Difference between revisions of "Snehana (unction therapy)"

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Apart from above mentioned three dosage forms,a fourth dosage is also in practice, which is the smallest dosage among all the dosage forms. [A.H Sutra Sthana 16/17]<ref name=Hridaya/>  This can also be termed as the ‘test dose’ for an individual.  
 
Apart from above mentioned three dosage forms,a fourth dosage is also in practice, which is the smallest dosage among all the dosage forms. [A.H Sutra Sthana 16/17]<ref name=Hridaya/>  This can also be termed as the ‘test dose’ for an individual.  
  
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The safety and efficacy of unction therapy depends mainly on digestive capacity (agni) and nature of gut (koshta) of the individual. In order to assess this, administration of a test dosage is always preferable. The amount of unctuous substance that can be digested in 3 hours is considered as the test dose. [A.H Sutra Sthana 16/17]<ref name=Hridaya/> By assessing the response for this initial dose, the further dosages can be decided. This dosage improves the digestion and can be given to persons affected with less severity of dosha.[Su.Sa.ChikitsaSthana 31/25]<ref name=Susruta/>
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The safety and efficacy of unction therapy depends mainly on digestive capacity (agni) and nature of gut (koshta) of the individual. In order to assess this, administration of a test dosage is always preferable. The amount of unctuous substance that can be digested in 3 hours is considered as the test dose. [A.H Sutra Sthana 16/17]<ref name=Hridaya/> By assessing the response for this initial dose, the further dosages can be decided. This dosage improves the digestion and can be given to persons affected with less severity of dosha.[Su.Sa.Chikitsa Sthana 31/25]<ref name=Susruta/>
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==Objective of unction therapy==
 
==Objective of unction therapy==
  

Revision as of 15:50, 23 September 2020

The word ‘snehana’ means providing unction, oleation, lubrication, rubbing or smearing with oil or unguents, being or becoming oily etc. It also shows a psychological ‘feeling of affection’.[1] The process of unction or unction therapy is an important preparatory procedure (purvakarma) performed before purification therapies (panchakarma). It includes internal and external administration of unctuous substances like ghee, oil etc. (sneha dravya). Besides this unction therapy (snehana) is also applied as principle treatment in various disease conditions due to vitiated vata and pitta dosha. It is one among the major six treatment modalities in Ayurveda. [Cha.Sa.Sutra Sthana 22/04]

Contributors
Section/Chapter/topic Chikitsa / Snehana
Authors Aneesh E.G., Deole Y.S.
Reviewed by Basisht G.
Affiliations Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar
Correspondence email: carakasamhita@gmail.com
Date of first publication: August 24, 2020

Etymology and derivation

The word ‘sneha’ is derived from the Sanskrit root ‘Snih’. It means ‘to render affection’, or ‘to render lubrication’.[2] Adding suffix ‘lyut’ with this root makes the word ‘snehana’.[3] The procedure through which the body attains moistness, smoothness, unctuousness, fluidity and ooziness is called snehana. [Cha.Sa.Sutra Sthana 22/11]

Classification

Based on the route of administration

  1. External application (bahyasnehana)
  2. Internal administration (abhyantarasnehana)

External application

This includes following procedures:

  • Massage (abhyanga)
  • Pouring of medicated unctuous substance, generally oil over body surface (parisheka)
  • Immersing body parts (avagaha)
  • Retaining oil over the head (shirobasti)
  • Pouring oil over the head (shirodhara)
  • Retaining oil over particular body parts like lumbar region (katibasti), knee (janubasti) etc.

Internal administration

This includes following procedures:

  • Oral administration of unctuous substance (snehapana)
  • Per rectal administration (snehabasti)
  • Intra nasal administration (nasya)

Properties of unctuous substances

The unctuous substances used possess properties like liquidity, minuteness, unctuousness, sliminess, heaviness, coldness, sluggishness and softness. [Cha.Sa.Sutra Sthana 22/15]

General indications of unction therapy

Based on age of person: Unction therapy can be administered from age of one year to old age.[A.H.SutraStana 16/5] [4] The growth and development is more during the early stages of life. Unction therapy supports this process in childhood. In the old age, there is degeneration of body tissues. Unction therapy prevents this degeneration and helps to maintain quality of body tissues.

Based on daily activities: Unction therapy is indicated for those who indulge in daily physical and mental activities like exercises, sexual intercourse, intellectual activities etc. It is also indicated in alcoholics to prevent its adverse effects. [Cha.Sa.Sutra Sthana 13/52] Unction therapy helps to reduce vatadosha aggravated due to these activities.

Based on the body constitution:Unction therapy is indicated for individuals with vata dominant body constitution and those who are weak, possess lean body frame, dry skin etc. [A.H. Sutra Sthana 16/5][4] Unction therapy increases strength of body, removes dryness and nourishes the body tissues.

As a preparatory procedure: Unction therapy is indicated as prerequisite to all the purification therapies. It aids free movement of dosha through body channels. Unction therapy followed by sudation therapy liquefies morbid dosha and brings them to gut from the peripheral parts of body. Then, these morbidities can be easily evacuated by following purification therapies like therapeutic emesis, purgation etc.

As the principle treatment:In diseases caused by vatadosha, unction therapy itself acts as principle treatment.

Contraindication of unction therapy

Unction therapy is contraindicated in following conditions.

  1. Presence of metabolic toxins (ama): Unction therapy is contraindicated in the presence of metabolic toxins (ama) in the body and poor metabolic state. Administration of unctuous substance in these conditions worsens it. [Cha.Sa.Sutra Sthana 13/ 53]
  2. Poor digestion and metabolism: Unction therapy is contraindicated in persons having abnormal digestion and metabolism like too low or too high capacity of digestion. [A.H. Sutra Sthana 16/6][4] In case of too low capacity of digestion, the unctuous substance will lead to indigestion and associated disorders. In case of too high capacity of digestion, the unction therapy further increases the digestion leading to complications. Hence unction therapy is always indicated after normalizing the capacity of digestion and metabolism.
  3. After purification therapy:Unction therapy is contraindicated immediately after the purification therapies, owing to transient reduction in digestive capacity. [A.H. Sutra Sthana 16/7][4]
  4. In specific disease conditions:Unction therapy is contraindicated in specific diseases like diseases of thigh (urustambha), diarrhea (atisara), diseases of throat (galaroga), ascitis (udara). [A.H. Sutra Sthana 16/6][4]
  5. Unction therapy is contraindicated in case of excess increase of kaphadosha and adipose tissue (meda dhatu). Unction leads to further increase and complications. [Cha.Sa.Sutra Sthana 13/53]

Dosage of unction therapy

The dosage forms are categorized as below: [Cha.Sa.Sutra Sthana 13/29]

  1. Maximum dose (pradhanamatra)
  2. Medium dose (madhyamamatra)
  3. Minimum/Low dose (hrasvamatra)
  4. Lowest dose or test dose (hrasiyasimatra)

Maximum dose

The quantity of unctuous substance that can be digested in 24 hours is the maximum dosage for that individual.

Indications:The individuals who are accustomed with taking large quantity of unctuous substances daily, who can tolerate hunger and thirst, who have strong digestive and physical strength.

This dosage form is used in the treatment of inflammation in digestive tract, snakebite, erysipelas, insanity, dysuria and constipation.

Benefits: It can cure the diseases quickly, removes the vitiated dosha from body, spreads all over body, improves strength and rejuvenates body, mind and sense organs.[Cha.Sa.Sutra Sthana 13/31-34]

Medium dose

The quantity of unctuous substance that can be digested in 12 hours is considered as the medium dosage.

Indications: Skin disorders, vesicles, itching, eruptions in scalp, obstinate urinary disorders, gout etc.are treated with moderate dose. It is indicated for persons having medium strength, who are used to consume food in medium quantity and who have soft bowel habits.

Benefits: Administration of unction therapy in medium dosage helps to attain unctuousness easily and helps in purification procedures. [Cha.Sa.Sutra Sthana 13/35-37]

Low dose

The quantity of unctuous substance that can be digested in 6 hours is considered as the minimum dosage.

Indications: This dosage is indicated for individuals with less strength, old age, children, and those with tender constitution, who can’t tolerate hunger, who have less digestive capacity. In chronic conditions of diseases like fever, diarrhea and cough, unctuousness in less dosage is indicated.

Benefits: Unction therapy in this dose produces oleation and stoutness of the body. It acts as aphrodisiac and increases strength of the body. This can be continued for longer duration as it won’t cause any complications.[Cha.Sa.Sutra Sthana 13/38-40] It can be administered in case of moderate vitiation of dosha. [Su.Sa.Chikitsa Sthana 31/26][5]

Lowest dose or test dose (hrasiyasimatra)

Apart from above mentioned three dosage forms,a fourth dosage is also in practice, which is the smallest dosage among all the dosage forms. [A.H Sutra Sthana 16/17][4] This can also be termed as the ‘test dose’ for an individual.

The safety and efficacy of unction therapy depends mainly on digestive capacity (agni) and nature of gut (koshta) of the individual. In order to assess this, administration of a test dosage is always preferable. The amount of unctuous substance that can be digested in 3 hours is considered as the test dose. [A.H Sutra Sthana 16/17][4] By assessing the response for this initial dose, the further dosages can be decided. This dosage improves the digestion and can be given to persons affected with less severity of dosha.[Su.Sa.Chikitsa Sthana 31/25][5]

Objective of unction therapy

Based on the objective of internal administration of unctuous substance, this therapy can be divided into three broad practices.

  1. Purification (shodhana)
  2. Pacification (shamana)
  3. Nourishing (brimhana)

Unction therapy for purification(shodhana snehapana)

This includes administration of unctuous substances prior to the purification procedures like therapeutic emesis, purgation etc. The main objective is to enhance the movement of dosha towards gut from affected site for easing purification (doshautkleshana).

Time of administration: The unctuous substance is administered at early morning in empty stomach after complete digestion of the previous meals and when the person is not feeling hungry.

Dose:Maximum dose of unctuous substance should be given in order to achieve the desired effect. [A.H. Sutra Sthana 16/18][4] Dosage depends on digestive capacity of the person. According to increase in digestive capacity, the dosage also can be increased day by day. [Vangasena]

Duration:This can be given for three days to a maximum of seven days. [Cha.Sa.Sutra Sthana 13/51] After seven days, the body of individual gets accustomed with unctuous substance and may lead to poor response to purification therapy and complications.

Unction therapy for pacification (shamanasneha)

It includes internal oleation therapy performed to pacify a particular disease or symptom.

Time of administration: It should be administered at meal time, when the person is hungry.

Dose:Medium dose is indicated for pacification. [A.H Sutra Sthana 16/19][4]

Duration: This therapy can be continued till the subsidence of disease or symptom.

Nourishing unction therapy (brimhanasneha)

Unctuous substances are administered in low dose with food for nourishment purpose. This can be continued for a longer duration till proper nourishment is attained. [A.H. Sutra Sthana 16/20][4]

Substances used in unction

Following four unctuous substances are generally used for unction therapy. The general indications and benefits are described below. However, specific properties and indications may vary based on the source of the unctuous substance.

  1. Ghee (ghrita)
  2. Edible oil (taila)
  3. Muscle fat (vasa)
  4. Bone marrow (majja)

1. Ghee: It isgenerally indicated for individuals of vata-pitta dominant constitution and diseases, old age, children, who have less strength. It is beneficial for promoting good eye sight, healthy progeny, nourishment, good memory and intelligence etc. [Cha.Sa.Sutra Sthana 13/41-43] Cow ghee and buffalo ghee are used widely for regular consumption and therapeutic purpose.

2. Edible oil: It is generally indicated in vatadominant diseases and constitution, aggravated conditions of kapha and adipose tissue (meda) and obese individuals. It is beneficial to promote strength, slim and lean physique, lightness, stability, unctuous, soft and smooth skin. It is used to treat worminfestation, hard bowels and sinus disorders.[Cha.Sa.Sutra Sthana 13/44-46]Sesame oil is used for therapeutic purpose. Groundnut oil, coconut oil, sunflower oil, cottonseed oil, olive oil, safflower oil are generally used for dietary purpose. Castor oil is used for purgation purpose.

3. Muscle fat: This is generally indicated for those who are exposed to wind and sunlight such as open field workers, frequent travelers etc.; those emaciated due to excessive weightlifting and walking. It is used in the conditions with depleted kapha and adipose tissue, pain in bones, joints, vital points. It is useful in treating excessively aggravated vatadosha causing obstruction in channels. Muscle fat is generally administered in individuals with strong digestive power and habituated to its consumption (non-vegetarians). [Cha.Sa.Sutra Sthana 13/47-49]

4.Bone marrow: It is generally indicated in individuals with strong digestive power, who are habituated to excessive physical exertion and consume food in large quantity.It is used to treat vatadoshadisorders and hard bowels. [Cha.Sa.Sutra Sthana 13/50-51]

Dietary articles used in unction therapy

Boiled rice (odana), thick gruel (vilepi) , meat soup (mamsa rasa) , milk (paya) , curd (dadhi) , soup of green leafy vegetables, soup made from pulses or dal (yusha) , a recipe prepared from mixing sesame with curd, oil, salt etc.(kambalika), processed buttermilk( khada), roasted flour of barli, horse gram etc. (saktu), wine(madya), confections(leha), snacks(bhakshya) are used in unction therapy. [Cha.Sa.Sutra Sthana 13/23-24]

Therapeutic procedures

Oil massage(abhyanjana), unctuousenema(basti), urethral and vaginal enema(uttarabasti), gargles(gandusha), filling ear with oil(karnataila), nasal administration(nastakarma), ophthalmic procedures like filling eye with unctuous substance (akshitarpana) are other therapeutic procedures for unction therapy. [Cha.Sa.Sutra Sthana 13/23-24]

Medicinal substances

Medicated ghee or oils are administered both internally and externally to attain oleation and treat specific indicated conditions. For e.g.: Mahatiktakaghrita in management of skin disease, Ksheerabalataila in management of vata diseases etc.

Action of unction therapy in body constituents

Unction therapy improves the quality of body constituents. Unction with ghee and bone marrow is beneficial to nutrient fluid (rasa dhatu) and reproductive tissues (shukra dhatu). Bone marrow helps to increase the bone marrow itself and adipose tissue. It is especially beneficial to strengthen the bones. [Cha.Sa.Sutra Sthana 13/14-17] Muscle fat, if used for oleation increases the semen and blood. [Cha.Sa.Sutra Sthana 13/47]

Importance of unction in preservation and promotion of health

Human body is made from essence of unctuous substances (sneha).[Su.Sa.ChikitsaSthana 31/03]A person habitual to consume unctuous substance daily is benefitted with good digestion, proper evacuation of bowels, optimum quality of body constituents, good strength and complexion, proper functioning of sense organs and longevity. [Su.Sa.ChikitsaSthana 31/56]Unctuous therapy subside vatadosha, makes the body soft and disintegrates morbid materials. [Cha.Sa.Siddhi Sthana 1/8]

Unctuous therapies are utilized as part of daily regimens to preserve and protect health. The herbal cigar prepared out of animal fat, ghee.etc [Cha.Sa.Sutra Sthana 5/25] helps to increase strength of scalp hair roots, sense organs and voice. [Cha.Sa.Sutra Sthana 05/32) Nasal administration of Anu taila (a medicated oil)provides nourishment and preventsmany diseases related to head and supraclavicular region. [Cha.Sa.Sutra Sthana 5/56-63] A person accustomed with therapeutic massage is not afflicted by injury due to external trauma or strenuous physical exertion. [Cha.Sa.Sutra Sthana5/86-89]

Importance in management of disease

Unction therapy is extensively used for moving deep seated dormant dosha towards gut. After the vitiated doshas are in a state of getting expelled out, the purification therapies are applied. [Su.Sa.ChikitsaSthana 33/47]Therefore unction therapy is important prerequisite before applying purification therapies in the management of diseases. Not following this protocol results into iatrogenic complications. [Su.Sa.ChikitsaSthana 33/46][5]

Unction therapy is the first principlefor treatment ofdisorders caused exclusively by vatadosha. [Cha.Sa.ChikitsaSthana 28/75] Unction therapy is also administered after completing purification treatments to restore normal strength and equilibrium. [A.H.SutraSthana 18/57][4]

Contemporary views

Among all types ofunctuous substances ghee is considered as most important substance.It is also the most commonly used unctuous substance. In view of bio chemistry, each unctuous substance is studied on the basis of fatty acid levels present in it.[6] Ghee contains 53.9 to 66.8 percent of saturated fatty acid.[7] High saturated fatty acid level in body is consideredas a risk factor for cardio vascular diseases. Excess consumption of saturated fat in diet increases cholesterol concentration, but ingestion of highly unsaturated fattyacids usually reduces the blood cholesterol concentration. It is observed that internal administration of lipids before purification therapies doesn’t increase the blood lipid levels; rather it normalizes lipid levels. In many studies, reduction in lipid levels isreported after the internal oleation therapy.[8]

As observed in a study, when ghee is used as the sole source of fat, total cholesterol, LDL, VLDL and triglycerides level are decreased. Polyunsaturated fatty acids in the serum and liver lipids were reduced significantly. Cholesterol ester levels, which are involved in the atherogenesis process, decreased significantly. It shows an increase in levels of oleic acid, which helps the LDL to resist oxidation.[9]

The second most commonly used unctuous substance is oil. Among oil, sesame oil is commonly used. It contains fatty acids like linoleic acid, oleic acid, palmitic acid, stearic acid, vitamin K etc.[10] The anti-atherosclerotic and anti-inflammatory action of sesame oil is reported. A significant reduction in atherosclerotic lesions, plasma cholesterol, triglyceride, LDL along with reduction in inflammatory cytokines like IL1-alpha, IL-6 etc. is reported.[11]

Coconut oil is reported to increase the HDL cholesterol levels significantly, when compared with butter. LDL cholesterol levels were increased significantly by butter than coconut oil. Even though coconut oil and butter are predominantly saturated fats, its effect on serum lipids differ. A significant reduction in C reactive protein is also reported by the use of coconut oil.[12]

Current researches

The grade of purification achieved by a purificatory procedure depends on the grade of oleation. The better the oleation both qualitatively and quantitatively, provides better grade of purification.

As mentioned earlier, the efficacy of oleation largely depends on accurate assessment of digestive power and nature of gut. For a more objective assessment of above said factors and to fix the trial dosage for internal oleation the following criteria is developed.

Factor Score
Digestive capacity (agnibala) 20
Endurance (vyayama shakti) 10
Habit (satmya) 10
Nature of gut/bowels (Hard or dry/medium/soft) 30/20/10

If the score is 50 or more, test dose is 50ml. If the score is 40 to 49, test dose is 40ml and if the score is 30 to 39, 30ml of test dose can be given.

In order to determine the power of digestion the following formula is postulated by the researchers.

BSI (Bio fire strength index) = (Total dose/Given dose) x Time taken for the digestion of ghee.

BSI is inversely proportional to the intensity of digestive fire.

As compared to a fix daily dose of internal oleation, an increasing dose pattern based on digestion power and bowel habits of the person is found to be more beneficial in attaining the desired effects of oleation.[13]

Cells in the body get saturated with lipids after proper internal oleation as the lipids are hydrophilic. Through osmosis the fat materials are transported to the extra cellular fluid. The plasma volume is increased as a result of increase in fatty acids etc. The metabolic waste from the tissues are liquefied through oleation and sudation. In order to maintain normalcy, the extra amount of liquid reaches the gut and gets expelled out through proper purificatory procedure.[13]

Administration of ghee as internal oleation, increases the excretion of bile. The cholesterol excretion through the bile increased significantly. Along with this excretion of phospholipids, uronic acid and total bile acids were also increased. This might be the cause for hypocholesterolemic effect of ghee when administered in more amounts.[8]

The Ayurvedic treatments including shirobasti, shirodhara etc. are found to be safe and effective, and showed improvement in balance in patients with progressive degenerative cerebellar ataxia.[14] Oil massage results in increase of weight, length and head circumference in infants.[15] Therapeutic massage is found to be effective in reducing the subjective stress experience.[16] Oil pulling (kavalagraha) with coconut oil seems to have supragingival plaque inhibition activity.[17]

List of theses done

  1. Patel Kalapi B (2001): A clinical study on the development of subtype of abhyanga with reference to its role in the management of Grivahundana (cervical spondylosis),Department of Kayachikitsa, IPGT&RA Jamnagar
  2. Saxena Sushmita (2001): A comparative study on effect of panchabhautikatailanasya with samvardhanagritha and jyotishmatitaila in management of mandabhudditva (mental retardation),Department of Kaumarabrithya, IPGT&RA Jamnagar
  3. Khagram Rita V (2004): ComparativestudyofKatiBastiandMatra-BastiinthemanagementofGridhrasi(sciatica), Department of Kayachikitsa, IPGT&RA Jamnagar
  4. Pillai Srikumar (2005): Role of Anu tailanasya and Varunadigritha in the management of pratishyayajanyashirashoolaw.s.r. to chronic sinusitis.Department of Shalakyatantra, IPGT&RA Jamnagar
  5. Vasant Patil (2006): Further clinical study on Standardization of ShodhanarthaSnehapana.Department of Kayachikitsa, IPGT&RA, Jamnagar
  6. Vaidya Gauri A (2009): An observer blind clinical study on Standardization of Shodhanarthasnehapana WSR to Sneha pravicharana.Department of Panchakarma, IPGT&RA, Jamnagar

More information

Snehadhyaya

Langhanabrimhaniya Adhyaya

Kalpana Siddhi

References

  1. ↑ Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Snehana, Page 1267
  2. ↑ Vasant C patil.Further clinical study on Standardization of Shodhanartha Snehapana [MD Dissertation]. Jamnagar: IPGT&RA Jamnagar;2006
  3. ↑ Mukundilal Dwivedi. Ayurvediya Pancakarma cikitsa. Delhi:Chaukhamba Sanskrit Pratishthan;2012.Chapter 2, Purvakarma parichaya;p.66.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.
  5. ↑ 5.0 5.1 5.2 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005
  6. ↑ Wikipedia contributors. Fatty acid. Wikipedia, The Free Encyclopedia. July 16, 2020, 05:47 UTC. Available at: https://en.wikipedia.org/w/index.php?title=Fatty_acid&oldid=967931881. Accessed August 20, 2020.
  7. ↑ Ghee [Internet]. [2020 Jul 26; cited 2020 Aug 15]. Available from: https://en.wikipedia.org/wiki/Ghee
  8. ↑ 8.0 8.1 Vasant Patil, Bagel MS, Thakar A B, Effect of snehapana (internal oleation) on lipids.Ancient Science of Life, Vol. 29, No.2 (2009) Pages 32 - 39
  9. ↑ Sharma H, Zhang X, Dwivedi C. The effect of ghee (clarified butter) on serum lipid levels and microsomal lipid peroxidation. Ayu. 2010;31(2):134-140. doi:10.4103/0974-8520.72361
  10. ↑ Sesame oil [Internet]. [2020 Aug 5; cited 2020 Aug 15]. Available from: https://en.wikipedia.org/wiki/Sesame_oil
  11. ↑ Narasimhulu, C. A., Selvarajan, K., Litvinov, D., & Parthasarathy, S. (2015). Anti-atherosclerotic and anti-inflammatory actions of sesame oil. Journal of medicinal food, 18(1), 11–20. https://doi.org/10.1089/jmf.2014.0138
  12. ↑ Khaw K-T, Sharp SJ, Finikarides L, et al. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open 2018;8:e020167. doi:10.1136/ bmjopen-2017-020167
  13. ↑ 13.0 13.1 Vasant C patil,Anup B Thakar, MS Baghel. Clinical trial on different dose patterns of shodanartha abhyantara snehana. Ayu. 2013 Apr-Jun; 34(2): 147–153.doi: 10.4103/0974-8520.119668
  14. ↑ Sriranjini S J, Pal PK, Devidas K V, Ganpathy S. Improvement of balance in progressive degenerative cerebellar ataxias after Ayurvedic therapy: A preliminary report.Neurol India 2009;57:166-171
  15. ↑ Li X, Zhong Q, Tang L, A Meta-Analysis of the Efficacy and Safety of Using Oil Massage to Promote Infant Growth.J Pediatr Nurs. 2016 Sep-Oct;31(5):e313-22. doi: 10.1016/j.pedn.2016.04.003. Epub 2016 Apr 29.
  16. ↑ Annetrin Jytte Basler. Pilot study investigating the effects of Ayurvedic Abhyanga massage on subjective stress experience. J Altern Complement Med. 2011 May;17(5):435-40. doi: 10.1089/acm.2010.0281. Epub 2011 May 13.
  17. ↑ Sezgin Y, Memis Ozgul B, Alptekin NO, Efficacy of oil pulling therapy with coconut oil on four day supragingival plague growth: A randomized cross over clinical trial. Complement Ther Med. 2019 Dec;47:102193. doi: 10.1016/j.ctim.2019.102193. Epub 2019 Sep 4.
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