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Chest (Thoracic) Breathing: Effects, Tests and Solutions

Chest (or thoracic) breathing is very common in modern people. More than 50% of adults have
predominantly chest breathing at rest.
More than 90% of sick people have upper chest breathing with increased minute ventilation,
respiratory rates, and minute volume (i.e., automatic deep breathing at rest or taking too much air
per one breath). Chest breathing causes three fundamental health effects that promote chronic
diseases and lead to low body oxygen levels.
This is due to the misbelieve that taking deep breath helps body to not only get more oxygen but
makes one healthy. Let us see what happens when we breathe through chest.
1. Chest breathing reduces blood oxygenation
The textbook, Respiratory Physiology (West, 2000), suggests that the lower 10% of the lungs
transports more than 40 ml of oxygen per minute, while the upper 10% of the lungs transports
less than 6 ml of oxygen per minute. Hence, the lower parts of the lungs are about 6-7 times
more effective in oxygen transport than the top of the lungs due to richer blood supply mostly
caused by gravity.
During thoracic breathing, lower layers of the lungs, which are most valuable in oxygen
transport, get much less, if any, fresh air (less oxygen supply). This causes reduced oxygenation
of arterial blood in the lungs and can lead to so called "ventilation-perfusion" mismatch (as in
COPD or emphysema). Normal breathing is diaphragmatic and slow, allowing homogeneous
inflation of both lungs with fresh air, similar to what happens in the cylinder of a car engine due
to the movement of the piston. Hence, during diaphragmatic breathing, all alveoli are
homogeneously stretched vertically and get fresh air supply with higher O2 concentration for
superior arterial blood oxygenation. In contrast, chest breathing creates problems with blood
oxygenation. This leads to reduced cell oxygenation: the driving force of all chronic diseases.
2. Chest breathing causes lymphatic stagnation
Dr. Shields, in his study, "Lymph, lymph glands, and homeostasis" (Shields, 1992) reported that
diaphragmatic breathing stimulates the cleansing work of the lymph system by creating a
negative pressure pulling the lymph through the lymph system. This increases the rate of
elimination of toxins from visceral organs by about 15 times. Why
is this so?
The lymph system, unlike the cardiovascular system with the heart,
has no pump. Lymph nodes are located in parts of the human body
that get naturally compressed (squeezing) due to movements of
body parts. for example, lymph nodes are located around the neck,
above arm pits and groin area. Hence, when we move, stretch or
turn the head, arms and legs, these lymph nodes get mechanical
stimulation to push the lymph through valves. This is how the
lymphatic system works. However, the lymph nodes connected to the stomach, kidneys, liver,
pancreas, spleen, large and small colons, and other vital organs are located just under the
diaphragm - over 60% of all lymph nodes in total!
Hence, nature expects us to use the diaphragm in order to remove waste products from these vital
organs all the time - literally with each breath, 24/7. Hence, another problem with thoracic or
chest breathing is stagnation in the lymph system and accumulation of waste products in vital
organs located under the diaphragm.
3. Thoracic breathing means hyperventilation and low oxygen levels in cells
People who are chest breathers virtually always have deep breathing (large breaths) at rest or
sleep and suffer from hyperventilation (breathing more than the norm). When we breathe more
air, we get less oxygen in body cells. In fact, the slower your automatic breathing pattern at rest
(down to only 3 breaths/min), the larger the amount of oxygen delivered to cells.
Keep in mind that, while healthy normal breathing is abdominal or diaphragmatic. It is very
small in amount (only 500 ml of air per one breath at rest) so that healthy people usually do not
feel their breath.
Diaphragmatic breathing 24/7 is absolutely necessary for nearly maximum oxygenation of the
arterial blood (98-99%) and efficient lymphatic drainage of abdominal organs (up to 60% of all
lymph nodes are located just under the diaphragm). Bear in mind that ideal or healthy automatic
breathing at rest is very small in amount, but mainly abdominal. Once a person starts taking
breathe through lungs he gets a habit of it and then it is very hard to get rid of it. Here are some
methods of diaphragmatic breathing exercises and techniques to get rid of thoracic breathing
Abdominal (Diaphragmatic) Breathing Techniques and Instructions
How to test your own breathing technique
How to check one's predominant automatic breathing technique? Do you
usually breathe using the belly and diaphragm or chest at rest?
Self-test or simple breathing exercise. Put one hand on your stomach (or
abdomen) and the other one on your upper chest (see the picture on the
right). Relax completely so that your breathing dynamic has little changes.
(We want to know more about your usual unconscious breathing.) Pay
attention to your breathing for about 20-30 seconds. Take 2-3 very slow but
deep breaths to feel your breathing in more detail. Now you know about
your usual breathing technique. In order to be certain, you can ask other
people to observe how you breathe when you do not pay attention to your
breathing (e.g., during sleep, while reading, studying, etc.).

Diaphragmatic breathing exercises and techniques
Here are three abdominal breathing exercises to test and develop belly breathing.
Exercise 1. Diaphragmatic breathing exercise to check your ability to move the diaphragm
Diaphragmatic breathing exercise 1: Check your ability to move the diaphragm.Put your hands on your
body as in the picture above. Try to push out your lower hand (which is on the belly button or navel)
with your abdominal muscles. Can you breathe using your belly only so that your rib cage and upper
hand do not move?
Warning. It is vital for your health, abdominal breathing, good blood oxygenation, and respiratory
and GI health to have a straight spine 24/7. Correct posture encourages abdominal breathing,
while slouching prevents belly breathing.
Exercise 2. Abdominal respiratory exercises with books
Take 2-3 medium weight books or one large phone book and lie down on your back with the books on
your tummy. Focus on your breathing and change the way you breathe so that
1) you can lift the books up about 2-3 cm (1 inch) with each inhalation and then relax to exhale (the
books will go down);
2) your rib cage does not expand during inhalations.
Repeat this abdominal breathing exercise for about 3-5 minutes
before your main breathing exercises to reconnect your
conscious brain with the diaphragm. You can practice this exercise for some days until you are sure that
diaphragmatic breathing is the usual way to breathe during the breathing sessions.
For some people with persistently tense diaphragms and big fatty belly, who in addition have problems
with slouching and constipation, magnesium can be an additional assisting factor. (Lack of magnesium
leads to spasm and tension in body muscles.)
If the diaphragm is still not the main muscle for your automatic breathing, and/or you have doubts about
your ability to keep your chest relaxed during breathing exercises, apply this ultimate solution.

Exercise 3. Diaphragmatic breathing technique with a belt
You can use a strong belt to restrict your rib cage and force the diaphragm to be the main breathing
muscle using the following technique.
Put a belt around your lower ribs (in the middle of the trunk) and buckle it tightly so that
you cannot take a deep inhalation using your rib cage or chest. Now for slow deep
inhalations your body needs to use your tummy (or abdomen). Try it. While leaving the belt
in place for some minutes or even hours, you can acquire diaphragmatic breathing and
corresponding sensations.
This breathing retraining process will be faster, if you focus your attention on your
breathing and try to practice Buteyko reduced breathing with very light air hunger (taking
small inhalations using your diaphragm and then immediately relaxing it). The focus of
attention makes nervous links between your conscious mind and the diaphragm reinforced
so that you can regain control of this muscle.
When you pay attention to your breathing, be careful not to hyperventilate. Breathe slowly
and remain relaxed so that even if your inhalations deepen, your CO2 will not lessen.
Important note. The diets of modern people are low in magnesium, which is a known
relaxant of smooth muscles, the diaphragm included. The normal daily requirement for Mg is about 400-
500 mg. Typical symptoms of magnesium deficiency include: a tendency to slouch (indicating muscular
tension), predisposition to constipation (muscles of the bowel also get into a state of spasm; hence "Milk
of magnesia" or magnesium oxide is a popular and safe remedy for constipation) and tense diaphragm
causing chest breathing 24/7. Try taking a Mg supplement (about 400-500 mg daily plus calcium to
maintain balance) for 3 days and monitor your symptoms and any effects on your posture, breathing
mechanics and CP.
You need to restore a light and easy automatic breathing pattern or normalize your breathing in order to
have abdominal breathing 24/7. What are the most effective abdominal breathing techniques? Hatha
yoga and the Buteyko breathing technique help to prevent chest breathing. There are even more
effective ways.
Advanced diaphragmatic breathing exercises for unblocking the diaphragm
The easiest way, however, to increase the CP and release or unblock the diaphragm 24/7 is to use
breathing devices, such as the Frolov breathing device and the Amazing DIY breathing deice. If one has
problems with abdominal breathing when using these devices, it is smart to use the belt technique for
breathwork. After a few days of such practice, most people can easily involve diaphragm for

Let us see all in more detail, why modern people do not have diaphragmatic breathing
Modern people breathe about 2 times more air than the medical norm. Hyperventilation causes alveolar
hypocapnia (CO2 deficiency), which reduces blood flow and oxygenation of the diaphragm muscle, while
arterial hypocapnia makes smooth and skeletal muscles tense, the diaphragm included. If you were to take
a close look at some old movies, you would hardly see any chest breathing at all. This is because people
in the past had only 4-5 L/min for minute ventilation at rest (modern numbers are about 12 L/min for
normal subjects). Hyperventilation makes modern people oxygen deficient (see instructions for the body
oxygen test below) and this makes them chest breathers.
Abdominal Breathing vs. Chest Breathing and Body Oxygen Content
Body Oxygen Content
Automatic breathing at rest:
diaphragmatic or chest?
1-10 s Virtually always chest
11-20 s Chest in over 90% of people
21-30 s Mostly chest
31-40 s Mostly belly
over 41 s Virtually always belly
As we see from this Table, diaphragmatic breathing usually becomes the norm (24/7), when the
morning body oxygen level (CP) is over 30 s. It is logical then that people in the past (about 100
years ago or more) had abdominal breathing 24/7 because they had more than 40 s for the body
oxygen test. Since relatively healthy people have only about 20-25 s CP these days, most of them
are chest breathers.
The abdominal exercises, methods, and techniques are useful to prevent problems with chest
breathing and achieve higher body oxygen level (CP) sooner. The more you practice them, the
faster you get there. For better understanding let us see in more detail how can it be achieved by
simple change in breathing style. Firstly let us understand LymphoId System.

The Lymphoid System
The lymphoid system is the part of the immune system
comprising a network of conduits called lymphatic vessels that
carry a clear fluid called lymph (from Latin lympha "water)
unidirectionally toward the heart. Lymphoid tissue is found in
many organs, particularly the lymph nodes, and in the lymphoid
follicles associated with the digestive system such as the tonsils.
The system also includes all the structures dedicated to the
circulation and production of lymphocytes, which includes the
spleen, thymus, bone marrow and the lymphoid tissue associated
with the digestive system.
The blood does not directly come in contact with the
parenchymal cells and tissues in the body, but constituents of the
blood first exit the micro-vascular exchange blood vessels to
become interstitial fluid, which comes into contact with the
parenchymal cells of the body. Lymph is the fluid that is formed
when interstitial fluid enters the initial lymphatic vessels of the
lymphatic system. The lymph is then moved along the lymphatic
vessel network by either intrinsic contractions of the lymphatic
passages or by extrinsic compression of the lymphatic vessels via
external tissue forces (e.g. the contractions of skeletal muscles).
Functions of Lymphoid System
The lymphoid system has multiple interrelated functions.
it is responsible for the removal of interstitial fluid from tissues
it absorbs and transports fatty acids and fats as chyle from the circulatory system
it transports white blood cells to and from the lymph nodes into the bones
The lymph transports antigen-presenting cells (APCs), such as dendritic cells, to the lymph nodes
where an immune response is stimulated.
Lymphatic tissue is a specialized connective tissue - reticular connective, that contains large
quantities of lymphocytes.
Clinical significance
The study of lymphatic drainage of various organs is important in diagnosis, prognosis, and
treatment of cancer. The lymphatic system, because of its physical proximity to many tissues of
the body, is responsible for carrying cancerous cells between the various parts of the body in a
process called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not
successful in destroying the cancer cells the nodes may become sites of secondary tumors.
The lymphoid system can be broadly divided into the conducting system and the lymphoid tissue.
The conducting system carries the lymph and consists of tubular vessels that include the lymph
capillaries, the lymph vessels, and the right and left thoracic ducts.
The lymphoid tissue is primarily involved in immune responses and consists of lymphocytes and
other white blood cells enmeshed in connective tissue through which the lymph passes. Regions
of the lymphoid tissue that are densely packed with lymphocytes are known as lymphoid
follicles. Lymphoid tissue can either be structurally well organized as lymph nodes or may
consist of loosely organized lymphoid follicles known as the mucosa-associated lymphoid tissue
Lymphoid tissue
Lymphoid tissue associated with the lymphatic system is concerned with immune functions in
defending the body against the infections and spread of tumors. It consists of connective tissue
with various types of white blood cells enmeshed in it, most numerous being the lymphocytes.
The lymphoid tissue may be primary, secondary, or tertiary depending upon the stage of
lymphocyte development and maturation it is involved in. (The tertiary lymphoid tissue typically
contains far fewer lymphocytes, and assumes an immune role only when challenged with
antigens that result in inflammation. It achieves this by importing the lymphocytes from blood
and lymph.)
Primary lymphoid organs
The central or primary lymphoid organs generate lymphocytes from immature progenitor
The thymus and the bone marrow constitute the primary lymphoid tissues involved in the
production and early selection of lymphocytes.
Secondary lymphoid organs
Secondary or peripheral lymphoid organs maintain mature naive lymphocytes and initiate an
adaptive immune response. The peripheral lymphoid organs are the sites of lymphocyte
activation by antigen. Activation leads to clonal expansion and affinity maturation. Mature
lymphocytes recirculate between the blood and the peripheral lymphoid organs until they
encounter their specific antigen.
Secondary lymphoid tissue provides the environment for the foreign or altered native molecules
(antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes, and the
lymphoid follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc. that are associated with
the mucosa-associated lymphoid tissue (MALT).
Lymph nodes
A lymph node showing afferent and efferent
lymphatic vessels
A lymph node is an organized collection of
lymphoid tissue, through which the lymph
passes on its way to returning to the blood.
Lymph nodes are located at intervals along
the lymphatic system. Several afferent
lymph vessels bring in lymph, which
percolates through the substance of the
lymph node, and is drained out by an
efferent lymph vessel.
The substance of a lymph node consists of lymphoid follicles in the outer portion called the
"cortex", which contains the lymphoid follicles, and an inner portion called "medulla", which is
surrounded by the cortex on all sides except for a portion known as the "hilum". The hilum
presents as a depression on the surface of the lymph node, which makes the otherwise spherical
or ovoid lymph node bean-shaped. The efferent lymph vessel directly emerges from the lymph
node here. The arteries and veins supplying the lymph node with blood enter and exit through the
Lymph follicles are a dense collection of lymphocytes, the number, size and configuration of
which change in accordance with the functional state of the lymph node. For example, the
follicles expand significantly upon encountering a foreign antigen. The selection of B cells
occurs in the germinal center of the lymph nodes.
Lymph nodes are particularly numerous in the mediastinum in the chest, neck, pelvis, axilla
(armpit), inguinal (groin) region, and in association with the blood vessels of the intestines.
Tubular vessels transport back lymph to the blood ultimately replacing the volume lost from the
blood during the formation of the interstitial fluid. These
channels are the lymphatic channels or simply called
Function of the fatty acid transport system
Lymph vessels called lacteals are present in the lining of the gastrointestinal tract, predominantly
in the small intestine. While most other nutrients absorbed by the small intestine are passed on to
the portal venous system to drain via the portal vein into the liver for processing, fats (lipids) are
passed on to the lymphatic system to be transported to the blood circulation via the thoracic duct.
(There are exceptions, for example medium-chain triglycerides (MCTs) are fatty acid esters of
glycerol that passively diffuse from the GI tract to the portal system.) The enriched lymph
originating in the lymphatics of the small intestine is called chyle. As the blood circulates, fluid
leaks out into the body tissues. This fluid is important because it carries food to the cells and
waste back to the bloodstream. The nutrients that are released to the circulatory system are
processed by the liver, having passed through the systemic circulation. The lymph system is a
one-way system, transporting interstitial fluid back to blood.
Diseases of the lymphatic system
Lymphedema is the swelling caused by the accumulation of lymph fluid, which may occur if the
lymphatic system is damaged or has malformations. It usually affects the limbs, though face,
neck and abdomen may also be affected.
Some common causes of swollen lymph nodes include infections, infectious mononucleosis, and
cancer, e.g. Hodgkin's and non-Hodgkin lymphoma, and metastasis of cancerous cells via the
lymphatic system. In elephantiasis, infection of the lymphatic vessels cause a thickening of the
skin and enlargement of underlying tissues, especially in the legs and genitals. It is most
commonly caused by a parasitic disease known as lymphatic filariasis. Lymphangiosarcoma is a
malignant soft tissue tumor, whereas lymphangioma is a benign tumor occurring frequently in
association with Turner syndrome. Lymphangioleiomyomatosis is a benign tumor of the smooth
muscles of the lymphatics that occurs in the lungs.
Development of lymphatic tissue
Lymphatic tissues begin to develop by the end of the fifth week of embryonic development.
Lymphatic vessels develop from lymph sacs that arise from developing veins, which are derived
from mesoderm.
The first lymph sacs to appear are the paired jugular lymph sacs at the junction of the internal
jugular and subclavian veins. From the jugular lymph sacs, lymphatic capillary plexuses spread
to the thorax, upper limbs, neck and head. Some of the plexuses enlarge and form lymphatic
vessels in their respective regions. Each jugular lymph sac retains at least one connection with its
jugular vein, the left one developing into the superior portion of the thoracic duct.
The next lymph sac to appear is the unpaired retroperitoneal lymph sac at the root of the
mesentery of the intestine. It develops from the primitive vena cava and mesonephric veins.
Capillary plexuses and lymphatic vessels spread from the retroperitoneal lymph sac to the
abdominal viscera and diaphragm. The sac establishes connections with the cisterna chyli but
loses its connections with neighboring veins.
The last of the lymph sacs, the paired posterior lymph sacs, develop from the iliac veins. The
posterior lymph sacs produce capillary plexuses and lymphatic vessels of the abdominal wall,
pelvic region, and lower limbs. The posterior lymph sacs join the cisterna chyli and lose their
connections with adjacent veins.
With the exception of the anterior part of the sac from which the cisterna chyli develops, all
lymph sacs become invaded by mesenchymal cells and are converted into groups of lymph
The spleen develops from mesenchymal cells between layers of the dorsal mesentery of the
stomach. The thymus arises as an outgrowth of the third pharyngeal pouch.
Lymphatico-Venous Communications
Present research has found cues about a lymphatico-venous communication. In mammals,
lymphatico-venous communications other than those at the base of the neck are not easy to
demonstrate, but described in some experiments.
The specialists observed that the pulmonary complications following lymphangiography (a test
which utilizes X ray technology, along with the injection of a contrast agent, to view lymphatic
circulation and lymph nodes for diagnostic purposes) are more often severe in patients with
lymphatic obstruction. In these cases, the contrast medium is thought to reach the vascular
system via lymphovenous communications with shunt the material directly into the venous
stream, bypassing those lymph nodes distal to the communications, Because less contrast agent
is absorbed in lymph nodes, a greater portion of the injected volume passes into the vascular
system. Since pulmonary complications are related to the amount of medium reaching the lungs
area, the early recognition of lymphovenous communications is a great significance to the
lymphangiographer. Another "hint" in proving a lymph-vein communication is offered by a
Robert F Dunn experiment. The passage of radioactively tagged tracers, injected at elevated
pressure, through the lymph node-venous communications coincides with the increased pressures
of injection and subsequent nodal palpation in dogs. The passage of iodinated I 125 serum
albumen (ISA) indicates that direct lymph node-venous communications are present, whereas
passage of nucleated erythrocytes requires a communication structure the size of a capillary or
larger. Moreover, the evidence suggest that in mammals under normal conditions, mostly of the
lymph is returned to the blood stream through the lymphatico-venous communications at the
base of the neck. When the thoracic duct-venous communication is blocked, however, the
resultant raised intralymphatic pressure will usually cause other normal non-functioning
communications to open and thereby allow the return of lymph to the blood stream.
Hippocrates was one of the first persons to mention the lymphatic system in 5th century BC. In
his work "On Joints," he briefly mentioned the lymph nodes in one sentence. Rufus of Ephesus, a
Roman physician, identified the axillary, inguinal and mesenteric lymph nodes as well as the
thymus during the 1st to 2nd century AD. The first mention of lymphatic vessels was in 3rd
century BC by Herophilos, a Greek anatomist living in Alexandria, who incorrectly concluded
that the "absorptive veins of the lymphatics", by which he meant the lacteals (lymph vessels of
the intestines), drained into the hepatic portal veins, and thus into the liver. Findings of Ruphus
and Herophilos findings were further propagated by the Greek physician Galen, who described
the lacteals and mesenteric lymph nodes which he observed in his dissection of apes and pigs in
the 2nd century AD.
Until the 17th century, ideas of Galen were most prevalent. Accordingly, it was believed that the
blood was produced by the liver from chyle contaminated with ailments by the intestine and
stomach, to which various spirits were added by other organs, and that this blood was consumed
by all the organs of the body. This theory required that the blood be consumed and produced
many times over. His ideas had remained unchallenged until the 17th century, and even then
were defended by some physicians.
In the mid 16th century Gabriele Falloppio (discoverer of the fallopian tubes) described what are
now known as the lacteals as "coursing over the intestines full of yellow matter." In about 1563
Bartolomeo Eustachi, a professor of anatomy, described the thoracic duct in horses as vena alba
thoracis. The next breakthrough came when in 1622 a physician, Gaspare Aselli, identified
lymphatic vessels of the intestines in dogs and termed them venae alba et lacteae, which is now
known as simply the lacteals. The lacteals were termed the fourth kind of vessels (the other three
being the artery, vein and nerve, which was then believed to be a type of vessel), and disproved
Galen's assertion that chyle was carried by the veins. But, he still believed that the lacteals
carried the chyle to the liver (as taught by Galen). He also identified the thoracic duct but failed
to notice its connection with the lacteals. This connection was established by Jean Pecquet in
1651, who found a white fluid mixing with blood in a dog's heart. He suspected that fluid to be
chyle as its flow increased when abdominal pressure was applied. He traced this fluid to the
thoracic duct, which he then followed to a chyle-filled sac he called the chyli receptaculum,
which is now known as the cisternae chyli; further investigations led him to find that lacteals'
contents enter the venous system via the thoracic duct. Thus, it was proven convincingly that the
lacteals did not terminate in the liver, thus disproving Galen's second idea: that the chyle flowed
to the liver. Johann Veslingius drew the earliest sketches of the lacteals in humans in 1647.
The idea that blood recirculates through the body rather than being produced anew by the liver
and the heart was first accepted as a result of works of William Harveya work he published in
1628. In 1652, Olaus Rudbeck (16301702), a Swede, discovered certain transparent vessels in
the liver that contained clear fluid (and not white), and thus named them hepatico-aqueous
vessels. He also learned that they emptied into the thoracic duct, and that they had valves. He
announced his findings in the court of Queen Christina of Sweden, but did not publish his
findings for a year, and in the interim similar findings were published by Thomas Bartholin, who
additionally published that such vessels are present everywhere in the body, and not just the
liver. He is also the one to have named them "lymphatic vessels". This had resulted in a bitter
dispute between one of Bartholin's pupils, Martin Bogdan, and Rudbeck, whom he accused of

Breathing Problems: Foundation for Chronic Diseases
Over 90% of modern people suffer from breathing problems, such as chest
breathing, mouth breathing, and hyperventilation (breathing more than the medical
norm). All these abnormalities reduce oxygen levels in body cells and promote
chronic diseases. Consider how sick people breathe.
Myth #1. Breathing is regulated by want for oxygen.
If you open any medical or physiological textbook with the description of the
control of respiration, you will find that in normal conditions, breathing is
regulated by the CO2 concentration in the arterial blood and the brain. Whatever
we do (sit, walk, eat, run, sleep, etc.), CO2 concentration is kept within a narrow
range (0.1% accuracy) by the breathing centre located in the medulla oblongata of
the brain.
Myth #2. CO2 is a poisonous or toxic waste gas and a waste product to get rid
When a healthy person tries to hyperventilate
or is forced to breathe deeply and fast, they
experience hypocapnia (CO2 deficiency) in
the blood and other fluids, tissues, and cells.
The immediate effects are: constriction of
blood vessels (CO2 is a powerful vasodilator)
and reduced blood and oxygen supply to the
brain, heart and all other vital organs. This is
the reason why it is so easy to faint or pass out
after 2-3 minutes of forceful hyperventilation.
Another CO2 effect is the suppressed Bohr
effect or diminished release of oxygen by the
blood in the tissues due to the same
hypocapnia. Apart from these phenomena,
there are many other vital functions of CO2 in
the human body (see links to medical studies below). Meanwhile, reduced tissue
oxygenation is sufficient to promote cancer, heart disease, diabetes and many other
chronic conditions.
Myth #3. When a person is healthy, they can feel how they breathe.
If people with normal breathing are asked what they feel about their breathing,
they will say that they feel nothing at all (as if they are barely breathing). The
perfect man breathes as if he is not breathing Lao-Tzu, circa 4th century BC.
Indeed, if you have any healthy people around you and observe their breathing for
20-30 seconds, you will see and hear nothing. The medical norm for breathing is
tiny. It is only 6 L/min or only 12 breaths/min with tiny 500 mL for one breath,
while most modern people have about 700 mL. They are deep breathers.
Myth #4. My breathing is OK and I know how to breathe.
Less than 10% of people have normal
breathing parameters and body oxygen stores
these days. Check these 24 medical and
physiological respiratory studies done on
ordinary or normal subjects during last 80
years (Hyperventilation: Present in Over 90%
of Normals). It is a fact that the medical norm
established about a century ago is not a norm
anymore. Modern people breathe about 2 times
more air than we did 100 years ago.
Hyperventilation results in tissue hypoxia and
many other biochemical abnormalities. Your
breathing is normal, if and only if you have
normal body oxygenation. How can you check it? You should be able to easily
hold your breath for at least 40 s after your usual exhalation and with no stress at
the end of the test. This test is described in detail below.
Myth #5. More breathing (deeper and/or greater volume) means better body
oxygenation or even over oxygenation of the blood.
During miniscule normal breathing, oxygenation of the arterial blood is about 98-
99%. Note that normal breathing is invisible and inaudible. It is so light that most
people do not feel it.
As a result, breathing more air cannot get much more oxygen in the blood. It
follows that, no matter how deep and fast one breathes, he or she cannot get over
oxygenated blood using normal air, while pure oxygen is toxic for the lungs tissue.
There is zero scientific evidence about this deep breathing myth, but hundreds of
published studies have clearly shown that hyperventilation (or breathing more
than the tiny medical norm) REDUCES oxygen supply to the brain, heart, liver,
kidneys, and all other vital organs due to losses in CO2. (There are hundreds of
studies presented on this website that proved this fact.)
Nevertheless, on TV, radio, and in everyday life situations, people who have little
knowledge of physiology say, Take a deep breath, get more oxygen, or Breathe
deeper for better oxygenation, etc.
Myth #6. Sick people notice when their breathing becomes abnormal.
100% prevalence of hyperventilation at rest for the sick people is confirmed by
over 40 published western studies on heart disease, cancer, asthma, COPD,
diabetes, cystic fibrosis, epilepsy, panic attacks, chronic fatigue, and many other
conditions. These sick patients breathe about 2-3 times more than the norm (see
this Table with Minute Ventilation Rates for Chronic Diseases), and usually do not
complain or even notice that their breathing is heavy or too deep. Why? This is
because air is weightless and the main breathing muscles (diaphragm and chest)
are very powerful: we can pump 25 times more air during maximum exercise (or
about 150 liters of air in one minute), than we require for normal breathing at rest
(only about 6 L/min). People may notice that their breathing is heavy during heart
attacks, stroke, asthma attacks, or morning hyperventilation (between 4 and 7 am).

Minute ventilation rates (chronic diseases)

Condition Minute ventilation
Normal breathing 6 L/min
Healthy Subjects 6-7 L/min
Heart disease 15 (4) L/min
Pulm hypertension 12 (2) L/min
Cancer 12 (2) L/min
Diabetes 12-17 L/min
Asthma 13 (2) L/min
COPD 14 (2) L/min
Sleep apnea 15 (3) L/min
Liver cirrhosis 11-18 L/min
Hyperthyroidism 15 (1) L/min
Cystic fibrosis 15 L/min
CF and diabetes* 10 L/min
Epilepsy 13 L/min
CHV 13 (2) L/min
Panic disorder 12 (5) L/min
Bipolar disorder 11 (2) L/min
Dystrophia myotonica 16 (4) L/min
Yoga Breathing: Main Secret of Yoga's Super Health
Many people believe that yoga is about postures and maybe breathing exercises. Well, one may
spend years practicing asanas and thousands of hours doing breathing exercises, but his or her
health can get worse and worse. Instead of these silly ideas, it is smart to think about finding
some criteria or measurements of super health. Then we can decide who is a real yoga master.
Super health of real yoga masters is possible to measure. They should have the ideal automatic
breathing pattern (with about 3 small breath per minute at rest or during sleep). This slow and
relaxed breathing pattern provides the human body with superior body oxygenation: about 2-3
minutes for the DIY body oxygen test. Yoga masters should have only about 2 hours of natural
sleep and do not require more. There are many other effects that corresponds to the ideal
breathing pattern. You can find them on the web page Ideal Breathing Pattern.
Indeed, the body and cells require oxygen 24/7. One can practice best yoga sessions, but if he or
she sleeps on their back at night, or breathes through the mouth while sleeping, all positive
effects of yoga practice will be demolished by tissue hypoxia and free radicals generated during
According to ancient hatha yoga manuscripts, the goal of yoga
breathing exercises is to "restrain", "hold", "suspend", and "calm"
the breath 24/7. There are no any hints or quotes in these classical
yoga texts about "breathing more" or "breathing deeper". According
to these books, progress in pranayama (the main yoga breathing
exercise) is measured in longer cycles for breath holds, inhalations,
and exhalations. This is possible only if one's unconscious
breathing becomes smaller and slower.
When the diaphragmatic breathing pattern gradually becomes
slower and lighter (breathing less air 24/7), blood supply, perfusion,
abilities of the immune system, cells oxygen content, and many
other key parameters of the human body are improved.

Buteyko Table of Health Zones (average parameters at rest)
Type of
CO2 in
alveoli, %
AP, s CP, s MP, s
Super-health Shallow
5 48 3 7.5 16 180 210
4 50 4 7.4 12 150 190
3 52 5 7.3 9 120 170
2 55 6 7.1 7 100 150
1 57 7 6.8 5 80 120
Normal Normal - 60 8 6.5 4 60 90
Disease Deep
-1 65 10 6.0 3 50 75
-2 70 12 5.5 2 40 60
-3 75 15 5.0 - 30 50
-4 80 20 4.5 - 20 40
-5 90 26 4.0 - 10 20
-6 100 30 3.5 - 5 10
Comments on Buteyko Table of Health Zones. Pulse heart rate or pulse rate in
1 minute; Breathing or Respiratory frequency in one minute (number of inhalations
or exhalations); % CO2 - %CO2 in alveoli of the lungs (*or arterial blood if there
is no mismatch); AP - the Automatic Pause or natural delay in breathing after
exhalation (*during unconscious breathing); CP - the Control Pause (body oxygen
test, breath holding time after usual exhalation and until first distress only); MP
(the Maximum Pause, breath holding time after usual exhalation and as long as
This discovery is patented (see the bottom of this page) and the table is based on
Buteyko KP, The method of volitional elimination of deep breathing [Translation
of the Small Buteyko Manual], Voskresensk, 1994.
* Note about pulse. Not all people with low CPs (less than 20 s) have a greatly
increased heart rate, as is given by this table. Some categories of people with less
than 20 s CP can have a resting pulse of around 60 70 beats per minute.
However, increased heart rate for lower CPs is the feature of, for example, heart
patients and patients with severe asthma. During the 1960's, when conducting his
research, and later, Buteyko and his colleagues applied the Buteyko breathing
retraining program mainly for heart and asthma patients, who were mostly
hospitalized with frequent deficiencies in blood cortisol levels. This explains the
increased heart rates provided by the Table.
Buteyko norms
Dr. Buteyko suggested his own standards for health so that one can be free from
about 200 chronic conditions. As we see in the Buteyko Table of Health Zones (the
middle or central row), healthy people should have breathing frequency no more
than 8 breaths per minute at rest, more than 60 s CP, over 6.5% CO2, less than 60
beats per min for heart rate, and at least 4 s for automatic pause.
At this stage people enjoy and even crave physical activity. They are full of energy
(when they have a normal blood glucose level). Standing throughout the day is
easy and natural. Sleep is less than 5 hours and early morning parameters are not
worse than evening ones.
All tissues of the body are histologically normal (or in accordance with medical
books), while chronic disorders are impossible.
Steps of Buteyko Method
1. Nasal breathing
The Buteyko method emphasizes the importance of nasal breathing, which protects the
airways by humidifying, warming, and cleaning the air entering the lungs. A majority of
asthmatics have problems sleeping at night, and this is thought to be linked with poor
posture or unconscious mouth-breathing. By keeping the nose clear and encouraging
nasal breathing during the day, night-time symptoms can also improve. Other methods of
encouraging nasal breathing are full-face CPAP machines - commonly used to treat sleep
apnea - or using a jaw-strap or paper-tape to keep the mouth closed during the night.
Strictly nasal breathing during physical exercise is another key element of the Buteyko
2. Reduced breathing exercises
The core Buteyko exercises involve breath control; consciously reducing either breathing
rate or breathing volume. Many teachers refer to Buteyko as 'breathing retraining' and
compare the method to learning to ride a bicycle. Once time has been spent practicing,
the techniques become instinctive and the exercises are gradually phased out as the
condition improves.
Rather than using traditional peak flow measurements to monitor the condition of
asthmatics, Buteyko uses an exercise called the Control Pause (CP), defined as the
amount of time that an individual can comfortably hold breath after a normal exhalation.
According to Buteyko teachers, with regular Buteyko reduced-breathing practice,
asthmatics are expected to find that their CP gradually increases and in parallel decreased
asthma symptoms.
3. Relaxation
Dealing with asthma attacks is an important factor of Buteyko practice. The first feeling
of an asthma attack is unsettling and can result in a short period of rapid breathing. By
controlling this initial over-breathing phase, asthmatics can prevent a "vicious circle of
over-breathing" from developing and spiraling into an asthma attack. This means that
asthma attacks may be averted simply by breathing less.

Yoga Pranayama: How to Get Pranayama Benefits
Instead of exploring the essence of yoga pranayama, most yoga teachers today are
busy with dividing and sub-dividing this wise and exceptionally powerful
breathing practice into various forms. Yes, there are many possible exercises in
pranayama, but only one essential process: slowing down our automatic breathing.
Indeed, when this main pranayama mechanism and its physiological effects are
poorly understood, attention will be diverted from true progress in pranayama onto
relatively meaningless topics and subjects. What is true progress in pranayama?

The Shiva Samhita
(5) The Pranayama
"22. Then let the wise practitioner close with his right thumb the pingala (right
nostril), inspire air through the ida (the left nostril); and keep the air confined
suspend his breathing as long as he can; and afterwards let him breathe out
slowly, and not forcibly, through the right nostril.

23. Again, let him draw breath through the right nostril, and stop breathing as
long as his strength permits; then let him expel the air through the left nostril, not
forcibly, but slowly and gently."
"39. When the Yogi can, of his will, regulate the air and stop the breath (whenever
and how long) he likes, then certainly he gets success in kumbhaka, and from the
success in kumbhaka only, what things cannot the Yogi commend here?"
"43. ... from the perfection of pranayama, follows decrease of sleep, excrements
and urine."
I ncrease of Duration
"53. Then gradually he should make himself able to practice for three gharis (one
hour and a half at a time, he should be able to restrain breath for that period).
Through this, the Yogi undoubtedly obtains all the longed for powers."
"57. When he gets the power of holding breath (i.e., to be in a trance) for three
hours, then certainly the wonderful state of pratyahar is reached without fail."

Kussmaul breathing
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Kussmaul breathing is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure. It is a form of
hyperventilation, breathing which is increased above the required rate. Kussmaul breathing is
characterized as rapid, deep breathing.
In metabolic acidosis, breathing is first rapid and shallow
but as acidosis worsens, breathing
gradually becomes deep, labored and gasping.
1 Terminology
2 History
3 Mechanism
4 References
[edit] Terminology
Kussmaul, who introduced the term, referred to breathing when metabolic acidosis was
sufficiently severe for the respiratory rate to be normal or reduced.
This definition is also
followed by several other sources,
including for instance Merriam-Webster, which defines
Kussmaul breathing as "abnormally slow deep respiration characteristic of air hunger and
occurring especially in acidotic states".
Other sources, however, use the term Kussmaul
respiration also when acidosis is less severe, in which case breathing is rapid.

Note that Kussmaul breathing occurs only in advanced stages of acidosis, and is fairly rarely
reached. In less severe cases of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is
a kind of very deep, gasping, desperate breathing. Occasionally, medical literature refers to any
abnormal breathing pattern in acidosis as Kussmaul breathing; however, this is inaccurate.
[edit] History
Kussmaul breathing is named for Adolph Kussmaul,
the 19th century German doctor who first
noted it among patients with advanced diabetes mellitus. Kussmaul's sign is also an eponymous
finding attributable to Kussmaul, and should be distinguished from Kussmaul breathing.
He published his finding in a classic 1874 paper.

Kussmaul breathing is respiratory compensation for a metabolic acidosis, most commonly
occurring in diabetics in diabetic ketoacidosis. Blood gases on a patient with Kussmaul breathing
will show a low partial pressure of CO
in conjunction with low bicarbonate because of a forced
increased respiration (blowing off the carbon dioxide). Base excess is severely negative. The
patient feels an urge to breathe deeply, an "air hunger", and it appears almost involuntary.
A metabolic acidosis soon produces hyperventilation, but at first it will tend to be rapid and
relatively shallow. Kussmaul breathing develops as the acidosis grows more severe. Indeed,
Kussmaul originally identified this type of breathing as a sign of coma and imminent death in
diabetic patients.
Duration of fasting, presence or absence of hepatomegaly and Kussmaul breathing provide clues
to the differential diagnosis of hyperglycemia in the inborn errors of metabolism.

Agonal respiration
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This article includes a list of references, related reading or external links, but its sources remain
unclear because it lacks inline citations. Please improve this article by introducing more precise
citations. (January 2011)
Agonal respiration is an abnormal pattern of breathing characterized by shallow, slow (3-4 per
minute), irregular inspirations followed by irregular pauses. It may also be characterized by
gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Possible
causes include cerebral ischemia, extreme hypoxia or even anoxia. Agonal breathing is an
extremely serious medical sign requiring immediate medical attention, as the condition generally
progresses to complete apnea and heralds death.
The term is sometimes (inaccurately) used to refer to labored, gasping breathing patterns
accompanying organ failure (e.g. liver failure and renal failure), SIRS, septic shock, and
metabolic acidosis (see Kussmaul breathing, or in general any labored breathing, including Biot's
respirations and ataxic respirations. Correct usage would restrict the term to the last breaths
before death.
Agonal respirations are also commonly seen in cases of cardiogenic shock or cardiac arrest
where agonal respirations may persist for several minutes after cessation of heartbeat. The
presence of agonal respirations in these cases indicates a more favorable prognosis than in cases
of cardiac arrest without agonal respirations.A victim who has agonal gasps and does not
respond and has no pulse is in cardiac arrest, agonal gasps are not effective breaths.
Agonal respiration is not the same as, and is unrelated to, the phenomenon of death rattle.

Cheyne-Stokes respiration
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Cheyne-Stokes respiration
ICD-10 R06.3
ICD-9 786.04
MeSH D002639

Graph showing the Cheyne-Stokes breathing pattern.
Cheyne-Stokes respiration ( /tenstoks/) is an abnormal pattern of breathing characterized
by progressively deeper and sometimes faster breathing, followed by a gradual decrease that
results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle
usually taking 30 seconds to 2 minutes.
It is an oscillation of ventilation between apnea and
hyperpnea with a crescendo-diminuendo pattern, and is associated with changing serum partial
pressures of oxygen and carbon dioxide.

Cheyne-Stokes respiration and periodic breathing are the two regions on a spectrum of
severity of oscillatory tidal volume. The distinction lies in what we observe happening at the
trough of ventilation: if there is apnea, we describe it as Cheyne-Stokes respiration (since apnea
is a prominent feature in their original description); if there is only hypopnea (abnormally small
but not absent breaths) then we call it periodic breathing. Physiologically and mathematically,
the phenomena are less different than they appear, because breaths that are smaller than the
anatomical dead space do not actually ventilate the lung and so - from the point of view of gas
concentrations in an alveolus - the nadir of hypopnea in periodic breathing may be
indistinguishable from apnea.
These phenomena can occur during wakefulness or during sleep, where they are called the
Central sleep apnea syndrome (CSAS).

It may be caused by damage to respiratory centers,
or by physiological abnormalities in
chronic heart failure,
and is also seen in newborns with immature respiratory systems and in
visitors new to high altitudes.
1 History
2 Pathophysiology
3 Associated conditions
4 Related patterns
5 References
[edit] History
The condition was named after John Cheyne and William Stokes, the physicians who first
described it in the 19th century.

[edit] Pathophysiology
In heart failure, the mechanism of the oscillation is unstable feedback in the respiratory control
system. In normal respiratory control, negative feedback allows a steady level of alveolar gas
concentrations to be maintained, and therefore stable tissue levels of oxygen and carbon dioxide
). At the steady state, the rate of production of CO
equals the net rate at which it is exhaled
from the body, which (assuming no CO
in the ambient air) is the product of the alveolar
ventilation and the end-tidal CO
concentration. Because of this interrelationship, the set of
possible steady states forms a hyperbola:
Alveolar ventilation = (body CO
production)/end-tidal CO
In the figure below, this relationship is the curve falling from the top left to the bottom right.
Only positions along this curve permit the body's CO
production to be exactly compensated for
by exhalation of CO
. Meanwhile there is another curve, shown in the figure for simplicity as a
straight line from bottom left to top right, which is the body's ventilatory response to different
levels of CO
. Where the curves cross is the potential steady state (S).
Through respiratory control reflexes, any small transient fall in ventilation (A) leads to a
corresponding small rise (A') in alveolar CO
concentration which is sensed by the respiratory
control system so that there is a subsequent small compensatory rise in ventilation (B) above its
steady state level (S) that helps restore CO
back to its steady state value. In general, transient or
persistent disturbances in ventilation, CO
or oxygen levels can be counteracted by the
respiratory control system in this way.

However, in some pathological states, the feedback is more powerful than is necessary to simply
return the system towards its steady state. Instead, ventilation overshoots and can generate an
opposite disturbance to the original disturbance. If this secondary disturbance is larger than the
original, the next response will be even larger, and so on, until very large oscillations have
developed, as shown in the figure below.

The cycle of enlargement of disturbances reaches a limit when successive disturbances are no
longer larger, which occurs when physiological responses no longer increase linearly in relation
to the size of the stimulus. The most obvious example of this is when ventilation falls to zero: it
cannot be any lower. Thus Cheyne-Stokes respiration can be maintained over periods of many
minutes or hours with a repetitive pattern of apneas and hyperpneas.
The end of the linear decrease in ventilation in response to falls in CO
is not, however, at apnea.
It occurs when ventilation is so small that air being breathed in never reaches the alveolar space,
because the inspired tidal volume is no larger than the volume of the large airways such as the
trachea. Consequently, at the nadir of periodic breathing, ventilation of the alveolar space may be
effectively zero; the easily-observable counterpart of this is failure at that time point of the end-
tidal gas concentrations to resemble realistic alveolar concentrations.
Many potential contributory factors have been identified by clinical observation, but
unfortunately they are all interlinked and covary extensively. Widely accepted risk factors are
hyperventilation, prolonged circulation time, and reduced blood gas buffering capacity.

They are physiologically interlinked in that (for any given patient) circulation time decreases as
cardiac output increases. Likewise, for any given total body CO
production rate, alveolar
ventilation is inversely proportional to end-tidal CO
concentration (since their mutual product
must equal total body CO
production rate). Chemoreflex sensitivity is closely linked to the
position of the steady state, because if chemoreflex sensitivity increases (other things being
equal) the steady-state ventilation will rise and the steady-state CO
will fall. Because ventilation
and CO
are easily to observe because they are commonly-measured clinical variables which do
not require any particular experiment to be conducted in order to observe them, abnormalities in
these variables are more likely to be reported in the literature. However, other variables, such as
chemoreflex sensitivity can only be measured by specific experiment, and therefore
abnormalities will not in them will not be found in routine clinical data.
When measured in
patients with Cheyne-Stokes respiration, hypercapnic ventilatory responsiveness may be elevated
by 100% or more. When not measured, its consequences - such as a low mean Pa
elevated mean ventilation - may sometimes appear to be the most prominent feature.

Circulatory delay may determine the length of the apnea-hyperpnea cycle although it is rarely
sufficiently prolonged itself to be a major driving factor for instability.

[edit] Associated conditions
This abnormal pattern of breathing, in which breathing is absent for a period and then rapid for a
period, can be seen in patients with heart failure,
strokes, traumatic brain injuries and brain
tumors. In some instances, it can occur in otherwise healthy people during sleep at high altitudes.
It can occur in all forms of toxic metabolic encephalopathy.
It is a symptom of carbon
monoxide poisoning, along with syncope or coma. This type of respiration is also often seen
after morphine administration.
Hospice personnel sometimes document the presence of Cheyne-Stokes breathing as a patient
nears death, and report that patients able to speak after such episodes do not report any distress
associated with the breathing, although it is sometimes disturbing to the family.
[edit] Related patterns
Cheyne-Stokes respirations are not the same as Biot's respirations ("cluster breathing"), in which
groups of breaths tend to be similar in size.
They differ from Kussmaul respirations in that the Kussmaul pattern is one of consistent very
deep breathing at a normal or increased rate.

Biot's respiration
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Biot's respiration, sometimes also called ataxic respiration,
[citation needed]
is an abnormal pattern
of breathing characterized by groups of quick, shallow inspirations followed by regular or
irregular periods of apnea.

It generally indicates a poor prognosis.
It is named for Camille Biot, who characterized it in 1876.

1 Causes
2 Related patterns
3 References
4 External links
[edit] Causes
Biot's respiration is caused by damage to the medulla oblongata due to strokes or trauma or by
pressure on the medulla due to uncal or tentorial herniation.
It can be caused by opioid use.

[edit] Related patterns
It is distinguished from ataxic respiration by having more regularity and similar-sized
inspirations, whereas ataxic respirations are characterized by completely irregular breaths and
pauses. As the breathing pattern deteriorates, it merges with ataxic respirations.
In common medical practice, Biot's respiration is often clinically equivalent to Cheyne-Stokes
respiration, although the two definitions are separated in some academic settings.

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This article is about the philosophical concept. For other uses, see Pneuma (disambiguation).

Look up pneuma in Wiktionary, the free dictionary.
Pneuma () is an ancient Greek word for "breath," and is related, in theological and
philosophical contexts, to psyche ( "spirit" or "soul"), as in the phrase "breath of life".
It is
given various technical meanings by medical writers and philosophers of classical antiquity, and
is also used in Greek translations of the Hebrew Bible and in the Greek New Testament.
1 Classical antiquity
o 1.1 Ancient Greek medical theory
o 1.2 Aristotle
o 1.3 Stoic pneuma
2 Judaism and Christianity
3 See also
4 References
[edit] Classical antiquity
Pneuma, "air in motion, breath, wind," is equivalent in the material monism of Anaximenes to
aer (, "air") as the element from which all else originated. This usage is the earliest extant
occurrence of the term.
[edit] Ancient Greek medical theory
See also: Pneumatic school
In ancient Greek medicine, pneuma is the form of circulating air necessary for the systemic
functioning of vital organs. It is the material that sustains consciousness in a body. According to
Diocles and Praxagoras, the psychic pneuma mediates between the heart, regarded as the seat of
Mind in some physiological theories of ancient medicine, and the brain.

The disciples of Hippocrates explained the maintenance of vital heat to be the function of the
breath within the organism. Around 300 BC, Praxagoras discovered the distinction between the
arteries and the veins. In the corpse arteries are empty; hence, in the light of these preconceptions
they were declared to be vessels for conveying pneuma to the different parts of the body. A
generation afterwards, Erasistratus made this the basis of a new theory of diseases and their
treatment. The pneuma, inhaled from the outside air, rushes through the arteries till it reaches the
various centres, especially the brain and the heart, and there causes thought and organic

The "connate pneuma" of Aristotle is the warm mobile "air" that in the sperm transmits the
capacity for locomotion and certain sensations to the offspring.
Stoic pneuma
In Stoic philosophy, pneuma is the concept of the "breath of life," a mixture of the elements air
(in motion) and fire (as warmth). For the Stoics, pneuma is the active, generative principle that
organizes both the individual and the cosmos. In its highest form, the pneuma constitutes the
human soul (psych), which is a fragment of the pneuma that is the soul of God (Zeus). As a
force that structures matter, it exists even in inanimate objects.

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Prana (, pra) is the Sanskrit word for "vital life" (from the root pr "to fill", cognate to
Latin plenus "full"). It is one of the five organs of vitality or sensation, viz. prana "breath", vac
"speech", chakshus "sight", shrotra "hearing", and manas "thought" (nose, mouth, eyes, ears and
mind; ChUp. 2.7.1).
In Vedantic philosophy, prana is the notion of a vital, life-sustaining force of living beings and
vital energy, comparable to the Chinese notion of Qi. Prana is a central concept in Ayurveda and
Yoga, where it is believed to flow through a network of fine subtle channels called nadis. Its
most subtle material form is the breath, but it is also to be found in the blood, and its most
concentrated form is semen in men and vaginal fluid in women.
The Pranamaya-kosha is one
of the five Koshas or "sheaths" of the Atman.
Prana was first expounded in the Upanishads, where it is part of the worldly, physical realm,
sustaining the body and the mother of thought and thus also of the mind. Prana suffuses all living
forms but is not itself the Atman or individual soul. In the Ayurveda, the Sun and sunshine are
held to be a source of prana.
In the Hindu philosophy of Kashmir Shaivism, prana is regarded as an aspect of Shakti (cosmic
[citation needed]

1 Nadis
2 The Five Pras
3 The Five Upa-Pranas
4 Pranayama
5 See also
6 References
7 External links
[edit] Nadis
Further information: Nadi (yoga)
In Yoga, the three main channels of prana are the Ida, the Pingala and the Sushumna. Ida relates
to the right side of the brain, and the left side of the body, terminating at the left nostril and
pingala to the left side of the brain and the right side of the body, terminating at the right nostril.
In some practices, alternate nostril breathing balances the prana that flows within the body. In
most ancient texts, the total number of nadis in the human body is stated to be 72,000. When
prana enters a period of uplifted, intensified activity, the Yogic tradition refers to it as

[edit] The Five Pras
In Ayurveda, the Pra is further classified into subcategories, referred to as prana vayus.
According to Hindu philosophy these are the vital principles of basic energy and subtle faculties
of an individual that sustain physiological processes. There are five pranas or vital currents in the
Hindu system:

1. Pra : Responsible for the beating of the heart and breathing. Prana enters the body through
the breath and is sent to every cell through the circulatory system.
2. Apna : Responsible for the elimination of waste products from the body through the lungs and
excretory systems.
3. Una : Responsible for producing sounds through the vocal apparatus, as in speaking, singing,
laughing, and crying. Also it represents the conscious energy required to produce the vocal
sounds corresponding to the intent of the being. Hence Samyama on udana gives the higher
centers total control over the body.
4. Samna : Responsible for the digestion of food and cell metabolism (i.e. the repair and
manufacture of new cells and growth). Samana also includes the heat regulating processes of
the body. Auras are projections of this current. By meditational practices one can see auras of
light around every being. Yogis who do special practise on samana can produce a blazing aura at
[citation needed]

5. Vyna : Responsible for the expansion and contraction processes of the body, e.g. the voluntary
muscular system.
[edit] The Five Upa-Pranas
In Yoga the Prana is further classified into subcategory Upa-prana with following items:

1. Naga : Responsible for burping.
2. Kurma : Responsible for blinking.
3. Devadatta : Responsible for yawning.
4. Krikala : Responsible for Sneezing.
5. Dhananjaya : Responsible for opening and closing of heart valves.
[edit] Pranayama
Pranayama is the practice in which the control of prana is achieved (initially) from the control of
one's breathing. According to Yogic philosophy the breath, or air, is merely a gateway to the
world of prana and its manifestation in the body.
[citation needed]
In yoga, pranayama techniques are
used to control the movement of these vital energies within the body, which is said to lead to an
increase in vitality in the practitioner.
[citation needed]
However, intensive practice
of these
techniques is not trivial. Kason
describes situations where intensive pranayama techniques
may have adverse effects on certain practitioners. According to kundalini yoga, intensive and
systematic practice of pranayama can lead to the awakening of kundalini.
[citation needed]

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Qi (Ch'i)

Chinese name
Traditional Chinese

Simplified Chinese


Japanese name

Korean name

Thai name

Vietnamese name
Quc ng kh

This article contains Chinese text. Without
proper rendering support, you may see
question marks, boxes, or other symbols
instead of Chinese characters.
For other uses, see Qi (disambiguation).
In traditional Chinese culture, q (also chi or ch'i) is an active principle forming part of any living
thing. Qi is frequently translated as "lifeforce" or "energy flow". Notions in the west of energeia,
lan vital, or vitalism are purported
[by whom?]
to be similar. Qi is the central underlying principle in
traditional Chinese medicine. The literal translation of "qi" is air, breath, or gas.
1 Term and character
2 Definition
3 Pronunciation
4 Early philosophical texts
5 Traditional Chinese medicine
6 Scientific investigation
7 Feng shui
8 Martial arts
9 See also
10 References
11 Further reading
12 External links
[edit] Term and character
The etymological explanation for the form of the qi logogram in the traditional form is steam
() rising from rice () as it cooks. The earliest way of writing qi consisted of three wavy
lines, used to represent one's breath seen on a cold day. A later version, , identical to the
present-day simplified character, is a stylized version of those same three lines. For some reason,
early writers of Chinese found it desirable to substitute for a cognate character that originally
meant to feed other people in a social context such as providing food for guests.
[citation needed]

Appropriately, that character combined the three-line qi character with the character for rice. So
plus formed , and that is the traditional character still used today (the oracle bone
character, the seal script character and the modern "school standard" or Ki sh characters in the
box at the right show three stages of the evolution of this character).

Traditional Chinese character q, also used in Korean hanja. In Japanese kanji, this character was used
until 1946, when it was changed to .
[edit] Definition
References to concepts analogous to the qi taken to be the life-process or flow of energy that
sustains living beings are found in many belief systems, especially in Asia. Philosophical
conceptions of qi from the earliest records of Chinese philosophy (5th century BC) correspond to
Western notions of humours and the ancient Hindu yogic concept of prana, meaning "life force"
in Sanskrit. The earliest description of qi in the current sense of vital energy is found in the
Vedas of ancient India (circa 1500-1000BC)
, and from the writings of the Chinese philosopher
Mencius (4th century BC). Historically, it is the Huangdi Neijing translated as, The Yellow
Emperor's Classic of Medicine (circa 2nd century BC) that is credited with first establishing the
pathways through which qi circulates in the human body.

Within the framework of Chinese thought, no notion may attain such a degree of abstraction
from empirical data as to correspond perfectly to one of our modern universal concepts.
Nevertheless, the term qi comes as close as possible to constituting a generic designation
equivalent to our word "energy". When Chinese thinkers are unwilling or unable to fix the
quality of an energetic phenomenon, the character qi () inevitably flows from their

Manfred Porkert
The ancient Chinese described it as "life-force". They believed qi permeated everything and
linked their surroundings together. They likened it to the flow of energy around and through the
body, forming a cohesive and functioning unit. By understanding its rhythm and flow they
believed they could guide exercises and treatments to provide stability and longevity.
Although the concept of qi has been important within many Chinese philosophies, over the
centuries the descriptions of qi have varied and have sometimes been in conflict. Until China
came into contact with Western scientific and philosophical ideas, they would not have
categorized all things in terms of matter and energy. Qi and li (, li, pattern) were 'fundamental'
categories similar to matter and energy.

Hand written calligraphic Qi.
Fairly early on, some Chinese thinkers began to believe that there were different fractions of qi
and that the coarsest and heaviest fractions of qi formed solids, lighter fractions formed liquids,
and the most ethereal fractions were the "lifebreath" that animates living beings.

Yun q is a notion of innate or pre-natal qi to distinguish it from acquired qi that a person may
develop over the course of their lifetime.
[edit] Pronunciation
Other spellings include in simplified Chinese: ; traditional Chinese: ; Mandarin Pinyin: q;
WadeGiles: ch'i; Jyutping: hei. Qi is pronounced /ti/ in English and [t] in Standard
Chinese; Korean: gi; Japanese: ki; Vietnamese: kh, pronounced [x]) The approximate English
pronunciation of qi, similar to "chee" in cheese, should also be distinguished from the
pronunciation of the Greek letter chi, which has a hard c sound, like "c" in car, and a long i,
similar to other Greek letters phi, psi, xi.
[edit] Early philosophical texts

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v d e
The earliest texts that speak of qi give some indications of how the concept developed. The
philosopher Mo Di used the word qi to refer to noxious vapors that would in due time arise from
a corpse were it not buried at a sufficient depth.
He reported that early civilized humans
learned how to live in houses to protect their qi from the moisture that had troubled them when
they lived in caves.
He also associated maintaining one's qi with providing oneself adequate
In regard to another kind of qi, he recorded how some people performed a kind of
prognostication by observing the qi (clouds) in the sky.

In the Analects of Confucius, compiled from the notes of his students sometime after his death in
479 B.C., qi could mean breath,
and combining it with the Chinese word for blood (making
, xue-qi, blood and breath), the concept could be used to account for motivational

The [morally] noble man guards himself against three things. When he is young, his xue-qi has
not yet stabilized, so he guards himself against sexual passion. When he reaches his prime, his
xue-qi is not easily subdued, so he guards himself against combativeness. When he reaches
old age, his xue-qi is already depleted, so he guards himself against acquisitiveness.

Confucius, Analects, 16:7
Mencius described a kind of qi that might be characterized as an individual's vital energies. This
qi was necessary to activity, and it could be controlled by a well-integrated willpower.
properly nurtured, this qi was said to be capable of extending beyond the human body to reach
throughout the universe.
It could also be augmented by means of careful exercise of one's
moral capacities.
On the other hand, the qi of an individual could be degraded by averse
external forces that succeed in operating on that individual.

Not only human beings and animals were believed to have qi. Zhuangzi indicated that wind is
the qi of the Earth.
Moreover, cosmic yin and yang "are the greatest of qi."
He described qi
as "issuing forth" and creating profound effects.
He said "Human beings are born [because of]
the accumulation of qi. When it accumulates there is life. When it dissipates there is death...
There is one qi that connects and pervades everything in the world."

Another passage traces life to intercourse between Heaven and Earth: "The highest Yin is the
most restrained. The highest Yang is the most exuberant. The restrained comes forth from
Heaven. The exuberant issues forth from Earth. The two intertwine and penetrate forming a
harmony, and [as a result] things are born."

"The Guanzi essay 'Neiye' (Inward training) is the oldest received writing on the subject of
the cultivation of vapor [qi] and meditation techniques. The essay was probably composed at the
Jixia Academy in Qi in the late fourth century B.C."

Xun Zi, another Confucian scholar of the Jixia Academy, followed in later years. At 9:69/127,
Xun Zi says, "Fire and water have qi but do not have life. Grasses and trees have life but do not
have perceptivity. Fowl and beasts have perceptivity but do not have yi (sense of right and
wrong, duty, justice). Men have qi, life, perceptivity, and yi." Chinese people at such an early
time had no concept of radiant energy, but they were aware that one can be heated by a campfire
from a distance away from the fire. They accounted for this phenomena by claiming "qi" radiated
from fire. At 18:62/122, he too uses "qi" to refer to the vital forces of the body that decline with
advanced age.
Among the animals, the gibbon and the crane were considered experts in inhaling the qi. The
Confucian scholar Dong Zhongshu (ca. 150 BC) wrote in Luxuriant Dew of the Spring and
Autumn Annals:
"The gibbon resembles a macaque, but he is larger, and his color is black.
His forearms being long, he lives eight hundred years, because he is expert in controlling his
breathing." ("")
Later, the syncretic text assembled under the direction of Liu An, the Huai Nan Zi, or "Masters
of Huainan", has a passage that presages most of what is given greater detail by the Neo-
Heaven (seen here as the ultimate source of all being) falls (duo , i.e., descends into proto-
immanence) as the formless. Fleeting, fluttering, penetrating, amorphous it is, and so it is called the
Supreme Luminary. The dao begins in the Void Brightening. The Void Brightening produces the universe
(yu-zhou ). The universe produces qi. Qi has bounds. The clear, yang [qi] was ethereal and so formed
heaven. The heavy, turbid [qi] was congealed and impeded and so formed earth. The conjunction of the
clear, yang [qi] was fluid and easy. The conjunction of the heavy, turbid [qi] was strained and difficult. So
heaven was formed first and earth was made fast later. The pervading essence (xi-jing) of heaven and
earth becomes yin and yang. The concentrated (zhuan) essences of yin and yang become the four
seasons. The dispersed (san) essences of the four seasons become the myriad creatures. The hot qi of
yang in accumulating produces fire. The essence (jing) of the fire-qi becomes the sun. The cold qi of yin
in accumulating produces water. The essence of the water-qi becomes the moon. The essences
produced by coitus (yin) of the sun and moon become the stars and celestial markpoints (chen, planets).
Huai-nan-zi, 3:1a/19
[edit] Traditional Chinese medicine
Further information: Traditional Chinese medicine and Acupuncture
Traditional Chinese medicine (TCM) asserts that the body has natural patterns of qi that circulate
in channels called meridians.
In TCM, symptoms of various illnesses are believed to be the
product of disrupted, blocked, or unbalanced qi movement through the body's meridians, as well
as deficiencies or imbalances of qi in the Zang Fu organs.
Traditional Chinese medicine often
seeks to relieve these imbalances by adjusting the circulation of qi using a variety of techniques
including herbology, food therapy, physical training regimens (qigong, tai chi chuan, and other
martial arts training),
moxibustion, tui na, and acupuncture.

[edit] Scientific investigation
There have been a number of studies of qi, especially in the sense used by traditional Chinese
medicine and acupuncture. These studies have often been problematic, and are hard to compare
to each other, as they lack a common nomenclature.
Some studies claim to have been able to
measure qi, or the effects of manipulating qi, such as through acupuncture
[citation needed]
, but the
proposed existence of qi has been rejected by the scientific community.
A United States National Institutes of Health consensus statement on acupuncture in 1997 noted
that concepts such as qi "are difficult to reconcile with contemporary biomedical information."

In 2007 the MD Anderson Cancer Center at the University of Texas published an article

covering the concepts by which qi is believed to work and research into possible benefits for
cancer patients. A review
of clinical trials investigating the use of internal qigong for pain
management found no convincing evidence that it was effective.
[edit] Feng shui
Main article: Feng shui
The traditional Chinese art of geomancy, the placement and arrangement of space called feng
shui, is based on calculating the balance of qi, interactions between the five elements, yin and
yang and other factors. The retention or dissipation of qi is believed to affect the health, wealth,
energy level, luck and many other aspects of the occupants of the space. Attributes of each item
in a space affect the flow of qi by slowing it down, redirecting it or accelerating it, which is said
to influence the energy level of the occupants.
One use for a Luopan is to detect the flow of qi.
The quality of qi may rise and fall over time,
feng shui with a compass might be considered a form of divination that assesses the quality of
the local environment.
[edit] Martial arts
Main article: Nei Jing

It has been suggested that Nei Jing be merged into this article or section. (Discuss) Proposed
since January 2010.
Qi is a didactic concept in many Chinese, Korean and Japanese martial arts. Martial qigong is a
feature of both internal and external training systems in China
and other East Asian
The most notable of the qi-focused "internal" force (jin) martial arts are Baguazhang,
Xing Yi Quan, T'ai Chi Ch'uan, Snake Kung Fu, Dragon Kung Fu, Lion Kung Fu, Aikido,
Aikijujutsu, Kyudo, Hapkido, jian and katana swordplay, Lohan Chuan, Shaolin Kung Fu, Liu
He Ba Fa, Buddhist Fist, and some forms of Karate and Silat.
Demonstrations of qi or ki power are popular in some martial arts and may include the
immovable body, the unraisable body, the unbendable arm and other feats of power. All of these
feats can alternatively be explained using biomechanics and physics.

Respiratory rate
From Wikipedia, the free encyclopedia
Jump to: navigation, search
This article is about the measurement of breathing. For the parameter used in ecological and
agronomical modelling, see respiration rate.
Respiratory rate (V
, R
or RR) is also known by respiration rate, pulmonary ventilation
rate, ventilation rate, or breathing frequency is the number of breaths taken within a set
amount of time. Typically within 60 seconds.
There is limited research on monitoring respiratory rate. However it is not yet proven whether or
not this is due to age or environment and these studies have focused on such issues as the
inaccuracy of respiratory rate measurement and respiratory rate as a marker for respiratory
1 Measurement
2 Normal range
o 2.1 By Age
3 Minute volume
4 Diagnostic value
5 See also
6 References
[edit] Measurement
The human respiration rate is usually measured when a person is at rest and simply involves
counting the number of breaths for one minute by counting how many times the chest rises.
Respiration rates may increase with fever, illness, OR other medical conditions. When checking
respiration, it is important to also note whether a person has any difficulty breathing.
Inaccuracies in respiratory measurement have been reported in the literature. One study
compared respiratory rate counted using a 90 second count period, to a full minute, and found
significant differences in the rates.
[citation needed]
Another study found that rapid respiratory rates in
babies, counted using a stethoscope, were 6080% higher than those counted from beside the cot
without the aid of the stethoscope.
[citation needed]
Similar results are seen with animals when they
are being handled and not being handledthe invasiveness of touch apparently is enough to
make significant changes in breathing.
[edit] Normal range
Average respiratory rate reported in a healthy adult at rest is usually given as 12-18 breaths per
minute (V
but estimates do vary between sources, e.g., 1220 breaths per minute, 1014,

between 1618,
etc. With such a slow rate, more accurate readings are obtained by counting
the number of breaths over a full minute.
[edit] By Age
Average Respiratory Rates (V
) By Age:
Newborns: 30-40 breaths per minute
Less Than 1 Year: 30-40 breaths per minute
1-3 Years: 23-35 breaths per minute
3-6 Years: 20-30 breaths per minute
6-12 Years: 18-26 breaths per minute
12-17 Years: 12-20 breaths per minute
Adults Over 18: 1220 breaths per minute.
[edit] Minute volume
Respiratory minute volume is the volume of air which can be inhaled (inhaled minute volume) or
exhaled (exhaled minute volume) from a person's lungs in one minute.
[edit] Diagnostic value
The value of respiratory rate as an indicator of potential respiratory dysfunction has been
investigated but findings suggest it is of limited value.
One study found that only 33% of people presenting to an emergency department with an oxygen
saturation below 90% had an increased respiratory rate.
[citation needed]
An evaluation of respiratory
rate for the differentiation of the severity of illness in babies under 6 months found it not to be
very useful. Approximately half of the babies had a respiratory rate above 50 breaths per minute,
thereby questioning the value of having a "cut-off" at 50 breaths per minute as the indicator of
serious respiratory illness.
It has also been reported that factors such as crying, sleeping, agitation and age have a significant
influence on the respiratory rate.
[citation needed]
As a result of these and similar studies the value of
respiratory rate as an indicator of serious illness is limited.

From Wikipedia, the free encyclopedia
Jump to: navigation, search
For the alcoholic beverage or "spirits", see Distilled beverage. For other uses, see Spirit

This article needs additional citations for verification. Please help improve this article by
adding citations to reliable sources. Unsourced material may be challenged and removed. (June

Look up spirit in Wiktionary, the free dictionary.
The English word spirit (from Latin spiritus "breath") has many differing meanings and
connotations, most of them relating to a non-corporeal substance contrasted with the material
body.The spirit of a living thing usually refers to or explains its consciousness. The notions of a
person's "spirit" and "soul" often also overlap, as both contrast with body and both are imagined
as surviving the bodily death in religion and occultism,
and "spirit" can also have the sense of
"ghost", i.e. a manifestation of the spirit of a deceased person.
The term may also refer to any incorporeal or immaterial being, such as demons or deities, in
Christianity specifically the Holy Spirit experienced by the disciples at Pentecost.
1 Etymology
2 Metaphysical and metaphorical uses
o 2.1 Metaphysical contexts
o 2.2 Metaphorical usage
3 Related concepts in other languages
4 See also
5 References
6 Further reading
[edit] Etymology

This section does not cite any references or sources. Please help improve this section by
adding citations to reliable sources. Unsourced material may be challenged and removed.
(November 2010)
The English word spirit comes from the Latin spiritus, meaning "breath", but also "spirit, soul,
courage, vigor", ultimately from a Proto-Indo-European *(s)peis. It is distinguished from Latin
anima, "soul." In Greek, this distinction exists between pneuma (), "breath, motile air,
spirit," and psykh (), "soul."
The word "spirit" came into Middle English via Old French. The distinction between soul and
spirit also developed in the Abrahamic religions: Arabic nafs () opposite r (); Hebrew
neshama ( nmh) or nephesh (in Hebrew neshama comes from the root NM or "breath")
opposite ruach ( ra).
[edit] Metaphysical and metaphorical uses
English-speakers use the word "spirit" in two related contexts, one metaphysical and the other
[edit] Metaphysical contexts
In metaphysical terms, "spirit" has acquired a number of meanings:
An incorporeal but ubiquitous, non-quantifiable substance or energy present individually in all
living things. Unlike the concept of souls (often regarded as eternal and sometimes believed to
pre-exist the body) a spirit develops and grows as an integral aspect of a living being.
[citation needed]

This concept of the individual spirit occurs commonly in animism. Note the distinction between
this concept of spirit and that of the pre-existing or eternal soul: belief in souls occurs
specifically and far less commonly, particularly in traditional societies. One might more properly
term this type/aspect of spirit "life" (bios in Greek) or "aether" rather than "spirit" (pneuma in
A daemon sprite, or especially a ghost. People usually conceive of a ghost as a wandering spirit
from a being no longer living, having survived the death of the body yet maintaining at least
vestiges of mind and of consciousness.
In religion and spirituality, the respiration of a human has for obvious reasons become seen as
strongly linked with the very occurrence of life. A similar significance has become attached to
human blood. Spirit, in this sense, means the thing that separates a living body from a corpse
and usually implies intelligence, consciousness, and sentience.
Latter-day Saint prophet Joseph Smith Jr. taught that the concept of spirit as incorporeal or
without substance was incorrect: "There is no such thing as immaterial matter. All spirit is
matter, but it is more fine or pure, and can only be discerned by purer eyes."

In some Native American spiritual traditions, the Spirit, or 'Great Spirit', is a term for the Creator.
Various forms of animism, such as Japan's Shinto and African traditional religion, focus on
invisible beings that represent or connect with plants, animals (sometimes called "Animal
Fathers)", or landforms (kami)
[citation needed]
: translators usually employ the English word "spirit"
when trying to express the idea of such entities.
Individual spirits envisaged as interconnected with all other spirits and with "The Spirit" (singular
and capitalized). This concept relates to theories of a unified spirituality, to universal
consciousness and to some concepts of Deity. In this scenario all separate "spirits", when
connected, form a greater unity, the Spirit, which has an identity separate from its elements
plus a consciousness and intellect greater than its elements; an ultimate, unified, non-dual
awareness or force of life combining or transcending all individual units of consciousness. The
experience of such a connection can become a primary basis for spiritual belief. The term spirit
occurs in this sense in (to name but a few) Anthroposophy, Aurobindo, A Course In Miracles,
Hegel, Ken Wilber, and Meher Baba (though in his teachings, "spirits" are only apparently
separate from each other and from "The Spirit.")
In this use, the term seems conceptually
identical to Plotinus's "The One" and Friedrich Schelling's "Absolute". Similarly, according to the
panentheistic/pantheistic view, Spirit equates to essence that can manifest itself as mind/soul
through any level in pantheistic hierarchy/holarchy, such as through a mind/soul of a single cell
(with very primitive, elemental consciousness), or through a human or animal mind/soul (with
consciousness on a level of organic synergy of an individual human/animal), or through a
(superior) mind/soul with synergetically extremely complex/sophisticated consciousness of
whole galaxies involving all sub-levels, all emanating (since the superior mind/soul operates
non-dimensionally, or trans-dimensionally) from the one Spirit.
Christian theology can use the term "Spirit" to describe God, or aspects of God as in the "Holy
Spirit", referring to a Triune God (Trinity)(cf Gospel of Matthew 28:19).
"Spirit" forms a central concept in pneumatology (note that pneumatology studies "pneuma"
(Greek for "spirit") not "psyche" (Greek for "soul") as studied in psychology).
Christian Science uses "Spirit" as one of the seven synonyms for God, as in: "Principle; Mind;
Soul; Spirit; Life; Truth; Love"

Harmonism reserves the term "spirit" for those that collectively control and influence an
individual from the realm of the mind.
[edit] Metaphorical usage
The metaphorical use of the term likewise groups several related meanings:
The loyalty and feeling of inclusion in the social history or collective essence of an institution or
group, such as in school spirit or esprit de corps.
A closely related meaning refers to the worldview of a person, place, or time, as in "The
Declaration of Independence was written in the spirit of John Locke and his notions of liberty",
or the term zeitgeist, meaning "spirit of the age".
As a synonym for "vivacity" as in "She performed the piece with spirit" or "She put up a spirited
The underlying intention of a text as distinguished from its literal meaning, especially in law; see
Letter and spirit of the law
As a term for alcoholic beverages.
In mysticism: existence in unity with Godhead. Soul may also equate with spirit, but the soul
involves certain individual human consciousness, while spirit comes from beyond that. Compare
the psychological teaching of Al-Ghazali.
See soul and ghost and spiritual for related discussions.
[edit] Related concepts in other languages
Similar concepts in other languages include Greek pneuma and Sanskrit akasha/atman, see also
Some languages use a word for "spirit" often closely related (if not synonymous) to "mind".
Examples include the German, Geist (related to the English word "ghost") or the French,
'l'esprit'. English versions of the Judaeo-Christian Bible most commonly translate the Hebrew
word "ruach" (; "wind") as "the spirit", whose essence is divine
(see Holy Spirit and ruach
hakodesh). Alternatively, Hebrew texts commonly use the word nephesh. Kabbalists regard
nephesh as one of the five parts of the Jewish soul, where nephesh (animal) refers to the physical
being and its animal instincts. Similarly, Scandinavian languages, Baltic languages, Slavic
languages and the Chinese language (qi) use the words for "breath" to express concepts similar to
"the spirit".

Liquid breathing
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article to make it understandable to non-experts, without removing the technical details. The
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Liquid breathing
MeSH D021061

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Liquid breathing is a form of respiration in which a normally air-breathing organism breathes
an oxygen-rich liquid (such as a perfluorocarbon), rather than breathing air.

Computer models of three perfluorochemical molecules used for biomedical applications and for liquid
ventilation studies: a) FC-75, b) perflubron, and c) perfluorodecalin.
Perfluorochemical (perfluorocarbon) molecules have very different structures that impart
different physical properties such as respiratory gas solubility, density, viscosity, vapor pressure,
and lipid solubility.
Thus, it is critical to select the appropriate PFC for a specific biomedical
application, such as liquid ventilation, drug delivery, blood substitutes, etc. The physical
properties of PFC liquids vary substantially; however, the one common property is their high
solubility for respiratory gases. In fact, these liquids carry more oxygen and carbon dioxide than

In theory, liquid breathing could assist in the treatment of patients with severe pulmonary or
cardiac trauma, especially in pediatric cases. Liquid breathing has also been proposed for use in
deep diving
and space travel.
Despite some recent advances in liquid ventilation, a standard
mode of application has not been established yet.
Liquid breathing is sometimes called "fluid breathing", but this can be misleading, as normal
atmospheric air is also a fluid.
Physicochemical properties (37C at 1 atm) of 18 perfluorochemical liquids used for biomedical
applications. This table characterizes the most significant physical properties related to systemic
physiology and their range of properties.
gas solubility

Oxygen 33-66 mL / 100 mL PFC
Carbon dioxide 140-166 mL / 100 mL PFC
vapor pressure 0.2-400 torr
density 1.58-2.0 g/mL
viscosity 0.8-8.0 cS
1 Approaches
o 1.1 Total liquid ventilation
o 1.2 Partial liquid ventilation
o 1.3 PFC vapor
o 1.4 Aerosol-PFC
2 Proposed uses
o 2.1 Diving
o 2.2 Medical treatment
o 2.3 Space travel
3 Examples in fiction
4 See also
5 References
6 External links
[edit] Approaches
Because liquid breathing is still a highly experimental technique, there are several proposed
[edit] Total liquid ventilation
Although total liquid ventilation (TLV) with completely liquid-filled lungs can be beneficial,

the complex liquid-filled tube system required is a disadvantage compared to gas ventilation - the
system must incorporate a membrane oxygenator, heater, and pumps to deliver to, and remove
from the lungs tidal volume aliquots of conditioned perfluorocarbon (PFC). One research group
led by Thomas H. Shaffer has maintained that with the use of microprocessors and new
technology, it is possible to maintain better control of respiratory variables such as liquid
functional residual capacity and tidal volume during TLV, than with gas ventilation.

Consequently, the total liquid ventilation necessitates a dedicated liquid ventilator similar to a
medical ventilator except that it uses a breatheable liquid. Many prototypes are used for animal
experimentations, but experts recommend continued development of a liquid ventilator toward
clinical applications.

[edit] Partial liquid ventilation
In contrast, partial liquid ventilation (PLV) is a technique in which a PFC is instilled into the
lung to a volume approximating functional residual capacity (approximately 40% of Total Lung
Capacity (TLC)). Conventional mechanical ventilation delivers tidal volume breaths on top of it.
This mode of liquid ventilation currently seems technologically more feasible than total liquid
ventilation, because PLV could utilise technology currently in place in many neonatal intensive-
care units (NICU) worldwide.
The influence of PLV on oxygenation, carbon dioxide removal and lung mechanics has been
investigated in several animal studies using different models of lung injury
applications of PLV have been reported in patients with acute respiratory distress syndrome
(ARDS), meconium aspiration syndrome, congenital diaphragmatic hernia and respiratory
distress syndrome (RDS) of neonates. In order to correctly and effectively conduct PLV, it is
essential to
1. properly dose a patient to a specific lung volume (10-15 ml/kg) to recruit alveolar volume and
2. redose the lung with PFC liquid (1-2 ml/kg/hr) to oppose PFC evaporation from the lung.
If PFC liquid is not maintained in the lung, PLV can not effectively protect the lung from
biophysical forces associated with the gas ventilator.
New application modes for PFC have been developed.

[edit] PFC vapor
Vaporization of perfluorohexane with two anesthetic vaporizers calibrated for perfluorohexane
has been shown to improve gas exchange in oleic acid-induced lung injury in sheep.

Predominantly PFCs with high vapor pressure are suitable for vaporization
[edit] Aerosol-PFC
With aerosolized perfluorooctane, significant improvement of oxygenation and pulmonary
mechanics was shown in adult sheep with oleic acid-induced lung injury.
In surfactant-depleted piglets, persistent improvement of gas exchange and lung mechanics was
demonstrated with Aerosol-PFC.
The aerosol device is of decisive importance for the efficacy
of PFC aerosolization, as aerosolization of PF5080 (a less purified FC77) has been shown to be
ineffective using a different aerosol device in surfactant-depleted rabbits. Partial liquid
ventilation and Aerosol-PFC reduced pulmonary inflammatory response.

[edit] Proposed uses
[edit] Diving
Gas pressure increases with depth, rising 1 bar every 10 meters to over 1,000 bar at the bottom of
the Mariana Trench. Diving becomes more dangerous as depth increases, and deep diving
presents many hazards. All surface-breathing animals are subject to decompression sickness,
including aquatic mammals
and free-diving humans (see taravana). Breathing at depth can
cause nitrogen narcosis and oxygen toxicity. Ascending after breathing at depth can cause air
embolisms, burst lung, and collapsed lung.
Special breathing gas mixes such as trimix or heliox ameliorate the risk of decompression illness
but do not eliminate it. Heliox further eliminates the risk of nitrogen narcosis but introduces the
risk of helium tremors below 500 feet (152 meters). Atmospheric diving suits maintain body and
breathing pressure at 1 bar, eliminating most of the hazards of descending, ascending, and
breathing at depth. However, the rigid suits are bulky, clumsy, and very expensive.
Liquid breathing offers a third option,
promising the mobility available with flexible dive
suits and the reduced risks of rigid suits. With liquid in the lungs, the pressure within the diver's
lungs could accommodate changes in the pressure of the surrounding water without the huge gas
partial pressure exposures required when the lungs are filled with gas. Liquid breathing would
not result in the saturation of body tissues with high pressure nitrogen or helium that occurs with
the use of non-liquids, thus would reduce or remove the need for slow decompression.
A significant problem, however, arises from the high viscosity of the liquid and the
corresponding reduction in its ability to remove CO
All uses of liquid breathing for diving
must involve total liquid ventilation (see above). Total liquid ventilation, however, has difficulty
moving enough liquid to carry away CO
, because no matter how great the total pressure is, the
amount of partial CO
gas pressure available to dissolve CO
into the breathing liquid can never
be much more than the pressure at which CO
exists in the blood (about 40 mm of mercury

At these pressures, most fluorocarbon liquids require about 70 mL/kg minute-ventilation
volumes of liquid (about 5 L/min for a 70 kg adult) to remove enough CO
for normal resting
This is a great deal of fluid to move, particularly as liquids are generally more
viscous than gases, (for example water is about 850 times the viscosity of air
). Any increase in
the diver's metabolic activity also increases CO
production and the breathing rate, which is
already at the limits of realistic flow rates in liquid breathing.
It seems unlikely that a
person would move 10 liters/min of fluorocarbon liquid without assistance from a mechanical
ventilator, so "free breathing" may be unlikely.
[edit] Medical treatment

Computer-generated model of perflubron and gentamicin molecules in liquid suspension for pulmonary
The most promising area for the use of liquid ventilation is in the field of pediatric
The first medical use of liquid breathing was treatment of premature
and adults with acute respiratory distress syndrome (ARDS) in the 1990s.
Liquid breathing was used in clinical trials after the development by Alliance Pharmaceuticals of
the fluorochemical perfluorooctyl bromide, or perflubron for short. Current methods of positive-
pressure ventilation can contribute to the development of lung disease in pre-term neonates,
leading to diseases such as bronchopulmonary dysplasia. Liquid ventilation removes many of the
high pressure gradients responsible for this damage. Furthermore, perfluorocarbons have been
demonstrated to reduce lung inflammation,
improve ventilation-perfusion mismatch and
to provide a novel route for the pulmonary administration of drugs.

In order to explore drug delivery techniques that would be useful for both partial and total liquid
ventilation, more recent studies have focused on PFC drug delivery using a nanocrystal
suspension. The first image is a computer model of a PFC liquid (perflubron) combined with
gentamicin molecules.
The second image shows experimental results comparing both plasma and tissue levels of
gentamicin after an intratracheal (IT) and intravenous (IV) dose of 5 mg/kg in a newborn lamb
during gas ventilation. Note that the plasma levels of the IV dose greatly exceed the levels of the
IT dose over the 4 hour study period; whereas, the lung tissue levels of gentamicin when
delivered by an intratracheal (IT) suspension, uniformly exceed the intravenous (IV) delivery
approach after 4 hours. Thus, the IT approach allows more effective delivery of the drug to the
target organ while maintaining a safer level systemically. Both images represent the in-vivo time
course over 4 hours. Numerous studies have now demonstrated the effectiveness of PFC liquids
as a delivery vehicle to the lungs.

Comparison of IT and IV administration of gentamicin.
Clinical trials with premature infants, children and adults were conducted. Since the safety of the
procedure and the effectiveness were apparent from an early stage, the US Food and Drug
Administration (FDA) gave the product "fast track" status (meaning an accelerated review of the
product, designed to get it to the public as quickly as is safely possible) due to its life-saving
potential. Clinical trials showed that using perflubron with ordinary ventilators improved
outcomes as much as using high frequency oscillating ventilation (HFOV). But because
perflubron was not better than HFOV, the FDA did not approve perflubron, and Alliance is no
longer pursuing the partial liquid ventilation application. Whether perflubron would improve
outcomes when used with HFOV remains an open question.
In 1996 Mike Darwin and Dr. Steven B. Harris proposed using cold liquid ventilation with
perfluorocarbon to quickly lower the body temperature of victims of cardiac arrest and other
brain trauma to allow the brain to better recover.
The technology came to be called gas/liquid
ventilation (GLV), and was shown able to achieve a cooling rate of 0.5 C per minute in large
It has not yet been tried in humans.
Most recently, hypothermic brain protection has been associated with rapid brain cooling. In this
regard, a new therapeutic approach is the use of intranasal perfluorochemical spray for
preferential brain cooling.
The nasopharyngeal (NP) approach is unique for brain cooling due
to anatomic proximity to the cerebral circulation and arteries. Based on preclinical studies in
adult sheep, it was shown that independent of region, brain cooling was faster during NP-
perfluorochemical versus conventional whole body cooling with cooling blankets. To date, there
have been four human studies including a completed randomized intra-arrest study (200
Results clearly demonstrated that prehospital intra-arrest transnasal cooling is
safe, feasible and is associated with an improvement in cooling time.
[edit] Space travel
Liquid immersion provides a way to reduce the physical stress of G forces. Forces applied to
fluids are distributed as omnidirectional pressures. Because liquids cannot be practically
compressed, they do not change density under high acceleration such as performed in aerial
maneuvers or space travel. A person immersed in liquid of the same density as tissue has
acceleration forces distributed around the body, rather than applied at a single point such as a
seat or harness straps. This principle is used in a new type of G-suit called the Libelle G-suit,
which allows aircraft pilots to remain conscious and functioning at more than 10 G acceleration
by surrounding them with water in a rigid suit.
Acceleration protection by liquid immersion is limited by the differential density of body tissues
and immersion fluid, limiting the utility of this method to about 15 to 20 G.
acceleration protection beyond 20 G requires filling the lungs with fluid of density similar to
water. An astronaut totally immersed in liquid, with liquid inside all body cavities, will feel little
effect from extreme G forces because the forces on a liquid are distributed equally, and in all
directions simultaneously. However effects will be felt because of density differences between
different body tissues, so an upper acceleration limit still exists.
Liquid breathing for acceleration protection may never be practical because of the difficulty of
finding a suitable breathing medium of similar density to water that is compatible with lung
tissue. Perfluorocarbon fluids are twice as dense as water, hence unsuitable for this application.

On the other hand, although perfluorochemicals are denser than water, lung tissue floats within
the PFC filled lungs, and if the lungs are not over-filled, there is no compromise in pulmonary or
systemic blood flow.
Therefore, if the astronaut is immersed in liquid and their lungs are filled
with liquid PFC, they should not experience adverse effects, in spite of the almost twofold
density difference. Based on interviews with adult patients that experienced partial liquid
ventilation, when they became conscious they were unaware that 20-30 ml/kg of PFC was in
their lungs during recovery.
[edit] Examples in fiction
Joe Haldeman's 1975 Novel The Forever War describes liquid immersion and breathing in great
detail as a key technology to allow space travel and combat with acceleretion up to 25 G.
In The Lost Symbol by Dan Brown, Robert Langdon (the protagonist) is completely submerged in
breathable liquid mixed with hallucination agents and sedatives as a torture technique by Mal'akh
(the antagonist). He goes through a near death experience when he inhales the liquid and blacks
out, losing control over his body, but is soon revived.
The James Cameron film The Abyss features a character using liquid breathing to dive thousands of
feet without compressing. The Abyss also features a scene with a rat submerged in and breathing
fluorocarbon liquid, filmed in real life.

In the anime Neon Genesis Evangelion, the cockpits of the titular Mecha are filled with a fictional
oxygenated liquid called LCL which helps to dampen impacts on the pilot in battle and helps him to
better psychically-synchronize with his biomechanical vehicle.
The aliens in the Gerry Anderson UFO series use liquid-breathing spacesuits.
Hal Clement's 1973 novel Ocean on Top portrays a small underwater civilization living in a 'bubble'
of oxygenated fluid denser than seawater.
In an episode of the Adult Swim cartoon series Metalocalypse, the other members of the band
submerge guitarist Toki in a "liquid oxygen isolation chamber" while recording an album in the
Mariana Trench.
In an episode of the SyFy Channel show Eureka, Sheriff Jack Carter is submerged in a tank of
"oxygen rich plasma" to be cured of the effects of a scientific accident.
In the movies Mission to Mars and Event Horizon, a character is depicted as being immersed in
apparent breathable fluid before a high-acceleration launch.
In season 1, episode 13 of Seven Days chrononaut Frank Parker is seen breathing a hyper-
oxygenated perfluorocarbon liquid that is pumped through a sealed full body suit that he is wearing.
This suit and liquid combination allow him to board a Russian submarine through open ocean at a
depth of almost 1000 feet. Upon boarding the submarine he removes his helmet, expels the liquid
from his lungs and is able to breathe air again.
Ben Bova's novel Jupiter features a craft in which the crew are suspended in a breathable liquid that
allows them to survive in the high pressure environment of Jupiter's atmosphere.
In the book Mechanicum from the Horus Heresy series of novels in the Warhammer 40,000 setting,
physically crippled Titan pilots are encased in nutrient fluid tanks to allow them to continue
operating beyond the limits normally imposed by the body.
In the classic PC Turn-Based Strategy game X-COM: Terror from the Deep, "Aquanauts" fighting deep
ocean conditions breathe a dense oxygen-carrying fluid.
In the Star Trek: The Next Generation novel "The Children of Hamlin" the crew of the Enterprise-D
encounter an alien race whose ships contain a breathable liquid environment.

Bohr effect
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Hemoglobin Dissociation Curve. Dotted red line corresponds with shift to the right caused by Bohr effect
Bohr effect is a property of hemoglobin first described in 1904 by the Danish physiologist
Christian Bohr (father of physicist Niels Bohr), which states that an increasing concentration of
protons and/or carbon dioxide will reduce the oxygen affinity of hemoglobin
. Increasing blood
carbon dioxide levels can lead to a decrease in pH because of the chemical equilibrium between
protons and carbon dioxide.
1 Proton and oxygen coupling
2 Physiological role
3 Carbamates
4 Effects of cooperativity
5 See also
6 References
7 External links
[edit] Proton and oxygen coupling
In deoxyhemoglobin, the N-terminal amino groups of the -subunits and the C-terminal histidine
of the -subunits participate in ion pairs. The formation of ion pairs causes them to decrease in
acidity. Thus, deoxyhemoglobin binds one proton for every two O
released. In oxyhemoglobin,
these ion pairings are absent and these groups increase in acidity. Consequentially, a proton is
released for every two O
bound. Specifically, this reciprocal coupling of protons and oxygen is
the Bohr effect.

[edit] Physiological role
This effect facilitates oxygen transport as hemoglobin binds to oxygen in the lungs, but then
releases it in the tissues, particularly those tissues in most need of oxygen. When a tissue's
metabolic rate increases, its carbon dioxide production increases. Carbon dioxide forms
bicarbonate through the following reaction:
+ H

Although the reaction usually proceeds very slowly, the enzyme family, carbonic anhydrase
in red blood cells accelerates the formation of bicarbonate and protons. This causes the pH of
tissues to decrease, and so, promotes the dissociation of oxygen from hemoglobin to the
tissue, allowing the tissue to obtain enough oxygen to meet its demands. Conversely, in the
lungs, where oxygen concentration is high, binding of oxygen causes hemoglobin to release
protons, which combine with bicarbonate to drive off carbon dioxide in exhalation. Since
these two reactions are closely matched, there is little change in blood pH.
The dissociation curve shifts to the right when carbon dioxide or hydrogen ion concentration
is increased. This facilitates increased oxygen dumping. This mechanism allows for the body
to adapt the problem of supplying more oxygen to tissues that need it the most. When
muscles are undergoing strenuous activity, they generate CO
and lactic acid as products of
cellular respiration and lactic acid fermentation. In fact, muscles generate lactic acid so
quickly that pH of the blood passing through the muscles will drop to around 7.2. As lactic
acid releases its protons, pH decreases, which causes hemoglobin to release ~10% more

[edit] Carbamates
Carbon dioxide modulates O
binding to hemoglobin directly by combining reversibly to N-
terminal amino groups of blood proteins to form carbamates:
+ CO
+ H

Deoxyhemoglobin binds to CO
more readily to form a carbamate than oxyhemoglobin.
When CO
concentration is high (as in the capillaries), the protons released by carbamate
formation further promotes oxygen release. Although the difference in CO
between the oxy and deoxy states of hemoglobin accounts for only 5% of the total blood
, it is responsible for half of the CO
transported by blood. This is because 10% of
the total blood CO
is lost through the lungs in each circulatory cycle.

[edit] Effects of cooperativity
The Bohr effect is dependent on cooperative interactions between the hemes of the
hemoglobin tetramer. This is evidenced by the fact that myoglobin, a monomer with no
cooperativity, does not exhibit the Bohr effect. Hemoglobin mutants with weaker
cooperativity may exhibit a reduced Bohr effect.
In the Hiroshima variant hemoglobinopathy, cooperativity in hemoglobin is reduced, and
the Bohr effect is diminished. During periods of exercise, the mutant hemoglobin has a
higher affinity for oxygen and tissue may suffer minor oxygen starvation.

Cerebral hypoxia
From Wikipedia, the free encyclopedia
(Redirected from Brain hypoxia)
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For other uses, see hypoxia (disambiguation).
Cerebral hypoxia
Classification and external resources

Circle of Willis
Arteries beneath brain
ICD-9 437.9
MeSH D002534
Cerebral hypoxia refers to a reduced supply of oxygen to the brain. Cerebral anoxia refers to a
complete lack of oxygen to the brain. There are four separate categories of cerebral hypoxia; in
order of severity they are; diffuse cerebral hypoxia (DCH), focal cerebral ischemia, cerebral
infarction, and global cerebral ischemia. Prolonged hypoxia induces neuronal cell death via
apoptosis resulting in a hypoxic brain injury.

Cases of total oxygen deprivation are termed anoxia, which can be hypoxic in origin i.e. reduced
oxygen availability, or ischemic in origin i.e., oxygen deprivation due to a disruption in blood
flow. Brain injury as a result of oxygen deprivation either due to hypoxic or anoxic mechanisms
are generally termed hypoxic/anoxic injuries (HAI). Hypoxic ischemic encephalopathy (HIE) is
a condition that occurs when the entire brain is deprived of an adequate oxygen supply, but the
deprivation isn't total. While HIE is associated in most cases with oxygen deprivation in the
neonate due to birth asphyxia, it can occur in all age groups, and is often a complication of
cardiac arrest.

1 Classification
2 Causes
3 Signs and symptoms
4 Treatment
5 Prognosis
6 See also
7 References
[edit] Classification
Cerebral hypoxia is typically grouped into four categories depending on the severity and location
of the brains oxygen deprivation:

Aneuyrsm in a cerebral artery
One cause of Hypoxic Anoxic Injury (HAI).
1. Diffuse cerebral hypoxia. A mild to moderate impairment of brain function due to low oxygen
levels in the blood.
2. Focal cerebral ischemia; is a stroke occurring in a localized area that can either be acute (sudden
onset)and/ or transient (of short duration). This may be due to a variety of medical conditions
such as an aneuryrsm which causes a hemorrhagic stroke, or an occlusion occurring in the
affected blood vessel/s due to a thrombus (thrombotic stroke) or embolus (embolic stroke).

Focal cerebral ischemia constitutes a large majority of the clinical cases in stroke pathology with
the infarct usually occurring in the middle cerebral artery (MCA).

3. Global cerebral ischemia. A complete stoppage of blood flow to the brain.
4. Massive Cerebral infarction; is a "stroke", caused by complete oxygen deprivation due to an
interference in cerebral blood flow which affects multiple areas of the brain.

Cerebral hypoxia can also be classified by the cause of the reduced brain oxygen:

Hypoxic hypoxia. Limited oxygen in the environment causes reduced brain function. Divers,
mountain climbers and fire fighters are all at risk for this kind of cerebral hypoxia. The
term also includes oxygen deprivation due to obstructions in the lungs. Choking, strangulation, the
crushing of the windpipe all cause this sort of hypoxia. Severe asthmatics may also experience
symptoms of hypoxic hypoxia.
Hypemic hypoxia. Reduced brain function is caused by inadequate oxygen in the blood despite
adequate environmental oxygen. Anemia and carbon monoxide poisoning are common causes of
hypemic hypoxia.
Ischemic hypoxia (a.k.a. stagnant hypoxia). Reduced brain oxygen is caused by inadequate blood
flow to the brain. Stroke, shock, and heart attacks are common causes of stagnant hypoxia. Ischemic
hypoxia can also be created by pressure on the brain. Cerebral edema, brain hemorrhages and
hydrocephalus exert pressure on brain tissue and impede their absorption of oxygen.
Histotoxic hypoxia. Oxygen is present in brain tissue but cannot be metabolized. Cyanide poisoning
is a well known example.
[edit] Causes
Cerebral hypoxia can be caused by any event that severely interferes with the brain's ability to
receive or process oxygen. This event may be internal or external to the body.
Mild and moderate forms of cerebral hypoxia may be caused by various diseases that interfere
with breathing and blood oxygenation. Severe asthma and various sorts of anemia can cause
some degree of diffuse cerebral hypoxia. Other causes include work in nitrogen rich
environments, ascent from a deep water dive, flying at high altitudes in an un-pressurized cabin,
and intense exercise at high altitudes prior to acclimatization.
Severe cerebral hypoxia and anoxia is usually caused by traumatic events. Examples include
choking, drowning, strangulation, smoke inhalation, drug overdoses, crushing of the trachea,
status asthmaticus, and shock.
It is also recreationally self-induced in the fainting game and in
erotic asphyxiation.
Transient ischemic attack (TIA), is often referred to as a "mini-stroke". The American Heart
Association and American Stroke Association (AHA/ASA) refined the definition of transient ischemic
attack. TIA is now defined as a transient episode of neurologic dysfunction caused by focal brain,
spinal cord, or retinal ischemia, without acute infarction. The symptoms of a TIA can resolve within
a few minutes unlike a stroke. TIAs share the same underlying etiology as strokes; a disruption of
cerebral blood flow. TIAs and strokes present with the same symptoms such as contralateral
paralysis (opposite side of body from affected brain hemisphere), or sudden weakness or
numbness. A TIA may cause sudden dimming or loss of vision, aphasia, slurred speech and mental
confusion. The symptoms of a TIA typically resolve within 24 hours unlike a stroke. Brain injury may
still occur in a TIA lasting only a few minutes. Having a TIA is a risk factor for eventually having a

Silent stroke is a stroke which does not have any outward symptoms, and the patient is typically
unaware they have suffered a stroke. Despite not causing identifiable symptoms a silent stroke still
causes damage to the brain, and places the patient at increased risk for a major stroke in the future.
In a broad study in 1998, more than 11 million people were estimated to have experienced a stroke
in the United States. Approximately 770,000 of theses strokes were symptomatic and 11 million
were first-ever silent MRI infarcts or hemorrhages. Silent strokes typically cause lesions which are
detected via the use of neuroimaging such as fMRI.
The risk of silent stroke increases with age
but may also affect younger adults. Women appear to be at increased risk for silent stroke, with
hypertension and current cigarette smoking being predisposing factors.

[edit] Signs and symptoms
The brain requires approximately 3.3 ml of oxygen per 100 g of brain tissue per minute. Initially
the body responds to lowered blood oxygen by redirecting blood to the brain and increasing
cerebral blood flow. Blood flow may increase up to twice the normal flow but no more. If the
increased blood flow is sufficient to supply the brains oxygen needs then no symptoms will

However, if blood flow cannot be increased or if doubled blood flow does not correct the
problem, symptoms of cerebral hypoxia will begin to appear. Mild symptoms include difficulties
with complex learning tasks and reductions in short-term memory. If oxygen deprivation
continues, cognitive disturbances and decreased motor control will result.
The skin may also
appear bluish (cyanosis) and heart rate increases. Continued oxygen deprivation results in
fainting, long term loss of consciousness, coma, seizures, cessation of brain stem reflexes, and
brain death.

Objective measurements of the severity of cerebral hypoxia depend on the cause. Blood oxygen
saturation may be used for hypoxic hypoxia, but is generally meaningless in other forms of
hypoxia. In hypoxic hypoxia 95-100% saturation is considered normal. 91-94% is considered
mild. 86-90% is considered moderate. Anything below 86% is considered severe.

It should be noted that cerebral hypoxia refers to oxygen levels in brain tissue, not blood. Blood
oxygenation will usually appear normal in cases of hypemic, ischemic and hystoxic cerebral
hypoxia. Even in hypoxic hypoxia blood measures are only an approximate guide the oxygen
level in the brain tissue will depend on how the body deals with the reduced oxygen content of
the blood.
[edit] Treatment
For newborn infants starved of oxygen during birth there is now evidence that hypothermia
therapy for neonatal encephalopathy applied within 6 hours of cerebral hypoxia effectively
improves survival and neurological outcome
[citation needed]
. In adults however the evidence is less
convincing and the first goal of treatment is to restore oxygen to the brain. The method of
restoration depends on the cause of the hypoxia. For mild to moderate cases of hypoxia, removal
of the cause of hypoxia may be sufficient. Inhaled oxygen may also be provided. In severe cases
treatment may also involve life support and damage control measures.
A deep coma will interfere with bodys breathing reflexes even after the initial cause of hypoxia
has been dealt with. Mechanical ventilation may be required. Additionally severe cerebral
hypoxia causes an elevated heart rate. In extreme cases the heart may tire and stop pumping.
CPR, defibrilation, epinephrine, and atropine may all be tried in an effort to get the heart to
resume pumping.
Severe cerebral hypoxia can also cause seizures. Seizures put the patient at
risk of self injury. If convulsions are sufficiently severe medical professionals may not be able to
provide medical treatment. Various anti-convulsant drugs may need to be administered before
treatment can continue.
Brain damage can occur both during and after oxygen deprivation. During oxygen deprivation,
cells die due to an increasing acidity in the brain tissue (acidosis). Additionally, during the period
of oxygen deprivation, materials that can easily create free radicals build up. When oxygen
enters the tissue these materials interact with oxygen to create high levels of oxidants. Oxidants
interfere with the normal brain chemistry and cause further damage. This is called reperfusion
Techniques for preventing damage to brain cells are an area of on-going research.Hypothermia
therapy for neonatal encephalopathy is the only evidence-supported therapy, but anti-oxidant
drugs, control of blood glucose levels, and hemodilution (thinning of the blood) coupled with
drug-induced hypertension are some treatment techniques currently under investigation.

In severe cases it is extremely important to act quickly. Brain cells are very sensitive to reduced
oxygen levels. Once deprived of oxygen they will begin to die off within five minutes.

[edit] Prognosis
Mild and moderate cerebral hypoxia generally has no impact beyond the episode of hypoxia.
Severe cerebral hypoxia is another matter. Outcome will depend on the success of damage
control measures, the amount of brain tissue deprived of oxygen, and the speed with which
oxygen was restored to the brain.
If cerebral hypoxia was localized to a specific part of the brain, brain damage will be localized to
that region. The long term effects will depend on the purpose of that portion of the brain.
Damage to the Broca's area and the Wernicke's area of the brain (left side) typically causes
problems with speech and language. Damage to the right side of the brain may interfere with the
ability to express emotions or interpret what one sees. Damage on either side can cause paralysis
of the opposite side of the body.
The effects of certain kinds of severe generalized hypoxias may take time to develop. For
example, the long term effects of serious carbon monoxide poisoning usually may take several
weeks to appear. Recent research suggests this may be due to an autoimmune response caused by
CO induced changes in the myelin sheath surrounding neurons.

If hypoxia results in coma, the length of unconsciousness is often used as an indication of long
term damage. In some cases coma can give the brain an opportunity to heal and regenerate,

but, in general, the longer a coma continues the greater the likelihood that the person will remain
in a vegetative state until death.
Even if the patient wakes up, brain damage is likely to be
significant enough to prevent a return to normal functioning.
The effects of long term comas are not limited to the comatose person. Long term coma can have
significant impact on their families.
Families of coma victims often have idealized images of
the outcome based on Hollywood movie depictions of coma.
Adjusting to the realities of
ventilators, feeding tubes, bedsores and muscle wasting may be difficult.
Treatment decision
often involve complex ethical choices and can strain family dynamics.

Haldane effect
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The Haldane effect is a property of hemoglobin first described by the Scottish physician John
Scott Haldane. Deoxygenation of the blood increases its ability to carry carbon dioxide; this
property is the Haldane effect. Conversely, oxygenated blood has a reduced capacity for carbon
1 Carbamino
2 Buffering
3 Clinical significance
4 See also
5 References
6 External links
[edit] Carbamino
Carbon dioxide can bind to amino groups, creating carbamino compounds. Amino groups are
available for binding at the N-terminals and at side-chains of arginine and lysine residues in
hemoglobin. This forms carbaminohemoglobin. Carbaminohemoglobin is the major contributor
to the Haldane effect.

[edit] Buffering
Histidine residues in hemoglobin can accept protons and act as buffers. Reduced (deoxygenated)
hemoglobin is a better proton acceptor than the oxygenated form.

In red blood cells, the enzyme carbonic anhydrase catalyzes the conversion of dissolved carbon
dioxide to carbonic acid, which rapidly dissociates to bicarbonate and a free proton:
+ H

By Le Chatelier's principle, anything that stabilizes the proton produced will cause the reaction
to shift to the right, thus the enhanced affinity of deoxyhemoglobin for protons enhances
synthesis of bicarbonate and accordingly increases capacity of deoxygenated blood for carbon
dioxide. The majority of carbon dioxide in the blood is in the form of bicarbonate. Only a very
small amount is actually dissolved as carbon dioxide, and the remaining amount of carbon
dioxide is bound to hemoglobin.
In addition to enhancing removal of carbon dioxide from oxygen-consuming tissues, the Haldane
effect promotes dissociation of carbon dioxide from hemoglobin in the presence of oxygen. In
the oxygen-rich capillaries of the lung, this property causes the displacement of carbon dioxide
to plasma as venous blood enters the alveolus and is vital for alveolar gas exchange.
The general equation for the Haldane Effect is: H
+ HbO
Hb + O
; however, this
equation is confusing as it reflects primarily the Bohr effect. The significance of this equation
lies in realizing that oxygenation of Hb promotes dissociation of H
from Hb, which shifts the
bicarbonate buffer equilibrium towards CO
formation; therefore, CO
is released from RBCs.
[edit] Clinical significance
In patients with lung disease, lungs may not be able to increase alveolar ventilation in the face of
increased amounts of dissolved CO
This partially explains the observation that some patients with emphysema might have an
increase in P
(partial pressure of arterial dissolved carbon dioxide) following administration
of supplemental oxygen even if content of CO
stays equal.