A clinical study on shodhananga snehapana with special reference to Samyak Snigdha Lakshana

Snehana (internal oleation) is the major preparatory procedure to be performed before Shodhana (Biopurification).The entire procedure of Shodhana depends upon the proper mobilization of humors ( Dosha ) from peripheral circulation ( Shakha) to intestinal circulation ( Koshtha ),which is achieved with the help of Snehana and Svedana. Oleation leads and decides total outcome of The Bio purification therapy; Hence in this study standard guidelines are applied for performing internal oleation in an effective manner to avoid Ayoga (insufficient use) and Atiyoga (excessive use) of Snehana. For that we start and increased dose of lipids in an appropriate manner considering Agni (power of digestion) and Koshtha (nature of bowels) of patients. The study was carried out on total 30 healthy volunteers undergoing Vasantik Vamana . Shodhananga Snehapana with Shuddha Ghrita was administered according to Agni and Koshtha of patients. Samyak snigdha Lakshanas were assessed using special scoring pattern. Statistical analysis using paired‘t’ test were done. Onset of samyak snigdha lakshana occurs in sequence. Vatanuloman, Agnidipti, Gatra Mruduta, Klama, Snehodvega, Adhastat Sneha Darshana was seen in all patients; whereas , glani, Anga Laghava, Twak Snighdata were noted in less percentage of patients.


Introduction
Snehana (oleation) is a procedure mentioned under Shad Upakrama. (1) (Six type of treatment) which is being used independently for the promotion of health, cure of many diseases as well as a part of Shodhana (purification) as its Poorvakarma (preparatory procedure). Snehana (oleation) is an important preoperative procedure that has to be done before Vamana and Virechana. Proper Snehana (oleation) is essential for attainment of Samyak Shuddhi Lakshana. The careful daily assessment of oleation is very important for deciding further steps like sudation, emesis, or purgation. Any error in the assessment may lead to complications. The assessment of the outcome of oleation therapy is done on the basis of the symptoms of adequate oleation described as per classics.

Objective
To assess signs and symptoms of Samyak Snehana with various clinical parameters.

Source of Data
30 healthy volunteers willing to participate in the study were selected from OPD of Panchakarma department in Dr.Rajendra Gode Ayurved College, Amravati Maharashtra.

Selection Criteria
To t a l 3 0 p a t i e n t s w e r e e x a m i n e d b y randomized, open, prospective trial, irrespective of sex, religion, education, occupation, economic status.

Abstract
Snehana (internal oleation) is the major preparatory procedure to be performed before Shodhana (Biopurification).The entire procedure of Shodhana depends upon the proper mobilization of humors (Dosha) from peripheral circulation (Shakha) to intestinal circulation (Koshtha),which is achieved with the help of Snehana and Svedana. Oleation leads and decides total outcome of The Bio purification therapy; Hence in this study standard guidelines are applied for performing internal oleation in an effective manner to avoid Ayoga (insufficient use) and Atiyoga (excessive use) of Snehana. For that we start and increased dose of lipids in an appropriate manner considering Agni (power of digestion) and Koshtha (nature of bowels) of patients. The study was carried out on total 30 healthy volunteers undergoing Vasantik Vamana. Shodhananga Snehapana with Shuddha Ghrita was administered according to Agni and Koshtha of patients. Samyak snigdha Lakshanas were assessed using special scoring pattern. Statistical analysis using paired't' test were done. Onset of samyak snigdha lakshana occurs in sequence. Vatanuloman, Agnidipti, Gatra Mruduta, Klama, Snehodvega, Adhastat Sneha Darshana was seen in all patients; whereas, glani, Anga Laghava, Twak Snighdata were noted in less percentage of patients.

healthy volunteers were assigned for
Snehapana before undergoing Vamana. Detailed history, physical and mental examinations were done on the basis of specialized proforma designed for this purpose. They were also assessed on the basis of Agni and koshtha along with other criteria. Deepana and Pachana (2) were done by using Trikatu Churna 3gm (3) twice a day with lukewarm water for 5 days till the appearance of Niram Lakshana (4).on 6 th day in morning around 6 am. After praying god and Swastivachana non medicated ghee was given to the patient in an increasing pattern from 30ml to 250ml after assessing Jeerna Aahar Lakshana (clear belching and proper evacuation of bowels) (5) and Akshudhita Awastha (not feeling hungry). Patients were advised to take lukewarm water as Anupana. After the consumption of Ghee instruction was given to the patients not to take food until he/she feels hungry. The Snigdha Lakshanas were observed daily and were scored according to the Scoring pattern.

Criteria for Assessment
The following subjective parameters were considered for assessing Samyak Snigdha Lakshana.

Observations and Results
Maximum patients were from 26 to 45 years age group. Among total patients, 66.67% of subjects were male and 33.33% were female. Religion wise distribution showed that maximum number of patients (93.3%) were from Hindu community. Economic status wise distribution of patient shows that 66.67% patients were belonging to middle class.80% patients were of Madhyama Sara and 63.3% of patients having Madhyama Samhana.    Observation related with mean score of Samyak Snigdha Lakshana with S.D. and percentage was on last day of Snehapana all subjects showed Purish snigdhata w i t h m e a n s c o r e 2 . 0 . Va t a n u l o m a n a n d Snehodvega shows in 90% and 93% of patients respectively with mean score of 1.8, and 1.6 respectively. Whereas 86.67% subjects showed Klama Lakshana and Agnidipti with S.D. 1.4, 73.33% subjects showed glani with S.D. 1.2. 23.33% subjects noticed Tvak Snigdhata with mean score of 0.8 and only 13.3% subjects perceived Angalaghavata with mean score of 0.6 (S.D.±0.2). After assessing 30 patients, it was observed that the passage of flatulence was present in almost 80 % patients from the day one. The nature of feces started changing in 13.33 % patients from the fourth day. Feces were oleaginous in 53.46% of patients on fifth day and 33.33% on sixth day.. Maximum patients having Klama from4 th day,5 th and 6 th day. Snehodvega (Rejection to consume oleaginous substance) got initiated from the day four in 23.3% patients and it is maximum 46.67% on the fifth and sixth day.  T h e t h e r a p e u t i c a c t i o n a t t r i b u t e d to Shodhananga Snehapana by Caraka is 'Snehanam Sneha Vishyandam Mardava Kledakarakam' (10).This action is due to the their properties like Drava (liquid), Sukshma (minute), Sara (fluidity), Snigdha (unctuous), Pichhil (sticky), Guru(heavy), Sheetal (cold), Manda (slow), Mrudu (soft) (11). So, when they enter the circulation, the said properties start acting on various Dhatus and Srotas (channels). They convert solidified and stucked up Doshas into liquefied complex. This complex then starts gliding through the channels towards Koshtha. This process of liberation of doshas from channels and their travel towards koshtha is reflected through various signs and symptoms over the body. These are identified as "Samyka snigdha lakshanas".
Action of Sneha over the body was seen from the day one. Vatanulomana and Diptagni was the immediate sign present in the maximum patients on the day one. When Sneha Dravyas enters into the Annavaha srotas, due to its Snigdha Guna.
Anulomana of Apana Vayu occurred, which resulted in the good functioning of Apana Vayu and Pachaka Pitta and in turn Agnidipti was observed.
Purisha Snigdhata was started to be observed from 3 rd day onwards. It suggests the gradual Snigdhata of Purishavaha Srotas, which will reach maximum by 7 th day. During the digestion of oleaginous drugs due to their Guru (heavy to digest) property, gastro intestinal blood flow increases (post prandial or functional hyperemia) with decreased blood flow to the brain due to parasympathetic activity. (12) This gives the feeling of tiredness, i.e. Klama. This was present from the first day itself in all the patients for the whole period. This symptom gets corrected once the digestion process is completed.Twak Snigdhata reveals that Sneha has reached up to Rasa, Rakta, Mamsa and also Majja Dhatu (13) At the end of the Snehapana course, when the body gets saturated with enough sneha and when it exceeds the limit of Agni Body starts rejecting it and the patient shows the sign named "Adhah staat sneha darshanam". So, from the above data it can be u n d e r s t o o d t h a t t h e o n s e t o f S n e h a n a Lakshana described by Caraka and other Acharyas are in the sequence of appearance. However, in this study the symptom of Twak Snigdhata is little difficult to achieve or may not appear in all the patients.