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{{#seo:
{{#seo:
|title=Swedana
|title=Swedana(fomentation therapy/sudation therapy/sweating therapy)
|titlemode=append
|titlemode=append
|keywords=Swedana in ayurveda,Swedana meaning,Swedana,Charak samhita,carakasamhitaonline, Indian system of medicine, Sudation, Fomentation
|keywords=Swedana in ayurveda,Swedana meaning,Swedana,Charak samhita,carakasamhitaonline, Indian system of medicine, Sudation, Fomentation
|description=The therapy in which individual is made to perspire or sweating is enhanced is termed as 'swedana' (fomentation/sudation)
|description=The therapy in which individual is made to perspire or sweating is enhanced is termed as 'swedana' (fomentation/sudation)
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|image_alt=carak samhita
|type=article
|type=article
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}}
The word ‘swedana’ means providing fomentation or sudation or steam or making a person sweat.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Svedana, Page 1285</ref> It is an important treatment modality among the six primary treatments in Ayurveda. [Cha.Sa.[[Sutra Sthana]] 22/4] It is the principal treatment for diseases caused by vitiation of [[vata]] and [[kapha]]
[[dosha]]. This treatment is administered before purification therapies ([[panchakarma]]). Fomentation therapy essentially includes sweating induced for therapeutic purpose by specific techniques or methods. Thus, it excludes pathological sweating either due to disease or sweating due to environmental conditions.
In ancient times, various sweating methods were applied for the therapeutic purpose by utilization of natural resources. In current times, modified techniques are used to induce sweating, which allows better heat regulation and enhanced therapeutic control. However, both methods are equally effective and can be applied depending upon the availability of resources.
{{Infobox
{{Infobox
|label2 = Authors
|label2 = Authors
|data2 = Blinded
|data2 = Aneesh E.G., Deole Y.S.
|label3 = Reviewed by
|label3 = Reviewed by
|data3 = Open for review till November 05, 2020
|data3 = Basisht G., Gandhi R.
|label4 = Affiliations
|label4 = Affiliations
|data4 = Blinded
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar
|label5 = Correspondence email:
|label5 = Correspondence email:
|label6 = Date of publication:
|label6 = Date of publication:
|data6 = October 04, 2020
|data6 = October 04, 2020
|label7 = DOI
|data7 = [https://doi.org/10.47468/CSNE.2020.e01.s09.031 10.47468/CSNE.2020.e01.s09.031]
}}
}}
==Etymology and derivation==
==Etymology and derivation==
<div style='text-align:justify;'>
The word ‘swedana’ is derived from Sanskrit root ‘swid’ with suffix ‘dhy’. This means ‘to ripe’ or ‘cook’. It also means perspiration.<ref>VC Patil. Principles and practice of pancakarma. NewDelhi:Chaukhabha publications;2106.Chapter 9, Svedana Karma(Sudation therapy);p.193.</ref> The therapeutic procedure which relieves obstruction, stiffness, heaviness and cold by sweating is called ‘swedana’. [Cha.Sa.[[Sutra Sthana]] 22/11]
The word ‘swedana’ is derived from Sanskrit root ‘swid’ with suffix ‘dhy’. This means ‘to ripe’ or ‘cook’. It also means perspiration.<ref>VC Patil. Principles and practice of pancakarma. NewDelhi:Chaukhabha publications;2106.Chapter 9, Svedana Karma(Sudation therapy);p.193.</ref> The procedure which relieves stiffness, heaviness and coldness and that which causes sweating is called ‘swedana’. [Cha.Sa.[[Sutra Sthana]] 22/11]
The word ‘fomentation’ is used in this article to denote ‘swedana’ therapy.
==Classification==
==Classification==
===Based on utilizing fire in the heating technique===
===Based on inclusion of fire ===
The fomentation therapy is classified into two categories based on inclusion of fire in the heating techniques. [Cha.Sa.[[Sutra Sthana]] 14/65]
There are mainly thirteen methods of sudation in which fire is used for providing heat to induce sweating. [Cha.Sa.[[Sutra Sthana]] 14/39-40]
A. Inclusion of fire (sagni) in therapy
B. Without using fire (niragni) in therapy
====Inclusion of fire (sagni)====
There are thirteen methods of fomentation in which fire is used to induce sweating. [Cha.Sa.[[Sutra Sthana]] 14/39-40]. These methods utilize natural resources for fomentation making it relatively convenient and cost-effective. These can be used in healthcare practices with the same efficacy as of modern fomentation techniques.[table 1]
{| class="wikitable"
{| class="wikitable"
|+ Table 1: Various types of fomentation (swedana)
|-
|-
!Serial No !!Name of method !! Details
!Serial No !! Name of method !! Procedure
|-
|-
| |1 ||Bolus fomentation (Sankara) || Fomentation by means of bolus containing prescribed drugs with or without being wrapped with cloth. [Cha.Sa.[[Sutra Sthana]] 14/41] Application of this type of sudation can be done in the following methods also
| |1 ||Bolus fomentation (Sankara Sweda) || In this method, a bolus of various natural materials (herbs or mud or cow dung or sand) is heated and applied to the affected part. [Cha.Sa.[[Sutra Sthana]] 14/41] This is generally used for local fomentation due to predominance of [[kapha]] [[dosha]], adipose tissue ([[meda dhatu]]), tumors (granthi) and on painful body parts.[A.S. Sutra Sthana 26/7]
|-
|-
| | 2 ||Lying on medicinal mattress (Prastara) ||Mattress is prepared with corn, pulses, steamed boneless meat (vesavara), sweet porridge, boiled mixture of pulses and cereals (krishara) etc. covered with silk cloth, woolen pieces or leaves of Ricinus communis (panchangula), Calotropis gigantean etc. The individual after proper oleation is made to lie over this mattress. [Cha.Sa.[[Sutra Sthana]] 14/42]
| | 2 ||Lying on a medicinal mattress prepared for the therapeutic purpose (Prastara Sweda) ||A mattress is prepared with various medicinal materials and covered with silk cloth, woolen pieces or leaves of Ricinus communis (eranda), Calotropis gigantean (arka), etc. After proper oleation ([[snehana]]), the individual is advised to lie on this mattress. Generally, corn, pulses, steamed boneless meat (vesavara), sweet porridge, a boiled mixture of pulses and cereals (krishara), etc. are used for preparing the mattress. [Cha.Sa.[[Sutra Sthana]] 14/42] This method is used for whole-body fomentation.
|-
|-
| | 3 ||Steam sudation using a tube (Nadi) ||The drugs is placed in a pot and sufficient amount of water is added and boil it. The pot should be properly sealed so that the vapor should only pass through a hollow tube attached with the pot. The tube should have a length of approximately 45-90 cm and 20cm circumference in proximal end and 10cm at distal end. It should have 2 to 3 curves. [[Vata]][[dosha]] alleviating leaves should be placed at the opening of this tube and the vapor coming out should be directed over the body parts. [Cha.Sa.[[Sutra Sthana]] 14/43]
| | 3 || Steam fomentation using a tube (Nadi Sweda) ||In this method, fomentation is done by using medicinal steam vapors through a hollow tube. This method is generally used for localized fomentation on a particular body part. [Cha.Sa.[[Sutra Sthana]] 14/43]
|-
|-
| | 4 || Shower technique for fomentation or affusion (Parisheka)||The drugs which mitigates [[vata]] are boiled in water, milk etc. This is filled in pots or vessels and is showered over the body. [Cha.Sa.[[Sutra Sthana]] 14/44]
| | 4 || Shower technique for fomentation or affusion (Parisheka Sweda)||Medicated liquid is poured or sprinkled or showered slowly and steadily over the body part covered with cloth. [Cha.Sa.[[Sutra Sthana]] 14/44]
|-
|-
| | 5 ||Tub fomentation (Avagahana) ||Person made to sit or lie in a tub filled with decoction, milk, water or oil. [Cha.Sa.[[Sutra Sthana]] 14/45]
| | 5 || Tub fomentation (Avagahana Sweda) ||Person is made to sit or lie in the medicated liquid or warm water, neck- or navel-deep. This method is used for whole body and local fomentation. [Cha.Sa.[[Sutra Sthana]] 14/45]
|-
|-
| | 6 ||Sudation therapy in cottage (Jentaka) ||A circular cottage is constructed with approximately 7 meter height and diameter beside a pond. The walls should be well plastered with mud and should have many windows. All around the wall a bench having approximately 45cm height and width should be made. In the center of the room an oven of clay and having approximately 6 feet tall should be constructed. This oven should be filled with Acacia catechu (khadira) and Dipterocarpus alatus (ashwakarna) and ignited. When the cottage is properly heated the patient who is oleated is adviced to enter into it and should lay on the bench. After getting perspiration if the person feels lightness, relief of stiffness, numbness, pain etc., should come out and take rest for 48minutes. After that the patient is advised to have a warm water bath. [Cha.Sa.[[Sutra Sthana]] 14/46]
| | 6 ||Fomentation therapy in a chamber (Jentaka Sweda) ||The person in this method is advised to stay in a specially constructed and circular vaulted chamber for sweating. A pillar-shaped furnace with burning coal is in the chamber room's center to generate heat. It is a type of dry fomentation used for whole-body fomentation. [Cha.Sa.[[Sutra Sthana]] 14/46]
|-
|-
| | 7 || Sudation by heated slab of stone (Ashmaghana)||A stone slab having approximately 6 feet length, is made warm by burning [[vata]] alleviating wooden fuel over it. When stone becomes warm the firebrands are removed and sprinkled with hot water, covered with silk or woolen cloth. The person after proper oleation and covered with garments is made to lie over that stone slab for sudation. [Cha.Sa.[[Sutra Sthana]] 14/47-49]
| | 7 || Fomentation by heated slab of stone (Ashmaghana Sweda)||A heated stone slab is used for fomentation. It is used for whole-body fomentation. [Cha.Sa.[[Sutra Sthana]] 14/47-49]
|-
|-
| | 8 ||Sudation using heat in a trench under cot (Karshu) ||A cot is paced over a trench which is filled with smokeless burning charcoal. Person is made to lie over this cot. [Cha.Sa.[[Sutra Sthana]] 14/50-51]
| | 8 ||Fomentation using heat in a trench (Karshu Sweda) ||In this method, fomentation is done by using a trench filled with burning charcoal. [Cha.Sa.[[Sutra Sthana]] 14/50-51]
|-
|-
| | 9 ||Sudation in a chamber (Kuti) ||A circular chamber should be constructed with thick walls and no windows. The inner walls of the chamber should be plastered with drugs like Saussurea lappa (kushtha). A cot covered with cotton, silk or woolen blankets should be placed at the middle of this chamber. The bed should be surrounded with furnaces filled up with firebrands. The person after proper oleation is made to lie over the cot. [Cha.Sa.[[Sutra Sthana]] 14/52-54]
| | 9 ||Fomentation in a closed chamber (Kuti Sweda)||The person is advised to stay in a specially constructed circular chamber with thick walls and without windows. Heat is generated through furnaces beside the walls. The person is made to lie on a cot in the center and covered with thick blankets. This method is used for whole-body fomentation. [Cha.Sa.[[Sutra Sthana]] 14/52-54]
|-
|-
| | 10 ||Sudation on floor (Bhu) ||Simillar to ‘ashmaghana’ but without a stone slab[Cha.Sa.[[Sutra Sthana]] 14/55]
| | 10 ||Fomentation on heated floor (Bhu Sweda) ||Here the fomentation is done on a heated floor. [Cha.Sa.[[Sutra Sthana]] 14/55]
|-
|-
| | 11 ||Sudation with a pot (Khumbika) ||A pot filled with [[vata]] alleviating decoction should be buried on the ground. A cot or chair is placed over it and properly oleated person is made to lie or sit over that. Vapors are produced by repeatedly dipping hot metal balls or stones into the pot.[Cha.Sa.[[Sutra Sthana]] 14/56-58]
| | 11 ||Fomentation with a pot (Khumbika Sweda) ||In this method, fomentation is done using vapors coming out of a pot with hot medicated liquid. [Cha.Sa.[[Sutra Sthana]] 14/56-58]
|-
|-
| | 12 || Sudation in a pit (Kupa)||A pit with the width of a cot and twice as deep as wide, should be dug. It should be filled with dung of cow, camel, horse etc and burned. When it subsided a cot covered with a thin sheet is placed over that pit and person after oleation is made to sit or lie over that bed. [Cha.Sa.[[Sutra Sthana]] 14/59-60]
| | 12 || Fomentation in a pit (Kupa Sweda)||Cow dung, camel dung, horse dung, etc. are filled in a wide pit and burnt. A traditional Indian bed (charpai or khat) covered with a thin sheet is placed over the pit after burning subsides. The person is advised to lie on the bed for whole body fomentation. [Cha.Sa.[[Sutra Sthana]] 14/59-60]
|-
|-
| | 13 ||Sudation using a heap of dung (Holaka) ||A heap of dung of the size of a cot is ignited. When it is subsided place a cot covered with a thin sheet over it and patient after oil application all over the body is made to lie over that. [Cha.Sa.[[Sutra Sthana]] 14/61-63]
| | 13 ||Fomentation using a heap of dung (Holaka Sweda) ||In this method, a wide heap of dung is burnt. After burning subsides, a traditional Indian cot covered with thin sheet is placed over it. The person is advised to lie on the bed for whole body fomentation. [Cha.Sa.[[Sutra Sthana]] 14/61-63]
|-
|-
|}
|}
====Without use of fire (niragni):====
====Without using fire (niragni)====
There are twelve methods to induce sweating without use of fire.
There are twelve methods to induce sweating without using fire as heating media. These methods are generally used to reduce [[kapha]] [[dosha]] and fats ([[meda dhatu]])by enhancing basic metabolism.[Su.Sa.Chikitsa Sthana 32/15]
#Physical exercise (vyayama)
#Physical exercise (vyayama)
#Staying in warm chamber (ushnasadana)
#Staying in warm chamber (ushnasadana)
#Walking(adhwa)[Su.Sa.Chikitsa Sthana.32/15]<ref name=Susruta/>
#Walking(adhwa)[Su.Sa.Chikitsa Sthana.32/15]<ref name=Susruta/>
===Based on the form of heat used (3types)===
===Classification based on form of heat ===
*Heat in moist form(snigdha): This is applied in conditions due to vitiation of [[vata]][[dosha]].
*Heat in moist form(snigdha): This is applied in conditions due to vitiation of [[vata]] [[dosha]].
*Heat in dry form(ruksha): This is applied in conditions due to vitiation of [[kapha]][[dosha]].
*Heat in dry form(ruksha): This is applied in conditions due to vitiation of [[kapha]] [[dosha]].
*Mix (snigdha-ruksha): This is applied in conditions due to vitiation of both [[vata]] and [[kapha]][[dosha]].[Cha.Sa.[[Sutra Sthana]] 14/8]
*Mix (snigdha-ruksha): This is applied in conditions due to vitiation of both [[vata]] and [[kapha]] [[dosha]].[Cha.Sa.[[Sutra Sthana]] 14/8]
===Based on intensity of heat (3 types)===
===Classification based on the intensity of heat ===
*Mild (mridu): Indicated in mild conditions
*Mild (mridu): Mild fomentation is indicated on sensitive areas like testicles, precordium and eyes. This type of fomentation can be done in individuals with weak constitution or in mild diseases.
*Moderate (madhyama): Indicated in moderate conditions
*Moderate (madhyama): Moderate fomentation can be done on groins, in moderate intensity of disease and in persons with moderate strength.
*Intense (mahat): Indicated in severe morbidities[Cha.Sa.[[Sutra Sthana]] 14/07]
*Intense (mahat): Indicated in severe morbidities and if the person is strong. [Cha.Sa.[[Sutra Sthana]] 14/07]
===Based on the application on body part===
===Classification based on the application on body part===
*Local or on any single body part (ekanga): Indicated when a particular part is affected
*Local or on any single body part (ekanga): Indicated when a particular part is affected
*Whole body(sarvanga): Indicated in generalized conditions [Cha.Sa.[[Sutra Sthana]] 14/66]
*Whole body(sarvanga): Indicated in generalized conditions [Cha.Sa.[[Sutra Sthana]] 14/66]
===Based on the medium of sudation:===
===Classification based on the medium of fomentation ===
*Heat bath/Radiant heat (tapa): This includes fomentation therapy in a chamber room (jentaka), fomentation using heat in a trench (karshu), fomentation in a chamber (kuti), fomentation in a pit (kupa), and fomentation using a heap of dung (holaka) types.
*Vapours or steam (ushma): This includes bolus fomentation (sankara), lying on the medicinal mattress (prastara), fomentation by heated stone slab (ashmaghana), steam fomentation using a tube (nadi), fomentation using a pot (kumbhi), fomentation on heated floor (bhu) types.
*Liquid medium (drava): This includes shower technique or affusion (parisheka) and tub fomentation (avagaha).
*Bandage (upanaha)[Su.Sa.Chikitsa Sthana 32/3]<ref name=Susruta/>
===Classification based on the therapeutic purpose===
*For pacification (samshamana) of vitiated dosha
*For purification (samshodhana) of vitiated dosha[Dalhana on Su.Sa.Chikitsa Sthana 32/22]<ref name=Susruta/>
==Properties of the drug which impart fomentation==
The herbs used for fomentation therapy possess properties like hot potency, penetrating, motile, unctuous, rough, heavy and liquid.[Cha.Sa.[[Sutra Sthana]] 22/16]
*Painful conditions: E.g.earache, headache cervical pain, pain in foot, knee, thigh, calf, colicky pain etc.
==General indications of fomentation therapy==
*Painful conditions: E.g.earache, headache, cervical pain, pain in foot, knee, thigh, calf, colicky pain etc.
*In stiffness conditions: E.g.stiffness of muscles, joints, stiffness in flanks, lumbar and abdominal region
*In stiffness conditions: E.g.stiffness of muscles, joints, stiffness in flanks, lumbar and abdominal region
*Diseases due to [[vata]]: E.g.hemiplegia, monoplegia, facial palsy, sciatica, subluxation of ankle etc.
*Diseases due to [[vata]]: E.g.hemiplegia, monoplegia, facial palsy, sciatica, subluxation of ankle etc.
*General conditions: E.g.rhinitis, cough, hiccup, breathing difficulty, heaviness of body
*General conditions: E.g.rhinitis, cough, hiccup, breathing difficulty, heaviness of the body
*As a prerequisite to [[panchakarma]] procedures[Cha.Sa.[[Sutra Sthana]] 14/24]
*As a prerequisite to [[panchakarma]] procedures[Cha.Sa.[[Sutra Sthana]] 14/24]
==Contraindications:==
==Contraindications of fomentation therapy==
*In conditions and body constitutions with predominance of [[pitta]][[dosha]].
*Conditions with predominance of [[pitta]] [[dosha]] in basic body constitution ([[Prakriti]]) and disease.
*Conditions like bleeding disorders, diarrhea, diabetes mellitus, rectal prolapsed etc.
*Conditions like bleeding disorders, diarrhea, diabetes mellitus, rectal prolapse etc.
*Those who regularly consumes alcohol and astringents
*Those who regularly consume alcohol and astringents
*During hunger, anger, depression
*During hunger, anger, depression
*Pregnant ladies
*Pregnant ladies
*Weak, extremely emaciated, immune-compromised and unconscious persons[Cha.Sa.[[Sutra Sthana]] 14/16-19]
*Weak, extremely emaciated, immune-compromised and unconscious persons[Cha.Sa.[[Sutra Sthana]] 14/16-19]
==Signs of optimal sudation:==
==General instructions during fomentation therapy==
*Exposure to direct wind shall be avoided during fomentation therapy.
*If the fomentation is performed for purification treatments (shodhana), it must be done after proper internal and external oleation ([[snehana]]).
*Fomentation should be done only after the complete digestion of meals.
*After fomentation the person should take rest by covering the body with a blanket. Warm water shall be used for bath after fomentation treatment.
==Assessment of effect of fomentation therapy==
===Features of optimal fomentation===
The signs of optimal fomentation are relief from cold, pain, stiffness, heaviness; and disease pacification.[Cha.Sa.[[Sutra Sthana]] 14/12]
===Features of inadequate fomentation===
The signs of optimal sudation are relief from coldness, pain, stiffness,and heaviness and pacification of disease.[Cha.Sa.[[Sutra Sthana]] 14/12]
The features of inadequate fomentation include persistent feeling of heaviness, stiffness, pain, and associated complaints.
==Properties of the drug which imparts swedana:==
===Features of excessive fomentation===
Excess fomentation leads to vitiation of [[pitta]] [[dosha]], unconsciousness, giddiness, excessive thirst, burning sensation, weakness of body, eruptions in the body parts, pain in joints, and increased body temperature. [Cha.Sa.[[Sutra Sthana]] 14/14] [A.H. Sutra Sthana 17/16]
==Importance in preservation of health and prevention==
==Importance in the preservation of health and prevention==
Fomentation therapy improves the process of digestion and metabolism [Su.Sa.Chikitsa Sthana 32/22]<ref name=Susruta/> and removes obstruction. Administering fomentation, especially after oleation, controls [[vata]] and prevents clogging of feces, urine as well as semen.[Cha.Sa.[[Sutra Sthana]] 14/4] Good digestion and proper elimination of wastes are essential components of health. [Su.Sa.Sutra Sthana 15/41]<ref name=Susruta/> Fomentation in a chamber room (jentaka) and exposure to sunlight (atapa) are indicated in season-specific regimen for the preservation of health in winter. [Cha.Sa.[[Sutra Sthana]] 6/14]
==Importance in management of disease==
==Importance in management of diseases==
Fomentation therapy liquefies the dormant [[dosha]] adhered to the micro channels of body.[Cha.Sa.[[Siddhi Sthana]] 1/8] It relieves pain [Cha.Sa.[[Sutra Sthana]] 14/12], removes stiffness in joints and improves functioning. [Su.Sa.Chikitsa Sthana 32/22]<ref name=Susruta/> Generally,fomentation therapy pacifies the diseases caused due to [[vata]] and [[kapha]] [[dosha]]. [Cha.Sa.[[Sutra Sthana]] 14/3]
In the diseases caused by the suppression of natural urges, swedana is indicated to relieve the obstruction of [[vata]]. It is an important treatment in the initial stage of fever [Cha.Sa.[[Chikitsa Sthana]] 3/142], accumulation of metabolic wastes (ama condition) [Cha.Sa.[[Vimana Sthana]] 2/13],piles (arsha) [Cha.Sa.[[Chikitsa Sthana]] 14/250] and hemiplegia (pakshaghata). [Cha.Sa.[[Chikitsa Sthana]] 28/100]
==[[Dosha]] specific action of fomentation methods==
*Heat bath/Radiant heat (tapa) and vapors or steam (bashpa sweda): Mitigate [[kapha]]
*Bandage (upanaha sweda) : Mitigates [[vata]]
*Liquid medium (drava sweda): : Mitigates [[pitta]] [[dosha]] associated with [[kapha]]
*Sweda without using fire (niragni sweda): Mitigates [[vata]] associated with [[kapha]] and adipose tissue ([[meda dhatu]])[Su.Sa.Chikitsa Sthana 32/14-15]<ref name=Susruta/>
==Contemporary approach:==
==Contemporary approach==
In fomentation therapy (swedana), the body is exposed to varying intensities and qualities of heat which results in sweating. Nowadays different heating techniques are used as a therapeutic measure. This includes diathermy, infra-red, ultraviolet, ultrasound, wax bath, heat pads, hot water bags etc. Sauna bath is practiced in many parts of the world as a method for fomentation.
==Physiology of sweating:==
==Physiology of sweating==
Among the three main types of sweat glands, eccrine sweat glands are distributed over a much larger body surface area and they are mainly responsible for thermoregulation. These glands get stimulated by thermal heat and also by emotional stress. When the body is exposed to hot conditions or by doing exercises a redistribution of heat from the core to periphery happens through an increase in blood flow in the periphery (skin). This thermophysiological change stimulates the sweat gland. The increase in body temperature is sensed by central and skin thermoreceptors. The preoptic area of hypothalamus process this information and triggers the sudomotor response. Sympathetic cholinergic stimulation mediates the thermal sweating. The release of acetylcholine from nonmyelinated class C sympathetic postganglionic fibers, which binds to muscarinic receptors on the sweat gland, stimulates sweat production. The clear cells present in the secretory coil of eccrine gland produce an isotonic fluid. It moves to the resorptive duct which traverses the dermis. The sodium and chloride ions get reabsorbed in this stage. The resultant hypotonic fluid is released on to the skin surface as sweat. On termination of exercise or hot conditions, due to a drop in nonthermal feedback to the brain, sweat rate drops and the surface sweat gets evaporated quickly.<ref>Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin). 2019;6(3):211-259. Published 2019 Jul 17. doi:10.1080/23328940.2019.1632145</ref> <ref name=glandtoskin>Gerrett N, Griggs K, Redortier B, Voelcker T, Kondo N, Havenith G. Sweat from gland to skin surface: production, transport, and skin absorption. J Appl Physiol (1985). 2018;125(2):459-469. doi:10.1152/japplphysiol.00872.2017</ref>
Among the three main types of sweat glands, eccrine sweat glands are distributed over a much larger body surface area and they are mainly responsible for thermoregulation. These glands get stimulated by thermal heat and also by emotional stress. When the body is exposed to hot conditions or by exercises a redistribution of heat from the core to periphery happens through an increase in blood flow in the periphery (skin). This thermophysiological change stimulates the sweat gland. The increase in body temperature is sensed by central and skin thermoreceptors. The preoptic area of hypothalamus process this information and triggers the sudomotor response. Sympathetic cholinergic stimulation mediates thermal sweating. The release of acetylcholine from nonmyelinated class C sympathetic postganglionic fibers binds to muscarinic receptors on the sweat gland, stimulating sweat production. The clear cells present in the secretory coil of eccrine gland produce an isotonic fluid. It moves to the resorptive duct which traverses the dermis. The sodium and chloride ions get reabsorbed in this stage. The resultant hypotonic fluid is released on to the skin surface as sweat. Due to a decline in non-thermal feedback to the brain on termination of activity or hot conditions, sweat rate drops and the surface sweat gets evaporated quickly.<ref>Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin). 2019;6(3):211-259. Published 2019 Jul 17. doi:10.1080/23328940.2019.1632145</ref> <ref name=glandtoskin>Gerrett N, Griggs K, Redortier B, Voelcker T, Kondo N, Havenith G. Sweat from gland to skin surface: production, transport, and skin absorption. J Appl Physiol (1985). 2018;125(2):459-469. doi:10.1152/japplphysiol.00872.2017</ref>
==Effect of sweating on body fluid dynamics:==
==Effect of sweating on body fluid dynamics==
Heat stress results in sweating. Sweating causes water loss which leads to a reduction in water volume and electrolyte content in the body. Osmolarity of body fluids increases due to sweating as sweat is hypotonic to the body fluids. In a study conducted on six healthy men, a reduction of 4.1% in body weight was reported when subjected to dehydration through thermal means (sauna) and through exercise. The extra cellular fluid loss was found to be more after thermal heat stress when compared to exercise dehydration. Loss of sodium chloride was more during thermal dehydration while potassium loss was more through exercise.<ref>KOZLOWSKI S, SALTIN B. EFFECT OF SWEAT LOSS ON BODY FLUIDS. J Appl Physiol. 1964;19:1119-1124. doi:10.1152/jappl.1964.19.6.1119</ref>
Heat stress results in sweating. Sweating causes water loss which leads to a reduction in water volume and electrolyte content in the body. The osmolarity of body fluids increases due to sweating. Sweat is hypotonic in body fluid. In a study conducted on six healthy men, a reduction of 4.1% in body weight was reported when subjected to dehydration through thermal means (sauna) and through exercise. The extracellular fluid loss was found to be more after thermal heat stress when compared to exercise dehydration. Loss of sodium chloride was more during thermal dehydration while potassium loss was more through exercise.<ref>KOZLOWSKI S, SALTIN B. EFFECT OF SWEAT LOSS ON BODY FLUIDS. J Appl Physiol. 1964;19:1119-1124. doi:10.1152/jappl.1964.19.6.1119</ref>
Another study conducted in 10 volunteers who exercised in heat for 90-110 minutes reported decrease in plasma volume by 9.4% immediately after dehydration exposure when compared with the pre exposure value. The body is compensating the reduction in central circulating blood volume, due to hypovolemia as a result of dehydration or due to dilation of peripheral vasculature, through the body’s ability to mobilize water from extravascular to intravascular space. During dehydration higher water loss is reported from extra cellular fluid space than from intra cellular fluid. Sodium and Chlorine are the main electrolytes found to be excreted during thermal dehydration. These are the main electrolytes in extra cellular fluid.<ref>Nose H, Mack GW, Shi XR, Nadel ER. Shift in body fluid compartments after dehydration in humans. J Appl Physiol (1985). 1988;65(1):318-324. doi:10.1152/jappl.1988.65.1.318</ref>
Another study conducted in 10 volunteers who exercised in the heat for 90-110 minutes reported decreased plasma volume by 9.4% compared with the pre-exposure value. The body is compensating for the reduction in central circulating blood volume, due to hypovolemia as a result of dehydration or due to dilation of peripheral vasculature, through the body’s ability to mobilize water from extravascular to intravascular space. During dehydration higher water loss is reported from extra cellular fluid space than from intracellular fluid. Sodium and Chlorine are the main electrolytes found to be excreted during thermal dehydration. These are the main electrolytes in extra cellular fluid.<ref>Nose H, Mack GW, Shi XR, Nadel ER. Shift in body fluid compartments after dehydration in humans. J Appl Physiol (1985). 1988;65(1):318-324. doi:10.1152/jappl.1988.65.1.318</ref>
==Therapeutic use:==
==Therapeutic use==
The main physiological function of sweating is thermoregulation. While sweating the heat is transferred from body to the water present on the surface of skin.<ref name=glandtoskin/>
The main physiological function of sweating is thermoregulation. While sweating the heat is transferred from body to the water present on the skin's surface.<ref name=glandtoskin/>
==Removal of toxins:==
===Removal of toxins===
Some studies report the presence of chemicals, persistent organic pollutants, heavy metals, bisphenol A etc in sweat. Their concentrations are also reported to be higher in sweat than in blood or urine. This suggests the possible action of skin as an excretory organ for body toxins. Further studies are required to prove this activity of the skin.<ref name=glandtoskin/>
Some studies report the chemicals, persistent organic pollutants, heavy metals, bisphenol A etc. in sweat. Their concentration is also reported to be higher in sweat than in blood or urine. This suggests the possible action of skin as an excretory organ for body toxins. Further studies are required to prove this activity of the skin.<ref name=glandtoskin/>
==Skin health==
===Skin health===
The secretions from the sweat glands play an important role in maintaining the health of skin. Through the eccrine sweat water, natural moisturizing factors and antimicrobial peptides are delivered to the surface of skin. This might be helpful to maintain the epidermal barrier homeostasis. In the treatment of atopic dermatitis and other dry skin conditions, preservation of sweating might have a positive effect. Sweat glands also produce antimicrobial peptides such as dermcidin, lactoferrin etc which are essential components of defense mechanism against skin infections.<ref name=glandtoskin/>
The secretions from the sweat glands play an important role in maintaining the health of skin. Through the eccrine sweat water, natural moisturizing factors and antimicrobial peptides are delivered to the skin's surface. This might be helpful in maintaining the epidermal barrier homeostasis. In the treatment of atopic dermatitis and other dry skin conditions, the preservation of sweating might have a positive effect. Sweat glands also produce antimicrobial peptides such as dermcidin, lactoferrin etc. which are essential components of defense mechanism against skin infections.<ref name=glandtoskin/>
In type 2 diabetic patients improved glucose balance was reported when subjected to hot water heat stress intervention. Hot water immersion induced therapy is also found to have beneficial effects in peripheral artery disease.<ref>Heinonen I, Laukkanen JA. Effects of heat and cold on health, with special reference to Finnish sauna bathing. Am J PhysiolRegulIntegr Comp Physiol. 2018;314(5):R629-R638. doi:10.1152/ajpregu.00115.2017</ref>
In type 2 diabetic patients, improved glucose balance was reported when subjected to hot water heat stress intervention. Hot water immersion induced therapy is also found to have beneficial effects in peripheral artery disease.<ref>Heinonen I, Laukkanen JA. Effects of heat and cold on health, with special reference to Finnish sauna bathing. Am J PhysiolRegulIntegr Comp Physiol. 2018;314(5):R629-R638. doi:10.1152/ajpregu.00115.2017</ref>
Stem cell stimulation therapy: An increase in CD34-positive cells in circulation has been reported after repeated heat stress therapy.<ref name=PHcentralbloodV>Crandall CG, Wilson TE, Marving J, et al. Effects of passive heating on central blood volume and ventricular dimensions in humans. J Physiol. 2008;586(1):293-301. doi:10.1113/jphysiol.2007.143057</ref>
Stem cell stimulation therapy: An increase in CD34-positive cells in circulation has been reported after repeated heat stress therapy.<ref name=PHcentralbloodV>Crandall CG, Wilson TE, Marving J, et al. Effects of passive heating on central blood volume and ventricular dimensions in humans. J Physiol. 2008;586(1):293-301. doi:10.1113/jphysiol.2007.143057</ref>
Cardiovascular diseases: In a cohort study it is reported that repeated heat stress therapy results in a reduction of cardiovascular risks.<ref name=PHcentralbloodV/>
==Methods of induction of sweating:==
==Current clinical practices ==
In current clinical practice, fomentation therapy is done through three different forms:
#Application of heated bolus (pottali)
#Application of heated bolus (pottali)
#Application of vapour/steam
#Application of vapour/steam
#Application of hot liquid
#Application of hot liquid
===Sudation using bolus===
===Fomentation using bolus===
The medicines are made into a bolus form and is applied over affected body part directly or after dipping in suitable medium like oil, decoctions, milk etc.
The medicines are made into a bolus form and are applied over the affected body part directly or after dipping in a suitable medium like oil, decoctions, milk etc.
====Valukasweda:====
====The bolus of sand (valuka sweda) ====
Clean and fresh sand is used for sudation. The sand is heated and made into a bolus by tying it inside a cloth. This bolus is further heated by placing it over a hot pan and is applied over the body parts. It is dry form of sudation. This is usually indicated in conditions of acute pain associated with swelling where presence of accumulation of metabolic waste (ama) is suspected.
Clean and fresh sand is used for fomentation. The sand is heated and made into a bolus by tying it inside a cloth. This bolus is further heated by placing it over a hot pan and is applied over the body parts. It is a dry form of fomentation. This is usually indicated in acute pain conditions associated with swelling where presence of accumulation of metabolic waste (ama) is suspected.
====Churnapindasweda:====
====Bolus of herbal powders and paste (churna pinda sweda) ====
Medicated powders are used to induce sweating. The bolus can be used in dry form or along with oil as per the condition. It is indicated in conditions of osteoarthritis, stiffness of neck etc.
Medicated powders are used to induce sweating. The bolus can be used in dry form or along with oil as per the condition. It is indicated in disorders of osteoarthritis, stiffness of neck etc.
====Jambeerapindasweda:====
====Bolus of citrus fruit (jambeera pinda sweda)====
The bolus is prepared with citrus fruit, medicated powders and oil. This is indicated in conditions of joint pain, stiffness etc
The bolus is prepared with citrus fruit, medicated powders and oil. This is indicated in conditions of joint pain, stiffness etc
====Patrapindasweda:====
====Bolus of leaves of herbs (patra pinda sweda)====
Leaves of medicinal plants are used for making the bolus. These leaves along with medicated powders and grated coconut is cooked along with sutable medicated oil. The bolus is prepared out of this and applied over the body parts. It is indicated in diseases caused by [[vata]][[dosha]], hemiplegia, paraplegia etc.
Leaves of medicinal plants are used for making the bolus. These leaves along with medicated powders and grated coconut, are cooked along with suitable medicated oil. The bolus is prepared out of this and applied over the body parts. It is indicated in diseases caused by [[vata]] [[dosha]], hemiplegia, paraplegia etc.
====Shashtikashalipindasweda:====
====Bolus of medicated rice (shashtikashali pinda sweda) ====
Medicinal pudding is prepared using a special variety of rice grain along with milk and Sida cordifolia (Bala). Bolus is prepared out of this pudding. Before applying it over the body it should be again heated by dipping it in a mixture of hot milk and decoction. This is the most nourishing type of sudation. It is indicated in muscle wasting, degenerative diseases, cerebral palsy etc.
Medicinal pudding is prepared using a particular variety of rice grain along with milk and Sida cordifolia (Bala). Bolus is prepared out of this pudding. Before applying it over the body it should be again heated by dipping it in a mixture of hot milk and decoction. This is the most nourishing type of fomentation. It is indicated in muscle wasting, degenerative diseases, cerebral palsy etc.
===Sudation using vapour===
===Fomentation using vapour===
====Bashpasweda:====
====Steam chamber (bashpa sweda)====
Fomentation using a chamber room, in which the person either can sit or lie, associated with a steam source outside. Through this whole-body sudation is made possible. Usually this type of fomentation is used before purification therapies.
====Nadisweda:====
====Steam through tube (nadi sweda) ====
The vapors coming from a steam source is redirected into the affected body parts using a hollow tube. This is indicated in conditions of painful joints like low back ache, knee OA etc.
The vapors coming from a steam source is redirected into the affected body parts using a hollow tube. This is indicated in conditions of painful joints like low backache, knee OA, etc.
===Sudation using liquid===
===Fomentation using liquid===
====Pouring method====
====Pouring method====
Pouring fermented liquid (dhanyamladhara):Warm fermented liquid (dhanyamla), prepared from cereals is poured over the affected body parts to attain fomentation.
Medicated buttermilk, decoctions, medicated milk and medicated oils can also be used as per the patient's condition.
====Immersion method====
====Immersion method====
The effected body parts are immersed in warm decoctions or oils
The affected body parts are immersed in warm decoctions or oils
==Mode of action of induced sweating:==
==Mode of action of induced sweating==
A raise in external environment temperature leads to the vasodilation of cutaneous blood vessels. This increases the cutaneous microvascular blood flow. The systemic conductance is also increased. In order to maintain homeostasis, the cardiac output increases. As a result, the cardiac system gets stimulated which in turn may stimulates the entire body metabolism. An improvement of endothelial function and reduction in arterial stiffness may also happen as a result of sweating. Sweating results in reduction of core body temperature. Anti-oxidant capacity might get also improved. It may also improve the lungs vital capacity and there by aids in micro ventilation. The above data shows the action of induced sweating on different systems however more studies are required to find out the exact mode of action.<ref name=PHcentralbloodV/>
A raise in the external environment temperature leads to the vasodilation of cutaneous blood vessels. This increases the cutaneous microvascular blood flow. The systemic conductance is also increased. To maintain homeostasis, the cardiac output increases. As a result, the cardiovascular system gets stimulated, which in turn may stimulate the entire body metabolism. An improvement of endothelial function and reduction in arterial stiffness may also happen as a result of sweating. Sweating reduces the core body temperature. Anti-oxidant capacity might get also improved. It may also improve the lung's vital capacity and thereby aids in micro ventilation. The above data shows the action of induced sweating on different systems however, more studies are required to find out the exact mode of action.<ref name=PHcentralbloodV/>
==Current researches:==
==Current researches==
Whole body heating results in cardio vascular stress. There will be increase in cutaneous vascular conductance followed by increase in systemic conductance. But the homeostasis will be maintained by decrease of conductance at non cutaneous bed and by increased cardiac output. It might be due to this increased cardiac output and by the redistribution of blood from central to peripheral circulation, a reduction in central venous pressure occurs during the onset of passive heating. In certain studies, it is noted that passive heating significantly raises the left ventricular ejection fraction.<ref name=PHcentralbloodV/> In an observational study on sarvangabashpasweda, significant increase in pulse rate and blood pressure was recorded immediately after the completion of the therapy. This raise in blood pressure and pulse rate was transient as it came back to normal after five minutes of therapy.<ref>Sanjeev R, Francesco C.Hemodynamic effects of Sarvanga Swedana (Ayurvedic passive heat therapy): A pilot observational study.Ayu. 2013 Apr;34(2):154-9. doi: 10.4103/0974-8520.119669.</ref>
Whole body fomentation therapy results in cardiovascular stress. There will be increase in cutaneous vascular conductance followed by increase in systemic conductance. But the homeostasis will be maintained by decreased conductance at noncutaneous bed and increased cardiac output. It might be due to this increased cardiac output and by the redistribution of blood from central to peripheral circulation, a reduction in central venous pressure occurs during the onset of passive heating. In certain studies, it is noted that passive heating significantly raises the left ventricular ejection fraction.<ref name=PHcentralbloodV/> In an observational study on whole body steam fomentation (sarvangabashpa sweda), significant increase in pulse rate and blood pressure was recorded immediately after the completion of the therapy. This raised blood pressure and pulse rate were transient as it came back to normal after five minutes of therapy.<ref>Sanjeev R, Francesco C.Hemodynamic effects of Sarvanga Swedana (Ayurvedic passive heat therapy): A pilot observational study.Ayu. 2013 Apr;34(2):154-9. doi: 10.4103/0974-8520.119669.</ref>
==Effect of nadisweda:==
===Effect of fomentation through tube (nadi sweda)===
Fomentation through a tube (nadi sweda) and simultaneous passive stretching have shown a beneficial effect in knee joint contractures due to rheumatoid arthritis.<ref>Patel MM, Patel MV, Gupta SN, Patel KB. Effect of Nadisvedana with simultaneous passive stretching on correction of sandhijadya. J Ayurveda Integr Med. 2018;9(1):61‐63. doi:10.1016/j.jaim.2017.07.002</ref> Local hyperthermia improves blood circulation and local blood tissue metabolism. It also helps in reducing inflammation by lowering various inflammatory mediators.
In a study 50 patients of osteoarthritis (sandhigatavata) were treated with Nirgundipatrapindasweda for 21 days and is found to be effective in reducing the symptoms like pain and swelling in joints, stiffness and crepitus. Range of movements of effected joint was improved.<ref>Alpesh J, Charmi SM, Alankruta RD, VD Shukla. Clinical effect of Nirgundi Patra pinda sweda and AshwagandhadiGuggulu Yoga in the management of SandhigataVata (Osteoarthritis).Ayu. 2011 Apr;32(2):207-12. doi: 10.4103/0974-8520.92588.</ref>
In a study on 50 patients of osteoarthritis (sandhigatavata) treated with Nirgundipatra pinda sweda for 21 days, it was effective in reducing the symptoms like pain and swelling in joints, stiffness and crepitus. Range of movements of effected joints improved.<ref>Alpesh J, Charmi SM, Alankruta RD, VD Shukla. Clinical effect of Nirgundi Patra pinda sweda and AshwagandhadiGuggulu Yoga in the management of SandhigataVata (Osteoarthritis).Ayu. 2011 Apr;32(2):207-12. doi: 10.4103/0974-8520.92588.</ref>
Fomentation with bolus of medicated rice (Shashtikashali pinda sweda) for 28 days in 8 children with cerebral palsy showed promising results in improving the motor system functions like muscle power, muscle tone, deep tendon reflexes etc. It also showed improvement in the quality of life.<ref>Apexa GV, VK Kori, S Rajagopala, Kalpana Sp. Etiopathological study on cerebral palsy and its management by ShashtikaShali Pinda Sweda and SamvardhanaGhrita.Ayu. 2013 Jan;34(1):56-62. doi: 10.4103/0974-8520.115450.</ref>
==List of theses done==
==List of theses done==
#Shakuntala Sundi (2008): Comparative study of Nirgundighanavati and Tindukamrita capsule with nirgundipatrapindasweda in the management of Amavata. Department of Kayachikitsa, IPGT&RA Jamnagar
#Shakuntala Sundi (2008): Comparative study of Nirgundighanavati and Tindukamrita capsule with nirgundipatra pinda sweda in the management of Amavata. Department of Kayachikitsa, IPGT&RA Jamnagar
#Jayadip Kumar P Shah (2008): Effect of Tiktakshirabasti and patrapindasweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA Jamnagar
#Jayadip Kumar P Shah (2008): Effect of Tiktakshira basti and patrapinda sweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA Jamnagar
#Apexa G Vyas (2011): A clinical study on SamvardhanaGhrita and Shashtikashalipindasweda in the management of Cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
#Apexa G Vyas (2011): A clinical study on Samvardhana Ghrita and Shashtikashali pinda sweda in the management of Cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
#Rahul Ghuse (2015) : A clinical study on Shashtikashalipindasweda and Yoga basti in the management of cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
#Rahul Ghuse (2015) : A clinical study on Shashtikashali pinda sweda and Yoga basti in the management of cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
#Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadiyapanabasti and patrapindasweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata.Department of Panchakarma, IPGT&RA Jamnagar
#Rani Sangeeta Ishwar Singh (2017): A randomized clinical trial on brihatyadi yapanabasti and patrapinda sweda with aadityapakaguggulu in the management of cervical spondylosis w.s.r to asthigatavata.Department of Panchakarma, IPGT&RA Jamnagar
#Purohit Palak Kishorbhai (2017): A comparative clinical study on Shashtikashalipindasweda and Yoga basti in the management of cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
#Purohit Palak Kishorbhai (2017): A comparative clinical study on Shashtikashali pinda sweda and Yoga basti in the management of cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
==More information==
==Related chapters==
[[Sweda Adhyaya]]
[[Sweda Adhyaya]],
[[Langhanabrimhaniya Adhyaya]]
[[Langhanabrimhaniya Adhyaya]]
==Abbreviations==
Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita
==List of References==
The list of references for Swedana in Charak Samhita can be seen [[Media:References_of_word_Swedana_in_Charak_Samhita-converted.pdf|here]]
[[Category: Concepts & Practices | Practices]]
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==References==
==References==
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