Role of Panchatiktaka Ghrita as Shodhanartha Snehapana  
in management of Ekakushta (Psoriasis) 
 
By 
ANILA M 
DISSER...
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PPPAAANNNCCCH...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, 
BANGALORE, KARNATAKA 
 
DECLARATION BY THE CANDIDATE 
I  hereby  declare  tha...
COPYRIGHT 
DECLARATION BY THE CANDIDATE 
 
I  hereby  declare  that  Rajiv  Gandhi  University  of  Health  Sciences,  Ban...
Acknowledgement
My gratitude, which is the mother of all virtues and most capital of all duties, has all there order
and d...
I am extremely grateful to my co-guide Dr. Ashvinikumar M. Asst. professor & H.O.D.,
Dept. of Panchakarma, for his constan...
 
 
LIST OF TABLES
Table No. Table descriptions Page No
1 Panchamahabhuta combination of Sneha 5
2 Sthavara Sneha and part...
35 Samhanana wise distribution of the sample 87
36 Satva wise distribution 87
37 Satmya wise distribution of the sample 87...
65 No of days reqired for Samyak Snehana 102
66 Paired ‘t test - fixed ArohanaMatra group 103
67
Assessment of signs & sym...
LIST OF GRAPHS 
1 Age wise distribution 93
2 Koshta wise distribution 93
3 Jarana wise distribution 93
4 Addiction wise di...
CONTENTS
Page no.
1. Introduction and Objectives 1
2. Review of Literature
• Snehana Karma 4
• Vrechana Karma 29
• Twak 36...
Introduction…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
1
INTRODUCTION
Snehana...
Introduction…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
2
3. To compare the ef...
Introduction…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
3
In fixed Arohana Mat...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
4
LITERARY REVIEW
...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
5
GUNAS OF SNEHA D...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
6
Maha Snehas or P...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
7
TABLE -2
STHAVAR...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
8
II. Paka Bheda -...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
9
b) Vicharana - U...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
10
Sneha dose is n...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
11
TABLE-7
INDICAT...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
12
TABLE-8
OPNION ...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
13
become accustom...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
14
TABLE-10
SHAMAN...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
15
Urusthambha. If...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
16
85
i.e. in pers...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
17
I. Purvakarma-
...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
18
a) Sneha Jiryam...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
19
of Jataragni in...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
20
ii). Asnigdha -...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
21
2. Brahmacharya...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
22
Mistakes of Pat...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
23
preceeded by ce...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
24
Drava-Sneha inc...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
25
DIGESTION OF SN...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
26
clear that ther...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
27
Romakupa Mala e...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
28
Pakvasaya is th...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
29
VIRECHANA KARMA...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
30
Vamana Dravya, ...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
31
CLASSIFICATION ...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
32
Bhedaniya, Vire...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
33
TABLE -16
DOSES...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
34
TABLE -18
ASSES...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
35
III. PASCHAT KA...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
36
TVAK
Tvak is th...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
37
TABLE-20
LAYERS...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
38
SKIN
The Skin o...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
39
layer heals wit...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
40
Keratinization:...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
41
iv. Immunity: S...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
42
KUSHTA
Kushta i...
Conceptual Study…
Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta
43
permutation and...
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Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in management of Ekakushta (Psoriasis), ANILA M, DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA, SHRI DHARMASTHALA MANJUNATHESHWARA, COLLEGE OF AYURVEDA & HOSPITAL, HASSAN

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  1. 1.     Role of Panchatiktaka Ghrita as Shodhanartha Snehapana   in management of Ekakushta (Psoriasis)    By  ANILA M  DISSERTATION SUBMITTED TO  RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,  BANGALORE, KARNATAKA    IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE  OF  AYURVEDA VACHASPATI (M.D.‐AYURVEDA)  IN PANCHAKARMA UNDER THE GUIDANCE OF Dr. Girish K.J, M.D. (Ayu.), Ph.D.,     DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA  SHRI DHARMASTHALA MANJUNATHESHWARA   COLLEGE OF AYURVEDA & HOSPITAL,  HASSAN – 573 201    2009 
  2. 2. DDDEEEPPPAAARRRTTTMMMEEENNNTTT OOOFFF PPPOOOSSSTTT---GGGRRRAAADDDUUUAAATTTEEE SSSTTTUUUDDDIIIEEESSS IIINNN PPPAAANNNCCCHHHAAAKKKAAARRRMMMAAA SHRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA & HOSPITAL HASSAN – 573 201 CCCeeerrrtttiiifffiiicccaaattteee This is to certify that the Dissertation entitled ‘Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta (Psoriasis) is the bonafide record of research work conducted by “Anila m” under our direct supervision and guidance as a part fulfillment for the award of the degree of M.D. in Ayurveda – Panchakarma The candidate has put in sincere and laborious effort after making an intense study coupled with theoretical and practical observations. She tried to critically analyze Ayurvedic references and observations in this regard. The candidate has fulfilled all the requirements of ordinances laid down in the prospectus of Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for the award of Degree of Doctor of Medicine (Ayu.) Panchakarma We are fully satisfied with her work and recommend this thesis to be forwarded for adjudication. P.G.. . HassanHassan 573201 – 573201 Date: Guide Dr. Girish K.J. M.D. (Ayu.)Ph.D., Asst. Prof., Dept. of P G Studies in Panchakarma SDM College of Ayurveda, Hassan Date: Place: Hassan   Co – Guide Dr. Ashvini Kumar M M.D. (Ayu.), Asst. Prof. & H.O.D. Dept. of P G Studies in Panchakarma SDM College of Ayurveda,Hassan  
  3. 3. DDDEEEPPPAAARRRTTTMMMEEENNNTTT OOOFFF PPPOOOSSSTTT ––– GGGRRRAAADDDUUUAAATTTEEE SSSTTTUUUDDDIIIEEESSS IIINNN PPPAAANNNCCCHHHAAAKKKAAARRRMMMAAA SHRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA & HOSPITAL HASSAN – 573201 (Affiliated to R.G.U.H.S, Karnataka, Bangalore) ENDORSEMENT BY THE HOD AND HEAD OF THE INSTITUTION  This is to certify that the dissertation entitled “Role of Panchatiktaka Ghrita as  Shodhanartha Snehapana in the  management of Ekakushta  (Psoriasis).” is the  bonafide record of research work conducted by “Anila.M” under the guidance of  Dr. Girish K.J, Asst. Prof., Dept. of P.G. Studies in Panchakarma, SDM College of  Ayurveda, Hassan – 573 201.  Dr. Ashvini Kumar M M.D. (Ayu.), Asst. Prof. & H.O.D. Dept. of P G Studies in Panchakarma SDM College of Ayurveda, Hassan Date: Place: Hassan     Dr. Prasanna N Rao, M.S. (Ay.), Ph.D., Principal SDM College of Ayurveda, Hassan
  4. 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,  BANGALORE, KARNATAKA    DECLARATION BY THE CANDIDATE  I  hereby  declare  that  this  dissertation/thesis  entitled  “Role  of  Panchatiktaka  Ghrita  as  Shodhanartha  Snehapana  in  the    management  of  Ekakushta   (Psoriasis)” is a bonafide and genuine research work carried out by me under the  guidance  of  Dr.  Girish  K.J.  M.D.  (Ayu.),  Ph.D.,  Asst.  Prof.,  Dept.  of  P.G.  Studies  In  Panchakarma, SDM College of Ayurveda, Hassan – 573 201      Date:      Signature of the candidate  Place: Hassan                                                       Anila M         
  5. 5. COPYRIGHT  DECLARATION BY THE CANDIDATE    I  hereby  declare  that  Rajiv  Gandhi  University  of  Health  Sciences,  Bangalore,  Karnataka  shall  have the rights to preserve, use and disseminate this dissertation/ thesis in print or electronic  format for academic/ research purpose.      Date:                Signature of the candidate  Place: Hassan                Anila M                        © Rajiv Gandhi University of Health Sciences, Karnataka 
  6. 6. Acknowledgement My gratitude, which is the mother of all virtues and most capital of all duties, has all there order and diligence to all those who graciously involved in this venture of mine. There is much greatness of mind in acknowledging a good turn, as in doing it. I humbly, seek this opportunity to bow my head to the feet of almighty Lord Dhanwantari for showering their blessings and empowering me to this eventful outcome without any impediments. I pay my respectful salutations to his Holiness Poojya Shri Veerendra Heggadeji, founder father of SDMCA&H, Hassan and fountainhead of educational movements, for his divine blessings in disguise and who has been kind enough to provide me an opportunity to study and render my service in this esteemed institution. My vocabulary falls short of suitable words to express my recondite sense of indebtedness to my benevolent teacher Prof. Prasanna N. Rao, Principal, who has been a guiding force and instrumental in all the proceedings of my postgraduate study and stood as an excellent encouraging stanchion in all strides in accomplishing this meticulous effort. It is beyond the reach of my language to inscribe the profound respect and devotion towards affectionate Prof. Gurdip Singh. Director, P.G. Board of Studies, for his constant support, timely guidance and valuable suggestions to get this work done successfully. The words are inadequate to express with profound reverence my heartiest gratitude and indebtedness to my guide Dr. Girish K. J. Asst. Prof., Dept. of Panchakarma, for his untiring help, close and constant attention with constructive and valuable suggestions at every steps of this work.
  7. 7. I am extremely grateful to my co-guide Dr. Ashvinikumar M. Asst. professor & H.O.D., Dept. of Panchakarma, for his constant support and guidance during my thesis work. I extend my respect to Dr. T. B. Tripathy Dr. Muralidhar P. Pujar vice principal, Dr.Narayana Prakash for their valuable guidance throughout my post graduation & helping me in various aspects to complete this work. I express my gratitude and cordial thanks teachers Dr. Lohith B. A, Dr. Praveen B. S., Dr. Prakash Hegde,Dr. Kiran Kumar,Dr. Pratibha ,Dr.D.P Joshi for providing support during my thesis work. The truth dawns on me that, the language of words suffers very stringent limitation to express my gratitude and indebt to the sacrifices of my most beloved and respected parents Shri Muraleedharan Pillai and Sou. Rajambika who are the cause for me to take this noble profession and shape me into what I am today. I am equally thank full to my in –laws Gopinathan Nair,Girija Kumari and my husband Mr.Srijith who have supported me during each and every step My vocabulary falls short of suitable words to express my deep sense of gratitude to my brother Mr. Aswin M for supporting, blessing and praying for my success in life. Anila.M
  8. 8.     LIST OF TABLES Table No. Table descriptions Page No 1 Panchamahabhuta combination of Sneha 5 2 Sthavara Sneha and part 7 3 Jāngama sneha & their Ashaya 7 4 Jangama sneha and its Upayoga 7 5 Opinion of different acharyas regarding varieties of Sneha paka and its indications 8 6 Sneha Matra according to Sushruta 10 7 Indication of Sneha Matra 11 8 Opnion in Laghu trayis regarding the dosage of Snehapana 12 9 Opinion of Vangasena regarding dosage of Arohana Snehapana 12 10 Shamana and Brumhana Snehana Yogya: 13 11 Snehapana arha for Ghrita Taila Vasa Majja 14 12 Time of administration of Sneha according to Dosha dominance 16 13 Sneha Jiryamana and Jirna Lakshana 19 14 Asnigdha Lakshana 20 15 Bhautik composition of Virechana Dravya 29 16 Doses of Virechana drugs 33 17 Matra according Koshta 33 18 Assessment parameters of Virechana 34 19 Layers of the skin 36 20 Layers of skin according to Acharya Shusruta and commonly occurring disease in that layer 37 21 Different layers according to other Acharyas 37 22 Lakshanas according to predominance of Doshas 48 23 Lakshanas according to Dhatu Dushti 48 24 Lakshanas according to Srotas 48 25 Pharmacidynamics of the Panchakola churna 72 26 Pharmacodynamics of drugs used for Moorchana of Tilataila 72 27 Scoring for Samyak Snigdhata 74 28 Assessment of Lakshans of Ekakushta 81 29 Age wise distribution of 30 patients of Ekakushtha 85 30 Sex wise distribution of 30 patients of Ekakushtha 85 31 Religion wise distribution 86 32 Kostha wise distribution 86 33 Occupation wise distribution 86 34 Sara wise distribution of the sample 87
  9. 9. 35 Samhanana wise distribution of the sample 87 36 Satva wise distribution 87 37 Satmya wise distribution of the sample 87 38 Abhyavaharana shakti wise distribution 88 39 Jarana sakthi wise distribution of the sample 88 40 Diet habit wise distribution of the sample 88 41 Vyasana wise distribution 88 42 Shareerika prakriti distribution 89 43 Nature of sleep 89 44 Dominant rasa wise distribution 89 45 Viruddha Ahara wise distribution 90 46 Emotional status reported wise distribution 90 47 Family history of psoriasis 90 48 Aggravating factors reported wise distribution 91 49 Relieving factor wise distribution 91 50 Site of lesion 91 51 Distribution of Symptoms of Ekakushta 92 52 Characteristics of lesion in 30 patients of psoriasis 92 53 Distribution according to total quantity of Abhyantara Snehapana 95 54 Distribution according maximum dose given on last day of Snehapana 95 55 Appearance of Jeeryamana Lakshana- Shiroruja 96 56 Appearance of Jeeryamana Lakshana-Bhrama 97 57 Appearance of Jeeryamana Lakshana-Nisthiva 97 58 Appearance of Jeeryamana Lakshana-Klama 98 59 Appearance of Jeerna Lakshana-Shareera Laghuta 98 60 Appearance of Ksudpravrutthi 99 61 Appearance of Jeerna Lakshana-Vatanulomana 100 62 Appearance of Jeerna Lakshana-Trishna 100 63 Appearance of Jeerna Lakshana - Udgara Suddhi 101 64 Appearance of Jeerna Lakshana - Utsaha 101
  10. 10. 65 No of days reqired for Samyak Snehana 102 66 Paired ‘t test - fixed ArohanaMatra group 103 67 Assessment of signs & symptoms Before Snehapana and after Snehapana 104 68 Fixed 10Arohana Matra group assessment of signs & symptoms before Snehapana (BS) and after Virechana (Av) 105 69 Appearance of Jeeryamana Lakshana-Shiroruja 106 70 Appearance of Jeeryamana Lakshana-Bhrama 106 71 Appearance of Jeeryamana Lakshana-Nishtiva 107 72 Apearance of Jeeryamana Lakshana-Klama 107 73 Appearance of Jeerna Lakshana-_Shareera laghuta 108 74 Appearance of Jeerna Lakshana-Ksudpravruthi 108 75 Appearance of Jeerna Lakshana- Vatanulomana 109 76 Appearance of Jeerna Lakshana-Trishna - 110 77 Appearancence of Jeerna Lakshana - Udgara Suddhi 110 78 Appearance of Jeerna Lakshana- Utsaha 111 79 No of days required for Samyak Snehana 111 80 Effect of non fixed Arohana Matra Snehapana on Samyak Snigdha Lakshanas paired ‘t’ test- 112 81 Assessment of signs & symptoms Before Snehapana bt and after Snehapana as 113 82 Assessment of signs & symptoms Before Snehapana bt and after Virechana 114 83 Result of un- paired “t” test 115  
  11. 11. LIST OF GRAPHS  1 Age wise distribution 93 2 Koshta wise distribution 93 3 Jarana wise distribution 93 4 Addiction wise distribution 93 5 Parkruthi wise distribution 93 6 Signsa and symptoms wise distribution 93 7 No of days required for Samyak Snigdhata wise distribution 93 8 Percentage of Samyak Snigdhata obtained 93 9 Maximum dose of Snehapana given on last day 116 10 Gradation of Samyak Snigdhata 116 11 Effect of Snehapana on Lakshanas of Ekakushta 116 12 Effect of Snehapana on Lakshanas of Ekakushta 116 13 Overall result of Snehapana on Lakshanas of Ekakushta 116 14 Overall result of Snehapana on Lakshanas of Ekakushta 116 15 Jeerna Lakshana in F-group 123 16 Jeerna Lakshan in NFgroup 123
  12. 12. CONTENTS Page no. 1. Introduction and Objectives 1 2. Review of Literature • Snehana Karma 4 • Vrechana Karma 29 • Twak 36 • Skin 38 • Kushta 42 • Psoriasis 54 • Drug Review 67 3. Clinical Study 76 4. Observation 84 5. Results 94 6. Discussion 117 7. Summary 132 8. Conclusion 136 9. References 139 10.Bibliography 149 11.Annexure 151
  13. 13. Introduction… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 1 INTRODUCTION Snehana is a procedure mentioned under Shad Upakrama which is being used independently for the promotion of health, cure of many diseases as well as a part of Shodhana as its Purvakarma. Snehana is an important preoperative procedure that has to be done before Shodhana. Proper Snehana is essential for attainment of Samyak Suddhi. Sneha is the important Karma that decides the whole outcome of Shodhana. The Shodhananga Snehana effect can be achieved by following one of the available methods of administration of Sneha such as, Matranusara Snehana, Arohana Snehana, Sadyo Snehana and Pravicharana Snehana. Currently Arohana Sneha Matra is done by increasing the dosage of Snehapana in multiples of Hrusiyasi Matra. Samyak Snehana is based on Agni and Koshta. So in this study a new approach was done by increasing Snehapana on basis of Agni Deepana attained on that particular day of Snehapana. Acharya Shusruta has advised to administer a dose that gets digested in 9 hours in Bahu Doshaja Rogas for Snehapana (Su Chi 31:28). This seemed to be a very practical dose. Ekakushta was taken as the disease in this study as an example as it is a Bahu DoshajaVyadhi. Psoriasis is one of the most common skin diseases, affecting up to 1-2% of the world’s population. Males & females are equally predisposed & all the age groups are affected. It has been recognized as non-infectious, papulosquamous skin disease easily diagnosable in its typical form, usually runs a chronic course with remission and exacerbations. The exact etiology is still unknown, but many precipitating factors like genetic, environmental, immunological and psychological have been found to be influential in the manifestation of the disease. In Ayurveda there is no single entity, which can be exactly correlated with psoriasis. In present study it has been taken as Ekakushtha, because it is more similar with psoriasis than any other type of Kushtha OBJECTIVES OF THE STUDY 1. To evaluate the efficacy of fixed Arohana Matra Snehapana on Samyak Snigdhata and effect on Lakshanas of Ekakushta. 2. To evaluate the efficacy of Non -fixed Arohana Matra Snehapana on Samyak Snigdhata and effect on Lakshanas of Ekakushta.
  14. 14. Introduction… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 2 3. To compare the effects of both groups to ascertain that which Snehapana Matra is better in obtaining Samyak Snigdhata and Providing relief in Lakshanas of Ekakushta after Virechana . 30 patients of Ekakushta from the I.P.D of S.D.M College of Ayurveda and Hospital, Hassan were selected irrespective of their age, sex, religion etc. They were examined clinically in detail .The selected patients were divided randomly into Fixed Arohana Matra group and Non-Fixed Arohana Matra group with 15 patients in each group. Fixed Arohana Matra group- In this group, following Samyak Deepana & Pachana, on the first day Hrusiyasi Matra i.e. 30ml of Sneha was given and dose of Sneha was increased in multiples of Hrusiyasi Matra daily till the appearance of Samyak Snigdha Lakshanas or maximum 7 days whichever was earlier. Non fixed Arohana Matra group- In this group, after Nirama Lakashanas are seen, on the first day, Hrusiyasi Matra (TD - Test dose) i.e. 30ml was given. For the next day the dose was calculated using the following formula. Next day dose = P.D D. X 9 ÷ Time for digestion of previous day dose P.D.D. = Previous day dose 9 = is a constant Time required for digestion of digestion of Sneha in Bahudoshaja Vyadhi. Snehapana was continued till the appearance of Samyak Snigdha Lakshanas or maximum 7 days, whichever was earlier. So the increase in dose of Sneha was not fixed and was variable from person to person depending upon the time for digestion. (Su Chi 31:28). Then Virechana Karma was done and effects on two groups were evaluated .The results showed that the Fixed Arohana Matra group and Non fixed Arohana Matra group showed Samyak Snigdha Lakshana, but on comparison Non fixed Arohana Snehana was found to have better effect in terms of % of Samyak Snehana. In fixed Arohana Matra group after Snehapana, no Patients had marked improvement and in Non fixed Arohana Matra -group 1 patients had marked improvement .In F-group, no Patients had moderate improvement and in Non fixed Arohana Matra group 2 patients had moderate improvement In F-group mild change was seen in 10 patients and in Non fixed Arohana Matra -group, mild change was seen in 5 patients. In F-group no change was seen in 5 patients and in Non fixed Arohana Matra -group, no change was seen in 7 patients.
  15. 15. Introduction… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 3 In fixed Arohana Matra group after Virechana, no Patients had marked improvement and in Non fixed Arohana Matra -group 2 patients had marked improvement .In fixed Arohana Matra -group, 5 Patients had moderate improvement and in Non fixed Arohana Matra -group 5 patients had moderate improvement .In fixed Arohana Matra -group mild change was seen in 7 patients and in Non fixed Arohana Matra -group, mild change was seen in 6 patients. In fixed Arohana Matra -group no change was seen in 3 patients and in Non fixed Arohana Matra - group, no change was seen in 2 patients. Overall results shows that Non fixed Arohana Matra -Group had better results on Samyak Snigdhata, Lakshanas of Ekakushta after Snehapana and after Virechana than fixed Arohana Matra -group.
  16. 16. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 4 LITERARY REVIEW SNEHAPANA Snehana is the main Poorvakarma to be administered before Shodhana therapy i.e.Vamana, Virechana etc. 1 Snehana is one among the Shadvidhopakrama.2 NIRUKTI OF SNEHA-The word Sneha is Masculine in gender and is derived from ‘Snih’ Dhatu by suffix ‘lyut’ Pratyaya. (Vachaspatya) The mool ‘Snih’ has two meanings --‘Snih - Preetau’ to render affection and ‘Snih – Snehane’ to render lubrication. Among these later Snih – Snehane’ to render lubrication will be more adopted in the present context. The meaning of term Sneha means, a substance that brings oiliness or unctuousness. Sneha literally means oiliness, unctuousness, fattiness, greasiness, lubricity, viscidity, affection, love, kindness and tenderness3 . DIFFERENCE BETWEEN SNIGDHA AND SNEHA4 -Snigdha represents a Guna present in a Dravya and indicates presence of Sneha in it. That which promotes strength, colour, and softness in body is called Snigdha. Snigdha is Guna capable of rendering Kledana in body. PARIBHASHA OF SNEHA- ‘Snehanam Snehavishyandanam Mardavakledakarakam’5 Charaka defines Snehana as, the procedure by which Snigdhata, Vishyandana (Drava Srutihi –Vilayana) 6 Mardavata and Kledana are produced in the body. The measures adopted to bring about Snigdhata in the body are known as Snehana. • Word Sneha is used to describe the external application of Sneha Dravyas. 7 • Charaka has explained the action of Sneha as “Snehoanilamhanti Mrudukarotideham, Malanam Vinihantisangam” i.e. Sneha helps in bringing balance in vitiated Vata, renders the body, softens and clears the accumulated Malas which have obstructed the Srotamsi.8 Shodhanaga Abhyantara Snehapana indicates the administration of Sneha Dravyas before the Shodhana procedures i.e. Vamana and Virechana. 9 SYNONYMS-The synonyms mentioned for Snehana are Sneha, Snigdhata, Mrtkshana, Mrksha, Abhyanga and Abhyanjana.10
  17. 17. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 5 GUNAS OF SNEHA DRAVYAS-The Karma of a Dravya is dependent on its Guna. The Properties of Sneha Dravya’s are Sukshma,Sara,Snigdha, Drava, Picchila, Guru, Shita, Manda and Mrdu,which are having opposite properties of Rukshana Dravyas. 11, 12 There are certain exception regarding all Sneha Dravya having Sneha Guna, The word Prayo in indicates that exceptions.13 TilaTaila14 (best among Stavara Sneha) even though it is Tikshna and Ushna it acts like Snehana. Yava, though it possesses Guru, Sheeta, and Sara gunas produces Rukshata15.  BHOUTIKA SANGHATANA-All the Ahara, Aoushada Darvya is composed of Panchamahabhutas. Sneha is predominantly constituted of Apya Mahabhuta. The properties and qualities of AP Mahabhuta are more ascribed to Sneha Dravyas such as Snigdha, Sita, Manda, Sara, Mridu, Picchila, Sukshma, Mridu Gunas of Sneha is ascribed to Akasha Mahabhuta and Guru Guna is ascribed to Prithvi Mahabhuta. So confirms that Sneha is of Apya Mahabhuta Predominance.16 It is told that, the Tridosha, Saptadhatu and Malas increase by the use of Substances possessing homologous properties, and decreases by the use of antagonistic substances i.e. Substances possessing opposite properties. Panchabhoutika composition of Snehas and its Guna, Karma is mentioned below.  TABLE NO -1  PANCHA MAHA BUTAKATVA Dominant Mahabhutha Guna Prithvi Ap Teja Vayu Akasha Karmukata Picchila ++++ Lepana, Jivana, Samghata, Sandhana, Balya, Gouravata17 Sukshma ++ ++ +++ Sroto Vishodhana, Vivarana, Soushiryakara.18 Sara ++ + Anulomana, Vyaptisheela, Preranasheela.19 Snigdha + ++++ Snehana, Mardavata, Kledana Bandhana, Vishyandana.20 Drava ++++ Prakledana, Vilodhana, Prasari.21 Guru ++++ ++ Brumhana, Malavriddhikara, Tarpana, Angaglani, Balakara.22 Shita +++ ++ Sthambhaka, Hladana.23 Manda ++ + Shamana.24 Mrdu ++ +++ Shaithilya of Avayava, Mardavata.25
  18. 18. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 6 Maha Snehas or Pravara Sneha-Among all the Sneha Dravyas, Ghrita, Taila, Vasa and Majja are the most important Snehas because of their excellence in Snehana qualities26 .Out of these Ghrita is best because of its properties like Samskarasya Anuvarthanam27, 28 (i.e. it can imbibe the qualities of that Dravya with which it is combined without losing its own property).Out of Maha Sneha Ghrita is the less Guru compared to all the other 3 and Majja is most Guru. Sneha Action of on Doshas 1. on Vata Shleshma- Taila – Vatashleshmaghnatama Majja - Vatashleshmaghna Vasa - Vatashleshmaghnatara 2. on Pitta Dosha- Vasa- Pittaghna Majja – Pittaghnatara Ghrita - Pittaghnatama CLASSIFICATION OF SNEHA I. Based on Yoni (source)-There are two sources of Dravyas viz.Sthavara and Jangama29 . The first Classification of Sneha Dravya is done according to their origin or source of procurement. Sneha is obtained from two sources) (A). Sthavara or plant origin -Ghrita Pradhanam (b). Jangama or animal originTaila Pradhanam30 Sthavara is the Sneha from Phala& Sara Phala Snehas (fruits and seeds) - which include the Snehas obtained from seeds; in case of fruits, mesocarp or endocarp,and nuts of marrow. E.g. Tila, Shigru, Akshoda, etc.Sara Snehas -Snehas obtained from complete stem or only the central portion of stem i.e. Pith.E.g.Sarala, Devadaru, Agaru, Candana etc. Sthavara Sneha Ashaya -Tila, Priyala, Abhishuka, Bibhitaka, Chitraka, Abhaya Eranda,Madhuka, Sarshapa, Kusumba, Bilva, Aruka, Mulaka, Atasi, Aksoda, Karanja and Shigruka. Snehas are not limited only to these two types of classification. Snehas are also obtained from the other parts of the plants, which are as follows-
  19. 19. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 7 TABLE -2 STHAVARA SNEHA AND PART Oil rich part of plant Example Mula Sunthi, Gambhari Tvak Tvak Patra Nirgundi, Tailaparni Pushpa Kesara, Lavanga Jangama: a. Natural - Milk, Medas, Majja, Egg, Khagaja, Mrigaja, Jalaja b. Artificia-Vasa,Navaneeta,Dadhi,Beewax,Ghee. Acharya Shusruta also has mentioned the Classification of Sneha on basis of origin 32 ,where he has mentioned approximately 31 Sthavara Sneha along with their area of action. TABLE -3 JANGAMA SNEHA & THEIR ASHAYA 33  Sneha Ashaya Ghrita Ksheera & Dadhi Taila Phala & Daru Vasa Mamsa Majja Asthi                                   TABLE -4 STHAVARA SNEHA AND ITS UPAYOGA  Dravya Upayoga Lodhra, Eranda, Koshamra, Danti, Dravanti,Saptala, Sankhini, Vishanika, Gavakshi,Kampillaka Virechana Jimutaka, Kutaja, Kritavedhana, and Madana Vamana Vidanga, Pilu, Jyotishmati, Kharamanjari, Madhusigru, Siddharthak & Jyotishmati Siro Virechana Upayogi Karanja, Putika, Kritamala Ingudi,Kirata tikta Dushta Vranopayogi Tuvaraka, Kapitthaka, Kampillaka, BhallatakaPatola. Maha Vyadhi Upayogi Trapusha, Ervaruka, Tumbi Mutra Sangopayogi KapotaVanga, Avalguja, Haritaki Sarkara, Asmari Upayogi Sarshapa, Kusumbha, Atasi, Pichumarda Prameha Upayogi Narikela, Panasa, Mocha, Priyala,Bilva, Madhuka, Sleshmataka Pittasamsrusta Vayu Upayogi Bibhitaka, Bhallataka, Madana Krishnikarana Upayogi Ingudi, Priyangu, Syonyaka Pandukarana Upayogi
  20. 20. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 8 II. Paka Bheda -Classification of Sneha according to Paka TABLE NO-5 OPINION OF ACHARYAS REGARDING TYPES OF SNEHA PAKA AND IT’S INDICATIONS Snehana Caraka,Vagbhatta34,36 Sushruta35 Sharangdhara37 Abhyanga Khara Madhyama Madhyama Pana Madhyama Mrdu Madhyama Nasya Mrdu Madhyama Mrdu Basti Madhyama Khara Madhyama Karnapurana - Khara Madhyama III.Samyoga Bheda38, 39 A) Yamaka Sneha-Combination of two Sneha Eg – (Ghrita +Taila) B) Trivruth Sneha -Combination of three Snehas Eg – (Taila+ Vasa + Majja) C) Maha Sneha- Combination of three Snehas Eg-(Sarpi +Taila +Vasa+ Majja)-It is considered the best as it is a combination of all the Snehas IV.Upayoga Bheda- Based on the route of administration, Snehana is classified as A) Abhyantara b) Bahya Abhyantara – Eg -Pana, Anuvasana, Uttarabasti, Bhojana. Bahya - Eg -Abhyanga, Shirobasti, Gandusha, and Karnapurana, Mastishkya, and Lepa et. This type is either of pouring, retaining or applying40 . V.Prayoga Bheda -Depending upon the use of Sneha alone or in combination of other substances, it is classified into two groups. A) Accha Peya (Sneha without mixing with any other Dravya) B) Vicharana Snehapana (Sneha with various preparations like Vilepi and Yavagu etc). a) Achhapeya –AcchaSneha means, the Sneha which is administered orally, in unmixed form and consumed abundantly. In Amara Kosha the meaning of word Accha is given as ‘clean & clear’. According to Dalhana, medicated or non-medicated Snehas when given alone are to be considered as Accha Pana. Chakrapani has quoted Acchapana as‘Prathamakalpika’, meaning primary one or superior to any other, which should always be the first choice.41
  21. 21. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 9 b) Vicharana - Use of Sneha after mixing it with other substances e.g. with Rice,Yusha, Basti, Gandusha etc.42 24 different combinations have been mentioned byAcharya Charaka for Pravicharana, and acording to permuatation and combination of different Rasas 64 Pravicharanas are mentioned. External application of Sneha is also Pravicharana as it doesnt come in contact with Agni.Here the basic difference, according to Chakrapani is that ‘Vicharana dose not come in direct contact with Jatharagni while in case of Accha Sneha digestion is compulsory. As per Dalhana, Accha-Sneha may be medicated or non-medicated. VI.Miscallaneous Classification a) Sadyo Snehana b) Panchaprasritika Peya Sadyo Snehana is a procedure of administration of Sneha to achieve Snigdha Lakshana immediately or within shorter duration. It is based on the principles of Pravicharana Snehana. Dalhana, Adhamalla and Cakrapani commentaries give the description that, Sadyo Snehana brings Snigdha Lakshana quickly on the day of administration43 44. Adhamalla opine that, the Snehana therapy, which produces unctuousness instantaneously, may also take three days to bring Snigdha Lakshana. To explain its importance it is called Sadyo Sneha.46 Sadyo Snehana quickly oleates the person with in three or four days of Snehapana48 . Indications-Bala,Vruddha,Sneha Vishay Parihara Asahishnuta, 49 Sukumara,Krusha.50 Sadyo Snehana Yogas51 -Many references regarding Sadyo Snehana Yogas are available in the classics but their Dosage and method of administration is not clearly mentioned. Only while explaining Pancha Prasritika Peya, dosage is mentioned in the numerical value. Pancha Prasrta Peya-Pancha Prasrta Peya is prepared with one Prasta each of Chatuh Sneha and one Prasta of rice.53, 54, 55 It is also considered a subtype of Sady osneha. Sneha along with Saindava Lavana is Sadyo Snehana.56 VII. Matra Bheda-Matra Nirnaya (Fixation of dose of Snehana), Samyak Snigdhata has got role a major role to play in achieving Samyak Shuddhi. To attain Samyak Snighdhata, knowledge of proper selection of dose of Snehapana is very important. The duration of Shodhanartha Snehapana is based on the dosage. So the study of the dosage is very important. The Matra of Snehapana has to be decided by taking into account many factors like Dosha, Kala, Agni, Vaya, Bala57 . If the
  22. 22. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 10 Sneha dose is not decided properly then it will lead to many other Upadrava like Sotha, Tandra, and Murcha etc58 . If the Sneha is administered in less than required quantity, it fails to produce the desired Utklesha and if Sneha is used in excessive quantity, it is likely to produce Ati- Snigdhata or Upadravas. AcahryaCharaka quotes a similie to emphasize the importance of proper dose, as cloth absorbs water and release the excess, the Sneha substance is assimilated according to digestive power and the excess is thrown out. But when the Sneha substance is taken at once in excess, it goes out entirely like water poured over an earthen mass quickly flows out without moistening it59 . In Bruhat Trayis there are two views regarding Matra of Sneha. Charaka and Vagbhatta have explained three Matra where as, Acharya Shusruta has explained 5 Matras as per time required for digestion 1) Hrusva Matra - The dose of Sneha that is gets digested within 6 hours. 61 2) Madhyama Matra - The dose of Sneha that is gets digested within 12 hours.62, 63 3) Uttama Matra - The dose of Sneha that is gets digested within 24 hours.64, 65 Vagbhata along with the above mentioned three Matra recognises one more type of Matra i.e. Hrusiyasi Matra which is still less than Hrusva Matra. When the type of Koshta is not known we need to take the help of Hrisayasi matra. 66 So before administering any type of Matra, a physician should consider the Hrasiyasi Matra to understand the Koshta. Matras mentioned by Shusruta-Prathama Matra which digests in 3 hours,Dvitiya Matra which digests in 6 Hours,Tritiya Matra which digests in 9 hours, and Chaturtha Matrawhich digests in 12 Hours, Panchama Matra which digests in 24 hours. 67 TABLE-6 SNEHA MATRA ACCORDING TO SUSHRUTA Dose Time required for digestion Action Indication Prathama Matra 3 Hours. Agnidipti Alpa Dosha Dvitiya Matra 6 Hours. Vrushya Madya Dosha Tritiya Matra 9 Hours. Brumhana Bahu Dosha Chaturtha Matra 12 Hours. Snehaniya Glani, Murcha, Mada Panchama Matra 24 Hours. Pujaniya Kushta, Visha, Unmada, Graha, Apasmara
  23. 23. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 11 TABLE-7 INDICATIONS OF SNEHA MATRA Criteria for selection ofDose Individual Disease Action Uttama Matra • Prabhuta Sneha nitya • Kshut–Pipasa Saha • Uttama – Agnibala Sharira Bala Manasa Bala Gulma Sarpa- damshtra Visarpa Unmatta Mutrakrcchra GadhaVarcha • Shighravikara Shamana • Doshanukarshini • Pervades through all marga • Balya • Rejuvenates-body, sense organs and mind Madhyama Matra Madhyama – Sharira bala Manasa bala Agnibala Mrdu Koshta Arushka Sphota Pidaka Kandu Pama Kushta Vatarakta • No much complication • Does not affect strength much • Brings Snehana comfortably Used as Shodhanartha Snehana Hrasva Matra • Vriddha • Bala • Sukumara/Sukhocit • Mandagni • Durbala/Avara bala • Person not able to withstand hunger. Chronic condition of disease like- Jvara Atisara Kasa • Brumhaniya • Snehaniya • Vrushya • Balya • Long lasting benefits • Does not cause Complications One of the actions of Uttama Matra Snehapana is explained as Vikara Shamana and that of Hrusva Matra as Brumhana as shown in above said table. Cakrapani mentions that Uttama Matra should be used for Shamana and not for Shodhana Purva Snehana. So doubt may arise regarding usage of Uttama and Hrasva Matra as Shodhana Purva Snehapana dosage. But Dalhana commenting on,68 clears this by mentioning that, the Uttama, Madhyama and Hrasva Matra, can be used as Shodhana Snehapana Matra in appropriate condition. Laghu trayis and Matra Nirnayana -According to Sarangdhara and Bhavamishra - 2, 3 and 4 Tolas are the Hrasva, Madhyama and Uttama Matra of Sneha.69,70 Chakradatta also recognises the Sneha Matra that ½ Pala, 3 Karsha and 1 Pala are the Hrasva, Madhyama and Uttama Matra respectively. These classification is based mainly on numerical value or Mana and not according to time taken for digestion.
  24. 24. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 12 TABLE-8 OPNION IN LAGHU TRAYIS REGARDING THE DOSAGE OF SNEHAPANA Author Hrasiyasi Matra Hrasva Matra Madhyama Matra Uttama Matra Sharangdhara Bhavamishra - 2 tola 3 Tola 4Tola Cakradatta 2 Karsha 3 Karsha 1 Pala Arohana Snehapana –Snehapana has to be given as Arohana Snehapana.The clear cut reference of this in Kalyanakaraka. The word Arohana means the act of rising, ascending. Arohana Snehapana can be defined as an oral administration of Sneha in the increment Dosage. He has quoted that the individual who is posted for Snehapana should consume Ghrita or Taila in the increment (Krama Vardhitam Pibet) dosage for 3, 5 or 7 days. Vangasena has also described the method of Arohana Snehapana. Vangasena recommends three dose schedules. Hrasva Matra starts from 3 Karsha with daily increase of ½ Karsha reaching maximum 6 Karsha i.e. 1 ½ Pala on Seventh day. Where as Madhyama Matra starts from 6 Karsha with an increase of 1 Karsha daily reaching to 3 pala on seventh day. Uttama Matra starts from 3 pala and with increase of 1 pala reaches to 6 pala on Seventh day. TABLE-9 OPINION OF VANGASENA REGARDING DOSAGE OF AROHANA SNEHAPANA DAY 1 2 3 4 5 6 7Dosage (Matra) Uttama 12 Karsha 14 Karsha 16 Karsha 18 Karsha 20 Karsha 22 Karsha 24 Karsha Madhyama 6 Karsha 7 Karsha 8 Karsha 9 Karsha 10 Karsha 11 Karsha 12 Karsha Hrusva 3 Karsha 3½ Karsha 4 Karsha 4½ Karsha 5 Karsha 5½ Karsha 6 Karsha   In Brhattrayi, the Vardhamana Krama for Shodhanartha Snehana is not given but Chakrapani gives a clue in his commentry .70 There he says that the Snehapana after 7 days is prohibited because, Sneha Satmya to the body, and it doesn't perform the desired Snehana Karma. Matra should be arranged in this way that body doesnt
  25. 25. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 13 become accustomed to it. If the Sneha is administered in constant dosage, the body becomes habituated to Sneha and Sneha will fail to produce the required Klinnata of Doshas and Shodhana can not be done if the Doshas are not Klinna (Utklishta). The Klinnata is described in the form of Samyak Snehana Laksanas VIII. Karmukata Bheda: Based on the action of Sneha, Snehana are of 3 types viz. Shamana Snehana Brumhana Snehana Shodhana Snehana Shamana Snehana-Shamana Snehana is a procedure of administration of Madhyama Matra of Accha Sneha during Annakala when one feels hungry without taking the meal. 71, 72 Brumhana Snehana-The Snehana used for Brumhana is called as ‘Bhrumhana Snehana.’ The word ‘Rasa’ here means Mamsa Rasa. 73 It can be given during the start of the intake of food in the middle of intake or towards end of intake of food. If Brumhana Snehana is given in the beginning of food it will cure Adhobhaga Rogas and helps in Vatanulomana, in the middle of food cures Madhyamabhaga Rogas, after food cures Urdhwabhaga Rogas and strengthens the body. The dose of Sneha should be Alpa or even less than quantity of Hrusiyasi Matra.74 (iii)Shodhanga Snehapan-Acharya Sushruta has described the importance of Snehana as “Snehasaro Ayam Purusha, Pranascha Sneha Bhuyistha, and Sneha Sadhyascha Bhavati.”Sneha is the Saravasthu of the human body believed to be present in all parts of the body, which has been considered to be in Prana. Agni, Soma, Vayu, Satva, Raja, Tama, Panchendriya all these are called Prana. 75 Shodhana Snehana is carried out through Matranusara or Arohana or Pravicharana. Matranusara and Pravicharana Snehapana and Arohana Snehapana have been already explained. SNEHANA YOGYA-In the classics one can find the indications of Snehana therapy in general. However, it is to the intelligence of the physician to decide the type of Snehana and implicate the same appropriately in each of the different conditions.
  26. 26. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 14 TABLE-10 SHAMANA AND BRUMHANA SNEHANA YOGYA Abala Vata Vikari Vyayama – Madya – Stree nitya Bala Chintaka Vriddha Daruna pratibodha Madhyasevita Timira Krsha Abhishyanda Mandagni Ruksha MruduKoshtawith alpa dosha Shodhana Snehana Yogya-Shodhananga Snehapana is one of the essential Purvakarma for Shodhana. Hence in almost all the Shodhana Arha conditions Shodhananga Snehapana is advised. Indication of Shodananga Snehapana 76 Swedya, Shodhayitvya, Ruksha, Vata- Vikar, Vyayama nitya, Madya nitya,Stri nitya,Chintaka, Vriddha, Bala, Abala,Kshina,Asra-retasa, Abhishyanda, Timira, Daruna Pratibodhaka.77,78 TABLE -11 SNEHAPANA ARHA FOR GHRITA TAILA VASA MAJJA Ghrita 79 Taila80 Vasa81 Majja82 Vataprakruti Pravruddha shleshma Asthiroga Deepthagni Pittaprakruti Pravruddha medhas Sandhiroga Kleshasaha Vatarogi Sthoola Siraroga Snehasevi Pittarogi Vatharoga Snayuroga Vatarogi Chaksukama Vathaprakriti Marmaroga Krurakosta Kshataksheena Balarthina Kostangaroga Vruddha Tanuthwarthina Vasasathmya Bala Laghuvarthina Avruthavata Abala Dhardhyarthina Ayuprakarsha kama Sthiaryarthina Balarthina For SnigdhaTvak Swararthina For SlashnaTvak Pustikama Krimikosta Soukumaryarthina KruraKoshta Agnideepti Nadeevrana Ojus Smruti Medha Bhuddhi Indriyabala Daha Shastraghata Visha SNEHA ANARHA-Acharyas have told contraindications of Snehana karma in general. A few condition of the Shodhana Snehana Anarha are analyzed as follows- • Rukshana Arha-As mentioned by Charaka,Rukshana Arha persons are generally Abhishyandha, Bahudosha Rogas manifested in Marmasthana and
  27. 27. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 15 Urusthambha. If Snehana is administered in such conditions, it will further aggravates the condition.83 • Dattabasti, Virikta- Soon after Basti and Virechana, Agni will become Manda. Hence Snehapana is contraindicated. • Agni Vikruti - Tikshnagni and Mandagni are considered in Agnivikriti, where as for achieving Samyak Snigdha condition Deepthagni is essential. 84 • Tikshnagni -If Sneha is administered in this condition, then Agnibala further enhances and leads to many complications such as Trishna etc. • Mandagni -If Sneha administered in Mandagni it will leads to Sneha Ajirna or Ama. • Mada and Murcha- Even though Shodhanaga Snehapana is indicted in Mada and Murcha, it is included under Snehana Anarhata with the intention to specify that during attack / episodes of Mada, Murcha Snehapana is contraindicated. • Kshirapa- in Kshirapa Avastha the body of the child will be having Snigdha Guna. Hence Snehapana is not indicated. • Garardita- If Snehapana administered in Garardita, and then Sneha by property of Vyavayi and Sara property further potentiate and facilitate the spreading of the poison all over the body. Hence Snehapana is contraindicated in Garardita. • Durdina- Durdina means the day of cloudy atmosphere. In this atmosphere the chances of aggravation of Kapha and Mandagni is high. So Snehana is contraindicated. • Ama Pradoshaja- as Ama and Sneha are having homologues property, if Snehapana administered in Ama condition, then condition will be aggravated. • Akala- Shodana Snehana will not give desired benefit if it is administered untimely. SNEHANA PRAKARSHA KALA-Prakarsha kala is the time taken for snehana procedure. Aim of Shodhananga Snehapana is achievement of Doshotkleshana within a specific number of days. The minimum and maximum number of days for Shodhananga Snehapana is 3 to 7 respectively. It can be any days in between 3 and 7.
  28. 28. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 16 85 i.e. in person with Mrdu Koshta for 3 days, in Madhyama Koshta for 4 to 5 or 6 days and Krura Koshta for 7 days . Vagbhata emphasizes that Shodhananga Snehapana should be continued till one achieves Samyak Snigdha Laxanas or for 7 days whichever is earlier. After 7 days it will lead to Satmyata of Sneha 87 and fail to produce Doshotkleshana. Here Satmya refers to the meaning that individual get accustomed to Sneha just as food article. If the person doesn’t get Samyak Snigdha laxanas in 7 days then in the Arundatta Acharya advises to give rest for one day and resume Snehapana fore one more day in a higher dosage. 88 On seeing different opinion regarding Sneha Prakarsha Kala, it can be concluded that, irrespective of Prakrti or Koshta, the duration of administration of Shodhananga Snehapana should be till the appearance of Samyak Snigdha Lakshana. But maximum duration is 7 days. Time and Regimen of administering particular Sneha – Sneha Phala Shruti depends upon proper time of administering Sneha, strength of patients, Doshas vitiated and disease. Wrong time of administration can induce many diseases. TABLE -12 TIME OF ADMINISTRATION OF SNEHA ACCRDING TO DOSHA DOMINANCE Dosha Charak 89 Sushrut Vaghbhat Vata-Kapha Mid-day Day Day Vata, Vata-Pitta Evening Night Night Rtu wise administration of Sneha 90 Ghrita Sharad (Month) Vasa-Majja Madhav Taila Pravrita Any Sneha- Sadharana ritu & Prashast Dina. SHODHANANGA SNEHAPANA VIDHI-The administration of Shodhananga Snehapana is followed in three different stages such as Purvakarma, Pradhana karma and Paschat karma.
  29. 29. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 17 I. Purvakarma- It includes-(i) Atura Pariksha, (ii) Atura Siddhata, (iii) Sambhara Sangraha (iv) Atura Pariksha (i) Atura Pariksha –a)Dasha Vidha Pariksha i.e. Prakruthi, Vikruthi, Sara, Samhana Satmya etc. - this helps the physician to decide the right Sneha Dravya, Anupana; Agni Bala helps to assess the Matra, Satmya helps Decide between Achha and Parvicharana and type of Pravicharana. b) Deciding suitable Snehana yogya and Ayogya.91 c) Koshta Pariksha Understanding Snehapana Prakarsha Kala, helps to decide the number of days required for Snehapan .92 (ii) Atura Siddhata-Patient should be prepared physically and mentally through following procedures a)Deepana – Pachana (b) Manasopachara (c) Sambhara Sangraha a) Deepana –In Sama avastha of the disease, ‘Ama Pachana’ is very essential. It causes loosening / detachment of morbid doshas from the Dushya and Srotass. To eliminate the Doshas, they need to be brought to Koshtha from Shakhas. Due to Paka, Ama is liquified and cleansing of Srotas takes place.Deepana drugs are those which enhances the Agni. It increases appetite & increases the better absorption of drug for e.g. Deepaniya Gana drugs, Guduchyadi Gana drugs, Chitraka.94, 95 Deepana Pachana should be given till the Nirama Avastha is acheived. Pachana 96 The drug or action which has the capacity of digesting Ama, but may / may not increases the Agni is known as Pachana Dravyas like Nagakeshara.97 Pippalyadi Gana, Musthadi gana98 b) Manasopachara-In Shodhananga Snehapana, a large quantity of Sneha is administered.Because of non-palatability,discomfortness felt during Sneha Jirna Kala. Individual might show avertion to drink Sneha. So prior to Snehapana, complete procedure of Snehapana and Shodhana should be explained to the individual and he should be encouraged to drink Sneha. This will infuse confidence in the patient regarding Snehapana. c) SambharaSangraha -One should keep ready the required Sneha / medicaments and first aids and essential materials to treat the Vyapat or arises if any.99 II. Pradhana Karma-Pradhana karma includes following steps viz. 1. Administration of Sneha, Anupana and proper selection of Prakshepa Dravya 2. Observation of -
  30. 30. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 18 a) Sneha Jiryamana Lakshanas and Sneha Jirna Lakshanas b) Snigdha, Ati Snigdha and Asnigdha Lakshanas Administration of Sneha -In the early morning when the Sun rises, Athura is advised to take medicated Taila or Ghrita. The Sneha should administer after complete digestion of food which was taken on previous night. After performing auspicious rituals, appropriate quantity of selected Sneha which is lukewarm should be given to drink. 100 Proper digestion of Sneha Dravya, some substances are said to be added in little quantity, according to Dosha Prabalata. In Vata Vikara Lavana is to be added where as Trikatu and Kshara in Kaphaja Vikara. In Paittika Vikara, only Ghrita should be given. 101 Anupana: Anupana should be given along with the Snehadravya. It helps in breakdown, softening, digesting, proper assimilation and instant diffusion of the Sneha taken. It also helps in refreshing the patient and will give pleasure, energy to the patient. In case of doubt regarding digestion of Snehapana Acharya has advised to sip hot water. 102 For Chaturvidha Snehas the Anupana used are- Ushna jala – Ghrita, Yusha – Taila, Manda – Vasa and Majja103 Shitala Jala – For Bhallataka and Tuvaraka Taila In Ushana jala can be used for most of the conditions except in Tuvaraka and Bhallataka Taila.104 The dosage of the Anupana may be decided on the basis of digestion capacity. (a) Observation of Sneha Jiryamana and Jirna Lakshana -After administration of Sneha, one should carefully observe for symptoms which are produced during the digestion of Sneha i.e. Jeeryaman and after digestion i.e. Jeerna Lakshanas. During Jeeryamana Avastha, patient may develop some discomforts which get subsided after some time with no need of any specific treatment. However, if symptoms persist, only lukewarm water is advised. Jeerna laxanas are found after the complete digestion of Sneha. At Jeeryamana Avastha i.e. first phase of Avastha paka, production of Kapha takes place, which is having similar qualities to Sneha. Thus production of Kapha will be more which causes Lalasrava. Due to large amount of Sneha the quantity of secretions
  31. 31. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 19 of Jataragni increases and Jataragni is having Agneya quality which may cause Trishna, Bhrama, Murcha, Daha etc. The onset of symptoms like Kshut, Trishna etc. indicate the completion of Sneha digestion (Sneha Jirna). In doubt regarding digestion of Sneha, one should take cup of hot water, which brings Shuddha Udgara, Laghuta, and desire for food. That can be considered as confirmatory test to know whether Sneha is digested or not. 105 After complete digestion of Sneha the patient can be advised to take Bhojana as explained above. If Sneha does not digest after administration of warm water and takes more time than required. It should be eliminated by Vamana. This condition should be treated like the Sneha Vyapat. 106  TABLE -13 SNEHA JIRYAMANA AND JIRNA LAKSHANA Jiryamana Lakshana107 Jirna Lakshana107 Shiroruja Shirorujadi Jiryamana Lakshana Prashamana Bhrama Vatanulomana Nishtiva(Lalasrava) Kshudha pravrtti Murcha Trishna pravrtti Sada Udgarashudhi Arati Laghuta Klama Trishna Daha b) Observation of Snigdha–Asnigdha–Ati Snigdha Lakshanas. All acharyas have mentioned about important Lakshanas of Samyak Snigdhata,Asnigdhata and Atisnigdhata, which serves the purpose of further administration of Swedana and Shodhana therapies. 108,109,110, 111. Evaluation of Snehapana based on parameters like – i) Samyak Snigdha Lakshanas ii) Asnigdha Lakshanas iii) Ati Snigdha Lakshanas i).Samyak Snigdha Lakshanas-Attainment of Samyak Snigdha Lakshana is an important milestone of Shodhananga Snehapana. After observing these Lakshanas Snehapana has to be stopped. Vatanulomana, Deeptagni, Snigdha Varcha, Asamhata Varcha, Purisha Mrduta Adhastat Sneha Darshana, Gatra Mardavata, Gatra Snigdhata, Tvak Snigdhata ,Anga Laghava, Klama, Glani ,Snehodvega ,Vimalendriyata.
  32. 32. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 20 ii). Asnigdha - Asnigdha Lakshanas may be present prior to Snehana therapy, if Snehana therapy is not done properly then these Lakshana persist at the end also. By observing these Lakshana physician should rectify and adjust Matra or Snehana and carry out Snehana properly. If Snehana is not done properly the following symptoms are observed. TABLE -14 ASNIGDHA LAKSHANAS Lakshanas Grathita Purisha – Hard stools Ruksha Purisha Shushka Purisha - dry stools Vayu Pratilomana upward movement of Adhovata Agnimandhya–loss of digestion power Avipaka / Krcchrat Annam Vipachyate Indigestion Anila Purita Udara – flatulence Gatra Rukshata – dryness of body Gatra Kharata – roughness of body Urovidahata, Dourbalya – weakness Dourvarnyata Adhrti Shodhananga Snehapana is to be continued till the appearance of Samyak Snigdha Lakshana, but if Snehapana is continued even after that then it may lead to increase of Apyamsa in the body and Atisnigdha Lakshana may manifest. Panduta Gaurava, Jadya Apakva Purisha Purisha-Ati Pravrutti Guda Srava, Mukha Srava, Bhakta Dvesha ,Angadaha, Adhmana ,Tandra and Moha. III. Paschat Karma: Paschat Karma is categorized as – • Paschat Karma on the days of Snehapana • Paschat Karma after attainment of Samyak Snigdha Lakshanas. Paschat Karma on the days of Snehapana The patient should be advised to follow specific Pathya, Apathya and Vihara. Pathyapathya –It is important to follow the Pathya Apathya procedures in order to obtain optimum results and avoid any complications in the patients. 1. Ushnodakopchari –The patient shoul be advised to take only warm as cold water increases Abhishyanda leading to Sneja Ajeerna.
  33. 33. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 21 2. Brahmacharya – Strict abstinence has to be followed. 3. Kshapashaya – sleep only during the night. Sleep during the day vitiates Kapha / Abhishyandakara and causes improper digestion of Sneha. 4. Vegavarodha Varjana – to avoid natural urges as it vitiates Vata Dosha. 5. Vyayama Varjana – to avoid vigorous exercise. 6. Shoka, Krodha Varjana – to avoid anger or anxiety. They vitiate Vata and Pitta Doshas. 7. Hima Aatap Varjana –avoid exposure to hot or cold weather. 8. Pravata Varjana –avoid walking in open air. 9. Uccha Bhashya Varjana – patient should avoid speaking loudly which again vitiates Vata dosha. 10. Yanadhwa Varjana – t o avoid journey or excessive walking. 11. Samsthitah – use of suitable posture. 12. Dhuma-Rajamsi Varjana – to avoid fume and dust. 13. Abhishyandi Ruksh-Anna Vivarjana – to avoid coarse and constipating diet. 115 For Shodhananga Snehana, indicated diet is Drava (liquid), Ushna (warm), Anabhishyandi (not having ‘Abhishyandi’ property), Na Atisnigdha (not too much Snigdha) and Pramanayukta (not too less or not much).116,117 Paschat Karma after attainment of Samyak Snigdha Lakshanas The period between completion of Shodhananga Snehapana to the day of Virechana or Vamana is known as Vishrama Dina. During this period the individual will be subjected for Sarvanga Abhyanga, Svedana and provided with appropriate diet. Stopped and then they are posted for further process like Sarvanga Abhyanga, Svedana and Shodhana. SNEHA VYAPAD (Complications of Snehapana)118,119,120 Due to improper administration of Sneha certain complications are observed frequently. It can be Vaidya Krita or Atura Krita. Mistakes of Physician- 1) By improper judgement of the Sneha Arha or Anarha, Matra, Kala, Anupana. 2) Inappropriate considerations of time factor 3) Not properly selecting Sneha Dravya.
  34. 34. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 22 Mistakes of Patients- If subject fails to follow proper instructions given by physician regarding Pathya Apathya he may land in many complications. Snehavyapat Lakshanas--Based on the need for emergency of handling the Vyapads it is divided into two types- 1. Ashuchikitsya Vyapad is the diseases which need emergency treatment. 2. Ciracikitsya Vyapad is diseases which occur after some days following improper Snehapana. (i)Ashu Utpanna Vyapat-These types of disorders may have acute onset and may needs immediate management (1) Ajirna, (2) Aruchi, (3) Amapradosha, (4) Shula, (5) Jvara, (6) Anaha, (7) Trishna, (8) Sthambha, (9) Utklesha, (10) Tandra, (11)SamjnaNasha. (ii) Chira Utpanna Vyapat- These disorders may manifest in due course of time. (1) Kandu, (2) Kushta, (3) Grahani, (4) Pandu, (5) Arsha, (6) Shotha, (7) Udara, (8) Staimitya, (9) Vakgraha These complications should be treated in long run as explained in various classical texts. Sneha Vyapat Chikitsa-121, 122 1. Upavasa/Trshna - Alpa Dosha Avastha and enhances Agni Bala. 2. Ullekhana - In Utklishta Dosha Avastha, SnehaAjirna, Utklesha Janya Trishna, Sadyo Vaman is practiced. 3. Svedana can be given in conditions of Stambha 4. Rukshana Anna Pana and Bheshaja are administered in Sneha Atiyoga janya Vyapat. Sneha Ajirna Janya Trishna Chikitsa- 123, 124 - If Sneha Ajirna produces severe thirst, the patient’s head and face should be splashed with cold water. If this does not relieve the thirst, the Pitta dominant patient should be given Ruksha Anna and Shita Jala and then made to vomit. In case of persons who have predominance of Kapha and Vata or all the Doshas increased in equal proportion, Vamana is induced after giving Ushna Jala. MODE OF ACTION OF SHODANARTHA SNEHAPANA -Shodhana therapy is intended for purification of the body, by which the accumulated Dosha responsible for disease are expelled to bring about a healthy state. Shodhana is the Pradhana Karma,
  35. 35. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 23 preceeded by certain preparatory procedures i.e.Purva Karma and followed by procedures known as Paschat Karma. The entire Shodhana procedure depends upon the proper mobilization of Doshas, which is achieved with the help of Snehana and Svedana. Out of these two, the Snehana is a major procedure which decides the whole outcome of Shodhana procedure. Importance of Shodhananga Sneha – If Shodhana is performed without doing Snehana, the body will be broken like dry wood. 125 Sneha loosens the Doshas which are adherent to the walls of minute channels. Dalhana explains that to bring the Shakhagata Doshas into Koshtha, Snehana is essential. Charaka has given simile that as from oil smeared container, the water can be easily separated without much effort, and similarly Kaphadi Doshas are easily expelled out from the oleated body. 126 As Klishta Mala of a cloth is easily washed by water, if we loosen it from its site similarly, Malas are easily expelled out by Shodhana. Dosha are to be brought to Utklesha Avastha by Snehana followed by Sveda for easy expulsion.127 Main purpose of Purvakarma is to bring Doshas from Shakha to Koshta. It is done by Snehana and Swedana. Acharya Charaka has described about movement of Doshas from Shakha to the Koshta. Acharya Sushruta explains that due to Snehana and Svedana, the morbid Doshas, become liquefied and brought to Koshta for easy elimination by the Shodhana.128 How Snehana and Svedana bring about Doshautkleshana? 129 Different measures employed for bringing doshas to Koshtha are Vriddhi, Vishyandana, Paka and Srotomukha-ViShodhana. Snehana Karma achieves these with the helps of its Gunas Vridhi - Sneha has Ap as its predominant Mahabhuta.130 Sneha spreads in the body due to its Drava and Suksham Svabahava. It Dosha Vilayana (helps in liquefying the Doshas). It acts like a dissolving media for the vitiated Doshas.It cause Dosha Vrudhi. Vishyandanat-Vishyandana means liquefaction. Sneha converts the Dosha into liquid form so that may be facilitated for transport. This is done by its Snigdha, Mridu, Drava, and Sara properties. Snigdha-On account of its Kledana action Sneha increases and liquefies the Doshas as explained earlier. Mridu- Due to this property Sneha loosens and softens the Dosha so that they may be mobilized.
  36. 36. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 24 Drava-Sneha increases the liquidity of Dosha on behalf of its panchabhautika configuration, thus mobilizing them. Sara- With help of Sara guna Sneha directs the Doshas in its proper direction e.g. Shakha to Koshta. Pakat: Sneha increases Agni at all levels i.e. Jatharagni, Bhutagni, and Dhatvagni thus digest the Doshas and Ama. Srotomukha Vishodhanat: Sneha penetrates Srotas and removes Sroto Sanga, which is one of the important steps in the Samprapti Vighatana, allowing proper movement of Dosha. According to Sushruta, the disease is produced due to the Sthana Samshraya of vitiated Doshas wherever there is Khavaigunya (Srotovaigunya) during their circulation in the body. 131 Sara guna of Sneha also helps this process. Sara has the property of Prerana i.e. it puts the things into motion. This quality of Sneha helps in redirecting the Dosha, Dhatu, and Mala in proper direction. Vayoshcha Nigrahat: It helps to reduce Vata Dosha by Sneha Guna which is antagonist to Vata dosha. Mrudu Guna of Sneha loosens and softens the Dosha, these all properties of Sneha helps to prevent the lodging of Utklista Dosha. In Siddhisthana, Acharya Charaka explains one more mode of action os Sneha .132 ♦ Sneho Anilam Hanti ♦ Mrdu Karoti Deham ♦ Malanam Vinihanti Sangam. Sneho Anilam Hanti -Vata Nigraha is one of the criteria mentioned by Charaka to bring Doshas back to Koshta. As Sneha is having exactly opposite Guna to Vata Dosha, Sneha attains the proper Gati of Vata and helps to bring the Shakhagata Dosha into Koshta. Vatashamana effect of Snehana can be known by observing Vatanulomana action. ♦ Mrdu Karoti Deham -Sneha by virtue of its Snigdha, Mrdu qualities brings softness in Dosha Sanghata, Srotas and Deha, which are very important to bring Doshas to Koshta in Utkleshana stage. This Mrdukarana effect of Sneha can be confirmed by observing Gatra Mardavata. ♦ Malanam Vinihanti Sangam -Mala Sanga generally occurs due to Rukshata, Sneha overcomes this Rukshata by its Snigdha and Vishyanda properties and the Sanga gets relieved.
  37. 37. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 25 DIGESTION OF SNEHA IN AYURVEDA-The knowledge of digestion and absorption of Sneha is very important. In Ayurveda, the Paka of Sneha is not separately explained by Acharyas. So no clear references are available about the digestion of Sneha dravyas. The process of Sneha digestion can be studied on the basis of Sneha Jeeryamana and Jeerna Laxanas described in texts. The body is the result of food, and the healthy and disease conditions of the body results due to the status of digestion. The principle of digestion of food holds good to digestion of Sneha. 133 Any food item can not be assimilated without presence of Agni. This process is to be performed by three types of Agnis i.e Jatharagni, Dhatvagni and Bhootagni. In nut shell, the food i, e. heterogenous form is converted into homogenous form by means of Jatharagni. Then again this is subjected to Dhatvagni Paka & Bhutagni Paka leading to then formation of Dhatus. Agni digests the four types of Ahara and Provides energy for sustaining life. Hence Agni performs the functions of digestion and metabolism. Jatharagni-Jatharagni is the leader of all factors concerned with digestion and metabolism in the body. And the activities of all these factors, normal and abnormal are derived from it.134 the term Jatharagni comprises several factors such for e.g., several enzymes which participate in the digestion of the different components of food in the small intestine. In this sense Jatharagni would represent a complex of substances and not only one substance isolated from others of its kind, present in the alimentary canal. It is mainly concerned with chemical processes involved in gastrointestinal digestion. Reference made by Vagbhata to the organ Grahani indicates the seat of Pachakagni. According to Charaka, Grahani is so called because it receives and retains the food for its digestion. 135 He further explained that the food, which has reached the Amasaya after undergoing digestion, is absorbed and distributed to all Ashayas in the body through Dhamanis.136 Pittadhara Kala is the term given to Grahani by Shusruta and Vagbhata. It provides the digestive juices not only digest the food but also aids the separation of Sara and Kitta i.e. nutrientfraction and undigested food residue.138 (a) The fact that the Pittadhara Kala constitutes the integral part of the structure of Annavaha Srotas which provides Pachaka Pitta, which is essential for the digestion. (b) The nutrients of the digested food gets absorbed (Rasa-Soshana) i.e.transported accros this Kala for distribution throughout the body throughDhamanis. Hence it is
  38. 38. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 26 clear that there are two types of digestion by Jatharagni i.e. Samanya and Vishista. Samanya refers to factors which are related with the digestion of food materials in the Amasaya and Pacyamanasaya, corresponding to the gastric and intestinal digestion. 139 Vishista refers to the hormonal and enzymatic mechanisms. Bhutagni-According to the physiology of Ayurveda Bhutagni Paka follows Jatharagni Paka. The digestion of food by Jatharagni leads to the Sarnghatabheda or breakdown of the former into five distinct physiochemical group’s viz. Parthiva, Apya, Tejas, Vayaveeya, and Nabhasa. The Agni present in the substances belonging to each group is, digests the substance of that group leading to a radical change in their qualities i.e.,Vailakshanya Guna.140 Thus food substances are rendered fit for being assimilated for the build up as parts of the corresponding Panchabhuta class. According to Shusruta, the food which consists of five Mahabhutas is digested in its turn by the Bhutagnis and each of its principles proceeds to its own dominant part of the body.141 Dvarakanath states in his book on digestion and metabolism that according to some the reaction comparable to Bhutagni Paka takes place in Yakrit and not in Amasaya, which derives the support to the post digestive functions and metabolic events in liver as per modern physiology and Biochemistry. Proceeding on the basis of principle Samanya, it may therefore be noted that a Parthiva substance can alone contribute to an increase of Parthiva constituent of the body. Sneha is said to be Apya substance. So it increases the Apya constituent in the body. According to Vagbhta, Sara-Kitta Vibhajana takes place after completion of Bhutagni Paka. Dhatvagni:-The specific Agni corresponding to each Dhatu is called as Dhatvagni. Dhatvagni Paka is stated to metabolise the products of Bhutagni Paka. Rasagni is stated to aid in the structural synthesis of the several constituents of the Rasa Dhatu. Likewise the formation of the constituents of Rakta Dhatu is catalysed by Raktagni and similarly in cases of Mamsa, Meda, etc. The nutrients that support the body are subjected to Paka by the seven Dhatvagnis, leading to the Dhatus through their respective Srotamsi. 142 . The substances produced in these reactions are known as Asthayi or Poshaka Dhatus. 143 Dhatvagni Paka is stated to have two aspects - (a) Prasada Paka and (b) Kitta Paka. The end products of Prasada Paka are utilised for the nourishment of Dhatus, where as, those of Kitta Paka provide the materials for the formation of various kinds of Mala, Such as Sveda, Mutra, Pureesha, Vata, Kapha, Karna-
  39. 39. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 27 Romakupa Mala etc.144 The Prasada fraction is transported by Rasa - Rakta. The final synthesis of Asthayi Dhatu into Sthayi Dhatu takes place in Dhatu themselves by the help of Dhatvagnis. Avastha Paka-Gastro intestinal digestion or change in the state or form of the food substances in Amasaya and Pakvasaya in the course of digestive process. Two phases of the Paka i.e, Prapaka and Vipaka have been envisaged. The Prapaka has been defined by Chakrapani datta as Prathama Paka.145 These changes have been described in terms of the Rasa or taste of the end products of gastro-intestinal digestion viz. Madhura, Amlamand Katu.146 Prapaka commences right from the time, when food is introduced into the mouth. This aspect of digestion and the digestion in the upper portion of Urdhva Amasaya are comprehended by Madhura bhava. When the food is introduced into the mouth, the perception of its rasa takes place which is stated to be enabled by Bodhaka Kapha 147 148 .The next event which takes place is Vibhajana of food by the tejas element of them saliva, which is described in Ayurveda Sutra and Yoganandnatha commentry. Taste perception and preparatory digestion and the begining of the Madhura bhava occures here. The movements are brought by Prana Vayu. 149 The second phase i.e. Amla Avastha Paka involves the Vidagdhavastha of food. The term Vidagdha has been interpreted by Chakrapanidatta asn 'Pakva-Apakvam' or 'Kinchit Pakvam Kinchit Apkvam' i.e. partly or not fully digested 150 . As the partly digested food which has attained Amla Bhava is moved down, Accha Pitta is secreted. 151 The term amla refers to the production of Pitta under influence of the Ahara which has since assumed Amla Bhava. The third aspect of Avastha Paka is the Katu bhava. This aspect relates to pungent nature of the reactions that occure in the Pakvasaya. Charaka says that the material passed down from the Amasaya having reached the Pakvasaya is dehydrated and converted into lumps by heat. 152 Chakrapanidatta has observed that the term Soshana used by Charaka instead of Pachana is significant. The former relates to the dehydration of the food residue which has been brought to Pakvasaya whereas the later refers to the digestion of food in the Amasaya by Agni. The term 'Paripindita Pakvasya' according to him refers to the process of formation of fecal lumps. The term 'Vayu syat Katubhavat' describes the production of acrid and pungent gas. 153
  40. 40. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 28 Pakvasaya is the seat of Vayu where five Vayus are produced. According to Shusruta, the seperation of Rasa, Mala and Mutra brought about by Pachaka Pitta. Sarangdhara and Bhavamishra have stated that the Sara Bhaga is known as rasa, and the Saraheena Bhaga is Mala. The molecular qualities and properties of three kinds of end products of Jatharagni Paka are- (1) Madhura Vipaka having Guru, Snigdha, Mridu and Seeta Gunas. (2) Amla Vipaka having Laghu, Snigdha, Tikshna and Ushna Gunas (3) Katu Vipaka - having Laghu, Ruksha, Teekshna and Ushna Gunas.Thus it can be said that - while Sneha is taken internally, it may not be changed in each stage of digestion. Absorption of Ghrita -Human cell membrane is made up of Phospholipids. Watersoluble substance cannot cross the cell membrane while lipid and lipid soluble substance are permeable to the cell membrane. Cell membrane acts as a barrier to the passage of water soluble molecules, but provides free passage to lipids and lipid soluble substances. From above description it can be said that Sneha, by its Sukshma Guna reaches at the cellular level and it can be correlate with the “Anutva of Sneha”. Phospholipids which are a part of a class of fat increases during Snehapana. Phospholipids function as a carrier of various cellular elements. Increase in their level may enhance this transport which may helpful in some way in various diseases. This could also be compared with Gati of Dosha from Shakha to Koshta. Snehapana produce Kledana in body because 1 gm of fat on combustion gives 1.07 gm of water as a side product while combustion of protein produces 0.41 gm of water and carbohydrate produces 0.55 Gms of water. This water may help in dissolution of various Doshas and this can be compared with the Kledana property ascribed to Sneha dravya. Lipid consuming is helpful in excretion of lipid soluble substance. It suggests that Sneha liquefies the compact Dosha and destroy morbid Mala.The Membrane permeability is important for it’s functioning and it depends on its lipid components. Phospholipds composed of chains of poly unsaturated fatty acids increased the membrane permeability by banding some chains and double bonds prevent them from compacting themselves. By increasing cellular permeability Sneha directs the Dosha from Sakha to Koshta.
  41. 41. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 29 VIRECHANA KARMA Among Shodhana therapy described in Ayurveda, Virechana is mostly commonly used procedure especially it is best for the removal of disorders occurring due to vitiated Pitta. Along with this, it is also useful in the disorders in which Pitta is associated with Kapha, or Dushita Kapha in Pitta Sthana. 154 DEFINITION:-The process by which the elimination of Doshas through the Adhobhaga occurs is known as Virechana.155 Virechana can be understood as a procedure involving intake of medicine through oral route and expelling vitiated Pitta Dosha and Mala through Adhomarga.156 PROPERTIES OF VIRECHANA DRUGS:-Virechana drugs are generally having Prithvi and Jala Mahabhuta dominancy. Virechana drugs are having Ushņa, Teekshna, Sukshma, Vyavayi and Vikashi Guņa and Adhobhagahara Prabhava. Virechaka drugs mostly act by the virtue of its Prabhava. Table -15 BHAUTIK COMPOSITION OF VIRECHANA DRAVYA Bhautik Composition Properties expected Properties present Sneha Ushna Manda Tikshna Sthula Sukshma Bhumi Jala Guru Vyavayi Virechana Dravya has Guna, which are not in accordance with Bhutas, which may be explained in terms of Vichitra Pratyayarabdhata. This Vichitra Pratyayarabdhata causes bivalent action of the drug an action in the Shakhas, which is entirely opposite to the Koshta. The drugs with properties like Ushna, Tikshna, Vyavayi and Sukshma by virtue of their penetrative as well as infiltrative properties enter Hridaya and from there, they spread through Dhamanis. These drugs cleanse the adhesive Doshas by their Agneya Guna and thoroughly disintegrate them by Tikshna Guna. This brings the Doshas to Amashaya. Proper Snehana and Svedana which has been done previously facilitate this process. The circulating metabolic abnormal or waste products are thus treated by this process and actively excreted to the intestinal lumen. In the Koshta contrary to the
  42. 42. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 30 Vamana Dravya, further action takes place according to the Bhuta predominance and Adhobhaga Prabhava of the drugs. This bivalent property makes the Virechana drug practically less complicated and easily employable. Moreover this is the only reason for the elimination of Dosha through Virechana from Kaphasthana (Amashaya), Pittasthana (Pachyamanashaya) and Vatasthana (Pakvashaya). But the action of Vamana is focused in Amashaya only. INDICATIONS AND CONTRAINDICATIONS OF VIRECHANA KARMA: Prior to subjecting the patient to any therapy, it is necessary to examine whether the patient is fit for proposed therapy or not. Following are the indications and contra indications for Virechana karma. Doshas -Utklishta Pitta, Kapha Samsrshta Pitta, Pittasthanagata AlpaKapha, Kaphasthanagata Bahu Pitta.157 Pakvashayagata Pitta or Kapha Pitta, Pitta Avruta Vata, Kapha Avruta Vata.158 Charaka advises that Tiryakgata Dosha should be taken back to Koshta, gradually by proper acts and after that elimination should be carried out. This denotes that Virechana is the treatment of choice in Tiryakgata Dosha as seen in Kushta. Dushya-For Rasa, Rakta Vikaras Virechana Karma is described in direct and indirect way 159 160 In Svastha 161 As a Purvakarma of Rasayana and Vajikarana -Virechana is indicated in disorders like,Gulma (Vatadhikya), Kamala (Paittika), Gara (Tridoshaja), Unmada (Tridoshaja), Kushta (Tridoshaja) etc. From the above references it becomes clear that Virechana karma has a specific action on all Doshas. CONTRAINDICATION-In Classics, contra indications of Virechana are explained in detail. They can be summarized in following headings • Incapable to tolerate the stress of therapy like Vilanghita, Durbala, Subhaga, Navaprasuta etc. • Sama Avastha of the disorders like Navapratisyaya, Ajirna, Navajvara • Diseases of rectum like Kshata Guda, Muktanala. • Some conditions like Ratri Jagarita, Atisnigdha, Atiruksha, Bhayoptapta, and Cintaprasakta. • Disorders like Adhoga Raktapitta, Hradroga, Atisara, Rajayakshma, Urusthambha etc, 162
  43. 43. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 31 CLASSIFICATION OF VIRECHANA- A) According to Mechanism of Action: AcharyaSharangadhara was the first person who has mentioned the classification of Virechana as per the action, potency of drug, onset consistency of excretory products .164 1. Anulomana: The drug which make the digestion of Mala and breaks its compactness and after that brings it towards Adhobhaga is known as Anulomana e.g. Haritaki. 2. Sramshana: The drugs which expels the half digested and sticky Mala without its prior digestion is known as Sramshana e.g. Amavata. 3. Bhedana : The drug which breaks all types of Mala like Abaddha, Baddha, Pindita and throws them through anal route are called Bhedana e.g. Katuki. 4. Rechana: The drugs which eliminates digested as well as undigested Mala by making them watery, through Anal route is known as Rechana e.g. Trivrit. B) CLASSIFICATION ACCORDING TO PROPERTY 1) Sneha Virechana: The preparation containing Sneha is known as Sneha Virechana. Sneha Virechana should be used in all patients except Snigdha patients165 It is contraindicated in patients who have been given higher dose of Sneha. 166, 167 2) Ruksha Virechana: The preparation which is devoid of Sneha is known as Ruksha Virechana. It is prescribed in the patients who have taken more Sneha .In such cases Sneha Virechana makes the Utklista Dosha adhere instead of being detached. 3) According to Prayoga Bheda: Churna, Vati, Asava, Arista, Avaleha, Sneha and Kashaya etc, Virechana yoga can be administered in different forms. 4)Based on Part of the Dravya used: Sushruta describes the following drugs with priority for Virechana Karma. 168 i) Mula Virechana - Shyama Trivrt ii) Phala Virechana - Haritaki iii) Taila Virechana - Eranda iv) Svarasa Virechana - Karavellaka v) Paya Virechana - Snuhi. Charaka also describes in general Virechana drugs like Mulini, Phalini, Lavana and Kshira etc .According to Charaka, there are 3 types of Virechana Dravya Viz, Trivrut, Aragvadha and SnuhiKshira are considered as the best Sukha Virechana, Mrdu Virechana and Tikshna Virechana respectively. 169 Acharya Charaka also described
  44. 44. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 32 Bhedaniya, Virechanopaga and Anulomana, which are also suggestive of the types of Virechana. PROCEDURE OF VIRECHANA For easy understanding purpose whole Virechana procedure can be grouped under headings like I) Purva Karma II) Pradhana Karma and III) Pascat Karma I.PURVAKARMA: These are the rules which are to be considered prior to performing the main process of Virechana. It includes the following parts. -Collection of essential materials or Sambhara Sangraha - Collection of all the necessary equipments, drugs, diet etc used for the therapy. - Examination of patient or Atura Siddhata - Patients should be examined by Ashtavidha and Dashavidha Pariksha. The examination of the Dosha, Dushya, Atura Bala etc to be carried out to know fitness of individual to Shodhana. Before giving the Virechana to the subject, it is necessary that the selection of subject must be done carefully. It must be decided priorly that whether the subject is Virechana Yogya or Ayogya (contraindicated). - Preparation of patient- Prior to Virechana the patients are prepared with Deepana, Pachana, Snehana and Svedana. A) Dipana Pachana: Should be performed in the Amavastha. 170 B) Snehapana: Snehapana procedure is to be followed after observing Nirama Lakshanas. C) Sarvanga Abhyanga and Svedana: During 3 days of Visrama Kala Sarvanga Abhyanga and Bashpa Sveda should be performed. Three days Vishramam Kala is given to make Kapha Manda 171 1. Ahara- Snigdha, Ushņa, Drava, Mamsarasa, Yusha, Amla Rasa Ahara is preferable during Visrama Dina. But Kapha Vardhaka Ahara is to be strictly avoided172 2. Manasopachara- Whole procedure of Virechana is to be explained to for easy conduction of Virechana. 3. Matra Vinischaya- Matra should be selected in such a way that the desired effect of Shodhana may be achieved without any complications. The dose is to be decided based on Atura, Agni, Koshta and Aushadha. While describing the process of Virechana the dose mentioned of Trivrta yoga is one Aksha (1 tola). However Sharangdhara has given the dose schedule, which seems to be applicable now a day.
  45. 45. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 33 TABLE -16 DOSES OF VIRECHANA DRUGS Kalpana Hina Matra Madhyama Matra Uttama Matra Kvatha ½ Pala (2 tola) 1 Pala ( 4 tola) 2 Pala (8 tola) Curna,Modaka Kalka etc 1 tola 2 tola 4 tola Swarasa 1 tola 2 tola 4 tola Ushnodaka(Anupana) 4 tola 8 tola 12 tola TABLE -17 MATRA ACCORDING KOSHTA Authors Mrdu Koshta Madhyama Koshta Krura Koshta Sushruta(Su.Ci.33/21) Mrdu Matra Madhyama Matra Tikshna Matra Vangasena 1 tola 2 tola 3 tola According to Vagbhata, persons having less strength, Shodhita previously, having less quantity of Dosha, having thin structure and unknown Koshta should be administered Mrdu Aushadha in very less quantity.173 II PRADHANA KARMA : 1. Administration of Virechana yoga-174 Acharya Charaka has given elaborately the administration of Virechana Dravya. (i) After Samyak Sneha and Svedana (ii) While the subject is cheerful, slept well and has fully digested his previous meal (Suprajirnabhakta) Virechana is performed on empty stomach (iii) and after Svastivacana. Regarding giving Virechana, Vagbhaţa mentions, ‘Sleshma Kala gate’ (means after passing ‘Sleshma Kala i.e. around 9-10 a.m.). Just after administration of Virechana Yoga, cold water is sprinkled on the face to avoid vomiting. The subject is asked to gargle with hot water and asked to have fragrance of flowers. 2. Observation and management during Virechana Vega: During all the time, Vaidya should concentrate on the manifestation of Lakshaņa of Jirna-Ajirna Aushadha, Suddhi and Vyapat etc. 3. Observation of Suddhi Lakshaņa: Virechana Suddhi can be assessed as shown in the Table-18, based on parameters like Vaigiki, Maniki, Antiki and Laingiki Lakshana.
  46. 46. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 34 TABLE -18 ASSESSMENT PARAMETERS OF VIRECHANA Shuddhi Hina Madhyama Pravara Vaigiki 10 Vega 20 Vega 30 Vega Maniki 2 Prastha 3 Prastha 4 Prastha Antiki Kaphanta Kaphanta Kaphanta Laingiki Lakshana - - - Manifestation of Samyak yoga, Atiyoga, Ayoga Lakshana and Vyapat should be observed as per texts.175, 176,177,178,179 Samyak Yoga Lakshana-Sroto Visuddhi, Indriya Prasada, Laghuta, Agnivriddhi, Anamayatva, Kramat Vata Pitta Kapha Nirgamana180 Among different Laingiki Lakshana documented in the classics some are manifested on the day of Virechana and others on later days. In comparison to other Shuddhi Lakshana the Laingiki Lakshana is to be given much importance.181 Ayoga Lakshaņa of Virechana Karma-Kapha Prakopaka, Pitta prakopaka, Vata prakopaka, Agnimandya, Gaurava, Pratishyaya, Tandra, Chhardi, Aruchi, Vata Pratilomana .182 Atiyoga Lakshaņa of Virechana Karma-Kapha Kshaya Vikara, Pitta Kshaya Vikara, Vata Kshaya Vikara, Supti, Angamarda, Klama, Vepathu, Nidra, Balabhava, Tamah pravesha, Unmada,Hikka. 183 Management of Atiyoga: Administration of Takra , Water should be sprinkled on the patient’s body, Tandulodaka should be given with honey, Padmakastha, Nagakesar, and Raktachandana should be administered with honey. Virechana Vyapat-These are 10 in number viz.Adhmana, Parikartika, Parisrava,Hrdgraha, Gatragraha, Jivadana, Vibhramsha, Stambha, and Klama & Upadrava.184, 185,186
  47. 47. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 35 III. PASCHAT KARMA-Following points can be considered under Paschat Karma. 1. Tat Kalina Paschat Karma : After the stoppage of Virechana Vega, the hands, feet and face of the individual should be well washed and he should be consoled for sometime and instructed to follow Pathya as explained in the context of Snehana and Virechana .187 2. Kalantarina Paschat Karma: Individual is instructed to follow appropriate Samsarjana Krama as per the Shuddhi Lakshana a. Peyadi Samsarjana b. Tarpandi Samsarjana. Samsarjana Krama is a specific dietary regimen, which is to be followed after Shodhana Karma. The aim of this Krama is to increase Agni, Bala gradually, which has become weak due to Shodhana. Charaka reveals importance by giving example that small sources of fire, if simulated by adding small and light fuel, later on become so big that it can burn anything. Similarly by applying Samsarjana Krama Jatharagni can be increased to such an extent that it can digest all types of food.188 Caraka has mentioned that Peya, Vilepi, Akrta Yusha and Krta Yusha should be administered for the period of 3, 2, and 1 meal times to the patient having Pravara, Madhyama and Avara type of Shuddhi respectively 189 . Sushruta has described Yusha of Kulattha, Adhaki, Mudga and Mamsa Rasa for this purpose.Dalhana advises that the Peya should be given in the conditions of Kshina Kapha, but when Vata is dominant Mamsa Rasa should be recommended 190 When proper Virechana doesn’t occur at that time instead of Peyadi Krama, Tarpana is indicated. It is also recommended that the persons addicted to alcohol, having Vata Pitta Prakrti and if Kapha and Pitta are dominant even after Virechana Karma, Cakrapani mentioned that in the place of Peya and Vilepi, Svaccha and Ghana Tarpana should be given respectively 191
  48. 48. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 36 TVAK Tvak is the Updhatu of Mamsa.245 Acharya Charaka has said it is Matrujabhava.246 Tvak develops after the fertilization of the ovum. At the time of fertilization Sukra, Sonita and Atma get united for the manifestation of Garbha. Its growth is rapid and nourished by Tridosha. Seven layers of the layers of the skin are formed and deposited rapidly transforming in the same manner as the layers of cream are formed and accumulates on the surface of the boiling milk. 247 Tvak is formed by the Paka of Rakta Dhatu by its Dhatvagni. After the Paka of Rakta, by its Dhatvagni, Rakta become dry in the form of skin like the deposition of cream on the surface of the boiling milk. Thus, Tvak is also called as “Rakta Santanika”. 248 LAYERS OF THE SKIN-There are some different opinions regarding the number of the layers of the skin (Tvacha) among the ancient Acharyas. Achary Charaka has mentioned six layers of skin but only first two layers are named and rest of the four layers are named upon the disease producing in that layer. 249 TABLE-19 LAYERS OF THE SKIN Layer Contents Udakadhara Udaka means watery substance or lymph Ashrukadhara Blood capillaries. 3rd Manifestation of Sidhma and Kilas. 4th Manifestation of Dadru and Kushta. 5th Manifestation of Alaji and Vidradhi. 6th Manifestation of Arunshi. If this layer is injured then the individual gets trembled and enters in to the darkness. Sushruta has described seven layers of skin along with the specific names. He has also mentioned the thickness of each layer along with the diseases, which are prone to that layer.
  49. 49. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 37 TABLE-20 LAYERS OF SKIN ACCORDING TO ACHARYA SUSHRUTA AND COMMONLY OCCURRING DISEASE IN THOSE LAYERS Name Thickness Disease 1) Avabhasini 1/18 of Vreehi Sidhma, Padmakantaka 2) Lohita 1/16 of Vreehi Vyanga Tilakalaka, Nyachchha, 3) Shweta 1/12 of Vreehi Charmadala,Mashaka,Ajagallika 4) Tamra 1/8 of Vreehi Kilasa, Kushtha 5) Vedini 1/5 of Vreehi Kushtha, Visarpa 6) Rohini 1 Vreehi Granthi,Arbuda,Apachi, Shleepada,Gala ganda 7) Mamsadhara 2 Vreehi Bhagandara, Vidradhi,Arsha c) Vagbhatta has described seven layers of skin similar to that of Sushruta but description is not given. Commentator of Ashtanga Hridaya, Arundatta and Hemadri have named them as explained in the Sushrtua Samhita. TABLE-21 DIFFERENT LAYERS ACCORDING TO OTHER ACHARYAS Arundutta Sharangadhara 250 Bhela Bhasini Avabhasini Udakdhara Lohita Lohita Asrikdhara Sweta Sweta 3rd Tamra Tamra 4th Vedini Vedini 5th Rohini Rohini 6th Mamsadhara Sthula
  50. 50. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 38 SKIN The Skin or integument in Latin it means a -a covering. 251 Covers the body and protects the deeper tissues from injury, from drying and from invasion by foreign organisms; it contains the peripheral endings of many of the sensory nerves; it plays an important part in the regulation of the body temperature, and has also limited excretory and absorbing powers. 252 Skin is one of the largest organs of the body in surface area and weight. It covers the entire surface of the body. 253 In adults, the skin cover an area of about 2 square meters and weighs 4.5 to 5 kg. It ranges in thickness from 0.5 to 4.0 mm, depending on location. ANATOMY: The skin consists of superficial epithelial layer –Epidermis. The epidermis is attached to the inner, thicker, connective tissue part called the Dermis or corium .Beneath the corium is another connective tissue layer, loose in texture the hypodermis or subcutaneous layer.254 Hypodermis, consists of areolar and adipose tissue. The subcutaneous layer, in turn, attaches to underlying tissues and organs. (A) Epidermis: The epidermis is composed of non vascular stratified squamous epithelium ,Usual thickness (0.07-0.12mm) soles of feet and palms it is thick ranging from 0.8mm to 1.4mm.Squamous epithelium is 10-12 cells thick in palms and soles 3- 4 cells in eyelids and fore arms .The epidermis can be divided into two main systems the keratainising or the malphagian (keratinocytes) which form the bulk and the pigmentary system (melanocytes) which produce the pigment .Melanin is transferred to the keratinocytes through dendrite of malanocytes (cytocrine secretion).The epithelium contains four principal types of cells: (i) Keratinocytes (ii) Melanocytes (iii) Langerhans cell (iv) Marked cell. Four or five distinct layers of cells form the epidermis. The following are the main layers which can be made out microscopically in a section perpendicular to skin surface 1) Stratum basal or germinativum or stratum mucosum255 -It forms the deepest portion of epidermis and consists of single row of columnar cells and is capable of continued cells division. The whole of epidermis geminates from the stratum germinativum as these cells multiply,they push up towards the surface and become part of the upper layers. Trauma to this layer results in scarring .trauma above this
  51. 51. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 39 layer heals without scarring . The stratum basal also contains tactile (Merkel) discs that are sensitive to touch. 2) Stratum spinosum or Malpighi layer or prickle cell layer -It is superficial to basal layer this prickle – cell layers lies upon the basal layer and has 8 to10 rows of polyhedral cells that fit close together. This layer involves most of the pathological conditions of the skin. 3) Stratum granulosum: It is superficial to stratum malphigi .It consists of about three to five rows of flattened fusiform cells that develop darkly staining granules of a substance called Keratohyalin. This compound is the precursor of keratin. Keratin forms a barrier that protects deeper layers from injury and microbial invasion and makes the skin waterproof. 4) Stratum lucidum: Superficial to stratum granulosum is pale wavy looking layer .Normally, only the thick skin of the palms and soles has this layer. It consists of three to five rows of clear, flat, dead cells that contain refractive droplets of eleidin, an intermediate substance that is formed from keratohyalin and is eventually transformed to Keratin. 5) Stratum corneum or horny layer This is the most superficial layer, the outer surface of which is exposed to atmosphere. It consists of many layers of flattened ,non-nucleated cornifed cells. This layer is thickest on palms of hands and soles of the feet but thinnest on outer aspect of the lips on the glans penis and eyes. This layer consists of 25 to 30 rows of flat, dead cells completely filled with keratin. These cells are continuously shed and replaced by cells from deeper strata. The stratum corneum serves as an effective barrier against light and heat waves, bacteria, and many chemicals. (B) Dermis (Cutis vera or corium)-The dermis is profusely supplied with blood vessel .Chiefly consists of white fibrous tissue, elastic fibers and non-stripped muscles and contains blood vessels, nerves, hair, sweat gland and sebaceous glands and nerve corpuscles. Dermis is divided into papillary and reticular dermis. The outer portion of the dermis, about one fifth of the thickness of the total layer, is named the papillary region. The deeper portion of the dermis is called the reticular region. It consists of dense irregular connective tissue containing interlacing bundles of collagen and coarse elastic fibres. The reticular region is attached with underlying organs, such as bone and muscle, by the subcutaneous layer, also called the hypodermis or superficial fascia.
  52. 52. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 40 Keratinization:-In the process of keratinization, cells newly formed in the basal layers undergo a developmental process as they are pushed to the surface. As the cells relocate, they accumulate keratin. At the same time the cytoplasm, nucleus, and other organ cells disappear, and the cells die. Eventually, the keratinized cells slough off and are replaced by underlying cells that, in turn become keratinized. The whole process, by which a cell forms in the basal layer, rises to the surface, become keratinized and sloughs off take two to four weeks. Pigmentation of the skin:-Three pigments melanin, carotene and hemoglobin give skin a wide variety of colours. Melanin is located mostly in the epidermis; carotene is mostly in the stratum corneum and dermis; and hemoglobin is in red blood cells within capillaries in the dermis. BLOOD SUPPLY OF THE SKIN:-There are two horizontal and parallel systems of plexuses, which supply the skin. The plexus or network of blood vessels exists between the dermis and the subcutaneous tissue. Its exact position can never be accurately described. Each arterioles supply an area of skin and each various plexus associated with it drains the same area. NERVE SUPPLY:-The nerve supply of the skin is very complicated, and the pathways for the mediation of sensations through the various nerves are very much under debate. The varied sensations arising from skin are derived from a diverse population of cutaneous nerve endings or receptors, thus tactile, temperature and pain sensations are each sub served by different groups of receptors. FUNCTION OF THE SKIN: The skin is a metabolically active organ with vital functions including the protection and homeostasis of the body. i. Regulation of body temperature: Skin does the evaporation of sweat and converts the high temperature into lower elevated body temperatures or to the normal. Changes in the flow of blood to the skin also help the regulation of body temperature. ii. Protection: The skin is considered under the Integumentary system. It provides a physical barrier that protects the underlying tissues from physical abrasion, bacterial invasion, and dehydration and UV radiation. iii. Sensation: The skin contains abundant nerve endings and receptor that detect stimuli related to temperatures, touch, pressures and pain.
  53. 53. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 41 iv. Immunity: Sweat of the epidermal cells is important components of the skin immune system, which tends off foreign invaders. v. Excretion: Sweat is the vehicle for loss of a small quantity of ions and several organic compounds along with removal of heat and some part of water. vi. Blood reservoir: The dermis is a house of extensive networks of blood vessels that carry 8 to 10% of the total blood flow in a resting adult. In moderate exercise this flow increase, which helps to dissipate the heat from the body. While during the exercise skin’s blood vessels constrict so this allows more blood to circulate through contracting muscles. vii. Synthesis of Vitamin – D: Synthesis of vitamin D begins with activation of a precursor molecule in the skin by ultraviolet rays in the sunlight. Enzymes in the liver kidneys then modify this molecule and produces calcitrol, the most active from of vitamin D.
  54. 54. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 42 KUSHTA Kushta is one of the commonly found diseases of skin. It has been mentioned in all the Sthanas of Charaka Samhita, which shows the importance of the diseases. It is understood that the etiology and pathogenesis of Kushta is that of Santarpanajanya Vyadhis. ETYMOLOGY:-The word “Kushtha’ is derived from - ‘Kus nishkarshane’ + ‘Kta’ which implies‘to destroy’ to deform, or ‘to scrap out’, by adding the suffix ‘kta’ which stands for Firmness or certainty. 191 DEFINITION: According to author of Siddhanta Kaumudi, the condition in which different body organs, Dhatus, Upadhatu are destroyed is known as Kushta. In Shabda Kalpadruma it has been described as the disease which causes despise or contemptible. In Halayudha Kosha it is mentioned that - vitiated Rakta leads to the destruction of body, so it is called Kushtha. Kushta is one which causes vitiation as well as discoloration of the skin 192    Acharya Charaka and Acharya Sushruta noted the Kushta Saptha Dravya Sangraha i.e. Tridosha, Tvacha, Rakta, Mamsa and Lasika which makes the skin Kutsita (deformed). If it is neglected then normal condition of whole body may be affected so it is called as Kushta.Kushta is a Bahudoshaja Vyadhi. Kushta is that which disfigures the organs. 193 If left untreated it makes the body contemptible (Kutsit). So it is called as Kushta that which causes vitiation as well as discoloration of skin. When the vitiated Dosha provokes the four body elements (Dhatus) and if this vitiation of seven Dravyas is not cared, a disease is formed inside the body which manifests itself on the skin and makes it Kutsit or contemptible. The entire body becomes despised and therefore it is called Kushtha. Arunadatta mentions Kushta as one which causes vitiation as well as discoloration of the skin .194 CLASSIFICATION OF KUSHTA -There are many types of Kushta. It is divided into seven, eighteen or infinite categories195 Charaka has classified Kushtha in to seven types and of eighteen types The main two divisions of Kushta is MahaKushta and KshudraKushta.196 Chakrapani explained that KshudraKushta has Alpa (less) Dosha and has Lakshanas in comparison to MahaKushta. So, it is known as KshudraKushta. 197 This classification is Dependent upon the different factors like
  55. 55. Conceptual Study… Role of Panchatiktaka Ghrita as Shodhanartha Snehapana in the management of Ekakushta 43 permutation and combination of Dosha and Dhatu, locations in the body, nature of pain, colour, and shape etc. Mahakushtha-Acharya Charaka has classified the Mahakushtha in to Kapala, Audumbara, Mandala, Rishya Jihwa, Pundareeka, Sidhma, and Kakanaka. 198 Madhava Nidana and Bhela Samhita have also classified Kushta. However Sushruta and Astanga Hridaya have maintained the same description as that of Charaka Samhita with some difference. Sushruta has excluded Sidma Kushtha and considered as Kshudra Kushtha where as DadruKushtha is included under MahaKushtha. Sushruta and Vagbhata have considered Aruna Kushtha instead of Mandala Kushtha, which was included by Charaka as one of the Mahakushtha. Acharya Sarangadhara described eighteen types of Kushtha but he has not classified it. Kshudra Kushtha:-There are difference of opinion regarding the types of Maha Kushta among the Acharyas . Madhavakara has followed the classification of Charaka Acharya.All the authors have accepted that there are only eleven types of Kshudra Kushtha and seven of Maha Kushtha. NIDANA PANCHAKA: In our texts specific etiology for Ekakushta has been not described.So the etiology of Ekakushta can be understood on the basis of general etiology of Kushta. In Bruhat Trayis,specific Nidanas for Ekakushta not been described.So Samanya Nidana of Kushta is to be considered. I) NIDANA - i) AHARAJA NIDANA- - Agnimandya leading to Ama vishauttpati.199 - Prakopa of all Doshas but do not get expelled out of the body.200 - ‘Deha Dhatubhi Virodhamapadhyante’ Chakrapani- It causes Dusti of Dosha and Dhatu. - Srotorodha in different Srotas of the body.201 Virudha Ahara for Kushta –Virudahara causing Kushta are Intake of Mulaka, Lashuna ,Gramya, Anupa, Audaka Mamsa, Intake of Chilchima fish with milk. Milk with Nimbuka. Intake of food mostly containing Hayanka, Yavaka, Chinaka, Uddalaka along with Ksheera, Dadhi, Takra, Kola, Kulattha, Masha, Atasi, Kusumbha, Sneha Pippali, Kakamachi, Lakucha with Dadhi and Ghritha Mulaka with Guda Excessive Alcohol and green vegetables with milk. Articles having sour taste,

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