Sneha in chikitsa

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Keynote Address - By Dr. K. Shiva Rama Prasad, Assessment and Utility of Sneha Karma in Disease Management - CME On
19th June 2012, Organized by Department of Panchakarma, At: Seminar Hall,
MGAC, DMIMS, Selod (H), Wardha, Maharastra

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Sneha in chikitsa

  1. 1. Assessment and Utility of Sneha Karma in Disease Management Dr. K. Shiva Rama Prasad, Vice Dean, AyurvedaProf. & Head of Dept. of Panchakrma, MGACH&RC, Wardha 19th June 2012 At: Seminar Hall, MGAC Campus, Organized by Department of Panchakarma Mahatma Gandhi Ayurved College, DMIMS, Selod (H), Wardha, Maharastra Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  2. 2. Assessment and Utility of Sneha Karma in Disease Management“Develop something what people want andNOT What you can do.” Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  3. 3. Assessment and Utility of Sneha Karma in Disease Management Introduction • Sneha – indicates / includes – Oiliness, Unctuousness, Viscidity, Lubricity, etc. – “Sneha” is the essence of Human – “Life” it self is dependent on “Sneha” – The entire strength of an individual is dependent on “Sneha”xlÉåWûxÉÉUÉåÅrÉÇ mÉÑÂwÉ: mÉëÉhÉÉ: xlÉåWûpÉÔÌrɸÉ: xlÉåWûxÉÉkrÉÉ¶É pÉuÉÎliÉ – xÉÑxÉëÑiÉ ÍcÉÌMüixÉ 31/3Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  4. 4. Assessment and Utility of Sneha Karma in Disease ManagementSneha in Normal • Sneha makes the Vishyanda i.e. vilayana – which means the dissolution, liquefaction, destruction, death, etc. – The all above are referral to the Dosha and the Dhatu • The Death is inevitable with the lack of sneha in the body – a cellular death or – organ function cessation • Excess Unctuousness cause thinning of the cell membrane & intiate the cytokins • Apart from it induces the softnessxlÉåWûlÉÇ xlÉåWû ÌuÉwrÉlS qÉÉSïuÉqÉç YsÉåSMüÉUMüqÉç – and generate Kleda (Glucose?? – cÉUMü xÉ賈 22/10 – ÌuÉwrÉÇSå - ÌuÉsÉrÉlÉqÉç as in lipid metabolism) Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  5. 5. Assessment and Utility of Sneha Karma in Disease Management Sneha in Normal• Sneha makes the person with – – Increased appetite – Clean Kosta (GIT) – Increased tissue metabolism – Control on senses – Strength – Colour / complexion – Delayed ageing SÏmiÉÉÎalÉ zzÉÑ®MüÉå¸¶É mÉѹkÉiÉÑÎeÉïiÉåÎlSìrÉ: ÌlÉeÉïUÉå oÉsÉuÉhÉÉïžxlÉåWûxxÉåuÉÏ pÉuÉå³ÉU: - zÉÉ. xÉÇ E. 1/ 32 Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  6. 6. Assessment and Utility of Sneha Karma in Disease Management What are lipids • Sneha vis-à-vis Lipids are a broad group of naturally-occurring molecules which includes - – fats, waxes, sterols, fat-soluble vitamins (such as vitamins A, D, E and K), monoglycerides, diglycerides, phospholipids, and others. • The main biological functions of lipids include energy storage, as structural components of cell membranes, and as – • important signaling molecules.Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  7. 7. Assessment and Utility of Sneha Karma in Disease Management • Ayurveda states that – disease causative factors are – 5 Samprapti Ghataka – viz.The route of – Dosha (Vata, Pitta, Kapha) – Dhatu (Rasa, Rakta, Mamsa, Meda, Asthi,Disease Majja, Sukra) – Agni (Teekshna, Manda, Vishama) – Ama (Leena, Aleena) – Srotas – (13 srotas along with sanjna, Chesta, Sthanya, & Artava) • The manifested Disease is predominantly in Shakha (peripheral [tissue] – not in the Kosta i.e. Central lumen / GIT) • As the Disease manifestation starts from Kosta (GIT) and spreads to the (Shakha (Tissues), the pathogen particles are brought back to kosta for elimination of disease. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  8. 8. Assessment and Utility of Sneha Karma in Disease Management Bringing the Dosha to Kosta• The methods of Shakha precipitated Dosha to bring back to Kosta are – – Vruddhi (increasing dosha) – Vishyanda (dissolution) – is done by “Sneha” – Paka (ripening the Dosha) – Srotomukha Vishodhana (opening the srotas outlets) – Vata Nigrahana (blocking the neural reflexes) uÉëÑSèkrÉÍpÉwrÉlSlÉiÉç mÉÉMüÉiÉç xÉëÉåiÉÉåqÉÑZÉÌuÉzÉÉåkÉlÉÉiÉç zÉÉZÉÉÇ irÉYiuÉÉ qÉsÉÉ: MüÉå¸Ç rÉÉÎliÉ uÉÉrÉÉå¶É ÌlÉaÉëWûÉiÉç - cÉUMü Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  9. 9. Assessment and Utility of Sneha Karma in Disease Management Sneha Vishyanda • The infectious theory is denied in Ayurveda • The pathogenic origin of Ayurveda is Tridosha • The levels of Dosha accumulation & segregation cause the stages of disease & pathogenesis • Reversal of the pathogenesis is based upon the “dissolution of Segregated Dosha” which is brought back to Central Lumen – Kosta and eliminated – or – Suppressive management of Dosha and Disease • So, the Moorchita Sneha (Taila / Ghrita) – medicated fragmented lipid bonds join the segregated pathogenic Dosha in Tissues and dissolute / liquefy Dosha • Lipid fragments leaves the drug active principle in Shakha (where the pathogenesis is) and lodge dissolute Dosha to bring back to Kosta through mucosal secretion • From Koshta, the sneha lodged Dosha is eliminated.Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  10. 10. Assessment and Utility of Sneha Karma in Disease Management Sneha timing • The consumption of sneha as – shodhana is in the morning, when the previous day meal is digested – for shamana it is consumed in the night • Day snehana in cold season / Vata sleshma predominance & • Night snehana in hot season / Vatapitta predominanceCharaka sutra 13/61, Susruta chikitsa 31 /23-24, Sharngdhara Uttara 1/15 Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  11. 11. Assessment and Utility of Sneha Karma in Disease Management Sneha Typology• The lipids vivid in use are – Taila, Ghrita, Vasa and Majja (these sneha are used either one or in combination & permutations, according to the severity and Dosha predominance)• Abhyantara (Internal) – Pana (oral administration – Shodhananga – to eliminate the Dosha) – Bhojana (oral – Shamananga – to pacify the Dosha)• Bahya (External) – Anuvasana (per-rectal), Uttara (per-urethral), Nasya (per- nasal), Karna Poorana (per-ear canal), Gandusha (per-oral gargling), Akshi Tarpana (per-ophthalmic) – Moordhnitaila Chikitsa (Shirovasti [Residual oil], Pichu [oil patch], dhara [oil pouring], mastishkya [oil cover], lepa [oily paste]) – Gatrabhyanga (body massage), Padabhyanaga (pedal massage), Mardana (centrifugal massage), Udwartana (centripetal massage), Padaghata (Foot Massage), Samhanana (smooth massage), – Parisheka (pouring), Avagaha (submerging), Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  12. 12. Assessment and Utility of Sneha Karma in Disease Management Dalhana Clarification• Ayurveda suggest the • Sneha reaches – Snana (bath) before • Romakoopa (hair follicle) in external oil application 300 matra (95sec) – Abhyanaga (Massage) • Twak (Skin) in 400 matra (133 – It facilitates the rapid sec) absorption of the Sneha • Rakta (Blood) in 500 matra used and reaches the (160 sec) target faster • Mamsa (muscle) in 600 matra• In the context of (190sec) Abhyanaga, Dalhana • Medas (Fat) in 700 sec (228 sec) (Su.Chi. 24/30) has • Asthi (bone) in 800 matra (245 clarified about the sec) dynamics of Sneha • Majja (Marrow) in 900 matra absorption from the (285sec) skin - Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  13. 13. Assessment and Utility of Sneha Karma in Disease Management Sadyah-Sneha • Sadyah-Sneha means instant unctuousness • Sandhava Lavana added sneha (Ghee /Oil) is a faster unctuous agent as it has the qualities of – – Abhshyandi – quality of liquefaction – Arooksha – non dry – Sookshma – minute – Ushna – hot – Vyavayi – spreads in the body well before to digest • These qualities enhance the unctuousness in the body instantly sÉuÉhÉÉåmÉÌWûiÉÉ: xlÉåWûÉ: xlÉåWûrÉlirÉÍcÉUɳÉUqÉç - cÉxÉëMü xÉ賈 13/98Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  14. 14. Assessment and Utility of Sneha Karma in Disease Management Best Sneha for Practice• Out of the 4 sneha we practice the best two are – – Morchita tilataila (Sha. Sam. Madyama 6/13-14) – Kolakulutha Ghrita (cha. Su. 13/94)• Apart from the sadya sneha of – – Dharoshna Sneha (Sha. Sam. Uttara 1/20) Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  15. 15. Assessment and Utility of Sneha Karma in Disease Management Disease management with Sneha• Even though the Shodhananga Sneha pana is practiced in Vata vyadhi & twak (Skin) diseases – many other areas are also indicated – viz. – Jwara, Gulma, Rajayakshma, Apasmara, Unmada, Shotha, Udara, Kasa swasa, Grahani, Pandu, Shiroroga, Yonivyapat, Vandhya, etc. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  16. 16. Assessment and Utility of Sneha Karma in Disease Management Utility of Sneha• Sneha is used as Vicharana or directly as Sneha pana either to pacify (Shamana) the disease or to expel (Shodhana)• The regulated use of the sneha will make the person to expel the deposited sneha (fats) and restructure the “fatty contents” in the body• The excess usage of Sneha cause the “Santarpanotha Vikara” (Over Nutritive Disorders) such as Medomaya Yakrut, Ama, Kusta, pandu, Jwara, Sthoulya, Vandhya, Klaibya, etc. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  17. 17. Assessment and Utility of Sneha Karma in Disease Management Assessment of sneha• Assessment of the Samyak Snehana is done by the Symptoms• Here we observe the 3 sets as – Jeeryamana, Jeerna & Samyak lakshana (symptoms)• Why not a parametric evaluation is introduced to check the same? •Jeeryamana •Jeerna •samyak lakshana lakshana lakshana AHSu 16/30, SuChi 31/ 43 AH Su 25/, Su chi 31/ 33 ChaSu13/38 Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  18. 18. Assessment and Utility of Sneha Karma in Disease Management ASAMYAK SNIGDHA LAKSHANAS• Asnigdha Lakshanas – Ruksha Purisha/ Grathita Purisha/ Apravaguna Vata/ Mrdu Pakta/ Kharatva/ Raukshyata.• Ati Snigdha Lakshana – Panduta/ Gaurava/ Jadya/ Tandra/ Aruchi/ Utklesha/ Purishasya Avipakvata.• SNEHAPANA VYAPAT - Tandra/ Utklesha/ Anaha/ Jvara/ Stambha/ Visanmyatha/ Kushta/ Pandu/ Kandu/ Shopha/ Arsha/ Aruchi/ Trishna/ GrahaniDosha/ Staimitya/ Vakyanigraha/ Shula/ Ama Pradosha. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  19. 19. Assessment and Utility of Sneha Karma in Disease Management Objective parameter for Sneha Assessment• As the observation offer an area of setting the objective assessment apart from “Lipid Profile”• The sneha (Fat) quantity in the fecal matter is the best method as – – The samyak sneha symptom is oiliness in fecal matter - and – the excess is also seen in the same Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  20. 20. Assessment and Utility of Sneha Karma in Disease Management THE STUDY OF AROHANA SNEHAPANA AND ITS EFFECT ON SAMEDARAKTA WITH SPECIAL REFERENCE TO HYPERLIPIDAEMIA AND NORMALLIPID VALUES• Large quantities of Sneha is using for Snehapana, the people in this era are afraid of this therapy, because it may increase fat specially Cholesterol and Triglycerides which was the important causative factor for Atherosclerosis, Heart attack etc.,• Shodhananga Snehapana with Murchita Tila Taila was given in Arohana Krama in two groups.• In one group, the 15 patients with primary Hyperlipidaemia (especially raised values of either Cholesterol or Triglycerides) and who are fit for Snehana and Shodhana karma excluding secondary Hyperlipidaemia were selected Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  21. 21. Assessment and Utility of Sneha Karma in Disease Management STUDY OF AROHANA SNEHAPANA . . . continued• In both the groups after Ama Pachana, Snehapana was done in Arohana krama after 30ml of Hrasiyasi matra – the result is under -Varsha S. Kulkarni, THE STUDY OF AROHANA SNEHAPANA AND ITS EFFECT ON SAMEDARAKTA WITHSPECIAL REFERENCE TO HYPERLIPIDAEMIA AND NORMAL LIPID VALUES, 2005, RGUHS, Bangalore Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  22. 22. Assessment and Utility of Sneha Karma in Disease ManagementThe effect of ghee (clarified butter) on serum lipid levels and microsomal lipid peroxidation• In the present study, investigated the effect of 10% dietary ghee on microsomal lipid peroxidation, as well as serum lipid levels in Fischer inbred rats to assess the effect of ghee on free radical mediated processes that are implicated in many chronic diseases including cardiovascular disease.• Results showed that 10% dietary ghee fed for 4 weeks did not have any significant effect on levels of serum total cholesterol, but did increase triglyceride levels in Fischer inbred rats.• Ghee at a level of 10% in the diet did not increase liver microsomal lipid peroxidation or liver microsomal lipid peroxide levels.• Animal studies have demonstrated many beneficial effects of ghee, including dose-dependent decreases in serum total cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglycerides; decreased liver total cholesterol, triglycerides, and cholesterol esters; and a lower level of nonenzymatic-induced lipid peroxidation in liver homogenate. Hari Sharma, et.al. Ayu. 2010 Apr-Jun; 31(2): 134–140. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  23. 23. Assessment and Utility of Sneha Karma in Disease ManagementInfluence of vitamin D supplementation on plasma lipid profiles: A meta-analysis ofrandomized controlled trials • Observational studies have shown that low serum levels of vitamin D have been associated with an atherogenic lipid profile. However, the intervention studies gave divergent results. • The mean change in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) from baseline was treated as a continuous variable. • In all, 12 clinical trials consisting of 1346 participants were included in the analysis. • The pooled estimate of effect for vitamin D supplementation on LDL-C was 3.23 mg/dl (95% confidence interval, 0.55 to 5.90 mg/dl). • No statistically significant effects for vitamin D supplementation were observed for TC, HDL-C and TG (differences in means were 1.52 mg/dl (-1.42 to 4.46 mg/dl), -0.14 mg/dl (-0.99 to 0.71 mg/dl) and -1.92 mg/dl (-7.72 to 3.88 mg/dl) respectively). • The lipid modulating effects of vitamin D supplementation should be further investigated though large-scale, randomized trials with adequate doses which can effectively elevated the active form of vitamin D in plasma and with proper population which has hyper-lipemia as an inclusion criterion. Wang et al. Lipids in Health and Disease 2012, 11:42, 11:42, http://www.lipidworld.com/content/11/1/42 Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  24. 24. Assessment and Utility of Sneha Karma in Disease Management Influence of diet with different lipid composition onneutrophil chemiluminescence and disease activity in patients with rheumatoid arthritis • Twelve patients were randomly assigned either to a diet high in polyunsaturated fatty acids supplemented with eicosapentaenoic and docosahexaenoic acids or to a diet high in saturated fatty acids. • A correlation with clinical and laboratory parameters is also reported. No statistical difference was observed in neutrophil chemiluminescence and in clinical parameters in the group of patients treated with a diet high in saturated fatty acids. • Fish oil ingestion resulted in subjective alleviation of active rheumatoid arthritis and reduction of neutrophil chemiluminescence. This study corroborates the hypothesis of an anti-inflammatory role for polyunsaturated fatty acids in patients with chronic inflammatory diseases. M MAGARO et. al. Annals of the Rheumatic Diseases, 1988; 47, 793-796 Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  25. 25. Assessment and Utility of Sneha Karma in Disease ManagementHypocholesterolemic effect of anhydrous milk fat ghee is mediated by increasing the secretion of biliary lipids • To evaluate the mechanism of the hypocholesterolemic effect of ghee, male Wistar rats were fed a diet containing 2.5 or 5.0 wt% ghee for a period of 8 weeks. The diets were made isocaloric with groundnut oil. • Both native and ghee heated at 120 degrees C containing oxidized lipids were included in the diet. The ghee in the diet did not affect the 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity in the liver microsomes, but it significantly increased biliary excretion of cholesterol, bile acids, uronic acid, and phospholipids. • The rats fed ghee had lower levels of cholesterol esters in the serum as well as in the intestinal mucosa. Both native and oxidized ghee influenced cholesterol metabolism. • These results indicate that supplementation of diets with ghee lipids would increase the excretion of bile constituents and lower serum cholesterol levels. Kumar MV, Sambaiah K, Lokesh BR. J Nutr Biochem. 2000 Feb;11(2):69-75. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  26. 26. Assessment and Utility of Sneha Karma in Disease ManagementDr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  27. 27. Assessment and Utility of Sneha Karma in Disease Management • The Sneha bound medicines are long acting with smaller chains of Lipid molecules • The Ayurvedic Medicinal Fats are homogeneous and target oriented • The sneha in Ayurveda (under normal dose) does not increase the fats in body rather regulate them • Assessment parametric in Ayurveda is based upon the “Symptoms” is necessary to be shifted for Objective TypeConclusion • Even though the Fatty Medicine usage in Ayurveda is more – a standard research to establish the facts is necessary. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

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