Effect Of Siddhar Varma Therapy On Sialorrhea Assessed By The Drooling Severity And Frequency Scale: A Case Report

Sialorrhea, commonly referred to as excessive drooling, is a frequent and distressing complication in patients with neurological disorders such as stroke, cerebral palsy and traumatic brain injury. It results from impaired oro-facial motor control, reduced lip closure and altered swallowing reflex. Persistent drooling leads to physical discomfort, social embarrassment, speech difficulties and increased risk of aspiration, thereby significantly reducing quality of life.

In Siddha medicine, disorders of oro-facial motor control and abnormal secretions are understood as manifestations of deranged Vaatham and Kabam humors, affecting the normal functioning of Oral structures. Classical Varmam literatures by our Siddhars Agathiyar, Theraiyar & Thirumoolar describe specific Varma points that regulate neuromuscular coordination and secretory balance in the head and neck region.

Siddhar Varma Therapy is a non-invasive therapeutic modality that stimulates vital energy points to restore physiological harmony. Certain Varma points namely Ottu Varmam, Urakka Kalam, and Kavzha Varmam are anatomically located near the sublingual, submandibular and parotid salivary glands respectively. These points are traditionally indicated for oro-facial motor dysfunctions and disorders of speech & swallowing.

This case report evaluates the effect of Siddhar Varma Therapy on Sialorrhea in a post-stroke patient using the Drooling Severity and Frequency Scale (DSFS) as an objective outcome measure.

CASE PRESENTATION:

A 21-year-old female participant has been presented with persistent drooling of saliva following a history of trauma and subsequent ischemic stroke due to cerebral ischemia. The cerebro vascular trauma resulted in impaired oro-facial motor control and reduced oral muscle coordination leading to Sialorrhea, which significantly affected her daily activities, communication and social interaction.

The patient exhibited continuous anterior drooling, poor lip seal and difficulty in voluntary swallowing. There was no active infection or structural abnormality of the oral cavity. The condition was diagnosed as neurologically induced Sialorrhea secondary to cerebral ischemic stroke.

Baseline assessment was performed using the Drooling Severity and Frequency Scale (DSFS). The pre-treatment scores were:

Severity: 4 (Profuse drooling; clothing, hands and objects become wet)

Frequency: 3 (Frequent drooling; part of every day)

Based on Siddha Varmam principles and anatomical correlation with salivary glands, Siddhar Varma Therapy was administered using three specific Varma points located near the major salivary glands, as depicted in the intervention image:

1. Ottu Varmam – Corresponding to the sublingual gland region

2. Urakka Kalam – Corresponding to the submandibular gland region

3. Kavzha Varmam – Corresponding to the parotid gland region

These points are traditionally described in Siddha Varma literature as regulating oro-facial motor functions and Vaatham–Kabam dynamics. Gentle, standardized manual pressure was applied over each Varma point in a therapeutic sequence, following Siddhar Varma methodology. The intervention was carried out over a defined treatment period under controlled clinical conditions.

METHODOLOGY:

Study Design:

Case Report clinical observational study.

Study Period:

15 days

Study Place:

Government Siddha Medical College & Hospital, Palayamkottai,Tirunelveli

Inclusion Criteria:

• Patient with neurological history
• Presence of persistent drooling (sialorrhea)
• Willingness to participate and give informed consent

Exclusion Criteria:

• Active oral infection
• Structural abnormality of oral cavity
• Acute systemic illness

Assessment Tool:

Drooling Severity and Frequency Scale (DSFS)

The Drooling Severity and Frequency Scale (DSFS) has been employed for clinical assessment.

Severity Scale:

1 – Dry

2 – Mild (wet lips only)

3 – Moderate (wet on lips and chin)

4 – Severe (clothing becomes wet)

5 – Profuse (clothing, hands, objects wet)

Frequency Scale:

1 – Never

2 – Occasionally

3 – Frequently

4 – Constantly

Intervention:

Therapy Type:

Siddhar Varma Therapy

PROCEDURE:

Figure 1 : Anatomical Representation of Salivary Glands with Corresponding Varma Points

Table 1: The intervention targeted three Varma points anatomically correlated with the major salivary glands

Gentle, standardized manual pressure was applied to each Varma point in a therapeutic sequence as per Siddhar Varma methodology. The therapy was administered under controlled clinical conditions over a defined treatment period. The pressure applied was non-invasive and within tolerable limits.

DSFS scoring was performed before initiation of therapy and after completion of the intervention period.

Preparation & Safety

Before beginning, ensure the patient is in a relaxed, upright position. This prevents choking and allows for better access to the neck and jawline.

Warmth: Ensure your hands are warm to avoid muscle guarding.

Pressure: Varma points are sensitive. So gentle pressure should be given to the tissue, never sharp or painful.

3-Step Regulation Procedure

Step 1: Kavzha Varmam (Targeting the Parotid Glands)

The parotid glands are the largest salivary glands, located just in front of and below each ear.

• Hand Position: Use your thumb on one side of the face and the middle finger on the other.
• Action: Apply simultaneous inward pressure.
• Timing: Hold for 5–10 seconds, then release slowly.
• Frequency: Repeat 3 times.

Step 2: Urakka Kalam (Targeting the Submandibular Glands)

These glands are located beneath the floor of the mouth, along the inner side of the lower jawbone.

• Hand Position: Use your index, middle and ring fingers.
• Action: Apply a gentle downward stroke along lower jaw.
• Sequence: Treat one side at a time to ensure precision.
• Frequency: 3 repetitions per side.

Step 3: Ottu Varmam (Targeting the Sublingual Glands)

The sublingual glands sit directly under the tongue, beneath the chin area.

• Hand Position: Thumb goes above the chin (just below the lower lip) and the other three fingers cradle the area below the chin.
• Action: Apply a gentle inward "pinching" or stabilizing pressure toward the center point.
• Timing: Hold for 5–10 seconds.
• Frequency: Repeat 3 times.

Note: If the patient experiences any dizziness or discomfort during the stimulation of Urakka Kalam (Step 2), stop immediately, as this area is close to major blood vessels in the neck.

Duration:

5 Minutes per session

Frequency:

Once daily

Outcome Measurement:

• Post-treatment DSFS recorded
• Comparison of pre- and post-intervention scores

Ethical Consideration:

• Written informed consent obtained
• Patient identity kept confidential
• No invasive procedures performed

This is a single-patient clinical case study conducted in accordance with Siddha clinical practice principles. Written informed consent was obtained from the participant.

RESULTS:

A significant reduction in both severity and frequency of drooling was observed following Siddhar Varma Therapy.

Table 2 : DSFS Scores Before and After Intervention

Clinically, the patient exhibited:

• Improved lip seal
• Better voluntary swallowing control
• Reduced anterior drooling
• Enhanced comfort during daily activities
• No adverse effects were reported during or after the intervention.

Chart 1: DSFS Scores Before and After Intervention