ksheera Dhuma: Milk Steam Therapy Uses, Procedure, Mode Of Action

Article by Dr Raghuram Y.S. MD (Ay)
Ksheera Dhuma is a special Ayurvedic treatment wherein the patient is made to face warm medicated vapours of milk. It is used in the treatment of facial paralysis, locked jaw and disorders of head and neck, with Vata dosha imbalance.
The name Ksheera Dhuma is made up of 2 terms:
Ksheera – means milk
Dhuma – means vapours

Benefits

Benefits of Ksheera Dhuma – milk vapour therapy:
Ksheera dhuma is highly beneficial in effectively treating:

• Ardita – Facial paralysis, Bells palsy, hemiplegia
• Jihva stambha – stiffness of the tongue
• Manya stambha – stiffness of the neck, cervical spondylosis
• Visarpa – herpes, erysipelas
• Kati graham – lumbago, low back discomfort
• Vatarakta – Gout
• Kroshtu shirshaka – swelling of knee joints

Swedana variant

Ksheera Dhuma is a variant of Swedana –
Since the treatment is done in the form of vapours or steaming it can be considered as a variant of Swedana – sweating therapy.

Mild heat:
Generally steaming is contraindicated to be done to the head and face since the head consists of vital organs like eyes etc which might get damaged with administration of heat. It is also said that head is an important Marma (vital organ) comprising of many important structures including the brain which are heat sensitive. Hence much heat should not be given to the head. It is also said that one should not take head bath with hot water, in fact should be taken with warm water.

Swedana –
Sweating therapy is one of the very effective treatments for Vata Dosha disorders. Usually it is done after oil massage. Abhyanga and Swedana form the best combination to alleviate many painful conditions of the musculoskeletal system including arthritis, low back pain, myalgia etc.
Read related: Sweating Treatment – Swedana Types And Methods

Ksheeradhuma is a type of Sa-agni sweda because we use fire to heat milk or prepare medicated milk used for providing vapours

Swedana can be –
Ekanga Sweda – wherein only the afflicted part of the body is subjected to sweating treatment
Kshiradhuma too is given to only a part of the body i.e. head, therefore it is a variant of Ekanga Sweda

Though Ksiradhuma can be called as Swedana, it is termed as dhuma (smoke or smoking) because the steam is inhaled with gaping mouth. But the procedure resembles that of swedana. It can be included under bashpa sweda (vapour steaming, bashpa=vapours) or nadi sweda (tube fomentation, wherein the steam comes through a long heat resistant tube).

Reference of Bashpa Sweda –
Gada Nigraha – Sannipata jwara prakarana (treatment of intermittent fevers and fevers occurring due to the vitiation of all the 3 doshas) and Shwayathu chikitsa (treatment of swelling)
Bhavaprakasha – In jataragni vikara (digestion disorders or errors of metabolism – in this context Bashpa sweda is said to be given to the patient suffering from udara shula or pain abdomen caused due to indigestion
Brihad yoga chintamani – Chopachini dhuma in Vatarakta (gout)

Procedure

Procedure of Ksheera Dhuma:
3 different stages

Purvakarma

Purvakarma (Pre-treatment procedures) –
Examination and 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 Ksheera Dhuma 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:

• A big closed vessel with narrow opening (a big vessel with a lid which can be closed over the vessel by screwing, the lid having a tapering opening, narrow enough for the steam to come out in a channelized way with uniform velocity)
• Alternatively a pressure cooker with a heat and leak resistant long tube (pipe meshed in the interior with heat resistant material) being fit to its nozzle tightly
• Big vessels to prepare decoction of Bala Mula (Sida Cordifolia)
• Milk – 2 litres
• Water – 10 litres for all purposes
• Bala Mula – Roots of Sida cordifolia chopped into small pieces (coarse powder) – 500 grams roughly
• Amalaki Churna (fine powder of Emblica officinalis or Indian gooseberry)
• Bandage cloth
• Cotton swab or large pieces of cotton cut uniformly into square shapes
• Tissue papers, sterile cloth
• Stove
• Lotus petals, if available

For Abhyanga (massage) – Taila (medicated oil), Ghee (medicated ghee) or both suitable to the disease and diseased are collected and stored beforehand.

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

Preparation of the Medicine:
Bala mula Kashayam (decoction of Bala mula) –

• 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 big 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
• Note: Roughly 500 grams of coarse powder of Bala mula is boiled in 16 times quantity of water and reduced until 2 litres remain
• The solid part is filtered out
• The Bala kwatha (decoction of bala) is prepared now

Preparation of Bala sidda ksheera (milk processed in bala decoction) –
2 litres of milk is taken in the big vessel (or steam cooker or milk cooker) and is kept to boil
To this boiling milk the prepared and filtered fresh decoction of Bala mula is added
The lid is closed and the heat is continued (moderate flame)

Abhyangam (Herbal oil massage):
The patient is made to sleep on the table made and meant for conducting massage. Generally for Ksheera Dhuma treatment the patient is made to sit. 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.

Head massage is given with one of the above said oils. Generally the head, face and neck along with shoulders are massaged gently for 20-30 minutes duration.

Amalaki Tala-dharana:
A small pre-treatment procedure called Amalaki Tala-dharana is done mandatorily after massage. (Some people prefer skipping this procedure, but it is safe to do it before ksheera dhooma)

On the previous day, 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.

Ksheera Dhuma is a procedure which includes administration of hot fumes or vapours to the head and face, the place of the body having vital organs like brain and sense organs which are heat sensitive. 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.

Alternatively the pate of amalaki made in buttermilk is pasted on the head (crown) and is tied with a bandage cloth to keep it in position throughout the duration of treatment. This is the easiest method of Tala Dharana.

Netra Bandhana –
Protection of eyes during the treatment is very essential.
The petals of lotus (natural coolants) are kept on the eyes and tied with a bandage cloth and loosely knotted behind the head. Alternatively if lotus petals are not available, sterile cotton pads are dipped in milk, squeezed and kept on the eyes, tied with a bandage and knotted as said above.

Pradhana karma

Providing Ksheera Dhooma –
The patient who has been given Abhyanga is made to sit comfortably on the chair. The vessel consisting of hot bala ksheera (milk processed with roots of bala) is kept in front of the patient. He or she is advised to slowly inhale the vapours coming from the narrow opening of the closed vessel through his mouth, keeping his mouth open. It is just like smoking the vapours.

Alternatively if the pressure cooker or milk cooker fit with tube is being used, the tube is brought near the mouth of the patient and the patient is advised to inhale the vapours coming from the tube through his mouth.

While Ksheera dhuma is being administered, the rest of the body of the patient is covered with the blanket up to the shoulders.

The procedure is conducted for 25-30 minutes (may be for more time if the physician thinks so or if the nature of morbidity demands) or until the samyak swinna lakshanas (signs of proper fomentation) are obtained

Signs of proper fomentation (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)

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):
Cleansing of face – The face is cleansed with sterile cloth or tissue papers
Removal of tala – The amalaki taladharana is removed and the head is cleansed with sterile cloth or cotton pads dipped in warm water
Rest and restrictions – The patient is allowed to relax for a while.The patient is not allowed to wash his face or have bath or go out of the treatment room. He is also not allowed to expose himself to the wind or heat.
Shower – Patient is advised to take a refreshing hot water bath after going home or after an hour or so 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, Mode of action

Duration of the course –
The number of days of treatment varies from 7-21 days depending on the nature and intensity of the disease

Probable mode of action and benefits of Ksheera Dhuma –
The combination of Bala and milk is highly nutritive. Ksheera dhuma provides strength to facial muscles and nerves in facial paralysis and helps in recovery. When combined with Shiro Vasti (oil pooling over the head) and Nasya (nasal instillation of medicines) it enhances the healing effect. But the mentioned treatments should be done at different time periods.

Ksheera Dhuma controls vitiated Vata in the upper parts of the body and hence is useful in neurological disorders afflicting the head and neck. It also relieves pain in lockjaw and enables easy movements at the joints. It strengthens the muscles, bones and joints. It relieves spasm associated with cervical spondylosis and frozen shoulder. Ksheera Dhuma also helps in Jihwastambha, relieves the stiffness of tongue and helps in easy movements.

The combination is also highly effective against Vata and Pitta morbidity. Hence by controlling the pitta, it helps in recovery from Visarpa (herpes). This also indicates that the dhuma has an antiviral and antimicrobial action. It also helps relieve nerve irritation in Visarpa and reduces symptoms like burning sensation etc.

By relieving vitiated Vata and Pitta and also associated morbid kapha, by providing strength to bones, joints and soft tissues, Ksheera Dhuma helps in relieving pain, burning sensation and catches associated with Katigraha (low back discomfort and pain, lumbago) and Vatarakta (Gout). In Vatarakta (especially kapha predominant) it shall be provided. In Vatarakta with Vata or Pitta morbidity, Ksheera dhuma should not be hot but shall be provided warm after giving abhyanga with vata-pitta alleviating oils like Pinda taila, ksheerabala taila etc.

Ksheeradhuma also enhances the colour and complexion of the skin. It removes the debris in the skin and cleans the pores. It helps in enhancing blood supply and proper nerve conduction to the skin, detoxifies it and keeps it healthy and immune against diseases.

Other areas of administration of Ksheera Dhuma –
Ksheera dhuma is effectively administered in:
Kroshtu Shirshaka – Swelling of knee joints, in this ksheera dhuma is administered after having given a massage to the joints with castor oil (eranda taila) mixed with rock salt (saindhava lavana)
Kati graham (lumbago) – In this Kshira dhuma with milk or decoction of paddy or decoction of panchamla (5 sour herbs)

Clinical experience

My clinical experience –
I have successfully administered Ksheera Dhuma in tamaka shwasa (bronchial asthma and chronic bronchitis). For this I have used milk processed with coarse powder of Yashtimadhu (Glycyrrhiza glabra, Indian Liquorice). This provides instant relief from breathlessness clears breathing passages and makes breathing easy. I have tried it though it is not mentioned as a reference in any book. This indicates a scope of innovative treatment planning in Ayurveda. Having said so, there are many other useful treatments and medicines which can be administered in the above said respiratory conditions and Ksheera Dhuma might not be a choice in all patients and all conditions. It shall be skilfully planned and in the absence or impossibility of other choices of treatment.

Limitations

Limitations of Ksheera Dhuma –
It is not the ultimate option in either of the above said conditions. It is one of the options. Again the consulting doctor shall take a call as per the demand of the situation.

It shall be carefully administered or avoided when a person is known to have cardiac diseases or breathlessness of cardiac origin, in patients who panic taking vapours and in unwilling and non-cooperating patients.

It shall be avoided in known cases of hypertension (high BP), glaucoma (eye diseases occurring due to raised pressure in the eyes), high pitta conditions and people with sensitive skin
Click to Consult Dr Raghuram Y.S. MD (Ayu)