Swedana

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Section/Chapter/topic Chikitsa /Panchakarma/ Swedana
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Date of publication: October 04, 2020

The word ‘swedana’ means act of sweating or perspiring.[1] The terms like sudation, fomentation, steam are used to denote swedana therapy. It is one among the major six treatment modalities in Ayurveda. [Cha.Sa.Sutra Sthana 22/4] It is also used as main treatment to subside various disease conditions due to vitiation of vata and kaphadosha. This is an important procedure performed before purification therapies (panchakarma). Different heating modes are used to induce sweating. The swedana therapy essentially includes sweating induced by implementing techniques or following methods for therapeutic purpose. Thus, it excludes pathological sweating either due to disease or sweating due to environmental conditions.


Etymology and derivation

The word ‘swedana’ is derived from Sanskrit root ‘swid’ with suffix ‘dhy’. This means ‘to ripe’ or ‘cook’. It also means perspiration.[2] The procedure which relieves stiffness, heaviness and coldness and that which causes sweating is called ‘swedana’. [Cha.Sa.Sutra Sthana 22/11]

Classification

Based on utilizing fire in the heating technique

  1. With use of fire (sagni)
  2. Without use of fire (niragni)[Cha.Sa.Sutra Sthana 14/65]

With use of fire (sagni):

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]

Serial No Name of method Details
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
  • Bolus made out of mud or stone or metal is made into red hot. It is then dipped into liquid having sour property. Cover the bolus with woolen or silk cloth. This can be used for sudation

Indication: Predominance of kaphadosha and adipose tissue (medadhatu), tumors (granthi) and in painful body parts.[3]

  • Bolus prepared out of sand, dried cow dung, grains etc, is applied to the affected body parts after dipping in sour liquids. Based on the condition different types of oils or fermented liquid preparations can be used for this.
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]
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. Vatadosha 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]
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]
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]
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]
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]
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]
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]
10 Sudation on floor (Bhu) Simillar to ‘ashmaghana’ but without a stone slab[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]
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]
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]

Without use of fire (niragni):

There are twelve methods to induce sweating without use of fire.

  1. Physical exercise (vyayama)
  2. Staying in warm chamber (ushnasadana)
  3. Covering with thick coat or blanket(guru pravarana)
  4. Fasting (kshudha)
  5. Excessive intake of alcohol (bahupana)
  6. Fear(bhaya)
  7. Anger (krodha)
  8. Applying bandage (upanaha)
  9. Wrestling(ahava)
  10. Exposing to sunlight(atapa)[Cha.Sa.Sutra Sthana 14/64]
  11. Carrying heavy weights(bhara vahana)[Su.Sa.Chikitsa Sthana.32/15][4]
  12. Walking(adhwa)[Su.Sa.Chikitsa Sthana.32/15][4]

Based on the form of heat used

  • Heat in moist form(snigdha): This is applied in conditions due to vitiation of vatadosha.
  • Heat in dry form(ruksha): This is applied in conditions due to vitiation of kaphadosha.
  • Mix (snigdha-ruksha): This is applied in conditions due to vitiation of both vata and kaphadosha.[Cha.Sa.Sutra Sthana 14/8]

Based on intensity of heat

  • Mild (mridu): Indicated in mild conditions
  • Moderate (madhyama): Indicated in moderate conditions
  • Intense (mahat): Indicated in severe morbidities[Cha.Sa.Sutra Sthana 14/07]

Mild sudation is indicated in sensitive areas like testicles, precordium and eyes. Moderate sudation can be done in groins. In other parts of the body any forms of sudation can be done as per the discretion of the physician. [Cha.Sa.Sutra Sthana 13/10]

Based on the application on body part

  • 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]

Based on the medium of sudation:

  • Heat bath/Radiant heat (tapa):This includes jentaka, karshu, kuti, kupa and holaka types.
  • Vapours or steam (ushma): This includes sankara, prastara, ashmaghana, nadi, kumbhi, bhu types.
  • Liquid medium (drava): This includes parisheka and avagaha.
  • Bandage (upanaha)[Su.Sa.Chikitsa Sthana32/3][4]

Based on the purpose:

  • For pacification (samshamana)
  • For purification (samshodhana)[Dalhana on Su.Sa.Chikitsa Sthana32/22][4]

Indications:

  • 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
  • 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
  • As a prerequisite to panchakarma procedures[Cha.Sa.Sutra Sthana 14/24]

Contraindications:

  • In conditions and body constitutions with predominance of pittadosha.
  • Conditions like bleeding disorders, diarrhea, diabetes mellitus, rectal prolapsed etc.
  • Those who regularly consumes alcohol and astringents
  • During hunger, anger, depression
  • Pregnant ladies
  • Weak, extremely emaciated, immune-compromised and unconscious persons[Cha.Sa.Sutra Sthana 14/16-19]

Signs of optimal sudation:

The signs of optimal sudation are relief from coldness, pain, stiffness,and heaviness and pacification of disease.[Cha.Sa.Sutra Sthana 14/12]

Properties of the drug which imparts swedana:

The drug should be warm, penetrating, motile, unctuous, rough, can reach minute level, stable, heavy and liquid.[Cha.Sa.Sutra Sthana 22/16]

Importance in preservation of health and prevention

Swedana improves the process of digestion and metabolism [Su.Sa.Chikitsa Sthana 32/22][4] and remove obstructions. Administering sudation, 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][4] Jentaka and atapa type of sudation are indicated in season specific regimen for preservation of health in winter. [Cha.Sa.Sutra Sthana 6/14]

Importance in management of disease

Swedana can liquefy the dormant dosha adhered in 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][4] Generally,swedana pacifies the diseases caused due to vata and kaphadosha. [Cha.Sa.Sutra Sthana 14/3]

Action of different types of sweda on dosha

  • Tapa and bashpa sweda : Mitigates kapha
  • Upanaha sweda : Mitigates vata
  • Drava sweda: Mitigates pittadosha associated with kapha
  • Niragnisweda: Mitigates vata associated with kapha and adipose tissue (meda dhatu)[Su.Sa.Chikitsa Sthana 32/14-15][4]

In the diseases caused due to the suppression of natural urges, swedana is indicated to relieve the obstruction of vata. It is an important treatment in 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]

Contemporary approach:

Through the sudation 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, ultra sound, wax bath, heat pads, hot water bags etc. Sauna bath is practiced in many parts of the world as a method for sudation.

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.[5] [6]

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.[7]

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.[8]

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.[6]

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.[6]

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.[6]

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.[9]

Stem cell stimulation therapy: An increase in CD34-positive cells in circulation has been reported after repeated heat stress therapy.[10]

Cardio vascular diseases: In a cohort study it is reported that repeated heat stress therapy results in a reduction of cardio vascular risks.[10]

Methods of induction of sweating:

Practically the sweating is induced as a therapy through three different forms

  1. Application of heated bolus (pottali)
  2. Application of vapour/steam
  3. Application of hot liquid

Sudation 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.

Valukasweda:

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.

Churnapindasweda:

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.

Jambeerapindasweda:

The bolus is prepared with citrus fruit, medicated powders and oil. This is indicated in conditions of joint pain, stiffness etc

Patrapindasweda:

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 vatadosha, hemiplegia, paraplegia etc.

Shashtikashalipindasweda:

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.

Sudation using vapour

Bashpasweda:

Sudation using a chamber, 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 sudation is used as pre-operative procedure before purification therapies.

Nadisweda:

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.

Sudation using liquid

Pouring method

Dhanyamladhara: Warm fermented liquid (dhanyamla), prepared from cereals is poured over the affected body parts to attain sudation. Instead of dhanyamla, medicated buttermilk, decoctions, medicated milk and medicated oils can also be used as per the condition of the patient.

Immersion method

The effected body parts are immersed in warm decoctions or oils

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.[10]

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.[10] 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.[11]

Effect of nadisweda:

Nadisweda and simultaneous passive stretching have shown beneficial effect in a case of knee joint contractures due to rheumatoid arthritis.[12] Local hyperthermia improves blood circulation and local blood tissue metabolism. It also helps in reducing the inflammation by reducing 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.[13]

Shashtikashalipindasweda carried out for 28 days in two courses, each course of 14days with 7 days gap in between, over 8 children shows promising results in improving the motor system functions like muscle power, muscle tone, deep tendon reflexes etc and thereby improving the quality of life of children with cerebral palsy.[14]

List of theses done

  1. Shakuntala Sundi (2008): Comparative study of Nirgundighanavati and Tindukamrita capsule with nirgundipatrapindasweda in the management of Amavata. Department of Kayachikitsa, IPGT&RA Jamnagar
  2. Jayadip Kumar P Shah (2008): Effect of Tiktakshirabasti and patrapindasweda in the management of cervical spondylosis (Asthigatavata). Department of Panchakarma, IPGT&RA Jamnagar
  3. Apexa G Vyas (2011): A clinical study on SamvardhanaGhrita and Shashtikashalipindasweda in the management of Cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
  4. Rahul Ghuse (2015) : A clinical study on Shashtikashalipindasweda and Yoga basti in the management of cerebral palsy. Department of Kaumarabhritya, IPGT&RA Jamnagar
  5. 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
  6. 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

Related chapters

Sweda 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 here

References

  1. ↑ Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Svedana, Page 1285
  2. ↑ VC Patil. Principles and practice of pancakarma. NewDelhi:Chaukhabha publications;2106.Chapter 9, Svedana Karma(Sudation therapy);p.193.
  3. ↑ Vridha Vagbhata. Sutra Sthana, Cha.26 Swedavidi Adhyaya verse 7. In: Shivaprasad sharma, Editor. Ashtanga Sangraha. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
  5. ↑ 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
  6. ↑ 6.0 6.1 6.2 6.3 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
  7. ↑ 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
  8. ↑ 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
  9. ↑ 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
  10. ↑ 10.0 10.1 10.2 10.3 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
  11. ↑ 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.
  12. ↑ 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
  13. ↑ 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.
  14. ↑ 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.
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