Swedadhyaya

Sutra Sthana Chapter 14. Sudation Therapies

Swedadhyaya

Section/Chapter	Sutra Sthana Chapter 14
Tetrad/Sub-section	Kalpana Chatushka
Preceding Chapter	Snehadhyaya
Succeeding Chapter	Upakalpaniya Adhyaya
Other Sections	Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Mangalasseri P.
Reviewer	Galib, Dwivedi L.K., Thakar A. B., Patil V.
Editors	Mangalasseri P., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s01.016

Abstract

This chapter deals with sudation (Swedana, therapeutic sweating) therapy, essentially followed after oleation therapy. Swedana (sudation) is a process in which the individual is subjected to therapeutic sweating. It is considered an essential prerequisite to Panchakarma (purification therapy involving five procedures) in Ayurveda. Swedana is intended to remove excessive vata and kapha dosha and is contraindicated in pitta disorders. The extent and intensity of swedana depends upon various factors such as physical strength, severity of dosha, season, site, age etc. There are specific indications and contraindications for swedana karma and the optimal signs should be strictly followed for the procedure. There are many agents to induce sweating which can be broadly divided into sagni sweda (sweating induced with the help of fire) and niragni sweda (induced without using fire). Bolus fomentation, steam fomentation, tub fomentation and poultice fomentation are some of the very common types of swedana procedures. There are thirteen varieties of fomentations (prevalent in the olden days) that involve direct usage of heat derived from fire, and ten methods without fire. Swedana is an effective therapeutic method in Ayurveda and is the focus of study in this chapter.
Keywords: Avagaha sweda, fomentation, jentaka sweda, nadi sweda, niragni sweda, ushma sweda, pottali sweda, ruksha sweda, sagni sweda, sankara sweda, samyak swinna lakshana, snigdha sweda, sudation swedana, swedatiyoga, swedayoga, trayodasha sweda, upanaha sweda, fomentation, heat, sudation therapy, hydrosis.

Introduction

As per Ayurveda, the functioning of the universe depends upon agni and soma which symbolize sources of hot and cold energy. Uttarayana (northward sojourn of sun) and dakshinayana (southward sojourn of sun) are together responsible for maintaining homeostasis on this planet. This homeostasis is also mirrored in the individual through the concept of loka purusha samanya siddhantha (that the individual is a microcosm of the universe, the macrocosm). The purusha (individual human being) imbibes this energy and confines it in the sharira (body) as pitta. This pitta controls, or rather regulates, the ushmanattva (core body temperature) of the body. [Cha.Sa.Sutra Sthana 12/11] It is responsible for all the metabolic processes at the cellular level and digestion at the level of the gut. Pitta is the contributor of ushna guna (warmth) to the body. The stimulator (preraka) of pitta is vata (the accelator-sameerano agnehe. [Cha.Sa.Sutra Sthana 12] Vata, in association with pitta and kapha, maintains the normal core body temperature by controlling the heat regulating system and balancing the sheeta and ushna guna.

Swedana uses the agni principle in therapy. Practical applications of swedana procedures, along with indications, contraindications and complications associated with their management have been described in this chapter. It is recommended after proper snehana and is enlisted as one among six important therapies along with langhana (fasting or reducing therapy), brimhana (nourishing therapy), snehana (oleation), stambhana (styptic therapy) and rukshana (drying therapy).Swedana has to be adopted based on the symptoms and conditions considering the samanya visesha sidhantha (theory of similarity and dissimilarity). Swedana procedures are indicated in vata, kapha and vata-kapha dosha dominant disorders, but are contraindicated in pittaja disorders. There are three types of twin procedures (with opposing actions to each other) used for various conditions:

1. Thirteen types of procedures of sagni sweda (induced with help of fire) and ten types of niragni/anagniswedana (induced without help of fire) described for various sudation procedures.
2. Ekangtah-sarvangtah (localized-generalized). An ekangtah, or localized swedana, is administered by means of sankara sweda (bolus fomentation) and naadisweda (using a tube for fomentation) etc. and sarvantah or generalized swedana is administered by means of prastar (lying down on medicated hot mattress) and jentaaka, (sudation in a heated room) etc.

Snigdha (unctuous) procedures for vata dominant disorders and ruksha (dry) procedures for kapha dominant disorders are advised. In vata-kapha dominant disorders, snigdha-ruksha procedures are recommended.

Sanskrit text, Transliteration and English Translation

अथातः स्वेदाध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaḥ svēdādhyāyaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtaH svedAdhyAyaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Sweda"(sudation). Thus said Lord Atreya. [1-2]

Importance of swedana

अतः स्वेदाः प्रवक्ष्यन्ते यैर्यथावत्प्रयोजितैः| स्वेदसाध्याः प्रशाम्यन्ति गदा वातकफात्मकाः||३||

स्नेहपूर्वं प्रयुक्तेन स्वेदेनावजितेऽनिले| पुरीषमूत्ररेतांसि न सज्जन्ति कथञ्चन||४||

शुष्काण्यपि हि काष्ठानि स्नेहस्वेदोपपादनैः| नमयन्ति यथान्यायं किं पुनर्जीवतो नरान्||५||

ataḥ svēdāḥ pravakṣyantē yairyathāvatprayōjitaiḥ| svēdasādhyāḥ praśāmyanti gadā vātakaphātmakāḥ||3||

snēhapūrvaṁ prayuktēna svēdēnāvajitē'nilē| purīṣamūtrarētāṁsi na sajjanti kathañcana||4||

śuṣkāṇyapi hi kāṣṭhāni snēhasvēdōpapādanaiḥ| namayanti yathānyāyaṁ kiṁ punarjīvatō narān||5||

ataH svedAH pravakShyante yairyathAvatprayojitaiH| svedasAdhyAH prashAmyanti gadA vAtakaphAtmakAH||3||

snehapUrvaM prayuktena svedenAvajite~anile| purIShamUtraretAMsi na sajjanti katha~jcana||4||

shuShkANyapi hi kAShThAni snehasvedopapAdanaiH| namayanti yathAnyAyaM kiM punarjIvato narAn||5||

Now the various techniques of sudation will be explained. A well administered sudation cures various disorders of vata and kapha origin, provided they have been identified among a set of diseases that are curable by inducing sweat. Administering sudation, especially after oleation, controls vata and prevents clogging of feces, urine as well as semen. If oleation and sudation could soften dried out timber, then why not a human being? [3-5]

Scope of Swedana

रोगर्तुव्याधितापेक्षो नात्युष्णोऽतिमृदुर्न च| द्रव्यवान् कल्पितो देशे स्वेदः कार्यकरो मतः||६||

rōgartuvyādhitāpēkṣō nātyuṣṇō'timr̥durna ca| dravyavān kalpitō dēśē svēdaḥ kāryakarō mataḥ||6||

rogartuvyAdhitApekSho nAtyuShNo~atimRudurna ca| dravyavAn kalpito deshe svedaH kAryakaro mataH||6||

Sudation that is neither too hot (and unbearable) nor too mild (and insufficient), administered with suitable drugs and applied as per the disease condition, season and the diseased person in specific, at the affected and the indicated body part, is indeed effective. [6]

व्याधौ शीते शरीरे च महान् स्वेदो महाबले| दुर्बले दुर्बलः स्वेदो मध्यमे मध्यमो हितः||७||

वातश्लेष्मणि वाते वा कफे वा स्वेद इष्यते| स्निग्धरूक्षस्तथा स्निग्धो रूक्षश्चाप्युपकल्पितः||८||

vyādhau śītē śarīrē ca mahān svēdō mahābalē| durbalē durbalaḥ svēdō madhyamē madhyamō hitaḥ||7||

vātaślēṣmaṇi vātē vā kaphē vā svēda iṣyatē| snigdharūkṣastathā snigdhō rūkṣaścāpyupakalpitaḥ||8||

vyAdhau shIte sharIre ca mahAn svedo mahAbale| durbale durbalaH svedo madhyame madhyamo hitaH||7||

vAtashleShmaNi vAte vA kaphe vA sveda iShyate| snigdharUkShastathA snigdho rUkShashcApyupakalpitaH||8||

Strong fomentation is indicated in a physically strong patient with severe illness in an extreme cold climate. In a weak person, mild fomentation and in a moderately strong patient, moderate fomentation is preferred. In vatakapha, vata or kapha-dominant, sudation technique is to be applied with the help of unctuous and dry agents, only unctuous agents or only dry agents respectively. [7-8]

Mode of swedana as per site of dosha

आमाशयगते वाते कफे पक्वाशयाश्रिते| रूक्षपूर्वो हितः स्वेदः स्नेहपूर्वस्तथैव च||९||

āmāśayagatē vātē kaphē pakvāśayāśritē| rūkṣapūrvō hitaḥ svēdaḥ snēhapūrvastathaiva ca||9||

AmAshayagate vAte kaphe pakvAshayAshrite| rUkShapUrvo hitaH svedaH snehapUrvastathaiva ca||9||

When vata is located at the site of ama (amashaya or stomach), sudation is administered with dry agents and when kapha is located in the site of pakva (pakwashaya,or colon) , sudation is initiated with unctuous agents. [9]

Sensitive body parts for swedana

वृषणौ हृदयं दृष्टी स्वेदयेन्मृदु नैव वा| मध्यमं वङ्क्षणौ शेषमङ्गावयवमिष्टतः||१०||

vr̥ṣaṇau hr̥dayaṁ dr̥ṣṭī svēdayēnmr̥du naiva vā| madhyamaṁ vaṅkṣaṇau śēṣamaṅgāvayavamiṣṭataḥ||10||

vRuShaNau hRudayaM dRuShTI svedayenmRudu naiva vA| madhyamaM va~gkShaNau sheShama~ggAvayavamiShTataH||10||

In the sensitive areas of testicles, precordium and eyes, sudation is not done or done very gently. Moderate sudation may be applied in the area of groins. In other parts of the body, sudation is done as desired. [10]

Pre-sudation care

सुशुद्धैर्नक्तकैः पिण्ड्या गोधूमानामथापि वा| पद्मोत्पलपलाशैर्वा स्वेद्यः संवृत्य चक्षुषी||११||

Suśuddhairnaktakaiḥ piṇḍyā gōdhūmānāmathāpi vā| padmōtpalapalāśairvā svēdyaḥ saṁvr̥tya cakṣuṣī||11||

sushuddhairnaktakaiH piNDyA godhUmAnAmathApi vA| padmotpalapalAshairvA svedyaH saMvRutya cakShuShI||11||

Before starting sudation, eyes should be closed and covered with very clean cloth or bolus of wet wheat powder or petals of lotus (Nelumbo nucifera) or white lotus (Nymphaea alba). [11]

Care during sudation therapy

मुक्तावलीभिः शीताभिः शीतलैर्भाजनैरपि| जलार्द्रैर्जलजैर्हस्तैः स्विद्यतो हृदयं स्पृशेत्||१२||

muktāvalībhiḥ śītābhiḥ śītalairbhājanairapi| jalārdrairjalajairhastaiḥ svidyatō hr̥dayaṁ spr̥śēt||12||

muktAvalIbhiH shItAbhiH shItalairbhAjanairapi| jalArdrairjalajairhastaiH svidyato hRudayaM spRushet||12||

While sudation is being administered, the precordial region should be frequently touched with a string of cool pearls or cold vessels or wet lotuses or even with wet hands. [12]

Indications for stopping sudation

शीतशूलव्युपरमे स्तम्भगौरवनिग्रहे| सञ्जाते मार्दवे स्वेदे स्वेदनाद्विरतिर्मता||१३||

śītaśūlavyuparamē stambhagauravanigrahē| sañjātē mārdavē svēdē svēdanādviratirmatā||13||

shItashUlavyuparame stambhagauravanigrahe| sa~jjAte mArdave svede svedanAdviratirmatA||13||

It is indicated that sudation procedure should be stopped when the patient is relieved from feeling cold, pain, stiffness, heaviness and feels softness in the body. [13]

Signs of over-sudation and its treatment

पित्तप्रकोपो मूर्च्छा च शरीरसदनं तृषा| दाहः स्वराङ्गदौर्बल्यमतिस्विन्नस्य लक्षणम्||१४||

उक्तस्तस्याशितीये यो ग्रैष्मिकः सर्वशो विधिः| सोऽतिस्विन्नस्य कर्तव्यो मधुरः स्निग्धशीतलः||१५||

pittaprakōpō mūrcchā ca śarīrasadanaṁ tr̥ṣā| dāhaḥ svarāṅgadaurbalyamatisvinnasya lakṣaṇam||14||

uktastasyāśitīyē yō graiṣmikaḥ sarvaśō vidhiḥ| sō'tisvinnasya kartavyō madhuraḥ snigdhaśītalaḥ||15||

pittaprakopo mUrcchA ca sharIrasadanaM tRuShA| dAhaH svarA~ggadaurbalyamatisvinnasya lakShaNam||14||

uktastasyAshitIye yo graiShmikaH sarvasho vidhiH| so~atisvinnasya kartavyo madhuraH snigdhashItalaH||15||

kaShAyamadyanityAnAM garbhiNyA raktapittinAm|

The symptoms of oversudation include aggravation of pitta, fainting, generalized fatigue, thirst, burning sensation, low or weak voice, and weakness of limbs. In oversudation the entire regimen explained for summer season in Tasyashiteeya chapter, and consuming food articles that are sweet, unctuous and cool is to be followed. [14-15]

Contra-indications of swedana

कषायमद्यनित्यानां गर्भिण्या रक्तपित्तिनाम्| पित्तिनां सातिसाराणां रूक्षाणां मधुमेहिनाम्||१६||

विदग्धभ्रष्टब्रध्नानां विषमद्यविकारिणाम्| श्रान्तानां नष्टसञ्ज्ञानां स्थूलानां पित्तमेहिनाम्||१७||

तृष्यतां क्षुधितानां च क्रुद्धानां शोचतामपि| कामल्युदरिणां चैव क्षतानामाढ्यरोगिणाम्||१८||

दुर्बलातिविशुष्काणामुपक्षीणौजसां तथा| भिषक् तैमिरिकाणां च न स्वेदमवतारयेत्||१९||

kaṣāyamadyanityānāṁ garbhiṇyā raktapittinām| pittināṁ sātisārāṇāṁ rūkṣāṇāṁ madhumēhinām||16||

vidagdhabhraṣṭabradhnānāṁ viṣamadyavikāriṇām| śrāntānāṁ naṣṭasañjñānāṁ sthūlānāṁ pittamēhinām||17||

tr̥ṣyatāṁ kṣudhitānāṁ ca kruddhānāṁ śōcatāmapi| kāmalyudariṇāṁ caiva kṣatānāmāḍhyarōgiṇām||18||

durbalātiviśuṣkāṇāmupakṣīṇaujasāṁ tathā| bhiṣak taimirikāṇāṁ ca na svēdamavatārayēt||19||

pittinAM sAtisArANAM rUkShANAM madhumehinAm||16||

vidagdhabhraShTabradhnAnAM viShamadyavikAriNAm| shrAntAnAM naShTasa~jj~jAnAM sthUlAnAM pittamehinAm||17||

tRuShyatAM kShudhitAnAM ca kruddhAnAM shocatAmapi| kAmalyudariNAM caiva kShatAnAmADhyarogiNAm||18||

durbalAtivishuShkANAmupakShINaujasAM tathA| bhiShak taimirikANAM ca na svedamavatArayet||19||

The physician should be aware that sudation is contraindicated in those who regularly consume astringents and alcohol, in pregnant women, persons with bleeding disorders, individuals with pitta predominance, those who are suffering from diarrhoea and sicca, patients with diabetes mellitus, inflamed colon, prolapsed rectum, in toxic conditions, fatigued, unconscious, obese, pitta-predominant diabetics, individuals having thirst, hunger, anger, depression, jaundice, ascitis, injured, rheumatoid diseases, weakness, extremely emaciated, highly immune compromised and those who often suffer from blackouts. [16-19]

Indications of swedana

प्रतिश्याये च कासे च हिक्काश्वासेष्वलाघवे| कर्णमन्याशिरःशूले स्वरभेदे गलग्रहे||२०||

अर्दितैकाङ्गसर्वाङ्गपक्षाघाते विनामके| कोष्ठानाहविबन्धेषु मूत्राघाते विजृम्भके||२१||

पार्श्वपृष्ठकटीकुक्षिसङ्ग्रहे गृध्रसीषु च| मूत्रकृच्छ्रे महत्त्वे च मुष्कयोरङ्गमर्दके||२२||

पादजानूरुजङ्घार्तिसङ्ग्रहे श्वयथावपि| खल्लीष्वामेषु शीते च वेपथौ वातकण्टके||२३||

सङ्कोचायामशूलेषु स्तम्भगौरवसुप्तिषु | सर्वाङ्गेषु विकारेषु स्वेदनं हितमुच्यते||२४||

pratiśyāyē ca kāsē ca hikkāśvāsēṣvalāghavē| karṇamanyāśiraḥśūlē svarabhēdē galagrahē||20||

arditaikāṅgasarvāṅgapakṣāghātē vināmakē| kōṣṭhānāhavibandhēṣu mūtrāghātē vijr̥mbhakē||21||

pārśvapr̥ṣṭhakaṭīkukṣisaṅgrahē gr̥dhrasīṣu ca| mūtrakr̥cchrē mahattvē ca muṣkayōraṅgamardakē||22||

pādajānūrujaṅghārtisaṅgrahē śvayathāvapi| khallīṣvāmēṣu śītē ca vēpathau vātakaṇṭakē||23||

saṅkōcāyāmaśūlēṣu stambhagauravasuptiṣu | sarvāṅgēṣu vikārēṣu svēdanaṁ hitamucyatē||24||

pratishyAye ca kAse ca hikkAshvAseShvalAghave| karNamanyAshiraHshUle svarabhede galagrahe||20||

arditaikA~ggasarvA~ggapakShAghAte vinAmake| koShThAnAhavibandheShu mUtrAghAte vijRumbhake||21||

pArshvapRuShThakaTIkukShisa~ggrahe gRudhrasIShu ca| mUtrakRucchre mahattve ca muShkayora~ggamardake||22||

pAdajAnUruja~gghArtisa~ggrahe shvayathAvapi| khallIShvAmeShu shIte ca vepathau vAtakaNTake||23||

sa~gkocAyAmashUleShu stambhagauravasuptiShu | sarvA~ggeShu vikAreShu svedanaM hitamucyate||24||

It is said that swedana is useful in rhinitis, cough, hiccups, breathing difficulties, heaviness of body, earache, headache, cervical pain, hoarseness of voice, choking sensation of throat, facial palsy, monoplegia, quadriplegia, hemiplegia, prostrated postures, abdominal flatulence, constipation, urinary retention, excessive yawning, stiffness of flanks, dorsum, lumbar and abdomen, sciatica, dysuria, scrotal enlargement, body ache, pain and stiffness of dorsum of foot, knee, thigh and calf, edema, severely painful radiculopathy, indigestion, chills and shivering, subluxation of ankle, contractures, convulsions, colicky pains, stiffness, heaviness and numbness, and such disorders anywhere in the body. [20-24]

Swedana dravya (material for sudation)

तिलमाषकुलत्थाम्लघृततैलामिषौदनैः| पायसैः कृशरैर्मांसैः पिण्डस्वेदं प्रयोजयेत्||२५||

गोखरोष्ट्रवराहाश्वशकृद्भिः सतुषैर्यवैः| सिकतापांशुपाषाणकरीषायसपूटकैः||२६||

श्लैष्मिकान् स्वेदयेत् पूर्वैर्वातिकान् समुपाचरेत्| द्रव्याण्येतानि शस्यन्ते यथास्वं प्रस्तरेष्वपि||२७||

tilamāṣakulatthāmlaghr̥tatailāmiṣaudanaiḥ| pāyasaiḥ kr̥śarairmāṁsaiḥ piṇḍasvēdaṁ prayōjayēt||25||

gōkharōṣṭravarāhāśvaśakr̥dbhiḥ satuṣairyavaiḥ| sikatāpāṁśupāṣāṇakarīṣāyasapūṭakaiḥ||26||

ślaiṣmikān svēdayēt pūrvairvātikān samupācarēt| dravyāṇyētāni śasyantē yathāsvaṁ prastarēṣvapi||27||

tilamAShakulatthAmlaghRutatailAmiShaudanaiH| pAyasaiH kRusharairmAMsaiH piNDasvedaM prayojayet||25||

gokharoShTravarAhAshvashakRudbhiH satuShairyavaiH| sikatApAMshupAShANakarIShAyasapUTakaiH||26||

shlaiShmikAn svedayet pUrvairvAtikAn samupAcaret| dravyANyetAni shasyante yathAsvaM prastareShvapi||27||

Fomentation bolus prepared with tila (Sesamum indicum Linn.), masha (Phaseolus radiates Linn.), kulatha (Dolichos biflorus Linn.), sour preparations, ghee, oil, meat, boiled rice (odana), sweet porridge (payasa), boiled mixture of cereals and legumes (krishara) and flesh, feces of cow, ass, camel, pig and horse along with barley grains with chaff, sand, dust, stone, dried cow dung and iron powder is effective for fomentation in the cases of kapha and vata related diseases. These articles may also be used for fomentation using a hot stone (prastara sweda). [25- 27]

Preparation for comfortable sudation

भूगृहेषु च जेन्ताकेषूष्णगर्भगृहेषु च| विधूमाङ्गारतप्तेषु स्वभ्यक्तः स्विद्यते सुखम्||२८||

bhūgr̥hēṣu ca jēntākēṣūṣṇagarbhagr̥hēṣu ca| vidhūmāṅgārataptēṣu svabhyaktaḥ svidyatē sukham||28||

bhUgRuheShu ca jentAkeShUShNagarbhagRuheShu ca| vidhUmA~ggAratapteShu svabhyaktaH svidyate sukham||28||

To get a comfortable sudation experience, the patient should have oil applied to his body and then exposed to some heat in an underground cellar (jentaka) type room, or a warm enclosed room that is heated with firebrands and is devoid of smoke. [28]

Decoctions for nadi sweda (tubular fomentation)

ग्राम्यानूपौदकं मांसं पयो बस्तशिरस्तथा| वराहमध्यपित्तासृक् स्नेहवत्तिलतण्डुलाः||२९||

इत्येतानि समुत्क्वाथ्य नाडीस्वेदं प्रयोजयेत्| देशकालविभागज्ञो युक्त्यपेक्षो भिषक्तमः||३०||

वारुणामृतकैरण्डशिग्रुमूलकसर्षपैः| वासावंशकरञ्जार्कपत्रैरश्मन्तकस्य च||३१||

शोभाञ्जनकसैरेयमालतीसुरसार्जकैः | पत्रैरुत्क्वाथ्य सलिलं नाडीस्वेदं प्रयोजयेत्||३२||

भूतीकपञ्चमूलाभ्यां सुरया दधिमस्तुना| मूत्रैरम्लैश्च सस्नेहैर्नाडीस्वेदं प्रयोजयेत्||३३||

grāmyānūpaudakaṁ māṁsaṁ payō bastaśirastathā| varāhamadhyapittāsr̥k snēhavattilataṇḍulāḥ||29||

ityētāni samutkvāthya nāḍīsvēdaṁ prayōjayēt| dēśakālavibhāgajñō yuktyapēkṣō bhiṣaktamaḥ||30||

vāruṇāmr̥takairaṇḍaśigrumūlakasarṣapaiḥ| vāsāvaṁśakarañjārkapatrairaśmantakasya ca||31||

śōbhāñjanakasairēyamālatīsurasārjakaiḥ | patrairutkvāthya salilaṁ nāḍīsvēdaṁ prayōjayēt||32||

bhūtīkapañcamūlābhyāṁ surayā dadhimastunā| mūtrairamlaiśca sasnēhairnāḍīsvēdaṁ prayōjayēt||33||

grAmyAnUpaudakaM mAMsaM payo bastashirastathA| varAhamadhyapittAsRuk snehavattilataNDulAH||29||

ityetAni samutkvAthya nADIsvedaM prayojayet| deshakAlavibhAgaj~jo yuktyapekSho bhiShaktamaH||30||

vAruNAmRutakairaNDashigrumUlakasarShapaiH| vAsAvaMshakara~jjArkapatrairashmantakasya ca||31||

shobhA~jjanakasaireyamAlatIsurasArjakaiH | patrairutkvAthya salilaM nADIsvedaM prayojayet||32||

bhUtIkapa~jcamUlAbhyAM surayA dadhimastunA| mUtrairamlaishca sasnehairnADIsvedaM prayojayet||33||

Proper decoctions may be prepared out of flesh of domesticated, marshy or aquatic animals, milk, head of goat, blood, bile and flesh of pig, unctuous substances like sesame seeds and cereals, and tubular fomentation may be applied appropriately by an expert physician, considering variations in geography and season. Tubular fomentation can also be done with decoctions of leaves of varuna (Crataeva religiosa Forst.), amritaka (Tinospora cordifolia), eranda (Ricinus communis), shigru (Moringa oleifera), mulaka (Raphanus sativus), sarshapa (Brassica nigra), vasa (Adathoda vasica), vamsha (Bambusa arundinacea), karanja (Pongamia pinnata), arka (Calotropis gigantea), ashmantaka (Bauhinia racemosa), sobhanjana (variety of shigru), saireya (Barleria prionitis), malati (Jasminum grandiflorum), surasa (Ocimum sanctum), and arjaka (Ocimum gratissimum). [29-33]

Material for avagaha sweda (tub fomentation)

एत एव च निर्यूहाः प्रयोज्या जलकोष्ठके| स्वेदनार्थं घृतक्षीरतैलकोष्ठांश्च कारयेत्||३४||

ēta ēva ca niryūhāḥ prayōjyā jalakōṣṭhakē| svēdanārthaṁ ghr̥takṣīratailakōṣṭhāṁśca kārayēt||34||

eta eva ca niryUhAH prayojyA jalakoShThake| svedanArthaM ghRutakShIratailakoShThAMshca kArayet||34||

These same decoctions can be used in a water tub for fomentation. In a similar manner, ghee, milk, and sesame oil may also be used in tub fomentation. [34]

Material for upanaha sweda (poultice fomentation)

गोधूमशकलैश्चूर्णैर्यवानामम्लसंयुतैः| सस्नेहकिण्वलवणैरुपनाहः प्रशस्यते||३५||

गन्धैः सुरायाः किण्वेन जीवन्त्या शतपुष्पया| उमया कुष्ठतैलाभ्यां युक्तया चोपनाहयेत्||३६||

चर्मभिश्चोपनद्धव्यः सलोमभिरपूतिभिः| उष्णवीर्यैरलाभे तु कौशेयाविकशाटकैः||३७||

gōdhūmaśakalaiścūrṇairyavānāmamlasaṁyutaiḥ| sasnēhakiṇvalavaṇairupanāhaḥ praśasyatē||35||

gandhaiḥ surāyāḥ kiṇvēna jīvantyā śatapuṣpayā| umayā kuṣṭhatailābhyāṁ yuktayā cōpanāhayēt||36||

carmabhiścōpanaddhavyaḥ salōmabhirapūtibhiḥ| uṣṇavīryairalābhē tu kauśēyāvikaśāṭakaiḥ||37||

godhUmashakalaishcUrNairyavAnAmamlasaMyutaiH| sasnehakiNvalavaNairupanAhaH prashasyate||35||

gandhaiH surAyAH kiNvena jIvantyA shatapuShpayA| umayA kuShThatailAbhyAM yuktayA copanAhayet||36||

carmabhishcopanaddhavyaH salomabhirapUtibhiH| uShNavIryairalAbhe tu kausheyAvikashATakaiH||37||

Poultice for fomentation can be prepared with wheat powder and/or barley flour mixed with sour preparations, oily substances, yeast, and salt. Poultice can also be logically prepared with aromatic drugs, jivanti (Leptandenia reticulata), shatapushpa (Foeniculum vulgare), uma (Linum usitatissimum), and kushta (Saussurea lappa) mixed with oil.

Non-putrefied hairy leather of hot potency animals should be used as a bandage when using poultice. In case of non availability, silk or woolen blanket can also be used. [35-37]

रात्रौ बद्धं दिवा मुञ्चेन्मुञ्चेद्रात्रौ दिवा कृतम्| विदाहपरिहारार्थं, स्यात् प्रकर्षस्तु शीतले||३८||

rātrau baddhaṁ divā muñcēnmuñcēdrātrau divā kr̥tam| vidāhaparihārārthaṁ, syāt prakarṣastu śītalē||38||

rAtrau baddhaM divA mu~jcenmu~jcedrAtrau divA kRutam| vidAhaparihArArthaM, syAt prakarShastu shItale||38||

To prevent burning sensations, the bandage applied at night should be removed in the morning and the one applied during the day should be removed at night. The duration of bandage application may be prolonged in cold weather. [38]

Thirteen types of sweda

सङ्करः प्रस्तरो नाडी परिषेकोऽवगाहनम्| जेन्ताकोऽश्मघनः कर्षूः कुटी भूः कुम्भिकैव च||३९||

कूपो होलाक इत्येते स्वेदयन्ति त्रयोदश| तान् यथावत् प्रवक्ष्यामि सर्वानेवानुपूर्वशः||४०||

saṅkaraḥ prastarō nāḍī pariṣēkō'vagāhanam| jēntākō'śmaghanaḥ karṣūḥ kuṭī bhūḥ kumbhikaiva ca||39||

kūpō hōlāka ityētē svēdayanti trayōdaśa| tān yathāvat pravakṣyāmi sarvānēvānupūrvaśaḥ||40||

sa~gkaraH prastaro nADI pariSheko~avagAhanam| jentAko~ashmaghanaH karShUH kuTI bhUH kumbhikaiva ca||39||

kUpo holAka ityete svedayanti trayodasha| tAn yathAvat pravakShyAmi sarvAnevAnupUrvashaH||40||

Thirteen varieties of fomentation are sankara, prastara, nadi, parisheka, avagahana, jentaka, ashmaghna, karshu, kuti, bhu, kumbhika, kupa, and holaka. They are further detailed accordingly in the same sequence. [39-40]

Sankara sweda (bolus fomentation)

तत्र वस्त्रान्तरितैरवस्त्रान्तरितैर्वा पिण्डैर्यथोक्तैरुपस्वेदनं सङ्करस्वेद इति विद्यात्||४१||

tatra vastrāntaritairavastrāntaritairvā piṇḍairyathōktairupasvēdanaṁ saṅkarasvēda iti vidyāt||41||

tatra vastrAntaritairavastrAntaritairvA piNDairyathoktairupasvedanaM sa~gkarasveda iti vidyAt||41||

Fomentation by means of bolus containing prescribed drugs with or without being wrapped with clothes is termed as sankarasweda. [41]

Prastara sweda (lying on a medicinal mattress)

शूकशमीधान्यपुलाकानां वेशवारपायसकृशरोत्कारिकादीनां वा प्रस्तरे कौशेयाविकोत्तरप्रच्छदेपञ्चाङ्गुलोरुबूकार्कपत्रप्रच्छदे वास्वभ्यक्तसर्वगात्रस्य शयानस्योपस्वेदनं प्रस्तरस्वेद इति विद्यात्||४२||

śūkaśamīdhānyapulākānāṁ vēśavārapāyasakr̥śarōtkārikādīnāṁ vā prastarēkauśēyāvikōttarapracchadēpañcāṅgulōrubūkārkapatrapracchadē vā svabhyaktasarvagātrasyaśayānasyōpasvēdanaṁ prastarasvēda iti vidyāt||42||

shUkashamIdhAnyapulAkAnAM veshavArapAyasakRusharotkArikAdInAM vA prastarekausheyAvikottarapracchadepa~jcA~ggulorubUkArkapatrapracchade vA svabhyaktasarvagAtrasyashayAnasyopasvedanaM prastarasveda iti vidyAt||42||

The fomentation technique involving an individual with oil properly applied all over his/her body, lying down on a mattress prepared with corn, pulse and pulaka (type of grain), or steamed boneless meat (vesavara), sweet porridge, boiled mixture of pulses and cereals (krishara), and pudding cake (utkarika), covered with silk, woolen pieces or leaves of panchangula (Ricinus communis), urubuka (variety of the same plant) and arka (Calotropis gigantean, is termed as prastara sweda. [42]

Nadi sweda (tubular steam sudation)

स्वेदनद्रव्याणां पुनर्मूलफलपत्रशुङ्गादीनां मृगशकुनपिशितशिरस्पदादीनामुष्णस्वभावानां वायथार्हमम्ललवणस्नेहोपसंहितानां मूत्रक्षीरादीनां वा कुम्भ्यां बाष्पमनुद्वमन्त्यामुत्क्वथितानां नाड्याशरेषीकावंशदलकरञ्जार्कपत्रान्यतमकृतया गजाग्रहस्तसंस्थानया व्यामदीर्घया व्यामार्धदीर्घया वाव्यामचतुर्भागाष्टभागमूलाग्रपरिणाहस्रोतसा सर्वतो वातहरपत्रसंवृतच्छिद्रया द्विस्त्रिर्वा विनामितयावातहरसिद्धस्नेहाभ्यक्तगात्रो बाष्पमुपहरेत्; बाष्पो ह्यनृजुगामी विहतचण्डवेगस्त्वचमविदहन् सुखं स्वेदयतीतिनाडीस्वेदः||४३||

svēdanadravyāṇāṁ punarmūlaphalapatraśuṅgādīnāṁmr̥gaśakunapiśitaśiraspadādīnāmuṣṇasvabhāvānāṁ vā yathārhamamlalavaṇasnēhōpasaṁhitānāṁmūtrakṣīrādīnāṁ vā kumbhyāṁ bāṣpamanudvamantyāmutkvathitānāṁ nāḍyāśarēṣīkāvaṁśadalakarañjārkapatrānyatamakr̥tayā gajāgrahastasaṁsthānayā vyāmadīrghayāvyāmārdhadīrghayā vā vyāmacaturbhāgāṣṭabhāgamūlāgrapariṇāhasrōtasā sarvatōvātaharapatrasaṁvr̥tacchidrayā dvistrirvā vināmitayā vātaharasiddhasnēhābhyaktagātrōbāṣpamupaharēt; bāṣpō hyanr̥jugāmī vihatacaṇḍavēgastvacamavidahan sukhaṁ svēdayatītināḍīsvēdaḥ||43||

svedanadravyANAM punarmUlaphalapatrashu~ggAdInAMmRugashakunapishitashiraspadAdInAmuShNasvabhAvAnAM vAyathArhamamlalavaNasnehopasaMhitAnAM mUtrakShIrAdInAM vA kumbhyAMbAShpamanudvamantyAmutkvathitAnAM nADyA shareShIkAvaMshadalakara~jjArkapatrAnyatamakRutayAgajAgrahastasaMsthAnayA vyAmadIrghayA vyAmArdhadIrghayA vAvyAmacaturbhAgAShTabhAgamUlAgrapariNAhasrotasA sarvato vAtaharapatrasaMvRutacchidrayAdvistrirvA vinAmitayA vAtaharasiddhasnehAbhyaktagAtro bAShpamupaharet; bAShpo hyanRujugAmI vihataca NDavegastvacamavidahan sukhaM svedayatIti nADIsvedaH||43||

Drugs for fomentation like plant-based articles (roots, fruits, leaves, buds etc.) or animal-based articles (flesh and heads of animals and birds) are mixed up with sour, salt or unctuous substances and urine, milk, etc. and decocted in a pitcher in such a way that the vapor does not leak out. Then, a pipe made up of leaves of vamsha (Bambusa arundinacea Retz.), karanja (Pongamia pinnata Merr.) or arka (Calotropis gigantea) with its fore part having the shape of the trunk of an elephant is inserted into the pitcher. The pipe required should be of one vyama (91.44cm) or half a vyama (45.72 cm) length, with its circumference being one-fourth of a vyama (22.86 cm) in its proximal end, one-eighth of a vyama in the distal end, and curved twice or thrice. All the clefts in the pipe should be well covered with leaves that alleviate vata. The well-massaged patient should then get this steam through the curved pipe. Curvatures of the pipe help in lessening the intensity of steam and thus help in providing a comfortable fomentation experience. This fomentation technique is called nadi sweda. [43]

Parisheka sweda (shower technique for fomentation)

वातिकोत्तरवातिकानां पुनर्मूलादीनामुत्क्वाथैः सुखोष्णैः कुम्भीर्वर्षणिकाः प्रनाडीर्वा पूरयित्वा यथार्हसिद्धस्नेहाभ्यक्तगात्रंवस्त्रावच्छन्नं परिषेचयेदिति परिषेकः||४४||

vātikōttaravātikānāṁ punarmūlādīnāmutkvāthaiḥ sukhōṣṇaiḥ kumbhīrvarṣaṇikāḥ pranāḍīrvā pūrayitvāyathārhasiddhasnēhābhyaktagātraṁ vastrāvacchannaṁ pariṣēcayēditi pariṣēkaḥ||44||

vAtikottaravAtikAnAM punarmUlAdInAmutkvAthaiH sukhoShNaiH kumbhIrvarShaNikAH pranADIrvApUrayitvA yathArhasiddhasnehAbhyaktagAtraM vastrAvacchannaM pariShecayediti pariShekaH||44||

A fomentation technique that involves taking shower, using pitchers or vessels with holes at the bottom (varshanika) or pipes, filled with lukewarm decoctions of roots of drugs that alleviate isolated vata or vata-predominant disorders, after suitable application of oil over body parts covered with cloth, is termed as parisheka. [44]

Avagaha sweda (tub fomentation)

वातहरोत्क्वाथक्षीरतैलघृतपिशितरसोष्णसलिलकोष्ठकावगाहस्तु यथोक्त एवावगाहः||४५||

vātaharōtkvāthakṣīratailaghr̥tapiśitarasōṣṇasalilakōṣṭhakāvagāhastu yathōkta ēvāvagāhaḥ||45|

vAtaharotkvAthakShIratailaghRutapishitarasoShNasalilakoShThakAvagAhastu yathokta evAvagAhaH||45||

Fomentation by immersion in a tub filled up with vata alleviating decoctions, milk, oil, ghee, meat juices or hot water is termed as avagaha. [45]

Jentaka sweda (sudation therapy in room)

अथ जेन्ताकं चिकीर्षुर्भूमिं परीक्षेत- तत्र पूर्वस्यां दिश्युत्तरस्यां वा गुणवति प्रशस्ते भूमिभागे कृष्णमधुरमृत्तिके सुवर्णमृत्तिकेवा परीवापपुष्करिण्यादीनां जलाशयानामन्यतमस्य कूले दक्षिणे पश्चिमे वा सूपतीर्थे समसुविभक्तभूमिभागे सप्ताष्टौवाऽरत्नीरुपक्रम्योदकात् प्राङ्मुखमुदङ्मुखं वाऽभिमुखतीर्थं कूटागारं कारयेत्, उत्सेधविस्तारतः परमरत्नीः षोडश, समन्तात्सुवृत्तं मृत्कर्मसम्पन्नमनेकवातायनम्; अस्य कूटागारस्यान्तः समन्ततो भित्तिमरत्निविस्तारोत्सेधां पिण्डिकांकारयेदाकपाटात्, मध्ये चास्य कूटागारस्य चतुष्किष्कुमात्रं पुरुषप्रमाणं मृन्मयं कन्दुसंस्थानंबहुसूक्ष्मच्छिद्रमङ्गारकोष्ठकस्तम्भं सपिधानं कारयेत्; तं च खादिराणामाश्वकर्णादीनां वा काष्ठानां पूरयित्वा प्रदीपयेत्; सयदा जानीयात् साधु दग्धानि काष्ठानि गतधूमान्यवतप्तं च केवलमग्निना तदग्निगृहं स्वेदयोग्येन चोष्मणा युक्तमिति,तत्रैनं पुरुषं वातहराभ्यक्तगात्रं वस्त्रावच्छन्नं प्रवेशयेत्, प्रवेशयंश्चैनमनुशिष्यात्- सौम्य! प्रविश कल्याणायारोग्याय चेति,प्रविश्य चैनां पिण्डिकामधिरुह्य पार्श्वापरपार्श्वाभ्यां यथासुखं शयीथाः, न च त्वया स्वेदमूर्च्छापरीतेनापि सता पिण्डिकैषाविमोक्तव्याऽऽप्राणोच्छ्वासात्, भ्रश्यमानो ह्यतः पिण्डिवकावकाशाद्द्वारमनधिगच्छन् स्वेदमूर्च्छापरीततया सद्यःप्राणाञ्जह्याः, तस्मात् पिण्डिकामेनां न कथञ्चन मुञ्चेथाः; त्वं यदा जानीयाः- विगताभिष्यन्दमात्मानंसम्यक्प्रस्रुतस्वेदपिच्छं सर्वस्रोतोविमुक्तं लघूभूतमपगतविबन्धस्तम्भसुप्तिवेदनागौरवमिति, ततस्तां पिण्डिकामनुसरन्द्वारं प्रपद्येथाः, निष्क्रम्य च न सहसा चक्षुषोः परिपालनार्थं शीतोदकमुपस्पृशेथाः, अपगतसन्तापक्लमस्तु मुहूर्तात् सुखोष्णेनवारिणा यथान्यायं परिषिक्तोऽश्नीयाः; इति जेन्ताकस्वेदः||४६||

atha jēntākaṁ cikīrṣurbhūmiṁ parīkṣēta- tatra pūrvasyāṁ diśyuttarasyāṁ vā guṇavati praśastēbhūmibhāgē kr̥ṣṇamadhuramr̥ttikē suvarṇamr̥ttikē vā parīvāpapuṣkariṇyādīnāṁ jalāśayānāmanyatamasyakūlē dakṣiṇē paścimē vā sūpatīrthē samasuvibhaktabhūmibhāgē saptāṣṭau vā'ratnīrupakramyōdakātprāṅmukhamudaṅmukhaṁ vā'bhimukhatīrthaṁ kūṭāgāraṁ kārayēt, utsēdhavistārataḥ paramaratnīḥṣōḍaśa, samantāt suvr̥ttaṁ mr̥tkarmasampannamanēkavātāyanam; asya kūṭāgārasyāntaḥ samantatōbhittimaratnivistārōtsēdhāṁ piṇḍikāṁ kārayēdākapāṭāt, madhyē cāsya kūṭāgārasya catuṣkiṣkumātraṁpuruṣapramāṇaṁ mr̥nmayaṁ kandusaṁsthānaṁ bahusūkṣmacchidramaṅgārakōṣṭhakastambhaṁsapidhānaṁ kārayēt; taṁ ca khādirāṇāmāśvakarṇādīnāṁ vā kāṣṭhānāṁ pūrayitvā pradīpayēt; sa yadājānīyāt sādhu dagdhāni kāṣṭhāni gatadhūmānyavataptaṁ ca kēvalamagninā tadagnigr̥haṁ svēdayōgyēnacōṣmaṇā yuktamiti, tatrainaṁ puruṣaṁ vātaharābhyaktagātraṁ vastrāvacchannaṁ pravēśayēt,pravēśayaṁścainamanuśiṣyāt- saumya! praviśa kalyāṇāyārōgyāya cēti, praviśya caināṁpiṇḍikāmadhiruhya pārśvāparapārśvābhyāṁ yathāsukhaṁ śayīthāḥ, na ca tvayā svēdamūrcchāparītēnāpisatā piṇḍikaiṣā vimōktavyāprāṇōcchvāsāt, bhraśyamānō hyataḥ piṇḍivakāvakāśāddvāramanadhigacchansvēdamūrcchāparītatayā sadyaḥ prāṇāñjahyāḥ, tasmāt piṇḍikāmēnāṁ na kathañcana muñcēthāḥ; tvaṁyadā jānīyāḥ- vigatābhiṣyandamātmānaṁ samyakprasrutasvēdapicchaṁ sarvasrōtōvimuktaṁlaghūbhūtamapagatavibandhastambhasuptivēdanāgauravamiti, tatastāṁ piṇḍikāmanusaran dvāraṁprapadyēthāḥ, niṣkramya ca na sahasā cakṣuṣōḥ paripālanārthaṁ śītōdakamupaspr̥śēthāḥ,apagatasantāpaklamastu muhūrtāt sukhōṣṇēna vāriṇā yathānyāyaṁ pariṣiktō'śnīyāḥ; itijēntākasvēdaḥ||46||

atha jentAkaM cikIrShurbhUmiM parIkSheta- tatra pUrvasyAM dishyuttarasyAM vA guNavati prashastebhUmibhAge kRuShNamadhuramRuttike suvarNamRuttike vA parIvApapuShkariNyAdInAMjalAshayAnAmanyatamasya kUle dakShiNe pashcime vA sUpatIrthe samasuvibhaktabhUmibhAgesaptAShTau vA~aratnIrupakramyodakAt prA~gmukhamuda~gmukhaM vA~abhimukhatIrthaMkUTAgAraM kArayet, utsedhavistArataH paramaratnIH ShoDasha, samantAt suvRuttaMmRutkarmasampannamanekavAtAyanam; asya kUTAgArasyAntaH samantato bhittimaratnivistArotsedhAMpiNDikAM kArayedAkapATAt, madhye cAsya kUTAgArasya catuShkiShkumAtraM puruShapramANaMmRunmayaM kandusaMsthAnaM bahusUkShmacchidrama~ggArakoShThakastambhaM sapidhAnaMkArayet; taM ca khAdirANAmAshvakarNAdInAM vA kAShThAnAM pUrayitvA pradIpayet; sa yadA jAnIyAtsAdhu dagdhAni kAShThAni gatadhUmAnyavataptaM ca kevalamagninA tadagnigRuhaM svedayogyenacoShmaNA yuktamiti, tatrainaM puruShaM vAtaharAbhyaktagAtraM vastrAvacchannaM praveshayet,praveshayaMshcainamanushiShyAt- saumya! pravisha kalyANAyArogyAya ceti, pravishya cainAMpiNDikAmadhiruhya pArshvAparapArshvAbhyAM yathAsukhaM shayIthAH, na ca tvayAsvedamUrcchAparItenApi satA piNDikaiShA vimoktavyA~a~aprANocchvAsAt, bhrashyamAno hyataHpiNDivakAvakAshAddvAramanadhigacchan svedamUrcchAparItatayA sadyaH prANA~jjahyAH, tasmAtpiNDikAmenAM na katha~jcana mu~jcethAH; tvaM yadA jAnIyAH- vigatAbhiShyandamAtmAnaMsamyakprasrutasvedapicchaM sarvasrotovimuktaMlaghUbhUtamapagatavibandhastambhasuptivedanAgauravamiti, tatastAM piNDikAmanusaran dvAraMprapadyethAH, niShkramya ca na sahasA cakShuShoH paripAlanArthaM shItodakamupaspRushethAH,apagatasantApaklamastu muhUrtAt sukhoShNena vAriNA yathAnyAyaM pariShikto~ashnIyAH; itijentAkasvedaH||46||

Examine the land thoroughly before resorting to the jentaka type of fomentation. Construct a circular building facing east or north, with a pond in front and ensuring that the site is in the eastern or northern side of the village. The building should be situated at a distance of 7- 8 aratnis (320-365 cm) from the pond. The land should be fertile, plain, and black or golden in colour. The height and diameter of the building should be 16 aratni each. (731 cm) and should be circular (as mentioned earlier), well plastered with mud and with many windows. A bench having 1 aratni (approximately 45 cm) width and height should be prepared all around the wall up to the door. An oven of clay, with a lid and with many holes, of four hasta diameter, and of height equal to that of the individual should be prepared in the center of the room. This oven should be filled up with fuel of khadira (acacia catechu) and aswakarna (dipterocarpus alatus) and ignited. As the wooden fuel is properly burned and the room is wellheated with fire alone (i.e., devoid of any smoke), it should be understood as fit for sudation with heat. Then you request the patient,who is well massaged with oil prepared with vata alleviating drugs and covered with a cloth, to enter the room by saying “Oh gentleman! Enter the room for the sake of your auspicious health. Go to the bench and lie down thereon, alternately changing sides comfortably, you should not leave the bench even if you feel fainting by severe sweating until you feel suffocated, otherwise on leaving you may not be able to reach the door and it may be fatal, do not leave the bench. As you feel yourself free from all clogging, with sticky sweat drained and all channels open, light and devoid of obstructions, stiffness, numbness, pain, and heaviness, you should then leave the bench and exit through the door. After coming out of that room, do not immediately apply cold water for the sake of your eyes. After one muhurta, as the heat and exertion subsides, you should bathe in lukewarm water and then eat a meal”. This is jentaka sweda. [46]

Ashmaghana sweda (sudation on heated slab of stone)

शयानस्य प्रमाणेन घनामश्ममयीं शिलाम्| तापयित्वा मारुतघ्नैर्दारुभिः सम्प्रदीपितैः||४७||

व्यपोज्झ्य सर्वानङ्गारान् प्रोक्ष्य चैवोष्णवारिणा| तां शिलामथ कुर्वीत कौषेयाविकसंस्तराम्||४८||

तस्यां स्वभ्यक्तसर्वाङ्गः स्वपन् स्विद्यति ना सुखम्| कौरवाजिनकौषेयप्रावाराद्यैः सुसंवृतः ||४९|| इत्यक्तोऽश्मघनस्वेदः,...|५०|

śayānasya pramāṇēna ghanāmaśmamayīṁ śilām| tāpayitvā mārutaghnairdārubhiḥ sampradīpitaiḥ||47||

vyapōjjhya sarvānaṅgārān prōkṣya caivōṣṇavāriṇā| tāṁ śilāmatha kurvīta kauṣēyāvikasaṁstarām||48||

tasyāṁ svabhyaktasarvāṅgaḥ svapan svidyati nā sukham| kauravājinakauṣēyaprāvārādyaiḥ susaṁvr̥taḥ ||49||

ityaktō'śmaghanasvēdaḥ,...|50| |

shayAnasya pramANena ghanAmashmamayIM shilAm| tApayitvA mArutaghnairdArubhiH sampradIpitaiH||47||

vyapojjhya sarvAna~ggArAn prokShya caivoShNavAriNA| tAM shilAmatha kurvIta kauSheyAvikasaMstarAm||48||

tasyAM svabhyaktasarvA~ggaH svapan svidyati nA sukham| kauravAjinakauSheyaprAvArAdyaiH susaMvRutaH ||49||

ityakto~ashmaghanasvedaH,...|50|

A compact slab of stone, of the length of an average human body, is heated with vata alleviating wooden fuel. Then all the firebrands are removed and the slab sprinkled with hot water and covered with silk or woolen sheets. The person, well massaged with oil all over his body and covered with garments is made to lie down on the slab for sudation. This fomentation technique is called ashmaghna sweda. [47-49]

Karshu sweda (sudation by using heat in a trench under bed)

...कर्षूस्वेदः प्रवक्ष्यते| खानयेच्छयनस्याधः कर्षूं स्थानविभागवित्||५०||

दीप्तैरधूमैरङ्गारैस्तां कर्षूं पूरयेत्ततः| तस्यामुपरि शय्यायां स्वपन् स्विद्यति ना सुखम्||५१||

...karṣūsvēdaḥ pravakṣyatē| khānayēcchayanasyādhaḥ karṣūṁ sthānavibhāgavit||50||

dīptairadhūmairaṅgāraistāṁ karṣūṁ pūrayēttataḥ| tasyāmupari śayyāyāṁ svapan svidyati nā sukham||51||

...karShUsvedaH pravakShyate| khAnayecchayanasyAdhaH karShUM sthAnavibhAgavit||50||

dIptairadhUmaira~ggAraistAM karShUM pUrayettataH| tasyAmupari shayyAyAM svapan svidyati nA sukham||51||

A physician well versed in location should get dug a flask-shaped trench right below the bed-stead (this technique assumes earthen/mud-thatched houses), fill it up with smokeless firebrands and lay the patient on the bed over this. This fomentation technique is termed as karshu sweda. [50-51]

Kuti sweda (sudation in a cottage) and bhu sweda (sudation on floor)

अनत्युत्सेधविस्तारां वृत्ताकारामलोचनाम्| घनभित्तिं कुटीं कृत्वा कुष्ठाद्यैः सम्प्रलेपयेत्||५२||

कुटीमध्ये भिषक् शय्यां स्वास्तीर्णामुपकल्पयेत्| प्रावाराजिनकौशेयकुथकम्बलगोलकैः||५३||

हसन्तिकाभिरङ्गारपूर्णाभिस्तां च सर्वशः| परिवार्यान्तरारोहेदभ्यक्तः स्विद्यते सुखम्||५४||

य एवाश्मघनस्वेदविधिर्भूमौ स एव तु| प्रशस्तायां निवातायां समायामुपदिश्यते||५५||

anatyutsēdhavistārāṁ vr̥ttākārāmalōcanām| ghanabhittiṁ kuṭīṁ kr̥tvā kuṣṭhādyaiḥ sampralēpayēt||52||

kuṭīmadhyē bhiṣak śayyāṁ svāstīrṇāmupakalpayēt| prāvārājinakauśēyakuthakambalagōlakaiḥ||53||

hasantikābhiraṅgārapūrṇābhistāṁ ca sarvaśaḥ| parivāryāntarārōhēdabhyaktaḥ svidyatē sukham||54||

ya ēvāśmaghanasvēdavidhirbhūmau sa ēva tu| praśastāyāṁ nivātāyāṁ samāyāmupadiśyatē||55||

anatyutsedhavistArAM vRuttAkArAmalocanAm| ghanabhittiM kuTIM kRutvA kuShThAdyaiH sampralepayet||52||

kuTImadhye bhiShak shayyAM svAstIrNAmupakalpayet| prAvArAjinakausheyakuthakambalagolakaiH||53||

hasantikAbhira~ggArapUrNAbhistAM ca sarvashaH| parivAryAntarArohedabhyaktaH svidyate sukham||54||

ya evAshmaghanasvedavidhirbhUmau sa eva tu| prashastAyAM nivAtAyAM samAyAmupadishyate||55||

A thick – walled, round cottage that is neither too high, nor too wide, and without any windows should be constructed with its inner walls plastered with drugs like kushtha (Saussurea lappa). There should be a bed at the center of this cottage covered with sheets prepared from cotton, silk, animal skin, a variety of grass (kuttha), woolen blanket, or a variety of woolen cloth / wooden ball (golaka). The bed should be surrounded with furnaces filled up with firebrands. The person, with oil applied all over his body, would lie on this bed for fomentation. This fomentation technique is termed as kuti sweda.

Bhusweda is done on floor with the same methods as asmaghna sweda and is administered in well chosen, leveled sites free from excessive wind. [52-55]

Kumbhi sweda (sudation with a pitcher)

कुम्भीं वातहरक्वाथपूर्णां भूमौ निखानयेत्| अर्धभागं त्रिभागं वा शयनं तत्र चोपरि||५६||

स्थापयेदासनं वाऽपि नातिसान्द्रपरिच्छदम्| अथ कुम्भ्यां सुसन्तप्तान् प्रक्षिपेदयसो गुडान्||५७||

पाषाणान् वोष्मणा तेन तत्स्थः स्विद्यति ना सुखम्| सुसंवृताङ्गः स्वभ्यक्तः स्नेहैरनिलनाशनैः||५८||

kumbhīṁ vātaharakvāthapūrṇāṁ bhūmau nikhānayēt| ardhabhāgaṁ tribhāgaṁ vā śayanaṁ tatra cōpari||56||

sthāpayēdāsanaṁ vā'pi nātisāndraparicchadam| atha kumbhyāṁ susantaptān prakṣipēdayasō guḍān||57||

pāṣāṇān vōṣmaṇā tēna tatsthaḥ svidyati nā sukham| susaṁvr̥tāṅgaḥ svabhyaktaḥ snēhairanilanāśanaiḥ||58||

kumbhIM vAtaharakvAthapUrNAM bhUmau nikhAnayet| ardhabhAgaM tribhAgaM vA shayanaM tatra copari||56||

sthApayedAsanaM vA~api nAtisAndraparicchadam| atha kumbhyAM susantaptAn prakShipedayaso guDAn||57||

pAShANAn voShmaNA tena tatsthaH svidyati nA sukham| susaMvRutA~ggaH svabhyaktaH snehairanilanAshanaiH||58||

A pitcher, filled up with decoction of vata alleviating drugs should be buried in earth upto one-fourth or one-fourth of it and a bed covered with a thin sheet kept over it. The patient, well massaged with oil alleviating vata and covered with a cloth, should either lie down or sit on the bed. Thereafter hot iron balls or stones should be put into the pitcher. The heat coming out of the pitcher helps in fomentation and this is termed as kumbhisweda. [56-58]

Kupa sweda (sudation in a pit)

कूपं शयनविस्तारं द्विगुणं चापि वेधतः| देशे निवाते शस्ते च कुर्यादन्तःसुमार्जितम्||५९||

हस्त्यश्वगोखरोष्ट्राणां करीषैर्दग्धपूरिते| स्ववच्छन्नः सुसंस्तीर्णेऽभ्यक्तः स्विद्यति ना सुखम्||६०||

kūpaṁ śayanavistāraṁ dviguṇaṁ cāpi vēdhataḥ| dēśē nivātē śastē ca kuryādantaḥsumārjitam||59||

hastyaśvagōkharōṣṭrāṇāṁ karīṣairdagdhapūritē| svavacchannaḥ susaṁstīrṇē'bhyaktaḥ svidyati nā sukham||60||

kUpaM shayanavistAraM dviguNaM cApi vedhataH| deshe nivAte shaste ca kuryAdantaHsumArjitam||59||

hastyashvagokharoShTrANAM karIShairdagdhapUrite| svavacchannaH susaMstIrNe~abhyaktaH svidyati nA sukham||60||

In a location free from excessive wind, a pit of the width of a bed and twice as deep as wide should be dug. Its inner portion should be well cleaned and filled with dried dung of elephant, horse, cows, ass, or camel and then ignited. A bed or sheet covered with a thin sheet should be kept over it. The patient, well massaged with oil and covered with cloth, should either lie down or sit over the bed till proper fomentation. This technique is called as kupasweda. [59-60]

Holaka sweda (sudation using a heap of dung)

धीतीकां तु करीषाणां यथोक्तानां प्रदीपयेत्| शयनान्तःप्रमाणेन शय्यामुपरि तत्र च||६१||

सुदग्धायां विधूमायां यथोक्तामुपकल्पयेत्| स्ववच्छन्नः स्वपंस्तत्राभ्यक्तः स्विद्यति ना सुखम्||६२||

होलाकस्वेद इत्येष सुखः प्रोक्तो महर्षिणा| इति त्रयोदशविधः स्वेदोऽग्निगुणसंश्रयः||६३||

dhītīkāṁ tu karīṣāṇāṁ yathōktānāṁ pradīpayēt| śayanāntaḥpramāṇēna śayyāmupari tatra ca||61||

sudagdhāyāṁ vidhūmāyāṁ yathōktāmupakalpayēt| svavacchannaḥ svapaṁstatrābhyaktaḥ svidyati nā sukham||62||

hōlākasvēda ityēṣa sukhaḥ prōktō maharṣiṇā| iti trayōdaśavidhaḥ svēdō'gniguṇasaṁśrayaḥ||63||

dhItIkAM tu karIShANAM yathoktAnAM pradIpayet| shayanAntaHpramANena shayyAmupari tatra ca||61||

sudagdhAyAM vidhUmAyAM yathoktAmupakalpayet| svavacchannaH svapaMstatrAbhyaktaH svidyati nA sukham||62||

holAkasveda ityeSha sukhaH prokto maharShiNA| iti trayodashavidhaH svedo~agniguNasaMshrayaH||63||

A heap of dung (of similar description as above) of the size of a bed is ignited. After it is completely burnt and becomes smokeless, a bed covered with a thin sheet is kept over it. The patient, well massaged with oil and covered with cloth, is made to lie down over the bed for comfortable fomentation. This is called holaka sweda and is considered healthy by sages.

Thus ends the description of the thirteen types of fire-induced sudation. [61-63]

Ten sudation methods without using fire

व्यायाम उष्णसदनं गुरुप्रावरणं क्षुधा| बहुपानं भयक्रोधावुपनाहाहवातपाः||६४||

स्वेदयन्ति दशैतानि नरमग्निगुणादृते|६५|

vyāyāma uṣṇasadanaṁ guruprāvaraṇaṁ kṣudhā| bahupānaṁ bhayakrōdhāvupanāhāhavātapāḥ||64||

svēdayanti daśaitāni naramagniguṇādr̥tē|65|

vyAyAma uShNasadanaM guruprAvaraNaM kShudhA| bahupAnaM bhayakrodhAvupanAhAhavAtapAH||64||

svedayanti dashaitAni naramagniguNAdRute|65|

Ten methods of sudation without fire include exercises, residing in a warm chamber, wearing heavy clothing, restraining hunger, consuming excess liquid (specially alcoholic beverages) , fear, anger, poultice, wrestling and exposure to sunlight. [64-65]

इत्युक्तो द्विविधः स्वेदः संयुक्तोऽग्निगुणैर्न च||६५||

एकाङ्गसर्वाङ्गगतः स्निग्धो रूक्षस्तथैव च| इत्येतत्त्रिविधं द्वन्द्वं स्वेदमुद्दिश्य कीर्तितम्||६६||

ityuktō dvividhaḥ svēdaḥ saṁyuktō'gniguṇairna ca||65||

ēkāṅgasarvāṅgagataḥ snigdhō rūkṣastathaiva ca| ityētattrividhaṁ dvandvaṁ svēdamuddiśya kīrtitam||66||

ityukto dvividhaH svedaH saMyukto~agniguNairna ca||65||

ekA~ggasarvA~ggagataH snigdho rUkShastathaiva ca| ityetattrividhaM dvandvaM svedamuddishya kIrtitam||66||

As described earlier, fomentation can be categorized into two types- using fire and not using fire. Again, there could be two types of fomentation based on whether the whole body is exposed or only parts of it. Another categorization is based on whether it is wet or dry fomentation. These three pairs of fomentation types are well known forms of sudation. [65-66]

स्निग्धः स्वेदैरुपक्रम्यः स्विन्नः पथ्याशनो भवेत्| तदहः स्विन्नगात्रस्तु व्यायामं वर्जयेन्नरः||६७||

snigdhaḥ svēdairupakramyaḥ svinnaḥ pathyāśanō bhavēt| tadahaḥ svinnagātrastu vyāyāmaṁ varjayēnnaraḥ||67||

snigdhaH svedairupakramyaH svinnaH pathyAshano bhavet| tadahaH svinnagAtrastu vyAyAmaM varjayennaraH||67||

A well oleated person should be subjected to sudation and on proper sweating, should take a wholesome diet. After fomentation, the patient should abstain from exercise that day. [67]

Summary

तत्र श्लोकाः-

स्वेदो यथा कार्यकरो हितो येभ्यश्च यद्विधः| यत्र देशे यथा योग्यो देशो रक्ष्यश्च यो यथा||६८||

स्विन्नातिस्विन्नरूपाणि तथाऽतिस्विन्नभेषजम्| अस्वेद्याः स्वेदयोग्याश्च स्वेदद्रव्याणि कल्पना||६९||

त्रयोदशविधः स्वेदो विना दशविधोऽग्निना| सङ्ग्रहेण च षट् स्वेदाः स्वेदाध्याये निदर्शिताः||७०||

स्वेदाधिकारे यद्वाच्यमुक्तमेतन्महर्षिणा | शिष्यैस्तु प्रतिपत्तव्यमुपदेष्टा पुनर्वसुः||७१||

tatra ślōkāḥ-

svēdō yathā kāryakarō hitō yēbhyaśca yadvidhaḥ| yatra dēśē yathā yōgyō dēśō rakṣyaśca yō yathā||68||

svinnātisvinnarūpāṇi tathā'tisvinnabhēṣajam| asvēdyāḥ svēdayōgyāśca svēdadravyāṇi kalpanā||69||

trayōdaśavidhaḥ svēdō vinā daśavidhō'gninā| saṅgrahēṇa ca ṣaṭ svēdāḥ svēdādhyāyē nidarśitāḥ||70||

svēdādhikārē yadvācyamuktamētanmaharṣiṇā | śiṣyaistu pratipattavyamupadēṣṭā punarvasuḥ||71||

tatra shlokAH-

svedo yathA kAryakaro hito yebhyashca yadvidhaH| yatra deshe yathA yogyo desho rakShyashca yo yathA||68||

svinnAtisvinnarUpANi tathA~atisvinnabheShajam| asvedyAH svedayogyAshca svedadravyANi kalpanA||69||

trayodashavidhaH svedo vinA dashavidho~agninA| sa~ggraheNa ca ShaT svedAH svedAdhyAye nidarshitAH||70||

svedAdhikAre yadvAcyamuktametanmaharShiNA | shiShyaistu pratipattavyamupadeShTA punarvasuH||71||

In summary, the mode of action of sudation, safety, types, suitability to various body parts, recommended protection measures for specific regions of the body, symptoms of optimum and oversudation, medicaments for oversudation, contraindications and indications of sudation, materials used for sudation, preparations, thirteen types of fire-induced fomentation, ten types of fomentation without fire, and six concise types of sudation have been explained in this chapter on sudation. [68-71]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने स्वेदाध्यायो नाम चतुर्दशोऽध्यायः||१४||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē ślōkasthānē svēdādhyāyō nāma caturdaśō'dhyāyaḥ||14||

ityagniveshakRute tantre carakapratisaMskRute shlokasthAne svedAdhyAyo nAmacaturdasho~adhyAyaH||14||

Thus ends the fourteenth chapter on sudation in the Sutra Sthana of treatise written by Agnivesha and redacted by Charak.[14]

Tattva Vimarsha (Fundamental Principles)

• Sudation is a procedure applied to remove stiffness, heaviness and cold. It induces sweating by causing vasodilatation. It is indicated after oleation in most diseases.
• Vata and kapha dominant diseases are indications of sudation therapy.
• Both unctuous and dry agents can be prescribed, depending on the condition of the patient and the disease. For example, snigdha in vata vikara and ruksha in kapha vikara.
• The choice of sudation (wet or dry) also depends upon the location of vitiated dosha e.g., if vata is in the stomach, initial swedana is ruksha, and if kapha is in the intestine then snigdha swedana is indicated.
• Mild sudation, applied with caution, is advised for vital organs in case of absolute indication with specific agents.
• Swedana is contraindicated in conditions where bleeding, circulatory failure, dehydration, hypotension and neuropathy are likely to occur. Swedana is absolutely contraindicated in patients with generalized debility and in comatosed patients.

Vidhi Vimarsha (Applied Inferences)

Clinical administration of swedana

Swedana should only be administered following a proper snehana (unless indicated otherwise). On application of unctuous substances like oil (taila) on various body parts, sweda forms an intervening viscous layer between the skin and the immediate environment prior to transdermal drug absorption. Thus the heat lost through sudation, along with large amounts of fluid and a marginal amount of Na+ and Cl- ions through radiation / conduction / convection / evaporation (which could potentially impair thermoregulation or cause hypothermia) does not happen too rapidly. Also, the procedure of swedana promotes the transdermal absorption of the sneha by inducing peripheral vasodilatation. However, environmental humidity and the duration of swedana procedure has to be strictly monitored, as exposure to small rise in temperature for a prolonged time can have a greater impact (more evaporation) than exposure to high temperature for a short time in a humid atmosphere. Hence yathavath prayojithaihi has been written expressly to denote the optimal exposure to swedana.

Proper application of snehana (abhyanthara and bahya) and swedana enhances gastro-intestinal motility. A study enumerates the instantaneous as well as prolonged benefits of continued swedana, concluding that habitual use of swedana improves one’s heat tolerance capacity and physical endurance, while observing increased autonomic functions among patients due to intermittent purposeful heat stress. There are numerous studies which claim that gastrointestinal motility disorders are caused due to decreased autonomic activity and its therapeutic increase, therefore helps cure motility disorders, thereby improving bowel-bladder functioning. [verse 3-5]

Environmental and age related factors also need to be considered for sudation. In extremely warm regions or during the peak of summer, there is remarkable body dehydration. And in an intensely humid climate or in an ill ventilated room where there is peripheral heat production from the body surface (and yet minimal evaporation), sudation has to be strictly monitored and precautionary procedures have to be well thought-out. Cold seasons are ideal for swedana procedures because body homeostasis favors or demands heat (evident from the behavioral response mechanisms adopted by each one of us in cold seasons). Among specific fomentation techniques, sarvangasweda is contraindicated in individuals at the extremes of age (i.e., infants and very elderly people) where there is ineffective thermoregulation, although ekanga and mridu sweda could be prescribed. [verse 6]

Health indicators such as serum electrolytes, blood urea, creatinine, mean acid base balance, serum and urine osmolarity, hemoglobin, hematocrit and vital signs should also be assessed before and after swedana.

Bala (physical fitness) of the individual has to be assessed through vyayama shakti (exercise capacity), which corresponds to the time taken for spending one’s ardha shakti (half strength). Based on the outcome of this assessment, pravara (maximum), avara (minimum) and madhyama (medium) bala have to be assessed. Based upon the results of these bala assessments, maha sweda (whole body sudation for an extended duration) and various minor/major sweda measures could be prescribed.

Exercise intolerance has a significant impact on heat intolerance. People who exhibit exercise intolerance (like in the case of mitochondrial diseases, or in persons leading a sedentary lifestyle) may have autonomic dysfunction including vascular autonomia characterized by tachycardia, dizziness, changes in heart rate and blood pressure, heat intolerance and unusual sweating pattern. Also, deficiency in energy metabolism may cause exercise intolerance and reduced stamina. It is evident that exercise intolerance leads to heat intolerance and abnormal sweating pattern, making it difficult - and hazardous- to conduct swedana in those individuals. An interesting observation is that if an individual is acclimatized to hot environment, he gradually attains exercise tolerance by an increase in plasma and thereby increase in blood volume, increased venous return, increased cardiac output, sub maximal heart rate, sustained sweat response, earlier onset of sweat and increased capacity for evaporative cooling, decreased osmolality of sweat and electrolyte conservation and decreased likelihood for fatigue

Contemporary science believes that heat has a beneficial effect (through thermotherapy, for instance) on pain relief. Effect of heat on pain is mediated by heat-sensitive channels. These channels respond to heat by increasing intracellular calcium (Ca). An increase in intracellular Ca generates action potentials that increase the stimulation of sensory nerves. These channels are a part of a family of receptors called TRPV receptors. TRPV1 and TRPV2 channels are sensitive to noxious heat, while TRPV4 channels are sensitive to normal physiological heat. These channels have certain characteristics in common, such as sensitivity to menthol, etc. Multiple binding sites allow a number of factors to activate these channels. Once activated, they can also inhibit the purin pain receptors. These receptors, termed as P2X2 and P2Y2, are mediated pain receptors located in the peripheral small nerve endings. For peripheral pain, heat can directly inhibit pain. However when pain is originating from deeper tissues, heat stimulates peripheral pain receptors that can alter what can be termed as “gating” in the spinal cord and reduce the sensation of deep pain. Another effect of heat is its ability to increase circulation. These same TRPV1 and TRPV4 receptors, along with nociceptor, increase blood flow in response to heat. The initial response to heat is mediated through the sensory nerves that release substance P and calcitonin-related peptide to increase circulation. After approximately one minute, Nitric Oxide is produced in vasculature endothelial cells and is responsible for sustained response of circulation to heat. This increase in circulation is considered to be essential in tissue protection from heat and repair of damaged tissue. Thermotherapy is of two types: dry and moist. A study was conducted to assess the effect of moist and dry heat on delayed onset of muscle soreness. Moist heat not only had similar benefits as dry heat but in some cases was more beneficial, requiring only 25% of time for application as dry heat. This study was conducted on quadriceps muscles. The study also witnessed immediate (and maximum) reduction in pain on application of moist heat, since moist heat penetrates deeper tissues faster than dry heat. Also, dry heat draws out moisture from the areas of application leaving them dehydrated, unlike moist heat.

Heat therapy shows best results in increasing extensibility of collagen tissues, decreasing joint stiffness, relieving muscle spasm, reducing pain, inflammation, and edema. It also helps in post acute phase of healing and increasing blood flow. Examples of applications of dry heat in contemporary medicine include diathermy, ultra sound, and heat packs, while examples of moist heat include hydrocololator heat packs (1650F), heat regulated hydrotherapy (1050 F) (basically for 5-20 mins).

Practically, valuka sweda may be considered to be an extreme form of ruksha sweda and taila droni as an ultimate form of snigdha sweda. Patrapotala sweda, jambheera pinda sweda etc are na atisnigdharuksha (neither too unctuous nor too dry) in nature. From this, a spectrum of swedana techniques could be formulated starting from valuka sweda (sudation using sand as driest form) and ending in taila droni (dipping in warm oil as most unctuous form). The complete sequence of techniques would imply valuka sweda at one end of the spectrum, followed by thusha sweda, kareesha sweda, pinyakasweda, dhanyamla dhara, churnapindasweda, jambheera panda sweda, patrapotala sweda, anda sweda, shashtika pinda sweda, sarvanga dhara and eventually ending with taila droni. [verse 7-8]

In general practice, early degenerative conditions such as pre-senile dementia, demyelinating poly neuropathy of adolescence or adulthood such as CIDP, and post-infective (febrile) neurological disorders such as GBS present themselves as amashayagata vata samprapthi lakshanas (signs of vata vitiated in amashaya) and therapeutic swedana measures such as rukshana (dry fomentation techniques) are found to be very effective in the initial stages of these conditions. Metabolic disorders of the aged, such as vascular dementia, and various rheumatological disorders resemble pakwashayagata kapha lakshanas and the treatment may be initiated with snigdha sweda. [verse 9]

For some of the disorders mentioned above that are sweda sadhya, mridu sweda alone should be performed. If the disease is sweda asadhya, it’s better to avoid administering swedana to these areas. This indicates that utmost care has to be taken when it comes to applying fomentation to vital areas as well as fomenting the whole body. Various acharyas suggest using dravyas, or medicated formulations, to shield or protect vital organs from any adverse affects of swedana. Gangadhara recommends the use of sheeta veerya dravyas, in this context, while administering mridu sweda to these vital parts, and Chakrapani also advises the use of these dravyas as protective measures of those parts while performing swedana. It is well established that hyperthermia in testicular region adversely affects spermatogenesis and virility of semen, in turn hampering fertility.

A sudden increase in body temperature produces a corresponding increase in cutaneous vascular conductance. This is followed by an increase in systemic conductance which produces alterations in cardiac output (decrease in central venous pressure and increase in cardiac output thereby increased left ventricular ejection fraction), oxygen consumption and water loss. Heart rate increases.

There is a significant hemodynamic change at the beginning of swedana like significant cardiovascular stress which causes an increase in blood pressure (systolic and diastolic) and pulse rate. Whole body fomentation is therefore contraindicated in elderly and those with cardiomyopathy, congestive heart disease, bundle branch block, anemia, MI, hyperthyroidism etc. Extra caution needs to be exercised when it comes to administering swedana procedure to patients with heart conditions .

Regarding eyes, the scientific community is interested in knowing more about the side effects of transpupillary thermotherapy (TTT). A study conducted on normal mouse retina reveals that retinas treated with a power of 70 mW exhibited progressive retinal damage that was almost exclusively restricted to the photo-receptors. In those cases, early damage to the outer segments of the photo-receptors was seen one day after the thermotherapy and saw degeneration of outer nuclear layer after five days. At the same time, an accumulation of pigmented cells, presumably of macrophages, was seen in the sub-retinal space. No apparent damage was seen in the RPE or choroid. Today, researchers are considering the importance of using sub-threshold effects while applying TTT to patients with neurovascular age-related macular degeneration. [verse 10] These practices are very common nowadays except for the usage of wheat balls. When lotus petals are unavailable, rose flower petals are substituted these days. Even cotton balls soaked in cold water, bandaged with cloth are commonly used to protect eyes while sudation. [verse 11]

The sarvanga abhyanga (whole body) fomentation technique should be administered for approximately 8-10 mins, in suitable humid conditions, and until the patient sweats profusely. Ekanga sweda, when administered for 5-20 minutes, helps provide relief to patients showing symptoms of joint stiffness, restricted movements and acute pain.

Swedana procedures are recommended for a specific duration and not for prolonged periods of time. How do we know when to stop it? Repeated thermal stress elicits adaptations evident within the neural networks and integrating regulatory systems that appear as morphological changes (sweat gland hypertrophy) and may be expressed as adjustments within effector processes altered vasomotor or sudomotor sensitivities. The most common functional effect of heat acclimation is a change in the effector activation being shifted downwards. One can also observe effector adaptations evident from changes in the gain of the effector response. Thus, for a given thermal stimulus acclimatized individuals frequently display an increased effector sensitivity such as greater sweating response for an equivalent change in body temperature. Phenotypic adaptation evident after sufficient fomentation (continuum model, not with respect to time):

1. Reduced heart rate at a fixed work rate
2. Expanded plasma volume
3. lower core temperature at an equivalent workload, and
4. Superior Na and Cl reabsorption from sweat, and an elevated sweat secretion. [verse 13]

It is very essential to differentiate heat exhaustion from heatstroke. Both come under the concept of atiswinna (over sudation). But from the treatment advised for atiswinna, we may infer it as heat exhaustion. Contemporary science advises fluid replacement therapy for heat exhaustion whereas rapid aggressive cooling techniques are prescribed for heat stroke. Charak Samhita advises treatment procedures that include greeshma ritucharya along with madhura, snigdha, seethala prayogas as ahara & vihara. Symptoms of heat exhaustion include normal to slightly elevated core temperature (39 – 40°C), fatigue or malaise, orthostatic hypotension, tachycardia, clinical signs of dehydration, nausea, vomiting, and diarrhea (due to splanchnic and renal vasoconstriction). Similarly, Symptoms of heat stroke include elevated core temperature (usually greater than 40.5°C), vague symptom of weakness, nausea, vomiting, headache, CNS symptoms including confusion, ataxia, coma, seizures, delirium, hot, dry skin, hyperdynamic cardiovascular systems (high central venous pressure [CVP], low systemic vascular resistance [SVR], tachycardia), elevated hepatic transaminases (usually in the tens of thousands range), coagulopathy, rhabdomyolysis, and renal failure [verse 14-15]

Type of patients at high risk of suffering from untoward reactions during fomentation include athletes exercising strenuously in hot climates, elderly patients (because of decreased efficacy of thermoregulation, comorbid illness or medications, lack of fans or air conditioning, inappropriate dress), infants and small children (because of high ratio of surface area to weight, inability to control fluid intake), patients with cardiac ailments or those taking beta-blockers (because of inability to increase cardiac output sufficiently for vasodilation) Patients who are dehydrated because of poor fluid intake, gastroenteritis, or diuretic use (dehydration increases demand on ATPase pumps, which contribute 25-45% of basal metabolic rate.), patients prone to higher endogenous heat production, patients taking medications that inhibit sweat production or increase heat production (eg, anticholinergics, antidepressants, antihistamines, neuroleptics, zonisamide, sympathomimetics, lithium, alpha- and beta-blockers), and patients taking medications that cause dehydration (eg, diuretics, alcohol). This coincides with most of the contraindications mentioned in Charak Samhita.

In demyelinating neuropathy or in other demyelinating as well as in diabetic neuropathy conditions or in severe DM without neuropathy, swedana should not be practiced. Hypothermia in demyelinating disorders is a common manifestation. In some patients, core temperature drop to 33 – 34°C has been noted. If the temperature decreases to (or less than) 33°C, severe lethargy, muscle stiffness, rigid limbs, a confused state of mind or even mutism might develop. These patients show full symptomatic clinical recovery on passive “rewarming” at 35 – 36°C. As the temperature rises to more than 36.5°C the symptoms become adverse. Hence there is always a requirement to maintain the core temperature between 33 – 36°C. Swedana thus always poses a risk to such patients.

In diabetes mellitus & diabetic polyneuropathy, there is impaired distal thermoregulation, distal sudomotor & micro vascular dysfunction. The nerve fibres that play an important role in thermoregulation are the earliest nerve fibres affected in polyneuropathy. Neuronal activity is highly temperature sensitive and causes neuropathic pain. Many studies have pointed out that there is an increased peripheral insulin resistance associated with hyperthermia. Starved off glucose cells turn to lipids as a source of energy in a diabetic patient. Hyperthermia promotes further lipolysis which hampers the condition

In patients with hypothyroidism who are undergoing thyroxin supplementation, there is a chance of development of an increased basal metabolic rate that stimulates increased heat production. The same is the condition with persons suffering from hyperthyroidism.

Hence swedana is contraindicated in both of these conditions. [verse 14-15]

Thermotherapy can be used to treat a number of painful conditions. A number of studies with thermotherapy conducted worldwide has shown significant results in a wide range of disease conditions. These include:

• (Chronic) muscle spasms in the form of persistent and often painful tension and shortness in a muscle or group of muscles that cannot be released voluntarily.
• Types of arthritis that may benefit from thermotherapy include: Subacute or chronic inflammatory conditions, osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, gout, psoriatic arthritis, reiter's syndrome, and sources of back pain such as a herniated disc.
• Whiplash and other musculoskeletal types of neck pain, shoulder pain, such as rotator cuff injuries.
• Decreased range-of-motion like in frozen shoulder, other types of joint pain, including many forms of arm pain (e.g., tennis elbow), leg pain (e.g., restless leg syndrome), knee pain (e.g., injured anterior cruciate ligament), foot pain (e.g., plantar fasciitis), tendonitis, bursitis, sprain, costochondritis, abdominal and pelvic pain, and fibromyalgia,
• Other chronic pain disorders, including lupus and myofascial pain syndrome, asthma, reduction of joint contractures. Other conditions that may be treated with heat include back sprain, degenerative disc disease, sciatica and scoliosis, as these conditions are usually associated with muscle spasm. [verse 20-24]

Swedana accounts for a major part of Ayurvedic Panchakarma therapy. It is considered an essential preparatory procedure before bio-cleansing. It is normally done after internal or external oleation. Swedana liquefies and separates the vitiated body humors adhered to the tissues and facilitates their flow to the elementary tract for easy evacuation from the body. In Ayurvedic practise majority of swedana (sudation) procedures are done in the form of kizhi / pindasveda (sudation using bolus). The commonly practiced few are detailed below with its preparation, application indication etc.

Kizhi / Pinda / Pottali

These words mean bolus. Fresh herbs / powders / fruits / cereals etc are used to make bolus of different varieties. This bolus is heated and used to induce sweating. Before coming to the procedural details, the preparation of a kizhi should be generally understood.

Preparation of Kizhi

Take cotton cloth of one square meter size and divide it into four equal square pieces. Place four square pieces of cloth (each four inch) at the center of each cloth. Put equal portion of prepared drug into four pieces. Hold the cloth by the four corners and make the drug into a bolus. Hold tightly at the junction. Leave the larger end of the cloth and fold the other three corners by inserting into the center. Using the large flap of cloth surround the folded ones neatly and tightly so that it is sufficient to hold. Tie the twine at the junction of handle and bolus. Wind this tightly with the free end of the twine and fasten the knot.

Kizhi once prepared is used upto a maximum of three days.

Preparation of the patient

Medicated oil massage is done before pindasweda. Oil is specially applied over the vertex, ears and the feet. The patient is comfortably placed on the droni (special wooden cot for administering treatment). Normally pindasweda is done in seven positions. These are sitting, supine, left lateral, again supine, right lateral, again supine and lastly sitting.

Application of kizhi

Kizhi is heated on a metallic pot with or without using oil or any other liquid media (depends on clinical presentation). The heat is checked by the masseur himself and applied on the body of the patient. The pressure, direction of movement, rubbing etc are controlled by the experienced masseur while applying the kizhi according to the clinical condition as well as the body part.

General Indications of swedana by kizhi

• As a part of seasonal rejuvenative therapy for healthy persons
• Different musculoskeletal problems including chronic, degenerative, traumatic, infective or autoimmune nature.
• Neurological disorders including stiffness, tremor, palsy and convulsions.
• General debility, fatigue and wasting

Dosha-specific indications of kizhi

• Kizhi is primarily administered in kapha-vata or isolated vata disorders.
• Specific types / modifications of kizhi are administered in pitta / rakta disorders

Prakriti & season specific indications of kizhi

• Kizhi can be safely employed in kapha and vata-predominant prakriti
• Pitta-predominant individuals should take specific precautions.
• Ideal seasons for kizhi are winter, spring and rainy seasons.
• Special care should be taken in summer and autumn seasons
• Major types of pinda sweda include patrapinda sweda, jambheera pinda sweda, choorna pindasweda and shashtikapinda sweda

Patrapottali sweda (sudation using bolus made of herbal leaves)

Patrapotala sweda is a pindasweda, which is a variety of ushma sweda (wet heat). It is one of the major sudation processes practiced in Ayurveda.

Materials required

Leaves of eranda (Ricinus communis), arka (Calotropis procera), sindhuvara (Vitex negundo), vataghni, amleeka (tamarindus indicus), shigru (Moringa olifera), karanja (Pongamia glabra), dhattura (Datura metel) etc – total 500 gm.

Powders of satahva and methika	100 gm each
Saindhava (rock salt)	50 gm
Grated coconut	50 gm
Lemon	Four
Nimba taila (Neem oil)/Eranda taila (Castor oil)	As required
Cloth (one), Twine (2m long), Towel, Vessels, Spoons, Frying Pan, Stove

Preparation of pottali

Take some oil in a frying pan. Place it on mild fire. Then add slices of lemon into it. When it becomes slightly fried, add the churna and stir it well. Then add grated coconut. When it turns into brown color add saindhava and stir it well. Then add the leaves (large leaves should be cut into small pieces) one by one. Thicker leaves should be added first then add the thinner one (for example add arka leaves first and tamarind leaves last) When it becomes well fried, take it out from fire, and divide it.

Procedure

Heat the pottali by dipping in the liquid medium. Heat it on a gentle fire and apply it as mentioned earlier in seven postures; 5-10 minutes in each posture. The duration of the procedure depends on the condition of patient. Do gentle massage all over the body and advise the patient to take rest it bed, in a non-windy room, cover the body with a thick blanket. After taking rest for about one hour, take bath in hot water. Water boiled with dhatri (Indian gooseberry) can be used for washing the head and that with vata alleviating leaves for body. Then apply rasanadi churna on vertex. Advice the patient to take hot peya (rice soup).

Indications

Dosha	Alleviates vata as well as vata-kapha
Prakriti	Suitable to vata, kapha, vata-kapha and tridosha constitutions
Diseases	Joint diseases of inflammatory, degenerative, or autoimmune nature. Neurological disorders like paralysis, sciatica, cervical radiculopathy, lower back pain, etc.

Jambeera pinda sweda (sudation using bolus made of lemon)

Jambeera pinda sweda is a variety of ushma sweda (moist heat). It is a procedure which is neither too ruksha (dry) nor too snigdha (oily).

Materials required

Lemon	24 nos.
Methika	250 gm
Shatahva (Anethum sowa)	250 gm
Tila (Sesamum indicum)	250 gm
Haridra (Curcuma longa)	250 gm
Kulattha (Dolochos biphoros)	250 gm
Lashuna (Garlic)	250 gm
Saindhava (Rock salt)	50 gm
Nimba taila (Neem oil)	500 ml
Cloth (1 meter), Twine (2 meter), Towel, Vessels, Frying pan, Stove

Preparation of medicine

Take half of quantity of above-mentioned drugs. Cut the lemon into 8 small pieces. Crush the garlic. Powder the other drugs and keep apart. First fry lemon and saindhava in a vessel containing very little oil, placed over mild fire. Add garlic when lemon turns brown color. Following this add powdered drugs and stir it well, till becomes well fried. Care should be taken not to burn the drug.

Remove from fire and make pottali as mentioned before.

Preparation of the patient & Procedure

(As mentioned in the general sweda procedure) After completion of the process apply rasnadi churna on the vertex of patient. Ask the patient to take rest in a non-windy room with his body covered using a thick blanket for about one hour. After the rest period advise the patient to perform bath using warm water. Wash the head using cooled water medicated with amalaki. Body can be washed with medicated water according to the disease of the patient. Peya is ideal diet during this process. This helps to replace the water content lost due to the process of sweda (perspiration).

Indications

Dosha	Alleviates vata-kapha
Prakriti	Suitable to vata,kapha, vata-kapha, & tridosha constitutions
Diseases	Joint diseases, specifically those that are traumatic in origin; lower back ache, kaphadominant sciatica, frozen shoulder, stiff neck, rheumatic arthritis

Specific care

Skin rash is a common complication observed in hairy individuals. Excess friction may be the reason. Castor oil may be used along with neem oil to reduce the friction.

Churna pinda sweda (Sudation using bolus made of herbal powders)

Churna pinda sweda is a rukshana (de-oleation) procedure practiced in vata-kapha conditions. Generally, it is done without adding oil. Internal oleation is not done as preparatory procedure of churna pinda sweda

Material required

Fine powders of the following herbs:

Methika (Foeniculam vulgare),Satapushpa (Anethum sowa),Kulattha (Dolochos biphoros), Devadaru (Cidrusdeodara), Shveta eranda (Ricinuscommunis), Kola (Ziziphus jujuba), Haridra (Curcuma longa), Raasna (Alpinia galanga), Jataamansi (Nordostachys jatamansi), Tila (Sesame seed)	Each weighing 150 gm
Saindhava (rock salt)	50 gm
Dravadravya (liquids) , kashaya (decoctions) or takra (butter milk)	As required
Cloth, thread, towel, frying pan, spoon, stove etc.

Preparation of pottali

Fry the drugs in a frying pan placed over gentle fire. Care should be taken not to burn the drugs. When they become crispy, make four pottalis as described in the introduction.

Procedure

Heat the pottali by dipping in the dravadravya. Heat it on a gentle fire and apply it as mentioned earlier in seven postures. After completion of the procedure do gentle massage all over the body for a few minutes and cover the patient with a blanket and allow him to take rest for about one hour. After the rest instruct him to take bath with hot water for body and water medicated with dry Indian gooseberry for head. Apply raasnadi churna on head and allow taking light food.

Indications

Dosha	Alleviates kapha as well as kapha dominant vata. Contraindicated in isolated vata vitiation
Prakriti	Suitable to kapha, vata-kapha and tridosha constitutions. Contraindicated in asthenic persons
Disease	Joint problems of kapha predominance, associated with ama, acute lumbago & sciatica, neurological disorders suspected of association with kapha, early stages of demyelination, GBS, rheumatoid arthritis, etc.

Special care

Each time before the application of the kizhi temperature should be checked to avoid burning of skin. Cloth for making the pottali should be strong so that it may not tear during procedure.

Shashtika pinda sweda (sudation using bolus made of shashtika rice)

It is a variety of pindasweda in which shashtika, shali (a special variety of rice with medicinal value which is cropped in just 60 days) processed in kwatha (decoction) and milk is used for swedana. It is well known in Kerala as nhavara kizhi. As it provides swedana (sudation), snehana (oleation) and brimhana (anabolic quality) simultaneously it is widely used in vata vitiated conditions. As it possesses inherent cool property and it is also advised moderately vitiated pitta.

Materials required

Shashtika shali	200 gms
Balamoola (root of Sida retusa)	200 gms
Milk	1.5 liters
Medicated oil	50 ml
Churna (powder) for talam (application on head)	5 gm
Earthen pot, wide mouthed vessels, cotton cloth, twine, coconut leaves.

Preparation of medicine

Preparation of kwatha (decoction):

Take 200 gm of crushed balamoola in an earthen pot. Add 3 liters of water to it. Put it in mild fire and reduce to half to get 1.5 liter decoction.

Preparation of shashtika

Take 200g shashtika rice in a vessel. Add 750 ml bala decoction and 750 ml of milk to it. Keep the vessel mild fire until the rice gets cooked well to a semi-solid consistency.

Preparation of pottali

Divide the cooked rice into four equal parts. Prepare four pottali as mentioned earlier.

Procedure

Ask the patient to sit in the droni in leg stretched position. Apply oil on head and body. Do gentle massage for few minutes. Take the remaining 750 ml kwatha in a wide mouthed vessel. Dip the pottali in the mixture. Heat the vessel in mild fire. Take heated pottali form the vessel. Check the temperature and apply it over the body as mentioned earlier. The process is done in seven postures. While doing the process apply pressure on the pottali so that the contents will come out through the cloth. Soon after completing the procedure wipe-out the remaining shashtika from the body using the coconut leaves. Warm medicated oil is applied on the body. Cover the patient with a thick blanket and advised rest for one hour.

Indications

Dosha	Alleviates vata as well as vata-pitta, but contraindicated in isolated kapha and ama associated conditions
Prakriti	Suitable for vata, vata-pitta and tridoshi constitutions, but need to be avoided in obese persons
Diseases	Nourishes in the cases of muscle atrophy, later stages of demyelination, palsy, Perthe’s disease, cervical myelopathy, post-polio residual paralysis, conditions that result in muscle dystrophy and emaciation. In such cases, it is administered in the final stage of rejuvenative Panchakarma.

Special care

As soon as the process is completed, the remnants of the rice are wiped out to prevent cooling and massage with hot oil is carried out. The patient is covered with a thick blanket so that temperature loss can be prevented.

Ksheera dhuma (fomentation by steam of medicated milk)

Ksheera dhuma is a popular nadisweda that is therapeutically very effective in the case of facial palsy. Ksheera dhuma is a modified swedana procedure. It is found to be effective especially in diseases pertaining to udradhavanga (upper part of body specifically head and neck region).

Materials required

Balamoola	100 gm
Milk	500 ml
Lotus bud	2 nos.
Medicated oil	30 ml
Churna for tala 5 gm, bandage cloth, blanket, cotton pad, utensils, pressure cooker (3 liter), rubber tube –1.5 mt., vessel, stool etc.

Preparation of medicine

Take 100 gm of balaamoola and add 1.5 liter of water to it. Heat it in a mild fire and reduce to get half-litre kashaya. Take the prepared kashaya along with half-liter milk in the pressure cooker. Place the cooker over stove and fit one end of the rubber tube to the nozzle of the cooker.

Preparation of the patient

After satisfying the natural urges bring the patient to treatment room. Heat the medicated oil and apply over vertex, face, neck and shoulder. Do massage in upward direction for a short while. Take 2-3 petals of lotus and place them over both eyes. Take two cotton pads and dip them in cold water. Put them over the petals. Now tie the eyes using bandage cloth.

Procedure

Ask the patient to sit comfortably on a stool. Cover the body with blanket. After attaining the vapors, take the free end of rubber tube, direct the vapor toward the oleated areas. Continue till sweat appears on the nose, forehead etc. Care should be taken to prevent scalding. During the procedure ask the patient to open his mouth wide, protrude his tongue and inhale deeply. After process remove the blanket, towel, cotton, and lotus petals and wipe out the excessive sweda with soft cloth. Apply rasnadi churna over the vertex of the head. Allow the patient to got to bed and take rest.

Indications

Cervical disc diseases

Facial palsy

Trigeminal neuralgia

Mastoiditis

Osteoarthritis of jaw

Brachial plexes disorders

Hanugraha(jaw lock)

Manyaagraha (neck stiffness)

Apabahuka (frozen shoulder)

Vishvachi (brachial neuropathy)

Avagaha (sitz bath)

Avagaha is a commonly used swedana which is a variant of drava sweda. Here the patient is made to sit in a tub filled with decoction, dhaayaamla, oil etc. It is found to be very effective in correcting vitiated apana vayu.

Materials required

Water as required

Drugs: vatahara leaves like eranda, karanja, tulasi, vasha, arka, vaataghni, etc. Instead of these, dashamoola can be used as per the condition.

Preparation of medicated water:

Take required amount of water. Boil it after adding the above mentioned drugs. Filter it when it is well boiled.

Preparation of patient

Do whole body massage with moderately heated medicated oil.

Procedure

Ask the patient to sit in the tub containing medicated lukewarm water. The level of water should be up to the level of the navel of the patient. Cover the body of the patient with a blanket. Maintain the temperature by replacing the cold water with warm water frequently. The patient made to sit for about 45 minutes. After completion of the process apply raasnaadi churna on the vertex.

Wipe the body using a dry towel. Allow the patient to take rest in a non windy room with his body covered, for about one hour. Then ask the patient to take bath in lukewarm water. In case of generalized diseases like motor neuron disease, Parkinson’s etc. whole body should be immersed in the medicated water or dhaanyaamla.

Indications

Katishula (lumbago)

Ashmari (calculi)

Mutrakrichhra (dysuria)

Arsha (hemorrhoids)

Urinary incontinence

Rectal prolapse

Anal fissure

Fissure in ano

Poultice type of fomentation is useful in cases where both agneya and niragneya fomentation can be done. In agneya, articles are heated over fire and warm medicine is applied to the skin. Niragneya is more important since in this case self-generated heat is utilized for fomentation. When the medicines of upanaha (which also contain sediments of toddy or ethanolic preparations, vinegar, buttermilk, grains etc.) are made into a paste and kept covered overnight, heat is generated within the preparation either due to acetic acid fermentation, or anerobic culture of microorganism. The temperature generated is stable and continuous. The inclusion of various oils, sour items, and salt items in the mixture ensures the exclusive vata alleviating property of upanaha sweda.

Thirteen types of agnisweda mentioned in Charak Samhita are based on four principles of heat transfer, namely, conduction, convection, radiation, and evaporation. Conduction is the transfer of heat between two surfaces that are in direct contact with each other and depends on the temperature gradient between body & surface, the total body surface area, velocity of the cutaneous blood flow & thickness of subcutaneous insulating tissue. Examples of agnisweda that leverage conduction include sankara, prastara, parisheka, avagaha, and ashmaghna.

Convection is the transfer of heat between two surfaces without direct contact through the medium of air. Examples of swedana techniques leveraging convection are naadi, jenthaka, karshu, kuti, bhu, kumbhi and koopa.

Radiation is the difference in temperature between the body surface and objects in the environment. It decides the rate of cooling. Examples of swedana techniques that use radiation for heat transfer include jenthaka, karshu, kuti, bhu, kumbhi, holaka and koopa.

Finally, evaporation involves the transfer of heat as vapor from the surface. Adequate humidity minimizes evaporative loss.

Physical factors affecting the rate of evaporation include relative humidity, velocity of air flow and minute (time factor) ventilation. 20% of heat-loss happens on a daily basis through the medium of evaporation via lungs and skin. Examples of fomentation techniques leveraging evaporation include parisheka, jentaka, bhu, kumbhi and koopa.

The thirteen agniswedas mentioned in Charak Samhita either refer to any one of the above mentioned heat-transfer techniques or a combination of these. This classification can be made only when heat transfer is considered. But as the drugs used are completely different in many of the procedures, the effect of herbs has yet to be explored.

A study2 has been conducted regarding sarvanga sweda. It mentioned the hemodynamic effects of sarvanga sweda. The remarkable points from this study are:

1. Significant rise in the blood pressure (systolic & diastolic) was observed immediately after sarvanga swedana (found to reach near base levels after five minutes rest). Hence five minutes is the minimal period for which the patient should be kept in a supine posture, preferably at the same place. A continued sarvanga swedana therapy was noted to cause a significant decrease in pulse rate & systolic BP compared to the base levels observed at the beginning of the procedure.
2. The study recommended lying or supine posture during the procedure as opposed to sitting posture with head tilted downwards with cold draping over the head, since heat stress is supposed to cause a reduction in central venous pressure and a shift in blood volume from splanchnic to cutaneous area. Hence supine posture is considered ideal. Maximum time should be 8 – 10 minutes.

Another study reported that infrared radiation application was more effective than hot water fomentation in minimizing the level of pain among patients with osteoarthritis of the knee.

Pizhicchil

Pizhiccil is a process that includes both snehana and swedana. In this warmed taila dhaara is done along with simple massage. It can be included under drava sweda.

Materials required (for 7 days)

Medicated taila	5 liters
Gandharvahastadi kwatha
Cloth 1m, vessels, stove, pillow, taila (for abhyanga), rasnadi churna.

Preparation of patient

After satisfying natural urges, make the patient sit in the droni. Apply little taila on the vertex. Do karna abhyanga and pada abhyanga with the same oil. Perform abhyanga all over his body with medicated oil for a few minutes. A band of cloth is tied over forehead.

Preparation of medicine

Heat half the quantity of the taila (2.5 litre) on gentle fire and pour this to another two vessels placed on either sides of the droni. Then check the temperature of oil. Divide the cloth into 4 pieces measuring 1.5 sq.feet each.

Procedure

Duration: 45 – 90 minutes for 7 – 14 days.

Soak the clothes in the oil and squeeze them by holding the fist in downward direction with stretched thumb, from a height of 20 – 24 cms, so that the taila flows in a continuous single stream along the thumb. The dhara is done in the anuloma direction.

Temparature of taila should be checked each time, to avoid burning of skin.

Meanwhile gently massage the part following the path of stream. The process is done in seven postures, about 5-10 minutes in each posture. Collect the taila in the droni and heat it again. (This taila is used for three days and the rest half is used for another three days. On the final day supernatant taila of both halves is taken and pizhiccil is done with it. Everyday the taila has to be boiled after the process, so as to evaporate the water content.)

After completing the procedure wipe off the taila with a clean towel. Do gentle massage with fresh taila. Give gandharvhasthadi kwatha. Take rest for about one hour covered with blanket. Then take bath with hot water. Water boiled with vatahara leaves can be used for body and that with amalaki for head. Apply raasnadi churna on vertex after bath and allow to take light food when hungry.

Usually, mridu shodhana is done following the whole process to eliminate the utklishta dosha (aggravated dosha).

Temperature of taila should be checked each time, to avoid burning of skin.

Complications

If height of dhara is increased or decreased or if done with more speed or for long time many complications can occur. They include burning sensation, rashes on body, giddiness, weakness of body, joint pain, vomiting, fever etc.

Indications

Neurological problems, ankylosing spondilitis, rheumatoid arthritis, chorea etc.

Dhanyamla dhara

Dhanyamla dhara is another type of parisheka. The word dhanyamla means that which is fermented from dhanya. In this procedure dhara is performed using dhanyamla. This procedure is a type of rukshana karma also it comes under dravasweda.

Materials required

Dhanyamla	2-4 liters
Oil for abhyanga
Dhara pot, droni, 4-6 helpers, vessels, spoon

Preparation of patient

As common procedure of dhara.

Procedure

As common procedure of dhara.

Indications

Vatashonita, amavata, sarvangadaha.

Practical tips

Cover body with a thick blanket to maintain body temperature.

Rest in non windy rooms to prevent chills.

Normal thermoregulation in a human body consists of an important voluntary regulating mechanism termed as behavioral control wherein the person adopts various postures (fetal posture), food habits (like alcohol derivatives), exclusive clothings (woolen sweaters) or passively attains certain emotional states (like anger, fear which stimulates sympathetic nervous system with release of epinephrine & norepinephrine that increases BMR which in turn increases heat production) which significantly modulates the core temperature as a response to changing environmental conditions. Thus niragnisweda corresponds to adaptive mechanisms of human beings.

After proper swedana person is equally exhausted as after doing moderate to severe exercise (increased sweating, fatigue etc). Hence if a person indulges in vyayama after swedana it results in atiswedana or ativyayama.

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