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Breathing as a Healing Tool- Ancient Tradition and Modern Science
 
There is a long tradition of using breathing as a salutogenic tool to enhance wellbeing and as a therapeutic tool to treat disease.
 
In Indian and Chinese Taoist yoga, the salutogenic and therapeutic potency of breath control, is explained in terms of its ability to influence life force (Prana and Qi) and also to calm the nervous system and reduce stress (Ramacharaka 1904; Swami Rama 1976; Nagendra 1999; Sovik 2000; Janke 2002). In Chinese Taoist yoga it is believed that a person who practices breathing control is able to prevent disease and prolong life (Blofeld 1978; Zi 1994; Lewis 1997).
 
In a classic text of Chinese Medicine from the Han Dynasty (200 BCE-220BCE) - "The Yellow Emperors Classic Book of Medicine" it is stated:
 
 “Health, well-being, and long life can only be achieved by remaining centered with one’s spirit, guarding against squandering one’s Qi, using breath and movement to maintain the free flow of Qi and blood, aligning with the natural forces of the seasons, and cultivating the tranquil heart and mind.” (p75, Janke 2002)
 
A complete list of diseases that Indian and Taoists yogis claim to be improved with regular breathing practices (often combined with movement) would be very long and is not attempted here. However, some common examples include:
 
 "bronchial asthma, diabetes mellitus, hypertension, ischemic heart disease, ophthalmic disorders, irritable bowel syndrome, colitis, anxiety neurosis, depression, tension headache, migraine, arthritis, back pain and epilepsy." (Foundation 1996; Sancier 1996; Nagendra 1999)
 
Research studies on Indian yoga breath control or pranayama have indicated that pranayama may be of benefit in the following conditions, insomnia (Khalsa 2004), heart disease (Spicuzza 2000; Shannahoff-Khalsa, Sramek et al. 2004), asthma (Murthy 1983; Nagarathna 1985; Singh 1990; Vedanthan 1998), non-insulin dependent diabetes (Monro R 1992), epilepsy, obsessive compulsive disorder and depression (Janakiramaiah 1998; Murthy 1998; Janakiramaiah 1999; Vedamurthachar, Janakiramaiah et al. 2006).
 
There are also a number of more recently developed western breathing therapies which are used to treat a wide range of disorders. There is a growing body of scientific evidence for the effectiveness of some of these breathing therapies in a range of diseases including asthma, heart disease, anxiety and depression (Brown and Gerbarg 2005; Dixhoorn van 2007; Karavidas, Lehrer et al. 2007; Meuret, Wilhelm et al. 2008; Bruton and Thomas 2011).
 
In a systematic review of breathing techniques for asthma, Ernst reported that at least 30% of the 3,837 respondents interviewed used breathing techniques to relieve their asthma symptoms (Ernst 2000). The most recent Cochrane review on breathing therapies for asthma identified a number of possibly helpful therapies including the Buteyko Breathing Technique (BBT) (Holloway 2003). There have been at least five published clinical trials on BBT for asthma (Bowler 1998; Opat, Cohen et al. 2000; Cooper, Oborne et al. 2003; McHugh, Aicheson et al. 2003; Abramson, Borg et al. 2004; Slader, Reddel et al. 2006; Cowie, Underwood et al. 2008). 
 
These clinical trials indicate that people learning the Buteyko Method are able to substantially reduce medication with no deterioration in their lung function or asthma control, although no studies have demonstrated objective changes in lung function. The quality of evidence for the Buteyko Method according to an Australian Department of Health report is stronger than that for any other complementary medicine treatment of asthma (Marks, Kotsirilos et al. 2005).
 
Recent studies indicate that several other types of breathing therapies also help asthma symptoms and lung function, for example, resonant frequency breathing biofeedback (Lehrer, Vaschillo et al. 2004), capnometry biofeedback (Ritz, Meuret et al. 2009) and breathing rehabilitation (Holloway and West 2007; Thomas, McKinley et al. 2009).
 
Breathing therapy has also been found to be very helpful for cardiovascular disease. In a study comparing patients who received standard cardiac rehabilitation with those receiving additional training in breathing therapy after myocardial infarction (MI), it was found that the breathing therapy group had about a 30% decrease in cardiac events at 5 year follow-up (van Dixhoorn and Duivenvooden 1999). Another study showed that exercise training in patients with MI was not always successful in preventing future cardiac events, however the risk of treatment failure was reduced by half when relaxation and breathing training was added to exercise training (Dixhoorn, Duivenvoorden et al. 1989).
 
Other breathing therapy based on yoga breathing was also found to improve hemodynamics and various cardiorespiratory risk factors in cardiac patients (Murthy 1998; Shannahoff-Khalsa, Sramek et al. 2004).
 
The effectiveness of breathing therapies in psychological conditions and chronic stress has also been shown in several studies.
 
In major depression, both resonant frequency biofeedback and modern yoga derived breathing techniques appear to be effective (Janakiramaiah 1998; Murthy 1998; Karavidas, Lehrer et al. 2007). People with anxiety and panic disorder also show beneficial response to capnometry and other breathing therapy protocols (Tweedale, Rowbottom et al. 1994; Abu-Hijleh, Habbal et al. 1995; Meuret, Wilhelm et al. 2008).
 
This sampling of the literature on breathing therapies, while not exhaustive, strongly suggests that breathing may be able to function as a therapeutic or salutogenic aid, yet despite many positive research findings, breathing therapies are not widely utilised. One reason for this may be that there is insufficient understanding of the mechanisms underlying breathing therapies. Certain theories about the mechanisms of breathing therapies propose that they helpful because they correct some aspect of dysfunctional breathing.