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Line 825: − + + + + + + + + + − 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. − 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] − 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] +
→Vidhi Vimarsha
*''Swedana'' is contraindicated in conditions where bleeding, circulatory failure, dehydration, hypotension and neuropathy are likely to occur. ''Swedana'' is absolutely contraindicated in patients with generalized debility and in comatosed patients.
*''Swedana'' is contraindicated in conditions where bleeding, circulatory failure, dehydration, hypotension and neuropathy are likely to occur. ''Swedana'' is absolutely contraindicated in patients with generalized debility and in comatosed patients.
=== 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''.
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]
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]
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]. 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.
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]. 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 oedema. 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 oedema. 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