Changes

''Swedana'' procedures are recommended for a specific duration and not for prolonged periods of time. How do we know when to stop it? Repeated thermal stress elicits adaptations evident within the neural networks and integrating regulatory systems that appear as morphological changes (sweat gland hypertrophy) and may be expressed as adjustments within effector processes altered vasomotor or sudomotor sensitivities. The most common functional effect of heat acclimation is a change in the effector activation being shifted downwards. One can also observe effector adaptations evident from changes in the gain of the effector response. Thus, for a given thermal stimulus acclimatized individuals frequently display an increased effector sensitivity such as greater sweating response for an equivalent change in body temperature. Phenotypic adaptation evident after sufficient fomentation (continuum model, not with respect to time) 1) Reduced heart rate at a fixed work rate 2) Expanded plasma volume 3) lower core temperature at an equivalent workload 3) Superior Na and Cl reabsorption from sweat, and an elevated sweat secretion. [8] [verse 13]

''Swedana'' procedures are recommended for a specific duration and not for prolonged periods of time. How do we know when to stop it? Repeated thermal stress elicits adaptations evident within the neural networks and integrating regulatory systems that appear as morphological changes (sweat gland hypertrophy) and may be expressed as adjustments within effector processes altered vasomotor or sudomotor sensitivities. The most common functional effect of heat acclimation is a change in the effector activation being shifted downwards. One can also observe effector adaptations evident from changes in the gain of the effector response. Thus, for a given thermal stimulus acclimatized individuals frequently display an increased effector sensitivity such as greater sweating response for an equivalent change in body temperature. Phenotypic adaptation evident after sufficient fomentation (continuum model, not with respect to time) 1) Reduced heart rate at a fixed work rate 2) Expanded plasma volume 3) lower core temperature at an equivalent workload 3) Superior Na and Cl reabsorption from sweat, and an elevated sweat secretion. [8] [verse 13]

It is very essential to differentiate heat exhaustion from heat stroke. 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 [9] [verse 14-15]

It is very essential to differentiate heat exhaustion from heat stroke. 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 [9] [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]]. [10]

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]]. [10]