Navarakizhi: Shashtika Shali Pinda Sweda Procedure, Benefits

Article by Dr Raghuram Y.S. MD (Ay)
Navarakizhi or Shashtika Shali Pinda Sweda is a form of sweat inducing massage treatment. It is used to improve muscle strength, rejuvenate and re-energize body. Here, milk and rice are mainly used. 

Introduction

Milk is a well known nutrient to us, so is rice. They form a part of our daily diet. But in this write-up we shall see how these 2 food products are used for treatment purposes, not when taken internally but when applied externally.

Yes! You have heard it right. Milk processed with medicinal herbs and a special type of rice are combined together to be used as an effective external therapy. This treatment is used to provide strength and nutrition to the body tissues, especially bones, muscles and other soft tissues.

The treatment is a special gift from Ayurveda to the ailing world and is called Shashtika Shali Pinda Sweda in Sanskrit and Njavarakizhi in Kerala Ayurvedic practice.
Though it is a sweating form of treatment, often, the term massage is associated with this treatment because sweating is used by massaging.

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 many systemic diseases, especially in rheumatological conditions like Amavata vis-à-vis Rheumatoid arthritis, Sandhigata Vata (Osteoarthritis), Kati Shula (Low back pain), Mamsagata Vata (Myalgia), Fibromyalgia etc.

Njavarakizhi massage treatment is a form of swedana which is included under the category of Pinda Sweda (bolus fomentation).
In this procedure we use Shashti Rice (a special type of rice harvested in 60 days) processed in herbal decoctions and milk tied in a bolus to rub against the whole body or afflicted part of the body so as to provide heat to the pain afflicted joints, muscles or body parts. It is a strengthening therapy. It gives nutrition to the tissues which are undergoing depletion and degeneration. It is a time tested treatment administered to those ailing from musculoskeletal and neuromuscular diseases.

Synonyms of the therapy

Shashtika Sweda, Shahstika Pinda Sweda
Navarakizhi, NNjavarakizhi, Njavara Kizhi, Navara Kizhi.

Before going into details of what are Shashtika Shali Pinda Sweda and the method of doing it, I would like to give a brief introduction of Swedana in a few paragraphs

Swedana

Swedana (sweating therapy) – introduction

स्तंभ गौरव शीतघ्नं स्वेदनं स्वेद कारकम्। (च.सू.२२/१२)
Stambha gaurava sheetaghnam swedanam sweda kaarakam (Ref-Charaka sutra sthana 22/12)

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), Gaurava (heaviness) and Sheeta (coldness) in the body or body parts.

Swedana is said to be the best form of treatment in expelling morbid Vata and Kapha and also destroying the diseases manifested due to morbid Vata and Kapha.

Swedana is usually done after Abhyanga and or Snehana (administration of medicated oils and ghee for oral consumption in metered doses, as a pre-treatment procedure for cleansing treatments like Vamana – Therapeutic vomiting and Virechana – Therapeutic purgation).

After Swedana, the body starts sweating, we feel lighter and energetic, the cells get activated and flush the toxins away. The cellular metabolism improves and we feel light and at ease.

There are many types of Swedana as explained in Ayurvedic texts. There are about 13 types of Sagni Sweda’s (sweat inducing treatments administered by procedures involving utilisation of fire or heated materials) and 10 types of Niragni Sweda (sweat inducing treatments where in the fire or heated materials are not utilised ex. sleeping covering thick blankets until we sweat etc).

Again, Swedana can be done in 2 ways –
Rooksha Sweda (dry fomentation) and
Snigdha Sweda (wet fomentation or sweat inducing treatment done after giving oil massage or by using the medicinal drugs which are processed or fried in herbal oils).

In some pathological conditions both forms can be skilfully combined as and when required. In conditions where pain and associated symptoms are due to ama (metabolic toxins having a sticky nature, tending to block the transport systems of the body and cause painful conditions), meda (contaminated or accumulated fat) and or kapha (morbid kapha) we generally prefer doing Rooksha Sweda or dry fomentation. In conditions where the pain and related symptoms are due to vitiation of only morbid Vayu, we generally prefer Snigdha Sweda (wet or unctuous fomentation)

Every form of Sweda can provide relief from pain, stiffness and swelling. But their area of utilisation and the diseases and pathological conditions in which they are administered or preferred will differ. In this context I would limit my discussion to Shashtika Shali Pinda Sweda (rice-milk bolus fomentation)

Note –
Ama means metabolic wastes created by low metabolism and indigestion which have a sticky nature and has a tendency to produce pain and stiffness.
Meda means fat.
Shashtika Shali Pinda Sweda and Patra Pinda Sweda falls into the category of Snigdha Sweda and Pinda Sweda.

Click to Consult Dr Raghuram Y.S. MD (Ayu)

Pinda 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.

Pinda sweda is generally done as a local fomentation, applied on the pain afflicted body parts. It can be expanded so as to cover the entire body also. There are many variants of Pinda sweda, the name is given on the basis of the material / medicaments tied within the bolus.

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), Shashtika Shali Pinda Sweda (rice-milk bolus fomentation) etc.

Shashtika Shali Pinda Sweda

What is Njavara Kizhi / Shashtika Shali Pinda Sweda?

The term Shashtika Shali Pinda Sweda is made up of 4 words –
Shashtika means sixty,
Shali means rice,
Pinda means bolus,
Sweda is sweat,
Swedana is sweat inducing treatment.

Navarakizhi is a treatment in which a special type of rice called Shashtika Shali (which is harvested in 60 days and is exclusively used for treatment purposes in Ayurveda) prepared in milk processed with herbal decoction is tied in boluses and used for rubbing on the body parts which are intended to receive nutrition and strength. The treatment is also used in painful and or degenerative conditions like Osteoarthritis, Myalgia, GB Syndrome, Fibromyalgia, various types of Neuro-muscular and Musculoskeletal diseases.

It is basically a strengthening and nutritious treatment. It also has an extraordinary relaxing and analgesic effect. In this form of treatment, initially decoction of Bala mula (roots of Sida cordifolia) is prepared. Two portions of this Bala decoction are boiled with equal quantity of milk separately. In one portion of processed milk, the Shashtika rice is cooked until properly formed. This processed rice is tied in 8 boluses. The boluses are dipped in the other portion of processed milk and continuously rubbed over the body. The process is carried out until proper sweating occurs.

This treatment is generally preferred in the absence of ama (intermediate products of digestion and cell metabolism, circulating or tissue toxins which get adhered in the cells due to their sticky nature, block the channels and transport systems of the body and cause pain and stiffness) or done after getting rid of ama through treatment procedures like Valuka Sweda (sand bolus fomentation) or Udwarthana (massage in an upward direction usually done with herbal powders).

Medicines which can enhance the metabolism (deepana) and digest or expel the ama (pachana) – toxins blocking the cells and channels can also be administered before the treatment procedure. Disease modifying drugs can also be given (Some of these medicines will be enlisted at the end of the article)

Shashtika Shali Pinda Sweda is an unparalleled treatment in Vata, Pitta and Rakta (vitiated blood) morbidity or any disease or painful conditions caused by morbid Vayu, Pitta and or Rakta, usually degenerative and inflammatory diseases or diseases caused due to contamination of blood.

Benefits

Navarakizhi treatment benefits:

Shashtika Shali Pinda Sweda is used mainly to provide strength and rejuvenate the tissues and also to provide relief from pain, inflammation, and stiffness (catch) associated with bone, joint, neuromuscular and or musculoskeletal pains. Many times it also acts as a disease-modifier wherein it provides a substantial relief of more than 90% and a long standing one too. It is more effective when combined skilfully with Abhyanga (massage with herbal oils), Kati Vasti (oil pooling for low back pains), Greeva Vasti (oil pooling for neck pains) etc treatments. Shashtika Sweda can be done in a later period of these treatments to strengthen the nerves, joints and soft tissues and enhance blood flow to the affected area.

Indications

Navarakizhi indications:
Osteoarthritis (Sandhigata Vata) – Osteoarthritis is the common form of arthritis. It results from the breakdown or damage of protective joint cartilage on the ends of the bones and underlying bone. OA can affect and damage any joint in the body.

The most common symptoms are joint pain and stiffness. Joint swelling and decreased range of movements are also present in many cases.

Navara Kizhiis in preventing the degeneration process from progressing and strengthens the joints and muscles.

Rheumatoid Arthritis (Amavata) – It is a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet and ankles. It has an autoimmune component also.

SSPS will be useful in the chronic stages of RA (Jeerna or pravruddha Amavata) wherein the inflammation has subsided but pain has been left over. This will serve the purpose of rejuvenating and strengthening the joints, muscles and soft tissues. It can also be applied when RA has developed complications in the later stages. It will help in improvising the movements.

Musculo-skeletal pains as in myalgia and or fibromyalgia (Mamsagata Vata)

Low back pain or Lumbago (Lumbar spondylosis) and Sacroiliac Joint Syndrome or Sacroiliac Joint Dysfunction (Kati-shula / Kati-graha)

Cervical spondylosis – Neck pain due to damage of neck bones and joints or osteoarthritis of neck bones (Greeva-shula, Greeva-stambha)

Sciatica (Gridhrasi) – Pain affecting the back, hip and outer side of the leg caused by compression of a spinal nerve root in the lower back is called Sciatica. It happens due to the effect of degeneration of intervertebral disc or discs causing compression on the Sciatic nerve.

Intervertebral disc protrusion or prolapsed (IVDP) – is impinging or compressing on the nerves supplying the lower limbs. It presents with pain, numbness, pain extending down the limbs, pain worsening at night, muscle weakness, tingling, aching or burning sensations in the neck, back, legs and arm etc depending on the site of prolapse.

Note: In Sciatica and IVDP, SSPS should be done with caution and should be done after the acute symptoms of nerve irritation and inflammation have been reduced after administration of suitable medications and treatments. This will help in strengthening the joints and muscles of the back.

Spondylolisthesis – is a forward displacement of a vertebra, especially a 5^th lumbar vertebra. Generally it occurs following a fracture. It presents with back stiffness, tight hamstrings, leaning forward posture, waddling gait and generalized lower back pain with intermittent shooting pain from buttocks to the posterior thigh and or lower leg via sciatic nerve.

Whiplash – neck pain caused when a person’s head moves backward and then suddenly forward with great force.  Whiplash presents with neck pain and stiffness, headaches, dizziness, blurred vision, ringing in ears etc.

Wry neck (Torticollis) – It is a painfully twisted and tilted neck. The top of the head in this condition generally tilts to one side and the chin tilts to the other side. Symptoms include, an inability to move your head normally, neck pain or stiffness, headache, having one shoulder higher than the other, swollen neck muscles, a tilting of your chin to one side.

Ankylosing Spondylitis – It is a form of arthritis which primarily affects the spine. It causes severe inflammation of the vertebrae that might eventually lead to chronic pain and disability. The disease will cause pain and stiffness in other parts of your body. Other large joints such as the shoulders, hips and knees can be involved as well.

Polymyalgia Rheumatica – It is an inflammatory disorder that causes pain and stiffness in various parts of the body. It commonly affects neck, shoulders, arms, thighs and hips.

Fibromyalgia – It is a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body

Guillain Barre Syndrome – It is a rare condition in which your immune system attacks your nerves leading to muscle weakness and even paralysis. There is a rapid onset of muscle weakness as a result of damage of the peripheral nervous system

Paralysis – It is the loss of muscle function in part of your body (one or more muscles). It can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor. It happens when something wrong happens with the way messages pass between your brain and muscles. It can be complete or partial, can occur on one or both sides of your body. (Hemiplegia – paralysis of one side, Diplegia – Paralysis affecting symmetrical parts of the body, Facial paralysis etc)

Hemiparesis – It is the weakness of the entire left or right side of the body.

Poliomyelitis – It is a highly contagious disease caused by a virus that attacks the nervous system. Children younger than 5 years are the victims. (The disease has been largely eradicated)

Paraplegia – It describes complete or incomplete paralysis affecting the legs and possible also the trunk, but not the arms. It is usually caused by spinal cord injury or a congenital condition such as spina-bifida that affects the neural elements of the spinal canal.

Spinal stenosis – It is a condition in which the spinal column (backbone or spine) narrows and starts compressing the spinal cord. It is a gradual process. The symptoms include leg or arm weakness, lower back pain while standing or walking, numbness in legs or buttocks and balance problems.

Spina bifida (occulta) – It is a birth defect where there is an incomplete closing of the backbone and membranes around the spinal cord. It presents with leg weakness and paralysis, club foot, hip dislocation, bladder and bowel control problems etc
Coccydynia – Tail bone pain

Frozen Shoulder – Chronic pain and stiffness of the shoulder joint with limitation of range of movements, also known as adhesive capsulitis

Iliotibial band syndrome – The ilio-tibial band is a band of rough tissue that runs from your hip down to the outer part of your knee. If it is irritated by overuse or other problems, it becomes inflamed and cause pain on the outer side of the knee.

Patello-femoral pain syndrome (Chondromalacia patellae) – This often results from issues associated with muscle imbalance, tightness and alignment of the legs, rather than an injury. Pain is present between the patella and the underlying thighbone (femur).

Other conditions:

• Old (chronic) joint injuries which was not properly treated, 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
• Pain due to repeated trauma of bones, joints, muscles, soft tissues
• Elbow pain due to various conditions like Tendinitis, Olecranon bursitis, elbow sprain, cellulitis, arthritis, nerve entrapment etc
• Neuromuscular diseases and various musculoskeletal disorders
• Emaciation / Wasting diseases (Karshya, Shosha)
• Breathing disorders (Shwasa)
• Diseases caused by contamination / morbidity of blood (Rakta Prakopaja Roga)

Procedure

Navarakizhi procedure:

There are three stages – Pre-treatment, treatment and post treatment stage. 

Purvakarma

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 Shashtika Shali 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:

• Shashtika Shali – A special type of rice harvested in 60 days
• Milk
• Balamula – Roots of Sida Cordifolia
• Water
• Big vessels – to prepare Kashayam and to cook rice in processed milk
• Sterile clothes to tie the boluses
• Thicker threads to tie the cloth into bolus after placing leaves in it
• Spoons
• Stove for heating
• 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. Some effective oils used for Abhyanga are

For Shiro-Abhyanga (Head Massage): Ksheerabala Taila, Chandanabala Lakshadi Tailam, Shatavari Tailam, Lakshadi Tailam etc

For Sharira Abhyanga (body massage): Sahacharadi Taila, Ksheerabala Taila, Chandanabala Lakshadi Tailam, Dhanwantara Tailam, Mahanarayana Tailam, Balashwagandhadi Tailam, Karpasastyadi Tailam, Panchaguna Tailam etc keep in view the body constitution, morbid doshas and nature of morbidity involved

• Amalaki churna (fine powder of Indian gooseberry)
• Bandage clothes
• Sterile clothes or sponges to sponge out after treatment

Preparation of the Medicine:
Bala mula (roots of Sida cordifolia) is taken in a quantity of 12 pala (576 grams)
The roots should be washed with sterile water thoroughly so as to remove the dirt, mud and dust from them
The roots should then be cut into small pieces
The roots should now be put in a vessel consisting of water in the quantity of 12 prastha (768 tola=9216 grams of water)
The contents are boiled until 3 prastha of liquid (192 tola=2304 grams) remains i.e. ¼ of the taken content should remain
The solid part is filtered out
The Bala kwatha (decoction of bala) is prepared now
The Kashaya is divided into 2 equal parts i.e. each part weighing 96 tola(1152 grams)
To one part of Kashayam, equal portion of milk is added (96tola kashayam + 96 tola milk = 192 tola=2304 grams)
In this mixture of Kashayam and milk, Shashtika Shali (Shashtika rice) is added in a quantity of ½ prastha (32 tola=384grams) and cooked thoroughly

Once the rice is cooked properly, it is grinded into soft mass
8 pieces of sterile clothes cut into dimensions of 18×18 inches each are spread over a table

The cooked rice is divided into 8 equal portions. Each portion is put on once cloth piece each. The clothes are tied into boluses, tightly bound at their upper free ends with thick and strong threads such that the four ends of the cloth are bound with an elevation so as to form hand grips. These hand grips help us to hold the boluses while using them for treatment.

The other half of the Kashaya which had been kept apart is added with equal quantity of milk and kept on mild flame of the stove. The above said 8 boluses consisting of Shashtika Shali are dipped in the hot processed milk

Abhyangam (oil massage):
The patient is made to sleep on the table made and meant for conducting massage. Holy hymns are recited and the almighty is worshiped for the welfare of the patient and success of the treatment in terms of providing good relief to him or her. Massage is an essential part of Shashtika Shali Pinda Sweda. First of all a head massage is given with one of the above said oils. Later a full body massage is given with one of the above mentioned oils. Overall the massage is done for 30-40 minutes.

Amalaki Tala-dharana:
A small pre-treatment procedure called Amalaki Tala-dharana is done compulsorily after massage.
On the previous day of Pinda Sweda, Amalaki Churna (powder of Emblica officinalis) 10 tola (120 grams) in quantity is boiled and processed in 20 tola (240 grams) of buttermilk. When being processed it gains semisolid consistency, the contents are grinded and made into a soft mass. It is kept in a cool place for cooling.

This paste is used for Tala Dharana. Tala Dharana means applying the paste on the crown of the head and tie a bandage cloth around it to keep it in position such that the knot occupies the place near the ear.

To do this, a small compartment / cabin with elevated walls is constructed with the paste of Amalaki so as to cover a small area on the crown of the scalp. The space within the wall of the cabin is filled with coolant oils like Chandanabala Lakshadi Tailam etc. Over this, leaf of a plant having a capacity of alleviating Vata like leaf of Nirgundi (Vitex negundo), Eranda Patra (castor leaf) etc is placed. A bandage cloth is wrapped around the construction and the knot is tied near the ear.

Shashtika Shali Pinda Sweda is a procedure which includes application of heat to the body of the patient for more than 1 hour. The head might affect the brain and sense organs in due process. To protect these organs, Amalaki Tala Dharana is done. This provides a coolant effect on the body and mind of the patient.

If Tala-dharana is not done, pitta gets aggravated due to heat and the aggravated Pitta causes symptoms like giddiness, burning sensation, feeling of darkness in front of the eyes, fainting etc.

When doing Shashtika Shali Pinda Sweda for a part of the body like low back or lower limb or upper limb or shoulder, we need not tie the Tala-dharana since the heat will be provided for a portion of the body and for a short time.

Pradhana Karma

Pradhana Karma (Actual Njavarakizhi massage therapy procedure):

We need at least 4 attendants or masseurs to carry on the treatment in a synchronized and uninterrupted way on either side of the patient. The rubbing or stroking of the Pinda or boluses on both sides of the body (left and right) should be done in a rhythmic way by all the 4 masseurs. They should be trained in such a way that they should be able to efficiently carry out the treatment procedure. 2 masseurs should stand on one side of the patient and the other 2 on other side. We need a 5^th person as helper (can have 2 helpers too) who should be standing near the stove on which the vessel consisting of medicated milk along with the dipped Pinda’s (boluses) is kept for constant heating on a mild flame. They will be supplying the boluses dipped in the heated medicated milk to the masseurs. As and when the boluses lose temperature, the masseurs return them to the helpers and in turn receive the other boluses kept in the heated milk. This method is conducted for the prescribed duration without interruption. Care should be taken that neither the bolus nor the body of the patient gets cold at any point of the treatment. This is possible only with a cyclic synchronizing between the main masseurs and the helpers in terms of how they keep changing and exchanging the boluses so as to maintain the heat throughout the treatment procedure. The masseurs should not only be skilled but also should be compassionate towards the patient.

Two masseurs should take in charge of rubbing and stroking the boluses against the body of the patient in a gentle way and cover the lower portion of the body i.e. one masseur should attend the hip, buttock, anterior and posterior portions of thigh, leg, knee, ankle and lumbo-sacral area on the right side and the other masseur on the left side.

The other 2 masseurs should carry on the procedure simultaneously on the upper portion of the body. One among them should cover the abdomen, chest, sides of the chest, flanks, upper back, neck (nape), shoulder, elbow, wrist and small joints of the hands, arm and forearm of the right side and the other masseur should cover the left side of the body.

The treatment should be carried out in a skilful and synchronized way on both left and right sides of upper and lower portions of the body by all the 4 masseurs in an uninterrupted way.

The rice boluses are dipped in hot milk; temperature of the boluses 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 milk dripping from the boluses. If not, the excessive milk dripping from the boluses will spill all around and create inconvenience to the treatment procedure. The hot milk can also fall on the patient’s body and cause burns.

The bolus is rubbed on the affected part gently (as good as massaging with bolus). The strokes are given from above downwards from nape of the neck to the lower back and the masseurs attending the lower portion of the body will give a descending stroke by rubbing the boluses from hip downwards towards the feet. The strokes are done in a circular and clockwise fashion while covering joints of the body. Similar method is followed while conducting the treatment on the upper limbs. While rubbing the part with the bolus in right hand, the masseur can move his left hand over the body part following the direction of the bolus and give a soothing stroke. Circular strokes can be given over the joints and vertical strokes from above downwards on the back and limbs.

When the boluses lose their temperature (as felt by touching the bolus with the hand) the masseurs should immediately hand them over to the helper and receive the heated boluses and continue the procedure. For changing purposes, 4 boluses shall be kept in the heated medicine and the other 4 shall be used by masseurs (1 bolus by each masseur). The bolus is repeatedly interchanged with the backup bolus throughout the treatment duration. The key is to maintain the temperature of the bolus.

The fomentation given by Shashtika Shali Pinda Sweda method should reach all parts of the body. To achieve this, the procedure should be carried out in all the 7 postures in which Abhyanga (herbal oil massage) is done.

The 7 postures of doing Shashtika Shali Pinda Sweda are, patient in –

• Sitting posture
• Sleeping by facing the roof (supine position)
• Sleeping in left lateral position (towards left)
• Sleeping on tummy (prone position or face downwards)
• Sleeping in right lateral position (towards right)
• Sleeping back by facing the roof
• Sitting posture

The treatment procedure is carried out for 10-15 minutes in each posture. Thus the time duration of the treatment ranges from 70-105 minutes. By the time we finish off this procedure, the patient would be sweating, which gives a sign to stop the treatment. At the same time, the medicine (processed milk) kept on the stove too would have been exhausted.

Signs of good Navarakizhi process: (Samyak Swinna or Samyak Swedana Lakshanas) –

शीत शूल व्यूपरमे स्तंभ गौरव निग्रहे।
संजाते मार्दवे च एव स्वेदनात् विरतिर्मता॥(सु.चि.१४/१३)
स्वेद स्रावो व्याधि हानिः लघुत्वं शीतार्थित्वं मार्दवः च आतुरस्य।
सम्यक् स्विन्ने लक्षणं प्राहुः एतान् मिथ्या स्विन्ने व्यत्यनेने एतदेव॥(सु.चि.३२/२३)

Sheeta shula vyuparame stambha gaurava nigrahe
Sanjaate maardave cha eva svedanaat viratirmataa (Ref – Sushruta Chikitsa 14/23)
Sveda sraavo vyaadhi haanihi laghutvam sheetaarthitvam maardavaha cha aaturasya
Samyak svinnae lakshanam praahuhu etaan mithyaa svinne vyatyyane etadeva (Ref – Sushruta Chikitsa 32/23)

Properly done sweating therapy brings about the below said signs –

• Sheetoparama – The feeling of coldness pacifies
• Shuloparama – Pacification of pain
• Stambha nigraha – reduction of stiffness
• Gaurava nigraha – reduction of the feeling of heaviness
• Maardava – smoothness of the body or body parts
• Sweda praadurbhaava – sweating of body or body parts subjected to fomentation
• Roga lakshana prashamanam – Pacification or reduction of the symptoms of the disease
• Sheetaartitvam – Liking towards taking cold foods and comforts

Care should also be taken so as to see that the patient is not subjected to excessive or deficit sweating

Parameters for improper / less sweating (Asamyak / Heena Swinna / Aswinna Lakshana) – In this the symptoms opposite to those explained in the Ati Swinna Lakshana are manifested i.e.

• Sheeto anuparama – no relief from the feeling of cold
• Shula anuparamam – non-pacification of pain
• Stambha anigraha – no relief from stiffness
• Gaurava anigraha – no relief from heaviness
• Amaardavam – lack of smoothness of the part
• Aswedam – absence of manifestation of sweat
• Alaghutvam – no feeling of lightness
• Vyadhi anupashama – no relief from disease

Parameters of excessive / over sweating (Ati Swinna Lakshana) –

• Pitta prakopa – aggravation of pitta
• Asra prakopa – aggravation of rakta
• Trushna – thirst
• Murcha – loss of consciousness
• Svara sadana – weakness of voice
• Anga sadana – weakness of the body
• Bhrama – giddiness
• Sandhi peeda – joint pains
• Jwara – fever
• Shyava-rakta mandala – brownish-red eruptions
• Chardi – vomiting

Paschat Karma

Paschat Karma (Post-treatment procedures):

• After the procedure, the boluses are opened. The rice in the boluses is rubbed gently over the body of the patient for 10-15 minutes. After this, the rice is wiped out with the help of tissue or sterile cloth. Traditionally the leaves of coconut tree or castor plant can also be used to wipe off the remnants on the patient’s body.
• The Tala-dharana is slowly removed; the construction of Amalaki and the containing oil are also removed. The head should be wiped off with a sterile cloth.
• Sponging should be given with a sponge or sterile cloth dipped in hot water so as to remove the oil from the body and head. This is followed by hot water shower.
• Alternatively, a light massage is once again given after the procedure followed by hot water shower. 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 etc can be administered if a small amount of detoxification is essential on a daily basis or if morbid Dosha’s need to be tackled (optional and strictly based on the decision of the doctor)
• 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 7-21 days depending on the nature and intensity of the disease

Benefits of Navara kizhi Shashtika Shali Pinda Sweda –

• Provides strength to the tissues, mainly muscle tissue
• Rejuvenates and energizes the body
• Prevents wasting of muscles and degeneration of joints and soft tissues
• Relieves pain, stiffness and swelling associated with arthritis and other painful conditions mentioned above
• Pacifies the morbidity of Vata, Pitta and Rakta in the skin, 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
• When combined with Nitya Virechana, Shashtika Shali Pinda Sweda eliminates the body toxins, establishes health and tones up the joints and soft tissues
• Improves the movements of the joints and enhances flexibility of the body
• Soothes the nerves and improves blood circulation
• Removes stress, relaxes mind
• Improves circulation to skin, improves colour and complexion

Diet to follow:

During the therapy,
Avoid: Restaurant foods, excess oily and fatty foods, high spices, smoking, chips, junk foods and alcohol.
Have more of dry fruits, raisins, avocado, pista, almond, spinach, broccoli, rice and green gram kichdi, rice ganji, green gram soup, etc.

Contraindications

Contra-indications of Shashtika Shali Pinda Sweda –

• Diabetes mellitus (can be done for a short period with caution, giving proper medicines to treat diabetes or in controlled and uncomplicated diabetes to enhance strength and immunity)
• High blood pressure (Hypertension) – SSPS can be done for local problems in joints and soft tissues, but under supervision
• Severe varicosity of veins
• Deep vein thrombosis
• Fractures
• Fever
• Severe inflammation

Shashtika Shali Pinda Sweda can be done with caution and under supervision in Diabetes and Hypertension if doing it is mandatory and no other better options are available or if the condition demands the treatment to be done. Care should be taken to see that there is no excessive sweating and resulting dehydration.

Limitations of Shashtika Sweda –
Shashtika Sweda is one of the best Ayurvedic treatments which is used in providing relief from pain and associated conditions related with Osteoarthritis, Rheumatoid arthritis, Low back pain, Sciatica etc conditions. It provides good strength and energy. It relieves stress and provides good immunity. It is also highly nutritious. 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 drugs and or compounds and effective treatments for better relief. Along with this some oral medications which enhance strength and stability should be included along with some immune-modulators, anti-ageing medicines and rejuvenators.

Ayurvedic medicines During Therapy

Parallel Medications to expel morbid Doshas, strengthen and rejuvenate the joints and soft tissues (Diseases modifying medications) –

Many medicines prescribed below are given

Kashaya’s (Herbal decoctions):

• Maharasnadi Kashayam
• Punarnavadi Kashayam
• Guggulutiktakam Kashayam
• Sahacharadi Kashayam
• Sahacharabaladi Kashayam
• Kokilaksham Kashayam
• Guluchyadi Kashayam
• Gandharvahastadi Kashayam
• Drakshadi Kashayam
• Mahamanjishtadi Kashayam

Asava / Arishtam (herbal fermented liquids):

• Ashwagandharishtam
• Balarishtam
• Dashamuraishtam
• Punarnavasavam
• Devadarvarishtam etc

Lehas and Rasayana’s (rejuvenators, herbal confections, anti-ageing medicines, immune-modulators) –

• Ashwagandha Rasayanam
• Amalaki Rasayanam
• Ajashwagandhadi Rasayanam / Leham
• Kushmandam Rasayanam
• Chyavanaprasham
• Brahma Rasayanam
• Giloy Satwa etc

Ghritam and Tailam (medicated ghee and oils):

• Guggulutiktakam Ghritam
• Varanadi Ghritam
• Rasnadi Ghritam
• Dhanwantaram Ghritam
• Shatavari Ghritam
• Shunti Ghritam
• Ksheerabala tailam 101
• Dhanwantaram tailam 101
• Maharajaprasarini Tailam

Vati and Gulika (Tablets):

• Kanchanara Guggulu
• Kaishora Guggulu
• Yogaraja Guggulu
• Trayodashanga Guggulu
• Mahavata vidhwamsini Ras
• Vatagajankusha Ras
• Shallaki etc

Just before finish,
Shashtika Shali Pinda Sweda is the best treatment which Ayurveda provides for enhancing strength, immunity and nutrition to the tissues, to prevent degeneration and inflammation, to tackle pain, swelling and catches related to Arthritis, Neuromuscular and Musculoskeletal disorders. All you need to do is to meet an experienced Ayurvedic doctor and put forth your problems. The doctor will help you to get fit and healthy. A proper diagnosis should be made before the treatment is planned. The best way of taking the treatment is to have it done under the supervision of the doctor.
Click to Consult Dr Raghuram Y.S. MD (Ayu)

For Ligament Tear

Shashtika Shali Pinda Sweda is very good to re-build the tissues, muscles, ligaments and tendons. Hence, after an injury leading to partial tear of ACL in the knee joint (anterior cruciate ligament).
After an injury, first the care is taken to reduce the swelling. Once after the swelling and inflammation are reduced, Shashtika Shali Pinda Sweda is done to heal the ligament tear and to strengthen the joints.
But in case of complete ACL ligament tear, then it is not possible to heal it with Sastika Sali Pinda Sweda.