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Role of udvartana in prevention and management of metabolic syndrome
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Role of udvartana in prevention and management of metabolic syndrome

Introduction

Metabolic syndrome is a cluster of interrelated metabolic abnormalities characterized by central obesity, hyperglycaemia, hypertension, elevated low-density lipoprotein (LDL), and reduced high-density lipoprotein (HDL). It represents the cumulative effect of unhealthy lifestyle patterns along with genetic and physiological predisposition. The global prevalence of metabolic syndrome has risen markedly over the past three decades, now affecting over one billion individuals worldwide. This escalating burden necessitates early preventive strategies and comprehensive management approaches.

Ayurveda offers an integrative framework for lifestyle disorders through Dinacharya, Ritucharya, Shodhana, and Shamana Chikitsa. Among Shodhana modalities, Udvartana is described as a specialized therapeutic procedure involving dry powder massage using Ruksha dravyas. Regular application is reported to reduce body fat, improve lipid profile by lowering LDL, and enhance HDL levels, thereby addressing key components of metabolic syndrome. Excess adiposity and dyslipidaemia are central contributors to disease progression; therefore, their correction through Udvartana may have preventive and therapeutic relevance.

Udvartana

Udvartana is a therapeutic external procedure described in Ayurveda involving vigorous massage with herbal powders or medicated substances applied in an upward direction with consistent pressure. It is primarily indicated for Kapha disorders and Meda dhatu imbalance. It may be performed as oil-based (Snigdha) or dry (Ruksha) massage, depending on the clinical condition, with Ruksha Udvartana being preferred in obesity and metabolic disorders.

According to Venimadhav Shastri Joshi in Ayurveda Mahakosha, Udvartana is defined as Gatramardana (body massage) and Twakgharshana (skin friction). Classical texts describe its wide therapeutic utility, including relief from body odour, lethargy, heaviness, excessive sweating, anorexia, itching, and Kapha-related disorders. Acharya Sushruta further emphasizes its role in reducing Meda, alleviating vitiated Kapha, and pacifying Vata.

In obesity management, Udgharshana is a specific form of Ruksha Udvartana using fine powders such as Haritaki (Terminalia chebula) and brick powder, which promote Meda vilayana (fat dissolution) and Vilekhana (scraping action).

Types (according to Acharya Sushruta)

  • Udgharshana:

It involves dry powder rubbing over the body without the use of oil or liquid media. It is primarily indicated for Kapha-Meda dominance and obesity-related conditions.

  • Utsadana:

This is similar to Udgharshana but performed with the use of oil or liquid-based media. It is generally indicated for individuals requiring a less intense form of stimulation.

Indications of ruksha udvartana

  • Severe Kapha predominance and Meda accumulation
  • Obesity and hyperlipidaemia
  • Body heaviness and stiffness
  • Fatigue, lethargy, and reduced physical activity tolerance
  • Patients fit for intensive external therapies

Indications of various drugs for udvartana in conditions similar to metabolic syndrome1

  • Kulattha churna: Excess sweating and subcutaneous fat reduction
  • Shailayadi churna: Obesity management
  • Triphala churna: Obesity and skin disorders
  • Nalpamaradi churna: Diabetes-associated pruritus
  • Kolkulattadi churna: Obesity and neurological conditions
  • Mrittika churna: Reduction of skin oiliness
  • Reetha and wood powders: Udgharshana in Kapha disorders
  • Ishtika churna: Obesity, pruritus, and skin eruptions

Duration of udvartana

Udvartana is typically performed for 30–45 minutes per session, with 3–5 minutes allocated per body region. Treatment duration ranges from 7 to 14 days depending on disease severity and patient response.

Probable mode of action of udvartana on metabolic syndrome

Udvartana exerts its therapeutic effects through Kapha–Meda vilayana, facilitated by the application of Ruksha, Ushna, Tikshna, and Laghu properties of medicinal powders. According to the Samanya-Vishesha Siddhanta, the procedure induces reduction of pathological Meda through opposing qualities.

The therapy enhances microcirculation, promotes lymphatic drainage, and facilitates mobilization of accumulated lipids. The mechanical friction combined with bioactive herbal constituents may stimulate β-adrenergic receptors in adipose tissue, leading to triglyceride breakdown into free fatty acids. This supports systemic lipid utilization and reduction of adiposity.

The combined effect of drug and procedure acts at the level of Srotas, removing obstruction caused by Kapha and Meda accumulation and restoring metabolic homeostasis.

Effect of udvartana on different attributes of metabolic syndrome

  • Obesity:

Udvartana improves local circulation and enhances mobilization of subcutaneous fat. Mechanical stimulation and herbal activity promote lipolysis and breakdown of triglycerides. Clinical evidence suggests reduction in BMI, body weight, and serum lipid levels, indicating reversal of Sthaulya samprapti at a metabolic level.2

  • Insulin resistance:

Since insulin resistance is closely linked with adiposity and lipid accumulation, reduction in fat mass and improvement in metabolic activity through Udvartana may enhance insulin sensitivity.

  • Dyslipidaemia:

Udvartana has been associated with reduction in total cholesterol, LDL, and triglycerides, along with improvement in HDL levels. It may also enhance lipolytic enzyme activity, contributing to improved lipid metabolism.

  • Hypertension:

In metabolic syndrome, hypertension is partly driven by insulin resistance and elevated free fatty acids. Udvartana improves peripheral circulation, induces vasodilation, and enhances metabolic clearance of lipids, thereby contributing to better vascular function and reduced cardiovascular risk.

Conclusion

Metabolic syndrome is a rapidly growing global health concern requiring multifaceted therapeutic strategies. Udvartana, a classical Ayurvedic procedure, offers a non-invasive and cost-effective intervention targeting obesity, dyslipidaemia, and insulin resistance.3 Through mechanical stimulation and pharmacological action of herbal powders, it facilitates lipid mobilization, improves metabolic efficiency, and restores doshic balance. Regular application of Udvartana may serve as an effective preventive and adjunct therapeutic modality in metabolic syndrome, particularly by addressing obesity as the root pathological factor.

References:

    1. WADHWA R, Kayachikitsa MD. Udvartana ( Massage Therapy). IJMPNP. Volume 6, Issue 3, 2020, PP 24-27 ISSN 2454-7999(Online) DOI: http://dx.doi.org/10.20431/2454-7999.0603003. https://www.arcjournals.org/pdfs/ijmpnp/v6-i3/3.pdf
    2. Sharma P, Sharma VB. A clinical study to evaluate the effect of lekhan basti, udvartana and navak guggulu in the management of Obesity vis-à-vis Sthoulya. International Ayurvedic Medical Journal. 2015 Feb;3(2). https://jaims.in/jaims/article/view/1859
    3. Mishra S, Kumar M. Role of Udvartana in Prevention and Management of Metabolic Syndrome-A Review. International Journal of Health Sciences and Research. 2024;14(8):388-93. https://www.ijhsr.org/IJHSR_Vol.14_Issue.8_August2024/IJHSR43.pdf