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THE STUDY OF AROHANA SNEHAPANA AND ITS
EFFECT ON SAMEDARAKTA WITH SPECIAL
REFERENCE 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
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
DECLARATION BY THE CANDIDATE
hereby declare that this dissertation / thesis entitled “The Study
of Arohana Snehapana and its Effect on Samedarakta with
special reference to Hyperlipidaemia and Normal Lipid Values”
is a bonafide and genuine research work carried out by me under the
guidance of Dr. P. Shivaramudu M.D. (Ayu), Asst. Professor, Post graduate
department of Panchakarma and Co-guidance of Dr. Shashidhar H.
Doddamani, M.D.(Ayu), Assistant Professor, Post graduate department of
Panchakarma.
I
Date: Place: Gadag Varsha S. Kulkarni.
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 of
Arohana Snehapana and its Effect on Samedarakta with special
reference to Hyperlipidaemia and Normal Lipid Values” is a
bonafide research work done by Varsha S. Kulkarni in partial
fulfillment 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
COPYRIGHT
Declaration by the candidate
hereby declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and disseminate
this dissertation / thesis in print or electronic format for academic /
research purpose.
I
Date:
Place: Gadag Varsha S. Kulkarni.
© Rajiv Gandhi University of health Sciences, Karnataka
Effect of Arohana Snehapana on Samedarakta
Acknowledgement This work is the result of the combined effort of a good number of people who include
researchers, academicians, friends, colleagues, and above all the patients who cooperated with us in all
aspects. Moreover it is because of Gods’ grace only the work could be completed as per to my
expectation.
My deep sense of gratification is due for my parents who are the architects of my career. The
culture, 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 encouragement
at various levels of my study.
I express my deep gratitude to my respected guide Dr. P. ShivaramuduMD.(AYU) for his
sympathetic, compassionate, extensive guidance, suggestion, encouragement and kindheartedness.
I am extremely happy to express my deepest sense of gratitude to my beloved and respected
HOD, Prof. G. Purushothamacharyulu,MD.(AYU) whose sympathetic, scholarly suggestions and ablest
guidance 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) will
be cherished by me for long. His invincible and radical thinking were very valuable in achieving this
research 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 this
study.
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. Hanumanth
Gowda, Dr. Shankar Gowda.
I can not move further before thanking to my intimate friend Dr. Ravikumar who has been stood
indefatigable 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 all
the moments during my Post Graduate studies.
Acknowledgement - I
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 Junior
Colleagues 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 their
timely 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 pathology
laboratory staff and Hospital staff and to all those names my memory fails to recollect.
Dr. Varsha S. Kulkarni.
Acknowledgement - II
Effect of Arohana Snehapana on Samedarakta
ABSTRACT
yurveda uses two main modalities in the treatment of disease each with its
own distinct purpose. These modalities are Shodhana and Shamana chikista. The
Snehana is the one of the main preparatory procedure to be performed before
Shodhana Karma.
A
In the present study the Shodhananga Snehapana with Murchita Tila Taila was
given in certain specific quantity in the Arohana Krama till the appearance of
Samyak snigdha laxanas seen. 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., It becomes essential to clear the cloud from the
mind of people. Hence the present study has been undertaken to assess the effect of
Arohana Snehapana over the Samedarakta (Hyperlipidaemia & Normal Lipid Values).
The objectives of this study was to evaluate and to compare the effect of
Arohana Snehapana with Murchita Tilataila on Samedarakta with special reference to
Hyperlipidaemia and Normal Lipid Values.
In the present Clinical study, two groups were made. 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. In another group 15 voluntaries with
Normal Lipid Values who were desirous to under go Shodhana therapy for
maintenance of good health were selected.
Abstract - III
Effect of Arohana Snehapana on Samedarakta
In both the groups after Ama Pachana, Snehapana was done in Arohana
krama till the Samyak snigdha laxanas are observed. Snahapana was given 30ml as
Hrisiyasi matra at morning around 6 to7am with ushnajala as anupana. Next day dose
was increased depending upon the previous days sneha digestion. Lipid profile values
are done on first day before Snehapna and after Samyak snigdha laxanas, with 12
hours 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 Snigdha
Laxanas, Samedarakta, Meda, Hyperlipidaemia, Lipids, Lipid Profile.
Abstract - IV
CONTENTS
INTRODUCTION 1- 4
OBJECTIVES 5
REVIEW OF LITERATURE 6 - 92
HISTORICAL RIVIEW 6 - 8
SHODHANA POORVA AROHANA SNEHAPANA 8 - 32
NIRUKTI AND PARIBHASHA OF SNEHA 8 - 9
MAHA SNEHAS 11
CLASSIFICATION OF SNEHA AND SNEHANA 12 -18
SNEHANA YOGYAYOGYA 18 - 22
SNEHA PRAKARSHA KALA 22 - 23
SHODHANANGA SNEHANA VIDHI 23 - 32
KARMUKATA OF SHODHANANGA SNEHANA 33 - 38
MEDA 39 - 42
CONCEPT OF LIPIDS 43 - 68
SAMEDARAKTA AND HYPERLIPIDAEMIA 69 - 84
DRUG REVIEW 85 - 92
Methodology 93 - 99 Results 100 -126
Observations 100 -117 Results 118 -126
Contents - V
Discussions 127 -143
Conclusions 144 -145
Summary 146 -148
Bibliographic References 149 -164
Annexure
Contents - VI
Effect of Arohana Snehapana on Samedarakta
ABBREVIATIONS
C.S. Charaka Samhita
S.S Sushruta Samhita
A.S. Astanga Sangraha
A.H. Astanga Hridaya
B.P. Bhava Prakasha
Sha.S Sharanghadhara Samhita
K.S Kashyapa Samhita
Ckd Cakradatta
M.N Madhavanidana
Y. R Yogaratnakar
Va.Se Vangasena
Su Sutrasthana
Sha Shareerasthana
Vi. Vimanasthana
Abbreviations- VII
Effect of Arohana Snehapana on Samedarakta
LIST OF TABLES
Sl. No. Tables Pages 1 Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of
Sneha Dravys. 11
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
Acharyas. 19
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
choorna 86
25 Showing Pharmacodynamics of Drugs Used For Moorchana of Tilataila
88-89
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
Effect of Arohana Snehapana on Samedarakta
41 Koshta wise distribution of the Samples 107 42 Prakriti wise Distribution of the Sample 107 43 Sara wise Distribution of the Sample 107 44 Showing Samhanana of the Samples 108 45 Showing Pramana of the Samples 108 46 Showing Satmya of the Samples 108 47 Showing Satva of the Sample 109 48 Showing Abhyavaharana Shakti of the Sample 109 49 Showing Jarana Shakti of the Samples 109 50 Showing Vyayama Shakti of the Samples 110 51 Shows the matra of Arohana Snehapan with Murchita Tila Taila in
both groups. 111
52 Showing the mean on set of Jeeryamanya laxanas of both Groups 112 53 Showing time taken for Sneha Jeerna laxanas 113 54 Showing Summary of time taken for Sneha Jeerana (in minutes) 114 55 Showing Mean time taken for Samyak Snigadha laxanas of both
Groups A & B. 115
56 Showing Samyak Snigdha Laxanasa of each individual in both the groups
116
57 Showing the Total number of Samyak Snigdha Laxanas observed on last day of Snehapana in both the groups
117
58 Showing Serum Cholesterol levels in both groups before and after Arohana Snehapana.
118
59 Showing Serum Triglycerides levels in both groups before and after Arohana Snehapana.
119
60 Showing HDL levels in both groups before and after Arohana Snehapana
120
61 Showing LDL levels in both groups before and after Arohana Snehapana
121
62 Showing VLDL levels in both groups before and after Arohana Snehapana.
122
63 Showing the weight and BMI of Group A before and after Arohana Snehapana
123
64 Showing the weight and BMI of Group B before and after Arohana Snehapana
124
65 Showing the overall results of Serum Lipid Values 124 66 Showing statistical results of Group A samples 125 67 Showing statistical results of Group B samples 125 68 Showing comparative statistical results of Group A & Group B
samples 125
List of Tables - IX
Effect of Arohana Snehapana on Samedarakta
LIST OF FIGURES
Sl. No. Figures Pages 1 Showing Bio Synthesis of Cholesterol 48 2 Showing Metabolism Summary 67
LIST OF FLOW CHARTS Sl. No. Flow Charts Pages
1 Showing Sthana and Swaroopa of Meda dhathu 40 2 Showing Samprapthi of Medo vriddhi 76
LIST OF GRAPHS
Sl. 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 PHOTOGRAPHS
Sl. No. Photographs Pages 1 Ingredients of Panchakola Choorna 87 2 Drugs Used for Murchana of Tilataila 90
List of Tables - X
Effect of Arohana Snehapana on Samedarakta
he ancient Indian science of health, Ayurveda is now being increasingly
accepted by the world at large for its facilities and adoptability even to the modern
times.
T
It is not surprising that, the ancient science is accorded such importance in
countries where modern medicine itself has made immense advances. The only
reasonable explanation for this phenomenon is the fact that Ayurveda remains the
only system of medicine that possesses a natural form of treatment, one that
prescribes remedies in accordance with nature itself. It approaches a patient
holistically, taking in to account while treating person, not only the patient but also his
general condition.
Shodhana and Panchakarma are the two terms we can come across in the
Ayurvedic classics that have seen almost used synonymously. If we meticulously
explore the literature regarding these two terms, we may unveil the subtle differences
existed between both of them.
The term Shodhana has been used in broader perspective in Ayurvedic
classics. This envisages the wider meaning and implication of the Shodhana therapies.
Samshodhana is a term used for various eliminating procedures. Panchakarma
therapy which is known as Samshodhana therapy is designed to eliminate the vitiated
doshas. In order for these therapies to work the vitiated doshas must be brought to the
kostha. This is accomplished by two primary means i.e., Snehana and Swedana
therapies. Snehana is one such procedure, mentioned under Shadvidhopakrama.
Snehana can act as a Poorvakarma for Shodhana procedures, i.e., Shodhana sneha, as
Introduction - 1
Effect of Arohana Snehapana on Samedarakta
a Pradhana karma in alleviating diseases ie., shamana snehana and as a paschat karma
in bringing compactness to the body i. e., Bruhmana sneha.
Almost all the Acharyas have given the prime importance to Snehana therapy
as a Poorva karma, Pradhanakarma and Paschat karma according to the need of the
person or disease. Acharya Sushruta beautifully delineates the importance of Sneha as
a “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 in
regular 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 Sneha
should be administered after the complete digestion of food which was taken in the
previous night and Snehas are given in certain specific quantity in the increasing order
for specific number of days or till Samyak Snigdha Laxanas get manifested. After
adopting the necessary regimen in Vishrama kala Shodhana i.e, either Vamana or
Virechana are performed.
In this most advanced modernised era, the humans are gifted with lot of
sophistication, luxuries but at the same time left with sedentary ways of life, stress
induced hectic, unhealthy schedules. Further indiscriminate dietary habits,
overeating, consuming high quantity and high caloric foods etc., propping into one’s
life are strongly influencing the homeostasis leading to the maximum number of
pathological conditions, one amongst them is Hyperlipidaemia.
Introduction - 2
Effect of Arohana Snehapana on Samedarakta
On the theoretical grounds it has been tried to co-relate the Hyprlipidaemia
with many diseases described in Ayurveda i.e., Medoroga, Medhovriddhi,
Abhadhamedus, Sthaulya etc.,
These are getting manifested due to vitiation of Medadhatu. Hence the excess
amount of Meda in Rakta will be considered as Hyperlipidaemia and the normal
amount of Meda in Rakta is taken as normal Lipid.
The term coined for the word Lipidaemia is Samedarakta whether it is
physiological or pathological. Literally Samedarakta means Rakta associated with
Meda.
Hyperlipidaemia refers to an increased concentration of either Cholesterol or
Triglycerides 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
Effect of Arohana Snehapana on Samedarakta
In the present study Murchita Tilataila was taken in increasing order (Arohana
Snehapana). But people in this era are afraid of this Snehana therapy which is taken
in large quantities, may leads to increase of plasma lipids, especially Cholesterol and
Triglycerides which are the important risk factors for Atherosclerosis and CHD
further life threatening conditions.
But Tilataila is having special characters as “Krishanam Bhrimhanayalam
Sthoolanam Karshanaya Cha” means in Krisha people it acts as Bhrimhana and in
Sthoola person it does Karshana of Meda. By its teekshana Ushnadi gunas enters all
sukshma, sthoola srotases and does Chedana, Kshapana of Medodhatu.
Hence this study has been intended to assess the effect of Arohana Snehapana
on Samedarakta (Hyperlipidaemia and Normal Lipid Values).
Introduction - 4
Effect of Arohana Snehapana on Samedarakta
Objectives - 5
To evaluate the effect of Arohana snehapana with Murchita Tilataila on
Samedarakta (Hyperlipidaemia and Normal Lipid Values).
To compare the effect of Arohana Snehapana in both Hyperlipidaemia and
Normal Lipid Values.
Effect of Arohana Snehapana on Samedarakta
HISTORICAL REVIEW:
On Sneha karma:
It would be quite judicious to review the reference of Sneha which is available
from 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 the
use of Sneha therapeutically. We find the use of both animal product (ghee) and plant
products (oil) in the Materia Medica of Atharvanas. Among the plant products, oil of
Ingida and Tila taila are found embodied in the pharmacopoeia of Atharvanas.
Samhita Kala
In Charaka Samhita (800 BC), we find ample of references regarding the
therapeutically use of Sneha in various disorders. The author has devoted an entire
chapter in the Sutra Sthana on “Shadvidopakramas”2. Snehana as pradhana karma is
the most significant therapeutic procedure. Among them Charaka has extensively
dealt with the subject “Snehana” and its salient features separately in 13th chapter of
Sutra Sthana3 and about Shodhananga snehana in Charaka siddhisthana4. Here he has
described 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 his
Chikitsasthana. Here he has classified Snehana on the basis of its Karmukata as
Shodhana, Shamana and Brumhana. Sushruta explained the preparation of “Sneha”
i.e., Ghrita and Taila5. Also we find good number of references regarding the use of
sneha in the Shodhana and Shamana or alleviation of different diseases. Sushruta,
Historical Review - 6
Effect of Arohana Snehapana on Samedarakta
being a surgical man has also used “Sneha” in various surgical ailments. Detailed
explanation 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 Aushadhisiddha
tailas and method of preparation of Hingutriguna taila have been mentioned in
Sutrasthana and Chikitsasthana of Astanga Hridaya6.
Kasyapa (600 BC), an eminent personality in Koumarabhritya has dealt in
detail regarding Snehana in 22nd chapter of his Sutrasthana. Also he has used
different ghrita and taila in managing various Balarogas7. Bhela, one of the six
celebrated disciples of Atreya has mentioned the use of different Sneha in treating
different disorders8. Qualities of each taila their specific indications have been
mentioned in 14th Chapter in Harita samhita9.
Sangraha Kala
Common qualities of each taila and shresthatha of Tila taila is mentioned in
Yogaratnakara 1st Chapter10. In Bhavaprakash Nigantu detail explanation of
paryayas, swaroopa utpattisthana guna of taila are available11.
During this period, authors like Chakrapani Datta12, Vangasena13 and
Sharangadhara14 have included Sneha, both ghrita and taila in the cure of various
disorders.
Adhunika Kala
Detailed explanation about oils, fats, classification of oils, properties and
sources of oil, expression of oils, have been mentioned in text of pharmacognocy15
Teiz’s text book of clinical Bio – Chemistry16.
Historical Review - 7
Effect of Arohana Snehapana on Samedarakta
On Meda and Vyadhi:
About Meda and Medoroga there is no any direct reference is available in
Veda but all most Samhitas of Ayurveda refereed these ailment with their different
aspects. All the Bhrahatrayees, Laghutrayees, Vangasena and Yogaratnakara have
explained about Meda and Medoroga as follows;
C. S. Sha. 7/6 - Meda pramana
C. S. Vi. 5/8, 16 - Medovaha sroto moola, Medovahasroto dusti karana
C. S. Vi. 8/106 - Medasara purusha laxana
C. S. Su. 13/5 - Taila sevana yogya
C. S. Su. 21/3-19 - Asta dosha of Sthoulya and Madhyama pramana of
purusha
C. S. Su. 28/15 - Abaddha medas
S. S. Su. 14/11 - Meda is forming from mamsa
S. S. Su. 15/ 6, 13 - Meda karya, Medovriddhi
S. 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 Meda
A. H. Su. 11/18,26 - Medovriddhi, Ashrayaashrayee Bhava of kapha and Meda
A. 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 in
Guyton Medical physiology17, Ganonge Medical physiology18, API text book of
medicine19, Davidson text book of medicine and Basic pathology20.
Historical Review - 8
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 9
SHODHANA POORVA AROHANA SNEHAPANA
Snehana is the classical poorvakarma to be administered as a preparatory
measure before Shodhana therapy i.e., vamana, virechana etc, independently21.
Charaka has described Snehana as one among the Shadvidhopakrama and can be
adopted as treatment22.
Snehana is a therapy intended for alleviation of vitiated doshas as a part of
preparatory 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 by
suffix ‘lyut’ Pratyaya. (Vachaspatya )24
The mool ‘Snih’ has two implications or meanings --‘Snih - Preetau’ to render
affection and ‘Snih – Snehane’ to render lubrication. Among these the later will be
more 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)25
PARIBHASH 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 bring
about Snigdhata in the body is known as Snehana.
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• 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 of
Sneha dravyas before the Shodhana procedures ie., Vamana and Virechana.
SYNONYMS
The synonyms mentioned for Snehana are Sneha, Snigdhata, Mrtkshana,
Mrksha, Abhyanga and Abhyanjana.27
GUNAS OF SNEHA DRAVYAS: 29,30,31
Gunas in the drugs are responsible for the different functions of drug. The
Properties of Sneha Dravya’s are like Sukshma, Sara, Snigdha, Drava, Picchila,
Guru, Shita, Manda and Mrdu, which are having opposite properties of Rukshana
Dravyas. Though drug having these qualities but always it may not produce Snigdhata
in the body. There are few exceptions to this general rule like Yava, though it
possesses Guru, Sheeta, Sara gunas produces Rukshata. Rajamasha inspite of having
guru guna produces rukshata. Tila Taila even though it is Tikshna and Ushna it acts
like Snehana. That may be the reason why Acharyas have used the term Prayo, while
explaining Sneha Dravya properties.
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Table No. 1: Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of Sneha
Dravys32.
Dominent Mahabhutha Guna Prathvi Ap Teja Vayu Akasha Karmukata
Picchila ++++ Lepana, Jivana, Samghata, Sandhana, Balya, Gouravata
Sukshma ++ ++ +++ Sroto Vishodhana, Vivarana, Soushiryakara
Sara ++ + Anulomana, Vyaptisheela, Preranasheela
Snigdha + ++++ Snehana, Mardavata, Kledana Bandhana, Vishyandana,
Drava ++++ Prakledana, Vilodhana, Prasari.
Guru ++++ ++ Brumhana, Malavriddhikara, Tarpana, Angaglani, Balakara,
Shita +++ ++ Sthambhaka, Hladana
Manda ++ + Shamana
Mrdu ++ +++ Shaithilya of Avayava, Mardavata.
By seeing above table it can be justified that Sneha Dravyas are of apyamahabhuta
predominant.
MAHA SNEHAS OR PRAVARA SNEHA:33,34,35
Among all the Sneha Dravyas, Ghrita, Taila, Vasa and Majja are the most
important 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
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PROPERTIES OF TAILAS: 37, 38
Table No. 2: Showing Properties of Taila
Rasa Anurasa Virya Vipaka Guna
Madhura Tikta,Kashaya Ushna Madhura. Tikshna,Guru,Snigdha,Vikasi,Sara
Karma 39
VataKaphahara, Pittakara, Balakara, Varnakara, Mardava Kara, Tvachya,
Krimighna, Garbhashaya Shodhaka, Bhagna Sandhanakara , Subsides Shula in Yoni,
Shira and Karna.
Seasonal indication : Pravrt, Shita Kala
Suitable condition for Taila Snehana:40,41
Vata Prakrti, Pravriddha Shleshma Medaska, Chala Sthula Gala Udara, Taila
Satmya, Vatavyadhi, Krimikoshta, Nadivrna, Bhagna, Krura Koshta, those desires of
Bala, Tanutva, Laghuta, Drdhata and Sthiragatrata.
CLASSIFICATION OF SNEHA
I. BASED ON YONI (SOURCE)42,43
There are two sources of Dravys viz., Sthavara and Jangama
Based On Yoni (Source)
Sthavara Jangama
A) 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 eighteen
Ashayas of Sthavara snehas.
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Table 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 Haritaki
Sushruta 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 Upayogi
B) Jangama Sneha (Animal Origin)
Jangama Sneha is derived from animal sources. Ex: Kshira, Dadhi, Ghrita,
Mamsa, Vasa, Majja etc
II. PAKA BHEDA
Opinion of different authors regarding varieties of Sneha Paka and its
indications
Table 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
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III. 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.
VI. ACCORDING TO VISHISTHA SAGNA 55,56,57
Vishistha sagna
Sadyo Snehana Pancha Prasrta Peya Achapeya
(Sneha without mixing with any other Dravya)
(Sneha with various preparations like Vilepi and Yavagu etc.)
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VII. MATRA BHEDA:58,59
The following dosage schedule is advocated in the classics based on the time
required 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, which
digests within three hours, is known as Hrasiyasi Matra. This is used when the Koshta
of the person has not been properly diagnosed60.
Fixing the Dosage of Sneha in numerical value is not possible with the reason
that, 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 digestion
of Sneha viz,
(i) Hrasiyasi Matra
(ii) Hrasva Matra
(iii) Madhyama Matra
(iv) Uttama Matra
Table No. 6 Opinion about Sneha Matra60, 61, 62
Author Hrasiyasi Matra Hrasva Matra Madhyama
Matra Uttama Matra
Hemadri 1 Pala, 2 Pala, 4 Pala, 6 Pala - - -
Sharangdhara Cakradatta - 2 Tola 3 Tola 4 Tola
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Table No. 7 Sneha Matra according to Sushruta63
Dose Time
required for digestion
Action Indication
Sadharana Matra (1/4th day) 3 Hrs. Agnidipti Alpa Dosha Atur
Bruhmana Matra (1/2 day) 6 Hrs. Brumhana, Vrushya Madya Dosha Atur
Prabhala Dosha Matra (3/4th day) 9 Hrs. - Bahu Dosha Atur
Shrestha Matra (Full day) 12 Hrs. - Glani, Murcha, Mada
Uttama Matra (Day & Night) 24 Hrs. -
Kushta, Visha, Unmada, Graha,
Apasmara
Table No. 8 Indications of Sneha Matra64, 65
Criteria for selection of Dose Person Disease Action
Uttama Matra
• Prabhuta Sneha nitya • Kshut–Pipasa Saha • Uttama – Agnibala Sharira Bala Manasa Bala
Gulma Sarpa-damshtra Visarpa Unmatta Mutrakrcchra GadhaVarcha
• Shighravikara Shamana • Doshanukarshini • Pervades through all
marga • Balya • Rejuvenates-body,
sense organs and mind
Madhyama Matra
Madhyama – Sharira bala Manasa bala Agnibala Mrudu Koshta
Arushka Sphota Pidaka Kandu Pama Kushta Vatarakta
• No much complication • Does not effect strength
much • Brings Snehana
comfortably • Used as Shodhanartha
Snehana Hrasva Matra
• Vriddha • Bala • Sukumara/Sukhocita • Mandagni • Durbala/Avara bala • Person not able to
withstand hunger.
Chronic condition of disease like-
Jvara Atisara Kasa
• Brumhaniya • Snehaniya • Vrushya • Balya • Long lasting benefits • Does not cause Complications
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Hrasiyasi Matra is a trail dose, which is administered on the first day of
Snehapana.
One of the actions of Uttama Matra Snehapana is explained as Vikara
Shamana and that of Hrasva Matra as Brumhana Cakrapani mentions that Uttama
Matra should be used for Shamana and not for Shodhana Purva Snehana. So doubt
may arise regarding usage of Uttama and Hrasva Matra as Shodhana Purva
Snehapana Dosage.
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 of
Accha Sneha during Annakala when one feels hungry without taking the meal.66,67
Hemadri defines Shamana Snehana is one which normalizes the aggravated doshas
without expelling them and disturbing the normal doshas68.
(ii) Brumhana Snehana:
The snehana used for Brumhana is called as ‘Bhrumhana Snehana’. The
administration of Sneha along with Mamsa Rasa, Madya, Kshira etc., are known as
Brumhana Snehana69. Before food if Brumhana Snehana is given will cures
Adhobhaga rogas, in the middle of food cures Madhyamabhaga rogas, after food
cures Urdhwabhaga rogas and strengthens the body70. The dose of Sneha should be
Alpa or even less than quantity of Hrasiyasi Matra71.
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(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 Snehapana73
DAY Matra (Dosage) 1 2 3 4 5 6 7 Uttama 6 pala 7 pala 8 pala 9 pala 10 pala 11 pala 12 pala Madhyama 6Karsha 7Karsha 8Karsha 9Karsha 10Karsha 11Karsha 12Karsha Hrasva 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.
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Table No. 10 Shamana and Brumhana Snehana Yogya: 74,75
Abala Vata Vikari Vyayama – Madya – Stree nitya Bala Chintaka Vriddha Daruna pratibodha MadhyasevitaTimira Krsha Abhishyanda Mandagni Ruksha Mrudukostha with alpa dosha
Shodhana Snehana Yogya:
Shodhananga Snehapana is one of the essential Purvakarma for Shodhana.
Hence in almost all the Shodhana Arha conditions Shodhananga Snehapana is
advised.
Table No. 11 Showing General Indications of Shehana According to Different
Acharyas.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 - - - + -
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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
Visha
SNEHA 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 Anarha
are 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.
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• 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.
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Table 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. Shodhananga
Snehapana is a process of administering Sneha to achieve the desired Doshotkleshana
within a specific number of days.The minimum and maximum number of days for
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Shodhananga Snehapana is 3 to 7 respectively. i.e. if the person with Mrdu Koshta for
3 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 Vataja
Prakrti needs 3, 5 and 7 days of Snehapana respectively.
Vagbhata emphasizes that Shodhananga Snehapana should be continued till
one 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 Shodhananga
Snehapana should be till the appearance of Samyak Snigdha Lakshana. But maximum
duration is with in 7 days.
Sneha Prakarsha Kala –why 7 days? 97,98,99
Shodhananga Snehapana creates Doshotkleshana in the body. If
Shodhananga Snehapana continued after 7 days, then Sneha becomes Satmya and fail
to produce Doshotkleshana. Here Satmya refers to the meaning that individual get
accustomed 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 of
Sneha should be given after some interval.
SHODHANANGA SNEHAPANA VIDHI:
The administration of Shodhananga Snehapana is followed in three
different stages such as Purvakarma, Pradhana karma and Paschat karma.
I. Purvakarma
II. Pradhana karma and
III. Paschat karma.
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I. PURVAKARMA:
It includes-(i) Atura Pariksha, (ii) Atura Siddhata, (iii) Sambhara Sangraha
i. Atura Pariksha 100
Dasha Vidha Pariksha, Prakruti, Vikruti, Sara, etc in the Atura is to be
examined. 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 through
following procedures -
(a) Deepana – Pachana (b) Diet regimen (c) Manasopachara
a] Deepana – Pachana
People having mandagni & Amavastha condition. So it is essential to take
Deepana & 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.
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b] Diet regimen 105,106,107
For shodhananga snehana Indicated diet ;
• Drava – Liquid
• Ushna – Warm
• Anabhishyandi – not having ‘Abhishyandi’ property
• Na Atisnigdha – Not too much Snigdha
• Pramanayukta – Regulated quantity
c] Manasopacara
In Shodhananga Snehapana, a large quantity of Sneha is administered.
Because of non-palatability, discomfortness felt during Sneha Jirna Kala, individual
might show avertion to drink Sneha. So prior to Snehapana, complete procedure of
Snehapana and Shodhana should be explained to the individual and he should be
encouraged to drink Sneha. This may give confidence to the patient.
iii. Sambhara Sangraha
One should keep ready the required medicaments and first aids and essential
materials to treat the Vyapat or arises if any .108
II. PRADHANA KARMA
Pradhana karma includes following steps viz,
1. Administration of Sneha and Anupana
2. Observation of
a) Sneha Jiryamana Lakshanas and Sneha Jirna Lakshanas
b) Snigdha, Ati Snigdha and Asnigdha Lakshanas
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1. Administration of Sneha 109
In the early morning when the Sun rises Athura is advised to take medicated
Taila or Gritha. The sneha should administered after complete digestion of food
which was taken on previous night. After performing auspicious rituals, appropriate
quantity 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. It
also 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 and
Bhallataka Taila.The dosage of the Anupana may be decided on the basis of normal
digestion 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 produces
some symptoms called as ‘Sneha Jiryamana Lakshanas’. These Lakshanas will be
subsided after Sneha Jirna and does not need any sort of therapeutic intervention.
During first phase of avastha paka. Production of kapha takes place, which is
having similar qualities to sneha. Thus production of kapha will be more which causes
lalasrava. Due to large amount of sneha the quantity of secretions of Jataragni
increases and Jataragni is having Agneya quality which may cause Trishna, Bhrama,
Murcha, Daha etc.,
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The onset of symptoms like Kshut, Trshna, etc. indicates the completion of
Sneha digestion (Sneha Jirna). In doubtable cases regarding digestion or indigestion
of Sneha one should take hot water, which brings Shuddha Udgara, Laghuta, and
desire for food. If sneha does not digest after administration of warm water and takes
more time than required. It should be eliminated by vamana further cold water
sprinkling and applying of chandna paste on scalp and cold water bath should be
employed.113
Table 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 Daha
2. (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 of
swedana and shodhana therapies.
Evaluation of Snehapana based on parameters like –
i) Samyak Snigdha Lakshanas
ii) Asnigdha Lakshanas
iii) Ati Snigdha Lakshanas
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 28
i) Samyak Snigdha Lakshanas
Attainment of Samyak Snigdha Lakshana is an important action of
Shodhananga 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 Snehana
therapy is not done properly then these Lakshana persist at the end also. By observing
these Lakshana Physician should rectify and adjust matra or snehana and carry out
Snehana properly. If snehana is not done properly the following symptoms are
observed.
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 29
Table 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 Samyak
Snigdha Lakshana, but if Snehapana is continued even after that then it may lead to
increase of Apyamsa in the body and Atisnigdha Lakshana may manifest.
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 + + +
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 30
III. 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 and
they 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.
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 31
Apathya
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 during
the 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 of
Virechana or Vamana is known as Vishrama Dina. During this period the individual
will be subjected for Sarvanga Abhyanga, Svedana and provided with appropriate
diet.
SNEHA VYAPAT 133, 134, 135
Sneha vyapat is produced either by faultly administration of sneha by vaidya
without considering matra, kala, rutu, anupana etc. or by the patient when he doesnot
follows the rules during snehana karma.
(i) Ashu Utpanna Vyapat: These types of disorders may have acute onset and
may 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.
Effect of Arohana Snehapana on Samedarakta
Arohana Snehapana - 32
(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 various
classical 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 be
splashed with cold water. If this does not relieve the thirst, the Pitta dominant patient
should be given Ruksha Anna and Shita Jala and then made to vomit. In case of
persons who have predominance of Kapha and Vata or all the Doshas increased in
equal proportion, Vamana is induced after giving Ushna Jala.
Effect of Arohana Snehapana on Samedarakta
KARMUKATA OF SNEHANA AS A PURVAKARMA OF SHODHANA
When Doshas are present in their vitiated condition, which have left the
Shakha (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 and
when 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 are
available 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
Ayam Purusha: Pranascha Sneha Bhuyistha: Sneha Sadhyascha Bhavati.” 143
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 softness
in the Srotas by that Doshas will come back to Koshta from Shakha and when
Shodhana is administered vitiated Doshas are expelled out without causing
discomfortness 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
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 Shakha
to 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 to
Koshta and bring Utkleshana of the Doshas. In this connection, Vagbhata while
narrating the different therapies that precedes the Shodhana renders Snehana in equal
position to other therapies.
2. Actions of Snehana:
Actions of Snehana can be attributed to properties present in the Sneha
Dravyas. In this regard it is very much necessary to discuss the actions of these
properties with respect to Shodhana Snehana.146
Karmukata of Snehana - 34
Effect of Arohana Snehapana on Samedarakta
• Drava :
It imparts some sort of moisture to the Srotas that removes impediment of
doshas. 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 channels
of body. Sukshma is having Sroto Vishodhana property, thus aiding in bringing the
Doshas back to Koshta. It was defined by some as the capabilities of dilatation of
channels, which augment the movement of Sneha Dravyas freely even through the
minute channels.
• Sara
Sara is having ‘Vyaptishilatva’ i.e., spreading nature, thus helps in spreading
of Sneha all over the body. Prerana and Vatanulomana action of Sara Guna helps in
movement of Doshas back to Koshta.
• Snigdha
Snigdha brings softness of Srotas and by this there is a better conveyance of
Dosha, Dhatu and Mala.
• Picchila
Shleshmala property is important to bring Dosha Utklesha. Helps Sneha to
come in contact with Doshas for longer duration. It is termed as Sandra &
Cikkanattva by Arunadatta. The properties attributed to this are Jivana, which would
be shown on Raktadi Dhatus, Balya by imparting strength, Sanghata by the
compactness of morbid elements.
Karmukata of Snehana - 35
Effect of Arohana Snehapana on Samedarakta
• Guru
It can be defined as the quality by virtue of which the body dimensions will be
increased.
• Shita
It keeps intactness of the body, by virtue of this quality it creates satiety and
prevents the occurrence of Murcha, Sveda and Daha.
• Mrdu
Brings Srotomardavata. By generating softness, laxity, loosens the Dosha
Sanghata.
Though Guru, Shita and Manda are mentioned as properties of Sneha, but
these have more of Shamana or Brumhana value than aiding in Shodhana Snehana
action.
In Siddhisthana, while dealing with the Snehana Karya, Charaka very vividly
explains as-147
♦ Sneho Anilam Hanti
♦ Mrdu Karoti Deham
♦ Malanam Vinihanti Sangam.
Cakrapani clarifies that these are functions of Shodhana Snehana; on the basis
of 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
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 procedures
they 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 of
vitiated Doshas through srotases during their circulation in the body.149 Sneha
administered inside the body reaches the Srotamsi and acts as solvent to remove
obstruction by dissolving those morbid factors in it, resulting in the removal of Sroto
vibhandha which is one of the important steps in the Samprapti Vighatana.
This view can be emerged by the study related to the permeability of Dravyas
into the innermost recess of the body. It can be recognized that Kalas surround the
Dhatus and Srotamsi are semi permeable. 150
Karmukata of Snehana - 37
Effect of Arohana Snehapana on Samedarakta
Chakrapani favors this by that every Dhatu will have specific srotases
pertaining to them and by the srotases concerned with a particular Dhatu, other
Dhatus will not be nourished.151
Thus Sneha acts as a solvent both for lodged morbid factors and as well as
unexcreted tissue waste products.
o Increases the Apyamsa of the body
The nature of Sneha has the predominance of Apa Mahabhuta152. So by this
property of Sneha liquefied Malas brought from the tissues, the levels of fatty acids
etc., and increases in the blood, resulting in the high plasma volume. To keep up the
equilibrium of the normal plasma level, the extra amount of liquid from it are reached
in the Kostha for excretion. Later on when Shodhana Karma are administered this
increased amount of body fluid are evacuated by which the vitiated Doshas and
unexcreted 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 accumulated
malas from Sakhas, by bringing them to Kostha which are afterwards expelled from
the body by Shodhana Karma. In this connection Acharya Sushruta expound his
views that due to Snehana and Svedana, the morbid humor of the disease being
instigated, become liquefied and brought to Kostha for easy elimination by the
Sodhana or radical therapies.153
Karmukata of Snehana - 38
Effect of Arohana Snehapana on Samedarakta
MEDA:
The topic of the study is Samedarakta (i.e Hyperlipidaemia and Normal lipid
values). Hence important aspects of Meda are discussed here.
Basic concept of Meda :
Meda is an important dhatu among Saptadhatu. Being a dushya dominant
disorder, Meda plays a major role in pathogenesis of Medoroga.
Nirukti :
Literally, the word Meda is derived from root “Jhimida Snehana”. Which
stands for Sneha, Fat, Oil etc. (Vachaspathya). It means the substance which has
snigdhatva property is called Medas.
In Sabdakalpadruma, it is mentioned that Meda is the fourth dhatu which
performs the Dharana-support the body, mind and life. “Medhyate anen iti medah” 154
Formation of Meda dhatu : 155
According to Charaka, the Rakta dhatu is combined with Teja, Apa and is
made solid by the agni so that it gets converted into Mamsa, that again being digested
by its own agni, “Medodhatvagni” and stirred up by the agni and getting combined
with 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 three
Anjali. Thus, total Meda content of body is enumerated as 5 Anjali and total
measurable body elements are counted as 56.5 Anjali, from this proportion, it is
evident that total Meda content of body is 11 to 12% approximately. Modern
physiology also mentioned the same amount of fat i.e 12%. This quantity may vary
from person to person and exact measurement of body humeral is not possible due to
unpredictable and ever changing nature of body.
Meda - 39
Effect of Arohana Snehapana on Samedarakta
Flow chart No. 1 Showing Sthana and Swarupa of Meda dhatu157
Medadhatu
Poshaka (Mobile in nature)
Poshya (Immobile in nature)
Which is circulated in whole body along with Gatiyukta Rasa-Rakta dhatu for nourishing the Poshya
Meda dhatu
Which is stored in Medodharakala in its sites. i.e. Udara, Sphika, Stana, Gala, etc. and Vasa (Mamsagata
sneha)
It can be correlated with cholesterol and lipids, which are present in
circulating blood.
It can be correlated with adipose tissues / fat.
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 not
hypertrophied 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
BMI = Weight in Kgs
Height in Meter2
Meda - 40
Effect of Arohana Snehapana on Samedarakta
Functions of Meda Dhatu :
According to Sushruta, Sneha, Sweda, Drudhatva and Asthipushti are the
functions of Medadhatu. Again Netra and Gatrasnigdhata are the additional functions
of Meda mentioned by Astang Sangraha. Snehana is the main function of Meda dhatu
and with Sneha property it helps to keep luster of skin, hair, eye, etc. Snigdha gatrata
symptom of Medoroga may arise through increased Snehana function of Meda.159, 160
Another function of Meda is nourishment of Asthi Dhatu and Upadhatu Snayu
and 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 of
Meda. One more function of Meda is Drudhatva, which is possible through help of
Snayu.161
Ashryashrayeebhava of Meda :162
Dhatu, which is the shelter for any doshas of its allied nature depicts the
concept of Ashryashrayeebhava. Similar allied properties of homogenous Dhatu or
Dosha may serve as a cause to the nutrition or vitiation of Dosha or Dhatu and it is in
this context Meda can be considered as a location of the sthanika Kapha, since Meda
plays 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 has
been given a place of fundamental importance in Ayurevda both in health and disease
condition. Dhatus are nourished through their respective srotases and one srotas
cannot provide nourishment to another dhatu. The Meda Dhatu gets nutrition from the
preceding 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 tissue
is transported are to be termed as the Medovaha Srotas.
Meda - 41
Effect of Arohana Snehapana on Samedarakta
Moola of Medovaha Srotas :
Each and every srotas has two parts or endings one is from which the srotas is
originated i.e. the moola and another is through which nutritive material travel to their
respective places in the body. According to Charaka and Sushruta, Mool may be
enumerated as fallows:
Charaka - Vrikka and Vapavahana,163 Sushruta - Vrikka and Kati164
The Acharyas have considered unanimously Vrikka as one of the moola of
Medovaha Srotas but Vapavahana and Kati are mentioned as second moola
separately. Sushruta have given more anatomical preference than the physiological
point of view by considering Kati as “Moola” of the Medovaha Srotas while
Charaka’s consideration was a physiological one.
Vrikka :
Vrikka, one of the Kosthanga formed by the Sara of Rakta and Meda dhatu.
Sharangadhara says that Vrikka nourish the Meda dhatu inside the stomach area of the
abdominal cavity, while Charaka has considered as “Moola” so these structures must
be directly related with fat metabolism. But, there is no such exact evidence in
Modern science as well as Ayurevdic Science. If we take into the consideration of two
structures situated above the two kidneys i.e. Supra-renal glands as Vrikka that fulfils
the all aspects of fat metabolism.
Vapavahana :
Vapavahan is also a Kosthanga and second root of Medovaha Srotas Dr.
Ghanekar has considered it as omentum, where the maximum Meda is stored.
Kati :
Acharya Sushruta has clearly pointed out the exact site of the Kati but
normally the Kati is the place where the fat accumulates.
Meda - 42
Effect of Arohana Snehapana on Samedarakta
BASIC CONCEPT OF FAT / LIPID : 165,166,167
Lipids constitute a heterogeneous group of compounds of biochemical
importance. Lipids may be defined as compounds which are relatively insoluble in
water, but freely soluble in organic solvents like benzene, ether, chloroform etc. They
are found in the membranes, which maintain the integrity of cells and allow the
compartmentalization of cytoplasm in to specific organelles. Lipids functions as a
major farm of stored nutrients (TGs), as a precursor for adrenal and gonadal steroids
and bile acids (cholesterol) and as a extra cellular and intra cellular messengers
(prostaglandins). Lipoproteins provide a vehicle for transporting the complex lipids
in the blood as a water - soluble complexes and deliver lipids to cells through out the
body.
CLASSIFICATION OF LIPIDS:
Lipids are classified into simple lipids, compound lipids, derived lipids and
miscellaneous one.
1. Simple lipids: Esters of fatty acids with alcohols.
(a) Neutral fats : Triglyceride, Esters of various fatty acids with glycerol.
(b) Waxes : Cholesterol and its esters.
2. Compound lipids : Esters of fatty acids with alcohols and containing other
groups.
(a) Phospholipids : Esters containing phosphoric acid and a nitrogenous
base i.e. lecithin, cephalin.
(b) Glycolipids : Esters containing a carbohydrate and a nitrogenous base
i.e. cerebrosides.
(c) Sulpholipids : Esters containing sulphuric acid.
(d) Lipoproteins : Lipids attached with proteins.
Concept of Lipids - 43
Effect of Arohana Snehapana on Samedarakta
3. Derived lipids : Derivatives obtained by the hydrolysis of 1 and 2 mol. and
which still possess the physical characteristics of lipids which are divided as :
(a) Fatty acids : Saturated and unsaturated
(b) Sterols
(c) Fat soluble vitamins
4. Miscellaneous : a) Aliphatic hydrocarbons include iso-octa-decome
b) Carotenoids c) Squalene d) Vit E and K
The lipids in the body physiologically form two components:
A. Elements constant or structural lipids:
The value of this lipid remains constant even under extreme starvation.
Cytoplasm and cell membrane of all organs are composed of element constant, so that
their fat content does not diminish in starvation. Chiefly element constant is
composed of phospholipids & is independent of the state of nutrition. Cholesterol is
another lipid present in cell membranes, it has also an important role in fat transport in
the blood.
B. Elements variable:
It is stored in the body in excess. It is composed mainly of neutral fat. It
present mostly in the depot fat or adipose tissue in free form and represents stored
energy. It has been observed that depot fat is not static but in a continuous state of
change is due to its continuous synthesis and breakdown in the body. Thus fat is
chiefly composed of glyecrides of various fatty acids and usually contains 75% of
oleic acid, 20% palmitic acid and 5% stearic acid.
A third type of fat, brown fat, which has a high metabolic rate has been
observed in infants but not in adults.
Concept of Lipids - 44
Effect of Arohana Snehapana on Samedarakta
Depot fats:
Fat in the body is present in two form i.e. Blood fat and Depot fat. About 12%
of the total body weight of a man consists of fat. The major part of it remains stored in
the so-called fat depots. Which is known as Depot fats.
Distribution of Fat in Body tissue :
(i) Subcutaneous tissue - 50% (ii) Peripheral tissue - 15%
(iii) Mesentry - 20% (iv)Omentum - 10%
(v) Intramuscular connective tissue - 05%
Composition of Depot fats :
Depot fat is chiefly composed of mixed triglycerides. Trace of lecithin and
cholesterol, as well as a little amount of polyunsaturated fatty acids.
PLASMA LIPIDS:
Although the lipids are present in both body cells and plasma of blood, but the
composition of lipids in plasma and cells widely vary. Since the composition of
plasma lipids accurately reflects the actual state of lipid metabolism, so the
composition of plasma lipids is generally studied.
The composition of blood lipids is not a static because of process of addition
and removal of lipids from blood:
Addition of lipids Removal of lipids (i) Absorption from intestine (i) Deposition of fat in the depot (ii) Synthesis of fat and its (ii) Oxidation of fat in the tissue
Mobilization (iii) Utilization for formation of tissue structures components.
Main plasma lipids are –
I. Cholesterol and its esters II. Triglycerides
III. Phospholipids IV. Non-esterified fatty acids
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(I) Cholesterol :168
The Cholesterol is a waxy, fat-like compound that belongs to a class of
molecules called steroids. Cholesterol is made primarily in liver (about 1,000
milligrams a day), but also by cells lining the small intestine and by individual cells in
the body. Cholesterol might feel like a soft, melted candle and is essential for:
Cholesterol is an important component of biomembranes cholesterol, is
present in plasma either as free form or esterified. Bile has high concentration of
cholesterol and so bile serves as the major excretory route for cholesterol.
Occurrence
It is widely present in the body tissues, cholesterol is found largest amounts in
normal human adults.
Brain & Nervous Tissue - 2%
In the Liver - 0.3%
Skin - 0.3%
Intestinal mucosa - 0.2%
Certain endocrine glands Viz - adrenal cortex contains -10% or more Corupus
leutiem is also rich in cholesterol. Cholesterol is present in blood and bile usually a
major constituent of Gall Stones.
Sources
Exogenous - Dietary cholesterol approximately 0.3gm/day. Diet rich in
cholesterol are butter. Cream, milk, egg yolk, meat etc.
Cholesterol content of different food items
Food Item Cholesterol mg/100gm.
Food Item Cholesterol mg/100gm.
Hens egg-whole 500 Brain 2000 Egg Yolk 1330 Butter 280 Liver 300-600 Ghee 310 Meat and Fish 40-200 Milk 10 Milk Powder 90 Milk P (Skimmed) <1
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Endogenous
Synthesized in the body from Acetyl CoA, approximately 1g/day.
Forms of Cholesterol
Cholesterol occurs both in free form and in ester form. The various fatty
acids, which form cholesterol esters are
Linoleic Acid 50% Oleic Acid 18% Palmitic Acid 11% Arachidonic acid 50% Other Fatty Acids 16%
Biosynthesis of Cholesterol
Essentially all tissue forms cholesterol. Liver is the major site of
cholesterol biosynthesis and also other tissues which are active in this aspect are -
adrenal cortex, gonads, skin, intestine. Low order of synthesis occurs in adipose
tissue, muscle, aorta and nervous tissues. Brain of the new born baby can synthesize
the cholesterol while adult brain cannot synthesize the cholesterol.
Slightly less than half of the cholesterol in the body derived from biosynthesis
de novo, Biosynthesis in the liver accounts for approximately 10% and in the
intestines approximately 15%, of the amount produced each day. Cholesterol
synthesis occurs in the cytoplasm and microsomes from the two-carbon acetate group
of acetyl-CoA. The process has five major steps,
1. Acetyl-CoAs are converted to 3-hydroxy-3-methyglutaryl-CoA (HMG-CoA).
2. HMG-CoA is converted to mevolonate
3. Mevalonate is converted to the isoprene based molecule, isopentenyl
pyrophosphate (IPP), with the concomitant loss of CO2.
4. IPP is converted to squalene
5. Squalene is converted to cholesterol.
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Figure No. 1 Showing the Biosynthesis of Cholesterol
1. The acetyl-CoA utilized for cholesterol biosynthesis is derived from an oxidation
reaction (eg. fatty acids or pyruvate) in the mitochondria and is transported to the
cytoplasm by the same process as that described for fatty acid synthesis. Acetyl-
CoA can also be derived from cytoplasmic oxidation of ethanol by acetyl-CoA
Synthetase. All the reduction reaction of cholesterol biosynthesis use NADPH as
a cofactor. The isoprenoid intermediates of cholesterol biosynthesis can be
diverted to other synthesis reaction, such as those for dolichol (used in the
synthesis of N-linked glycoproteins coenzyme Q (of the oxidative
phosphorylation) path way of the side chain of heme a. Additionally, these
intermediates are used in the lipid modification of some proteins.
2. Acetyl-CoA units are converted to mevalonate by a series of reactions that begins
with the formation of HMG-CoA. Unlike the HMG-CoA formed during ketone
body synthesis in the mitochondria, this form is synthesized in the cytoplasm.
However, the pathway and the necessary enzymes are the same as those in the
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mitochondria. Two moles of acetyl-CoA are condensed in a reversal of the
thiolase reaction, forming acetoacetyl-CoA. Acetoacetyl-CoA and a third mole of
acetyl-CoA are converted to HMG-CoA by the action of HMG-CoA synthase.
HMG-CoA is converted to mevalonate by HMG-CoA reductase (this enzyme is
bound to the endoplasmic retuculum). HMG-CoA reductase absolutely requires
NADPH as a cofactor and two moles of NADPH are consumed during the
conversion of HMG-CoA to mevolanate.
3. The reaction catalyzed by HMG-CoA reductase is the rate limiting step of
cholesterol biosynthsis, and this enzyme is subject to complex regulatory controls.
4. Mevalonate is then activated by three successive phosphorylations, yielding 5-
pyrophosphomevalonate. In addition to activating mevalonae, the
phosphorylations maintian its solubility, since otherwise it is insoluble in water.
After phosphorylation, an ATP-dependent decarboxylation yields isopentenyl
pyrophosphate, IPP, an activated isoprenoid molecule.
5. Isopentenyl pyrophosphateis in equilibrium with its isomer, dimethylallyl
pyrophosphate, DMPP. One molecule of IPP condenses with one molecule of
DMPP to generate geranyl pyrphosphate, GPP. GPP further condenses with
another IPP molecule to yield farnesyl pyrophosphate, FPP. Finally, the NADPH-
requiring enzyme, squalene synthase catalyzes the head-to-tail condensation of
two molecules of FPP, yielding squalene.
Squalene synthase also tightly associated with the endoplasmic reticlulum.
Squalene undergoes a two step cyclization to yield lanosterol. The first reaction is
catalyzed by squalene mnoxygenase. This enzyme uses NADPH as a cofactor to
introduce molecular oxygen as an epoxide at the 2,3 position of squalene. Through a
series of 19 additional reactions, lanosterol is converted to cholesterol.
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Factors that Influence Cholesterol Level in the Blood
• Dietary Fats - Increased intake of fats in the diet increases the level of
cholesterol by increased synthesis. Greater amount of saturated fatty acids
increases cholesterol level. Substitution in the diet of saturated fatty acids by
poly unsaturated fatty acids has beneficial effect and lowers the cholesterol
levels.
• Dietary Cholesterol - Increased feeding of cholesterol in diet decreases
endogenous synthesis and reduces cholesterol level.
• Dietary Carbohydrates - Increased consumption of carbohydrates increases
cholesterol levels. Consumption excessive amount of sucrose and fructose
cause increase in plasma lipids particularly Triglycerides and Cholesterol.
When ratio between starch: Sucrose is 1:4, an increase in plasma cholesterol is
observed.
• Calorie Intake - Intake of excess calories increases cholesterol level
• Blood Groups - Cholesterol level found to be slightly higher in the persons
belonging to blood group ‘A & ‘AB’.
• Heredity - Heredity factors play greatest role in determining individual blood
cholesterol concentrations. Persons, who are prone to become obese, have a
high level of plasma cholesterol
• Vit-B-Complex - Nicotinic acid in large doses has cholesterol lowering effect.
Pyridoxine deficiency produces increase in cholesterol level.
• Mineral - In vitro acetate to cholesterol conversion in tissue cell culture
depressed by addition of vanadium and iron salts and increased by chromium
and manganese salts. Conversion of mevalonate to cholesterol is inhibited by
vanadyl So4.
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• Physical Exercise - Hard physical exercise brought about lowering in serum
cholesterol level and increased level of HDL Cholesterol.
• Dietary Fibres - Increased fibres in the diet caused an increased exerction of
choolesterol and bile acids in feces.
Functions of Cholesterol:
Structural component of cell membrane.
Acts as precursors in biosynthesis of bile acids.Control cell permeability.
Protects the red cells from being easily haemolysed.
Prevent toxins from entering into the cells.
It is also needed for synthesis of Vitamin-D to form cell membrane.
It helps in the synthesis of steroid hormones of sex glands in adernal cortex
and synthesis of vitamins.
Cholesterol helps in the synthesis of mylein sheath of nerves and acts as
insulator for nerve impulses.
In human being 60-70% cholesterol is transported by LDL, 20-30% by HDL
and 5-10% by VLDL.
(II) Triglyceride:
Triglycerides are esters of three fatty acids and glycerol. They are divided into
two types according to fatty acid contents.
1. Simple - in which all three fatty acids are same.
2. Mixed - in which all three fatty acids are different.
They are transported primarily as chylomicrones and VLDL but in minor
amounts as LDL and HDL also. They are main form of lipid storage in men.
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(III) Phospholipid :
It is compound type of lipid, containing phosphoric acid with nitrogen base
and constitutes 20% LDL and 30% HDL. The phospholipids and cholesterol always
remain together, which are not stored in adipose tissue, but present in all other tissues.
Phospholipids are an important constituent of Lipoproteins in the blood & are
essential for the formation & function of most of these; in their absence serious
abnormalities of transport of cholesterol & other lipids can occur.
(IV) Fatty acid :
These are basic units of fats & are grouped as saturated & unsaturated fatty
acids. Fatty acids are monocarboxylic acid ranging in chain length from 6 – 24 carbon
atoms. In human body free fatty acids are formed only during metabolism due to
hydrolysis of fat. They are very small fraction in plasma protein.
Table No. 18 showing classification of fatty acids
FATTY ACIDS Depending upon no. of
Carbon atoms Depending length Nature of Hydrocarbon
chain i) Even Chain ie., having 2-4.6 carbon atoms
i) Short chain 2-6 carbon atoms
i) Saturated fatty acids
ii) Odd chain ie., having 3-5.7 Carbona atoms
ii) Medium chain 8-14
ii) Unsaturated
iii) Long chain 16 & above (24)
a) Mono unsaturated
b) Poly unsaturated iii) Branched chain FA iv) Hydroxy FA v) Cyclin FA.
(V) The Sterols
Sterols are not true fats. These are derivatives of phenanthrene & have the
parent nucleus with 17 carbon atoms consisting in 3 hexagon & 1 pentagon rings.
When the natural
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In a 70kg individual, about 6000 gms of fats almost 90% pure form, is stored
subcutaneous, intra muscular, perinepheric, omental and mesentric tissues. Nearly
300gms in brain and nervous tissue 75gm in liver and blood pool, altogether 10kgs in
70kg individual. Each gram of TG can supply twice the amout of energy compared to
the protein and carbohydrates per gram.
In post absorptive state, the blood plasma contain about 550mg of lipids.
Elevated levels of the profile is important since they can caues two life threatening
disease atherosclerosis and pancreatities.
PLASMA LIPOPROTEINS:
They are formed almost entirely in liver and transport cholesterol and
triglyceride in the blood steram. Which are classified in four types :
(a) Chylomicrons
(b) VLDL
(c) LDL
(d) HDL
Table No. 19 showing the characteristics of lipoproteins
Composition Chylomicrons VLDL LDL HDL Protein % 1-2 7-10 18-22 45-55 Lipid % 99 93 80 50 Major lipid Triglyceride Triglyceride Cholesterol Cholesterol
phospholipids Diameter(nm) 80-500 30-100 21.5 7.5-10.5 Origin Intestine Liver and
intestine End product of VLDL
Liver and Intestine
Function Transport Exogenous Triglycerides
Transport Endogenous Triglycerides
Transport of cholesterol and phospholipids to peripheral cells
Proposed to transport cholesterol from peripheral cells to liver
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a. Chylomicrons
These are the major exogenous lipoproteins synthesized in the intestinal
mucosal cells form the products of lipid digestion. They are large complexes rich in
Triglycerides. The particles enters the lacteals in the intestinal villi and are
transported via the thoracic duct to the blood stream. In the lymph and blood, the
chylomicron particles acquire apoprotein C and E from HDL. As they pass through
peripheral capillery beds of adipose tissue and skeletal muscles, their Triglycerides
are hydrolysed by apoprotein CII activated lipoprotein lipase, an enzyme bound to the
endothelial surface, releasing fatty acids and glycerols. The resultant cholesterol rich
chylomicron remnant with its apoprotein B48 and E is recognised by specific
receptors on the hepatic parenchymal cells and is rapidly cleared from plasma.
Glycerol enters the liver to be converted to glucose or used for synthesis of
Triglycerides.
Thus chylomicrons are the transport form of dietary Triglycerides to be
delivered to adipose tissue for storage and muscles for its energy needs. Hence
chylomicron particles are not considered to be atherogenic. The atherogenic potential
of chylomicron remnants is a matter of dispute.
b. VLDL
These lipoproteins are the major carriers of endogenous Triglycerides. They
are synthesized in the liver from glycerol and fatty acids and incorporated into VLDL
along with hepatic cholesterol, ApoB, C, E. Apoprotein B100 and E are required
structural components for this secretary process. In the fasting state, majority of
plasma Triglycerides are carried in this particles.
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The VLDL is secreted into blood stream gains more apoC from HDL. When
they reach the peripheral tissues, they are acted upon by the Lipoprotein lipase
liberating fatty acids that are taken up by the adipose tissue and muscle. The VLDL
remnant is now designated as IDL (Intermediate Density Lipoprotein) and contains
TG. Cholesterol, apo-B & E. Part of the IDL is taken up by the Liver. A major
fraction of IDL further loses Triglycerides and gets converted into LDL.
Normal VLDL is probably not atherogenic. The smaller and more cholesterol
rich VLDL remnants appear to have atherogenic potential. Persons with the genetic
disorder Familial dysbeta lipoproteinaemia have accelerated atherogenesis. Although
elevation of plasma Triglycerides are common in patients wth CHD, they are not
uniformely independent predictors for CHD risk.
c. LDL
The LDL molecules are cholesterol rich lipoprotein molecules containing only
Apo-B (B-100). Most of the plasma cholesterol is incorporated into LDL particles.
Being small in size they can infiltrate through arterial walls and have a longer half life
than others. LDL receptors are present on all cells but most abundant in hepatic cells.
The receptors recognise the apo-B and apo-E and can therefore take up LDL or IDL.
Once the LDL particles binds to the cell, they are internalised and chlesterol is
released into the cell. Most of the Cholesterol metabolised into steroid hormones.
There is a cellular feed back regulating mechanism which inhibits intra cellular
syntheis of cholesterol when extraneous cholesterol is taken up from LDL. When the
cellular cholesterol pool is increased, further uptake is also preventing by decreasing
the synthesis of LDL receptors. The liver therefore has a major role in controlling the
plasma level of the LDL or cholesterol. most of the LDL receptors are present in the
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liver, the liver synthesis cholesterol and removes cholesterol from lipoprotein
remnants. It is also the only organ that can excrete cholesterol through bile. The
cholesterol which is thus excreted into the intestine is partly reabsorbed (30-60%).
The rest is excreted as fecal sterols, caprostanol and cholestenol after bacterial action.
The liver also controls body cholesterol pool by converting cholesterol to bile acids.
Excess intracellular cholesterol can lead to 3 metabolic events.
♦ Inhibition of HMG - CoA reductase, the rate limitig step in cholesterol
synthesis.
♦ Activation of enzyme Acylcoenzyme A Cholesterol acyl Transferase (ACAT)
which esterfies cholesterol for storage.
♦ Inhibition of production of additional LDL receptors, thereby reducing cellular
uptake of plasma cholesterol.
Individuals with Homozygous or Heterozygous familial hypercholesterolemia
can have absent diseased or defective receptors. Undiscovered abnormalities or
numbers LDL receptors and Apo-B may be casual in the majority of patients with
CHD.
When the LDL levels in the plasma become excessive they are removed by the
macrophages of retculoendothelial system in the scavenger pathway. Macrophages
seated in the arterial wall eventually become over loaded with cholesterol esters and
are converted into the foam cells that characterise early atherosclerosis. Because the
majority of plasma cholesterol (60-75%) is carried int he LDL particles, elevation of
the total cholesterol usually reflect increased LDL levels. The anatomic degree of
coronary atheroselerosis has been directly linked to the concentration of LDL.
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d. HDL
The HDL mainly plays an important role in the transport of cholesterol from
peripheral tissues to liver. The only excretory route of cholesterol from the body is
bile. HDL is synthesized mainly in the hepatic cells and intestinal cells and are seen
as complexes of Apo A and Apo E with phospholipids. The cholesterol derived from
peripheral tissues and other lipoprotein are esterified in HDL because it has a LCAT
activity. After esterification, the ester form of cholesterol may be transferred to other
lipoprotein and transported to liver. A small portion of esterified cholesterol is stored
in the case of HDL and this cholesterol rich HDL may be taken up by the liver. When
cholesterol esters are internalised, the discoid HDL molecules becomes spherical,
HDL also acts as a carrier of Apo-C to be delivered to the Triglyceride rich
lipoprotein like VLDL and Chylomicrons. HDL is protective, but low HDL
concentration <30mg/dl is a potent risk for CHD.
HDL appears to exert a protective influence by removing cholesterol from
tissues. Total body cholesterol is inversly related to HDL levels.
Important Functions of Lipoproteins
Chylomicrons transport mainly TG and smaller amounts of plasma
lipoproteins, cholesterol esters and fat soluble vitamins from intestine to liver
and adipose tissue. The lipids carried by chylomicrons principally dietary
lipids.
VLDL transports mainly “Endogenous TG” synthesized in hepatic cells from
liver to extra hepatic tissues including adipose tissue for storage. High
carbohydrate intake, high ratio of insulin / glucogen, high plasma free fatty
acids and alcohol intake increases the hepatic synthesis of both TG and VLDL
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so that enhanced amount of fatty acid reaching the liver is speedily mobilized
in VLDL to adipose tissue.
LDL rich cholesterol esters transports cholesterol and its esters from hepatic
cells to extrahepatic tissues.
LDL also regulates cholesterol synthesis in extra hepatic tissues, as regulates
cholesterol delivered by LDL to cells inhibits HMG-CoA reductase, the rate
limiting enzyme for cholesterol synthesis.
HDL transports cholesterol and its esters from peripheral tissue to liver for its
catabolism (scavanging action).
Apo-D of HDL3 functions as the cholesterol ester transfer protein.
Albumin - FFA complexes transport maily FFA, released by adipose tissue
lipolysis and small amouts of Lyso-phospholipids from extra hepatic tissues to
the liver.
Certain apoproteins can act as activators / inhibitors of specific enzymes.
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DIGESTION AND ABSORPTION OF SNEHADRAVYA (FATS):
Bile plays an important role in fat digestion & absorption, not because of any
enzymes in the bile that cause fat digestion, but the bile acids of bile do two things.
♦ They helps to emulsify the large fat particles of the food in to many minute
particles that can be attacked by lipase enzyme secreted in pancreatic juice.
♦ They aid in absorption of the digested fat end products through the intestinal
mucosal membrane
The digestion of fats and other lipids process special problem because of (a)
the insolubility of fats in water and (b) because Lipolytic Enzymes, like other
enzymes are soluble in the aqueous medium. This problem is solved in the gut by
emulsification of fats, particularly by bile salts, present in the bile and plasma
lipoproteins. The breaking of large fat particles or oil globules into smaller fine
particles by emulsification increases the surface exposed to interaction with Lipase
and thus, the rate of digestion is proportionally increases.
The whole process of digestion of dietary lipids and its subsequent absorption
may arbitrarily divided into three phases.
1) Preparatory Phase - Which includes the digestion of lipids in the intestine.
The large lipid particles are broken down into smaller particles with the help of
Lipolytic enzymes. This is called emulsification of fat.
2) Transport Phase - Which includes the transport of digested fats across the
membrane of intestinal villous layer into intestinal epithelial cells.
3) Transportation Phase- Which includes the events of action that takes place
inside intestinal epithelial cells and its passage through lacteals to lymph or in portal
blood.
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Fat Digestion169
Table No. 20 showing fat digestion
Organs Digestive juice Enzyme and Action Mouth Saliva No action Stomach Gastric juice No action Small intestine Bile Bile salts emulsify fats Small intestine Pancreatic juice Lipase converts fats into fatty
acids and glycerol Small intestine In microvilli Lipase completes the digestion of
fats to fatty acids and glycerol
1. Preparatory Phase
Digestion in Mouth & Stomach - No fat digestion takes place in the mouth. Recently
a lipase has been detected called Lingual lipase which is secreted by the dorsal surface
of the tongue.
Lingual Lipase - pH range of activity 2.0 to 7.5. Its activity is continued in the
stomach also where pH value is low. Due to retention of food bolus for 2-3 hours,
about 30% of dietary TG may be digested. Lingual lipase is more specifically active
on TG having shorter FA chains and is found to be more specific for ester linkage at 3
position rather than position 1.
Gastric Lipase - There is a evidence of presence of small amounts of gastric lipase in
gastric secretion. The overall digestion of fats, brought about by Gastric Lipase is
negligible because where gastric lipase activity is more effective at alkaline pH
(average pH 7.8). Gastric lipase activity requires presence of Ca++. Activity of
gastric lipase is seen when intestinal contents are regurgitated in to gastric lumen.
Role of fats in the Stomach - Fats do play an important role in the stomach in that they
delay the rate of emptying of stomach, presumably by way of the hormone
enterogastrome, which inhibits gastric mobility and retards the discharge of bolus of
food from the stomach. Thus fats have a high “Satiety Value”.
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Digestion in Small Intestine - The major site of fat digestion is the small intestine.
This is due to presence of powerful lipase (steapsin) in the pancreatic juice and
presence of bile salts, which acts as an effective emulsifying agent for fats. Pancreatic
juice and bile enter the upper small intestine, the duodenum, by way of the panereatic
and bile ducts respectively. Secretion of pancreatic juice is stimulated by i) passage
of an acid gastric contents (acidic chyme) in to the duodenum, and ii) by secretion of
the GI harmones. Secretion and CCK-PZ.
Secretion increases the secretion of electrolytes and fluid components of
pancreatic juice, whereas pancreozymin of CCK-PZ, stimulates the secretion of
paneratic enzymes.
Cholecystokinin of CCK-PZ in turn causes contraction of gall bladder and
discharge the bile into the doudenum. Discharge of bile is also stimulated by
secretion and bile salt themselves. Hepatocrinin released by the intestinal mucosa
stimulates more bile formation whch is relatively poor in the bile salt content.
The above sequences of events prepares the small intestine for the digestion of
fats. Pancreatic juice has been shown to contain number of lipolytic enzymes.
Pancreatic lipase, Phospho lipase A2 (Lecithinase) and Cholesterol esterase.
The pancreatic lipase is the most important which hydrolyses TG containing
short chain FA as well as long chain FA. Other two are required for phospholipids
and cholesterol respectively.
Emulsification of Fat by Bile Acids
The first step in fat digestion is to break the fat globules into small sizes so
that water soluble digestive enzymes can act on the globule surfaces. This process is
called as Emulsification of fat. It is achieved by the influence of bile, which does not
contain any digestive enzymes. But bile contains large quantity of bile salts, mainly
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in the form of ionized salts, which are extremely important for emulsification of fat.
The carboxyl and other polar parts of bile salts molecule are highly soluble in water.
Where as most of sterol portion of the bile salt dissolves in the surface layer of the fat
globule but with the polar portion of the salt projecting outward and soluble in
surrounding fluids, this effect greatly decreases the surface tension of the fat. And
this property of the bile acids is multiplied even several more times by the small
amounts of Lecithin that are also in bile.
Each time the diameter of the fat globules are decreased by a factor, as a result
of agitation in small intestine the total surface area of fat increases two times. Since
the average size of the emulsified fat particles in the intestine is only 1 micron, this
represents as increase of as much as 1000 fold in the total surface area of fats caused
by the emulsification process.
Digestion of Fats by Pancreatic Lipase
The lipases are water soluble compounds and can attack the fat globules only
on their surfaces. Important enzyme pancreatic lipase and Enteric lipase causes
hydrolysis of fat. Most of TGs of the diet are split into FFA and 2 mono glycerides.
The cholesterol in the diet is in the form of cholesterol esters, which are
combination of free cholesterol and one molecule of fatty acids. Phospholipids also
contain molecules of fatty acid. Both are hydrolysed by lipases in the pancreatic
secretion which frees the fatty acids.
2 Transport Phase
The hydrolysis of TG is a highly reversible process, therefore accumulation of
monoglycerides and free fatty acids in the vicinity of digesting fats vary quickly
blocks further digestion. Fortunately, Bile salts play an important role in removing
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monoglycides and FFA from the vicinity of the digesting fat globules almost as
rapidly as these and products of digestion are formed.
Bile Salt Micelle
Bile salts have the propensity to form micelles, which are small spherical
globules about 25 A0 in diameter composed of 20-40 molecules of bile salts. The
products of digestion namely monoglycerides, long chain fatty acids, cholesterol,
phospholipids and lysophospho lipids are all incorporated into molecular aggregates
to form mixed micelle. Because of highly charged exterior and diameter is 2.5
nanometer, they are soluble in chyme. In this form monoglycerides and fatty acids
are transported to the surfaces of brush border microvilli, even penetrating into the
recesses among the moving and agitating microvilli.
On coming into contact with these surfaces both monoglycerides and fatty
acids with traces of cholesterol and phospholipids immediately diffuse through the
epithelial membrane, because they are equally soluble in this membrane as in the
micellae. This leaves behind the bile acid micelles still in the chyme. The micelles
then diffuse back through chyme. And absorb still more monoglycerides and fatty
acids and similarly transport these to epithelial cells. Thus bile acids perform a
“ferrying” function, which is highly important for the fat absorption. In the presence
of abundance of bile acids, approximately 97% of the fat is absorbed, in the absence
of bile acids only 50% is normally absorbed.
3. Transportation Phase
After entering the eithelial cells, the fatty acids and monoglycerides are taken
up by the smooth endoplasmic reticulum, here they are mainly recombine to form new
Triglycerides. However, a few of monoglycerides are further digested into glycerol
and fatty acids by an epethelial cell lipase. Then fatty acids are reconstituted by
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smooth endoplasmic reticulum in to Triglycerides. Most of the glycerol that is utilized
for this purpose is synthesized de novo from alpha-glycerophosphate, this synthesis
requiring both energy from ATP and a complex of enzymes to catalyze the reactions.
Once formed, the Triglycerides aggregate within the ER into globules along
with absorbed cholesterol & phospholipids. This provides an electerical charged
surface that makes these globules miscible with the fluids of the cells. In addition
small amounts of β lipoprotein, also synthesized by ER, coat part of the surface of
each globule. In this form the globule diffuses to the side of epithelial cells and is
excreted by the process of cellular exocytosis in the space between the cells, from
there it passes into lymph in the central lacteal of the villus. These globules are then
called Chylomicrons.
From the sides of the epithelial cells the chylomicrons wend their way into the
central lacteals of the villi and from here are propelled, along with the lymph, by the
lymphatic pump upward through the thoracic duct to be emptied into the great vein of
the neck. Between 80-90% of all fat absorbed from the gut is absorbed in this manner
and is transported to the blood by way of thoracic lymph in the form of chylomicrons.
Small quantities of short chain fatty acids, such as those of butter fat are absorbed
directly into the portal blood rather than being converted into Triglycerides and
absorbed into the lymphatics.
FAT METABOLISM IN AYURVEDA:
According to Ayurveda, Kapha is seated in Rasa, Mamsa, Majja and Sukra-
dhatu. Kapha and Meda are having similar properties. On the basis of
Ashrayashrayeebhava vitiation of Kapha also lead to vitiation of above dushyas. In
this way, vitiation of Kapha also leads to vitiation of Meda dhatu. Except Asthi dhatu
all the dhatus contain Snigdha guna.
Concept of Lipids - 64
Effect of Arohana Snehapana on Samedarakta
Hence, Hyperlipidaemia is the disease of Medodhatvagni vikriti. If Agni will
be good and potent, through passing from the level of Rasagni, Raktagni and
Mamsagni the Medodhatuvriddhi will occur and if Agni will be poor, it will create
Dhatvagnimandya. So, Rasagata, Raktagata, Mamsagata and Medogata Snehamsa
will be increased due to their own Dhatvagnimandya respectively.
The circulating triglycerides, cholesterol and lipids should be treated as Rasa
Raktagata Sneha. only the fat deposited in adipocytes should be accepted as
Medadhatu.
CHOLESTEROL AND LIPOPROTEIN METABOLISM, 170, 171
Exogenous Pathway
Exgenous lipid transport begins with intestinal incorporation of dietary
triglycerides and cholesterol into large lipoprotein particles called chylomicrons
(diameter, 80-500nm) which are secreted into the lymph and subsequently enter the
blood stream. When chylomicrons reach the capillaries of adipose tissue and muscle,
they are digested by an enzyme lipoprotein lipase, that is bound to the surface of the
endothelial cells. Lipoprotein lipase hydrolyzes the triglycerides in the core of the
chylomicrons, and the liberated fatty acids cross the endothelium and enter the
underlying adipocytes or muscle cells, they are then either esterfied again to form
triglycerides for storage or oxidized to provide energy.
After most of the triglycerides have been removed in this fashion, the
chylomicron dissociates from the capillary endothelium and enters the circualtion
again. Its size has been reduced and its content of triglycerides diminished, but its
cholesterol esters remain intact. The particle is now designated as a chylomicron
remnant (diameter 30-50nm). When the remnant reaches the liver it is cleared from
the circulation by a receptor that recognizes two of its protein components,
Concept of Lipids - 65
Effect of Arohana Snehapana on Samedarakta
apoproteins E and B-48. The receptor bound remnant is taken into the hepatic cell by
a process termed receptor mediated endocytosis. Within the cell the remnant is
digested in lysosomes, and the cholesterol esters are cleaved to generate free
cholesterol. The free cholesterol has several fats: it can be used for membrane
synthesis, it can be stored by the liver cell as cholesterol esters, it can be excreted into
the bile either as cholesterol or after conversion to bile acids, or it can be used to form
endogenous lipoproteins that are secreted into plasma.
Endogenous Pathway
Endogenous lipid transport begins when the liver secretes triglycerides and
cholesterol into the plasma in very-low-density lipoproteins (VLDL: diameter, 30-
80nm.). the major stimulus for such secretion is a high-calorie intake (especially a
high - carbohydrate intake),which induces the liver to assemble Triglycerides for
export and storage in adipose tissue. The Triglycerides of VLDL are cleaved in
capillaries by the same lipoprotein lipase that digests chylomicrons. Digestion
produces a VLDL remnant that is designated as intermediate-density lipoprotein
(IDL; diameter, 25-35nm.). After release from the endothelium, the IDL particles
have two metabolic fates. Some of the particles are cleared rapidly by the liver, again
by receptol-mediated endocytosis. The receptor that acts on the IDL particle is called
Low Density Lipoprotein (LDL) receptor. It binds lipoproteins that contain
apoprotein E or B-100 and it therefore interacts with both IDL and LDL particles.
About half of the IDL particles are not cleared rapidly by the liver. Rather
they remain in the circulation, where most of the remaining Triglycerides are
removed, and the density of the particle increases further, until it becomes LDL
(diameter 18 - 28 nm). LDL circulates for a relatively long time in man (half-life of
about 1.5days). The particles are eventually degraded by binding to LDL receptors in
Concept of Lipids - 66
Effect of Arohana Snehapana on Samedarakta
liver and certain extrahepatic tissues. Circulating LDL constitutes the major reservoir
of cholesterol in human plasma, accounting for 60-70% of the total. When liver or
extrahepatic tissues require cholesterol for the synthesis of new membranes, steroid
hormones or bile acids, they synthesize LDL receptors and obtain cholesterol by
receptor mediated endocytosis of LDL. Conversely, when tissues no longer require
cholesterol for cell metabolic purposes, they decrease the synthesis of LDL receptors.
Figure No. 2 Showing the Metabolism summary
Concept of Lipids - 67
Effect of Arohana Snehapana on Samedarakta
Reverse Cholesterol transport
As cells of the body die and as cell membranes undergo turnover, free
cholesterol is continually released into the plasma. This cholesterol is immediately
absorbed into high-density lipoproteins (HDL; diameter, 5-12nm.) and in this location
it is esterified with a long - chain fatty acid by an enzyme in plasma, lecithin;
cholesterol acyltransferase (LCAT). The newly formed cholesteryl esters are rapidly
transferred from HDL to VLDL or IDL particles by a cholesterol from transfer protein
in plasma. The HDL promote the removal of cholesterol from the peripheral cells and
facilitates its delivery back to the liver is referred to as reverse cholesterol transport.
This transport is facilitates by the synthesis and secretion of apoprotein E by
peripheral tissues.
In addition to degradation by specific receptors, lipoproteins are also disposed
of by less specific pathways, some of which operate in macrophages and other
scavenger cells. When the plasma concentration of a lipoprotein rises, the rate of its
degradation by such pathways increases. This contributes to deposition of cholesterol
in macrophages of arterial walls (producing atheromas) and macrophages of tendons
and skin (producing xanthomas).
Concept of Lipids - 68
Effect of Arohana Snehapana on Samedarakta
SAMEDARAKTA AND HYPERLIPIDAEMIA
The topic of the study is Samedarakta (i.e Hyperlipidaemia and Normal lipid
values). Here the term Samedarakta is coined for Lipidaemia. The lipids present in the
plasma in the abnormal or pathological condition like Hyperlipidaemia. So here in
this study medovriddhi laxanas have been taken for the study with respect to
Hyperlipidaemia.
Medovriddhi, Medoroga, and Sthoulya are synonyms. Here Medovriddhi was
main pathological phenomena of the disease. Hence it is necessary to explain about,
Nidana, Laxshanas, Samprapthi of Medovriddhi. These are explained as fallows.
Nidana
The law of nature say that without cause, affect is not possible. As per the
sequence of pathogenesis of disease given by Madhavakara and Vagbhat Nidana is
the first and foremost step for the manifestation of the disease and it gives the
particular knowledge about the pathogenesis of disease.
Table No. 21 showing the Nidana of Medovriddhi according to different
Acharyas. 172, 173, 174, 175,176
Nidana C.S. S.S M. N. B. P. Y. R. Ati sampoorana + - - - - Adhyashana - + - - - Kaphakarak ahara sevana - + + - + Guru,Seeta,Snigdha ahara sevana + - - - - Madhura rasa pradhana ahara + - - + - Adhika snehayukta ahara sevana + - - + - Avyayama + + + + + Divaswapna + + + + + Avyavaya + - - - - Harsha nityatwa + - - - - Achitana + - - - - Beeja swabhava + - - - -
Medovriddhi and Hyperlipidaemia - 69
Effect of Arohana Snehapana on Samedarakta
• Adhyashana, Atimatra ahara and Atiamporana:
Improper consumption of food interns of quality, quantity and not abiding the
rules of intake of food Produces Ama and ultimately leads to the formation of adhura
annarasa, which intern forms Medovriddhi.
• Kaphakarak ahara sevana
Kaphakara ahara means Atiguru, Snigdha, Sheeta etc., guna pradhana ahara.
These gunas predispose aggravation of Kapha, ultimately Medadhatu Upachaya will
occurs. Meda is seat of shelshma. So Shelshmavardaka ahara can cause production
of excessive fat in the body by Ashrayashrayi bhava and samanyavriddhikarana
siddhanta. An excess of calories leads to eventually a large accumulation of fat.
• Madhura rasa pradhana ahara
Madhura rasa is Apa and prithvi mahabhoota predominant leading to vriddhi
of samanagunas ie., Kapha and Meda. By this Medovriddhi will occur. Biochemically
madhura rasa dravyas comes in the category of carbohydrates more and less fat.
Carbohydrates when metabolized get converted into fat for the purpose of deposition
and storage leading to Medovriddhi.
• Avyayama
A person, who will not does physical exercise, lives luxuriously with
sedentary life style will always tend to accumulate Kapha dosha and then Meda dhatu
in the body. This leads to Medovriddhi in the long course of time. Along with
madhura, sheeta, snigdhadi ahara, if person not does exercise will leads to
Medovriddhi.
Medovriddhi and Hyperlipidaemia - 70
Effect of Arohana Snehapana on Samedarakta
• Divaswapna
Day sleep is the major santarpaka hetu hence this will lead to kaphavriddhi.
During sleep the BMR will be minimal and the energy for the body is also minimal
and probably there are greater chances of accumulation of energy, especially in the
form of adipose tissue in the body, in turn increasing the bulk.
• Avyavaya: It is also a kind of physical work. If person not indulging in vyavaya leads to
dhatu pusthi and also Shukra is seat for Kapha. Hence due to samana guna vriddhi,
leads to Medovriddhi.
• Beeja swabhava: Chakrapani clearly told that “ati sthula mata pitra souitha sukra swabhavat”
means the character of Medhovriddhi is inherited from obese parents.
• Harsha nityatwa and Achintana:
Psychological factors play an important role in the manifestation of
Medoroga. Achientana can be divided as the complete relaxed psychological mode of
the person or tranquility of mind which always helps in the nourishment of body
and may leads to Medoroga and secondly can be considered as a depression state of
the mind,in that time person does not want to think and tend to eat more as a
compensatory mechanism and become obese.
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Effect of Arohana Snehapana on Samedarakta
RUPA :
The symptomatology of Medoroga is asserted by Acharyas in broad manner,
to understand them, need to elaborate as follow.
Table No. 22 showing Roopa of Medoroga177, 178, 179, 180,181
Roopa C.S. S.S A.H M. N. B. P.Chala Spik, Sthana, Udara + - + + - Ayurhasa + - + + - Javoparodha + - - - - Krichravyavayata + + + + + Dourbalya + - + + - Dourghandhyata + + + + + Swedadhikyata + + + + + Atikshudha + + + + + Atipipasa + + + + + Atinidra - + - + + Krathana - + - + + Gadgadhatwa - + - + + Soukumarata - - - + -
• Spik, sthana udara vriddhi
Madhuratara ama annarasa produced will be responsible for Medo Dhatwagni
mandyata leading to Medovriddhi in the body. The seat of meda is Udara, Spik,
Sthana hence increased meda accumulates more at these places and leads to Udara,
Spik, Sthana Vriddhi.
• Dourgandhyav and Atiswedha
Sweda is the mala of Medodhatu. When Medodhatu is excessively formed
and deposited in the body. The mala of Medodhatu i.e., sweda is also excessively
formed leading to swedadhikyata. As dustha meda is Amagandhi in nature. Hence it
gives bad odour and also due to excessive sweat produces dourgandhya in the body.
Medovriddhi and Hyperlipidaemia - 72
Effect of Arohana Snehapana on Samedarakta
• Kshudra swasa and Krathana
An increased amount of fat in the chest wall and abdomen has an effect on the
mechanical properties of the chest to diaphragm and leads to an alteration of
respiratory excretion during inspiration and expiration.
• Ayushohrasa :
The other dhatus do not grows to the extent that of the fat grows in Medashi
persons hence it shortens the life span.
• Javoparodha (lethoergy) :
The deficient co-ordination, shaitilyata, Gurutwata of Meda may causes
Medaroga with slowed down movement.
• Snigdhangata :
As the Medodathu and Kaphadoshas are having Sadharmya guna. Samana
gunas when combined will increases further in there gunas. Hence due to snigdhadi
gunas it gets Snigdhangata.
• Kasa:
Kapha dosha and Medodhatu are present in Ashrayashrayi bhava. So the
vitiated Meda will vitiates Kapha. This will in turn causes cough reflex.
• Krichravyavayata :
The deficient semen production and avarana of Meda to channels of Shukra
leads to poor sexual performance or difficulty in sexual act.
• Dourbalya (General debility) Weakness is the consequence of disturbed equilibrium of dhatus.
Medovriddhi and Hyperlipidaemia - 73
Effect of Arohana Snehapana on Samedarakta
• Atikshadha and Atipipasa :
Due to Meda avarana leads to Vata vriddhi in kostha. This vitiated Vata
stimulates Jatharagni excessively, this leads to Agni sandhukshana. By this person
feels Atikshudha and Atipipasa.
• Atinidra :
It persons sleeps in day time. This will increases the Kapha due to this
accumulation of Meda will takes place and leads to Medovriddhi.
SAMPRAPTI GHATAKAS :
i. Tridosha : Kapha dominant, Vyanavayu, Samanavayu, Pachaka pitta
ii. Dushya : Rasa, Meda.
iii. Agni : Jataragni, Medodhatvagni
iv. Srotas : Rasavaha, Medavaha.
v. Srotodusti prakara : Sanga
vi. Agni : Jatharagni & medodhatwagnimandyajanya
vii. Udbhavasthana : Amashaya
viii. Sancharasthana : Rasayani
ix. Adhisthana : : Medodhara kala, Vapavaham
x. Vyaktasthana Specially Udara, Spika, Sthana
xi. Roga swabhawa : Chirakari
Dosha
Kapha : As Medoroga is considered as Kaphaja Nanathamaja Vyadhi. Due to
excessive intake of Guru, Snigdha, Madhura, Sheeta ahara and Viharas like
Divaswapna, Achintana etc., leads vitiation of kapha. Hence kapha is predominately
present as a Dosha.
Medovriddhi and Hyperlipidaemia - 74
Effect of Arohana Snehapana on Samedarakta
Pitta
Due to Margavarodha by Medovriddhi, Sandukshana of Jataragni will takes
place. Hence person has excessive Jataragni.This is due to vitiation of Pitta.
Vata
Margavarodha causes inactiveness of Vyanavayu which in turns responsible
for the improper circulation and distribution of nutrients to the Dathus.
Due to Sanga in the Medovahasrotasa the nutrients cannot be carried out by
Vyanavayu to their respective Dhatus. Vitiated Samanavayu makes agni
sandhukshana and improper distribution of fat in the body.
Dushya
In this disease excessive production of abnormal Medadhatu is present. Here
Rasa, Meda, Mamsa, Majja, Shukra are Dushyas, as kapha is seated in all these dhatus
on the basis of ashryaashryibhava.
Srotas
Avyayama, Divaswapna, excessive intake of madhur dravyas are vitiating
factors for Medovaha srotodusthi as mentioned in Charaka samhita.
Agni
Tikshnagni is predominant feature due to vitiation of vata. In tikshnagni
condition if person consumes adhyashana, which leads to disturbance in agni and
subsequently formation of Ama may takes place, this leads to improper formation of
Dhatus.
Medovriddhi and Hyperlipidaemia - 75
Effect of Arohana Snehapana on Samedarakta
Flow chart No. 2 SAMPRAPTHI
Due to Nidana
Vitiation of Kaphadi doshas
Spreads all over the body very quickly
Mixes with Medodhatu first because of Ashrayashrayi bhava and vitiates it
Vikruta poshaka Meda circulates all over the
body along with gatiyukta rasa, rakta
dhatu
Excessive accumulation of vikruta poshya meda
Vata dusthi in Kostha leading to Sandhukshana of Jataragni
Increase of Meda in Rasa (plasma) ie.,
Medovriddhi (raised level of lipids or fats in
the Plasma)
Rapid digestion of food and does crave for food
Medovriddhi does margavarodha for other dhatus
Accumulates in Spik, Sthana, Udara (Accumulation of depot fat)
Medoroga
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Effect of Arohana Snehapana on Samedarakta
CHIKITSA: 182
Shodhana karma is indicated in following condition of Medoroga as explained
by Vagbhata.
Snehana should not be administered in Medoroga but Tilataila is indicated.
(C.S.Su.13/5). Essential Mrudu swedana is indicated.
Those who are very obese, strong and having predominance of Pitta and
Kapha, those suffering from Amadosha, Jwara, Chardhi, Atisara Hrudaya rogas,
Vibhandha, Gaurava, Hrullasa conditions, Shodhana karma is adopted.
Those who are madhyama sthoulya, previously Deepana and Pachana drugs
are given then Shodhana karma is adopted.
Those who are Heena sthoola, Kshudita, Pipasita, those who are troubled by
increased doshas, madhyama and alpa bala persons by exposing them to breeze
sunlight and exercise should be administered but not the Shodhana.
Medovriddhi and Hyperlipidaemia - 77
Effect of Arohana Snehapana on Samedarakta
HYPERLIPIDAEMIA
Lipoprotein disorder or dyslipidaemias are among the most common
metabolic diseases seen in clinical practice. They are important because they may
lead to number of sequel including CHD dermatological manifestations (xanthelasma
and xanthomata), pancereatitis and (more rarely) neurological and ocular anomalies.
Hyperlipidaemia is the excessive accumulation of lipid (especially plasma
lipids) in the body leading to acute or chronic condition.
Hyperlipidaemia refers to an increased concentration of either cholesterol or
Triglycerides or both lipids in the plasma. The elevation of lipid concentration in the
plasma is often the manifestation of disorders in the synthesis, absorption or
degradation of plasma lipids and lipoproteins.
ETIOLOGY
It includes both primary and secondary causes as follows:
1. Smoking >10 cigarettes, bidi / day.
2. Diabetes mellitus
3. Hypertension
4. Family history of premature CHD.
5. Excess Alcohol intake
6. chronic renal failure
7. drugs e.g., thiazides
8. beta adrenoceptor antagonists hypothyroidism
9. Nephritic syndrome
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Effect of Arohana Snehapana on Samedarakta
CLINICAL FEATURES
Hyperlipidaemia should be suspected from;
1. Xanthomas (cholesterol deposit in skin histicocytes located in buttocks,
pressure points, knees and elbows etc.,)
2. Xanthelasmas (cholesterol deposits in eyelids)
3. Premature arcus in cornea
4. Premature atherosclerosis
5. Attacks of pancreatitis
6. White and pale appearance of retinal vessels (lipemia retinalis).
CLASSIFICATION
A. Fredrickson Classification
Considering the raised levels of Triglyceride, cholesterol or both and the
Lipoprotein molecule which is excess in the circulation, hyperlipoproteinaemias have
been classified by Fredrickson into five major groups.
Table No. 23 Showing the Classification of Hyperlipidaemia
Lipoprotein Major elevation Lipid Example
Pattern in Plasma LP
Type I Chylomicrons TGs LPL deficiency Type II a LDL Cholesterol Familial
Hypercholesterolemia Type II b VLDL+LDL TG + Cholesterol Familial combined
hyperlipidemia Type III Remnants
(B-VLDL) TG + Cholesterol Type III
Hyperlipoprotenemia Type IV VLDL TG Familial
Hypertriglyceridemia Type V Chylomicron
+ VLDL TG + Cholesterol APO C II deficiency
Medovriddhi and Hyperlipidaemia - 79
Effect of Arohana Snehapana on Samedarakta
I. Type I Hyperlipoprotenaemia (Hyper Chylomicronaemia)
This autosomal recessive abnormality manifests itself in childhood as an
intolerance of dietary fat and failure to thrive. It presents clinically as a widespread
cutaneous popular rash, often accompanied by abdominal pain which may progress to
full blown pancreatitis. Plasma triglyceride values often exceed 50 mmol/1, reflecting
the increased amount of chylomicrons in the blood stream. In molecular terms, the
disease results from faulty operation of the plasma enzyme lipoprotein lipase, either
as a result of mutation in the lipase gene itself or because of a sequence defect in its
essential apoliporotein cofactor, apo CII, which normally circulates in association
with triglyceride – rich lipoproteins.
Secondary hyperchylomicronemia may occur in uncontrolled diabetes and in
dysprotenemia in multiple myeloma and macroglobenemia. High doses of cortico
steroids may induce lipaemia.
II. (a) Type II a Hyperlipoprotenaemia (Familial Hyper Cholesteremia )
This is the commonest type of primary disorder of cholesterol metabolism
where plasma LDL levels may rise up to 4 to 5 folds in heterozygotes and 6 to 8 folds
in homozygotes as a result of LDL receptor defect.
Plasma triglyceride levels and HDL cholesterol levels are normal or reduced.
As would be expected with a decreased number of LDL receptors, the fractional
clearance of LDL apo B is decreased. LDL production is increased because more
VLDL and more IDL are secreted by the liver and more LDL particles are converted
to LDL rather than taken up by the hepatic LDL receptors.
Besides premature Atherosclerosis and CAD, which manifest as early as the
fourth decade of life, xanthomas over the Achilles and other tendons as well as over
Medovriddhi and Hyperlipidaemia - 80
Effect of Arohana Snehapana on Samedarakta
bony prominences (knuckle legs, elbow, knee, etc) on the dorsal aspect of the
extremities holds the clinical diagnosis of FHC. Theses xanthomas are soft to firm,
nodular structures incorporating macrophage laden with cholesterol. Similarly, these
cells can get deposited at many other sites like the soft tissue of the eyelid
(xanthelasma) within the cornea (arcus corneae) buttocks, inter digital webs of hands,
etc.,
The homozygous form of FH occurs in one out of 1 million individuals and is
associated with plasma cholesterol levels > 13 mmol/L (>500 mg/dL), large
xanthelesmas, and prominent tendon and planar xanthomas. These individuals have
an aggressive, premature CHD that can be manifested in childhood.
II. (b)Type II b Hyperlipoprotenaemia (Familial Combined Hyperlipidaemia)
FCHL is inherited as an autosomal dominant disorder, and the initial case
discovered within a family may have combined Hyperlipidemia isolated
hypertriglyceridemia, or isolated elevated levels of LDL cholesterol.
Interestingly there is no Hyperlipidaemia in childhood nor do xanthomas
develop, but young adults suffering from FCHL may manifest with mild
hypercholesteremia, triglyceridaemia or both. The diagnosis is often prompted when
an individual has mixed Hyperlipidaemia with changing patterns of lipids in the
blood. The prevalence of impaired glucose tolerance / diabetes mellitus,
hyperuricaemia and obesity is more frequent in these subjects. Almost half of the first
degree relatives manifest with lipid abnormalities at some point of time. The lipid
abnormality could be types lla, IV or IIb.
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Effect of Arohana Snehapana on Samedarakta
III. Type III Hyperlipoprotenaemia (Broad β Hyperlipoprotenemia)
Transmitted as a single gene defect, this leads to partial catabolism of VLDL
with consequent accumulation of remnants in plasma; this leads to rise in both
cholesterol and Triglycerides. This disorder is also know as “Familial
dysbetalipoproteinaemia”. The genetic defect is in the gene that encodes the structure
of Apo E. Coexistent diabetes mellitus, Hypothyrodism and obesity are seen in many
patients with this lipid disorder. Patients present with xanthoma distributed as streaks
on the palmar creases and inter digital space, as also tuberous swellings over the
dorsal aspect of the body. Glucose intolerance and obesity occur sooner or later.
Diabetes Mellitus and Hyperthyroidism are the commonest causes of secondary Type
- III HLP.
IV. Type IV Hyperlipoprotenaemia (Hyper Pre β Lipoprotenemia)
This disorder is characterized by isolated increase in TG rich VLDL in
plasma. Unlike Type I a, Hypertriglyceredemia is endogenous and not dependent on
dietary fat intake. There is increase in the synthesis and release of VLDL from the
Liver as well as inadequacy of catabolism in the peripheral tissues. Although
inherited as autosomal dominant expression of the trait appears to depend on certain
promoting factors such as glucose intolerance, Hyperinsulinaemia, hypothyroid state
or excess of alcohol consumption. Rise in TGs may be moderate (150-200) until
some of the above lead to rise in VLDL production particularly in response to excess
intake of carbohydrate. This disorder is not apparent until puberty. Premature
coronary disease occurs, but the contribution of VLDL is difficult to assess in view of
high incidence of diabetes, obesity and hyperuricemia among these patients.
Pancreatitis may develop during the period of exacerbation.
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V. Mixed Hypertriglyceridemia (Type V - HLP)
This is a rare disorder manifests as combination of abnormalities of Type I and
Type IV HLP. Lipaemia is due to excess production of endogenous VLDL and
defective removal of exogenous chylomicrons may be because of LPL deficiency.
This disease is may be familial or sporadic. In the familial 50% of the adult relatives
of the patients have Hypertriglyceridemia. There is often genetic overlap between
Type IV and V HLP. The disorder manifest in adult life with Hepatospleenomegaly,
recurrent abdominal pain and Xanthomatous eruptions. Obesity, glucose intolerance
and premature vascular disease are common concomitants. Secondary Type V HLP is
observed in uncontrolled Diabetes, Hypothyroidism, Nephrotic syndrome and Gout.
B. CLASSIFICATION ACCORDING TO PRACTICAL POINT OF VIEW
From a practical point of view it is now more usual to divide the
Hyperlipideamia according to the pattern of abnormality on blood testing, namely
hyperceholesterolaemia, hypertiglyceridaemia or mixed hyperlipidaemia.
Hyperceholesterolaemia
Elevated levels of fasting plasma total cholesterol in the presence of normal
levels of triglycerides are almost always associated with increased concentrations of
plasma LDL cholesterol (type IIa) since LDL carries about 65 to 77 percent of total
plasma cholesterol. The rare patient with markedly elevated HDL cholesterol may
also have increased plasma total cholesterol levels. Elevations of LDL cholesterol
can result from single gene defects, polygenic disorders, and secondary effects of
other disease states.
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Effect of Arohana Snehapana on Samedarakta
Hypertriglyceridaemia
The diagnosis of Hypertriglyceridaemia is made by determining levels of
plasma lipids after an overnight fast. Because of the less certain association of
Triglycerides with CHD, plasma concentration greater than the 90th or 95th percentile
for age and sex have been used to define Hypertriglyceridaemia. Isolated elevations
of plasma triglycerides can be due to increased levels of VLDL and Chylomicrons
(type IV) or combination of VLDL and Chylomicrons (type V). Rarely only
Chylomicron levels are elevated (type I). Plasma is usually clean when Triglyceride
levels are < 4.5 mmol /L (<400 mg/dL) and becomes cloudy when levels are higher
and VLDL (and / or Chylomicron) particles become large enough to diffuse light.
When Chylomicrons are cold for several hours. Tendon xanthomas and xanthelasma
do not appear but small orange – red papules, can appear on the trunk and extremities
when triglyceride levels are > 11 mmol/L (>1000 mg/dL) (i.e., when
Chylomicronemia is present).
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Effect of Arohana Snehapana on Samedarakta
Drug Review - 85
DRUG REVIEW:
The Present study has been carried out to evaluate the effect of Arohana
Snehapana in Samedarakta with special reference to Hyperlipidaemia and normal
lipid values. Murchita Tilataila is the cheapest medicated Tilataila available; hence
this was selected as a Snehana Dravya.
The following drugs were used in this study:
1. Panchakola Churna (For Amapachana)
2. Murchita Tilataila (For Arohana Snehapana and Abhyanga)
I. Panchakola Churna :188
The ingredients of Panchakola Churna are
Pippali,
Pippali Mula,
Chavya,
Chitraka and
Shunti.
II. Murchita Tilataila:189
Drugs for murchana of Tila taila are
Manjistha - 1/16th part
Haritaki - 1/64th part
Vibhitaki - 1/64th part
Amalaki - 1/64th part
Mustha - 1/64th part
Haridra - 1/64th part
Lodra - 1/64th part
Vatankura - 1/64th part
Hrivera - 1/64th part
Nalika - 1/64th part
Ketakipushpa - 1/64th part
Tila taila - 1 part
Jala - 4 part
Table No. 24 showing the Pharmacodynamics of Ingredients of Panchakola choorna : 190, 191, 192, 193
Drug Family Name Latin Name Paryaya nama Rasa Guna Virya Vipaka Dhoshagnatha Karma Useful part
Pippali Piperaceae Piper longum Magadi, Vaidehi, Kana, Krishna
Katu Laghu, Snigdha, Tikshna
Anushna sheeta
Madhura Vatakaphahara Deepana, Vatanulomana
Phala, Moola
Pippali moola
Piperaceae Piper longum Magadi,Vaidehi, Kana, Krishna
Katu Laghu, Ruksha
Ushna Katu Kaphavatahara Deepana, Pachana, Anaha prashamana
Moola
Chavya Piperaceae Piper retrofractum Chavika Katu Laghu, Ruksha
Ushna Katu Kaphavatahara Deepana, Pachana Shoolaprashaman
Twak, Moola
Chitraka Plumbaginaeceae Plumbagozyelenica Agni, Jyoti, Shardula
Katu Laghu, Ruksha, Sheeta
Ushna Katu Kapha vata Shamaka
Deepana, Pachana, Pittasaraka, Grahi
Moola Twak
Nagara Zingiberaceae Zingiber officinalis Shunti, Mahoushadha
Katu Laghu, Ruksha
Ushna Madhura Kapha vata Shamaka
Trptighna, Rochana, Deepana, Pachana
Kanda
Drugs Chemical composition
Pippali Essential oil, caryophyllene, piperine, piplartine, piperlongumine, piperlognuminine, pipernonaline, pipercide, sesamin, β-sitsterol.
Pippali moola Essential oil, piperine, piplartine, piperlongumine, piperlognuminine, pipernonaline, pipercide, sesamin, β-sitsterol.
Chavya Piperine, sitosteral, piplatine. New amides – retrofractamide A, B, C & D isolated from aerial parts.
Chitraka Chitranone plumbagin, 3-chloroplumbagin, drosesone, elliphinone, isozeylinone, isozeylan – one, maritone, plumbagic acid, β- silosterol
Nagara Zingiberol, Zingerone, gingerols, paradol, gingerenone A, ginger glyeolipids A, B & C, gingerdiol, gingerone B & C etc.,
86
Table No. 25 Showing Pharmacodynamics of Drugs Used For Moorchana of Tilataila.194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204
Drug Family Name Latin Name Paryaya nama Rasa Guna Virya Vipaka Dhoshagnatha Karma Useful
part Manjistha Rubiaceae Rubia
Cordifolia Yojanavalli, Rakthangi, Vastrabhushana
Madhura Kashaya
Guru Ushna Madhura Kaphanashaka Rakth prasadaka Kanda
Haritaki Combretaceae Terminalia chebula
Abhaya, Pachani, Shiva
Lavana Varjita Kashayapradhana Pancha Rasa
Laghu Ruksha
Ushna Madhura Tridoshahara Deepana, Pachana, Anulomana, Rechana
Phala
Vibhitaki Combretaceae Terminalia bellirica
Karshaphala, Aksha, Kalidruma
Kashaya Laghu Ruksha
Ushna Madhura Tridoshanara, Especially Kaphahara
Deepana, Anulomana
Phala
Amalaki Euphorbiaceae Emblica Officinalis
Shriphala, Gayatri
Lavana Varjita Amlapradhana Pancha Rasa
Guru Ruksha, Sheeta
Sheeta Madhura Tridoshahara Deepana, Pachana, Anulomana, Rasayana
Phala
Mustha Cyperaceae Cyperus rotundus
Varida, Mustaka
Tikta, Katu Kashaya
Sheeta Sheeta Katu Kaphapitta Shamaka
Deepana, Pachana, Grahi, Mutrala
Kanda
Hardira Zingiberaceae Curcuma longa
Kanchani, Nisha, Krimighna
Titka, katu Ruksha, Laghu
Ushna Katu Tridoshahara Ruchya, Anulomana, Pitta Rechaka.
Kanda
Lodra Symplocaceae Symplocos recemosa
Sthulavalkala Kashaya Laghu, Ruksha
Sheeta Amla Kaphapitta shamaka
Shothahara, Kustagni, Raktastambana, Vrunaropana, Stambana
Twak
Vatankura Moraceae Ficus bangalensis
Nyagrodha, Bahupada
Kashaya Guru Ruksha,
Sheeta Katu Kaphapitta shamaka
Shothahara, Raktashodhaka, Vrunaropana, Chakshushya
Twak, kshira, patra, phala
Ketakipushpa Pandanaceae Pandanus odorotissimus
Suchipushpa Tikta, Madhura, katu
Lagu Snigdha
Ushna Katu Kaphapitta shamaka
Varnya, Vedanastapaka, Vrunaropana, Keshya , Dourgandhyahara
Pushpa, Mula
88
Hrivera* (Rasna)
Compositae Pluchea lanceolata
Sugandha, Gandhanakuli, Nakuli, Ishwarimoola
Tikta Guru Ushana Katu Kaphapitta shamaka
Shotahara, Vedanashaymak, Raktashodhaka, Rasayana
Patra
Nalika** (Tamala patra)
Lauraceae Cinnamomnm tamala
Naluka, Tamala patra, Teja patra
Katu Tikta madhura
Laghu, Ruksha, Teekshana
Ushana Katu Kaphapitta shamaka
Lekhana, Raktashodhaka, Sleshmahara
Twak, Taila, patra
Drugs Chemical composition Manjistha Anthraquinones manjistin, purpuroxanthin, rubiatriol, rubi coumaric acid, rubifolic acid, rubiadin, rubimallin, purprin, Haritaki Chebulinic acid, tannic acid, terchebin, vit C, behenic, lindeic, oleic, palmitic and stearic acids, chebulin. Vibhitaki Fructose, galactose, glucose, mannitol, edible oil, gallic acid, chebulagic acid, ellagic acid. Amalaki Ellagic acid, oleanolic, aldehyde, tannin vit C, phyllemblin, linolic acid, acetic acid, ellagic acid, phyllemblic acid and salts. Mustha Cyperenone, Cyperen, Cypertundone, cyperol, cyperolone, isocyperol, mustakone, rotundone, sugenol, β- sitosterol. Hardira Curcumene, curcumenone, curcone, curdione, cineole, curzorenone, eugenol, comphene, camphor, curcumins. Lodra Symposide, loturine, loturidie, colloturine Vatankura Leucoanthocyanin, tiglic acid, β - sisterol – a – d - glucoside Hrivera Kwarsitin, isoramnitin, pluchin. Nalika Cinnamaldehyde, Eugenol, Yuginal, fixed oil. Ketakipushpa Sughandita taila. Note : Hrivera* The Synonyms of Rasna mentioned in Nigantus are Hrivera, Nakuli, Gandhanakuli, Ishwarimoola, Note : Nalika** Indian Taj = Cinnamomum Tamala (Lauraceae) is known is Bengal as Naluka its leaves are known as Teja patra or Tamala Patra. Brihatrayi have mentioned as only Nalika. 205
89
Effect of Arohana Snehapana on Samedarakta
Drug Review - 91
TILA: 206, 207
Family : Pedaliaceae
Latin Name : Seasamum indicum
Charaka : Svedopaga,
English : Sesamum seeds
Hindi : Til
Kannada : Yellu
Habitat :
This is small bush bearing white or light pink coloured flowers is indigenous
to India and extensively cultivated in the warmer region.
Varieties :
Three varieties of seasmum seeds are found: black, white and red or brown.
The black variety is the most common and yields the best quality of oil and is best
suited for medicinal purposes. But white variety is richer in oil.
Constituents :
Seeds contain fixed oil 50 to 60 percentage (White varieties 48%, black and
red varieties about 46%)
Analysis:
Moisture Oil Black Til 2.0 to 5.2 % 44.6 to 56.9 % Red Til - 45.7 to 55.5 % White Til 2.0 to 4.4 % 44.9 to 58.2 %
Oil contains 70% of liquid fat of the glycerides of oleic and linolic acids and 13
to14% of solid gats, stearin, palmitin and myristin, and crystalline substance and a
phenol compound seasamol.
Effect of Arohana Snehapana on Samedarakta
Drug Review - 92
Method of preparation :
Seasame seeds contains about 50% of fixed oil. They are cleaned in
necessary, washed sundried and expressed to yield oil at room temperature.
Subsequently the temperature and pressure are raised. The oil is purified by refining
method and used.
Identification :
Badouin’s test : Shake 2ml of sesame oil with 1m of 1% of solution of sucrose
in hydrochloric acid . A pink or red colour is produced due to seasamol.
Description
Colour : Pale yellowish liquid.
Odour : Slight characteristic
Taste : Bland
Solubility : It is slightly soluble in alcholo.
Pharmacological properties
Rasa : Madhura, Anurasa : Kashaya, tikta
Vipaka : Mashura
Virya : Ushna
Guna : Guru snigdha
Doshaghnata : Vata Kapha shamaka
Karma : Agneya, Bhrimanakaraka, Indriyamanaatmatrupti,
Twaka prasadana, mamsasthirata, varna
balakarak, amadosha pachaka, kriminashaka.
Uses : Seeds are laxative, emollient and demulcent,
diuretic, nourishing, lactagogue and
emmenagogue.
Useful part : Seeds.
Effect of Arohana Snehapana on Samedarakta
MATERIALS:
The materials taken for the clinical study were
1. Panchakola Choorna (Ama pachana)
2. Murchita Tila taila (Arohana snehapana and abhyanga)
1. Panchakola Choorna:
The ingredients of Panchakola Choorna were Pippali, Pippalimoola, Chavya,
Chitraka and Nagar. All are taken in equal quantity and powdered well. Filtered
through cloth and made into fine powder. Panchakola Choorna was prepared in
Department of Rasashastra D.G.M.A.M.C, Gadag.
2. Murchita Tilataila :
Tila taila was purchased from the local market and taila moorchana was done
in Department of Rasa Shastra D.G.M.A.M.C, Gadag.
Drugs for murchana of Tila taila are
Manjistha - 1/16th part Haritaki - 1/64th part
Haridra - 1/64th part Vatankura - 1/64th part
Hrivera (Rasna)- 1/64th part Nalika - 1/64th part (Tamala patra)
Ketakipushpa - 1/64th part Lodra - 1/64th part
Vibhitaki - 1/64th part Amalaki - 1/64th part
Mustha - 1/64th part Tilataila - 1 part
Jala - 4 part
Collections of drugs:
All the raw drugs were purchased from the local market Gadag.
Methodology - 93
Effect of Arohana Snehapana on Samedarakta
Method of preparation :
Tilataila is heated over mandagni till the foam and sound is subsided
(phenashamana) then vessel is taken out from the fire. Above mentioned drugs are
made into coarse powder form, then made into kalka form by adding little amount of
water, then this kalka and mentioned quantity of water is added to Tilataila and heated
for making paka tillo attaining the Taila siddha laxanas. Then vessel is taken out from
the fire and Taila is filtered. Such Murchita Tilataila is not possess any durgandha
and it is having its own specific colour and odor.
METHODS: CLINICAL STUDY:
1. Sources of data:
The healthy voluntaries who were desirous to undergoing Shodhana therapy
for maintaining good health and patients of either sex suffering from Hyperlipidaemia
(i.e., raised Serum Cholesterol or Serum Triglycerides or both) were selected from the
OPD & IPD of D.G.M.A.M.C Hospital, Gadag.
The voluntaries and patients were selected on the basis of pre-selection
interview proforma specially designed for the purpose.
2. Selection of Individuals
Out of 36 individuals, 30 individuals of Samedarakta (15 patients of
Hyperlipidaemia and 15 voluntaries of Normal lipid value) with confirmed diagnosis
were selected.
The selection of healthy voluntaries was done as follows
i. Presently not suffering from any disorders. i.e. Healthy persons.
ii. Routine Blood and Urine investigations showing normal limits.
iii. A clinically performed physical and mental examination reveals no
significant findings.
Methodology - 94
Effect of Arohana Snehapana on Samedarakta
Desirable Criteria:
Feeling appetite in proper time, Proper digestion at proper time, Proper
evacuation of nature urges, Feeling lightness of body, Feeling alert and interested in
duties/ activities, Getting sound sleep regularly and feeling satisfaction of sleep.
Selection of Hyperlipidaemic cases were done as follows
Patients with raised Serum Cholesterol or Serum Triglycerides or both were
selected for the clinical study.
Investigations:
• Lipid profile was done as mandatory test before and after the treatment in
local diagnostic Laboratory, Gadag.
• Like Hb%, TC, DC, ESR, RBS as routine tests were done from D.G.M.A.M.C
Laboratory, Gadag.
3. Inclusion criteria:
The patients suffering from only Primary Hyperlipidaemia and who are fit for
Snehana karma and Pradhana karma were selected in Group A.
The voluntaries with Normal Lipid Values who were desirous to undergo
Shodhana therapy were selected in Group B.
Only those in whom Samyak snigdha laxanas appeared within Snehapana Kala
were included.
Persons between the age group of 20 to 60 years of both sexes were selected.
4. Exclusion criteria:
Secondary Hyperlipidaemia patients were not included eg. Hypothyroidism,
Diabetes mellitus etc.
Persons unfit for Snehana karma and Shodhanakarma were excluded.
Severe form of other systemic disorders.
Methodology - 95
Effect of Arohana Snehapana on Samedarakta
5. Grouping:
Total number of cases selected for the present study were 30. The cases were
divided into 2 Groups, Group A and Group B each consisting of 15 individuals
Group A- 15 patients of Hyperlipidaemia.
Group B- 15 voluntaries of Normal Lipid Values (Healthy persons)
Study design: Prospective clinical study
Sample size: 30 samples
Study durations: 15 days and fallow up 15 days.
Intervention:
All the individuals were administered with Panchakola churna 3-6 gms as
Ama pachana ½ hour before food with hot water till appearance of nirama lakshanas
or 3 -7 days.
• In the both groups, individuals were given test dose (30 ml) of Murchita
Tilataila at around 6.00 to 7.00 am. The second day onwards Murchita
Tilataila was administered in Arohana Krama (increasing dosage). The
increase (Arohana) per day was decided on the basis of Jiryamana, Jirna
lakshana etc. Thus the increase was not fixed and the dose schedule was
variable from person to person. After attainment of Samyak Snigdha
lakshanas individuals were subjected to Shodhana karma.
Procedure of Snehapana:
• Individuals were instructed to take Drava, Ushna, Anabhishyandi,
Pramanayukta Bhojana at night on the day before Snehapana.
• Early morning on the day of Snehapana after going through routine urges,
Jirna ahara lakshana (but Akshudhita Avastha) was assessed. Then at 6.00 to
Methodology - 96
Effect of Arohana Snehapana on Samedarakta
7.00 a.m. individuals with a fresh mind, enthusiasm, courage, by preying God,
the dose of Murchita Tilataila was administered. Hot water was given as an
Anupana followed by Tilataila intake.
• Individuals were instructed to follow Pathyapathya as explained in Snehapana
vidhi chapter.
• Individuals were instructed not to take any type of food until he/she feels
hungry.
• During those days individuals were given light diet like Peya, Rice and
Rasam.
• The duration of Jiryamana Lakshana as well as the time required for
appearance of Jirna Lakshana was assessed.
The individuals were observed for Samyak Snigdha Lakshana daily. After
getting Samyak Snigdha Lakshanas, Snehapana was stopped and then individuals
were subjected for Shodhana Karma.
6. Parameters for Assessment of Treatment:
The individuals of both the groups were assessed for Samyak Snigdha laxanas
on the basis of Subjective Parameters and assessed for results on the basis of
Objective parameters.
Samyak Snigdha Lakshanas :
The following subjective criteria were considered for assessment of Samyak
Snigdha Lakshanas.
• Vatanulomana - Assessed by normal expulsion of flatus, feces
and Urine.
• Diptagni - Based on the time and Dose of Sneha.
Methodology - 97
Effect of Arohana Snehapana on Samedarakta
• Asamhata Varcha - Based on the loose consistency of the faeces.
• Snigdha Varcha - Confirmed by Greasy / Sticky stool, floating of
fatty stool over water. Sense of oiliness over the
fingers on washing after defecation (Enquired
from the Volunteers)
• Twak Snigdhata - Assessed by comparing the touch, luster and
texture of skin before, during and after Snehana.
• Glani - It was assessed by presence of exhaustion /
fatigue / debility or weakness
• Anga Laghava - By enquiring with the Volunteers.
• Snehodvega - Confirmed by presence of aversion
towards Snehapana
OVER ALL ASSESSMENT OF RESULTS:
Results of Arohana snehapana with Murchita Tilataila, who had Samyak
snigdha laxanas, assessed mainly on the bases of changes in the Serum lipid values as
mentioned below.
Increased Abnormality :
o Any one or more Serum Lipid values i.e. i) Serum Cholesterol, Serum
Triglycerides, LDL, and VLDL values should increase ( No values
should decrease apart from normal limits ) and /or ii) HDL value
should decrease (Its values should not increase apart from normal
limits).
o Some values may be within normal limits.
Methodology - 98
Effect of Arohana Snehapana on Samedarakta
Decreased Abnormality :
o Any one or more Serum Lipid values i.e. i) Serum Cholesterol, Serum
Triglycerides, LDL, and VLDL values should decrease ( No values
should increase apart from normal limits ) and/or ii) HDL value should
increase (Its values should not decrease apart from normal limits).
o Some values may be within normal limits.
Normal Limits:
All the Serum Lipid values should present within the normal limits
irrespective of increase or decrease in the Lipid values.
Variable :
All the persons who do not come under above three criteria were fall under
this criteria.
7. Statistical Analysis
For better understanding the effect of Shodhana Poorva Arohana Sehapana on
Lipid profile, 2 groups were made.
Group A consists of Hyperlipidaemic patients, Group B consists healthy
individuals. Both the groups received same medication i.e., Ama pachana done with
Panchakola choorna 6 grams and Snehapana with Murchita Tilataila and then
necessary Shodhana procedures were done according to the need.
Statistical analysis was done for serum lipid profile before and after
Snehapana procedure. Analysis was done by calculating Mean, Standard deviation
(SD), Standard error (SE) and‘t’ value and ‘p’ value.
Methodology - 99
Effect of Arohana Snehapana on Samedarakta
OBSERVATIONS:
In the present Observational study 30 individuals were registered to evaluate
the efficacy of Shodhananga Arohana Snehapana on Samedarakta (Hyperlipidaemia
and normal lipid values). The prevalence of age, sex, socioeconomic status, Vyayama
Shakti etc. was observed. The details of which are as follows-
Table No. 26 Age wise Distribution of the Sample
Age Group Group A % Group B % 20–30 Years 0 0 7 46.62 30- 40 Years 8 53.28 2 13.32 40–50 Years 5 33.30 3 19.98
50 – 60 Years 2 13.32 3 19.98
Age: Group A (Hyperlipidaemia) : Among 15 patients, 8(53.28%) patients in
group 30 – 40 Years, 5 (33.30%) in group 40- 50 Years, 2 (13.32%) in group 50- 60
Years age group. GroupB (Narmolipidaemic) : Among 15 healthy persons,
7(46.62%) persons in group 20-30 Years, 2(13.32%) persons in group 30 – 40 years, 3
(19.98%) persons in group 40- 50 Years and 3(19.98%) persons in group 50- 60
Years age group.
0
46.62%
53.28%
13.32%
33.3%
19.98%
13.32%
19.98%
0
10
20
30
40
50
60
20–30 30- 40 40–50 50 – 60
Group AGroup B
Graph 1 :
Results - 100
Effect of Arohana Snehapana on Samedarakta
Results - 101
67%
33%
Group B
40%
60%
MaleFemale
86.58%
13.32%
0
86.58%
6.66% 6.66%
0102030405060708090
Group A Group B
HinduMuslimChristian
Table No. 27 Sex wise Distribution of the Sample
Gender Group A % Group B %
Male 10 66.60 6 39.96 Female 5 33.30 9 59.94
Sex : GroupA (Hyperlipidaemia) : Out of 15 patients 10 (66.60%) were male and 5
(33.30%) were female patients. GroupB (Narmolipidaemic) : Out of 15 persons
9(59.94%) were female and 6 (39.96%) were male patients.
Graph 2 : Group A
Table No. 28 Religion wise Distribution of the Sample
Religion Group A % Group B % Total % Hindu 13 86.58 13 86.58 26 86.66
Muslim 2 13.32 01 6.66 03 10.00 Christian 0 0 01 6.66 1 3.33
Religion : GroupA (Hyperlipidaemia) : Out of 15 patients 13 (86.58%) were from
Hindu and 2(13.32%) patients were from Muslim. GroupB (Narmolipidaemic) : Out
of 15 persons 13 (86.54%) were from Hindu, 1(6.66%) was from Muslim and 1
(6.66%) was from Christian religion.
Graph 3:
Effect of Arohana Snehapana on Samedarakta
Table No. 29 Occupation wise Distribution of the Sample
Occupation Group A % Group B % Total %
Labour 02 13.32 7 46.62 9 30.00
Student 0 0 4 26.64 4 13.33 Executive 04 26.64 2 13.32 6 20.00 Sedentary 09 59.94 2 13.32 11 36.66
Occupation: GroupA (Hyperlipidaemia) : Out of 15 patients 9 (59.94%) were
Sedentary 4(26.64%) patients were Executive and 2(13.32%) were labour. GroupB
(Narmolipidaemic): Out of 15 persons 7 (46.62%) were Labour, 4(26.64%) were
student, 2(13.32%) were Executive and 2 (13.32%) were Sedentary.
13.32%46.62%
026.64%
26.64%13.32%
59.94%13.32%
0 10 20 30 40 50 60
Labour
Student
Executive
Sedentary
Group BGroup A
Graph 4:
Table No. 30 Marital status wise Distribution of the Sample.
Marital status Group A % Group B % Total %
Married 15 100 11 73.26 26 86.66
Un married 00 0 04 26.64 04 13.3
Marital Status : GroupA (Hyperlipidaemia) : Out of 15 patients 15 (100%) were
Married GroupB (Narmolipidaemic): Out of 15 persons 11 (73.26%) were Married
and 4(26.64%) were unmarried.
Results - 102
Effect of Arohana Snehapana on Samedarakta
Results - 103
13.32%
73.26%
13.32%6.66%
79.92%
13.32%
0
10
20
30
40
50
60
70
80
Group A Group B
Poor ClassMiddle classHigher class
Group B
60%
40%VegetarianMixed
Group A
33%
67%
Table No. 31 Socio Economical Status wise Distribution of the Sample
Socio Economical Status Group A % Group B % Total %
Poor Class 02 13.32 01 6.66 03 10 Middle class 11 73.26 12 79.92 23 76.66 Higher class 02 13.32 02 13.32 04 13.33
Socio Economical Status : GroupA (Hyperlipidaemia) : Out of 15 patients, 11
(73.26%) were belongs to Middle Class, 2(13.32%) were belongs to Poor Class and
2(13.32%) were belongs to Higher class. GroupB (Narmolipidaemic): Out of 15
persons 12 (79.92%) were belongs to Middle Class, 2(13.32%) were belongs to
Higher Class and 1(6.66%) was belong to Poor class.
Graph 5:
Table No. 32 Type of Diet wise Distribution of the Sample
Type of Diet Group A % Group B % Total %
Vegetarian 05 33.30 09 59.94 14 46.66
Mixed 10 66.60 06 39.96 16 53.33
Type of diet: GroupA (Hyperlipidaemia) : Out of 15 patients 10 (66.60%)
were Mixed Diet & 5(33.30%) were Vegetarian. GroupB (Narmolipidaemic): Out of
15 persons 9(59.94%) were Vegetarian and 6(39.96%) were Mixed Diet.
Group 6 :
Effect of Arohana Snehapana on Samedarakta
Table No. 33 Diet Pattern wise Distribution of the Sample.
Diet Pattern Group A % Group B % Total % Samashana 11 73.26 11 73.26 22 73.33 Adhyashana 3 19.99 02 13.32 05 16.66
Vishamashana 1 6.66 02 13.32 03 10
Diet Pattern: Group A (Hyperlipidaemia) : Out of 15 patients, 11 (73.26%) had
Samashana Diet, 3(19.99%) had Adhyashana Diet & 1(6.66%) had Vishamashana
Diet. Group B (Narmolipidaemic): Out of 15 persons, 11(73.26%) had Samashana
Diet, 02(13.32%) had Adhyashana Diet and 02(13.32%) had Vishamashana Diet.
Table No. 34 Nature and Character of food wise Distribution of the Sample.
Nature of food Group A % Group B % Total %
Sammishra 08 53.28 11 73.26 19 63.33 Snigdha Pradhana 07 46.62 02 13.32 9 30 Ruksha Pradhana 0 0 02 13.32 2 6.66
Nature and Character of food: Group A (Hyperlipidaemia) : Out of 15 patients
08(53.28%) were taking Sammishra ahara, 7(46.62%) were taking Snigdha Pradhana
ahara. Group B (Narmolipidaemic): Out of 15 persons 11(73.26%) were taking
Sammishra ahara, 02(13.32%) were taking Snigdha Pradhana ahara and 02(13.32%)
were taking Ruksha Pradhana ahara.
53.28%46.62%
0
73.26%
13.32%13.32%
0
10
20
30
40
50
60
70
80
Group A Group B
SammishraSnigdha PradhanaRuksha Pradhana
Graph 7 :
Results - 104
Effect of Arohana Snehapana on Samedarakta
Table No. 35 Nature of work wise distribution of the Sample.
Nature of work Group A % Group B % Total % Day 13 86.58 14 93.24 27 90.00
Night 02 13.32 1 6.66 3 10.00
Nature of work : GroupA (Hyperlipidaemia) : Out of 15 patients 13(86.58%)
were day workers & 2(13.32%) were night workers. GroupB (Narmolipidaemic): Out
of 15 persons 14(93.24%) were day workers and 1(6.66%) was night worker.
Table No. 36 Sleep wise distribution of the Sample.
Sleep Group A % Group B % Total % Sound 13 86.58 14 93.24 27 90
Disturbed 2 13.32 1 6.66 3 10
86.58%
13.32%
93.24%
6.66%
0
1020304050607080
90100
Group A Group B
SoundDisturbed
Sleep : GroupA (Hyperlipidaemia) : Out of 15 patients, 13(86.58%) had
sound sleep and 2(13.32%) had disturbed sleep. GroupB (Narmolipidaemic): Out of
15 persons, 14(93.24%) had sound sleep and 1(6.66%) had disturbed sleep.
Graph 8 :
Table No. 37 Vyayama wise distribution of the Samples.
Vyayama Group A % Group B % Total % Yes 5 33.30 12 79.92 17 56.66 No 10 66.60 3 19.98 13 43.33
Vyayama : GroupA (Hyperlipidaemia) : Out of 15 patients, 10(66.60%) were
doing vyayama & 5(33.30%). GroupB (Narmolipidaemic): Out of 15 persons,
12(79.92%) were doing vyayama and 3(19.98%) were not doing vyayama.
Results - 105
Effect of Arohana Snehapana on Samedarakta
Table No. 38 Vyasana wise distribution of the Samples.
Vyasana Group A % Group B % Total % Alcohol 3 19.98 2 13.32 5 16.66 Smoking 4 26.64 0 0 4 13.33
Tobacco chewing 2 13.32 4 26.64 6 20 No habit 6 39.96 9 59.94 15 50
Vyasana : GroupA (Hyperlipidaemia) : Out of 15 patients, 6(39.96%) had no
habit, 4(26.64%) were smokers, 3(19.98 %) were Alcoholic & 2(13.32%) were
tobacco chewers. GroupB (Narmolipidaemic): Out of 15 persons, 9(59.94%) had no
habit, 4(26.64%) were tobacco chewers and 2(13.32%) were Alcoholic.
Table No. 39 Menstrual History of 14 female patients
Menstrual History Group A % Group B % Total %
Regular 2 13.32 8 53.28 10 33.33 Scanty 1 6.66 0 0 1 3.33 Heavy bleeding 0 0 0 0 0 0 Menopause 2 13.32 1 6.66 3 10
Menstrual History : Observation of menstrual history of 14 female showed
that maximum females i.e. 10(33.33%) were having regular mentstrual history,
3(10%) were having menopause and 1(3.33%) had scanty menstruation.
Table No. 40 Jataragnibala wise distribution of the Samples.
Jataragnibala Group A % Group B % Total % Pravara 3 19.98 1 6.66 4 13.33
Madhyama 12 79.92 14 93.24 26 86.66 Avara 0 0 0 0 0 0
Jataragnibala : GroupA (Hyperlipidaemia) : Out of 15 patients, 12(79.92%) had
Madhyama jataragni, 3(19.98%) had pravara jataragni. GroupB (Narmolipidaemic):
Out of 15 persons, 14(93.24%) had Madhyama jataragni, 1(6.66%) had pravara
jataragni.
Results - 106
Effect of Arohana Snehapana on Samedarakta
Table No. 41 Koshta wise distribution of the Samples.
Kostha Group A % Group B % Total % Krura 2 13.32 3 19.98 5 16.66
Madhyama 11 73.26 11 73.26 22 73.33 Mrudu 2 13.32 1 6.66 3 10
Vyasana : GroupA (Hyperlipidaemia) : Out of 15 patients, 11(73.26%) had
Madhyama kostha, 2(13.32%) had krura kostha and 2(13.32%) had mrudu kostha.
GroupB (Narmolipidaemic): Out of 15 persons, 11(73.26%) had Madhyama kostha,
3(19.98%) had krura kostha and 1(6.66%) had mrudu kostha.
Table No. 42 Prakriti wise Distribution of the Sample
Prakrti Group A % Group B % Total % Kapha Vataja 3 19.98 2 13.32 5 16.66 Kapha Pittaja 11 73.26 10 66.60 21 70 Pitta Vataja 1 6.66 3 19.98 4 13.33
Prakrti: GroupA (Hyperlipidaemia) : Out of 15 patients, 11(73.26%) were had
Kaphapittaja prakriti,3(19.98%) were Kapha vataja prakriti and 1(6.66%) was Pitta
vataja prakriti. Group B: Out of 15persons, 10(66.60%) were had Kaphapittaja
prakriti, 3(19.98%) were Pitta vataja prakriti. and 2(13.32%) were Kapha vataja
prakriti .
Table No. 43 Sara wise Distribution of the Sample
Sara Group A % Group B % Total % Pravara 3 19.98 4 26.64 7 23.33
Madhyama 11 73.26 11 73.26 22 73.33 Avara 1 6.66 0 0 1 3.33
Sara: GroupA (Hyperlipidaemia) : Out of 15 patients, 11(73.26%) were Madhyama
sara,3(19.98%) were Pravara sara and 1(6.66%) was Avara sara. Group B: Out of
15persons, 11(73.26%) were Madhyama sara, 4(26.64%) were Pravara sara.
Results - 107
Effect of Arohana Snehapana on Samedarakta
Table No. 44 Showing Samhanana of the Samples
Samhanana Group A % Group B % Total % Pravara 3 19.98 2 13.32 5 16.66
Madhyama 11 73.26 12 79.92 23 76.66 Avara 1 6.66 1 6.66 2 6.66
Samhanana :. GroupA (Hyperlipidaemia): Out of 15 patients, 11(73.26%) were had
Madhyama samhanana, 3(19.98%) were had Pravara samhanana and 1(6.66%) had
Avara Samhanana. Group B: Out of 15 persons, 12(79.92%) were had Madhyama
samhanana, 3(13.32%) were had Pravara samhanana and 1(6.66%) had Avara
Samhanana.
Table No. 45 Showing Pramana of the Samples
Pramana Group A % Group B % Total % Pravara 2 13.32 5 33.30 7 23.33
Madhyama 12 79.92 10 66.60 22 73.33 Avara 1 6.66 0 0 1 3.33
Pramana :. GroupA (Hyperlipidaemia): Out of 15 patients, 12(79.92%) were had
Madhyama pramana, 2(13.32%) were had Pravara pramana and 1(6.66%) had Avara
pramana. Group B: Out of 15 persons, 10(66.66%) were had Madhyama pramana,
5(33.30%) were had Pravara pramana.
Table No. 46 Showing Satmya of the Samples
Satmya Group A % Group B % Total % Pravara 3 19.98 5 33.30 8 26.66
Madhyama 11 73.26 9 59.94 20 66.66 Avara 1 6.66 1 6.66 2 6.66
Satmya:. GroupA (Hyperlipidaemia): Out of 15 patients, 11(73.26%) were had
Madhyama Satmya, 3(19.98%) were had Pravara Satmya and 1(6.66%) had Avara
Satmya. Group B: Out of 15 persons, 9(59.94%) were had Madhyama Satmya,
5(33.30%) were had Pravara Satmya and 1(6.66%) had Avara Satmya.
Results - 108
Effect of Arohana Snehapana on Samedarakta
Table No. 47 Showing Satva of the Sample
Satva Group A % Group B % Total %
Pravara 4 26.64 7 46.62 11 36.66 Madhyama 11 73.26 8 53.28 19 63.33
Avara 0 0 0 0 0 0
Satva: GroupA (Hyperlipidaemia): Out of 15 patients, 11(73.26%) were had
Madhyama Satva, 4(26.64%) were had Pravara Satva. Group B: Out of 15 persons,
8(53.28%) were had Madhyama Satva, 7(46.62%) were had Pravara Satva.
Table No. 48 Showing Abhyavaharana Shakti of the Sample
Abhyavaharana Shakti Group A % Group B % Total %
Pravara 2 13.32 4 26.64 6 20 Madhyama 12 79.92 11 73.26 23 76.66
Avara 1 6.66 0 0 1 3.33
Abhyavaharana Shakti: GroupA (Hyperlipidaemia): Out of 15 patients,
12(79.92%) were had Madhyama Abhyavaharana Shakti, 2(13.32%) were had
Pravara Abhyavaharana Shakti And 1(6.66%) had Avara Abhyavaharana Shakti.
Group B: Out of 15 persons, 11(73.26%) were had Madhyama Abhyavaharana Shakti,
4(26.64%) were had Pravara Abhyavaharana Shakti.
Table No. 49 Showing Jarana Shakti of the Samples
Jarana Shakti Group A % Group B % Total % Pravara 5 33.30 2 13.32 7 23.33
Madhyama 10 66.60 13 86.58 23 76.66 Avara 0 0 0 0 0 0
Jarana Shakti: GroupA (Hyperlipidaemia): Out of 15 patients, 10(66.60%) were
had Madhyama Jarana Shakti, 5(33.30%) were had Pravara Jarana Shakti. Group B:
Out of 15 persons, 13(86.58%) were had Madhyama Jarana Shakti, 2(13.32%) were
had Pravara Jarana Shakti.
Results - 109
Effect of Arohana Snehapana on Samedarakta
Table No. 50 Showing Vyayama Shakti of the Samples
Vyayama Shakti Group A % Group B % Total %
Pravara 1 6.66 4 26.64 5 16.66 Madhyama 12 79.92 11 73.26 23 76.66
Avara 2 13.32 0 0 2 6.66
Vyayama Shakti: GroupA (Hyperlipidaemia): Out of 15 patients, 12(79.92%) were
had Madhyama Vyayama Shakti, 2(13.32%) were had Avara Vyayama Shakti and
1(6.66%) had Pravara Vyayama Shakti. Group B: Out of 15 persons, 11(73.26%)
were had Madhyama Vyayama Shakti, 4(26.64%) were had Pravara Vyayama Shakti.
OBSERVATION OF SNEHAPANA LAXANAS :
The present study has been undertaken to see the effect of Arohana Snehapan
in Samedarakta (Hyperlipidaemia & Normal lipid values). Matra of Sneha taken,
time taken for digestion, on set of Jeeryamana Laxanas. Samyak snigdha laxanas
were recorded in both groups. Out of 30 samples all showed following Snehapana
laxanas.
PANA KALEEN LAXANAS :
Hrullasa – Out of 14 Females, 10 Females showed this laxanas and Out
of 16 Males, 5 males showed this laxana.
Udgara - 21 persons of the sample showed Udgara.
However the laxana chardhi was not observed by any persons.
Results - 110
Effect of Arohana Snehapana on Samedarakta
MATRA OF MOORCHITA TILA TAILA ADMINISTERED:
Table No. 51 The matra of Arohana Snehapan with Murchita Tila Taila in both groups.
Group A Group B Sl. No. 1st day 2nd day 3rd day 4th day 5th day 1st day 2nd day 3rd day 4th day 5th day 1 30 65 100 135 X 30 65 100 135 X 2 30 55 80 X X 30 60 90 X X 3 30 65 100 135 X 30 65 100 135 X 4 30 60 90 120 X 30 55 80 X X 5 30 60 90 X X 30 70 110 150 190 6 30 60 90 120 X 30 55 80 X X 7 30 65 100 135 170 30 65 100 X X 8 30 55 80 105 X 30 55 80 105 X 9 30 60 90 120 X 30 55 80 X X
10 30 55 80 X X 30 65 100 135 X 11 30 60 90 X X 30 55 80 105 X 12 30 60 90 X X 30 55 80 105 X 13 30 60 90 120 X 30 60 90 X X 14 30 60 90 120 X 30 65 100 X X 15 30 60 90 X X 30 60 90 X X
Men dose in ml.
30 60 90 123 170 30 56 84 124 190
Moorchita Tila Taila was given in the dose of 30 ml on the first day to all the
30 individuals which was considered as Hrisiyasi Matra. On the basis of digestion of
this Snehamatra second day dose was decided.
Group A (Hyperlipidaemia):In this group second day dose was minimum 55 ml.
and maximum dose was 65 ml. with mean value of 60 ml. The third day dose was
minimum 80 ml & maximum 100 ml. with mean value of 90 ml. Fourth day dose was
minimum 105 ml & maximum 135 ml. with mean value of 123 ml. Fifth day dose was
170 ml.
Group B (Normolipidaemic):In this group second day dose was minimum 55 ml.
and maximum dose was 70 ml. with mean value of 56 ml. The third day dose was
minimum 80 ml & maximum 110 ml. with mean value of 84 ml. Fourth day dose was
minimum 105 ml & maximum 135 ml. with mean value of 124 ml. Fifth day dose was
190 ml.
Results - 111
Effect of Arohana Snehapana on Samedarakta
JEERYAMANYA LAXANAS
The table No. 52 The mean on set of Jeeryamanya laxanas of both Groups
1st day mean onset time in
minutes
2nd day mean onset time in
minutes
3rd day mean onset time in
minutes
4th day mean onset time in
minutes
5th day mean onset time in
minutes Jeeryamanya
laxanas A B A B A B A B A B
Shiroruk 90 105 200 190 270 230 360 340 420 400 Bhrama - - - - - 320 - 350 - - Nistiva 80 100 130 110 180 165 200 190 300 230 Sada - - - 180 360 300 400 360 330 420
Klama - - - - 450 400 480 510 480 410
Group A (Hyperlipidaemia) : On the first day after snehapana the mean on set time
of Shiroruk & Nistiva were 90 and 80 minutes respectively. On the second day the
mean on set time of Shiroruk, Nistiva were 200, 130, minutes respectively. On the
third day the mean on set time of Shiroruk, Nistiva, Sada and Klama were 270, 180,
360, 240 minutes respectively. On the fourth day the mean on set time of Shiroruk,
Nistiva, Sada and Klama were 360, 200, 400, 480, minutes respectively. On the fifth
day the mean on set time of Shiroruk, Nisteeva, Sada and Klama were 420, 300, 330,
480 minutes respectively. Bhrama was not occurred in Group A. Klama was not
occurred on 1st and 2nd day.
Group B (Normolipidaemic): On the first day after snehapana the mean on set time
of Shiroruk & Nistiva were 105 and 110 minutes respectively. On the second day
the mean on set time of Shiroruk, Nistiva & Sada were 190, 110, 180 minutes
respectively. On the third day the mean on set time of Shiroruk, Bhrama, Nistiva,
Sada and Klama were 230, 320, 165, 300, 400, minutes respectively. On the fourth
day the mean on set time of Shiroruk, Bhrama, Nistiva, Sada and Klama were 340,
350, 190, 360, 510, minutes respectively. On the fifth day the mean on set time of
Shiroruk, Nisteeva, Sada and Klama were 400, 230, 420, 410 minutes respectively.
Results - 112
Effect of Arohana Snehapana on Samedarakta
TIME TAKEN FOR SNEHA JEERNA LAXANAS:
Table No. 53 showing time ( in minutes ) taken for Sneha Jeerna laxanas Group A Group B Sl.
No. 1st day
2nd
day 3rd day
4th day
5th day
1st day
2nd
day 3rd day
4th day
5th day
1 185 360 480 720 X 180 390 660 900 X 2 240 510 720 X X 210 420 660 X X 3 165 360 540 660 X 180 450 540 780 X 4 195 360 480 720 X 240 480 690 X X 5 215 480 780 X X 155 390 480 690 810 6 210 450 600 750 X 230 420 600 X X 7 180 380 540 780 900 180 390 600 X X 8 240 300 480 660 X 240 375 480 750 X 9 190 420 660 780 X 270 360 660 X X 10 230 390 660 X X 180 360 600 790 X 11 205 460 720 X X 270 450 600 810 X 12 210 450 630 X X 240 330 480 770 X 13 200 420 720 840 X 210 360 660 X X 14 195 410 690 960 X 180 420 720 X X 15 205 410 600 X X 210 450 660 X X
Group A (Hyperlipidaemia) : On the first day the minimum time taken for digestion
was 165 and maximum was 240 minutes respectively. On the Second day the
minimum time taken for digestion was 300 and maximum was 510 minutes
respectively. On the third day the minimum time taken for digestion was 480 and
maximum was 780 minutes respectively. On the fourth day the minimum time taken
for digestion was 660 and maximum was 960 minutes respectively. Fifth day time
taken for digestion was 900 minutes.
Group B (Normolipidaemic): On the first day the minimum time taken for digestion
was 155 and maximum was 270 minutes respectively. On the Second day the
minimum time taken for digestion was 330 and maximum was 480 minutes
respectively. On the third day the minimum time taken for digestion was 480 and
maximum was 720 minutes respectively. On the fourth day the minimum time taken
for digestion was 690 and maximum was 900 minutes respectively. Fifth day time
taken for digestion was 810 minutes.
Results - 113
Effect of Arohana Snehapana on Samedarakta
Table No. 54 showing Summary of time taken for Sneha Jeerana (in minutes)
Percentage of Individual Group A & B
1st day 2nd day 3rd day 4th day 5th day Duration (in minutes)
A B A B A B A B A B 0 – 180 13.32 39.96 - - - - - - - -
180 – 360 86.58 59.94 26.64 26.64 - - - - - - 360 – 540 - - 73.26 73.26 33.30 26.64 - - - - 540 – 720 - - - - 59.94 73.26 19.99 6.66 - - 720 – 900 - - - - 6.66 - 39.96 39.96 6.66 6.66 A = Group A (Hyperlipidaemia), B = Group B (Normolipidaemic)
Group A : Out of 15 Hyperlipidaemic patients, on the first day 2(13.32%) patients
within 180 minutes and 13(86.58%) patients were had Snehajeerna Laxanas between
180 – 360 minutes. On the second day 4(26.64%) patients within 180 - 360 minutes
and 11(73.26%) patients were had Snehajeerna Laxanas between 360 - 540 minutes.
On the third day 5(33.30%) patients within 360 – 540 minutes, 9(59.94%) patients
between 540 – 720 minutes and 1(6.66%) patient had Snehajeerna Laxanas between
720 - 900 minutes. On the fourth day 3(19.99%) patients within 540 - 720 minutes,
and 6(39.96%) patient had Snehajeerna Laxanas between 720 - 900 minutes. On Fifth
day 1(6.66%) patient had Snehajeerna Laxanas between 720 - 900 minutes.
Group B : Out of 15 Nomolipidaemic persons, on the first day 6(39.96%) persons
within 180 minutes and 9(59.94%) persons were had Snehajeerna Laxanas between
180 – 360 minutes. On the second day 4(26.64%) persons within 180 - 360 minutes
and 11(73.26%) persons were had Snehajeerna Laxanas between 360 - 540 minutes.
On the third day 4(26.64%) persons within 360 – 540 minutes and 11(73.26%)
persons between 540 – 720 minutes. On the fourth day 1(6.66%) person within 540 -
720 minutes and 6(39.96%) persons had Snehajeerna Laxanas between 720 - 900
minutes. On Fifth day 1(6.66%) person had Snehajeerna Laxanas between 720 - 900
minutes.
Results - 114
Effect of Arohana Snehapana on Samedarakta
Table No. 55 Mean time (in minutes) taken for Samyak Snigadha laxanas of both Groups A & B.
1st day mean time
2nd day mean time
3rd day mean time
4th day mean time
5th day mean time Samyak Snigadha
laxanas A B A B A B A B A B
Vatanulomana 230 220 430 400 600 630 780 760 920 830 Agnideepti 230 250 450 410 640 615 800 785 955 890 Purisha snigdhata - - - - 755 1075 1130 1080 960 900 Asamhat varchas - - - - 600 960 1000 980 840 800 Twak snigdata - - - - 600 540 720 660 - 660 Anga laghavatha - - - - 740 700 780 800 1000 900 Snehodwega - - - - 660 540 700 660 - 720 Glani - - - - 650 645 820 800 965 895 A = Group A (Hyperlipidaemia), B = Group B (Normolipidaemic)
Group A : Out of 15 Hyperlipidaemic patients, On the First day the mean time taken
for Vatanulomana and Agnideepti was 230, 230 minutes respectively. On the Second
day the mean time taken for Vatanulomana, Agnideepti was 430, 450 minutes
respectively. On the Third day the mean time taken for Vatanulomana, Agnideepti,
Purisha Snigdhata, Asamhat Varchas, Twak Snigdata, Agna laghavatha, Snehodwega
and Glani were 600, 640, 755, 600, 600, 740, 660 and 650 respectively. On the Fouth
day the mean time taken for Vatanulomana, Agnideepti, Purisha Snigdhata, Asamhat
Varchas, Twak Snigdata, Agna laghavatha, Snehodwega and Glani were 780, 800,
1130, 1000, 720, 780, 700 and 820 respectively. On the Fifth day the mean time taken
for Vatanulomana, Agnideepti, Purisha Snigdhata, Asamhat Varchas, Agna
laghavatha, and Glani were 920, 955, 960, 840, 1000 and 965 respectively.
Group B : Out of 15 Normolipidaemic persons, On the First day the mean time taken
for Vatanulomana and Agnideepti was 220, 250 minutes respectively. On the Second
day the mean time taken for Vatanulomana, Agnideepti was 400, 410 minutes
respectively. On the Third day the mean time taken for Vatanulomana, Agnideepti,
Purisha Snigdhata, Asamhat Varchas, Twak Snigdata, Agna laghavatha, Snehodwega
and Glani were 630, 615, 1075, 960, 540, 700, 540 and 645 respectively. On the
Fouth day the mean time taken for Vatanulomana, Agnideepti, Purisha Snigdhata,
Asamhat Varchas, Twak Snigdata, Agna laghavatha, Snehodwega and Glani were
Results - 115
Effect of Arohana Snehapana on Samedarakta
760, 785, 1080, 980, 660, 800, 660 and 800 respectively. On the Fifth day the mean
time taken for Vatanulomana, Agnideepti, Purisha Snigdhata, Asamhat Varchas,
Twak Snigdata, Agna laghavatha, Snehodwega and Glani were 830, 890, 900, 800,
660, 900, 720 and 895 respectively.
Table No. 56 showing Samyak Snigdha Laxanasa of each individual in both the groups
Group A 1st day 2nd day 3rd day 4th day 5th day
Sl.
No. SSL No. % SSL No. % SSL No. % SSL No. % SSL No. %
1 1 11 1,2 22 1,2,7 33 1,2,3,4,5,6,7,8 88 - - 2 1 11 1,2 22 1,2,3,5,8 55 - - - - 3 - - 1,2 22 1,2,7 33 1,2,3,4,5,7,8 77 - - 4 - - 1,2 22 1,2,7 33 1,2,3,4,5,6,7 77 - - 5 1 11 1,2,7 33 1,2,3,4,7,8 66 - - - - 6 - - 1,2 22 1,2,3,4,7,8 66 - - - - 7 1 11 1,2,7 33 1,2,7 33 1,2,6,7 44 1,2,3,4,5,
6,7,8,9 100
8 - - 1,2 22 1,2,6,7 44 1,2,3,4,5,6,7,8,9 100 - - 9 - - 1,2,4 33 1,2,4,7,9 55 1,2,3,4,5 88 - -
10 1 11 1,2,4,7 44 1,2,3,4,7,8,9 77 - - - - 11 - - 1,2,7 33 1,2,3,4,6,7,8, 77 - - - - 12 1 11 1,2,7 33 1,2,3,4,6,7,8,9 88 - - - - 13 1 11 1,7 22 1,2,4,7 44 1,2,3,4,5,7,8,9 88 - - 14 - - 1,2 22 1,2,7 33 1,2,3,4,6,7,8 77 - - 15 - - 1,2,7 33 1,2,3,4,7,8,9 77 - - - -
Group B Sl.
No. 1st day 2nd day 3rd day 4th day 5th day SSL No. % SSL No. % SSL No. % SSL No. % SSL No. %
1 1 11 1,2 22 1,2 22 1,2,3,4,6,7,8 77 - - 2 - - 1,2,7 33 1,2,3,4,5,7 66 - - - - 3 1 11 1,2,4 33 1,2,4,7 44 1,2,3,4,6,7,8,9 88 - - 4 1 11 1,2,7 33 1,2,3,4,5,6,7,8,9 100 - - - - 5 - - 1,2,7 33 1,2,7 33 1,2,7,9 44 1,2,3,4,5,
6,7,8,9 100
6 1,7 22 1,2,4,7 44 1,2,3,4,5,6,7,8 88 - - - - 7 - - 1,2,7 33 1,2,3,7,8,9 66 - - - - 8 - - 2,7 22 1,2,7 33 1,2,3,4,7,8 66 - - 9 1 11 1,2 22 1,2,3,4,5,6,7,8 88 - - - -
10 - - 1,2 22 1,2,4,7 44 1,2,3,4,5,6,7 77 - - 11 7 11 1,2,7 33 1,2,7 33 1,2,3,4,5,6,7,8,9 100 - - 12 - - 1,2 22 1,2,7 33 1,2,3,4,5,6,7,8 88 - - 13 1 11 1,2 22 1,2,3,5,6,8 66 - - - - 14 1 11 1,2 22 1,2,3,4,5,7,8 77 - - - - 15 - - 1,2,7 33 1,2,3,4,5,6,7,8,9 100 - - - -
SSL No. - Samyak Snigda Laxanas Number Number 1 - Vatanulomana Number 2 - Agnideepti Number 3 - Purisha Snigdhata Number 4 - Asamhat Varchas Number 5 - Twak Snigdata Number 6 - Mrudugatrata Number 7 - Agna laghavatha Number 8 - Snehodwega Number 9 - Glani
Results - 116
Effect of Arohana Snehapana on Samedarakta
Group A (Hyperlipidaemic) : 2(13.32%) patients got 100%, 5(33.30%) patients got
88%, 5(33.30%) patients got 77%, 2(13.32%) patients got 66% and 1(6.66%) patient
got 55% Samyak Snigdha Laxanas. On the Third day 6(39.96%) patients, on fourth
day 8(53.28%) patients and on the fifth day 1(6.66%) patient got Samyak Snigdha
Laxanas.
Group B (Narmolipidaemic) : 4(26.64%) persons got 100%, 4(26.64%) persons got
88%, 2(13.32%) persons got 77% and 5(33.30%%) persons got 66% Samyak Snigdha
Laxanas. On the Third day 7(46.62%) persons, on fourth day 7(46.62%) persons and
on the fifth day 1(6.66%) person got Samyak Snigdha Laxanas
Table No. 57 Showing the Total number of Samyak Snigdha Laxanas observed
on last day of Snehapana in both the groups
Total Number Percentage (%)Sl. No. Samyak Snigdha Laxanas A B A B
1 Vatanulomana 15 15 100 100 2 Agnideepti 15 15 100 100 3 Purisha snigdhata 15 15 100 100 4 Asamhat varchas 14 13 93.24 86.58 5 Twak snigdata 08 12 53.28 79.92 6 Anga laghavatha 15 13 100 86.58 7 Snehodwega 14 13 93.24 86.58 8 Klama 07 11 46.62 73.26 9 Glani 07 06 46.62 39.96
A = Group A (Hyperlipidaemia), B = Group B (Normolipidaemic)
Group A: Vatanulomana, Agnideepti, Purisha snigdhata, Anga laghavatha were
found in all the 15 patients. Asamhat varchas, Snehodwega found in 14 patients,
Twak snigdata in 8 patients, Klama, Glani were found in 7 patients.
Group B: Vatanulomana, Agnideepti, Purisha snigdhata, were found in all the 15
persons. Asamhat varchas, Snehodwega, Anga laghavatha found in 13 persons,
Twak snigdata in 12 persons, Klama in 11 persons, Glani was found in 6 persons.
Results - 117
Effect of Arohana Snehapana on Samedarakta
RESULTS:
Table No. 58 showing Serum Cholesterol levels in both groups before and after
Arohana Snehapana. (Normal Value 130 to 200 mg /dl)
Group A Group B
BT AT BT AT Sl. No. O. P. D.
NO. mg / dl Changes Observed
O. P. D. NO. mg / dl
Changes Observed
1 3979 193 189 ↓ 04 4193 189 182 ↓ 07 2 3978 185 184 ↓ 01 4275 187 168 ↓ 19 3 4019 201 184 ↓ 17 4271 172 175 ↑ 03 4 4039 197 185 ↓ 12 4289 168 165 ↓ 03 5 4188 257 266 ↑ 09 4301 185 175 ↓ 10 6 4347 198 198 00 4652 165 165 ↓ 00 7 4581 194 190 ↓ 04 4658 184 175 ↓ 09 8 4596 213 201 ↓ 12 228 176 172 ↓ 04 9 673 172 170 ↓ 02 614 174 172 ↓ 02 10 793 179 171 ↓ 08 621 200 187 ↓ 13 11 1433 193 190 ↓ 03 1100 178 178 ↓ 00 12 1475 194 188 ↓ 06 1101 172 182 ↑ 10 13 1501 204 202 ↓ 02 1102 177 172 ↓ 05 14 1546 192 190 ↓ 02 1107 198 196 ↓ 02 15 1590 196 194 ↓ 02 1951 179 175 ↓ 04
BT-Before treatment. A.T – After treatment.
Group A (Hyperlipidaemia) Out of 15 Hyperlipidaemic patients, 11 (73.26%)
patients lied in the range below the normal range of Serum Cholesterol (200 mg / dl),
2 (13.32%) patients were in the range of 201 – 210 mg/dl, 1 (6.66%) patient was in
the range of 211 – 220 mg/dl and 1(6.66%) patient was in the range 250 – 270 mg/dl
before treatement.
12 (79.92%) patients were lied in the range below the normal range of Serum
Cholesterol (200 mg / dl), 2(13.32%) patients were in the range of 201 – 220 mg/dl
and 1(6.66%) patient was in the range of 250 – 270 mg/dl after treatment.
Group B (Narmolipidaemic) All the healthy person had Cholesterol level within
200 mg/dl had Before and After Treatment.
Results - 118
Effect of Arohana Snehapana on Samedarakta
Table No. 59 showing Serum Triglycerides levels in both groups before and after
Arohana Snehapana. (Normal Value 25 to 200 mg /dl)
Group A Group B BT AT BT AT
Sl. No. O. P. D.
NO. mg / dl Changes Observed
O. P. D. NO. mg / dl
Changes Observed
1 3979 233 214 ↓ 19 4193 171 170 ↓ 01 2 3978 210 170 ↓ 40 4275 135 135 ↓ 00 3 4019 273 222 ↓ 51 4271 125 130 ↑ 05 4 4039 203 197 ↓ 06 4289 130 125 ↓ 05 5 4188 202 173 ↓ 28 4301 140 150 ↓ 10 6 4347 276 229 ↓ 47 4652 150 150 00 7 4581 270 210 ↓ 60 4658 160 150 ↓ 10 8 4596 290 227 ↓ 63 228 165 166 ↑ 01 9 673 229 200 ↓ 29 614 170 165 ↓ 05 10 793 221 198 ↓ 23 621 145 140 ↓ 05 11 1433 213 207 ↓ 06 1100 125 110 ↓ 15 12 1475 232 206 ↓ 26 1101 125 120 ↓ 05 13 1501 222 220 ↓ 02 1102 125 130 ↑ 05 14 1546 224 212 ↓ 12 1107 193 190 ↓ 03 15 1590 230 211 ↓ 19 1951 163 163 00
BT-Before treatment. A.T – After treatment.
Group A (Hyperlipidaemia) : 4 (26.64%), 7 (46.62%), 3 (19.98%) and 1(6.66%)
patients were in the range of 200 – 220 mg / dl, 220 – 240 mg / dl, 260-280 mg / dl
and 280 – 300 mg / dl before treatment respectively.
5 (33.30%), 7 (46.62%) and 3 (19.98%) patients were in the range of below
the normal, 200 – 220 mg / dl, 220 – 240 mg / dl, after treatment respectively.
Group B (Normolipidaemia) : All the healthy person had Triglycerides level within
200 mg/dl before and after treatment .
Results - 119
Effect of Arohana Snehapana on Samedarakta
Table No. 60 showing HDL levels in both groups before and after Arohana
Snehapana. (Normal Value 30 to 70 mg /dl)
Group A Group B BT AT BT AT
Sl. No. O. P. D.
NO. mg / dl Changes Observed
O. P. D. NO. mg / dl
Changes Observed
1 3979 46 47 ↑ 01 4193 48 48 00 2 3978 46 47 ↑ 01 4275 40 42 ↑ 02 3 4019 43 44 ↑ 01 4271 43 43 00 4 4039 46 48 ↑ 02 4289 41 42 ↑ 01 5 4188 48 50 ↑ 02 4301 42 47 ↑ 05 6 4347 44 48 ↑ 04 4652 40 43 ↑ 03 7 4581 45 46 ↑ 01 4658 42 43 ↑ 01 8 4596 52 54 ↑ 02 228 48 46 ↓ 02 9 673 40 44 ↑ 04 614 49 48 ↓ 01 10 793 48 51 ↑ 03 621 45 45 00 11 1433 46 47 ↑ 01 1100 40 43 ↑ 03 12 1475 47 48 ↑ 01 1101 40 42 ↑ 02 13 1501 44 46 ↑ 02 1102 40 42 ↑ 02 14 1546 48 49 ↑ 01 1107 48 49 ↑ 01 15 1590 49 51 ↑ 02 1951 48 50 ↑ 02
BT-Before treatment. A.T – After treatment.
Group A (Hyperlipidaemia) : 12(79.92%) and 3(19.98%) patients were in the
range of 40-50 mg / dl and 50-60 mg / dl after treatment respectively.
Group B (Normolipidaemia) : 5(33.30%) and 10(66.60%) persons were in the range
of 30 - 40 mg / dl and 40-50 mg / dl before treatment respectively. All the 15 (100%)
persons were in the range of 40-50 mg/dl after treatment.
Results - 120
Effect of Arohana Snehapana on Samedarakta
Table No. 61 showing LDL levels in both groups before and after Arohana Snehapana.
(Normal Value 70 to 210 mg /dl)
Group A Group B BT AT BT AT
Sl. No. O. P. D.
NO. mg / dl
Changes Observed
O. P. D. NO. mg / dl
Changes Observed
1 3979 101 99 ↓ 02 4193 107 110 ↑ 03 2 3978 104 78 ↓ 26 4275 116 99 ↓ 17 3 4019 104 96 ↓ 08 4271 104 109 ↑ 05 4 4039 110 98 ↓ 12 4289 101 100 ↓ 01 5 4188 141 140 ↓ 01 4301 115 98 ↓ 17 6 4347 96 100 ↑ 04 4652 95 94 ↓ 01 7 4581 95 104 ↑ 09 4658 110 102 ↓ 08 8 4596 146 143 ↓ 03 228 95 94 ↓ 01 9 673 104 98 ↓ 06 614 91 91 00 10 793 87 87 00 621 126 114 ↓ 12 11 1433 104 102 ↓ 02 1100 113 113 00 12 1475 101 88 ↓ 13 1101 124 116 ↓ 08 13 1501 116 112 ↓ 04 1102 117 104 ↓ 13 14 1546 102 99 ↓ 03 1107 112 109 ↓ 03 15 1590 98 95 ↓ 03 1951 98 95 ↓ 03
BT-Before treatment. A.T – After treatment.
Group A (Hyperlipidaemia): 1(6.66%), 11(73.26%), 1(6.66%) and 2(13.32%)
patients were in the range of 70 - 90 mg / dl, 90 - 110 mg / dl,110 - 130 mg/dl and
130 – 150 mg/dl before treatment respectively. 3(19.98%), 9(59.94%), 1(6.66%) and
2(13.32%) patients were in the range of 70 - 90 mg / dl, 90 - 110 mg / dl,110 - 130
mg/dl and 130 – 150 mg/dl after treatment respectively.
Group B (Normolipidaemia): 8(53.28%) and 7(46.62%) persons were in the range
of 90 - 110 mg / dl and 110 - 130 mg/dl before treatment respectively.12(79.92%)
and 3(19.98%) persons were in the range of 90 - 110 mg / dl and 110 – 130 mg/dl
after treatment respectively.
Results - 121
Effect of Arohana Snehapana on Samedarakta
Table No. 62 showing VLDL levels in both groups before and after Arohana
Snehapana. (Normal Value 20 to 40 mg /dl)
Group A Group B BT AT BT AT
Sl. No. O. P. D.
NO. mg / dl
Changes Observed
O. P. D. NO. mg / dl
Changes Observed
1 3979 46 43 ↓ 03 4193 34 34 00 2 3978 48 34 ↓ 14 4275 27 27 00 3 4019 54 44 ↓ 10 4271 25 26 ↑ 01 4 4039 41 39 ↓ 02 4289 26 25 ↓ 01 5 4188 40.4 34.6 ↓ 5.8 4301 28 30 ↑ 02 6 4347 55 45 ↓ 10 4652 30 30 00 7 4581 54 42 ↓ 12 4658 32 30 ↓ 02 8 4596 49 46 ↓ 03 228 33 33 00 9 673 36 30 ↓ 06 614 34 33 ↓ 01 10 793 44 38 ↓ 06 621 29 28 ↓ 01 11 1433 43 41 ↓ 02 1100 25 22 ↓ 03 12 1475 46 41 ↓ 05 1101 25 24 ↓ 01 13 1501 44 44 00 1102 25 26 ↑ 01 14 1546 44 42 ↓ 02 1107 38 38 00 15 1590 42 39 ↓ 03 1951 33 33 00
BT-Before treatment. A.T – After treatment.
Group A (Hyperlipidaemia) : 1(6.66%), 11(73.26%) and 3(19.98%) patients were
in the range of 30 – 40 mg / dl, 40 – 50 mg / dl and 50 - 60 mg / dl before treatment
respectively. 1 (6.66%), 5 (33.30%) and 9 (59.94%) patients were in the range of
20-30mg/dl, 30 – 40 mg / dl and 40 – 50 mg / dl after treatment respectively.
Group B (Normolipidaemia): 9(59.94%) and 6(39.96%) persons were in the range
of 20-30mg/dl and 30 – 40 mg / dl before treatment respectively. 10(66.60%) and
5(33.30%) persons were in the range of 20-30 mg / dl and 30 – 40 mg / dl after
treatment respectively.
Results - 122
Effect of Arohana Snehapana on Samedarakta
Table No. 63.The weight and BMI of Group A before and after Arohana
Snehapana.
GROUP A (HYPERLIPIDAEMIA) Wt. in Kg BMI
Sl No. O. P. D. NO. BT AT Changes
Observed BT AT Changes Observed
1 3979 90 89 ↓ 01 29.12 28.8 ↓ 0.32 2 3978 72 70 ↓ 02 25.53 24.82 ↓ 0.71 3 4019 87 85 ↓ 02 26.85 26.23 ↓ 0.62 4 4039 80 79 ↓ 01 29.09 28.72 ↓ 0.37 5 4188 90 88 ↓ 02 28.06 27.78 ↓ 0.28 6 4347 93 91 ↓ 02 28.09 27.49 ↓ 0.6 7 4581 79 77 ↓ 02 27.33 213.32 ↓ 0.67 8 4596 78 76 ↓ 02 25.4 24.8 ↓ 0.6 9 673 75 72 ↓ 03 25 24.08 ↓ 0.92 10 793 73 71.5 ↓ 1.5 23.62 23.13 ↓ 0.49 11 1433 72 71 ↓ 01 26.86 26.49 ↓ 0.37 12 1475 68 66.5 ↓ 1.5 25.95 25.38 ↓ 0.57 13 1501 70 69 ↓ 01 24.56 24.21 ↓ 0.35 14 1546 69 69 00 25.34 25.34 00 15 1590 77 75 ↓ 02 25.75 25.08 ↓ 0.67
In the group A (Hyperlipidaemia) : 03 kg weight was reduced in 1(6.66%) patient,
2 kg weight was reduced in 7(46.62%) patients, 1.5 kg weight was reduced in
2(13.32%) patients, 1 kg weight was reduced in 4(26.64%) patients and no reduction
of weight was observed in 1(6.66%) patient after Arohana Snehapana. In all
15(100%) patients BMI was slightly reduced.
In the group B (Narmolipidaemia) : 2 kg weight was reduced in 4(26.64%) persons,
1.5 kg weight was reduced in 2(13.32%) persons, 1 kg weight was reduced in
7(46.62%) persons and no reduction of weight was observed in 2(13.32%) persons
after Arohana Snehapana. BMI was reduced in 13(86.58%) persons and no
reduction in BMI for 2 (13.32%) persons.
Results - 123
Effect of Arohana Snehapana on Samedarakta
Results - 124
Group A -
66%
27%
7%Group B 0%
0%
100%
0%
Increased abnormality
Decreased abnormality
Normal limit
Variable
Table No. 64 The weight and BMI of Group B before and after Arohana Snehapana.
GROUP B (NARMOLIPIDAEMIA) Wt. in Kg BMI
Sl No. O. P. D. NO BT AT Changes
Observed BT AT Changes Observed
1 4193 62 60 ↓ 02 24.52 23.37 ↓ 1.15 2 4275 72 70 ↓ 02 25.8 25.1 ↓ 0.7 3 4271 66 64 ↓ 02 23.95 23.23 ↓ 0.72 4 4289 75 74 ↓ 01 25.95 25.60 ↓ 0.35 5 4301 81 80.5 ↓ 1.5 25.02 25.00 ↓ 0.02 6 4652 60 59 ↓ 01 24.03 23.63 ↓ 0.4 7 4658 59 59 00 23.63 23.63 0 8 228 80 78.5 ↓ 1.5 24.96 24.80 ↓ 0.16 9 614 60 58 ↓ 02 24.03 23.00 ↓ 1.03 10 621 66 65 ↓ 01 22.88 22.49 ↓ 0.39 11 1100 55 54 ↓ 01 23.8 23.37 ↓ 0.43 12 1101 60 60 00 21.77 21.77 0 13 1102 55 54 ↓ 01 23.8 23.37 ↓ 0.43 14 1107 69 68 ↓ 01 25.86 25.48 ↓ 0.38 15 1951 70 69 ↓ 01 24.82 24.46 ↓ 0.36
Table No. 65 Showing the overall results of Serum Lipid Values
Group A Group B Results No. of
Patients Percentage No. of Patients Percentage
Increased abnormality 0 0 0 0 Decreased abnormality 10 66.60 0 0 Normal limit 4 26.64 15 100 Variable 1 6.66 0 0
Group A (Hyperlipidaemia): Out of 15 patients, 10(66.60%) patients had decreased
abnormality, 1(6.66%) had variable in the values and 4(26.64%) patients had all the
lipid values within the normal range.
Group B (Normolipidaemic): In all the 15 persons, even after Samyak Snigdha
Laxanas the changes in the Serum Lipid values were within the Normal limits only.
Effect of Arohana Snehapana on Samedarakta
STATISTICAL RESULTS OF OBJECTIVE PARAMETERS:
Table No. 66 showing statistical results of Group A samples
Parameters Mean S. D. S. E. t– value p-value Remarks
Sr. Cholestrol 5.6 4.968 1.282 4.368 <0.001 H. S. Sr. T. G. 28.73 19.579 5.055 5.683 <0.001 H. S. HDL 1.866 1.06 0.273 6.835 <0.001 H. S. LDL 6.4 6.674 1.723 3.714 <0.001 H. S. VLDL 5.586 4.153 1.072 5.21 <0.001 H. S.
Table No. 67 showing statistical results of Group B samples
Parameters Mean S. D. S. E. t– value p-value Remarks
Sr. Cholestrol 6.066 5.284 1.364 4.447 <0.001 H. S. Sr. T. G. 4.666 4.303 1.111 4.199 <0.001 H. S. HDL 1.666 1.345 0.347 4.801 <0.001 H. S. LDL 6.133 6.034 1.557 3.938 <0.001 H. S. VLDL 0.866 0.915 0.236 3.669 <0.001 H. S.
Table No. 68 showing comparative statistical results of Group A & Group B samples
Parameters Group Mean S. D. S. E. P. S. E. t-value p-value Remarks
A 193.46 22.04 5.691Sr. Cholestrol B 175.93 8.258 2.132 6.077 2.884 <0.02 H. S.
A 206.4 17.17 4.433Sr. T. G. B 146.26 21.861 5.644 7.176 8.38 <0.001 H. S.
A 48.0 2.699 0.696HDL B 44.86 2.875 0.742 1.017 3.087 <0.01 H. S.
A 102.6 17.646 4.556LDL B 103.2 8.16 2.107 5.019 0.119 <0.05 N. S.
A 40.173 4.493 1.16 VLDL B 29.26 4.382 1.131 1.62 6.736 <0.001 H. S.
Results - 125
Effect of Arohana Snehapana on Samedarakta
When we compare except the parameter LDL the other parameters shows
highly significant (By paired t-test as p is less than 0.05). In group A the parameter
HDL has uniform effect on patients with least variations. The mean effect of
parameters Sr. Triglycerides is more and the Sr. Cholesterol has more variation in
Group A.
In group B the parameter Sr. Cholesterol shows stable effect of patients with
high mean effect. The parameter HDL has minimum variation and with more
variation in parameter weight in group B after the treatment.
Individually in Group A : All the parameters shows highly significant effect.
Assume that Tilataila is not responsible for changes in readings of observation before
and after of the Treatment. For this we use unpaired t – test. The parameter weight is
more significant in group A with least variance and the mean net effect and variation
is more in Sr. Triglycerides. The parameter HDL. Sr. Triglycerides shows more
effect in Group A than Group B, where as the Sr. Cholesterol is little more effect of
parameter LDL and variation in Sr. Cholesterol is more in group B. The parameter
VLDL is having less variation in group B (comparable II & III).
Results - 126
Effect of Arohana Snehapana on Samedarakta
Discussion - 127
REVIEW OF LITERATURE:
Shodhana means Bio-purification. The therapy which eliminates the vitiated
doshas from the body is known as Shodhana.
Shodhana therapies while eliminates the vitiated doshas from the body,
enhances the agni, eradicatess the diseases and restores the normal health. Therefore
one should take proper Shodhana therapies in time. Shodhana enhances strength of
Buddhi, indriyas, stability to dhatus, enhancement of agni and delays the ageing
process.
In the treatment regimen the Shodhana therapies are the main procedures or
Pradhana Karma. They are preceded by certain preparative procedures known as
Purvakarmas. This Purvakarma includes Ama pachana, Snehana and Swedana.
Among these, Snehana therapy is intended for alleviation of vitiated doshas
hence called as Shodhananga snehana. Snehana elicited by Snehana, Vishyandana,
Mardavata, Kledana properties. These properties are the tools for producing Samyak
snigdha laxanas.
Meda means Sneha that is lipid in the body. The sthana and swaroopa of
meda is in two forms that is poshya and poshaka swaroopa. Poshaka meda is mobile
in nature and poshya meda immobile in nature.
Poshaka meda circulates in the whole body along with gatiyuakta rasa, rakta
dhatu for nourishing the poshya meda dhatu. According to modern science it can be
correlated with lipids which are present in the circulating blood. Poshya meda dhatu
is stored in Medodhara kala i.e., Udara, Spik, Sthana and Gala etc. According to
modern science it can be correlated with adipose tissue or fat present beneath the skin.
If any abnormality is present, Poshaka meda will leads to meda dushti which in turn
Effect of Arohana Snehapana on Samedarakta
Discussion - 128
leads to Medovriddhi in rasaraktadi dhatus i.e raised level of serum cholesterol and
serum triglycerides in the plasma of the blood.
In the present study the term Samedarakta is coined for Lipidaemia i.e., the
lipids present in the plasma of blood whether physiological or pathological. Here the
literal meaning of word Samedarakta has been taken as Sa=with, meda = fat, rakth =
blood i.e., the fat or lipid present in the blood in the normal condition or abnormal
condition is taken as Samedarakta.
The dangerous pathological state may develop due to the morbidity of
Medodathu as Medovyapath. This Medovyapath is an abnormality of dathuparinama.
In case of emergency of insufficient supply of nutrients to the body, the adipose tissue
is disintegrated to provide the requisite fuel leading to dhatuja medovyapat. This
condition is common in severe Obesity, Diabetes mellitus, Nephritic syndrome etc
Kapha and Meda are interlinked as Ashrayashrayibhavas. Hence vitiation of
Kapha leads to vitiation of Meda, this is because of samanadharamvriddhi. Vitiated
Kapha leads to many vikaras known as kaphaja nanatmaja vyadhis which are 20 in
numbers. Among them Dhamani pratichaya is one, it means thickening of the arteries
which is due to vitiation of Kapha.
After scanning the both Ayurvedic and modern literatures, we get many
conditions like Samedarakta, Meda, Medavriddhi, Medovyapat, Abadha medasa,
Sthoulya, Medoroga, Dhamani pratichaya and some conditions like Hyperlipidaemia,
Atherosclerosis and Obesity etc., In the above said all the conditions, fat or lipids are
invariably present. In Hyperlipidaemia, circulating lipids like LDL, TG, Cholesterol,
VLDL etc. are increased and which can be compared with Poshakameda dhatu that
conditions may be considered as Samedarakta.
Effect of Arohana Snehapana on Samedarakta
Discussion - 129
MATERIALS AND METHODS :
The materials selected for the clinical study were
i. Panchakolachoorna (as Amapachana)
ii. Murchita Tilataila (for Arohana Snehapana)
i. Panchakola Choorna
Importance of Ama pachana before snehana therapy : Amapachana is the
therapeutic regimen which is the treatment for further therapies like Snehapana on
which the success of entire treatment will depend. Amapachana treatment prior to
Snehapana, facilitates Snehapana to achieve better therapeutic results. Persons having
normal state of agni are also being given Amapanchana to prevent the complications
that may raise from Snehapana. This makes the need of Amapachana before
undergoing Snehana therapy.
In the present study, Panchakola choorna was selected as Amapachana drug
which checks the formation of Ama by increasing the Agni and digest the Ama. It is
indicated in Kapha vata disorders also.
ii. Snehapana with Murchita Tilataila:
Tilataila : Tilataila is best Snehadravya among sthavara sneha as explained by
Charaka. Taila is used widely for internal and external conditions. Taila is most
easily available fixed oil of herbal origin used extensively in the form of food and
medicines.
Acharya charaka mentioned that Tilataila is best amongst the taila vargas.
Taila alleviates vata but, at the same time does not aggravate kapha. From therapeutic
point of view the quality of taila is “Na Anyaha Snehastatha Kwachitsamskaram
Effect of Arohana Snehapana on Samedarakta
Discussion - 130
nuvartate” ie., when taila treated with other dugs it takes the property of that drugs
after samskara.
Vagbhata explains the importance of Tilataila as “Krishanam Bhrimhanayalam
Sthoolanam Karshanaya Cha”. It does Bhrimahana Karya for Krisha persons and
does Karshana for sthoola persons.
In Krusha persons, Srotosankochana is present (i.e., constriction of channels).
Taila when administered, by its Tikshna Vyavayadi gunas enters the
Sukshmatisukshma Srotases and accomplishes Shodhana karya. By Shrotoshuddhi,
shareera pusthi will occur. Hence in this manner it does “Tasmath Krishanam
Bhrimhanayalam mittupanam”.
In Sthoola persons, by its sukshma, teekshnoshna gunas it enters
Sukshmasrotases does kshapana karya for meda. Due to kshapana of meda, the
person becomes krisha.
Importance of murchana of tila taila:
Crude oils contains Amadosha i.e, some enzyme lipase and racine (toxic
proteins), by morchana process Amadosha are removed and also durgandhata &
ugrata are removed. After doing Moorchana Samskara Sneha gets good smell and
colour. Apart from theses Sneha will gets the qualities of the drugs used for
Murchana. While by Sneha paka and Murchana the veerya of the Sneha is enhanced.
Before going to prepare any Aushadha siddha yogas, Taila Murchana is
required. Murchana means to enhance, to spread over. By this process amadosha is
removed. Usually Tailas are ushna veerya in nature. When treated with drugs like
Amalaki, Haritaki, etc., in the qualities of tailas changes takes place. i.e., Taila attains
Sheeta veerya. If Gritha & Tailas are treated with Rooksha, Ushna, Sheeta Dravyas,
snehatwa property will not be lost.
Effect of Arohana Snehapana on Samedarakta
Discussion - 131
The drugs used for Murchana of Tilataila are Haritaki, Vibitaki, Amalaki,
Haridra, Mustha, Vatankura, Hrivera (Rasna), Ketaki pushpa, Manjistha, Lodra. With
their lekhaneeya property and also removes the Amadosh of Taila.
Beneficial effect of Moorchana sanskara reduces the degree of Saturation but
enhances the degree of Unsaturation. It indicates the essential role of unsaturated
fatty acids in reducing Serum Cholesterol, Serum Triglycerides and LDL levels which
are other wise risk factor for the development of Atherosclerosis, Hyper tension,
Coronary heart diseases etc. (Sneha Murchana B. S. Hiremath)
CLINICAL STUDY:
Selection of individuals: The individuals were incidentally selected from exclusively
conducted medical camp and OPD and IPD of D.G.M.A.M.C, Gadag. Method of
selection was incidental because samples cannot be randomized in short time and
medical camp was conducted to get number of cases.
The individuals of both sex who were fit for Snehana karma and Shodhana
karma in age group of 20- 60 years were selected.
Criteria for making two groups
For better understanding the effect of Shodhananga Arohana Snehapana on
Serum lipid levels, the subject made into two groups as follows.
Group – A : Shodhanapoorva Arohana Snehapana in Hyperlipidaemic patients was
debated and hence in Group A the patient suffering from Hyperlipidaemia were
selected. i.e. patients who were suffering from Primary Hyperilipidemia and whose
Serum lipids were in high levels excluding secondary Hyperilipidemia.
Effect of Arohana Snehapana on Samedarakta
Discussion - 132
Group B : Healthy persons were selected in Group B. Healthy persons with their
lipid values under normal limits and who are intended to under go Shodhana karma
(virechana or vamana) for maintaining good health were selected.
Hence two groups were considered to study the effect of Shodhanapoorva
Arohana Snehapana on serum lipid levels of Hyperlipidaemia patients and healthy
persons.
Inclusive criteria:
Group A : The patients of either sex between the age group of 20-60 years. Patients
suffering from Primary Hyperlipidaemia whose Serum Cholesterol or Serum
Triglycerides level were found to be higher than the normal and who were fit for
Shodhana and Snehana therapies were considered.
Group B : The healthy persons of either sex between the age group of 20-60 years
with Normal Lipid Values and who were fit for Shodhana and Snehana therapies were
considered.
Exclusive Criteria:
Group A: The patients who were unfit for Shodhana procedure were excluded. The
patients secondary Hyperilipidemia were excluded because of the improper
metabolism of the lipids, which can alters the serum lipid levels.
Group B: The persons who were unfit for Shodhana procedure were excluded.
Intervention:
• All the individuals were administered with Panchakola churna as Ama
Pachana ½ hour before food with hot water till appearance of nirama
lakshanas. Amapachana was given for minimum of 3 days and maximum of 5
Effect of Arohana Snehapana on Samedarakta
Discussion - 133
days. Some persons got burning sensation in the Chest after taking
Panchakola choorna. Hence dose was reduced according to the need.
• In this study shodhananga Arohana Snehapana was administered to 30
individuals in which 15 patients of Hyperlipidaemia and 15 healthy persons
were selected for the study.
First day Murchita Tilataila was given in the dose 30 ml to all the 30
individuals, which was considered as Hrasiyasi matra. On the basis of digestion of
the sneha on previous day, the next day dosage was decided. Though the Hrisiyasi
matra was equal to all the persons, Sneha Jeerna Laxanas were appeared in different
times. Because Prakruti, Kostha, Age group, Agnibala and Dosha are different in all
persons. Hence the digestion of Sneha had not appeared at same duration in all
persons.
Group A (Hyperlipidaemia) : On the first day the minimum time taken for
digestion was 165 and maximum was 240 minutes respectively. In this group second
day dose was minimum 55 ml. and maximum dose was 65 ml. with mean value of 60
ml. The third day dose was minimum 80 ml & maximum 100 ml. with mean value of
90 ml. Fourth day dose was minimum 105 ml & maximum 135 ml. with mean value
of 123 ml. Fifth day dose was 170 ml.
Group B (Normolipidaemic): On the first day the minimum time taken for digestion
was 155 and maximum was 270 minutes respectively. Second day dose was minimum
55 ml. and maximum dose was 70 ml. with mean value of 56 ml. The third day dose
was minimum 80 ml & maximum 110 ml. with mean value of 84 ml. Fourth day dose
was minimum 105 ml & maximum 135 ml. with mean value of 124 ml. Fifth day dose
was 190 ml.
Effect of Arohana Snehapana on Samedarakta
Discussion - 134
This suggest that the Samyak Snigdha Laxanas had not manifested at the same
time. This may be because of Taratama Bhava of Kostha, Agni, Prakruti among
persons. This clearly suggests that snehapana increased the agnibala on each day,
though there was individual variation. Hence it can be said that agnibala is an
important factor in deciding the dosage of sneha along with other factors. In classics
also the snehapana kala was told as 3-7 days.
Blood samples were collected on day 1st before Snehapana in the morning
hours and after Samyaksnigdha laxanas appeared i.e., after completion of snehapana
with 12 hours fasting in the morning. After this, necessary shodhana karmas was
performed followed by vishrama kala.
Study duration:
In the present study duration was 15 days and fallow up for 15days.The study
duration was fixed upon the following points.
1. Time taken for Amapachana (i.e., till niramavastha seen)
2. Time taken for Arohana Snehapana
In the fallow up, 3 days for vishramakala ,1 day for shodhana karma and
Samsarjana karma for remaining days.
Laboratory Investigation:
The selected patients were subjected to laboratory investigation to role out the
secondary Hyperilipidemia and other systemic disorders and to confirm positively
whether they belong to Hyperilipidemic and Normolipidaemic groups.
Drop outs:
Out of 36 patients 4 patients were discontinued during Snehapana because of
aversion for drinking Sneha, 2 patients were discontinued due to inconvenience for
taking treatment and follow up.
Effect of Arohana Snehapana on Samedarakta
Discussion - 135
OBSERVATIONS:
In the present study 30 cases of Samedarakta (15 Hyperlipidaemic & 15
Normal Lipidaemic) were selected for trial and categorized into 2 groups of 15 each.
Age :
Group A (Hyperlipidaemic): 13 (86.58%) patients were in between 30-50 years which
substantiate incidence of Hyperlipidaemia over the age of 30 years.
Group B (Narmolipidaemic): Most of the persons i.e. 7 (46.62%) healthy persons
belonged to the age group of 20-30 years (23.33%).
But it cannot be concluded by this fact by our study because of age restricted
selection criteria and limitations for number of subjects.
Sex :
Group A (Hyperlipidaemic): Among the 15 patients, 10 (66.60%) patients were male
which substantiate risk of Hyperlipidaemia occurrence in males.
Group B (Narmolipidaemic) : Among15 healthy persons,9 were female which shows
health consciousness in females.
Religions:
Maximum 86.58% persons each in the both Groups were Hindu, this may be
the representation of the total community distribution in Gadag and Surrounding areas
from where most of the persons come.
Occupation :
Group A (Hyperlipidaemic): Maximum 59.94% patients were sedentary, there energy
expenditure is less than calories consumed which may leads to become
Hyperlipidaemia.
Group B (Narmolipidaemic): Maximum 46.62% persons were Labour.
Effect of Arohana Snehapana on Samedarakta
Discussion - 136
Marital Status:
It was observed that as for as marital status is concerned, there was no relation
for martial status has been found concerned to the Hyperlipidaemia and normal lipid
values.
Socio – Economic status:
This study shows that most of the persons in both groups belongs to middle
class. As most of the persons comes to this college hospital belongs to middle class.
Diet :
Group A (Hyperlipidaemic): Maximum 10 (66.60%) patients had mixed diet. This
shows clear association for high calories diet in Hyperlipidaemia.
Group B (Narmolipidaemic): Most of the persons i.e. 9(59.94%) were vegetarian.
Sleep :
Group A (Hyperlipidaemic): Maximum numbers of patients reported to have sound
sleep (86.58%). On this basis we cannot draw any conclusion relating to sleep and
hyperlipidaemia.
Group B (Narmolipidaemic) : 86.58% persons are having sound sleep.
Vyasana :
Group A (Hyperlipidaemic): It was observed that 39.96% patients were not having
any habits. But 26.64% persons were addicted for smoking, 19.98% persons were
addicted for alcohol and 13.32% were addicted for tobacco chewing. In allied science
also smoking and alcohol are considered as risk factors. So in this study it was
Effect of Arohana Snehapana on Samedarakta
Discussion - 137
observed. Hence this shows the incidence of smoking and Alcohol as causative
factors for Hyperlipidaemia.
Group B (Narmolipidaemic) : 59.96% persons were not having any habits.
Koshta :
Group A (Hyperlipidaemic): Maximum 73.26% patients had Madhyama Kostha. In
normal condition, Madhyama Kostha found due to Kapha dominancy.
Group B (Normolipidaemic): Maximum 73.26% persons had Madhyama Kostha. In
normal condition, Madhyama Kostha found due to Kapha dominancy.
Prakriti :
Group A (Hyperlipidaemic): Maximum 73.26% patients were kapha pittaja, 19.98%
were Kaphvataja. In this group most of the patients were having kapha dominant
prakriti which is the most incidental factor for the disease Hyperlipidaemia.
Group B (Normolipidaemic): Maximum 66.60% persons were kapha pittaja.
Agni :
Assessment of agni was made on the abhyavarana shakti and Jaraha shekti
which relieved that majority of the person were Madhyama agni in both groups.
Majority of the persons were of Madhyama sara, Madhyama samhanana,
Madhyama pramana, Madhyama satmya, Madhyama satwa, Madhyama Abhyavarana
Shakti, Madhyama Jaranashakti, and Madhyama Jaranashakti in both the groups.
Effect of Arohana Snehapana on Samedarakta
Discussion - 138
SNEHAPANA LAXANAS:
PANAKALEENA LAXANAS:
Hrullasa : Out of 14 females,16.66% in group A and 30% in group B showed this
laxana and out 16 male patients 20% showed this laxana because of higher dose of
sneha and may be they are more sensitive by their nature.
Udgara : This laxana was observed in 21(70%) of the samples and it was observed till
jeerna of sneha.
JEERYAMANA LAXANAS:
Among these laxanas except Murcha, Daha and Arati, all other laxanas were
observed in the individuals.
Shiroruja was found in 25 individuals the mean time of onset of shiroruja was
middle stage of the digestion of the sneha. Other laxanas Brama in 6 (20%) samples
Lalasrava in 23 (76.66%), Trishna 15 (50%) and Klama in 18 (60%) samples were
found. These may be due to higher intake of sneha.
SNEHA JEERNA LAXANAS
The individuals showed most of the Jeerna laxanas indicating the digestion of
administered sneha.
Jeerymana laxanas prashamana - in 30 (100%)
Shareera laghuta - in 28 (93.33%)
Kshudha pravritti - in 27 (90%)
Trishna pravritti - in 14 (46.66%)
Udgara shuddi - in 26 (86.66%)
Effect of Arohana Snehapana on Samedarakta
Discussion - 139
SAMYAK SNIGDHA LAXANAS
Dosha Utkleshana is brought only by Shodhananga snehapana. It can be
assessed by observing samyak snigdha laxanas.
Vatanulamana : It was observed in 30 individuals (Both Groups) in all the
days of Snehapana. Sneha by virtue of its Snigdha, Sara properties normalizes
or brings balance in vitiated vata. By this Vatanulomana will occurs.
Deeptagni : In all the 30 persons(Both Groups) deeptagni was observed in all
the days. This is due to increased secretion of bile from cholesterol
destruction, as bile is an essential for the digestion of Sneha.
Asamhat varchas and snigdha varchas : These were observed in 27(90%)
persons and 30(100%) respectively of Group A and Group B . These laxanas
may be due to drava, sara, snigdha and mrudu guna of Sneha. Pureesh
becomes drava and snigdha and person may passes Asamhat and snigdha
varchas. This will indicates for stopping the continuation of Sneha pana which
is consider as one of the prime Samyak snigdha laxana.
Twak snigdhata : It was found in 8(53.28%) and 12(79.92%) persons in Group
A and Group B respectively. It occurs due to Sneha taken because each and
every cell of the body will be saturated with Sneha that is all the dhatus get
saturated gradually one by one and produces mruduta in skin.
Gatra laghvata : It was observed in 15(100%) and 13(86.58%) persons in
Group A and Group B. Snehapana removes obstruction in the gati of vata
which makes vatanulomana. Due to this person passes asamhat varchas.
Hence person may feels Gatra laghavata.
Snehodwega : It was observed in 14(93.24% ) and 13(86.58%) in Group A
and Group B. Due to large quantity of Sneha in the body will reaches optimum
Effect of Arohana Snehapana on Samedarakta
Discussion - 140
level i.e., body is fully staturated with excess dose of sneha. Hence individual
will showing dislike towards Snehapana. This is also one of the symptom of
Samyak snigdha laxanas.
Glani : it was found in 7(46.66%) and 6 (39.96%) in Group A and Group B,
it may due to restriction of diet regimen and due to properties of Sneha.
Person may feel exhausted or Glani on the last day of Snehapana.
All these are different parameters to assess proper Snigdhata of the body.
Effect of Arohana Snehapana on Samedarakta
Discussion - 141
RESULTS:
In both groups serum lipid profile was carried out and also weight and BMI
were taken before and after Shodhanaga Arohana Snehapana.
Total Serum cholesterol
Group A (Hyperlipidaemia): The statistical analysis was done at P value < 0.001
which shows highly significant effect on Serum Cholesterol level. 14(46.66%)
patients showed a significant reduction in cholesterol levels while only 1 (6.66%)
patient showed raised cholesterol.
Group B (Narmolipidaemic): The statistical analysis was done at P value < 0.001
which shows highly significant effect on Serum Cholesterol level. 13(86.58%)
persons showed a significant reduction in cholesterol levels while only 2 (13.32%)
persons showed raised cholesterol within normal limit only.
Serum Triglycerides
Group A (Hyperlipidaemia): The statistical analysis was done at P value < 0.001.
All patients showed highly significant results. i.e., marked reduction in the serum
Triglycerides levels.
Group B (Narmolipidaemic): The statistical analysis was done at P value < 0.001.
10 (66.60%) persons showed slight reduction in Triglyceride level, 3(19.98%) persons
showed increase in the Triglyceride within normal limit only and for two persons
there is no reduction in Triglyceride level.
Effect of Arohana Snehapana on Samedarakta
Discussion - 142
HDL
Group A (Hyperlipidaemia): The statistical analysis was done at P value < 0.001. All
patients showed highly significant values i.e., HDL level increased in all 15 (100%)
patients. This indicates the safety of Shodhanaga Arohana Snehapana with Murchita
Tilataila.
Group B (Narmolipidaemic): The statistical analysis was done at P value < 0.001.
10(66.60%) persons showed raise in the HDL, 3(19.98%) persons showed no
reduction and 2(13.32%) persons showed slight reduction, indicating the protective
action of Shodhanaga Arohana Snehapana.
LDL
Group A (Hyperlipidaemia): The statistical analysis was done at P value < 0.001. It
showed significant result. 12(79.92%) patients showed slight reduction in LDL
levels, 2(13.32%) patients showed slight increase and 1(6.66%) patient showed no
change. This decrease may be due to Murchana samsakar of Sneha.
Group B (Narmolipidaemic): The statistical analysis was done at P value < 0.001.
11 (73.26%) persons showed slight reduction, 2(13.32%) persons showed no
reduction and 1(6.66%) person showed slight increase in the LDL level.
VLDL
Group A (Hyperlipidaemia): The statistical analysis was done at P value < 0.001.
Almost all 14(93.24%) patients showed marked reduction in VLDL levels, 1(6.66%)
patients showed no change in the value this shows the significance of Snehapana.
Group B (Narmolipidaemic): The statistical analysis was done at P value <0.001.
6(39.96%) persons showed slight reduction and 6(39.96%) persons showed no
reduction and 3(19.98%) persons showed slight increase in the VLDL level within
normal limits only.
Effect of Arohana Snehapana on Samedarakta
Discussion - 143
Weight and BMI
Group A (Hyperlipidaemia): In this group 14(93.24%) patients showed 3 to 1 kg
reduction in Weight and BMI. It may be due to Chedhana, Karshana property of
Tilataila Snehapana.
Group B (Narmolipidaemic): 13 (86.58%) persons showed slight reduction in Weight
and BMI and 2(13.32%) persons showed no reduction in Weight and BMI.
On overall results:
The results shows that Snehapana with Murchita Tilataila was highly effective
in decreasing the abnormality of Serum Lipid Values at the same time it showed a
specific quality i.e, not increase (apart from normal limits) in the values of Serum
lipids of healthy persons even after undergoing Arohana Snehapana.
Effect of Arohana Snehapana on Samedarakta
LIMITATIONS:
Samples were selected incidentally.
Sample size is small to generalize the results
Serum lipid values were taken before and after Snehapana but not after the
Shodhanakarma.
RECOMMENDATION FOR FURTHER STUDY :
Further specific studies like Poorvakarma with Shodhana karma to know the
effect on serum lipid values (Hyperlipidaemia and Normal Lipid Values) can
be taken up. So that better understanding of Shodhanang snehapana on Serum
lipid values is possible.
Along with Moorchita Tilataila, other classical Sneha yogas can be studied
comparatively.
Effect of Bhrumhana Snehana and Shamana Snehana on serum lipid profile is
to be estimated.
Present study pattern can be continued in the form of prospective clinical
study with increased sample size.
Conclusion - 144
Effect of Arohana Snehapana on Samedarakta
CONCLUSION:
Shodhananga Arohana Snehapana plays a major role as a Poorva Karma to
Shodhana (Vamana Or Virechana) procedures.
Shodhananga Arohana Snehapana with Murchita Tilataila has a role in
Samedarakta by reducing the Serum Triglyceride and Serum Cholesterol and
in controlling the primary Hyperlipidaemia.
Literal meaning of word Samedarakta has been taken as Sa=with, meda = fat,
rakth = blood i.e., Rakta associated with Meda. The fat or lipid present in the
blood in the normal condition or abnormal condition is taken as Samedarakta.
Almost samples showed decrease in the total Cholesterol, LDL in both
groups. This shows significance of Shodhananga Arohana Snehapana.
Serum Triglyceride and VLDL values shows highly significant reduction in
Hyperlipidaemic group compared to Normolipidaemic group.
All Hyperlipidaemic samples showed rise in the HDL level and in
Normolipidaemic group most (67%) samples showed raise in HDL level
which indicates the protective role of the Shodhananga Arohana Snehapana.
After Arohana Snehapana in healthy persons the Serum Lipid Values were
within normal limits which shows the specificity of Murchita Tilataila.
Murchita Tilataila showed its effect in reducing weight & BMI through its
properties.
Conclusion - 145
Effect of Arohana Snehapana on Samedarakta
hT e present work entitled as “The study of Arohana (Shodhanaga) Snehapana
and its effects on Samedarakta with special reference to Hyperlipidaemia and Normal
Lipid Values”. is designed into 5 main parts namely Review of Literature, Clinical Study,
Discussion, Summary and Conclusion.
The first part mainly deals with the Introduction, Objectives of the study, Nirukti,
Paribhasha of Sneha, Sneha Gunas, Panchabhautikata, General Classification, methods of
Shodhananga Snehana, indications of Snehana, procedure of Snehapana, Sneha
karmukata etc.
Regarding disease review about the term Samedarakta and about Meda Utpatti,
Swarupa Medovaha srotas, functions of meda dhatu, pramana, Ashrayashrayee bhava of
Meda, moola of Medovaha srotas and also about literary review of Medovriddhi along
with Nidana, Roopa and Samprapti, Medhodhatu srotodusti are dealt and also modern
review of the correlation Hyperlipidaemia was dealt.
The drug selected for this study was Murchita Tilataila and details of its
ingredients used for Murchana have been mentioned with their properties. The
pharmacodynamics of Ama pachana drugs i.e. about Panchakola Choorna have been
dealt.
In the second part, Clinical study deals with Methodology, Criteria for selection
of Individuals, the details of grouping, Criteria for assessment, Observations presented in
tabular form along with graphs. Later the results obtained in two groups were shown
with statistical analysis.
The observations pertaining to the literary and clinical study are discussed to draw
the logical conclusions in the second part of the dissertation.
Summary - 146
Effect of Arohana Snehapana on Samedarakta
The brief summary of the results are as follows :
Among 30 individuals 15 patients were Hyperlipidaemic and 15 Volunteers were
Normo Lipidaemic. For all 30 patients Murchita Tilataila was given as Snehapana.
Group A (Hyperlipidaemic) : Maximum individuals were belonged to the age group of
30-50 years (53.30%), maximum (66.60%) persons were males, Hindu (86.58%),
Sedentary occupation (59.94%), Married (100%), Middle Class (73.26%),
Non – vegetarian (66.60%), Shamishra diet (53.28%), (86.58%) day workers, (66.60%)
were not doing exercise and also maximum persons were of Madhyama Jataragni
(79.92%), Madhyama Kostha (73.26%), Kaphapitta prakruti (73.26%), Madhyama Sara
(73.26%), Madhyam Samhanana (73.26%), Madhyama pramana (79.92%), Madhyama
Satmya (73.26%), Madhyama Satva (73.26%), Madhyama abhyavarana Shakti (79.92%),
Madhyama Jaranashakti (66.60%) & Vyayama Shakti (79.92%).
Group B (Narmolipidaemic) : Maximum individuals were belonged to the age group of
20-30 years (46.62%), maximum (59.94%) persons were females, Hindu (86.58%),
Labour occupation (46.62%), Married (73.26%), Middle Class (79.92%),Vegetarian
(59.94%), Shamishra diet (73.26%), (93.24%) day workers, (79.920%) were doing
exercise and also maximum persons were of Madhyama Jataragni (93.24%), Madhyama
Kostha (73.26%), Kaphapitta prakruti (66.60%), Madhyama Sara (73.26%), Madhyam
Samhanana (79.92%), Madhyama pramana (66.60%), Madhyama Satmya (59.94%),
Madhyama Satva (53.28%), Madhyama abhyavarana Shakti (73.26%), Madhyama
Jaranashakti (86.58%) & Vyayama Shakti (73.26%).
Summary - 147
Effect of Arohana Snehapana on Samedarakta
Except Murcha, Arati and Daha, remaining Jeeryamana laxashanas were
observed in both Groups. All the 30 persons were showed Samyak Snigdha Laxashanas.
♦ Effect on Group A(Hyperlipidaemic) : All parameters Serum Triglycerides,
Serum Cholesterol, LDL and VLDL showed highly significant results. All
patients showed increase in HDL value.
♦ Effect on Group B (Narmolipidaemic) : All parameters showed highly
significant and most of the persons showed rise in the HDL level.
♦ Comparison :
The parameter HDL, Serum Triglycerides and VLDL showed more effective in
Group A than Group B, where as the Serum Cholesterol was little more effective than
parameter LDL in Group A and variation in Serum Cholesterol was more in group B. The
parameter VLDL was had less variation in group B.
On the basis of results finally this study concluded that Arohana Snehapana with
Murchita Tilataila showed safety and protective action in both Hyperlipidaemia patients
as well as healthy persons. Suggesting the fact that Chikista advised in Ayurveda is more
comprehensive, rational and can be adopted in the modern times also without any
untoward effects.
Summary - 148
Effect of Arohana Snehapana on Samedarakta
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163. Agnivesha, Charaka samhita, Vimanasthana, Chapter 5. Shloka 7. Edited by Rajeshwaradatta Shastry, 4th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1994. p. 592.
164. Sushruta, Sushruta samhita, Shareerasthana, Chapter 9, Shloka 12. Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. p. 72.
165. Guyton and Hall, Text book of Medical Physiology. Lipid Metabolism and Digestion & Absorption. 10th edn. Harcourt Asia Pvt., Ltd.: A harshold publisher international company ; 2001. p. 756-758, 781 – 790.
166. William Ganonge, Review of Medical Physiology. Chapter 25. Lipid Metabolism. 16th edn. Apple ton and Lange Norwalk Connecticut ; p. 433- 434.
167. C. C. Chatarjee’s Humana physiology, Volume I . 11th edn. Calcutta: Medical allied agency; 2000. p. 552-553.
168. http://web.indstate.edu/thcme/mwking/cholesterol.html and http://www.elmhurst.edu/~chm/vchembook/622overview.html.
169. Ross and Wilson, Anatomy and Physiology in health and illness, Fat digestion. Edited by Kathleen J. W, Wilson OBE, Anne Waugh. 8th edn. Newyork : Churchill Livingstone ; 1996. p. 317.
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170. API text book of medicine, Section-V, Metabolism. Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India ; 1999. p. 190 -191.
171. William Ganonge, Review of Medical Physiology. Chapter 17. Energy balance, Metabolism and Nutrition. 16th edn. Apple ton and Lange Norwalk Connecticut; p.271-279.
172. Agnivesha, Charaka samhita, Sutrasthana, Chapter 21. Shloka 4. Edited by Rajeshwaradatta Shastry, 4th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1994. p. 278.
173. Sushruta, Sushruta samhita, Sutrasthana, Chapter 15, Shloka 37. Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. p. 62.
174. Madhavakara, Madhava Nidana, Chapter 34, Shloka 1. Edited by Sudarshana Shastry, 26nd edn. Varanasi: Choukambha Sanskrit Sansthan ; 1996. p. 28.
175. Bhavamishra, Bhavaprakasha, Chapter 39 , Shloka 1. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; p.405.
176. Yogaratnakara, Indradeva Tripathi, Medoroga Nidana, Shloka 1. 1st edn. Varanasi : Krishnadasa Academy ; 1998. p.541.
177. Agnivesha, Charaka samhita, Sutrasthana, Chapter 21. Shloka 4-9. Edited by Rajeshwaradatta Shastry, 4th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1994. p. 278-280.
178. Sushruta, Sushruta samhita, Sutrasthana, Chapter 15, Shloka 19. Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. p. 60.
179. Vagbhata, Astanga Hridaya, Sutrasthana, Chapter 11, Shloka 11. Edited by Kaviraj Atridev Gupta, 10th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1992. p. 86.
180. Madhavakara, Madhava Nidana, Chapter 34, Shloka 2-4. Edited by Sudarshana Shastry, 32nd edn. Varanasi: Choukambha Sanskrit Sansthan ; 2002. p. 28.
181. Bhavamishra, Bhavaprakasha, Chapter 39 , Shloka 3. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan; p.405.
182. Arunadatta, Astanga Hridaya, Sarvanga sundhari commentary, Chapter 14, Shloka 12-14. Edited by Priyavrat Sharma, 1st edn. Varanasi : Choukambha Orientalia ; 1978. p. 180.
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183. Vagbhata, Astanga Hridaya, Chikitshasthana, Chapter 11, Shloka 12-14. Edited by Kaviraj Atridev Gupta, 10th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1992. p. 395.
184. Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of International Medicine, volume II. Chapter 341. Disorders of Intermediary Metabolism. 14th edn. New York. : Mc Graw Hill Companies 1998. p. 2138-2144.
185. API text book of medicine, Disorders of Lipid Metabolism. Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India ; 1999. p. 191 -195.
186. Davidson’s Principles and Practice of Medicine. Nutrition, Metabolism and environmental diseases. Chapter10. Edited by CRW Edwards. 19th edn. London : Churchil Livngstone Publications ; 2002 p. 308-311.
187. The Antiseptic Journal, Amara k Uxa, Pranesh Nigam. Hyperlipidaemia-recent advances in management. November 2000 Vol 97.No 11.P.410.
188. West / Todd / Manson / Van Bruggen, Text book of Biochemistry, pp.991
189. Sharangadhara, Sharangadhara Samhita, Madyama Khanda, Chapter 6, Shloka 13-14, Edited by Dr. Smt. Shailaja Srivatsava, 3rd edn. Varanasi : Choukambha Orientalia ; 2003. p.275.
190. Bhaishajyaratnavali, Chapter 5, Shloka 1286-1287. Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002 p.130-131.
191. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 16th edn. Varanasi : Choukambha Bharati Academy ; 1995. P.275-278.
192. Ibid, p335-336
193. Ibid, p359-361
194. Ibid, p331-335
195. Ibid, p800-804
196. Ibid, p753-758
197. Ibid, p 239-241
198. Ibid, p758-760
199. Ibid, p 370-372
200. Ibid, p 162-165
Bibliography - 163
Effect of Arohana Snehapana on Samedarakta
201. Ibid, p 616-617
202. Ibid, p 664-666
203. Ibid, p 141-143
204. Ibid, p 39-41
205. Bhavamishra,Bhavaprakasha Nighantu. Edited by G.S. Pande. , 6th edn. Varanasi : Choukambha Bharati Academy ; 1982. p.266-267.
206. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 16th edn. Varanasi : Choukambha Bharati Academy ; 1995. P. 120-123.
207. Kokate CK, Purohit AP, Gokhale SB, Pharmocognocy. 1st edn. Pune : Publisher Dinesh Furia Niroli prakashana ; 1990. p. 242-243.
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DEPARTMENT OF POST GRADUTE STUDIES IN PANCHAKARMA D.G.M.C. GADAG.
SPECIAL CASE SHEAT PROFORMA FOR “ THE STUDY OF AROHANA SNHEHAPANA AND ITS EFFECT ON SAMEDARAKTA WITH SPECIAL
REFERANCE TO HYPERLIPIDAEMIA AND NORMAL LIPID VALUES.”
GUIDE : DR. P. SHIVARAMUDU. DR. VARSHA.S.KULKARNI. M.D. (AYU) M.D.SCHOLAR CO-GUIDE : DR. S.H.DODDAMANI. M.D. (AYU) 1. Name of the patient : 2. Father’/Husband’ Name : 3. Age : Sl. No. : 4. Sex : O.P.D. No. : Male Female 5. Religion : I.P.D. No. : Hindu Muslim Christen Others
6. Education : D O.A : D.O.D : M UM 7. Marital Status : 8. Occupation :
Labour Student Executive Sedentary
9. Economic status :
Poor Middle Cl High Cl
10. Address : Ph. No. : Mail I.D : PIN
A Hyperlipidaemic B Narmolipidaemic
10. Group : Increased
abnormality Decreased
abnormality Normal Limits Variable
11. Result :
CONSENT
I am fully educated with the disease and treatment there by I got satisfied whole heartedly. I accept for the medicinal trial over me.
Investigator signature Patient’s signature
1) PRADHANA VEDANA (MAIN COMPLAINTS):
Laxanas Before Treatment After Treatment
Chala Spik, Sthana, Udara Krichravyavayata Dourbalya Dourghandhyata Swedadhikyata
2) ANUBHANDHI VEDANA (ASSOCIATED COMPLAINTS) :
Lakshanas P/A Duration Atikshudha Atipipasa Atinidra Gadgadhatwa Javoparodha Soukumarata Krathana Ayurhasa
3. POORVA VYADHI VRUTTANTA (PAST HISTORY) : 4. KULA VRUTTANTA ( FAMILY HISTORY) : Father Husband / Wife Mother Children Brother Sister If anybody in the family suffering from
Hyperlipidaemia Hypertension
5. VAYAKTIK VRUTTANTA ( PERSONAL HISTORY) :
A) AHARA
AHARA Alpa Sama Atipramana
FOOD Veg Mixed
DOMINANT RASA IN DIET Madhu Amla Lavan Katu Tikta Kashaya GUNA Snigda Sheeta Guru Ushna DIETIC HABIT Samashana Vishamashana Adhyashana OTHER
B) VIHARA NATURE OF WORK Manual Sedentory Labour Travelling Day Night
Sleep time Sound Disturbed Day / Night SLEEP
VYAYAMA No Occasionally Every Day C) VYASANA
Alcohol Smoking Tobacco Chewing Any other
Quantity Quantity Quantity Quantity
VYASANA Duration Duration Duration Duration
D) JATARAGNI Jataragni Mandagni Teekhanagni Vishamagni
E) RUTUSHRAVA VRUTTANTA
Rutushrava vruttanta Prasootika Vruttanta
Issues Abortion Operation Age of menarche Menapause
Artava pravrithi
If the patient female
Day Sama Alpa Adhik
6) ASTHASTHANA PAREEKSHA:
Nadi ( Pulse) Shabda Mootra Jihwa Mala Drik Akruti Sparash (Temp)
7. SAMANYA PAREEKSHA: B.P. R.Rate H.Rate Height
Before Treatment After Treatment Weight
Body mass index = Weight in Kg . Height in meter2
8. a) DASHAVIDHA PAREEKSHA:
Shareerik V P K VP PK KV Sama Prakruti Manasika S R T SR ST TR Sama Sarataha Pravara Madhyama Avara Samhananataha Pravara Madhyama Avara Pramanataha Pravara Madhyama Avara Satmyataha Pravara Madhyama Avara Satwataha Pravara Madhyama Avara Ahara Shakti Abhyavaharana
Pravara Madhyama Avara
Shakti Jeerana Shakti
Pravara Madhyama Avara
Vyayama Shakti Pravara Madhyama Avara Vayataha Bala Madhyama Vriddha Vikrutitaha VIKRUTITAHA PAREEKSHA. * Nidana ------- * Roopa -------- b) SYSTEMIC EXAMINATION * Gastro-intestinal System ------- * Respiratory System ------ * Cardio Vascular System ------
* Nervous System ------
9. LABORATORY INVESTIGATION:
a. SPECIAL INVESTIGATIONS
Serum Lipid Profile Pre Test Post Test Changes Observed
1. Serum Cholesterol mg/dl mg/dl mg/dl 2. Triglycerides mg/dl mg/dl mg/dl 3. HDL mg/dl mg/dl mg/dl 4. LDL mg/dl mg/dl mg/dl 5. VLDL mg/dl mg/dl mg/dl
b. OTHER INVESTIGATIONS
HB % TC DC ESR FBS RBS Urine (R) Alb Sug Micr
10. CHIKITSA PATRIKA :
AMAPACHANA -------- Amapachana by 3-6gm Panchakola choorna before food with hot water till Niramavasta seen (3-7 days)
SNEHAPANA
Sneha used ------- Murchita Tilataila Anupana -------- Ushnajala
PRADHANA KARMA
Day/Date I II III IV V VI VII Sneha matra Pana kala (time of sneha administration)
Agnipradurbhava kala Total time taken for Sneha Jeerna
• OBSERVATION OF JEERYMANA LAXANAS Laxanas I Time II Time III Time IV Time V Time VI Time VII Time
Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati
• SNEHA JEERNA LAXANAS
Laxanas I Time II Time III Time IV Time V Time VI Time VII Time
Jeeryamana lakshana Prashama
Shareera Laghuta Kshudha pravrutti Trishna Pravrutti Udgara Shuddhi Anya
• OBSERVATION OF SAMYAK SNIDHA LAXANAS
Laxanas I Time II Time III Time IV Time V Time VI Time VII Time Vatanulomana Agnideepti Purish snigdhata Asamahata varchas Twak snigdhata Anga laghavata Gatra mardhavata Snehodwega Klama Shaithilya
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/ Grahani
Dosha/ Staimitya/ Vakyanigraha/ Shula/ Ama Pradosha.
• DAILY DIET CHART DURING SNEHAPANA
Day Anna Kala Kind of (Anna) Food I II III IV V VI VII
Advised for follow up treatment: 1. Vishram kala (Abhyanga & Sweda) : 2. Shodhana karma : Signature of Co - Guide Signature of Guide
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