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Study - "Sukhmani and High Blood Pressure"

Journal of Sikh Studies
Department of Guru Nanak Studies
Guru Nanak Dev University


 

This is a beautiful study of 'psalam of peace'- Sukhmani Sahib is suppose to provide peace. Thanks to researchers Dr Harcharan, Dr Ajinder. A good job! May Guru ji give you all peace too! sukh - happiness The first canto of sukhmani if rightly read nd understood is enough to realise what a soothing effect this 'bani' has for a reader, what more if read daily 'net-net japo bhai! Sukhmani' essence is for daily reading, and those who have made it their daily 'bhajan' are always in peace and tranquility- that is what it promises and then delivers.
Go for it fellow brothers!

The Editor:

The 'Sukhmani' a poem of one hundred and ninety two cantos, composed by Guru Arjan Dev, the fifth Guru of the Sikhs, and included in the Guru Granth Sahib, the Sikh Scripture, is claimed by its author, to cure distress, disease and confusion. It's recitation is popularly believed to be tranqualising and soothing, but not even a tentative scientific investigation has ever been conducted by any of our medical scientists to substantiate the popular belief. The "Journal of Sikh Studies" takes pleasure in publishing the report of a scientific enquiry into the curative influence of 'Sukhmani' in cases of High Blood Pressure. Dr. Harcharan Singh, the eminent physician, under whose guidance the present research has been conducted is presently engaged in guiding two other similar research theses for M.D. Degrees of Guru Nanak Dev University. The subjects relate to:

(i) The Curative Value of Dips under Dukh Bhanjani Tree in the Amrit Sarovar
(ii) The Effect of Devotional Music (Kirtan) on Cardiac Neurosis

It is hoped that the scientific lead given by the Professor & Head of the Department of Medicine, Government Medical College, Amritsar, will be taken up by other medical scientists, in order to achieve further confirmation of results so that all possibilities of their contamination through methodological or procedural errors and ommissions, if any, are eliminated. In order to facilitate clear understanding of the subject, a glossary of technical words has been given at the end of the paper.

(The first part of the paper describes the various non-drug techniques used to control hypertension which had been evaluated before the present study. These include Transcendental Meditation, Yoga, Biofeedback, Relaxation Techniques, Psychotherapy, Environmental Modification, Suggestion and Placebo Effect and Reassurance. This study was published in 1979.)  

THE SUKHMANI AND HIGH BLOOD PRESSURE: FINDINGS OF A CLINICAL ENQUIRY

Authors:

Dr. Harcharan Singh
Professor and Head Department of Medicine and Vice-Principal
Medical College, Amritsar

(Dr)Ajinder Singh
Post-Graduate Student of Medicine
Medical College, Amritsar

Statistical Analysis was conducted by:-
S. Rattan Singh & S. Swaran Singh
Punjab Irrigation Department
Amritsar  

The Present Study

In the present study we have checked the comparative effects of Sukhmani recitation/non-recitation on the blood pressure of the hypertensive patients and compiled the results.

The text of "Sukhmani" is designed to stir the deeps of human nature and to start a current of religious emotions that will cleanse and invigorate our tiny selves and unite them with the Source of all existence. It soothes the heart in affliction, and deepens the joy in life.[1]

The most characterstic feature of the "Psalm of Peace" (the Sukhmani) is the soothing effect it has on the nerves, shattered by the life of hurry and furious activity, and on the soul tossed on by the waves of passion and inordinate desire. There is in it the still sad music of humanity, a lyrical cry rising from the heart that has known suffering and found peace. It is a peace behind which lies a tremendous struggle with pain, culminating in victory, like the calm of the serene weather brought about by a shower of rain following a storm of dust and wind.[2]

The English translation of the first canto of the "Sukhmani" starts as:

"Remember, remember God, by remembering Him you shall obtain happiness
And erase from your hearts trouble and affliction."[3]

The last canto of "Sukhmani" ends as follows:

"He who listens to this Psalm with love, and gives it a place in his heart,
Shall be able to commune with the Lord,
His fear of falling back into the groves of mortality shall be over,
And this much-cherished life shall be consummated in an instant;
With the Name of the Sole Master inspiring his mind,
His fame shall be spotless; and his words immortal.
All sorrows, pains and fears shall roll away,
Leaving him serene in character, with the Name of a Saint to distinguish him.
Thus shall his life be crowned with the highest glory,
Wherefore this Hymn has been called "The Psalm of Peace"[4]  

Patients and Method

There are atleast four 'Sukhmani Sahib Societies' in Amritsar. All members of these societies congregate on Sundays to recite Sukhmani. Many of them, invariably, recite this sacred text at their homes as well. These societies were approached and the aims of the study were explained to their members. Any member who has been reciting the Sukhmani every week for the last three months fulfilled the criterion for inclusion in the study. A total of 336 such recitors were checked up and comprised 'Group A'.

'Group B' comprised a random collection of 412 subjects who were checked up for their blood pressure at their homes. Broadly speaking, they matched in age, food habits, area and socio-economic conditions to that of Group A.

A standardised aneuroid sphymomanometer, checked for its accuracy, and having a cuff-width of 5 inches was employed. The brachial blood pressure was checked while the subjects were in the sitting position. Ordinarily the subjects were not allowed preliminary rest, prior to the examination. But any subject, with blood pressure reading higher than 150/90 mmHg, not known to be hypertensive, was checked up again after 10 minutes rest. All those found to be hypertensive were subjected to all necessary investigations, including fundus examination, electrocardiography and radiography.

The hypertensive patients were divided into two groups: 'Trial Group' and 'Control Group'.

The patients, of both groups, were put on an equal dosage of the drug Indapamide, a new antihypertensive agent except three who were put on another drug.

Twenty-five patients comprised the 'Trial Group'. Only those who had profound faith in the curative potency of the Sukhmani were included in this trial.

These patients were instructed to recite at their homes one-sixth part of the Sukhmani which took about 10 minutes. This was done for 6 days. On the 7th day, i.e., on every sunday, they were required to sit down in the company of others to recite collectively the whole of the Sukhmani in 60-75 minutes. They were checked fortnightly and the progress was noted. The blood pressure was checked by a third person, who did not know the group to which the patient belonged so as to eliminate any factor of bias. They were given a 10 minute preliminary rest before their blood-pressure was checked.

Twenty five patients comprised the 'Control Group'. They were also treated with the same drug and the same dosage (dose of Indapamide was one tablet of 2.5 mg per day), short of the Sukhmani recitation. They were also checked and followed in the similar way.  

Observation

A total of 748 subjects belonging to both the groups, namely, 'recitors' and 'non-recitors' of the Sukhmani was checked up for their blood pressure. 347 out of them were males and 401 were females. The incidence of hypertension in the checked population was 7.48%.

The incidence of hypertension amongst the total number of subjects studied according to their sex-distribution is shown below:

(Table:1)

Total Males Females
Population Surveyed 748 347 401
Hypertensive 56 25 31
Percentage 7.48% 7.21% 7.73%

Out of the total of 748, 336 subjects were regular recitors of the Sukhmani and 412 subjects were non-recitors. Sixteen people were found to be hypertensive amongst the recitors whereas 40 subjects suffered from hypertension out of the non-recitors, i.e., their blood pressure recording was persistently higher than 150/90 mmHg. The incidence of hypertension was found to be 4.76% and 9.70% in the recitors and non-recitors, respectively as shown below:

(Table:2)

  Recitors Non-Recitors
  Number % Number %
Hypertensive 16 4.76% 40 9.70%
Non-Hypertensive 320 95.24% 372 90.30%

The data given above has been checked statistically using the Chi Square test. The X~2 (X to the power 2) value has been found to be 6.33, which means that the difference between the incidence of hypertension in both these groups is statistically significant.

The incidence of hypertension and the sex-distribution amongst the hypertensives belonging to both these groups is shown below:

(Table:3)

  No. of cases studied No.of hyper-tensives % No. of cases studied No.of hyper-stensives % Ave.
Males: 152 5 3.28% 195 20 10% 0.25%
Females: 184 11 5.97% 217 20 9.2% 1%
Total: 336 16 4.76% 412 40 9% 0.70%

Age and sex distribution amongst the hypertensives in the recitors and the non-recitors is given below:

(Table:4)

Age (yrs) Males Females Total
  Recitors Non-Recitors Recitors Non-Recitors Recitors Non-Recitors
(11-20) (--) (--) (--) (--) (--) (--)
(21-30) (--) (1) (--) (3) (--) (4)
(31-40) (1) (3) (2) (3) (3) (6)
(41-50) (1) (8) (4) (3) (5) (11)
(51-60) (1) (4) (4) (7) (5) (11)
(61-70) (2) (3) (1) (3) (3) (6)
(71-80) (--) (1) (--) (1) (--) (2)
(81-90) (--) (--) (--) (--) (--) (--)
Total: (5) (20) (11) (20) (16) (40)

The sex-distribution among the Trial and Control groups is shown below:

(Table:5)

  Trail Group Control Group
  Males Females Males Females
  (10) (15) (13) (12)
Total: (25) (25)

Ten patients out of the sixteen hypertensives of the 'Recitor Group' were included in the 'Trial Group', and the rest did not join the study. Fifteen other patients, from the out-patient clinic, who were having faith in the curative potency of the recitation of the Sukhmani were included in the study, thereby, making the total of 25 patients in the Trial Group.

Age distribution in both the groups is as follows:-

(Table:6)

Age(yrs) Trial Group Control Group
(11-20) (--) (--)
(21-30) (1) (--)
(31-40) (6) (8)
(41-50) (6) (11)
(51-60) (9) (3)
(61-70) (3) (3)
(71-80) (--) (--)
(81-90) (--) (--)
Total: (25) (25)

The vast majority of the patients had idiopathic hypertension. Two patients belonging to the 'Trial Group' revealed renal stones on plain skiagrams of the abdomen. Further relevant investigations were done. One patient firmly refused to undergo operation for removal of these stones while surgery is yet to be undertaken in the other case. Two control patients gave the past history of renal stones but relevant investigations did not reveal any renal stone. The complete urine examination of all the patients was normal.

The mean blood pressure reading in the 'Trial Group', at the start of the treatment was 175.2 mmHg systolic and 108.4 mmHg diastolic. After the treatment and observation period of three months, the mean blood pressure recording came down to 144.8 mmHg systolic and 92.2 mmHg diastolic.

The mean blood pressure in the 'Control Group', before the treatment was 179.6 mmHg systolic and 108.4 mmHg diastolic. After the treatment and observation of three month period, the mean blood pressure reading came down to 149.4 mmHg and 97.2 mmHg diastolic.

The results in both the groups were tested statistically by applying 't' test. The average diastolic blood pressure reading in both groups was 108.4 mmHg. It decreased to 92.2 mmHg and 97.2 mmHg in cases of 'Trial' and 'Control' groups respectively. This mean difference i.e., the difference between 97.2 and 92.2 was tested by using the 't' test. The value of 't' was found to be 2.000, which is statistically significant at about 6% level, obviously much above the 10% level, indicating thereby that the level of diastolic blood pressure has decreased more in cases of the 'Trial Group' ('t' value at 5% level and 40 degrees of freedom is 2.021 and the 't' value at 5% level and 60 degrees of freedom is 2.00)

(Table:7)

Blood Pressure Trial Group Control Group
  Before Treatment After Treatment Before Treatment After Treatment
  mmHg mmHg mmHg mmHg
Systolic (175.2) (144.8) (179.6) (149.4)
Diatolic (108.4) (92.9) (108.4) (97.2)

Out of twenty five participants in the 'Trial Group', twenty two were initially put on the drug Indapamide (Natrilex) and the rest were put on Emdopa and Chlorthalidone. They all responded well to the treatment. In the 'Control Group' in which all of them were initially put on Natrilex, five patients did not respond to the drug and were failures in connection with this drug after a fair trial of about four weeks, and the rest continued with it. They were all controlled with the treatment. The four failures were then put on other medicines like Endopa and Frusemide and tranquilisers. One of these patients did not respond to this treatment also and so this patient and the fifth failure on Natrilex were controlled with Reserpine, Chlorthalidone and tranquilisers. Drug Procainamide was used in another Control patient for the frequent ventricular ectopics (Extra beats) that the patient was having.

The amount of the drugs used to control the blood pressure in both the groups was calculated. The amount of the drugs used in the 'Trial Group' was much less than it was required in the 'Control Group' as shown below:

(Table:8)

Name of Drug used Trial Group Control Group
  Total Amount Number of Patients Amount per Patient Total Amount Number of Patients Amount per Pat.
Emdopa (28.5G) (2) (14250.0mg) (127.0G) (4) (317 50.0mg) (222.15G)* (5553 7.5mg)*
Reserpine (--) (--) (--) (0.4525mg) (2) (22.62mg) (0.675G)* (33.7 5mg)*
Chlorthalidone (0.6G) (1) (600.0mg) (9.05G) (2) (4525 .0mg) (13.50G)* (6750 .0mg)*
Frusemide (--) (--) (--) (1.76G) (3) (586 .6mg) (5.52G)* (184 0.0mg)*
Diazpam (--) (--) (--) (2.31G) (3) (770 .0mg)
Haloparidol (--) (--) (--) (0.0135G) (1) (13. 50mg)
Procainamide# (--) (--) (--) (53.25G) (1) (532 5.0mg)
Indapamide (3.27G) (22) (148.63mg) (2.81G) (20) (140 .5mg) (0.58G) (5)!

 

 

 

 

 

 

Notes:
* This is the computed amount of medicine needed for the duration of three months
! These patients did not respond to Natrilex and so they were put on other medicines as mentioned.
# It was used for venticular ectopics in the case of one patient.

Three patients in the 'Trial Group' required drug treatment for a shorter period of two to four weeks and were controlled only on 'Recitation Therapy'.

Three patients of the 'Trial Group' could not attend the weekely congregations to recite the Sukhmani because no such congregations were held in their localities, but they used to recite the Sukhmani regularly at their homes. Three other patients were irregular with their recitation programmes and attendence of the congregations. The rest of the patients were regular. The first group of patients is categorised as 'II-a' and the other three patients who were quite irregular are categorised as 'II-b'. The remaining nineteen patients of the 'Trial Group' are designated as 'Group I'.

The mean blood pressure in 'Group I' was 176.05 mmHg and 109.47 mmHg systolic and diastolic respectively. It came down to 144.73 and 91.57 mmHg respectively, after treatment. The average fall of blood pressure in this group is 31.32/17.90 mmHg. In Goup II the mean sytolic/diastolic blood pressure of 172.5/105.0 mmHg came down to 145.0/94.16 mmHg with an average fall of blood pressure as 27.5/10.84 mmHg. The mean bllod pressure figures in Group II-a came down from 173.3/108.3 mmHg to 145.0/96.7 mmHg with the treatment. The average fall of blood pressure in this group works out to be 28.3/11.6 mmHg. In Group II-b the mean blood pressure recording was 171.7/101.7 mmHg before treatment and 145.0/91.7 mmHg after treatment. The average fall of blood pressure in this subgroup is 26.7/10.0 mmHg. The mean fall in the blood pressure in the 'Trial Group', as a whole, is 30.4/16.2 mmHg.  

Discussion

The role of the Sukhmani in controlling high blood pressure has never been studied before in the world literature.

The incidence of blood pressure amongst the regular recitors of the Sukhmani in the city of Amritsar is much lower than the incidence of blood pressure amongst the non-recitors, i.e., 4.76% and 9.70% respectively. The difference in the incidence is statistically significant (X~2 = 6.33). The subjects belonging to both the groups, by and large, had similar socio-economic conditions and food habits.

The average reduction in the systolic blood pressure inthe 'Trial Group' was found to be 30.4 mmHg whereas in the 'Control Group', it was 30.2 mmHg. Significantly, the diastolic blood pressure fell by 16.2 mmHg in the 'Trial Group' compared with a fall of 11.2 mmHg in the 'Control Group'. The amount of drugs used to control blood pressure in the 'Trial Group' was much lower than that used in the 'Control Group', as indicated before.

The per person amount of Methyldopa used in the 'Control Group' was 31750 mg while it was 14250 mg in the 'Trial Group'. The amount of chlorthalidone for the 'Control' and the 'Trial' Groups was 4525.0 mg and 600 mg respectively. Value of per person amount of Indapamide for the 'Control' and 'Trial' Groups was 140.5 mg and 148.63 mg respectively; this difference is not considered significant. Frusemide, Reserpine, Diazepam and Haloparidol were used in the 'Control Group' only and the values of the amount of these drugs per person turned out to be 586.6 mg, 22.62 mg, 770.0 mg and 13.50 mg respectively. Procainamide in the dose of 53250 mg per person was used only in one person belonging to the 'Control Group'. The computed amounts of Methyldopa, Reserpine, Chlorthalidone and Frusemide, per person, which would have been used in the course of three months are 55537.5 mg, 33.75 mg, 6750 mg and 1840 mg respectively.

The average fall of blood pressure in Group I, whose members were regular recitors and in Group II, whose members were irregular in their recitation programme, was 31.32/17.9 mmHg and 27.5/10.84 mmHg respectively. In sub-groups IIa and IIb the mean fall of blood pressure was 28.3/11.6 mmHg and 26.7/10.0 mmHg respectively. This finding implies that the fall in blood pressure is comparatively less in those people who were irregular in their recitation programme, than in those who took to their recitation programme regularly. The mean reduction in blood pressure by the recitation of the Sukhmani in Group I is much higher than the mean fall in blood pressure by other relaxation methods except the hathya yoga study, conducted only on ten cases, which showed comparable results. The number of the patients included in our study is much greater than in any of the previous studies so as to give more reliable results.

Twenty two patients of the 'Trial group' were put on Natrilex and they all responded well and their blood pressure was controlled. All the twenty five patients of the 'Control Group' were initially put on this drug but the blood pressure of five patients was persistently higher even after four to six weeks of treatment with this drug. All the five failures on this drug belonged to the 'Control Group'. Four out of these patients were put on Emdopa and Diuretics, but only one of them did not respond to this drug regimen also. That patient ultimately responded to Reserpine and Chlorthalidone. The adjuvant drugs like tranqulisers were also required to be used only in the 'Control Group'.

The results of this study are very encouraging. The statistically significant fall of blood pressure and that too of the diastolic pressure and the wide disparity of the amount of the drugs used to control the blood pressure in the 'Trial' and 'Control Group' patients shows the beneficial effect of regular recitation of Sukhmani in controlling blood pressure.  

Conclusions

The incidence of hypertension amongst the surveyed population of 748 in the city of Amritsar, was 7.48%. The incidence of hypertension amongst the regular recitors of the Sukhmani and the non-recitors was 4.76% and 9.70% respectively. The difference between these figures is statistically significant (X~2 = 6.33).

The mean fall of blood pressure, especially that of diastolic, was significantly greater in the 'Trial Group' than in the 'Control Group' ( 't' value 2.000) and the amount of the drugs needed to control the blood pressure of the 'Trial Group' was lesser than that used in the 'Control Group'.

The patients of the 'Trial Group' were more cooperative and their blood pressure was more easily controlled whereas five patients out of the 'Control Group' did not respond to one drug and another patient out of these patients did not respond to the second drug regimen also.

The simplicity and the efficacy of this method of treating hypertension are attractive. The treatment does not demand any amount of training on the part of the physician. The total time required in recitation comes to about two hours a week.

Our research establishes that regular recitation of "Sukhmani" is a very effective, simple, easy and economical non-pharmacologic adjunct to the antihypertensive therapy and in some cases an alternative to antihypertensive drugs.  

***************************
"Jis(u) man(i) basai sunai lai prit(i).
Tis(u) jan avai Hariprabh(u) chit(i).
Janam maran ta ka dukh(u) nivarai.
Dulabh deh tatkal udharai.
Nirmal sobha ammrit ta ki bani.
Ek(u) nam(u) man mah(i) samani.
Dukh rog binase bhai bharam.
Sadh nam nirmal ta ke karam.
Sabh te uch ta ki sobha bani.
Nanak ih gun(i) nam(u) Sukhmani."

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