Introduction

Everything in this world is the expression of guna. Sneham is an essential component of human being. The complete health what we call as swastha is nothing but the combination of three gunas, i.e. sheetam, snigdham and agneyam. Hemanta and sisheera ritu are sheeta,snigdha and agneyam. They are called ritu uttama because the body is snigdha and at the same time the agni is functioning properly.

Ojas the basis of life is also sheeta,snigdha and agneyam. Ghritam is also sheeta,snigdham but agnivardhanam. Hence snigdha guna is the essential most part of body.

Susruta called body as a sneha sara due to the following reasons.

Snehasro ayam purisha pranashcha snehabuyishtha…..
         Su.chi.31/

• Dhātu: Among the seven dhatus all the dhatus except asthi have the sneha guna. Rasa, rakta, māmsa, meda, majja, śukra dhatus are sneha yukta
• Upadhātu: Among the Upadhatus vasa, stanya artavam are also snehayukta
• Mala: Purīşa, mūtra  and swedam are also snehayukta.

Moreover in the srushti,

‘Sukra sonitam garbhashayastham atma prakriti vikara sammurcchitam….’

The sukram and sonitham also contain sneha guna that is why they are responsible for the creation of life.

• The average adult body fat is closer to 15-18 % for men and 22-25 % for women. Fat is higher for women.

Snigdha description:

It is a Santarpaņa guņa. Guņa of pitta is uşņa snigdha and kapha is śīta snigdha. In the modern biochemistry, anything which is uşņa snigdha is unsaturated in nature and it will not solidify in room temperature, and anything that is sheeta snigdha will solidify at room temperature and is saturated in nature.

For e.g. Tila tailam, is ushna snigdham, and unsaturated because it can not solidify at room temperature. Ghrita and coconut oil are Śīta snigdha  that is saturated in nature.

Snehana:

Snehanam sneha visyandam mardavam kleda karakam…….     

The four therapeutic goals of performing snehana are as follows.    

1. Snehana – To Bring about Lubrication (snigdhata)
2. Vişyandana – To enhance Diffusion (Dravasŗuti)
3. Mārdhavakara – To soften (Ślāthane)
4. Kledana – To produce Moisture (Apvŗddhi )

References about snehana:

• Ghŗta and Agni are told in all vedās  & purāņās Mārkandeya purāņa – 165,166
• Catur mahāsneha guņa karma explained C.S.Su. Ch.1
• Introduction of Paňcakarma C.S. Su. Ch.2
• Whole snehana C.S. Su. Ch.13
• Şadkriyās including snehana C.S. Su. Ch.22
• Duration of snehapāna C.S. Si. Ch.1
• Body described as sneha sāra  S.S. Ci. Ch. 31
• Mode of action of snehana  Bhela Sam.Ch.14
• Elaborate discussion on snehana A.S. Su.Ch.25, A.H. Su.Ch.16
• Dosage in terms of pala and karşa  Sa.Sam.Utt.kh.
• Snehapānakrama vŗddhi  Vańgasena 12A.D.
• Vardhamāna mātra for Śodhana sneha Kalyāņakāraka  8A.D.

Qualities of sneha dravya:

In Caraka samhita, 6 gunas are given high priority as they are essential in Ayurvedic practice. They are Guru, Laghu, Ushna, Seeta, snigdha, Ruksha.

These six gunas are used as Shadvidhopkrama.

1. Guru guna - Brimhanam
2. Laghu gunam - Langhanam
3. Ushna gunam - Swedanam
4. Sheeta guna - Stambhanam etc …
5. Snigdha guna – Snehana
6. Ruksha guna – Rukshana

Practicing the detoxification using these gunas represents panchakarma. Practicing the detoxification by giving kashaya represents samana chikitsa. Whether shamana chikitsa or shodhana chikitsa, use of these six gunas are inevitable.

Sneha guņa in detail:

Guņa	Therapeutic effect
Guru Upalepa	malavŗddhi, tarpaņa, bŗmhaņa
Śīta	Stambhana, dāha nāśaka
Sara	Anulomana – vāta mala pravartana
Snigdha	Mārdavam, snigdhata
Manda	Śamanam
Sūkşma	Srotośodhanam
Mŗdu	Mārdavakaram
Dravam	Dravīkaraņam

Sneha Catuşţayam:

Ghritam, Majja, Vasa and taila are called sneha catustayam. Though there are many forms of sneha these four are given importance due to their efficacy in bringing about snigdhata.
 
Combinations of sneha:

Combination of two snehas is called Yamalam,
e.g. Sukumāram ghŗtam, Mukkūttu tailam

Combination of three snehas is called Tŗvŗt sneham,
e.g. Paňcasneham

Combination of four snehas is called Mahāsneham 
e.g.  Mahāsneham (told in vāta vyādhi)

Ghrita:

• Ghee has lipophilic action
• Increases the transportation of ingredients to the target organ inside the cell (as cell membrane is made up of lipids). 
• Increases cellular entry and delivery of active constituents into mitochondria.
• Up to 10 % of ghee in diet doesn't increase cholesterol.
• Useful in
• Non healing ulcers
• Acid peptic disorders
• Psychiatric conditions
• Pyrexia of Unknown Origin
• Mixed Connective Tissue Disorder
• Macular degeneration
• Epilepsy
• IBS
• Osteoporosis

Tailam:

• Useful in
  • Vāta kapha disorders
  • Vāta vyādhis
  • Obesity
  • Spastic colon
  • Atonic bladder
  • Goitre
  • Sinus and fistulas
  • Fibromyalgia

Vasa:

• Useful in
  • Atyagni
  • Mahat agni balam
  • Chronic vata rogam
  • Osteoporosis
  • Oligospermia
  • 2nd degree  Uterine prolapse
  • Post traumatic conditions
  • Vasa sātmyam (non veg)

Majja:

• Useful in
  • Multiple myeloma
  • Uterine prolapse
  • Meniere’s disease
  • Myelo dysplasia

Anupanas for sneha:

1. Uşņodaka

• Uşņa jalam is good for disintegrating the saturated fat.
• Helps in the better absorption and bio availability of ghee.
• Not advised for snehās of bhallātaka and tuvaraka.

2. Yūşa

• Yūşam is very good for vāta doşa and tailam is very good for vāta vyādhi
• Taila is a poly unsaturated fat & is mostly vidāhi in nature
• Yūşam contains pulse, more protein and digestion rate is much high.
• The pH of oil is 4.33 and pH of yūşam  is 6.6. So anupanam is alkaline in nature.
• Yusha anupanam prevents the acid peptic disorders, erosions and vidahitwam of taila.

3. Maņḍa

• Vasa and majja are abhiśyandi so laghu yukta anupānam has to be given.
• Maņḍam is dīpana, pācana, vātanulomana which is helpful to digest the heavier snehās like vasa and majja.
• Maņḍam is simple starch in a liquid form & can be digested easily. So it helps as a solvent for vasa.

Anupānam Dietetic source Digestive effect
Uşņa jalam Nil calori Carminative effect
Yūşam High protein content Alkaline effect
Maņḍam High starch content Acidic effect

General Considerations of Snehana:

Snehana kāla
• Diurnal modification
• In Kaphānubandha rogās, it is done in Day time (Taila)
• In Pittānubandha rogās, it is done in Night time (Ghŗta)
• Seasonal modification
• In summer ghŗta snehapāna at Night time
• In winter - taila snehapānam at  Day time

Classification of Snehana:

Based on the mode of administration snehana is classified into achapana and vicharana.

Characteristics of achapana:

• Sneha without adding any supplements orally
• Can be used for sodhana and śamana
• Involves Pathya karma
• Only internal administration
• Given in larger doses.

Characteristics of vicharana:

• As a sneha food or Supplements or along with food
• Used as samana and bŗmhaņa
• No very strict pathya krama
• Internal & external administration
• Given in smaller dose

Vicharana can further be classified as internal administration and external administration.

Internal administration: 

• Various food preparations
• Māmsa, Rasa, Kşīra, Madya, etc.,

External administration:

Ekangam

• Gaņḍūşam
• Karņa tailam
• Nasya
• Akşi tarpaņam
• Karņa tarpaņam

Sarvāńga

• Abyańga
• Mātra vasti

A detailed perspective on Sneha mātra:

According to Caraka & Vāgbhaţa,

• Hŗsva Mātra      Digested in 2 yāmās (6 Hrs.)
• Madhyama Mātra     Digested in 4 yāmās (12 Hrs.)
• Uttama Mātra      Digested in 8 yāmās (24 Hrs.)

Vāgbhaţa has included:

• Hŗsyasi Mātra     Digested in 1 yāma (3 Hrs.) to assess the agni bala and koşţha

Indications of Hīna mātra:

• Gastritis
• Paediatric practice
• Geriatric practice
• Type A people
• Pyrexia of Unknown Origin
• IBS
• Respiratory pathology

Indications of Madhyama mātra: 

Paittika koşţham:

• Metabolic syndromes
• Bacterial skin lesions
• Other skin pathologies
• MCTD and auto immune disorders

Indications of Uttama mātra:

• Gulma spectrum
• Psychosis
• Second phase of visarpa
• Spastic colon
• Bipolar disorders

Deciding the mātra:

It is calculated on the basis of agni and koşţha of individual.

In śamana and bŗmhaņa sneham, the dosage depends upon agni, koşţha and age. In śodhana sneham, the dosage is very difficult to calculate as the metabolic action differs from person to person.

Calculating Śodhana sneha mātra:

Incase of sodhana, the sneha mātra is madhyama (to be digested in 12 hours)
E.g. For a person who digests 20 ml of sneha in 4 hours, in 12 hours he can digest 12 x 20 / 4 = 60 ml. So the maximum quantity of snehapāna on the first day will be around 60 ml. Note: Madhyama matra is not for 5 days, for madhyamakoshta, it is for 5 days.

Procedure of Snehapāna:

The selection of type of sneha is based on the disease. The dosage of sneha depends upon the agni and purpose, i.e. Śodhana / Śamana The duration of snehpana is calculated after considering koşţha.

Acchapānam:

For practical purposes the following points should be considered.

Śodhana Accham Śamana Accham
Matra Madhyama (Caraka)
Bahu (Vāgbhaţa) Madhyama
Duration 3 to 7 days Till vyādhi śamana
Time of admn Fixed time  - Early morning  When there is good appetite
Anupāna  Depends on sneha  Depends on roga
Samyak lakşaņās  Visible   Certain lakşaņās are seen
Post therapy Followed by śodhana  Need not be followed by śodhana

Procedure:

It is given at sunrise time. After taking the sneha, cover the patient with the blanket (optional). If there is thirst, warm water has to be given. Practically headache, vasovagal features denotes digestion. Hungers, thirst, vātanulomanam, udgāram disappearance of the above symptoms indicate completion of digestion.

Diet during snehapāna:

• 200 – 300 ml kaňji with little bit of ghee and sirupayaru curry (Dravam, uşņam, anabhişyandi, nāţisnigdham, asamkaram)

Diet:

During Snehapāna During Viśrāmakāla
Dravam Dravam
Uşņam Uşņam
Na atisnigdham Snigdham
Asamkaram Jāńgala māmsa rasam
Anabhişyandi Utklesana Abhişyandi

Assessment of snigdha lakşaņās:

The snigdha laksanas can be broadly classified under the following heads in order to access them for practical purposes.

• Vāyu gati related lakşaņās
• Agni related lakşaņās
• Purīşa related lakşaņās
• Tvak  related lakşaņās
• Physical & mental status related lakşaņās

Vāyu gati related lakşaņās:

It includes:

• Vātanulomana & vata pratiloma
• Anila pūrita udara
• Ādhmāna
• Vāta pratiloma and anila pūrita udara are seen in asnigdha lakşaņās
• Ādhmāna is atisnigdha lakşaņa due to āvaraņa of vāta by atisneha.

Agni related lakşaņās:
 
It includes:

• Agni dīpti
• Agni māndya
• Avipākam
• Uro dāham
• Aruci
• Bhakta dveşam during snehapānam
• Agni dīpti denotes samyak snigdham.

Agni māndhyam may be produced by agni’s inability to tackle the sneha and vāyu. Avipāka, urovidāha are due to agni māndhya. Utkleśa, aruci, bhaktadveşa are seen in atisnigdha lakşaņa pointing the saturation of the system with sneha.

Purīşa related lakşaņās:

It includes:

• Adhastāt sneha darśanam
• Purīşa snigdhata
• Asamhata varcas
• Apakva purīşam
• Kŗcra mala pravartanam
• Purīşa ati pravŗtti
• Śuşka, Rūkşa grathita purīşam
• Purīşa snigdhata, Asamhata varcas, Adhastāt sneha darśanam are seen in Samyak snigdha, produced by snigdha, sara, drava guņās of sneha. Suşka, Rūkşa grathita purīşam, kŗccra mala pravartanam are seen in asnigdha, due to ineffectiveness of sneha to overpower rūkşata in koşţha. Purīşa avipakvata, purīşa ati pravŗtti and pravāhika are seen in Atisnigdha, due to agni māndhya

Tvak related lakşaņās:

It includes:

• When sneha reaches māmsa, majja dhātu, skin changes occur.
• Gātra mārdavam
• Gātra tvak snigdhata
• Gātra khara rūkşatvam
• Dourvarņīyam

Physical & mental status related lakşaņās:
 
It includes:

• Klama  -Fatigue
• Glāni  -Exhaustion
• Gaurava  -Heaviness
• Jādya  -Fever like feeling
• Śaithilya  -Lack of firmness
• Ańgalāghava -Lightness of the body
• Ańga dāha -Burning sensation of body parts
• Pāņḍuta  -Paleness
• Tandra   -Lethargy
• Dourbalya -Debility

In Samyak snigdha, Klama, Glāni, Ańgalāghava are seen. In Asnigdha, dourbalya is encountered. In Atisnigdha, Gaurava, Jādya, Śaithilya, Ańga dāha, Pāņḍuta, Tandra are seen.

Assessment of samyak snigdha lakşaņa:

In order to make the assessment of samyak snigdha laksana more precise, a subjective and objective scale needs to be designed. The following scales can be used for the same.

Assessment of Vātanulomana:

• Downward movement of vāyu with lightness of abdomen - Grade 0
• Distension with out belching - Grade 1
• Belching with moderate distension -  Grade 2
• Belching with high distension – Grade 3

Assessment of mala

• Loose stools with fat -  Grade 0
• Semi solid stools with fat -  Grade 1
• Dry, hard pellets  -  Grade 2

Assessment of Skin changes:

• Oily skin -  Grade 0
• Normal skin  -  Grade 1
• Dry rough skin -  Grade 2

Assessment of Ańgalāghavam (According to kāla):

• Present in all 24 hrs  - Grade 0
• Present after 3-5 hrs. of snehapāna - Grade 1
• Present after 6-11 hrs. of snehapāna - Grade 2
• Present after 12-17 hrs. of snehapāna - Grade 3
• Present after 18-24 hrs. of snehapāna - Grade 4

Clinical evaluation of Samyak lakşaņa:

• For Śodhana

Adhastāt sneha darśanam is the primary criterion. Snigdha varcas with other criteria are secondary.

• For Śamana

Snehadveśam remains the primary criterion. Others are secondary criteria.

• For Bŗmhaņa

Vimalendriyam, etc., are usually seen in the long course.

Side effects of Mithya snehanam:

Short Term Long Term:

• Urticaria and itching
• Low grade fever
• Fatigability
• Abdominal colic
• Rhinitis
• Mal absorption syndrome
• Vasovagal changes
• Hyper ventilation • Metabolic  syndrome X 
• Dyslipidimia

Treatment of Mithya snehanam:

• Upavāsam
• Vamanam
• Rūkşa svedam
• Takrārişţham
• Triphala
• Pippali
• Harītaki
• Guggulu
• Yava
• Śyāmaka
• Kodrava

Two important forms of snehana which have to be discussed in detail are sadya snehana and avapidaka sneha.

Sadya snehana: 

Indications:

• Paediatric age group in conditions like acute bronchitis with sputum
• Geriatric age group with psoriasis, allergies
• Those who have aversion to sneha
• Alcoholics
• People who use ghee regularly like brāhmins
• Generalized anxiety disorder
• In summer

Practical views:

It has more śamana effect than śodhana. It can be used for mŗdu śodhana in children.

Procedure:

It can be given for one day, and to a maximum of 3 days if needed. Usually, it is given with pālpāyasam, māmsa rasam, milk, etc.   It can also given by adding 3 to 5 gms of salt with 50 gms of ghee as single dose. Ghee, salt with kanji can be given.

Practical Preparations:

• Pāl pāyasam with ghee
• Muḍga tila pāyasam with ghee
• Pānakam with ghee
• Arişţam with tailam
• Dadhi with trikaţu

Avapīḍaka sneham:

The sneha given in bahu matra, immediately before food and after digestion of the food (Sāmuḍga prayogam) is called Avapidaka sneha.

• Ghŗtam can be given up to 300 ml
• Tailam can be given up to 125 ml

Actions:

• It cures diseases of pitta and vāyu, strengthens the vasti.
• It has Vājikaraņa properties and Ūrjaskara and sramaskara in nature.

Useful in:

• Mūtra vega rodhajanya vikārās
• Adho nābhi gata vāta vikārās
• Rakta arśas
• Vājikaraņa

Practical administration in Avapīḍaka snehapānam:

Spastic colon  Dāḍimādi ghŗtam
BPH Vastyāmayāntaka ghŗtam
Endometriosis Kalyāņaka ghŗtam
Atonic bladder Dhānvantara tailam

Arhās of uttama mātra are also arhās of avapīḍaka snehapānam:

Mode of action of snehana:

After a detailed study on the role of lipids in the cells, it can be seen that the sneha at cellular level has three important actions,

1. When it helps in building up of cellular components, it becomes Brmhana sneha.
2. When it stimulates or modifies the metabolic reaction, it becomes samana sneha.
3. When it augments the rate & quality of cellular excretion, it becomes sodhana sneha.

Fat metabolism:

Concise information on the metabolism of fat is given below. 

Fat in the diet are mainly triglycerides (tgl). Tgl are hydrolyzed to fatty acids and monoglycerides and then absorbed into the system. Fat is absorbed almost 90%

Fat in the food travels into the stomach. Churning of the stomach helps in the formation of emulsion. Gastric lipase begins and proceeds about 25 % of fat digestion.

These molecules then travel into the small intestine where bile salts from the gall bladder emulsify the relatively insoluble fats in to micelles.

Triacylglycerols form micelles with non-polar cores and are surrounded by bile salts during solvation. The “R” groups of the triacylglycerols are non polar so they point towards the center of the micelles.

The micelles then continue down the small intestine. Here an enzyme called pancreatic lipase degrades the triacylglycerols into fatty acids plus glycerol.

The triacylglycerols are then packaged with apoproteins and cholesterol into blood-soluble complexes called chylomicrons. The chylomicrons move across the blood vessel membrane and into the blood stream.

The chylomicrons travel through the bloodstream and have two possible fates. Lipoprotein lipase in capillary walls hydrolyzes Tgl to fatty acids and supplies them to adipose tissue (where it is stored) and muscles (where it is burnt as fuel).

Mode of action of Acchapana:

The action of acchapana in the removal of diseases as a sodhana procedure can be hypothesized as follows.
 
The sneha which is consumed by the person undergoes digestion in the alimentary tract primarily under the action of bile salts, pancreatic lipase and many other enzymes. It enters into the systemic circulation in the form of lipoproteins and free fatty acids. The free fatty acids react with the receptors at the cell membrane and gain entry into the cell.

Free radical chain reaction is a cycle which takes place with in the cells constantly producing innumerable amount of free radicals. As with any radical reaction the reaction consists of three major steps: initiation, propagation and termination. These free radicals are in turn responsible for accumulation for toxins and for disease.

The increased amount of free fatty acids provided by administering acchapana interferes with this chain to produce excretable metabolite in the cell. These metabolites after reaching the threshold level enter into the systemic circulation and reach the liver. 

With in the liver these metabolites are detoxified and excreted via bile. This changes the quality of bile transiently and therefore the fat ingested is not digested properly and it appears in the stools. This is the reason for adhastat sneha darsana, which is the samyak snigdha laksana.

The diet given on the day prior to sodhana, further induces the metabolite excretion into the alimentary tract. This enables the effective removal of toxins by sodhana performed on the next day.