1

The 3rd World Conference on Buddhism and Science (WCBS)

Why do monks chant at 6 breaths a minute? Is it beyond science?

Dr Paul Johnson, Oxford University

Health is a state ofphysical, mental and social wellbeing not simply the absence of disease or disability. WHO 1948

Modern (western) healthcarewith its many remarkable innovations has failed to prevent either the pandemic of life style-related diseases now accounting for over 2/3rdof illnessand healthcare cost globally, or cure them. Mostare preventable and reversible with a change in lifestyle. Since less than 3% of western healthcare budgets are spent on health promotion and disease prevention this is unlikely to change. What little health promotionthere is focuses on diet and exercise with the mind neglected except recently in the treatment of depression (1).

Thesubordinateposition of Complimentary and Alternative Medicine(CAM) usually results from the view that it lacks the clinical evidence base or scienceof modern medicine. However, modern science has already demonstrated that a wide range of traditional practices, such as Pranayama, Yoga, Qi Gong, Tai Chi, meditation, and mindfulness improve autonomic nervous system (ANS) and immune function and outcome in people with a wide range of acute and chronic diseases. In contrast, most modern pharmaceutical and surgical therapies are targeted at organ specific diseases and do not aim to correct homeostatic imbalance which frequently underlies the onset and severity of many acute and chronic disorders. Improving life style is usually of secondary importance to the western clinician as well as their patients and is often an unquantified recommendation or addition to clinically ‘managed’ interventionist measures. It thus might be argued that modern or conventional medicine because of its organ/disease-specific approach is never likely to be comparable to holistic traditional medicine, especially those practices based on mindfulness and movement.

While considering what constitutes an approved evidence base one should also be aware that the majority of randomized control trials (RCTs) that form the bedrock of modern clinical services are limited by two major factors. Firstly, they are not individualized and are confined totightly defined groups of patients that often exclude the majority with the condition under evaluation (2). Secondly, outcome measures are limited to quality of life scores (seldom quantified physiological measurement) or mortality if the study is large enough. This raises the question of what should be the appropriate physiological measurement used to assess patient ‘entry’ condition and outcomes in many RCTs.

One of the most consistent generic measurements predictive of risk and outcome is heart rate variability an increasingly impressive index of autonomic nervous system dysfunction spanning many acute and chronic diseases (e.g. risk for heart disease, heart attack, diabetes, stroke, sudden death). Appropriately analyzed HRV exceeds most organ- specific gold standards (e.g. LVEF (heart failure), HbA1 (diabetes), and yet is still not widely used. Is this because HRV is viewed as a cardiac measurement and therefore not specific to other organs? Is this specialist bias? One of the other reasons that clinical use of HRV is undervalued is because, like so many modern clinical measurements which are point-in-time, dynamic measurements, such as HRV, are averaged over time to produce a singular value. Is it ‘scientific’ to reduce the dynamics of the many Buddhist practices that interactively contribute to holistic wellbeing and health to a ‘spot’ measurement to be equate with an illness-orientated western health paradigm?

HRV is a sensitive index of ANS function that is dynamically related to neuro-immune stress responses and wellness (3). The chronic stress of today’s urban lifestyle leads to ANS imbalance, loss of resilience which is generallydecreased vagal tone, and exposure of weak or susceptible organs to avoidable damage (4). These thresholds of susceptibility are genetically influenced. Recently the direct relationship of ANS functionto emotional and cognitive performance in man has been shown (e.g. polyvagal theory) (5), so the role of the mind in influencing homeostatic mechanisms previously considered as subconscious becomes a paramount issue in wellness and disease.

Even here the segregation of mind fromneurophysiology including the ANS by the divergent sectors of modern medical science may be overlooking the messages and knowledge of ancient Buddhism. The earliest teachings consistently refer to awareness of breathing, both in and out, and especially the role of abdominal or diaphragmatic breathing. An obvious though not exclusive featureof pranayama yoga, Tai Chi, Qi Gong is slow deep breathing. Indeed full benefit from these relaxation exercises movement depends on breath control.

Physiological benefits of slow breathing

Breathing and slow diaphragmatic breathing is akey part of many Buddhist practices.Daily practice of slow breathing ‘retrains’ stress and disease damaged ANS function throughout the body, restoring resilience to reverse risk and many chronic diseases;the heart being only one of the beneficiaries. A remarkably consistent finding has been that 6 breaths a minute has a maximal benefit on mental wellbeing but also a remarkable positive effect on a wide range of cardiovascular, respiratory and brain functions;

  • increase 'resting' HRV (RSA) and reduce sympathetic (stress) activity
  • increase baroreceptor response
  • reduce blood pressure (in hypertensives)
  • improve immune responses
  • increase expiratory control
  • reduce breathing frequency
  • reduce heart rate
  • increase thoracic diameter
  • increase oxygenation and exercise performance in heart failure
  • increase brain blood flow (during slow breathing)
  • increase EEG theta activity
  • increase a feeling of wellbeing and relaxation

Whilst 6 breaths a minute is the key frequency and a few weeks of daily training improves cardiorespiratory and ANS performance.

Recently it has been shown – by cardiologists - that chanting of the Pali mantra “om­mani­padme­om.”and recitation of the Catholic Rosary are both recited at 6 breaths a minute (6). Coincidently heart rate, blood pressure, brain blood flow, and oxygenation were synchronized and a feeling of wellbeing occurred. AlsoRespiratory Sinus Arrhythmia RSA oscillation in heart rate and blood pressure becomes maximal and coherent with a near-forgotten ‘brain’10 second pressure cycle the ‘Traube Hering Mayer wave’, discovered independently in the 1870s by 3 German physiologists.

This breathing technique emphasizes compliance with breathing slowly to optimize heart rate entrainment (respiratory sinus arrhythmia RSA) for 10 minute periods daily.This is usually maximal at 6 breaths per minute.However, diaphragmatic breathing adds considerably to the benefit of slow breathing (7), but this breathing technique may take over a year to perfect according to Chinese research.

‘When the mind is healthy the body also becomes healthy’- Supreme Patriarch of Thailand 1995

Preliminary results

Heart rate variability HRV and thus ANS function can now be readily measured wirelessly from micro monitors worn in clothing, and transmitted and displayed remotely. In the course of using such devices to study traditional exercises, breathing and ANS function, a preliminary study has been commenced on randomly selected Theravadic Monk volunteers – in addition to one highly trained Indian Tulka - some monitored for 24 hours- to include chanting, meditation and sleep periods. In all cases 2-4 monks of 9in 4 different chanting choirswere monitored (Alivetectechnology) including at least 2 hours chanting.Of eight successfully monitored so far, 6 consistently breathed at 6 per minute during most of the time spent chanting and RSA was obviously entrained. The two who did not breathe at 6 breaths a minute (between 8-9 per minute) were in the same group.

This is a record of heart rate and chest movement during chanting by the young Indian Tulka. The most striking pattern of oscillation in heart rate and breathing occurred at 6 breaths a minute

None of the participants had any idea that they were breathing in this way and did not recall any respiratory training when learning to chant. They had no knowledge of any relationship between heart rate, breathing and any of their practices. Indeed, the tulka was adamant that his chanting did not include ‘breathing mantras’ and was therefore unlikely to have a regular respiratory rhythm. His reasoning seemed to be supported by his view that his mantras also varied in length as well as chanting cadence. However, the evidence from his recording (see figure) was that over a range of mantras used during his chanting his breathing frequency was nevertheless 6 per minute. Six monks subsequently monitored during temple ceremonies in Hua Hin also showed that the number of mantras per breath may vary but the 6 breaths per minute remained fairly constant throughout 1-2 hour chanting periods. When this is so the entrainment of heart rate at 6 cycles per minute is a striking feature as research has shown with naïve subjects and patients who practice breathing at this frequency.

Note the oscillations in heart rate occurring at 6 per minute during chanting (see more clearly in the lower recording displayed over 10 minutes. The unexpected period of meditation during the chanting in one of the monks is also clearly seen in the heart rate pattern

My current observations support the view that when slow breathing at 6 per minute includes an emphasis on diaphragmatic breathing that the entrainment is further increased performing pranayama and Qi Gong at 6 breaths per minute.

Next steps

From a practical point of view it is necessary to include simultaneous audiovisual monitoring with the physiological measurements to accurately relate chanting to breathing and heart rate changes. A further technological development is to be included, namely the accurate measurement of chest and abdominal ‘breathing’ and EEG measurement using a portable wireless system that can be used in the practitioners’ normal environment. Also the aim is to study practitioners over 24 hour periods so that the individual effects of different practices can be measured in the context of 24 hour circadian rhythms.

The large (healthy) variation in heart rate during wakefulness as well as sleep is shown by the thick line in the HRV (upper trace); the fall in heart rate during sleep but with episodes of increased variability that probably equates with REM or dream sleep. Note the elevated heart rate at the end of the recording when the tulka is performing sala dancing. The traces below show how vagal activity (RMSSD) in HRV indicative of relaxation can be separated out by algorithms. Light blue line METS indicates energy expenditure.

The impact of music on ANS and mind has also to be considered (8) and measurement techniques that take this into account will be helpful (9)

Comments and advice is welcome at

The origin and extent of these mantra health benefits are being further investigated. It is also hoped that this will provide further insight into how mind (emotion and cognition), breathing and body functions are related. In particular, the interdependence of breathing and mindfulness, both of which can profoundly affect HRV, ANS function and wellbeing

.

  1. Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy fordepression: A new approach to preventing relapse. New York: Guilford Press.
  2. Rothwell PM Treating individuals 1. External validity of randomized controlled trials: ‘to whom do the results of this trial apply?’ Lancet 2005;365:82-93
  3. Davidson RT, Kabat-Zinn J, Schumacker J et al. Alterations in brain and immune functions produced by mindfulness meditation. Psychosomatic medicine 2003;65:564-570
  4. Weber C S, Thayer J, Rudat M et al. Low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers. Eur J appl Physiol2010; jan online
  5. Porges SW The polyvagal perspective Biol Psychol. 2007; 74(2): 116–143.
  6. Bernardi L, Sleight P, Bandinelli G, Cencetti, Fattorin Li,Wdowczyc­Szulc J, Lagi A.Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ 2001; 323:1446-9.
  7. Martarelli D, Cocchioni M, Scurio S, Pompei P. Diaphragmatic breathing reduces exercise-induced oxidative stress eCAM 2009;1-9
  8. Bernardi I, Porta C, Sleight P cardiovascular cerebrovascular, and respiratory changesinduced by different types of music in musicians andnon-musicians: the importance of silence. Heart 2006;92:445-452
  9. Orini M, Bailon R, Enk R, Koelsch S, Mainardi L, Laguna P. A method for continuously assessing the autonomic response to music-induced emotions through HRV analysis Med Biol Eng Comut 2010;48:423-433