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ABHYANGA – AN EXPLORATORY JOURNEY

Eliana Freiseis-Trinaistic, BEd, MISt

Abstract

Background: The Ayurvedic medicine maintains that the process of healing necessitates

spiritual growth and awareness - outcomes that can be measured only with great difficulty. As

traditional medical knowledge (TMK) systems, such is Ayurveda, often fail to respond to

western medicine metrics and evidence-based requirements, so TMK bodywork-related practices

equally struggle to be quantified. Yet, our failure to measure and properly translate the

knowledge is the major obstacles to gaining significant benefits from integrating largely non-

invasive TMK within the scope of both, complementary and alternative medicine (CAM) and

registered massage therapy (RMT).

Purpose: This paper presents the results of broad exploratory research examining Abhyanga

within its historical and regulatory context, reflection on issues related to TMK translation and

integration, and reporting on personal experiences with Abhyanga.

Conclusions: Qualitative observations and reflections support the argument that opportunities

for successful integration of Abhyanga modality are largely limited. Scarcity of Abhyanga-

specific research, lack of standardized Abhyanga curriculum and an absence of integrative,

Abhyanga – inclusive, complementary medicine protocols demonstrates that the impetus for

inclusion will be likely consumers rather than educational policy driven.

Keywords: complementary and alternative medicine (CAM); health care; education; integration;

massage; organizational models interdisciplinary; massage research; massage education;

massage practice.

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Historical exploration: – where in the world is Abhyanga?

The earliest instances of practicing Ayurvedic medicine in ancient Vedic texts are

indicated around 4000 B.C (1). Medical historians provided substantial evidence about

early Indian scholars carrying the Ayurveda to ancient China, via Tibet, attesting

Ayurvedic claim to be "the mother of Natural Healing” (2). Ayurveda not only shares

common practices with Traditional Chinese Medicine (TCM) but also influenced Unani,

a Middle Eastern natural healing medical philosophy/practice that served as foundation

for early Hippocratic (Grecian), Galen (Roman) and the Traditional European Medicine

(TEM) doctrine. However, the actual written records of basic Ayurvedic medical

encyclopedia, Suśruta Saṃhitā and Charaka Saṃhitā, are compiled only around 1000

BC (2).

The nucleus of Ayurvedic therapeutic modality revolves around balancing the three life

energy forces or Doshas: Vata, the energy of movement, Pitta, the energy of digestion,

and Kapha, the energy of retention. These forms arise from the five Ayurvedic

Elements: Space, Fire, Water, Air and Earth. To sort the knowledge and aid physician

training Ayurveda is branched into eight specialty domains or eight limbs of Ayurveda.

Two of these branches, Rasayana (rejuvenation) and Vajikarana (aphrodisiacs)

concentrate on preventative health and longevity while others, Kayachikitsa (internal

medicine), Bhuta Vidya (psychiatry), Shalya Tantra (surgery), Vishagaravairodh Tantra

(toxicology), Shalya Tantra (ears, nose and throat), and Kaumara Bhritya (pediatrics)

focus on treatments and remedies (3).

Ayurvedic therapeutic massage, Abhyanga, nested within the limb of Rasayana,

incorporates Ayurvedic assessment of body types/ personality in relation to their

anatomical, physiological and pathological issues, including provision of relevant

cautionary principles and contraindications. Etymologically, Abhyanga is the Sanskrit

word meaning “the great oiling” ( or ), representing an intense oleation

prescribed as a medicine or daily maintenance. Abhyanga utilizes warm oils, carefully

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customized strokes and a choice of prescribed pressure (Marma) points. Abhyanga

massage is “the combination of massage with medicinal oils and acupressure where

specific types of strokes are chosen based on the disturbed Doshas, body constitution,

injuries, and disease conditions” (4, p. 28).

Due to the principal Ayurvedic emphasis on understanding a broader view such as

interplay of elements (Doshas) arising from interaction of clients’ inner and outer

nature, the literature exploring isolated therapeutic components of treatments was not

considered essential or useful (5, p. 4). However, recent emergence of “modern”

Ayurvedic health education in India and Europe prompted by ambitious efforts of the

Indian Council for Scientific and Industrial Research (CSIR) and Indian Ministry of

Health and Family Welfare to promote Ayurveda world-wide created fertile grounds for

sprouting a small number of Abhyanga studies. Yet, these studies, mainly focused on

systematization and taxonomies of the basic Abhyanga strokes and techniques, were

relying extensively on the Western quantitative metrics. Without necessary effort to

focus and describe unique values built into all traditional medical knowledge the

complexity of TMK therapist-client interactions becomes dangerously over-simplified,

thus failing to provide any qualified evidence (4, p. 29).

In March of 1995 the Indian Government formed a Department of Ayurveda, Yoga and

Naturopathy, Unani, Siddha and Homoeopathy that was principally tasked with an

exploration of Ayurvedic historical and practical perspectives, including relationships of

Ayurvedic doctors (“vaidyas”), to the “modern medicine”(6). The conclusion, still

informally stated although supported substantially by an outcome of a massive survey,

was that the Indian public not only supports but also desires an integrative, Ayurveda-

inclusive, medical services (6). Consequently, between 1996 to early 2000’s India has

witnessed an eruption of over two hundred private Ayurveda colleges producing an

annual cohort of 20,000 contemporary “vaidyas”. Further, the Indian Government

continued with allocating resources to support projects relevant to preservation and

catalogization of Ayurvedic herbal remedies. For example, the Traditional Knowledge

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Digital Library (TKDL) founded in 2001was formed with a single purpose of gathering

and keeping records of traditional Ayurvedic herbal formulas to counteract damages

caused by bio-piracy (7). The other purpose of the TKDL was “digitalization of plant

resources, standardization of Ayurvedic formulas, and integrative research on herbal

ingredients … all measures meant to enhance the 'safety' of herbal drugs for the western

consumers” (8, p. 116). Comparable trends in preserving and promoting traditional

medical knowledge have been noted in China too in relation to Traditional Chinese

Medicine (TCM):”China became successful in integrating TCM in the national health

care system. Science-based approaches were utilized and inculcated in the education of

TCM with emphasis on research... Today, about 95% of general hospitals in China have

traditional medicine departments”(9, p.4).

By 2010, perhaps influenced by ever- increasing number of TCM-related research

studies in China and the USA, non-pharmacological components of Ayurvedic

medicine, such as manual therapies, begun its emergence. Some of the studies found

minor evidence for Abhyanga as a remedy for nervous system disorders, backache,

myocardial infarction, drug addiction, gynecological disorders, and post-delivery

recovery, and issues related to bad circulation and obesity (10). Most of the studies,

however, echoed cry of educational bodies to standardize Abhyanga to keep it in-line

with the general promotion of Ayurvedic medicine (4, 11, 12, 13, 14). Yet, unlike China,

India transpired to be less systematic and persistent in popularizing a wide range of own

TMK options. While “Chinese medicine became successful in crossing philosophical

barriers through constant reworking of the basic system (and one of the twelve focal

points in the current Five-Year Plan of China's Ministry of Science and Technology is to

modernize research in TCM” (9, sec. 5)), in India, an absence of long term vision to

strategically position Ayurveda as one of the major Indian exports is hurting both

practitioners and researchers. For example, even the basic requirement - creating

Ayurvedic taxonomy in the National Library of Medicine Medical Subject Heading

(MeSH) - has not been completed sufficiently enough to provide a proper language and

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standardization needed for complementary medicine (CAM) inquires (15). What can not

be formulated cannot be defined, nor measured, managed or integrated.

By 2008 further burgeoning of Ayurvedic colleges in Europe combined with demands to

standardize and raise the bar of Ayurvedic education across North America broadened

Ayurvedic educational discourse. The objectives, mostly endorsed by the National

Ayurvedic Medical Association (NAMA), were creation of Ayurvedic medicine policies

and quality standards for integration practice and research models. By 2009 NAMA was

certain that the Ayurvedic medicine in the Western World reached the level where it can

“meet the Western massage standards” efficiently by being able to “identify and

articulate good, responsible minimum standards of practice and competencies of

graduates and practitioners”(16). Same year the UK Government responded with

standardization of the Indian Head Massage by state-wide World Class Qualification

Awarding Body widely but informally used in Canada.

Presently, the number of Ayurvedic educators (Ayurveda doctors and Ayurvedic

complementary practitioners) in North America reached the level where setting the

minimum standard became urgent. If NAMA would not able to press forward are new

influencers in the field such as recently formed Academic Consortium for

Complementary and Alternative Health Care (ACCAHC) could take over this role (17).

Yet, the challenge is enormous and requires a collaborative, non-discriminatory

approach that will include an input from variety of schools and practitioners. Only by

collaborating and having an open dialogue in optimal, all-inclusive environment oral

knowledge narratives can be successfully filtered down into relevant metrics and

taxonomies.

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Regulatory exploration: The case for Abhyanga inclusion

As mentioned previously, Abhyanga appearances in journals, including Ayurvedic

medical journals in India, are rather sporadic (18). In the West, as expected, Abhyanga

is not recognized amongst CAM therapies or accepted under the registered massage

therapy “bundles” across Canada because of its perceived out- of- scope status, non-

relevancy to the current massage therapy literature and absence of randomized control

trials* (RCTs)

However, this paper purports that there is a clear evidence that Abhyanga is, indeed,

fully compliant with the Canadian RMT requirements and deserves its CAM inclusion.

In terms of relevancy to the scope of the registered massage therapy in Canada Mishra’s

classification of Abhyanga ten basic massage strokes should be compared with the

definition of strokes prescribed by the 2006 Scope of Practice Techniques Standards by

the College of Massage Therapists of Ontario (CMTO). Specifically, Mishra classifies

Abhyanga strokes within twelve categories, namely “friction where pressure is applied

by thumb and finger tips more on muscular part, and gentle pressure on bony parts;

kneading, deep of superficial; rounding; wringing or twisting; crunching; stroking;

percussion; vibration; joint movement, and soft, gentle massage with thumbs and palms”

(4, p. 28). The CMTO standard categorizes strokes in 15 categories, namely: stroking,

rocking, effleurage, petrissage, friction, vibration, tapotement, deep facial, myofacial,

low and high grade joint mobilization, stretch, intra-oral, breast massage, chest wall

massage and hydrotherapy (19). Similarities are evident, if not interchangeable.

_____________________________________________________________________

(*Based on informal interviews conducted with Abhyanga practitioners in Toronto and

general over-the-phone inquire with several registered massage therapy regulatory

bodies in Canada.)

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Next, in terms of relevancy to the current and relevant massage therapy literature,

research studies conducted by the Touch Research Institute (TRI) have been steadily

providing continuous, uninterrupted evidence about benefits of Ayurveda based Yoga

practices in conjunction with massage therapy since early 1990s. Ayurveda, Abhyanga

and Yoga share the same philosophy and practice of assessment that includes Tri- Dosha

theory and self-care recommendations (posture, breathing, diet, asana, massage). TRI’s

research studies related to rejuvenating “Yoga incorporated” massage therapy are

highly– pertinent to Abhyanga (20). In Ayurveda, one massage component does not

thrive isolated from other hands-on approaches. Thus, researching one rejuvenating

Ayurvedic hands-on component provides an evidence for all rejuvenating (Rasayana)

treatments. In other words, an evidence for Yoga “massage”, by the same measure, must

be applicable to Abhyanga as the core metrics needs to describe the entire relationship or

dance of Doshas versus describing an isolated muscle response.

Finally, in terms of providing data by randomized control trials (RCTs), the value of

RCTs for massage therapy in general remains a challenge. Although Ayurvedic herbal

formulas have been frequently submitted to RCT protocols (aiming toward replicability

for mass production) measuring services have never been an easy task (18). Enormous

tension between laboratory-centered RCT standards and life –centered Ayurveda is

difficult to ignore: “controlled trials themselves depend on interpretation of evidence

based on previously confirmed medical beliefs and contradictory evidence may be

bypassed by finding fault with the experimental protocol. Controlled trials have little to

do with the patients' experience … unless large number of patients is affected in one

location... hence; RCTs are not necessarily the only and the best methods for validation

of therapeutic efficacy” (8, p. 4). The issue with creating evidence in Ayurveda/

Abhyanga maintains the need for multiple paths of inquiry. As Ayurveda spans

taxonomies of several health care domains, so the valid evidence must be searched for

and found across those sections simultaneously (15, 21).

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Personal exploration: Abhyanga blossoming

“The body of one who uses oil massage regularly does not become affected much even if

subjected to accidental injuries, or strenuous work. By using oil massage daily, a person

is endowed with pleasant touch, trimmed body parts and becomes strong, charming and

least affected by old age.”

Charaka Samitha, Vol. 1, V: 88-89

Abhyanga aims to disperse accumulation of Vata Dosha, condition that arises from the

dry and cold, movable and irregular internal and external elements that, while

controlled, increase creativity and enthusiasm but otherwise propagate worry, anxiety,

insomnia and chronic fatigue (22, 23). Vata Dosha, as one of three Ayurvedic Doshas/

disorders (the other two being Pitta and Kapha), is often affected first leading the

domino-effect discordance. Cool and windy nature of Vata is further aggravated by cold

and windy climate or irregular habits. Thus, maintaining a regular Vata balancing

routine in winter is recommended for all body types and all constitutions: Vata -

dispersing diet, regular and disciplined daily schedules, plenty of quiet activities such as

meditation, and an intense body oleation (23).

An abundance of warm oils also prevents friction. Skin friction, Ayurveda reveals, also

aggravates Vata. Ayurveda, “a Mother of Healing”, uses warm oils as a therapeutic,

continuously outpouring, oleating vehicle of the Mother providing an uninterrupted

opportunity for restoring constitutional balance. The most poetic element of Abhyanga

narratives is that the Sanskrit word for oil, snehana, has a dual meaning of oil and love.

Snehana/oil is plump, young, giving and loving while Vata/dry is old, isolated, depleted

and distant. Saturating the body with snehana, the oil/love becomes both a behavioral

guide and a physical experience of a deep visceral understanding of how, why and when

we heal. Ayurveda, as all traditional medical knowledge, uses each and every

opportunity for story telling traversing the boundaries of art and science. Through

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relationships and narratives that engage us freely with the basic human emotions we are

able to connect with the internal sources of health and rejuvenation.

Abhyanga assessment takes into consideration not only an individual’s basic body

constitution (Prakriti), but also the current condition of the person (Vikriti) and the

environment one resides in. For example, my basic Pita Prakriti provides me with

sufficient body heat (including metabolic) and good circulation. However, it also makes

me prone to anger and irritation further aggravated by maturation Vata (Vikriti) and

seasonal Vata (winter). Customized Abhyanga will incorporate a number of specific

techniques, each one having a unique name with an added “abhyanga” suffix: the head

massage - Shiro-abhyanga, the facial massage – Mukhabhyanga, feet massage is

Padhabhyanga and hand massage - Hastaabhyanga. Each technique has a unique

choreography based on specific physiological and symbolical goals that need to be

accomplished. Multiple Abhyanga-s assigned within one single treatment express

therapist’s interpretation of how and where the client’s Prakriti and Vikriti are

intersecting in space and time. Further, Abhyanga will often engage two therapists

simultaneously to synchronize masculine/ feminine polarity (therapists not necessarily

of the opposite gender). Traditional medical systems such as Ayurveda and Traditional

Chinese Medicine (TCM) are dualistic by nature operating within concepts of Shiva-

Shakti (Ayurveda) or Yin-Yang (TCM). When two touch-es are synchronized by shared

rhythms of inhaling/exhaling they are believed to have greater potential to integrate

alienated and disowned dualism of the body/ psyche.

Between the October and December of 2012, I experienced four Abhyanga treatments

performed by combinations of male and female therapists. By virtue of being a body

therapy aficionado, and having years of professional training in body therapies actively

working as a body therapist for over ten years I consider myself to be reasonably well

equipped to provide an objective, qualitative feedback. In my view the following six

types of unique cerebral and sensory experiences distinguished Abhyanga from other

body treatments I have had an opportunity to experience in the past:

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Greater awareness/ experience of comfort when experiencing slow outpour of

warm oils;

Greater awareness/ experience of alignment with internal body rhythm when

experiencing synchronized, four-hands lateral pressure;

Greater awareness/ experience of deepening and expanding chest breathing;

Intensified sense of faster “surrender” to the healing component of the treatment;

Intensified sense of physical, emotional and mental rejuvenation;

Prolonged experience of post-treatment “skin elasticity”.

Other benefits noted coincided with general massage therapy benefits experienced

elsewhere such as better sleep over the next couple of days immediately following the

treatment, general muscle relaxation and curbed sugar cravings.

The ultimate benefit experienced by receiving Abhyanga - for a lack of better

clarification- was a sense of free- flowing emotional attachments to people around me, a

sense of being able to easily connect on a deep level and easily let go. This type of an

effortless emotional connect-disconnect awareness was maintained steadily for a day or

two after the treatment. Perhaps, it could be an indication of my compatibility with

Abhyanga. Perhaps, some sequence of Abhyanga strokes was able to precisely ignites

certain neurological pathway leading my body to nearly identical emotional response

four times in the row. Or, perhaps, the snehana, oil-love, is an actual, physical and

replicable quality that could be, in fact, easily subjected to metrics of randomized

control trials.

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Conclusion: Abhyanga redefined

This short observation and exploration of the history, purpose and personal experience

of Abhyanga led to the following conclusions:

From regulatory perspective, Abhyanga would certainly benefit from consistent

and standardized training structure accurately translating and incorporating

traditional medicine knowledge (TMK) - specific model (24, 25). However,

concealed symbolic values of oral transmission can be attained only through

apprenticeships. A cross-cultural pollination amongst practitioners, educators

and researchers is required to allow for multiple paths of inquire and

establishment of best practices that will influence curriculum, research and refine

the TMK metrics.

Integration of TMK models in China and India demonstrate that focusing on the

quality of the processes versus the outcomes, on opportunities for collaborative

research and on Government commitment are proven to be the fastest and the

most profitable ways of merging the TMK with current CAM findings (26, 27).

Qualitative research methods seem to be valuable tool of lobbying for

integration.

To instigate Abhyanga research Ayurvedic taxonomies need to be MeSH-

compliant. Solid vocabularies/ keywords will lead to consistency in inquiries and

research and, hopefully, to more solid funding to undertake them.

Finally, a recent economical downturns and slow recovery and reduction in workers’

benefits and compensation upset the equilibrium of massage therapy profession in

Canada. As discretionary income or company health plans will be likely reduced further

the individual health consumers might become more educated, cost-minded and quality-

oriented. To integrate inexpensive, drug-less TMK practices into preventative health

care systems is a visionary way of building public health of the future to be more

economically, environmentally and holistically sustainable.

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CONFLICT OF INTEREST NOTIFICATION - The author is not aware of any conflicts of

interest with regard to this material.

COPYRIGHT - Published under the Creative Commons Attribution Non Commercial-No Derivs

3.0 Licenses.

ACKNOWLEDGMENTS -The author wants to express thanks to Andrea Olivera and Davis

Batson for sharing their vast knowledge of Ayurveda, Abhyanga and Jyotisha. Her deepest

gratitude is extended to Mantriji and Margaret Mahan for awakening the mind to mysteries.

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