Snehapana samedarakta pk002-gdg


Published on


  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Snehapana samedarakta pk002-gdg

  1. 1. THE STUDY OF AROHANA SNEHAPANA AND ITS EFFECT ON SAMEDARAKTA WITH SPECIALREFERENCE TO HYPERLIPIDAEMIA AND NORMAL LIPID VALUES By Varsha S. Kulkarni. Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M. D. In PANCHAKARMA Under the guidance of Dr. P. Shivaramudu, M.D. (Ayu) And co-guidance of Dr. Shashidhar. H. Doddamani, M.D. (Ayu) DEPARTMENT OF PANCHAKARMA, POST GRADUATE STUDIES AND RESEARCH CENTER,SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103. 2005
  2. 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “The Studyof Arohana Snehapana and its Effect on Samedarakta withspecial reference to Hyperlipidaemia and Normal Lipid Values”is a bonafide and genuine research work carried out by me under theguidance of Dr. P. Shivaramudu M.D. (Ayu), Asst. Professor, Post graduatedepartment of Panchakarma and Co-guidance of Dr. Shashidhar H.Doddamani, M.D.(Ayu), Assistant Professor, Post graduate department ofPanchakarma.Date:Place: Gadag Varsha S. Kulkarni.
  3. 3. SHRI D. G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF PANCHAKARMA CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “The Study ofArohana Snehapana and its Effect on Samedarakta with specialreference to Hyperlipidaemia and Normal Lipid Values” is abonafide research work done by Varsha S. Kulkarni in partialfulfillment of the requirement for the degree of Ayurveda Vachaspathi.M.D. (Panchakarma).Date:Place: Gadag Dr. Shashidhar. H. Doddamani, M.D. (Ayu). Assistant Professor, Department of Panchakarma. Post Graduate studies and research center DGM Ayurvedic Medical College. Gadag
  4. 4. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation / thesis in print or electronic format for academic /research purpose.Date:Place: Gadag Varsha S. Kulkarni. © Rajiv Gandhi University of health Sciences, Karnataka
  5. 5. Effect of Arohana Snehapana on Samedarakta Acknowledgement This work is the result of the combined effort of a good number of people who includeresearchers, academicians, friends, colleagues, and above all the patients who cooperated with us in allaspects. Moreover it is because of Gods’ grace only the work could be completed as per to myexpectation. My deep sense of gratification is due for my parents who are the architects of my career. Theculture, discipline and perseverance, which I could imbibe, is solely because of their painstaking,upbringing and strong moral support. I am deeply indebted and sincerely gratefulness to my Principal, Dr. G. B. Patil, D. G.Melmalgi Ayurvedic Medical College, Gadag for their continues cooperation and timely encouragementat various levels of my study. I express my deep gratitude to my respected guide Dr. P. ShivaramuduMD.(AYU) for hissympathetic, compassionate, extensive guidance, suggestion, encouragement and kindheartedness. I am extremely happy to express my deepest sense of gratitude to my beloved and respectedHOD, Prof. G. Purushothamacharyulu,MD.(AYU) whose sympathetic, scholarly suggestions and ablestguidance at every step have inspired me not only to accomplish this work but in all aspects. Indeed, the affectionate guidance of my co-guide Dr. Shashidhar H. Doddamani,MD.(AYU) willbe cherished by me for long. His invincible and radical thinking were very valuable in achieving thisresearch work invoking scientific spirit throughout the course of the study. I am grateful to Dr. Santosh N. Belavadi,MD(AYU) Lecturer, for his co-operation and advice in thisstudy. I take this opportunity to thank HOD’s, of other departments Dr. Varadhacharyulu, Dr.M. C. Patil, Dr. G. V. Mulgund. For their inspiration and valuable suggestions. I am grateful to all the PG, teachers Dr. K. S. R. PrasadMD.(AYU), Dr.DilipkumarMD.(AYU), Dr. R. Y. ShettarMD.(AYU), Dr. Kuber SankMD.(AYU), Dr. G. N. DanappagoudarMD.(AYU),Dr. Jagadish MittiMD.(AYU), Dr. MulkiPatil, Dr. Yasmin, MD.(AYU), Dr. Shashidhar NidagundiMD.(AYU),and Dr. D. M. Patil MD.(AYU), for their valuable inputs and suggestions. I extend my immense gratitude to Dr. R. K. Gacchinmath, Dr. G. S. Hiremath, Dr. S. A. Patil,Dr. B. G. Swami, Dr. Reddar, Dr. U. V. Purad and other teaching staff who helped during my study. My sincere thanks are extended to Dr. Basavaraj SaraganachariMD.(AYU), and Dr.Muralidhar Pujar for their inspiration and valuable suggestions. I would like to express my sincere thanks to Mr. V. M. Mundinamani, Librarian and Asst.Librarian Mr. S. B. Sureban for providing valuable books in time throughout the study. I am thankful to Mr. P. M. Nanadkumar, Statistician, who helped me in Statistical Analysis. I seek privilege to extend my obligations to my seniors Dr.Srinivas Reddy, Dr. HanumanthGowda, Dr. Shankar Gowda. I can not move further before thanking to my intimate friend Dr. Ravikumar who has been stoodindefatigable with me in each and every circumstances and gave me in depth sense of friendship. I am highly under the debt of my beloved friends Smt. Manjula, Dr. Naganur, Dr. Hosalli, Dr.Seema. M.B., Dr. Pampanagowda, Dr. Manjula, Dr. Girish and Dr. Deepa, who have helped in allthe moments during my Post Graduate studies. Acknowledgement - I
  6. 6. Effect of Arohana Snehapana on Samedarakta I take this moment to express my thanks to all my Post Graduate colleagues Dr. Subin, Dr.Febin, Dr. Satheesh, Dr. Santosh, Dr. Joshi, Dr. Chetan, Dr. V.S. Hiremath, Dr. Santoji, Dr. Koteshwar,Dr. Jaggal, Dr. Veena, Dr. Mangala, Dr. Shashikala, Dr. K. S. Hiremath, Dr. Paraddi and JuniorColleagues Dr. Shaila, Dr. Hugar, Dr. Chandramouli, Dr. Jayaraj, Dr. Kendadmath, Dr. Lingareddi,Dr. Vijay, Dr. Akki, Dr. Hakkandi, Dr. Ashwin, Dr. Umesh, Dr. Suvarna, Dr. Anitha, Dr. Jagadish, Dr.Sharanu and Dr. Anand. I am very much thankful to Smt. P. K. Belavadi, Mr. M. M. Joshi, Mr. Shankar, Mr.Biradar, Mr. Kallanagoudar, Mr. Dasar and Smt. Sarangamath. I am very much thankful to Raghu S. K. and Raju S. K., Net Nota Cyber Café, Gadag for theirtimely help in typing and bringing out this computer print. Last but not least, I thank to the patients who are pillars of my research work, Khona pathologylaboratory staff and Hospital staff and to all those names my memory fails to recollect. Dr. Varsha S. Kulkarni. Acknowledgement - II
  7. 7. Effect of Arohana Snehapana on Samedarakta ABSTRACT Ayurveda uses two main modalities in the treatment of disease each with itsown distinct purpose. These modalities are Shodhana and Shamana chikista. TheSnehana is the one of the main preparatory procedure to be performed beforeShodhana Karma. In the present study the Shodhananga Snehapana with Murchita Tila Taila wasgiven in certain specific quantity in the Arohana Krama till the appearance ofSamyak snigdha laxanas seen. Large quantities of Sneha is using for Snehapana, thepeople in this era are afraid of this therapy, because it may increase fat speciallyCholesterol and Triglycerides which was the important causative factor forAtherosclerosis, Heart attack etc., It becomes essential to clear the cloud from themind of people. Hence the present study has been undertaken to assess the effect ofArohana Snehapana over the Samedarakta (Hyperlipidaemia & Normal Lipid Values). The objectives of this study was to evaluate and to compare the effect ofArohana Snehapana with Murchita Tilataila on Samedarakta with special reference toHyperlipidaemia and Normal Lipid Values. In the present Clinical study, two groups were made. In one group, the 15patients with primary Hyperlipidaemia (especially raised values of either Cholesterolor Triglycerides) and who are fit for Snehana and Shodhana karma excludingsecondary Hyperlipidaemia were selected. In another group 15 voluntaries withNormal Lipid Values who were desirous to under go Shodhana therapy formaintenance of good health were selected. Abstract - III
  8. 8. Effect of Arohana Snehapana on Samedarakta In both the groups after Ama Pachana, Snehapana was done in Arohanakrama till the Samyak snigdha laxanas are observed. Snahapana was given 30ml asHrisiyasi matra at morning around 6 to7am with ushnajala as anupana. Next day dosewas increased depending upon the previous days sneha digestion. Lipid profile valuesare done on first day before Snehapna and after Samyak snigdha laxanas, with 12hours fasting in the morning. Tilataila is having special properties like Teekshna, Ushna, etc., by these it enters sthoola and sukshma srotases and does chedana, kshapana of Medodhatu. Both the groups showed Samyak Snigdha Laxanas without producing vyapat. On the basis of the results of both the groups it was observed that there was a decrease in the total Cholesterol, Triglycerides, LDL, VLDL & raise in HDL level which shows the protective role of the Shodhanapoorva Arohana Snehapana therapy in Samedarakta (Hyperlipidaemia & Normal Lipid Values).Key words Snehana, Shodana, Arohana Snehapana, Murchita Tilataila, Samyak SnigdhaLaxanas, Samedarakta, Meda, Hyperlipidaemia, Lipids, Lipid Profile. Abstract - IV
  10. 10. Discussions 127 -143Conclusions 144 -145Summary 146 -148Bibliographic References 149 -164Annexure Contents - VI
  11. 11. Effect of Arohana Snehapana on Samedarakta ABBREVIATIONSC.S. Charaka SamhitaS.S Sushruta SamhitaA.S. Astanga SangrahaA.H. Astanga HridayaB.P. Bhava PrakashaSha.S Sharanghadhara SamhitaK.S Kashyapa SamhitaCkd CakradattaM.N MadhavanidanaY. R YogaratnakarVa.Se VangasenaSu SutrasthanaSha ShareerasthanaVi. Vimanasthana Abbreviations- VII
  12. 12. Effect of Arohana Snehapana on Samedarakta LIST OF TABLESSl. No. Tables Pages 1 Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of 11 Sneha Dravys. 2 Showing Properties of Taila 12 3 Source of Sthavara Sneha according to Charaka 13 4 Sushruta’s Sthavara Sneha classification 13 5 Paka Bhedha of Sneha 13 6 Opinion about Sneha Matra 15 7 Sneha Matra according to Sushruta 16 8 Indications of Sneha Matra 16 9 Opinion of Vangasena regarding dosage of Arohana Snehapana 18 10 Shamana and Brumhana Snehana Yogya 19 11 Showing General Indications of Shehana According to Different 19 Acharyas. 12 Showing the Deserving Condition for Snehana 20 13 General Contraindications of Snehana. 22 14 Sneha Jiryamana and Jirna Lakshana114 27 15 Samyak Snigdha Lakshanas 28 16 Asnigdha Lakshanas 29 17 Ati Snigdha Lakshanas 29 18 Showing classification of fatty acids 52 19 Showing the characteristics of lipoproteins 53 20 Showing fat digestion 60 21 Showing the Nidana of Medovriddhi according to different Acharyas 69 22 Showing Roopa of Medoroga 72 23 Showing the Classification of Hyperlipidaemia 79 24 showing the Pharmacodynamics of Ingredients of Panchakola 86 choorna 25 Showing Pharmacodynamics of Drugs Used For Moorchana of 88-89 Tilataila 26 Age wise Distribution of the Sample 100 27 Sex wise Distribution of the Sample 101 28 Religion wise Distribution of the Sample 101 29 Occupation wise Distribution of the Sample 102 30 Marital status wise Distribution of the Sample. 102 31 Socio Economical Status wise Distribution of the Sample 103 32 Type of Diet wise Distribution of the Sample 103 33 Diet Pattern wise Distribution of the Sample. 104 34 Nature and Character of food wise Distribution of the Sample 104 35 Nature of work wise distribution of the Sample 105 36 Sleep wise distribution of the Sample 105 37 Vyayama wise distribution of the Samples 105 38 Vyasana wise distribution of the Samples 106 39 Menstrual History of 14 female patients 106 40 Jataragnibala wise distribution of the Samples. 106 List of Tables - VIII
  13. 13. Effect of Arohana Snehapana on Samedarakta41 Koshta wise distribution of the Samples 10742 Prakriti wise Distribution of the Sample 10743 Sara wise Distribution of the Sample 10744 Showing Samhanana of the Samples 10845 Showing Pramana of the Samples 10846 Showing Satmya of the Samples 10847 Showing Satva of the Sample 10948 Showing Abhyavaharana Shakti of the Sample 10949 Showing Jarana Shakti of the Samples 10950 Showing Vyayama Shakti of the Samples 11051 Shows the matra of Arohana Snehapan with Murchita Tila Taila in 111 both groups.52 Showing the mean on set of Jeeryamanya laxanas of both Groups 11253 Showing time taken for Sneha Jeerna laxanas 11354 Showing Summary of time taken for Sneha Jeerana (in minutes) 11455 Showing Mean time taken for Samyak Snigadha laxanas of both 115 Groups A & B.56 Showing Samyak Snigdha Laxanasa of each individual in both the 116 groups57 Showing the Total number of Samyak Snigdha Laxanas observed on 117 last day of Snehapana in both the groups58 Showing Serum Cholesterol levels in both groups before and after 118 Arohana Snehapana.59 Showing Serum Triglycerides levels in both groups before and after 119 Arohana Snehapana.60 Showing HDL levels in both groups before and after Arohana 120 Snehapana61 Showing LDL levels in both groups before and after Arohana 121 Snehapana62 Showing VLDL levels in both groups before and after Arohana 122 Snehapana.63 Showing the weight and BMI of Group A before and after Arohana 123 Snehapana64 Showing the weight and BMI of Group B before and after Arohana 124 Snehapana65 Showing the overall results of Serum Lipid Values 12466 Showing statistical results of Group A samples 12567 Showing statistical results of Group B samples 12568 Showing comparative statistical results of Group A & Group B 125 samples List of Tables - IX
  14. 14. Effect of Arohana Snehapana on Samedarakta LIST OF FIGURESSl. No. Figures Pages 1 Showing Bio Synthesis of Cholesterol 48 2 Showing Metabolism Summary 67 LIST OF FLOW CHARTSSl. No. Flow Charts Pages 1 Showing Sthana and Swaroopa of Meda dhathu 40 2 Showing Samprapthi of Medo vriddhi 76 LIST OF GRAPHSSl. No. Graphs Pages 1 Showing Age of the Samples 100 2 Showing Sex of the Samples 101 3 Showing Religion of the Samples 101 4 Showing Occupation of the Samples 102 5 Showing Socio Economical Status of the Samples 103 6 Showing Type of Diet of the Samples 103 7 Shwoing Nature and Character of food of the Samples 104 8 Showing Sleep of the Samples 105 LIST OF PHOTOGRAPHSSl. No. Photographs Pages 1 Ingredients of Panchakola Choorna 87 2 Drugs Used for Murchana of Tilataila 90 List of Tables - X
  15. 15. Effect of Arohana Snehapana on Samedarakta The ancient Indian science of health, Ayurveda is now being increasinglyaccepted by the world at large for its facilities and adoptability even to the moderntimes. It is not surprising that, the ancient science is accorded such importance incountries where modern medicine itself has made immense advances. The onlyreasonable explanation for this phenomenon is the fact that Ayurveda remains theonly system of medicine that possesses a natural form of treatment, one thatprescribes remedies in accordance with nature itself. It approaches a patientholistically, taking in to account while treating person, not only the patient but also hisgeneral condition. Shodhana and Panchakarma are the two terms we can come across in theAyurvedic classics that have seen almost used synonymously. If we meticulouslyexplore the literature regarding these two terms, we may unveil the subtle differencesexisted between both of them. The term Shodhana has been used in broader perspective in Ayurvedicclassics. This envisages the wider meaning and implication of the Shodhana therapies.Samshodhana is a term used for various eliminating procedures. Panchakarmatherapy which is known as Samshodhana therapy is designed to eliminate the vitiateddoshas. In order for these therapies to work the vitiated doshas must be brought to thekostha. This is accomplished by two primary means i.e., Snehana and Swedanatherapies. Snehana is one such procedure, mentioned under Shadvidhopakrama.Snehana can act as a Poorvakarma for Shodhana procedures, i.e., Shodhana sneha, as Introduction - 1
  16. 16. Effect of Arohana Snehapana on Samedaraktaa Pradhana karma in alleviating diseases ie., shamana snehana and as a paschat karmain bringing compactness to the body i. e., Bruhmana sneha. Almost all the Acharyas have given the prime importance to Snehana therapyas a Poorva karma, Pradhanakarma and Paschat karma according to the need of theperson or disease. Acharya Sushruta beautifully delineates the importance of Sneha asa “Human being is composed of Sneha, prana is predominantly contains Sneha.Hence prana can be protected or preserved by Snehana”. Even though various varieties of Snehas are available, only four of them are inregular usage and known as uttama Snehas. They are Sarpi, Taila, Vasa and Majja.In Taila vargs Tilataila is best. By examining the Rogabala, Doshabala and Shareera bala, the proper Snehashould be administered after the complete digestion of food which was taken in theprevious night and Snehas are given in certain specific quantity in the increasing orderfor specific number of days or till Samyak Snigdha Laxanas get manifested. Afteradopting the necessary regimen in Vishrama kala Shodhana i.e, either Vamana orVirechana are performed. In this most advanced modernised era, the humans are gifted with lot ofsophistication, luxuries but at the same time left with sedentary ways of life, stressinduced hectic, unhealthy schedules. Further indiscriminate dietary habits,overeating, consuming high quantity and high caloric foods etc., propping into one’slife are strongly influencing the homeostasis leading to the maximum number ofpathological conditions, one amongst them is Hyperlipidaemia. Introduction - 2
  17. 17. Effect of Arohana Snehapana on Samedarakta On the theoretical grounds it has been tried to co-relate the Hyprlipidaemiawith many diseases described in Ayurveda i.e., Medoroga, Medhovriddhi,Abhadhamedus, Sthaulya etc., These are getting manifested due to vitiation of Medadhatu. Hence the excessamount of Meda in Rakta will be considered as Hyperlipidaemia and the normalamount of Meda in Rakta is taken as normal Lipid. The term coined for the word Lipidaemia is Samedarakta whether it isphysiological or pathological. Literally Samedarakta means Rakta associated withMeda. Hyperlipidaemia refers to an increased concentration of either Cholesterol orTriglycerides or both lipids in the Plasma. • The amount of Cholesterol in the blood can range from 3.6 to 7.8 mmol / ltr. A level above 6 mmol / ltr is regarded as high and is a risk factor for arterial disease. • The high Cholesterol level can cause narrowing of the arteries, heart attacks and Strokes. The risk of CHD also raises as blood Cholesterol level increases. When other risk factors like HT, DM are present, CHD risk increases even more. • The first step in the treatment of Hyperlipidaemia is attention to diet. A single dietary approach to all form of Hyperlipidaemia includes reduced in take of calories and saturated fats, but Mustered oil, Tila oil, Fish fat can be taken in desirable quantity. Weight reduction is essential for prevention of these above risk factors. Introduction - 3
  18. 18. Effect of Arohana Snehapana on Samedarakta In the present study Murchita Tilataila was taken in increasing order (ArohanaSnehapana). But people in this era are afraid of this Snehana therapy which is takenin large quantities, may leads to increase of plasma lipids, especially Cholesterol andTriglycerides which are the important risk factors for Atherosclerosis and CHDfurther life threatening conditions. But Tilataila is having special characters as “Krishanam BhrimhanayalamSthoolanam Karshanaya Cha” means in Krisha people it acts as Bhrimhana and inSthoola person it does Karshana of Meda. By its teekshana Ushnadi gunas enters allsukshma, sthoola srotases and does Chedana, Kshapana of Medodhatu. Hence this study has been intended to assess the effect of Arohana Snehapanaon Samedarakta (Hyperlipidaemia and Normal Lipid Values). Introduction - 4
  19. 19. Effect of Arohana Snehapana on SamedaraktaTo evaluate the effect of Arohana snehapana with Murchita Tilataila onSamedarakta (Hyperlipidaemia and Normal Lipid Values).To compare the effect of Arohana Snehapana in both Hyperlipidaemia andNormal Lipid Values. Objectives - 5
  20. 20. Effect of Arohana Snehapana on SamedaraktaHISTORICAL REVIEW:On Sneha karma: It would be quite judicious to review the reference of Sneha which is availablefrom Vedic period to modern period.Veda Kala In Rigveda description of many herbal plants and qualities of Tilataila,Sarshapa etc., are available1. Atharva Veda, gives plenty of references regarding theuse of Sneha therapeutically. We find the use of both animal product (ghee) and plantproducts (oil) in the Materia Medica of Atharvanas. Among the plant products, oil ofIngida and Tila taila are found embodied in the pharmacopoeia of Atharvanas.Samhita Kala In Charaka Samhita (800 BC), we find ample of references regarding thetherapeutically use of Sneha in various disorders. The author has devoted an entirechapter in the Sutra Sthana on “Shadvidopakramas”2. Snehana as pradhana karma isthe most significant therapeutic procedure. Among them Charaka has extensivelydealt with the subject “Snehana” and its salient features separately in 13th chapter ofSutra Sthana3 and about Shodhananga snehana in Charaka siddhisthana4. Here he hasdescribed in detail the properties of Sneha dravyas, basic sources of Sneha dravya,indication and contraindications of Snehana etc. Acharya Sushruta (600 BC) has contributed separate chapter on “Sneha” in hisChikitsasthana. Here he has classified Snehana on the basis of its Karmukata asShodhana, Shamana and Brumhana. Sushruta explained the preparation of “Sneha”i.e., Ghrita and Taila5. Also we find good number of references regarding the use ofsneha in the Shodhana and Shamana or alleviation of different diseases. Sushruta, Historical Review - 6
  21. 21. Effect of Arohana Snehapana on Samedaraktabeing a surgical man has also used “Sneha” in various surgical ailments. Detailedexplanation about Sneha, nishapatti of Taila, type of Snehas, sources of Snehas,qualities of Tailas and their preparation have been mentioned in Sushruta sutrasthana. Types of Tailas, qualities of Tailas, method of preparation of Aushadhisiddhatailas and method of preparation of Hingutriguna taila have been mentioned inSutrasthana and Chikitsasthana of Astanga Hridaya6. Kasyapa (600 BC), an eminent personality in Koumarabhritya has dealt indetail regarding Snehana in 22nd chapter of his Sutrasthana. Also he has useddifferent ghrita and taila in managing various Balarogas7. Bhela, one of the sixcelebrated disciples of Atreya has mentioned the use of different Sneha in treatingdifferent disorders8. Qualities of each taila their specific indications have beenmentioned in 14th Chapter in Harita samhita9.Sangraha Kala Common qualities of each taila and shresthatha of Tila taila is mentioned inYogaratnakara 1st Chapter10. In Bhavaprakash Nigantu detail explanation ofparyayas, swaroopa utpattisthana guna of taila are available11. During this period, authors like Chakrapani Datta12, Vangasena13 andSharangadhara14 have included Sneha, both ghrita and taila in the cure of variousdisorders.Adhunika Kala Detailed explanation about oils, fats, classification of oils, properties andsources of oil, expression of oils, have been mentioned in text of pharmacognocy15Teiz’s text book of clinical Bio – Chemistry16. Historical Review - 7
  22. 22. Effect of Arohana Snehapana on SamedaraktaOn Meda and Vyadhi: About Meda and Medoroga there is no any direct reference is available inVeda but all most Samhitas of Ayurveda refereed these ailment with their differentaspects. All the Bhrahatrayees, Laghutrayees, Vangasena and Yogaratnakara haveexplained about Meda and Medoroga as follows;C. S. Sha. 7/6 - Meda pramanaC. S. Vi. 5/8, 16 - Medovaha sroto moola, Medovahasroto dusti karanaC. S. Vi. 8/106 - Medasara purusha laxanaC. S. Su. 13/5 - Taila sevana yogyaC. S. Su. 21/3-19 - Asta dosha of Sthoulya and Madhyama pramana of purushaC. S. Su. 28/15 - Abaddha medasS. S. Su. 14/11 - Meda is forming from mamsaS. S. Su. 15/ 6, 13 - Meda karya, MedovriddhiS. S. Su. 24/13 - Medodhatudusti, Granthi, Osta prakopa, Madhumeha, Sthoulya are manifesting due to dusti of Meda dhatu.S. S. Sha. 9/12 - Moola of MedaA. H. Su. 11/18,26 - Medovriddhi, Ashrayaashrayee Bhava of kapha and MedaA. S. Su. 19/26 - Sthoulya is counted as disorder of Shleshma dosha seated in Medadathu.M. N. 34/1-9 - Medoroga nidana, samprapti laxanas.Va. Se. 39/1-10 - Medorogadhikara Karana, Samprapti, laxana, Chikista. Modern concept of Lipids, Lipid metabolism and Hyperlipidaemia available inGuyton Medical physiology17, Ganonge Medical physiology18, API text book ofmedicine19, Davidson text book of medicine and Basic pathology20. Historical Review - 8
  23. 23. Effect of Arohana Snehapana on Samedarakta SHODHANA POORVA AROHANA SNEHAPANA Snehana is the classical poorvakarma to be administered as a preparatorymeasure before Shodhana therapy i.e., vamana, virechana etc, independently21.Charaka has described Snehana as one among the Shadvidhopakrama and can beadopted as treatment22. Snehana is a therapy intended for alleviation of vitiated doshas as a part ofpreparatory therapy for Shodhana & imparts strength, unctuousness to the body23.NIRUKTI OF SNEHA The word Sneha is Masculine in gender and is derived from ‘Snih’ Dhatu bysuffix ‘lyut’ Pratyaya. (Vachaspatya )24 The mool ‘Snih’ has two implications or meanings --‘Snih - Preetau’ to renderaffection and ‘Snih – Snehane’ to render lubrication. Among these the later will bemore adopted in the present context. The term Sneha implies that, a substance that brings oiliness or unctuousness.Sneha literally means oiliness, unctuousness, fattiness, greasiness, lubricity, viscidity,affection, love, kindness and tenderness. (Monier Williams 1889 & Apte 1970)25PARIBHASH OF SNEHA:‘Snehanam snehavishyand mardavakledakarakam’ 26 Charaka defines Snehana as, the procedure by which Snigdhata, Vishyandana,Mardavata and Kledana are produced in the body .The measures adopted to bringabout Snigdhata in the body is known as Snehana. Arohana Snehapana - 9
  24. 24. Effect of Arohana Snehapana on Samedarakta • In Rajanighantu the word Sneha is used to describe the external application of Sneha dravyas.27 • Charaka has explained the value of Sneha as “Snehoanilamhanti mrudukarotideham, Malanam vinihantisangam” ie., Sneha helps in bringing balance in vitiated vata, renders the body, softens and clears the accumulated malas which have obstructed the srotamsi.28 Hence Shodhanaga abhyantara Snehapana indicates the administration ofSneha dravyas before the Shodhana procedures ie., Vamana and Virechana.SYNONYMS The synonyms mentioned for Snehana are Sneha, Snigdhata, Mrtkshana,Mrksha, Abhyanga and Abhyanjana.27GUNAS OF SNEHA DRAVYAS: 29,30,31 Gunas in the drugs are responsible for the different functions of drug. TheProperties of Sneha Dravya’s are like Sukshma, Sara, Snigdha, Drava, Picchila,Guru, Shita, Manda and Mrdu, which are having opposite properties of RukshanaDravyas. Though drug having these qualities but always it may not produce Snigdhatain the body. There are few exceptions to this general rule like Yava, though itpossesses Guru, Sheeta, Sara gunas produces Rukshata. Rajamasha inspite of havingguru guna produces rukshata. Tila Taila even though it is Tikshna and Ushna it actslike Snehana. That may be the reason why Acharyas have used the term Prayo, whileexplaining Sneha Dravya properties. Arohana Snehapana - 10
  25. 25. Effect of Arohana Snehapana on SamedaraktaTable No. 1: Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of Sneha 32Dravys . Dominent Mahabhutha Guna Karmukata Prathvi Ap Teja Vayu Akasha Lepana, Jivana, Samghata,Picchila ++++ Sandhana, Balya, Gouravata Sroto Vishodhana, Vivarana,Sukshma ++ ++ +++ Soushiryakara Anulomana, Vyaptisheela,Sara ++ + Preranasheela Snehana, Mardavata,Snigdha + ++++ Kledana Bandhana, Vishyandana, Prakledana, Vilodhana,Drava ++++ Prasari. Brumhana, Malavriddhikara,Guru ++++ ++ Tarpana, Angaglani, Balakara,Shita +++ ++ Sthambhaka, HladanaManda ++ + Shamana Shaithilya of Avayava,Mrdu ++ +++ Mardavata.By seeing above table it can be justified that Sneha Dravyas are of apyamahabhutapredominant.MAHA SNEHAS OR PRAVARA SNEHA:33,34,35 Among all the Sneha Dravyas, Ghrita, Taila, Vasa and Majja are the mostimportant Snehas because of their excellence in Snehana qualities.Sneha Action of on Doshas :36 1. On Vata Shleshma- Taila – Vatashleshmaghnatama Majja - Vatashleshmaghna Vasa - Vatashleshmaghnatara 2. On Pitta Dosha- Vasa - Pittaghna Majja - Pittaghnatara Ghrita - Pittaghnatama Arohana Snehapana - 11
  26. 26. Effect of Arohana Snehapana on SamedaraktaPROPERTIES OF TAILAS: 37, 38Table No. 2: Showing Properties of Taila Rasa Anurasa Virya Vipaka Guna Madhura Tikta,Kashaya Ushna Madhura. Tikshna,Guru,Snigdha,Vikasi,SaraKarma 39 VataKaphahara, Pittakara, Balakara, Varnakara, Mardava Kara, Tvachya,Krimighna, Garbhashaya Shodhaka, Bhagna Sandhanakara , Subsides Shula in Yoni,Shira and Karna.Seasonal indication : Pravrt, Shita KalaSuitable condition for Taila Snehana:40,41 Vata Prakrti, Pravriddha Shleshma Medaska, Chala Sthula Gala Udara, TailaSatmya, Vatavyadhi, Krimikoshta, Nadivrna, Bhagna, Krura Koshta, those desires ofBala, Tanutva, Laghuta, Drdhata and Sthiragatrata. CLASSIFICATION OF SNEHAI. BASED ON YONI (SOURCE)42,43 There are two sources of Dravys viz., Sthavara and Jangama Based On Yoni (Source) Sthavara JangamaA) Sthavara Sneha (Vegitable Origin) Sthavara Sneha is extracted from plant source. Phala, Sara, Mula, Tvak, Patra& Pushpa are the main sources of Sthavara Sneha. Charaka has told eighteenAshayas of Sthavara snehas. Arohana Snehapana - 12
  27. 27. Effect of Arohana Snehapana on SamedaraktaTable No. 3 Source of Sthavara Sneha according to Charaka44 Tila Sarshapa Eranda Bibhitaki Priyala Abhishuka Bilva Moolaka Chitra Atasi Madhuka Kusumbha Akshodha Abhaya Karanja Shigru Nikothaka HaritakiSushruta has classified Sthavara Sneha according to their action.Table No. 4 Sushruta’s Sthavara Sneha classification45 Action Virechanopayogi Pittasamsrusta Vayu Upayogi Vamanopayogi Krshnikarana Upayogi Shiro Virechanopayogi Pandukarana Upayogi Dushta Vranopayogi Dadru, Kushta, Kitibha Upayogi Maha Vyadhi Upayogi Ashmari Upayogi Mutra Sangopayogi Prameha UpayogiB) Jangama Sneha (Animal Origin) Jangama Sneha is derived from animal sources. Ex: Kshira, Dadhi, Ghrita,Mamsa, Vasa, Majja etcII. PAKA BHEDA Opinion of different authors regarding varieties of Sneha Paka and itsindicationsTable No. 5 Paka Bhedha of Sneha 46,47,48 Snehana Caraka Sushruta Sharangdhara Abhyanga Khara Madhyama Madhyama Pana Madhyama Mrdu Madhyama Nasya Mrdu Madhyama Mrdu Basti Madhyama Khara Madhyama Karnapurana - Khara Madhyama Arohana Snehapana - 13
  28. 28. Effect of Arohana Snehapana on SamedaraktaIII. SAMYOGA BHEDA:49 Samyoga Bheda Yamaka Sneha Trivrut Sneha Maha Sneha (Taila + vasa) (Taila+ Vasa + Majja) (Sarpi +Taila +Vasa+ Majja)IV. UPAYOGA BHEDA:50,51 52 Based on the route of administration, Snehana is classified as – Upayoga Bheda Abhyantara Snehana Bahya Snehana (Pana, Basti, Nasya, Bhojana) (Abhyanga, Lepa, Udvartana, etc.,)V. PRAYOGA BHEDA 53,54 Based on the method of administration Snehana is of 2 types viz, Prayoga Bheda Accha Peya Vicharana Snehana. (Sneha without mixing with (Sneha with various preparations any other Dravya) like Vilepi and Yavagu etc.)VI. ACCORDING TO VISHISTHA SAGNA 55,56,57 Vishistha sagna Sadyo Snehana Pancha Prasrta Peya Achapeya Arohana Snehapana - 14
  29. 29. Effect of Arohana Snehapana on SamedaraktaVII. MATRA BHEDA:58,59 The following dosage schedule is advocated in the classics based on the timerequired for digestion of sneha taken.(i) Hrasva Matra - The dose of Sneha that is digested within 6 hours.(ii) Madhyama Matra - The dose of Sneha that is digested within 12 hours.(iii) Uttama Matra - The dose of Sneha that is digested within 24 hours Vagbhata has mentioned about Hrasiyasi Matra the quantity of Sneha, whichdigests within three hours, is known as Hrasiyasi Matra. This is used when the Koshtaof the person has not been properly diagnosed60. Fixing the Dosage of Sneha in numerical value is not possible with the reasonthat, dose will vary from person to person based on Dosha, Kostha and Agni level.Hence dosage of the Sneha is explained based on the time required for the digestionof Sneha viz, (i) Hrasiyasi Matra (ii) Hrasva Matra (iii) Madhyama Matra (iv) Uttama MatraTable No. 6 Opinion about Sneha Matra60, 61, 62 Hrasiyasi Madhyama Uttama Author Hrasva Matra Matra Matra Matra 1 Pala, 2 Pala, 4Hemadri - - - Pala, 6 PalaSharangdhara - 2 Tola 3 Tola 4 TolaCakradatta Arohana Snehapana - 15
  30. 30. Effect of Arohana Snehapana on SamedaraktaTable No. 7 Sneha Matra according to Sushruta63 Time Dose required for Action Indication digestionSadharana Matra (1/4th day) 3 Hrs. Agnidipti Alpa Dosha Atur Brumhana,Bruhmana Matra (1/2 day) 6 Hrs. Madya Dosha Atur VrushyaPrabhala Dosha Matra (3/4th 9 Hrs. - Bahu Dosha Aturday)Shrestha Matra (Full day) 12 Hrs. - Glani, Murcha, Mada Kushta, Visha,Uttama Matra (Day & 24 Hrs. - Unmada, Graha,Night) ApasmaraTable No. 8 Indications of Sneha Matra64, 65 Criteria for selection of Dose Action Person DiseaseUttama • Prabhuta Sneha nitya Gulma • Shighravikara ShamanaMatra • Kshut–Pipasa Saha Sarpa- • Doshanukarshini • Uttama – damshtra • Pervades through all Agnibala Visarpa marga Sharira Bala Unmatta • Balya Manasa Bala Mutrakrcchra • Rejuvenates-body, GadhaVarcha sense organs and mindMadhyama Arushka • No much complicationMatra Madhyama – Sphota • Does not effect strength Sharira bala Pidaka much Manasa bala Kandu • Brings Snehana Agnibala Pama comfortably Mrudu Koshta Kushta • Used as Shodhanartha Vatarakta SnehanaHrasva • Vriddha ChronicMatra • Bala condition of • Brumhaniya • Sukumara/Sukhocita disease like- • Snehaniya • Mandagni Jvara • Vrushya • Durbala/Avara bala Atisara • Balya • Person not able to Kasa • Long lasting benefits withstand hunger. • Does not cause Complications Arohana Snehapana - 16
  31. 31. Effect of Arohana Snehapana on Samedarakta Hrasiyasi Matra is a trail dose, which is administered on the first day ofSnehapana. One of the actions of Uttama Matra Snehapana is explained as VikaraShamana and that of Hrasva Matra as Brumhana Cakrapani mentions that UttamaMatra should be used for Shamana and not for Shodhana Purva Snehana. So doubtmay arise regarding usage of Uttama and Hrasva Matra as Shodhana PurvaSnehapana Dosage.VIII. KARMUKATA BHEDA: Based on the action of Sneha, Snehana are of 3 types viz. (i) Shamana Snehana (ii) Brumhana Snehana (iii) Shodhana Snehana(i) Shamana Snehana: Shamana Snehana is a procedure of administration of Madhyama Matra ofAccha Sneha during Annakala when one feels hungry without taking the meal.66,67Hemadri defines Shamana Snehana is one which normalizes the aggravated doshaswithout expelling them and disturbing the normal doshas68.(ii) Brumhana Snehana: The snehana used for Brumhana is called as ‘Bhrumhana Snehana’. Theadministration of Sneha along with Mamsa Rasa, Madya, Kshira etc., are known asBrumhana Snehana69. Before food if Brumhana Snehana is given will curesAdhobhaga rogas, in the middle of food cures Madhyamabhaga rogas, after foodcures Urdhwabhaga rogas and strengthens the body70. The dose of Sneha should beAlpa or even less than quantity of Hrasiyasi Matra71. Arohana Snehapana - 17
  32. 32. Effect of Arohana Snehapana on Samedarakta (iii) Shodhana Snehana: The Uttama Matra of Accha Sneha is administered in morning hours when preceeding evening food has been digested but individual have shown less hunger is called as Shodhana Snehana. 66,67,72 Shodhana snehana is carried out through Matranusara or Arohana or Pravicharana. Matranusara and Pravicharana snehapana were already explained. Arohana Snehapana: The word Arohana means rising or ascending Arohana Snehapana can be defined as an oral administration of Sneha in the periodical increasing dosage. Vangasena clearly described the method of Arohana Snehapana. Table No. 9 Opinion of Vangasena regarding dosage of Arohana Snehapana73Matra DAY(Dosage) 1 2 3 4 5 6 7Uttama 6 pala 7 pala 8 pala 9 pala 10 pala 11 pala 12 palaMadhyama 6Karsha 7Karsha 8Karsha 9Karsha 10Karsha 11Karsha 12KarshaHrasva 3Karsha 3½Karsha 4Karsha 4½Karsha 5 Karsha 5½Karsha 6 Karsha Through all the opinions mentioned regarding the Arohana Krama Snehapana is advised to achieve Snigdha Lakshana with in 7 days. But the method of Arohana Krama Snehapana is left to the physican. SNEHANA YOGYA In the classics we 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. Arohana Snehapana - 18
  33. 33. Effect of Arohana Snehapana on SamedaraktaTable No. 10 Shamana and Brumhana Snehana Yogya: 74,75 Abala Vata Vikari Vyayama – Madya – Stree nitya Bala Chintaka Vriddha Daruna pratibodha Madhyasevita Timira Krsha Abhishyanda Mandagni Ruksha Mrudukostha with alpa doshaShodhana Snehana Yogya: Shodhananga Snehapana is one of the essential Purvakarma for Shodhana.Hence in almost all the Shodhana Arha conditions Shodhananga Snehapana isadvised.Table No. 11 Showing General Indications of Shehana According to DifferentAcharyas.76, 77, 78, 79, 80 Snehya C.S A. S A.H S.S K.S I As a Poorva Karma i) Swedya + + + + - ii) Samsodhya + + + + - II Different Stage of Life i) Vruddha - + + + - ii) Bala - + + + - III In Different Conditions i) Rooksha + + + + - ii) Krusha - + + + - iii) Abala - + + - - IV In Different Viharas i) Vyayama nitya + + + + + ii) Madhya nitya + + + + + iii) Stree nitya + + + + + iv) Chintaka + + + + + v) Srama - - - - + VI In Different Diseases i) Vatavikara + + + + - ii) Kshinasra - + + + - iii) Ksheena retasa - + + + - iv) Abhishyanda - + + + - v) Timira - + + + - vi) Daruna practibodha - - - + - Arohana Snehapana - 19
  34. 34. Effect of Arohana Snehapana on Samedarakta Table No. 12 Showing the Deserving Condition for Snehana 81,82,83,84 Ghrita Taila Vasa Majja 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 Ayuprakasha kama Sthiaryarthina Balarthina For snigdhatwak Swararthina For Slashnatwak Pustikama Krimikosta Soukumaryarthina Krurakoshta Agnideepti Nadeevrana ojus Smruti Medha Bhuddhi Indriyabala Daha Shastraghata VishaSNEHA ANARHA: Acharyas have told different contra indications of Snehana karma in general.By going through (Table No. 14) a few condition of the Shodhana Snehana Anarhaare analyzed as follows: • Rukshana Arha-As mentioned by Charaka - Rukshana Anarha persons are generally Abhishyandhya, Bahudosha, Rogas manifested in Marmastana, Urhusthambha. If Snehana administered in such condition, it will further aggravates the condition85,86. • Dattabasti, Virikta- Soon after Basti and Virechana, Agni will become Manda. Hence Snehapana is contraindicated. Arohana Snehapana - 20
  35. 35. Effect of Arohana Snehapana on Samedarakta• Agni Vikruti- Tikshnagni and Mandagni are considered in Agnivikriti 87 i) Tikshnagni – If Sneha is administered in this condition, then Agnibala further enhances and leads to many complications such as Trishna etc. ii) Mandagni – If Sneha administered in Mandagni it will leads to Sneha Ajirna or Ama.• Mada and Murcha- Even though Shodhananga Snehapana is indicted in Mada and Murcha, it is included under Snehana Anarhata with the intention to specify that during attack 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, then Sneha by virtue 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 Pradosha- As Ama and Sneha are having homologues property, if Snehapana administered in Ama condition, then condition will be aggravated.• Akala- Shodhana Snehana will not give desired benefit if it is administered untimely. Arohana Snehapana - 21
  36. 36. Effect of Arohana Snehapana on SamedaraktaTable No. 13 General Contraindications of Snehana 88,89,90,91,92 Asnehya C.S. S.S. A.H. K.S. Sh.S. Rukshanam Samshodhanadrute + Utsanna Kapha medasa + Kapha Prakopa,Dagdha + Abhishyanna anana guda + Nitya Mandagni + + Shleshma Pittopahata antaragni + Tikshnagni + Durbala + + + + Pratanta (Klamayukta) + Shranta + Shramanvita, Akala Prasuta + Garbhini + + Prasuta + Apaprasuta, Urustambha,Udara + Kshirapa, Ativruddha, Jadya, Glani + Madatura, Murcha, Trishna + + Talu Shoshi + Sneha Glani + Garardita + Amajahara + Anna Dvesha + + Arochaka + + Ajirna + + Chardi + + + + + Atisara + Vit Prakopa + Taruna Jvara + + + Sthula + + Gala roga + + Datta Vireka + + Datta Basti + + + + Datta Nasya + + + Akala, Durdina + +SNEHANA PRAKARSHA KALA: 93,94,95,96 Prakarsha kala is the time taken for snehana procedure. ShodhanangaSnehapana is a process of administering Sneha to achieve the desired Doshotkleshanawithin a specific number of days.The minimum and maximum number of days for Arohana Snehapana - 22
  37. 37. Effect of Arohana Snehapana on SamedaraktaShodhananga Snehapana is 3 to 7 respectively. i.e. if the person with Mrdu Koshta for3 days, in Madhyama Koshta for 4 to 5 or 6 days and Krura Koshta for 7 days Bhoja is of the opinion that a person having Kaphaja, Pittaja and VatajaPrakrti needs 3, 5 and 7 days of Snehapana respectively. Vagbhata emphasizes that Shodhananga Snehapana should be continued tillone develops the manifestation of Snigdha Lakshana irrespective of any time limit. On seeing different opinion regarding prakarsha kala, it can be concluded that,irrespective of Prakrti or Koshta, the duration of administration of ShodhanangaSnehapana should be till the appearance of Samyak Snigdha Lakshana. But maximumduration is with in 7 days.Sneha Prakarsha Kala –why 7 days? 97,98,99 Shodhananga Snehapana creates Doshotkleshana in the body. IfShodhananga Snehapana continued after 7 days, then Sneha becomes Satmya and failto produce Doshotkleshana. Here Satmya refers to the meaning that individual getaccustomed to Sneha just as food article. If the dose of administered Sneha is less,then it will fail to produce the desired effect in 7 days. In such cases higher dose ofSneha should be given after some interval.SHODHANANGA SNEHAPANA VIDHI: The administration of Shodhananga Snehapana is followed in threedifferent stages such as Purvakarma, Pradhana karma and Paschat karma. I. Purvakarma II. Pradhana karma and III. Paschat karma. Arohana Snehapana - 23
  38. 38. Effect of Arohana Snehapana on SamedaraktaI. PURVAKARMA: It includes-(i) Atura Pariksha, (ii) Atura Siddhata, (iii) Sambhara Sangrahai. Atura Pariksha 100 Dasha Vidha Pariksha, Prakruti, Vikruti, Sara, etc in the Atura is to beexamined. Specific importance is given for deciding Agnibala and nature of Koshta.Depending upon Atura Pariksha we can easily assess a. Snehana yogya and Ayogya. b. Understanding Snehapana Prakarsha Kala. c. Selection of appropriate Sneha Dravyas and Shodhananga Snehana method. d. Matra nirnaya and Anupana.ii. Atura Siddhata Individual Aturas should be prepared physically and mentally throughfollowing procedures - (a) Deepana – Pachana (b) Diet regimen (c) Manasopacharaa] Deepana – Pachana People having mandagni & Amavastha condition. So it is essential to takeDeepana & Pachana before undergoing Snehana therapy.• Deepana –Is the drug which effectively enhances the state of agni. It increases appetite remarkably & increases the better absorption of drug.101 Deepaniya Gana drugs,102 Guduchyadi Gana drugs103 can be used for Dipana effect. Deepana – Pachana are used as conventional therapeutic regimens before undergoing snehana therapy & should be given till the Nirama Avastha is seen.• Pachana – The drug or action which has the capacity of digesting Ama but doesn’t increases the agni of an individual is known as Pachana Dravyas like Nagakeshara,103 Pippalyadi Gana, Musthadi gana,104 Dashamooladi gana etc as Amapachana dravyas. Arohana Snehapana - 24
  39. 39. Effect of Arohana Snehapana on Samedaraktab] Diet regimen 105,106,107For shodhananga snehana Indicated diet ; • Drava – Liquid • Ushna – Warm • Anabhishyandi – not having ‘Abhishyandi’ property • Na Atisnigdha – Not too much Snigdha • Pramanayukta – Regulated quantityc] Manasopacara In Shodhananga Snehapana, a large quantity of Sneha is administered.Because of non-palatability, discomfortness felt during Sneha Jirna Kala, individualmight show avertion to drink Sneha. So prior to Snehapana, complete procedure ofSnehapana and Shodhana should be explained to the individual and he should beencouraged to drink Sneha. This may give confidence to the patient.iii. Sambhara Sangraha One should keep ready the required medicaments and first aids and essentialmaterials to treat the Vyapat or arises if any .108II. PRADHANA KARMAPradhana karma includes following steps viz,1. Administration of Sneha and Anupana2. Observation of a) Sneha Jiryamana Lakshanas and Sneha Jirna Lakshanas b) Snigdha, Ati Snigdha and Asnigdha Lakshanas Arohana Snehapana - 25
  40. 40. Effect of Arohana Snehapana on Samedarakta1. Administration of Sneha 109 In the early morning when the Sun rises Athura is advised to take medicatedTaila or Gritha. The sneha should administered after complete digestion of foodwhich was taken on previous night. After performing auspicious rituals, appropriatequantity of selected Sneha should be given to drink.Anupana : 110,111,112 Anupana should be given along with the Snehadravya. It helps in breakdown,softening, digesting, proper assimilation and instant diffusion of the Sneha taken. Italso helps in refreshing the patient & will give pleasure, energy to the patient.For Chaturvidha snehas the Anupana used are : Ushna jala – For Grith, Yusha – For Taila , Manda – For Vasa and Majja, Shitala Jala – For Bhallataka and Tuvaraka Taila For all the Snehas Ushnajala is used as Anupana, except Tuvaraka andBhallataka Taila.The dosage of the Anupana may be decided on the basis of normaldigestion capacity or according to the pharmaceutical process involved.2. (a) Observation of Sneha Jiryamana and Jirna Lakshana The administered Sneha undergoes various digestive phases, which producessome symptoms called as ‘Sneha Jiryamana Lakshanas’. These Lakshanas will besubsided after Sneha Jirna and does not need any sort of therapeutic intervention. During first phase of avastha paka. Production of kapha takes place, which ishaving similar qualities to sneha. Thus production of kapha will be more which causeslalasrava. Due to large amount of sneha the quantity of secretions of Jataragniincreases and Jataragni is having Agneya quality which may cause Trishna, Bhrama,Murcha, Daha etc., Arohana Snehapana - 26
  41. 41. Effect of Arohana Snehapana on Samedarakta The onset of symptoms like Kshut, Trshna, etc. indicates the completion ofSneha digestion (Sneha Jirna). In doubtable cases regarding digestion or indigestionof Sneha one should take hot water, which brings Shuddha Udgara, Laghuta, anddesire for food. If sneha does not digest after administration of warm water and takesmore time than required. It should be eliminated by vamana further cold watersprinkling and applying of chandna paste on scalp and cold water bath should beemployed.113Table No. 14 Sneha Jiryamana and Jirna Lakshana114 Jiryamana Lakshana Jirna Lakshana Shiroruja Shirorujadi Jiryamana Lakshana Prashamana Bhrama Vatanulomana Nishtiva(Lalasrava) Kshudha pravrtti Murcha Trishna pravrtti Sada Udgarashudhi Arati Laghuta Klama Trishna Daha2. (b) Observation of Snigdha–Asnigdha–Ati Snigdha Lakshanas 115, 116, 117, 118, 119, 120, 121 All acharyas have mentioned about important laxanas of samyak snigdha,asnigdha and atisnigdhata, which serves the purpose of further administration ofswedana and shodhana therapies.Evaluation of Snehapana based on parameters like –i) Samyak Snigdha Lakshanasii) Asnigdha Lakshanasiii) Ati Snigdha Lakshanas Arohana Snehapana - 27
  42. 42. Effect of Arohana Snehapana on Samedaraktai) Samyak Snigdha Lakshanas Attainment of Samyak Snigdha Lakshana is an important action ofShodhananga Snehapana. After observing these laxanas snehapana will be stopped.Table No. 15 Samyak Snigdha Lakshanas Lakshanas C.S. S.S. A.H. K.S. Sh.S Ckd Va Se Vatanulomana + + + + + Deeptagni + + + + + + + Snigdha Varcha + + + + + Asamhata Varcha + + + + + + Purisha Mrduta - - - + - - - Adhastat Sneha Darshana - + - - - - - Gatra Mardavata + + + - + - + Gatra Snigdhata + - + - + - + Tvak Snigdhata - + - - - - - Anga Laghava - + + - + - - Klama - - - - - + - Glani - + + - + - - Snehodvega - - + - + - - Vimalendriyata - - - + - - - Medha - - - + - - - Pusthi - - - + - - - Dhrti - - - + - - - Kale Sharira Vrtti - - - + - - - Teja Vrddhi - + + - + + -ii] Asnigdha Asnigdha Lakshanas may be present prior to Snehana therapy, if Snehanatherapy is not done properly then these Lakshana persist at the end also. By observingthese Lakshana Physician should rectify and adjust matra or snehana and carry outSnehana properly. If snehana is not done properly the following symptoms areobserved. Arohana Snehapana - 28
  43. 43. Effect of Arohana Snehapana on SamedaraktaTable No. 16 Asnigdha Lakshanas Lakshanas C.S. S.S K.S. Va Se A.H. Grathita Purisha + + + + - Ruksha Purisha + + - - - Shushka Purisha - - + - - Vayu Pratilomana + + + + - Agnimandhya + - + + + Avipaka / Krcchrat Annnam Vipachyate - + - - + Anila Purita Udara - - - - + Gatra Rukshata + - + - + Gatra Kharata + - + + - Urovidahata, Dourbalya - + - - + Dourvarnyata - + - - + Adhrti - - + - -iii] Ati Snigdha Lakshanas Shodhananga Snehapana is to be continued till the appearance of SamyakSnigdha Lakshana, but if Snehapana is continued even after that then it may lead toincrease of Apyamsa in the body and Atisnigdha Lakshana may manifest.Table No. 17 Ati Snigdha Lakshanas Lakshanas C.S. S.S A.H K.S Sh.S Ckd Va Se Panduta + - - + + + + Gaurava + - - + - - - Jadya + - - + - - + Apakva Purisha + - - + - - + Purisha ati pravrutti - + + - + - - Guda Srava - - - - - + - Ghrana Srava - - - - - + - Mukha Srava - + - - + + - Pravahika - + + - + - - Utklesha + - + + - - + Aruci + - + + - - + Bhakta Dvesha - + - - + - - Adhmana - - - + - - - Tandra + - - + + - + Moha - - + - - - - Angadaha - - + - - - + Gudadaha + + + Arohana Snehapana - 29
  44. 44. Effect of Arohana Snehapana on SamedaraktaIII. PASCHAT KARMA:Paschat Karma is categorized as – • Paschat Karma on the days of Snehapana • Paschat Karma after attainment of Samyak Snigdha Lakshanas On the days of Snehapana: During Snehapana individual is advised to follow instructions like-122 (i) Guru Pravarana - covering body with thick cloth. (ii) Nivata Shayana Sthitaha - residing in a room devoid of breeze. (iii) Jaranantam Pratiksheta-awaiting digestion of Sneha. (iv) Drinking little quantity of Ushna Jalapana or any other specified Anupana if feels thirsty. (v) When Sneha is digested taking hot water bath, and consuming Yavagu etc. food (vi) During snehana the diet should be mrudu which affects in stimulation of digestive power & lightness of abdomen. Paschat Karma after attaining Samyak Snigdha Lakshanas:123,124,125,126 After Samyak Snigdha Lakshanas, Shodhananga Snehapana is stopped andthey are advised for further process like Sarvanga Abhyanga, Svedana and Shodhana.Pathya (a) Ushna Jalapana - Ushna Jala is having Dipana, Pachana and Vatanulomana properties, hence helps in Snehapachana process. (b) Bramhacharya - Helps in Snehana process. (c) Kphashaya - As day sleep and Ratri Jagarana aggravates Kapha and Vata Dosha respectively, only night sleep is advised. Arohana Snehapana - 30
  45. 45. Effect of Arohana Snehapana on SamedaraktaApathya a) Vyayama - Exercise b) Uccha Vacana - Loud speech c) Vega Samrodha - Suppression of Urges d) Shoka, Krodha - Anger, anxiety. e) Hima, Atapa - Mist, Sunlight. f) Pravata - Open breeze g) Atyasana-Sitting at a place for long time. h) Neecha/Uccha Upadhana - Usage of too low or too high pillows. Pathya- Apathya is to be followed sincerely for equal number of days duringthe course of Snehana therapy and after therapy also.POST SNEHANA THERAPIES 127, 128, 129, 130, 131, 132 The period between completion of Shodhananga Snehapana to the day ofVirechana or Vamana is known as Vishrama Dina. During this period the individualwill be subjected for Sarvanga Abhyanga, Svedana and provided with appropriatediet.SNEHA VYAPAT 133, 134, 135 Sneha vyapat is produced either by faultly administration of sneha by vaidyawithout considering matra, kala, rutu, anupana etc. or by the patient when he doesnotfollows the rules during snehana karma.(i) Ashu Utpanna Vyapat: These types of disorders may have acute onset andmay needs immediate manegement (1) Ajirna (2) Aruci (3) Amapradosha (4) Shula (5) Jvara (6) Anaha (7) Trshna (8) Sthambha (9) Utklesha (10) Tandra (11) Samjna Nasha. Arohana Snehapana - 31
  46. 46. Effect of Arohana Snehapana on Samedarakta(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 for long time as explained in variousclassical text.Sneha Vyapat Chikitsa:136, 137, 138 Classics has metioned to treat Sneha Vyapat’s through different therapies like-1 Upavasa/Trshna :Beneficial in alpa Dosha Avastha and enhances Agni Bala.2. Ullekhana :In Utklishta Dosha Avastha SadyoVamana is beneficial and is also advised in conditions like Sneha Ajirna, Utklesha, Snehajanya Trshna.3. Svedana :In conditions such as Sthambha, Svedana is beneficial.4. Rukshana :Rukshana therapy is highly beneficial in Sneha Atiyogajanya Vyapat. Rukshana Dravya can be administered in the form of Pana, Anna and Bheshaja.Sneha Ajirna Janya Trshna Chikitsa:139, 140, 141 If Sneha Ajirna produces severe thirst, the patient’s head and face should besplashed with cold water. If this does not relieve the thirst, the Pitta dominant patientshould be given Ruksha Anna and Shita Jala and then made to vomit. In case ofpersons who have predominance of Kapha and Vata or all the Doshas increased inequal proportion, Vamana is induced after giving Ushna Jala. Arohana Snehapana - 32
  47. 47. Effect of Arohana Snehapana on SamedaraktaKARMUKATA OF SNEHANA AS A PURVAKARMA OF SHODHANA When Doshas are present in their vitiated condition, which have left theShakha (periphery) and have occupied Koshta (central place) as well as their Linatva(latency) has withered away and their Uthkesha Avastha (Patency) has been acquired.Thus, Panchakarmas are indicated when vitiated Doshas have become Utkleshita andwhen they have accumulated in Kostha and are not scattered in remote srotases.1. Importance of Shodhananga Sneha To substantiate the importance of Shodhananga Snehana many references areavailable in the classics. • Snehana is required to be administered first, then Swedana; finally followed by Shodhana.142 • Acharya Sushruta has described the importance of Snehana as “Snehasaro 143 Ayam Purusha: Pranascha Sneha Bhuyistha: 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 and Bhootatma all these are called Prana. By going through this version we can understand that Snehana brings softnessin the Srotas by that Doshas will come back to Koshta from Shakha and whenShodhana is administered vitiated Doshas are expelled out without causingdiscomfortness to the individual. As the dirt of the cloth is washed with water after deterging (with alkali etc.), the impurity of the body is eliminated by Shodhana measures after deterging (Utklesha) with Snehana and Svedana. This version is of extreme importance for explaining the mode of Action of Snehana and Svedana as Purvakarmas to Karmukata of Snehana - 33
  48. 48. Effect of Arohana Snehapana on Samedarakta Shodhana in bringing Doshotkleshana. Among these two Purvakarmas Snehana by virtue of its Vishyandana, properties aids in bringing Lina and Anutklishta Doshas to Utklishta Avastha. 144 When the inner portion of the vessel is smeared with ghee and then it is filled with water, water can be removed completely without living a single drop in it. In the same way after administering Sneha as a preoperative measure to Shodhana procedure the excited doshas are eliminated completely. As a cloth absorbs certain amount of water but oozes out the water in excess. Similarly the Snehana therapy used just in proportion with the digestive power gets digested, it oleates only when it is administered in excess.Acharya Caraka has mentioned about the ways to bring vitiated Doshas form Shakhato Koshta by means of-145 ⇒ Vrddhi -increasing ⇒ Vishyandana - Dissolving / by increasing fluidity of Doshas ⇒ Paka- results in detachment of the Dosha from the place of lodgment. ⇒ Srotomukha Vishodhanat – Clearing the orifice of Srotas. ⇒ Vata Nigrahat – By controlling Vata Dosha . Here Sneha acts in every aspect of the above processes to bring Doshas toKoshta and bring Utkleshana of the Doshas. In this connection, Vagbhata whilenarrating the different therapies that precedes the Shodhana renders Snehana in equalposition to other therapies.2. Actions of Snehana: Actions of Snehana can be attributed to properties present in the SnehaDravyas. In this regard it is very much necessary to discuss the actions of theseproperties with respect to Shodhana Snehana.146 Karmukata of Snehana - 34
  49. 49. Effect of Arohana Snehapana on Samedarakta• Drava : It imparts some sort of moisture to the Srotas that removes impediment ofdoshas. Helps in diffusion of Sneha over the body. Helps in Dosha Vilayana process.Acts like a dissolving media to the Doshas by Alodhana Sandhan Karaka property.• Sukhshma : By virtue of Sukshma property of Sneha easily enters into the minute channelsof body. Sukshma is having Sroto Vishodhana property, thus aiding in bringing theDoshas back to Koshta. It was defined by some as the capabilities of dilatation ofchannels, which augment the movement of Sneha Dravyas freely even through theminute channels.• Sara Sara is having ‘Vyaptishilatva’ i.e., spreading nature, thus helps in spreadingof Sneha all over the body. Prerana and Vatanulomana action of Sara Guna helps inmovement of Doshas back to Koshta.• Snigdha Snigdha brings softness of Srotas and by this there is a better conveyance ofDosha, Dhatu and Mala.• Picchila Shleshmala property is important to bring Dosha Utklesha. Helps Sneha tocome in contact with Doshas for longer duration. It is termed as Sandra &Cikkanattva by Arunadatta. The properties attributed to this are Jivana, which wouldbe shown on Raktadi Dhatus, Balya by imparting strength, Sanghata by thecompactness of morbid elements. Karmukata of Snehana - 35
  50. 50. Effect of Arohana Snehapana on Samedarakta• Guru It can be defined as the quality by virtue of which the body dimensions will beincreased.• Shita It keeps intactness of the body, by virtue of this quality it creates satiety andprevents the occurrence of Murcha, Sveda and Daha.• Mrdu Brings Srotomardavata. By generating softness, laxity, loosens the DoshaSanghata. Though Guru, Shita and Manda are mentioned as properties of Sneha, butthese have more of Shamana or Brumhana value than aiding in Shodhana Snehanaaction. In Siddhisthana, while dealing with the Snehana Karya, Charaka very vividlyexplains as-147 ♦ Sneho Anilam Hanti ♦ Mrdu Karoti Deham ♦ Malanam Vinihanti Sangam. Cakrapani clarifies that these are functions of Shodhana Snehana; on the basisof above version actions of Shodhananga Snehana may be analysed as follows-148 ♦ 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. Karmukata of Snehana - 36
  51. 51. Effect of Arohana Snehapana on Samedarakta ♦ 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 get relieved.3. Karmukata of Shodhana Poorva Snehapana The reason behind its action as a Purvakarma to various Sodhana proceduresthey are highly esteemed the following actions can be clearly observed. o It acts as a solvent. o It increases the Apyamsha of the body. o It brings the lodged morbid and unexcreted waste products to gastro intestinal tract.o Action as a solvent. According to Sushruta the disease is produced due to the sthana samshraya ofvitiated Doshas through srotases during their circulation in the body.149 Snehaadministered inside the body reaches the Srotamsi and acts as solvent to removeobstruction by dissolving those morbid factors in it, resulting in the removal of Srotovibhandha which is one of the important steps in the Samprapti Vighatana. This view can be emerged by the study related to the permeability of Dravyasinto the innermost recess of the body. It can be recognized that Kalas surround theDhatus and Srotamsi are semi permeable. 150 Karmukata of Snehana - 37
  52. 52. Effect of Arohana Snehapana on Samedarakta Chakrapani favors this by that every Dhatu will have specific srotasespertaining to them and by the srotases concerned with a particular Dhatu, otherDhatus will not be nourished.151 Thus Sneha acts as a solvent both for lodged morbid factors and as well asunexcreted tissue waste products.o Increases the Apyamsa of the body The nature of Sneha has the predominance of Apa Mahabhuta152. So by thisproperty of Sneha liquefied Malas brought from the tissues, the levels of fatty acidsetc., and increases in the blood, resulting in the high plasma volume. To keep up theequilibrium of the normal plasma level, the extra amount of liquid from it are reachedin the Kostha for excretion. Later on when Shodhana Karma are administered thisincreased amount of body fluid are evacuated by which the vitiated Doshas andunexcreted Malas also expelled out resulting in the cure of the ailment.o It brings the lodged morbid and unexcreted waste products to gastro intestinal tract The main purpose of Purvakarma is to promote elimination of the accumulatedmalas from Sakhas, by bringing them to Kostha which are afterwards expelled fromthe body by Shodhana Karma. In this connection Acharya Sushruta expound hisviews that due to Snehana and Svedana, the morbid humor of the disease beinginstigated, become liquefied and brought to Kostha for easy elimination by theSodhana or radical therapies.153 Karmukata of Snehana - 38
  53. 53. Effect of Arohana Snehapana on SamedaraktaMEDA: The topic of the study is Samedarakta (i.e Hyperlipidaemia and Normal lipidvalues). Hence important aspects of Meda are discussed here.Basic concept of Meda : Meda is an important dhatu among Saptadhatu. Being a dushya dominantdisorder, Meda plays a major role in pathogenesis of Medoroga.Nirukti : Literally, the word Meda is derived from root “Jhimida Snehana”. Whichstands for Sneha, Fat, Oil etc. (Vachaspathya). It means the substance which hassnigdhatva property is called Medas. In Sabdakalpadruma, it is mentioned that Meda is the fourth dhatu whichperforms the Dharana-support the body, mind and life. “Medhyate anen iti medah” 154Formation of Meda dhatu : 155 According to Charaka, the Rakta dhatu is combined with Teja, Apa and ismade solid by the agni so that it gets converted into Mamsa, that again being digestedby its own agni, “Medodhatvagni” and stirred up by the agni and getting combinedwith Apa and unctuous substances and finally gets converted into the Medodhatu.Pramana of Meda dhatu :156 The total quantity of Meda is two Anjali and the Vasa (Muscle’s fat) is threeAnjali. Thus, total Meda content of body is enumerated as 5 Anjali and totalmeasurable body elements are counted as 56.5 Anjali, from this proportion, it isevident that total Meda content of body is 11 to 12% approximately. Modernphysiology also mentioned the same amount of fat i.e 12%. This quantity may varyfrom person to person and exact measurement of body humeral is not possible due tounpredictable and ever changing nature of body. Meda - 39
  54. 54. Effect of Arohana Snehapana on Samedarakta Flow chart No. 1 Showing Sthana and Swarupa of Meda dhatu157 Medadhatu Poshaka Poshya (Mobile in nature) (Immobile in nature)Which is circulated in whole body Which is stored in Medodharakala in along with Gatiyukta Rasa-Rakta its sites. i.e. Udara, Sphika, Stana, dhatu for nourishing the Poshya Gala, etc. and Vasa (Mamsagata Meda dhatu sneha)It can be correlated with cholesterol It can be correlated with adipose and lipids, which are present in tissues / fat. circulating blood.Body Mass Index : 158 It is one of the diagnostic criteria for measuring the Medovriddhi. The B.M.I. is the actual body weight divided by the height squared (kg/m2).This index provides a satisfactory measure of obesity in people who are nothypertrophied athletes. The classification of obesity as per B. M. I. Under weight - <18.5 kg/m2 Normal weight - 18.5 - 24.9 kg/m2 Over weight - 25 - 29.9 kg/m2 Obesity (Class-I) - 30 - 34.9 kg/m2 Obesity (Class-II) - 35 - 39.9 kg/m2 Morbid Obesity (Class-III) - > 40 kg/m2 Weight in KgsBMI = Height in Meter2 Meda - 40
  55. 55. Effect of Arohana Snehapana on SamedaraktaFunctions of Meda Dhatu : According to Sushruta, Sneha, Sweda, Drudhatva and Asthipushti are thefunctions of Medadhatu. Again Netra and Gatrasnigdhata are the additional functionsof Meda mentioned by Astang Sangraha. Snehana is the main function of Meda dhatuand with Sneha property it helps to keep luster of skin, hair, eye, etc. Snigdha gatratasymptom of Medoroga may arise through increased Snehana function of Meda.159, 160 Another function of Meda is nourishment of Asthi Dhatu and Upadhatu Snayuand Sandhi. Snayu provides support to the Asthi and Sandhi helps in joint formation.Another function of Meda is creation of Sweda and Sweda is mentioned as mala ofMeda. One more function of Meda is Drudhatva, which is possible through help ofSnayu.161Ashryashrayeebhava of Meda :162 Dhatu, which is the shelter for any doshas of its allied nature depicts theconcept of Ashryashrayeebhava. Similar allied properties of homogenous Dhatu orDosha may serve as a cause to the nutrition or vitiation of Dosha or Dhatu and it is inthis context Meda can be considered as a location of the sthanika Kapha, since Medaplays a major role in nutrition or vitiation of Kapha and vice versa.Medovaha Srotasa : The internal transport system of the body is represented as Srotamsi. It hasbeen given a place of fundamental importance in Ayurevda both in health and diseasecondition. Dhatus are nourished through their respective srotases and one srotascannot provide nourishment to another dhatu. The Meda Dhatu gets nutrition from thepreceding dhatu i.e. Mamsa (Poshaka) through its own srotas called Medovaha Srotas.As per Dr. C. Dwarkanath, the channels through which nutrition to the adipose tissueis transported are to be termed as the Medovaha Srotas. Meda - 41