Jambeera Pindasweda, Naranga Kizhi: Method, benefits

Article by Dr Raghuram Y.S. MD (Ay)
When you are tired, you feel relaxed and rejuvenated when you are served with ‘cold lemon juice’ isn’t it?
Can you really imagine ‘rubbing pieces of hot lemon packed in cloth bolus against your sore joints and muscles’ and you feeling really relaxed and pain free!! 

This is what I am going to explain in this article i.e. ‘the method of using lemon for alleviating joint and muscle pains’ in an Ayurvedic treatment named ‘Jambira Pinda Sweda’!

Jambeera Pinda Sweda or Naranga Kizhi (Malayalam) is a speciality treatment done by Kerala Vaidyas (doctors) for treating cervical spondylosis and frozen joints. It is a type of hot bolus fomentation and thus is classified under Pinda (bolus) sweda.

Jambeera is an Ayurvedic term for wild lemon or Citrus medica (citron fruit). Naranaga is a word used in Malayalam for both citron fruit and lemon. But in practice lemon is used in the treatment. Thus the use of term Jambeera and use of lemon in the treatment looks controversial. But we shall not look into the names. Some physicians have effectively used the citron fruit for the treatment, including me. Thus, the term jambira or naranga doesn’t seem controversial. Both these terms cover the usage of both lemon and wild lemon in the treatment.
kizhi

Word meaning –
Jambira=Citron fruit or lemon, Pinda=bolus, Sweda=fomentation or sudation
Naranga=citron fruit or lemon, lemon to be precise, Kizhi=bolus

To keep it simple, the term Naranga Kizhi translates to ‘hot fomentation or sweating treatment given to the painful parts by tying sliced lemon or wild lemon heat processed with other medicinal herbs tied in a bolus’

Swedana or fomentation (sudation, sweat inducing treatments, steaming treatment) is a specialized treatment of Ayurveda which helps in providing unparalleled relief in pain, swelling and stiffness associated with sore joints, spine, nerves and soft tissues including muscles, ligaments and tendons.

Jambira Pinda Sweda falls in the category of ‘Pinda Sweda’ subtype of Swedana treatment.
Before knowing about the procedure and the benefits of Jambira Pinda Sweda, let me give a brief explanation of the Swedana treatment, for convenience of understanding.
Citrus medica

Swedana – sweating treatment:
Swedana is a treatment procedure in which sweat is induced by application of heat and warmth in the form of steam or by bringing the body / body parts in contact with heated medicaments (powders, leaves, processed rice, sand etc) tied in boluses. Swedana provides relief from Stambha (stiffness and catches), Gourava (heaviness) and Sheeta (coldness) in the body or body parts.
Read related: Sweating Treatment – Swedana Types And Methods – Charaka Samhita 14

Jambira Pinda Sweda is included under Sagni sweda (since we use heat) and Snigdha Sweda.

Pinda Sweda (Bolus Fomentation) –
Pinda means bolus, Sweda means inducing sweating. Thus in Pinda sweda, the medicaments, generally hot or boiled to tolerable temperature are tied in a cloth so as to make a bolus. The bolus is gently rubbed over the painful area. Heat is provided until sweating occurs.

Example –
Patra Pinda Sweda (leaves of medicinal plants which can relieve pain, stiffness and swelling are used in the bolus),
Churna Pinda Sweda (herbal powders prepared by pounding the medicinal drugs which can relieve pain and associated conditions are tied in the bolus), Valuka Sweda (heated sand is tied in the bolus) etc.

Naranga Kizhi
As already said Jambira Pinda Sweda is a procedure in which sliced lemon along with other medicaments are selected based on their analgesic and anti-inflammatory properties, in fact the combination is such that it serves the purpose of relieving pain and inflammation of the sore joints and soft tissues. These herbs are heat processed in herbal oil or castor oil. The hot contents are tied in a bolus (enclosed in bolus made up of sterile cloth). The bolus is rubbed hot (tolerable) over the painful parts of the body, after those parts have been subjected to abhyanga (herbal oil massage).

It is an unparalleled treatment in Vata and kapha morbidity or any disease or painful conditions caused by morbid Vayu and or kapha, usually presenting with pain, stiffness (catch) and or swelling.

Indications of Jambira Pinda Sweda (Naranga Kizhi)
Jambira Pinda Sweda is used mainly to provide relief from pain. This treatment also effectively wards of the inflammation, swelling and stiffness (catch) associated with bone, joint and or musculoskeletal pains.

Patra Pinda Sweda is used in the treatment of –
Rheumatoid Arthritis (Amavata)
Osteo Arthritis
Cervical spondylosis

Lumbar Spondylosis and Lumbago
Frozen Shoulder
Whiplash – neck pain caused when a person’s head moves backward and then suddenly forward with great force.
Wry neck (Torticollis)
Bursitis
Ankylosing Spondylitis
Polymyalgia Rheumatica
Musculo-skeletal pains as in myalgia and or fibromyalgia (Mamsagata Vata)
Muscular cramps
Low back pain or Lumbago (Lumbar spondylosis)
Knee injuries: like ACL (Anterior cruciate ligament) injury, Torn Meniscus, Knee Bursitis, Patellar tendonitis etc
Sprained ligaments
Cartilage tears
Sports injuries
Sprains and strains
Pains and catches in the joints and spine (especially neck and low back) due to bad postures
Musculoskeletal disorders

Note –
In all the above said conditions, Jambeera Pinda Sweda should be carried out after doing Abhyanga (massage with medicated oils).
Abhyanga and Jambira Pinda Sweda forms a very effective combinationin relieving pain, stiffness and swelling caused due to many conditions. Patra Pinda Sweda is highly effective in musculoskeletal diseases.
It is also found that it relieves nerve related pains in neurological conditions, though it might not be the first choice of treatment in these conditions.

Method of doing Naranga Kizhi or Jambeera Pinda Sweda
Purvakarma (Pre-treatment procedures): This includes –

  • Preparation of the patient:
  • The patient is thoroughly examined.
  • The Prakriti (basic constitution) and Vikriti (details of morbidity) are documented in detail.
  • The disease is also examined.
  • After careful assessment, it is decided if Jambira Pinda Sweda is suitable to the disease and diseased or not.
  • The treatment line-up, materials and medicines which need to be used are enlisted.

Preparation for the treatment:
Materials needed for the treatment are collected beforehand. They are:

  • Jambira – Big sized Lemon or Citron Fruit, 4-6 in number should be taken. If large boluses are need to be prepared, more lemon fruits should be collected as more slices may be needed. Large boluses will be needed when broader areas having pain like low back etc are attended. Care should be taken to see that the fruits are in good condition, fresh, not infested, and not damaged. The jambira fruits should be cut into small slices with the help of knife. Every day fresh jambeera should be taken and disposed after completion of the treatment.
  • Methika churna – powder of Methika (fenugreek powder)
  • Shatahva Churna – powder of shatahva or dill seeds
  • Haridra churna – turmeric powder
  • Saindhava Lavana – Powder of Saindhava Lavana (rock salt)
  • Lashuna – 1-2 big sized Garlic should be taken, their cloves should be separated and de-husked and later their paste should be prepared.
  • Narikela – Grated coconut
  • Eranda Taila – Castor oil

Other materials –

  • Large non-stick pans
  • Stove
  • Big spoons
  • Sterile clothes to tie the bolus
  • Thicker threads to tie the cloth into bolus after placing the above mentioned ingredients in it
  • Sterile napkins or tissue papers for wiping

For Abhyanga (massage) – Taila (medicated oil), Ghee (medicated ghee) or both suitable to the disease and diseased are collected and stored beforehand. The same oils shall be used for frying or processing the ingredients. Some effective oils used for Abhyanga are –

  • Vishagarbha Taila,
  • Kottamchukkadi Taila
  • Murivenna
  • Mahanarayana Taila
  • Ksheerabala Tailam
  • Mahamasha tailam
  • Balashwagandhadi Tailam
  • Ashwagandhabalalakshadi Tailam
  • Sahacharadi tailam
  • Pinda tailam
  • Tiktaka ghritam
  • Guggulutiktaka ghritam
  • Tila taila (sesame oil) etc

Materials needed to conduct local treatments like oil pooling (sthanika vasti’s like Kati Vasti for low back pain, Greeva Vasti for neck pain etc) like black gram flour etc

Medicines needed to conduct Virechana (therapeutic purgation), Nasya (nasal drops) or Vasti (therapeutic enemas), enema cans and syringes, sterile cotton etc

Treatment procedures which are done in Purvakarma and also form effective combo’s with Jambeera Pinda Sweda –

  • Abhyanga or Samvahana – Good herbal oil massage
  • Kati Vasti – Oil pooling in the low back region for low back pain
  • Greeva Vasti – Oil pooling in the cervical region (nape of the neck) for neck pain or cervical spondylosis
  • Nasya – nasal medication for neck and nape pain, cervical spondylosis
  • Prishta Vasti – Oil pooling to the whole spine
  • Janu Vasti – Oil pooling around the knee joints for knee joint pain and arthritis
  • Valuka Sweda – Sand bolus fomentation in the initial or acute conditions of RA and stiffness of the thigh
  • Udwardthanam – Massage with herbal powder in upward direction is called Udwarthanam. This helps in mobilisation of excess fat from the areas of deposition. It also helps in clearing the blocks caused by morbid kapha and enhances circulation. It helps in reduction of weight and releases the pressure on the joints and soft tissues. It forms an important combination with jambeera pinda sweda.

Pradhana Karma (Treatment proper):

Preparing the Jambira Pinda:

  • The sliced Jambira (Naranga) fruits are put in the pan. The pan is kept on fire. The lemon slices are fried on medium flame.
  • Later the castor oil (eranda taila) or any medicated oil having analgesic property (vata alleviating) is added to the pan and the lemon slices are fried in the oil. Herbal oils (oils used for Abhyanga mentioned above) selected so as to suit (antagonistic) the disease and dosha involved in causing the pathology are taken in required quantities and put over the chopped lemon and other ingredients consisting in the pan.
  • The ingredients are fried in the oil.
  • After this, the powders of fenugreek, turmeric, rock salt, dill seeds, coconut grating and garlic paste is added.
  • Garlic paste is optional. Garlic paste has counter irritant property and may produce irritation in some people, though less. The presence of coconut gratings and medicinal oils used for frying the composition might counter act the garlic effect but garlic shall be withdrawn if irritation persists during first 2 sittings, though it is rare to find such reactions.
  • When the ingredients turn golden red or brownish the pan is removed from the fire.
  • The ingredients are poured on 2 sterile cloths (double layered) and 2 boluses are prepared. The upper free ends of the clothes are tied with strong thick threads so as to form a bolus or Jambira Pinda (Lemon bolus). Though 1 bolus is sufficient, an extra bolus should be prepared as back up. Both these boluses shall be used alternatively.
  • When one bolus gets cold or loses temperature, it shall be replaced with the 2nd bolus which has been heated on the pan or dipped in hot oil.

Administration of fomentation:

  • A pan is kept on the stove. The stove is ignited and kept in a mild flame. Medicated oils are poured in the pan and allowed to get hot.
  • The lemon bolus is dipped in warm oil; temperature of the bolus is tested and used for giving fomentation.
  • Before rubbing the bolus over the afflicted painful body part of the patient, the bolus is wiped along the rim of the pan to rip off the excessive oil sticking to the bolus. If not, the excessive oil dripping from the bolus will spill all around and create inconvenience to the treatment procedure.
  • The bolus is rubbed on the affected part gently (as good as massaging with bolus).
  • The hot bolus should not be kept in contact with the sore part for long time as it may cause irritation or burn (anyhow the temperature should be checked by the masseur every time).
  • Once the bolus gets cooled (as felt by touching the bolus with the hand), it is changed with another bolus which has been kept in the pan containing the oil.
  • The bolus is repeatedly interchanged with the backup bolus throughout the treatment duration. The key is to maintain the temperature of the bolus.
  • The procedure is repeated many times for a period of 30-40 minutes.

Caution – Everyday the bolus is replaced or the lemon slices and other ingredients are replaced with fresh ones.

The procedure is done till sweating occurs and the patient feels light and healthy or until the signs of proper fomentation have been achieved (Samyak Swinna or Swedana Lakshanas)

Signs of proper fomentation (Samyak Swinna or Samyak Swedana Lakshanas) such as relief from pain, reduction in stiffness, heaviness etc are observed.

Paschat Karma (Post-treatment procedures)
The body parts of the patient subjected to Jambira Pinda Sweda is wiped with sterile cloth dipped and squeezed in warm salt water or wiped with tissue papers. The couch is also cleaned.

The patient is asked to relax for a while

Snana – Patient is advised to take a refreshing hot water bath after going home or after a few hours if the patient is being handled as in-patient

Nitya Virechana
Daily metered dose of purgation with purgative decoctions or oils like Gandharvahastadi Kashayam, Gandharvahastadi Eranda tailam, Nimbamritadi Eranda Tailam, Trivrit Churna etc can be administered if a small amount of detoxification is essential on a daily basis or if morbid Doshas need to be tackled (optional and strictly based on the decision of the doctor).

Nitya Virechana might not be needed since the treatment involves providing heat to limited areas of the body or sore joints and muscles.
But administration of Nitya Virechana or Vasti doesn’t harm, in fact they will enhance the effect of the treatment.

Vasti

  • Medicated enema’s can be combined with Jambira Pinda Sweda especially in chronic conditions of OA etc diseases.
  • A combination of Sneha Vasti (enemas with medicated oils and ghee) with Brihat Saindhavadi Taila or Guggulutiktakam Ghritam, Mahanarayana Tailam or Dhanwantaram tailam / mezhupakam / Sahacharadi tailam etc and Kashaya Vasti (Decoction enemas) with Erandamuladi Vasti or Dashamula Vasti or Mustadi Yapana Vasti is highly effective in Amavata and other musculoskeletal diseases.
  • Vasti shall be thought of when generalized systemic condition like amavata or sandhigata vata are being addressed. Jambira pinda sweda will take care of local pain and stiffness, while vasti and virechana will have systemic action.
  • Lekhana Vastis (fat and kapha depleting enemas) can be done while managing obesity and diseases caused due to errors of fat metabolism which are causing stress on the bones, joints, soft tissues and muscles.
  • These therapies can also be planned after finishing the course of Jambira Pinda They can also be carried out in line with Naranga Kizhi.
  • External and internal therapies / treatments can be planned individually or in combination depending on the severity of the disease and strength and tolerance of the patient.
  • Matra Vasti – daily metered doses of oil enema is given alongside Jambeera Pinda Sweda. Matra Vasti controls morbid Vata and Pitta, strengthens the bones, joints, muscles, soft tissues and soothes nerves.

Nasya (nasal medication) –
Nasya or nasal instillation of medication is the best combo with abhyanga and jambeera pinda sweda for effectively treating frozen shoulder, cervical spondylosis and neck pain.

Discharge –
The patient is discharged on daily basis (out-patient) or after the course has been completed (in-patient) after giving proper lifestyle and diet advices along with suitable medicines (oral). The patient is also advised to undergo the treatment twice or thrice in a year.

Duration of the course –
The number of days of treatment varies from 7-14 days depending on the nature and intensity of the disease

Benefits of Jambira Pinda Sweda –

  • Relieves pain, stiffness and swelling associated with arthritis and other painful conditions mentioned above
  • Pacifies the morbidity of Vata and Kapha in the afflicted joints, muscles and soft tissues
  • Causes sweating and brings about lightness and a feeling of health in the afflicted joints, muscles and soft tissues
  • Forms an effective combination with local treatments like Greeva Vasti, Kati Vasti, Abhyanga etc and fortifies the results w.r.t providing relief from pain and related conditions
  • When combined with Nitya Virechana and or Vasti, Naranga Kizhi eliminates the body toxins, establishes health and tones up the joints and soft tissues
  • Improves the movements of the joints
  • Soothes the nerves and improves blood circulation

Contra-indications of Patra Pinda Sweda –

  • High Pitta condition, acute and persisting inflammation
  • Diabetes mellitus (can be done for a short period with caution, giving proper medicines to treat diabetes or in controlled and uncomplicated diabetes)
  • High blood pressure (Hypertension)
  • Fractures
  • Fever
  • Severe inflammation

Naranga Kizhi can be done with caution and under supervision in Diabetes and Hypertension if doing it is mandatory and no other better options are available. Care should be taken to see that there is no excessive sweating and resulting dehydration.

Limitations:
Jambeera Pinda Sweda is one of the best Ayurvedic treatments which is used in providing relief from pain and associated conditions related with cervical spondylosis, frozen shoulder, myalgia, osteoarthritis, rheumatoid arthritis, low back pain, etc conditions. But on the other hand it is not a sole remedy in these conditions. Parallel to it we might have to add some disease modifying herbs and or compounds and effective treatments for better relief.\

My clinical experience with Jambeera Pinda Sweda
In my 20 years of clinical experience, I have found Jambeera Pinda Sweda to be highly effective in relieving pain and stiffness associated with arthritis, sore muscles and soft tissues.

I have adequately used this treatment in treating cervical spondylosis, and frozen shoulder, myalgia, muscular rheumatism and polymyalgia. To a lesser extent I have used it in low back pain, knee pain due to osteoarthritis, ankylosing spondylitis and or rheumatoid arthritis.

In osteoarthritis, I have found the effect of the treatment when combined with abhyanga and janu vasti. Similarly the treatment is highly effective when combined with abhyanga and or kati vasti in low back pain and when combined with abhyanga and greeva vasti and nasya in cervical spondylosis. Though I have seen that Naranga kizhi is effective when administered individually also, but the effect is enhanced when combined with the said treatments.

I have generally preferred Patrapinda sweda (leaf bolus fomentation) when it comes to larger areas like low back pain. In some patients, I have conducted Jambeera Pinda Sweda after patra pinda sweda and found that the effect is better in comparison to both treatments individually conducted. Of course, I have conducted them in different schedules. Jambeera Pinda Sweda is found to have similar pain alleviating property like Patra Pinda Sweda.

Jambeera Pinda Sweda has always been my option in frozen shoulder and cervical spondylosis. Along with greeva vasti and nasy it has given good results.

In amavata or rheumatoid arthritis, I have found Jambeera Pinda Sweda to give good results after having conducted dhanyamla dhara for 7-10 days rather than doing it individually.

I have found Matra Vasti being good accompaniment to Jambeera Pinda Sweda in chronic pains related to osteoarthritis, lumbar spondylosis, lumbago and neuromuscular pains. Jambeera Pinda Sweda is effective in chronic conditions of Rheumatoid arthritis in comparison to acute exacerbations.

The bottom line is Jambira Pinda Sweda should be tried with many combinations according to the condition of the disease and diseased and shall be changed from time to time accessing the current scenario of the disease and related pathology.

I have even advised Jambira Pinda Sweda as preventive measure for those who have started to develop pains or prone to arthritis and other musculoskeletal or neuromuscular diseases. Since the treatment is easy to do and can be done at home, it comes handy. The ingredients used in the treatment are also simple, easily available and yet reliable in terms of providing results and pain relief.

I have never finished my treatment protocol without proper diet advice and suggestions regarding life style modulations, regular exercise and Yoga and of course without prescribing good disease modifying formulations. After 3-4 months I generally keep my patients on good Rasayanas i.e. immune-modulator medicines.

Just before finish,
Jambeera Pinda Sweda is a very simple, cost effective and reliable cure for your pains. It is a good option for your sore neck, back and joints, painful muscles and swelling. But it is very essential that your pain should be diagnosed properly in an Ayurvedic way. The doctor will let you know if you really fit into the format of Naranga Kizhi. Thanks to Ayurveda for having given the best options for alleviating and conquering pain by using the herbs and fruits provided by nature. When you use the natural things from nature to treat your problems, the result too will be natural.
‘Move along happily and get relieved of your pain in a natural way through Ayurvedic remedies’
Click to Consult Dr Raghuram Y.S. MD (Ayu)

 


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