Pandu kc009 udp

EFFECT OF DHATRI LAUHA IN PANDU ROGA

By

PARDHV.BALENE. B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment

Of the requirements for the degree of

DOCTOR OF MEDICINE (Ay)

In

KAYA CHIKITSA

Under the guidance of Dr.U.N.Prasad, M.D. (Ay)

Professor & HOD

Co-Guide

Dr.Jonah.S, M.D. (Ay) Assistant professor

DEPARTMENT OF KAYA CHIKITSA S.D.M. COLLEGE OF AYURVEDA,

KUTHPADY, UDUPI 2005-06

I

Ayurmitra

TAyComprehended

Rajiv Gandhi University of Health Sciences

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “Effect of Dhatri Lauha in

Pandu Roga” is a bonafide and genuine research work carried out by me under the

guidance of Dr. U.N.Prasad. M.D. (Ayu), Professor, Department of Kaya

Chikitsa and co-guidance of Dr. Jonah.S.M.D. (Ayu), Assistant Professor,

Department of Kaya Chikitsa.

Date: Signature of the candidate

Udupi Pardhv.Balene.

II


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Effect of Dhatri Lauha in

Pandu roga” is a bonafide research work done by Pardhv Balene. in partial

fulfillment of the requirement for the degree of DOCTOR OF MEDICINE

(Ayu)

Signature of the Co-Guide Signature of the Guide Dr.Jonah.S.M.D. (Ayu) Dr.U.N.Prasad. M.D. (Ayu) Asst.Prof, Dept of Kaya chikistsa Professor, Dept.Of Kaya Chikitsa Date: Place: Udupi

III


ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “Effect of Dhatri Lauha in

Pandu roga” is a bonafide research work done by Pardhv Balene. under the

Guidance of Dr.U.N.Prasad. M.D. (Ayu), Professor, Department of Kaya

Chikitsa and co-guidance of Dr. Jonah.S.M.D. (Ayu), Assistant Professor,

Department of Kaya Chikitsa.

Signature of the H.O.D Signature of the Principal Dr.U.N.Prasad Dr.Bala.Krishna.Bhat

Date: Date:

Udupi Udupi

IV

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print

or electronic format for academic / research purpose.

Date: Signature of the Candidate Udupi:

Pardhv Balene.

© Rajiv Gandhi University of Health Sciences, Karnataka

V

I Would Like to Place This Dissertation on the Lotus Feet of My Parents

VI

ACKNOWLEGEMENT

I am ever grateful to my teacher and Guide Dr.U.N.Prasad. Prof & HOD of Kaya

Chikitsa department SDM College of Ayurveda for his support and guidance throughout

the study.

I wish to express my gratitude to my teacher and Co-Guide Dr.Jonah.S.Asst.Prof Dept of

Kaya Chikitsa SDMCA for his support and guidance.

I wish to express my gratitude to my teacher Dr. Srnivas.Acharya.G.Asst.Prof Dept of

Kaya Chikitsa SDMCA for his support.

I wish to express my thanks to Prof Dr.Bala Krishna Bhat.Principal & Dr.K.Ramachandra

Rao. Prof & Dean of the PG department SDM College of Ayurveda for their support.

I wish to express my gratitude to all the authorities of SDM Educational Society for

providing me all the requisite facilities to carry out this work.

I am grateful to Dr.Siddhinandan Mishra manager, Dr.Muralidhar.B and staff of the SDM

Ayurvedic Pharmacy for providing me the drug compounds of my study to specifications.

I am grateful to Mr.Harish Bhat, Librarian for providing me with all the books I needed.

Dr.Anil Kumar.G, Dr.Madhusudanan.I.K, Dr.Mithun.M.Bhondre, Dr.Vittal.G.Huddar,

Dr.Gajanan Prabhu, Dr.Rajashekar.V.S, Dr.Kuldeep, Dr.Ramesh, Dr.Deepthi.M.S. and

Dr.Devanathan.R will forever remain in my memories for their tremendous support and

help.

PARDHV.BALENE

VII

LIST OF ABBREVIATIONS IDA – Iron Deficiency Anaemia. HB% - Haemoglobin percentage. TIBC – Total Iron binding capacity. MCV – Mean cell volume

VIII

Abstract

ABSTRACT

Back ground and Objectives:

Pandu roga is a common disorder prevalent all over India. If it is not treated, it

interferes with routine activities of a person and neglecting it leads to the development of

various upadravas. A formulary, which is effective, cheap and devoid of side effects is

needed to treat this disease. The present study is focused on the literary review & clinical

study of the Pandu roga and to evaluate the therapeutic effect of Dhatri Lauha in patients

of Pandu with out alteration in their routine dietary and physical activities.

Methods:

It is a single blind clinical study with pre test and post test design where in 20

patients diagnosed as Pandu roga of either sex were selected. All were administered with

Dhatri Lauha for a period of 30 days. The relevant investigation HB% was adopted for

diagnosis and to assess the improvement.

Results:

In this present series majority of patients registered were females at the age group

of 20-50 years. Who were on sedentary life style, Middle class family, and are lowly

educated. The effect of treatment on the symptoms reordered, that the Dhatri Lauha

showed good effect on Vatakaphaja lakshanas rather on Pittaja lakshana, and slight

changes shown on mean score values of over all body than when compared to

Haemoglobin levels.

Key words:

1. Pandu 2.Rakta 3.Anaemia 4.Dourbalya 5.Varna.

IX

TABLES

Sl.No. Table No. Name of the Table Page no.

1) 1 Nidana of Pandu roga 18

2) 2 Proova roopa 21

3) 3 Samanya Lakshana 24

4) 4 Vataja Pandu Lakshana 25

5) 5 Pittaja Pandu Lakshana 26

6) 6 Kaphaja Pandu Lakshana 27

7) 7 Tridoshaja Pandu Lakshana 28

8) 8 Mrutbhakshanajanya Pandu Lakshana 29

9) 9 Types of Pandu 44

10) 10 Upadrava of Pandu roga 51

11) 11 Asadhya Lakshana in Pandu roga 52

12) 12 Differential Diagnosis of IDA 67

13) 13 The similarities between IDA and Pandu 68

14) 14 Incidence Acc. to their Age 77

15) 15 Incidence Acc. to Sex incidence 78

16) 16 Incidence Acc. to religion 78

17) 17 Incidence Acc.g to Martial status 79

18) 18 Incidence Acc. to occupation 80

19) 19 Incidence Acc. to habitat 80

20) 20 Incidence Acc. to socio-economic status 81

21) 21 Incidence Acc. to Education status 82

XI

22) 22 Incidence Acc. to their Dietary habits 82

23) 23 Incidence of Prakruthi 83

24) 24 Incidence of Sara 84

25) 25 Incidence of Samhanana 85

26) 26 Incidence of satva 85

27) 27 Incidence of Rasa satmya 86

28) 28 Incidence of Agni 87

29) 29 Incidence of kosta 87

30) 30 Incidence of Bala 88

31) 31 Effect of Treatment on Haemoglobin 89

32) 32 Effect of Treatment on Pandutwa 90

33) 33 Effect of Treatment on Alasya 90

34) 34 Effect of Treatment on Shrama 91

35) 35 Effect of Treatment on Arohana ayasa 92

36) 36 Effect of Treatment on Katiruk 92

37) 37 Effect of Treatment on Swetha akshi 93

38) 38 Effect of Treatment on Hridrava 94

39) 39 Effect of Treatment on Aruchi 94

40) 40 Effect of Treatment on Dourbalya 95

41) 41 Effect of Treatment on Gaurava 96

XII

LIST OF FIGURES

SI.No Chart No. Name of the Chart Page No.

1) 1 Chart of Samprapti 47

2) 2 Chart of Mrudbhakshanajanya Pandu 48

3) 3 Chart of Nidana sevana Samprapthi 49

4) 4 Chart of Age incidence 77

5) 5 Chart of Sex incidence 78

6) 6 Chart of religion incidence 79

7) 7 Chart of Martial status incidence 79

8) 8 Chart of occupation incidence 80

9) 9 Chart of habitat incidence 81

10) 10 Chart of socio-economic status incidence 81

11) 11 Chart of Qualification incidence 82

12) 12 Chart of dietary habit incidence 83

13) 13 Incidence of Prakruthi 83

14) 14 Incidence of Sara 84

15) 15 Incidence of Samhanana 85

16) 16 Incidence of Satva 86

17) 17 Incidence of Rasa satmya 86

18) 18 Incidence of Agni 87

19) 19 Incidence of Kosta 88

20) 20 Incidence of Bala 88 21) 21 Effect of HB% 89

XIII

22) 22 Effect of Pandutwa 90 23) 23 Effect of Alasya 91 24) 24 Effect of Shrama 91 25) 25 Effect of Arohana ayasa 92 26) 26 Effect of Kati ruk 93 27) 27 Effect of Swetha akshi 93 28) 28 Effect of Hridrava 94 29) 29 Effect of Aruchi 95 30) 30 Effect of Dourbalya 95 31) 31 Effect of Gourava 96

XIV

Review of Literature Introduction

1

INTRODUCTION

The need for the discussion of Pandu roga becomes important due to the gravity

of the problem. It is the commonest nutritional disorder all over the world and forms a

major problem of mankind especially in a country like India due to low socio economic

status, illiteracy and malnutrition in a major part of the population. It affects the physical

and mental health of children, affects school performance and increases susceptibility to

various infections. Further infants born to anaemic mothers have low Iron reserves and

fall prey to Anaemia later in life with its adverse consequences. A survey in Asia by

World Health Organization showed that approximately 10% of men, more than 20%

women (more than 40% during pregnancy); more than 50% of children of all ages and

92% of children below the age of two years suffer from Anaemia. In India 20-40% of the

population, equally of all ages and either sexes have been suffering from IDA. For its

diffuse global spread IDA is recognized as a world health problem. The National

Nutritional Anaemic Control Programme launched by Government of India is an

important step in this direction. Therefore such study gains importance. Hence I have

taken this topic for my dissertation work.

Pandu roga has been identified as a disease since Vedic Period. Description of Pandu

roga is available in Rigveda, and Atharvaveda (6000). Pandu has been depicted as

`Vilohita` and Halima.

The Nomenclature of Pandu roga based on the vaikarika varna i.e., pandutwa.

According to Sabdarnava and Sabdhasthoma mahanidhi. The term pandu means swetha

varana, Dhoosara, swetabha, swetavabhasata and peetabha and peetavabhasata, and

Gangadhara explains is as mlana varna. To explain the above varnas the following


2

examples have been described such as shanka, pakwamadanaphala, keetakadhooli,

apakwa parooshaka phala etc. owing to the importance attached to varna in the

samprapthi of pandu roga both prakrita and vikrita varna has been dealt in a separate

chapter.

The term Vilohitha indicates of Raktalpata a most important clinical condition of pandu

roga. It is very much appreciated by the sloka in charaka chikitsa sthana stating “sa

alparakto alpa medasko nissaraha shithilendriyaha”. Mandagni an out come of pachaka

pitta vikriti at another important defective formation of rasa and there by both qualitative

and quantitatively defective rakta dhatu occurs. Probably that is the reason pandu roga

has been included in rasa pradoshaja vikaras.

Dhatu shaithiliyam Nissarata and shithilendriyatwam also result because of shonita

nimattaja, based on the above factors it can be stated that rakta dushti and pachaka pitta

vikriti play a vital role in the samprapthi of pandu roga.

Charaka and Vagbhata have mentioned pitta pradhanyata in the vitiation of tridoshas

i.e., pitta prakopa is an invariable condition of all the varieties of pandu. Unlike that

pittarabdha katwam that pittara is seen in pittaja pandu roga. Basically pandu roga is

tridoshaja vyadhi but according to dosha predominance it is named as vataja, piitaja,

kaphaja, sannipataja respectively and mrudbhakshana which is a visista vyadhi karana

forms another variety of pandu roga.

Keeping rakta dusti and pachaka pitta vikriti in view it can be concluded that pitta an

important part in the causation of pandu roga. Describing the pitta tejasa gunas.

Chakrapanidatta says that 2 types of pitta are responsible for the development of pandu

roga. Owing to its weakness of pachaka pitta rasa forms defectively formation of


3

rakthadhatu occurs. And in the second type pitta owing to its kshapana guna causes

destruction of rakta dhatu. It can be deducted from the above facts that the pahcaka pitta

dushti in the essential prime factor in causing rakta dushti.

Apart from pachaka pitta, Ranjaka pitta plays an important role in the formation of

rakta dhatu, the role of ranjaka pitta in the formation of rakta dhatu has been discussed in

detail in a separate chapter. Sadhaka and bhrajaka pitta also go into vaikarika state, which

results vaivarnya and abhrajishnuta and hridvikaras in severe conditions of pandu roga

alochaka pittavaikriti also occurs and it is evident from the clinical conditions such as

pandu sanghatadarsee etc.

In pandu roga owing to excessive destruction of snigdha roopa rakta and sneha kshaya

of bala varna sneha ojus results. In consequence of the above factors rookshatwam occurs

in the body and patient appears kanthiheena, because of nissarata and ojokshaya and then

the complete roopa of pandu roga sets in.

To counter act the above pathologic conditions of pandu roga snehana forms the first

principle of the treatment. Snehana causes purification of the kosta and facilitates the

doshas to get back into kosta. After having achieved sampoorna snigdhatwa lakshanas

shodhana is indicated in pandurogi. Here shodhana implies both oordhwa and adaha

shodhana. Visista pandu hara oushadas along with oushadas to combat the ill effects of

dosha prakopa. During the treatment pathyavastha is also indicated while advocating

pathyavastha the following points should be observed strictly.

1. Foods that is easy for digestion.

2. Foods that is capable of causing Brimhana.


4

Previous work done:

1. Clinical evaluation of the effect of Navayasa Churna in different types of pandu roga.

By Radha Krishna – Bangalore, 1992.

2. A comparative study on the effect of Dhatri Avaleha and kaseesa bhasma in pandu

roga. By Bhasavaraj.R. Tubaki-Udupi-2002.

3. The study of virechana purvaka snehana in pandu roga by Raval K.R.-Jamnagar, 1987.

PRESENT STUDY

For the present study Tab Dhatri lauha has been selected for clinical trials on Pandu

roga. The drug has been widely advocated in the treatment of the pandu roga. The above

drug have been put together to achieve good clinical prognosis in pandu rogi by

counteracting the following pathological conditions of pandu roga.

1. To restore the normal lohamsa which is essential factor to increase the quality and

quantity to rakta dhatu.

2. To bring back the vaikaraika pachakapitta to prakritavasatha, this forms as an

important causative factor for rakta dushti and for improper development of rasa.

3. To stimulate rakta vaha srothomoola especially yakrit and pleeha to increase the

capacity of the production of rakta and also to restore the prakritavastha of

ranjaka pitta for the proper ranjana of rasa.

4. To remove the srotoavarodham a vaikarika state which commonly occurs because

of the ama condition in the body which is an out come of pachaka pitta vikriti

again. By removal of srotoavarodham proper dhatwa pryayanam is possible, so

that important pathological conditions such as nissarata, dhatushaithilyam,

shithilendriyatwam could be cured effectively.


5

To remove the above causative factors a drug should have the qualities of

deepana pachana, pittasamana, pittasarakata, srotas shodhana and which is having

abundance of lohamsa in it.

To fulfill the above requirements Dhatri lauha have been selected. Dhatri

lauha has been given bhavana in Amrutha kwatha for 7 times for 7 days.

For the present study the following materials and methods have been taken:

1. Literary Study.

2. Clinical Study.

1. Literary Study: The necessary references regarding the disease and the drug

have been compiled and theoretical basis for the clinical trials has been prepared.

2. Clinical Study: Under the clinical material the records and the results of the

practical study in the applications of medicines and the clinical data of the

patients are included for this purpose 20 patients suffering from pandu roga

registered in O.P.D. and I.P.D. have been studied with emphasis on leading

symptoms and signs of pandu roga.

The following are the silent features of the procedure of the clinical trials with Dhatri

lauha on pandu roga.

1. Name of the drug: Dhatri Lauha

2. Dose of the drug: 500mg bid

3. Anupana: Jala

4. Duration: 1 month

5. No. of patients: 20

Objectives

OBJECTIVES

• To do a comprehensive conceptual study on Pandu roga.

• To evaluate the therapeutic effect of Dhatri Lauha in Pandu roga patients without

alteration in their routine, dietary and physical activities.

6

Review of Literature Historical Review

HISTORICAL REVIEW

As one of our aims is to root out the disease in the diseased, accordingly, while

attempting to find a proper management of a disease, it is very much important to study

the disease from its roots.

“The function of the historian is neither to love the past nor to emancipate himself

from the past but to master and understand it as the key to the understanding of the

present”. E H. Carr.

“Those who fail to read history are destined to suffer the repetition of its

mistakes”.

“The further back you look, the further forward you can see” - Winston Churchill.

The study can be divided into:

1) Vedic – Samhitas, Brahimanas, Upanishad, Kalpasutra (2000-1000BC)

2) Samhita (1000BC – 500 AD).

3) Sangraha Kala (500 AD – 1700 AD).

4) Adhunika Kala (1700 AD onwards).

Vedic:

Ayurveda is intimately connected with the Vedas. This is evident from the fact

that the former is regarded as Upaveda of Rigveda (Kashyapa). Some scholars consider

Ayurveda as Upaveda of Atharvaveda(1-50; 1-22-4) because of its similarity.

Hariman and Harita are the diseases mentioned in Rigveda and Atharvaveda.

Hariman is interpreted by Sayana as pallor and yellowishness of the body caused by the

disease. Similar explanation is available in Rigveda(Rig 1-50-11-13)

7


The author of History of Medicine in India (pg 20) states, “Hariman and Harita

look like synonyms but on careful examination, the former appears to be jaundice while

latter as pallor. ‘Hr’ in Harita denotes loss of blood (Anaemia). In Rigveda, the Harita

colour of frogs is taken as green by Sayana, but Harita infact is pale. The skin colouration

of anaemic patients due to rakta arsha is simulated to the frog`s skin colouration in

Madhava nidana. In fact, Charaka has included different skin discolourations in Pandu

roga.”

Prof. P. V. Sharma opines, “Initially it is Harita denoting pallor of skin (Pandu)

developing further into Hariman (Kamala, jaundice). In post-vedic texts, the same

description about Pandu and Kamala is observed. It is interesting to note that they have

retained the Vedic term Hariman in a slightly modified form as Halimaka and have

described it as a type of Kamala.”

Rig Veda prescribes its treatment with morning sun rays. In Atharvaveda, red

cow’s milk and the drug Anjana has been said as Harita Bheshaja. Kaushika Sutra

prescribes intake of cooked rice mixed with Haridra and anointing the same over the

body for this disease.

In Jaiminiya Brahmana, there is reference regarding Hariman.

In the Mahabharata, King Pandu, who was the father of Pandavas, was suffering

from Pandutwa.

Samhita Kala (1000 BC – 500 AD):

This period is considered to be golden era in the Ayurvedic history. Ayurveda

attained its summit both in conceptual and treatment aspects. In this period, it received

patronage from both king as well as society. Like other diseases, Pandu roga is also

8


elaborately discussed including its Nidana, Samprapti, Lakshanas, Bheda, Upadrava and

Chikitsa. It is extensively dealt by Acharyas like Charaka, Sushruta and Vagbhata.

Charaka:

This Samhita plays main role in wide explanation of pandu roga, in charaka

samhita chikitsa sthana 16th chapter pandu roga nidanas, bhedas, lakshanas and chikitsa

mentioned very clearly. In pandu bhedas mrutbhakshana janya pandu mainly explained

very particularly.

Sushruta:

Sushruta explained pandu roga in uttara tantra 44th chapter in detailed along with

its nidana, purva roopa, Roopa, sadhya asadhya and treatment. Kamala and other diseases

are maintained as a stage of the pandu roga.

Sushruta explained synonyms for the term pandu as kamala, panaki, panduva,

kumba kamala, laghavaka and alasam.

Vagbhata:

Astanga hridayam nidana sthana 13th chapter pandu roga nidana, bhedas,

lakshanas and upadravas mentioned very clearly. Over all the brihatrayee the detail

description of pandu roga is available and which in mostly followed by laghuthrayees in

its treatment and other aspects.

Madhava nidana & Bhava prakasha:

In madhava nidana 8th chapter explained pandu roga nidana, bhedas, lakshanas

and upadravas and also sadhaya asadhya.

In Bhava prakasha 46th chapter explaines the disease of pandu roga nidana,

bhedas, lakshanas and chikitsa very clearly.

9


The description about pandu roga is also seen in ksayapa samhitha, belasamhitha.

Sangraha (500-1700 AD):

Chakrapani, Dalhana, Indu, Vijayarakshita, Srikantadatta, Adamalla,

Amarasimha, Madhavakara, Sharangadhara, Bhavamishra, Yogaratnakara, Arunadatta

and Hemadri have dealt Pandu Roga in detail. They have commented and discussed on

the important previous works. In Garuda Purana, in Nidana, many diseases are described

including Pandu and treatment being Loha Churna administered with Takra.

Adhunika Kala (1700 AD onwards):

Kaviraja Sri Rama Raksha Pathak has devoted a complete book to Pandu Roga

giving elaborate discussion regarding different aspects of Pandu Roga. Rasa Tarangini by

Sri Sadananda Sharma and Bhaishajya Ratnavali by Sri Govind Das have also

contributed descriptions regarding Pandu roga during this period.

10

Review of Literature Vyutpatti

VYUTPATTI

The word “Pandu” is formed from the dhatu “Padi Gatou”. Padi means “gati” i.e.

parinamana or transformation.

The word Padi Gatao (transformation) signifies the formation of Rasa, Rakta and

other Dhatus. If the transformation process is hindered or having any aberration then it

leads to Pandu.

NIRUKTI

In Ayurveda, diseases are named after considering certain criteria that are very

much important. Sometimes they are named after the pre-dominant Dosha and Dushya

viz., Rakta-Pitta, Vata-Rakta; on the basis of similes, eg: Shlipada, Kroshtukasheersha;

anatomical structures e.g.: Hridroga, Shiroroga; colouration of the body viz. Pandu,

Kamala and based on pain as in Hrutshoola and Parinamashoola and so on.

A disease named on the basis of Varna is Pandu roga.

• Pandu Varna is a combination of Shweta and Peeta Varna in equal

proportions, similar to pollen grains of Ketaki (Harita.S).

• Pandu Varna is the combination of Shukla and Peeta (Raja Nighantu).

• Pandu Varna is the combination of Shweta and Peeta (Shabdakalpadruma).

• Pandu Varna is the combination of Shweta and Peeta Varna (Amarakosha) .

By observing the above references, it may be considered that Pandu Varna is the

combination of Shweta and Peeta Varna. The degree of coloration varies according to the

severity of the disease.

11

Review of Literature Vyutpatti

PARIBHASHA

The term Pandu is explained widely in the classics.

• The disease in which Pandu bhava is more predominant is called Pandu roga.

• The disease in which Pandutva is predominant.

• In all the varieties of Pandu roga, Pandu Varna is a predominant feature.

• Disease named after Pandutva.

• The disease is named Pandu roga wherein Pandu, Harita and Haridra Varna

are included.

It is evident from the above references that Pandutwa is the predominant feature

of Pandu Roga.

PARYAYA

The synonyms of Pandu are Kamala, Panaki, Kumbhava, Lagharaka, and

Alasaka.

Though Kamala etc. are considered as synonyms of Pandu; even then, Pandu and

Kamala are separately explained in terms of Nidana, Lakshana and Chikitsa. Dalhana

clarifies that Acharya Sushruta has considered it as a synonym only on the basis of

Kamala being an avastha vishesha of Pandu. Charaka also includes Haridra, Harita and

all other skin discolorations under Pandu.

12

Review of Literature Nidana

NIDANA

``Nimitta hetwayatana pratyayothana karnahinnilaka mahuparyaythi``

``Seti kartavyatako rogotpadaka heturnidanam``

Means vividha ahitha ahara vihara which cause vyadhi by vitiating doshas and dhatus.

The following are the nidanas of pandu roga1, 2:

The causative factors of pandu roga can divided into following three types:

1. Ahara

2. Vihara

3. Nidanartha kara rogas.

1).Ahara dravyas causing vataja pandu:

A) According to Charaka

1. Adhika katu sevana 8. Kshudhitambhupana

2. Adhika tikta sevana 9. Vishavi sevana

3. Adhika kashaya sevana 10. Meenashana

4. Adhika rooksha sevana

5. Adhika vistambha dravya sevana

6. Adhika Trinadhanya sevana

7. Adhika seta sevana

B) According to Susrutha:

1. Shuskamamsa

2. Udalaka

3. Shyamaka

4. Mridga

13


5. Adhakee

6. Nishpava

7. Anashana

8. Vishamashana

9. Adhyashana

2) Vihara causing Vataja Pandu roga:

A) According to Charaka:

1. Vegadharana

2. Virechanadi karma athiyoga

3. Ratrijagarana

4. Pravataseva

5. Atimaituna

6. Ativyayama

7. Ati langhana

8. Atyadhyayana

9. Sahasam

10. Bhaya

II.Causitive factors Pittaja Pandu:

1) Ahara Sambandee:

According to Susrutha

1. Laghu dravya

2. Pinyaka

3. Sarshapa

14


4. Matysa

5. Ajamamsa

6. Amlaphala

7. Sura sevana

II.Vihara Sambandhee:

1. Shoka

2. Bhaya

3. Shodhana

4. Ayasa

According to Astangha Sangraha:

1. Ahara Sambhandee

1. Katurasa

2. Amlarasa

3. Lavana rasa

4. Dadhi

5. Mastu

6. Madhya

7. Kshara

8. Thaila

9. Kulatha

10. Maricha

11. Dhanyaamla

12. Vidhahee dravya

15


II.Vihara Sambandhee:

1. Atapa

2. Agni

3. Krodha

4. Ershya

5. Ahara vidhakala

III.Causitive factors of Kaphaja Pandu:

1) Ahara Sambhandee

1. Madhura dravya

2. Amla dravya

3. Lavana dravya

4. Seetha Dravya

5. Snigdha dravya

6. Guru dravya

7. Abhishyandhi

8. Dadhi

9. Dugdha

10 Payasa

11. Masha

12. Maha masha

13. Vasa

14. Visha

15.Anoopa mamsa

16


According to Astanga Sangraha:

1. Ikshurasa

2. Kadhalee phala

3. Nareekela

4. Atyambupana

5. Ati santarapana

IV.Causitive factors of Sannitaja Pandu roga:

Combination of tridosha dusti karanas produces sannipataja pandu roga.

V.Causitive factors of Mrudbhakshana Janya Pandu:

Kashaya mrit causes vataja pandu roga.

Ooshara mrit causes pittja pandu roga

Madhura mrit causes kaphaja pandu roga

VI.Nidanarthakara Rogas:

Due to rakta kshaya the following diseases cause pandu roga:

1. Rakta gulma 2.Pleehodara

3. Asrugdhara 4.Arshas

5. Raktasrava 6.Raktapitta

7. Raktapradara 8.Raktaarbuda

9. Rakta vahee dhamani vedha 10.Yakrut pleeha vedha

17


TABLE 1: NIDANA

Sl. No

Lakshana C.S. Su. S. A.H. M.N.

B.P. Dl G.N.

1 Kshara sevana + - - - - - - 2 Amla sevana + + + + + + + 3 Lavana rasa sevana + + + + + + + 4 Atyushna bhojana + - - - - - - 5 Asatmya bhojana + - - - - - - 6 Viruddha bhojana + - - - - - - 7 Matsya sevana - - - - - + - 8 Amisha sevana - - - - - + - 9 Ikshu sevana - - - - - + - 10 Pishta sevana - - - - - + - 11 Paya sevana - - - - - + - 12 Pinyak ati sevana + - - - - - - 13 Mashati sevana + + - - - + - 14 Madya sevana - + - + + + + 15 Mrut bhakshana + + - + + + + 16 Teekshna ahara sevana - + + + + + - 17 Maithuna + - - - - - - 18 Vega Vidharana + - - - - - - 19 Pachakarma prati-karma

vaishamya + - - - - - -

20 Rutu vaishamya + - - - - - - 21 Kama + - - - - - - 22 Krodha + - - - - - 23 Chinta + - - - - - - 24 Bhaya + - - - - - - 25 Shoka + - - - - - - 26 Divaswapna + + - + + + + 27 Vyayama + + - + + + + 28 Bharaharana - - - - - + - 29 Nishpava sevana + - - - - - - 30 Tilataila sevana + + - - - + +

18

Review of Literature Poorva roopa

POORVA ROOPA

“Sthanasamsraymaha kruddha bhavi vyadhi Prabhodhakam,

Doshaha kurvanti yallingam poorvaroopam, Taduchyute”.

Doshas which have attained sthana samshravastha show certain symptoms pertaining to

future disease known as poorva roopa3.

According to charaka the following symptoms have been mentioned as poorva roopa

(ch.chi.16)4

1. Hridaya spandanadhikya

2. Roukshyam

3. Swedabhava

4. Shrama

Acoording to susrutha the following symptoms have been mentioned as poorva roopa of

pandu roga. (su.ut.44)5

1. Twaksphotana

2. Steevana

3. Gatrasada

4. Mrid Bhakshaneccha

5. Prekshana koota shotha

6. Avipaka

7. Vitpeetata

8. Mootra peetata

19


According to Astanga Hridayakara the following symptoms have been mentioned as

poorva roopa of pandu roga6.

1. Hridaya spandana

2. Aruchi

3. Alpa vanhita

4. Sada

1) Hridaya Spandanadhikya: This is due to the Prakopa of Pitta pradhana tridosha. In

the Hridaya, the Chala guna of Vyana vayu coupled with Sara guna of Sadhaka pitta

causes Rasa dhatu kshaya and reduced Preenana to the Dhatus. It causes increased

functioning of Hridaya, which is its mulasthana, producing Spandanadhikya.

2) Twak Roukshya or Twak Sphutana: Twak Roukshya or Twak Sphutana can be produced by:

1) Increased vyana vayu 2) Raktadhatu kshaya 3)Sarahani

3) Swedabhavata: Swedabhava can be caused by Srotorodha due to Kapha.

4) Shrama: Shrama can be produced by

1) Vyanavayu vriddhi 2) Rasa, Mamsa, Meda, Asthi, Shukra and Ojokshaya

5) Shteevana and Hrillasa: Due to Malaroopi kapha vriddhi produced by Rasa

dhatwagnimandya, Shteevana and Hrillasa are seen in Pandu.

6) Gatrasada: Is caused by Vyana vayu prakopa and ojokshaya.

7) Mrud-bhakshana Iccha: Is said to be the Prabhava in disease, mainly due to the

vitiation of Sadhaka pitta, which disturbs Dhriti and Medha and this disturbed mental

status induces the patient to such activities.

20


8) Prekshana Koota shotha: Increased Malaroopi kapha cause Srotorodha, thus

causing Prekshana koota shotha.

9) Aruchi, Avipaki, Alpavannita: Increased Pitta (drava rupi) when produces

Agnimandya produces Aruchi etc.

10) Peetata of Vit and Mootra: Dravyataha vriddhi of pitta due to Nidana and the

vicious cycle of Rakta-agnimandya, thus increases Ranjaka pitta and causes increased

colouration of Vit and Mootra.

Table No.2. POORVA RUPA

Sl. no

Lakshana C. S.

S. S.

A.H.

A.S.

M.N.

B.P.

Vanga

H.S.

Y.R.

G.N.

Basa.

1 Hrudaya Spandadhikya

+ - + + - - - - - - -

2 Roukshya + - + + - - - - - - - 3 Swedabhava + - + + - - - - - - - 4 Shrama + - + + - - - - - - - 5 Twak Sphotana - + - - + + - + + + + 6 Shteevana - + - - + + - + + + + 7 Gatra Sada - + - - + + - + + + 8 Mrudbhakshana

Iccha - + - - + + - + + + +

9 Prekshana Koota Shotha

- + - - + + - + + +

10 Avipaka - + - - + + - + + + 11 Vitpeetata - + - - + + - + + + 12. Mootra Peetata - + + + + + - + + + + 13. Aruchi - - + + - - - - - - - 14. Alpa Vahni - - + + - - - - - - - 15 Sada - - + + - - - - - - - 16 Pipasa - - - - - - + - - - - 17 Hrullasa - - - - - - + - - - - 18 Urodaha - - - - - - + - - - - 19 Anga gourava - - - - - - + - - - - 20 Rakta lochana - - - - - - + - - - - 21 Shareera

pandutwa - - - - - - - + - - -

21

Review of Literature Roopa

ROOPA

``Tadeva vyaktata yatam roopa mitya bhidheeyate

samsthanam, vyanjanam, lingam, lakshanam, chinnam, akruthi``.

The poorva roopa which has attained vyaktavastha known as roopa. The following are

samnya roopa of panduroga.

Samanya Lakshana:

1) Panduta: It is the Pratyatma lakshana of Pandu. Pandu roga is named on the basis of

discolouration of body parts. This is due to Rasa pradosha.

2) Alpa Raktata: Includes both qualitative and quantitative decrease. Quantitatively

Rakta is 8 Anjalis in body. Normal Rakta is produced by Pachaka pitta, which helps in

proper production of Rakta poshaka sara part from Rasadhatu. Ranjaka pitta effectively

converts this to Rakta. Alpa raktata causes Shareera vaivarnya, Twacha rukshata.

3) Dourbalya: Means reduction in the normal strength (Bala), Normal Bala is

measured by Vyayama shakthi. In Pandu it is reduced due to Dhatukshaya

4) Karshya7: Reduction of various Dhatus in body leads to affliction of Samhanana

leading to emaciation of Spik, Udara, Greeva and prominence of Dhamani jala.

5) Karna Kshweda: Due to debility in the sense organs, increased Vata produces this

symptom and is one of the Vataja nanatmaja vyadhi.

6) Gatra peeda: Different types of pain in the different parts of the body caused by

Vata vriddhi due to Dhatu kshaya.

22


7) Shoonakshi koota shotha and steevana: Is the continuation of sign from

Poorvaroopa stage. Kapha vriddhi producing Srotorodha produces Shoonakshi koota

shotha

8) Sheerna lomata8: Asthi dhatu kshaya.

9) Hridrava: Means increased Hrit Gati. Involvement of Sadhaka pitta, Vyana vayu,

Raktavaha srotodushti causes Hridrava.

10) Shwasa: Due to Dhatu kshaya and Dourbalya shwasa is produced. Even debility in

the hridaya can cause Shwasa. Prakopa of Pranavayu can also cause Shwasa. There, it

refers to Arohana Ayasa (exertional dyspnoea). But in Upadrava stage, it is severe state

of Kshudra Shwasa.

11) Bhrama: Vata-pitta-rajogunadhikya leading to various Dhatu kshaya like Majja and

Rakta will produce Bhrama.

12) Annadwesha: Charaka mentioned both Annadwesha and Aruchi in Samanya

lakshana. Sushruta has mentioned this in Upadrava stage and is caused due to Kapha

vriddhi and Agnimandya.

13) Gourava: Heavyness of body indicates Kapha and Amavriddhi and is one of

Kaphaja nanatmaja vikara.

14) Jwara: Indicates Pitta prakopa.

15) Harita Varna: Indicates Pitta vriddhi.

16) Hata prabhatwa: Pitta prakopa, Oja kshaya cause Prabha hani.

23


Table No.3. SAMANYA LAKSHANA

Sl. No. LAKSHANA C.S. S.S. A.H. A.S. K.S.

1. Karna Kshweda + - + + - 2. Hatanala + - + + + 3. Dourbalya + - + + - 4. Sadana + - + + - 5. Bhrama + - + + - 6. Annadwesha + - + + - 7. Shrama + - + + - 8. Gatrashoola + - - - - 9. Jwara + - + + - 10. Shwasa + - + + - 11. Gaurava + - + + - 12. Aruchi + - - - - 13. Gatramarda + - - - - 14. Gatrapeeda + - - - - 15. Gatronmathana + - + + - 16. Shunakshikoota + - + + + 17 Hareeta Varnata + - - - - 18 Sheerna lomata + - + + - 19 Hataprabha + - - - - 20 Kopa + - + + - 21 Shishiradwesha + - + + - 22 Nidralu + - - - - 23 Shtivana + - + + - 24 Alpavak + - + + - 25 Pindikodweshtanam + - - - - 26 Katiruk + - - - - 27 Kati sada + - - - - 28 Padaruk + - - - - 29 Pada sada + - - - - 30 Uru ruk + - - - - 31 Uru sada + - - - - 32 Dhatushaithilya + - + + - 33 Ojo gunakshaya + - + + - 34 Alparaktata + - + + - 35 Alpamedaskata + - + + - 36 Nissarata + - + + - 37 Hridrava + - + + - 38 Shithilendriya + - + + - 39 Shareera Vaivarnya - - - - + 40 Twachi panduta + + - - - 41 Nabhi Shotha - - - - +

24


42 Shwetha Akshi - - - - + 43 Shwetha Nakha - - - - + 44 Shwetha Vakrata - - - - + 45 Shotha - - - - + 46 Karshya - - - - + 47 Satwahani - - - - + 48 Alasya - - - - + 49 Sanna Saktha - - + + - 50 Nirutsaha - - - - + 51 Rudhira Spriha - - - - +

Vishista Lakshana:

• Vataja Pandu: Vata vriddhi produces various Vataja manifestations in the

presentation of Pandu roga like Krushnata, Panduta and Arunangata of body parts,

various types of Shoola.

Table No.4. VATAJA PANDU LAKSHANA

Sl. No.

Lakshana C.S.

S. S.

A.H.

A.S.

M.N.

B.P.

Y.R.

G.N.

Basa.

1 Krishna pandutwa + - - - - - - - + 2 Ruksha angata + - + + + + + + - 3 Arunangata + - - - + + + - - 4 Angamarda + - - - - - - - - 5 Raja + - + + - - - - - 6 Toda + - + + + + + + + 7 Kampa + - + + + + + + + 8 Parshwa shoola + - + + - - - - - 9 Shirashoola + - + + - - - - - 10 Varcha shosha + - + + - - - - - 11 Asya vairasya + - + + - - - - - 12 Shopha + - + + - - - - - 13 Anaha + - + + + + + + - 14 Bala kshaya + - - - - - - - - 15 Krushna akshi - + + + - - - + + 16 Krushna Sira

Avanaddha - + - - - - - - -

17 Krushna Varnatwa - + - - - - - - + 18 Krushna mala - + + + - - - - -

25


19 Krusha mootra - + + + - - - + - 20 Krusha nakha - + + + - - - - + 21 Krushna anana - + - - - - - - - 22 Aruna sira - - + + - - - - - 23 Aruna nakha - - + + - - - - + 24 Aruna mala - - + + - - - - - 25 Aruna mootra - - + + - - - + - 26 Aruna akshi - - + + - - - + + 27 Bhrama - - - - - - - + - 28 Vata upadrava - + - - - - - - - 29 Krushna sira - - + + - - - - + 30 Aruna sira - - + + - - - - - 31 Twak krushnabhata - - - - + + + - - 32 Mootra krushnabhata - - - - + + + - - 33 Nayana krushnabhata - - - - + + + - - 34 Twak arunabhata - - - - + + + - - 35 Mootra arunabhata - - - - + + + - - 36 Nayana arunabhata - - - - + + + - - 37 Rakta netra - - - - - - - + + 38 Aruna twak - - - - - - - + -

• Pittaja Pandu: Pitta vriddhi produces various Pittaja presentations like Peetabhata,

Haritabhata, Jwara.

Table No.5. PITTAJA PANDU LAKSHANA

Sl. no. LAKSHANA

C.S.

S. S.

A.H.

A.S.

M.N.

B.P.

Y.R.

G.N.

1 Peetabha + - - - - - - - 2 Haritabha + - + - - - - - 3 Jwara + - + + + + + + 4 Daha + - + + + + + + 5 Trushna + - + + + + + + 6 Moorcha pipasartha + - - - - - - - 7 Peeta mootra + + - - + + + + 8 Peeta shakrut + + - - + + + + 9 Swedana + - - - - - - - 10 Sheeta kamitva + - + + - - - - 11 Na annam abhinandathi + - - - - - - - 12 Katukasya + + + - - - -

26


13 Anupashaya - - - - - - - - 14 Ushna + - - - - - - - 15 Amla + - - - - - - - 16 Amla udgara + - - - - - - - 17 Vidahata + - - - - - - - 18 Vidagdhata + - - - - - - - 19 Dourgandhya + - + + - - - - 20 Bhinna varcha + - + + + + + + 21 Dourbalya + - - - - - - - 22 Tama + - + + - - - - 23 Peetakshi - + - - + + + + 24 Peeta Sira Avanaddha - + - - - - - - 25 Peeta nakha - + - - - - - - 26 Pittaja upadrava - + - - - - - - 27 Peeta anana - + - - - - - - 28 Moorcha - - + - - - - - 29 Amlata - - + - - - - - 30 Atipeetabha - - - - + + + -

• Kaphaja Pandu: Kapha vriddhi produces various Kaphaja manifestations like

Shuklavarnata, Gourava and Shwayathu.

Table No.6. KAPHAJA PANDU LAKSHANA

Sl. no.

LAKSHANA C.S. S. S. A.H. A.S. M.N.

B.P. Y.R. G.N.

1 Gourava + - - - - - - + 2 Tandra + - + + + + + + 3 Chardhi + - + + - - - - 4 Shewatavabhasata + - - - - - - - 5 Praseka + - - - + + + - 6 Lomaharsha + - + + - - - - 7 Sada + - - - - - - - 8 Moorcha + - - - - - - - 9 Bhrama + - - - - - - - 10 Klama + - - - - - - - 11 Shwasa + - - - - - - - 12 Kasa + - + + - - - 13 Alasya + - - - + + + - 14 Aruchi + - - - - - - - 15 Vatagraha + - - - - - - -

27


16 Swasa graham + - - - - - - - 17 Shukla motra + - - - + + + - 18 Shukla akshi + - - - + + + - 19 Shukla varcha + - - - - - - - 20 Katu kamatwam + - - - - - - - 21 Ruksha kamatwam + - - - - - - - 22 Ushna kamatwam + - - - - - - - 23 Shwayatu + - - - + + + - 24 Madhurasyatwa + - - - - - - - 25 Shukla sira - + + + - - - - 26 Shukla nakha - + - - - - - - 27 Shukla anana - + - - + + + - 28 Kaphaja upadrava - + - - - - - - 29 Lavanasyata - - + + - - - - 30 Swarakshaya - - + + - - - - 31 Atigourava - - - - + + + - 32 Shukla twacha - - - + + + -

• Tridoshaja Pandu: Tridosha prakopa causes presentation of all the Tridoshaja

lakshanas.

Table No.7. TRIDOSHAJA PANDU LAKSHANA

Sl.No. Lakshana G.N. H.S.1 Jwara + + 2 Arochaka + - 3 Hrullasa + + 4 Vamana + + 5 Trushna + + 6 Bhrama + - 7 Tandra - + 8 Alasya - + 9 Shotha - + 10 Kasa - + 11 Shosha - + 12 Vitbandha - + 13 Parushata - + 14 Klama - + 15 Moha - +

28


• Mridbhakshanaja Pandu: Mridbhakshana causes Agnimandya, Roukshyata of

body, Shotha, Dhatu dourbalya, Indriya-Teja-Bala-Oja-Virya kshaya and Krimi etc.

Madhavakara has considered Mridbhakshana as vyadhi hetu. Sushruta has considered this

under Tridoshaja Pandu as Mridbhakshana produces Tridosha prakopa.

Table No.8. MRUDBHAKSHANAJANYA PANDU

Sl. no.

LAKSHANA C.S. S.S. A.H. A.S. M.N.

B.P. Y.R

G.N.

1 Indriya bala hani + - - - - + + + 2 Teja hani + - - - - + + + 3 Bala hani + - - - - + + + 4 Ojo hani + - - - - + + + 5 Varna nasha + - - - - + + + 6 Agni nasha + - - - - + + + 7 Shoona ganda + - - - - + + + 8 Shoona akshi koota + - - - - + + + 9 Shoona bhru + - - - - + + + 10 Shoona pada + - + + - + + + 11 Shoona nabhi + - + + - + + + 12 Shoona mehana + - + + - + + + 13 Krumi koshta + - - - - + + + 14 Atisara + - - - - + + + 15 Mala with rakta + - + + - + + + 16 Mala with kapha + - + + - + + + 17 Pandu - - - - - + - - 18 Tandra - - - - - + - - 19 Aruchi - - - - - + - - 20 Alasya - - - - - + - - 21 Kasa - - - - - + - - 22 Swasa - - - - - + - - 23 Shoola - - - - - + - - 24 Sada - - - - - + - - 25 Mala with krimi - - + + - - - - 26 Bhinna Mala - - + + - - - -

29

Review of Literature Samprapti

SAMPRAPTHI

Charaka in chikitsa sthana describing the pandu roga samprapthi states that when

pitta pradhana vatadi dosha gets prakopa avastha in dhatus, cause dhatu shythilyam and

dhatu gaurava. Owing to vitiation of shareera by this dushitha dosha dushyas, excessive

kshaya of bala varna, snehana and ojus occurs, resulting in alpraktata, alpamedhastaka,

nissaratha, shytilendriyatha and vivarnya which is known as pandu roga9,10.

Charaka further describing the samprapthi of pandu roga states that when the

person who indulges in kshara, amla, lavana, adhika ushna, asatmya ahara sevana,

pinyaka and tilataila sevana. Diwaswapna, ativyayama, atimaituna and vegadharana the

person who is akrantha kama, chinta, bhaya, krodha, hrudhyastha sadhaka pitta attains

vriddha avastha.

The balee vayu displaces this sadhaka pitta from hrudaya and spreads throughout

the body by means of dasha dhamani. Thus when twak, Mamsa madhya asritha pitta

vitiates kapha, vata, rakta, twacha, mamsa causes pandu, haridra, haritha varna twacha

which is known as pandu roga11, 12.

Susrutha describing the samprapthi of pandu roga states that prakopagata

tridoshas vitiate rakta cause pandu varna on twacha and the condition is known as pandu

roga.

``NISHEVA MANASYA VIDUSHYARAKTAM KURUVANTHI DOSHA TWACCHI

PANDUBHAVAM`` su/ut 44/3.

Associating the Nidana and Samprapti:

Ahara, vihara and vaidyakruta etiology cause Alparaktata through

30


• Pitta dosha prakopa,

• Agnimandya and

• Rasavaha and Raktavaha srotodushti.

Further, Alparaktata is due to two causes viz. Raktaposhaka sara bhaga

Anutpadana and Raktaposhaka sara bhaga Kshapana due to Pitta. Another aetiological

consideration for the Anutpadana and Kshapana are the Aharaja, Viharaja, Oushadha and

Vyadhi prabhava factors.

As a result of Nidanarthakara roga: Nidanarthakara rogas can lead to Pandu by any of the

following:

1. Raktaposhaka sara bhaga Anutpadana,

2. Raktaposhaka sara bhaga Kshapana and

3. Alparaktata by Raktasrava. Again, it can be Sadya and Chirottha.

This pathogenic pathway holds good also for Aharaja, Viharaja and Vaidyakruta

nidanas.

Samprapti:

Samprapti of the disease Pandu can be studied under two headings -

1. Samanya

2. Vishesha

1) Samanya: It is the general pathogenesis in which the vitiated Doshas affect and

vitiate the Dathus and Srotas. This is common to all types of Pandu.

2) Vishesha: It is the specific pathogenesis in which the disease is manifested

according to the Samanya samprapti. However a specific aetiology which can

31


aggravate a specific Dosha, slightly modifies the general Samprapti and produce a

specific type of Pandu.

Samanya Samprapti:

Samprapti can be clearly understood by studying the following aspects of

Samprapti

1) Samprapti ghataka

2) Samprapti bheda

Samprapti ghataka:

1) Dosha: Prakopa of all the Tridoshas produces Pandu, the main aggravated Dosha being

Pitta.

PITTA:

Normal physiological understanding of Pitta will give a clear picture of its role in

Pandu. Like the sun which gives energy and controls the universe, similarly in our body

Pitta is responsible for the energy and governance of metabolic and other activities like

Ushma, Kshudha, Trushna including governing of the higher mental functions like

Buddhi, Medha etc13.

The predominantly involved Pitta are as follows-

Pachaka Pitta:

Pachaka pitta helps in Ahara pachana i.e. digests and separates Ahara rasa into

Sara and Kitta rasa. As it is seated in Grahani, it gives strength to Grahani as well as to all

the other Pitta. Its function includes Ayu, Varna, Prabha, Bala, Ojas14.

32


This is the first Pitta, which gets vitiated because of Nidana sevana and causes

Agnimandya, Aruchi, Rasa pradosha and further can produce Dhatu shaithilya.

Ranjaka pitta:

Ranjaka pitta with its Ushma gives Raga to the Rakta poshaka sara bhaga of Rasa

and produces Rakta15. When this Ranjaka pitta is vitiated, it produces Rakta that is altered

either quantitatively or qualitatively. This affliction causes Rakta kshaya, which in turn

increases Mala rupi pitta.

Mulasthana of Ranjaka pitta is Yakrut, Pliha16 and Amashaya17. Similarly, studies

in contemporary science have also proved that Liver and Stomach have a significant role

in production and maturation of RBC’s. In 1926, Minot and Murphy showed that liver

was most effective in treating Anaemia in dogs. A factor in liver is essential for the

maturation of Erythrocytes and is demonstrated to be associated with non-protein fraction

of liver substance that is known as Anti Anaemic or Haematinic principles. (Ricks et. al.

1945).

In 1929, Castle showed the presence of a substance in gastric tissue responsible

for formation of Anti-anaemic factor, it being like liver itself, is effective in the treatment

of Pernicious Anaemia18.

Sadhaka pitta:

Along with Pachaka pitta, the predominant Pitta that is affected is Sadhaka pitta,

the one that is located in Rasavaha srotomula (hridaya). Vitiation of this Pitta cause Rasa

dhatu agnimandya leading to Anutpadana or Kshapana of Rakta poshaka sara bhaga.

Sadhaka pitta vitiation produces anger, lessened speech and Mrud-bhakshana in Pandu.

33


KAPHA:

Kapha has also an important role to play in the pathogenesis of Pandu roga

Excess intake of Santarpana Karaka regimen has been regarded as a causal factor

for Pandu19. Kaphaja vyadhi produces lakshanas like Pandutwa and Panduta21.

Inspite of the Kapha being in its Prakruta avastha, the decreased Vata displaces it

along with Pitta to all parts of the body causing Pandu20.

Kapha in Twacha produces Shwetavabhasata. Kapha in Rakta produces Pandu22.

These cross-references from classics suggest active involvement of Kapha in

pathogenesis of Pandu. And the type of Kapha is Avalambaka.

VATA:

Vayu in Hridaya is responsible for the spread of the vitiated Pitta via the Dasha

dhamanis to the whole body. This Vayu can be Vyana vayu as it is responsible for all the

Gati in the body23.

2) Dhatu:

Rasa dhatu:

Pandu is considered as one of the Rasa Pradoshaja Vikara24. Chakrapani

comments that the aggravated Pitta does the Kshapana of the Rakta poshaka rasa and it’s

Anutpadana. Affliction of Rasa dhatu is due to affliction of Agni by Pitta; this causes

Ama roopi rasa disturbing the Dhatu poshana parampara and producing Dhatu

shaithilya25.

34


Rakta dhatu:

In Samprapti it is said that the doshas will vitiate Rakta dhatu (raktam vidushya)

and produce Panduta in Twacha26. Both Raktalpata27 and Rakta pradosha28 can cause

Pandu.

Ojo guna kshaya means Rakta dhatu roopa oja kshaya, as Rakta dhatu is similar

to Ojus29. “Nayati Rudhira Shosham” is the explanation given by Harita to denote Alpa

raktata30. Excess blood loss and Artava atipravruthi produces Pandu31. There will also be

a desire towards intake of blood32

From the above references, we can gather that both Dushti and Kshaya of Rakta

dhatu are seen in Pandu.

Mamsa dhatu:

Mamsam Pradushya33.

Meda dhatu:

Alpa meda34.

Ojas:

Ojo Guna kshaya is the feature mentioned in the context of Pandu35. Wide ranges

of interpretations are attributed to the term Ojas. Ojas is said to be of two types i.e. Para

and Apara ojas. In classics Prakruta Kapha, Rasa, Rakta, Shukra, Sarva dhatu sara and

Agni are also referred to as Ojas36. As specific Dhatu kshaya has been mentioned in

Samprapti specifically, here Ojo kshaya means Apara Ojas kshaya.

Nissara:

Refers to decrease in Ashta sara37.

35


Indriya:

Due to affliction to all the Dhatus there will be a decrease in the functioning

ability of Indriya38, along with other Indriya gata lakshanas like Karna Kshweda, Alpa

vaktwa.

Twacha:

Twacha will also be vitiated and this is responsible for different colouration39.

Mana:

Impact on mind will be via manifestation of Krodha.

3) Agni:

Agni has a very important role to play in both maintaining health as well as in

states of disease. Agni in normalcy is called life, and in deranged state is disease; if it

stops functioning is called death40.

Agni is of 3 types:

1. Jataragni

2. Dhatwagni

3. Bhootagni

Jataragni:

Aetiological factors of Pandu are Pitta kara and Vidahi. These cause increase in

Drava guna of Pitta resulting in Jataragnimandya41. This is the first pathological

derangement, which sets Pandu samprapti rolling. Jataragni mandya causes ama.

36


Dhatwagni and Bhootagni:

Jataragni governs the state of functioning of all the Agnis. Its decrease causes

Dhatwagni and Bhootagni mandya. This leads to impaired absorption of the ingredients

required for Poshana of Swadhatu, Upadhatu and in production of Sarabhaga required by

the next Dhatvagni and Bhootagni for its specific Dhatu production.

Jataragni mandya produces Sama ahara rasa. When it sets into circulation, the

already debilitated Dhatwagni and Bhootagni produces Samarasa and leads to Rakta

poshaka sara bhaga Kshapana and Anutpadana. This vicious chain continues and causes

Ojo kshaya.

4) Ama:

Ama is a pathological entity responsible for all diseases; Agnimandya being the

key factor in the causation of any disease.

5) Srotas:

Important Srotas affected in Pandu are Rasavaha and Raktavaha.

Rasavaha srotas:

Pandu is a Rasa pradoshaja vikara

In Pandu due to Agnimandya, Rasa dhatu is first affected, the Prakupita pitta having

sthanasamshraya in Hridaya (mula sthana) spreads all over the body through

Dashadhamanis and causes different Rasa vaha srotodushti lakshanas like-

• Hridrava42

• Hridaya spandana43

• Shrama43

• Aruchi44

37


• Agninasha44

• Jwara44

• Angasada44

• Pandutwa44

• Tama44

• Trushna43

Thus producing Rasa kshaya and even other Dhatu kshaya, because Preenana karma is

affected.

2. Raktavaha srotas:

Yakrit and Pliha are the Raktvaha srotomula. Rasaranjana takes places in Yakrit and

Pliha. The improper formation of Rasa dhatu leads to improper formation of Rakta

Along with Pachaka pitta, Sadhaka and Ranjaka pitta are also affected. These produce

Rakta kshaya by vitiating Raktavaha srotas.

6) Udbhava sthana:

Aetiological factors cause vitiation of Dosha and the place through which they

sprout is called Udbhava sthana. Pandu being an Amashaya samuttha vyadhi, after

reaching to Hridaya (Srotomula) the Doshas spreads throughout body.

7) Sanchara Sthana:

After spreading from the Udbhava sthana it all depends on the route through

which the Doshas spread. This decides the systemic involvement and the disease in

particular. This is further decided by the Nidana sevana and status of the system. In

Pandu, Sanchara is through the Dasha dhamanis.

38


8) Ashraya:

In Pandu, the Doshas take Ashraya between Twak and Mamsa thereby causing

vitiation of different Dhatus and producing different Varnas.

9) Avayava:

After the primary localization, the Doshas spread out afflicting the various areas

of the body. Here all the Angas are involved.

Effect of Dosha Dushya Sammurchana:

Dhatu Shaithilya:

After the involvement of Agni the disease process affects Rasa and other Dhatus, finally

causing Dhatu kshaya and Ojo kshaya. Kshaya lakshanas of specific Dhatus are:

1) Rasa:

• Hritspandana (A.S.Su19/10)

• Hridrava45

• Shrama46

2) Rakta:

• Twak Roukshya47

• Twak Sphutana48.

• Bhrama49.

• Trushna50.

• Swasa51.

• Manda anala52.

• Pandutwam53.

39


• Dhatu kshaya54.

3) Mamsa:

• Gatra Toda55.

• Shrama56.

• Gatra Roukshya57.

4) Meda:

• Shrama58.

• Mamsa Kshaya Lakshanas58.


5) Asthi:

• Sheerna Lomata.

• Shrama60.

• Gatre Rukshata61.

6) Majja:

• Bhrama.

• Tama.

7) Shukra62:

• Pandutwa.

• Gatrasada.

• Dourbalya.

• Shrama.

40


8) Ojas:

• Gatrasada63.

• Varna Bheda64.


• Dourbalya66.

• Shrama67.

• Murccha67.

Dhatu Gourava:

Reduced the functioning ability of Dhatu due to Dhatu Kshaya.

Varna Kshaya:

Pitta dosha and Rakta dhatu are responsible for Varna prasadana (Agni guna bhuyishta).

Pandu is a vyadhi that is named on the basis of discolouration of skin and this

discolouration is elaborated in detail.

Different discolourations of the body parts in Pandu are -

Twak:

• Vaivarnya68

• Varnakshaya69

• Varna nasha70

• Pandu71

• Haridra71

• Bahuvidha Varna71

• Krushna Panduta72

41


• Arunangata72

• Shwetata73

• Shwetavabhasata74

• Pandura75

Akshi:

• Krushna76

• Peetata77

• Shuklata78

• Arunata79

Mukha and Nakha:

• Sweta80

• Peeta81

• Krushna

• Aruna82

Sira:

• Sweta83.

• Peeta84.

• Krushna84.

• Aruna86.

Pitta involment cause Peetata and other discolourations. When Gambhira dhatus like

Majja are involved, it produces Haridra nakha and netrata87.

Prakruta Varna of body is Krushna, Shyama, Shyamavadata, Avadata88

42


Prakruta Varna of Jihva and oshta is Rakta Varna. Nakha is Rakta and Tamra Varna89.

In Pandu roga because of Ojo kshaya, dhatu kshaya and Ashta sara kshaya, there

will be decrease and discolouration of different body parts. Due to Raktalpata the Rakta

Varna bhuyishta parts like jihva, oshta and nakha may appear Alpa rakta varnatmaka.

Colour of the skin depends not only on Hb level in blood but also on the state of

blood vessels, the amount of fluid in the subcutaneous tissue and the degree of skin

pigmentation. Pallor of the palms particularly skin creases are more reliable than pallor

elsewhere. Pallor of nail beds, mucous membrane of mouth and conjunctiva are more

reliable than pallor of skin.

Skin discolourations in Anaemia:

• Dead white colour of skin- severe acute blood loss.

• Pallor with ashen tint of the skin- Acute Leukaemia.

• Lemon or Pale yellow-Advanced Pernicious Anaemia.

• Petechiae in Anaemia-Thrombocytopenia.

• Ecchymosis - Thrombocytopenia or disturbed coagulation.

Samprapti bheda of Pandu:

1) Sankhya Samprapti:

5 types of Pandu (Charaka, Vagbhata)

4 types of Pandu (Sushruta)

8 types of Pandu (Tantrantara)

43


Table No.9. TYPES OF PANDU

Sl. No. Types

C.S.

S. S.

A. H.

A.S.

M.N.

B.P.

Y.R.

Sh.S.

Tantra-ntara

G.N.

K.K.

Basa. H.S.

1. Vataja + + + + + + + + + + + + + 2. Pittaja + + + + + + + + + + + + + 3. Kaphaja + + + + + + + + + + + + + 4. Sannipataja + + + + + + + + + + + + + 5. Mrudbhakshanaja + + + + + + + + + + + + +

Vidhi Samprapti:

Usually Swatantra Pandu is Sadhya whilst Paratantra Pandu is Kashta sadhya.

The Chart No 1. explains Vidhi samprapti.

Vikalpa Samprapti:

The Amshamsha kalpana of the Samprapti of Pandu is separately dealt with under the

heading of Samprapti ghataka of Pandu.

Pradhanya Samprapti:

Pradhana dosha - Pitta pradhana tridosha.

Swatantra Pandu is pradhana.

Nidanarthakara roga janita Pandu is apradhana.

Bala Samprapti:

The Bala of Pandu depends on the Nidana, Poorvaroopa, and Roopa are manifested

partially or completely. When they appear with full strength, the Bala is greater than

when they appear partially. Pandu with Upadrava and Asadhya lakshanas are difficult to

treat.

44


Kala Samprapti:

It is the Samprapti that confirms the role of a particular Dosha in a disease i.e., the Bala

that produced the disease or increased its intensity with change in time like Dina, Ratri

etc. or in accordance with stages of digestion.

Vishesha Samprapti:

The role of vata in development of pandu roga:

Owing to vata nidana along with pitta prakopakara ahara viharas becomes

vatanubandhata causes pandutwam and arunangata in the body the condition is known as

pandu vataja roga. In this type of pandu vata and pitta predominanace is there.

The role of pitta in development of pandu roga:

Owing to pittakara ahara vihara pitta araddhakatwam occurs and causes pittaja pandu

roga. Pittaja pandu roga causes peetata, haritata in the body.

The role of kapha in development of pandu roga:

Owing to kaphakara ahara vihara along with pittakara ahara vihara kaphanubandhata

develops there by resulting in kaphaja pandu. Kaphaja pandu roga causes swethata on the

twak. In kaphaja pandu both kapha and pitta predominance is seen.

Sannipataja pandu roga:

Owing to indulgence of tridosha prakopaka pandu roga ahara vihara tridosha vitiation

occurs, which results in tridoshaja pandu roga. In tridoshaja pandu roga dhatu shaitilyam

and dhatu gauravam are deep set and the patients rakta, bala, varna, sneha gunas go into

teevra ksheenavasta and probably that could be the reason sannipataja pandu has been

termed as asadhyam and achikitsitam.

45


Mrudbhakshana janya pandu:

Owing to Kashaya mrittika bhakshana vata gets vitiated. With Ooshara mrittika

bhakshana piita gets vitiated and because of Madhura mrittika bhakshana kapha gets

vitiated. Hence depending upon dosha vitiation that particular doshaja pandu develops in

the body with mrittika bhakshana.

46


Illustration no. 1 - Samprapti flow chart Pandu Roga Nidanasevana

Rasavahasrotas Raktavaha srotas

Hridaya prapti

Through Vyanavayu

Prasara

Prakopa

Sanchaya

Pitta pradhana tridosha prakopa

Agni vikruti Dushya Dusti Rasa & Rakta

Jatharagani mandya

Circulation through Dasadhamani

Aharaja Viharaja Vaidyakruta Nidanaratkara Roga

Khavaigunya in Srotas - Rasovaha

Raktavaha

Stanasam-shraya

Varnahani (Bahuviddha twaha) Pratyatma lakshana, Samanya laxanas

Poorvaroopa

Bala kshaya, Varna kshaya, Snehakshaya, Nissar, Shithilendriya

Dhatu – Shaitilya & Dhatu gourava

Alpa Raktaka Alpamedoska, ojokshaya, mamsa – twak dushya

Dosha – Dushya samurchana

Twak mamsantana ashraya

Vyakta

Bheda Upadrava, Asadhya and Arishta Lakshanas

Vataja, pittaja Kaphaja Sannipataja, Mrudbhakshanajanya Pandu

47


Illustration no. 2 - Mrudbhakshanajanya Pandu:

Mruda

Kashaya Ushara

Vata Pitta

Avipakwatha of mruttika causes

Kapha

Madhura

Agnimandhya & srotorodha

Rukshaguna cause Roukshya in Rasadidhatus & shareera

Affects the dhatu-poshana

Indriya, teja Bala ojus veeryahani

Respective dosha Prakopaja Mrud bhakshanajanya - Pandu

48


49

Nidana Sevana

Illustration no. 3 - Nidana and Samprapti

Alpa Rakthata-Raktha Srava

Ahara –

Samprapti

Aharatah Viharatah Vaidyakruta Sahaja Nidanartakara Roga

Alpa Raktha Pitta Prakopa

Agini Mandya

Rasavaha Sroto Dusti

Alpa Rakta due to

Sadhya Chirottah

Rakta Pitta, Arsha Raktati Pravarthan,

Yakrut Pleeha Vrudhi

Raktaja Gulma Krumi Raktarbuda

Rakta Poshaka Sara Bhag Anutpadana

Rakta Poshaka Sarabhaga Kshapana due to Pitta

Eka rasa satmya Anashana Ati madya pana Vishamashana Virudda bhojana Asatmya bhojana Mrud bhakshana

Ahara – Amla Kshara Lavana Ushna Matsya Tila taila Teekshna Vihara Atapasevana

Oushada – Apatarpana karaka Vyadhi - Raktapitta

Vihara – Ati maithuna Ati vyayama

Oushadi – Apatarpana karaka Oushadi atiyoga

Vyadhi - Anna vaha sroto vikara- Grahani Prana vaha sroto vikara- Pittaja Kasa, Pratishyaya Pureshavaha sroto vikara- Arsha Anya sroto vikara

Review of Literature Upadrava

UPADRAVA

The following have been mentioned as upadrava of pandu roga90,91:

1. Aruchi 11. Hridaya peedana

2. Pipasa 12. Swasa

3. Jwara 13. Atisara

4. Moorbharaja 14. Trasa

5. Agnisada 15. Shoola

6. Sopha 16. Daha

7. Chardi 17. Avipaka

8. Avalatwam 18. Swarabhedha

9. Moorcha 19. Swarasada

10. Klama 20. Shotha

Upadrava may not have a separate samprapthi of their own. But the pain will

be deep and severe, and the important character of upadrava is vyadhikalottaraja

though the above lakshanas are seen in sadharana and visista lakshanas of pandu roga

only differentiating points are upadravas having the qualities of moolatwam, and

peedaakaratwam.

50

Review of Literature Upadrava

Table No.10. UPADRAVA

Sl. no.

Lakshana S.S A.H. Bas

1 Aruchi + - + 2 Pipasa + - - 3 Chardi + - + 4 Jwara + - - 5 Shiroruja + - - 6 Agnisada + - - 7 Shopha + + + 8 Kanthagata abalatwam + - - 9 Moorcha + - - 10 Klama + - - 11 Hrdayavapeedanam + - - 12 Shwasa + - - 13 Atisara + - + 14 Kasa + - - 15 Daha + - - 16 Avipaka + - - 17 Swarabheda + - - 18 Sada + - - 19 Adhmana - - + 20 Tandra - - + 21 Pandu danta - - + 22 Pandu nakha - - + 23 Pandu netra - - + 24 Pandu sangatha darshi - - +

ARISHTA LAKSHANA

The lakshanas that indicate the imminent death are called as Arishta lakshanas97.

• Pandu varnata in excess.

• Ati krushata.

• Trushna.

• Kupita ucchwasa.

• Dambary

51

Review of Literature Sadya asadyata

ASADHYA PANDU ROGA LAKSHANAS

The following conditions which present in rogi, the person is said to be achikitsa they

are92-96:

1. Chirotpanna kharibhuta pandu rogee

2. Kala prakarshcchoona peeta darshee pandu rogee

3. Sa kapha harita baddha alpa vit atisaree pandu rogee

4. Asrik khaya setangee pandu rogee

5. Chardi moorcha tridardita deena swetati digdhanya pandu rogee

6. Anta pradesha shotha and Madhya shareera krisa pandu rogee

7. Antaha pradesha and Madhya shareera shoona pandu rogee

8. Shotha in guda, sephasa and mushka pradesha pandu rogee

9. Jwara atisara peeditha pandu rogee

10. Pandu danta, nakha, netra pandu sanghata darshee pandu rogee.

Table No. 11. ASADHYA LAKSHANAS IN PANDU ROGA Sl. no.

Lakshana C. S. S. S. B. P. Y. R.

G. N.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Anteshu shoona parihina madya Mlana (Krisha) Madya shoona anteshu parihina Guda shopha Muska (yoni) shopha Pratamya (murcha) Visamjnatha Atisara peeditha Jwara peeditha Chirothpanna Pandu Karibhootha Pandu Kala prakarshath shoona Peetha darshana Bhadda vit Alpa vit

- - - - - - - - - + + + + + +

+ + + + + + + + + - - - - - -

+ + + + + + + + + - - - - - -

+ + + + + + + + + - - - - - -

+ + + + + + + + + + + + + + +

52

Review of Literature Sadya asadyata

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Sakapha, Haritha Atisaryathe Deena Shwethatidigdhanga Chardhi Trit Ardhitha Swethatha due to adhika rakta kshaya Arochaka Hrillasa Klama Ksheena Hatendriya Pandu danta, naka, netra Pandu sanghatha darshi Tridoshaja Pandu

+ + + + + + + - - - - - - - -

- - - - - - - - - - - - - - -

- - - + + - - + + + + + - - +

- - - + + - - + + + + + + + -

+ + + + + - - + + + + + + + +

53

Review of Literature Chikitsa

CHIKITSA

Shamana: In Shamana, various single and compound preparations are told which

include herbal, mineral and herbomineral preparations. Illustrating a few,

1) Vyoshadya Ghrita98

2) Shuddha Kanta Loha Bhasma99

3) Vidangadi Loha100

A point of interest to be noted here is that most mineral preparations contain Loha.

LOHA AND LOHA YOGAS:

Loha and loha yogas have been considered very important and most specific

drugs for panduroga. Nearly about 188 loha yogas have been mentioned. Due to its

wide advocation has pandu hara dravya in ayurvedic texts Dhatri lauha has been

selected for the present clinical trails on pandu. Apart from loha, suddha kaseesa,

swarna makshika, shuddha shilajatu, gairika, gomootra, pravala, mukta, hareetakee,

trivrit, yastichoorna, guduchikashyam, draksha or moolika phanta, vardhaman

pippalee are some among the very specific drugs for pandu roga treatment.

SHODHANA:

The terms shodhana denotes oordhwa and adhah shodhana also, some acharyas

have contraindicated vamana in pandu roga. But dalhana on the other hand advocated

mridu vamana when ritu, desa, kala, are in favour. For this purpose the following drugs

have been mentioned in charaka siddhisthana kota phala indicated for vamana.

Dhamargava kalpa, ikshwakukalpa, kritavedhana kalpa, sthana have also been mentioned

the drugs of choice for the vamana karma of pandurogee.

54


ADAH SHODHANA OR VIRECHANA:

For virechana karma the following yogas have been mentioned.

1. Godugdham or gomootra yukta dugdham, may be given for mridukoshta rogee.

2. Dantee phala, Draksha choorna

3. Trivrit choorna in pittaja pandu

4. Aragvadha majja with trikatuchoorna in kaphaja pandu.

5. Gomootra bhajjita hareetakee choorna in kaphaja pandu.

Susrutha has advocated preparation of ghritas with virechana dravyas for doing

virechana karma. These types of yogas also available in charaka chikitsasthana such as

dadimadya ghrita, katukadhya ghrita, pathya ghrita, dhanti ghrita, drakshadya ghrita,

haridradi ghrita, darvyadi ghrita and in susrutha uttarasthana 44th chapter bhrihatyadi

ghrita, kaleyaka ghrita, drakshadya ghrita have been mentioned for the sake of virechana

karma.

Mrudbhakshanajanya Pandu Chikitsa101:

At the outset, the Balabala of the patient has to be assessed.

1) Shodhana:

Teekshna shodhana in order to remove the ingested Mruttika.

2) Shamana:

1) Medicated Ghrita ie Sarpi for baladana. Eg. Vyoshadya Ghrita

2) Treatment according to the Prakupita Dosha.

3) Krimihara Chikitsa in Udara Krimi.

55


3) Nidana Parivarjana:

Mruttika given bhavana with Vidanga, Ela, Ativisha, Nimbapatra, Pata, Varthaka,

Katurohini, Murva and Kutaja. These

• Will produce aversion towards Mrudbhakshana i.e. Dweshartha.

• Are Mrudbhakshanajanya dosha nashaka.

56

Review of Literature Pathya apathya

PATHYA

A) Ahara:

1) Shuka dhanya varga :Purana yava,Purana godhuma,Jeerna Shali.

2) Shami dhanya varga :Mudga,Masura,Adhaki.

3) Mamsa varga :Jangala mamsa and Matsya

4) Shaka varga: Patola,Jeevanti,Guduchi,Punarnava,Dronapushpi

Tanduliyaka, Lashuna, Palandu, Bimbi, Vartaka

5) Phala varga : Vriddha Kushmanda, Taruna kadali

Amalaki, Haritaki, Pakwa amra

6) Ikshu varga : Ikshu rasa

7) Gorasa varga :Takra,Ghrita and Navaneeta

8) Mootra varga :Gomootra

9) Madya varga :Souveeraka and Tushodaka

10) Kritanna varga :Yusha

11) Anya :Haridra,Chandana,Keshara

Yavakshara and Loha bhasma

B) Karma:

1) Vamana

2) Virechana

3) Abhyanga to a) Padasandhis

b) 2 angulas below nabhi

c) Mastaka

d) Stanakakshayormula

57


PATHYA VYAVASTHA102:

Foods that are capable of causing agni deepana and bhrimana should form as

important principles of pathya-vyavastha of pandu roga. After having achieved kosta

suddhi by means of snehana and shodhana pathya vyavastha. For this purpose bakshya

prepared from puranashalidhanyam, purana yava, godhuma, to be given with

mridgayosha, jangalamamsa rasa, or ikshu rasa and preparing mantha by adding madhu.

Apart from kooshmanda taruna, kadlee jeevantee shaka, gudoochi, punarnava, drona

pushpee, vartaka, lashana, bimbee etc. Dugdham, takram, ghritam, navaneetam and

tailam are said to be pathya for pandu rogee.

APATHYA

A) Ahara:

1) Rasa: Kshara, Amla, Lavana, Katu

2) Anna: Viruddha bhojana, Asatmya bhojana, Vidahi bhojana, Guru bhojana

3) Jala : Adhika ambupana, Dushta jala, Jala from rivers of Sahyadri,

Vindhya Mountains

4) Kritanna varga : Pinyaka

5) Shamidhanya varga : Masha, Tila, Kulattha, Nishpava.

6) Sneha varga: Tila taila

7) Gorasa varga: Dadhi mastu

8) Madya varga: Sura

9) Aharopayogi dravya: Hingu, Tambula

10) Anya dravya: Mrittika

58


B) Vihara:

1) Atapa, Vahni Sevana

2) Ayasa, Krodha, Adhwa and Maithuna

C) Karma:

Raktasruti

Dhoomapana

Swedana

Vamana vega vidharana.

APATHYA103:

The drugs which cause rakta hrasa are said to be apathya for pandurogee, such as

agni and atapa, atisevana, adhika vyayama, pittala annapana, maithuna, krodham, adhika

margagamana. So the above things must be sacrificed by pandu rogee.

By samprapthi we can infer that in panduroga pitta pradhana dosha vitiation. So

generally we should have to use such a pandu hara dravya which acts as pitta prasadaka

and tridosha hara dravya as well. Apart from this specific pandu hara dravyas are to be

used along with respective dosha hara dravyas along with general principle of treatment

in vataja pandu snehabhooyista dravya, in pittaja pandu tikta seetala dravya and in

kaphaja pandu katu tikta and ushna dravya yogas should be used respectively.

59

Review of Literature Anaemia

ANAEMIA

History:

The term Anaemia is an ancient one and can be found in the Carpus

Hippocraticus. It literally means without blood and is derived from Greek ‘a’ or without

and ‘haima’ or blood.

James Combe, an Edinburgh Physician (1824), first used the term Anaemia in

English. Gebrial Andral, a French physician, laid much of the foundation on modern

concepts of Anaemia in 1843.

The therapeutic use of Iron was mentioned in Greek mythology in the story of

Iphicius. Vanandeus applied the term chlorosis and was described by Jahonnes Lange in

1554. In 1830, Hoefer detected hypochromia in blood. In 1832, Pierre described the

response of chlorosis to his famous pills containing ferrous sulphate and potassium

carbonate.

Classification of Anaemia:

Classification of Anemia’s by pathophysiology

I. Blood Loss

a) Acute Haemorrhage

b) Chronic Haemorrhage

II. Decreased Production of Red Blood Cells

1. Hameoglobin synthesis- a) Iron deficiency anaemia

b) Thalassemia(heriditory)

60


c) Anaemia of chronic disease

2. D.N.A synthesis - Megaloblastic Anaemia

3. Stem cell - Aplastic Anaemia

4. Bone Marrow infiltration – a) Carcinoma

b) Lymphoma

5. Pure Red cells Aplasia

III. Increased destruction (Classification of Haemolytic Anaemia)

a) Haemolysis (Intrensic)

1) Membrane - i) Heriditary Spherocytosis

ii) Eleptocytosis

2) Haemoglobin – i) Sickle cell

ii) Unstable Haemoglobin

3) Glycolysis - Pyruvate Kinase

4) Oxidation - G6PD deficiency

b) Haemolysis (Extrinisic)

1) Immune - i) Auto immune

ii) Drug toxicity

iii) Lympho Preliferative Disease

61


Etiology

Causes of Iron Deficiency Anaemia (API Medicine)

1. Nutritional - 50%

2. Malabsorption - 20%

3. Parasitic Infestation - 20%

4. Chronic blood loss - 5 %

5. Others - 5%

1) Nutritional (commonest cause)

a) Poor dietary Intake

b) Poor bioavailability of Iron from cereal based diet

c) Increased requirement of Iron

2) Malabsorption

a) Any malabsorptive disorder leads to poor iron absorption

b) Geophagia interferes with Iron absorption and aggravates IDD.

3) Parasitic Infestation

a) Ankylostomiasis

4) Chronic blood loss

a) GIT bleeding Eg: Peptic Ulcer Disease, Bleeding gum, Ulcerative colitis, Crohns

disease, Oesophageal varies, MeloryWeiss syndrome.

b) Anorectal Disease Eg: Bleeding Piles

c) Genito urinary bleeding Eg: Menorrhagia, Metrorrhagia, Recurrent Haematuria,

Haemosideriuria, antipartal post partal, haemorrage etc.,

62


5) Others

Regular blood donation in India where majority of the population has a precarious iron

balance.

In many cases IDA is multifactor in origin, with dietary deficiency, poor bioavailability

and blood loss all contributing to a variant extent.

PATHOGENESIS OF IRON DEFICIENCY ANAEMIA

Three pathogenic factors are implicated in the Anaemia of iron deficiency. They are as

follows.

1) Impaired Haemoglobin Synthesis

When transferrin saturation falls below 16% the supply of iron to the marrow is

inadequate to meet the basic requirement for haemoglobin production. Each cell

produced contains less haemoglobin resulting in hypochromia. The number of cell

divisions and the ultimate erythrocyte size are related to the rate of haemoglobin

synthesis. Haemoglobin enters the nucleus and reacts with nucleohistones, thereby

causing nuclear inactivation. In iron deficiency, it takes long to reach the critical

haemoglobin. Concentration and the generation time is unaffected, hence more cell

divisions occur before nuclear inactivation and the resulting cell is microcytic or small in

size.

2) Generalized defect in Cellular Proliferation

In iron deficiency, the cellular proliferation is decreased as evidenced by a

reduced red blood cell count, reticulocyte count and haemoglobin percentage. The

degree of erythroid hyperplasia is low in relation to the degree of anemia. In addition

63


there is a significant component of ineffective erythropoiesis. A portion of cells in iron

deficient subjects are so defective that they are rapidly destroyed.

3) Reduced Erythrocyte Survival

This is the least important factor involved in the pathogenesis of iron deficiency

anaemia and is found only when the anaemia is severe. Cross transfusion studies have

demonstrated that the shortened survival results from an intra corpuscular defect. There

is a significant co-relation between the proportion of morphologically abnormal cells on

blood smear and the degree of reduction in red cell survival. The reduced erythrocyte

viability is associated with decreased membrane deformability. This abnormality

appears to resist it from productive damage to the membrane which in turn may be a

consequence of reduced glutathione peroxidase activity.

Several iron proteins are reduced in iron deficiency and some of these proteins

may be responsible for certain clinical and pathological manifestations of the disease.

Iron is a component of haem proteins like cytochromes, myoglobin, catalase and

peroxidase, iron sulphur proteins and metalloflavo proteins are important in oxidation

reduction reactions, especially those that take place in mitochondria. Iron is a co factor

for certain enzymes and a reduction in tissue enzymes is presumed to be related to the

occurence of epithelial changes in iron deficiency. Impaired resistance to infection in

iron deficiency is multifactorial, one important cause being myeloperoxidase deficiency.

Stages of Iron Deficiency Anaemia

Iron deficiency is usually the end result of a long period of negative iron balance

and develops in sequential stages. These stages include,

64


1) Stage of Iron Depletion (Pre Latent Iron Deficiency)

During this stage, the Iron stores in the hepatocytes and the macrophages of the

liver, spleen and bone marrow are exhausted, serum ferritin values are reduced. This is

because iron stores are mobilized for erythropoiesis.

Iron absorption in the gut is usually increased in an attempt to compensate for the

negative iron flow. The RDW (reticulocyte distribution width) is frequently elevated and

may be the first indication of a developing iron deficiency in a non anaemic patient.

2) Stage of Iron Deficient Erythropoiesis (Latent Iron Deficiency)

In this 2nd stage certain biochemical abnormalities in iron metabolism are usually

detected. Serum iron is decreased. TIBC is increased and transferrin saturation is

decreased. FEP (free erythrocyte protoporphyrin) levels measured as ZPP (zinc

protoporphyrin) are increased. Measurement of ZPP is a sensitive index of this stage of

iron deficiency. Other observation, include sub normal urinary iron excretion after

desferroxamine injection, decreased tissue cytochrome oxidase levels and absence of

bone marrow sideroblasts and marrow iron is markedly reduced.

Few microcytes may be detected on the peripheral smear. But MCV (mean

corpuscular volume) remains within normal limits. However Hb level is still normal. A

large portion of Indian population falls under this group.

3) Iron Deficiency Anaemia

In the last stage, the blood haemoglobin falls below the lower limit of normal.

The most sigificant findings is the classic microcytic hypochromic anaemia. Other iron

containing enzymes, such as the cytochromes, also reach abnormal levels during this

65


period. Epithelial manifestations of iron deficiency usually represent a very late phase of

iron depletion.

As the negative iron balance continue, serum iron level falls further, TIBC

increases and transferrin saturation falls below 16%. Serum ferritin is reduced. Iron

deficient erythropoiesis ensures with the appearance of erythroid precussors with ragged

cytoplasmic margins in the marrow. MCV, MCH, MCHC falls down.

DIFFERENTIAL DIAGNOSIS OF IDA

In a patient with hypochromic microcytic anaemia, the major diagnostic possibilities are

1. Iron deficiency Anaemia

2. Thalassemia

3. Anaemia of chronic Inflamation

4. Lead poisoning

5. Sideroblastic Anaemia

Several laboratory tests are useful in the differential diagnosis Mild Iron deficiency may

be readily confused with b thalassemia trait or with the 2 deletion forms of a thalassemia.

In these mild forms of thalassemia, microcytosis is much more marked than hypchromia,

accordingly the MCHC is usually normal. The red cell size distribution is more uniform

than that in iron deficiency. Target cells and basophilic stippling are usually more

prominent in thalassemia than in Iron deficiency. HbA2 is elevated in b thalassemia and

decreased in iron deficiency. The level of HbA2 may fall to normal. Serum Iron is

normal or elevated in Thalassemia and decreased in both iron deficiency and the

66


Anaemia of chronic disease. However the transferrin level is also decreased in the later

condition.

The laboratory tests shown in table are not very helpful in determining whether a patient

with a chronic inflammatory disease such as Rheumatoid arthritis has become iron

deficient. The finding of a low serum ferritin level or absent iron stores in a bone marrow

aspirate would be diagnostic of Iron deficiency in such patients. A trial of Iron therapy

may be necessary to settle the issue.

The diagnosis of sideroblastic Anaemia rests on the demonstration of ringed

sideroblast in the bone marrow. These often have a population of hypochromic,

microcytic red cells, even though the MCHC is usually normal.

Table No.12. LABORATORY DIFFERENTIAL DIAGNOSIS OF

IRON DEFICIENCY ANAEMIA

SL. NO.

Test Iron Deficiency

Chronic Disorders

Thalassaemia Siderblastic Anaemia

1)

MCV, MCH, MCHC

Reduced

Low normal to reduced

Very low

Very low (except MCV raised in acquired type)

2) Serum Iron Reduced Reduced Normal Raised

3) TIBC Raised Reduced Normal Normal

4) Serum Ferritin Reduced Raised Normal Raised (complete saturation)

5)

Marrow Iron stores

Absent

Present

Present

Present

6)

Iron in normoblasts

Absent

Absent

Present

Ring sideroblasts

7) Hb electrophoresis

Normal Normal Abnormal Normal

67


Table 13. Showing the Similarities between I.D.A. and Pandu I.D.A

Samanya Pandu roga

Lakshana Vataja Pandu

Lakshana a) Pallor of skin mucous membrane conjunctiva, nails b) Exhertional dyspnoea c) Lassitude, Fatigue Exhaution d) Weakness e) Palpitations, Tachycardia f) Anorexia, Indigestion g) Tinnitus h) Brittle nails, Koilonychia, nail Cracking i) Hypersensitiveto cold j) Headache k) Nausea l) Bowel irregularity m) Insomnia n) Low grade fever o) Aches and pains in Various parts of the Body

p) Oedema

Pandutha of twak, nakha,

ekshana, Anana, Vivarnatha Hataprabha

Arohana, Adhwa ayasa

Anga sada, Nissaratha,

Gourava

Dourbalya, Bala Hani

Hridrava

Annavit, Aruchi, Hatanala

Karnakshweda

Nakha rukshatha

Shishira dweshi

Shiro ruk,

Hrillasa, Praseka

Vit bandha (vit shosha)

Anidra

Jwara

Gatra mardhana peedanadi pindikodwestana, kati, uru,

pada ruk, gatrashoola,

Shoona akshi koota Shopha

Krishna varna mishritha pandutha in these parts.

Shrama

Balakshaya

Asya Vairasya

----

----

Shiro gourava ----

Anaha

----

Anga marda, toda parshwaruk

68

Drug Profile Dhatri lauha

DRUG PROFILE OF DHATRI LAUHA

Ingredients of Dhatri Lauha104

1. Amalaki

2. Madhuyasti

3. Lauha Bhasma

4. Guduchi Quatha for Bhavana

1. Amalaki

Family : Euphorbiaceae

Gana : Vayasthapana, Virechanopaga105, Triphala, Parushakadi106.

Latin Name : Embilica officinalis Gaertn.

Properties107:

Rasa: Amla pradhana, Lavana rahita pancharasa

Guna: Guru, Sheetha

Virya: Sheetha

Vipaka: Madhura

Chemical composition108:

Fruits contain Galeic acid, Tannic acid, Sugars, Albumin, Cellulose, Calcium and other

minerals and Vit C.

Protein 0.5%, Fat 0.1%, Fiber 9.4%, Carbohydrate 14.1%, Minerals 0.7%: Phosphorous

0.02%, Calcium 0.05%, Iron 1.2μg, Nicotinic acid 0.2μg - per 100g.

69


Ayurvedic view:

Amlapradhana drugs are Agnidipaka, Brimhana, Indriyadridikaraka, Balavardhaka and

help in Preenana. It is a Rasayana, Vrishya and Rakta pittahara109

Pharmacological Action:

Increased acid favours dissolution and reduction of Ferric Iron. Ascorbic acid, which is

the main content of Amalaki, is a reducing substance, which reduces Ferric Iron and

forms absorbable complexes. Ascorbic acid is even required for maturation of RBC110.

There are many preparations of Amalaki, which are useful in Pandu viz., Dhatri Avaleha,

Dhatryarishta etc.

2. Madhuyashti

Family : Leguminoseae

Gana : Jeevaniya, Varnya, Snehopaga, Shonitasthapana111,

Kakolyadi, Sarivadi, Anjanadi112.

Latin name : Glyzyrrhiza glabra Linn.

Properties113:

Rasa: Madhura

Guna: Guru, Snigdha

Virya: Sheetha

Vipaka: Madhura

Chemical composition114:

Glycyrrhizin 2.14%, Glucose 3.8%, Sucrose 2.4%-6.5%, Resin 2.4%, steroid Oestrogen –

possibly Estriol is also present. Anthoxanthin, a glycoside, Isoliquartin stimulate salivary

glands.

70


Ayurvedic view:

Properties of Madhuyashti bring about Dhatu-vardhana, Pittaghna, Jeevana115 effects and

are also a Bala varnakaraka116.

Yashtimadhu forms one of the main ingredients in Haridradi ghrita, Madhuyashti yoga117,

which are useful in Pandu.

Guduchi:

Tinospora cordifolia:

The stem of Guduchi, which is used for the therapeutic purposes, is said to possess Tikta,

Kashaya, and Madhura Rasa as well as Madhura Vipaka. Guru and Snigdha are the

properties. Further, Guduchi is categorized as an Ushna Veerya drug. Principal

constituents of this drug include Tinosporine, Tinosporide, Tinosporaside, Cordifolide,

Cordifol, Heptacosanol, Clerodane, Furano diterpene, Diterpenoid furanolactone

Tinosporidine, Columbin and ß-sitosterol. Recent researches indicate that, bitter

principles present in the drug show antiperiodic, antispasmodic, anti-inflammatory and

antipyretic properties. It is well known to improve the immune system and the body's

resistance against infections. It is used as an immunomodulator in the

immunosuppression of obstructive jaundice, hepatic fibrosis, peritonitis and sepsis. In

general, Guduchi is beneficial in alleviating the imbalances of all the three Dosha and is

also prescribed as Rasayana.

3. Loha Bhasma Properties118:

It possesses Madhura Vipaka, Sheetha Veerya and is Netrya, Balya, Vrishya, Medhya,

Pandu-Krimi-Kshayahara, and Hridya. It is a Nasa- Garbha shayagata rakta srava

sthambhaka, relieves Pandu roga, which is commonly seen in females during puberty.

71


Amashaya-Pakwashayagata Kshata vrana, Raktasrava are the other indications where

Loha Bhasma is useful.

Method of preparation of Medicines119:

Dhatri Lauha:

Amalaki choorna - 8 Pala = 384gms

Lauha Bhasma - 4 Pala = 192gms

Madhu yasti Fine powder - 2 Pala

Guduchi Quatha – Sufficient quantity for Bhavana.

Drugs Dhatri, Lauha, Yastimadhu are powdered separately and mixed together and put in

Amritha kashaya for Bhavana. After seven days it is taken and dried in the sun. It is then

mixed well.

Dosage: 1gm.

72

Clinical Study Methodology

Materials and Methods

Materials taken for the study were

1. Dhatri Lauha.

Collection of drugs: Drugs were collected and prepared by S. D. M. Ayurvedic

Pharmacy, Udupi, Karnataka.

Method of administration:

1) Dhatri Lauha:

Dhatri Lauha was administered 500mg, twice a day, after food, with water.

Objectives of the study:

• To do a comprehensive conceptual study on Pandu roga.

• To evaluate the therapeutic effect of Dhatri Lauha in Pandu roga patients without

alteration in their routine, dietary and physical activities.

Methods:

Source of data:

Patients presenting the Pratyatmaka Lakshanas of Pandu roga was selected for

the study from OPD and IPD section of SDM Ayurveda Hospital, kuthpady, Udupi.

Method of collection of the data:

It is a single blind clinical study with a pre-test and post-test design where minimum of

20 patients diagnosed as Pandu roga are selected.

A special proforma prepared with all points of physical signs, symptoms and laboratory

investigations.

73


Inclusion criteria:

1) Patients with pratyatma lakshana of Pandu

2) Haemoglobin percentage between 5-9 g %

3) Patient’s age in between – 16-60 yrs of both sexes.

Exclusion criteria:

1) Patients of disorders like Hepatic cirrhosis, Uraemia,

2) Patients of Malignant disorders.

3) Patients diagnosed as Hemolytic Anaemia.

4) Patients of age below 16 and above 60 years.

Assessment parameters before and after treatment:

1. Relief in signs and symptoms of Pandu roga.

2. Changes in Haemoglobin percentage.

Grading of the Assessment criteria.

Balahani (Weakness):

No weakness - 0

Weakness not affecting his daily activities - 1

Weakness affecting his daily activities - 2

Activities reduced due to weakness - 3.

Shrama (Fatigue):

No Fatigue - 0.

Fatigue not affecting his daily activities - 1

Fatigue affecting his daily activities - 2

Activities reduced due to Fatigue - 3.

74


Arohanaayasa (Exertional Dyspnoea):

No Exertional Dyspnoea - 0

Mild dyspnoea with normal activities - 1

Dyspnoea stops his daily activities intermittently -2

Dyspnoea stops his daily activities frequently -3

Hridrava (Palpitation):

No Palpitation - 0.

Mild Palpitation with normal activities - 1.

Palpitation with daily activities - 2

Palpitation during rest - 3

Pandutwa (Pallor):

No Pallor - 0.

Conjunctiva slightly pale, nail and other mucus membrane not pale -1

Conjunctiva pale, nail and other mucus membrane slightly pale -2.

Conjunctiva, mucus membrane and nails pale -3

Grading of Severity of disease:

1. Subjective Symptoms-

Severity of manifestation >70% -Severe.

Severity of manifestation-50-70% -Moderate

Severity of manifestation-<50% -Mild.

2. Laboratory Criteria-

Hbg%- 5-6g% and Hypo chromic Microcytic – Severe.

Hbg%-6-8g% and Normochromic Microcytic – Moderate.

75


Hbg%-8-9g% and Normochromic Normocytic – Mild.

Between the two grading, the grading of highest severity is considered as grading

of severity of the disease.

Duration of treatment:

This therapy is continued for 1 month.

Hb% is done before and after the treatment.

76

Clinical Study Observation

Observation

In the present study, 20 patients suffering from Pandu, fulfilling the inclusion criteria

were registered, Following are the detailed descriptive statistical analysis of the patients

included in the study.

Total patients registered for the study : 20

Completed : 20

Observations

1. Age Incidence: The majority of the patients (50 %) were reported in the age group of

20 – 29 years followed by 40% in the age group of 30 - 39 years, 10% in the age group of

40 – 49 years (table 14 & chart 4).

TABLE 14: SHOWING AGE INCIDENCE OF PATIENTS

Age Group No. of Pts No. of pts in % 20-29 10 50 30-39 8 40 40-49 2 10 50-59 0 0

CHART 4: SHOWING AGE INCIDENCE OFPATIENTS

0

5

10

15

20

25

30

35

40

45

50

20-29 30-39 40-49 50-59

Age in years

No of Pts in %

77


2. Sex Incidence: Total 100% incidence of Pandu was found in females.

(Table15 & chart 5)

TABLE 15: SHOWING SEX INCIDENCE OF PATIENTS

Sex No. of pts No of Pts in % Male 0 0

Female 20 100

CHART 5: SHOWING SEX INCIDENCE OF PATIENTS

0

10

20

30

40

50

60

70

80

90

100

Male Female

Sex Incidence

No of Pts in %

3. Religion incidence: Maximum number of patient’s i.e. 80% were Hindus, 5% patients

were Christians and 15% patients were Muslims. (Table16 & chart 6)

TABLE 16: SHOWING RELIGION INCIDENCE OF PATIENTS

Sex No. of pts No of Pts in %

Hindu 16 80 Muslim 3 15

Christian 1 5

78


CHART 6: SHOWING RELIGION INCIDENCE OF PATIENTS

0

10

20

30

40

50

60

70

80

Hindu Muslim Christian

Religion

No of Pts in %

4. Marital status incidence: 75% patients were married. 25% was unmarried. (Table17

& chart7)

TABLE 17: SHOWING MARITAL STATUS OF PATIENTS

Marital Status No.of pts %

Unmaried 5 25

Married 15 75

CHART 7: SHOWING MARITAL STATUS OF PATIENTS

0

10

20

30

40

50

60

70

80

Unmaried Married

Marital Status

No of Pts in %

79


5. Occupational Incidence: Most of the patients were housewives i.e. 50%, social

workers were 35%. While the remaining 25% were students (table18 & chart 8)

TABLE 18: SHOWING OCCUPATIONAL INCIDENCE OF PATIENTS

Occupation No. of pts No of Pts in %

HouseWife 10 50 SocialWorker 7 35

Student 3 15

CHART 5: SHOWING OCCUPATIONAL INCIDENCE OF PATIENTS

0

5

10

15

20

25

30

35

40

45

50

HW SW ST

Occupational incidence

No of Pts in %

6. Habitat Incidence: Most of the patients wereof rural area i.e., 55% and from urban area 45% (Table19 & Graph 9)

TABLE 19: SHOWING HABITAT INCIDENCE OF PATIENTS

Habitat No. of pts No of Pts in %

Urban 9 45 Rural 11 55

80


CHART 9: SHOWING HABITAT INCIDENCE OF PATIENTS

0

10

20

30

40

50

60

Urban Rural

Habitat incidence

No of Pts in %

7. Socio-Economic status incidence: It is observed that maximum patient belongs to

middle class i.e.50%, followed by higher middle 25%, lower middle 25% (table 20 &

chart 10)

TABLE 20: SHOWING SOCIOECONOMIC STATUS OF PATIENTS

Status No.of pts No of Pts in %

MiddleClass 10 50 LowerMiddle 5 25 HigherMiddle 5 25

CHART 10: SHOWING SOCIOECONOMIC STATUS OF PATIENTS

0

5

10

15

20

25

30

35

40

45

50

MC LM HM

Socio-economic status

No of Pts in %

81


8. Educational status incidence: 10% of the patients were educated up to Post-

Graduation. While 10% had completed Graduation. 65% were completed high school.

15% were stopped their education to primary school level. (Table 21 & chart11)

TABLE 21: SHOWING EDUCATIONAL STATUS OF PATIENTS

Education No. of pts No of Pts in %

PrimarySchool 3 15 HighSchool 13 65 Graduation 2 10

PostGraduation 2 10

CHART 11: SHOWING EDUCATIONAL STATUS OF PATIENTS

0

10

20

30

40

50

60

70

PS HS G PG

Educational status

No of Pts in %

9. Incidence of Dietary Habits: 80% of the patients were accustomed to mixed type of

diet while 20% were Vegetarians (table22 & graph 9).

TABLE 22: SHOWING DIETARY HABITS OF PATIENTS

Diet No.of pts No of Pts in %

Veg 4 20 Mixed 16 80

82


CHART 12: SHOWING DIETARY HABITS 0F PATIENTS

0

10

20

30

40

50

60

70

80

Veg Mixed

Dietary habits

No of Pts in %

10. Incidence of Deha Prakruti: A predominance of Vatakapha prakruti was observed

in the patients with 80% followed by Pittakapha 20% (table23 &chart 13).

TABLE 23: SHOWING PRAKRUTI OF PATIENTS

Prakruti No.of pts No of Pts in %

VataPitta 0 0 VataKapha 16 80 PittaKapha 4 20

CHART 13: SHOWING PRAKRUTI OF PATIENTS

0

10

20

30

40

50

60

70

80

VP VK PK

Prakruti

No of Pts in %

83


11. Incidence of Sara: 55% of the patients were of Mamsa Sara while 25% were of

Asthi Sara,15% were of Medho sara and 5% were of Rakta sara observed(table24 & chart

14).

TABLE 24: SHOWING SARATAHA OF PATIENTS

Sarataha No.of pts No of Pts in %

Twak 0 0 Rakta 1 5

Mamsa 11 55 Medo 3 15 Asthi 5 25 Majja 0 0 Sukra 0 0 Sarva 0 0

CHART 14: SHOWING SARATAHA OF PATIENTS

0

10

20

30

40

50

60

Tk Rt Mm Md At Mj Su Sv

Sarataha

No of Pts in %

12. Incidence in Samhanana: Patients of Madhyama Samhanana were 100% (table25 &

chart 15).

84


TABLE 25: SHOWING SAMHANANA OF PATIENTS

Samhanan No.of pts No of Pts in %

Pravara 0 0 Madhyam 20 100

Avara 0 0

CHART 15: SHOWING SAMHANANA OF PATIENTS

0

10

20

30

40

50

60

70

80

90

100

Pravara Madhyam Avara

Samhanana

No of Pts in %

13. Incidence of Satva: Satva analysis of the patients revealed 100% of Madhyama a

Satva, (table 26& chart 16).

TABLE 26: SHOWING SATVA OF PATIENTS

Satva No.of pts No of Pts in %

Pravara 0 0 Madhyam 20 100

Avara 0 0

85


CHART 16: SHOWING SATVA OF PATIENTS

0

10

20

30

40

50

60

70

80

90

100


Satva

No of Pts in %

14. Incidence of Rasa Satmya: 50% of the patients were Lavana and Madhura rasa

Satmya while 30% were Amla Madhura Rasa Satmya and 20% were accustomed to

Madhura Rasa (table27 & chart 17).

TABLE 27: SHOWING RASA SATMYA OF PATIENTS

Rasa No.of pts No of Pts in %

Madhura 4 20 AmlaMadhura 6 30

LavanaMadhura 10 50 Katu 0 0

CHART 17: SHOWING RASA SATMYA OF PATIENTS

0

5

10

15

20

25

30

35

40

45

50

M A+M L+M K

Rasa satmya

No of Pts in %

15. Incidence of Agni: Manda Agni was observed in 100% of the patients (table28 &

graph 18).

86


TABLE 28: SHOWING INCIDENCE OF AGNI IN PATIENTS

Agni No.of pts No of Pts in %

Sama 0 0 Vishama 0 0 Manda 20 100

CHART 18: SHOWING INCIDENCE OF AGNI IN PATIENTS

0

10

20

30

40

50

60

70

80

90

100

Sama Vishama Manda

Agni

No of Pts in %

16. Incidence of Koshta: Madhyama Koshta was observed in 100% of the patients

(table29 & graph 19).

TABLE 29: SHOWING INCIDENCE OF KOSHTA IN PATIENTS

Koshta No.of pts No of Pts in %

Mridu 0 0 Madhyama 20 100

Krura 0 0

87


CHART 19: SHOWING INCIDENCE OF KOSHTA IN PATIENTS

0

10

20

30

40

50

60

70

80

90

100

Mridu Madhyama Krura

Kosta

No of Pts in %

17. Incidence of Bala: 100% of the patients were of Madhyama Bala, (table 30 & chart

20).

TABLE 30: SHOWING BALA OF THE PATIENTS

Bala No.of pts No of Pts in %

Pravara 0 0 Madhyama 20 100

Avara 0 0

CHART 20:SHOWING BALA OF THE PATIENTS

0

10

20

30

40

50

60

70

80

90

100


Bala of pts

No of Pts in %

18. Incidence of Family History: All the patients are not having any family history.

88

Clinical Study Results

RESULTS

1. Effect on Haemoglobin%

The mean score of Haemoglobin which was 8.613±0.593 before treatment came down to

9.238±0.522 after treatment. Statistical analysis of this data proved to be highly

significant. (P=<0.001) (Table31).

Table 31: Effect on Haemoglobin %

Mean Difference in Means Paired ‘t’ Test

BT AT S.D. S.E.M ‘t’ P 8.613+0.593

9.238+0.522 0.625 0.275 0.0615 10.162 <0.001

Chart 21: Effect on Haemoglobin %

8

8.5

9

9.5

Mean

Effect on Haemoglobin%

BTAT

2. Effect on Pandutwa

The mean Pandutwa which was 1.050±0.686 before treatment reduced to 0.250±444

after treatment statistical analysis of data proved to be significant at P<0.001 (table 32).

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Table 32: Effect on Pandutwa


BT AT S.D. S.E.M ‘t’ P 1.050+0.686

0.250+0.444 0.800 0.410 0.0918 8.718 <0.001

Chart 22: Effect on Pandutwa

0

0.5

1

1.5

Mean

Effect on Pandutwa

BTAT

3. Effect on Alasya

Before treatment the mean score of Alasya was 1.350±0.250 and after treatment it was

0.489±0.444 indicating that there was a significant improvement. This result is highly

significant at P<0.001 (table 33).

Table 33: Effect on Alasya


BT AT S.D. S.E.M ‘t’ P 1.350+0.250

0.489+0.444 1.100 0.308 0.0688 15.983 <0.001

90


Chart 23: Effect of Alasya

0

0.5

1

1.5

Mean

Effect on Alasya

BTAT

4. Effect on Shrama

Improvement was seen in this symptom with a reduction in the mean score from

0.950±0.224 to 0.1000±0.308 which is statistically significant at P<0.001 (table 34).

Table 34: Effect on Shrama:


BT AT S.D. S.E.M ‘t’ P 0.950+0.224

0.1000+0.308 0.850 0.366 0.0619 10.162 <0.001

Chart 24: Effect on Shrama

0

0.5

1

Mean

Effect on Shrama

BTAT

91


5. Effect on Arohana ayasa

There was statistically significant P<0.001 change in the symptomatology with the mean

scores being 0.400±0.503 and 0.0500±0.224 pre and post treatment respectively

(table35).

Table 35: Effect on Arohana ayasa


BT AT S.D. S.E.M ‘t’ P 0.400+0.503

0.0500+0.224 0.350 0.489 0.109 3.199 0.005

Chart 25: Effect on Arohana ayasa

0

0.2

0.4

Mean

Effect on Arohana ayasa

BTAT

6. Effect on Kati Ruk

The mean score of Kati ruk before treatment was 1.400±0.503 treatment and this reduced

to 0.450±0.510 following the treatment which indicates that the difference is highly

significant statistically. (P<0.001) (Table 36)

Table 36: Effect on Kati ruk


BT AT S.D. S.E.M ‘t’ P 1.400+0.503

0.450+0.510 0.950 0.224 0.0500 19.000 <0.001

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Chart 26: Effect on Kati ruk

0

0.5

1

1.5

Mean

Effect on Kati ruk

BTAT

7. Effect of Swetha Akshi

The mean score for Swetha akshi which was 1.250±0.550 before treatment came down to

0.300±0.470 after the treatment. This difference is highly significant statistically.

(P=<0.001) (Table37).

Table 37: Effect on Swetha akshi


BT AT S.D. S.E.M ‘t’ P 1.250+0.550

0.300+0.470 0.950 0.224 0.0500 19.000 <0.001

Chart 27: Effect on Swetha akshi:

0

0.5

1

1.5

Mean

Effect on Swetha Akshi

BTAT

93


8. Effect on Hridrava

The mean score was 0.350±0.489 before treatment and 0.150±0.366 after treatment. This

is statistically significant at P<0.042 and rules out the possibility of the change having

occurred by chance (table 38).

Table 38: Effect on Hridrava


BT AT S.D. S.E.M ‘t’ P 0.350+0.489

0.150+0.366 0.200 0.410 0.0918 2.179 0.042

Chart 28: Effect on Hridrava

0

0.2

0.4

Mean

Effect on Hrudrava

BTAT

9. Effect on Aruchi

The mean score was 0.950±0.224 before treatment and 0.200±0.410 after treatment. This

is statistically significant at P<0.001 (table 39)

Table 39: Effect on Aruchi


BT AT S.D. S.E.M ‘t’ P 0.950+0.224

0.200+0.410 0.750 0.444 0.0993 7.550 <0.001

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Chart 29: Effect on Aruchi

0

0.5

1

Mean

Effect on Aruchi

BTAT

10. Effect on Dourbalya

The mean of Dourbalya score before treatment was 1.050±0.224 and after treatment

0.250±0.444 this is statistically highly significant at P<0.001 (table 40).

Table 40: Effect on Dourbalya


BT AT S.D. S.E.M ‘t’ P 1.050+0.224

0.250+0.444 0.800 0.410 0.0918 8.718 <0.001

Chart 30: Effect on Dourbalya

0

0.5

1

1.5

Mean

Effect on Dourbalya

BTAT

95


11. Effect on Gaurava

The mean scores of Gaurava was reduced from 0.350±0.489 to 0.150±0.366 following

the treatment. This result was found to be highly significant at P=<0.042 (table 11) and

rules out the possibility of the change having occurred by chance (table 41).

Table 41: Effect on Gaurava


BT AT S.D. S.E.M ‘t’ P 0.350+0.489

0.150+0.366 0.200 0.410 0.0918 2.179 0.042

Chart 31: Effect on Gaurava

0

0.2

0.4

Mean

Effect on Gourava

BTAT

96

Clinical Study Discussion

DISCUSSION

Pandu and Iron Deficiency Anaemia:

The disease Pandu includes Iron Deficiency Anaemia, told in contemporary

science. Similarities can be studied under following sub headings,

• Aetiology

• Pathogenesis

• Treatment

Aetiology:

Pandu has various aetiologies like Asatmyabhojana, Atimadyapana, Kshara, Nishpava,

Pinyaka, Krodha, Bhaya that increase Vata and Pitta. These are Apatarpanakaraka. This

Apatarpana may be grossly taken as, the inadequate dietary intake which can cause

Anaemia119. However, poor economic status and pregnancy where both anorexia and

increased requirements coexist can cause Iron Deficiency Anaemia.

Ativyayama, Atimaithuna, Bharaharana, Panchakarma pratikarma cause excessive

karshana of body, because of which the body requirements increases, which is once again

similar to the aetiology of Iron Deficiency Anaemia.

Excess intake of Paya, Ikshu, Amla, Lavana, Masha, Asatmyabhojana cause

Agnimandya and Ama, which can lead to decreased absorption from the Gastro -

intestinal tract and cause nutritional deficiency Anaemia. Even certain diseases like

Grahani can cause the same120.

Increased blood loss is the direct cause for Anaemia. Even in texts, various

haemorrhagic conditions are described which cause Pandu like Raktati pravrutti,

Raktarbuda, Krimi, Arsha, etc.

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The aetiologies of Pandu Roga are having similarities with the aetiologies of Iron

Deficiency Anaemia.

Pathogenesis:

Among the Dhatu involvement, Pandu chiefly affects the Raktadhatu as it is

clearly told by Sushruta, Chakrapanidatta, Charaka and Vagbhata. Iron Deficiency

Anaemia also involves the same phenomenon.

Rakta and Lauha:

• Rakta is also called Lohita121

• In excessive blood loss, there will be perception of Lauha like odour as in

poorvaroopa of Raktapitta122 and in Abhyantara koshtagata Rakta srava123.

• In Rakta srava, Sushruta has advised consumption of Yakrut124, which is the chief

source of Iron.

• Alparaktata produces decrease in its functions i.e. Jeevana, Mamsapushti125, Dhatu

poshana and Vardhana126, Bala varnakara127. So also, reduction of blood affects its

various functions related to Nutrition, Respiratory, Homeostatic process and

defense mechanisms of the body.

• Important components required for haemopoietic system are Iron, Vit. B12, and

Folic acid, their deficiency leads to anaemia.

• In conditions of Alparaktata, texts have advised many Lauha preparations. When

there is Apatarpana nimittaja alparaktata, then this should be considered as being

caused by deficiency of few of the key components required for production of rakta.

Among these, Lauha can be considered as one of the main constituents.

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In Iron Deficiency Anaemia, symptomatologies referred to muscular system are common

like, tiredness, easy fatiguability and generalized muscular weakness128. Ojakshaya can

lead to destruction of body129, Bala and Tejahani130 and it decreases the Vyadhi kshamata.

Anemic condition will make any one susceptible to infection. In deficiency state,

activity of cytoplasmia enzyme, myclo peroxidase coupled with hydrogen peroxide

generating system in granulocytes is affected131. This affects phagocytic function and

reduces immunity. Iron deficiency lowers antibody production in response to the

administration of bacterial antigens. Cell mediated immunoresponse in Anaemia is

impaired132. Host mechanism against infection is reduced133.

Iron has a vital function of sustaining life through essential Iron containing compounds

like Cytochrome catalyse, Peroxidase and Xanthine oxidase134. Pandu affects body parts

like Indriya, Mana and Twacha. In Iron Deficiency Anaemia, various Central nervous

system and gastrointestinal system features reveal the involvement of above body parts.

Pandu Roga as a Sahaja vyadhi:

Adibala pravrutta (Sushruta), Sanchari (Yagnavalkya), Kulaja (Charaka), Sahaja

(Vagbhata) and Prakrutibhava (Bhela), are synonymous with Sahaja vyadhi. Sushruta

opines that, “Kushta arsha prabhrutaha” are Adibala pravrutta vyadhis. Dalhana

commenting on it says that in “Adibala”, there is Doshic vitiation of Shukra Shonita

causing Beeja dushti and “Prabhrutaha” includes other diseases like Meha, Kshaya etc.

However, “Adi” also includes other diseases that are due to Bija dushti.

Hereditary Anaemia can be included under Pandu Vyadhi. Considering the fact

that few of the Anaemia are hereditary, we can give a parallel thinking that Pandu can be

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a Sahaja Vyadhi though no concrete references regarding Pandu as Sahaja Vyadhi are

found in Ayurvedic texts.

Clinical manifestation:

Table no. 13 shows the similarity in the manifestation of Pandu and Iron

Deficiency Anaemia. Thus, we can conclude that the conceptual study of Pandu and Iron

Deficiency Anaemia reveals later as one of the aetio-pathology of Pandu. Clinical study

revealed that Iron Deficiency Anaemia mainly presented as Vataja Pandu. Conceptual

study reveals that Pandu as a whole entity cannot be equated with Iron Deficiency

Anaemia in particular. But the clinical study reveals Vataja Pandu having more

inclination towards Iron Deficiency Anaemia.

Regimen:

After a thorough clinical and laboratory confirmation of the disease, patients were

registered for the study. Medication was in accordance with the principles of treatment.

Plan of study:

After careful examination, 20 patients were registered for the study. They were

randomly divided. Before the medication, thorough laboratory investigations were done.

The regimen was started with medication for 1 month

General Description of the patients:

20 patients were registered for the study. Incidence study of all the registered

patients is as follows:

1) Age incidence: Maximum number of patients in the study was in between 20-29 yrs

(50%) of age. Contributory factors for women were menstruation, marital tension,

lactation and finally dietary inadequacy.

100


2) Sex Incidence: True to the basic feature of the disease i.e. its predominance in females

(100%), in this study all females were registered. Menstruating female requires double

the quantity of dietary Iron supplement than the non-menstruating. This may be the cause

for maximum prevalence among females.

3) Religion Incidence: Study records larger number of Hindus (80%), when compared to

Muslim (15%) and Christian (5%) religions. Data reflects more on the geographical

predominance of a particular sect, Hindus being dominant in Udupi

4) Occupational Incidence: Most of the patients of Pandu were accustomed to medium

work.

5) Habitat Incidence: Patients were more of rural area (55%) than urban (45%)

6) Socio-economic Status: Patients belonging to the middle class (50%) were more

affected by Pandu (Iron Deficiency Anaemia). Lower socio-economic Group (25%)

consumes food deficient in Iron and contributing to this, is their heavy labour work,

which triggers depletion of Iron stores in body. Patients of upper middle class (25%)

were also affected may be due to low dietary Iron intake, poor bio-availability or

absorption of Iron

7) Marital Status Incidence: Married patients (75%) were the most sufferers of Pandu

than the unmarried patients (25%).

8) Educational Status: More patients had completed their education till high school (65%)

followed by graduate (10%) and post-graduation (10%), primary school (15%).

9) Incidence of Addiction: Most of the patients of Pandu were not addicted to any habits

10) Dietary Incidence: Patients of mixed diet (80%) were maximum

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11) Satwa and Sara Incidence: Most of the patients were of Madhyama Satwa (100%)

and Mamsa Sara (55%)

12) Incidence of Prakruti: Maximum patients of Pandu were vatakaphaja prakruti(80%),

followed by pittakapha (20%).

13) State of Agni in patients of Pandu: In most of the patients Agni was Manda(100%)

14) Koshta in Pandu Rogi: Most patients had Madhyama Koshta (100%)

15) Duration of Illness: Most of the patients had a history of less than 3 months

16) Sleep Pattern: Most had normal sleeping habit

17) Doshic involvement: Vata Pradhana, Pitta Anubandha Pandu was maximum

18) Symptomatology Incidence: Pandutwa, Arohana ayasa, Shrama were present in all

the patients of Pandu (Iron Deficiency Anaemia). Other manifestations like Balahani,

Hridrava, Angamarda were also observed. Study showed predominance of Vataja

lakshanas. Based on the data, relation can be drawn that in Pandu the predominant

presenting features are Pandutwa, Arohana ayasa and Shrama

Discussion on observations during study:

• Aharataha Nidana:

Detailed questioning in clinical study elicited few of the Nidanas as told in the

text. But in most of the patients, it was difficult to elicit the specific Nidana due to non-

compliance and in few due to Avara Satwa and irritable mental status.

80% of patients took mixed diet, mainly comprising of Matsya. Most of the patients were

Satmya to Madhura, Lavana Pradhana Rasa (55%) and Amla, Katu Pradhana Rasa

(35%). Patients were in the habit of taking Teekshna and fried foodstuffs. Patients’ food

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contained more proportion of Masha. Most of the patients were of lower middle class,

dietary history revealed Teekshna Bhojana (60%), Alpamatra Bhojana (40%).

• Nidanarthakara roga: Pandu due to other disease were ruled out by proper history,

examination and laboratory findings. Laboratory examinations were conducted to aid our

diagnosis and to exclude associated pathologies.

• Poorvaroopa: In the clinical study, patients did not approach during the stage of

Poorvaroopa.

• Roopa: Majority of the manifestations in the body had Samanya lakshana of Pandu,

such as,

o Main features

Pandutwa – Pandutwa was seen in skin, nails and eyes of all patients (100%).

The family members often noticed it.

Shrama – Was the feature that troubled the patients much (100%). Reduced

working capacity was the often the complication of Shrama.

Arohana ayasa – was also one of the main symptoms, which was seen in all

patients (100%). Climbing stairs or any slight exertion caused breathlessness forcing

them to stop their work intermittently.

o Associated features: Dourbalya (76.19%), Hridrava (57.1%) and Shoola were the

other presenting features. Different types of Shoola were observed like Udarashoola and

other Vataja lakshanas were 65.6%, Pittaja were 7.7% and Kaphaja were 15.4%

• Past illness: Patients with history of similar presentation in the past were not seen.

• Family history: No history of Pandu in patient Families.

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• Treatment history: No history of haematinics was found in patients.

Effect of treatment:

Effect of treatment was assessed both clinically as well as based on laboratory

parameters. Clinical features were assessed in 30 days with Hb%.

Weakness: Weakness was significantly reduced (76.19%) in maximum no. of patients.

Fatigue: Marked relief (89.4%) was seen in 30 days of medication.

Exert ional Dyspnoea: 87.5% remission was observed in 30 days of medication.

Pandutwa: maximum improvement (76.5%) was seen in 30 days of treatment

Hridrava: 57.1% relief was observed in 30 days of medication.

Haemoglobin Percentage: maximum increase (92.75%) was seen in 30 days

Overall affect of medication on the features of Pandu:

After 1 month of medication: Dhatri Lauha is better in the following features of Pandu

(Iron Deficiency Anaemia):

Features: Weakness, Fatigue,Hridrava, Exertional Dyspnoea, Pandutwa, Haemoglobin

percentage, Kasa, Karna Kshweda, Shoola, Shrama, Tamah pravesha, Alpanidrata.

PROBABLE MODE OF ACTION OF MEDICINE

Dhatri Lauha

Ingredients in decreasing order of their proportions in Dhatri lauha are as follows:

a) Amalaki 8Phala (384gms)

b) Yashtimadhu 2phala (96gms)

c) Loha bhasma 4Phala (192gms)

d) Guduchi kwatha Sufficient Quantity for bhavana

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Amalaki is the main ingredient in this Yoga and hence the name Dhatri lauha in

Bhaishajya Ratnavali. Action of a medicine mainly depends upon its subtle constituents

like Rasa, Guna, Virya, Vipaka, and Prabhava etc. When the Rasadis are equally strong,

the Vipaka dominates over Rasa; Virya suppresses the Rasa and Vipaka while Prabhava

dominates over all.

Rasa: Amalaki is Amla rasa pradhana and can increase Rakta and hence in Raktalpata,

Amla preeti is seen. Madhura rasatmaka dravyas like Yashtimadhu, are Preenana,

Brimhana, Ksheena dhatu Vardhaka.

Guna: Guru, Snigdha guna of Yashtimadhu snigdha,

Virya: Amlaki have Sheeta virya.

Vipaka: Most of the Dravyas have Madhura vipaka viz. Amalaki, Madhura, Sheetaguna

are Balavarnakara, Dhatuvardhaka, Preenana and Jeevana. Thus it can revert back the

Dhatu shathilya, Gourava, Oja guna kshaya and other Dhatu kshaya.

Prabhava:

• Amalaki Vrishya, Rasayana, Chakshushya

• Yashtimadhu Chakshushya, Shukrala, Swarya

Karma:

Dosha karma:

• Pittahara: Amalaki, Yashtimadhu,

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• Vatahara: Yashtimadhu

• Kaphahara: Amalaki

• Tridoshaghna: Amalaki,

Vyadhi karma:

• Amalaki Raktapitta, Meha

• Yashtimadhu Sadyo kshatasruk harati, Kshaya, Shosha

These qualities can have an impact on all the entities of the Samprapti like

Dosha : Vatapittahara mainly

Dushya : Santarpanakaraka, Balya, Dhatuvardhaka, few are

Specially effective on Raktaja vikara

Srotas : Also acts on Rasavaha srotas (Aruchi, Twak panduta)

Raktavaha srotas (Kushta, Raktapitta, Kamala)

Agni : Agnivardhaka

Ama : Amapachaka

Mruta loha guna:

Rasa : Tikta, Kashaya

Guna : Ruksha

Virya : Sheeta

Karma : Balya, Vrishya, Twak rogahara, Medhya Also helpful in other Alpa rakta

conditions like Rakta srava.

Lauha Bhasma is an Iron preparation with Iron in the ferrous state. Ferrous Iron can get

easily absorbed in the body.

106

Clinical Study Conclusion

CONCLUSION 1. Pandu Roga mostly affects the females than males.

2. Martial status, religion, Social status bear no relation in causation of Pandu Roga.

3. Sedentary life style, and fault dietary habits are main contributing factors in the

establishment of the disease. Tendency towards sedentary life style and faulty dietary

habits, leads to vitiation of Pitta and Rakta leading to Pandu roga.

4. Etiological factors here mainly related with Pitta and Rakta vitiation

5. The study confirms the dominancy of Pitta Dosha, Rakta Dhatu Dusti, Rasavaha and

Rakta Srotodushti in the pathogenesis of Pandu roga.

6. Pandu Roga is a disease characterized by Pandutva, Swethakshi, Hridaya spandana and

Rukshtva of the body.

7. It can be concluded that on the basis of Nidana, purva rupa and Samprapti of vataja

Pandu can be correlated with Iron deficiency anaemia.

8. Dhatu apakarshana and Ojo dushti is an invariable manifestation of the disease.

9. On the basis of result of the therapy it can be deduced that Dhatri Lauha provided relief

in the chief complaints like Pandutva, swethakshi, Daurbalya.

10. It was effective in increasing the Hemoglobin percentage. The mean difference in

Hb% was 0.607 with P< 0.001 whis is statistically significant.

11. The present study was carried on small sample for a limited time with out alteration

in their routine dietary and physical activities and it showed encouraging results.

However to be more confirmative further study should be conducted on large sample for

longer duration with diet.

107

Clinical Study Summary

SUMMARY

This dissertation entitled “Effect of Dhatri Lauha in Pandu roga” with special

reference to Iron deficiency Anaemia comprises of six chapters namely Historical review,

Conceptual study, Drug profile, Clinical study, Discussion, Summary and Conclusion.

Historical Review

This chapter deals with the historical aspects related to Pandu. Description

regarding diseases related to discolouration of body is available in Rigveda and

Atharvaveda. Hariman and Harita are two such diseases that appear to be Jaundice and

Pallor respectively. Along with the identification of the disease, treatment for the same

has also been described. Other books like Jaiminiya Brahmana and Garuda Purana have

also mentioned Hariman. Elaborate description of the disease Pandu is available from

Sangrahakala onwards. Charaka, Ashtanga Hridaya and Ashtanga Sangraha, have

elaborately discussed regarding Pandu and accepted 5 types of Pandu whereas Sushruta

has classified it as of 4 types. But few other scholars acknowledge 8 types of Pandu. The

major contribution during sangraha kala was the addition of different loha preparations in

the treatment of Pandu.

Conceptual Study

Conceptual study of Pandu and Iron deficiency Anaemia are elaborately

discussed in this chapter. Nirukti, Paribhasa, Paryaya, Nidana, Samprapti, Lakshana,

Upadrava, Sadhyasadhyata and Arishta of Pandu are discussed in detail. Also included

are Definition, classification, manifestation and treatment of Iron deficiency Anaemia.

The Nirukti of Pandu Roga reveals that, the disease is named after varna viz.

Pandu. Pandu varna means shweta and peeta mishrita varna.

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Pandu nidana can be broadly classified into Aharaja, Viharaja,

Nidanarthakararogaja and Vaidyakruta. Most of the Nidana are Vatapittakara and Vidahi.

Nidanarthakara roga can produce Pandu by causing Raktalpata directly by Raktasrava or

by Rasadhatu dushti. Panchakarma pratikarma vaishamya can produce Pandu.

Samanya and vishesha samprapti of the disease is discussed at length.

Lakshana are mainly divided into Samanya and Vishesha. Vishesha includes

Vataja, Pittaja, Kaphaja, Tridoshaja and Mrudbhakshanajanya Pandu. These have been

dealt within relation to different texts.

Purvarupa, upadrava, sadhyasadhyata are reviewed according to different authors.

Chikitsa is mainly of two types, Shodhana and Shamana. All the patients in this study

were suffering from Vataja Pandu.

Drug Profile

The chapter on Drug profile includes a detailed study on Dhatri Lauha along with

ingredients and their probable mode of action in Panduroga.

Clinical Study

Clinical study describes the registration of patients and details of inclusion and

exclusion criteria, diagnostic criteria, assessment criteria and the investigations

conducted. After registration, patients were randomly selected for administration of trial

drug Dhatri Lauha.

• Dhatri Lauha was administered in the dosage of 500mg bd.

• A total of 20 patients were registered, who are having the Pratyatmaka lakshanas of

Pandu roga.

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Observations: Various observations regarding incidence study like patient’s age, sex

etc., clinical findings like satwa, sara, agni, koshta, incidence of clinical features of Pandu

are tabulated and shown.

Results: Results of the clinical trial were assessed on the basis of the grading given for

assessment criteria. Observations were subjected to standard statistical analysis, the data

of which have been presented in the chapter.

Discussion

Here, discussion of the conceptual aspect of disease, its comparison with Iron

Deficiency Anaemia and the interpretations of the results of the clinical trials has been

included. Major emphasis is on the clinical trials. Clinical elicitation of the different

aspects of the disease like nidana, poorvarupa, roopa and upadrava are discussed. Both

observation and results related to the study are discussed with derivation of possible

inferences.

Conclusion

An abstract of the complete dissertation and the conclusions drawn are presented here.

• Conclusions are as follows:

Conceptual study

1) Vyutpatti reveals that the word Pandu is formed from ‘Padi gatou’. Here ‘Gatou’ is

related to transformation. In this context it is the affliction of the process of

transformation of the dhatus like Rasa, Rakta.

110


2) Nirukti and paribhasha reveals that Panduroga is a disease named after different

discolourations of the body mainly Pandu varna. Pandu varna refers to shweta and peeta

mishrita varna.

3) Study of the Nidana of Pandu reveals:

a) Apatarpana karaka -

• Ahara: Tila, Pinyaka, Kshara, Viruddhahara, Asatmya, Pista, Amla, Lavana etc.

These are mainly Pitta Rakta Vata vardhaka and Vidahi.

• Vihara: Ativyayama, Bharaharana, Atimaithuna, Vegadharana, Krodha.

• Vaidyakruta: Panchakarma pratikarma vaishamya

b) Santarpana karaka – Amisha, Paya, Ikshu, Yapana basti atiyoga.

c) Nidanarthakara roga – They lead to Pandu by causing Alparaktata. This Alpa raktata

can either be directly due to rakta srava or due to rasavaha srotodushti.

In the aspect of treatment, texts have given importance to both Vamana and

Virechana. But difference of opinion between types of Shodhana is seen between

Charaka and Sushruta. Charaka suggests Teekshna, Snigdha shodhana while Sushruta

recommends Snigdha shodhana.

Clinical study:

From the clinical study, following conclusions are being drawn.

Observation: Maximum patients belonged to age group of 20-29 years (50%).

Predominantly afflicted were of female population (100%). Majority of them belonged to

Hindu religion (80%) and were from rural area (55%). Most of the patients were educated

till high school (65%), had no addiction and patients of consumed mixed diet (80%).

111


Most of patients were of Madhyama Satwa (100%), were of Madhyama

Samhanana (100%); Bala was Madhyama (100%); predominance of Mamsa Sara was

observed (55%), Prakriti of most of the patients was Vata-Kapha (80%), most of them

were having Satmya to Lavana, Madhura rasa (50%), status of Agni was Mandagni in

most of the patients (100%) and Koshta was Madhyama (100%). Most patients had sound

sleep, most were suffering from the symptoms since 0-3 months. Doshas involved in the

patients of Pandu was Pittanubandha Vataja Pandu, Pitta-kaphanubandha Vataja Pandu,

Kaphanubandha Vataja Pandu; Severity of the disease among the patients was moderate,

severe and mild.

Past history: No history of major disease in family members and no past history of

Haematonics intake.

Result:

Dhatri Lauha:

Weakness: Reduction in weakness (76.19%) was significant. This was assessed after 30

days. (P<0.001).

Fatigue: There was an improvement in the reduction of Fatigue (89.4%) after 30 days

(P<0.001).

Exertional Dyspnoea: Reduction in Exertional Dyspnoea was observed (87.5%) after 30

days medication (P<0.001).

112


Pandutwa: Significant reduction in Pandutwa was observed (76.5%) after 30 days

(P<0.001).

Hridrava: Improvement in Hridrava was significant (57.1%) after 30 days of medication

(P<0.001).

Haemoglobin Percentage: Improvement in Haemoglobin Percentage (92.75%) was highly

significant after 30 days of medication (P<0.001).

113

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123

DEPARTMENT OF KAYA CHIKITSA

S. D. M. COLLEGE OF AYURVEDA, UDUPI.

CASE PROFORMA FOR CLINICAL STUDY ON PANDU ROGA

I. ATURA VIVARA

1. Atura Nama : 10. Serial No. :

2. Linga : M / F 11.O.P.D.No.:

3. Vaya : ___ years. 12. Date

4. Vaivahika Vruttanta : M / UM / W / D 13. Group. :

5. Vrutti : 14.D.O.A :

6. Jati : H / M / C / J / Si

7. Saksharata : UE / PS / MS / HS / GR / PG :

8. Samajika Sthithi : VP / P / LM / M / UM / R

9. Dinanka :

II. VEDANA SAMUCHRAYAM

A. PRADHANA VEDANA Kala prakarsha

Alpa raktata/Alpa medaskata/ Nissarata/Ojo guna kshaya/ Pandutwa/Anya pandu

lakshana/ Shitilendriya.

III. VEDANA VRUTTANTA

IV. POORVA VYADHI VRUTTANTA

V. KOUTUMBIKA VRUTTANTA

Relative Dead / Alive Health status Treatment history

Chikitsa Vruttanta:

1) Ayurveda: 1.Shodana 2.Shamana

2) Allopathy: 1.Haematinics 2.Others

VI. VYAKTHIGATA VRUTTANTA :

1.AHARA : Veg / Mixed

A) Habits:samashana/vishamanshana/adhyashana/anashana/pratimashana

2.Madakari dravya Abyasa: smoking/Alcohol/Tobacco chewing/Tobacco snuff/others

vihara sambandhi vruttanta

Sleep : ___Hours / day: __Hours / night :sound sleep/inturupted/Delayed/Disturbed

Exercise: Routine work/occasional/irregular/ regular/morning walk

Mala : ________ times daily regular / irregular

Mootra : ________ times daily

RAJO SAMBANDHI VRUTTANTA :

1. Menstruating / attained menopause at ________ years of age.

2. Menstrual cycle :

3. History of : Udavartini/Asrugdara/ Shwethapradar / Anya YonigataVikara

4. P ____ G _____ L ____ D ____

5. History of infertility : primary / secondary

VIII MANASIKA VRUTTANTA:

X. GENERAL PHYSICAL EXAMINATION

Built and Nourishment : __Wt __ Ht

Pallor / Edema / Nail changes / Cyanosis / Icterus / Lymphadenopathy / Neck

Nails: Clubbing/koilnychina/onychia/discolouration/haemorrhage

Hair:Falling/Thick/premature graying/ Loss of hair/

Lips: Pale/dry/wet/swelling/Fisures/ulcers.

Angle of mouth: Pale/dry/wet/swelling/Fisures/ulcers.

Tongue:Pale/coated/dry/wet/Fissured/ulcers/tremour/deviation.

Palate: ulcer/pigmentation/bleeding.

Superficial lymph nodes:

Cervical

Inguinal

Axillary

Others

Vital-signs:

Temperature:

Pulse rate:

Blood Pressure:

Respiratory rate:

Cyanosis/Icterus/Pallor:

SYSTEMIC EXAMINATION

Respiratory system :

Cardiovascular system :

Genitourinary system :

Central nervous system :

Gastro intestinal system :

Stomach: organomegaly/hard/smooth/tenderness

Liver: organomegaly/hard/smooth/tenderness

Spleen: organomegaly/hard/smooth/tenderness

Kidney: organomegaly/hard/smooth/tenderness

SROTO PAREEKSHA :

Pranavaha Srotas :

Udakavaha Srotas :

Annavaha Srotas :

Rasavaha Srotas :

Raktavaha Srotas :

Mamsavaha Srotas :

Medavaha Srotas :

Astivaha Srotas :

Majjavaha Srotas:

Shukravaha Srotas:

Mootravaha Srotas :

Pureeshavaha Srotas:

Swedavaha Srotas :

Dasha vidha pareeksha:

Prakriti V/P/K/VP/VK/KP/VPK

Sara Twak/rakta/mamsa/meda/asthi/majja/shukra/ssarva sara.

Satwa P/M/A

Samhanana P/M/A

Pramana P/M/A

Satmya P/M/A

Aharasakti purvakalina P/M/A Adhyatana P/M/A

Jarana sakti Purvakalina P/M/A Adhyatana P/M/A

Vaya Bala/Madhyama/Vriddha.

Vikriti

Nidana:

Ahara Sambandhi: kshara sevana/ amla sevana/ lavana rasa sevana/ atyushna bhojana/

asatmya/ viruddha bhojnana/.mathya sevana/ amisha sevana/ ikshu sevana/ pishta sevana/

paya sevana/ pinyak ati sevana/ mashati sevana/ Madhya sevana/ mrut bhakshana/

teekshana ahara sevana/ maithuna/ vega vidharana/ rutu vaisha,mya/ kama/ krodha/

chinta/ bhaya/ shoka/ divaswapna/ vyayama/ bharaharana/ nishapava sevana/ tilataila

sevana.

Vihara sambandhi

Shareerika/ atimaithuna/ vegadharana/ divaswapna/ vyayama/ratrijagarana/others.

Manogatha karana: kama/ krodha/ chinta/ bhaya/ shoka.

Nidanarthakara roga: Rakta ati pravruthi/raktarbuda/antarlohita/

raktapitta/raktapradara/raktakshya/ raktasrava/grahani/arshas/pureeshaja krimi/vyavaya

shotha/ pitaja prathishayaya/pittaja kasa/Prameha others.

Poorva roopa

Hridayaspandhana/twakspootana/swedabhava/shrama/steevana/hrillasa/gatrasada/mru

bhakshana

Samanya lakshana:

Karana kshweda/ hatanal/ dourbalya/ sadana/ bhrama/ anndwesha/

shrama/gatrashoola/jwara/shwasa/ gaurava/ aruchi/ gatramanda/gatrapeeda/

gatromatra/shunakshikoota/hareetavarnata/sheernalomata/hatprabha/kopa/shishiradwesha

/nidralu/steevana/alpavak/pindikodweshtanam/katiruk/katisad/padarauk/padasada/ururuk/

dhatushithilyam/ojogunakshaya/ araktata/alpamedeskata/nabhishotha/ alsya/ nirutsaha.

Vishista lakshana:

Vataja:Krishna Panduta/rukshagaanata/kampa/shoola/varcha shosha.

Pittaja: peetabhata/haritabhata/murchapipasartha/ sweda/ sheeta kamata

vidhaha/atisara/tamah/murrcha/ushna anupshaya/amla anupaashaya.

Kaphaja:tandra/chardhi/shwetavabhasata/lomaharsha/murcha/bhrama/kasa/vakgraha/sw

aragraha/swarakshaya/kantakamata/rukshakamta/ushnakamata/shoonagandha/shoonakshi

koota/krimi kosta/atisara.

Mrudbhakshana:

SAMPRAPTI GHATAKA

DOSHA :

DUSHYA :

SROTAS :

SROTODUSTI LAKSHANA :

AGNI :

AMA :

UDBHAVA STHANA :

SANCHARA STHANA :

ADHISHTANA :

VYAKTA STHANA :

ROGA MARGA :

UPASHAYA ANUPASHAYA :

VYADHI :

PRAKARA :

SADYASADYATA :

CHIKITSA :

ASSESSMENT CRITERIA

BT AT

Pandutwa

Hridrava

shrama

Arohana ayasa

Swetha akshi

Dourbalya

Jwara

Alpavak

Sadana

Aruchi

Katiruk

Shotha

Alasya

B. ROUTINE

HAEMATOLOGY

BT AT

Hb%

Lymphocytes

Monocytes

Neutrophils

Eosionophils

Basophils

Total WBC Count

(cells/cumm)

ESR (in mm/I hour)

Stool examination

Ova for cyst

Other investigations

if necessary

Documents

Pandu kc009 udp