Materials required:

1. Shashtika shali – 500g
2. Balamoola – 750g
3. Water – Q. S.
4. Cow’s milk – 3litres
5. Cotton cloth (45cm X 45cm) – 4 pieces
6. Threads (75cm) – 8
7. Vessels:
   1. For preparing kwatha
   2. For cooking rice
   3. To heat the boluses in mixture of kwatha and milk during the procedure (5 litres capacity with wide mouth made of bronze)
   4. A plate for carrying heated pottali
8. Stove -1
9. Oil for talam – 10ml
10. Rasnadi choorna – 5g
11. Suitable oil for abhyanga – 100ml
12. Coconut leaves/tongue cleaner – 2
13. Tissue paper/towel – 2
14. Masseurs – 2
15. Attendant – 1

Preparation of the medicine:

Balamoola kwatha – 750g of Balamoola is cleaned, crushed and boiled in 12 litres of water and reduced to 3 litres.

Shashtika rice cooking: In 1.5 litres of Balamoola kashaya and 1.5 litres of milk, 500 g of Shashtika rice should be added and boiled till it becomes thick and semisolid. Sufficient quantity of hot water can be used for proper cooking of the rice. Another method is that the Shashtika rice can be semi cooked in pure water; gradually added milk and kwatha; cooked again.

Preparation of the boluses:

The cooked rice should be divided into 4 equal parts and put into 4pieces of cotton cloths. The three corners should be folded neatly together so as to come under the fourth corner and the fourth fold is used to cover the other three corner folds underneath. One end of the thread is held tight with left hand and the other end is wound around the folds. In short, the boluses should be tied in such a way that the mouth of the sac leaves a tuft at the top of the bundle, for holding it with ease. Conventionally, the size of a bundle is half kernel of a moderate coconut.

Pre operative procedure:

The patient should be seated with leg extended over the droni and talam should be applied with suitable oil. Abhyanga should be then performed with prescribed oil for about 10 minutes. Out of 4 pottalis, 2 are kept in the mixture of Balamoola kwatha and milk (1.5 litres of each was already kept for this purpose), which should be put on a stove with moderate heat.

Procedure:

2 warm potalis should be gently applied in a synchronised manner by the two therapists on two sides of droni. It is followed by a gentle massage with other hand. They should ensure that the heat of the boluses is bearable to the patient by touching them over the dorsum of their hand. The temperature of the boluses should be maintained throughout the procedure by continuous relay of the four boluses after reheating by dipping in milk kwatha mixture. The process should be continued till the patient gets samyak swinna lakshana or until the contents of the boluses exhausted. This procedure is done in the seven positions as in kayaseka or as advised by the physician.

Duration:

 45 minutes – 1 hour, preferable time is in between 7 – 11 am and 4 – 6 pm. The procedure can be stopped if the medicine in the boluses or the milk mixture is exhausted.

Post operative procedure:  

At the end of the procedure, the medicine remained over the body should be scrapped of with the coconut leaves or with any similar device and the body is wiped dry with tissue paper or soft towels. After that medicated oil should be applied. Talam should be removed and Rasnadi choorna applied over the head. Gandharvahastadi kashaya can be given for drinking. The patient should take complete rest for at least half an hour, and then the patient is allowed to take warm water bath.

Precautions:

1. During the preparation of the rice, care should be taken to avoid over/under cooking and should be stirred frequently for the better extraction and cooking.
2. Tie bolus firmly to avoid leaking of contents during rubbing.
3. The therapists in both the sides of the patient should massage with the bolus in a synchronised manner.
4. Ensure uniformity of pressure and temperature on all the body parts.
5. Boluses should be applied with sufficient warmth (45⁰C – 50^oC).
6. The therapy should be stopped at any time if the patient gets good perspiration or shivering.

Complications and management:

1. Shivering: It usually occurs due to the uneven distribution of temperature or prolonged time gap in between the taking up of new boluses; or if body is exposed to cold breeze immediately after the procedure. Allow the patient to take rest cover with a blanket and give warm liquid diet.
2. Fainting: Due to increased body temperature or low heat threshold of the patient or atiyoga of kriyakrama. Sprinkle cold water over the face and body, and put talam with appropriate medicated oil and choorna. Drakshadi kashaya can be given internally.
3. Rashes: Due to heat intolerance of the patient of pitta prakriti. Apply madhu & ghrita, preferably Shatadhouta Ghrita or Murivenna.