UDVARTANA

Definition

अभ्यङ्गपूर्वकत्वादुद्वर्तनस्य तमनु परिमार्जनमुद्वर्तनं ब्रूते । (चक्रपाणि च​. सू. ५ ९३-९४)

The simple procedure of massaging the whole body below the neck with powder of herbs in direction opposite to the orientation of hair in the body is called as udvartana.Śarīra parimārjana is another name for this procedure. Hence the direction is quite opposite to the one carried out in the abhyaṅga.

Benefits

Udvartana opens the circulatory channels, facilitates metabolic activity and improves the complexion of the skin. By virtue of these therapeutic effects one can obtain the following benefits by the udvartana therapy.

उद्वर्तनं कफहरं मेदसः प्रविलायनम्‌ ।

स्थिरीकरणमङ्गानां त्वक्प्रसादकरं परम्‌ ॥ (अ. हृ. सू. २/१५)

दौर्गन्ध्यं गौरवं तन्द्रां कण्डूं मलमरोचकम्‌ ।

स्वेदबीभत्सतां हन्ति शरीरपरिमार्जनम्‌ ॥ (च​. सू. ५/९३)

उद्वर्तनं वातहरं कफमेदोविलापनम्‌ ।

स्थिरीकरणमङ्गानां त्वक्प्रसादकरं परम्‌ ॥ (सु. चि. २४/५२)

Kaphahara – alleviates vitiation of kapha doṣā

Medasah pravilāyanam – reduces excess of fat in the body

Sthirikaraṇamaṅgānām – increases the stability of the extremities.

Tvakprasādakaram – promotes the excellence of skin.

Kāntimatvapuh – increase the body complexion.

Vatāhara – corrects the imbalance of the vātadoṣā.

Gauravam hanti – leads to a sense of lightness in the body.

Daurgandhyam hanti – eliminates the bad body odour, due to excessive sweating.

Tandram hanti – prevents untimely drowsing.

Kaṇḍu – cures itching sensation.

Types

Udvartana: In the texts, Udvartana is also named as ‘churnodvartana’. Actually some powders or pastes (kalkās) are used during this procedure.

According to Caraka, Udvartana is of two types.

1. a) Snigdha Udvartana: indicated for lean and thin (kṛśa).
2. b) Rūkṣa Udvartana: indicated for obese (sthūla).

In Suśruta, it is classified in more detail. According to him it is of three types:

1. a) Udvartana,
2. b) Udgharṣaṇa,
3. c) Utsādana.

The basic differences in clinical procedures of these three are as follows:

सिरामुखविविक्तत्वं त्वक्स्थस्याग्नेश्च तेजनम्‌ ॥

उद्धर्षणोत्सादनाभ्यां जायेयातामसंशयम्‌ ।

उत्सादनाद्भवेत्‌ स्त्रीणां विशेषात्‌ कान्तिमद्वपुः ॥

प्रहर्षसौभाग्यमृजालाघवादिगुणान्वितम ।

उद्धर्षणं तु विज्ञेयं कण्डूकोठानिलापहम्‌ ॥

ऊर्वोः सञ्जनयत्याशु फेनकः स्थैर्यलाघवे ।

कण्डूकोठानिलस्तम्भमलरोगापहश्च सः ॥

तेजनं त्वग्गतस्याग्नेः सिरामुखविवेचनम्‌ ।

उद्धर्षणं त्विष्टिकया कण्डूकोठविनाशनम्‌ ॥

(सु. चि. २४ ५६)

UDVARTANA:

It is done by the methods used in Pravilāpana and Vimlāpana. Suśruta has advised to use palm and thumb with some pressure to perform Vimlāpana . This procedure is similar to thumb or palm effleurage, which may be used to treat oedema. Generally deep stroking is applied in this procedure. In deep stroke, a heavy pressure is transmitted to the deeper tissues to enhance venous circulation and lymphatic drainage. It also has a stretching effect on the superficial fascia that reduces congestion and nodular formation. When the pressure is to be given in a small area, thumb may also be used.

UDGHARṢAṆA:

It is done by the brick powder or wood powder, etc. which are unctuous (rūkṣa) in nature. It is a friction movement applied in the opposite sequence (pratiloma gati). It may be compared with intermittent type of lymph massage movement. A variable degree of pressure by the palm and fingers are applied for a short time, in this procedure. Underlying tissues are stretched in two directions here, one along with the finger line and the other as clockwise or anti clockwise as per the position of the physician towards the next proximal lymph nodes. During this procedure, lubrication should be avoided to facilitate the stretching.

UTSADANA:

It is done by the application of oils or pastes of fatty substances (sneha kalkās) in almost the same procedure. It is specially indicated for the beautification of women . It is also a kind of effleurage where stretching is not intended. Light or deep stroke may be used as per requirement of the patients.

Indications

• Sthaulya – Obesity and related complications
• Medo rogās
• Diabetes
• Metabolic syndrome
• In the Pūrvakarma (pre-treatment procedures) of Virecana (therapeutic purgation) and Vamana (therapeutic emesis)
• Santarpaṇottha Vikarās – Diseases manifesting due to over nutrition
• Nervous disorders, Motor neuron diseases, Parkinsonism
• Hypothyroidism
• Āmavāta(Rheumatoid arthritis)
• Sciatica
• Skin diseases

Contraindications

• Garbhiṇi
• Kṛśa
• Rūkṣa puruṣa
• Bāla
• High Pitta condition or pitta related disorders having high inflammation, redness, rise in local temperature, burning sensation etc
• Diseases with severe pain – degenerative arthritis (osteo-arthritis), colic etc
• Presence of wounds and cuts
• Presence of burns
• Too dry skin (typical vātaconstitution)

Avagāha

Avagāha means dipping, immerse, Svedana means sudation, steaming, sweating,

Avagāha Sveda is a type of sudation in which the patient who has been given Abhyaṅga (herbal oil massage) is made to lie down to the neck level in a tub big enough to accommodate a person, filled with medicinal decoctions and other liquids.

AVAGĀHA SVEDA

The person (patient) who is to be given Avagāha Sveda is given Abhyaṅga (herbal oil massage) with Vatāhāra tailās (oils which alleviate vitiated vāta). He is later made to sit in a big tub having the dimensions enough to accommodate him. He should sit in the tub such that his neck and head are out of the tub. The tub should be filled with hot vatāhāra dravyās (liquids having vātaalleviating property). These liquids may be one or the other among.

• Vatāhāra Pātra Kvātha – decoctions made by processing leaves having vāta-alleviating property in water
• Vatāhāra Kvātha Siddha Kṣīra — milk processed with the vātaalleviating decoctions
• Taila – medicated oils
• Ghṛta – medicated ghee
• Māṃsarasa – meat soup
• Uṣṇodaka – warm water etc

AVAGĀHA DROṆI OR THE AVAGĀHA TUB

Avagāha Tub is a mandatory need for this treatment. Dimensions of the Avagāha Tub – The tub should be big enough to comfortably accommodate the entire length and breadth of a person. The tub should be 6 feet (approximately) in length, approximately 2 feet in width and 1.5 feet in height. The tub should have an opening at one of its corners for draining the liquid after the treatment. It should be connected to a tube. The opening should be fit with a cork while the treatment is in process so that the medicines don’t flow out. The tub should also have a lid. The tub shall be made up of vatāhāra kāṣṭha (vātaalleviating woods). Now days it can be made with cement, metal, fiber or fiber-glass. The tub shall be fit with an arrangement of hot and cold water taps. This enables temperature regulation of the avagāha drava in the bath tub.

AVAGĀHA DRAVA

Avagāha Drava (liquid for avagāha) – As mentioned above, a wide range of medicinal liquids can be used in Avagāha Sveda as per need and condition to be addressed. The medicines need to be prepared fresh every time and used hot. Below mentioned avagāha dravyās should be kept ready beforehand (as prescribed).

• Kvātha -infusions prepared from medicines should be prepared every day and used fresh and hot. Some important Kvāthas which are regularly used in Avagāha Sveda are:
  • Daśamūla Kvātha
  • Nirguṇḍī Kvātha
  • Balādi Kvātha
  • Erandamulādi Kvātha etc

• Siddha Jala – water processed with herbs too can be used for avagāha sveda. In this decoction is not prepared in traditional method but the water is only boiled with the herbs. Some examples of siddha jala are –
  • Daśamūla siddha jala
  • Nimbi pātra jala
  • Nirguṇḍī pātra siddha jala
  • Baladi Kvātha cūrṇa siddha jala
  • Erandamuladi Kvātha cūrṇa siddha jala etc

• Siddha Kṣīra – Milk processed with vatāhāra Kvāthas like Daśamūla Kvātha siddha kṣīra, Baladi Kvātha siddha kṣīra etc are used especially in painful conditions associated

• Tailās — medicated herbal oils like Mahānārāyaṇa Taila, Kṣīrabala Taila, MahāmāṣaTaila etc are used for avagāha sveda. Sesame oil is cost effective.

• Ghṛta or medicated ghee can be used when pitta is involved. It can be used either individually or in combination with effective vātaalleviating oils mentioned above. Medicated ghee like Guggulutiktakam Ghṛta etc. are used apart from the mixture of plain cow ghee and sesame oil which form a good, yet cost reliable combination for conducting Avagāha.

• Māṃsarasa — meat soup of animals or birds are used to nourish the bones and joints and strengthen them, especially in painful conditions like arthritis, low back pain, spondylosis etc.

• Uṣṇodaka —warm water is the best and cheap thing which can be used for Avagāha Sveda. This is beneficial for mild to moderate painful and sore conditions of muscles, muscle fatigue, stiffness of muscles etc conditions. This can be done daily and will be handy if a bath tub is available in the personal bathroom. Adding little bit of salt or essential oils will do wonders in relieving body-mind stress.

PROCEDURE

PŪRVAKARMA

Sambhāra Saṅgrahaṇa – Avagāha tub, Abhyaṅga oil (like Mahānārāyaṇa Taila, Sahacarādi Taila, Kṣīrabala Taila, Murivenna, etc)

Swasti Vachana – Prayers should be offered to the God for the welfare of the patient and success of the treatment. The patient too should be involved in the spiritual process if she is comfortable doing it.

Positioning of the patient – the patient subjected to abhyaṅga should be made to sit comfortably in the tub provided for avagāhana. The patient should be made to sit or lie down facing North or East.

PRADHĀNA KARMA

Avagāha Prakriya – The liquid medicament should be checked for heat. When it is comfortably warm, it should be gradually be poured in the avagāha tub. The lid of the tub should be closed till the neck level. The whole body of the patient except her neck and head are immersed in the liquid medicament poured in the tub. The head and neck should be outside the brim of the tub. The liquid should maintain its temperature throughout the treatment procedure. It should be hot enough to produce sweating in the patient. When the liquid gets cold, it should be removed, heated again and poured back into the tub.

According to Bhavaprakasha treatise, the patient who is given herbal oil massage should be seated in the avagāha tub and the warm liquids shall be poured over the shoulders of the patient gradually such that they flow into the tub and fill it up to the level of 6 aṅgulas above the nābhi i.e. navel. (1 aṅgula = 1.763 cm or finger width or approximately 3/4 inches)

Udakoṣṭha – According to Bhela Samhita treatise, the avagāha droṇi should be prepared with wood. This tub should be filled with vātaalleviating Kvātha, kṛśara (semisolid preparation of rice and green gram), kṣīra (milk) etc. the patient who has been given herbal oil massage should be seated in this tub and avagāha sveda should be given. Svedana should be given until the patient properly sweats. Udakoṣṭha is a method of providing avagāha in which the tub is half filled with hot water and the patient is made to sit in it.

TIME DURATION

Avagāha Kālaḥ — Avagāha Sveda should be provided for a time period of 1 muhūrta (48 minutes) to 4 muhūrta (192 minutes) as per the need and condition or following the general principle of Svedana, sudation should be done until the patient gets sweating properly along with signs and symptoms of proper svedana. Avagāha Sveda can be done daily for a period of 7-14 days or according to the requirement (condition of the disease and diseased). Sneha Avagāha Sveda (tub sudation with oil, ghee) and Kṣīra Avagāha Sveda (hot milk tub sudation) shall be done with a gap of 1 or 2 days (Ref — Bhavaprakasha).

BENEFITS OF AVAGĀHA SVEDA

• Aśmari
• Śūla – abdominal colic
• Katiśūla
• Katigata vāta- painful vātadisorders occurring in the hip, pelvis and lumbo-sacral region
• Pṛṣṭhagata vāta— painful vāta conditions occurring in the back (spine)
• Gṛdhrasī
• Sandhigata vāta
• Vināma — bending of the body