Physio-Anatomical Explanation of Abhyanga: An Ayurvedic Massage Technique for Healthy Life

Ayurveda literally means ‘science of life’. According to Ayurveda the term health does not stand only for the freedom from diseases but it is called as healthy only when a person’s mind, sense organs and the soul are in a perfect state of equilibrium to endow happiness and the body is free from diseases. So it is clear that maintaining a good health was for the longevity of life, which Ayurveda is meant for. Maharshi Charaka has used the term ‘Samhanana’ to denote the compactness of body. According to him the man, measure of whose growth is proportionate and whose limbs are symmetrical, is never in consequence of firmness or strength of his senses, overwhelmed by the force which put forth. A compact body is characterized by the symmetrical and well divided bones, well-knit joints and well bound muscles and blood. An individual having a compact body is very strong, otherwise he is weak. Thus a patient should be examined with reference to his samhanana or compactness of the body. This is the main reason for why Ayurveda has given paramount importance on maintaining a positive health, either by following strict routine daily life and doing particular things or by getting some therapeutic measures, like Rasayana, Panchakarma etc. Abhyanga is the therapeutic intervention of Panchakarma in which the body is treated with simple or medicated oil on particular body part according to need. Whenever there is a discomfort or uneasiness over the body we unknowingly try to soothe it through massage. *Corresponding author: Lahange Sandeep Madhukar, Department of Sharir Rachana NIA, Assistant Professor, Jaipur-302002, India, E-mail: sandiplahange@gmail.com Received November 13, 2017; Accepted December 01, 2017; Published December 10, 2017 Citation: Madhukar LS, Nivrutti BA, Bhatngar V, Bhatnagar S (2018) PhysioAnatomical Explanation of Abhyanga: An Ayurvedic Massage Technique for Healthy Life. J Tradit Med Clin Natur 7: 252. doi: 10.4172/2573-4555.1000252 Copyright: © 2018 Madhukar LS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
A physician's knowledge is incomplete without the knowledge of the whole body. In the ancient ages Abhyanga or oil massage was the inseparable part of daily life because of the huge benefits it provides to the human body to make it strong and free of disease. It is also a subtype of Bahya Snehan (external massage), which is a part of Panchakarma therapy. It has many a qualities for what hardly there may be a few classical texts of Indian origin that have not mentioned about its practice and qualities. In both therapeutic as well as preventive purpose is has been used with great results. But with the time changing fast, Abhyanga has got the worldwide popularity as Ayurvedic massage. In the present era life is running very fast and to cope up with its ups and downs man has to run faster than his capacity. At present we are reaching a point where we are becoming increasingly more conscious of our bodies and the need to keep them in the best possible condition. Staying in the best condition reflects in all our life's activities. Daily balancing of our physical state provides not only maximum performance also a richer emotional life. All the stress and tension of modern people attract them towards the easily accessible massage therapy centers for a time being relief. Around 250 types of massage therapies are available all over the world. Ayurveda has its own stand on the importance of Abhyanga. So it is high time to show some light on this very much rejuvenating as well as relaxing natural and powerful method of Abhyanga to establish some facts about it before the world. Though we find with ease in the internet or in many books various types of methods for ayurvedic massage which have been named as Abhyanga, there are rare descriptions of actual method of Abhyanga in the classical texts. It has been said that Abhyanga should be done in Anuloma direction i.e. towards the growth of hair. We have to keep the point in mind that knowledge of anatomical structures of the body is a must to give a relaxing and fruitful massage. For this purpose massaging procedures along with its anatomical explanation should be explained [1-3].

Experimental
Human being can't live in an island. Our first contact with the world is through the sense of touch. The medium, our skin, is the largest surface area as compared to the other senses. Skin has the capacity to receive varied signals and to respond to them differently. The sense of touch is the first of the senses to become functional. Touch can be soothing and have a healing effect. The one who touches also benefits from the experience. One of the ancient techniques of touching, healing and curing that man has practised over the years is the art of massage. Using oil in massage has been known since Biblical times. Even before that Hippocrates prescribed oil anointment.
Massage works on the body on both levels:

Physical
Rubbing the body produces heat and increases blood circulation, it affects the lymphatic system and supplies more nourishment to the blood.

Psychological
Through touch, massage works on the nervous system and affects the circulation of growth hormones.

Need of the Study
Our Ayurveda classics have sufficient descriptions about Abhyanga and its benefits. But there are no such details about its techniques as they are described in Shloka form. Then with due course of time commentators of many classics have tried their best to provide some more explanation of this procedure. Yet with the very advancement of modern science those are insufficient now. For the present stressful life pattern and for the urban people who hate the ancient practice of daily oil massage, the need for getting easy relaxation through some massage therapist has been highly increasing [4]. So for the purpose of giving a crystal view about what the Abhyanga or Ayurvedic oil massage is and how it benefits us, is to be studied.
Proper knowledge of Shadanga Sharir and its components like Peshi, Asthi, Sira, Dhamani Kandara, Twacha Marma etc. are of great importance. As their knowledge is the base of any successful treatment. Although there are several kinds of massage procedures, the basic knowledge of anatomy is needed for all fruitful therapies. There is no explanation of mode of action of Abhyanga, hence it has to be explained properly that how does our body react to the therapy of oil massage.

Concept of Shadanga Sharir
Maharshi Charaka has mentioned that the physician, who is always conversant with the various aspects of the entire body, is verily proficient in the Ayurveda which can bring about happiness to the universe. So we can understand easily that to get healthy happy life, knowledge of Shadang Sharir is needed. According to Auyrveda science, Sharir is the human body that keeps on degenerating with time due to some digestion process going on it continuously. Sharir is the one who destroys itself due to its constant motion. In other language Sharir has been considered as the vehicle of equilibrium being the dwelling place of consciousness and comprising the sum of modifications of five great elements. Therefore when the elements in the body become discordant, the organism suffers affliction or death. Therefore the discordant tendency of the elements is brought about by their tendency to hypertrophy or atrophy, whether complete or partial.
The human body is composed of six main parts, namely the four Shakha (upper and lower Extremities), Madhya Sharir (Trunk or middle body) and Shir (Head and Neck). There are fifty six subsidiary members attached to these six main members of the body. Now we shall describe the Pratyangas of the body. The head, the belly, the back, the navel, the bladder and the throat (neck) occur singly. The ears, the eyes, the nostrils, the eyebrows, the armpits, the breasts, the testis, the sides, the knee joints etc. occurs in pairs. The fingers and toes which number twenty in all and the Srotas of the body to be presently described are likewise included within the Pratyanga.
The knowledge of Shadanga Sharir is very important for a physician. For this purpose the physician must have to acquire the knowledge of anatomy and physiology. In the Vedic period also we find that the people of that era too were very much attracted towards the knowledge of human anatomy as in the Atharva veda we find reference of many anatomical terms. It is understood that the study of the body and its parts was of much importance in ancient Indian medical tradition. In Susrut Samhita we can find the different parts or members of the body as mentioned before including even the skin cannot be correctly described by anyone who is not versed in anatomy. For a thorough knowledge can only be acquired by comparing the accounts given in the Shastra (books on the subject) by direct personal observation. Thus we can say that the knowledge of Shadanga Sharir is very important to apply any kind of therapy to it. Abhyanga is a rejuvenating procedure and to perform it properly one must have the knowledge of detailed anatomy, so that no harmful effect is offered by applying it in an improper way.

Role of Twacha (Skin) in Abhyanga
According to modern physiology the skin functions as an enormous sense organ. Its millions of nerve endings serve as receivers for the body, keeping it informed of changes in the environment. Specialized receptors make it possible for the body to detect sensations of light touch (Meissners corpuscles) and pressure (Pacinian corpuscles) as well as pain, heat and cold. The emotional connection to sensory stimulation has long been understood. The classical texts describe this stimulation of the senses as both normal and pleasing. This point is made in the Upanisad and throughout the Bhagavad Gita by Lord Krishna. Acharya Vagbhata warns that the sense organs should neither be strained very much nor should they be fondled very much. In the first chapter of Charaka Samhita section on principles one finds a description of how pain and pleasure inflict the body: "Excessive use, non-use and inappropriate use of time, intellect and sense objects is the three-fold cause of both mental and physical diseases. Both body and mind are the locations of diseases as well as pleasures. In a later section we find a description of this three-fold cause of disease: "Too much indulgence in very hot and very cold objects and in bath, massage, anointing, etc. is excessive use of tactile objects; total abstinence from them is negative use; and the application of tactile objects such as hot and cold etc. without the usual order; and the touch of uneven surfaces, injury, dirty objects, organisms, etc. is perverted use of tactile objects. In the section on anatomy Charaka declares that contacting the organ of touch with mind gives rise to pleasure and pain experiences.
Modern physiology gives another view of how touch can help physiology by bringing pleasure through direct stimulation of the organs of touch. Massage soothes the two master systems of the body, the nervous system and the endocrine system mainly. Nervous and endocrine systems are seen as communication systems connecting all cells with information about what is happening in the body, which provides knowledge and instructions for control and integration. This pleasure from touching is mediated through the limbic system which causes the secretion of hormones physically equivalent to health and happiness. Massage or touching, from the perspective of modern physiology, has been found to increase secretion of growth hormone [5].

Concept of Abhyanga in Ayurveda
Abhyanga means applying oil and lightly massaging the body. Often medicated and usually warm, the oil is massaged into the entire body before bathing. It can be beneficial for maintaining health and used as a medicine for certain disorders. It can be incorporated into a routine appropriate for almost everyone. Abhyanga therapy is an ancient practice which predates the Vedic period. Early humans practiced life-sustaining ways for manipulating the body to produce strength, mobility, flexibility and memory which interlaced with the cosmos [6] Application of oil to the skin followed by massage in specific directions is well known by the name Abhyanga in Ayurveda. Massage in specific direction improves blood circulation, facilitates removal of the toxins from the tissues, relieves physical and mental fatigue, improves the functioning of musculoskeletal system, clears stiffness and heaviness of the body and leads to feeling of lightness. It assists development of healthy body, helps in improvement of body figure, recuperates the body tissues and reduces body weight as well as fat.
Added to this in a plethora of diseases Abhyanga has curative effect by the pharmacological action of the drugs used in the processing of the oil. The Sanskrit word Sneha means both "oil" and "love," and the effects of Abhyanga are similar to the effect of saturation with love. Both experiences can give a deep feeling of stability, warmth and comfort. All the Ayurvedic classics have described the various benefits of Abhyanga along with its contra indications. There is no such description about the procedure of Abhyanga except the commentary of Dalhana, who mentioned that Abhyanga should be applied in Anuloma (downward) direction. Again in later period, Shri Kasture has described the specific movements of Abhyanga in limbs and joints. He told that in the limbs Abhyanga should be practiced in the direction of hair growth. This is probably because, if Abhyanga is applied in opposite direction of the hair growth, then it may cause breaking of the hairs as well as it will do discomfort to the receivers. The logic behind circular movements over the joints may be the presence of lymph nodes and co-lateral venous networks around the areas. Massing these areas may be improving the lymphatic drainage as well as venous drainage of the respected areas.
Considering these advantageous effects of this special maneuver, in the promotion and maintenance of health in the healthy, as well as cure of illness in diseased, this procedure has gained ample importance in the clinical practice. This process of manipulating skin and muscles is highly recommended in Ayurveda for routine practice even for a healthy person who has the conscious of happy healthy life. This is also reckoned to be an effective therapeutic procedure in abating and eliminating the pathological process playing havoc in the body tissues. Acharya Charaka similes the human body as a wooden wheel which becomes much stronger by proper application of oil and thus prevents the wear and tear, in the same manner the Abhyanga process prevents the wear and tear or we can say prevents the degenerative changes of the body [6].
According to Haris Johari the region of spine and head should be massaged as a unit as they develop in embryonic life together as a unit. In the region of pelvis to toes, the Prana or energy flows downwards as the body pushes against the earth and the force of gravity with the legs. The upper limbs form a co-ordinate whole to draw energy into the body. He explained that during back massage strokes should be applied in upward direction as the opposite movement will be applicable only for sex play. Here we can analyze that the reason behind the directions of downward strokes may be the formation of the muscle shape, as they are mostly linear in shape in the limbs and their insertions are also in the distal part of the limbs, so the massage manipulations are carried out in downward direction to improve the muscular blood circulation. In the back region the direction for massage is upward, may be because, here also the insertions of the muscles are superior to the origin, so the reason for massaging the back in upward direction is the same as of the limb massage.

Sequence of Abhyanga
The patient is undressed to minimum clothes and asked to sit in the Dhara table upright and oil is applied to the whole body from scalp to soles. He/she is then made to lie on his/her back and this position is ideal for applying oil to the chest and abdomen as well as anterior aspect of the limbs. Face is also best manipulated in the same position. Then the patient is asked to rest on his/her left side. Right side of the back, trunk, right shoulder, right arm and outer side of the right hip and lower limb are easily accessible in this position. Right lateral position is just opposite of left lateral position. In prone position the patient is made to rest on his/her abdomen. The back, buttocks, posterior aspect of the limbs and sole are easily treated with oil in this position.

Abhyanga in daily routine:
Abhyanga is included in the daily routines to promote the health in hale and healthy. Regular practice of Abhyanga is advised to maintain the physical fitness.

Abhyanga in different seasons:
Abhyanga is advised to protect the body from the biting cold of Hemant ritu. Similarly extreme cold as well as dry weather is characteristic of Shishira ritu. Abhyanga is beneficial in this season to counteract the detrimental effect of the cold weather.

Abhyanga in trivial manifestations:
Natural urges have to be cleared as and when they manifest, lest they will causes imbalance of Dosha and produce symptoms. Holding or suppressing these urges produces certain symptoms. Abhyanga is advised for the treatment of symptoms caused by holding or suppressing the urges of Adhovata, Shakrit, Mutra, Kshut, Nidra, Shramaswasa, Vamathu, Shukra etc.

Abhyanga in different diseases:
Sneha used for Paana, Nasya, Anuvasana and Abhyanga at the proper time, quickly brings down the aggravated Vata. Abhyanga is indicated mainly in Vata predominant states of diseases. Oleation along with sudation brings down the disfigured and painful body parts due to aggravated Vata into normalcy. The analogy given by Vagbhata about Abhyanga is worth explaining here. Vagbhata says that proper Snehana and Swedana given to an inanimate dry stick will help to regain its original condition, then what to say about the living body. Some of the diseases in which Abhyanga is indicated in Ayurveda are as follows:

Beneficial Effects of Abhyanga
Abhyanga is not a simple procedure of oil application and maneuvers rather it maintains the excellence of body tissues, if the oil applied is suitable for the Prakriti of the patient. Hence it is recommended in normal persons for routine daily practice. Further, when the oil is selected according to the illness in the diseased, it cures the diseases also.

Contraindications of Abhyanga
Abhyanga is an efficient therapeutic as well as health promoting procedure. In spite of these therapeutic benefits Abhyanga is not ideal to practice in the following conditions like -Kaphagrastha (suffering from Kaphaja disorders), Ajeerna (suffering from indigestion), Krita samsudha (who are just subjected to shodhana Procedure), Aama (suffering from Aama condition), Saamadosha (having vitiated dosha in Aama state), Navajwara (Suffering from fever of short duration), Santarpana Samutha Roga (diseases caused by over nourishment), Agnimaandya (suffering from impaired digestive activity).

Absorption of Sneha
The oil applied to the body surface in different procedures of Abhyanga, were absorbed and distributed to the whole body and show systemic or generalized effect. The absorption as well as distribution of the oil with the herbal ingredients impregnated in it takes specific duration and the same is detailed in the following lines (Table 1).

Abhyanga Kaala (Penetrating time of oil)
Preparation of the patient: Early morning hours are ideal for Abhyanga Karma. The patient should be in empty stomach and the food that is consumed in the previous day should be digested properly. After smearing the oil, each part of the body is massaged one after the other. Therapist moves his palms on the surface of the patient`s body in a direction similar to the orientation of hair in these parts. This is the general principle of Abhyanga technique.

Absorption through skin
In man, subcutaneous absorption probably occurs mainly from the surface. Absorption through the hair follicles occurs, but the follicles in man occupy too small a portion of the total integument to be of primary importance. Absorption through the sweat gland and sebaceous glands generally appears to be minor. When the medicament is rubbed on vigorously, the amount of the preparation that is forced into the hair follicles and glands is increased. Rubbing also forces some material through the stratum corneum without molecular dispersion and diffusion through the barrier. In this way we can say that massaging the skin with some oil may help in the absorption of it through skin layers.

Role of Bhrajaka pitta in action of Abhyanga
Bhrajaka Pitta is located in the skin. It imparts the characteristics of color and luster, so it is termed as Bhrajaka. Acharya Charaka has also stated that the production of normal and abnormal temperature of the body as well as the normal and abnormal color of the skin is due to Pitta. The variations in the colour of the skin are the functions of the Bhrajaka Pitta which is located in the skin. Arunadutta the Commentator of Ashtanga Hridaya has described the Bhrajaka Pitta and its functions like Deepana and Pachana. The substances applied on the skin by Abhyanga, Lepana and Parisheka are being digested by the Bhrajaka Pitta. Thus Abhyanga, Parisheka etc. do their action properly only after being digested by Bhrajak Pitta, as no substance can act properly without digestion. Acharya Indu says that due to Abhyanga the hardness and roughness of skin is diminished, so from this point of view we can say that Abhyanga helps to improve the quality of skin by getting digested by the Bhrajaka Pitta.

Results and Discussion
Ayurveda is written in sutra form. It is because the detailed description of Abhyanga and its explanations are not available in the main classics of Ayurveda. As the time passed by the commentators have tried their best to establish their thoughts about the Abhyanga on the basis of the main texts. Acharya Charaka described 107 points (Marmas) in the Sharir Sthana 6 th chapter. These are most lively in expressing the connection of Consciousness (our most fundamental nature) to physiology. It is said that touching these vital points can have both positive and negative results. Proper massage of these points (including such exercise as yoga Asana) helps dissolve stresses or remove blocks accumulated there. Removing stress improves physiology directly. Sushruta described the effects of rubbing with characteristic emphasis upon the Pitta value that rubbing and friction tend to dilate the orifice of the (superficial) ducts and increase the temperature of the skin. Rubbing specifically improves the complexion of females and gives a lovely appearance, cleanliness, beauty and suppleness to the female form. Friction pacifies Vata, cures itches, rashes and eruptions. Therefore, by the Law of Similarity and Dissimilarity the heat generated in this fashion balances the cold Vata and also helps liquefy impurities which block physiology and the motion of rubbing provides the impetus for moving the impurities to the channels of elimination.
During physical exercise or ordinary work, some metabolic products get accumulated in the neuro-muscular junctions (Marma points?) leading to fatigue. If the neuro-muscular junctions are kept clean and if both nerve and muscle tissues are toned up, then the person could avert fatigue in spite of hard work and physical exercise. This is possible through massage therapy. Vaidya Bhagavan Dash suggests that movement of soft tissue probably helps wastes (free radicals?) and nutrition to flow in appropriate manner by helping to relax tension in the tissue. When waste and tension are removed then tissue and organs return to their ground-state status of natural functioning--a restful alertness where sensory apparatus is ready and able to function. In this section an additional benefit is realized from deeper touching or massage. There is no evidence that this and the former section obtain benefits which are mutually exclusive. Rather, the idea is simply that stress may be released from different levels of the anatomy, depending upon the type of massage such as light or deep. This section does emphasize that the connection to healing can be through the body first and then the emotions and nervous system. Thus another avenue of releasing stress and providing pleasure and well-being is added to the above aspects.
Balanced physiology is the best means of preventing disease and health can mean longer life. Acharya Charaka states that appetite is normalized by sesame oil application. Appetite and digestion go hand-in-hand. Appetite is the normal or healthy desire for food but hunger is variable according to digestion. If digestion is too speedy then hunger can become voracious, for example. Digestion is such an important process according to Ayurveda; it is regarded as the root of all health. The digestive fire actually determines how well sesame oil can be utilized by the body through Bhrajaka Pitta. As we have seen above sesame oil helps to promote balanced functioning, by balancing Vata, the wind that fans the fire is balanced (Samana); by balancing Pitta the digestion of the food is balanced (Pachana); and by balancing Kapha the food is appropriately moistened and loosened for digestion (Kledana).
Thus Abhyanga also contributes to a qualitatively better life by promoting many side-benefits. The functioning of the sense organs benefits from the lubricating and releasing actions of sesame oil. Sensitivity is proportionate to proper functioning. The sesame oil makes tissue stronger and more flexible. This means that the senses can work efficiently. The fact that dirt, toxins and other stresses are released by the presence of sesame oil means that these "filters", which cloud perceptions, cease to impair sensitivity and accuracy of sensory experience. Therefore, to expect good hearing, taste, healthy sensitivity to touch, vision and smell from regular application of sesame oil.
Massage therapy which is popularly practiced in the western countries has been summarized to the part wise massage techniques of the body using the anatomical explanation. The anatomical landmarks are mentioned along with the structures which are directly related with massage. So it is mandatory for a clinician to know the anatomical structures related to that part, as this prevents from damaging any structures by inappropriate technique. Modern pharmacology describes that body rubbing improves the absorption through skin layers. This may be the reason for why after Abhyanga, Mardana (rubbing) in the classical texts also have been indicated. Massage mainly affects the nervous system and endocrine system of our body. These two systems are related with each other. Excitation of this two systems play great role in affecting the other systems of the body. Massage has local and systemic effects on the body. It mainly affects the nervous system and endocrine system. But also helps in increasing blood circulation to the skin. It increases circulation to massaged area, bringing more oxygenated blood and nutrients to the area which in turn reduces muscle fatigue and soreness. This increase in circulation also aids the removal of toxins and waste products from the muscle. It relieves muscular tightness, fatigue, stiffness and spasms.

Conclusion
Anatomical knowledge of Shadanga Sharir is quite beneficial while attempting the process of Abhyanga. The various kinds of Abhyanga (massage)therapies has been practiced today following the single rule of increase the circulation of vital fluid in the applied part, as well as to stimulate the nervous system to provide a soothing and relaxing effect to the patient. Abhyanga should be done in Anuloma (to the direction of hair growth) to prevent any damage to the hair roots. It is practiced in circular movements in the joints to facilitate the lymph drainage and venous drainage as most of the lymph nodes are situated in the joint spaces and collateral venous networks are also there in the joint regions so circular movements help in emptying the vessels. All the benefits of Abhyanga are directly or indirectly related with the stimulation of autonomic nervous system and central nervous system.