SWEDANA – FOMENTATION OR SUDATION

SWEDANA – FOMENTATION OR SUDATION
Fomentation which is given by different types of heat, brings sweat on the skin through the hair follicles as it opens the pours of the skin, also liquefies the aggravated doshas embedded in the sakhas. Fomentation also dilates all the srothases (channels) in the body. It is an extremely important preparatory procedure which is indicated in preparation for panchakarma except in diseases where there is an extreme aggravation of pitta dosha. Fomentation is considered to be a powerful method of treatment in most of the vata and Kapha disorders. It is instrumental in helping to liquefy the sticky and adherent doshas which are lodged in the sakhas (peripheral tissues). Properly timed fomentation will soften and melt these toxins sufficiently for the body to efficiently expel them with the assistance of pradhana karma which then directly follow.

Indications for fomentation:

1. Vata constitution and disorders 2. Exposure to cold and Kapha disorders 3. Hiccough 4. Asthma 5. Heaviness of the body and obesity 6. Pain in neck, lumber-sacral region, back, hip, legs, head, hands etc. 7. pharyngitis & laryngitis 8. Facial paralysis 9. Hemiplegia 10. Paraplegia 11. Myopathies 12. Tympanitis 13. Constipation 14. Stiffness in neck, hip and back 15. lock jaw 16. Sciatica 17. Joint diseases 18. Urinary disorders 19. After delivery 20. Muscle atrophy and contracture of joints.

Contra indications for fomentation:
1. Habituated Alcoholic 2. Pregnancy 3. Pitta predominant diseases like fever, inflammations 4. Bleeding tendencies and jaundice 5. Skin diseases with external ulcers & Oozing 6. Severe diarrhoea 7. Tired due to excessive physical work 8. Toxic conditions 9. Unconscious patient 10. Obesity 11. Severe anemic patient 12. Leprosy 13. During menstruation 14. Diseases of eye and scrotum.


Fomentation should not be given in the eyes, heart, or the testicles. During fomentation of the entire body, these areas should be protected with cool moist cloths, wet lotus leaves or cool water. During the fomentation therapy, the physician must always keep constant watch on the patient and one attendant should also remain in the vicinity to help the patient if needed.

Signs of excessive fomentation:

· Burning sensation
· Circular rashes on the skin
· Vomiting
· Fainting
· Excessive thirst
· weak voice
· Unconsciousness
· Pain in the joints

If these signs of Pitta aggravation are observed, the fomentation must be immediately stopped. The best treatment is stambhana or astringent therapy. Patient should be then removed to cool, well ventilated place and be given cool drinks containing sugar and praval or oxide of coral. To ease the symptoms of burning on the skin, sandalwood paste should be applied.

Signs of improper fomentation:
· Coldness, stiffness and heaviness remain in the body
If these signs are observed then the heat should be increased and the fomentation should be again properly started.

Clinical signs of optimum fomentation:
· visible and adequate perspiration
· disappearance of coldness
· alleviation of pain
· reduction in stiffness
· reduction in heaviness
· increased softness of the body

Types of fomentation:


Fomentation is of two main types viz., Agni Sweda and Anagni sweda. In Agni Sweda heat is directly applied and in Anagni sweda heat is indirectly applied. According to Caraka Anagni sweda are of 10 types which includes 1.exercises like boxing, 2.walking, 3. lifting heavy weights, 4. exposure to hot sunlight, 5. staying in a closed room with no ventilation, 6. covering oneself with heavy blankets,7. hunger, 8. administration of different kinds of alcoholic beverages, 9.emotions like fear or pain, 10. anger.

Again fomentation has been divided into external fomentation and internal. For internal, various herbs having pungent taste and hot potency are used. e.g. ricinus comunis, moringa pterrigosperma, curcuma longa, calotropis procerra, comiphora mukul, agaru and Dasamulam.

Fomentation has also been divided again into two types depending upon, whether it has been given to the whole body or the part of it.

Similarly, depending on the quality of the substances used in fomentation, it has been divided into oleating or dry fomentation types. If the fomentation is done with poultice or steam it is good to alleviate Vata, while the dry type of fomentation is good for Kapha and Pitta disorders.







Four Main types of Swedanam (Fomentation)

S.No.	Type of Swedana	Material Used
1.	Tapa sweda	Usually solid material like sand, stone, brick, rice etc. are used
2.	Upanaha sweda	Semi-solid or semi-liquid material like poultice is used
3.	Ushma sweda	A type of steam therapy whereby water is sprinkled on hot materials i.e. stone, ashes or kept in pressure pan to produce steam.
4.	Drava sweda	Bathing in decoctions of herbs to promote fomentation

Usually following swedanas are very useful and commonly used in practice.

No.	Type of swedana	Particulars of the type
1.	Bashpa sweda	Steam/vapour fomentation of nirgudi leaves, dasamoola, nimba, eranda leaves etc.,
2.	Naadi sweda	Steam/vapour of above leaves for local use by pine method.
3.	Shashtika shali pinda sweda	Rice bolus of particular type of rice which matures in 60 days, is used with special decoction of roots of bala to cook it. Hot bolus are moved on the body in the fashion of abhyanga with special techniques.
4.	Pizhichal	Oil pouring on the body
5.	Valuka pottali sweda	It is a dry fomentation by sand
6.	Avagaha sweda	It is a tub bath in warm decoction, siddha jala (Medicated water) or in oil.

1. Tapa Sweda
In this procedure substances like sand, bricks or cotton cloths are heated and are directly applied to the body of the patient to produce sweat. This fomentation can be dry as well as wet type. For dry fomentation, in ancient time, various substances like sand, bricks and cloths were heated and used for this purpose. Now a days one can use infra red lamps, electric hot pads etc.,

For wet fomentation, use of water bottles of various sizes is good.
2. Upanaha sweda – Fomentation by poultice
This has been described under sankara sweda. Sushruta has described a special poultice – Salvana – with salt. In this poultice various substances like salt, oil, flour of wheat, herbs, meat and some sour substances should be cooked together and while they are hot they should be kept in suitable cloth bundle and then firmly applied to the particular part of the body.

3. Ushma Swedana – Steam fomentation
Whole body fomentation
In this procedure, a person is made to perspire by the application of medicated steam in a closed wooden chamber. This is whole body sudation procedure, however the head of the patient must be kept outside the chamber.

This chamber is specially prepared in which patient can sit or lie down. After proper oleation by abhyanga, the patient is asked to sit or lie in this chamber with minimum clothes. The head of the patient must remain outside the chamber. Chamber is then closed and simple or medicated steam is allowed to pass inside. The temperature should be adjusted to 102⁰ F. The person should be asked to stay inside till the proper perspiration is achieved (Perspiration on forehead is the limit of fomentation)

Then he is asked to come out and his body is wrapped properly. When the body temperature returns to normal, he is allowed to take warm water bath and then take rest.

Local fomentation by Naadi sweda
For steam fomentation of joint or some other local part of the body, one should use very simple instrument of naadi sweda. This can be prepared by any person at home. Attach rubber tubing which can be fitted to the top of the pressure cooker. Keep water and some suitable herbs like vitex negundo or dashmoola inside and keep the pressure cooker on the gas stove for heating. When the steam starts coming out of the tube direct the steam to the proper organ which you want to give fomentation.

4. Drava Sweda
In this procedure, warm liquid, medicated oil or milk is poured on the body (kayaseka) or on the head (Siraseka). This is an extremely important therapy for all Vata disorders.

To decide the particular type of sudation procedure, one must take into account the constitution of the patient, the disease and the bodily organs most affected, the season, the age of the patient, and the place where the treatment is being given (i.e. one has to take into consideration the TEN main factors before deciding the strength and the type of any treatment viz. Dhushyam (doshas and dhatus), Desham (Dwelling place of the patient), Balam (Strength of the patient), Kalam (Rutu/Season during which treatment is given), Analam (Strength of the Jataragni), Prakurti (Constitution), Vayah (Age of the patient), Satwam (Mind of the patient), Satmeeyam (Compatibility of the patient) and Aaharam (Nature of the food the patient consumes).

Post fomentation regimen:
Having completed a course of fomentation, patient should be advised to take rest, avoid cold, take warm baths and get adequate fresh air.

Food should be primarily easy to digest, and non obstructive.
Care must be taken to consume only moderate amounts of both food & liquids.

If purgation has to be done afterwards it should be done two days after fomentation is completed.

Nasya, Vasti or bloodletting can be done immediately after fomentation.