External Treatments To Keep Doshas In Balance

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Balance of 3 doshas Vata, Pitta and Kapha is said to be one of criteria to determine comprehensiveness of health.

Imbalance of doshas should be normalised by proper and timely interventions. Treatments for imbalanced doshas may involve oral medicine administration or external application of herbs in the form of cream (Lepa), oil massage etc.
Read – Chikitsa: Treatment Types, Ayurvedic classification

Effect of external therapies

Effect of Bahya Upakramas / External Therapies on Doshas
One of the classifications of treatments in Ayurveda explains two fold interventions. They are antah parimarjana i.e. internal cleansing and bahih parimarjana i.e. external cleansing.
Read – Classification of Vyadhi (diseases) according to Ayurveda

External cleansing treatments comprise of treatments and therapies done on surface of the body. Here, cleaning also means to heal. These treatments are done to combat vitiated doshas and also to modify disease process on exterior of the body. Sometimes these treatments need to be used in combination with internal cleansing treatments.
Read – Ayurvedic Treatment Strategies To Break The Pathogenesis

In external cleansing, medicines are applied, sprinkled, tied or poured outside the body, mainly at site of disease or where symptoms of dosha aggravation i.e. pain, swelling, redness, burning sensation etc are evident. Medicines used in external healing, heal from outside after coming into contact with body.

Examples

• Abhyanga – herbal oil massage
• Swedana – sudation
• Dhara – stream pouring of liquid medicines
• Lepa – application of medicinal pastes etc

Similarly fourfold interventions are mentioned –
Samshodhana i.e. cleansing therapies
Samshamana i.e. palliative treatments
Ahara i.e. dietetic regimen
Achara i.e. behaviour and lifestyle corrections.
Read – Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation

Among these, samshodhana is classified as – Bahirashraya i.e. external cleansing and Antarashraya i.e. internal cleansing. Internal cleansing includes panchakarma procedures i.e. therapeutic emesis and purgation, enemas, bloodletting and nasal medication.

Below mentioned treatments are included under external cleansing –

• Shastra karma – use of surgical instruments
• Kshaara – use of alkalis
• Agni – cauterization
• Pralepa – application of medicinal pastes etc

Pralepa can be done to alleviate all doshas by choice of dosha specific herbs to prepare pastes.

Samshamana means palliative treatment. Here, morbidity of doshas is tackled at place of their aggravation. In this type, elimination of doshas will not be needed. Palliative treatments are usually preferred when there is mild to moderate dosha aggravation. Palliative treatments are also of two types.
Read – Main Cause For Diseases As Per Ayurveda

External palliative treatment

Bahya Samshamana / External palliative treatment –

• Aalepa – application of medicinal pastes prepared by dosha pacifying herbs on afflicted parts or at places where symptoms of dosha aggravation is found. Specific doshas need to be tackled with pastes prepared with specific dosha-pacifying herbs.
• Parisheka – stream pouring medicinal liquids on areas where symptoms of dosha aggravation are seen.
• Avagaha – tub bath with medicated liquids prepared with dosha alleviating herbs.
• Abhyanga – massage using herbal oils prepared with dosha specific herbs.
• Shiro vasti – oil pooling over head using oils prepared with dosha-specific herbs.
• Kavala graham and Gandoosha – oral rinsing and gargling with liquids, powders or pastes which alleviate doshas.

Internal treatment

Aabhyantara samshamana (internal palliative treatment) –
Pachana i.e. ama digesting medicines
Lekhana i.e. fat depleting medicines
Brimhana i.e. bulk promoting medicines
Rasayana i.e. rejuvenation medicines
Vajikarana i.e. aphrodisiacs

Specific treatments and their role in dosha palliation

Dosha predominant symptoms to be observed for administering dosha-specific external treatments
When vitiated Vata is involved, there will be signs and symptoms of degeneration and nerve irritation including –
excessive pain,
stiffness,
reduced movements,
roughness and dryness along with coldness in afflicted areas.

Examples of Vata predominant disorders –
osteoarthritis,
hemiplegia,
Parkinson’s,
myalgia,
fibromyalgia, etc.
Read – Vata Disorders (Vatavyadhi): Definition, Causes, Symptoms

When vitiated Pitta is involved, there will be signs and symptoms of inflammation and burnouts including –
excessive burning sensation,
burning pain,
rise in local temperature,
redness of afflicted area,
formation of pus and other exudates.

Examples of pitta predominant disorders –
rheumatoid arthritis,
gouty arthritis,
myositis,
fibrositis,
tendonitis,
synovitis,
migraine,
psoriasis,
dermatitis,
eczema etc.

When vitiated Kapha is involved, there will be signs and symptoms of stagnation, accumulation and blocks in channels of body including -swelling and accumulation of fluids in afflicted parts,
heaviness and
stiffness of afflicted parts,
increased coldness.

Examples of kapha predominant symptoms –
swelling of joints with collection of fluids,
synovitis,
edema of parts of body or at many areas of body,
arthritis with stiffness of joints or spine etc.
Read- How To Make Prognosis Of Disease According To Ayurveda?

These symptoms will help in identifying dosha involvement in each disease. This will help in conducting dosha specific external treatments. When more than one dosha is involved in pathogenesis of a disease, mixed symptoms of both or all doshas are seen. External treatments should be planned accordingly.

Example –
Treatment for knee arthritis presenting with inflammation, burning sensation and severe pain, medicines prepared with both pitta and vata mitigating herbs should be used. In this instance, if pitta symptoms are more, like burning sensation and redness but vata symptoms are of less intensity, i.e. pain. Here medicine should be rich in pitta alleviating properties and predominantly be prepared with pitta alleviating herbs and also including herbs which act on both doshas.

Since pitta is more, temperature of oil or milk should be kept warm or cold. Since oil or milk will be processed with pitta alleviating medicines, in spite of being cold, medicine will not aggravate vata. We should remember that in this case vata aggravation is secondary since vata is associated dosha and pitta is predominant dosha in causation of arthritis which is inflammatory in nature. Thus, vata symptoms are feeble and will not be affected by nature of medicine. When main dosha is addressed and when pitta subsides, vata and its symptoms too subside. Similar principles shall be followed in all dual and triple vitiation of doshas.
Read – Samprapti Vighatana – Breaking Of Pathogenesis Meaning, Importance

There are many treatments which are done on outside of the body. But when we see all those treatments, most of them are included under snehana i.e. external application medicated fats or swedana i.e. sudation.

External oil therapies

1. Bahya Snehana for alleviating doshas and their symptoms

Abhyanga – Herbal oil massage is specific remedy for combating increased vata. Massage relieves vata symptoms and mitigates diseases caused by vitiated vata dosha.

Ayurveda advocates massage to be done as a part of daily regimen. It balances vata, delays ageing, improves skin color and complexion and hence balances bhrajaka pitta and vyana vayu in skin. Skin is one of the chief seats of vata. Since it is good for eyesight, it also balances alochaka pitta.

Massage induces calmness of mind and bestows good sleep. Thus, it also balances prana vata, sadhaka pitta and tarpaka kapha. When these doshas in head are balanced, stress and hormonal regulation is kept in balance.

Variants of massage

Below mentioned are variants of massage –

Samvahana – gentle application of medicated oils / gentle massage without much pressure – has more calming effect on vata

Mardana – rubbing whole body or afflicted body parts with medicated oil

Pada abhyanga – foot massage with herbal oils balances vata in legs and lower parts of body.

Shiro Abhyanga – head massage with herbal oils balances doshas in head. Head is said to be master of all organs. When doshas are controlled in head, which is said to be root of tree called body, entire tree i.e. entire body will be healthy and fit.

Shiro Abhyanga is one among the oil treatments done on head i.e. murdni taila. Other three procedures are –
shiro pichu i.e. placing a swab soaked in oil on the crown of head,
shiro dhara i.e. stream pouring of medicated oil over head and
shiro vasti i.e. oil pooling over head.

These treatments also have similar impact as that of shiro abhyanga and are done in different conditions as per choice of physician.

All these procedures balance doshas especially prana vata, sadhaka pitta, alochaka pitta and tarpaka kapha in head, conducive and calming for entire nervous system, balances hormonal functions and good for sense organs. They help in controlling stress, keep mind calm and conducive for hair health.

Sthanika Vasti – local pooling of medicated oil around painful or dosha afflicted parts of body is called sthanika vasti.

Below mentioned are variants of sthanika vasti –
Kati vasti – oil pooling in low back region to combat dosha symptoms in low back area and treat conditions like low back pain, sciatica, spondylosis, lumbago, lumbo-sacral pain etc.

Janu vasti – oil pooling around painful knee joints to combat dosha symptoms in knee joints and treat conditions like knee arthritis, soft tissue injuries, etc

Greeva vasti – same as kati vasti, done over cervical region to combat pain, inflammation etc dosha symptoms in neck, along cervical spine and treat conditions like cervical spondylosis etc.

Similarly, prishta vasti is done over entire back region,
vankshana vasti is done over hip joints and
uro vasti is done over chest to balance dosha aggravation in those areas and to treat diseases occurring in those regions.

Taila dhara / Kaya Seka / Pizhichil – is a procedure in which medicated oils / ghee is poured on dosha afflicted parts or diseased parts in the form of stream or shower for a fixed duration of time.

When this procedure is done on particular part of body like on a sore joint, it is called sthanika dhara. When oils are poured on entire body, it is called as sarvaga dhara / pizhichil / kaya seka. When done on entire body, medicated oil balances dosha imbalances taking place in entire body. Dosha specific oils may be used to tackle specific doshas or dosha combinations.

Netra tarpana – is a procedure of pooling medicated oils and ghee around eyes. This treatment balances alochaka pitta in eye which is responsible for health of eye and perception of visual objects and visual understanding of objects and subjects.

Sneha Avagaha – Tub bath where dosha afflicted body part or entire body is kept dipped in medicated liquids, medicated oils in this case. This mainly conquers vitiated vata and balances it. Oils processed with pitta alleviating herbs can be used to cure high pitta conditions and also pitta disorders. When hot liquid medicines are used for tub bathing purposes, it can be included in a form of sudation called avagaha sweda.

Karna purana – is a method of filling medicated oil in ears. This cures ear related disorders and balance vata in ear. Ear is one of the chief sites of operation of vata. Vata alleviating vata drops will help in keeping ear health in a good condition and also enables proper perception of sounds.

All these snehana treatments can be done for healthy people too. When done frequently these treatments will help in keeping doshas in a state of balance and contribute towards comprehensive body-mind health.
Read – Oral, Ear And Head Therapy – Ashtanga Hrudaya Sutrasthana 22

Murdni taila – is an external oleation procedure wherein medicated oil is applied over scalp in four different methods, swab method, pooling method, massage method and stream pouring method.

All varieties of oil applications over head are vata mitigating and cure vata disorders effectively. Apart from this, they control doshas in head with choice of different dosha-specific oils. Doshas in head control many psycho-somatic functions, mental functions, hormonal regulation and also are conducive for balancing health of sense organs. Thus, head-oil procedures are multidimensional in nature, just like herbal enemas and are helpful in preventing and curing many psycho-somatic disorders.

Svedana

2. Swedana for alleviating doshas and their symptoms
Swedana – means sudation. Here heat is provided to the parts of body afflicted by vitiated dosha(s) and presenting with symptoms of dosha increase, so as to induce sweating.

Sudation is best remedy for vata, kapha and vata-kapha pathological conditions. There are 13 types of sudation treatments explained in classics wherein heat of fire in different forms are used and other 10 forms of mild form of sweating treatments wherein heat of fire is not used.
Read – 4 Types Of Swedana As Per Sushruta And Vagbhata

Below mentioned are important forms of sudation therapies that are popularly used in practice –

Nadi Sweda – tubular sudation is popularly used for alleviation of localized doshas in pathological conditions. Example – it is administered in presence of symptoms of vata and kapha aggravation in joints. Generally it is used of providing sudation to limited area of body or a part of body afflicted by vitiated doshas. It can also be used for complete body sudation to control vitiated vata and kapha in case of non-availability of other forms of sudation therapies.

Sarvanga Bashpa sweda i.e. chamber or box sudation is preferred for providing sudation to the whole body. Here, patient who has been given herbal oil massage is made to sit in a sweating chamber and sudation provided. It can be considered as a variant of kuti sweda i.e. cabin sudation explained in texts.

Parisheka Sweda – is a method in which sudation is given by showering / sprinkling / affusion / stream pouring method. This is explained in types of dhara.

Avagaha Sweda – is known as bath sudation. In this, patient who has been subjected to herbal oil massage is made to lie down to the level of neck in a specially prepared tub, keeping his head out of tub filled with medicinal fluids like decoction, milk, oil etc.

Upanaha / Upanaha Sweda – is a method in which medicines or medicinal pastes which are of semisolid nature i.e. not too much of solid nature are heated and tied in a bundle of cloth and used to provide heat to dosha afflicted body parts. It can be considered as poultice sudation.

Sankara Sweda / Pinda Sweda – is a type of sudation wherein dosha mitigating medicines are tied in a cloth in form of bolus and heated to tolerable temperatures or dipped in hot / warm liquids. This bolus is later applied / rubbed to parts of body afflicted by doshas and sudation given. This relieves dosha symptoms like pain, stiffness, swelling etc. Alternatively medicines are directly heated and applied. Upanaha sweda is also a variant of sankara sweda.

This can be used in unctuous form wherein it is used to treat vata disorders and balance vata. When it is used in dry form, it is used to treat high kapha and ama symptoms and diseases.

Variants of Sankara Sweda or Pinda Sweda

Shashtika Shali Pinda Sweda or Navarakizhi – paddy / rice grown in 60 days, processed in medicated milk is used for sudation. It is beneficial in mitigating vata and treating vata disorders. It is also used as strengthening treatment.

Anna Lepana – paddy or rice which is prepared is directly applied or rubbed over body. It is a variant of anointment / poultice sudation and shashtika panda sweda explained above. It is also used to treat vata disorders and diseases caused due to blood vitiation. It is also beneficial in treating inflammatory conditions like rheumatoid arthritis, hence useful in mitigating pitta also.

Valuka Sweda – sand is used in bolus and used for sudation. It is effective in diseases caused by vitiated kapha and ama.

Patra Pinda Sweda / Ela Kizhi – leaves of medicinal herbs having analgesic and anti-inflammatory properties are used in bolus. With the choice of dosha-specific herbs, it is used to treat painful conditions caused by vata, pitta and also kapha. It is beneficial in treating sciatica, low back pain, arthritis and other painful conditions.

Churna Pinda Sweda / Podikizhi – powder of medicinal herbs having medicinal properties are used in bolus. It is used to treat ama and vata disorders, painful conditions with swelling and stiffness like back pain, musculoskeletal pains and joint pains etc.

Jambira Pinda Sweda / Naranga Kizhi – pieces of wild lemon / Citrus medica are used in bolus. It is used to mitigate vitiated vata and kapha and relieve painful conditions caused due to these doshas.

Types of dhara explained in ‘other external therapies’ section below may be considered as forms of Parisheka Sweda i.e. showering form of sudation if materials of treatment i.e. medicated liquids are used warm and with an intention of inducing warmth and sweating.

3. Other forms of external therapies for alleviating doshas and their symptoms

Dhara – stream pouring of herbal liquids on body or dosha afflicted parts of body is called dhara.

Below mentioned are variants of dhara treatment –
Ksheera dhara –
Medicated milk is used for stream pouring in ksheera dhara. Generally milk is medicated with pitta alleviating herbs and used as dhara for mitigating high pitta conditions and to treat pitta disorders.

When done on head, it controls head doshas i.e. prana vata, sadhaka pitta, alochaka pitta and tarpaka kapha. This has an overall beneficial impact on systemic functions and good for physical and mental health. When done on localized areas afflicted with doshas, especially pitta and vata, treatment helps in mitigating mentioned doshas, cure related diseases and inflammatory conditions. I have conducted this treatment in treating inflammatory arthritis, migraine, pitta related gastrointestinal disorders, psoriasis etc.

Takra dhara – is a method of dhara wherein buttermilk processed with medicinal and dosha-specific herbs is used. It is also used to cure high pitta and high vata conditions and diseases caused by dosha aggravation. I have extensively used this treatment for controlling and maintaining hypertension, migraine and tension headaches, pitta related gastrointestinal disorders, psoriasis etc.

Dhanyamla dhara – is a procedure wherein fermented medicinal fluids are poured on body or on parts of body afflicted by doshas. It is highly effective in combating ama and vitiated vata, kapha, vata-kapha, sama-vata and sama-pitta conditions.

Sama vata and sama pitta are pathological conditions of vata and pitta being associated with a metabolic toxin called ama. It is also used as an effective remedy for amavata i.e. rheumatoid arthritis to reduce pain, inflammation and to balance metabolism as local irrigation and total body irrigation. It is also used in chronic and stubborn fevers and localized painful conditions like frozen shoulder, bursitis, and lumbago etc conditions.

Taila Dhara – discussed above

Udwarthana –
Treatment wherein herbal powders are rubbed against body in upward direction. This is used to remove and mobilize morbid kapha, fat and cellulites. It is used as a part of daily regimen to keep kapha in balance.

This helps in prevention of metabolic diseases and in prevention of accumulation of unwanted wastes in body. It removes excessive fat and is thus an effective treatment for overweight and obese conditions. It is effective remedies to remove blocks in the body channels caused by excess kapha and fat tissues and re-establish normal functions.
Read – 7 Methodical Positions for Oil Massage And Ubtan

Anjana –
Herbal collyrium applied to eyes. Anjana is a paste applied to inner part of eyelids. It is used to protect eye and maintain good eye health and vision. Anjana mainly balances alochaka pitta located in eye which is related to perception of vision.

It also protects pitta from being afflicted by kapha, by destroying vitiated kapha in eyes. It is an effective remedy for many eye disorders and prevents many diseases related to eye. It is used in form of tablet, juice, powder, wick and many other forms. It serves benefits including scraping off excessively accumulated doshas and wastes in eyes, healing and soothing, calming and comforting eyes.
Read – Ayurveda Eye Treatment Types, Methods – Astanga Hrudaya Sutrasthana 23

Kavala / gandusha –
Methods of rinsing and gargling mouth and throat with medicated liquids including decoctions, pastes, milk, sugarcane juice, oils, ghee, honey, gruel, fermented liquid, wine, meat soup etc.

These procedures help in oral rinsing, oral hygiene, control dosha vitiation taking place in mouth and throat. They also balance doshas in head and sense organs, good for sense organs and nerves.

When processed with dosha-specific herbs, they help in mitigating all doshas. Mainly these therapies remove excessive kapha from mouth and throat and also balance pitta. They are also remedies for many diseases related to head, neck and throat and also have a preventive role. They also cure many diseases like stupor, excessive salivation, mouth ulcers, dryness of mouth, anorexia, rhinitis, etc caused by vitiated doshas.

Lepa – means external application of medicinal pastes on dosha afflicted parts.
Its variants are –
Pralepa – prepared with coolant herbs, used in treating high pitta conditions.

Pradeha – prepared with herbs having hot potency, used to treat high kapha conditions.

Doshaghna lepas are used to mitigate vitiated doshas.
Shothaghna lepa reduces swelling caused by doshas,
vishaghna lepa has anti-toxic effect and
varnya lepa is used for beautification and hence balances bhrajaka pitta.
Read – Lepa Kalpana: Ayurvedic Dosage Forms For External Application

Other points of interest regarding dosha-external therapy relationship

Combination with panchakarma – External treatments are highly effective in dosha mitigation and also cure diseases caused by vitiated doshas but they are highly useful when used in combination with panchakarma cleansing treatments.

This combo will make sure that there is a comprehensive elimination of doshas which are vitiated inside body from and also mitigating effects of doshas on outside of body. This forms a bilateral approach towards effective tackling of morbid doshas.

External treatments in combination with therapeutic emesis will effectively expel and balance vitiated kapha and cure kapha disorders and pitta disorders.

Similarly external treatments in combination with therapeutic purgation will take care of morbid pitta and vata and external treatments when administered with herbal enemas will control hyperactivity of vata. Enemas also balance tridoshas.

Along with bloodletting, external therapies like application of medicinal pastes and anointment cure high pitta conditions and diseases caused due to morbid blood like gout, chronic skin diseases etc.

When used simultaneously with nasya i.e. nasal medications, external therapies like dhara, lepa etc help in tackling dosha aggravation in head, neck and sense organs.

Mind healing – external treatments are not only effective in mitigating doshas at physical level, they are also found to be highly effective in healing mind and senses which have been impacted by vitiated doshas.

Therefore external treatments are highly effective in treating psychosomatic diseases. When external treatments like massage, stream pouring of medicinal liquids, powder massages, sudation etc are done, they are also found relieving stress, elevate mood, induce good sleep, relieve depression and mood swings and improve sensory perception.
Read – Meditation By Watching Mind: Stages, Method, Benefits

Cure of systemic illnesses – Just like internal cleansing of doshas by Panchakarma treatments cure diseases on surface of body, external treatments, most of which have been mentioned above, cure diseases inside the body.

Example – shirodhara, takradhara and ksheeradhara have seen to be highly effective in curing chronic gastrointestinal ailments like inflammatory bowel diseases. Powder massages and sudation along with purgation provide good cure for fatty liver and polycystic ovarian diseases and also effective in curing obesity.

Snehana and swedana as purvakarmas – oleation and sudation are mandatory inclusions before administering cleansing therapies in the form of panchakarma treatments. Thus they form perquisites for preparing body for expulsion of doshas and thus contribute towards body cleansing and cure of many systemic disorders.

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype