द्वात्रिंशोऽध्यायः । अथातः स्वेदावचारणीयं चिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।
Now we shall discourse on the medical treatment by measures of fomentations, diaphoretic measures, etc. (Sveda-vacharaniya). 1
चतुर्विधः स्वेदः; तद्यथा – तापस्वेद, उष्मस्वेद, उपनाहस्वेदो, द्रवस्वेद इति । अत्र सर्वस्वेदविकल्पावरोधः ॥ २ ॥
Sveda¹ (calorification, fomentation, diaphoretic measures, etc.) may be divided into four groups such as, the application of direct heat (Tapa-sveda), fomentation (Usma-sveda), poulticing (Upanah sveda) and the application of heated fluids (Dravasveda). All kinds of diaphoretic measures (Sveda) belong to one or the other of these groups. 2
तत्र तापस्वेदः पाणिकांस्यकन्दुककपालवालुकावस्त्रैः प्रयुज्यते, शयानस्य चाङ्गतापो बहुशः खादिराङ्गारैरिति ।। ३ ।।
Tapa-sveda : Of these the Tapa-sveda consists in repeatedly applying heat to (any affected part of the body of) a patient made
1. The Sanskyt term “Sveda” is not properly rendered by the terms fomentations, diaphoretic measures or any other such word or phrase. Sveda is used to mean the application of heat in any possible way-it may be to cause or not to cause perspiration. Vapour baths, hot water baths, applications of warm poultices, etc., are also included in the meaning of the term Sveda. We have however, for convenience sake, used the term fomentation as a synonym of Sveda in general to lie down (on a bed) with the help of the palm of the hand, a piece of brass, an Indian saucer, a piece of baked clay or sand, or a piece of cloth after heating them over a fire of Khadira wood, etc. 3
उष्पस्वेदस्तु कपालपाषाणेष्टकालोहपिण्डानग्निवर्णानद्धिरासिञ्चेदम्लद्रव्यैर्वा, तैरार्द्रालक्तकपरिवेष्टितैरङ्गप्रदेशं स्वेदयेत् । मांसरसपयोदधिस्नेहधान्याम्लवातहरपत्रभङ्गक्वाथपूर्णां वा कुम्भीमनुतप्तां प्रावृत्योष्माणं गृह्णीयात् । पार्श्वच्छिद्रेण वा कुम्भेनाधोमुखेन तस्या मुखमभिसन्धाय तस्मिञ्छिद्रे हस्तिण्डाकारां नाडीं प्रणिधाय तं स्वेदयेत् || ४ ||
Usma-sveda : A piece of stone, brick, iron, or baked clay should be made red-hot and sprinkled over with water or with sour gruel (Kanjika). The affected part of the body should be covered with (cotton plugs soaked in) Alaktaka¹ and then fomented with the above-named (heated) articles. As an alternative, a metal saucer containing milk, curd, Dhanyamla, meat-soup and a decoction of the tender leaves of the Vayu-subduing plants (jointly or separately) should be heated over a fire. The mouth of the saucer should be covered (with a piece of blanket or such other cloth)² and the affected part of the body should be fomented with the vapours rising therefrom. As an alternative, another pitcher should be placed with its mouth downward over the mouth of the above pitcher (containing the above-named heated articles). Then an aperture should be made in the side of the upper pitcher and a pipe to the shape of an elephant’s trunk should be inserted into it. The affected part of the body should then be fomented with the vapour escaping through that pipe. 4
सुखोपविष्टं स्वभ्यक्तं गुरुप्रावरणावृतम् । हस्तिशुण्डिकया नाड्या स्वेदयेद् वातरोगिणम् ॥ ५ ॥ सुखा सर्वाङ्गगा ह्येषा न च क्लिश्नाति मानवम् । व्यामार्धमात्रा त्रिर्वक्रा हस्तिहस्तसमाकृतिः । स्वेदनार्थे हिता नाडी कैलिञ्जी हस्तिशुण्डिका ।। ६ ।।
1. Jejjata reads “तैराद्रैरलक्तकपरिवेष्टित” instead of “तैरार्द्रालिक्तकपरिवेष्टित” and explains that the cotton plug soaked in Alaktaka should be made wet and placed over the affected part before applying the fomentation.
2. The mouth of the pitcher should be covered only to mitigate and regulate the heat.
Metrical Texts: The mode of applying heat to a patient suffering from any disease or affection of the bodily Vayu (disease of the nervous system, etc., ) is as follows :- He should be first anointed with oil, etc.,) and wrapped up in a thick cloth. He should then be made to sit in an easy posture. Then the heat should be applied through a pipe shaped as an elephant’s trunk. The advantage of this mode of fomentation is that the entire body of the patient may be easily fomented without causing him any serious trouble. The pipe should be made half a Vyama¹ in length with three bends or turns2 in its body to resemble the trunk of an elephant.³ The use of pipe made of the materials (such as Kusa, Kasa, etc.) used in the making of a Kailinji (basket) and resembling the trunk of an elephant in shape is only recommended for the purposes of Sveda (heat-application). 5-6
भूमिमुत्कीर्य पुरुषायाममात्राञ्च खादिरैः । काष्ठैर्दग्ध्वा तथाभ्युक्ष्य क्षीरधान्याम्लवारिभिः ॥ ७ ॥
पत्रभङ्गैरवच्छाद्य शयानं स्वेदयेत् ततः। पूर्ववत् स्वेदयेद् दग्ध्वा भस्मापोह्यापि वा शिलाम् ॥ ८ ॥
A plot of ground commensurate with the length of the patient’s body should be dug and heated with fire of Khadira wood and then sprinkled over with milk, water and Dhanyamla. The heated ground should be then covered with a layer of leaves (of the Vayusubduing plants) and the patient should be made to lie down full stretched upon the (bed of ) leaves and thereby fomented. + As an alternative, a stone slab should be heated and the fomentation (Sveda) should be applied similarly to the patient by making him lie down upon it after the ashes have been removed.57-8
पूर्ववत् कुटीं वा चतुर्द्वारां कृत्वा तस्यामुपविष्टस्यान्तश्चतुर्द्वारिऽङ्गारानुपसन्धाय तं स्वेदयेत् । कोशधान्यानि वा सम्यगुपस्वेद्यास्तीर्य
1. A Vyama is the length measured by the outstretched hands of a man.
2. The reasons for bending the tube are to make the fomentation delightful in consequence of the vapour not passing in a straight course.
3. This is called the “Nadi-sveda”.
4. This is called the “Karsu-sveda”.
5. This is called the “Asma-ghana-sveda”.
किलिञ्जेऽन्यस्मिन् वा तत्प्रतिरूपके शयानं प्रावृत्य स्वेदयेत् । एवं पांशुगोशकृत्तुषबुसपलालोष्मादिभिः स्वेदयेत् ।। ९ ।।
As an alternative, the patient should be seated inside a chamber with four doors (one on each side) and fomented by lighting up a good blazing fire (of Khadira wood) at all the doors (simultaneously).¹ Another alternative is that the patient should be laid on a mattress (made of Kusa, Kasa, etc.) or on a similar bed as before and fomented with the fumes of duly boiled paddy (and Masa-pulse, etc.) kept under the same mattress. In the same manner, Sveda (fomentation) might be applied with the help of heated cow-dung, sand, husks of paddy, weeds, etc. 9
उपनाहस्वेदस्तु वातहरमूलकल्कैरम्लपिष्टैर्लवणप्रगाढैः सुस्निग्धैः सुखोष्णैः प्रदिह्य स्वेदयेत् । एवं काकोल्यादिभिरेलादिभिः सुरसादिभिस्तिलातसीसर्षपकल्कैः कृशरापायसोत्कारिकाभिर्वेशवारैः साल्वणैर्वा तनुवस्त्रावनद्धैः स्वेदयेत् ।। १० ।।
Upanaha-Sveda : (Poulticing ): The roots of the Vayusubduing drugs should be pasted together with Amla (Kanjika) and mixed with an abundant quantity of rock-salt and of Sneha (clarified butter, etc.). The paste should be heated and applied lukewarm to the affected part. The pastes of the drugs included within the Kakolyadi, the Eladi or the Surasadi groups as well as a paste of mustard seed, sesainum or linseed, or Krsara, Payasa ( porridge) Utkarika, or Vesavara, or the drugs of Salvana ( as described ) under the treatment of Vata-Vyadhi) should be similarly applied (lukewarm to the affected locality) folded in a piece of thin linen. This is called the Upanaha-Sveda. 10
द्रवस्वेदस्तु वातहरद्रव्यक्वाथपूर्णे कोष्णकटाहे द्रोण्यां वाऽवगाह्य स्वेदयेत् । एवं पयोमांसरसयूषतैलधान्याम्लघृतवसामूत्रेष्ववगाहेत। एतैरेव सुखोष्णैः कषायैश्च परिषिञ्चेदिति ।। ११ ।।
1. This is called the “Kuti-Sveda”.
2. Drugs of the Kakolyadi group should be used in cases of the dominant deranged pitta acting in concert with the deranged Vayu: those of Eladi group in cases of the dominant deranged Kapha acting in concert with the deranged Vayu and the Salvana, or sesamum linseed, etc. in cases of a simple or complicated deranged Vayu.
Drava – Sveda (Diaphoresis with fluids) : A jar or a cauldron should be filled with a lukewarm decoction of any of the Vayusubduing drugs and the patient should get himself immersed therein. In the same way, the patient should be immersed in tubful of warm milk, meat-soup, soup (of Mudga or Masa pulse), oil, Dhanyamla (fermented or sour gruel), clarified butter, lard, cow’s urine, etc. The patient may also be sprit ove or washed with a tepid decoction (of the above-mentioned drugs.)2 This is called the Drava-Sveda. 11
तत्र तापोष्मस्वेदौ विशेषतः श्लेष्मघ्नौ । उपनाहस्वेदो वातघ्नः । अन्यतरस्मिन् पित्तसंसृष्टे द्रवस्वेद इति ।। १२ ।।
Of the four forms of Sveda described above those known as the Tapa-Sveda and Usma-Sveda pre-eminently destroy the deranged Kapha, while the Upanaha-Sveda subdues the deranged Vayu of the body; the Drava-Sveda, however, is beneficial in cases due to the concerted action of the deranged Pitta with either of the other two Dosas (viz., Vayu and Kapha). 12
कफमेदोऽन्विते वायौ निवातातपगुरुप्रावरणनियुद्धाध्वव्यायामभारहरणाम: स्वेदमुत्पादयेदिति ।। १३ ।।
The patient should be diaphorised by making him put on warm clothing or exposing himself to the sun or by becoming fatigued after a long walk, or by wrestling, or some other physical exercise, load-carrying, etc., or by arousing his anger in a case where the deranged Vayu would be found to be subcharged with the deranged fat or Kapha. 13
भवन्ति चात्रतथा ।। १४ ।॥ चतुर्विधो योऽभिहितो द्विधा स्वेदः प्रयुज्यते । सर्वस्मिन्नेव देहे तु देहस्यावयवे येषां नस्यं विधातव्यं बस्तिश्चैव हि देहिनाम् । शोधनीयाश्च ये केचित् पूर्वं स्वेद्यास्तु ते मताः ।। १५ ।।
1. This is called the Avagaha-Sveda. 2 This is called the “Pariseka-Sveda.”
पश्चात् स्वेद्या हृते शल्ये मूढगर्भानुपद्रवा । सम्यक् प्रजाता काले या पश्चात् स्वेद्या विजानता ।। १६ ।। स्वेद्यः पूर्वञ्च पश्चाच्च भगन्दर्यर्शसस्तथा । अश्मर्या चातुरो जन्तुः शेषान् शास्त्रे प्रचक्ष्महे ।। १७ ।।
Memorable Verses: The four forms of Sveda mentioned above may be employed in two ways, viz. : either to the whole body or to any particular part of it. Sveda should be first employed in cases of patients fit to be treated with errhines (Nasya), purgatives, emetics or with Basti-measures. It should be applied to the enciente in cases of obstructed foetus (Mudha-garbha) unattended with any other supervening distresses (i.e., excessive discharge of blood, etc.) after the extraction of the Salya (the obstructed foetus ) from the womb, and after parturition, and in cases where pregnancy runs to its full and natural term. Sveda should similarly be applied both before and after the surgical operation in cases of fistula-in-ano and stones, gravel, etc., (in the bladder) and of haemorrhoids. Specific modes of applying Sveda in other diseases should be duly described under their respective heads. 14-17
नानभ्यक्ते नापि चास्निग्धदेहे स्वेदो योज्य: स्वेदविद्भिः कथञ्चित् । दृष्टं लोके काष्ठमस्निग्धमाशु गच्छेद् भङ्गं स्वेदयोगैगृहीतम् ।। १८ ।
Men conversant with the rules of Sveda (fomentations, etc.) should, under no circumstances, employ it before rubbing or softening the body or the limb with a Sneha (oil, etc.) inasmuch as a piece of wood is found to break or burst immediately under the application of heat if not previously rubbed with a Sneha. 18
Effects of Sveda
स्नेहक्लिन्ना धातुसंस्थाश्च दोषाः स्वस्थानस्था ये च मार्गेषु लीनाः । सम्यक् स्वेदैर्योजितैस्ते द्रवत्वं प्राप्ताः कोष्ठं यान्ति देहादशेषात् ।। १९ ।। अग्नेदर्दीप्ति मार्दवं त्वक्प्रसादं भक्तश्रद्धां स्त्रोतसां निर्मलत्वम् । कुर्यात् स्वेदो हन्ति निद्रां सतन्द्रां सन्धीन् स्तब्धांश्चेष्टयेदाशु युक्तः ।। २० ।।
Effects of Sveda : Improved digestive capacity (Agni-dipti), softness of the limbs, smoothness and clearness of the skin, relish for food, clearness of the bodily ducts or channels, absence of somnolence and drowsiness and restored functions (free movements) of the numbed bone-joints are the benefits which result from an application of Sveda. The Dosas (morbific principles) having been moistened with a Sneha and lying inherent in the root principles (Dhatus) of the body or imbedded in its ducts or channels or located in their specific seats within the system, become liquefied and carried down into the bowels (Kostha) by and after an application of Sveda and are eventually totally eliminated from the system (by means of correcting measures -D.R.). 19-20
स्वेदास्त्रावो व्याधिहानिर्लघुत्वं सम्यस्विन्ने लक्षणं शीतार्थित्वं प्राहुरेतन्मिथ्यास्विन्ने स्विन्नेऽत्यर्थं सन्धिपीडा विदाहः स्फोटोत्पत्ति: पित्तरक्तप्रकोपः । मूर्च्छाभ्रान्तिर्दाहतृष्णे क्लमञ्च कुर्यात् तूर्णं तत्र शीतं विधानम् ।। २२ ।। मार्दवञ्चातुरस्य । व्यत्ययेनैतदेव ।। २१ । ।
A perfect or satisfactory application of Sveda is marked by a copious flow of perspiration, an abatement or amelioration of the disease, a lightness of the body and a desire for cool things and the softening of the patient’s limbs, while the contrary effects result from an imperfect or unsatisfactory application of the same. An excessive application of Sveda would produce pain in the joints, and heart-burn. It produces blisters, an aggravation of the Pitta, an excited condition of the blood, epileptic fits, delusion, burning sensation thirst, and fatigue. In such a case the evils should be speedily remedied with cooling measures. 21-22
Prohibited cases of Sveda
पाण्डुर्मेही पित्तरक्ती क्षयार्त: क्षामोऽजीर्णी चोदरात विषार्तः । तुच्छर्ता गर्भिणी पीतमद्यो नैते स्वेद्या यश्च मर्त्योऽतिसारी ।। २३ ।। स्वेदादेषां यान्ति देहा विनाशंनोसाध्यत्वं यान्ति चैषां विकाराः । स्वेदैः साध्यो दुर्बलोऽजीर्णभक्तः, स्यातां चेद्वौ स्वेदनीयौ ततस्तौ ।। २४ । ।
Prohibited cases of Sveda: Applications of Sveda should not be resorted to in cases of persons suffering from anaemia, urinary complaints, haemorrhage, pulmonary consumption ( Ksaya), emaciation, indigestion, ascites (Udara),¹ thirst, vomiting. diarrhoea, and from diseases due to the effects of poison. It is also prohibited in respect of pregnant women and intoxicated persons, inasmuch as an application of Sveda proves fatal in these cases or tends to impart an incurable character to the disease (inflicting an irreparable injury to the whole organism). If the patient is suffering from a disease curable by sudation therapy and even though he may be week or suffering from indigestion, sudation therapy should be given to him. 23-24
1. Vrnda evidently quotes this verse from Susruta Samhita but by a little change in the versification he excludes cases of vomiting and poisoning from the list and mentions only the cases of Dakodara (instead of Udara in general) as unfit for Sveda and this is consistent with the treatment prescribed by Susruta himself in Chapter XIV, Chikitsa Sthana.
एतेषां स्वेदसाध्या ये व्याधयस्तेषु बुद्धिमान् ।
मृदून् स्वेदान् प्रयुञ्जीत तथा हन्मुष्कदॄष्टिषु ।। २५ ।।
Mild Sveda may be applied (and that only in cases of emergency) to the aforesaid persons suffering from diseases amenable only to an application of Sveda as well as to the regions of the eyes, the heart ( Hrdaya) and the scrotum. 25
सर्वान् स्वेदान् निवाते च जीर्णान्नस्यावचारयेत् । स्नेहाभ्यक्तशरीरस्य शीतैराच्छाद्य चक्षुषी । स्विद्यमानस्य च मुहुर्हृदयं शीतलैः स्पृशेत् ॥ २६ ॥
Sveda should be applied unto a patient in a covered and windless place and after the complete digestion of his ingested food, and after having anointed his body with a Sneha. During the application of Sveda (to the eyes and to the heart) the eyes of the patient should be (first) covered with something cold (e.g., lotus leaves etc.) and the heart should be constantly touched with something cold (e.g., cold palms of the hand, etc.) 26
सम्यस्विन्नं विमृदितं स्नानमुष्णाम्बुभिः शनैः । स्वभ्यक्तं प्रावृताङ्गञ्च निवातशरणस्थितम् । भोजयेदभिष्यन्दि सर्वं चाचारमादिशेत् ।। २७ ।।
After a full and complete application of Sveda, the (body of the) patient should be well rubbed with a Sneha (oil, etc.) and a hot bath should be prescribed. The patient should then be made to keep his body well covered (with warm clothes) and be removed to a windless chamber (immediately afterwards). The diet should consist of such articles as would not produce any internal secretion (in the channels of the system) and he should observe, if necessary, the other rules of conduct ( enjoined in such cases). 27
इति सुश्रुत संहितायां चिकित्सास्थाने स्वेदावचारणीयं चिकित्सितं नाम द्वात्रिंशोऽध्यायः ।। ३२ ।।
Thus ends the Thirty-second Chapter in the Chikitsa Sthana Susruta Samhita which treats of the applications of Sveda.