massage Method (Thokkanam Murai)

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1.30.5 STIMULATING METHOD (THOONDAL MURAI)

Stimulating Method (Thoondal Murai) in varma therapy is done according to

the specific ailment, by stimulating the specific varma points pertaining to the ailment

and making the prana skathi to flow in a proper manner to the affected area .

1.30.6 MANIPULATING METHOD (ELAKKAL MURAI)

Manipulation method in Varma Therapy is a method of curing the body or

parts of the body which is injured due to accident or an internal injury which is caused

due to attack or hit.

1.30.7 CLASSIFICATION OF VARMA POINTS IN THE HUMAN BODY

The ancient manuscript “VARMAKANNAADI 500” classifies the total varma

points of the human body are into five KANDAMS (Five regions) in the following

manner. There are total 108 varma points in the body as per the above

classification,however the number of varma pints in each region is differing in

different varma texts (Rajendran T, 2006).

Table V Varma points in the human body

Sl. No. Region No of Points

1 Head Region 25

2 Neck to Naval Region 45

3 Naval to Anal Region 9

4 Hands 14

5 Legs 15

Total 108

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1.30.8 IMPORTANT CATEGORIES AND APPLYING METHODS OF

VARMA POINT

Thodu varma - pressure points

Paddu varma - micro pressure points

Thattu varma - tapping points

Thadavu varma - massage points

Nakku varma - licking points

Oodhu Varma - blowing points

Nokku varma - visual points

1.30.9 THODU VARMA (PRESSURE POINTS)

The varma points which are handled by using the fingers are called Thodu

varma or pressure points. In this method the selected varma points are stimulated by

pressing the varma points using the finger which in turn increases the flow of prana in

the affected area and hence the cure takes place.

1.30.10 PADDU VARMA (MICRO PRESSURE POINTS)

The varma points which functions in the minutest arteries, veins & regions eg.

Thilardhakaalam (eyebrow point) Natchatra Kaalam (bone of eye cup) pidari varma

(Point near C1 of cervical) where the vital energy (prana) flowing is called PADDU

VARMA or (Micro Pressure points). When there is injury in these varma points a

moderate pressure only should be applied.

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1.30.11 THATTU VARMA (TAPPING POINTS)

Those varma points which are stimulated by tapping the particular affected

region are called THATTU VARMA.

1.30.12 THADAVU VARMA (MASSAGE POINTS)

Certain varma points starts functioning well when they are stimulated by

slightly massaging or rubbing with the help of palms. Such varma points are termed

as THADAVU VARMA.

1.30.13 NAKKU VARMA (LICKING POINTS)

Those varma points which are stimulated by using the tongue are called

NAKKU VARMA. Children less than 6 months old are to be treated by stimulating

their affected varma points using the tongue

1.30.14 OODHUVARMA (BLOWING POINTS)

The process of stimulating the varma points by blowing air through the mouth

in the affected region is called OODHU VARMA. Touching method should not be

used while treating pregnant women instead of that Oodhu varma is used on them.

1.30.15 NOKKU VARMA –(VISUAL POINTS)

The process of treating a patient by passing the prana and stimulating the

varma points in the affected region through vision (seeing) and not by touching

method is called NOKKU VARMA.

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1.30.16 LOCATIONS OF VARMA POINTS

Head Region Varma Points

Head Region Varma Points

1. Kondai Kolli Varma

2. Patchi Ner Varma

3. Patchi Varma

4. Malar Varma

4. Thilartha Varma

5. Vala Moorthi Varma

6. Eda Moorthi Varma

7. Kanni Varma

8. Udhira Kalam

9. Urakka Kalam

10. Ottu Varma

11. Sanguthiri Varma

12. Sumai Varma

13. Thiripura Varma Figure 9a

Head Region Varma Points

1. Puruva Varma

2. Kannadi Varma

3. Mandhira Kalam

4. Pala Varma

5. Kambodharik Kalam

6. Soondi Kalam

7. Min Vetti Varma Figure 9b

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Head Region Varma Points

1. Seerunk Kolli

2. Shruthi Varma

3. Pidari Kalam

4. Porchai Kalam (PenKolli Adangal)

Figure 9c

Head Region Varma Points

1. Sunnambu Kalam

2. Natchathira Kalam

3. Annaan Kalam

4. Poigai Kalam

5. Kutri Varma

6. Sevikutri Varma Figure 9d

58

Chest and Abdomen Region Varma Points

1. Sumai Varma

2. Sanguthiri Varma

3. Sakthi Varma

4. Thummik Kalam

5. Kadhir Varma

6. Kadhirkama Varma

7. Koombu Varma

8. Ner Varma

9. Urumik Kalam Figure 10a

Chest and Abdomen Region Varma Points

1. Thoosumuga Varma

2. Kuthu Varma

3. Kaikootu Kalam

4. Putru Varma

5. Hanuman Varma

6. Anna Kalam

7. Kilipirrapizh Varma

8. Kakattai Kalam

9. Vilangu Varma

10. Endhi

12. Buja Varma

13. Piratharai

59

Abdomen and Thigh Region Varma Points

1. Kareeral Varma

2. Ettal Varma

3. Velleral Varma

4. Adappak Kalam

5. Siriya Athi Surukki

6. Valiya Athi Surukki

7. Mundal Varma

8. Palla Varma

9. Araiyappu Thalam

10. Aamai Kalam

11. Ulthodai Varma

12. Kannu Varma

13. Kaikatti Kalam

14. Jadapirazh Varma

15. Adaippu Kalam Figure 11a

Abdomen and Thigh Region Varma Points

1. Moothirai Kalam

2. Kallidai Kalam

3. Idamburi Kalam

4. Valamburi Kalam

5. Thandu Varma

6. Vithu Varma

Figure 11b

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Back and Hand Region Varma Points

1. Suzhiadi Varma

2. Mudichi Varma

3. Kaisulukki Varma

4. Sippi Varma

5. Nattal Varma

6. Poonool Varma

7. Vayvu Kalam

8. Katchai Varma

9. Nangana Pootu

10. Aani Kalam

11. Nodi Varma

Figure 12a

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1. Savvu Varma

2. Kai Mootu Varma

3. Theetha Varma

4. Soondodhari Varma

5. Thudhikai Varma

6. Manipandha Varma

7. Ullangai Vallai Varma

8. Thatchanai Kalam

9. Gowri Varma

10. Mozhi Pirazhkai Varma

Figure 12b

Leg Region Varma

Points

1. Padhukal Varma

2. Veera Adangal

3. Pakka Varma

4. Mootu Varma

5. Mudichu Maiya Varma Figure 13a

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Leg Region Varma Points

1. Komberi Kalam

2. Mannai Varma

3. Uppukutri Varma

4. Padhamudichu Varma

5. Padangaal Varma

6. Soondigai Varma

7. Kanpugaichal Varma

8. Pulimuthadangal

9. Viruthi Kalam

10. Kudhikal Varma Figure 13b

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1.31 REASONS FOR THE SELECTION OF THE TOPIC

Worldwide, over 425 million people are having diabetes, and approximately

33% of them are in the age group of above 65 years. Due to increasing lifespan, the

number of men at high risk of diabetes is rising. The health toll diabetes takes on men

is significant, particularly in terms of diabetes-related complications such as eye,

kidney and heart disease. This results in high rates of mortality and morbidity of men

with diabetes. There is little gender difference in the global numbers of people with

diabetes from 2013 to 2035. If nothing is done, the number of people with diabetes

may rise to 629 million in the year 2045. By the end of this year, 4 million deaths will

happen as a result of diabetes and its complications. China alone has 121 million

people with Diabetes and India’s diabetes population is 74 million. According to the

statistics of union health ministry, Govt of India, the prevalence of Diabetes in

Chennai is 25% in 2016.

Various research studies on Yoga treatment for Diabetes have shown positive

results. Like wise, the results of Varma Therapy administered to diabetes patients are

encouraging. The Practices of both Yoga and Varma pertaining to Diabetes are very

easy to follow and regularity and continuity is feasible. Considering the difficulties

faced by the aged diabetic persons and with a hope to reduce the sufferings and the

expenditure on Diabetic Treatment the researcher has selected this topic.

1.32 REASONS FOR THE SELECTION OF VARIABLES

Physiological variables like Blood Pressure (Systolic), Blood Pressure

(Diastolic) and Resting Heart Rate are the sub causes or complications of diabetes.

Bio- Chemical variable Blood sugar (Fasting) HbA1c and Blood Urea are the basic

parameters to monitor the conditions of diabetes. Psychological variables like Anxiety

and Adjustment with Life play a vital role in determining day today contributions to

the development of their family, community and in turn to the society as a whole.

Since the above Physiological, Bio-chemical and Psychological variables are directly

related to the study of diabetes, these variables are selected for this study.

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1.33 OBJECTIVES OF THE STUDY

To find out whether there would be any significant difference on selected

physiological variables among aged Type II diabetic men due to yoga practices with

and without Varma Therapy

To find out whether there would be any significant difference on selected Bio-

chemical variables among aged Type II diabetic men due to yoga practices with and

without Varma Therapy.

To find out whether there would be any significant difference on selected

psychological variables among aged Type II diabetic men due to yoga practices with

and without Varma Therapy.

1.34 STATEMENT OF THE PROBLEM

The purpose of the study was to find out the effect of Yoga Practices with and

without Varma Therapy on selected Physiological, Bio-Chemical and Psychological

variables among Aged Type II Diabetic Men.

1.35 HYPOTHESIS

It was hypothesized that there would be significant differences due to yoga

practices with and without Varma Therapy on Selected Physiological, Bio-chemical

and Psychological Variables among aged Type II diabetic men than the control group.

It was hypothesized that there would be significant differences between Yoga

Practices with Varma Therapy and Yoga Practices without Varma Therapy on

Selected Physiological, Bio-chemical and Psychological Variables among aged type II

Diabetic Men.

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1.36 SIGNIFICANCE OF THE PROBLEM

According to an estimate of IDF, (International Diabetic Federation), in 2017,

there are about 425 million people with diabetes throughout the world. It is also

estimated that there would be 629 million people with diabetes in the world in 2045.

India has the dubious distinction of being the diabetic capital of the world.

Around 33% aged more than 65 years are diabetic from the World Diabetic

Population and 19% of the World Diabetic Population is from India.

Of these, 90 to 95% have type II diabetes, and 5-10% has type I diabetes.

Nearly 12.5% of India’s urban populations have diabetes.

The above statistics shows that the Diabetic scenario is world wide is alarming

in general and it is further more aggravated in India. India is being projected as the

diabetic Capital of the world which is matter of concern. Diabetes is a silent killer and

initially it starts attacking the tissue cells and disturbs the functioning of the cells

leading to cell damage or cell death. Further it affects the vital organs in the body like

the Heart, kidney, liver, eyes legs and foot and leads to other complications in the

body, mind and psychologically disturbs the affected individual. Hence the problem

of Diabetic is more significant in the society.

1.37 DELIMITATIONS

The following delimitations were taken into consideration in the interpretation

of results:

The study was confined to Aged Type II diabetic men only.

The age of the subjects was ranged from 60 to 70 years only.

The subjects were selected from Chennai city only.

The subjects were treated with Yoga Practices and Varma Therapy

independent variables only.

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The study was conducted on Physiological variables of Blood Pressure

(Systolic), Blood Pressure (Diastolic) and Resting Heart Rate as

dependent variables only.

The study was conducted on Bio-chemical variable of Blood Sugar

Fasting, HbA1c and Blood Urea as dependent variables only.

The study was conducted on Psychological variables of Anxiety &

Adjustment as dependent variables only.

1.38 LIMITATIONS

The patient’s way of life style was not considered.

During the treatment period patients’ occupation or their daily

activities were not considered by the scholar.

Environmental conditions were not considered.

1.39 MEANING AND DEFINITION OF THE TERMS

1.39.1 YOGA

Yoga is a discipline to improve or develop one’s inherent power in a balanced

manner. It offers the means to attain complete self-realization. The literal meaning of

the Sanskrit world YOGA is ‘Yoke’. Yoga can therefore be defined as a means of

uniting the individual spirit with the universal spirit of self truth. According to

Maharishi Patanjali, Yoga is the suppression of modification of the mind.

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1.39.2 ASANA

Asana is steady comfortable posture. In the Yoga Sutras of Patanjali there is

concise definition of Asanas - “Sthiramsukhamaasanam”, meaning “that position

which is comfortable and steady’.

1.39.3 PRANAYAMA

Prana is translated as ‘energy’ or ‘vital force’. The word prana assumes the

quality of ‘livingness’ and from yogic point of view, the entire cosmos is alive,

throbbing with Prana.

1.39.4 MEDITATION

The world “Meditation” is used to describe various application of mind, from

contemplation and focus to devotion, chanting and complete silence. It may probably

be derived from Latin word “Mederi” meaning “to heal”. Meditation can certainly be

looked on as a process of healing, emotionally, mentally and physically too.

1.39.5 VARMA THERAPY

Varma therapy is an ancient Tamil medicinal system practiced by the

Siddhars, and written only in Tamil.Siddhars gave treatment to the masses besides

having a record in manuscript form. Varma means “vital energy”. By stimulating the

vital energy of a particular point of the human body the problems in the affected area /

region gets cured.

1.39.6 AGED MEN

Ageing is inevitably a natural process however its degeneration and associated

health hazards can at best be postponed to an extent through regular practice of yoga.

Yogic practice can postpone the age-related effects of aging motor systems as well as

pathological conditions. Researchers speculate that controlled and slow breathing

which is inherent in yoga practices helps to maintain blood pressure levels and

declines nervous disorder among elderly.

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1.39.7 DIABETES

The medical name for diabetes, “Diabetes Mellitus” comes with Greek and

Latin Roots. Diabetes comes from Greek word that means to “Siphon”. The most

obvious sign of diabetes is excessive urination. Water passes through the body of a

person with diabetes as it were being siphoned from the mouth through the urinary

system out of the body. Mellitus comes from a Latin word that means “sweet like

honey”.

1.39.8 BLOOD PRESSURE

Blood pressure (BP) is a force exerted by circulating blood on the walls of blood

vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a

maximum (systolic) and a minimum (diastolic) pressure. The mean BP, due to pumping

by the heart and resistance in blood vessels, decreases as the circulating moves away from

the heart through arteries. It has its greatest decrease in the small arteries and arterioles,

and continues to decrease as the blood moves through the capillaries and back to the heart

through veins. Gravity, valves in veins, and pumping from contraction of skeletal

muscles, are some other influences on BP at various places in the body.

1.39.9 RESTING HEART RATE

Resting Heart Rate (RHR) is the number of times heart beats per minute while

at complete rest. It is an indicator of physical fitness of the resting heart rate which

will decrease as heart becomes stronger with exercise training. A low resting heart

rate indicates better fitness in people who are in workout program.

1.39.10 FASTING BLOOD SUGAR

A test to determine how much glucose (sugar) is in a blood sample after fasting

for overnight. Fasting blood glucose test is commonly used to find diabetes mellitus. A

blood sample is taken in a lab or physician place or in a hospital. The testing is done in

the morning before the person eats. Normal range for blood glucose is 60 to 100 mg/dl.

Levels between 101 and 126 mg/dl are referred to as impaired fasting glucose

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or pre-diabetes. Diabetes is typically diagnosed when fasting blood glucose levels

are 126 mg/dl or higher.

1.39.11 HbAlc

When the body processes sugar, glucose in the bloodstream naturally attaches

to haemoglobin. The amount of glucose that combines with this protein is directly

proportional to the total amount of sugar that is in the body system at that time. By

measuring glycated haemoglobin (HbA1c), one can get the overall picture of average

blood sugar levels for a period of weeks/months. For people with diabetes this is

important as the higher the HbA1c, the greater the risk of developing diabetes-related

complications. Because red blood cells in the human body survive for 8-12 weeks

before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect

average blood glucose levels over that duration, providing a useful longer-term gauge

of blood glucose control. If blood sugar levels have been high in recent weeks, it is

obvious HbA1c will also be greater.HbA1c can indicate whether a person is with

prediabetes or diabetes.

1.39.12 BLOOD UREA

A blood urea nitrogen (BUN) test checks kidney function by measuring how

much urea nitrogen is in blood. Urea nitrogen is a waste product from the breakdown

of protein in the body. Normally, this waste is filtered by the kidneys and leaves the

body through urine.

1.39.13 ANXIETY

Anxiety is psychological and physiological state characterized by somatic,

emotional, cognitive, and behavioral components. The root meaning of the word

anxiety is 'to vex or trouble'; in either presence or absence of psychological stress,

anxiety can create feelings of fear, worry, uneasiness, and dread. Anxiety is

considered to be a normal reaction to a stressor. It may help an individual to deal with

a demanding situation by prompting them to cope with it. When anxiety becomes

excessive, it may fall under the classification of an anxiety disorder.

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1.39.14 ADJUSTMENT

A test of personality that assesses the individual's adjustment in a variety of

situations such as at home, health, social, emotional and overall dimensions. Home

adjustment is expressed in terms of satisfaction or dissatisfaction with home life,

health adjustment in terms of shyness, submissiveness, introversion etc., and

emotional adjustment in terms of depression, nervousness etc.,