Jour. Res. Ay. Sid. Vol. VI No.1, 3 & 4 pp. 44-58

The Role of Snehapana in Pakshavadha(Hemiplegia)- A Study

P.K.N. Namboodiri', T.V. Menon", N.P. Vijayao'"aod D. Vijayakumar· •••••

Received on January 21st, 1984

The paper presents the therapeu-tic value of Snehapana in Paksha-vadha.

Hemiplegia is a chronic diseaseill which snehana, sweda and vlrekaare said to be the mode of treatment.Thirty six hemiplegia cases weretaken for this study. They weredivided into three groups and giventhree different group of medicines.The patients in each group receivedfour to six days Snehapana, followedby bashpasweda and immediatelyafter this vireka was given. Thoughthe result was not significant statis-tically the patients in group IIshowed better improvement thangroup I and III. No complicationswere observed while the patientswere under stud}'. No significant

* Research Officer CAy.)•.• Asst. Research Officer CAy.)*** Asst. Research Officer (Pathology)*""'Research Assistant (Ay.)

changes were noted on blood pres-sure, T.C., D.C., E.S.R., Hb%blood sugar, Serum cholesterol andSerum protein after the trial. Theabove study shows that taila pre-pared with Sahachara is more usefulfor snehapana in Pakshavadha. Therecovery is gradual but the snehapanatherapy have no untoward effect inPakshavadha.

Introduction

Weakness in one side of thebody is the main clinical symptomobserved in Pakshavadha. ThoughAyurveda provides considerablerelief for this condition, a definiteline of treatment for completecure is yet to evolve in any systemof medicine.

According to Ayurveda sneha,sweda and virechana are the modeof treatment prescribed for thisdisease. Sneha can be applied

44

P. K. N. Namboodiri et ul

internally and externally in diffe-rent forms like snehapana, vasti,abhyanga, nasya, moordhataila,etc. according to the condition.

Qualities of snehana dravyas andtheir therapeutic application:

Those drugs which have snigdha(soothingnes), guru (heaviness),seetala (cooling), mridu (softness),drava (fluidity), pichila (sliminess),sara (mobility), manda (dullness)and sookshma (minuteness) qualitiesare used for snehana , Theseare classified into two dependingupon their origin-sthavara (vege-table) and janghama (animal).Ghrita (ghee), Majja (marrow),Vasa (animal fat) and Taila (oil)come under sneha dravyas. Thoughsarpi (ghrita) is said to be good forsnehapana (oleation therapy), ti/atai/a is commonly used for vatadisorders as this is best for thiscondition. Due to its sookshma(minuteness) and vyavayi (diffusive)qualities taila easi ly pen etratesand acts quickly in the body.

The administration of snehamixed with other substances (fooditems etc.) is known as vicharana.The administration of sneha aloneis termed as achhapana. Thelatter has the advantage of yieldingoptimum results. Depending uponthe time taken for digestion, theachhapana sneha is given in threedoses-Hriswa (six hours) Madhyama(twelve hours) Uttama (twenty fourhours) and it is administered in the

morning on an empty stomach.The does is to be decided by testingthe tolerance of the patient, withan initial small dose, to be incre-ased gradually during the nextthree to seven days. This type ofsnehapana followed by sweda karmais termed as poorvakarma (prepara-tory measures) to be given beforethe administration of Panchakarmatherapy; viz; vamana, virechana,niruha and anuvasana vasti andnasya. Sweda karma after snehapanahelps to bring the vitiated doshasto the koshta (G.I. Tract) fromwhich they can be easily eliminatedby the process of vamana, virekaand vasti. In case of Pakshavadha,vireka is advocated.

Materials and MetbodsThirty-six patients suffering

from Pakshavadha were includedin this study. They were dividedinto three groups. The study wascomparative and no placebo wasmaintained. Neurological statusof each patient was compared be-fore and after the treatment. Caseswith more than two years durationwere excluded from trial.

Three different(medicated taila) weresnehapana,

medicinesused for

GroupN

I-Taila prepared withNirgundi as describedin Caraka Samhita.

II-Taila prepared withSahachara as describedby Caraka.

GroupS

45

The Role of Snehapana in Pakshavadha (Hemiplegia)-A Study

Group IJI-Taila prepared withB Bhadradarvadi gana

(Bhadradaru or Deva-daru, Nata, Kushtha,Dashamu/a, Bala andAtibala) as describedin Ashtanga Hridaya.

Mode of administration

Snehapanu

On the first day 50 rot taila ofthe respective group was admini-stered, then increasing the doseby 50 m!. on each succeeding dayupto seven days or until samya-ksnigdha lakshanas appeared,

Sweda

Baspa sweda for three consecu-tive days after snehapana. Abhyangawith the taila of the respectivegroup was-given before sweda.

Vireko

Eranda taila 30 ml. at 6 a.rn, onthe next day after baspa sweda.

Diet

Light diet with peya (gruel) andvegetables was given at noon andin the evening.

Assessment

Each patient was subjected tocomplete clinical examination andsigns and symptoms and blood pres-

sure were recorded before snehapanaand after vireka. Numerical valueswere given for each neurologicalinvolvement like muscle power,muscle tone, grip strength and pos-ture and the assessment was doneon the basis of this. The proce-dure has been given in full detailelsewhere (Namboodiri et a/-1980).

Laboratory investigations ofblood for Hb.%, T. L. C., D. C..E. S. R., Sugar, urea, serum pro-tein and serum cholesterol weredone before snehapana and thesewere repeated after the treatment.

Results

The improvement varied from2.59% to 11.39/~ in Group I, 1.65%to 37.5% in Group Il and 2.11 %to 14.9[% in Group III (Table 6Fig. 3). Four cases each inGroup I and III and two cases ingroup II did not show any impro-vement.

There was no significant effect onblood pressure, Hb.%, total count,polymorphs, lymphocytes, cosine-phils,' E. S. R., blood sugar, ureaand cholesterol and total proteinin any of the three groups(Table 5).

Discussion

Thirty-six cases of Pakshavadhawere studied in order to assessthe efficacy of snehapana. Out of thethirty-six cases, thirty-three weremales (91.7%) and three (8.3%)

46

P. K. N. Namboodiri et e!

'V1

.1

(J' 200-r- - I'C .

The Role of Snehapana in Paklhavadho (Hemiplegiaj+-A Study

Age aDd Sex groups

Table-l

Age groups TotdMale Female

10-20 yrs.21-30 yrs,

31-40 yrs,41-50 yrs.

51-60 yrs.Above 60 yrs.

2

2

4

1411

12

22

41513

Total: 3633 3

Table-2

Side affected

Group No. TotalRight Left

I

II

III

5

7

8

7

5

4

12

12

12

Total: 3620 16

females. The highest number ofcases (41.6%) reported were inthe age group of fifty-one to sixtyyears (Table I). Twenty caseshad right-sided hemiplegia andsixteen cases left sided hemiplegia(Table 2). On the basis of historyand clinical signs and syrnp-tomp the cause of hemiplegiawas diagnosed as internal capsularartery thrombosis in thirty cases

(83.35%), Embolism in two cases(5.55%), Haemorrhage in two cases(5.55%) and other cerebrallession in two cases (Table 3)(Fig. 1).

All the patients were given acourse of snehapana varying fromfour to six days. Three differentmedicated oils were used forsnehapana. Quantity of taila con-sumed by the patient in each group

48

P. K. N. Namboodiri et al

Internal cClpsple.;~Clrfczr~thrombOstS'i~

m [ntrocronlo].haemorrhdqe

49

The Role of Snehapana in Pokshavadha (Hemiplegia)--A Study _

Table-3Cause of Hemiplegia according to Modern diagnosis

No. of patients in each groupDiagnosis

I 11 lIJ Total------------------

Internal capsuleartery thrombosis 10 11 9 30Internal capsuleartery embolism 1 1 2IntracranialHaemorrhage 2 2Others 2 2

Total 12 12 12 36

is given in Table No.4. SOO ml.was the minimum quantity requi-red to elicit Samyaksnigdhata in fourpatients whereas 750 ml. wereneeded in twelve cases and 1050ml. in seven cases (Fig.2).

The clinical improvement aftersnehapana is negligible except inone case in Group II. The compa-ratively .better improvement seenin Group II [Sahachara group)may be due to the Brimhana (nouri-shing) quality of this preparationwhich contains four times moremilk than oil and sugar. Howeverthe values were non-significantstatistically (Wilcoxon Rank SunTest, Hill-1979)~ There is alsono significant effect on bloodpressure but the study indicatethat the therapy has no adverseeffect on C V.S. No other side-effect

was noted in any of the patients. Theanalysis of the result in relationto age, sex and cause of the dis-ease also did not show any posi-tive findings.

Since Pakshavadha is a' krichra-sadhya disease (very difficult toget cured) the improvement willbe gradual. However, snehapanapalliates the abnormal Vata, ren-ders the body soft and helps inthe elimination of accumulatedmalas which obstructs thesrotas causing vata .vitiation.The object of snehapana therapyis to gain access to the innermostpart of the body so as to get thedoshas moistened before these arebrought to koshta after liquifyingby the sweda karma and eliminatedfrom the body by sodhana processlike vireka. Thus snehapana has

50

P. K. N. Namboodiri et 01

51

The Role of Snehapana in Pakshavadha (Hemiplegia)-A Study

far reaching-effect on the body,Further confirmation of the thera-peutic values 0( snehapana along-with sweda and vireka is possibleonly after including a large numberof cases in the clinical trial withsuitable follow-up so as to assessany recurrence of the complaints.

Conclusion

Taila prepared with SahacharaiStrobilanthes heyneanus) ksheera(milk) and sarkara (sugar) forsnehapana is more efficacious inPakshavadha than the tailasprepared with Nirgundi and Bhadra-darvadi gana drugs. The recoveryis gradual but there was no unto-ward effect after snehapana witheither these three tai/as in Paksha-vadha.

Acknowledgement

The authors are grateful tothe Director, CCRAS, New Delhifor permitting to conduct thistrial.

Thanks are due to Shri, B.Ravishankar, Asst. Research officer(Pharmacol.) and Mr. P. Chand-ran, Office Superintendent fortheir valuable suggestion. Wealso acknowledge the invaluableassistance of Shri. P. J. Paul inpreparing the drawings, Mrs. A.Chandrika for statistical assistance,Mrs. C. V. Sukumari and Mr. V.K. Sankaranarayanan for theirsecretarial assistance and Mr. V.Ramachandran Nair for photo-graphic work. We also wish tothank all other staff of the I. I. P.,Cherutburuthy who were helpfulat different occasions while con-ducting this clinical project.

Tnble-4

Total intake of oil to elicit Samyak snigdhata in patients

Quantity of oil No. of patients

N(l) B(IIl)S(lI)

1050 ml,1000 ml.975 m1.850 ml.750 ml.700 ml.650 ml,600. ml.500 mi.

411

12

111

31

3

141

431I

2

Total: 1212

52

•P. K. N. Namboodiri et al

Table-SEffect of drug treatment on Blood Pressure, Haemogram, Blood sugar, Urea, Cholesterol and Protein

Group B.P. Hb. T.e. P L E E.S.R. Blood Blood Cholesterol Proteinsugar urea

B.T. BT BT BT BT BT BT BT BT BT BT154.17/92 .17 6875 8129.17 56.00 41.17 2.83 24.92 130.00 23.29 183.75 6.62

VII.H

±12.63/9.11 ±2.69 ± 401.97 ±2.40 ±2.45 ±0.44 ±6.52 ±7.46 ±1.99 ±7.13 ±0.20

I AT . AT AT AT AT AT AT AT AT AT AT150.33/92 .50 69.58 7758.33 53.25 41.25 5.50 15.17 122.87 20.04 169.25 6.30

± 14.08/ 7 .29 ±2.34 ±344.90 ±3.55 ±3.31 ±1.32 ±2.55 ±6.60 ± 1.88 ±8.01 ±0.12

BT BT BT BT BT BT BT BT BT BT BT170.40/106.67 74.50 7883.33 52.67 42.33 5.00 23.83 131.50 27.91 180.08 6.77

± 8.611 4.66 ±3.94 ±253.45 ±3.67 ±3.56 ± 1.36 ±6.44 ±9.43 ±2.18 ± 10.58 ±O.18

(Contd.)

The Role of Snehapana in Pakshavadha (Hemiplegiaj=-A Study

Group B.P. Hb. T.C. P L E E.S R. Blood Blood Cholesterol Proteinsugar urea

-~--

II AT AT AT AT AT AT AT AT AT AT AT

165.50/102.67 74.17 7754.17 58.33 36.08 5.58 16.08 124.00 23.85 171.12 6.60

±7-42/ 6.46 ±3.68 ±345.15 ±3.38 ±3.58 ±0.99 ±2.55 ± 14.52 ± 1.80 ±7.83 ±0.26

BT BT BT BT BT BT BT BT BT BT BTU'o~

160.83/ 9667 76.67 8087.50 47.08 44.75 8.17 20.33 114.83 24.21 181.13 6.68

± 10.10 4.82 ±'.84 ±406.31 ±3.83 ±3.69 ±2.24 ±5.33 ±8.59 ± 1.84 ±9.92 ±0.19

III AT AT AT AT AT AT AT AT AT AT AT

158.33/ 95.00 72.92 8191.67 54.92 38.83 6.25 17.58 120.58 23.09 174.83 6.08

± 11.05/ 4.35 ±3.16 ±429.27 ±3.37 ±3.66 ±2.14 ±4.08 ±7.84 ±2.20 ± 10.40 ±0.17

Values = Mean±SEM Units:BT = Before treatment T. C. - Cells/crnm of blood S. Cholesterol ")AT = After treatment E. S.R. - mrn in I hour Sugar ~ mg% Protein - g%

Hb. - g% Urea j

P. K. N. Namboodiri et al

Table-6

Neurological status of the patients before and after the treatment

Group I N Group II S Group III B

S1. B.T. A.T. % SI. B.T. A.T. % Sl. B.T. A.T. %No. No. No.

VI 1. 74.5 72.5 2.68 1. 74 64 13.51 1. 64.5 59.5 7.75VI

2. 46.5 43 7.53 2. 66 62 6.06 2. 64 58.5 8.593. 58 56.5 2.59 3. 64 42 37.50 3. 71.5 67 6.29

4. 52 47.5 8.65 4. 60.5 59.5 1.65 4. 65 67.5 0

5. 39.5 35 11.39 5. 56 59.5 0 5. 69.5 60.5 12.95

6. 50.5 50.5 0 6. 55.5 57.5 0 6. 52.5 SO 4.76

7. 69 73 0 7. 49 48 2.04 7. 57 48.S 14.918. 54.5 52 4.59 8. 64 60.5 5.47 8. 54 54 0

(Contd.)

The Role of Snehapana in Pakshavadha (Hemiplegia)-A Study

(1) (2) (3) (4) (5) (6 ) (7) (8) (9) (10) (11 ) (12)------

9. 63 63 0 9. 72.5 61.5 1517 9. 47.5 46.5 2.1110. 61 62 0 10. 46.5 42.5 8.60 10. 585 58.5 0~II. 62 60 3.26 11. 76 74.5 1.97 II. 31 39 0

12. 53 49 3.77 12. 53 51.5 2.83 12. 51 48.5 4.98

VII0\ B.T. Before treatment A.T. = After treatment

P. K. N. Namboodiri et al

q'~crtT "{)~ it ~~«n'l CffTSI1f)~~~ ~Cfi 3T'elj'l{'l

I1T.~. ~., . .,t=~ft, iT. qT. lr.;." ~.,.I1T.f'l>;fq., ~cf ~r.f'l~q ~pn~

111ff'l~,{)lJ' lf ~U~ 'fiT ~ tfT~(~~--.rm) f.:rfG'5filfi?:T >;fraT ~ I ~~~TlJ' it ~aT ~T~'lq ffi'

The Role of Snehapana in Pakshavadha (Hemiplegia)-A Study

Chaturvedi, G.N. 1971 A study of Panchakarma therapyvis-a-vis its physiopathologicalbasis, JRIM, Vo1.6, No.4.

Namboodiri, P.K.N. et al 1980 Management of Pakshavadha-Aclinical study of 109 cases, JRAS,Vol.1, No.4.

Susruta 1966 'Susruta Samhita', Ayurveda TatwaSandhipika Hindi Commentary.Chowkhamba Sanskrit Series, Vara-nasi, Chi. 31,3.

(a) Do. Chikitsa 31, 4.(b) Do. Do. 3J, 36.

Vagbhata 1956 'Ashtanga Hridaya'. BhagirathiCommentary, Chowkhamba Sims-krit Series, Banaras, Sutra 16, 2.

(a) Do. Sutra I, 26.(b) Do. Do. 5, 55.(c) Do. Do. 16, 15.(d) Do. Do. 16, 16-19.(e) Do. Do. 17, 29.(f) Do. Do. 15, 5.(g) Do. Nidana 25, 41.

58