ROLE OF MASSAGE THERAPY IN THE MANAGEMENT AND PREVENTION OF DISEASES: A CASE SERIES OF MEDICATED MASSAGE

In this paper, authors have discussed the basic concept of massage and its mechanism of action from holistic point of view supported by modern perspective. At the end, authors described some case reports involving clinical interventions of massage therapy with different oils commonly used in Unani System of Medicine. In Unani, there are four methods of treatment viz, Regimental therapy, Dieto therapy, Pharmacotherapy and surgery. Massage is one of the most popular forms of regimental therapy and has been in use since antiquity. Massage therapy is actually the scientific mode of curing certain forms of diseases by systemic manipulations and it signifies a group of procedures which are usually done with hand on the external tissues of the body in a variety of ways either with a curative, palliative or hygienic point of view. Massage with medicated oils is indicated in a number of neurological, musculoskeletal and psychosomatic disorders for prophylactic as well as therapeutic purposes. Key-words: Massage therapy; Dalk; Medicated oils; Regimental therapy; Unani Medicine. INTRODUCTION Dalk (Massage therapy) is an integral part of Unani system of medicine. The Unani System of Medicine founded by Hippocrates in 460-377 BC is based on the concept of equilibrium and balance of natural body humours (blood, bile, black bile and phlegm). The imbalance in the quality and quantity of these humours leads to diseases whereas restoration of this balance leads to health. The treatment of diseases is based on four methods viz, Ilaj bil tadabeer (Regimental therapy), Ilaj bil ghiza (Dieto therapy), Ilaj bil dawa (Pharmacotherapy) and Ilaj bil yad (surgery). According to a great Unani scholar, Ibne Sina, Ilaj bil tadabeer is actually a part of tibbe amli (practical medicine) in which treatment is done by suitable modifications in asbabe sittae zarooria (six essentials), which are the hallmark of Unani tib and he has mentioned 36 regimes in his famous book Alquanoon Fit Tib (Canon of Medicine), including dalk (massage), riyazat (exercise), hijamat (cupping), fasd (veinesection), tareeqe (diaphoresis), kai (cauterization), hammam (steam bath), huqna (enema), ishal (purging), idrar (dieresis), tanfees (expectoration), irsale alq (leeching) etc. Dalk, one of the most important and widely practiced methods, is known from the time of extreme antiquity and is still alive nowadays. It signifies a group of procedures which are usually done with hand on the external tissues of the body in a variety of ways either with a curative, palliative or hygienic point of view. In other words we can say that massage is a healing art. 9 A typical massage technique includes three features known as triad of massage therapy, i.e. technique should apply mechanical force to the soft tissue of the body, the forces must not apply any change in the position of joint and the technique must evoke some physiological and or psychological effect which serves to achieve the therapeutic, restorative or preventive goal. 11 CLASSIFICATION OF MASSAGE In Unani system of medicine, 5-7 massage is classified on the basis of khafiayat (quality) and kameyat (quantity).On the basis of quality, massage is classified into three types viz; 1. Dalk sulb (hard massage): Massage done with pressure, which makes the body firm. 2. Dalk laiyyan (soft massage): Massage done lightly, which relaxes the body. 3. Dalk motadil (moderate massage): Intermediate between dalk sulb and dalk laiyyan which, makes the body muscular. On the basis of quantity, massage is classified into three types viz; 1. Dalk kaseer (prolonged massage): Massage done for long period of time, which makes the body thin. 2. Dalk qaleel (short duration massage): Massage done for short period of time. 3. Dalk motadil (moderate massage): Intermediate between the two. SPECIAL TYPES OF MASSAGE 1. Dalk khishan(rough massage):Massage done with a piece of rough cloth. It draws blood briskly towards the skin. It is used in chronic skin diseases for the resolution of morbid matter 2. Dalk amlas (smooth massage): Massage done with soft hands or soft piece of cloth. It increases the flow of blood in the affected part. 3. Dalk istardad or dalk musakkin (recuperative massage): Massage is done after the end of exercise. It is actually the terminal part of exercise. It is done with some oil vigorously in the beginning and gently towards the end. Its purpose is to liquefy and eliminate the waste products which have been stagnant in the tissues and thus prevents fatigue. 4. Dalk istedad (preparatory Massage): It is a special type of massage usually done before the exercise. It starts gently and vigorously as the time of exercise approaches. MECHANISM OF ACTION OF MASSAGE Massage is one of the oldest forms of treatment for human ailments. In traditional system of medicine, especially in Unani system of medicine, medicated massage is indicated in a number of neurological, musculoskeletal and psychosomatic disorders as follows; falij (hemiplagia, paraplegia, quadriplegia), luqwa (facial/ bell’s palsy), muscular weakness, muscular dystrophy, hemiparesis, cerebral disorders, upper and lower motor neuron lesions, wajaul muffasil (Rheumatoid arthritis, Osteoarthritis), niqras (gout), Irqun nissa (sciatica), tashweesh (anxiety), sehar (insomnia), malankholia (mania), hysteria, sudda (headache) etc. Its mechanism of action is based on holistic approach of two fundamental concepts i.e Tanqiyae Mawad (Evacuation of morbid humour) and Imalae Mawad (Diversion of humour). Tanqiyae Mawad means the resolution and excretion of morbid humors and excess fluids from the body, thereby maintaining the homeostasis in the quality and quantity of four bodily humors, which is actually responsible for the maintenance of normal health. Imalae Mawad refers to the diversion of the morbid fluids from the site of affected organ to the site where Lone Azad Hussain et al / IJRAP 2011, 2 (5) 1474-1477 International Journal of Research in Ayurveda & Pharmacy from it is easily expelled from the body tissues. It also induces sedation, analgesia and increased blood circulation. 3-6 From modern perspective, 8-11 as therapeutic modality, massage is used for the relief of pain, swelling, muscle sprain, restricted movements, tension and anxiety associated with a large no. of disorders afflicting muscular, nervous, cardiovascular, respiratory and other systems. It is the magnitude, duration and the direction of force applied during massage that determines the effect produced on the body. Massage affects almost all systems of the body as follows; · Increased venous and lymphatic flow, increased arterial blood flow to the muscle and skin. · Decreased stagnation of fluid in tissues spaces. · Increased removal of waste products of metabolism. · Increased WBC, RBC, and platelet count in blood. · Increased nutritive exchange between blood and cells. · Increased trophic status of the part massaged. · Induce sedation and decrease pain. · Facilitate contraction in hypotonic muscles. · Modulate autonomic responses. · Decreased excitability of motoneuronal pool in neurologically healthy person. · Increased removal of secretions from lungs. · Increased gaseous exchange across pulmonary capillaries. · Increased removal of dead cell from the skin. · Increased activity of sweat and sebaceous glands. · Lowers psychosomatic arousal such as anxiety and stress. · Mobilize soft tissues and breaks soft tissue adhesions. · Accelerates various metabolic processes by increasing arterial blood flow and venous lymphatic drainage. · Promotes lipoylsis. CLINICAL INTERVENTIONS CASE -1 A male patient naming A, age 60 years, farmer by occupation, resident of Magadi Bangalore, came to Outpatient department (OPD) of Moalajat, National Institute of Unani Medicine (NIUM) with the complaints of pain, swelling and difficulty of movements of left knee joint for last 2 years. There was no history of any trauma, infection, surgery or accident. He has been taking allopathic medicines but left as he developed gastric trouble. He was nonhypertensive, non-diabetic but had history of smoking since 20 years. On examination, his general condition was fair, vitals were stable (BP= 120/8O mm Hg, Pulse= 78/ min, Respiratory rate= 18/ min) with no systemic illness. Locally there was mild tenderness in left knee, crepitus and restricted movements of left knee joint but Straight Leg Raising (SLR) test was negative. Radiological examination of Knee joint revealed reduced joint space with osteophytes, thus he was diagnosed as a case of Wajual Muffasil (Osteo arthritis, OA) of left knee. Then the patient was advised Massage therapy for a period of one month. Massage (Dalk laiyyan) was done over the affected knee and leg with warm Roghane baboona (10 ml oil) for 15-20 minutes daily. The assessment of severity of symptoms and sings was done at 0 day, 15 day and 30 day, whereas the efficacy of Massage with Roghane baboona was carried out by Visual Analogue Scale (VAS). After one month, patient felt a remarkable improvement as the scores of different parameters reduced significantly (p<0.05) at the end of treatment. (Table-1) This beneficial effect of massage therapy may be due to the synergistic actions of various ingredients of Roghane baboona. Roghane baboona is a well known medicated oil commonly used for pain and inflammatory conditions. The ingredients of this oil are Baboona (Marticaria chamomilla) and Roghan kunjad (oil of Sesamum indicum) which are bestowed with Mussakin (analgesic), Muhallil (anti-inflammatory) and Jazib (absorbent) properties. The symptomatic relief may be attributed to these pharmacological activities of oil applied locally. The overall response of massage therapy may be attributed to its holistic mechanism of Tanqiyae Mawad and Imalae Mavad from the affected joint. According to the Unani doctrine, OA is a humoral disease occurring due to accumulation of morbid humours around the joint and its surrounding tiss