Principles and Practice of Snehana

Trishna-parita(Patients experiencing excessive thirst)

Murchcha-parita (Patients frequently suffering from loss of consciousness)

Garbhini (Pregnancy)

Talushoshinah (Patients having dryness of palate)

Annadvishah (Patients who have aversion towards food)

Chardi (Patients suffering from vomiting)

Garardita (Patients suffering from garavisha)

Ama (Patients suffering from ama)

Durbala (debilitated persons)

Snehaglanayah(who develop discomfort on intake of sneha)

Madatura(who are intoxicated)

Ajirna (persons suffering from indigestion)

Taruna jwara (patients suffering from fever of recent onset)

Basti karma (Patients who are undergoing basti karma)

Aruchi (persons suffering from lack of taste of mouth)

Sramita (who are tired after heavy physical work)

Virikta (after virechana karma)

Vamita (after vamana)

Akala-prasuta (woman who delivered a premature child)

Galarogi (Person suffering from disease of throat)

Udara rogi (Patients suffering from ascites)

Urustambha (individuals suffering from urusthambha)

Atisai (patients suffering from diarrhoea)

Tikshnagni (Persons having strong digestive fire)

Administration of Snehana in these persons will lead to complications

Snehana Common Contra-indications of snehana are

Excess association of Kaphadosha in the pathology

Medo anubandha

Varieties of Sneha
Sarpi, Majja, Vasa and Taila are the four sources of sneha. Their respective indications according to the dosha involved is as shown below

Sarpis - Vatapita

Maija - Vata

Thaila - VataKapha

The specific indications of all these our souices are as follows :
Ghritha

Mainly in Vatavyadhis, Manasika vyadhis and Agni related diseases

Sheetha veerya and Deepana

Samskaranauvarthana is the property

Thaila

Vata associated with Kapha

Kapha-Medo pathology

Provides dridhatha

Kroora koshta

Vasa and Majja

Marmabhighatha

Balya and Brimhana

Sramsa and Prolapsed conditions

Clinical Utility
Snehana is contra-indicated when there is Aarana of ata by Sounya dosha Dooshyadis
Importance of Yamaka and Mahasneha
It is useful in different degrees of Vata vitiation.
Eg: Jeevanthyadi Yamaka in Vipadika. Malasneha in Asti-Maljagatha vata
Snehana in Clinical Practice
In clinical practice Snehana is either Abhyanthara Snehana (Internal usage) or Bahya Snehana (External usage). The important factors to be assessed before internal Snehana is

Assessment of status of Koshta

Assessment of status of Agni

The physician should ty to eicit the status when the patient was not having any symptoms. Charaka has said that people of mrudukoshta have virechana even with ikshu rasa, draksha rasa, warm water etc. This can be kept in mind while assessing koshta. Assessment of Koshta can be done by the following parameters :

Nature of stool

Consistency of Stool

Frequency of Stool

Bowel movements

States of Malabsorption

Any associated GIT pathologies

Assessment of Agni

The functional status of agni can be assessed by the following parameters

Understand the level and degree of Appetite

Details of Food habit

Any history of Ajeerna

Quantity and Quality of food

Timing and interval of Food

Types of Internal Snehana in Clinical Practice

Acchapana

Vicharana

Sadyasnehana

Accha snechapana Acchapana is the oral intake of medicated or non medicated sneha in required quantities for a limited time period without mixing food articles other than prakshepa dravyas.
Duration of Administration Kroora koshta -7 days
Madhyama koshta 4 to 5 days
Mrudu koshta 3 days
Snehapana can be stopped if Samyak snigdha lakshana are observed before the above mentioned period.
Standard Operative Procedure of Accha snehapana :

Proper Patient examination

Assessment of digestion and bowel

Investigations required prion to Accha sachapana:

Blood CBC LE Blood Sugar,RFT Lipid profiles

Stool: Routine Bxamination

Urine: Routine Bxamination

Procedure: Dosage of the sneha must be decided according to age, health, prakrit Vikriti, dosha and agnibala. Test dose

It must be in between 50-75 ml for ghritha and 30-60 ml for taila on the first day

The dose for the next day should be fixed after assessing the time taken for digestion

For vasa and maija the maximum dose is 50 ml

Within half an hour of sunrise, patient should be seated in comfortable position and sneha should be given in empty stomach

After giving the sneha, eye bandage if used, should be removed Warm water should be given as anupana

The patient should wash the face and mouth with hot water to remove the taste of sneha.

Hot water can be given if the patient feels thirsty Note Saindhava lavana should be given with sneha as it helps the person to attain snigdhata because of its snigdha, sookshma, ushna and vyavayi guna

Precautions to be taken during snehapana

Patient should take rest during the snehapana period but he/she should not sleep during the day time

Usage of hot water for all purposes

Non-suppression of urges

Abstinence

Non-exposure to cold, dust & sun

Stable mentality

Pathya is to be followed.

Warm vilepi should be given when the sneha is completely digested and good appetite is observed

Samyak Snigdha Lakshanas as listed below should be carefully observed.
1.   Agnideepti (increase in appetite)
2.   Sneha- dvesha (intolerance to fat)
3.   Asamhata Varcha (loose stools)
4.   Angalaghava (lightness in the body)
5.   Gatra Mardawa (soft feeling of body parts)
6.   Snigdha Gatrata (smoothness in the body)
7.   Snigdha Pureesha (oily stools)
8.   Snigdha Twacha (oily skin)
9.   Vatanulomana (Proper passage of flatus)
10.   Klama (tiredness without doing physical work)
12.   Shaithilya (lethargy)
Key Points

Vatanulomatha -Normal GIT movements

Agnideepthi - Normal Appetite

Varcha snigdhatha and Asamhatha - Oily stool

Snehodwega - Aversion to Sneha

Klama - Lassitude

Biochemical Assessment criterias after Snehapana

Lipid Profile

- HDL
- LDL
- VLDL
- Triglycerides
Snehana - Possible Complications

Complications may be due to improper Dose, Drug, Kala, Pathya etc.

Ayoga/Heenayoga

Athiyoga

Mithyayoga

Asnigdha lakshana 1. Grathita purisha (passing of hard stool)
2. Ruksha purisha (passing of dry stool)
3. Agnimandya (weak digestive power)
4. Vayu pratilomata (unregulated vata)
5. Gatra kharata (roughness of body)
6. Gatra rukshata (dryness of body)
7. Uro vidaha (burning sensation in chest)
8. Dourbalya (weakness)
9. Kricchra annapachana (late digestion)
10.Susnigdha viparyaya (features opposite to those of samyak sneha)
Ati snigdha lakshana
1. Panduta (pallor)
2. Sharira gourava (heaviness of body)
3. Jadyata (sluggishness)
4. Apakva purisha (undigested foods in stools)
5. Tandra (drowsiness)
6. Aruchi (lack of taste in the mouth)
7. Utklesha (nausea)
8. Bhakta dvesha (aversion to take food)
9. Mukha srava (Excessive salivation)
10. Ghrana srava (discharge from the nose)
11. Guda srava (secretions in the anus)
12. Guda daha (burning sensation in the anal region)
13. Pravahika (dysentery)
14. Purisha-atipravritti (excessive passing of stools)
Sneha Vyapad The complications of snehapana can be two fold, Acute and chronic. They should be managed accordingly.
Acute complications 1. Ajirna
2. Trishna
3. Samjnanasha
4. Tandra
5. Utklesha
6. Anaha
7. Jwara
8. Stambha
9. Aruchi
10. Shula
11. Amapradosha
Chronic complications 1. Kushta
2. Kandu
3. Pandu
4. Shotha
5. Udara
6. Grahani
7. Arsha
8. Sthaimithya
9. Vak graha
Treatment For Acute Complications

Ushnodaka pana

Amapachana, Vatanulomana

Vamana, Thakra prayoga,Arishta prayoga

Rukshaanna pana

Triphala, Gomuthra, Guggulu prayoga.

Chronic complications should be treated according to the condition
Common Complications in practice

Indigestion, vomiting, nausea,anorexia

Agnimandya, headache, Constipation, fever, diarrhea,bhrama etc. may be seen.

In such conditions, stop snehapana immediately. Upavasa, vamana, arista's etc. Pachana dravya can be given according to the condition
Medicines for Snehapana in clinical practice Obesity
Tila taila
Skin Diseases

Thikthaka Ghritham

Aragwadha mahathikthakam Ghritham

Guggulu thikthakam Ghritham

Patoladi Ghritham

GIT Diseases

Dadimadi Ghritham

Indukantha Ghritham

Sukumara Ghritham

Neurological Diseases

Rasnadasamoola Ghritham

Gugguluthikthakam Ghritham

Vidaryadi Ghritham

Ksheerabala 101 Avarthi

Maharajaprasaranyadi Thailam

Sahacharadi Thaila

Narayana Thaila

Genito Urinary Diseases

Sukumara Ghritham

Vasthyamayanthakam Ghritham

Phala Ghritham

Psychiatry

Panchagavya Ghritha

Kalyanaka Ghritha

Brahmi Ghritha

Immunopathologies - Allergic states

Indukantha Ghritha

Shatphala Ghritha

Diabetic Neuropathy

Dhanwantharam Ghritha

Varanadi Ghritha

Guggulu thikthakam Ghritha

Locomotor system

Madhuyashtyadi Thaila

Dhanwantharam Thaila

Guggulutiktakam Ghritha

Gandha Thaila

Avapeedaka Snehapana The meaning of the word Avapeedaka' is to press down. Avapeedaka sneha is the treatment procedure administered for 'mootra Vegarodhajanya vikaras,adhonabhigata vata vikaras.
Methodology 1. The procedure involves two steps of administration of Sneha, one dose before food intake and second dose after the digestion of food.
2. On the day of snehapana, initially half portion of Sneha is given, followed by little quantity of hot water.
3. The patient should be advised to take breakfast immediately.
4. After the digestion of the food (when the patient feels hungry) the remaining portion of Sneha should be given.
5. The patient should be made to stay in a place devoid of breeze and by covering himself, awaiting the digestion of Sneha.
Avapeedaka Sneha can also be given in infertility, BPH, IBS, Spastic colon etc. Sneha is selected according to physician's yukthi.

Sadya Sneha Key Points
The procedure of administering sneha in short duration or single day and getting the desired effect of snehana instantaneously is known as sadya sneha. It is a type of abhyantara sneha where in sneha dravya is used in combination with dietary preparations. Medicated and non-medicated sneha dravyas can be used Rice ganji (Vilepi) can be prepared Ghritha or sneha in the desired quantity (30 to 50 ml) is added to this vilepi. Saindhava lavana should be added. The patient is made to drink this in the morning when he is hungry A very good usage of Sadhya snehapana can be seen in cases of jaundice and Hepatitis cases. After deepana-pachana, Sadhy snehapana can be given with Indu kanta ghritha(Hepatitis with already manifested Jaundice) Sukumara ghritha can be used in Hepatitis with constipation. Vidaryadi ghritha is useful in jaundice with spleenic enlargement and haemolytic jaundice and kalyanaka ghritha in hepatitis due to bacterial infections Virechana can be given the next day The late Dr. Eswar Reddy, a distinguished panchakarma physician from Karnataka has treated hundreds of Hepatitis B and jaundice cases adopting sadhya sneha with the above ghrithas There is a strong belief among modern doctors that administration of ghee, oil or any saturated fats increase the lipid levels.