From the caves to the clinics

M. Alejandro Chaoul , Ph.D., Assistant Professor of Body MInd Integrative Therapy Program, is a mind-body intervention specialist at the University of Texas M.D. Anderson Cancer Center. He is a senior student of Tenzin Wangyal Rinpoche and instructor at Ligmincha Institute and teacher of the Three Doors.

::::::::::::>>Q & A session

One of the wonderful things of these yogas was how close they were with the Tibetan teachings that i was receiving. The meditation group in the monastery practised every morning and every evening. The main teaching was from the dzogchen tradition called trek chö or cutting through the conceptual mind and trying to stay in that meditative state. What was interesting was the way they did the practise. Usually they start with some prayers at the beginning, and then they would stay in that meditative state. But acknowledging that after a while the mind wanders, or falls asleep, you probably noticed sometimes your mind is thinking of some other things-maybe dinner, what your son, daughter, friend is doing, or sometimes you´re meditating and you nod off, but when that happens there are tools to re-energise you. About 20 mins into the practise, Khenpo Nyima Wangyal would stand up and do a set of the trul khor that we had just learned, and then again sit and continue in the meditation. I realised that these were very powerful to reconnect to that state of mind. And it was interesting that they worked both when I was tired or when my mind was all over the place in what we call in tibetan our monkey mind.

what kind of studies did you make?

Realising how much impact these practises can have no matter what tradition you´re coming from, I began volunteering at a large hospital in Houston, Texas called MD Anderson, just guiding meditation practises for cancer patients and their support groups. And I felt what I was learning from these patients was really helpful for them, as well as their caregivers. Dr Lorenzo Cohen, asked me to create a research protocol for patients, a “Yoga intervention“. At the time I was doing my dissertation on Tibetan Yoga, and with the advice and blessings of my teachers, Lopon Tenzin Namdak and Tenzin Wangyal Rinpoche, I created a program.

We began with our study of integrative medicine in the year 2000 up till 2002 with a population with Lymphoma. We worked out what to measure and how we wanted to work with these tibetan yogas in cancer populations. We were looking for changes in quality of life, and aspects such as intrusive thoughts, anxiety, sleep that have an impact in a better quality of life. So we were not necessarily looking at curing cancer but rather improving the experiencing of the person who had cancer

If you put it in another framework like medical anthropology you would say that its more really altering the illness than adjusting the disease. In our case in the cancer hospital the disease would be the cancer itself, but the illness is the experience that the patients are going through. It could be many things besides the cancer – how they´re feeling emotionally, personal factors like relocation, job loss due to sickness, language etc. All these things are going on that are part of the illness experience that is related but not circumscribed to only the disease.

results? quality of life, etc…

In that first study, one of the most significant things that we found was that we were able to improve their sleep. Sleep quality, quantity and latency, which is the moment you want to go to sleep until you go to sleep, and with less sleep medicine.

what other groups could benefit?

Then we did another study with some similar results. We moved into another population of women with breast cancer who were doing chemotherapy treatment. We were able to help them through the chemotherapy. They were able to sleep better, have less intrusive thoughts and a better quality of life in general. And then we were lucky that this got a lot of attention from the media and part of the scientific world. We were able to get a large grant from the national cancer Institute for 2 million dollars to study this with a larger population of patients. And we have just concluded recruitment of over 300 patients so soon we´ll have some results. What was really impressive was that we were seeing how these practises help. We were even able to bring aspects of practise into the study that in religious contexts were more secret, e.g. the internal aspect of the channels of the lung or the prana or vital breath. And the patients who were totally naive of what even yoga meant, were a perfect population. They hadn´t heard of meditation or yoga, yet they were connecting to the channels and to the breath by doing these practises including having different experiences. It was beautiful to see that we were able to connect them to the inner channels of the body.

what plans do you have, what research would you like to realise?

Because of what we find in the research, we can bring these so-called evidence based practises into the clinic, both in groups and individually. At MD Anderson we have Oncologists referring to mind body practices as part of a group of complementary and integrative medicine. We have massage therapists and acupuncturists, mind body practitioners and music therapists, nutritionists and exercise therapists and so forth always at the same table when we discuss patients, focusing on the whole picture. In our newsletter for example just for June, all these different practices are offered for free. Not just for the MD Anderson patients but for anyone touched by cancer, which means you know someone who has cancer and that has impacted you. Unfortunately today its almost everyone, so you are eligible!. Of course for the clinic part you have to be a patient. So what we are seeing is that its really entering more into the field of integrated medicine. But its been very important in a hospital like MD Anderson that it has to be what they call evidence based. So the research is very important. Therefore when I think of this path in a way its like the Tibetan yogas going from the caves to the research in the clinic.

Since 2000 Ligmincha Institute has been collaborating with the University of Texas M.D. Anderson Cancer Center in Houston to design and implement a Tibetan Yoga program for cancer patients, utilizing the tsa lung trulkhor from the Bön tradition.


I´d like to know about your studies. If you made control groups who did once or twice a day tsa lung and what difference it might have made?

How do you train your patients?

In terms of control group the first of 2 studies being the 2 pilot studies-one with Lymphoma, one with breast cancer patients. These patients were either undergoing treatments of chemotherapy or radiation or 12 months after treatment, and they were both receiving the same kind of conventional medicine.In addition, the intervention group was receiving tsa lung. Those who were randomised to control did not; but since it was a wait list control, after they finished the assessments one week, one month, 3 months, they could actually do the tsa lung intervention too. Those in the intervention group, were doing the tsa lung, meeting with the instructor once a week. And then they were given recordings and asked to practise daily if possible, and still meeting once a week for 7 weeks.

By doing tsa lung exercises if you trained your patients to work with their emotions?

In terms of the emotions, they were told that if an emotion came, that its fine, and taught to ‘host it’, welcome it and let it be there in that meditation state. Thats why it is important that you first train the mind. So before we even started with the movements it was meditation, breathing and then we´d slowly incorporate the movements. So by the time they incorporated the movements they had some meditation practise for a couple of weeks. Then they were able to host that emotion and work with it through the tsa lung movement.

In the large funded study we were able to include an active control group for stretching. And we chose the stretching from a stretching book for breast cancer patients. We selected the movement to be similar to those of the tsa lung, so a movement like the life-force tsa lung which includes extending an arm could be similar to the movement in the stretching which was more useful after receiving the mastectomy to improve stretching. So we would select similar movements and we would match in the movement side. There´s quite good literature in saying how exercise can be helpful in the psycho-social effects. So that was the active control and standard of care.

In the large study that we´re just finishing, we have the intervention being the Tibetan yoga and the Tsa lung, the active control being the stretching and the standard of care being a kind of passive control.

Are there no dietary restrictions or anything?

There was no specific indication of what diet to use – at least not from us in the research protocol. And unfortunately not from the hospital. However there seems to be some anecdotal responses from patients to the instructors as well as written feedback which indicates that patients who are in the active intervention of the Tibetan yoga and in other interventions seem to start thinking more in healthy habits. This is something that we might be looking at in terms of a qualitative research.

The other thing is that its clear in other studies that when you put more than one healthy behavioural change together, there´s not just an addition, but a synergy. For example if you combine exercise and nutrition the benefits are going to be more than just exercise plus nutrition. We are soon starting a study that we call the comprehensive lifestyle study which will include 4 kinds of practises: nutrition, exercise, mind body and social support.

Could you imagine in the future that this kind of mind body integrative work could be introduced or welcomed into other systems e.g. the education system helping students to energise their learning capacities and abilities?

Sure, absolutely! Actually there are some exploratory studies in that way, some with meditation, yoga, etc. There was a recent a study in the US that said that 48% of the time we are not where we are i.e. the mind is not with us in the body. And that during a big part of that time we are engaged in negative thoughts and emotions. ….and even when we were engaged in positive emotions but not present we were less happy, so they concluded that ‘a wandering mind is an unhappy mind’. With tsa lung, If you notice how you feel even after a short practise, you can feel that we can transform the state of mind from the way that we usually are. Part of these practises of the magical movement is that we feel the magic. Again the magic is not this esoteric thing but its actually opening your heart. Of being seated emotionally, mentally and spiritually, not just physically. And maybe that seating, that presence allows us to be less wandering not just in practice but also in every day life, and thus be more happy. It is with that intention that we want to share it with others.