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== Introduction ==

== Introduction ==

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As per  [[Ayurveda]], the functioning of 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 ([[Charak Samhita]] [[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'' ([[Charak Samhita]] [[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''.

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 ([[Charak Samhita]] [[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'' ([[Charak Samhita]] [[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:

''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:

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=== Scope of ''Swedana'' ===

=== Scope of Swedana'' ===

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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]

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) ===

==== ''Sankara sweda'' (bolus fomentation) ====

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

==== ''Prastara sweda'' (lying on a medicinal mattress) ====

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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]

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) ===

==== ''Nadi sweda'' (tubular steam sudation) ====

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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]

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) ===

==== ''Parisheka sweda'' (shower technique for fomentation) ====

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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]

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) ===

==== ''Avagaha sweda'' (tub fomentation) ====

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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]

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) ===

==== ''Jentaka sweda'' (sudation therapy in room) ====

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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]

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) ===

==== ''Ashmaghana sweda'' (sudation on heated slab of stone) ====

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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]

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) ===

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

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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]

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) ===

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

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''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]

''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) ===

==== ''Kumbhi sweda'' (sudation with a pitcher) ====

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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]

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) ===

==== ''Kupa sweda'' (sudation in a pit) ====

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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]

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) ===

==== ''Holaka sweda'' (sudation using a heap of dung) ====

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