Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

''Swedana'' should only be administered following a proper ''snehana'' (unless indicated otherwise). On application of unctuous substances like ''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[1]. Hence ''yathavath prayojithaihi'' has been written expressly to denote the optimal exposure to ''swedana''.

''Swedana'' should only be administered following a proper ''snehana'' (unless indicated otherwise). On application of unctuous substances like ''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<ref>Cabanae, M., (2006), Journal of Applied Physiology, 100, Adjustable set point, 1338 – 1346.</ref>. 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. [2] 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]

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.<ref>Sanjeev Rastogy & Francesco Chiappelli, (2013 April – June), AYU, 34(2): Heamodynamic effects of Sarvanga swedana (Ayurvedic passive heat therapy): a pilot observational study 154-159.</ref> 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 bodily 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]

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 bodily 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''. [3]

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''. <ref>ibid</ref>

''Bala'' 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.

''Bala'' 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 [4].  

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<ref>Kondo, N., et. al, (2009), Global Environmental research, Thermoregulatory adaptations in Humans and its modifying factors, 13 (1), 35 - 41.- online research</ref>

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.  

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).5

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).<ref>Aroun Prasath, R., (2014), Journal of Science, Volume 4, Issue 1, A comparative study to assess the effectiveness of Infrared radiation and hot water fomentation on pain among patients with osteoarthritis of Knee, 1-3.</ref>

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]

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]

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.  

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 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.[6]Extra caution needs to be exercised when it comes to administering ''swedana'' procedure to patients with heart conditions .

There is 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.<ref> Sanjeev Rastogy & Francesco Chiappelli, (2013 April – June), AYU,34(2): Hemodynamic effects of Sarvanga swedana ( Ayurvedic passive heat therapy): a pilot observational study 154-159.</ref> 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. [7] [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]

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.<ref>A.P. Kvanta, P. Algvere  Department of Ophthalmology, St Erik's Eye Hospital, Stockholm, Sweden, Effect of Transpupillary Thermotherapy (TTT).</ref> [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.  

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.