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== Vidhi Vimarsha (Applied Inferences) ==
== 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 ''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 name="ref1">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''.
''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 name="ref1">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''.
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.<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 .
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.<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.<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]
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]
*Major types of ''pinda sweda'' include ''patrapinda sweda, jambheera pinda sweda, choorna pindasweda'' and ''shashtikapinda sweda''
*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]].
''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]].
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=== ''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).
''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).
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.
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''
''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''
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.
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''.
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''.
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.
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).
''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).
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''Avagaaha'' 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''.
=== 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 ====
==== Materials required ====
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 <ref name="ref3">.
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 <ref name="ref3">.
=== ''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''.
''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''.
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''.
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''.
== References ==
== References ==