SNEHA VYAPAT AND THEIR MANAGEMENT

स्नेह्स्मित्योपचाराद्धि जायन्ते दारुणा गदा:      – Ch.Su-13/64

अमात्रयाहितोऽकाले मिथ्याहारविहारत:।

स्नेह: करोति शोफर्शस्तन्द्रनिद्रविसंज्ञता॥

कण्डुकुष्ठज्वरोत्कलेशशूलानहबलक्षयान्।

जठरेन्द्रियदौर्बल्यजात्यामस्तम्भवाग्रहान्॥

तास्तान् स्वेदोषहेतूत्थान् पाण्ड्वार्दीश्चाति योजनात्॥ – As.Su-46-47

अकाले चाहितश्चैव मात्रया न च योजित

स्नेहो मिथ्योपचारच्च व्यापद्योताऽति सेविता॥ – Ch.Su-13/66

तन्द्रा सोत्क्लेश आनाहो ज्वर: स्तम्भो विसंज्ञता।

कुष्ठेनिकण्डू: पाण्डुत्वं शोफार्शस्यरुचितृषा।

जठरं ग्रहणीदोष स्तैमित्यं वाक्यनिग्रह।

शूलमामप्रदोषाश्च जायन्ते स्नेहविभ्रमात्॥         – Ch.Su.23/75

मात्राकाल वियुक्त: स्नेह: सात्म्योपचारगुणहीन:।

सुक्तो न्यापदम् च्छति………..॥-ka.sa.su-22/40

ज्वरपाण्डुकुष्ठ शोथास्तृमूर्च्छाच्छर्द्यरोचकोत्लेदा:।

ग्रहणीइन्द्रियउपघातस्तैमित्यानहशूलाद्या: ॥                 – Ka.Sa.Su-22/46

स्नेहं पीत्वा पुन: स्नेहं प्रति भुञ्जानमेव च।

स्नेह पथ्यापचारादि जायन्ते दारुणा गदा:।          – Ca.Si-Snehadikaara

Excessive sleep, Fatigue, Nausea, Distension of abdomen with stools and lots of flatus, Fever, Stiffness of the body, loss of consciousness, Swelling, piles, itching all over the body,  hives, skin diseases,  colic pain, loss of strength, speech difficulties, Stiff thighs, yellowish pale skin, Morbid thirst, IBS, Ulcerative colitis, and chrons. Various diseases of aama, Stiffness of the body, Dysfunction of sense organs, Vomiting, loss of taste and Other symptoms pertaining to one or more of the doṣas undergoing abnormality caused by their respective causes. The diseases mentioned under atisingdha lakṣaṇas like पाण्डुता etc., are also sneha vyāpad only. Sneha Vyapat results when there is faulty administration of sneha by the Vaidya without considering matra, kāla, Rtu, Anupaana etc. or if the patient does not follow the rules during snehana karma.

Charakaand Vāgbhaṭahave mentioned snehavyāpad separately but Suśrutahas not narrated snehavyāpad separately. But he says that Sneha Should be given incorrect Matra and sneha dravya consumed in more than the required quantity can kill the person. Atisnigdhalakṣaṇas are the warning signs of the forthcoming vyāpads. A wise physician should intervene at an appropriate time by observing the adverse effect of excessively administered fat so as to prevent snehavyāpad.

The vyāpad can occur due to the mistake of Vaidya or may be due to the wrong doings of the patient. (वैद्य कृत and रोगी कृत)

वैद्य कृत:

Advising snehapāna    in a contra-indicated person, administering snehapāna in an inappropriate time, excessive or less dose, choosing wrong sneha and a wrong way of administering sneha for e.g., administering śamana sneha where actually the patient needs a shodanaaṅga  sneha. Advising in appropriate diet regimen to the patient can also cause vyāpad to patient

Administering sneha dravya in day time during summer season or to a patient who suffers from vāta and pitta disease can cause tṛṣṇā, mūrchā, unmāda and kāmalā and administering snehapāna in evening during winter season or to patients suffering from diseases of kapha origin causes ānāha, aruchi, shoola and pāṇḍu.

 If snehapāna   is administered in ajīrṇa and in Udeerna Pitta grahaṇī, tṛṣṇā is caused. Also, if snehapāna is administered in a person who is having aggravation of vāta and pitta and during hot season, it leads to tṛṣṇā. Due to excessive amounts of sneha or improper food regimen after snehana, Ajirna is caused. Charaka explains that AcchaPeya should not be given in pitta dominant diseases when associated with āmaas it causes samnjanasha and also death.

Suśruta advises minimal snehapāna   dose in conditions like poison, trauma, eruptions, oedema, skin diseases and diabetes, and if Vaidya over looks this it can lead to vyāpad           

According to Charaka in case of kuṣṭa, prameha and sopha, sneha which is processed with Guda, anupāmamamsa, ksheera, tila, māṣa, sura and gadhi should not be given. Instead, sneha processed with Triphala, pippalī, Pathya and guggulu should be given.

In a nutshell, the Vaidyakruthavyāpads can be categorised into

• Improper assessment of koṣṭha
• Improper assessment of Agni
• Improper identification of prakṛti and vikṛti of patient
• Improper assessment of Rogi and Rogabala
• Wrong fixation of dose
• Improper assessment of sneha kāla i.e. Season, annakāla etc.

रोगी कृत:

अथ अज्यपानम् दद्यातखिल औषधंक्रियाक्रमंषु रोगाःप्रभवन्तिदेहिनां

भिषक्विशेषात् अहितमोहतां अपि वा तथा आतुरानात्मतयापचारतः l कल्याणकारकं – २८/१

In all treatment modalities starting from snehapāna  kriyas even if Vaidya genuinely wants the cure of the patient’s disease, if the patient is anatmavada i.e.- not following the advice of the physician and do’s and dont’s of the therapy, he will invite many diseases for sure.

आढ्यो रोगी भिषग्वश्यो ज्ञापकः सत्ववान् अपि l

If the patient is not following the advice of the Vaidya and if he is careless then sure he will invite vyāpad       . e.g. Indulging in aṣṭamahādoṣakarabhāvas.

अष्टोमहादोषकरभावा:

एतां प्रकृतिमप्राप्तःसर्ववर्ज्यानी वर्जयॆत्

महादोषकराणि अष्टोविमानितुविशेषतः

उच्चैर्भाष्यंरथक्षोभमतिचङ्क्रमण आसने

अजीर्णअहितभोज्येचदिवास्वप्नंसमैथुनं

तज्जाःदेहोर्ध्वसर्वाधोमध्यपीडामदोषजाः

श्लेष्मजाःक्षयजास्च्चैवव्याधयःस्यु: यथाक्रमम्  – Cha. Si. 12/06

Sneha vyāpad can be classified as āśukārii and Ccirakāriivyaapad

1.āśukārii vyāpad: 

These disorders have acute onset and need immediate management. Examples are 1. ajīrṇa 2. Aruchi 3. āmaPradoṣa 4. Shoola 5. Jwara 6. ānāha 7. tṛṣṇā 8. Stambha 9. utkleśa 10. Tundra 11. Samjna Nasha. 12. cirakārii Vyapat:

These disorders manifest in due course of time. Examples are

1. Kandu 2. kuṣṭa 3. grahaṇī 4. pāṇḍu 5. ārṣa 6. Śotha 7. Udara 8. Staimitya 9. Vakgraha.

Table showing various snehavyāpads’s

Reasons for Sneha vyāpad.

शोफ – Swelling

Excessive fat may interfere with the function of the liver. Because of too much fat ingestion Liver may not be able to produce albumin. Adequate supplies of nutrients and nitrogen are essential to fuel albumin synthesis. Inadequate intake of amino acids available for protein synthesis and/or inadequate nutrient absorption by the intestinal lumen as a result of disease can depress the liver’s ability to synthesize albumin. In states of metabolic stress, albumin synthesis becomes a low priority. Etc also sneha vyāpad only.

Fasting for as less than 18 to 24 hours can cause a 50% decrease in albumin production. Malnutrition decreases synthesis, increases redistribution of body fluid (ascites), and decreases albumin degradation. During starvation, albumin is spared as a catabolic protein source and muscle protein is used. Therefore, the body maintains serum albumin levels at the expense of muscle protein. The caloric needs of critical patients must be met to avoid secondary decreases in albumin production. This is often difficult to achieve in a hospital setting. Many patients are anorexic because of their condition, the unfamiliar environment, and unfamiliar individuals handling them. If the gastrointestinal (GI) tract is functioning, enteral nutrition may provide an option for nutritional support.

निद्रा – Excessive sleep, तन्द्रा – Fatigue

Due to delayed gastric emptying, blood flow is concentrated only on the stomach for the fat digestion. Thus less blood flows to the brain causing tantra and nidrā          .

कण्डु – itching all over the body कोठ- hives.

Due to excessive Bilirubin, bile salts in the blood cause itching and hives. High fat can cause higher levels of bile salt accumulating under the skin, which may cause itching. Not everyone with high levels of bile salts feel itchy.

Cholestasis is reduction or stoppage of bile flow. Bile is the digestive fluid produced by the liver. Disorders of the liver, bile duct, or pancreas can cause cholestasis. With cholestasis, the flow of bile is impaired at some point between the liver cells (which produce bile) and the duodenum (the first segment of the small intestine). When bile flow is stopped, the pigment bilirubin (a waste product formed when old or damaged red blood cells are broken down) escapes into the bloodstream and accumulates. Normally, bilirubin joins with bile in the liver, moves through the bile ducts into the digestive tract, and is eliminated from the body. Most bilirubin is eliminated in stool, but a small amount is eliminated in urine. The person may experience symptoms like yellowish discoloration of skin and conjunctiva, itchy skin dark urine, and stools may become light-coloured and smell foul.

ज्वर: Fever

If fat is administered to a person whose Agni is weak and if the patient indulges in mitya āhāra, then the fat may produce indigestion which in turn causes excessive salivation, vomiting and jwara.

High fat decreases the amount of insulin in the bloodstream. As a result, people may experience an increase in the amount of sodium, potassium, and water that is released in the urine, which causes dehydration. Electrolyte imbalance leads to fever. Excessive fat intake may stimulate inflammatory response in the cells and this could also be a reason for fever.

बलक्षयं – loss of strength

In a Weak agni and lean person, if an excessive dose is given,  it may lead to balakṣayam because the person needs more energy to digest the fat whereas he is already weak. Ketosis leads to weight loss and proteins will be used from the muscles during high fat intake. (starvation like situation.

वाक्ग्रहम्, इन्द्रियोपघात and विसंज्ञता.

Excessive fat intake-Electrolyte imbalance-mild hypovolemic shock- speech difficulties or loss of speech, dysfunctional sense organ and loss of consciousness.

ग्रहणीदोषं, आमदोषं and आनाह:

In maṇḍagni person too much quantity of fat administration leads aāmadoṣas which in turn Though  snehapāna causes grahaṇī doṣam and ānāha is digested well without any ulgestill if the patient ind, complications in mitya āhāra vihāra, he will suffer from the above said diseases.

स्नेहोपद्रवचिकित्सा -Management Of Excessive And Improper Oleation

क्षुत्तृष्णोल्लेखनस्वेदरूक्षपानान्न भेषजम्।

तक्रारिष्टखूलोद्दालयवश्चामाककोद्रवम्॥

पिप्पलि त्रिफलाक्षौद्रपथ्यागोमूत्रगुग्गुलु।

यथास्वं प्रतिरोगं च स्नेहव्यापदि साधनम्॥

विरूक्षणे लङ्गनवत् कृतातिकृतलक्षणम्॥           -As-Su-25/48

तत्रात्युल्लेखनं शस्तं स्वेद: कालप्रतीक्षणम्।

पति प्रति व्याधिबलं बुद्ध्वा स्रसनमेव च।

तक्रारिष्ठप्रयोगश्च रूक्षपानान्नसेवनं

मूत्राणां त्रिफलायाश्च रूक्षपानान्न सेवनम्।          – Ch.Su-13-76

…………………तस्मिन् संशोधनं पथ्या।

स्नेहापचारजास्तेरोगा: स्नेहोपपतिता ये (ते) षु।

मिथ्याचारद्वहुत्वाद्वा यस्य स्नेहो नजीर्यति।

विष्टभ्य वादिजीर्येत वारी उष्णेन बामयत्॥        – Vs – Snehadikaara

वमन विरेचनयोगा रूक्षाशन नत्र मूत्राद्या:॥

स्नेहाजीर्णे तृष्णाशूलं परिकर्तिका च यस्य स्यात्।

समतीतजरण्काले तस्य प्रच्छर्दनं श्रेय:॥               – Ka.Su-22/44

स्निग्धद्रवोष्णधन्व उत्तरसभुक्स्वेदं आचरेत्|

स्नेग्धस्यत्रैयाहंस्थित: कुर्यात्विरेकं, वामनंपुनः

एकाहंदिनमन्यत् चकफंउत्क्लेष्यतत्करै:             – As.Su-25

जीर्णाजीर्णविशंकी केवलमुष्णोदकं पिबेत्।

उद्गारस्य विशुद्धिं जनयति भक्ता भिलाषं च॥              – BP Snehadikaara

सोऽसूस्त्यजेद्युदक न पिबेताशु शीतलम्।

शीतसेकावगाहान् वा तत् तृष्णपीडितो भजेत्॥

स्नेहग्निना दहयमान: स्वविषेणेव पन्नग:।

अजीर्णेबलवत्या तुशीतैर्दिहयच्छिरोमुखम्।

छर्दयत्तदशान्तौ च पीत्वा शीतोदकं पुन:॥

रूक्षान्नमुल्लिथ्वद्रभुक्त्वा तादृश्यां तुकफानिले॥

समदोषश्च नि:शेषं स्नेहमुष्णाम्बुनोद्धरेत्।

ततो दोवादिबलत: पूर्वोक्तं च विधिं श्रयेत्।           – As.Su.52

स चेत् सुशीतं सलिलं नासादयति दह्यते।

यथैवाशीविष: कक्षमध्यग: स्वविषग्निना।

अजीर्णे यदि तु स्नेहे तृष्णा स्याच्छर्दयेद्भिषक्॥

शीतोदकं पुन: पीत्वा भुक्वा रूक्षान्न मुल्ल्त्खेत्।

अजीर्णे यदि तु स्नेह तृष्णा स्याच्छेद्येत भिषक्।

शीतोदकं पुन: पीत्वा भुक्तवा रूक्षान्नं उल्लिखेत्॥  – Ch.Su.13/70

स्नेहपीतस्य चेतृष्णा पिबेत् उष्णोदकं नर:।

एवं चानुपशाम्यन्तां स्नेहं उष्णाम्बुना वमेत्।

विहयाच्छीतै:शिर: शीतं तोयं चाप्यवगाहयेत्॥      – Su.Ch.32.24

स्नेहं पीतस्तु तृष्णायां पिबेदुष्णोदकं नर:।

एव चानुप्रशाम्यन्तं स्नेहमुष्णाम्बुणा हरेत्॥

If the oleating substance does not undergo digestion, producing thirst, the person should be splashed with cold water in his head and face. If this is not alleviating thirst, the patient should be given cold water to drink and made to vomit or foods which are dry in nature are given inducing vomiting. These methods should be advocated even for persons who have all these doṣas in equal proportion and in kapha vāta prakṛti persons.

To treat the sneha vyāpad the physician should ask the patient to control his hunger or thirst. Besides that, the physician should administer emesis, perspiration, use of food and drinks which create dryness, use of Takrarishta (self-fermented herbal preparation with buttermilk), khala (thick form of buttermilk), uddala (a kind of rice grain), yava (barley), syamaka(Barile millet), Kodrava (a variety of maize), pippalī       , Triphala, Madhu, Patya, Cow’s urine and Guggulu (in different forms) and the treatment for particular diseases raised due to sneha Mithyalakṣaṇam.

Table showing Vyāpad’s & Cikitsā

उदीर्णपित्तोपद्रवं – Acute G.E.R.D. Complication

स्नेहन पैत्तिकश्याग्निर्यदा तीव्रतरीकृत:।

स्नेहमाशु जरां नीत्वा पुनरोजोऽभितश्चरन्॥

उदीरयेत् सोपसर्गा पिपासामस्यबाधिकाम्॥         – As.Su.25/40

उदीर्णपित्ता ग्रहणी यस्य चाग्निबलं महत्।

भस्मी भवति तस्याशु स्नेह पीतोऽग्नितेणसा।

स जग्ध्वा स्नेहमात्रां तामोज: प्रक्षारयन् बलि॥     – Cs.Su.13/70

In case of unctuous substances taken by the person having excessive pitta in his grahaṇī and having strong digestive power, the oleation substance gets digested quickly (lithely burnt) by virtue of the digestive power. The above said phenomena imbalance and displace the ojas and cause fatal forms of thirst.

Management of उदीर्णपित्त

The person should be immersed in cold water and should be given other cold comforts both internally and externally. Anti-pitta drugs must be advised and the patient must be asked to take complete rest.

Note:

In Saṃhitas number of bad effects of internal oleation is narrated due to wrongdoings of patient or Vaidya, practically we may come across a few of them. The reason could be due to precautions taken while administering snehapāna or maybe in the present day to day practice, the physicians are not giving an extreme dose of snehapāna to avoid extreme side effects.

The complications which are usually observed nowadays are indigestion, drowsiness, abdominal discomfort and pain, fever, extreme weakness, thirst, false hunger, pruritus, diarrhea or constipation, dizziness, and emotional disturbances.

Therapies like Laṅghana, pācana, dīpana, takraprayoga, sadyo vamana, anulomana triphalā, śuṇḍī dhānyaka uṣṇodaka, coconut water and counselling are quite beneficial to manage the above-said complications.