Changes

=== 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 ([[Charaka 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'' ([[Charaka 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 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:

ityagniveshakRute tantre carakapratisaMskRute shlokasthAne svedAdhyAyo nAmacaturdasho~adhyAyaH||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 Charaka.[14]

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

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

#Superior Na and Cl reabsorption from sweat, and an elevated sweat secretion. <ref name="ref2">Kondo, N., et. al, (2009), Global Environmental research, Thermoregulatory adaptations in Humans and its modifying factors, 13 (1), 35 - 41.</ref> [verse 13]

#Superior Na and Cl reabsorption from sweat, and an elevated sweat secretion. <ref name="ref2">Kondo, N., et. al, (2009), Global Environmental research, Thermoregulatory adaptations in Humans and its modifying factors, 13 (1), 35 - 41.</ref> [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. [[Charaka Samhita]] advises treatment procedures that include ''greeshma ritucharya'' along with ''madhura, snigddha, 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 <ref name="ref1" /> [verse 14-15]

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, snigddha, 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 <ref name="ref1" /> [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 [[Charaka Samhita]]. <ref name="ref2" />

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]]. <ref name="ref2" />

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. <ref>Sullivan, F., Hutchinson, M., Bahandeka, S., Moore, R. E.,(1987), Journal of neurology, neurosurgery and psychiatry, Chronic hypothermia in multiple sclerosis, 50: 813 – 815 & Online article, By Picture: Inside the Brain, A “reasonable lesion”: Causes and effects of demyelinating diseases.)  </ref>

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. <ref>Sullivan, F., Hutchinson, M., Bahandeka, S., Moore, R. E.,(1987), Journal of neurology, neurosurgery and psychiatry, Chronic hypothermia in multiple sclerosis, 50: 813 – 815 & Online article, By Picture: Inside the Brain, A “reasonable lesion”: Causes and effects of demyelinating diseases.)  </ref>

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''.

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 [[Charaka 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''.

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''.

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''.

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''.

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 [[Charaka 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.  

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:  

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