Anesthesia

Excerpts from Counting Backwards – A Doctor’s Notes on Anesthesia by Henry Jay. This book caught my attention just to know more about this medical procedure which provides amnesia during invasive procedure on the body.

History
The inventions dates back to Jabir Ibn Hayyan, a resident of Persia in 8th century who nearly synthesized ether by combining Sulphur and alcohol. It still remains a speculation but he was a prolific author and said to have written some 3000 books and inspired a word ‘Gibberish’ (Geber being Latinized name of Jabir). In 1540, Valerus Cordus, a German physician combined fortified wine and sulphuric acid to form what he called oleum dulce vitriol – sweet oil of vitriol but was recognized for its anesthetic properties yet. Another 2 centuries later inhaling gases as a means of therapy flourished – by inhaling fumes of ether, this ether frolics provided relief and euphoria. In 1842, A Georgia doctor, Crawford Long brought ether frolics to his community and found during a fun party, some inhalants who got bruised never reported pain during its ‘subdued time’ and later one of his acquaintance sought his advice to remove a lump and as he dreaded pain, a novel idea was hatched and implemented, a towel saturated with ether was held under patients nose and asked to breathe and surgery was completed painless and safe. It went undocumented. On Oct 16,1846, Morton demonstrated publicly this method of inhaling gas for surgery and published a patent and called the procedure “Letheon” after river Lethe in Greek mythology which when its water drunk causes loss of memory. A month later, the term “Anesthesia” Greek for “without sensibility” was coined by Oliver Wendell Holmes (suggested via a letter) stuck and used now. Right now Sevoflurane is the choice of anesthetic gas compared to desflurane and isoflurane. Comes in variety of scents – bubblegum, cherry, strawberry or orange. 

Tools of the Trade
Anesthesia machine is CPU weighing many hundreds of pounds and stands about 5 ft high with 3 ft square base with 6 inch wheels anchored to a sturdy iron base. It has dials , switches and buttons to regulate gas flow and switch between modes of breathing. Plus a screen to monitor gas composition, rate and volume of breath. Also during anesthesia, patent’s airway needs to remain open and unobstructed that’s no snoring. Endotracheal tubes that help arrest snoring along with Laryngoscope which lights the path through the mouth to the vocal cords. IV anesthesia medications, narcotics for pain relief, relaxants for temporary paralysis (succinylcholine), Atropine/Epinephrine to speed up heart and antibiotics. Suction catheters to remove mouth secretions and a backup to the backup – the Ambu Bag – when squeezed, pushes a breath to a desperate patient in need – this is useful when gas flow or the electrical supply has failed and revert to manual mode.

Anesthesia and Its Adjuncts – The 5-As
The term anesthesia does encompass all goals of care, there are more adjuncts that are added to ether for full care and these side medicines create 5 effects called as 5-As of Anesthesia:

  • Anxiolysis, relieving stress created by an upcoming surgical procedure
  • Amnesia, preventing memory formation during anesthesia care
  • Analgesia, relieving pain during the procedure and after to include acute and chronic pain relief
  • Akinesia, preventing a patent’s movement during a procedure
  • Areflexia, stopping adrenaline surge and swings in blood pressure and heart rate while under anesthesia

Railroad Tracks
Anesthesiologists dream railroad tracks, no doubt, that’s what they want for a patient during their care. The rails are ticks and dots representing the patient’s blood pressure and heart rate as recorded during the progress of anesthetic care without variance. From “Your Patient is ready” – the comment made at that first painless surgery in 1846 and still used today – to “I’m finished” is to achieve the railroad tracks before handing over the patient to physician to take over.

Nothing by Mouth
First death due to anesthesia happened in 1848 the moment a patient inhaled the gas and an autopsy later revealed the patient’s lungs were found to be congested with blood and fluid. Possible caused could be heart related but also might be due to aspiration – stomach contents finds its way into wind pipe, trachea leading to “dry drowning”
The separate paths leading to the stomach and the lungs work on the either/or principle. Only one path may be open at a time, and eating and breathing are kept separate through a series of coordinated actions including muscles and reflexes. The vocal cords at the entrance to the trachea snap shut when food or drink enters the mouth. This reflex, the laryngeal adductor reflex, is beyond our active control and prevents any- thing in the mouth from going down the wrong pipe. To swallow, sphincters made of muscle in the esophagus relax and the contents of the mouth slide down into the stomach.
Gastroesophageal reflux—commonly referred to as GER D (for “gastroesophageal reflux disease”) and also known simply as heartburn—occurs when these sphincters fail and the stomach contents rise in reverse back up the esophagus. Silent aspiration results when the laryngeal adductor reflux fails. Food and drink entering the trachea can block the airway, preventing oxygen in the air from entering the bloodstream. Aspiration also pre- disposes a person to pneumonia.
Everyone experiences aspiration occasionally by accident. Either excited or impatient, we sometimes fill our mouths with too much food or drink, or too fast, or with a full mouth, and on a startle the contents go down the wrong pipe. Instead of passing down the esophagus into the stomach, the oral contents slide past the vocal cords and into the trachea, the windpipe. The system of protection that keeps the lungs clean and clear has failed. This is aspiration.
Acid is the anesthesiologist’s enemy. The stomach is capable of withstanding the acid it produces as an aid in digestion. But other tissue is not immune to this acid. Herein lies the risk of anesthesia, which relaxes muscles and turns off reflexes. The cinched esophageal sphincters relax, allowing the contents of the stomach to flow to the mouth while the laryngeal adductor reflex no longer guards the entrance to the trachea. To prevent aspiration under anesthesia, the stomach must be empty.
Nil per os. “Nothing by mouth.” The pre-anesthesia routine in decades gone by was to write and order: “NPO after midnight.” With first-scheduled cases in the morning, this worked fine. For afternoon cases, the patient might be left dehydrated. Today, a kinder, gentler sliding timescale is used, depending on the procedure schedule and the type of food or drink. Clear fluids are frequently allowed up to two hours before anesthesia; they don’t fill the stomach with acid and might actually aid in passing its contents out and along the intestines. Fatty foods produce the greatest amount of acid, requiring eight hours to clear acid from the stomach.

Amount of Anesthetic Agent
THE DOSE OF THE ANESTHESIA gas is measured as a percentage of the overall inhaled gases (as mixed with air and oxygen). The minimum alveolar concentration (MAC) is the percentage of gas inhaled that prevents fifty percent of patients from responding to a painful stimulus. Whether it’s a mouse, red-tailed hawk, monitor lizard, elephant, or human, regardless of species or size, the percentage of inhaled gas necessary to achieve the state of chemical coma is remarkably similar. Greater change exists with advancing age than between species: once you hit maturity, the older you are, the less gas you need. The same cannot be said for the anesthesia drugs administered by injection. Differences in species alter the IV (intravenous) or 1M (intramuscular) dose of the drugs necessary to provide anesthesia. More to the point, the required amount of drug increases as the level of oxygen consumed increases. Small species tend to consume oxygen in amounts that are magnitudes higher per pound or kilogram than the amounts that larger species consume and, as a result, anesthetizing small species requires larger doses of drug. The dose per pound of an anesthesia drug injected into a human might kill an elephant but leave a mouse unfazed and staring at you, wondering what just happened.

Pain Relief as a Right to be Sought
His call – paraphrased:
Most anesthesiologists had failed to understand or treat pain in non communicative patients. Those unable to speak for themselves had no advocates for comfort. Their families were either incapable of understanding them or, like most anesthesiologists, fearful of overmedicating. Hence, change from being a reactive analgesic administrator—depending on others beyond the patient to provide guidance for pain relief— to an activist, making pain relief as an important decision, with every intent to prevent as much moaning as possible. Instead of steering clear of overdosing, define its limits with greater precision.

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Mr. Parkinson and the disease that bears his name

The key to start this blog has been the inspiration after reading Michael Faraday’s biography in which I learnt about his very humble beginnings, struggle for proper schooling,  attending lectures and learning from borrowed books, he can later become one of the greatest scientist to usher in the electrical revolution. His life long passion is to learn and having poor memory always wanted it to be recorded for future reference. And this record keeping in the form of a blog has been continuing since long and hope to keep up for foreseeable future to at least an entry per month.  Similar to M. Faraday, next quintessential English gentleman that I admire and respect is Parkinson. He has similar thought process and background, worked very hard meet ends, was an active advocate for freedom of expression, universal suffrage and stood for abolishing dynastic rule. Being a medical practitioner, he was also interested in paleontology and fossils and a literary figure of his own making by publishing political propaganda and later tomes on medical and fossil science. Reading his biography ‘The Enlightened Mr. Parkinson’ by Cherry Lewis was an eye opener about this great English apothecary who had written about ‘physical tremors’ with great detail based on his careful and penetrating observations, that this disease bears his name. A great testimony to his service to medical science and its appreciation back. Let’s look at some excerpts from this book that I want to record that will be useful for those who want to pursue the book to find out more – a teaser of sorts:

Political Advocacy
Daniel Isaac Newton was the publisher of Hog’s Wash which ran for 60 numbers between Sep 1793 and Mar 1795, and it was renamed to Politics of the People – a sort of political propaganda for freedom wishers in England. Partly original material, partly excerpts from other works, and enlivened by satire, irony, humor and verse, the magazine was hugely successful. throughout the series ran an irregular , but al;ways ‘to be continued’ ‘Sketch of the Most Memorable Events in the History of England from the Landing of Julius Caesar, to reign of William the Conqueror’. Written by Parkinson masquerading as Old Hilbert, it was a clever parody of the Government, using examples from history to illustrate its current failings. Throughout, both Eaton and Parkinson advocated votes for all, annual parliaments, peace among nations, education of the poor, and unfettered discussion on politics and religion.

Trials and Tribulations
He was interrogated by Prime Minister and host of judges for sheltering a friend who committed treason. Possibly as Parkinson was a familiar face in the literary and magazine world and he not actually publishing his work may have prompted the then government not to punish him as his publishing friends. He did escape unscathed on all possible charges and emboldened to write about it and finally he withdrew from  London Corresponding Society that provided a political front for his literary proposition and started focusing on his career and writing.

Writings

  • Medical Admonishments – a 2 volume tome
  • The Villager’s Friend and Physician – aimed those who could not afford the above
  • The Way to Health – fireside easy reference
  • Hints for the Improvement of Trusses – especially for manual laborers to stop hernias
  • The Chemical Pocket Book – assemblage of chemical facts
  • Organic remains of a Former World – ultimately a textbook in geology
  • An Essay on shaking Palsy – (Eventually) About Parkinson’s Disease
  • Outlines of Oryctology – a text book on fossils

Child Welfare
Parkinson was also concerned for the welfare of working children and was moved to act when a child apprenticed in an adjacent parish was murdered by her mistress. The Vestry was responsible for some 70 orphans, most of whom were required to work, but those apprenticed in other parishes were often left to the almost unrestrained caprice of their masters or mistresses, ‘no law existing by which the duties of the master are defined, or any inspectors of his conduct appointed’. Parkinson proposed the introduction of a register of poor children seeking employment and advocated measures to monitor their working conditions, suggesting they were ‘visited by a committee of the trustees and overseers of the poor twice every year’. The Vestry appears to have accepted his recommendations, as a panel of inspectors was immediately appointed to make regular visits to the homes of apprentices. They checked that the children were being adequately fed and clothed, that they were not made to work excessive hours, and that they were being trained in work that would enable them to earn a living when the apprenticeship expired. Six months later the first inspections had been completed. The accompanying report illustrates how Parkinson’s concerns about ill treatment had been fully justified with the committee finding itself under the ‘painful necessity of reporting a ‘shocking instance of seduction and depravity’. A young girl had been seduced by her master, a married man and father of six children. On discovering that she was pregnant, the master ran away, leaving the young girl to deliver her child in the workhouse; tragically, both mother and child died shortly afterwards.

Parkinson served on the new committee set up to oversee these children and made detailed reports of his visits; these show that he called on no fewer than 72 houses each year, spread over a wide area of the parish. He then established a set of regulations governing the apprenticeship of these children, which included not allowing the children to work on Sundays and making sure that they went to church at least once every week. No child could be apprenticed before the age of twelve and they were not allowed to ‘work longer than twelve hours in any one day, and not before six in the morning, nor after nine o’clock in the evening’. Their masters were expected to furnish the children with new clothing on the first day of May each year, and no more than two children were permitted to sleep in a bed. Finally, each child was to be given a copy of the regulations — even though many could not read — and the name of someone in the Vestry to whom they could apply if they were mistreated. Six years later the committee noted that things were much improved: ‘Mr Parkinson reported that the Officers, himself and several of the Committee, visited the children apprenticed and found them in general comfortably situated.’

Pursuits for Children
The antidote to hazardous pursuits, Parkinson recommends, is to sit quietly at home reading a book, learning by rote ‘some little geographical table . the characters of some plant, or the natural history of some animal’, or examining the night sky ‘bespangled with suns and other worlds’. The micro- scope was also a source of endless instruction, demonstrating how ‘works of art are exceeded by those of nature’, and pro- viding far more amusement than ‘two or three of those foolish toys which are often destroyed weekly’. And if exercise was required, what better than a game of shuttlecock? ‘It is truly curious to see, in this sport, that almost every muscle in the body is called into action and that the whole might of a man may be employed to combat four feathers and a cork,’ he muses. We can well imagine Parkinson playing shuttlecock with his children in the park opposite their house. Despite his deep concern for the well-being of his children, he was nevertheless quite a disciplinarian, as was common at a time when a strict code of etiquette controlled social behavior, and children who misbehaved could ruin the reputation of their parents. Thus he entreats parents to regulate their infants’ passions and teach them to distinguish between right and wrong, lest the child becomes a ‘wretched nuisance’ which would ‘render him odious to all around him’. At the same time, it was important to administer restraint with mercy

Gout Prescription
Observations on the Nature and Cure of Gout was published in 1805, while he was following his self-prescribed diet and treatment, and in a period of remission. It relates a number of case histories, including his father’s and his own, and details the cure he had found in the hope that his observations might benefit his fellow sufferers. He opens the book with the statement that ‘gout is a hereditary disease’, notes correctly that men are more subject to the disease than women, and that it ‘seldom attacks those who live on a spare diet’. He therefore advises ‘that acids of every kind should be used with great moderation; spirituous liquors must never be drunk wines, particularly those of foreign production, and even malt liquors, must be avoided with equal care’. He may not have fully understood the origins of the disease, but careful observation over the years had shown him that insobriety, luxury, indolence and voluptuousness’ were likely to bring on an attack and should be avoided at all costs. Attempting to address what, exactly, gout is, he explains that it involves the deposition of a ‘concrete saline substance, which sometimes accumulates in considerable quantities, particularly on the joints of the fingers and hands’, and recalls that in 1797 Dr. William Wollaston had reported to the Royal Society that this ‘gouty matter’ contained a ‘peculiar lithic acid’. Six months later, Dr. George Pearson, also in a communication to the Royal Society, had recommended that lithic acid be more accurately termed uric acid. Today gout is known to be caused by an excess of uric acid in the blood, which crystallizes and settles in the joint spaces causing swelling in joints.


Shaking Palsy
James Parkinson’s treatise, An Essay on the Shaking Palsy, published in 1817 when Parkinson was 62, has deservedly become a medical classic.l Original copies of the work are now rare, although facsimiles have been reproduced from time to time and scanned versions of the original can be found online. Its significance lies in the fact that Parkinson was the first to identify and describe the symptoms that defined the shaking palsy, known to us today as Parkinson’s disease. The Essay opens with Parkinson’s famous definition of the shaking palsy, in which he captures the very essence of the disease:

SHAKING PALSY. (Paralysis Agitans.) Involuntary tremulous motion, with lessened muscular power, in parts [limbs] not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace: the senses and intellects being uninjured. As with so much of Parkinson’s work, it was not only his acute observational powers and attention to detail that enabled him to provide such an insightful commentary on the shaking palsy;

It was not until the 1860s that Parkinson’s Essay became widely cited. Daniel Maciachlan in his book A Practical Treatise on the Diseases and Infirmities of Advanced Life, written in 1863 refers to ‘Mr. Parkinson whose interesting essay must ever be referred to, as giving a faithful account of the symptoms of the disease from beginning to the end, and is still the best work on the subject’.8 Two years later, William Sanders, in a paper on an unusual case of nervous disease, which he called ‘pseudo-paralysis agitans’, also referred to Parkinson’s work and implied others were now following Parkinson’s classification of the symptoms. When going on to discuss a more appropriate name for the shaking palsy or paralysis agitans, Sanders refers to it as ‘Parkinson’s disease’, but in doing so he means the disease as described by Parkinson, and is not suggesting it should be called that. Along with several alternative names, he does propose paralysis agitans Parkinsonii, but this rather cumbersome mouthful did not catch on.9 It was more than 50 years after publication of Parkinson’s Essay before anyone seriously turned their attention to the disease, as Thomas Buzzard pointed out in 1882:

The disease ‘shaking palsy’, or ‘paralysis agitans’ … was first regularly described by our countryman Parkinson in 1817. Parkinson was a member of the Royal College of Surgeons, and his Essay on the Shaking Palsy presents so graphic and admirable a description of the disease that comparatively little has been left for subsequent observers to add to his account.

In our time Charcot has also made the disease the subject Of clinical investigation. In 1872, when giving a lecture on paralysis agitans, Charcot explained to his students that ‘The first regular description of it only dates from 1817; it is due to Dr Parkinson who published a little work entitled Essay on the Shaking Palsy’ .15 He also remarked how existing names for the disease were inappropriate since patients were not markedly weak or paralysed (paralysis agitans), but neither did they always have tremor, so the term shaking palsy was also unsuitable; it was then he suggested using the term maladie de Parkinson to describe the condition. ‘Parkinson’s disease’, he considered, was a much more appropriate name.

Accolades
Within weeks of the publication of Outlines, Parkinson received a most welcome surprise. Back in 1800 the Company of Surgeons had been granted a Royal Charter, becoming the Royal College of Surgeons, as it is still known today. Two years later the College established an Honorary Gold Medal to be awarded for ‘liberal acts or distinguished labors, researches and discoveries eminently conducive to the improvement of natural knowledge and of the healing art’. After twenty years, they still had not found anyone of sufficient caliber to be its first recipient, so it was to Parkinson’s great astonishment that a letter informed him the first Honorary Gold Medal would be awarded to ‘Mr. James Parkinson of Hoxton Square’,

… in consideration of his useful labors for the Promotion of natural Knowledge, particularly that expressed by his splendid Work on Organic Remains — and of his liberal and valuable information, when called upon by the College, in its Research for facts relating to its scientific Designs:

Accordingly, and appropriately on Parkinson’s 68th birthday,s he was made an Honorary Member of the Royal College of Surgeons and decorated with its Gold Medal. Sir William Blizard, the College President, delivered the oration, praising Parkinson for having provided the College, whenever asked, with information about fossils, for allowing other naturalists to consult his collection, and for the general ‘tenor’ of his scientific life. In particular, he considered that Parkinson’s work on both characterizing fossils and identifying the means by which they had been altered over long periods of time would prove invaluable not only to understanding the ‘physical Changes of this Globe’, but also to the sciences of anatomy, physiology and chemistry. Furthermore, by inspiring others to take up the subject, his work would live on. Sir William then conferred the medal on him: Mr. James Parkinson: by the Authority, and in the Name, of the Royal College of Surgeons in London, I deliver to you this Honorary Medal … And may you long enjoy the sweetest Solace of life, Reflect[ing] on your useful Works. Mr. Parkinson stood up and thanked Sir William, modestly protesting that the council had overestimated the value of his work. He went on to explain how his interest in fossils had been sparked by having seen Hunter’s collection almost 40 years ago, but he felt obliged to point out that solving some of the problems in paleontology would not necessarily contribute to a better understanding of anatomy and physiology, because the fossil remains of extinct species were so different from animals living today. Having thanked everyone for their favorable opinion of his exertions, Mr. Parkinson withdrew while the council finished its business.
Before the dinner could commence it was necessary for the council to suspend its regulation which prohibited ‘any member of the College in actual practice’ to dine with council members, which they accordingly enacted. It was an exceptional honor. Once the meeting was over, Parkinson sat down to dine with Sir William and eighteen members of council, which included all the great surgeons of the day: John Abernethy, Henry Cline, Sir Astley Cooper, Sir David Dundas, who had been physician to King George Ill; Sir Anthony Carlisle, then Surgeon Extraordinary to George IV; as well as his predecessor Professor Thomas Chevalier and twelve others. It was a magnificent gathering. 

Practical Meditation Aid

The Dzogchen Instructions of Aro Yeshe Jungne – The Nature of Mind

These instructions are similar to great Koans and also of Paul Brunton and Ramana Maharishi and Bodhi Dharma, essence is to enquire “Who am I” which is elucidated in a clear and lucid manner.

INSTRUCTIONS FOR LESSER CAPABILITY PRACTITIONERS OF THE HIGHEST CALIBER, AND THE FIVE STAGES OF MEDITATION

MASTER PAT RUL RINPOCHE says here that lesser capability practitioners may not understand the meaning of vipashyana at all, They might not have faith and trust in vipashyana. In some way, they might be uncomfortable and unfamiliar with the teaching. At the same time, their stability in shamatha practice is not strong. Even when they are sitting in good posture, their minds are easily scattered with conceptions and become dull, weak, and confused. In other words, for lesser capability practitioners, meditation—whether vipashyana or shamatha—does not come easily. Whenever this happens to you, ignite the skillful means or “appearance” practices, such as loving-kindness and compassion, joy, and appreciation. In other words, cultivate something positive and substantial that can be held in mind. Invoke these thoughts vigorously, and then sit down on your meditation cushion. Even if you are already sitting, renew the clarity of your body, speech, and mind. You can do this by reviewing and reapplying the seven postures of the Buddha Vairochana. These are as follows:

1. Sit cross-legged in the “vajra posture,” or if you prefer, sit on a
chair.
Sit up straight, with your neck bent slightly forward, so your entire
spine is aligned.
3. Place your hands in the equanimity mudra, or place them palms-
down on your knees.
4. Let the tip of your tongue gently touch the upper palate.
5. Keep your arms relaxed, with the elbows off the ribs.
6. Open your eyes and gaze toward the tip of your nose, or if you
prefer, close your eyes.
7. Breathe naturally.

In this posture spend a minute or two clearing your mind—try to Jet of your conceptions simmer down. Then do the breath purification excercise we do every morning. This exercise cleanses the three impure winds associated with attachment, anger, and ignorance, After that, relax. Abide in the nature of mind without conceptions for a minute two. Then in the sky in front of you—or if you prefer, above your head—- feel the presence of your teacher in the form of Guru Guru Padmasambhava is the embodiment of all buddhas and teachers of •the three times and ten directions. Feel strong devotion to him and recite the seven-line prayer as well as the prayers to the lineage masters and toot teacher. Tnen, after praying, visualize that blessing lights come from Guru Padmasambhava, cleansing and purifying all your negativities, obscurations, and habitual patterns. Doubt, hesitation, dullness, weakness in meditation—these and all other hindrances to your realization are completely removed. Feel this very vividly. Then Guru Padmasambhava dissolves into light. This light enters your crown chakra, moves down your central channel, and enters your heart center where it merges with your awareness. At that moment let your mind look at your mind. What happens ? The watcher and the watched merge, and there is no longer any subject and object, Now release your muscles and nervous system. Let everything go, Abide in the inexpressible nature of the mind, beyond categories and characteristics.

As you are relaxing in this state, suddenly thoughts will come up, As we said before, in the Dzogchen teachings thoughts are known as the display of the mind; they are the expressive energy of awareness. Do not regard thoughts as being bad. Do not prevent them, and also do not follow them, Let them come, be, and go. With regard to meditation experience, do not get excited over what might seem to be achievement, and do not despair over what might seem to be poor progress. These are just more thoughts. Instead of adding more thoughts, relax in the natural state, Do not expect good meditation; do not fear bad meditation. If dullness comes, reconnect to the energy of your awareness—re-invoke the clarity aspect of your mind. Let that power and its qualities arise anew, supported and checked by mindfulness. Employ any of these techniques as needed, with joy and devotion.

At times when you are practicing in this way, the surface of your mind may seem calm enough, but just below the surface, barely noticeable, are undercurrents of thought. Patrul Rinpoche here uses the metaphor U Underneath the hay there is running water.” If the water is left unattended, eventually it will soak all the hay, at which point the hay will be useless. “This is a metaphor for what can happen with the subtle, undercurrent thoughts. At first they might seem harmless, but if we do not attend to then) they will grow stronger and disrupt—and possibly even ruin—our meditation. therefore, when you notice undercurrent thoughts, you must increase your mindfulness. Meditation, from the top to the bottom, should bc beautiful, clear, and calm. Bring up the clarity aspect of your mind and recognize the undercurrent thoughts. The moment you recognize them they arc liberated. Once again, do not analyze or follow these thoughts. Just let them go.

There are times when you are meditating nicely, and suddenly your mind becomes busy and unstable. Your mind was peaceful and now it is wild. You might get upset with yourself and think, “Oh, I cannot meditate.” When this occurs do not be discouraged. When you notice your thoughts increase and intensify, this is generally a sign of progress. The Dzogchen teachings say that there are five different experiences in meditation that signal development, and this is the first one. Your mind is like a stream running down a mountain. When a stream runs down a mountain, it moves swiftly. But even though your mind seems to be running very fast, actually below the surface it is slowing down. Your mind is actually calmer than it was before you started meditating, even if for the moment it may not seem so. How is this? Your mind has to become calmer to notice what it is doing. In the past, your mind moved all the time and you never even noticed; now you do notice. This is why you should not see this experience as failure but rather as something positive. You are more aware of your mind than before; this means you are improving.

Continue to apply the skillful means techniques of joy, devotion, and bodhichitta without boredom or fatigue, and with courage and commitment continue to meditate on the true nature. If you maintain your practice in this way with perseverance, you will reach the second stage of meditation experience: alternating stable and unstable experiences. Great masters compare this second stage of meditation experience to a water bird. This creature dives into the water and then after a few moments resurfaces to rest on a rock or a log. Then it dives back into the water and comes up again. It does this continuously.

At this time the training remains the same. Continue with the skillful means practices and meditate on the true nature. In time your mind will become more stable. It will occasionally move, but mostly when you meditate, the mind will stay in its own natural state. Patrul Rinpoche uses the analogy of an old man. An old man stays seated most of the time. Once in a while he gets up for a cup of coffee or tea, or maybe even to play golf, but otherwise he sits comfortably. There is not too much activity. By now your mind is like an old man. It does not move much, nor does it need to. is the third stage of meditation experience.

Keep practicing as before. By now the surface of your mind is very smooth. Perhaps underneath the mind’s surface there is slight movement, but otherwise you have attained good stability. Patrul Rinpoche uses the analogy of an underground river: the river still flows, but it is hardly noticeable. So what do you do now? You should invoke more mindfulness and energy. Why? By this time your mind has become very tame. It does what you want it to do; you have control and are not scattered at all. In the beginning, you had trouble with your restless mind—it was running wildly in every direction. It would not stay still for even a few seconds. But now you can rest. Yet there is still the possibility of mind’s becoming weak and dull. You can prevent this by invoking mindfulness and clarity. Apply the skillful means techniques and continue to meditate. Soon your mind will become very bright and stable, and you will maintain this state day and night with- out getting bored or tired. At this time, there is no particular desire for meditation, and no desire for belongings such as clothes. In the Dzogchen teachings this state is likened to a mountain. Your mind is unshakable—it cannot be moved by conceptions or perceptions. This is the fourth stage of meditation experience.

When you reach this stage you must continue to apply the skillful means practices and cultivate virtuous thoughts. Even though your mind has become very stable, do not ignore the power of loving-kindness and com- passion, as well as joy, devotion, and appreciation. If you do not reactivate these skillful means practices at this time, you can get carried away by a blank, vague, dull state of mind that has no energy whatsoever. Also, there is still some subtle grasping and clinging that can erupt and create massive disturbances. You must continue to practice skillful means, and keep invoking the energy of mindfulness and clarity. Mind is not only empty—it is filled with many wonderful qualities. Unite this with emptiness meditation. Bringing this practice to the final state of complete fulfillment is the fifth stage of meditation experience. These five different meditation experiences accurately describe the progress of most practitioners. People have varying abilities; they also have differences in the ways their channels are configured and how they perceive phenomena. This means that not everyone proceeds in exactly the same way. But most people will experience these stages pretty much in the way and order they have been explained.

Idleness to Subtle yet Profound Thougths

Yoshida Kenko or Kaneyoshi was a Japanese monk of 12th century (1283 – 1352 AD) to seek seclusion and isolation from city life to pen this classic poems under ‘Essays in Idleness’ which is a celebrated classic in Japanese Literature, along with The Pillow Book and Hojoki. This reminds me of the musings by an equally creative French philosopher Michel de Montaigne who wrote on similar genre. Writing without a topic in mind and not methodically but write about random topics that entertain, inform, cajole, interest the author (posthumously the readers) during his lifetime which may capture practices, customs, incidents, popularities and teachings of their time. There’s always timeless advices to heed and benefit from reading this genre.

Excerpts from translation to prose which excited and piqued me and which may be beneficial to those want to get a gist and glimpse of this sage’s writings. The full book is available @ http://djm.cc/library/The_Miscellany_of_a_Japanese_Priest_Gusa_Porter.pdf. I find the Penguin Classics – Kenko and Chome – Essays in Idleness and Hojoki, Translated by Meredith McKinney – a better translation than the online one.

On Love
Nothing so distracts the human heart as sexual desire. How foolish men’s hearts are! Aroma, for instance, is a mere transient thing, yet a whiff of delightful incense from a woman’s robes will always excite a man, though he knows perfectly well that it is just a passing effect of robe-smoking. The wizard priest of Kume is said to have lost his supernatural powers when he spied the white legs of a woman as she squatted washing clothes. I can quite believe it — after all, the beautiful, plump, glowing flesh of a woman’s arm or leg is quite a different matter from some artificial allurement.

On Women
Beautiful hair on a woman will draw a man’s gaze but we can judge what manner of person she is and the nature of her sensibility even by simply hearing her speak from behind a screen. A mere unintended glimpse of a woman can distract a man’s heart; and if a woman sleeps fitfully, and is prepared to endure impossible difficulties heedless of her own well-being, it is all because her mind is on love. Yes indeed, the ways of love lies deep in us. Many are the allurements of our senses, yet we can distance ourselves from them all. But among them this one alone seems without exception to plague us all, young and old, wise and foolish. So it is that we have those tales of how a woman’s hair can snare and hold even an elephant, or how the rutting stag of autumn will always be drawn by the sound of a flute made from the wood of a woman’s shoe. We must discipline ourselves to be constantly prudent and vigilant lest we fall into this trap.

On Reading
It is a most wonderful comfort to sit alone beneath a lamp, book spread before you, and commune with someone from the past whom you have never met. As to books — those moving volumes of Wenxuan, the Wenji of Bai Juyi, the words of Laozi and Zhuangzi. There are many moving works from our own land, too, by scholars of former times.

On Boundless Ambition
What prevented the lay priest Chikurin In,838 who was a Sa-daijin, from being promoted to the rank of Prime Minister ? He simply said, ‘ It is not a prize that I wish for; I intend to stop at my present rank and entered the church. But DöIn, who was also a Sa-daijin, was so impressed with this, that he too gave up all desire of becoming Premier. They say that the dragon who has reached the heavens fears (a fall). The moon when full begins to wane ; where there has been increase there is bound to be decrease ; and in every case he who has reached the very front soon gets a set-back.

On Deceit
No human heart is quite guileless; there is some deceit In al But why should there not be the occasional person who is honest and upright? One may not be without guile oneself, but it is human nature to envy others who are wise and good. Really stupid people who come across the rare wise man, however, will hate him. ‘He turns up his nose at small gains because in his heart he hopes for bigger ones,’ they sneer. ‘It’s all a hypocritical pose, intended to impress and make a name for himself.’ Such a man scoffs so contemptuously because the other’s nature differs from his own, but this only reveals what he him- self is like — a born fool, who has no hope of transcending his own nature. Even the pretense of turning down a chance Of some small gain would be beyond him; likewise the merest imitation of wisdom. If you run about the streets pretending to be a madman, then a madman is what you are. If in pretense of being wicked you kill a man, wicked is what you are. A horse that pretends to fleetness must be counted among the fleet; a man who models himself on the saintly Emperor Shuni will indeed be among his number. Even a deceitful imitation of wisdom will place you among the wise.

On the Difficulty of an Easy Task
A man famed for his tree-climbing skills once directed another to climb a tall tree and cut branches. While the fellow was precariously balanced aloft, the tree-climber watched without a word, but when he was descending and had reached the height of the eaves the expert called co him, ‘Careful how you go! Take care coming down. ‘Why do you say that? He’s so far down now that he could leap to the ground from there,’ I said. ‘Just so,’ replied the tree-climber. ‘While he’s up there among the treacherous branches I need not say a word his fear is It’s in the easy places that mistakes will always occur’ Lowly commoner though he was, his words echoed the warnings of the sages. Apparently one of the laws of also states that if you relax after achieving a difficult kick, this is the moment when the ball will always fall to the ground.

The Accomplishments of a Gentleman
One’s education must first of all be directed to a thorough knowledge of the classics and an understanding of the teachings of the sages. Next, you should learn to write with a fine hand, even if you don’t make a specialty of it, as an aid to learning. After this, you should study the medicinal arts. Without these, you cannot look after your own health, help others or perform your filial obligations. Next, you must devote some time to archery and horse riding, skills which are listed among the Six Arts. A knowledge of the classics, the martial arts and medicine is absolutely essential, and no one who studies these can be accused of a useless life. Next is food, ‘man’s very heaven’, as the saying goes. The knowledge of how to concoct fine flavors must be deemed a fine virtue in a man. And next is fine handiwork, which is useful in all manner of ways. Aside from these, it is a matter of shame for a gentleman to cultivate too many accomplishments. Skill in the art of poetry and music is the acknowledged path of the truly refined sensibility, esteemed by ruler and subjects alike, but in our present age they have clearly grown increasingly unrealistic as a means of governing the country — just as gold, for all its glory, cannot compete with all the practical uses of iron.

The Necessities of Life
Any one wastes time in worthless pursuits must be called a fool or Obligation compels us to do many things for the sake of lord and nation, and we have little enough time left ourselves. Think of it like this: we have an inescapable need, first. to acquire food. second, clothes, and third, a place to live. These and these alone are the three great necessities of human life. To live without hunger or cold, sheltered from the elements and at peace — this is happiness. Yet we are all prey to sickness, and once ill the wretchedness of it is hard to bear, so we should add medical treatment to our list. Thus, we have four things without which a man is poor, while a man who lacks none of these is rich. It is sheer self- indulgence to pursue anything beyond these four. With these four in moderation, no one could be said to lack anything in life.

Against Leaving Property After Death
A sensible man will not die leaving valuables behind. A collection of vulgar objects looks bad, while good ones will suggest a futile attachment to worldly things. And it is even more unfortunate to leave behind a vast accumulation. There will be ugly fights over it after your death, with everyone determined to get things for himself. If you plan to leave something to a particular person, you should pass it on while you are still alive. Some things are necessary for day-to-day living, but one should have nothing else.

On Ominous Incident
When the now-deceased Tokudaiji Mlinister of the Right; r was Superintendent of Police, he was one day holding court at his central gate?’ when the ox of one of the officers, Akikane, broke loose, got into the court room, scrambled up on to the Superintendent’s seating platform and there settled down to chew its cud. “lhs was deemed a disturbingly untoward event, and everyone present declared that the beast should be taken off for Yin-Yang divination to determine the meaning.  However, when the Superintendent’s father the Minister heard of this, he declared, ‘An ox has no understanding. It has its four legs which can take it anywhere. There is no reason to impound a skinny beast that happens to have brought some lowly official here.’ He had the ox returned to its master, and changed the matting where the ox had lain. There were no ill consequences from the event. It is sometimes said that if you see something sinister and choose to treat it as normal, you will thereby avert whatever it portended.

On Married Life
The one thing a man should not have is a wife. One is impressed to hear that a certain man always lives alone, while someone who is reported to have married into this or that family, or to have taken a wife and be living together, will find himself quite looked down on. ‘He must have married that nondescript girl because he thought she was something special,’ people will say scornfully, or if she is a good woman they will think, ‘He’ll be so besotted that he treats her like his own personal Buddha. The impression is even more dreary when she runs the house well. It is depressing to watch her bear children and fuss over them, and things don’t end with his death, for then you have the shameful sight of her growing old and decrepit as a nun. No matter who the woman may be, you would grow to hate her if you lived with her and saw her day in day out, and the woman must become dissatisfied too. But if you lived separately and sometimes visited her, your feelings for each other would surely remain unchanged through the years. It keeps the relationship fresh to just drop in from time to time on impulse and spend the night.

Proof that Cosmos pervades, 7 Stages and the Cyclic nature

Veiled Pulse of Time by William Bryant – this book talks about biographical cycles and times and why I picked it, is to get some insights into astrological manifestations. I was more delighted to know how various cosmic rhythms and cycles affect our bodies, time and ultimately our biography. Gist of the reading is as follows:

Human and Cosmic Breathing

It’s always recognized by ancients of the encircling dance of planets and stars to rhythmic pulse of a dynamic and meaningful cosmos. This formidable insight confirmed the earlier belief that the cosmos made humankind in its image. In other words cosmic rhythms regulate everything from passage of world ages and the ebb and flow of civilizations to the biological cycles of the individual. It is a magnificent conception – unity in diversity. The ancients were aware of numerical correspondence between breathing and cosmic cycles. Our heart beats 72 times per minute and we breathe 18 times in a minute. Let’s take a look at cosmic numbers. Do note that a star rising in a particular spot on the horizon at 6 am on 23rd Jan 1972 will not be at the same spot on 6 am, 23rd Jan 1973 and so on. The star together with the celestial sphere, appears to creep westward year after year, century after century, until nearly after 25920 years, it returns to its first position. This cycle is known to ancients as the “Sacred Year” or “Great Year”, means that the zodiac drifts one degree (or gains one day) every 72 years. Dividing the Great Year into 12, we get the “Great Months” i.e. 2160 years, known as Zodiac Epoch which coincides with rise and fall of civilizations. There are 3 aspects to note here

  1. Breathing Cycle = 18
  2. Pulse Rate = 72
  3. Precessional Rhythm = 25920
  4. Cultural Epoch = 2160

A few simple computations reveals startling correspondences between them

ABOUT Detail FACT
Breathing Given our breathing rate is 18/minute, per day will be 18*24*60 = 25,920 times / day
Life Prototypical human life span = 72 years
Heart Pulse rate = 72 beats / minute, whereas Precessional movement of vernal sun = 1 degree / 72 years
Saturn Saturn’s orbit around the sun is ~ 30 years, in a “great month” (2160 years), it’s movement around sun =
(It  is also numerically linked to human respiration, life span, the Great Month and Great Year)
72 orbits
Jupiter For every “Great Year”, Jupiter orbits sun 2160 times
  Jupiter’s cycle in hours is reasonably close to heart beats per day = 103,680
  1 year in Jupiter equals heartbeats per hour =  4320 days

As we juggle all computations around astronomical facts, we can find innumerable permutations but the fact is as we delve more into these correspondences, we unearth the connections between geometry, temple building, cosmology, astronomy, meteorology, numerology and biography (individual’s life). All these facts points to incontrovertible connection between physical cycles and cosmos and our spiritual and mental development is also linked similarly.

Study of time is crucial as linear time stars operating the moment we are born, whereas the cyclic and rhythmic time is the harmonizer, meditator and coordinator of our physical and spiritual functions, enables the eternal to live in the deep recess to grow in the passing time of mortal world getting the imprints of all experiences as we interact with the world. Rhythmic time governs positions and placement of events and not what we do and how we react. Yet each experience is a seed planted in the continuum of rhythmic time to germinate in the right season. Because we retain our past, no experience is futile, infertile, or lost. Out of sight or out of mind, our life experience continues to live within us where it is dealt with by the juices of our physic digestion and spiritual metabolism. Thus, those things left undone, the missed opportunities, errors, and misjudgments, continue to prepare future stages for their correction, completion and redemption. Likewise, our suffering and setbacks serve to release new forces in the psyche which, when the time is ripe, “lead us to fortune”. The laws of rhythm decree that all things must take their course. This all alludes law of karma, nevertheless, its understanding clears human frailty and console ourselves on missed opportunities under due diligence.

The Sacred Seven

Stage SIGNIFICANE
0 to 7: Trailing clouds of glory Too much intellectual force/abuse at the expense of progress at tender age mires the nervous system and can cause mental and physic issues during prime time. It is a sacrosanct stage best left untouched by all education except by refreshing play world of stories, games, fantasy and imitation.
7 to 14: from Light tio Shadow As there’s tremendous physical growth, feelings take hold. Puberty arises and leads to more self-identity
14 to 21: Flush of independence With the competitive demands made by education, career and family groups, the individual stands at the cusp of independence and starts to contemplate the meaning of their existence and are ready for action and relationship
21 to 28: The chase of experience I like this poetic reflection: in verbatim here:
The voice of conscience , though stronger that it was in adolescence, is often smothered by the roar of action. On the other hand, the awakening sense of social responsibility drives many a flushed knight full tilt at the dragons of injustice and hypocrisy. These radical lances, however, are seldom tempered by perspective and wisdom
28 to 35: Adjusting the course Time of disorientation, stress or even dramatic change. Marriage obeys the law of life which states that a relationship which cannot transform itself destroys itself. Sometimes a stagnant marriage produces “Stale mates” than “soul mates”
35 to 42: under self-power Time to break free from straitjackets. Crisis and misfortunes arrive to tame illusions and self-inflation left by successes. They may enter in the form of marital conflict, illness, accidents or blighted hopes / missed opportunities. This period throws light to antagonism between instincts and desires of our lower life and our ideal or higher self, a deepening perception stirs new doubts and hopes in the soul
42 to 49: under dark wood Apart from menopause and mano-pause, this period is tainted with depressions, irritability, impotence, insomnia, hypochondria but it has its goodness – a time of psychological death and rebirth. Instead of a negative look to ‘dreadful drift to grave’ combined with fear of oblivion, loss of creative hope, unwelcome invitation to senility – we should  recover sense of purpose
49 to 56: a second wind In spite of all inner wear and tear, time not to lose pessimism and move forward
56 to 63: Reaping the harvest Time to withdraw from many of the temptations and superfluities of the external world further personalizes our existence. Aging represents a process of physical decrease and spiritual increase
63 to 70: Drawing the threads This marks a certain cyclic conclusion, a release from the remorseless drive of destiny as the will’s flame begin to withdraw to interiors to prepare for the approaching expansion across great divide. These years can offer as a blessing, a grace, the opportunity to complete the tapestry of destiny and pass the contributions to those who follow

Chrono’s Cycle – 30 year Saturn Cycle

Period Book
0 to 30 : Formative Integrate and add to our uniqueness all the shaping and modulating forces of our heredity and environmental backgrounds
30 to 60 : Constructive Pursue our goals and work the inner and outer core. Gather vast amount of experiences and inject our virtues, gifts and striving into a world which, in turn, continually deepens and modifies our consciousness and self-understanding.
60 to rest : Reflective All our previous experiences are incorporated that outlives our death. Event though we appear inflexible and resistant to change, our inner content and psyche in sharp contrast to outer activity is much more contemplative and inward.

After researching world personalities like Churchill, Nehru, Lawrence of Arabia, Christian Mutts, Kennedy, Mao, Mary Ann Evans, Marilyn Monroe, Balzac, Emerson, Darwin, Marie Curie, Johannes Kepler, Newton, Martin Luther King, most of them conform to a synchrony with some are misalignments. These are indeed tragedies – a deformed destiny. The thirty year cycles are often the most dramatic of all the cycles. This means that our thirtieth and sixtieth years, along with forty-fifth, are likely to be scored by crucial incidents or a change of pace, direction, and emphasis.

Conflict, Constriction, Release, and Breakthrough

For many souls the years between 28 and 30 are intensified by stress, turmoil (even conflict), as well as a key event. It could be described as a period of psychic compression, a constriction prior to a burst of expansion; indeed , it is rather a concentrated transition in many lives. This is where the sever and 30 year cycles are meshed as both complete their respective tasks before opening an expansive surge of creativity. For many, the span between 21 and 28 is teeming with raw experiences. Naturally, all this has to be properly absorbed and digested. There is a subtle though sometimes disconcerting change in self-awareness around 28 which interacts with the completion of the major destiny cycle at 30. The build-up of psychic pressure is released at 30 and this often results in a breakthrough into another phase of biographical genesis and fresh opportunity. Again my take is the years may shift a few years back and forth and needn’t be that accurate depending on individual’s case.

Jupiter’s Cycle

The seven regulates the cyclic patterns of our inward descent through the psychological layers of the personality, but the 12-year cycle translates this changing self-awareness into the sequential steps of our life’s work, the psyche’s expression in the world. Best described as a vocational rhythm, the 12th years mark phases of scientific, artistic, or philosophical activity, the maturing of ideas, spans of personal relationship, and even the strokes of good fortune that punctuate our path through life. These are moments when something clicks, something meets us just at the right moment, or a new idea or plan suddenly falls into place.

Leo Tolstoy and years of creativity

Period/Output Years
Childhood 23-24
Family Happiness 30-year transition
War and Peace 35-41
Anna Karenina 45-48
The Kreutzer Sonata 60-61 1/2
Resurrection 60-71 1/2

‘Fate, Freedom and Destiny’ & ‘The Seasons of Immortality’ chapters have been given an erudite thought and eloquent rendition. The gist of the 2 chapters is summarized in final thoughts as follows:
Never easily forget that everything has its share of time, its seasons of becoming, from the humble worm to civilizations and solar systems. Whenever we are impatient, we should remember that destiny decrees times of increase and times of decrease, times of action and times of assimilation. Thus, this added dimension of awareness permits us to look beyond temporarily to the “forever”

A Letter to Wealthy (Inheritor)–Modesty in Abundance

I came across this letter from GD Birla to his son and this wealthiest industrialist has been an advisor to Gandhi and had great influence on his industry policy matters. Gandhi borrowed the concept of trusteeship to promote capitalism over socialism. Gandhi gave his blessings to the abundant wealth of Birla, to his teaching on trusteeship, a concept which asserted the right of the rich to accumulate and maintain wealth as long as the wealth was used to benefit society. This is the letter Birla wrote in Marwari language to his son, reproduced in English and is appropriate for every wealthy but still applicable to every individual to do whatever he can afford for good. This is a brief yet precise life principles concisely expressed with a fatherly affection and to be referred every time and anytime in a lifetime and perhaps continues to your future times (births) having read many times.

Dear Basant,
Whatever I’m writing, you should read even when you are grown up and also at your old age. I’m writing this from experience, as to how life must be lived.
Birth as human, is a rarity and when born as human, whoever misuses the birth, it is like he lived like an animal. You have wealth, health, good social connections. If you use them for the service of mankind, as a good human being, these are successful, else they are devil’s tools.
Never use wealth on selfish ends or merry spending, as wealth may not be there always. Spend less on self, more on public welfare and for the welfare of the distressed. Wealth is a force. Possibility of injustice is likely with this force or power. Take care that no injustice is done.
Leave some good morals for your children. If they indulge in merry-making, they become sinful and spoil our business. Do not pass on wealth to such unworthy children, rather use it for public welfare or distribute among deserving poor. Do not have mental blindness or passion for such children. Boundless effort and labor has been put in by we brothers, to build the business, assuming that our children will make best use of wealth we have generated.
Never forget God. He gives good sense and intellect. Have control on sensuous impulses, else those will sink you.
Do exercise and Yoga daily. Health is our biggest wealth. Health gives deftness, accomplishment and prosperity. I have seem how unhealthy millionaires become poor and frail. Eat meals feeling as medicine. Eat for living not live for eating.

G.D, Birla

Health Treatises

Health is paramount of we got to experience all that we want in life – fame, name, food, sex, etc. But health awareness has been tarnished with the advent of allopathic medicine and doctors. Not that they’re all quacks but there’s a certain level of ignorance in modern medicine which diagnoses diseases in the body where they happen without finding it’s source. This source analysis is grossly missing and costs lives and huge loses financially which could have been spent for other good needs. Even though I have pharmaceutical pedigree (I used to help my father in his medical stores in yester years and being familiar with the pharmacopeia of medicines – their indications, pharmacology, side effects, etc.), I believed for any illness,  I thought the only solution is to administer medicine. Never it struck me that there are alternative medicines to every ailments both curable and incurable. It came to dawn on me very lately after a couple of readings which I have listed here in the order that I read them and hopefully, you could greatly benefit from them and the ultimate motive is to have a healthy life without any medicines – an utopia but readily & surely achievable. This requires broad understanding of body, how good food nourishes the body and the significance of blood and a bit of mindfulness to reach this utopian goal. These books gives you some basis of understanding the knowledge of body and its functions as our ancestors have seen it since millennia but narrated in modern times:

1. Anatomic Therapy

2. Nature Cure: Philosophy and Practice Based on the Unity of Disease and Cure by Henry Lindlahr

3. Five Element Constitutional Acupuncture & Pulse Diagnosis