It is a recognized fact in both the yogic tradition and in medical science that peptic ulcers have their roots in the mind, and are a direct consequence of mental tension and worry. In this stress filled day and age, it is estimated that at least 1 person in 10 is likely to have a peptic ulcer at one time or another.
Why and how ulcers form is still a mystery. Somehow or other the gastric juices burn a hole in the stomach lining, causing either a discreet ulcer or multiple, pinpoint bleeding spots called gastritis. The ulcer is a crater, a depression in the stomach lining, similar in appearance to those on the moon.
There are two main types of peptic ulceration:
Stressful situations, personality problems and genetic predisposition are thought to be major factors in causing ulcers. Smoking, alcohol, and dietary indiscretions are secondary factors aggravating the underlying condition. For example, in India, the excessive consumption of chillies and spicy foods, recognized irritants of the gastric lining, combined with mental tension lead to chronic peptic ulcer, and also further aggravate the condition when the ulcer has developed.
Ulcer patients are usually highly strung, excitable and ambitious people who are leading very active lives. Society sets high goals which these people feel they have to attain to be successful in their own eyes and in the eyes of others. Most ulcer sufferers are attempting many things at once, and worry about the results of their undertakings. These are the people who cannot rest, even when they have the chance. They may sleep too little and take insufficient food or alternatively smoke, drink and eat excessively because of underlying mental tension.
Ulcer patients are a distinct personality group. They usually are the type of people who handle their emotional drives internally, tending to 'bottle up' their worries and problems. That is, instead of becoming angry and relieving their tension or creatively channelling the excess emotional energy into the external world, they internalize this energy. Perhaps this is because they are afraid to let other people see how they feel, so they channel this energy into their nervous systems and internal organs. Then, if their body has its predisposed weak point in the stomach, ulcers can develop. This type of person allows worries and problems to gain the upper hand so that emotional energy literally eats him! With these people it is not a question of what they eat, so much as 'what is eating them'. The negative energy at the mental, emotional level is transmitted into the body as a negative, self destructive energy which eats into the lining of the stomach as well as their emotional and mental well-being.
The effects of anger and the emotions have been researched using hypnotism. Hypnotized subjects were placed in front of an X-ray machine, and the suggestion was made that they feel anger. X-rays were then taken which showed the stomach tense up, constrict and then go into spasm, indicating that it was grossly affected by tension.
Other experiments have shown that depression or fear tends to slow down gastric acid production while anger, resentment and hostility increase it. Emotional imbalance triggers the limbic system of the brain to readjust the nervous-endocrine system via the hypothalamus, which affects both the autonomic nervous system and the endocrine glands. If this emotional imbalance is inappropriate and ongoing, rather than short term and justified, then the whole delicate balance between acid secretion and the production of protective mucus is upset, allowing the acid to eat into the muscle coating.
Other factors thought to be involved in the formation of ulcers are certain drugs such as aspirin. Seasonal factors can also play a part, for example, in Britain there is an increased death rate from ulcers during winter.
Peptic ulcers tend to run in families. The children of parents with duodenal ulcer tend to get duodenal ulcers. This is especially true when ulcers occur in childhood or adolescence. Though it used to be thought that this indicated that ulcers were caused by a genetic weakness, more recent research is showing that the environment plays a more important role. Not only does the child inherit physical characteristics and weaknesses, but he also develops some of the same personality traits as his parents, the same tendencies that caused them to develop ulceration.
The social and economic environment is also important as gastric ulcers tend to be more common amongst the poor, while duodenal ulcers are evenly distributed throughout the population. An interesting relationship between sex and ulcers exists. Duodenal ulcers occur 5 to 10 times more commonly in men than women, while rupture of the ulcer (a serious complication) occurs 20 times more often in men. This is probably due in most part to the differences in life pattern of men and women. However, it is thought that the female sex hormones play a significant part in protecting women. During pregnancy, for example, active, acute ulcers are virtually unknown and the symptoms which cease soon after pregnancy begin to recommence after delivery.
Whatever the contributing causes to the occurrence of peptic ulcers, it seems sure that science will validate the claims that the major problem is mental tension interfering with the balance stomach acid versus stomach mucosal resistance.
The 3 most important symptoms of ulcer are chronic dyspepsia (discomfort after meals), pain and bleeding. Ulcer sufferers quite often have episodes of dyspepsia for many months before discovering they have an ulcer. This, or pain, usually takes them to the doctor. The pain is generally described as a gnawing or burning sensation, found in the upper abdomen just under the sternum of the rib cage, in the midline or just slightly to the right.
Duodenal ulcer pain tends to occur between meals and is characteristically relieved by food, especially milk. It is described as 'hunger pain' and may awaken the sufferer from sleep between 2 and 4a.m. Gastric ulcer pain, however, occurs mainly 1 hour after eating, is not relieved by taking food, and only rarely occurs at night.
In both cases the pain is episodic, that is, it occurs daily for days or weeks at a time and then disappears, only to reappear weeks or months later. Between attacks the individual feels perfectly healthy and can eat and drink without apparent harm. However, with time the episodes of pain become longer and the period between episodes diminishes. This is especially so when during attacks dietary indiscretions or alcoholic excesses occur. Other symptoms are feelings of discomfort and distension, loss of appetite, nausea, vomiting and weight loss (especially in gastric ulcers). Heartburn (bringing up of gastric contents into the throat or mouth) and waterbrash (excessive salivation caused by nausea) also occur. Bleeding from an acute ulcer can lead to vomiting of bright red blood from the mouth and black blood appearing in the faeces. It may also appear as anaemia or even acute shock from sudden loss of blood.
The ulcer personality tends to be dynamic and fiery, and is prone to the suppression of jealousy and anger. Thus the energy travels into the stomach where it causes excessive acid secretion and makes one more susceptible to ulcers.
Wolf and Wolff studied the case of a man whose stomach had been perforated by a bullet.*1 The wound did not heal completely but formed a fistula, a passage through the stomach and abdominal walls by which the interior of the stomach could be seen.
During depression, gastric secretion was reduced and it was subnormal for several months when the dominant psychic state was self-reproach. When the subject was unjustly reproached he experienced strong feelings of hostility and the supply of blood and subsequent acid secretion increased by about 25%, remaining elevated for 2 weeks. The mucosa (lining) was seen to become engorged, wet, swollen and dark - that is, full of blood. The general conclusion was that emotional states such as fear, sadness or withdrawal appear to reduce gastric secretion, but aggressiveness or the will to fight back appear to increase it.
Another experiment involved pairs of monkeys who were restrained and subjected to electric shocks delivered to the feet automatically, every 20 seconds for 6 hours. After a 6 hour rest, shocks were again repeated for 6 hours, and so on. The first monkey, the 'executive', was given a lever to press. When pressed at the right time, it prevented shocks to both monkeys and he quickly learned to stop the shocks. His partner, the 'control', received very few shocks. His lever was without effect and so he soon came to ignore it. The executive monkeys died after several days of continuous stress from gastrointestinal erosion and bleeding. No control monkey died or had ulceration.
People with ulcers tend to be like monkey number 1, the 'executive', except that they are not forced into their situation by anyone other than themselves. These people arc power dominant personalities who want to prove themselves to themselves and to their peer group. They feel insecure when they are not in a position of power, and because no one can achieve total power, they are never without some insecurity and tension, even in their dealings with themselves. They can sometimes be seen on their holidays walking by the sea, directing the action of the waves. This personality reflects tension in the manipura chakra area and therefore sadhana is directed towards its relaxation.
Rest and relaxation are acknowledged as being the major factor in relieving serious acute and chronic ulcer problems. In the field of rest and relaxation yoga is unsurpassed, as the essence of yoga is relaxation. All yoga practices, whether asanas or meditation techniques, are intended to remove tension in all its forms, either physical, emotional or mental. These practices allow the nervous system and consequently the digestive system to return to normal. This applies to all digestive problems, not just ulcers.
Furthermore, yoga creates a deeper understanding and tolerance of both oneself and others. This encourages each of us to live a more harmonious and happy life. Developing such feelings as optimism and confidence gives us a higher level of resistance to ward off diseases and problems and allows the body to better heal itself. Therefore we can say that yoga is the way to remove not only the symptoms but also the root cause, mental tension.
Yogic therapy should be used in conjunction with medical treatment for the best combination of methods to alleviate both the pain, distress and underlying tensions. The acute ulcer is treated with bed rest. Milk diet eases pain and antacids help to relieve excessive acid. Some doctors advise drugs to reduce acid. At best, this symptomatic form of treatment is only good for a short while until yogic relaxation practices have rebalanced the mind and nervous system so that the root cause is removed. Medical management of ulcer symptoms, though effective, will not prevent the ulcer from recurring, nor will it prevent the natural tendency of ulcer symptoms to increase and decrease.
A liquid or light, bland diet is to be taken until the ulcer heals completely. Only then should the normal diet be resumed. This bland diet should be taken every 2 or 3 hours and each meal should be small. These small regular meals throughout the day will help to protect the ulcer crater from the acids and give it a chance to heal. Rough foods such as bran, coarse cereals, leafy vegetables, grated carrots, etc. should be avoided along with all oily and spicy foods like chilli, pepper, rich sauces, curries, salad dressings, mustard, cheese, nuts, chutneys, fried food, cakes, etc. The following diet is recommended:
This diet is designed to provide essential food materials in an easily digestible form and is valuable for ulcers, colitis and other intestinal complaints. We do not, however, recommend this diet for general use; it should only be followed until the ulcer has healed.
Eventually, a normal diet can be resumed, but it will always be necessary even after the ulcer has completely healed, to be very careful about the following (i) fried food, (ii) pickles, curries, chilli, pepper, ginger, mustard, (iii) tobacco and alcohol in any form, (iv) excess tea or coffee, especially strong and black.
Rest is essential in healing an ulcer and until it has healed, complete rest is suggested. As strength is regained it will be possible to commence yogic techniques which, when practiced under expert guidance, are designed to reduce mental tension, give control over the autonomic nervous system, and thus prevent recurrence.
Until the ulcer has completely healed, the only practices that should be performed are as follows:
Later, when healing is complete, you can add kunjal kriya to the cleansing techniques. A yoga ashram is an excellent place to recuperate after an acute attack, because it provides a positive atmosphere away from worries and tensions.
*1. S. Wolf & H.G. Wolff, Human Gastric Function, 2nd ed., Oxford Uni. Press, New York, 1947.