BAHIRPARIMĀRJANA CIKITSĀ

यत् पुनः बहिःस्पर्शमास्रित्य अभ्यंग स्वेद प्रदेह परिषेक उन्मर्दनाद्यैरामयान्प्रमाष्टिः तद् बहिपरिमार्जनम् 

                                                                   -च.सं सू ११/५६

तत् बाह्यं अभ्यंग स्वेद प्रदेह परिषेक उपमर्दनादिभिः

                                                                   – अ.स. सु.१२/५

Abhyaṅga, sveda, pradeha, pariṣeka, unmardana are considered as bahiparimārjana.

स्नेहस्वेदावनभ्यस्य कुर्यात् संशोधनं तु यः|

दारुशुष्कमिवानामे शारीरं तस्य जीर्यते ||

                                                                – A.H.Su 18/60

The body of a person who undergoes śodhana therapies without undergoing snehana and svedana gets broken like a log of dry wood while being bent.

• CLASSIFICATION OF BĀHYA SNEHA

  Dalhana explains the following as the modes of administration of sneha

  स्नेहो हि पान-अनुवासन-मस्तिष्क-शिरोबस्ति-उत्तरबस्ति-नस्य-कर्णपूरण-गात्राभ्यङ्ग-भोजनेषूपयोज्यः ॥

  (सु. सू. ३१ ३)

  Among these the following are categorized as Bāhya Snehas

  • मस्तिष्क
  • शिरोबस्ति
  • उत्तरबस्ति
  • नस्य
  • कर्णपूरण
  • गात्राभ्यङ्ग

   

  Bāhya Snehas are:

  1. अभ्यङ्ग
  2. उत्सादन
  3. मर्दन​
  4. पदाघात​​
  5. परिषेक​
  6. अवगाह​
  7. मूर्ध्नितैल​​
  8. शिरोबस्ति
  9. नस्य
  10. अक्षितर्पण​
  11. कर्णपूरण
  12. कवल​
  13. गण्डूष​

   

   

• ABHYAṄGA

   

  PARIBHĀṢA:

  The word Abhyaṅga is derived from Abhyañjana Abhi- towards, into, upon etc Añjana – to smear, to anoint.

  Rubbing with unctuous substance, smearing the body with oil

  DEFINITION:

  Massagae of the whole-body including head with the help of taila, ghṛta etc. snigdha dravyās in the direction of romakūpa or in the anulomana gati is called abhyaṅga.

  UTILITY/ NECESSITY OF ABHYAṄGA:

  स्नेहाभ्यङ्गाद्यथा कुम्भश्चर्म स्नेहविमर्दनात्|
  भवत्युपाङ्गादक्षश्च दृढः क्लेशसहो यथा||८५||
  तथा शरीरमभ्यङ्गाद्दृढं सुत्वक् च जायते|
  प्रशान्तमारुताबाधं क्लेशव्यायामसंसहम्||८६|| (cha.su.5/85-86)

  How pot, leather, axle of cart becomes strong and efficient by oiling, similarly the body becomes strong and stable and so also skin becomes dṛḍha and good by anoiting it with oil.

  Abhyaṅga pacifies vāta and body becomes capable of withstanding fatigue and exercise.

   

  जलसिक्तस्य वर्धन्ते यथा मूलेऽङ्कुरास्तरोः |
  तथा धातुविवृद्धिर्हि स्नेहसिक्तस्य जायते ||३२|| (su.chi.24/32)

  The body is compared to tree. If the roots of trees are given water regularly, then it lives for long time. In the same way by abhyaṅga the person’s dhātu becomes healthy.

   

  BENEFITS OF ABHYAṄGA:

  • अभ्यङ्गमाचरेन्नित्यं, स जराश्रमवातहा|
    दृष्टिप्रसादपुष्ट्यायुःस्वप्नसुत्वक्त्वदार्ढ्यकृत्||८|| (Ah.Su.2/8)

  It wards off old age, exertion and aggravation of vāta, improve vision, nourishment to the body, long life, good sleep, good and strong (healthy) skin.

  • न चाभिघाताभिहतं गात्रमभ्यङ्गसेविनः|
    विकारं भजतेऽत्यर्थं बलकर्मणि वा क्वचित्||८८||
    सुस्पर्शोपचिताङ्गश्च बलवान् प्रियदर्शनः|
    भवत्यभ्यङ्गनित्यत्वान्नरोऽल्पजर एव च||८९|| (Cha.Su.5/88-89)

  One who practises oil massages regularly, the body even if subjected to injuries or strenuous work is not much injuries. His physique is smooth, flabby strong and charming.

  • अभ्यङ्गो मार्दवकरः कफवातनिरोधनः |
    धातूनां पुष्टिजननो मृजावर्णबलप्रदः ||३०|| (Su.Chi.24/30)

  Oil bath makes the body soft, controls kapha and vātaaggravation, and bestows nourishment to the tissues, good complexion/colour and strength to the body.

   

  METHOD:

  PŪRVA KARMA:

  Initially, one should commence the procedure with swasti vachana followed by śiro abhyaṅga and then continue with the application of sneha dravyās to the rest of the body.

   

  PRADHĀNA KARMA:

  The oil (prescribed by Ayurvedic Physician) with optimum temperature should be applied to the head first in the anterior fontanelle and then the whole scalp. Then oil massage of the Ear, Palm and Feet should be done prior to the main procedure.

  The heated oil should be applied uniformly to the body, by the two therapists standing on both sides of the Droṇi table. Then, massage of the scalp, head is done and subsequently moves down to the neck, upper back, shoulders, upper arms, forearms, hands, chest, abdomen, lower back and lower limbs.

   

  The proper procedure of Abhyaṅga is that it should be performed in seven (7) postures which are: sitting, supine, left lateral, prone, right lateral, supine and sitting.

  Alternative postures are:

  1. Sitting upright with knees extended
  2. Supine position
  3. Left lateral position
  4. Prone
  5. Right lateral
  6. Supine
  7. Sitting

  Prone positioning should be avoided as much as possible in patients with chronic diseases of heart, lungs and GIT. It is important to note that massage of limb joints should be done in a circular manner and muscles in a linear manner while the umbilicus region is massaged in a circular motion.

   

  Time and duration-As the procedure of Abhyaṅga is done in seven (7) postures and each posture takes approximately five minutes. So, the whole procedure should take place in approximately 35 to 45 minutes.

   

  PAŚCĀT KARMA:

  Oil is wiped off with a soft towel. Patient is advised to take rest for at least fifteen minutes. Patient is advised to take bath with warm water or Rāsnādi Cūrṇa is applied all over the body. The necessary/mandatory instructions are to be given to the patient to achieve the maximum therapeutic benefits to avoid the complications.

   

  CONTRAINDICATION:

  वर्ज्योऽभ्यङ्गः कफग्रस्तकृतसंशुद्ध्यजीर्णिभिः||९||(ah.su.2/9)

  Kapha pradhāna vyādhi, after vamana or virecana, patient having ajīrṇa.

MARDANA AND UNMARDANA:

MARDANA:

अङ्गमर्दनम् | (amarakosha)

तं कृत्वाऽनुसुखं देहं मर्दयेच्च समन्ततः||१२||(ah.su.2/12)

मर्दनं तु गाढं पादाभ्यामारभ्य कटिपर्यन्तं| (su.chi.24/83 dalhana)

UNMARDANA:

 हस्ततलेन मर्दनम् | (amarakosha)

मर्दनं चानुलोमेन विरुधोन्मर्दनम् तथा |

तैलादिकेन हस्ताभ्यां समुखं परिपीडनम् || (pan.sam.3/107)

INDICATION:

स्नेहाभ्यङ्गोपनाहाश्च मर्दनालेपनानि च |
त्वङ्मांसासृक्सिराप्राप्ते कुर्यात् चासृग्विमोक्षणम् ||७||(su.chi.4/7)

स्नेहोपनाहाग्निकर्मबन्धनोन्मर्दनानि च |
स्नायुसन्ध्यस्थिसम्प्राप्ते कुर्याद्………|| (su.chi.4/8)

1. Sarvāṅga mardana after vyāyāma (vāgbhaṭa)
2. Hemanta rutu (vāgbhaṭa)
3. Twakgata vāta– skin disorders due to imbalance of vāta
4. Asṛkgata vāta– disorders manifestation because of rakta dushti
5. Māṃsagata vāta– disorders of muscle tissue
6. Snāyugata vāta– disorders of ligaments/nerves
7. Sandhigata vāta– disorders of joints
8. Asthigata vāta– disorders of bones

PĀDĀGHĀTA

• पादाघात – पादेन मर्दनं (अरुणदत्त, अ हृ सू 3/10)
• Pādāghāta – pada + aghata
• Pādāghāta is a bāhya snehana procedure where patient is subjected to abhyaṅga and is made to lie down in prone position and mardana is done to the body with the help of pada.
• Traditional known as Keraliya chavitti thirumal.
• Acharya Vāgbhaṭa has mentioned about pādāghāta in rit carya, mentioned as a regimen to be followed in hemanta ritu.
• Acharya Vāgbhaṭa mentioned that pādāghāta has to be done after undergoing

1. abhyaṅga with vatāhāra taila
2.  śiro abhyaṅga
3.  mardana

• Suśruta has mentioned about pādāghāta in cikitsā sthāna.
• One has to do vyāyāma upto his half capacity, when he starts sweating after vyāyāma, should undergo pādāghāta i.e mardana with the foot.

Benefits

• व्यायामस्विन्नगात्रस्य पद्भ्यामुद्वर्तितस्य च |
  व्याधयो नोपसर्पन्ति सिंहं क्षुद्रमृगा इव ||४३||(su.chi.24/43)
• One should undergo pādāghāta after performing sufficient exercise.
• The person undergoing pādāghāta wouldn’t be effected by any vyādhi.
• A simile is explained where a deer will not come near a lion similarly a disease will not effect a person who undergoes pādāghāta.

Pūrva karma

• Sambhāra sangraha

1. Tailās needed for abhyaṅga like kṣīrabala , maha narayana tailam etc
2. ātura parīkṣā

• Check whether person is yogya for the therapy
• Prakṛti and vikṛti is assessed

1. Materials needed for pādāghāta

• Droṇi
• Therapist
• Taila for abhyaṅga
• 2-4 thick ropes for tying to the ceiling bars of the roof or wooden rods constructed from end to end.
• 2 ropes are used if 2 therapist are doing the treatment.

1. Ātura siddhata

• Abhyaṅga has to be done before pādāghāta with vatāhāra taila like kṣīrabala taila, narayana taila, etc.
• Svedana has to be done after abhyaṅga.

Pradhāna karma

• Person who has undergone abhyaṅga and śiro abhyaṅga is made comfortable in the therapy room.
• Swasthivachana and prayer to Lord Dhanwantari is done.
• Patient with minimal clothes is advised to lie down on droṇi on prone position.
• The therapist has to give mardana over the back, lower back with his pada by holding the rope hanging from the ceilings.
• The rope would help the therapist to balance their body while doing the therapy and also would help them from slipping down due to the oil over the patient’s body.
• The pressure can be altered depending upon the location of the pādāghāta performed. Balancing and monitoring uniform pressure, key point to be focussed in Pādāghāta – Holding the ropes also helps in applying and monitoring the pressure of their foot imparted on the body of the patient.
• The pressure also can be altered from superficial to moderate to deep depending on the location of Pādāghāta being performed.
• Pressure can be reduced when pādāghāta is done on the legs, calf region.
• If 4 masseurs are carrying over the treatment, each masseur will hold one suspended rope and conduct pādāghāta. The first masseur will conduct the procedure on the left side of the upper and lower back. The second masseur will conduct on the right side of the upper and lower back. The third masseur will conduct the procedure over the left lower limb and the fourth masseur will do it over the right lower limb.
• If 2 masseurs are carrying the procedure, one will take care of the entire left side of the upper and lower back along with left limbs and the other masseur will conduct the treatment on the right side of the body. In this case only 2 ropes will be enough.

Paścāt karma

• After the procedure the body of the patient has to be wiped with cloth
• Patient is advised to take snā
• Nitya virecana can be administered with gandharvahastādi taila, gandharvahastādi kaṣāya etc.
•  
• Precautionary measures

1. The treatment should be carried out by well-trained therapist who have mastered in pādāghāta since many years.
2. It is considered as one of the most difficult treatment as it needs perfect synchronizing and art of varying pressures at different points.
3. Foot of the therapist should be free from skin diseases, neurological, infectious diseases, cracks and fissures of foot.
4. Feet should be washed and cleaned before the treatment.

The therapist should be healthy and fit but shouldn’t be obese or over weight.

SAṂVĀHANA

• संवाहनं – सुखकरस्पर्श (डल्हण, सु चि 4/24).
• Saṃvāhana means Sukhakara Sparśa (comfortable touch).
• Squeezing with gentle pressure after application of taila is called Saṃvāhana.

BENEFITS:

• प्रीतिनिद्राकरं वृष्यं कफवातश्रमापहम् |
  संवाहनं मांसरक्तत्वक्प्रसादकरं सुखम् ||८३|| (Su.Chi.24/83)
• वृष्यं
• कफवातश्रमापहम्
• मांसरक्तत्वक्प्रसादकरं
• सुखं

Actions

• Prītikara (Affection), Nidrākara ( Induceed sleep), Vṛṣya ( Aphrodisiac)
• Mitigates Kapha, mitigates Vāta, relieves tiredness and does prasādana (normalization) of Māṃsa, Rakta and Twak.

Indication

• Vātarakta
• Nidrānāśa
• VātaVyādhi