Snehana or Oleation therapy in Ayurveda

It is a type of Poorva karma(pre operative) procedures in Panchakarma.Snehana stands for lubrication of  the body systems by the administration of fatty substances internally or externally.Internal administration of Sneha/oil is called Snehapanam.It is an important preparatory procedure for Panchakarma.
Mainly four types of Snehana dravyas.medicines are used for this purpose.they are Ghritha (Ghee), Taila (Oil),Vasa (Fat) and Majja (bone marrow). Out of these Ghritha is considered as the best.

Snehana types:

• Abhyanthara Snehana (Internal oleation)
• Bahya Snehana (External oleation)

Abhyanthara Sneha/Snehapanam (internal oleation):

it is again classified in to Achapana and Vicharana Snehapana.
Achapana Snehapana is the oral intake of medicated or non medicated Sneha (ghee/oil) without mixing with food or other medicinal preparations and used for the purpose of softening and lubricating the body tissues prior to the Sodhana therapy or Panchakarma.
Vicharana Snehapana is the intake of oil along with other food items or with some Ayurveda medicines as a divided quantity.
Internally it can also be given as through rectal route like Vasthi,through nasal route like Nasya karma.

Bahya Sneha (External oleation):

Externally sneha dravya are used in the following forms of treatments like:

• Gargles (oily) oil pulling,etc
• Head massage (Siro Abyangam)
• Oil massage (Abhyangam)
• Lepa (external application, etc..

Classification of Snehana:

From combination point of view:

1. Yamala Sneha: combination of any two varieties of fat substances.eg: Sarpi (Ghee) + Taila (oil).
2. Trivrit Sneha: combination of any three varieties of fatty substances. eg: sarpi+ Taila+ Vasa.
3. Maha Sneha: combination of all the three.Eg: Sarp+Taila+Vasa+Majja.

From therapeutic point of view:

depending on the therapeutic effect it can be divided into three:

1. Brhimhana Sneha: Sneha given with little amount of food or drink for nourishment purpose. Eg: Sarpi (10ml)+ milk (100ml).
2. Shamana sneha: given with processed drugs in moderate dosage for the purpose for treating small to moderate deranged doshic conditions.In these various medicated ghrithas or tailas are given in various diseases.Eg: Pancha thikthaka gritha in warm water.,ksheerabala.
3. Shodhana Sneha: Medicated sneha when given orally in the full therapeutic dose to cause vamana,etc. Eg:use of eranda taila,Sneha given under poorva karma for shodhana procedure is also known as Shodhana sneha.

On mode of administration:

1. Achapeya: Administering orally the pure sneha without adding anything in large dose.
2. Sadya sneha:is a rapid actilng sneha generally given with addition of Lavana.it causes Snehana within 3 days.
3. Pancha prasrutiki peya:100gm each of ghee,taila,vasa,majja and rice are combined together and cooked into peya(rice soup) form and given orally.it cause snehana in 2 to 3 days.

On the basis of paka:

1. Mridu Paka:In this Sneha prepared with minimum frying and subjected to Mridu paka. It is specially used in Nasya procedures.
2. Madhyama paka: Moderate frying used for internal and external purpose.
3. Kharapaka:sneha is obtained by subjecting to maximum frying.used only for external application.

On the basis of Maatra(dose):

1. Hrasiyasi matra (digest in minutes): oral administration of sneha for seven days almost,starting from the smallest amount,gradually increasing day by day.it is a test dose.
2. Hrasva matra: (digest in 6 hours): given in small amounts only.
3. Madhyama matra (digest in 12 hours): medium dose given orally for therapeutic benefits.
4. Uttama matra: (digest in 24 hours): big dose.

Attributes(qualities) of Sneha dravya/medicine:

The effect of the fatty substances on the body is mainly based on some qualities.they are

1. Snigdha guna: greasy or oil like character.which helps to decrease VATA DOSHA and increase the quality of kapha.thereby promotes softness of the body,colour,complexion,etc.
2. Guru guna: indicates heavy character.act a VATA HARA,pushti kara(nourishing) and as an anabolic agent.
3. Sita Guna:give cooling effects to the body,pacify thirsty feeling,burning sensation etc.helps to constrict and contract the body organs thereby imparts firmness and stability of the body.
4. Mridu guna:give softness to body channels/srothas.
5. Drava guna: liquid nature.spread quickly and bring moistening effect.
6. Pichila guna: cause slimness to the body.thereby helps in the integrity,firmness of the body parts etc.cause kapha dosha increase.
7. Sara guna:
8. Manda guna:cause sluggishness of activity of sneha dravya.
9. Sukshma guna: this penetrating character of sneha is responsible for quick action.

Seasonal prescription of Sneha dravya:

1. Sharat hritu (Autumn): since PITTA DOSHA is aggravated in this season ghee should be given as it is good pitta samana.
2. Grishma hritu (Summer): VASA  and MAJJA are suitable.because of excessive depletion due to heat takes place.
3. VARSHA, SARAT, and HEMANTHA: VASA and MAJJA are suitable.
4. Pravrit hritu: TILA TAILA is suitable.because in these season VATA dosha is dominent so tila taila is vatahara in nature

Sneha yogya Purusha or General indications for Sneha Therapy: 

Sneha chikitsa in generally is recommended for the following:

• For those who are given to be swedana or shodhana therapies like Vamana,Virechana etc.
• For those who are Rukshana (roughness in the skin).
• Vatavyadhi (vata aggravated) patients.
• For,those who indulge in physical exercises(more).
• Who drinks more and indulge in excess sex,etc.
• Persons of mental stress (Chintaka).
• Aged persons.etc

Sneha Ayogya Purusha or Contra Indications:

 Sneha chikitsa is generally contra indicated in the following:

• Who are fit for the rukshana type of treatment(opposite to sneha therapy),except for the purpose of samshodhana therapy.
• To those in whom Kapha and Medas are aggravated.
• To those who are having mandagni (weak digetion).
• Trishna piditha, murchita, Gharbhini stree(pregnant lady).
• Who are annedweshi (aversion for the food).
• Suffering from Chardi (vomiting).
• suffering from digestive disorders.
• gara visha piditha (poisoned),weak,emaciated.
• Sneha dveshi (who dislikes sneha), etc.

to such persons to such conditions ,sneha should not be given,if administered it may causes sever diseases.

 SNEHAPANA IN AYURVEDA TREATMENTS

Internal administration of Sneha or fat materials in the body is called Sneha panam/ Abhyantara Sneha.It is again classified into two Achapana Sneha and Vicharana Sneha.This type of snehana mainly used prior to the shodhana therapy as preparatory procedure and also to prepare the body and other morbid doshas to purification therapy. By doing so our body will be softened etc.
Before doing all these procedures one should understand patients condition like age,disease condition,season, digestive capacity etc. And also have some pre and post operative procedures before and after this Snehana therapy.

Pre-Sneha measures/poorva karma/preparatory measures:

One day before the actual administration of snehapana(internally),the concerned individual should be given food in the moderate quantity. The food should be liquid, hot and anabhishyandi(free from stickyness,etc),that does not cause avarodha/obstruction to the channel of circulation(srothas).

The food should be Drava(liquid), ushna (hot), pramana (proper quantity),not snigdha(excess),Asamkirna (Avirudha veerya) and one should not consume food quickly or slowly.Food should be taken calmly (without talking,should not laugh while taking food,and one should take the food, which is favorable and conductive to his body constitution(saatmyahara).

Materials Required:

Before initiating the snehapana always check the all emergency and routine things.because in an emergency situation some times it may not poosible to get the required drugs,etc.Further all anupana dravya like ushna jala/hot water,yusha etc.should be kept ready.

since snehapana in certain individual may cause some complaints,especially such drugs which control these effects should be kept ready.(if required).

materials required

some of the complaints are:

Agnimandya (indigetion)-Hinguvachadi vati,chitrakadi vati.

Arochaka (anorexia) -Ashtachurna,etc

Sula (pain)- Shanka basma,etc

Bhrama (giddiness)-Pravala pishti,etc

Murcha -Kamadugdha ras,etc.

and medicines required for vamana and virechana.

• Medicated Ghee or oil according to the requirement.
• Measuring glass.
• Hot water drinking.(boiled with Shundi+ Dhanyaka).

Medicines commonly used:

• indukantham ghritham
• Gulgulu thikthakam ghritham.
• Mahatikthakam ghritham.
• Sukumara ghritham.
• Ksheera bala tailam.
• Dhanwantaram tailam,etc.

Man Power:

• Ayurvedic Physician: 1
• Attendant/ Nurse: 1

Dosage of Snehapana:

Four types of Snehapana dosage schedules  are indicated-

1. Pravara Matra-Sneha digest in 24 hrs.
2. Madhyama Matra- Sneha digest in 12 hours.
3. Avara Matra - digest in 6hrs.
4. Hrasiyasi Matra with arohana krama-digest in minutes

These to be fixed,keeping in view the various factors like state of agni, clinical condition, Prakruti of patient,etc.and aim of snehapana.
Minimum dosage for snehapana is approximately 50ml,this can be increased gradually by 25 or 30ml every day for 3,5,and 7 days desired by the physician.

Procedure of Snehapana:

Agnibala (digestive power) may be assessed in the patient prior to Snehapana,so as to assess the dose of sneha dravya(unctous substances).For the patients with unknown doshas,agni,etc one may start with Hrasiyasi Matra (which digest in 2 yamas).

The patient who is intended to under go snehapana is to take sneha in the early morning (within 15mts of sunrise) in the prescribed dose based on his Agnibala,nature of the diseases,condition of the body,etc.The usual dosage is between 50 to 75mlof ghritha and 30 to 50ml for Taila on the first day.The dose for the next day should be fixed after assessing the time taken for digetion. Hot water boiled with piece of sundi (dry ginger) + Dhanyaka (dry coriander seeds)is given in small doses toenhance the digetion.

Snehapana (internal administration of unctuous substances) may be continued till Samyak snigdha lakshana (symptoms of disired effects) are observed and usually it is obtained within 3 to 7 days.

Step-wise procedure:

1. instructed to offer prayer to the god (according to one's faith).
2. Patient should be assured about the safety of treatment and confidence and courage levels should be raised.
3. selected Sneha should be heated to Luke warm water.
4. In Vata vyadhi- ghee mixed with little saindhava (rock salt), in Pitta diseases- pure ghritha should be used, in kapha diseases-powders of pippali,shundi,and maricha should be mixed before giving orally.
5. medicine should be given in early hours of morning at the time of sunrise in an empty stomach.(after patient completes daily routines like brushing,evacuation etc.
6. Patient asked to sit comfortably on a knee high chair.
7. The patient asked to drink the sneha.If the patient has some aversion to consume,he should be asked to close his eyes and nostrils and to drink (to avoid smell and appearance).
8. Hot liquids should be given as anupana.If required hot water should be taken repeatedly up to six hours of snehapana,especially when large dose is taken.

Usual practice of increasing order of snehapana dosage:

First day :          50ml.

Second Day :    100ml

Third day:         150ml

Fourth Day :      200ml

Up to 7th day :  350ml.

When to terminate the course of Snehapana:

The standered procedure of snehapana and pathya should be continued with gradual increase of Sneha (as described) for a maximum period of 7 days. During the treatment, every day the patient's condition should be assessed to "note the effect of snehapana".
This procedure of snehapana should be stopped on the day the patient/person develops the Samyak Jirna Lakshana.
The time of feeling of hunger and appearance of the Sneha (Fat) in the stools, are the correct indicators samyak snigdha hence further Sneha pana should be terminated.
If any adverse effects of Atisnigdha or Asnigdha occurs suitable treatment should be given.

Observation of Jeerna Lakshana:

After the intake of Sneha on first day as well as in the rest of days of treatment, the patient/person is likely to experience certain symptoms,which indicate the jeerna or ajeerna of consumed sneha.Hence observation is essential for continuing further treatment,because in certain instances, it may not be proper to continue.

Symptoms indicative of progression of digestion (Sneha Pachyamana Lakshana)Ref A.S.Su:

• Shirorug (head ache).
• Bhrama (giddiness).
• Nishti (Excess-salivation).
• Murcha (Fainting)
• Sada (Tiredness)
• Klama (feeling of tiredness even during rest).
• Trsna (Thirsty feeling)
• Daha (burning sensations) and
• Arati (Restlessness).

Symptoms indicative of complete digestion (Samyak jirna Lakshanas):

• Disappearance of all symptoms stated under pachyamana.
• Laghuta (Feeling of lightness in the body).
• Vatanulomana (Proper passage of the flatus).
• Kshut (appearance of proper hunger).
• Trshna (Proper thirst).
• Udgara shudhi (Clear erection with out any taste, odor,etc.).

After Snehapana:

After snehapana is considered as completed,after matching with symptoms of proper Snehana the individual should be subjected to abhyanga and swedana from the very next day as per the planned Panchakarma treatment by the concerned physician.

Paschat Karma(pathyapathya)/post operative regimen during Snehapana:

During Snehapana treatment one should use hot water, observe bhramhacharya (celibacy), should not sleep during day time or suppress urge like urine (mutra),etc.

He should avoid physical exercise, loud talking,anger,anxiety,cold,wind,sun,etc.These measures should be continued some more time even after the completion of snehapana. If one indulges in wrong regimen during the course of snehapana, is likely to suffer from serious upadravas (complications).

Take rice gruel after feeling hungry (when consumed sneha is digested).

Indications of Snehapana:

• Swedya, Samshodya (Persons eligible for sudation and bio cleansing procedures).
• Ruksha Sarira (Roughness in the body).
• Nithyamadya (Alcoholic).
• Krisha (emaciated).
• Timira (Premature cataract).
•  Vata roga (Neuromuscular disorders).
• Kasa (cough)
• Swasa (dyspnoea)
• Hikka (Hiccough).
• Swarabheda (Hoarseness of noise), etc.

Contra indications of Snehapana:

• Sthoola (Obese).
• Kaphaja Vikaras (Kapha disorders)
• Atisara (Diarrhoea)
• Raktapitta (Bleeding disorders).

Complications and managements:

• Indigestion.
• Vomiting.
• Nausea.
• Anorexia.
• Headache.
• Constipation.etc.

In such conditions Snehapana should be discontinued and fasting ,Deepana (Stomachic), Pachana (Digestive),drugs may be given based on the patients condition.

Benefits and Observations:

Oleation pacifies Vata,lubricates and softens the doshas.It improve digestion,regularizes bowels,improves the strength and complexion and prevents premature aging,etc.

ABHYANGA or Oil MASSAGE THERAPY

Abyangam

Abhynga is type of oleation therapy used in Ayurveda.Abhyanga can be defined as the procedure of application of Sneha Dravya/medicine over the body with mild pressure.The word abhyanga is derived from terms "abhi" and "anga". Thus it is a treatment comprised of Taila/ ghritha/ vasa etc, are rubbed over the body in directions comfortable to the patient.It improves strength and alleviate Vata.It is a type of bahya Sneha. It can be performed as therapeutic procedure as well as preventive procedure.Abhyanga can be done as part of the steps of panchakarma therapy, especially in the first stage: Purva Karma (pre-treatment), or as its own therapy. It is often followed by swedana therapy, a warm bath, yoga or laying out in the sun. Many times abhyanga is performed by two or more massage therapists working in sync but it can also be done by oneself. Oils used can vary depending on the season and the individuals constitution (dosha) It is mainly used an Vata aggravated diseases because oil has the effect reducing vata.In Ayurveda it also mentioned as a daily regimen.In Kerala it is largely used as therapeutic as well rejuvenativ and also as seasonal therapy.

Indications:

• Neuromuscular diseases like- Pakshaghata (Hemiplegia), Shaishaveerya vata (Poliomyelitis), Pangu (Paraplegia),Kateegraha (low back ache),grdhrasi (Sciatica),etc.
• Rheumatological problems -Arthrits, Lumbago, etc
• Vridhavastha - In old age disorders
• Shira shoola- Head ache
• Angamarda - Bodyache.
• Rejuvenation Therapy,etc.

Contra-indications:

• Navajwara (Acute Fever).
• Ajeerna (Indigetion).
• Rakthapitta (Hemmorrhagic disorders)
• Atisara (Diarrhoea)
• Immediately after Panchakarma,etc.

Actions:

• It provides smoothness and improves luster of the skin.
• It take care of body ehaustion.
• It controls Vata (Neurological diseases)
• It improves vision.
• It induces sound sleep.
• It strengthens the body and gives longevity.
• it improves (mainly head massage)will improve the memmory power,concentration.
• prevent premature haor fall,and whitening.etc.

The abhyanga with oils provides stimulation to the nerves.It improves the sensory and motor integration.It also gives passive exercises to the muscles thereby strengthening them.The gentle pressure used during massages relaxes the muscles.It also removes skin dryness and improve skin luster.

Procedure of Abhyangam:

Materials Required:

• Abhyanga table  - 1
• Medicated Oil    - 100 to 200ml.
• Vessel                 - 300 ml capacity
• Tissue Paper/ soft towel.
• Green gram powder/ Medicated Snana Churna/ Medicated soap.

Medicated oil Commonly Used:

abyanga table,

• Masha Taila
• Bala Taila
• Narayana Taila
• Dhanwantaram Tilam
• Karpasasthyadi Taila
• Sahacharadi Taila, etc.

Man Power:

1. Ayurveda Physician - 1
2. Masseur                  - 2

Poorva Karma or Pre operative Procedure:

Before starting the procedure ask the patient to evacuate bowel and bladder. The patient is made to sit on the Ahyanga table with leg extended.

Prdhana karma or Main procedure:

After sitting in a comfortable posture with leg extended, the oil is to be heated to optimum comfortable temperature and applied over the head,ears and soles of feet.Then the oil should be applied uniformly with mild pressure over the body by the two masseurs standing on both sides of the table.Massage is to be started from scalp,head and move down to neck,upper back,shoulders,upper arms,for arms,hands and then chest,abdomen,low back and lower limbs.

Abyanga should be done in siting,supine,right lateral and left lateral positions and prone position.At the end of the procedure the oil on the body is wiped off with tissue paper or towels.

Duration of the procedure:

This always depends upon the condition of the patient and severity of the diseases.In general

up to 30 - 40 minutes.

Post operative Procedure:  

Patient should take complete rest for half to one hour in a comfortable manner. Bath can be taken with hot water and medicated powder (Snana Churna) or soup may be used to remove the oil and to clean the body.Light semi solid digestible diet may be advised after bath.

By Dr:Rimin Razak

ref: Ayurveda panchakarma,