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Line 1,245: − + − </div> − === Special precautions in diseases of reproductive system === − <div class="mw-collapsible mw-collapsed"> − − तैलमज्जवसासर्पिर्बदरत्रिफलारसैः| − योनिशुक्रप्रदोषेषु साधयित्वा प्रयोजयेत्||९५|| − <div class="mw-collapsible-content"> − − tailaMajjavasāsarpirbadaratriphalāRasaiḥ| − yōniśukrapradōṣēṣu sādhayitvā prayōjayēt||95|| − − tailaMajjaVasasarpirbadaratriphalARasaiH| − yoniShukrapradoSheShu sAdhayitvA prayOjayet||95|| − </div></div> − − Oil, bone marrow, muscle fat, ''ghrita'' boiled with a decoction of ''badara'' and ''triphala'' (combination of terminalia chebula, terminalia bellirica and emblica officinalis) should be used in diseases of female and male reproductive system. [95] − ===Role of digestive power (agni) in oleation === − <div class="mw-collapsible mw-collapsed"> − − गृह्णात्यम्बु यथा वस्त्रं प्रस्रवत्यधिकं यथा| − यथाग्नि जीर्यति स्नेहस्तथा स्रवति चाधिकः||९६|| − − यथा वाऽऽक्लेद्य मृत्पिण्डमासिक्तं त्वरया जलम्| − स्रवति स्रंसते स्नेहस्तथा त्वरितसेवितः||९७|| − <div class="mw-collapsible-content"> − − gr̥hṇātyambu yathā vastraṁ prasravatyadhikaṁ yathā| − yathāgni jīryati snēhastathā sravati cādhikaḥ||96|| − − yathā vā''klēdya mr̥tpiṇḍamāsiktaṁ tvarayā jalam| − sravati sraṁsatē snēhastathā tvaritasēvitaḥ||97|| − − gRuhNAtyambu yathA vastraM prasravatyadhikaM yathA| − yathAgni jIryati SnehastathA sravati cAdhikaH||96|| − − yathA vA~a~akledya mRutpiNDamAsiktaM tvarayA jalam| − sravati sraMsate SnehastathA tvaritasevitaH||97|| − </div></div> − − <div style="text-align:justify;"> − Just as a piece of cloth only absorbs water as much as it can and leaves off the excess, similarly ''agni'' (digestive power) digests fat as much as it can and expels the excess from the body. Just as a mud ball expels excess water without getting over-moistened when water is poured over it quickly, similarly the body expels fat that has been consumed very quickly. [96-97] − </div> − === Use of salt to expedite oleation === − <div class="mw-collapsible mw-collapsed"> − − लवणोपहिताः स्नेहाः स्नेहयन्त्यचिरान्नरम्| − तद्ध्यभिष्यन्द्यरूक्षं च सूक्ष्ममुष्णं व्यवायि च||९८|| − <div class="mw-collapsible-content"> − − lavaṇōpahitāḥ snēhāḥ snēhayantyacirānnaram| − taddhyabhiṣyandyarūkṣaṁ ca sūkṣmamuṣṇaṁ vyavāyi ca||98|| − − lavaNopahitAH SnehaH SnehayantyacirAnnaram| − taddhyabhiShyandyarUkShaM ca sUkShmamuShNaM vyavAyi ca||98|| − </div></div> − − ''Sneha'' added with salt produces oleation quickly since salt is ''abhishyandi'' (produces more moisture in the tissues), not dry, subtle (enters minute pores), hot in potency and ''vyavayi'' (spreads to all parts quickly and then undergoes digestion). [98] − − === Sequence for oleation and sudation === − <div class="mw-collapsible mw-collapsed"> − − स्नेहमग्रे प्रयुञ्जीत ततः स्वेदमनन्तरम्| − स्नेहस्वेदोपपन्नस्य संशोधनमथेतरत् [१] ||९९|| − <div class="mw-collapsible-content"> − − snēhamagrē prayuñjīta tataḥ svēdamanantaram| − snēhasvēdōpapanNasya saṁśōdhanamathētarat [1] ||99|| − − Snehamagre prayu~jjIta tataH svedamanantaram| − SnehasvedopapanNasya Samshodhanamathetarat [1] ||99|| − </div></div> − − Oleation should be used first, then sudation. Only after oleation and sudation should the person undergo purification and other therapies. [99] − − === Summary === − <div class="mw-collapsible mw-collapsed"> − − तत्र श्लोकः- − स्नेहाः स्नेहविधिः कृत्स्नव्यापत्सिद्धिः सभेषजा| − यथाप्रश्नं भगवता व्याहृतं चान्द्रभागिना||१००|| − <div class="mw-collapsible-content"> − − tatra shlokaH- − SnehaH SnehavidhiH kRutsnavyApatsiddhiH sabheShajA| − yathAprashnaM bhagavatA vyAhRutaM cAndrabhAginA||100|| − − tatra ślōkaḥ- − snēhāḥ snēhavidhiḥ kr̥tsnavyāpatsiddhiḥ sabhēṣajā| − yathāpraśnaṁ bhagavatā vyāhr̥taṁ cāndrabhāginā||100|| − </div></div> − − ''Sneha'', procedures of oleation, complications, their treatments all have been described by Chandrabhagi (Atreya) as was questioned (by Agnivesha).[100] − <div class="mw-collapsible mw-collapsed"> − − इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने स्नेहाध्यायो नाम त्रयोदशोऽध्यायः समाप्तः||१३|| − <div class="mw-collapsible-content"> − − ityAgnivēśakr̥tē tantrē carakapratisaṁskr̥tē ślōkasthānē snēhādhyāyō nāma trayōdaśō'dhyāyaḥsamāptaḥ||13|| − − ityAgniveshakRute tantre carakapratisaMskRute shlokasthAne SnehadhyAyo nAma trayodasho~adhyAyaHsamAptaH||13|| − </div></div> − − Thus ends the thirteenth chapter by name [[Snehadhyaya]] in the [[Sutra Sthana]] of Agniveshatantra redacted by Charak.[13] − − == Tattva Vimarsha (Fundamental Principles) == − <div style="text-align:justify;"> − *There are two sources of lipids recommended for oleation: vegetable and animal origin. ''Ghrita'' (Clarified butter), oil (of sesame), ''vasa'' (muscle fat) and ''majja'' (bone marrow) are the best forms of lipids. [9-13] − *These lipids are essential for pacifying ''[[dosha]]'' and maintaining equilibrium. ''Ghee'' or ''ghrita'' is the best processing media as it adopts the properties of the processed drug without losing its own properties. ''Ghee'' pacifies ''[[vata]]'' and ''[[pitta]]''. Oil pacifies ''[[vata]]'' without aggravating ''[[kapha]]''. Muscle fat is best for improving virility and helpful in healing fractures and dislocations. Bone marrow is specifically beneficial for enhancing strength of bones, bone marrow and ''[[shukra]]'' (sperms). [13-17] − *The ideal season for administration of ''ghee'' is ''sharada'' (autumn), that for muscle fat and bone marrow is ''vaishakha'' (mid April to mid May), and the time for oil administration is ''pravrit'' (early rains). [18] − *Lipid shall be administered according to its indication, at specific time, with correct vehicle, and for a specific duration. Otherwise improper administration may lead to severe disorders. [19-22] − *The dose of lipids intended for purification treatment should be decided as per the digestive capacity of the recipient. The time taken for complete digestion of consumed lipid shall be considered. Thus, the dose is essentially personalized. [29] − *The effects of lipids are dose dependent. The larger dose, medium dose and small dose have different pharmaco-dynamic effects and different indications. [30-40] − *''Ghee'', oil, muscle fat and bone marrow have specific receptors that decide their indications, systemic effects and end results. [41-50] − *Oleation therapy shall be administered until the desirable signs of proper oleation are observed. Specific diet and lifestyle shall be followed during oleation therapy, otherwise it leads to severe diseases. [57-64] − *Duration for oleation therapy is three to seven days. − *Oleation leads to aggravation of ''[[kapha dosha]]'' in body. The status of ''[[kapha]]'' is key factor for deciding time of therapeutic emesis or purgation. Therapeutic emesis shall be prescribed immediately after one day of completion of oleation therapy when ''[[kapha]]'' is in aggravated state. Therapeutic purgation shall be prescribed when the ''[[kapha]]'' is less in body i.e. after three nights of completion of oleation therapy. [80-81] − *Oleation followed by sudation are essential procedures before body purification. These two are performed before purification in order to channelize ''[[dosha]]'' from ''shakha'' (periphery) to ''koshtha'' (gut). [99] − </div> − − == Vidhi Vimarsha(Applied Inferences) == − − === Sources of ''Sneha'' === − − ''Sneha'' i.e. fats that are available today can be categorized in ''sthavara'' (vegetable origin) and ''jangama'' (animal origin) as a part of therapeutics or dietetics. E.g. − − ''Sthavara Sneha'' (vegetable sources) − − Mineral oil, olive oil, palm oil, soybean oil, rapeseed oil, sunflower oil, peanut oil, cottonseed oil, coconut oil, rice bran oil, grape seed oil, corn oil, hazelnut oil etc. − Moreover, most of essential oils used in cosmetics and therapeutics are also ''sthavara'' type, as they are derived from sections of plants. For e.g. rose oil, clove oil, peppermint oil, cedarwood oil etc. − − ''Jangama Sneha'' (Animal sources) − − Cod liver oil, shark liver oil, all ''ghee'', milk, milk products, curd, all types of meats, etc. are sources of animal fats.[verse 9-11] − − === Reasons for superiority of sesame oil === − <div style="text-align:justify;"> − Sesame oil is considered the best among all oils because it provides strength and unctuousness in body. It is ''ushna'' (hot) in nature, possesses ''[[kapha]]-[[vata]]hara'' (pacifying ''[[kapha]]'' and ''[[vata dosha]]'') properties, and is beneficial for voice and complexion. It also cures fractures and dislocations, purifies ''[[dhatu]]'' (body tissues) and ''vrana'' (wound). [Ka.Sa.Sutra Sthana. 22/7] Ongoing research also indicates that the rich presence of antioxidants and polyunsaturated fats in sesame oil could help control blood pressure.<ref> "Sesame and rice bran oil lowers blood pressure, improves cholesterol", American Heart Association Meeting Report - Abstract 186, Retrived from http://newsroom.heart.org/news/sesame-and-rice-bran-oil-lowers-238424 [cited on 19 dec 2013] </ref> − − Due to high Vitamine E content<ref> "Cooking Oils That Are Good For You". CBS News. Retrived from http://www.cbsnews.com/news/cooking-oils-that-are-good-for-you/ cited on 19 dec 2013 </ref> , Sesame oil is an antioxidant and improves skin health and complexion<ref> Nachbar F, Korting HC, The role of vitamin E in normal and damaged skin. J Molecular Medicine. 1995 Jan;73(1):7-17. </ref> while also lowering cholesterol levels.<ref> Correlations between Cholesterol, Vitamin E, and Vitamin K1 in Serum: Paradoxical Relationships to Established Epidemiological Risk Factors for Cardiovascular Disease retrived from http://www.clinchem.org/content/44/8/1753.full cited on 19 dec 2013 </ref> Sesame oil also contains magnesium, copper, calcium, iron, zinc, and vitamin B6. Copper provides relief for rheumatoid arthritis. magnesium supports vascular and respiratory health.<ref> Retrived from http://en.wikipedia.org/wiki/Sesame_oil#cite_ref-16 cited on 19 dec 2013 </ref> Calcium helps prevent colon cancer, osteoporosis and migraine. Zinc promotes bone health. Clinical studies have shown that a sesame oil massage of infants improved their weight and length, as well as their mid-arm and mid-leg circumferences.<ref> Agarwal, KN; Gupta, A; Pushkarna, R; Faridi, MM; Prabhu, MK (2000). "Effects of massage & use of oil on growth, blood flow & sleep pattern in infants". Inian J Med Res. 112 (212): 7. PMID 11247199. </ref> − </div> − − === Properties of Castor oil === − − The United States Food and Drug Administration (FDA) has categorized castor oil as "generally recognized as safe and effective" (GRASE) for over-the-counter use as a laxative with its major site of action in the small intestine (where it is digested into Ricinoleic acid).<ref> "Ingredient List A-C" . FDA. Archived from the original on 2006-12-17. Cited on 19 dec 2013 </ref> − At low doses, castor oil is readily absorbed. As the oral dose increases, percent absorption decreases and laxation occurs.<ref> Watson, W. C. et al. (1963) Journal of Pharmacy and Pharmacology;15: 183 </ref> Castor oil is widely used in treatment of musculo-skeletal and spine disorders. It is considered useful in ''ama'' dominant conditions like rheumatoid arthritis where less absorption of ''sneha'', ''[[vata]]'' alleviation and body purification are expected simultaneously. Castor oil in large doses is administered for therapeutic purgation. [verse 12] − − === Best ''Sneha'' and their Therapeutic Applicabilities === − − ==== ''Ghrita'' (clarified butter / ''ghee'') ==== − <div style="text-align:justify;"> − ''Ghee'' is the best oleate due to prominence in its unctuousness. This property of fats is indicated by saponification value which is highest in ''ghee'' ( 225-235 )<ref> Dhurvey Y.R.*, Kawtikwar P.S., Sakarkar D.M., Evaluation of Physicochemical Properties of Cow Ghee before and after Hydrogenation, International Journal of ChemTech Research,2012, Vol.4, No.1, pp 185-189 </ref> as compared to sesame oil (188-193)<ref> Retrived from http://en.wikipedia.org/wiki/Sesame_oil, cited on 20 dec 2013 </ref>,and animal fat (190-205)<ref> Retrived from http://en.wikipedia.org/wiki/Animal_fat, cited on 20 dec 2013 </ref> etc. ''Samskara'' (processing) leads to transformation of inherent attributes of a substance. But this change is due to changes in the basic composition of a drug. ''Ghee'' has a unique quality to adopt properties of herbs processed with it without losing its own. If ''ghee'' is processed with drugs with nourishment properties, then it is indicated in degenerative diseases. If it is processed with drugs having hot and strong properties, then it is indicated in obstructive diseases. Therefore, it is considered as the best media for processing. One or the other medicated ''ghee'' preparation is indicated in almost all diseases. It pacifies ''[[vata]]'' due to ''snigdha [[guna]]'' (unctuous properties) and ''[[pitta]]'' due to ''madhura'' (sweet) and ''sheeta'' (cold) properties. [Cha.Sa.[[Nidana Sthana]] 1/39] It increases ''[[shukra]]'' and ''[[ojas]]'' due to similar properties. − − ==== ''Vasa'' (muscle fat) ==== − − ''Vasa'' i.e. intramuscular fat is a normal content of human body and its function is to lubricate the muscles while also serving the role of a fat store to be used up by the body when subjected to energy-intensive activities, such as physical workouts where it may contribute up to 20% of total energy turnover.<ref> Roepstorff C, Vistisen B, Kiens B (2005). "Intramuscular triacylglycerol in energy metabolism during exercise in humans". Exercise and Sport Science Reviews 33 (4): 182–8. </ref> This is a possible reason for it to be recommended for individuals engaged in intensive physical acitivities, as well as for oleation therapies. − − ==== ''Majja'' (bone marrow) ==== − − Bone marrow contains about 96 percent fat. It contributes to 50 to 175 g of protein required by body each day. It has all the amino acids needed for good health. Each serving of marrow provides 3% of the calcium required each day. Calcium is commonly understood to strengthen bones and decrease risk of developing brittle, easily-broken bones as one gets older.<ref> Retrieved from http://www.livestrong.com/article/445905-what-are-the-health-benefits-of-eating-bone-marrow/ cited on 2-01-2014 </ref> All these factors explain why bone marrow is beneficial, especially for one’s bone health. In Ayurvedic clinical practice, soup of bone marrow is prescribed for osteoporosis and degenerative disorders of the vertebrae.[verse 13-17] − </div> − − === Proper season and time for ''sneha'' consumption === − <div style="text-align:justify;"> − The proper season for consumption of a ''sneha'' depends upon the physiological dominance of ''[[dosha]]'' in the body during that particular season, as well as the inherent properties of the ''sneha''. On the basis of its inherent properties, ''ghee'' is indicated in ''sharada'' (autumn) season, when ''[[pitta dosha]]'' is increased. Muscle fat and bone marrow do not possess much hot or cold potency, and hence are advised in ''sadharana kala'' (i.e. seasons that are not very hot or cold), except in ''Chaitra'' month (mid-March to mid-April) when it may vitiate ''[[kapha dosha]]''. Oils are the best medicines for ''[[vata]]'', hence they are recommended for consumption in the ''pravritta'' (early rainy) season. These rules are to be followed universally according to seasonal and temperature variations. If this is not followed, then complications in oleation therapy could be observed.[verse 18-21] − </div> − − === ''Anupana'' (after consumption) === − <div style="text-align:justify;"> − Most of the ''sneha'' gets stuck in upper gastrointestinal tract due to stickiness. The vehicles or after-drinks assure proper transport of the ''sneha'' (oleate or lipid or fat) to its intended site of digestion and absorption, and help in proper metabolism to increase bio-availability. However, those after-drinks should not affect the actions of the ''sneha''. Warm water liquefies ''ghrita'' and facilitates its transport and absorption. Similar facilitation is seen in the use of lentil soup and scum of gruel after consuming oil and ''vasa-majja'' respectively. However, warm water is usually accepted as an after-drink in all cases of ''sneha'' consumption (with an exception of ''bhallatak'' and ''tuvaraka'' oil.)[verse 22] − </div> − − === ''Pravicharana'' (medium of administration) === − − ''Pravicharana'' implies the medium of administration of ''sneha'' advisable for those who need to undergo oleation therapy but are unfit to consume ''sneha'' as such. In such cases, optional modes of administration of oleation are suggested based on palatability of the oleate and the tolerance (and the digestive power) of the person. Ideally, food and external applications are considered as ''Pravicharana''. Cooked rice, gruel, meat juices etc. mixed with fats are administered and external massage, unctuous enema, oil through nose and ears etc. are considered optional modes of administration of oleation therapy.[verse 23-25] − − === ''Acchapana'' (drinking fat alone) as a preferred mode for oleation === − − There are number of factors that affect the absorption of any drug<ref> Retrieved from http://www.codental.uobaghdad.edu.iq/uploads/lectures/Pharma%20lectures/2%20Pharmacokinetics%20finishing%20with%20bioavailibility.pdf cited on 2-01-2014 </ref> , − − #Total surface area available for absorption of fat − #Contact duration at the absorption surface − #Quantity of food in the gastro-intestinal Tract − #Gastrointestinal pH changes − #Gastric emptying time & rate − #Pancreatic and intestinal enzymes − #Bile acids & biliary function − #Gastrointestinal flora − #Drug/food interaction − − === Dose of ''sneha'' === − − <div style="text-align:justify;"> − The recommended dose of ''sneha'' would be different for every individual, depending upon the individual’s ''agni'' (digestive capacity), ''koshtha'' (bowel habit) etc. However, for ease in therapeutic applicability, specific doses in ''pala, karsha'' etc. are advised by Arunadatta in his commentary on Ashtangahridaya (Sutra Sthana Chapter 16/17). Two ''pala'' (96 ml) as minimum, four ''pala'' (192ml) as medium, and six ''pala'' (288ml) as maximum dose have been suggested. Sharangadhara (Madhyama Khanda 1/7) and Bhavamishra (Bhavaprakash I-79 iv. 6) suggest the quantities of one ''pala'' (48ml), three ''karsha'' (36ml) and two ''karsha'' (24ml) as the best, medium and least doses respectively.[verse 29-30] − − In a research on 29 individuals, it is observed that increasing dose of fat after considering status of [[agni]] and bowel habit of individuals gives better results in oleation therapy. The onset of various symptoms of adequate oleation occur in a sequential manner which is helpful in predicting the duration of oleation and signs of oleation in gastro intestinal tract and peripheral tissues.<ref name="Patil Snehapana">Patil VC, Thakar AB, Baghel MS. Clinical trial on different dose patterns of Shodhanartha Abhyantara Snehana. AYU [serial online] 2013 [cited 2020 Jun 19];34:147-53. Available from: http://www.ayujournal.org/text.asp?2013/34/2/147/119668</ref> − − </div> − − === Deciding suitable dose === − <div style="text-align:justify;"> − [[Ayurveda]] ''acharyas'' have advised three dosage forms - high, medium and low doses. The following points need to be considered to determine the applicable dose for an individual: − − #Severity of disease − #Habitual use of sneha in diet − #''Agni'' (digestive power) − #Body strength − #Purpose of oleation − #Age − #Lifestyle − − When a disease is severe or chronic in nature, it implies a “deep-seated” or a chronic case of (vitiated) ''[[dosha]],'' blockages in microchannels, besides other imbalances and complications. In such conditions, the highest possible dose could be necessary to channelize and eject the ''[[dosha]]'' from its “seat” towards the gut. This quantity is beneficial for disorders of mind and sense organs. However, the patient needs to have strong digestive capacity and good strength of patient to be able to tolerate the highest dose. The body of the patient adapts to an increased fat intake (thereby increasing the rate of oxidation of fat) by two mechanisms:<ref> Flatt JP. Dietary fat, carbohydrate balance, and weight maintenance: effects of exercise. American Journal of Clinical Nutrition 1987;45:296–306. </ref> − − #Expansion of the fat stores or − #Maintenance of the glycogen stores in a lower range. − − Thus, for those using ''sneha'' routinely in diet, oleation is possible only when natural habitual intake of fats is exceeded to overcome this adaptation. This is also the possible reason for daily increase in dose of ''sneha,'' so that body can not get adapted to the dose administered on day before. Seven days is maximum duration for ''sneha'' consumption because ''sneha'' is adapted by body easily after seven days (Cha. Si. 1/7). This is based on the fact that for purpose of energy balance body adapts to fat oxidation within seven days of increased fat intake.<ref> Patrick schrauwen, wouter D vanMarken Lichtenbelt, Wim HM Saris, Klaas R Westerterp, “Changes in fat oxidation in response to a high fat diet”, American journal of clinical nutrituion, 1997; 66-276-82 </ref> − − The medium dose is suitable when disease is of moderate severity, in person having soft bowel, moderate diet and strength. This dose is enough to reach all over body as there is less obstructions, no fat adaptation, hence produce least complications. This is the ideal dose for purification therapies. − − Lowest dose of ''sneha'' consumption is fat substitute for diet. Thus, it holds more calorie contents, which strengthens body and is free from any complications. It can be used in old persons and children.[verse 31-51] − − ==== Formula for calculating strength of agni ==== − − A team of researcher postulated a formula for calculating strength of [[agni]] in oleation therapy for suitable dose <ref name="Patil Snehapana"/> as below: − − Bio-fire (Agni) Strength Index (BSI) = (Total Dose / Given Dose) × T. − − T = Time taken for the digestion of Ghee. − − Lesser the BSI, more will be the intensity of bio-fire. − </div> − − === Indications of oleation === − − Oleation and sudation are essential pre-purification therapies to channelize [[dosha]] from all body parts to the gut. − − ==== ''Sneha'' in regular exercise ==== − <div style="text-align:justify;"> − Those doing regular exercise require high calorific diet to maintain body weight and healthy fat deposits in the body. Hence ''sneha'' consumption is necessary for them. Fats also serve as energy stores for the body, containing about 37 kilojoules of energy per gram (8.8 Cal/g)<ref> United Kingdom The Food Labelling Regulations 1996 – Schedule 7: Nutrition labelling </ref> (the highest in comparison to those of proteins and carbohydrates which provides 4 Cal/g of energy).<ref> Retrived from http://www.fao.org/docrep/006/y5022e/y5022e04 cited on 2-01-2014 </ref> <ref> Retrived from http://en.wikipedia.org/wiki/Protein_(nutrient) cited on 2-01-2014 </ref> In case of starvation, fats are broken down in the body to release glycerol and free fatty acids.<ref> Retrived from http://en.wikipedia.org/wiki/Fat cited on 2-01-2014 </ref> Glycerol is further converted to glucose by the liver and thus used as a source of energy. − </div> − − ==== ''Sneha'' in chronic alcoholics ==== − − Alcoholics gain weight because of excess energy intake with food and inhibition of fat oxidation from alcohol.<ref> Suter PM, Schutz Y, Jequier E. The effect of ethanol on fat storage in healthy subjects. N Engl J Med. 1992 April 9;326(15):983–7 </ref> But chronic alcoholics (''Madyanitya'') show a lower body weight due to fat mass reduction.<ref> Addolorato G, Capristo E, Greco AV, et al. Energy expenditure, substrate oxidation, and body composition in subjects with chronic alcoholism: new findings from metabolic assessment. Alcoholism: Clinical and Experimental Research. 1997 September; 21(6):962–7. </ref> This alteration could be due to induction of the non-alcohol dehydrogenase pathway, likely the microsomal ethanol oxidizing system.<ref> Addolorato G, Capristo E, Marini M, et al. Body composition changes induced by chronic ethanol abuse: evaluation by dual energy X-ray absorptiometry. American Journal of Gastroenterology. 2000 September;95(9):2323–7. </ref> Moreover, ethanol might have direct effects on human adipocytes.<ref> Suthat Liangpunsakul, David W. Crabb,Rong Qi, Relationship between alcohol intake, body fat and physical activity- a population based study, Annals of Epidemiol. 2010 September; 20(9): 670–675. </ref> Therefore, ''sneha'' is indicated in chronic alcoholics. − − ==== ''Sneha'' in excessive sex ==== − − Those who are involved in excessive sexual activity lose their ''[[ojass]]'' (vitality) leading to ''dhatukshaya'' (depletion of ''[[dhatu]]''), ''[[vata]]'' aggravation and loss of unctuousness as mentioned in the pathology of ''rajayakshma''. [Cha.Sa.[[Chikitsa Sthana]] 8/24-25] Hence oleation is required in such debilitated persons. − − ==== Contraindications of ''Sneha'' ==== − − ''Sneha'' is mainly contraindicated in conditions where there are excessive body secretions especially from mouth and rectum, ''ama'' formation, poor digestion, excess aggravation of ''[[dosha]]'', and in cases where other therapies such as ''[[nasya]]'' and ''[[basti]]'' are being administered. Oleation therapy worsens the condition in these cases. [verse 52-56] − − === Signs of inadequate, proper and excess ''Sneha'' === − <div style="text-align:justify;"> − Inadequate oleation does not pacify ''[[vata]]'' and disturbs ''agni'' leading to poor digestion. Proper oleation due to proper ''sneha'' improves digestion. The skin acts as a water resisting barrier to prevent flow of essential nutrients out of the body. The nutrients and oils that help hydrate the skin are covered by the outer layer of skin, the epidermis.<ref> McCracken, Thomas (2000). New Atlas of Human Anatomy. China: Metro Books. pp. 1–240. ISBN 1-58663-097-0 </ref> Softness or tenderness of skin is a result of proper oleation since ''[[snehana]]'' adds to the functional improvement of fat deposits of the body. Excess oleation causes improperly formed faeces, which may be due to increase in colorectal transit time as a result of excess unctuousness in gastrointestinal lumen. Stools are formed in the colon in the last phase of digestion. Through peristalsis, the muscles of the colon and the abdomen advance the liquid feces through the colon and compress the fecal matter into stool. During this process the colon extracts water from liquid feces as it passes down. The water is absorbed by the lumen, leaving the larger waste particles to be further tumbled along and formed into stools.<ref> Retrieved from http://web.pdx.edu/~sujata/FruitEze/education/colon/stool.html cited on 2-01-2014 </ref> Due to excess oleation, blockage of microchnnels and villi occurs and absorptive function may become hampered leading to improperly formed stool. All other symptoms of excess oleation are due to increase in ''kleda'' (moisture) in body leading to heaviness, loss of digestive strength etc.[verse 57-59] − </div> − − === Do’s and Don’ts after ''Sneha'' Consumption === − − Guidelines to be followed after ''sneha'' consumption are intended: − <div style="text-align:justify;"> − *To maintain digestive power at optimum quality − *To avoid any physical exertion − *To keep mental balance intact − *To avoid any etiological factors for production of diseases. − − Digestion and physical activities are associated with large and sometimes opposite changes in several physiological parameters. Gastric acid secretion during digestion causes increased levels of plasma bicarbonate ([HCO-3] (pl)), whereas activity leads to a metabolic acidosis with increased lactate and decrease in plasma bicarbonate.<ref> Andersen JB, Wang T, Cardiorespiratory effects of forced activity and digestion in toads.Physiological and Biochemical Zoology. 2003 Jul-Aug;76(4):459-70. </ref> Thus naturally to keep digestion of ''sneha'' at optimum, person needs to avoid excess physical exertion. − − Emotions affect physiological processes and actions which are responsible for nutrient malabsorption and digestive health. Saliva becomes more acidic under stress, depression and negative emotions due to alteration in salivary digestive enzyme, ptyaline. The negative emotions also affect the production of pepsin in the stomach, enzyme release from the pancreas and also liver bile flow.<ref> Retrieved from http://www.humphreybacchus.com/blog/how-do-our-emotions-affect-digestion cited on 3-01-2014 </ref> Anxiety, is responsible for "fight or flight" response, that takes up a lot of brain's resources, so to compensate it slows down parts of brain that are not as necessary, such as the muscles involved in digestion.<ref> Addolorato, Giovanni, et al. Anxiety and depression: a common feature of health care seeking patients with irritable bowel syndrome and food allergy. Hepato-gastroenterology 45.23 (1998): 1559. </ref> Anxiety can also cause low serotonin, and that means that some of the messengers that are normally traveling into body are possibly being created at a lower rate, leading to digestive disorders. During the fight or flight response, body creates massive amounts of adrenaline to give extra energy. In order to create that energy, adrenaline needs to take it from "sugar storage" - While adrenaline does this, body starts processing nutrients at rates that aren't ideal. It changes how body processes nutrients as well and could conceivably affect digestive health.<ref> Retrieved from http://www.calmclinic.com/anxiety/symptoms/digestive-problems cited on 3-01-2014 </ref> All these factors collectively may cause adverse effects of ''sneha'' due to impaired digestive power. Therefore, avoiding negative emotions is important in oleation therapy. Avoiding breeze, snow, sunlight etc. are a must in order to avoid any environmental infections or altered immune responses.[verses 62-64] − </div> − − === Bowel habits and duration of oleation therapy === − <div style="text-align:justify;"> − ''Koshtha'' i.e. bowel habits are the outcome of ''[[dosha]]'' dominance in bowel. ''[[Vata]], [[pitta]]'' and ''[[kapha]]'' dominance causes ''krura'' (hard), ''mridu'' (soft) and ''madhyam'' (moderate) ''koshtha'' (bowel habit) respectively. ''[[Vata]]'' due to its ''ruksha'' (dry) [Indhu on A.S. Sutra Sthana 1/ 11]<ref name=Sangraha>Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref> properties causes fast absorption of ''sneha'' and also requires large doses and longer duration for complete oleation. ''[[Pitta]]'' has natural unctuousness associated with it due to its ''ushna'' (hot), ''sara'' (easy for dispertion), and ''drava'' (liquid) [A.H. Sutra Sthana 1/11]<ref name=Hridaya/> properties. These properties aid in the flow of ''sneha'' across all body parts and hence, an early push of ''[[dosha]]'' towards the bowel requires least dose and minimum duration. ''[[Kapha]]'' has similar properties as ''sneha''. However, the bowel habit in a ''[[kapha]]'' person is moderate due to its ''sthira'' (stable) and sticky properties. [A.H. Sutra Sthana 1/12]<ref name=Hridaya/> Modern science also explains bowel habits, its effects and considers intestinal transit time responsible for it. 40-45 hours is the normal bowel or in Ayurvedic terminology ''madhyama koshtha'' person’s intestinal transit time.<ref> Retrived from http://healthyliving.msn.com/health-wellness/what-your-bowel-movements-are-telling-you-about-your-health-1 cited on 3-01-2014 </ref> If it stays in the gut for longer than that, fluid is re-absorbed into the body and the stool becomes harder and dryer. Body secretes about eight liters of fluid during the course of a day<ref> F. John Gennari, and Wolfgang J. Weise, Acid-Base Disturbances in Gastrointestinal Disease, Clinical Journal of the American Society of Nephrology, November 2008, (3)6: 1861-1868 </ref> —from the stomach, salivary glands and pancreas—to decompose food and push it through the digestive system. But if food passes through too quickly, there isn’t enough time for all of that liquid to get absorbed, and the stool emerges in a semi-solid or liquid state. Thus, it is the physiological differences based on intestinal transit time that decide the duration of oleation therapy. The nature of a food item or a drug ingested affects bowel movement and explains the differences mentioned above.[verses 65-69] − </div> − − === Complications of oleation therapy === − <div style="text-align:justify;"> − Excessive thirst is a result of impaired digestion and absorption of lipids. Alpha-linolenic acid (an omega-3 fatty acid) and linoleic acid (an omega-6 fatty acid) are essential fatty acids supplied by almost all polyunsaturated fats.<ref> Reiffel JA, McDonald A (August 2006). "Antiarrhythmic effects of omega-3 fatty acids". The American Journal of Cardiology 98 (4A): 50i–60i. </ref> But any defect in their absorption may cause deficiency leading to excessive thirst and dry skin, brittle hair &nails, sleep and attention problems.<ref> Colquhoun I, Bunday S., A lack of essential fatty acids as a possible cause of hyperactivity in children., MedicalHypotheses. 1981 May; 7(5):673-9. </ref> − − Bile, to some extent acts as a surfactant, helping to emulsify the fats in food. Without bile salts, most of the lipids in food would be excreted in feces, undigested leading to steatorrhea and vitamin deficiency.<ref> Retrived from http://en.wikipedia.org/wiki/Bile cited on 3-01-2014 </ref> Thus ''sama [[pitta]]'' (''[[pitta]]'' that is not formed well) can be due to improper functions of biliary system that can not digest fats properly and produce severe symptoms. Moreover, fats boiled with some medicines may cause correction in this metabolic defect thus advocated in ''sama [[pitta]]'' condition. − − All the diseases produced as complications are basically of ''kleda'' (moisture) dominant and ''ama'' dominant in nature, hence dry, ''amapachaka'' drugs are indicated in therapy. Medicated buttermilk is indicated to counter the complications of oleation therapy. [Cha.Sa.[[Sutra Sthana]] 2/30] Therapeutic emesis, therapeutic purgation are prescribed to remove undigested ''sneha'' from gut preventing further complications.[verse 70-79] − </div> − − === ''[[Shodhana]]'' (purification) after oleation === − − ''[[Vamana]]'' (therapeutic emesis) is done in ''utklishta [[kapha]]'' (therapeutically aggravated ''[[kapha]]'' by oleation) condition. ''[[Virechana]]'' (therapeutic purgation) is done when ''[[kapha]]'' is reduced in body. [Cha.Sa.[[Siddhi Sthana]] 1/ 8-9], Hence, the rest period for performing ''[[virechana]]'' after oleation is more (three days) than that of ''[[vamana]]''.[verse 80-81] − − === ''Vicharana'' (alternative methods of fat administration) === − <div style="text-align:justify;"> − ''Sneha'' consumption alone is generally associated with considerable degree of nausea. Also, persons living luxurious lifestyles hate therapeutic fat consumption. Those habitual to fatty diets need larger doses of fats which in turn results in nausea. Soft bowel persons are naturally have rapid intestinal transit rate. Due to this, less fat absorption occurs and excreted without digestion. Those who cannot tolerate exertion also suffer from nausea due to ''sneha'' administration. Those having alcohol addiction can not suddenly discontinue their habit and thus they need fats to be given in some form of alcoholic preparation. − </div> − − === Benefits of ''pravicharana'' in palatability and taste perception === − − *''Pravicharana'' can change the physical nature of sneha by addition of different substances. − *It may change chemical property to some extent by ''samskara'' (transformation) − *It can stimulate or inhibit cholecystokinin- pancreozymine secretions. − *Also, ''sneha'' can be made more palatable and pleasant to mind by considering taste. − − Some important properties of ''vicharana'' have been enumerated in the following table: − − '''Table 2: Details of ''Pravicharana''''' − − {| class="wikitable" − |- − ! ''Type of Pravicharana'' !! ''Properties'' !! ''Reference'' − |- − | rowspan="1" style="text-align: left;" | ''Odana (boiled rice)'' − | rowspan="1" style="text-align: left;" | ''laghu, balya, truptikara'' − | rowspan="1" style="text-align: left;" | ''Yogaratnakara Purvakhanda Siddhannadipakaguna chapter'' − |- − | rowspan="1" style="text-align: left;" | ''Vilepi (thick gruel)'' − | rowspan="1" style="text-align: left;" | ''laghu, deepaniya, madhura, pathya, tarpana, hridya,[[vata]] [[pitta]]hara'' − | rowspan="1" style="text-align: left;" | ''[Su.Sa. Sutra Sthana 46/342]<ref name=Susruta/>'' − |- − | rowspan="1" style="text-align: left;" | ''Mamsarasa (meat soup) and mamsa (meat)'' − | rowspan="1" style="text-align: left;" | ''prinana, [[vata]] [[pitta]]hara, hridya, swasa, kasa, shrama,kshya hara, shukrakara'' − | rowspan="1" style="text-align: left;" | ''[Su.Sa. Chikitsa Sthana 46/359-60]<ref name=Susruta/>'' − |- − | rowspan="1" style="text-align: left;" | ''Dugdha (milk)'' − | rowspan="1" style="text-align: left;" | ''madhura, sheeta, snigdha, guru'' − | rowspan="1" style="text-align: left;" | ''[Cha.Sa.[[Sutra Sthana]] 1/112]'' − |- − | rowspan="1" style="text-align: left;" | ''Dadhi (curd)'' − | rowspan="1" style="text-align: left;" | ''madhura, guru, [[vata]]hara, [[pitta]] [[kapha]] vardhaka, agnimandyakara, amla'' − | rowspan="1" style="text-align: left;" | ''Yogaratnakara Purvakhanda Siddhannadipakaguna chapter'' − |- − | rowspan="1" style="text-align: left;" | ''Yavagu (thick gruel)'' − | rowspan="1" style="text-align: left;" | ''grahi, [[vata]]nashaka, balya, tarpana'' − | rowspan="1" style="text-align: left;" | ''[Ka.Sa. Khila Sthana 4/76]'' − |- − | rowspan="1" style="text-align: left;" | ''Supa (soup of green leafy vegetables)'' − | rowspan="1" style="text-align: left;" | ''laghu, grahi, [[kapha]] [[pitta]]hara'' − | rowspan="1" style="text-align: left;" | ''Yogaratnakara Purvakhanda Siddhannadipakaguna chapter'' − |- − | rowspan="1" style="text-align: left;" | ''Yusha (pulses soup)'' − | rowspan="1" style="text-align: left;" | ''[[deepana]], rochana, agnivardhaka, praswedajanana,tridoshashamaka'' − | rowspan="1" style="text-align: left;" | ''[Ka.Sa. Khila Sthana 4/15]'' − |- − | rowspan="1" style="text-align: left;" | ''Khada (cooked buttermilk)- Kambalika (Preparation of Sesame with curd, oil, salt etc.)'' − | rowspan="1" style="text-align: left;" | ''ruchikara, ushna, laghupaki, [[vata]] [[kapha]]hara, hridya'' − | rowspan="1" style="text-align: left;" | ''[Su.Sa. Chikitsa Sthana 46/376]<ref name=Susruta/>'' − |- − | rowspan="1" style="text-align: left;" | ''Saktu (roasted flour of barli, horse gram etc.)'' − | rowspan="1" style="text-align: left;" | ''saktu mantha - sadyobalakara, pipasa, shramanashana, [[mala]]-[[dosha]]nulomana, ruksha'' − | rowspan="1" style="text-align: left;" | ''[Su.Sa. Chikitsa Sthana 46/386-87]<ref name=Susruta/>'' − |- − | rowspan="1" style="text-align: left;" | ''Madya (alcohol)'' − | rowspan="1" style="text-align: left;" | ''amla, ushna, vatanulomana, [[kapha]]hara'' − | rowspan="1" style="text-align: left;" | ''[Cha.Sa. Sutra Sthana 27/178]<ref name=Susruta/>'' − |- − | rowspan="1" style="text-align: left;" | ''Leha (confections)'' − | rowspan="1" style="text-align: left;" | ''madhura, guru'' − | rowspan="1" style="text-align: left;" | ''[A.S. Sutra Sthana 25/20]<ref name=Sangraha/>'' − |- − |} − − In patients suffering from skin diseases, edema, diabetes, meat of domesticated animals and animals from marshy lands , or of aquatic animals is contraindicated. Moreover, jaggery, curd, milk and sesame are also not suitable for ''vicharana''. All these articles increase moisture content in body causing aggravation of symptoms. − − === Mode of action of ''sneha'' === − − ''Sneha'' acts as a solvent and it increases ''apyamsha'' (liquid content) of the body which ultimately leads to ''utklesha'' (aggravation of ''[[dosha]]'' for removal).[verse 96-97] − − ==== I. Action as a solvent ==== − <div style="text-align:justify;"> − Fats acts as good solvent for many metabolic wastes and it enters the cells easily because cell membrane is made up of phospholipids.<ref> Retrived from http://en.wikipedia.org/wiki/Cell_membrane cited on 3-01-2014 </ref> Compared to other non-unctous substances, fat materials stays in the body for a stipulated period without causing any harm and also possesses better permeability. The large quantity of fats administered before purification therapies do not undergo digestion and metabolism cycle because the sneha is intended to increase and channelize ''[[dosha]]'' towards ''koshtha''. − − According to Sushruta, the disease occurs due to dislodgement of vitiated ''[[dosha]]s'' in the channels during their circulation in the body. [Su.Sa.Sutra Sthana 24/10]<ref name=Susruta/> ''Sneha'' administered internally reaches microchannels and acts as a solvent to remove the obstruction by dissolving ''[[dosha]]s'' in it, resulting in the removal of obstructions in microchannels, which is one of the important steps in the treatment. − </div> − − ==== II. Increase in the ''apyamsha'' (liquid content) of the body ==== − <div style="text-align:justify;"> − This particular phenomenon should be understood regarding ''vriddhi'' i.e. increase in the ''apyamsha'' i.e. liquid content of the body. This leads to ''utklesha'' and can be called as transient increase in ''[[rasa]]'' (body fluids) and ''kleda'' (moisture). ''Sneha'' has the predominance of ''[[apa mahabhuta]]'', which is corroborated by the specific qualities. [Cha.Sa.[[Sutra Sthana]] 22/15], [A.H.Sutra Sthana 1/11]<ref name=Hridaya/> and it is hydrophilic in nature. After proper ''[[snehana]]'', all the cells of body become completely saturated with fats. Then the fat material comes out of the cell to extra-cellular fluid by osmosis. So, due to the aqueous properties of ''sneha'' and liquefied waste brought from the tissues, the levels of fatty acids etc. increase in the blood resulting in the high plasma volume. To keep up the equilibrium of the normal plasma, the extra amount of liquid from it, reaches the ''koshtha'' for excretion. This is called as ''anu pravana bhava''. Later on when emetics or purgatives are administered, this increased amount of the body fluids are evacuated by which the vitiated ''[[dosha]]s'' and in-excreted ''[[mala]]s'' also expelled out resulting in the radical cure of the disease. By the combined effect of oleation and sudation, excessive increase of ''[[dosha]]'' liquification of ''[[dosha]]'', digestion of ''[[dosha]]'', opening of micro-channels and control of ''[[vata]]'' occurs so that, the ''[[dosha]]s'' come to the ''kostha'' by Anupravana Bhava, then they are expelled out through nearest route by proper ''[[shodhana]] karma''. [Cha.Sa.[[Sutra Sthana]] 28/33] − </div> − − === ''Sadya [[snehana]]'' (instant oleation) and salt with fats for early oleation === − − Instant oleation is required in some conditions requiring immediate purification therapy. In exacerbation of ''asthma sadya [[snehana]]'' is done and ''[[vamana]]'' is performed to remove ''avarana'' (obstruction) by ''[[kapha]]''. Salt is having hygroscopic nature,<ref> Retrived from http://en.wikipedia.org/wiki/Hygroscopyhttp://en.wikipedia.org/wiki/Hygroscopy cited on 3-01-2014 </ref> thus when consumed with fats it increases moisture content in the body, that eventually results in early oleation.[verse 89-98] − − === Common method followed for oleation purpose before purification therapies === − <div style="text-align:justify;"> − Practically approximately 30 ml of ''sneha'' is administered on first day and based upon duration required for its digestion the dose of ''sneha'' to be administed is decided, which is the dose of ''sneha'' consumption on last day. For e.g. if a hard bowel person gets appetite after 2 hours of 30 ml sneha drinking and requires medium dose oleation (sneha dose which is digested in 12 hours) then the dose on last day will be approximately 180 ml, which is achieved by gradually increasing doses of ''sneha'' in seven days. − </div> − − === Researches === − − The research works carried out on oleation therapies are as follows: − <div style="text-align:justify;"> − *Venkataramana B.S. (1967): Roga- Marga and Shodhana poorva Snehana, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar. − *Goyel Shyamlal (1970): Acchapana Vimarsha, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar. − *Badve Varsha (2000): A Clinical study on standardization of Shodhanartha Abhyantara Snehapanam, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar. − *Vasant C. Patil (2006): Further clinical study on standardization of Shodhanartha Snehapana, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar. − *Gauri Vaidya (2009): an observer blind clinical study on standardization of Shodhanartha Snehapana w.s.r. to Sneha PraVicharana, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar. − *Raval K. R. (1987): The study of Virechana Poorvaka Snehana in Pandu Roga. Department of Kayachikitsa. Govt. Akhandanand Ayurvedic college, GAU, Ahmedabad. − *Ashvini Kumar M (2002): A Study on Shodhananga Arohana and Sadyo Snehana, Department of Panchakarma, SDM College of [[Ayurveda]], Rajiv Gandhi University of Health Sciences, Hassan. − *Alva Gauthama (2002): A clinical study to evaluate the role of Plain ghee and Panchatikta ghee as Poorva Karma of Virechana w.s.r. to Ekakushtha. Department of Panchakarma, SDM College of [[Ayurveda]], Rajiv Gandhi University of Health Sciences, Hassan. − *Mangalagi S.G. (1979): A Study on Abhyantara Sneha w.s.r to Virechana, Govt. Ayurvedic Medical College, Mysore. − </div> − − === Scope for further research === − − *To improve palatability of fats, scientific research on the alternative methods of consumption i.e ''vicharana'' must be carried out and the number of ''vicharana'' should be increased based upon contemporaneous food preparations. − *There is a wide scope in research regarding changes in the properties of fats when boiled with other substances i.e ''Samskara''. − *Therapeutic effects of oleation with fats used today should be ascertain clinically so that they can be accepted as medicinal ''sneha''. − *Combination of fats is an area least evaluated and has scope for improvement in fat properties. − * Research is needed for standardization of dose and gradation of oleation or unctuousness. − * It is important to study effect of instant oleation (Sadyo [[snehana]]), in large dose (Avapeedaka Sneha), processed fats (Avartita Sneha) and administration after meals (Auttara bhaktika Sneha). − − ===Related Chapters === − − [[Snehana (unction therapy)]], [[Langhanabrimhaniya Adhyaya]], [[Kalpana Siddhi Adhyaya]], [[Snehavyapat Siddhi Adhyaya]], − − [[Panchakarma]], [[Meda dhatu]], [[Shukra dhatu]], [[Ojas]] − − <big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big> − − == References == − − <references/> − <div id="BackToTop" class="noprint" style="background-color:#DDEFDD; position:fixed; − bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue; − font-size:8pt; font-face:verdana,sans-serif; border:0.2em outset #ceebf7; − padding:0.1em; font-weight:bolder; -moz-border-radius:8px; "> − [[#top| Back to the Top ]]</span></div>
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|data7 = Dwivedi L.K., Galib, Sabnis M., Patil V.
|data7 = Dwivedi L.K., Galib, Sabnis M., Patil V.
|label8 = Editors
|label8 = Editors
|data8 = Mangalasseri P., Deole Y.S., Basisht G.
|data8 = Mangalasseri P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|label9 = Year of publication
|data9 = 2020
|data9 = 2020
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For oleation of patients suffering from skin diseases, edema and diabetes, one should not use meat of animals either domesticated, or of marshy regions or those living in water. Jaggery, curd, milk and sesame seeds are also to be avoided. They should be given suitable fat boiled with ''pippali, haritaki'' or ''triphala''. The physician may prepare ''sneha'' by boiling it with ''draksha'' (grape), ''amalaki'' (emblica officinalis) or with sour curd added with ''vyosha'' (combination of black pepper, ginger and long pepper). The ''sneha'' processesd with decoction of ''yava'' (barley), ''kola'' (Bengal gram), ''kulattha'' (two flowered dolichos), ''yava kshara'' (''alakali'' prepared from ''yava''), ''sura''(beer), curd, milk and ''ghee'' is best in these cases. [91-94]
For oleation of patients suffering from skin diseases, edema and diabetes, one should not use meat of animals either domesticated, or of marshy regions or those living in water. Jaggery, curd, milk and sesame seeds are also to be avoided. They should be given suitable fat boiled with ''pippali, haritaki'' or ''triphala''. The physician