Sarvangadhara Ayurvedic treatment: Benefits, Procedure

Article by Dr Raghuram Y.S. MD (Ay)
Sarvangadhara or Parisheka treatment is a priceless gift of Ayurveda towards a comprehensive psycho-somatic healing. The beauty of the treatment is that it can be taken by both categories of people – the healthy and the ailing. It is not only a time-tested effective remedy for many physical ailments, but also the best in the business of relieving the mind related stress.

Body and mind are the sides of the same coin. If one is healthy, the other too is healthy but if one is disturbed, it has its bad impact on the other too. Both have to function in a synchronized way so as to contribute to our psycho-somatic wellness. Ayurveda and the treatment modalities in the system have always preached a holistic approach towards the body-mind component giving equal importance to both.

Sarvanga Dhara or Kayaseka falls into the category of Swedana (fomentation, sweat inducing, sudation) type of treatment. To be precise, it falls into the Parisheka Sweda (stream pouring of medicated liquids like oil, ghee, milk, kashayam, buttermilk etc) sub-category of Swedana Chikitsa.

Before knowing what Sarvanga Dhara is, we shall try to have a brief introduction of Swedana and Parisheka Sweda for a better understanding.

Swedana

Swedana (sweating therapy) – introduction

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 and many types of neuromuscular and musculoskeletal diseases etc.

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 – Ruksha 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 Ruksha 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 Parisheka Sweda (warm medicated liquids stream pouring type of fomentation) with special reference to Sarvanga Dhara.

Parisheka Sweda is a Sagni Sweda and drava sweda (sweating or steaming treatments wherein hot or warm medicated liquids are used)

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.

Parisheka Sweda

Parisheka Sweda – Definition, introduction

Vaatikottara vaatikaanaam punaha moolaadeenaam utkwaathaihi sukha ushnaihi kumbhau varshulikaaha pranaadihi vaa poorayitvaa yathaarha siddham sneha abhyaktam gaatram vastra avachchannam parishechayet iti parishekaha (Ref Dharakalpa 1)

Stream pouring or sprinkling or showering of warm kwatha (decoction or herbal extract) prepared with herbs which destroy or pacify Vata or Vata-Kapha morbidity over the body is called Parisheka. Since it is a type of Swedana or sweat inducing treatment the word Sweda has been added as a suffix to Parisheka. Thus Parisheka Sweda means stream pouring of hot medicinal liquids over the body so as to produce sweating.

Other names for Parisheka – Dhara, Seka, Kayaseka, Pizhichil (Sarvanga Taila Dhara – stream pouring of medicated oil)

Parisheka, like any other form of Sweda is done to a person who has undergone Abhyanga (herbal oil massage). Thus Abhyanga forms an essential Purva-karma (pre-treatment procedure) for Parisheka.

Parisheka is done in 3 different ways (depending on the equipment used for conducting Parisheka):

Kumbha Parisheka – In this the medicaments (Kwatha) is filled in a small earthen pot or metal pot with a small tube fitted to it with its one end opening into the space of the pot and the other end at the rear end of the tube. The tube has a u bend at the centre so that the liquid does not rush out of the pot once for all. The vessel is filled with liquid. The masseur tilts the pot to an adjusted angle such that the liquid falls on the body of the person subjected with Abhyanga through the tube is a small stream. The liquid is poured all over the body.

Alternatively, the pot itself has an orifice at the end into which cotton wick or wick of a sterile cloth is fit. In this set up the pot doesn’t consist of the lateral tube. The medicine dribbles through the wick and falls in stream over the body of the patient.

Another variant is a small vessel or pot with a tapering orifice. The liquid is poured in streams through this narrow tapering passage.

Varshulika Parisheka – Varshulika is a pot which is also called sahsradhara which means 1000 orifices. As the name indicates, the bottom of the pot has many small holes. When the vessel is filled with the liquid, it falls as a stream of shower over the body of the patient who has been given a massage.

Pranadika Parisheka – Pranadika means a tube. It is a modification of Varshulika. Just as in Kumbha Parisheka, the pot or vessel will have a bent tube fit to one of its lateral walls. At the end of the tube a cap with many holes is fit. Just as in Varshulika, the liquid falls as a stream of shower over the body of the person after he has taken a massage.

The medicated liquid filled in the vessel or pot may be Kashaya (decoction), Ksheera (milk), Dhanyamla (fermented liquid), Ghrita (ghee), Taila (oil) etc. all these are called Dhara or Parisheka. The names will follow the material or liquid used. Ex. When milk is used, the treatment will be called as Ksheera Dhara, when oil is used it will be called Taila Dhara etc.

Sarvanga Dhara, types

What is Sarvanga dhara?

The term Sarvanga Dhara is made up of 2 words, Sarvanga meaning full body and Dhara meaning stream pouring or showering or sprinkling of medicated liquids.

Thus Sarvanga Dhara means stream pouring or showering of warm medicated liquids over the entire body. It is synonymous with Parisheka.

Types of Sarvang Dhar:

1. Depending on the part of the body covered in the treatment –
Sarvanga Dhara or Kaya Seka – This form of Parisheka is done so as to cover the entire body. When the liquid medicines are poured in streams over the entire body, it will be called as Sarvanga Dhara. This is generally done in combating systemic diseases caused due to the morbidity of Vata, Kapha or Vata-Kapha. It is also highly beneficial in treating diseases like Paralysis (Hemiplegia, paraplegia etc), many neuromuscular and musculoskeletal disorders.

Ekanga Dhara or Sthanika Dhara – This form of Parisheka is done so as to cover only particular portions or parts of the body.
Ex. Shirodhara – medicinal liquids are poured in streams over the head and is useful in diseases like insomnia, paralysis, stress, hypertension, psoriasis etc.

Sandhi-dhara – medicinal liquids poured in streams over the afflicted joints like Sthanika Dhanyamla dhara (showering of fermented liquids) in Rheumatoid arthritis of the knee or Sthanika Ksheera Dhara (showering of medicated milk) in Gout affecting the knee and ankle joints etc.

2. Depending on the material / liquid used in Dhara –
Sneha Dhara – In this medicated fats like oil and ghee are used for stream pouring. It is highly beneficial in tackling Vata disorders like neuromuscular and musculoskeletal disorders, diseases like osteoarthritis, myalgia, fibromyalgia, paralysis, GB Syndrome etc. Sneha-dhara is best in dealing degenerative conditions. Its sub-types are as below mentioned:
Taila dhara – medicated oils are used
Ghrita dhara – medicated ghee is used
Yamaka dhara – medicated oils and ghee are used together as a combination or the medicine itself is prepared having both ghee and oil as base substances
Kashaya Dhara – stream pouring of herbal decoctions or extracts. This is useful in diseases caused by morbid Vata and Kapha or Vata-Kapha. It also combats ama (cellular toxins caused due to sluggish metabolism tending to block the cellular functions and channels of the body). This is not used over the head
Dhanyamla Dhara or Kanji Dhara – medicated fermented liquids are used. This is mainly used in combating the presence of high ama and inflammatory conditions. Its use in Rheumatoid arthritis is unparalleled. This is not used over the head.
Ksheera Dhara – medicated milk is used in this type of treatment. Basically it is used for strengthening purposes and also to combat inflammation. It is highly beneficial in gout. It is used for both body and head.
Takra dhara – medicated buttermilk is used in this type of treatment. Basically it is used in stress related disorders, blood pressure, psoriasis etc. it is used for both body and head.
Read related: Takradhara: Procedure, Methodology, Indication and Benefits

Benefits

Benefits of Sarvanga Dhara –

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
Deha sthairyam – makes the body strong
Agni sthairyam – establishes the normalcy of digestive fire and corrects metabolism
Varna sthairyam – provides and establishes proper colour
Ojo sthairyam – stabilises and fortifies ojus in the body (ojus is the essence of all the tissues formed as an end product of tissue formation, its normalcy in terms of quality and quantity points towards an established immunity)
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
Paatavam indriyasya – relaxes and rejuvenates the mind and senses
Jaraso maandhyam – delays ageing
Chiram jeevitam – provides longevity of life
Nitaraam doshaan – controls and creates equilibrium in all the doshas
Vrishataa – acts as an aphrodisiac
Improves circulation to skin, improves colour and complexion
Helps in easy delivery of the child during labour (difficult labour)

Indications

In which conditions is Sarvanga dhara done? Indications
The uses of Sarvanga dhara can be enumerated as mentioned below:
Sarvanga Sneha dhara is used in the below said conditions –

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. This treatment helps 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. Sarvanga dhara will be useful in the chronic stages of RA (Jeerna or pravruddha Amavata) wherein the inflammation and the stage of ama 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) after getting rid of ama by suitable medications.

Neuromuscular diseases and various musculoskeletal disorders
Emaciation / Wasting diseases (Karshya, Shosha)
Vertebral or spine pain including
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

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

Sthanika sneha dhara is effective in –

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
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).
Old (chronic) joint injuries which was not properly treated, sprained ligaments, cartilage tears, sports injuries, sprains and strains
Elbow pain due to various conditions like Tendinitis, Olecranon bursitis, elbow sprain, cellulitis, arthritis, nerve entrapment etc
Low back pain or Lumbago (Lumbar spondylosis)
Sacroiliac Joint Syndrome or Sacroiliac Joint Dysfunction (Kati-shula / Kati-graha),
Cervical spondylosis (Greeva-shula, Greeva-stambha),
Sciatica (Gridhrasi),
Intervertebral disc protrusion or prolapsed,
Spondylolisthesis (is a forward displacement of a vertebra, especially a 5^th lumbar vertebra)
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Benefits of specific types of Sarvangadharam:

Dhaatoonaam drudhataam karoti vrishataaM deha agni varna ojasaam
Sthairyam paatavam indriyasya jaraso maandhyam chiram jeevitam
Asthnaam bhagnam apakaroti nitaraam doshaan sameeraadikaan
Sarva snehakrutaa sukhoshna subhagaa sarvaanga dhaaraa nrunaam
(Ref-Dhaaraakalpa-2)

Dhaatu drudhata – strengthens and fortifies the tissues
Vrishataa – acts as an aphrodisiac
Deha sthairyam – makes the body strong
Agni sthairyam – establishes the normalcy of digestive fire and corrects metabolism
Varna sthairyam – provides and establishes proper colour
Ojo sthairyam – stabilises and fortifies ojus in the body (ojus is the essence of all the tissues formed as an end product of tissue formation, its normalcy in terms of quality and quantity points towards an established immunity)
Paatavam indriyasya – relaxes and rejuvenates the mind and senses
Jaraso maandhyam – delays ageing
Chiram jeevitam – provides longevity of life
Asthnaam bhagnam apakaroti – heals fractures and dislocations
Nitaraam doshaan – controls and creates equilibrium in all the doshas

Sarvanga Kashaya Dhara is used in pacifying and destroying –

Vata vitiation and Diseases caused due to excess morbidity of Vata
Kapha vitiation and Diseases caused due to excess morbidity of Kapha
Vata-Kapha vitiation and Diseases caused due to excess morbidity of Vata-Kapha
Ama dosha and Diseases caused due to excess formation and stagnation of Ama
Medo-roga and Diseases caused due to excess morbidity of Meda

Sarvanga Dhanyamla Dhara is used in the below said conditions –

Excess ama in the body
Sama-vata – When ama is associated with vayu and is causing painful conditions
Amavata – Rheumatoid arthritis
Agnimandhya – low metabolism
Painful conditions like myalgia, fibromyalgia etc

Sarvanga Ksheera Dhara is used in the below said conditions –

Inflammatory diseases
Gout
High pitta conditions and diseases caused due to vitiation of pitta
Rakta (blood) morbidity and diseases caused due to morbid rakta
Debility and loss of strength etc

Sarvanga Takra dhara is used in the below said conditions –

Psoriasis
Hypertension
Stress related diseases
Raised heat and burning sensation
Vata-pitta diseases etc

Conditions in which Ekanga Parisheka can be done (local stream pouring) –

Gulma – abdominal tumours
Anaha – flatulence
Bhagandara – fistula
Vrana – wounds and ulcers
Shula – colic
Abhighata – trauma, injury
Toda – pricking pain
Kotha – skin eruptions
Ashtila – prostate enlargement
Visarpa – herpes
Pliha – splenomegaly
Vidradhi – abscess

Procedure

How is Sarvanga dhara done?

Sarvangadhara is done in the below said method –

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 Sarvanga Dhara 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:
For Sneha dhara (Kaya seka, Pizichil) – medicated oils and ghee are collected. Sneha dhara can be done just by using gingely oil / sesame oil or ghee of cow. The below mentioned taila’s / ghrita’s are used in Sneha dhara or Kaya seka –

Tila tailam – sesame oil
Go ghrita – cow’s ghee
Vasa – muscle fat
Ksheerabala Tailam
Dhanwantaram Tailam
Sahacharadi Tailam
Mahanarayana Tailam
Balashwagandhadi Tailam
Karpasasthyadi Tailam etc

Since Tala-dharana should be done during Pizhichil or Sneha-dhara (Sarvanga dhara) – the materials required for it also should be kept ready – Amalaki churna (fine powder of Indian gooseberry), Bandage clothes, Chandanabala lakshadi tailam, Ksheerabala tailam etc

While doing Kaya Seka (Sarvanga dhara), Shiro dhara (stream pouring of medicated oils over the head) also can be carried out simultaneously as per the preference of the doctor.

For Kashaya Dhara – Coarse powder or chopped parts of roots, dry leaves, stem, bark etc of medicinal plants are collected and stored beforehand. Different Kashaya Churna’s (powders) suitable for different diseases and dosha morbidity are stored in different containers.

The oils which will be mentioned below for usage in Abhyanga (massage) can be used for massage.

For Dhanyamla dhara – the medicated fermented liquid should be kept ready. The liquid cannot be prepared overnight. Dhanyamla need to be prepared well in advance because fermentation process of the medicinal herbs takes time. Dhanyamla is prepared by processing medicinal herbs, some grains and pulses and is kept in closed containers and left for fermentation to take place. Dhanyamla is generally kept ready in Ayurvedic pharmacies so that it is always available. It is heated in big vessels at least once or twice a week so that it doesn’t decay.

The oils which will be mentioned below for usage in Abhyanga (massage) can be used for massage.

For Ksheera Dhara – Milk, roots of Dashamula (10herbs), Yashtimadhu (Liquorice), Laksha (Lac) etc are kept ready. The milk is processed with medicinal herbs and used for dhara.
The oils which will be mentioned below for usage in Abhyanga (massage) can be used for massage.

For Takra Dhara – Buttermilk, Amla powder (powder of Indian gooseberry) Musta churna (powder of Cyperus rotundus) should be kept ready for preparing medicated buttermilk

While doing Kaya Seka (Sarvanga dhara), Shiro dhara (stream pouring of medicated buttermilk over the head) also can be carried out simultaneously as per the preference of the doctor.
The oils which will be mentioned below for usage in Abhyanga (massage) can be used for massage.

The other materials needed for Sarvangadhara –
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

Water
Big vessels – to prepare Kashayam, medicated milk, buttermilk and Dhanyamla
Small vessels for heating oil and other liquids
Spoons
Stove for heating
Sterile clothes, sponges, napkins or tissue papers for wiping etc

Pradhana Karma

Pradhana Karma – Treatment proper (Sarvangadhara procedure):
Sarvangadhara is generally done as Swedana procedure (sweat inducing treatment) and is thus a part of Parisheka Sweda as we have already discussed in the earlier passages. In this the heated liquids need to be continuously poured over the body for a fixed duration of time until sweating occurs and the patient starts feeling light and good.

The patient fit for and chosen for Sarvanga Dhara or Parisheka sweda is made to sit in the Droni, a special type of table made in the shape of a boat, with elevated edges all around.

Dhara droni

Dhara Droni or Dhara Table –
The table is made up of woods of medicinal plants like Plaksha (Ficus lacor), Udumbara (Ficus glomerata), Chandana (sandal wood), Varuna (Crataeva nurvala), Devadaru (Cedrus deodara), Ashoka (Saraca asoka), Amra (mango), Nimba (neem), Bilwa (Aegle marmelos), Arjuna (Terminalia arjuna), Khadira (Acasia catechu), Agnimantha (Clerodendrum phlomidis) etc. its dimensions are that which can accommodate the body of an average individual.

The foot end of the table consists of an orifice or a tapered opening through which the liquid poured over the patient’s body flows down into a collection vessel. This collected liquid can be reheated and reused for the Dhara until the completion of treatment duration.

Similarly at the head end, there is an elevation for headrest which forms a bridge between an elongated portions of the table meant to accommodate the rest of the body from a small chamber (portion of table) which is extended behind the head end. The medicines poured on the head as a part of Shirodhara collects in this chamber and flows back into an orifice or tapered opening at its centre a few inches away from the crown of the head and gets collected in another collection pot. This too can be recycled and reused just like the liquid of Sarvangadhara is done.

Dhara droni is generally mounted on a frame consisting of 4 limbs of convenient height so that the masseurs can easily carry out the treatment procedure on the patient sleeping on it. Alternatively, the Droni can be kept on the floor on a small raised platform so that the vessels can be kept below the openings at the foot and head ends of the table. The masseurs in this case can sit around the table (instead of standing) and conduct the treatment.

Dhara patra

Dhara patra (Dhara pot or vessel) –
The dhara pot too is made up of the similar material as is the table. It is also made up of metals like silver, brass or earthen pot. A small hole which entertains the finger of the patient into it is made at the bottom. It is fit with a sterile cotton or cloth wick in case of Shiro-dhara pot. The Shirodhara pot is fit to an adjustable stand such that it is hung a few inches above the centre of the forehead.

Swasthi vachana, Abhyanga

Swasthi Vachana (welfare prayers) –
The patient should be brought on to the table after having performed the prayers, worship and recited holy hymns as a ritualistic practise. This is done for the welfare of the patient and for the success of the treatment.

The patient should have undressed to their convenience for better results. Alternatively they may be allowed to wear a thin dress (after having conducted massage)

Abhyangam (herbal oil massage) –
Head and body massage is given with one among the above said oils for 15-20 minutes. Any other suitable oil can be used as per the choice of the physician. Abhyanga can be considered as Purvakarma (pre-treatment procedure) for Sarvangadhara but I have included it in the discussion of the treatment proper because it is done in continuation with dhara (immediately before dhara).

For massage – oils prepared with herbs having hot potency should be used for the body and oils prepared with herbs having cold potency are used for head.

Oils can also be used as per the disease and morbidity of doshas. Ex. Sahacharadi Tailam in kapha morbidity, Ksheerabala Tailam and Chandanabala Lakshadi Tailam in pitta morbidity and Dhanwantaram Tailam or Mahanarayana Tailam in Vata morbidity etc.

Tala dharana

Tala-dharana (application and tying of coolant medicines over the head) –
A small pre-treatment procedure called Amalaki Tala-dharana is done mandatorily after massage.

On the previous day of Parisheka 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.

Sarvanga dhara (Kaya seka, Parisheka) is a procedure which includes pouring of hot medicinal liquids over 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 Sarvanga Dhara 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.

Alternately a sterile cloth (thin) is tied over the head while doing Shiro-dhara to avoid spilling of the liquid contents into the eyes. As a precaution during Sarvanga dhara or Shiro dhara, sterile cotton pads are kept over the closed eyes of the patient to avoid sprinkling of medicaments into the eye.

The 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 stream pouring of liquid medicines over the body of the patient 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). He should be standing near the stove, on which the vessel consisting of liquid medicines is being heated on mild flame. He will be constantly supplying heated liquid medicines to the masseurs.

As and when the liquid collected in the vessels at the foot and head end of the table lose temperature, the masseurs return it to the helpers and in turn receive the heated liquid medicine from him. 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 (The only exception being Sarvanga dhara done with cold liquids in case of Pitta and Rakta morbidity). 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 liquid 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 stream pouring the herbal liquids over 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 skillful 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 masseurs should have small Dhara pots in their hands (1 pot in each masseur’s hands). The liquids filled in it should be allowed gently and in a synchronized way on the patient’s body in the form of stream.

The stream should neither be too thick nor too thin, not falling in a rush or too slowly, neither too hot not too cold. It should neither fall from a lot of height from the patient’s body nor from too proximal distance. The procedure should be done so gently that it should not create a fear in the mind of the patient.

Alternately, Sarvanga dhara should be done with the help of sterile cloths of 18×18 inches dimension dipped in the dhara liquids. The masseur should take the cloth in his hand and squeeze in such a way the liquid should fall on the body of the patient in a stream flowing through his thumb which is pointing towards the body of the patient. While the masseur uses his right hand to squeeze the cloth and allow the stream to fall on the body of the patient, he should simultaneously stroke the body part on which the liquid is falling and give a light massage through his left hand.

In Sarvanga dhara the medicine should fall on the body of the patient from a height of 12 angula’s (i.e. approximately 9 inches). The temperature of the liquid medicine should be only so much that it is tolerable to the patient. The masseur’s should therefore check the temperature of the liquid every time before pouring it on the patient’s body. If the drava (dhara liquid) is too hot, it may cause burns and if it is not hot, the objective of Swedana is not achieved and there is no relief from the disease. Experienced masseurs will be able to do it to the perfection. Before doing the Dhara, the masseurs should allow the stream of liquid to fall on their left hand and test the temperature and conduct the Dhara after confirming that the patient can tolerate that temperature. The patient also should be asked if he or she can tolerate that particular temperature. Their consent forms a yardstick so as to what temperature they can tolerate. This comes only by experience.

Dhara liquids

As we have already discussed that the liquid used in the Sarvangadhara can be of many types like Kashayam, Tailam etc. Each liquid form will have its own importance and will be applicable to only those situations, diseases and morbidity wherein they have been prescribed. The qualified and experienced Ayurveda doctor will take a call so as to which liquid should be done and which type of dhara shall be carried out for a given patient.

The liquid and their subtypes (varieties) will vary depending on the disease and morbidity. Example – Dhanyamla dhara shall be done as a first choice in Rheumatoid arthritis whereas Taila dhara would be a preferred option in Paralysis and neuromuscular diseases.

Even when doing Taila dhara, Sahacharadi Tailam is preferably used in kapha morbidity, Ksheerabala Tailam and Chandanabala Lakshadi Tailam in pitta morbidity and Dhanwantaram Tailam or Mahanarayana Tailam in Vata morbidity etc.

Doctors can do the permutations and combinations of choice of medicine and their subtypes based on their wisdom and experience.

Sarvanga Tailadhara can also be done in healthy individuals. For them oil and ghee should be mixed in equal proportions for conducting dhara. In predominance of Vata, Kapha or Vata-Kapha morbidity or diseases caused due to them, warm or hot oil should be used. In case of Pitta predominance or Pitta disorders, cold oils should be used.

In Pitta disorders, warm oil or ghee can be used for dhara or parisheka. Oil, ghee and or muscle fat (vasa) shall be used in predominance of Vata, In morbidity wherein vitiated pitta and rakta (blood) are associated ghee shall be used for stream pouring, Tila taila (sesame oil) should be used in Kapha disorders, In disorders caused by vitiated Vata, Pitta and Rakta – oil and ghee should be mixed in equal proportions to conduct dhara and in Kapha association oil and ghee should be taken in 1:1/2 proportions.

The liquid poured in stream over the body of the patient (or on head as in Shirodhara) flows through the tapered opening at the foot end of the table and gets collected in a vessel kept beneath it after flowing through a pipe connected to the opening. In some tables, the tapered end bends towards and extends downwards, opening into the collecting vessel. The helper (5^th person) collects the oil in the vessel, heats it and gives it back to the masseurs for conducting dhara. This procedure is done until the duration meant to conduct dhara gets completed. Care should be taken to see that the oil or liquid used in dhara should not get cooled throughout the length of the treatment. Maintenance of uniform temperature of the liquid is important in Sarvangadhara. The helpers should be sharp and quick enough to heat the liquid and give it back to the masseurs conducting Sarvangadhara.

Change of medicine

Ksheeradhara – The milk should be changed every day while conducting Ksheeradhara. This means to tell that the medicine should be prepared fresh on a daily basis.

Dhanyamla dhara – The Dhanyamla liquid can be used for 3 days without changing it. Fresh Dhanyamla should be used after 3 days. (Medicine should be changed on 4^th, 7^th, 10^th day etc)

Snehadhara – The oil or ghee shall also be changed once in 3 days. Generally the oil used on first day is used for 3 days. This oil is stored in a bottle or vessel. On 4^th day fresh oil is taken. This oil is used for Parisheka upto 6^th day. On 7^th day, both this oil is mixed with the oil used for first 3 days and Sarvangadhara is carried out. Again on the 8^th day fresh oil is taken for the treatment. For best results of the treatment, the oil should be changed on daily basis. Since the medicinal oils will be very costly and will add on to the cost of the treatment, everyone cannot afford to get it changed every day. When the same oil is used on 2^nd day or 3^rd day, the sweat and dirt of the body too gets mixed in the oil which may lessen its efficacy. For those who cannot afford the cost of the treatment, the same oil can be continued for 7 days.

Kashaya dhara – The Kashaya shall be prepared fresh every day

Takra Dhara – The medicated buttermilk also should be prepared on a daily basis and taken fresh every day

Duration

Duration of treatment:

As a general rule, dhara should be done until the proper signs of Swedana (sweating treatment) have occurred or until the patient sweats
When the body is too dry and the morbidity is caused by pitta associated with Vata – Parisheka sweda can be done for 72 minutes
In the patient afflicted by morbidity and unctuousness of Kapha – sarvanga dhara shall be done for 36 minutes

Duration for Sneha Sarvangadhara or Kaya seka or Pizichil:
Again as a rule sweating is an indication for stoppage of treatment, i.e. Sarvanga Sneha dhara shall be done until sweating occurs. For this to happen 1 ½ hours (3 ½ nadika kala) will be sufficient.

Vata vyadhi – In Vata disorders, Sarvanga sneha dhara can be done up to 2 hours time duration (5 nadika kala)

In Vata-Kapha disorders – up to 1 and a half hours (3 ½ nadika kala)

The fomentation given by Sarvanga dhara or Parisheka 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 Sarvanga dhara 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.

According to dhara kalpa book – the oil will enter the orifices of skin within 300 matrakala (1/2 minute approximately) of stream pouring. The oil is said to reach the roots of other tissues within 300-500 matrakala.

Samyak swinna lakshana

Signs of proper fomentation (Samyak Swinna or Samyak Swedana Lakshanas) –

Sheeta shula vyooparame 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

Aswinna lakshana

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

Ati swinna lakshana

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 Sarvanga dhara, the person should be allowed to relax for a while. The body should not be immediately exposed to cold or cold measures. Doing so might induce some symptoms like cold, muscle cramps etc.
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.
Abhyanga – After a while, the patient is once again given a soothing massage. The whole body and the head should be given massage with herbal oil.
Snana – Following the massage a hot water bath should be given. Alternatively water boiled with Nirgundi (Vitex negundo), Nimba (neem) or Dashamula (10 roots) shall be used for bathing purpose. 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
After hot water shower, decoctions like Shunti Kwatha, Jeerakadi Kwatha or Gandharvahastadi Kwatha should be administered for oral intake either in the clinic or hospital or at home after discharge. These herbal extracts keep correcting the disturbed metabolism in the body and also keep micro-cleansing the system by removing blocks from the cells.
Nitya Virechana – Daily metered dose of purgation with purgative decoctions especially Gandharvahastadi Kashayam should be administered every day after Sarvanga dhara. It should be given in a dose of 24-48 ml at bedtime. This herbal extract is basically a laxative and best one in the business of controlling the morbidity and vitiation of Vayu. After Sarvanga dhara, small amounts of toxins are released from the cells into the gut every day. These toxins should be removed as and when they come towards Koshta (gut). Gandharvahastadi Kashayam / Kwatham is the best option for removing these toxins. Care should be seen that the constipation should not develop during the whole schedule of Sarvanga dhara. If constipation develops, the person will suffer from flatulence, distension of abdomen, sounds in gut, sluggish metabolism, indigestion, tastelessness and an increase in the morbidity and existing disease.
When the patient gets hungry, he or she should be served with light and easily digestible food. The food should preferably be liquid or semi-solid and should have been processed with ginger.
During Sarvanga dhara, the patient should keep his mind in a pleasant condition.
Pariharya (what not to do after Sarvanga dhara?): The person who has undertaken Sarvanga dhara should abstain from these things for at least the same number of days as the duration of treatment (i.e. if the treatment has been done for 14 days, the restrictions should be followed strictly for at least next 14 days): indulgence in sexual intercourse, being in the proximity or company of women (men) which includes seeing, touching or thinking about them, strenuous physical exercises, exposure to sunlight, forcibly withholding the natural urges or reflexes of the body like those of defecation, urination, hunger, thirst, sleep, sneeze etc, exposure to cold or intake of cold food substances and smoking, excessive sleeping, high or low leveled pillows, standing in cool breezy or dusty areas for long time, grief, anger, keeping awakened till late nights, walking for long distances, speaking or shouting in excess, speaking loudly etc.
The person should use hot water for bathing and drinking purposes. He should keep on a reasonably light diet and should not eat unnecessarily or in excess quantity. He should follow celibacy.
Management of complications if any:

When Sarvanga dhara is done with wrong methodology like keeping the liquid hotter than is prescribed, doing it from too high or too near etc will lead to some complications like burning sensation, herpes, tiredness, hoarse voice, splitting pain in joints, vomiting, bleeding, fever, itching patches, skin eruptions, rashes, etc. In this case, the treatment should be stopped immediately.

Remedy – On the first day Gandusha and Kavala (gargles) should be given with medicated liquids, Nasya (nasal instillation of medicines) and Shunti Kwatha (ginger decoction) in a dose of 24ml twice or thrice a day should be given for oral consumption. Light food should be given on the same evening. It should include gruel and soup preparations prepared with rice, grams, ginger etc. On the 2^nd day, sneha vasti (enema with medicated oils and or ghee should be administered. On the 3^rd day Niruha Vasti (decoction enema) should be administered. On the 4^th day the full treatment explained in management of Sneha Vyapat (complications arising due to improperly administered oil enemas) should be followed. On the 5^th day Sarvanga Dhara should be begun once again. On restart of treatment extra precaution should be taken to see that the procedure is done in correct methodology so as to not give rise to complications.

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). Disease specific and Dosha specific remedies in the form of oral medicines shall be prescribed to be taken during follow up. The follow up differs from person to person and from disease to disease. The quality and quantity of morbidity counts.

Rasayana’s are very useful during follow up because they not only rejuvenate the diseased cells and organs of the body; they also keep the mind out of stress and work as immune modulators and anti-ageing agents.

The patient is also advised to undergo the treatment twice or thrice in a year as a part of preventing the recurrence of diseases.

The healthy individuals can also take a course or 2 in a year, to keep them rejuvenated and also to keep many psycho-somatic diseases away.

Duration, limitations

Duration of the course –
The number of days of treatment varies from 7-28 days depending on the nature and intensity of the disease. It is usually done for 7, 14, 21 or 28 days.

Sarvanga dhara 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 Parisheka Sweda / Sarvanga dhara –
Sarvanga dhara is one of the best Ayurvedic treatments which are used in providing strength to the tissues and strengthening the body. It is the best stress relieving treatment and is effectively used as a remedy to many psychosomatic diseases. It provides relief from pain and associated conditions in musculoskeletal and neuromuscular diseases. It provides good strength and energy. It provides good energy and 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. Holistic mind-body healing is always the motto of Ayurveda.

Just Before Finishing,
Sarvanga dhara 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 Neuromuscular and Musculoskeletal disorders. Important thing to make a note in this aspect is that Sarvanga dhara is also useful in preventing and halting the progression of many psychosomatic disorders. But it has many variants and your Ayurvedic doctor is the best person to take a call so as to which form of Sarvanga dhara suits you the most.

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