Keywords

Background

Few health-care practitioners following a Western model of physical treatment of disease will know to wonder how, for example, asthma, eczema, and experiences of loss and grief may be connected. Thousands of years ago, Traditional Chinese Medicine (TCM) developed a complex concept of such diseases and formulated answers to health-care questions that are rarely, if ever, asked in Western medicine. TCM provides perspective regarding the complex connections between the physical, emotional, and spiritual dimensions of human beings, their health and disease. For a Western practitioner, it can be an intriguing journey to discover that there is more to the adequate intake of air than pulmonary functioning. TCM’s more comprehensive approach to the understanding of health and disease has the capacity to broaden the Western paradigm with its primarily physical and symptom amelioration orientation. TCM can enable Western health-care providers to respond more knowledgably to the ever-increasing patient demand for care that makes sense of symptoms with multiple causes and gives overarching meaning to what ails them.

Through a TCM paradigm, patients—together with their care providers—­understand that their physical, emotional, and spiritual life determines health or disease and that they can influence their health status by tending to all three dimensions knowledgably. For example, in the case of pulmonary disease, a patient can be offered Western standard treatment in conjunction with acupressure stimulation of specific energy points and a practice of mindful moving and breathing to ameliorate secondary symptoms such as physical and emotional stress and its sequelae. Similarly empowered, patients’ motivation to participate in the care for their health increases, as they move from being passive victims of a random illness to actively pursuing quality of life and health management that supports mind, body, and spirit.

Breathing can be considered the most important function of the body. Without breath, life and all other bodily activities will cease within minutes. Therefore, breath has been associated with life itself, and from the beginning of humankind, breath has been appreciated in its physical and spiritual dimensions. In many creation myths, the giver of the original breath gives life and creates order out of chaos. Breath in many cultures and spiritual traditions therefore is considered to be a direct manifestation of spirit, the carrier of the soul, or breathed into humans by a higher being. In Hebrew, the words for breath (neshem) and soul (neshama) are closely related, indicating that breath may connect humans to a higher plane. Ruach, the Hebrew word for wind, breath, mind, or spirit given to a living creature by the Creator, denotes both the power and the creative ability to give such life (Genesis 1:2). The Latin spiritus provides the foundation for the words “spirit” as well as for “breath,” as in “inspiration/expiration.” The Greek pneuma signifies both “god inspired wind,” spirit, and breath. Sanskrit’s Prana and the Tibetan Lung, as well as the Chinese Qi, signify breath as life’s energy and vitality together.

The English language makes many references to the act of breathing, such as taking, holding, regaining, saving, catching, or losing one’s breath, and being out of breath. Other references connect breath with an emotional state: to say something under one’s breath; to have one’s breath taken away; to waste one’s breath; in the same breath; one breath at a time; with bated breath; breathing a sigh of relief; breathing freely; taking a breather; a breath of fresh air, and many others. Such frequent referencing to the act of breathing in everyday language may well signify the importance of breath itself and its many nuances in daily living.

It is well understood that one can learn to control emotions through breathing. As fear affects breathing via the activation of the sympathetic nervous system, breathing mindfully can be utilized to reconnect with the parasympathetic system to slow the body down and restore itself. Unintegrated emotions find their physical manifestation in restricted movement and muscle tensions that negatively impact the available physical and emotional energy for daily living. Learning to control one’s breathing is a powerful means to regenerate energy flow and “dynamic harmony,” allowing for a flexible and appropriate response to the actual needs and possibilities of the present moment.

Many healing approaches in the East and in the West focus on breath, with the understanding that breath, beyond its mechanical qualities, connects the physical, emotional, and spiritual realms. Here, we will provide an introduction into the concept of breath as healing life energy in both Eastern and Western traditions.

Breath in Traditional Chinese Medicine and Other Eastern Traditions

TCM has long made the connection between correct breathing and health, as opposed to impeded breathing and disease. Breathing can be considered the most essential physical activity a body can perform, aiding in maintaining and obtaining Qi, life’s energy. Quite simply, without breath, all physical activity eventually ceases, and ultimately life itself ends.

The connection between breath and Qi is complex. Basic tenets hold that a person’s original Qi is inherited from his/her ancestors and, from the moment of conception, is also influenced by the environment [1]. Therefore, the amount of Qi available to the individual differs from person to person. Qi is thought to flow through channels (meridians) that comprise an energy network connecting every organ and every cell in the body. Twelve main meridians are connected to specific internal organs, after which they are named. The Lung meridian (see Fig. 15.1) is of special interest here, as it is closely connected with the physical breathing apparatus and a person’s vital Lung Qi. A person’s life span, according to TCM, is determined by the amount of available Qi. To put it simply, when all available Qi is used up, death occurs.

Fig. 15.1
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Lung meridian: Acupressure points LU-1 through LU-11 along the lung meridian (bold line) and their connection to the associated organs, lungs and large intestine (dotted lines)

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Every person’s original Qi decreases over the course of a lifetime. The rate of decline is determined by the inherited Qi and the net gains and losses of living one’s life. Thus, “external pathogens” such as environmental factors leading to physical illness, (e.g., respiratory distress), and/or “internal pathogens” such as unbalanced emotions (e.g., prolonged sadness leading to depression or other mental illness), may combine and interact to deplete available Qi. To minimize the loss of Qi, a life in both physical and emotional balance and moderation can help maintain available Qi.

According to TCM, Qi can be regained or rebalanced through four different means: (1) acupuncture, i.e., the insertion of fine needles into acupuncture points on the surface meridians of the body (e.g., Lung meridian; see Fig. 15.1), or acupressure, i.e., using pressure at acupuncture points [2, 3]. The application of heat at acupuncture points, called moxibustion, has a similar effect; (2) Qi also can be balanced through movement such as Qigong or T’aichi, (3) utilizing Chinese herbs and consuming healthy food in moderation; and (4) last, but not least, breathing properly is an additional means to restore and replenish Qi.

As in Western understanding, TCM considers the lungs to be the vehicle for breathing. In addition, TCM understands that the organ “Lung” is important for the formation and movement of Qi. Not only does the TCM organ “Lungs” govern the lungs, but the “Lungs rule the exterior of the body” [1], influencing the nose, sweat glands, body hair, and skin. It is important to note that TCM understands skin to function as the third lung, as skin with its pores combines with the two lobes of the lung to form the “Foundation of Qi”—generating specific Lung Qi through inhaling “Natural Air Qi” [1]. Defective Lung Qi then leads to the co-occurrence of skin and lung diseases, such as the combination of eczema and asthma, a presentation well known in Western medicine.

TCM teaches that in order for the Natural Air Qi to penetrate deeply into the body, to be “grasped,” and for the inhalation process to be completed and well utilized, proper breathing and the generation of Lung Qi require the help of the Kidneys, which are therefore considered the “root of the Qi.” Kidneys thus assist the Lungs in their generation of “Defensive” Qi and provide resistance to fight “internal” and “external” pathogens that threaten life’s energy. It follows that TCM considers Kidney difficulties a root cause for respiratory problems such as chronic asthma.

TCM considers the Lungs “tender organs,” easily affected by what Kaptchuk calls “fleeting” events [1], such as breathing itself, an acute respiratory illness, or emotional reactivity. Not surprisingly, TCM has long understood the physical underpinnings of human emotions and has developed an intricate system (Five-Element theory [4]) to make sense of, and give meaning to, the mind-body connections established by living one’s life.

In focusing on the Lungs, it is important to note that TCM considers the Lungs the storage place for our “Animal Soul” (“Poo”)—the part of our energy that is best described as untamed, erratic, and reacting emotionally to all the pressing demands of human life. When the “Animal Soul” is healthy, it reacts with flexibility to the emotional demands of living and quickly rebalances by being able to evaluate the “bigger picture.” When the Animal Soul is not able to react flexibly, a person may find himself or herself either emotionless or overly emotional. The great challenges to our “Animal Soul” are the experiences of mourning, loss and grief, and the inability to find completion. Therefore, the Lungs are quickly affected by loss, longing, and unresolved grief—and, vice versa, when the Lung Qi is disturbed by chronic respiratory illness, a sense of unresolved grief, loss, and longing can develop [1].

Focusing on the mechanics of breathing means focusing on the short-term aspects of Lung Qi: Inhalation as the means of bringing outside Qi (in the form of natural air) in contact with the Qi inside the body via the Lungs, which propel Qi downward and help disseminate it, and exhalation to expel “impure” air. The nose is considered the “thoroughfare for respiration,” the functioning of which is closely connected to the Lungs. The throat, including the vocal cords, functions as the “door” of the Lungs. Therefore, TCM will treat nose and throat disorders through treating the Lungs [1]. When breathing is healthy and unobstructed, the rhythm of exchange is smooth and even. An imbalance or obstruction interfering with Lung functioning will lead to symptoms such as asthma, cough, or dyspnea—not the other way around! Since the Lungs and their Qi are connected to the Qi of the chest and with that to the movement of all Qi in the body, Lung disharmony, especially in the case of a chronic lung disorder, leads to deficient Qi everywhere in the body affecting other organs and their energy systems as well.

As mentioned above, the Lungs affect the exterior of the body through the skin, sweat glands, and hair, regulating body temperature and offering protection from external pathogens. The Lungs’ ability to disseminate Qi influences the capacity of the Protective Qi to protect the body. If the Lung Qi is weak, the sweat glands may produce too little or too much sweat, which in turn will affect the Protective Qi’s ability to resist harmful influences. In that case, for example, a person may contract recurrent “colds,” as they will be unable to resist “what is going around.”

By now, it has become evident that in TCM, the cause, the process, and the outcome of illness merge. Instead of simple causality, there are circles of constant feedback loops involving Qi. Different parts of a person’s energy system resonate with each other either in an overall pattern of environmental, internal, physical, emotional, and spiritual harmony or disharmony, supporting a person’s health or being unable to prevent disease [1].

Acupressure as an Aid in Functional Respiratory Disease

Acupressure, or Tuina, exerting concentrated pressure at specific acupuncture points to activate the flow of energy along meridians, has been described in numerous works of TCM [5]. Over the past several decades, acupressure has been presented to the Western world mostly through descriptions in self-help books [2, 6–9]. While identification of pressure points can be learned from written instructions, it is advisable to also experience the precise activation of such points by a health-care professional trained in the broader healing context of TCM. Thus, the following description of points and their applications, as well as examples of accompanying interventions, serve the purpose of elucidating our approach but are not intended as instruction for unsupervised self-practice.

Following TCM’s principle that the prevention of disease is preferable to treating it [10, 11], several point combinations have been chosen for their use in health maintenance and well-being. We will introduce here the most commonly utilized points: the “Four Gates” (Fig. 15.2) [1, 3, 12] and their expanded version, the “Five Golden Points” (Fig. 15.3) [2, 3], and several points related to lung functioning and breathing. According to TCM, activating the points of the Four Gates, one on each foot and each hand (see Fig. 15.2), results in a better flow of energy not only in the associated meridians but throughout the entire body. The Five Golden Points consist of the Four Gates and additional points on the knees, elbows, and the crown of head (see Fig. 15.3) [12, 13]. Those additional points stimulate the immune system as well as invite general calm and well-being. Even though the location of the acupuncture points along the meridians is (mostly) identical regardless of the source or textbook used, individual names may vary. Here, we use the standard Western nomenclature for the points along the meridian that derives their name from the associated internal organs, and we will give the points’ Chinese names with English translation.

Fig. 15.2
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The acupressure points of the Four Gates

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Fig. 15.3
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The acupressure points of the Five Golden Points

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Description of the points of the Four Gates and the Five Golden Points (Fig. 15.2): LI-4, Large Intestine 4, He Gu (“Joining Valley”) is located in the middle of the webbing between the thumb and index finger of each hand. Grab the webbing from both sides with the tip of your thumb on one side of the webbing and your index finger on the other side to press the muscle in the webbing. LR-3, Liver 3, Tai Chong (“Great Rushing”) is the corresponding point located between the first and second toes on both feet. Use your index finger to find the point. Move from the toes toward the foot and come to a stop where the metatarsal bones join, and exert gentle pressure downward. DU-20, DU meridian with pressure points along the body’s midline, is also called Governing Vessel (GV). Bai Hui (“Hundred Meetings”), the highest point of the head (“Crown Chakra” in Indian tradition), is located at the midpoint of an imaginary line between the tips of the ears and a line between the tip of the nose and the middle of the head. LI-11, Large Intestine 11, Qu Chi (“Pool at the Crook”), with the elbow bent at a right angle, the point is at the outside end of the elbow crease. ST-36, Stomach 36, Zu San Li (“Leg Three Miles”) is situated on the outside of the lower leg below the knee. With the upper and lower leg bent at a right angle, the point is located the width of four fingers below the kneecap and one fingerbreadth to the outside of the crest of the shinbone.

At specific surface points along the meridians, so-called acupuncture or acupressure points Qi can be manipulated to increase the flow of energy along these meridians. Activation of energy on these specific points can be experienced as a tingling sensation, electricity, or a feeling of warmth, and is called the “DeQi” sensation. Traditionally, pressure at acupuncture points has been applied by the pads of the thumb and index finger, with slowly increasing pressure in a circular or back-and-forth motion for approximately a minute each, until DeQi sensation has been experienced, confirming that contact has been made with the energy at that pressure point. It is understood that open sores, bruises, swelling, or other points of acute discomfort should be avoided, and acupressure at points in the vicinity of the injury should be applied only after medical consultation (for details of contraindications see [2, 6, 7]).

In an acupuncturist’s office, acupressure is considered part to be part of the overall treatment. In contrast, in a mental health-care setting, touch is not part of most treatments offered. Therefore, with careful consideration being given to specific patient-therapist variables, acupressure may be offered or simply demonstrated by the mental health-care provider, who identifies acupressure points of the head, upper body, and extremities on a chart or on the therapist’s hands, feet, and crown of head and invites the patients to identify and experience those points on themselves. When the activation of acupressure points becomes part of treatment, it can serve as an additional tool for grounding, calming, and providing positive sensory feedback, especially when negative energy in the form of anxiety or posttraumatic disturbance is present. Once incorporated into self-care, acupressure is a portable self-regulatory tool, extending treatment between office visits and allowing the patient to take charge of maintaining and solidifying treatment gains.

It cannot be emphasized enough that successful treatment of mind-body and spirit depends on the creation of an overall tension and distraction-free inner and outer atmosphere of calm and focused healing. Just as electronic devices need to be silenced, so do inner chatter and errant thoughts need to quiet in order to allow the mind to focus on the acupressure points that are being stimulated, as well as on the sensations at those points as Qi is generated and begins to move.

Specific Energy Centers and Acupressure Points Related to Lung and Breathing

TCM refers to three major centers of energy, the Upper, Middle, and Lower Dantien, corresponding, respectively, to the space between the eyebrows, the solar plexus, and the lower abdominal region. Each of these energy centers is believed to harbor Shen energy, which in Chinese philosophy denotes the concept of spirit, god-given energy, awareness, and consciousness. Three different centers of energy are referred to as Triple Heater: The Upper Heater is located in the chest above the diaphragm, the Middle is in the upper abdomen between the umbilicus and the diaphragm, and the Lower heater is in the lower abdomen below the umbilicus. They are associated with the overall movement of Qi between the organs located within the Upper, Middle, and Lower Heater. Their energy is activated via acupuncture, acupressure, and/or focused breathing [14] in order to regulate and harmonize the energy exchange between the major internal organ networks.

Shen energy residing in the Upper Dantien is thought to be responsible for controlling the basic energy of the mind, clear thinking, and awareness. It generates consciousness that is communicated through a person’s eyes. When the Upper Dantien is open and energized, a person is able to experience strong intuition and a sense of real purpose. When it is closed, the attention is weak and scattered, and a person may be distracted and indecisive [15]. Thus, it is logical to stimulate this central acupressure point between the eyebrows for mental clarity and focus and to pair it with conscious, deep abdominal breathing.

In order to support the flow of Shen energy in the Middle Dantien, a body ­midline acupressure point (Conception Vessel (CV)-16) right at the end of the breastbone where the lowest right and left ribs meet and where the abdominal cavity begins, can be gently massaged. Again, pairing this massage with focused breathing will enhance the distribution of energy throughout the body.

Deep abdominal breathing is considered an effective way to maintain the proper flow of Shen energy in the Lower Dantien as well, effectively quieting a person’s brain and mind. A pressure point a hand width below the navel (CV-4) can be stimulated in conjunction with focused abdominal breathing to affect Lower Dantien energy flow. TCM postulates that keeping the Lower Dantien open and active results in increased Qi in all cells and tissues of the body and the brain. Overall, Shen energy supports healing and well-being and is considered to be a foundation for psychospiritual growth [15].

Special emphasis needs to be given to the acupressure points located on the body’s midline that are part of the GV and CV meridians. These two meridians can be considered as reservoirs for extra energy which when stimulated can enhance the effects of the overall acupressure treatment by helping to balance energies [2]. When stimulated and paired with focused slow and deep breathing, acupressure points on these two meridians invite deep centering and tapping into what may best be called one’s own wise or spiritual self and place of inner wisdom, generating calm and focused energy and the opportunity to center and regroup in times of physical and emotional stress.

The following midline points can be activated to aid in calming and centering:

  • Begin with the “Hundred Meeting” point (DU-20 or GV-20), at the crown of the head (see Fig. 15.3).

  • Proceed to the “Third Eye” point between the eyebrows (Yintang).

  • Press the point at the fulcrum below the nostrils at the place of the upper teeth (CV-26).

  • Gently massage the acupressure point in the middle of the breastbone (CV-17).

  • Exert gentle pressure at the point right underneath the rib cage (CV-16).

  • Do the same at the point three fingers width below the navel (CV-6).

  • And finally exert gentle pressure at the point three fingers width above the pubic bone (CV-3).

These “golden points” of the front of the body [2, 3] can be incorporated into a daily routine of centering and breathing to make central energies available for healing and health maintenance.

The organs “Lungs” by the mere act of breathing allow for the exchange of oxygen and carbon dioxide, letting us take in what we need (inhaling natural air), and to let go of what is no longer necessary (exhaling spent air). The “Lung” meridian, connected with the organs “Lungs” (Fig. 15.1), is part of a larger system of meridians that help release and eliminate what is no longer needed in order to make room for the acquisition of what might come in its stead.

The concept of such an exchange refers to both physical and spiritual needs and connects the human being with the larger energies of the Five Elements governing the world and the universe beyond it. Of the Five Elements (Wood, Fire, Earth, Metal, and Water), the Lung meridian is associated with the element “Metal,” the element of autumn, harvest, letting go, and taking care of material and spiritual needs [2, 4]. When “Metal” is not balanced, breathing problems can be observed as well as emotional struggles with resolving difficult feelings such as grief and loss, and the inability to grieve fully and appropriately, allowing one to eventually move on. Thus, the Lung meridian is connected with the complex and often intense emotion of grief, which, when unresolved, can cause disease in a person’s physical body as well, weakening the immune system and inviting opportunistic diseases, breathing problems, and potentially leading to the dramatic “broken heart syndrome” (Takotsubo cardiomyopathy) [16] after sudden and overwhelming emotional stress and massive release of adrenaline within a short time.

While TCM treatment incorporating Five Elements is complex and cannot be given full justice here, there are acupressure points that can be stimulated in conjunction with other treatment modalities of Western and/or Eastern orientation, in order to aid the overall release of physical and emotional tension related to Lung functioning and to encourage life energies to begin to flow again. LU-1, below the collarbone near the shoulder joint (Fig. 15.1), is a letting-go point, an antidepression point, and helps to deepen breathing. CV-17 in the middle of the sternum will also facilitate the flow of breath. In the case of asthma, these points can be used in conjunction with bronchodilator medication.

Conscious breathing techniques in conjunction with acupressure have to be considered an integral part of the treatment of depleted Lung Qi, whether from organic or emotional causes. Such breathing will help restore immune system functioning and overall energy. It will help to improve sleep and allow for a state of mindfulness indispensable in the emotional work of acknowledging and moving through loss and grief that may accompany breathing difficulties [17].

Breath in Complementary Medicine Approaches

Breathing for Health

Breath constitutes the pivotal mind-body connection. Breath is influenced by both mind and body, and breath influences mind and body, whether consciously or unconsciously. As one of the most basic functions embedded in the autonomic nervous system (ANS), the unconscious breath reacts to every internal or external stimulus. Just a single thought can change the breathing pattern from even and expansive to irregular and tight, depending whether it relates to comfort and affiliation, or whether it constitutes a threat and the need for self-defense.

It is understood that breathing is every individual’s own responsibility. In general, we cannot breathe for another person. Therefore, many therapies have the goal of teaching a patient to breathe differently—ultimately engaging that person in the process of moving and changing and unfreezing physical and emotional blockages. This often moves beyond solving any literal breathing problem and extends into problem-solving in the broader context of that person’s life. With breath, physical, emotional, and even spiritual stagnation and paralysis can be overcome. Learning how to breathe allows a person to create and be in touch with their own life energy and their possibilities [14, 18] and to overcome stagnated emotions.

It is well understood that one can learn to control emotions through breathing [14, 19]. As fear affects breathing via the activation of the sympathetic nervous system, breathing mindfully can be utilized to reconnect with the parasympathetic system to slow the body down and restore itself. Since unintegrated emotions find their physical manifestation in restricted movement and muscle tensions that negatively impact the available physical and emotional energy for daily living [20], mindful breathing can redirect energy flow to restore “dynamic harmony,” and awareness of the actual needs and possibilities of the present moment [15].

All breath training makes use of the fundamentals of the breathing process. The inbreathe or inhale is considered to be the active part of the breath cycle, produced through the contraction of the breathing muscle apparatus. With its tension and willfulness, it is often considered part of the sympathetic nervous system, allowing the breathing person to take in what he or she can. Of course, the transition to exhaling begins at the height of the inhalation, a moment of intense stillness, before we have to let go in order for breath and energy to keep moving. Exhaling occurs without much, if any, effort, counteracting the tension of inhaling in its more passive letting go. As such, it is considered part of the parasympathetic nervous system. At the end of the exhalation is a second moment of stillness, before active inhaling resumes. The rhythmic flow between these two poles creates the desired inner balance of a circle of breathing without beginning and end once it has begun and before it finally ends [18].

Heightening the act of inhaling by rapid chest breathing without complete inhalation (as in asthmatic conditions or in anxiety-related hyperventilation) will of course activate the sympathetic nervous system and the fight-flight-freeze response, while deep abdominal breathing with complete exhalation and slow inhalation will support parasympathetic activity, relaxation, and overall calm. For good reason, breathing well is associated with living a long life [17]. Or as a Hindu proverb puts it: “A person’s life is measured in breaths. And you can breathe quickly or slowly.”

Conscious breathing to assure the continuous unhindered flow of in and out breath to nourish body mind and spirit, leading to a better physical, emotional, and spiritual life, is considered the goal of all breath work. In order to achieve a greater flow of unhindered energy, it is important to learn how to breathe through physical, emotional, or spiritual blockages [18]. Because of breath’s unconscious/autonomic as well as conscious and deliberate aspects, breath is at the interface of the inner/unconscious and the outer/conscious world and can be utilized to connect the two worlds for the greater good of the living being. Many therapeutic approaches make good use of this.

In the Yogic tradition of India, “Prana” conceptualizes absolute energy, a vital force, life’s energy found in all forms of life. Yogic breathing uses all muscles of the breathing apparatus in a controlled and regulated way, in order to extract as much energy from Prana as possible. Such energy may then be stored in the cells of the body as well as the brain in order to nourish mind, body, and spirit. At the same time, such breathing gently massages the internal organs, allowing their maximal receptivity to life’s energy. Yogic teaching asserts that the body’s seven energy centers, chakras, are connected through breathing and that breath helps distribute each chakra’s available energy for the benefit of mind, body, and spirit.

The chakras correspond to the energy centers known to TCM [21]. For example, the seventh chakra, the Crown Chakra, is known as the “Hundred Meeting point” in TCM, signifying connection to inner wisdom, a person’s soul, and the spiritual world. The sixth chakra corresponds with TCM’s Third Eye point, balancing mind and body energetically. The third chakra, the Solar Plexus Center (Middle Dantien) with its sympathetic nerves and ganglia connecting it to many parts of the body is considered a central storehouse of Prana. There are many breathing exercises, pranayama, in Yoga, inviting focus, centeredness, invigoration, and mindful restoration of physical and emotional balance. Here, we will mention several that can be considered essential to emotional and physical self-regulation and anchoring practices.

Foundation Breathing or Three-Part Breath

(1). Sit or lie comfortably, eyes closed, hands in your lap. (2). Notice the ins and outs of your breath without changing anything. (3). Exhale, then inhale deeply through the nose. Exhale and empty your lungs, letting go of any thoughts. (4). Inhale deeply, filling the belly first, then the ribcage, then the upper chest all the way to the collarbone, with air. (5). Hold for a moment. (6). Then exhale, expelling all the air out from your lungs. Draw the navel back toward your spine to make sure that the belly is empty of air. (7). Repeat for five breaths [17].

Six-Second Breath

Inhale for 2 s—hold for 1 s—exhale for 2 s—hold for 1 s—repeat [17].

Alternate Nostril Breathing

(1). Sit comfortably. (2). Bring your thumb to the right side of your nose and your ring finger to the left side. (3). Close off your right nostril with your thumb. (4). Inhale through your left nostril. (5). Close off your left nostril with your ring finger. (6). Open and exhale through your right nostril. (7). Inhale through your right nostril. (8). Close off your right nostril with your thumb. (9). Open and exhale through your left nostril. (10). Inhale through your left nostril. (11). Continue alternating 5–10 times, (http://yoga.about.com/od/breathing/a/nadisodhana.htm)

Qigong and T’aichi, a combination of conscious body movements and breathing methods, encourage the stimulation of the same meridians acupressure uses, in order to allow Qi to circulate more freely. Purposeful breathing is utilized to aid in the generation and movement of Qi to all internal organs and systems via improved lung functioning and decrease in overall muscle tension. This process of mindful movement with breath is believed to aid in transforming stressful emotional states and an overactive sympathetic nervous system into positive inner energy that aids both physical and the emotional rebalancing. Qigong and T’aichi aim to activate the parasympathetic nervous system to harmonize the aggressive and restorative functions, the yang and yin of our nervous system [22]. Lewis [15] remarks that we could learn to fully utilize the 15,000 or more breaths we take each day to support our own inner growth and overall health. Especially in times of stress and narrowed, fear-based focus, when contraction of all muscles is likely, the ability to increase breathing space (instead of increasing breathing frequency) through mindful movement of body and emotions will increase sensory awareness and broaden one’s perspective and increase acceptance as well as the potential for problem-solving of existing physical and emotional needs.

In the tradition of “mindfulness-based stress reduction,” breath awareness is a central focus, returning us to the present moment, over and over again (see Chap. 16). Being aware of or observing one’s quality of breath without making any deliberate changes is a frequently used mindfulness practice to cultivate mental, emotional, and physical detachment from any interfering problem [17].

Other mindfulness practices involve conscious breathing that is controlled, intentional, and purposeful to achieve a result, such as balanced breathing (balanced inhalation and exhalation); cleansing breath, which emphasizes exhalation over inhalation; and energizing or refreshing breath, emphasizing inhalation over exhalation [20, 23–28].

Focused breathing in the form of breathing meditations attempts to attain a higher state of consciousness and to reconnect breath with spirit and bring about physical, emotional, and spiritual harmony and balance. Proper postural alignment [28] creates the physical space to, for example, follow the Buddhist invitation to contact one’s inner smile through expansive breathing [23, 24]. Mindful breathing can inspire, allow a new focus, and generate new health and growth through stimulation and nourishment that are being drawn into the mind-body system. Thought, feelings, and sensations can move and change through breathing new vitality into every corner of our being, preventing physical or emotional matter from becoming frozen and stale inside [15].

Especially when the respiratory system is already compromised and has become a weak link in the flow of Qi through the body’s energy channels, mindful daily breathing practice and a more efficient use of Qi through breath are paramount to supporting overall health. As Lee and Campbell [17] remark, conscious breathing, as a lifeline we can hold on to, does not change the sense of our own mortality, but it changes us. It allows us to live fully and be present for each moment, thus giving us the opportunity to live and therefore eventually die without regret.

Hypnosis

Hypnosis as an established mind-body approach to healing (see Chap. 12) has long focused on conscious breathing to aid in the induction, deepening, and maintenance of a hypnotic trance as well as in the process of realerting [29–33]. Hypnosis pairs breath with imagery and/or cognitive intention to achieve a previously established goal related to physical and/or emotional symptom relief as well as a means to explore the underlying causes of illness. This is true especially in the aftermath of a physical and/or emotional, traumatic, not yet integrated experience that has a somatic memory component, which may significantly contribute to a functional respiratory disorder (see Chap. 1). Notably, Anbar [34, 35] discusses the use of hypnosis in the treatment of respiratory disorders in young people.

We know now that breathing is not just an individual act but that it also creates connection between human beings. Mirror neurons are responsible for our ability to imitate what we observe in others either face to face or through mental practice and imagery. These same mirror neurons allow us to feel another person’s emotions and to have empathy for their experience [36–38]. It may well be possible that our mirror neurons allow synchronized breathing in jogging partners as well as groups of people singing together or sitting in meditation together. As those trained in hypnosis know, matching another person’s breathing can happen consciously as well as unconsciously, thanks to these mirror neurons, with the net effect of experiencing increased emotional connection and trust—the sense of being “in synch,” attuned, physically as well as emotionally. Being in tune with another person often means tracking his or her breathing and, in the case of disordered breathing, slowly, subtly, but deliberately beginning to match it, changing it to a more beneficial rhythm, perhaps thwarting a panic attack through prolonging the exhale [17], or inducing relaxation breathing to cope with acute or chronic breathing difficulties such as in quadrant breathing (equal inhale—hold—exhale—hold—inhale…; http://breathmastery.com/principles.htm).

Since breath supports life, any threat to breathing constitutes grounds for physical and emotional alarm, setting in motion an often counterproductive attempt to control breath by tensing and forcing inhalation, rather than letting go and allowing exhalation. In cases of such previously experienced and rehearsed maladaptive breathing, further focus on breathing may be initially contraindicated, as it might induce more anxiety (Anbar, personal communication). As a complementary alternative, the above described acupressure points in conjunction with hypnosis offer themselves as being useful for grounding and methodical slowing down as well as for shifting attention to an action that can be performed. This can help shift the focus and subsequently relax the breathing apparatus enough to provide relief and retrain breathing gradually, eventually allowing the patient to enjoy the inherently soothing, hypnotic quality of slow, satisfying, life-giving breath.

Case Studies

Case 1—Recurring Bronchitis

A 45-year-old woman recently began psychotherapeutic treatment for an adjustment disorder with anxious and depressed mood after she discovered her husband of 20 years was having an affair, which resulted in the rapid dissolution of their marriage 2 years ago. In addition to a host of fleeting physical symptoms such as headaches, stomachaches, and various muscle spasms, she reported low-grade agitation, lack of concentration, and low self-esteem, as well as difficulties falling asleep almost every night. Her third episode of bronchitis in as many months was making matters worse, causing her to rapidly lose stamina and falling behind at work, which only increased her overall anxiety. The various antibiotics prescribed by her primary care physician caused stomach upset and did not seem to truly eradicate the bronchial infection.

It became quickly apparent that the patient continued to feel devastated by the sudden loss of her marriage, experiencing it as a complete shock, with the above reported symptoms of anxiety beginning soon afterward. She reported beginning to seriously doubt herself in all areas of her life, withdrawing socially and experiencing what she called her “midlife existential crisis.” She felt “stuck” with intense feelings of sadness, anger, confusion, disbelief, guilt for her perceived shortcomings and failings, and an inordinate amount of anxiety about the chores of daily living—the hallmarks of a complicated grief reaction two years later. Although the recurring bronchitis was taxing, it also afforded her some sympathy at work and legitimate sick days.

The patient’s stated treatment goal was to “feel better” about herself. She also was interested in feeling less anxious and overwhelmed. She was amenable to cognitive behavioral therapy interventions and began to recognize different choices she could make toward her stated goals. However, little changed at her weekly presentation, and neither her mood nor her symptoms showed much, if any, improvement. When the therapist proposed to add new treatment modalities, the patient, after much hesitation and anxiety, agreed to explore complementary approaches to see whether these would be beneficial.

The patient was introduced to the concept and philosophy of TCM, and specifically acupressure, and, given her overall anxious presentation, was shown the two hand points (LI-4) on a picture.

She was successful in producing DeQi sensation and began to wonder whether her problem involved, according to TCM, the lack of freely flowing energy, depletion of energy in some areas, and too much “stuck” energy in other areas of her body. Almost imperceptibly, her breathing slowed and became less labored as she was applying those LI-4 points in the web between thumb and forefinger. Her coughing stopped. From there, it was a small step to suggest that she just begin to notice her breathing and enjoying its smooth in and out. She even followed the suggestion to gently increase her exhale, tolerate a little rest before inhaling, and inhaling easily and without strain, holding her breath again for a moment, letting her body become more comfortable with each exhale. She was surprised to notice that her breathing had become less labored, and she was willing to practice on her own during the week, whenever she saw fit.

The following week, the patient reported that she had utilized the LI-4 acupressure points with breathing and the (hypnotic) suggestion to become more comfortable. To her surprise, it had helped her stay calm instead of ruminating at the end of her workday. Next, the patient learned to apply pressure to the two foot points (LR-3), LI-11 at the elbow crease, and ST-36 below the knee to boost her immune system. She expanded her breathing practice, as her bronchitis decreased, to include slow deep abdominal parasympathetic breathing. As she learned to breathe more expansively, some of her anxiety symptoms and overall muscle tension loosened. She agreed to mindfully adjust her posture to allow for more breathing room. She began to attend yoga classes to help her feel more comfortable in her body and in her physical space.

The patient then incorporated specific lung acupressure points (LU-1, underneath collarbones; LU-9, where the thumb joint meets the wrist) into her self-­regulation routine and added several midline points (CV-17, middle of breastbone; CV-16, lower end of breastbone) to support the overall balancing of energies.

Lastly, as she began to physically and mentally quiet and began to believe that she had acquired the tools for sustained self-regulation, she was willing and able to enter the necessary grief work which she had so long resisted out of fear of becoming overwhelmed and dysfunctional. She utilized activation of the “Hundred Meeting” point and the “Third Eye” point as a focus for mindful exploration of her thoughts and feelings, and to connect with her own inner wisdom as well as with the wisdom of the universe.

At the end of 6 months of weekly therapy sessions, this patient had not had a recurrence of bronchitis for 3 months, despite the fact that it was in the middle of winter, a time when she typically had symptoms in the past. She felt renewed energy and enjoyed greater clarity of mind and spirit. She no longer felt overwhelmed by grief and had begun to move on. She experienced greater confidence in exploring new opportunities both at work and in her social life. She maintained her daily mindfulness breathing and self-observation practice together with the activation of the basic acupressure points she had come to trust. Through an e-mail follow-up one year later, this patient reported no recurrence of bronchitis or other breathing difficulties. She reported her mood as stable and her outlook on life as generally positive.

Questions:

  1. 1.

    The reason the therapist showed the acupressure points on a picture is

    1. (a)

      It is easier to see.

    2. (b)

      Touch was not part of this particular therapy setting.

    3. (c)

      The patient felt overwhelmed and had already withdrawn from social contact.

    4. (d)

      All of the above.

  2. 2.

    The therapist introduced acupressure points in order to

    1. (a)

      Facilitate self-regulation

    2. (b)

      Unblock energy

    3. (c)

      Provide a grounding tool

    4. (d)

      All of the above

  3. 3.

    What is the reasoning behind the order in which acupressure points were introduced?

    1. (a)

      The order was random.

    2. (b)

      The easier to find points come first.

    3. (c)

      More general points are introduced first, followed by more specific points.

    4. (d)

      The order hinges with whatever the patient can tolerate and is comfortable.

Answers:

  1. 1.

    (d): Especially in a psychotherapist’s office, touch is not expected. An anxious and depressed patient deserves a careful and measured approach that gradually increases safety and trust in the therapeutic relationship.

  2. 2.

    (d): Being able to actively participate in one’s healing allows a patient to take greater ownership over his or her process. Utilizing self-acupressure regularly promotes unblocking of stuck physical and emotional energies.

  3. 3.

    (d): While it is general practice to begin with the “Five Golden Points,” a patient’s comfort always comes first.

Case 2—Cough and Chest Pain in Terminal Lung Cancer

A 64-year-old recently retired man entered psychotherapy, in shock after a recent diagnosis of terminal lung cancer and with a life expectancy of no more than 3 months. A nonsmoker all his life, he had been healthy up until this diagnosis and had expected to live long enough to see his young grandchildren get married.

He presented with extreme anxiety and painful sensations around his heart that had been identified as transient due to the release of massive amounts of adrenaline. Other than an incessant cough that bothered him during the day and made sleeping difficult, he did not report any breathing difficulties. His goal for treatment was to help reduce his anxiety, to reduce the stress response in order not to exacerbate physical symptoms, and to die peacefully. He agreed to utilize a combination of hypnosis and acupressure and was willing to invite his wife to learn with him so that she could be of assistance during his final journey if necessary.

Consultation with the treating pulmonologist confirmed that the diagnosis of an inoperable lung carcinoma that at the time of detection (a random chest X-ray for insurance purposes) had grown into the lung walls and adjoining blood vessels and “could burst through the walls at any moment,” leading to rapid suffocation and death. No medical interventions were planned other than weekly monitoring with the agreement to keep the patient as comfortable as possible. He was prescribed several medications to stabilize blood pressure and help with sleep. His cough was explained as an attempt to clear mucus and developing bleeding in the lungs.

Under such dramatic circumstances, the patient and his wife were highly motivated to learn what they could do to stabilize both physical and emotional upheaval, in both of them. They learned the Five Golden Points and CV17 (middle of the sternum), and began to practice breath awareness with the suggestion to breathe comfortably and easily, emphasizing open airways and smooth in and out flow of air. As an immediate result, the patient’s cough became remarkably less frequent, and he reported that his throat did not feel irritated anymore. Within the first week, his breathing had slowed, his blood pressure had lowered (and the blood pressure medication had to be adjusted accordingly), and he felt more hopeful that he could “learn to die without too much trouble.”

The “spiritual points” (crown of head, between the eyebrows) were added and so were extra energy points in the Middle and Lower Dantien. Both he and his wife felt greater calmness and openness, enabling them to review their life together, to grieve the impending loss of their connection, and for the primary patient to grieve the loss of his life and of the opportunities he would have liked to still enjoy. They were able to enter deeper meditative trance states in session, utilizing a combination of ­acupressure and hypnosis, and allowing themselves to feel a spiritual connection to each other and to “something greater than us,” that allowed both of them to eventually move into acceptance of what was going to happen as well as a deep sense of gratitude for what had been.

The patient continued to breathe with relative ease over the last month of his life, to the astonishment of the pulmonologist. He remained calm, appropriately expressed his sadness, grief, and anger about his imminent death and enjoyed what he could every day. When his cough began to produce more sputum with traces of blood, he shared his astonishment because he kept feeling relatively well and had been ambulatory and in decent spirits. At the six-week point, getting up from eating lunch, he collapsed and almost immediately died. The carcinoma had finally broken through the walls of the lung. To the very end, he had been able to maintain his quality of life and had remained at home. He continued to be able to breathe on his own, to say what he had to say to his family, and to maintain his dignity.

Questions:

  1. 1.

    Acupressure was offered to this patient

    1. (a)

      To cure his lung cancer

    2. (b)

      To extend his life expectancy

    3. (c)

      To ameliorate secondary symptoms

    4. (d)

      As a distraction

  2. 2.

    Why the combination of acupressure and hypnosis?

    1. (a)

      Both modalities acknowledge the mind-body paradigm.

    2. (b)

      Both modalities address energy regulation and add to the overall efficacy of treatment.

    3. (c)

      In combination, they potentiate self-regulation.

    4. (d)

      All of the above.

  3. 3.

    This specific point combination was chosen in order to

    1. (a)

      Affect spiritual and physical healing

    2. (b)

      Affect emotional and physical healing

    3. (c)

      Affect physical comfort, emotional, and spiritual healing

    4. (d)

      Give the patient more time to live

Answers:

  1. 1

    (c): Acupressure in conjunction with standard Western treatment can ameliorate secondary symptoms such as physical and emotional stress and its sequelae.

  2. 2

    (d): Hypnotically induced trance with suggestions for the movement of energy, for emotional working through, and for spiritual connection and peacefulness of mind and body can support the same goals affected by the activation of acupressure points.

  3. 3

    (c): In this case, the diagnosis and prognosis were rather clear. Increasing the patient’s quality of life and comfort in the dying process seemed to be the appropriate interventions.

Case 3—Asthma

A 13-year-old boy sought acupressure treatment at the recommendation of his parents. He had been diagnosed with asthma at age eight and had been successfully using a bronchodilator as needed, usually no more than a few times per week, and had avoided any emergency interventions. Wheezing was induced by environmental stimuli and physical exertion.

He recently had experienced his first asthma attack playing soccer, and although he was able to avoid the emergency room, this episode scared him and made him hesitant to continue playing. He had just switched from a small elementary school into the seventh grade of a private college preparatory school, and although he had been an academic and athletic star in his elementary school, he found himself to be just one of many talented kids in his new school environment and needed to work much harder just to keep up. He felt himself becoming anxious thinking about school and had started to have trouble falling asleep at night.

His mother reported that she had been quite ill during her pregnancy with unremitting nausea and frequent episodes of “colds.” The mother’s father had suddenly died 6 weeks before she was giving birth to her son. While her son was born full term and healthy, his APGAR scores were not perfect, and before being diagnosed with asthma, he was prone to frequent colds affecting his ears, nose, and throat, which continues to be the case.

The boy did not want to have needles inserted into his skin, so we agreed on a course of acupressure. He also was interested in learning self-hypnosis skills to reduce his anxiety regarding the academic, athletic, and social aspects of school.

It made sense to him that his overall Qi, but especially his lung Qi, may have been deficient from birth because of his mother’s compromised physical and emotional well-being while she was pregnant with him. Because of the overall good care his parents gave him, he was able to generate enough Qi to become strong and capable—but his lungs continued to be affected, and with the first major stressor in his own life, losing his safety net by switching schools and having to fight for position, the lungs signaled problems.

Over a total of five sessions, the youngster had general (Five Golden Points) and specific (CV-17, LU-1, LU-7, DU-20, Yintang) energy points activated via acupressure by the acupuncturist, and, as he learned to find and activate these points on his own body, began to utilize them on his own in between sessions. He had enjoyed a particular hypnotic induction (Spiegel Eye Roll [30]) and had practiced inducing a self-hypnotic trance with it. He favored suggestions of staying calm, focused, and positive in all areas of his current life. He also was amenable to learn several breathing exercises and practiced them daily.

Within the 6 weeks of treatment, the boy had regained his ability to fall asleep, and with this felt more stable during the day. As he utilized acupressure points, self-hypnosis, and mindful breathing to manage his performance anxieties, his ability to perform well academically increased and improved his self-confidence. He was able to reliably breathe again, conscientiously activating acupressure points and deepening his exhale, making room for a smooth inhale, and slowing down his rate of breathing overall. He had greatly reduced the need for his asthma-related medication. Feeling more in control overall, he rejoined the soccer team for a successful season. He also enjoyed the bar and bat mitzvah circuit of seventh grade and reported back to the acupuncturist that so far he did not have to sit out a single dance. No further asthma attacks occurred.

Questions:

  1. 1

    Why would you consider the prenatal environment in the treatment of a breathing disorder?

    1. (a)

      You would not.

    2. (b)

      Because it cannot hurt to get a complete history.

    3. (c)

      Because a person’s Qi at birth is also determined by the parents’ contribution.

    4. (d)

      You would consider it, but in this case, everything was really ok.

  2. 2

    According to TCM, unresolved grief, loss, and breathing difficulties are connected. How?

    1. (a)

      The organ lung is governed by the element “Metal,” which involves letting go and moving on.

    2. (b)

      Lung Qi is affected by breathing difficulties in conjunction with unresolved grief.

    3. (c)

      Breathing difficulties are a sign of deficient Lung Qi.

    4. (d)

      All of the above.

  3. 3

    Why would it be important to inform the young patient of the connection between grief, loss, and lung Qi?

    1. (a)

      He should not have been informed.

    2. (b)

      Now he can appreciate his condition more fully.

    3. (c)

      Now he can take better care of himself both emotionally and physically, preventing further depletion of lung Qi and gradually restoring it through complementary approaches.

    4. (d)

      Now he understands his mother better.

Answers:

  1. 1

    (c): The mother’s compromised immune system alone poses a risk to the amount of Qi transmitted from the mother to the unborn child. Add to this her reduced food intake because of constant nausea and an acute grief reaction because of her father’s sudden death, it can be concluded with certainty following TCM’s teachings that the child’s Qi would be deficient.

  2. 2

    (d): TCM proposes that unresolved grief affects Lung Qi. When the Metal ­element is weak, a person struggles greatly with overcoming loss, and in the process of being “stuck” in grief, available Lung Qi is depleted.

  3. 3

    (c): Knowing that his Lung Qi will need extra care, and why such care is necessary, this young boy has a chance to implement proper breathing techniques, acupressure support, anxiety management, and emotional awareness of the need to address and work through losses, in order to maintain his Lung Qi.

These three case studies are indicative of the range of possibilities opened by combining the “technologies” of Eastern and Western healing techniques to accomplish a variety of medical outcomes, from life-limiting “physical” problems, to “psychological” problems that inhibit full enjoyment of life, to enhancing the quality of the inevitable end of life.

Conclusions

Breathing disorders can be life-threatening disorders since life itself depends on the availability of breath. Breathing blockages, whether they originate from internal or external disturbances, can be understood as energy blockages, depriving a person of beneficial and smooth flow of physical, emotional, and spiritual life energy. Eastern traditions of healing have long believed in the intricate connection of body, mind, and spirit and have treated all three dimensions following a complex system of energy paradigms. Physical stimulation of acupressure points and precise movements to stretch meridians in combination with conscious breath and mindfulness have been utilized in order to direct healing energy to places of emotional and/or physical injury and have been described as beneficial interventions. With appropriate training, primary health-care practitioners, as well as breathing disorders specialists, will be able to offer acupressure and therapeutic breathing interventions to their patient population.