Snehapana pandu pk028-gdg

“EVALUATION OF COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA”

BY

DDrr.. AANNEEEESSHH JJOOSSEEPPHH KKAALLAAYYIILL Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

In partial fulfillment of the requirements for the degree of

DDOOCCTTOORR OOFF MMEEDDIICCIINNEE ((AAYYUURRVVEEDDAA VVAACCHHAASSPPAATTII)) IN

PANCHAKARMA

Under the Guidance of

Dr. Santosh.N.Belavadi

M.D. (Ayu)

Assistant Professor

P.G. Dept. of Panchakarma

And Co-Guidance of

Dr. Jairaj. P. Basrigidad M.D. (Ayu)

Lecturer

P.G.Dept. of Panchakarma

POST GRADUATE DEPARTMENT OF PANCHAKARMA D.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER

GADAG – 582103

2008-2011

DECLARATION BY THE CANDITATE

I hereby declare that this dissertation / thesis entitled “EVALUATION OF

COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA

SNEHAPANA IN PANDUROGA” is a bonafide and genuine research work carried

out by me under the Guidance of Dr.Santosh. N. Belavadi MD (Ayu), Assistant

Professor and the Co-Guidance of Dr.Jairaj. P. Basrigidad MD (Ayu), Lecturer, Post

Graduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,

Gadag.

Date: Signature of the Candidate

Place: Gadag Aneesh Joseph. K

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “EVALUATION OF


SNEHAPANA IN PANDUROGA” is a bonafide research work done by

ANEESH JOSEPH. K in partial fulfillment of the requirement for the degree of

Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Guide

Place: Gadag

Dr. Santosh.N.Belavadi M.D. (Ayu) Assistant Professor Department of Panchakarma DGMAMC, PGS & RC, Gadag

CERTIFICATE BY THE CO - GUIDE




ANEESH JOSEPH. K in partial fulfillment of the requirement for the degree of

Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Co -Guide

Place: Gadag

Dr. Jairaj. P. Basrigidad M.D. (Ayu) Lecturer P.G.Dept. of Panchakarma DGMAMC, PGS & RC, Gadag

J.S.V.V. SAMSTHE’S

SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION




ANEESH JOSEPH. K under the guidance of DR. SANTOSH.N.BELAVADI

MD(Ayu) Assistant Professor, and Co-Guidance of DR. JAIRAJ. P. BASRIGIDAD

M.D(Ayu) Lecturer Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C,

Gadag and contributed good values to the Ayurvedic research.

Prof .Dr. P .Sivaramudu M.D.(Ayu)M.A.(San)M.A.(Psy) Professor & HOD P.G Department of panchakarma DGM Ayurvedic Medical College, Gadag

Date:

Place: Gadag

Dr. G. B. Patil Principal DGM Ayurvedic Medical College, Gadag

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

Place: Gadag. ANEESH JOSEPH. K

© Rajiv Gandhi University of Health Sciences,

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga i

ACKNOWLEDGMENT

With a bowed Head to the Almighty, With folded Hands to Revered Teachers And A warm Heart to Good Friends………. This work is the result of the combined effort of a good number of people who

include academicians, colleagues, and above all the patients who cooperated with me

in all aspects. Moreover it is only because of Gods’ grace, the work could be

accomplished as per my expectation.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Shivananda Mahaswamiji, for his divine blessings.

I give my respect at this moment to my father K.A Joseph my mother Smt.

N .V Mariyam who are the architects of my career. My deep sense of gratification is

due for my parents who are the architects of my career. The culture, discipline and

perseverance, which I could imbibe, are solely because of their painstaking nurture

and strong moral support. I thank to my brothers Biju Joseph and Dr Bineesh Joseph

and their family for affection and continuous encouragement.

It is a privilege to convey regards to my wife Dr. Jaya Aneesh and my

daughter Dhyeya Aneesh for their loving and caring support in my difficult times.

I am thankful to my in laws K Mohanan Nair and Smt. Snehalatha for their

encouragement, broadmindedness and affection towards me.

The inspiring force throughout this research work; was my Guide

Dr.Santosh N. Belavadi, M.D. (AYU), Assistant Professor, department of Panchakarma,

a person whose love and care became a source of light whenever I was in darkness,

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga ii

who provided necessary fuel for my innovative thoughts. I am deeply indebted for his

guidance.

I express my deep sense of gratitude to my HOD Dr. P. Sivaramudu,

M.D.(Ayu),M.A(San),MA(Psy), professor and HOD, department of Panchakarma, for

his humble nature, indulgence, and scholarly suggestions during the course of this

research work.

My deep gratitude to Dr. Jairaj Basarigidad MD (Ayu), Lecturer, Dept of Panchakarma,

my Co- Guide whose guidance with accuracy and commitment towards research has

helped me a lot from the very beginning to the end of this work.

I express my thankfulness to beloved principal Dr. G. B. Patil, for his

encouragement and support by providing all necessary facilities for this research

work.

I am very much thankful to my teachers Dr. U.V Purad, M.D.(Ayu), Dr. Sandeep

Patil MD (Ayu) for their timely help and suggestions during this study.

I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr.Suresh Babu, Dr. M.

C. Patil, Dr. Mulugund, Dr. G. S. Hiremath, Dr. C. S. Hiremath ,Dr. R. V. Shettar, Dr.

Girish Danappa Goudar, Dr. Jagadeesh Mitti, Dr. Kuber Sankh, Dr. B. M. Mulkipatil

and Dr. M.D. Samudri, Dr. Yasmeen phaniband for their valuable inputs and

suggestions.

I extend my immense gratitude to Dr. V. M. Sajjan, Dr.Yarageri, Dr.Suvarna

Nidugundi, Dr. Shakuntala and other teaching staff who helped during my study.

I express my sincere thanks to Prof. P.M Nandakumar and Dr.Ashok patil,

for their help in statistical analysis of results. I take the privilege to thank Sri.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga iii

Mundinamani, Librarian. I also extend my thanks to assistant librarians Mr. Shyavi

and Mr. Keroor who provided me all the necessary books and time for my literary

work.

I am very much thankful to Sri Tippanagowdar (Lab Technician), for his help

during the study. I extend my thanks to Sri Kulakarni, Sri Nabi, Smt. Sunanda and

Smt Renuka and all other hospital for their timely help in trail.

I feel extremely thankful to seniors Dr. Ashok M.G, Dr. Prasanna V. Joshi,

Dr. Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Sanjeev Chaudary, Dr. Shailej, Dr.

Mukta Hiremath, Dr. Sanath Kumar D.G, Dr. Sabareesh , Dr. Rajesh, Dr. Jayasankar,

Dr. Deepak and others for their valuable suggestions.

I am deeply indebted to my close friends Dr.Joshi George Mattathil , Dr.

Bhagyesh .K . Madavu and Dr. Surej Subash Pullarkkat for their rejoicing company

and timely help.

I pay sincere regards to my fellow Dr. Renukaraj Medegar , Dr. Biswajith Das,

Dr. Sangamesh Iddalgimath , Dr.Vijay Mahantesh, Dr.Vinod Barwal, Dr.Baba Saheb,

Dr.Srikanth Patel, Dr.Praveen, Dr. Pushpa, Dr. Triveni, Dr.Satheesh, Dr. Jayakar,

Dr.Vijay Chavadi and Dr. Sanjeev Reddy for their truly help and co-operation.

I thank my juniors Dr. Raghavendrachar, Dr. Manish, Dr. Paresh, Dr.

Jagadeesh, Dr. Shilpa , Dr. Vijay Raj,

I thank specially to Miss. Shweta Shirabadagi, Nanda Langotti, Netravathi,

Rekha Rani, Manjula Karadi, Priyanka and all UG friends for their help and supports.

I am also very much thankful to Mr. Shakthi (Local Guardian), Mr. Salimat,

Smt. Lalithamma who made my stay comfort throughout my P.G. carrier.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga iv

Lastly I pay my deepest respect for those patients who took part in the study

and I share my success with them.

“To err is Human” – certain names, who could be directly or indirectly helped

in this work, might have been missed unintentionally. Thanks are due to all of them.

Date : Dr. Aneesh Joseph. K

Place : Gadag

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga v

LIST OF ABBREVIATIONS USED

A.H – Astanga Hrudaya

A.S – Astanga Samgraha

B.P – Bhavaprakasha

B.S – Bhela Samhita

C.S – Charaka Samhita

M.N – Madhava Nidana

S.S – Sushruta Samhita,

V.S – Vangasena

Y.R – Yogaratnakara

G.N _ Gadanigraha

Sh.S _ Sharangadhara Samhita

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga vi

ABSTRACT

Anemia is a decrease in the normal number of red blood cells (RBCs) or

less than the normal quantity of hemoglobin in the blood. However, it can include

decreased oxygen binding ability of each hemoglobin molecule due to deformity or

lack in numerical development as in some other types of hemoglobin deficiency.

Globally, 30% of the total world populations are Anaemic and half these, some 600

million people have iron deficiency. Iron deficiency Anaemia (IDA) is most prevalent

nutritional problem in the world today. Young children and women of reproductive

age group especially pregnant and lactating women, are at greatest risk.

Panduroga is a pitta pradana tridoshaja vyadhi in which rasa and Rakta are

mainly affected. Charaka opines that due to excess intake of Tridosha prakopa Ahara

especially pitta prakopa Ahara viharas the vitiated doshas assumes sthana samshraya

in between tawk and mamsa resulting in Pandu, Harita, and Haridra varna to the skin.

Hence, the disease is named as Panduroga.

By doing the Snehapana it will be beneficial in relieving the pitta vriddi

and also helps in Rakta prasadana. Main focus is given for the procedure Snehapana

with Draksha Ghrita which mainly mitigates vata and pitta, enhances the qualities of

bala, varna and also increases the dhatus like rasa, sukra and ojus. The qualities of

Ghrita are Vrishya, Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara,

Papahara, Rakshoghna, Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya,

Rasayana, Sugandha, Rochana, Smriti vardhaka, Rasa, Shukra vardhaka. By

administrating the Draksha Ghrita Snehapana in both Arohana Krama and Sadharana

Krama research is mainly focused on bringing changes in subjective parameters like

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga vii

Panduta, Dourbalya, Arohanayasa, Agnimandhya and increasing of Haemoglobin

percentage is the research point. Here an attempt is made to “Evaluation of

comparative efficacy of Arohana & Sadharana Krama Snehapana in

Panduroga.”

Objective of the Study:

To evaluate the efficacy of Draksha Ghrita Arohana Krama Snehapana in

Panduroga.

To evaluate the efficacy of Draksha Ghrita Sadharana Krama Snehapana in

Panduroga.

To evaluate the comparative efficacy of both the groups.

Study Design:

It was a Simple randomized comparative clinical study.

In this study design 30 patients who were diagnosed to have Panduroga and fulfilling

the criteria of undergoing the process of Snehapana were selected.

Patients were given Deepana and Pachana aushadi ie; Jeeraka choorna and

were subjected to Snehapana with Draksha Ghrita in both Arohana and Sadharana

karma for 5-7 days .The assessment criteria were noted before and after treatment and

after follow up. Subjective parameters i.e. Panduta, Dourbalya, Arohanayasa, Brahma,

Agnimandhya and Aruchi are the chief complaints of Panduroga and objective

parameters are Hb%, Total count, Differential count, ESR, Total RBC and Packed cell

volume. Assessments are done before and after the treatment.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga viii

Results

In subjective parameters all other parameters except Panduta are not

significant before treatment, after treatment and after follow up. It means the

mean effects of two groups are not same in Panduta.

Similarly in objective parameter all parameters are not significant. It means

the mean effects of all the objective parameters are same in both the groups.

While comparing both groups group B is highly significant after treatment and

group A highly significant after follow up.

Key words

Arohana Krama Snehapana, Sadharana Krama Snehapana, Draksha Ghrita

Panduroga, Anaemia.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga ix

EVALUATION OF COMPARATIVE EFFICACY OF AROHANA &

SADHARANA KRAMA SNEHAPANA IN PANDUROGA

TABLE OF CONTENTS

SI. No. Contents Page No.

01 Introduction 1

02 Objectives 6

03 Review of Literature 9

04 Drug review 100

05 Methodology 108

06 Observations and Results 128

07 Discussion 194

08 Conclusion 219

09 Summary 222

10 Bibliography i

11 Annexure xxi

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga x

LIST OF TABLES

Table No.

Table showing the Page No.

01 The Sneha Guna, Bhoutika Sanghatana & Karmukata Of Sneha Dravys

15

02 Properties of Ghrita 16

03 Source of Sthavara Sneha according to Charaka 18

04 Sushruta’s Sthavara Sneha classification 18

05 Jangala Sneha & their Ashaya 19

06 Paka Bhedha of Sneha 19

07 Upayoga Bheda 20

08 Opinion about Sneha Matra 21

09 Sneha Matra according to Susruta 22

10 Indications of Sneha Matra 22

11 Opinion of Vangasena regarding dosage of Arohana Snehapana 24

12 Shamana and Brumhana Snehana Yogya 24

13 General Indications of Snehana According to Different Acharyas

25

14 Deserving Condition for Snehana 26

15 General Contraindications of Snehana 29

16 Sneha Jeeryamana lakshanas 38

17 Samyak snigda lakshanas 39

18 Asnigda lakshanas 40

19 Atisnigda lakshanas 41

20 Aharaja nidanas of panduroga 65

21 Viharaja Nidana of Panduroga. 66

22 Manasika Nidana of Panduroga. 66

23 Poorvaroopa of Panduroga. 68

24 Samanya lakshanas of Panduroga 69

25 Classification of Panduroga. 70

26 Lakshanas of Vataja Panduroga. 70

27 Lakshanas of Pittaja Panduroga. 70

28 Lakshanas of Kaphaja Panduroga. 71

29 Lakshanas of Mridbhakshanajanya Panduroga. 72

30 Complications of Panduroga. 76

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xi

31 Ingredients Of Jeeraka Choorna 101

32 Ingredients Of Draksha Ghrita 103

33 Pharmaco dynamic properties of Ghrita according to Samhitas and Nighantus

106

34 Demographical Data- master chart 116

35 Pradana vedana-master chart 117

36 Poorvaroopa-master chart 118

37 Anubandha Vedana- master chart 119

38 Subjective Variables Of Arohana Krama Snehapana- master chart

120

39 Subjective Variables Of Sadaranakrama Sneha Pana- master chart

121

40 Manasika nidanas- master chart 122

41 Manasika nidanas- master chart 123

42 Objective variables in Arohana krama Snehapana- master chart 124

43 Objective variables in Arohana krama Sneha pana- master chart 125

44 Objective variables in Sadharana krama Snehapana- master chart

126

45 Objective variables in Sadharana krama Snehapana- master chart

127

46 Distribution of patients by age 128

47 Distribution of patients by sex 129

48 Distribution of patients by Religion 129

49 Distribution of patients by Occupation 130

50 Distribution of patients by Economical status 131

51 Distribution of patients by Mode of onset of disease 131

52 Distribution of patients by Course of disease 132

53 Distribution of patients by Chikitsa vrittanta 133

54 Distribution of patients by Kula vrittanta 134

55 Distribution of patients by Type of diet 135

56 Distribution of patients by Dominant rasa 135

57 Distribution of patients by Diet pattern 136

58 Distribution of patients by Vyayama 137

59 Distribution of patients by Manasika vihara 138

60 Distribution of patients by Vyasana 139

61 Distribution of patients by Nidra 140

62 Distribution of patients by Menstrual history 141

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xii

63 Distribution of patients by Koshta 142

64 Distribution of patients by Prakriti 143

65 Distribution of patients by Satwa 143

66 Distribution of patients by Satmya 144

67 Distribution of patients by Samhanatha 145

68 Distribution of patients by Pramana 146

69 Distribution of patients by Abhyavarana shakti 146

70 Distribution of patients by Jarana shakti 147

71 Distribution of patients by vaya 148

72 Distribution of patients by Vyayama Shakti 149

73 Distribution of patients by Poorva roopa 149

74 Distribution of patients by Anubandha vedana 151

75 Distribution of patients by Pradana vedana 152

76 Matra of Ghrita administered 154

77 Snehapana kalavadhi 155

78 Mean on set of Jeeryamanya laxanas in Group A 156

79 Mean on set of Jeeryamanya laxanas in Group B 156

80 Mean on set of time in minutes for Sneha Jeerna laxanas in

group A

157

81 Mean on set of time in minutes for Sneha Jeerna laxanas in

group B

158

82 Samyak snigda lakshanas in both groups 160

83 Mean time taken for Samyak Snigadha laxanas of Group A &

B.

161

84 Group Statistics of Panduta 163

85 Group Statistics of Agnimandhya 165

86 Group Statistics of Arohanayasa 168

87 Group Statistics of Brama 170

88 Group Statistics of Dourbalya 172

89 Group Statistics of Hb% 174

90 Group Statistics of Total Count 176

91 Group Statistics of Platelets 179

92 Group Statistics of Lymphocytes 181

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xiii

93 Group Statistics of Esnophils 183

94 Group Statistics of ESR 185

95 Group Statistics of Total RBC 187

96 Group Statistics of PCV % 190

LIST OF GRAPHS

Graph No.

Graph showing Page No.

1 Distribution of patients by age 128

2 Distribution of patients by sex 129

3 Distribution of patients by Religion 130

4 Distribution of patients by Occupation 130

5 Distribution of patients by Economical status 131

6 Distribution of patients by Mode of onset of disease 132

7 Distribution of patients by Course of disease 133

8 Distribution of patients by Chikitsa vrittanta 134

9 Distribution of patients by Kula vrittanta 134

10 Distribution of patients by Type of diet 135

11 Distribution of patients by dominant rasa 136

12 Distribution of patients by Diet pattern 137

13 Distribution of patients by Vyayama 138

14 Distribution of patients by Manasika vihara 138

15 Distribution of patients by Vyasana 139

16 Distribution of patients by Nidra 140

17 Distribution of patients by Menstrual history 141

18 Distribution of patients by Koshta 142

19 Distribution of patients by Prakriti 143

20 Distribution of patients by Satwa 144

21 Distribution of patients by Satmya 145

22 Distribution of patients by Samhanatha 145

23 Distribution of patients by Pramana 146

24 Distribution of patients by Abhyavarana shakti 147

25 Distribution of patients by Jarana shakti 148

26 Distribution of patients by Vaya 148

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xiv

27 Distribution of patients by Vyayama Shakti 149

28 Distribution of patients by Poorva roopa 150

29 Distribution of patients by Anubandha vedana 152

30 Distribution of patients by Pradana vedana 153

31 Distribution of patients by Snehapana kalavadhi 155

32 Samyak snigda lakshanas in both groups 160

33 Mean effect of panduta 165

34 Mean effect of Agnimandhya 167

35 Mean effect of Arohanayasa 170

36 Mean effect of Brama 172

37 Mean effect of Dourbalya 174

38 Mean effect of Hb% 176

39 Mean effect of Total Count 178

40 Mean effect of Platelet Count 180

41 Mean effect of Lymphocyte Count 182

42 Mean effect of Esnophil Count 185

43 Mean effect of ESR 187

44 Mean effect of Total RBC 189

45 Mean effect of PCV (%) 191

LIST OF PHOTOGRAPHS

Figure No.

Figures showing the Page No

1 Digestion and Absorption of Fat

55

2 Emulsification of Fat 55

3 Micelles 56

4 RBC and Hemoglobin 96

5 Jeeraka choorna 101

6 Draksha 104

7 Ghrita 105

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xv

LIST OF FLOW CHARTS

Chart No.

Flow charts showing the Page No

1 Snehapachana 53

2 Nidana and Samprapti of Panduroga 73

3 Nidana sevana 74

4 Mrudbhakshanajanya Pandu 75

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 1

INTRODUCTION

Ailment is the inseparable companion of life. Springing up of many ailments

triggers the effort to heal the same, resulting in the development of Medicine in every

country whether primitive or advanced. Ayurveda is one of the oldest systems of health

care dealing with both the preventive and curative aspects of life in a most

comprehensive way. Ayurveda provides not only curative measures but also preventive

principles for healthy and long life. Restoration of dhosha, dhatu and mala to a state of

equilibrium is the main aim of chikitsa in Ayurveda and it also gives equal importance to

Prasanna, Atma, Indriya and Manas i.e. Manasika Swasthya.

Colour has been one of nature’s subtlest expression of conformities and

infirmities, the former being a poet’s passion and the latter, the object of medical

profession. Generally we see that the character of an object is proportionate to the

intensity of its colour, the more the intensity of the colour, the stronger the

character.Paleness has been associated with inadequacy, be it a fruit or man. Pandu is a

Varnopalakshita vyadhi wherein paleness is pathogenic. Anaemia is a disease that has

similar paleness, constitutional symptoms, pathogenesis and etiology.

Lacuna in current knowledge:

A research has shown that the incidence of anaemia is the highest in females,

whereas in males the numbers are lower. Also those women with a poor diet and low

economic status and living style are more vulnerable to this condition. It is often

criticized that Ayurvedic science is occult and subjective. But in fact it has derived its

principles by logical analysis and intellectual exercises. Although Draksha Gritha has


been described by the Acharyas as an ideal therapy for Panduroga,studies showing its

efficacy in alleviating this disease have not been undertaken on a large scale especially a

study comparing the efficacy of Arohana krama Snehapana and Sadharana krama

Snehapana in Panduroga is unavailable.

Incidence and Prevalence

Globally, 30% of the total world populations are Anaemic and half these, ie;

around 600 million people have iron deficiency. Iron deficiency Anaemia (IDA) is most

prevalent nutritional problem in the world today. Young children and women of

reproductive age group especially pregnant and lactating women are at greatest risk.

Though prevalent in all countries, IDA is most widespread in developing countries where

prevalence of this disease may be as high as 60-70% in pre-school children and 60-80%

in pregnant women.

Purpose of the study

The modern management of Anaemia is mainly oral therapy and parental

therapy for correcting iron deficiency. These in spite of many advantages still remains

unsatisfactory. Oral therapy can cause nausea, abdominal discomfort, diarrhoea, and

constipation as side effects and it almost turns stool black, which is harmless side effect.

The adverse effect of parental therapy includes hypersensitive reactions, haemolysis,

hypotension, and circulatory collapse, vomiting and muscle pain. Blood transfusion,

which is said as emergency treatment, can rise in Hb up to 1gm with a single unit. But it

can also cause some complication like acute intravascular hemolytic reactions, febrile


non-hemolytic reactions and allergic reactions. Thus it is important to search a safer, cost

effective therapy, which could be explored from the Ayurveda. Snehapana is one such

therapy, which can give wonderful results in many diseases including Panduroga.

Charaka has praised the importance of Draksha Ghrita in Chikitsa sthana

which is indicated in many disorders including Panduroga. In this study the patient

suffering having lakshanas of Panduroga were administered Snehapana therapy, with

specially indicated Draksha Ghrita in both Arohana and Sadharana Krama vidhi.

Panduroga is mentioned in Brihattrayi, Laghutrayi, and other classical texts.

This is a pitta pradhana tridoshaja vyadhi in which rasa and rakta are mainly affected.

Charaka opines that due to excess intake of pitta prakopaka ,tridosha prakopaka ahara,

viahara the vitiated doshas assumes sthanasamshraya in between tawk and mamsa

resulting in pandu, harita, and haridra varna to the skin. Hence, the disease is named as

Panduroga.

Panduroga can be correlated with “Anaemia” in modern medicine. It refers to a

state in which the level of haemoglobin in the blood is below the normal range (M-

14.0g/dl F-12.3g/dl) appropriate for the age and sex.

Almost all the Acharyas have given the prime importance to Snehana therapy

as Poorva karma, Pradhanakarma and Paschat karma according to the need of the person

or disease. Acharya Susruta beautifully delineates the importance of Sneha as

follows“Human being is composed of Sneha, prana predominantly contains Sneha.

Hence prana can be protected or preserved by Snehana”.


By examining the Rogabala, Doshabala and Shareera bala, the proper Sneha

should be administered after the complete digestion of food which was taken in the

previous night and Snehas are given in certain specific quantity in the increasing order for

specific number of days or till Samyak Snigdha Laxanas get manifested.

Research question

Whether internal administration of Draksha Ghrita in the form Arohana and

Sadharana krama Snehapana is effective in Panduroga or not?

Hypothesis:

By administrating the Draksha ghrita snehapana, it will be beneficial in

relieving the symptoms of Panduroga.

Research is mainly focused on bringing changes in subjective parameters

like Panduta,Dourbalya,Arohanayasa,Agnimandya and increasing of

Haemoglobin percentage is the research point.

Hence the present work titled as the “evaluation of comparative efficacy of Arohana

& Sadharana krama snehapana in panduroga.” is undertaken .

This study highlights on both theoretical and clinical aspects related to this disease. The

contents are divided into the following chapters:

Chapter I

Highlights on the historical aspects of both Snehapana and Panduroga.


Chapter II

Deals with conceptual study of both Snehapana and Panduroga It covers all the

relevant matters pertaining to the procedure and the disease.

Chapter III: Drug profile.

Details of all the ingredients and their role in the disease are dealt with.

Chapter IV: Methodology

Details of the clinical trial of Draksha Ghrita Snehapana in Panduroga are furnished.

Chapter V: Discussion

Discussion on both Snehapana and Pandu roga, discussions on the clinical trial with

observation and results have been described.

Chapter VI: Summary and Conclusion

Complete abstract of the dissertation and the conclusion are enumerated.


OBJECTIVES Blood is very essential for life, and nature has devised a very ingenious method

to continuously supply blood to every part of the body, in fact to every cell of the body.

Oxygen along with other nutrients is supplied continuously by the circulating blood, with

the heart at the center of this system.

Panduroga is a disease characterized by pallor of body which strikingly

resembles with ‘Anaemia’ of modern science,a disease characterized by the reduction in

number of Rbcs per cumm of Blood and quantity of Hb resulting in pallor like other

symptoms. Rakta has been considered as a key factor for the Jeevana, Prinana Dharana

and Poshana karma of the body. Many times it is seen that Rakta gets vitiated by Doshas,

mainly by Pitta dosha as Rakta is Pittavargiya and disease like Pandu appear. In

Ayurveda, Pandu is considered as a specific disease with its own pathogenesis and

treatment.1, 2

Anaemia has a very high global incidence3. It poses serious health problems

because it causes general weakness, lethargy, lassitude, sub-optimal work performance

and in certain situations mental retardation, poor intelligence and abnormal immune

response.4 The problem of nourishment is worldwide; it has assumed gigantic proportion

in the underdeveloped and developing countries. The main cause of Anaemia is

malnutrition.

In modern medicine, there is good treatment for Anaemia with considerable

result but that is only for acute deficiencies Anaemias. No significant therapy is available

for chronic Anaemias which occur due to metabolic defects. Ayurveda can provide better

management in this area.


By keeping the above point here an attempt is made to assess the efficacy of

both Arohana and Sadharana Krama Snehapana and to conclude which kind of

Snehapana is more beneficial in the management of Panduroga.

Objectives of the study:

To evaluate the efficacy of Draksha Ghrita Arohana krama Snehapana in

Panduroga.

To evaluate the efficacy of Draksha Ghrita Sadharana krama Snehapana in

Panduroga.

To evaluate the comparative efficacy of both the groups.

Reasons to Choose Following Therapy for Present Study:

Snehapana with Draksha Ghrita

Panduroga, a disease which is mainly characterized by, Panduta, Dourbalya,

Arohana ayasa, Brama, Agni mandya, Aruchi, Rakta heenata etc. in the contemporary

science anemia is characterized mainly by the decrease of the hemoglobin, which show

symptoms like Pallor, Tiredness, Fatigue, Muscular weakness, Lethargy, Anorexia and in

older patients symptoms of intermittent confusion and visual disturbances. Comparing

both the systems we can reach to conclusion that Panduroga in Ayurveda may be

compared with Anemia in the contemporary science.

The treatment should target in rectifying the above said problems. Here in this

study Snehapana with Draksha Ghrita is selected, since Acharya Charaka has mentioned

in his sutra sthana regarding the qualities of the Ghrita.

It mainly mitigates vata and pitta, it enhances the qualities of bala,varna and also

it increases the dhatus like rasa, sukra and ojus5. The qualities of Ghrita are Vrishya,

Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara, Papahara, Rakshoghna,


Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya, Rasayana, Sugandha, Rochana,

Smriti vardhaka, Rasa, Shukra vardhaka.

Draksha has the following qualities like snehopaga and Virechanopaga according

to Charaka. Draksha has the properties like Madhura rasa, Madhura vipaka and Sheeta

veerya does both the rakta and pitta shamana. This Draksha is processed with Ghrita;

which is best among the pitta shamaka. Draksha has the property of Rakta prasadana; so

that shuddha rakta is formed properly which is very essential in this condition. Because

of it snigdha and snehopaga6 property it helps in achieving the samyak snigdha lakshana

quickly. In Ashtanga Sangraha sutrasthana Ghrita are explained as best for snehana

(snehanam uttamam)7 and it is the best pitta shamaka.8

Research works done on Panduroga

01. Deshapande Swati S. – Clinical study of Panduroga and its Management with

Mandoora bhasma.

02. Pandey Shashi – Effect of Pathya ghrita in cases of Pandu.

03. Kottarshetti Irranna – The effect of Guda Nagaradi Vati in Panduroga.

04. Basavaraj R. – A Comparative study on the effect of Dhattriavaleha and

Kaseesa bhasma in Panduroaga w.s.r.t. to Iron deficiency

Anaemia.

05. Lobo Zenica – Evaluation of the effect of shuddha Kaseesa and Loha

Bhasma in Panduroga w.s.r.t. Iron deficiency Anaemia –

A comparative study.

06. Jaiswal Vipal – Efficacy of Ashta Dashanga lepa in the management of

Panduroga.


HISTORICAL REVIEW Sneha karma An up-to-date review of all the references available for Snehakarma

from Vedic period to the modern period is quite essential in this study.

Veda Kala: (4000-6000 BC)

Vedas are considered as the oldest recorded credentials, where in lies

some of the earliest evidence of the diseases and treatment. Abundance references of

therapeutic use of Sneha can be found in the Atharva Veda. In Atharva Veda Ghrita

has been described vividly but there is hardly any information regarding Snehapana.

The Materia Medica of Atharvanas contains references regarding the use of plant and

animal products as Snehadravyas like Ghrita, taila. In Rigveda, the word Ghrita is

used as a synonym for the nutritious diet. Also capacity of Ghrita to kindle Agni is

described. The description of qualities of Ghrita and taila as snehadravyas is also

found in Rigveda.9

Charaka Samhita: (1000 BC)

Among the classical literatures of Ayurveda, Charaka Samhita is the oldest, which

contains ample but scattered matter regarding the Snehana therapy. In the Very first

chapter of sutra Sthana, Mahasneha, and properties of four Sneha are described. In

second chapter, it is quoted that after Snehana and Svedana, Panchakarma should be

administered in proper dose and at suitable time. Acharya describes in detail about

Shadvidopakramas in Sutra sthana10. The 13th chapter of Sutrasthana in Charaka

Samhita explained in detail about Snehana11. He has extensively described about the


properties, sources, indications, and contraindications of Sneha dravyas. References

regarding Shodhananga snehana are found in the Siddhisthana12 of Charaka Samhita.

Susruta Samhita: (1000-1500 BC)

In Susruta Samhita, the description about Panchakarma Chikitsa was started from the

Snehopayougika Chikitsa Adhyaya of Chikitsa Sthana. All the information pertaining

to all types of Snehana is mentioned here along with the Snehapana Karma in a

beautiful manner. He had given prime importance to Sneha by explaining the quote

“Sneha saro ayam purushaha” An entire chapter in Chikitsa sthana of Susruta Samhita

deals with the topic of Snehakarma. In this he has described the use of Sneha in the

Shodhana and Shamana of various diseases including surgical ailments. The

preparation of Sneha has been described by him in this chapter13. The classification of

Snehana into Shodhana, Shamana and Brumhana on the basis of its Karmukata is also

found in Susruta Samhita.

Astanga Sangraha & Astanga Hrudaya :( 5th cent AD)

In Astanga Sangraha sutra sthana, the Snehana is described in elaborative manner14,

while in Astanga Hrudaya sutra sthana description is available in verse form. In both,

for the first time they have introduced the Hrasiyasi Matra (trial dose) of Sneha which

is very important in the clinical practice.15

Kashyapa Samhita (6th cent. BC)

Kashyapa has devoted a full chapter for Snehana Karma. All the description

pertaining to the all types Sneha is given. The 22nd chapter of Kashyapa’s

Sutrasthana has references regarding the use of Sneha in the treatment of various

Balarogas16.


Bhela Samhita (1000 BC): In the Sutra Sthana 14th chapter, the Snehana therapy is described. The mode of

action of Snehana as a Poorva Karma is beautifully narrated in a sloka that, “due to

Snehana, at the place of Vikriti, there will be an increase in Rasa and Klinnata is

generated”. Acharya Bhela had given the simile that, as water flows from upper level

to lower level, likewise after Snehana, Doshas came towards Koshta from all the

sides of body. The uses of Sneha in the treatment of various diseases have also been

mentioned. 17

Kalyaņakaraka (9th cent AD):

This is the first text to describe very clearly that, the dose should be given in

Vardhamana Matra.(Kramad Vardayeth)

Vangasena (12th cent AD):

Vangasena's Snehapanadhikara is of very much important as he has specified some

Practical points regarding the Sneha Pana. The complete dose Schedule of Jaghanya,

Madhyama and Uttama Matra is given. He also describe the dose Schedule in

ascending pattern in an explicit way18.

Sharangdhara Samhita (13th cent AD):

A separate chapter was devoted to the Snehana Karma in Uttara khanda in which

procedure, dose, time, indications, contraindications of Sneha, Ayoga, Samyaka Yoga

& Ati-yoga symptoms are described. He was the fisrt to mention the Dose of Sneha in

Numericals i. e, Pala & Karsha Pramaņa19.


Harita Samhita:

Qualities of each ghrita and their specific indications have been mentioned in 8th

Chapter in Harita Samhita. Gunas of purana ghrita also explained in this chapter20.

Bhavaprakasa (16th cent AD):

In Purvakhanda, a full description of Snehapana vidhi has been made. The days for

Snehana and Matra were mentioned on the basis of the Koshţha and Agni.21

Chakradatta (11th cent AD):

One full chapter on Sneha adhikara has been described, in which all the details

regarding the sodhana Sneha is narrated22

Adhunika Kala

The Kokate’s textbook of Pharmacognocy23 and the Teiz’s text book of clinical Bio-

Chemistry24 describes in detail about oils, fats, classification of ghee and properties of

ghee.


SNEHAPANA KARMA Among the Panchakarmas, Snehanakarma is regarded as the most important

preparatory measure before Shodhana therapy like Vamana and virechana25. Snehana

karma helps in the alleviation of the vitiated doshas before Shodhana therapy and it

also imparts strength and unctuousness to the body 26. As per the literature found in

Charaka Samhita, Snehakarma has been included as one of the Shadvidhopakramas

and can also be considered as treatment 27. In the treatment regimen, Shodhana

therapies are major procedures or Pradana karma. They are preceded by certain

preparatory procedures known as Poorva Karma and followed by certain recovery

procedures known as Paschat Karma. The entire Shodhana procedure depends upon

the proper mobilization of Doshas from the channels, which is achieved with the help

of Snehana and Svedana. Out of these two, the Snehana is a major procedure which

leads and decides the whole outcome of Shodhana procedure.

NIRUKTI OF SNEHA

The word Sneha is Masculine in gender and is derived from ‘Snih’ Dhatu

by suffix ‘lyut’Pratyaya. (Vachaspatya ) 28. There are two meanings to the mool word

Snih ie: one implying ‘Snih – Snehane’ to render lubrication and the other --‘Snih -

Preetau’ to render affection. But when the present context is considered the first one

holds more meaning. Thus Sneha is a substance which brings oiliness or

unctuousness. The literal meaning of word Sneha is oiliness, unctuousness, fattiness,

greasiness, lubricity, viscidity, affection, love, kindness and tenderness.(Monier

Williams 1889 & Apte 1970)29.


PARIBHASHA OF SNEHA:

‘Snehanam snehavishyand mardavakledakarakam’30

According to Charaka measures adopted to bring about Snigdhata in the

body is known as Snehana. According to him it is a procedure by which Snigdhata,

Vishyandana, Mardavata and Kledana can be obtained in the body.

As per Charaka Samhita the value of Sneha can be described as

“Snehoanilamhanti mrudukarotideham, Malanam vinihantisangam” which means

that Sneha brings about a balance in the vitiated vata, softens the body and eliminates

the accumulated malas which have obstructed the srotamsi 31.

As per Rajanighantu the word Sneha means the external application of Sneha

dravyas32

SYNONYMS

The word Snehana has many synonyms which are Sneha, Snigdhata,

Mrtkshana, Mrksha, Abhyanga and Abhyanjana 32.

GUNAS OF SNEHA DRAVYAS: 33, 34, 35

The different functions of a drug are due to the various gunas of the

dravyas. The various Gunas desirable for Snehadravyas are Sukshma, Sara, Snigdha,

Drava, Picchila, Guru, Shita, Manda and Mrdu. But all drugs having these Gunas do

not produce Snigdhata. Acharyas have used the word Prayo while describing the

properties of Snehadravyas due to certain variations noted.

Table No. 1: Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of Sneha

Dravys36.


Guna Dominent Mahabhutha

Karmukata Prathvi Ap Teja Vayu Akasha

Picchila ++++ Lepana, Jivana, Samghata, Sandhana, Balya, Gouravata

Sukshma ++ ++ +++ Sroto Vishodhana, Vivarana, Soushiryakara

Sara ++ + Anulomana, Vyaptisheela, Preranasheela

Snigdha + ++++ Snehana, Mardavata, Kledana Bandhana, Vishyandana,

Drava ++++ Prakledana, Vilodhana, Prasari.

Guru ++++ ++ Brumhana, Malavriddhikara, Tarpana, Angaglani, Balakara,

Shita +++ ++ Sthambhaka, Hladana

Manda ++ + Shamana

Mrdu ++ +++ Shaithilya of Avayava, Mardavata.

By the above table it can be concluded that Snehadravyas are predominantly

apyamahabhuta.

MAHA SNEHAS OR PRAVARA SNEHA 37, 38, 39

Ghrita, Taila, Vasa and Majja are considered the most important among all

the Snehadravyas due to excellence in Snehana qualities.

Sneha Action of Different Snehadravyas on Various Doshas 40

On Pitta Dosha- Ghrita – Pittaghnatama

Vasa - Pittaghna

Majja - Pittaghnatara

On Vata Shleshma- Taila – Vatashleshmaghnatama

Majja - Vatashleshmaghna

Vasa - Vatashleshmaghnatara


PROPERTIES OF GHRITA 41

Table No. 2: Showing Properties of Ghrita

Rasa Virya Vipaka Prabhava Guna

Madhura seeta Madhura Agnideepaka Snigdha, Mridu, Guru, Manda

Ghrita Karma 42, 43

It mitigates the Pitta & Vata; enhances the Svara, Varna, Teja, Bala ,Rasa, Sukra and

Ojas; Chakshushya, Medhya, Vayasthapaka, Dahashamaka, Alpa Abhishyandi,

Vrashya, best for Kshata Ksheena and Sosha.

Seasonal indication: Sharad Rutu.

Indications of Ghrita Snehapana 44

VataPitta Prakriti, Vata Pitta Vikari.

Those desires of longevity, Bala, Varna, Svara, Pushti, Smriti, Medha, Dhee, Agni.

Among all the Sneha Dravyas, Ghrita, Taila, Vasa and Majja are the most

important Snehas because of their excellence in Snehana qualities. Among these four

Sneha, Ghrita is considered as superior Sneha Dravya because of its following

characters,

(i) Samskarasya Anuvartanam - With its own qualities intact, it has the ability to

transform itself so as to imbibe the qualities of the substance added to it. This

property is not so prominent in other Sneha.

(ii) Madhuryat - Sweet in taste

(iii) Avidahitvat - Not causing Vidaha

(iv) Janmadyeva Cha Sheelanat – Being used since birth.


Taila also possess the potential of adoptability to some extent. Vasa is said to be the

most effective Snehadravya in Vata rogas because it is Dhatu Kshayahara and

Avritapathasodhaka. Vasa can be extracted by solvent method extraction or boiling

flesh with water. It fills the muscles and is a part of the adipose tissue. It is indicated

in cases of fractures, dislocations, etc. Majja plays an important role in the

production of sukra. This strengthens bones, softens Krura Koshţha.

CLASSIFICATION OF SNEHA

Classification of Sneha Dravya according to their origin:

All Dravyas are classified under three types according to their

origins i.e. Parthiva, Jangama and Audbhida or Sthavara. Hence, Snehas are also

having the same origin. However, Ayurveda recognizes Sthavara and Jangama

Snehas only. They are extensively used in therapeutics. Mineral oils are being used in

modern therapeutics such as Paraffin. (Liquid paraffin is used as laxative, soft

paraffin is used in ointments and hard paraffin is used in wax bath etc.) Although

Ayurveda has not separated the mineral oil substances as different Sneha dravyas.

Sneha dravyas belonging to Jangama origin are classified as 'Prakrita’ and 'Kritrima’.

The animal fat has been also classified on the basis of types of animals like Khagaja,

Mrigaja and Jalaja. In modern system of medicine, many animal origin oils like cod

liver oil, shark liver oil etc. is also used. Classification of Sthavara Snehas (fats from

plant kingdom) depends on the parts of the plants from which it is procured. Susruta

has mentioned the classification in Chikitsa Sthana 31st chapter.

I. BASED ON YONI (SOURCE) 45,46

Snehadravya is divided into the following based on the source


1) Sthavara (Vegetable origin)

2) Jangama ( Animal origin)

1) Sthavara (Vegetable origin)

Sthavara Snehadravyas are those which are of plant

origin. The main sources of Sthavara Snehadravyas are Phala, Sara, Mula,

Tvak, Patra & Pushpa.18 Ashayas of Sthavara snehadravyas have been

described in Charaka Samhita.

Table No. 3 Source of Sthavara Sneha according to Charaka47

Tila Sarshapa Eranda Bibhitaki Priyala Abhishuka

Bilva Moolaka Chitra Atasi Madhuka Kusumbha

Akshodha Abhaya Karanja Shigru Nikothaka Haritaki

The classification Sthavara Sneha by Sushrutha is according to their action

Table No. 4 Sushruta’s Sthavara Sneha classification48

Action

Virechanopayogi Pittasamsrusta Vayu Upayogi Vamanopayogi Krshnikarana Upayogi Shiro Virechanopayogi Pandukarana Upayogi Dushta Vranopayogi Dadru, Kushta, Kitibha Upayogi Maha Vyadhi Upayogi Ashmari Upayogi Mutra Sangopayogi Prameha Upayogi

2)Jangama Sneha (Animal Origin)

Jangama Sneha refers to the Snehadravyas which are of animal origin.

The common examples are Kshira, Dadhi, Ghrita, Mamsa, Vasa, Majja etc.


Table No. 5 Jangala Sneha & their Ashaya:

Sneha Ashaya Ghrita Ksheera & Dadhi

Taila Phala & Daru

Vasa Mamsa Majja Asthi

II. PAKA BHEDA

Table No. 6 Paka Bhedha of Sneha 49, 50, 51

Snehana Caraka Sushruta Sharangdhara

Abhyanga Khara Madhyama Madhyama

Pana Madhyama Mrdu Madhyama

Nasya Mrdu Madhyama Mrdu

Basti Madhyama Khara Madhyama

Karnapurana - Khara Madhyama

III. SAMYOGA BHEDA 52

Yamaka Sneha: The combination of any two Sneha is known as Yamaka

Sneha, for example Sarpi + Vasa and so on.

Trivrit Sneha: The combination of any three Sneha is known as Trivrit

Sneha, for example Sarpi + Vasa + Majja and so on.

Maha Sneha: The combination of all the 4 Sneha is termed as Maha

Sneha.

These Sneha combinations are used both internally and externally in Samsarga

and Sannipatika condition of Dosha.


Samyoga Bheda

Yamaka Sneha Trivrut Sneha Maha Sneha (Ghrita + Taila ) (Ghrita+Taila+ Vasa ) (Ghrita +Taila +Vasa+

Majja)

IV. UPAYOGA BHEDA 53.54,55

Sneha is classified into the following on the basis of their route

of administration

1) Abhyantara Snehana (Pana, Basti, Nasya, Bhojana)

2) Bahya Snehana (Abhyanga, Lepa, Udvartana)

Table No. 7 Upayoga Bheda

Abhyantara Snehana Pana, Basti, Nasya, Bhojana

Bahya Snehana Abhyanga, Lepa, Udvartana

V. PRAYOGA BHEDA 56,57

Sneha is divided into 2 types on the basis of the method of administration.

1) Accha Peya

In this method Sneha is given without mixing with any other dravya.

2) Vicharana Snehana

In this method Sneha is mixed with various preparations like Vilepi ,Yavagu

etc.


VI. ACCORDING TO VISHISTHA SAGNA 58, 59, 60

Vishistha sagna

Sadyo Snehana Pancha Prasrta Peya Achapeya

VII. MATRA BHEDA 61,62

In this Sneha is classified on the basis of the dosage of the

snehadravya.

In the classical ayurvedic textbooks the dosage of the Snehadravyas is based on

the time taken for its digestion. It is as follows

(i) Hrasva Matra - The dose of Sneha that is digested within 6 hours.

(ii) Madhyama Matra - The dose of Sneha that is digested within 12 hours.

(iii) Uttama Matra - The dose of Sneha that is digested within 24 hours

Another matra called Hrasiyasi Matra has also been mentioned by Vagbhata

which pertains to the quantity of Sneha, which is digested within three hours of

ingestion. This is used when the Kostha of the person has not been properly

diagnosed 63. Hrasiyasi Matra is a trail dose, which is administered on the first day of

Snehapana.

Table No. 8 Opinion about Sneha Matra 64, 65, 66

Author Hrasiyasi Matra Hrasva Matra Madhyama

Matra Uttama Matra

Hemadri 1 Pala, 2 Pala, 4 Pala, 6 Pala - - -

Sharangdhara Chakradatta - 2 Tola 3 Tola 4 Tola


Table No. 9 Sneha Matra according to Susruta 67

Dose Time required for digestion Action Indication

Sadharana Matra (1/4th day)

3 Hrs. Agnidipti Alpa Dosha Atura

Bruhmana Matra (1/2 day)

6 Hrs. Brumhana,

Vrushya Madya Dosha Atura

Prabhala Dosha Matra (3/4th day)

9 Hrs. - Bahu Dosha Atura

Shrestha Matra (Full day)

12 Hrs. - Glani, Murcha, Mada

Uttama Matra (Day & Night)

24 Hrs. - Kushta, Visha, Unmada,

Graha, Apasmara Table No. 10 Indications of Sneha Matra 68, 69

Dose Criteria for selection of Action Person Disease Uttama Matra

Prabhuta Sneha nitya Kshut–Pipasa Saha Uttama –

Agnibala ShariraBala Manasa Bala

Gulma Sarpa-damshtra Visarpa Unmatta Mutrakrcchra GadhaVarcha

Shighravikara Shamana Doshanukarshini Pervades through all marga Balya Rejuvenates-body, sense organs and mind

Madhyama Matra

Madhyama – Sharira bala Manasa bala Agnibala Mrudu Koshta

Arushka Sphota Pidaka Kandu Pama Kushta Vatarakta

No much complication Does not effect strength much Brings Snehana comfortably Used as Shodhanartha Snehana

Hrasva Matra

Vriddha Bala Sukumara/Sukhocita Mandagni Durbala/Avara bala Person not able to withstand hunger.

Chronic condition of disease like-

Jvara Atisara Kasa

Brumhaniya Snehaniya Vrushya Balya Long lasting benefits Does not cause

Complications


VIII. KARMUKATA BHEDA:

This refers to the classification of Sneha on the basis of its action. The

3 types of Snehana on the basis of action are

Shamana Snehana, Brumhana Snehana and Shodhana Snehana

(i) Shamana Snehana:

According to Charaka, Shamana Snehana is a procedure by which Madhyama Matra

of Accha Sneha is administered during Annakala when one feels hungry without

taking the meal. 70, 71 According to Hemadri , Shamana Snehana is one which

normalizes the aggravated doshas without expelling them and disturbing the normal

doshas. 72

(i) Brumhana Snehana:

‘Bhrumhana Snehana’ refers to the Sneha which is given for Bhrumhana. As per

Astanga Sangraha Brumhana Snehana is the administration of Sneha along with

Mamsa Rasa, Madya, Ksheera etc.73 Brumhana Snehana if given before food cures

Adhobhaga rogas, in the middle of food cures Madhyama bhagarogas, after food

cures Urdhwabhaga rogas and strengthens the body 74. The dosage of Sneha used for

Brumhana Snehana should be alpa or even less than quantity of Hrasiyasi Matra 75.

(ii) Shodhana Snehana:

Shodhana Snehana refers to Uttama Matra of Accha Sneha administered in the

morning hours when preceding evening food has been digested but the individual has

shown less hunger70,71,76.


Arohana Snehapana:

The word Arohana stands for rising or ascending. The oral administration of Sneha in

the periodical increasing dosage is defined as Arohana Snehapana. The concept of

Arohana Snehapana has been described in detail by Vangasena.

Table No. 11 Opinion of Vangasena regarding dosage of Arohana Snehapana 77

Matra (Dosage)

DAY 1 2 3 4 5 6 7

Uttama 6 pala 7 pala 8 pala 9 pala 10 pala 11 pala 12 pala

Madhyama 6Karsha 7Karsha 8Karsha 9Karsha 10Karsha 11Karsha 12Karsha

Hrasva 3Karsha 3½Karsha 4Karsha 4½Karsha 5 Karsha 5½Karsha 6 Karsha

According to the opinions mentioned by Acharya regarding the Arohana Krama

Snehapana it is given until patient gets samyak snigda lakshana or up to 7 days.

SNEHANA YOGYA

The general indications of Snehakarma can be found in the classical Ayurveda

textbooks. But the decision regarding the type of Snehana and the implication of the

same appropriately in different conditions depends on the intelligence of the

physician.

Table No. 12 Shamana and Brumhana Snehana Yogya 78, 79

Abala Vata Vikari Vyayama – Madya – Stree nitya Bala Chintaka Vriddha Daruna pratibodha Madhyasevita Timira Krsha Abhishyanda Mandagni Ruksha Mrudukostha with alpa dosha

Shodhana Snehana Yogya:

Shodhananga Snehapana is one of the essential Purvakarma for Shodhana

and hence it is indicated in almost all the Shodhana Arha conditions. The Sneha

which is given in Ananna / Akshudha Kala, when the meal of previous night is


completely digested in Medium dose is called as Sodhana Sneha. Snehana used in the

Purva Karma of Sodhana is Sodhana Snehana. This is also known as Sodhananga,

Sodhanartha or Sodhanapurva Snehana

Table No.13 Showing General Indications of Snehana According to Different

Acharyas 80, 81, 82 , 83, 84

Snehya C.S A. S A.H S.S K.S I As a Poorva Karma i) Swedya + + + + - ii) Samsodhya + + + + -

II Different Stage of Life i) Vruddha - + + + -

ii) Bala - + + + - III In Different Conditions i) Rooksha + + + + -

ii) Krusha - + + + - iii) Abala - + + - - IV In Different Viharas i) Vyayama nitya + + + + + ii) Madhya nitya + + + + +

iii) Stree nitya + + + + + iv) Chintaka + + + + + v) Srama - - - - +

VI In Different Diseases i) Vatavikara + + + + - ii) Kshinasra - + + + -

iii) Ksheena retasa - + + + - iv) Abhishyanda - + + + -

v) Timira - + + + - vi) Daruna practibodha - - - + -


Table No. 14 Showing the Deserving Condition for Snehana 85,86,87,88

Ghrita Taila Vasa Majja Vataprakruti Pravruddha

shleshma Asthiroga Deepthagni

Pittaprakruti Pravruddha medhas Sandhiroga Kleshasaha

Vatarogi Sthoola Siraroga Snehasevi

Pittarogi Vatharoga Snayuroga Vatarogi

Chaksukama Vathaprakriti Marmaroga Krurakoshta

Kshataksheena Balarthina Kostangaroga

Vruddha Tanuthwarthina Vasasathmya

Bala Laghuvarthina Avruthavata

Abala Dhardhyarthina

Ayuprakasha kama Sthiaryarthina

Balarthina For snigdha twak

Swararthina For Sleshma twak

Pustikama Krimikoshta

Soukumaryarthina Krurakoshta

Agnideepti Nadeevrana

Ojus

Smruti

Medha Bhuddhi

Indriyabala

Daha

Shastraghata

Visha


Snehya

Before commencing the Snehana Karma proper, one should have to know the

conditions, where the Snehana Karma can be administered. The classical indications

of Snehana are furnished in the chart given below

SNEHA ANARHA:

The general contra indications of Snehana karma have been

described by various Acharyas. The Table No. 14 shows few of the Shodhana

Snehana Anarha conditions. Few of these conditions are analyzed below

i) Rukshana Arha: According to Charaka, Rukshana Anarha persons are

generally Abhishyandhya, Bahudosha, Rogas manifested in Marmasthana,

Urhusthambha. Snehana administered in such condition, further worsens

the condition 89, 90

ii) Dattabasti, Virikta : Agni becomes Manda soon after Basti and Virechana

and so Snehapana is contraindicated.

iii) Agni Vikruti : Both Tikshnagni and Mandagni are considered in

Agnivikriti 91

a) Tikshnagni : Sneha administered in this condition further aggravates

Agnibala which in turn leads to many complications such as Trishna

etc.

b) Mandagni : Sneha administered in Mandagni leads to Sneha Ajirna or

Ama.


iv) Mada and Murcha : - Although Shodhananga Snehapana is indicted in

Mada and Murcha, it is contraindicated during an attack of Mada and

Murcha.

v) Ksheerapa : The body of the child will have Snigdha Guna in Kshirapa

Avastha and so Sneha is contraindicated.

vi) Garardita : When Snehapana is administered in Garardita Sneha due to its

Vyavayi and Sara property further potentiates and facilitates the spreading

of the poison all over the body. Hence Sneha is contradicted in this

condition.

vii) Durdina : The chances of aggravation of Kapha and Mandagni is high in

the days with cloudy atmosphere. Hence Sneha is contraindicated.

viii) Ama Pradosha : Snehapana administered in Ama condition further

aggravates it because Ama and Sneha have homologues properties and so

it is contraindicated.

ix) Akala : Untimely administration of Sneha does not give the desired effect.


Table No. 15 General Contraindications of Snehana 92 ,93, 94, 95, 96

Asnehya C.S. S.S. A.H. K.S. Sh.S. Rukshanam Samshodhanadrute + Utsanna Kapha medasa + Kapha Prakopa,Dagdha + Abhishyanna anana guda + Nitya Mandagni + + Shleshma Pittopahata antaragni + Tikshnagni + Durbala + + + + Pratanta (Klamayukta) + Shranta + Shramanvita, Akala Prasuta + Garbhini + + Prasuta + Apaprasuta, Urustambha,Udara + Kshirapa, Ativruddha, Jadya, Glani + Madatura, Murcha, Trishna + + Talu Shoshi + Sneha Glani + Garardita + Amajahara + Anna Dvesha + + Arochaka + + Ajirna + + Chardi + + + + + Atisara + Vit Prakopa + Taruna Jvara + + + Sthula + + Gala roga + + Datta Vireka + + Datta Basti + + + + Datta Nasya + + + Akala, Durdina + +


SNEHANA PRAKARSHA KALA :97, 98, 99, 100

Prakarsha kala is defined as the time taken for Snehana procedure. The

process of administering Sneha to achieve the desired Doshotkleshana within a

specific number of days is called Shodhananga Snehapana. The minimum and

maximum number of days for Shodhananga Snehapana is 3 to 7 days respectively.

i.e. if the person has Mrdu Koshta - 3 days, Madhyama Koshta - 4 to 5 or 6 days and

Krura Koshta - 7 days.

According to Bhoja persons having Kaphaja, Pittaja and Vataja

Prakrti needs 3, 5 and 7 days of Snehapana respectively. According to

Vagbhata,Shodhananga Snehapana should be continued untill samyak Snigdha

Lakshana appears irrespective of any time limit.

Considering the different opinions regarding prakarsha kala, it can be

concluded that irrespective of Prakrti or Koshta, the duration of administration of

Shodhananga Snehapana should be till the appearance of Samyak Snigdha Lakshana.

Sneha Prakarsha Kala in 7 days101, 102, 103

Shodhananga Snehapana does Doshotkleshana in the

body. When Shodhananga Snehapana is continued after 7 days, then Sneha becomes

Satmya ie: the individual get accustomed to Sneha just as food article and fail to

produce Doshotkleshana. If the dose of administered Sneha is less, then it will fail to

produce the desired effect in 7 days and in such cases higher dose of Sneha should be

given after some interval.


SHODHANANGA SNEHAPANA VIDHI:

To understand Snehana process more clearly, the whole procedure can be

divided under three parts namely

I. Purvakarma

II. Pradhana karma and

III. Paschat karma.

I. PURVAKARMA:

Under Purva Karma, following points are to be necessarily considered

(i) Atura Pariksha,

(ii) Atura Siddhata,

(iii) Sambhara Sangraha

i) Atura Pariksha 104

Charaka has described the Dashavidha Pareeksha viz., Prakriti, Vikriti,

Sara, Samhanana, Pramana, Satmya, Satva, Ahara Sakti, Vyayama Sakti, and Vaya

for knowing the Bala Pramana and Dosha Pramana of the patient. Specific

importance is to be given in fixing the Agnibala and nature of Koshta. Atura

Pareeksha helps to easily assess the following

a. Snehana yogya and Ayogya.

b. Understanding Snehapana Prakarsha Kala.

c. Selection of appropriate Sneha Dravyas and Shodhananga Snehana method.

d. Matra nirnaya and Anupana.


1.Prakriti

The study of Prakriti helps in Selection of type of Sneha. In Pitta and Vata Prakriti,

administration of Ghrita is preferred. In Pitta-Vata type constitution also Ghrita is

given, even though he may be suffering from Kaphaja Vikaras. In the same manner,

in Vatika Prakriti Patients, taila is prefered. Moreover Prakriti is to be assessed for the

proper diagnosis and prognosis of the disease.

2. Vikriti

Vikriti pariksa comprises the study of Hetu, Dosha, Dushya, Prakriti, Desa and Kala.

3. Sara 4. Samhanana 5. Pramana 6. Vyayama Sakti

All of these four points are helpful in assessment of Bala of the subject. Bala will help

in selecting Snehana dravya and in fixing the dosage. Some persons will be weak by

nature Vagbhata clearly states that Sneha is contraindicated in persons who are

extremely weak because they don't have capacity to digest the Sneha. While stating

about the indications of Vasa and Majja persons who’s Dhatus are depleted by Vata,

Atap, Adhva etc. has been considered.

7. Satva

Satva is of three types, viz. Avara, Madhyama and Pravara. Satva Pareeksha helps us

to understand that whether the subject is co-operative to the therapy or not.

8. Ahara Sakti

This helps in assessing the Agni of the subject and accordingly the fixation of dose as

well as Vardhamana Krama of Snehana karma.

9. Satmya

While selecting & deciding the dose of Sneha, history of Satmya is essential.

According to some authors, habituated Sneha should be preferred.


10. Vaya

Persons in the stages like Vriddha, Madhyama and Bala will have to be subjected to

different types of Snehana, because during Balyavastha, the developing or growing

phenomenon will be prominent. In young childrens Sadyaha Sneha itself will be

sufficient. During Yuvavastha and Madhyamavastha, the sustaining or collecting

phenomenon will be prominent in the body. During old age or senility, growing

phenomenon completely ceases and degeneration starts. Depending upon these three

stages, suitable snehadravya will be used.

ii. Atura Siddhata

Individual Aturas should be prepared physically and mentally through

following procedures -

(a) Deepana – Pachana

(b) Diet regimen

(c) Manasopachara

a) Deepana – Pachana

In disease state, when sodhana Purva Snehana is to be employed, we

have to consider the Samavastha of the disease, and thus Amapachana becomes

essential. Deepana - Pachana drugs are Agni and Vayu Mahabhuta dominant. By

Deepana, appetite and quantity of food intake is increased and by Pachana, digestive

power is increased. Pachana Karma is for the digestion of Ama and also detachment

of morbid Doshas from the Dushya and Srotasa. If Snehana is done in Amayukta

Dosha then it leads destruction of Sanjna (sensory) perception and even also death.


Also Sarvangashrita Ama, the Shodhana, it should not be given without the Pachana,

Snehana and Svedana, otherwise destruction of body occurs. Ama is harmful to the

body so it is to be expelled out, from the body. For its elimination, it is to be brought

to Koshtha from Sakha. It is essential to take Deepana and Pachana before

undergoing Snehana therapy to eliminate Mandagni & Amavastha condition.

Deepana:

It is the drug which will enhances the state of Jatharagni. It increases appetite

remarkably and hence increases the better absorption of drug 105. The usual drugs

used for Deepana effect are Deepaniya Gana drugs 106, Guduchyadi Gana drugs107.

Pachana:

Pachana Dravyas are that which have the capacity of digesting Ama but doesn’t

increase the agni of an individual. Nagakeshara107, Pippalyadi Gana, Musthadi

gana108Dashamooladi gana etc are used for Amapachana purpose.

b) Diet regimen

Before starting the Snehana therapy, which type of food should be

taken has been described by Acharyas in order to avoid the Agnimndyadi Upadravas.

The food to be administered should be Drava, Ushņa and Anabhishyandi, which are

not too Snigdha and Asankeerņa, excessive quantity of liquid, help in the digestion of

food and does not remain in the Koshţha for longer period. Ushņa ahara also digested

early and helps in increasing the taste and Agni. It also helps in Vatanulomana and

mitigation of Kapha. The food stuffs should be consumed on the basis of Agni, Kala

etc. and quantity of food varies accordingly. By consuming Asankeerna bhojana there

is less possibility of developing Varieties of diseases. There are different Kinds of


incompatible foods mentioned by Charaka; they are Deaa, Kala, Matra, Satmya,

Veerya, Koshţha, Avastha, Krama, Samyoga, etc. Excessive consumption of Snigdha

food stuffs does not get digested timely and aggravate Kapha Dosha, hence excessive

Snigdha articles should not be administered before Snehana therapy.

Diet indicated for shodhananga Snehana 109,110,111

Drava – Liquid

Ushna – Warm

Anabhishyandi – not having ‘Abhishyandi’ property

Na Atisnigdha – Not too much Snigdha

Pramanayukta – Regulated quantity

c) Manasopachara

The complete procedure of Snehapana and Shodhana should be explained to

the individual prior to Snehapana since a large quantity of Sneha is administered and

because of the non-palatability, discomfortness felt during Sneha Jirna Kala,

individual might show aversion to drink the Snehadravya. So the individual should be

encouraged to drink Sneha and he should be given confidence for the same.

iii. Sambhara Sangraha

The required medicaments, first aids and essential materials to treat

the Vyapat should be kept ready 112.


II. PRADHANA KARMA

After careful management of Purva Karma, the Snehya patients are

to be selected for Pradhana Karma.

Pradhana karma includes

1. Administration of Sneha and Anupana

2. Observation of

a) Sneha Jiryamana Lakshanas and Sneha Jirna Lakshanas

b) Snigdha, Ati Snigdha and Asnigdha Lakshanas

1. Administration of Sneha 113

A person with an empty stomach should be made to take Sneha. Sun would

appear on the summit of the hill at dawn and lighten up the horizon with first shoots

of its vermilion tinted golden rays. Rites of benediction should be first done to the

subject before administering the Sneha to him in an adequate dose. After that he

should wash his mouth with warm water and quietly stroll about with his shoes on.

Susruta has mentioned first time about Sneha intake time i.e. 15 to 30 minutes before

Sunrise because then only Dosha Utklesha is possible. In Charaka Samhita the time of

Sodhana Sneha intake was mentioned as after the digestion of previous night’s meal.

For Sodhana Purva Snehana, a large quantity of Sneha is to be given. So the will

power of the subject should be encouraged. Rites of benediction give the mental

serenity to the patient. Due to odor and taste of Sneha, there may be dislike towards

Sneha and he may not co-operate. So the suitable methods should be adopted. It is


better to close the eyes of the patient by a cloth, during the administration of Sneha.

There may be the Lakshaņas like Hrillhasa, Chardi, Aruchi, Udgara are produced as

patient gets aversion towards Sneha. So to overcome these symptoms, Lemon juice,

Hot water may be given along with Sneha.

Anupana 114,115,116

Anupana given along with the Snehadravya helps in breakdown,

softening, digesting, proper assimilation and instant diffusion of the Sneha taken. It

also helps in refreshing the patient and gives pleasure and energy to the patient.

Anupana used for Chaturvidha snehas are:

Ushna jala – For Ghrita,

Yusha – For Taila,

Manda – For Vasa and Majja,

Anupana also influences the digestion of Sneha,warm water is used in case of Ghrita

which is seeta veerya, to make it quicker distribution. Taila being Ushņa Veerya

dravya is followed by Yusha. Manda being Laghu, Deepana, and Vatanulomana will

promote the quicker digestion of Vasa and Majja which are heavy for digestion. Thus

Anupana plays an vital role by its virtues. Salt also behaves as catalyst in bringing

about the results of Sneha rapidly. The dosage of the Anupana may be decided on the

basis of normal digestion capacity or according to the pharmaceutical process

involved.


2. (a) Observation of Sneha Jiryamana and Jirna Lakshana

‘Sneha Jiryamana Lakshanas’ are certain symptoms produced when the

administered Sneha undergoes various digestive phases. These Lakshanas do not need

any sort of therapeutic intervention and subsides after Sneha Jirna.

Production of kapha takes place during the first phase of paka avastha

which has similar qualities to sneha. . Thus production of kapha will be more than

which causes lalasrava. Jataragni will increases because of the large amount of sneha

administered and since Jataragni has Agneya quality it causes Trishna, Bhrama,

Murcha, and Daha.

The completion of Sneha digestion (Sneha Jeerna) is indicated by the onset of

symptoms like Kshut, Trishna, etc. In cases where the digestion of Sneha is doubtful

hot water should be given to drink to get Shuddha Udgara, Laghuta, and desire for

food. If the Sneha is not digested even after administration of warm water and takes

more time than required it should be eliminated by Vamana .After this cold water

sprinkling and applying of Chandna paste on scalp and cold water bath should be

done 117.

Table No. 16 Sneha Jiryamana and Jeerna Lakshana 118

Jiryamana Lakshana Jeerna Lakshana Shiroruja Shirorujadi Jiryamana Lakshana Prashamana Bhrama Vatanulomana Nishtiva(Lalasrava) Kshudha pravrtti Murcha Trishna pravrtti Sada Udgarashudhi Arati Laghuta Klama Trishna Daha


2. (b) Observation of Snigdha–Asnigdha–Ati Snigdha Lakshanas 119,120,121,122,123,124,125

The important laxanas of samyak snigdha, asnigdha and atisnigdhata have

been described by all acharyas which helps in deciding regarding the further

administration of swedana and shodhana therapies.

Evaluation of Snehapana based on parameters are like

Samyak Snigdha Lakshanas, Asnigdha Lakshanas and Ati Snigdha Lakshanas

i) Samyak Snigdha Lakshanas

The most important action of Shodhananga Snehapana is the attainment

of Samyak Snigdha Lakshana. Snehapana has to be stopped after observing these

laxanas.

Table No. 17 Samyak Snigdha Lakshanas

Lakshanas C.S. S.S. A.H. K.S. Sh.S Ckd Va Se

Vatanulomana + + + + + Deeptagni + + + + + + + Snigdha Varcha + + + + + Asamhata Varcha + + + + + + Purisha Mrduta - - - + - - - Adhastat Sneha Darshana - + - - - - - Gatra Mardavata + + + - + - + Gatra Snigdhata + - + - + - + Tvak Snigdhata - + - - - - - Anga Laghava - + + - + - - Klama - - - - - + - Glani - + + - + - - Snehodvega - - + - + - - Vimalendriyata - - - + - - - Medha - - - + - - - Pusthi - - - + - - - Dhrti - - - + - - - Kale Sharira Vrtti - - - + - - - Teja Vrddhi - + + - + + -


ii) Asnigdha Lakshanas

In individuals who have Asnigdha Lakshanas prior to Snehana therapy if

Snehana therapy is not done properly then these Lakshana persist at the end also. The

Physician should adjust the matra of snehana according to these Lakshanas .The

following are the Lakshanas observed if Sneha is not carried out properly.

Table No. 18 Asnigdha Lakshanas

Lakshanas C.S. S.S K.S. Va Se A.H. Grathita Purisha + + + + - Ruksha Purisha + + - - - Shushka Purisha - - + - - Vayu Pratilomana + + + + - Agnimandhya + - + + + Avipaka / Krcchrat Annnam Vipachyate - + - - + Anila Purita Udara - - - - + Gatra Rukshata + - + - + Gatra Kharata + - + + - Urovidahata, Dourbalya - + - - + Dourvarnyata - + - - + Adhrti - - + - -

iii) Ati Snigdha Lakshanas

If Snehapana is continued even after the appearance of Samyak

Snigdha Lakshana, it may lead to increase of Apyamsa in the body and result in the

manifestation of Atisnigdha Lakshana. Atisnigdha Lakshanas are as follows


Table No. 19 Ati Snigdha Lakshanas

Lakshanas C.S. S.S A.H K.S Sh.S Ckd Va Se Panduta + - - + + + + Gaurava + - - + - - - Jadya + - - + - - + Apakva Purisha + - - + - - + Purisha ati pravrutti - + + - + - - Guda Srava - - - - - + - Ghrana Srava - - - - - + - Mukha Srava - + - - + + - Pravahika - + + - + - - Utklesha + - + + - - + Aruci + - + + - - + Bhakta Dvesha - + - - + - - Adhmana - - - + - - - Tandra + - - + + - + Moha - - + - - - - Angadaha - - + - - - + Gudadaha + + +

III. PASCHAT KARMA:

Paschat Karma is the post operative procedures which are adopted for

betterment of patient to achieve optimum therapeutic benefits and to avoid any

complications. As long as Snehana is administered, so long strict regimen should be

followed. Paschat Karma can be divided into two.

Paschat Karma on the days of Snehapana.

Paschat Karma after attainment of Samyak Snigda Lakshana.


Paschat Karma on the days of Snehapana:126

(i) Guru Pravarana - covering body with thick cloth.

(ii) Nivata Shayana Sthitaha - residing in a room devoid of breeze.

(iii) Jaranantam Pratiksheta-awaiting digestion of Sneha.

(iv) Taking little quantity of Ushna Jalapana or any other specified

Anupana type of Sneha.

(v) When Sneha is digested taking hot water bath, and consuming Yavagu

etc.

(vi) During snehana the diet should be mrudu which affects in stimulation

of digestive power and lightness of abdomen.

Paschat Karma after attaining Samyak Snigdha Lakshanas 127,128,129,130

Shodhananga Snehapana is stopped after attainment of Samyak Snigdha

Lakshanas and process like Sarvanga Abhyanga, Svedana and Shodhana are

advised.

Pathya

a) Ushna Jalapana - Ushna Jala does Deepana, Pachana and Vatanulomana

properties and so helps in Snehapachana process.

(b) Bramhacharya - Helps in Snehana process.

(c) Kshapashaya - As day sleep and Ratri Jagarana aggravates Kapha and

Vata Dosha respectively, only night sleep is advised.


Apathya

a) Vyayama - Exercise

b) Uccha Vachana - Loud speech

c) Vega Samrodha - Suppression of Urges

d) Shoka, Krodha - Anger, anxiety.

e) Hima, Atapa - Mist, Sunlight.

f) Pravata - Open breeze

g) Atyasana-Sitting at a place for long time.

h) Neecha/Uccha Upadhana - Usage of too low or too high pillows.

Pathya- Apathya should be followed sincerely for equal number of

days during the course of Snehana therapy and after therapy also.

POST SNEHANA THERAPIES 131,132,133,134,135,136

The period between completion of Shodhananga Snehapana to the

day of Virechana or Vamana is known as Vishrama Dina. During this period the

individual will be subjected for Sarvanga Abhyanga, Svedana and provided with

appropriate diet.

SNEHA VYAPAT 137,138,139

Sneha vyapat results when there is faulty administration of sneha by the

vaidya without considering matra, kala, rutu, anupana etc. or if the patient does not

follow the rules during snehana karma.


(i) Ashu Utpanna Vyapat:

These disorders have acute onset and need immediate management.

Examples are

(1) Ajeerna (2) Aruchi (3) Amapradosha (4) Shoola

(5) Jwara (6) Anaha (7) Trishna (8) Sthambha

(9) Utklesha (10) Tundra (11) Samjna Nasha.

(ii) Chira Utpanna Vyapat :

These disorders manifest in due course of time. Examples are

(1) Kandu (2) Kushta (3) Grahani (4) Pandu (5) Arsha

(6) Shotha (7) Udara (8) Staimitya (9) Vakgraha.

These complications should be treated as explained in the various classical textbooks.

Sneha Vyapat Chikitsa 140,141,142

The different therapies to treat Sneha vyapat mentioned in the various

classical textbooks are

1 Upavasa/Trshna: Beneficial in Alpa Dosha Avastha and enhances Agni Bala.

2. Ullekhana: In Utklishta Dosha Avastha SadyoVamana is beneficial and is

also advised in conditions like Sneha Ajirna, Utklesha,

Snehajanya Trshna.

3. Svedana : In conditions such as Sthambha, Svedana is beneficial.

4. Rukshana: Rukshana therapy is highly beneficial in Sneha Atiyogajanya

Vyapat. Rukshana Dravya can be administered in the form of

Pana, Anna and Bheshaja.


Sneha Ajirna Janya Trishna Chikitsa 143,144,145

If Sneha Ajirna produces severe thirst, the patient’s head and face should be

splashed with cold water. . In cases where it does not relieve the thirst, the Pitta

dominant patient should be given Ruksha Anna and Sheeta Jala and then made to

vomit. In case of persons who have predominance of Kapha and Vata or all the

Doshas increased in equal proportion, Vamana is induced after giving Ushna Jala.

KARMUKATA OF SNEHANA

The importance attached to Snehana prior to the administration of Sodhana

therapies can be well understood by the Citation of Charaka. He says prior to the

application of these depletory therapies first Snehana and Svedana must be done. The

view can be emerged by the study related to the permeability of Sneha dravyas into

the innermost recess of the body. It can be recognized that Kalas which surround the

Dhatus and Srotamsi are semi permeable. Chakrapani favours this by saying that

every Dhatus have specific channels pertaining to it and by the channels concerned

with a particular Dhatus, other Dhatus will not be nurtured. Thus Sneha acts as a

solvent both for lodged Dosha and Dooshya and as well as unexcreted tissue waste

products.

When Doshas are present in their vitiated condition, they leave the

Shakha (periphery) and occupy the Koshta (central place) and their Linatva (latency)

withers away and Uthkesha Avastha (Patency) is acquired and it is in this Avastha

that Panchakarmas are indicated when vitiated Doshas have become Utkleshita and

when they have accumulated in Kostha and are not scattered in remote srotases.


1. Actions of Snehana:

The various actions of Snehana results due to the properties of

the Sneha Dravyas and so a thorough evaluation of the actions of these properties

Snehana is very necessary.146

a) Drava: The Snehadravyas impart some moisture to the Srotas which removes

impediment of doshas, helps in diffusion of Sneha over the body, helps in

Dosha Vilayana process and acts as a dissolving media to the Doshas by

Alodhana Sandhan Karaka property.

b) Sukhshma: The Sukshma property of Sneha helps it to easily enter into the

minute channels of body. Sukshma has Sroto Vishodhana property, thus

aiding in bringing the Doshas back to Koshta. According to some the

capabilities of dilatation of channels was the property which augments the

movement of Sneha Dravyas freely even through the minute channels.

c) Sara: The spreading of Sneha all over the body is brought about by the

‘Vyaptishilatva’ property i.e., spreading nature of Sara. The Prerana and

Vatanulomana action of Sara Guna helps in movement of Doshas back to

Koshta.

d) Snigdha : Snigdha brings There is a better conveyance of Dosha, Dhatu and

Mala due to the softness of Srotas brought about due to the Snigdha property.

e) Picchila: Shleshmala property helps the Sneha to come in contact with

Doshas for longer duration and thus brings about Dosha Utklesha. Arunadatta

has described these as Sandra & Chikkanattva. . The properties attributed to


this are Jeevana, which is shown on Raktadi Dhatus, Balya which imparts

strength and Sanghata by the compactness of morbid elements.

f) Guru: This property of Sneha is the one responsible for the increase in body

dimensions.

g) Shita: It keeps the intactness of the body .As a result of this quality it creates

satiety and prevents the occurrence of Murcha, Sveda and Daha.

h) Mrdu: It brings about Srotomardavata. By generating softness, laxity and

loosening the Dosha Sanghata.

Although the properties of Guru, Shita and Manda have been described

as those of Sneha, they have more of Shamana or Brumhana value than aiding in

Shodhana Snehana action.

According to Charaka Samhita Siddhisthana 147 when dealing with Snehana

Karya it is described that

i) Sneho Anilam Hanti

ii) Mrdu Karoti Deham

iii) Malanam Vinihanti Sangam.

The above said have been described as the functions of

Shodhana Snehana by Cakrapani and these actions of Shodhananga Snehana may

be analysed as follows .148

i) Sneho Anilam Hanti

Sneha has exactly the opposite Guna of Vata Dosha and hence

Sneha attains the proper Gati of Vata and helps to bring the Shakhagata Dosha

into Koshta. This explains why Vata Nigraha is one of the criteria mentioned


by Charaka to bring Doshas back to Koshta. Vatashamana effect of Snehana

can be known by observing Vatanulomana action.

ii) Mrdu Karoti Deham

Sneha brings softness in Dosha Sanghata, Srotas and Deha by

virtue of its Snigdha and Mrdu qualities which in turn brings the Doshas to the

Koshta in Utkleshana stage. This Mrdukarana effect of Sneha can be

confirmed by observing Gatra Mardavata.

iii) Malanam Vinihanti Sangam

The Snigdha and Vishyanda properties of Sneha overcomes the

Rukshata which causes Mala Sanga and thus the Sanga get relieved.

2. Importance of Shodhananga Sneha

The importance of Shodhananga Snehana can be substantiated with the

help of various references available in the classics.

As per Charaka Samhita Snehana should be administered first, then

Swedana and finally followed by Shodhana 149. The importance of Snehana has been

described by Acharya Sushruta as “Sneha saro Ayam Purusha: Pranascha Sneha

Bhuyistha: Sneha Sadhyascha Bhavati.”150 which means that Sneha is the saravastha

of the human body which believed to be present in all parts of the body and also in

the in prana. The word Prana includes Agni, Soma, Vayu, Satva, Raja, Tama,

Panchendriya and Bhootatma.

The process of eliminating the impurity of the body with the help of

Shodhana measures after deterging Utklesha with Snehana and Svedana can be


compared to the process in which the dirt of the cloth is washed with water after

deterging (with alkali etc.). The above said version is of extreme importance in

explaining the mode of Action of Snehana and Svedana as Purvakarmas before

Shodhanakarma in bringing Doshotkleshana. Among these two Purvakarmas,

Snehana by virtue of its Vishyandana properties, aids in bringing Lina and

Anutklishta Doshas to Utklishta Avastha 151.

When Snehakarma is administered as a preoperative measure to

Shodhanakarma the excited doshas are eliminated completely. This can be compared

to a process in which the inner portion of the vessel when it is smeared with ghee and

then is filled with water, the water can be removed completely without leaving a

single drop.

When Snehana therapy is used in proportion with the digestive power of

the individual it gets digested and it oleates only when administered in excess. This

can be compared to o process in which a cloth absorbs only a certain amount of water

and oozes out the water in excess.

The different ways to bring vitiated Doshas form Shakha to Koshta has

been described by Acharya Charaka which are as follows. 152

Vrddhi – By increasing

Vishyandana – By dissolving / by increasing fluidity of Doshas

Paka- By detaching the Dosha from the place of lodgment.

Srotomukha Vishodhanat – By clearing the orifice of Srotas.

Vata Nigrahat – By controlling Vata Dosha .


Hence Sneha acts in every aspect of the above processes to bring the

Doshas to the Koshta and bring about Utkleshana of the Doshas.

3. Karmukata of Shodhana Poorva Snehapana

The inclusion of Snehana as a Purvakarma to various Sodhana

procedures can be attributed to the following actions

a) It acts as a solvent.

b) It increases the Apyamsha of the body.

c) It brings the lodged morbid and unexcreted waste products to gastro

intestinal tract.

Action as solvent

As per Sushruta a disease is produced due to the sthana samshraya of

vitiated Doshas through srotases during their circulation in the body 153. When Sneha

is administered inside the body it reaches the Srotamsi and acts as solvent to remove

obstruction by dissolving those morbid factors in it thus resulting in the removal of

Sroto vibhandha which is one of the important steps in the Samprapti Vighatana.

The study related to the permeability of Dravyas into the innermost recess of

the body confirms this view and it also can be seen that the Kalas which surround the

Dhatus and Srotamsi are semi permeable 154.

This view is favoured by Chakrapani who opines that every Dhatu will have

specific srotases pertaining to them and by the srotases concerned with a particular

Dhatu, other Dhatus will not be nourished 155


Therefore in short Sneha acts as a solvent both for lodged morbid factors and

for unexcreted tissue waste products.

Increases the Apyamsa of the body

Sneha by virtue of its predominance of Apa Mahabhuta 156 liquefies

the Malas brought from the tissues resulting in the increase in the levels of fatty acids,

blood and thereby resulting in high plasma volume. The extra amount of liquid from

the plasma is reached in the Kostha for excretion to keep up the equilibrium of the

normal plasma level. When Shodhana Karma is administered this increased amount

of body fluid is evacuated as a result of which the vitiated Doshas and unexcreted

Malas are also expelled out resulting in the cure of the ailment

Brings the lodged morbid and unexcreted waste products to gastro intestinal tract The main purpose of Purvakarma is to promote elimination of the

accumulated malas from Sakas, by bringing them to Kostha which are afterwards

expelled from the body by Shodhana Karma .According to Acharya Sushruta ,due to

Snehana and Svedana, the morbid humor of the disease being instigated, become

liquefied and are brought to the Kostha for easy elimination by the Sodhana or radical

therapies 157.

DIGESTION AND METABOLISM OF SNEHA

Role of agni:

The concept of Digestion and Metabolism in Ayurveda reflects in the

Jatharagni, Bhutagni and Dhatavagni Pakas.


At the end of Jatharagni Paka, Sanghata Bheda takes place, wherein

the substances acted upon by Jatharagni are broken down into minute fragments. Now

the substance which is to be subjected to the next Bhutagni Paka is in a uniform liquid

state. From here five types of Bhutagni act upon the respective Mahabhuta molecules

present in the semi digested food and the resultant is transported to respective Dhatus

for final Dhatwagnipaka. Qualities of Sneha Dravya such as Drava, Sara, Snigdha etc

are the qualities of Jala Mahabhuta.

So, we can understand the digestion of Sneha Dravya by studying the

events of digestion that takes place at the three Agni levels. Agni digests the four

types of Ahara and provides energy for sustaining life. It protects body from wear and

tear. Hence Agni performs the functions of digestion and metabolism.

Jataragni:

The term Jatharagni comprises several factors such for e.g. several

enzymes which participate in the digestion of the different components of food in the

small intestine. It is mainly concerned with chemical processes involved in

gastrointestinal digestion. Reference made by Vagbhata to the organ Grahani

indicates the seat of Pachakagni. According to Charaka, Grahani is so called because

it receives and retains the food for its digestion.

Bhutagni:

According to the physiology of Ayurveda, Bhutagni Paka follows

Jatharagni Paka. The digestion of food by Jatharagni leads to the Sanghatabheda or

breakdown of the former into five distinct physiochemical group’s viz. Parthiva,

Apya, Tejas, Vayaviya, and Nabhasa. The Agni moiety present in the substances


belonging to each group is, then stated to digest the substance of that group leading to

a radical change in their qualities i.e.,Vailakshanya Guna. Thus food substances are

rendered fit for being assimilated for the build up as parts of the corresponding

Panchabhuta class.

Dhatvagni:

The specific Agni corresponding to each Dhatu is called as Dhatvagni.

Dhatvagni Paka is stated to metabolise the products of Bhutagni Paka. The nutrients

that support the body are subjected to Paka by the seven Dhatvagnis, leading to the

Dhatus through their respective Srotamsi.

Flow chart: 1 showing Snehapachana

S

N

E

H

A

P

A

C

H

A

N

A

Bhutagni

Datwagni

Jataragni

Action of Pachaka Pitta at Pitta dara kala

Bhinnasangata( Break down of fat in the intestinal digestion ) and production of Amla bhava

Digest the Sneha having mainly Apya mahaboota so increase Apya constituent in the body

Action of all Datwagni in general and action of specific Datwagni in particular


Digestion and absorption of fats

Fats consist of a wide group of compounds that are generally soluble in

organic solvents and largely insoluble in water. Fats may be either solid or liquid at

room temperature, depending on their structure and composition. "Lipids" is used to

refer to both liquid and solid fats, along with other related substances.

Most of the fat in the human diet is in the form of triacylglycerol (TAG),

which consists of three fatty acids linked to glycerol. In the digestive tract, TAG is

hydrolyzed by the enzyme lipase, to release free fatty acids and monoglycerides.

Emulsification and digestion

The key issue in the digestion and absorption of fats is one of solubility:

lipids are hydrophobic, and thus are poorly soluble in the aqueous environment of the

digestive tract. Digestion is greatly aided by emulsification, the breaking up of fat

globules into much smaller emulsion droplets. Bile salts and phospholipids are

amphipathic molecules that are present in the bile. Motility in the small intestine

breaks fat globules apart into small droplets that are coated with bile salts and

phospholipids, which prevent the emulsion droplets from re associating.

The emulsion droplets are where digestion occurs. Emulsification

greatly increases the surface area where water-soluble lipase can work to digest TAG.

Another factor that helps is colipase, an amphipathic protein that binds and anchors

lipase at the surface of the emulsion droplet.


Figure: 1 Digestion and Absorption of Fat

Figure: 2 Emulsification of Fat


Micelles

After digestion, monoglycerides and fatty acids associate with bile salts

and phopholipids to form micelles. Micelles are much smaller than emulsion droplets

Micelles are necessary because they transport the poorly soluble monoglycerides and

fatty acids to the surface of the enterocyte where they can be absorbed. As well,

micelles contain fat soluble vitamins and cholesterol. Micelles are constantly

breaking down and re-forming, feeding a pool of monoglycerides and fatty acids that

are freely dissolved. It is the monoglycerides and fatty acids that are free in solution

that are absorbed, NOT the micelles. Because of their nonpolar nature,

monoglycerides and fatty acids can just diffuse across the plasma membrane of the

enterocyte.

Figure:3 Micelles


Chylomicrons

Once inside the enterocyte, monoglycerides and fatty acids are

re-synthesized into TAG. The TAG is packaged, along with cholesterol and fat

soluble vitamins, into chylomicrons. Chylomicrons are lipoproteins, special

particles that are designed for the transport of lipids in the circulation. Chylomicrons

are released by exocytosis at the basolateral surface of the enterocytes. Because they

are particles, they are too large to enter typical capillaries. Instead they enter lacteals,

lymphatic capillaries that poke up into the center of each villus. Chylomicrons then

flow into the circulation via lymphatic vessels, which drain into the large veins in the

neck. Chylomicrons deliver absorbed TAG to the body's cells. TAG in chylomicrons

and other lipoproteins is hydrolyzed by lipoprotein lipase, an enzyme that is found in

capillary endothelial cells. Monoglycerides and fatty acids released from digestion of

TAG then diffuse into cells.

Cholesterol absorption

Intestinal cholesterol absorption is important because of the clinical

relevance of cholesterol. Of the total cholesterol that passes through the small

intestine, only half is typically absorbed, and the rest is eliminated in the feces. Thus,

cholesterol in the bile is an example of a substance that is targeted for excretion via

the digestive tract.


REVIEW OF LITERATURE OF PANDUROGA HISTORICAL REVIEW

History is nothing but the record of past events. As one of our aims is to root

out the disease, accordingly, while attempting to find a proper management of a disease,

it is very much important to study the disease from its roots.

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

Ayurveda, the most indigenous system of medicine has propagated treatment

for many diseases. The principles of treatment described in our ancient Ayurvedic texts

still hold well since ages.

The study of the history of Panduroga can be divided into:

1) Vedic period - Samhitas, Brahmanas, Upanishad, Kalpasutra (upto 1000BC)

2) Samhita kala - (1000BC – 500 AD).

3) Sangraha Kala - (500 AD – 1700 AD).

4) Adhunika Kala - (1700 AD onwards).

1) Vedic period:

Ayurveda is intimately connected with the Vedas. This is evident

from the fact that the former is regarded as Upaveda of Rigveda (Kashyapa). Ayurveda is

Upanga or Upaveda of Atharvaveda because of its similarity. Thus Ayurveda, which is

intimately connected, with Atharva veda should have acquaintance with Puranas. It

would be logic to say that both Puranas and Ayurveda developed together with post

atharvanic period, thus creating an ideal environment for interacting between them.


The word “Pandu” is available in Mahabharata when sage “Vyasa” intercourse

with “Ambilika” the widows of “Vichitra veerya”, she becomes pale with fear. That’s

why her son who born with pale (Pandu) colour and named as “Pandu”.

In Vedas, we get the reference for the treatment of panduroga with morning

sunrays, red cow’s milk and the red anjana which have been said as harita beshaja.

Koushiaka sutra prescribes the intake of cooked rice mixed with Haridra and anointing

the same over the body for this disease.

Garuda Purana:

In Garuda Purana there is a reference that Takra mixed with loha churna was

advocated in the treatment of Panduroga. Besides the above description, Pandu is also

available in Agnipurana, Valmiki Ramayana and Yogavasistha.

Mythological origin of diseases and recitation of stotras like Vishnu sahasranama

in jwara chikitsa, Shiva suta aradhana in kushta chikitsa are the direct impact of the

puranas.

RigVeda:

In Rig veda it is stated ‘I will remove yakshma from various tissues and parts of

body like taruna asti, antara, yakruth, pleeha, masthiska, jiwha, hrudaya and puppusa’

( Rig veda 10/ 163). 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 .

As per the author of History of Medicine in India (pg 20), “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).


2) Samhitha kala:

During this period the scattered information were gathered and arranged in a

systematic manner resulting in the genesis of Samhitas. Later it became a living tradition

of the community and so it got patronage from both king and the community. Among the

many distinguished names in the Hindu medicine during this period Charaka, Susruta,

Haritha and Bhela stands out with prominence and all of them have very clearly

mentioned about Panduroga by covering all the aspects in detail.

Charaka Samhita:

Panduroga is explained elaborately in Charaka samhita Chikitsasthana 16th

chapter. In this chapter there is a detail description regarding the Nidana, Samprapti and

Chikitsa sutras of Panduroga been mentioned and considerd this as rasavaha srotovikara.

Susruta Samhita:

Susruta samhita gives elaborate explanation regarding Panduroga which is

described in Uttaratantra 44th chapter158. He has dealt in detail with the Panduroga giving

its Nidana, Samprapti, Bedha, Upadrava and Chikitsa considering it as a raktavaha

srotovikara.

Astanga Hrudaya:

Panduroga Nidana is explained in Ashtanga Hridaya Nidanasthana 13th chapter

159 and its management in chikitsasthana 16th chapter 160.

3) Sangraha kala:

It was during this period that the depicted scripture of samhita kala was given a

clear interpretation in the form of commentaries to elucidate it.


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

Amarasimha, Arunadatta, Gangadara all of them have written commentaries on this

disease given their own interpretations on various aspects of this disease.

Panduroga is described in Ashtanga sangraha Nidanasthana161 and

Chikitsasthana162, Kashyapa Samhita Sutrasthana163 ,Yogaratnakara164

Pandurogaadhikara, Bhavaprakahsa Madyamakhanda165, Madhavanidana 166,Chakradatta

Pandurogaadhikara 167.

In Rasaratna Samuchaya author Vagbhata have mentioned the shodana and

marana of Loha bhasma and its use pertaining to pandu.

Sharangadhara, in his treatise described the classification of Panduroga and

mentioned many kasta aushadis for its cure.

Yogaratnakara was unique in giving equal importance for both kasta and rasa

aushadi in the management of Panduroga.

3) Adunika kala:

Initially due to various foreign invasions and due to high patronage of

western medicine, Ayurveda had to face its stagnant state but after independence due to

supportive measures Ayurveda found a sprouting from the stage of dormancy.

Kaviraj Rama Rakshak Patak has written a complete book on pandu roga

giving elaborate description on various aspects of panduroga. Various books are written

on regional languages expectionally in Malayalam like ‘Pandu rogavyum chikitsayum’

by Dr. T N K Moosa.


Anemia:

The term anemia was first found in the Carpus Hippocraticus. It literally means

with out blood and is derived from Greek word “a” or with out and “haima” or blood.

The term anemia was first used in English by James Combe and Edinburg

physician in the year 1824. Gerbrial Andral a French physician laid much of the

foundation on modern concept of anemia.

NIRUKTI AND PARIBHASHA In Ayurveda, different diseases are named on the basis of signs and

symptoms, the origin of the disease, location of exhibition of the symptoms. Here the

disease Panduroga is named on the basis of “Varna.”

The word “Pandu” is derived from “Padi–Nashne” dhatu by adding “Ku”

Pratyaya to it. For Pandu specifically the Nashana will be of the Varna i.e. the colour,

which according to Acharya Charaka is “Vaivarnya” 168. Thus the derivation of the word

“Pandu” indicates the abnormal colouration of the body.

Pandustu Peetabhagardhaha Ketaki Dhuli Sannibham169

Pandu is a mixture of shweta and peeta varna in equal proportions, which

resembles the colour of pollen grains of Ketaki flower.

Pandu Haridra haritaan Varnancha Vividham Stwachi

Sa Pandurogaha Ityuktaha

Pandu Haridra Haritan Pandutwam Tesham Chaadhikam


The disease in which, twacha becomes Pandu, Haridra, Harita varna is known as

Panduroga 170.

Padutwenopalakshitaha Rogaha Pandurogaha

The disease in which Pandubhava, Pandutwa or Panduvarna is more is known as

Panduroga. 171

RELATION BETWEEN RAKTA, PITTA AND PANDU

Acharya Charaka has described symptoms like Vaivarnya, Ojogunakshayam,

Hataprabha, Alparaktanissara while describing the roopas of Panduroga. Therefore it is

necessary to know the role of Raktadhatu and Pittadosha which play a predominant role

in the maintenance of the complexion of the body.

According to Acharya Sushruta Rakta is considered as a key factor for the

Jeevana, and Poshanakarma of the body as said in the following sloka

Raktam Jeevam Iti Sthiti: 172.

But according to Acharya Charaka the proper functions of rakta can be expected only in

its pure form

Tadvishuddham Hi Rudhiram Balavarnasukhayusha |

Yunakti Pranianam Prana: Shonitam Hyunuvartate || 173

As per the classics, Raktadhatu is derived from rasadhatu which is an aqueous

fluid. It is a transparent and colourless substance due to the predominance of

Jalamahabhoota and reddish in colour due to the predominance of Teja mahabhoota.

Rasadhatu is sara of Shadrasayukta ahara called Poshya dhatu. When this

poshya dhatu undergoes pachana by agni derived from pitta, it transforms into raktadhatu.


Due to the action of ranjaka pitta on rasa, it gets transformed into reddish colour

substance i.e. Rakta.

According to Acharya Sushruta the main site of rakta is Yakrit and Pleeha 174.

Ranjaka pitta, located in Yakrit and Pleeha, plays a major role in ranjana karma of

Rasadhatu. As per Vagbhata, Amashaya is the site of Rajaka pitta 175.

Based on the above description it can be deducted that rakta depends on

pitta, which transforms rasa into rakta, and bala, varna, ayu depends on rakta. Pandu is

said to be a Pitta pradhana vyadhi 176. In all types of paittika disorders, there will be

impairment of pitta either in the vriddhi or kshaya stage.

Pitta plays an important role in the formation of rasaraktadi dhatus as agni

is represented by pitta in body which brings about good and bad effects according to its

normal or abnormal state 177.

When the pachaka pitta gets vitiated, due to its adverse effect, the digestive

process gets disturbed which in turn disturbs dhatu formation. Ranjaka pitta also plays a

vital role in formation of rakta, hence its vitiation also affect the formation of rakta.

The vitiation of sadhaka pitta disturbs the functions of hridaya and rakta

parisanchalana because of which the sthayi dhatus are poorly nourished. As a result, due

to rakta kshaya, Bhrajaka and Alochaka pitta also becomes durbala in performing their

normal functions and so various symptoms of pitta are observed in Panduroga. Therefore

it can be concluded that pitta plays a vital role in manifestation of disease Panduroga.


NIDANA PANCHAKA Panduroga can be diagnosed by the study of Nidana, Purvaroopa, Roopa,

Upashaya and Samprapti.

NIDANA 178,179,180

Many nidanas for manifestation of the disease Panduroga have been

explained by different authors. For the sake of convenience it can be categorized under

different groups.

A. Aharaja Nidana

Table No. 20. Showing the Aharaja Nidana of Panduroga. Sl. Nidana Ch Su Va

01. Amlarasa sevana

+ + +

02. Kshara seavnaa + - -

03. Lavana rasa sevana + + +

04. Ati ushna bhojana + - -

05. Viruddha bhojana + - -

06. Nishapava sevana + - -

07. Masha sevana + + -

08. Tilataila sevana + + -

09. Madya sevana + - -

10. Mrit bhakshana + + -

11. Teeskhnahara sevana - + -

12. Atikatu sevana - - +

13. Ati kashaya sevana - - +

Charaka has mentioned Panduroga in Santarpanajanya vyadhi 181. Above said

nidanas are causes for Pitta Pradhana Tridoshas Prakopa and Mandagni. Acharya


Madhavakar, Bhavamishra, Yogaratnakara have followed the Susruta’s version182. These

types of ahara may lead to disturbances in the digestive and assimilative process, leading

to Panduroga.

B. Viharaja Nidana

Table No. 21. Showing the Viharaja Nidana of Panduroga.

Sl. Nidana Ch Su Va 01. Vegavidharana in vamana karma + - - 02. Amatisara sangaha + + - 03. Dushtaraktanigraha in Raktarsha + - - 04. Snehavibhrama + - - 05. Ativyayama and Bharaharana + + -

06. Atimaithuna

+ + -

07. Rutu Vaishamya + + -

08 Vegadharana

+ + +

Table No. 22. Showing the Manasika Nidana of Panduroga.

Sl. Nidana Ch Su Va

1 Bhaya + - -

2 Krodha + - +

3 Chinta + - -

4 Shoka + - -

5 Kama + - +

C. Nidanarthakara Roga

Panduroga can also manifest secondary to some other disorders like

Raktarbuda 183

Asrgdhara184


Raktapitta 185

Yakrit-pleeha roga186

Raktarsha 187

Pleehodara 188

Yakrutodara 189

Pittaja Prameha 190

All these lead to either rakta kshaya due to bleeding or vikrita doshas which

results in Panduroga.

POORVAROOPA 191,192,193

Puvarupa or Prodoamal symptoms,

1). Samanaya Purvarupa

2). Vishishta Purvarupa

No specific description regarding Vishishta Purvarupa is available in the

classical texts. Although the symptoms of Purvarupavstha and Rupavstha are so much

similar with each other that sometimes it becomes difficult to distinguish between them,

because most of the symptoms of Purvarupavstha are also found in Rupavstha; but if one

is able to detect them, then to some extent he gets a clue to predict the possibility of

future disease.

Classical texts have mentioned the following symptoms and the heading of Purvarupa of

Panduroga.

The Panduroga manifests with following prodominal signs and symptoms.


Table No 23. Showing the Poorvaroopa of Panduroga. Sl. Poorvaroopa

lakshana

Ch Su Va Sl. Poorvaroopa

lakshana

Ch Su Va

01. Hritspandana + - + 08. Mritbhakshaneccha - + -

02. Rukshya + - + 09. Akshi koota shotha - + -

03. Swedabhava + - + 10. Avipaka - + -

04. Shrama + - + 11. Aruchi - - +

05. Twacha sphutana - + - 12. Peetamutrata - + +

06. Shteevana - + - 13. Peeta purisha - + -

07. Gatrasada - + + 14. Alpa agni - - +

Susruta’s version has been followed by Madhavakara, Bhavamishra and

Yogaratnakara 194.

ROOPA Vyakta Poorvaroopa is known as Roopa. Symptoms play most important role

in proper diagnosis of the disease. Curability and incurability of the disease depends upon

the severity of the presenting symptoms. Roopa appears in the Vyaktavastha i.e., fifth

Kriyakala of the disease. This is the unique stage of the illness, where it is clearly

recognizable as all its characteristic signs and symptoms manifest.

The term roopa implies to both the signs and symptoms by which a disease is

identified. These can be classified as

1) Pratyatma lakshana (Cardinal signs & symptoms)

2) Samanya lakshana (General signs & symptoms)

3) Vishesha lakshana (Distinguishing features of doshanubandha)


Pratyatma Lakshana

The Pratyatma lakshana of Panduroga is Pandurvarna. This colour has been

compared to that of the pollens of Ketaki flower.

Samanya lakshana

The Samanya lakshanas of Panduroga other than Panduta mentioned in the

classics can be considered as below

Table No. 24. Showing the Samanya lakshanas of Panduroga 195,196

Sl. Roopa Ch Su Va Sl. Roopa Ch Su Va

01. Panduta + + + 13. Shwasa + - +

02. Karna kshweda + - + 14. Gaurava + - +

03. Hatanala + - + 15. Gatra peeda + - -

04. Daurbalya + - + 16. Shunakshikuta + - +

05. Sadana + - + 17. Harita varna + - -

06. Annadwesha + - + 18. Hataprabha + - +

07. Shrama + - + 19. Kopanatwa + - -

08. Bhrama + - + 20. Shishira dwesha + - +

09. Gatrashoola + - + 21. Nidralu + - -

10. Jwara + - + 22. Pindikodweshtana + - -

11. Aruchi + - + 23 Sheerna lomata + - -

12. Gatramarda + - -

Vishishta Rupa

These are the lakshanas which are specifying the involvement of particular doshas

and thereby are helpful in differential diagnosis of Panduroga.

The classification of Panduroga is made with reference to samanya samprapti.

Though the classification is made on the bases of involvement of particular dosha, the

prime factor involved is pitta dosha197.


Classification of Panduroga 198,199,200,201

Table No.25. Showing the classification of Panduroga.

Sl. Prakara Ch Su Ah As BP YR MN 01. Vataja + + + + + + + 02. Pittaja + + + + + + + 03. Kaphaja + + + + + + + 04. Tridoshaja + + + + + + + 05. Mridbhakshnanajanya + - + + + + +

The description of vishishta roopa according to classification of Panduroga is presented as follows Vataja Panduroga Lakshana 202

Table No. 26. Showing the lakshanas of Vataja Panduroga.

Sl. Lakshana

Ch Su Va Sl. Lakshana

Ch Su Va

01. Krishna angata + - - 09. Toda + - + 02. Krishna nakhatwa - + - 10. Kampa + - + 03. Krishnekshanatwa - + - 11. Parshwaruk + - + 04. Krishna sira - + - 12. Shiroruk + - + 05. Krishna ananatwa - + - 13. Shopha + - + 06. Ruksha netrata - + - 14. Anaha + - + 07. Rukshangata + - - 15. Asya vairasya + - + 08. Angamarda + - - 16. Balakshaya + - +

Pittaja Panduroga lakshana 203

Table No. 27. Showing the lakshanas of Pittaja Panduroga.

Sl. Lakshana

Ch Su Va Sl. Lakshana

Ch Su Va

01. Gatra peetata + - + 09. Amlodgara + - - 02. Haritabha + - + 10. Daurbalya + - - 03. Murcha + - + 11. Peeta mutrata + + - 04. Jwara + + + 12. Shosha + - - 05. Daha + - + 13. Peeta vitkata + + - 06. Trishna + - + 14. Bhinna Varchas + - - 07. Sheetakamata + - + 15. Katukasyata + - + 08. Sweda + - + 16. Tama + - +


Kaphaja Panduroga lakshana 204

Table No. 28. Showing the lakshanas of Kaphaja Panduroga. Sl.

Lakshana Ch Su Va Sl.

Lakshana Ch Su Va

01. Shwetavabhasata + - + 11. Shwayathu + - -

02. Shuklakshita - + + 12. Shukla mutra + + -

03. Shukla nakha - + + 13. Shukla mala + + -

04. Shukla ananatwa - + + 14 Tandra + - +

05. Gaurava + + - 15 Chhardi + - +

06. Sadana - - - 16 Praseka + - -

07. Murchha + - - 17 Lomaharsha + - +

08. Bhrama + - - 18 Klama + - -

09. Shwasa + - - 19 Kasa + - -

10. Alasya + - - 20 Aruchi + - -

TridoshajaPandurogaLakshana Vitiation of all the three doshas causes severe degree of dhatushaithilya and

dhatu gauravata leading to dhatu and oja kshaya. The features of sannipataja pandu are

explained only in Hareeta samhita. All other authors have stated that it manifests due to

the vitiation of all the doshas and considered as asadhya type of Panduroga.

HareetaSamhita205

Tandra , Hrillasa, MohaShosha, Shosha, Trishna, Vitbheda, Vitbheda, Klama, Jwara

Kshudartata and Kshudartata

According to Brihattrayees, the lakshanas of Vataja, Pittaja and Kaphaja

Panduroga were seen severely in Tridoshaja Panduroga depending on their degree of

vitiation 206

Mridbhakshanajanya Pandu

Mridbhakshanajanya Pandu has been explained by Acharya Charaka207 and Vagbhata208.

Charaka’s version has also been followed by Madhavakara, Yogaratnakara and


Bhavamishra209. But Susruta has considered Mridbhakshana as a Nidana for Panduroga

rather than an individual type.

Mridbhakshanajanya Panduroga lakshana Table No. 29. Showing the lakshanas of Mridbhakshanajanya Panduroga.

Sl. Lakshana

Ch Va MN BP Yo

01. Shoonaganda + - + + +

02. Shoonakshikoota + - + + +

03. Shoona bhru + - + + +

04. Shoona pada + + + + +

05. Shoona nabhi + + + + +

06. Shoona mehana + + + + +

07. Krimikoshta + - + + +

08. Atisara + + + + +

09. Sasrik Mala Pravritti + + + + +

10. Kaphayukta malapravritti + + + + +

SAMPRAPTI Although the causes of Panduroga that are explained under the heading of

Nidanas leads to vitiation of Tridosha but however, Pitta is the dominant dosha

irrespective of the type of Panduroga.

The Samprapti of Panduroga has been explained in detail by Acharya

Charaka and Vagbhata. When there is excess intake of pitta pradhana ahara, pitta situated

in hridaya aggravates and it is propelled by aggravated (balina) vayu through

dashadhamani that spreads all over the body. The vitiated pitta affects in between twak

and mamsa and leads to vitiation of twak, mamsa, vata, asrik, thereby produces various

varna like Pandu, Haridra and Hareeta. Due to Panduvarna pradhanata it is called as

“Panduroga”210, 211.


Nidana Sevana

Nidana and Samprapti of panduroga

Flow chart: 2 showing Nidana and Samprapti of panduroga

Alpa Rakthata-Raktha Srava

Ahara –

Samprapti

Aharatah Viharatah Vaidyakruta Sahaja Nidanartakara

Alpa Raktha Pitta Prakopa

Agni Mandya

Rasavaha Sroto Dusti

Alpa Rakta due to

Sadhya Chirottah

Rakta Pitta, Arshas

Raktati Pravarthan,

Raktaja Gulma Krumi Raktarbuda

Rakta Poshaka Sara Bhag Rakta Poshaka Sarabhaga

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

Ahara – Amla Kshara Lavana

Vihara – Ushna Matsya Tila taila Teekshna 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


Flow chart: 3 showing Nidanasevana

Vyakta

Bheda

Rasavahasrotas Raktavaha srotas

Hridaya prapti

Through Vyanavayu

Stanasam-shraya

Prasara

Prakopa

Sanchaya

Nidanasevana

Aharaja Viharaja Vaidyakruta Nidanaratkara Roga

Pitta pradhana Agni vikruti Dushya Dusti Rasa & Rakta

Khavaigunya in Srotas - Rasavaha Raktavaha

Jatharagani mandya

Circulation through Dasadhamani

Twak mamsantana ashraya

Dosha – Dushya samurchana

Alpa Raktaka Alpamedoska, ojokshaya, mamsa – twak dushya

Dhatu – Shaitilya & Dhatu gourava

Bala kshaya, Varna kshaya, Snehakshaya, Nissar, Shithilendriya

Poorvaroopa

Varnahani (Bahuviddha twaha) Pratyatma lakshana, Samanya laxanas

Vataja, pittaja Kaphaja Sannipataja, Mrudbhakshanajanya Pandu

Upadrava, Asadhya and Arishta Lakshanas


Flow chart: 4 showing Mrudbhakshanajanya Pandu

Mrudbhakshanajanya Pandu:

Samprapati Ghataka

Udbhava - Hrudaya

Adhisthana - Rasa dhatu

Vyakti - Twak

Sanchara - Rasayani

Dosha - Sadhaka, Pachaka, Ranjaka Alochaka Pitta

Vyana, Samana Vayu

Kledaka Kapha.

Dushaya - Rasa, Rakta, Mamsa

Srotas - Rasavaha and Raktavaha

Mruta

Kashaya Ushara Madhura

Vata Pitta Kapha

Avipakwatha of mruttika causes

Agnimandhya & srotorodha

Rukshaguna cause Roukshya in Rasadidhatus & shareera

Affects the dhatu-poshana

Indriya, teja Bala ojus veeryahani

Respective dosha Prakopaja Mrud bhakshanajanya - Pandu


According to Acharya Sushruta, the indulgence of Nidana leads to Rakta pradushana that

causes vitiation in Twak which in turn causes the Pandubhava therefore it is called as

“Panduroga”212

UPADRAVA If the patient continues to indulge in ahara and vihara, which are said to be

the Nidana of Panduroga the doshas get further aggravated and thus produces upadrava.

The upadravass of Panduroga have been mentioned only by Acharya Sushruta213 which

are,

Table No. 30. Showing the complications of Panduroga.

Aruchi Pipasa Jwara

Chhardi Shiroruja Agnisada

Shopha Abalatwa Murchha

Klama Hridaya peedana Swarabheda

Daha

SADHYASADHYATA 214

Asadhya Panduroga lakshanas are as follows

Panduroga of long duration with excessive rukshata.

If the patient has developed shotha after long duration and is having vision of

objects in yellow.

If the patient passes Baddha and Alpamala with kapha and Hareeta varna.

If the patient is suffering from Atisara.

If the patient is deena, Shwetangayukta (Shwetavarna leepatanga).


If the patient is suffering from Chardi, Moorcha, Trishna.

If the patient is having Panduvarna of Danta, Nakha and Netra.

Whose bahu, janga, shira are shothayukta and madhyabhaga is durbala and vice

versa.

Patients whose guda, sheeshna and muska are shothayukta.

Patient having recurrent attacks of Sangnya nasha.

CHIKITSA SUTRA

In Ayurveda, three general principles of treatment have been mentioned by

Atreya in Charaka Samhita Sutra Sthana. They are

Daivayapashraya. Yuktivyapashraya and Satavawajya.

Here we are concerned with Yuktivyapashraya chikitsa with includes the

following,

1. Nidana parivajana (Planning the treatment so as to avoid aetiological factors)

2. Snehana (Olention therapy) and Swedana (Fomentation therapy)

3. Shodhana (Eliminating the factors responsible for producing the disease).

4. Shamana (Palliative treatment) to correct the deficiency or abnormality and also treat

the allied symptoms

SNEHANA

In case of Pandu, there is diminution of Rakta, Meda, Oja etc. and the body

becomes dehydrated, emaciated and deficient in lipid substances which provoke Vata

causing further deterioration in the lipid substances which provokes Vata causing further

deterioration in the condition. That is why in the beginning of Shodhana Chikitsa,

Snehana is essential because


(i) It protects the gastric mucosa from the irritability of drugs used in Shodhana.

(ii) It helps in producing tolerance to the organs for Shodhanakarma.

(iii) It alleviates the morbidity of vata and makes the body soft and disintegrates the

accumulation of morbid matter

(iv) It helps the organs and tissues to be capable of producing intrinsic factor and also in

absorbing and assimilating extrinsic factor.

For performing Snehana Karma, various preparations have been mentioned

in Ayurvedic text. For example, Draksha Ghrita Rajni Ghrita, Triphala Ghrita, Tailavaka

Ghrita, Dadhima Ghrita, Danti Ghrita, Panchgavya Ghrita, Mahatikta Ghrita, Panchatikta

Ghrita etc. They can be used in various types of Panduroga according to the

predominance of doshas, variation in pathogenesis and in symptoms. After completing

the snehana therapy successfully the signs of which are, the vata becoming regulated, the

Jatharagni becoming activated, the stool being unctuous and loose, the body becoming

soft and smooth, the next step is Swedana.

SWEDANA

After Snehana, Swedana karma is done depending upon thepatient's condition

so as to bring the doshas into koshta

SHODHANA

This is performed to eliminate the factor responsible for producing the disease.

In this, out of five Karmas only Vamana and Virechana is essential and even these two

should be employed when Snehana karma has been successfully completed. Commenting

on the performance of vomana Dalhana says that while performing vamana in case of

Panduroga one should always keep in mind about physical condition of the patient. After


kostha shuddhi the patient should be adopted with pathya ahara and vihara 215. The

Chikitsa sutra for Panduroga according to Acharya Sushruta is snehana followed by

vamana and virechana. Acharya Dalhana opines that though Urdhwashodhana (vamana)

is contra-indicated, Mrudu vamana can be administered in accordance with Ritu, Desha,

Prakruti, Kaala, Shareera216.

Snehairupakramya snigdamatva virechayet |

First snehana with indicated snehas should be given and there after virechana

should be followed 217.

For Mrutbhakshanajanya Pandu the line of treatment is Teekshna shodhana in

accordance with balabala, followed by snehapana to restore the strength 218

Dosha vishesha Chikitsa in Panduroga 219

1. Vataja pandu – Sneha bhooyistha

2. Pittaja Pandu – Tikta sheetala prayoga.

3. Shleshmaja Pandu – Katu, Tikta, Ushna dravya prayoga.

4. Sannipataja Pandu – Vimishra Chikitsa prayoga.

5. Mritbhakshanajanya Pandu – Nidana parivarjana along with the doshika chikitsa.

SHAMANAUSHADHIS A variety of Ghrita, Churna, Vati, Kashaya, Avaleha, Asavaarishta Bhasma

and other single drug preparations are described for the management of all types of

Panduroga in Pandurogadhikara.


Ghrita: Panchagavya ghrita, Kalyanaka ghrita, Mahatiktaka ghrita, Dadima ghrita, Katukadya

ghrita, Pathya ghrita, Danti ghrita, Draksha Ghrita, Haridradi ghrita, and Vyoshadi

ghrita.

Churna:

Navayasa churna, Tapyadi churna, Trivyushanadi churna, Triphala churna, and Shunthi

churna.

Vati:

Mandura vataka, Punarnava mandura, Bibitakadi vataka, and Shilajatu vataka.

Kashaya:

Negrodadivarga kashaya, Triphala kashaya, Vishaladi phanta, Guduchi kashaya.

Avaleha:

Vidangadyaavaleha, Darvyadileha, Dhatraavaleha, Triphaladyaavaleha, Yogaraj rasa,

Pravaladyavaleha, Abhayavaleha and Ayorajovyoshadyavaleha.

Asavaarishta:

Dhatryarishta, Goudarishta, Beejakarishta, Manduradyorishta, Abhayarishta, Phalarishta,

Bibhitakasava, and Lodhrasava.

Bhasma:

Lohabhasma, Mandurabhasma, and Swarnamakshikabhasma.

Others:

Suddha kasisa, Shuddha shilajatu, Shuddha gairika, Mandura, Pravala, Mukta, Amalaki,

Yashtimadhu, Chitrakamula, Guduchi Daruharidra, Nimba, Swarnakhiri, Ikshu, Goghrita,

and Takra.


PATHYAPATHYA 220

This includes dietic and environmental features which should be regulated according to

the need of the body.

Pathya

Generally for Pana and Bhojana, Shali, Yavagu, Yusha, Godhuma, Madya,

Mamsarasa, Dugdha, Ghrita, Patola, Shaka, Draksha, Dadima, Kharjura, Amalaki and

Ikshurasa are adviced.

Specific pathyas are

Vata - Laghupanchamula siddha Jala.

Pitta - Hribera, Shunthi sadhita ghrita.

Kapha - Arishta, Sidhu, Asava.

Tridosha - Takra

Apathya

Agni, Aatapa, Aayasa, Pittakaraka annapana, Maithuna, Krodha, Adwa and other

factors, which are said to be the causes for Panduroga, should be avoided.

ANAEMIA 221,222,223,224 Anaemia can be defined as a haemoglobin concentration in blood below

the normal range appropriate for the age and sex of the individuals. In adults, the lower

extreme of normal haemoglobin is taken as 14.0g/dl for males and 12.0g/dl for females.

A decrease in the oxygen carrying capacity of the blood can also be termed

as “Anaemia.” The haemoglobin content of the erythrocytes determines the oxygen


carrying capacity. Hence, a reduction in the blood haemoglobin level and in the number

of circulating erythrocytes is characteristics of Anaemia,

Although haemoglobin value is employed as the major parameter for determining

value is employed as the major parameter for determining whether or not Anaemia is

present, Hemoglobin percentage (Hb%), the red blood cell count (TRBC) and packed cell

volume (PCV) provide alternate means of assessing Anaemia.

Clinical features of Anaemia Symptoms In symptomatic cases of Anaemia, the presenting features are tiredness, easy

fatigability, generalized muscular weakness, lethargy and headache. In older patients

there may be symptoms of cardiac failure, angina pectoris, intermittent claudicating,

confusion and visual disturbances.

Signs A few general signs common to all types of Anaemia are as follows

01. Pallor – Pallor is the most common and characteristic sign, which may be seen in

the mucous membranes, conjunctiva and skin.

02. Cardiovascular System – A hyper dynamic circulation may be present with

tachycardia, collapsing pulse, cardiomegaly, miIdsystolic flow murmur, dyspnoea

on exertion and in case of elderly congestive heart failure.

03. Central nervous system – The older patients may develop symptoms like attacks

of faintness, giddiness, headache, Tinnitus, drowsiness, numbness and tingling

sensation of the hands and feet.


04. Occular manifestations – Retinal hemorrhages may occur if there is associated

vascular disease or bleeding diathesis.

05. Reproductive system – Menstrual disturbances such as Amenorrhea and

Menorrhagia and loss of libido are some of the manifestations involving the

reproductive system in Anaemia subjects.

06. Renal System – Mild Proteinuria and impaired concentrating capacity of the

kidney may occur in severe Anaemia.

07. Gastrointestinal system – Anorexia, flatulence, nausea, constipation and weight

loss may occur.

Investigations After obtaining the full medical history pertaining to different general and

specific signs and symptoms in order to confirm the presence of anaemia its type and its

cause the following plan of investigations is generally followed.

A. Haemoglobin estimation – The first and foremost investigation in any suspected

case of Anaemia is to carry out haemoglobin estimation. Several methods are

available, but most reliable and accurate is Cyanmethaemoglobin (HiCN) method

Drabkin solution and spectrophotometer. If the haemoglobin value is below the

lower limit of the normal range for particular age and sex, the patient is said to be

anaemic.

B. Peripheral blood film estimation – The haemoglobin estimation in invariably

followed by examination of peripheral blood film for morphologic features after


staining it with Romanowsky dyes (Leishman’s staining). The following

abnormalities we can look for in the smear study.

a. Variation in size – Microcytosis (Iron deficiency anaemia)

Macrocytosis (Megaloblastic Anaemia)

Dimorphic

b. Variation in shape – Poikilocytes.

c. Inadequate haemoglobin formulation – Hypochromasia.

d. Compensatory erythropoiesis

e. Miscellaneous changes

C. Red cell indices – An alternative method to diagnose and detect the severity of

anaemia is by measuring the red cell indices

a. In iron deficiency and Thalassaemia MCV, MCH and MCHC are reduced.

b. In Anaemia due to acute blood loss and Hemolytic Anaemia MCH, MCV

and MCHC are all within normal limits.

c. In Megaloblastic Anaemias, MCV is raised above the normal value.

D. Leucocytes and platelet count – Measuring of Leucocytes and platelet count helps

to distinguish pure anaemia form pancytopenia in which red cells, granulocytes

and platelet counts are often elevated.

E. Reticulocyte count – Reticulocyte count is done in each case of anaemia to assess

the marrow erythropoietic activity. In acute hemorrhage and in haemolysis, the

Reticulocyte response is indicative of impaired marrow function.


F. Erythrocyte sedimentation Rate – The ESR is non-specific test used as a screening

test for anaemia. It usually gives a clue to the underlying organic disease but

Anaemia itself may also cause to rise in ESR.

G. Bone marrow examination – Bone marrow aspiration is done in cases where the

cause for anaemia is not obvious. In addition to these general tests, certain

specific tests are done in different types of anaemias.

H. Total RBC Count:

It is the number of RBC in one cubic millimeter of blood. Normal values:

In men - 4.5-6.5 millions/mm3. In women - 3.8-5.8 millions/mm3.

I. Packed Cell Volume or Haematocrit (PCV):

When blood is mixed with anticoagulants and put in Wintrobe’s Haematocrit

Tube, centrifuged for a prolonged time, the formed elements are packed at the

bottom and clear supernatant plasma is obtained. Volume of these packed formed

elements is called packed cell volume.

Normal value: 45ml/100ml (45%).

Classification of Anaemia

Pathophysiologic

I. Anaemia due to impaired red cell production.

a. Acute post-hemorrhagic Anaemia.

b. Chronic blood loss.

II. Anaemia due to impaired red cell production.


Cytoplasmic maturation defects

i. Deficient haem synthesis – Iron deficiency anaemia.

ii. Deficient globin synthesis – Thalassaemic syndromes.

Nuclear maturation defects – Vitamin B12 or folic acid deficiency and

Megaloblastic Anaemia.

Defect in stem cell proliferation and differentiation

i. Aplastic Anaemia.

ii. Pure red cell aplasia.

Anaemia of chronic disorders.

Bone marrow infiltration.

Congenital Anaemia.

III. Anaemia due to increased red cell destruction (Hemolytic Anaemia)

Morphologic I. Microcytic, hypochromic.

II. Normocytic, Normochromic.

III. Macrocytic, Normochromic.

Iron deficiency Anaemia The commonest deficiency disorder present throughout the world is iron

deficiency, but its prevalence is higher in developing countries.

Pathogenesis Iron deficiency anaemia develops when the supply of iron is inadequate for the

requirement of haemoglobin synthesis. Initially, the negative iron balance is made good

by mobilization form the tissue stores so as to maintain haemoglobin synthesis. It is only

after the tissue stores of iron are exhausted that the supply of iron to the marrow becomes

insufficient for haemoglobin formation.


Etiology

I. Increased Blood Loss

01. Uterine - e.g. Excessive menstruation in reproductive years, repeated miscarriage,

at onset of menarche, post menopausal uterine bleeding.

02. Gastrointestinal - e.g. Peptic ulcer, hemorrhoids, hook worm infestation, cancer

of stomach and large bowel oeasophagel varices, hiatus hernia, chronic aspirin

ingestion, uncreative colitis, diverticulosis.

03. Renal tract e.g. Haematuria, haemoglobinuria.

04. Nose e.g. Repeated apitaxis.

05. Lungs e.g. Haemoptysis.

II. Increased Requirements

01. Spurts of growth in infancy, childhood and adolescence.

02. Prematurity.

03. Pregnancy and lactation.

III. Inadequate Dietary Intake

01. Poor economic status.

02. Anorexia e.g. in pregnancy.

03. Elderly individuals due to poor dentition, apathy and financial constraints.

IV. Decreased Absorption

01. Parietal or total gastrectomy.

02. Aschlorhydria.

03. Intestinal mal absorption such as in colic disease.


Clinical features 01. Anaemia – The onset of iron deficiency anaemia is generally slow. The usual

symptoms are weakness, fatigue, dyspnoea on exertion, palpitations and pallor of

the skin, mucous membranes and sclera. Patients may have unusual dietary

cravings such as pica. Menorrhagia is a common symptom in iron deficient

women.

02. Epithelial tissue changes – Long standing chronic iron deficiency causes changes

in nails (Koilonychia or spoon shaped nails), tongue (Atrophic glossitis), mouth

(Angular stomatitis) and oesophagus causing dysphagia from development of

thin webs at the postcricoid area (Pulmmer – Vinson Syndrome).

Treatment The management of iron deficiency anaemia consists of 2 essential principles

01. Correction of disorder causing the anaemia – The underlying cause of iron

deficiency is established after careful check-up and investigations. Appropriate

medical or preventive and surgical measures are instituted to correct the cause of

blood loss.

02. Correction of iron deficiency – This can be compensated by two ways

a. Oral Therapy – Administration of oral salts such as ferrous sulfate, tablets

containing 60 mg of elements iron is administered thrice daily

b. Parental therapy – This therapy is indicated in cases that are intolerant to oral

iron therapy, in GIT disorders such as mal absorption. This is hazardous and

expensive when compared with oral administration.


SHAREERA

Shareera which gives information about anatomical and physiological aspects of

stomach and intestine where absorption and digestion of Sneha mainly takes place.

Stomach225

The stomach has the shape of an expanded “J”. The stomach performs 4 major

functions. Viz.

01. The bulk storage of the ingested food.

02. Disruption of chemical bonds in chemical materials through the action of acids

and enzymes.

03. Mechanical breakdown of ingested food.

04. Production of intrinsic factor, a glycoprotein whose presence in the digestive tract

is required for the absorption of the vitamin B12.

Small Intestine226

The stomach is a holding tank where food is saturated with gastric juices and

exposed to stomach acids and the digestive effects of pepsin. These are the primary steps,

for most of the digestive and absorption functions occur in the small intestine, where the

products of digestion are absorbed.

The mucosa of the small intestine produces only a few of the enzymes involved.

The pancreas provides digestive enzymes as well as buffers that assist in the

neutralization of acidic chyme. The liver and the gall bladder provide bile, a solution that

contains additional buffers and bile salts, compounds that facilitates digestion and

absorption of lipids.


The small intestine averages 6 m. in length and has a diameter ranging from 4 cm

at the stomach and about 2.5 cm at the junction to the large intestine. It accompanies all

abdominal regions except the right and left hypochondriac regions. It has 3 subdivisions.

duodenum, jejunum and ileum.

Intestinal Movements

After chyme has arrived in the duodenum weak peristaltic contractions move it

slowly towards the jejunum. These contractions are mesenteric reflexes not under CNS

control. Their effects are limited to with in a few centimeters of the site of the original

stimulus. These short reflexes are controlled by motor neurons in the submucosal and

mesenteric plexus. In addition, some of smooth muscle cells contract periodically even

without stimulation, establishing a basic contractile rhythm that then spreads from cell to

cell.

Digestion and absorbtion of fat

Fat contains 8% lower saturated fatty acids which makes it easily

digestible. Due to having 4-5% linoleic acid, an essential fatty acid, it promotes proper

growth of human body. Fat also contains Vit.A, D, E and K. Vit.A and E are antioxidant

and are helpful in preventing oxidative injury to the body (A cause of about 80-90%

degenerative diseases). Fat is lipophilic and this action of Fat facilitates transportation of

ingredients of formulation to target organ and final delivery inside the cell, because cell

membrane also contains lipids. This lipophilic nature of Fat facilitates entry of

formulation into the cell and its delivery to mitochondria, microsome and nuclear

membrane.


Rasavaha Srotas and Raktavaha srotas

When we consider the pathogenesis of Panduroga, we must think of

Rasavaha srotas, Raktavaha srotas and twacha which shows the characteristics of this

disease i.e. “Panduta”

Rasavaha Srotas

The rasavaha srotas is the first dhatu to be developed form ahararasa and it

nourishes all tissues of the body. The ahararasa is produced in annavaha srotas from the

completely digested food and absorbed through the wall of the annavaha srotas. All

nutrients join together in hridaya (Thorasic heart) qualifying it as rasadhatu and it is the

same organ which ejects the rasa into circulation, triggered by the vyanavata.

Since the hridaya is the rasasthana, it is also the moola of rasavaha srotas.

Charaka added the ten dhamanees that emits from hridaya.227 According to Sushruta,

hridaya and rasavahini dhamanis are the moolas.228Hridaya is stated as the seat of rakta

and other fluids which are capable of circulation in the body.229

Since, the preenana and jeevana kriyas are essential for the maintenance of life

and rakta is the nearest dhatu to rasa they both circulate together. But because of the

inability of cellular component (which carries raktamsha) of the raktadhatu to enter all

srotases the rasa proceeds further carrying the nutrients.230

Raktavaha srotas In the process of the dhatu parinama, raktadhatu is stated to be developed from

rasadhatu.231


Raktadhatu is cellular in nature and the raktamsha which carries the vishishta

vayu known as “Prana”, with the function of jeevanakriya is located in these cells. The

raktamsha impairs colour to the rakta but the introducing this raktamsha into the Rakta

jeeva paramanus is the function of Ranjaka pitta.

According to Sushruta, the ranjakapitta is located in yakrit and pleeha.232

Vegbhata considered amashaya is the seat of ranjakapitta.233

Here it is essential to look into the modern science regarding the production of red

blood cells.

The liver and spleen are responsible for red blood cells production in the

gestational age. Then during the latter part of gestation and after birth, red blood cells are

produced exclusively by the bone marrow, of all bones until a person is 5 years old. After

approximately the age of 20 years, the marrow of long bones, except for the proximal

portion of the humerus and tibia, becomes quite fatty and there is no more production of

red blood cells. Beyond this age most red cells are produced in the marrow of the

membranous bones, such as vertebrae, sternum, ribs and iliac bones. Even in these bones

the marrow becomes less productive as age advances.

There is no direct reference in the samhitas to the part played by Majja (Bone

marrow), in the formation of rakta. But, there is a reference in Sushruta samhita stating

that “Sarakta Medas”, corresponding to the red bone marrow. Majja is present inside the

sthulasthis (larger bones). The substances present within other bones should be

considered as Saraktam medas (Medas mixed with the blood).234

Sushruta bestows importance of rakta equal to the three humours, that the body is

supported or maintained by the rakta.235 The most important function of rakta is


jeevanakriya i.e. sustains life.236 The word “Prananuvartam” also indicates that it carries

vishishta vayu “Prana”.

In panduroga (Anaemia) where the deficient production of raktadhatu is the main

pathological event, all authorities of Ayurveda have invariably prescribed the formulation

containing iron there by recognizing the importance of iron in the production of

raktadhatu. When iron is absorbed form the small intestines, it immediately combines

with a beta globulin to form transferrin and transported in the blood plasma. About 60%

of excess iron is stored in the liver cells, to be released whenever necessary to the body.

In normal infant and in adult with fibrosis of bone marrow, red blood cells are

produced in the spleen and the liver (Extra medullary hematopoiesis). The red blood cells

normally circulate an average of 120 days before being destroyed. Many of the red cells

fragment in spleen.

The above stated information clearly indicates the important part played by Yakrit

pleeha and amashaya in the development of raktadhatu and also in maintaing its

circulating volume.

Yakrit and pleeha are stated to be the moolas of raktavaha srotas.237Sushruta

added raktavaha dhamanis.238 Charaka has clearly stated that hridaya (Thoracic heart) and

the ten dhamanees also are to be taken as raktasthana.239 Therefore these also to be

considered as moola of raktavaha srotas.

Red blood cell formation [Erythropoiesis] 240

Red blood cell formation in adults occurs in the red bone marrow, or myeloid

tissue. Red marrow where active blood cell production occurs is located in portion of

Vertebrae, sternum, ribs, skulls, scapulae, pelvis and proximal limb bones. Other marrow

areas contain a fatty tissue known as yellow marrow.


Stages in RBC Maturation

During its maturation a red blood cell passes through a series of stages

Division of hemocytoblast in bone marrow produces

1) Myeloid stem cells, which in turn divide to produce red blood cells and several

classes of white blood cells and

2) Lymphoid stem cells, which divides to produce the various classes of

lymphocytes.

The cells destined to become RBCs first differentiate into

Proerythroblasts (Day 1)

Erythroblasts

Basophilic ethroblast (Day 2)

Polychromatophilic ethroblast (Day 3)

Orthochromatophilic ethroblast (Day 4)

Ejection of

Nucleus Reticulocyte (Day 5-7)

Enters the circulation

Mature red blood cell


After roughly 4 days of differentiation, the erythroblast, now called a normoblast,

sheds its nucleus and becomes a Reticulocyte. A Reticulocyte contains 80 percent of

haemoglobin of matured RBC and hemoglobin synthesis continues for 2-3 days.

After 2 days in the bone marrow, Reticulocytes enter the circulation. After 24

hours in circulation, the reticulocyte completes their maturation and becomes

indistinguishable from other mature RBC’s.

Twak

Vasa and Shat twacha are the upadhatus of mamsa dhatu, which are going to

develop in the process of dhatwagni paka sequential progression of dhatu.241a The twacha

shows the characteristic features of Panduroga as the twacha being affected or showing

the disease significance in the skin (Twacha).

According to the option of Vagbhata embryological development of the skin is

from the blood i.e. Rakta as if from boiling milk cream develops.241b The twacha is

having seven layers. At present disease concern the first two layers can be taken into

consideration.

Avabhasini242

This is outermost and first layer of the skin. If reflects or show the colour of the

second layer lohita. As it reflects the colour it is presumed that the colour change in lohita

is witness in Avabasini. It is being said at the size of 1/18th of vrihi.

Lohita243

Lohita looks like Arunavarna i.e. red in colour and 1/16th of vrihi. It prevents the

blood flow form the body. The colour of the blood in the lohita is reflected through

avabhasini.


Haemoglobin244

Molecules of hemoglobin (Hb) accounts for over 95% percent of the intracellular

proteins, which is specially adopted for gas transport to and from the lungs. It is

composed of four globin chains each containing an iron- containing porphyrin pigment

termed haem. Globin chains are a combination of two alpha and two non-alpha chains.

The hemoglobin content of whole is reported in terms of grams of Hb per 100 ml

of whole blood (g/dl). Normal range are 14 – 18 g/dl in males and 12-16 g/dl in females.

Each haem units hold an iron in such away that the iron can interact with an

oxygen molecule, forming oxyhemoglobin, HbO2.

Figure 4 showing RBC and Hemoglobin

Hemoglobin function

There are approximately 280 million Hb molecules in each red blood cell.

Because a Hb molecule contains four heme units, each erythrocyte can potentially carry


more than a billion Molecules of oxygen. Roughly 98.5 percent of oxygen carried by the

blood travels through the circulation bound to Hb molecules inside red blood cells.

The amount of oxygen bound to hemoglobin depends primarily on the oxygen

content of the plasma. When plasma oxygen level are low, hemoglobin releases oxygen

under these conditions, typical of peripheral capillaries, plasma carbon dioxide level are

elevated. The alpha and beta chain of hemoglobin then bind carbon dioxide, forming

“carbaminohemolobin”. In the capillaries of the lungs, plasma oxygen levels are high

and carbon dioxide level are low. Upon reaching these capillaries, RBCs absorb oxygen,

which is then bound to hemoglobin, and release carbon dioxide.

Functions of Rakta 245

01. Varna prasad – Colour of the skin.

02. Mansapushti – Nourishment to other dhatus like mamsa.

03. Jeevana vyapara – O2 supply.

04. Bala – Strength.

05. Prasannata – Tranquility.

06. Ayu – Life.

According to modern246

The transportation of dissolved gases, nutrients, hormones and metabolic wastes

The regulation of pH and electrolyte composition of intestinal fluid throughout the

body

The restriction of fluid losses through damaged vessels or at other injury sites.

Defense against toxins and pathogens.

Stabilization of body temperature.

Shuddha Rakta lakshanas247

The following colours indicate pure blood

01. Shuddha suvarna


02. Indragopa

03. Looks like padma and Alaktaka.

04. Gunjapahala savarnam.

Shuddha rakta purusha lakshanas248

As long as a person is having pure blood in him, he will have;

01. Prasanna sahreera varna.

02. Swasthyata of Indriya and Indriyartha grahana.

03. Prakrita agni.

04. Normal mala and Mutra visarjana.

05. Sukhanuvita.

06. Pushti and Bala.

Composition of Blood249

Blood is a highly complex fluid, which is composed of two parts

A liquid, called the plasma and different types of cells that remain suspended in

plasma. These cells the called blood corpuscles.

The plasma constitutes about 55%, and cells about 45% of the total volume of the

human blood. General composition of whole blood is as follows

A. Cells

1) Red blood corpuscles or erythrocytes (RBC)

2) White blood corpuscles or leucocytes (WBC)

3) Platelets or thrombocytes

B. Plasma

1) Water 91 to 92%

2) Solids 8-9 %


Inorganic constituents 0.9% (Sodium, Potassium, Calcium, Magnesium,

Phosphorus, Iron, Copper). It contains some organic constituents like –

i. Proteins 7.5% (Serum albumin, Serum globulin Fibrinogen, Prothrombin)

ii. Non-protein Nitrogenous substance [NPN](Urea, Uric acid, Xanthene,

Hypoxanthine, Creatine, Creatinin, Ammonia, amino acids)

iii. Fats (Natural fats, phaspholipid, cholesterol, choletrides)

iv. Carbohydrate (Glucose)

v. Other substances (Internal secretions antibodies and various enzymes)

vi. Colouring matter (The yellow colour of the plasma is due to small amounts of

bilirubin, carotene and xanthophylin).


DRUG REVIEW Health is the supreme foundation of virtue, wealth, enjoyment and

salvation. So in the fight against disease and premature death, drugs have been the

weapon used by man. In Ayurveda, drug is defined in broader perspective. It is that

which a physician use for restoring the equilibrium of Doshas i.e. relieving the disease.

Charaka has said that for the successful management of the disease, it is essential to

select proper medicine250 and examine it in all respects251 in other words correct

identification of the drug becomes the main prerequisite for its use as medicine. The

treatment without drug would be same as cipher without figures.

WHO is defined drug as “Any substance or product that is used or intended

to be used to modify or to explore physiological systems or pathological status for the

benefit of recipient”.

Ayurveda advocates using a drug (Dravya) in a whole state i.e. in its natural

integrity and design. The whole drug being in natural state is friendly for human body.

Thus Ayurveda treat the patient through a holistic approach and believes that each and

every substance existing in this universe is Panchabhautic in configuration. This

knowledge of configuration lead Acharya Charaka to conclude that every substance in the

world has more or less medicinal properties.

In this clinical study Jeerka choorna given for deepana pachana and Draksha

Ghrita is selected for Snehapana treatment.


Drugs used for deepana and pachana

JEERAKA CHOORNA

Figure 5 showing jeeraka choorna

INGREDIANTS OF JEERAKA CHOORNA252 Table No. 31: Showing Ingredients Of Jeeraka Choorna

1) Jeeraka choorna

The ingredient of Jeeraka Choorna is jeeraka, which is taken and powdered

well, Filtered through cloth and made into fine powder. Jeeraka choorna was

prepared in Department of Rasashastra D.G.M.A.M.C, Gadag.

Collections of drugs:

All the raw drugs were purchased from the local market Gadag.

Pharmaco dynamics of ingredients of Jeeraka choorna

Botanical Name : Cuminum cyminum

Family : umbelliferae

San. Name

Latin Name

Family Rasa

Guna Veerya Vipaka

Doshagnata Karma Useful part

Jeeraka Cuminum cyminum

Umbelli ferae

katu Laghu, rooksha

Ushna Katu Kapha vata shamaka

Deepan pachana vathanu lomana

Seed


Synonyms : Jeeraka, Jarana ,Ajaji, Deerkha Jeeraka.

Part used : seed

Pharmacodynamics

Rasa : katu

Guna : Laghu,rooksha

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kaphavata shamaka

Karma : Deepana, pachana and vathanulomana

Vernacular names

English : Cumin seed.

Hindi : Jeera

Kannada : Jeerige

Habitat: Distribution – Throughout India it is cultivated

Plant description:

A small annual herb grows up to 40 cm in height. Leaves alternate,

compound, filiform segment, with sheeting bases; flowers small white, found in

compound umbels. Fruits greenish, turns grey when ripe, tapering towards both ends,

covered with papillose hairs.

Pharmacological Activities:

Plant pacifies vitiated kapha, vata, dyspepsia, colic, indigestion, worm

infestation, flatulence, vomiting, hemorrhoids, calculi, leucorrhoea, skin diseases, fever,

asthma, cough, and general debility.


Drugs used for Snehapana

Draksha Ghrita

INGREDIENTS OF DRAKSHA GHRITA253

Table No. 32: Showing Ingredients Of Draksha Ghrita

2) Draksha Ghrita :

Draksha Ghrita was be prepared according to the sneha kalpana vidhi mentioned

in Sharangadhara samhita madhyama khanda in the Department of Rasa Shastra

D.G.M.A.M.C, Gadag.

Ingredients of draksha Ghrita are

Draksha – ½ prastha (384gm)

Ghrita – 1prastha (768ml)



Method of preparation:

Ghrita paka should be done with 1 prastha of Ghrita by adding 4 prastha of jala

and ½ prastha of draksha kalka.

Pharmaco dynamics of ingredients of Draksha Ghrita.

San. Name

Latin Name

Family Rasa Guna Veerya Vipaka Dosha gnata

Karma Useful part

Draksha

Vitis vinifera

Vitaceae

Madhura, Amla

Guru, Snigdha

Sheeta

Madhura

Vata pitta samaka

Rakta prasadana vrushya, balya, jeevaneeya

Phala


DRAKSHA

Botanical Name : Vitis vinifera Linn.

Family : Vitaceae

Figure 6 showing Draksha

Synonyms : Draksha, Mrudvika, Gosthana, Svaduphala, Amritaphala, Karavi

Part used : Phala

Pharmacodynamics Rasa : Madhura, Amla

Guna : Guru, Snigdha

Virya : Seeta

Vipaka : madhura

Doshaghnata : Vata pitta shamaka

Rogaghnata : Rakta prasadana, vrushya, balya, jeevaneeya

Karma : Rakta prasadana


Vernacular names :

English : Grape wine, Wine grape.

Hindi : Dakh, Drak

Kannada : Drakshi

Habitat:

Distribution: Cultivated in the dry-cold areas of India mainly in Kashmir, Punjab and

Himachal Pradesh .

Plant description:

A perennial, deciduous tendril climber. Tendrils bifid, opposite to leaves.

Leaves simple, 3-5 lobed, cordate, toothed; flowers small, green, found in panicled

cymes; fruits vary in color from bluish black to green, globes, contain 2-4 seeds within

the sweet pulp.

Pharmacological Activities:

Plant pacifies vitiated pitta, burning sensation, constipation, hemorrhoids, anemia, skin

diseases, colic, flatulence, jaundice, vomiting, splenomegaly, arthritis, and amenorrhea.

GHRITA254

Figure 7 showing Ghrita


Ghrita is best among all the Sneha Dravya.

Safe even in higher doses.

Suitable to all age group persons.

Can be used in all seasons

Easily available.

Classical name:

Ajaya, Havish, Sarpish, Ghritam

Vernacular name:

English - Ghee

Hindi - Ghee

Kannada - Tuppa

Pharmaco dynamic properties of Ghrita according to Samhitas and Nighantus Table No. 33 Showing Pharmaco dynamic properties of Ghrita according to Samhitas and Nighantus

Samanya Karma:

Vrishya, Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara, papahara,

Rakshoghna, Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya, Rasayana,

Sugandha, Rochana, Smriti vardhaka, Rasa, Shukra vardhaka

Samhitas and Nighantus

Rasa Guna Virya Vipaka Doshaghnata

Ch. S. Madhura - Sheeta Madhura Vatapittahara Su.S Madhura - Sheeta Madhura Vatapittahara A.S - - Sheeta Madhura Vatapittahara A.H - - Sheeta - - K.S Madhura - - - - D.N Madhura - Sheeta Madhura - M.N Madhura Guru Sheeta - Vatapittahara K.N - - - Madhura Vatapittahara R .N - - - - Tridoshahara B.P.N Madhura Guru Sheeta Madhura Tridoshahara Sh.N Madhura - Sheeta Madhura Tridoshahara


Rogaghnata:

Visha, Unmada, Shosa, Jvara, Mada, Apasmara, Murchcha, Yoni shoola, Karna shoola,

Shira shoola.

Chemical Constituents:

Fatty acids, Phospholipids, Sterols, Sterols esters, Fat soluble Vitamins (Vit.

A, D,K) Hydrocarbons, Carotenoids, Casein, Traces of iron Phosphorus, copper, Traces

of iron Phosphorus, Copper, β carotene.

Chemical composition of Ghrita255: Triglycerides : 97.98%

Diglycerides : 0.25 -1.5%

Monoglycerides : 0.16 - 0.038%

Ketoacid glycerides : 0.015 - 0.018%

Glycerylesters : 0.011 - 0.015%

Free fatty acid : 0.1 - 0.44%

Phospholipids : 0.2 -1%

Sterols : 0.22 - 0.4%

Pharmacological effects: Like any clarified butter, ghee is composed almost entirely of saturated

fat. Ghee contains 8% lower saturated fatty acids which makes it easily digestible. Its

digestibility coefficient or rate of absorption is 96% which is highest of all oils and fats.

Ghee is lipophilic and this action of ghee facilitates transportation of ingredients of

formulation to a target organ and final delivery, inside the cell, up to the mitochondria,

microsome and nuclear membrane, because cell membrane also contains lipid. Due to the

Palatability of Ghee even at higher dose, relative to oil it is most acceptable to the

internal environment of the body.


METHODOLOGY

“The man of Science has learned to believe in justification not by faith, but by verification” Clinical study is the essence of any research work. It reveals the promises

and short comings of any hypothesis. It further rectifies the hypothesis and improves its

practical applicability. Ayurveda has its own dictum and principles which have stayed

against the test of time. Still if we can support them by findings of modern pathology

then they would be more acceptable to the whole world. The classification of diseases in

Ayurveda is done on the basis of their dosha predominance and the symptoms vary

accordingly. Interpretation of laboratory investigations is very much significant in the

present scenario of Ayurvedic practice.

This study is a humble effort to derive a possible hypothesis regarding the role

of Snehapana in Panduroga by giving Arohana and Sadharana . So here the disease

Panduroga is being selected for the study due to its predominance in the community and

the difference in its lakshanas according to specific dosha predominance. The classical

references state that Raktha dhathu is affected in the pathogenesis of Panduroga along

with Rasadhathu. Objective study of Raktha dhathu is possible by laboratory parameters.

Anemia is a disorder where there is an abnormality in the elements of blood and

clinically most of the symptoms of anemia come under the description of Panduroga. So

selected blood parameters to assess anaemia is subjected here for the study.

Research approach:

The main aim of this study is the Evaluation of comparative efficacy of arohana &

sadharana krama snehapana in panduroga. After the completion of the full treatment, the


outcome were assessed by comparing the before treatment data with the after treatment

data.

MATERIALS:

The materials taken for the clinical study were

1. Jeeraka choorna (Depana pachana)

2. Draksha ghritha (Arohanakrama snehapana and sadaranakrama snehapana)

1) Jeeraka Choorna:

The ingredient of Jeeraka Choorna is jeeraka, which is taken and powdered

well, Filtered through cloth and made into fine powder. Jeeraka choorna was prepared in

Department of Rasashastra D.G.M.A.M.C, Gadag.

2) Draksha Ghrita :

Draksha Ghrita was being prepared according to the Sneha kalpana vidhi

mentioned in Sharangdhara Samhita Madhyama khanda in the Department of Rasa

Shastra D.G.M.A.M.C, Gadag.

Ingredients of Draksha Ghrita are

Draksha – ½ Prastha (384gm)

Ghrita – 1Prastha (768ml)



Method of preparation:

Ghrita paka should be done with 1 prastha of Ghrita by adding 4 prastha of jala

and ½ prastha of Draksha kalka.


Research Design:

Simple randomized comparative clinical study.

Sample Size: A total number of 30 Patients will be selected randomly and assigned in two groups.

Group A: 15 patients will receive Draksha ghrita Arohana krama snehapana.

Group B: 15 patients will receive Draksha ghrita Sadharana krama snehapana.

Source of Data: Patients: Patients of Panduroga will be selected from O.P.D. and I.P.D, Dept of

Panchakarma, P.G.studies and Research Centre, Shri D.G.M.A.M.C. and Hospital,

Gadag.

Literary: Literary aspect of the study will be collected from classical Ayurvedic and

modern text with updated recent medical journals.

Criteria for diagnosis:

The clinical features of Panduroga mentioned as per Ayurvedic texts like,

Panduta Arohanayasa Dourbalya

Agnimandya Brama

These will be the basis for diagnosis and further confirmed by the hematological

tests.

Selection criteria:

The cases selected strictly as per the signs and symptoms mentioned as per classics.

Inclusion criteria: 1) Patients with classical features like panduta, raktalpata, dourbalya,

annadwesaha etc of sadhya Panduroga and other than that of exclusion criteria are

included.


2) Patients of both sex, between the age of 18 to 60 years.

3) Patients who are fit for Snehanapana.

Exclusion Criteria: 1) Patients of age below 18 years and more than 60 years.

2) Pregnancy and lactating mothers.

3) Associated with severe systemic disorders like Hypertension, Diabetes

mellitus, etc.

Administration of therapy: 1) Deepana - Pachana with Jeeraka choorna 3-6 gms,with sukhoshna jala as

Anupana three times a day before food for 3-5 days or till the appearance of nirama

lakshana

2) Snehapana with Draksha Ghrita in Arohana vidhi starting with 30ml

increasing 30 ml every day for 5-7 days or till samyak snigdha lakshanas are seen for 15

patients.

3) Snehapana with Draksha ghrita in sadharana vidhi 40ml (each day) for 7 days

for 15 patients.

Pathya:

All the patients were advised to take drava, ushna, anabhishyandi and Luke warm water

and Some Pathya Ahara Vihara mentioned for panduroga.

Apathya:

All the patients were advised not to take cold drinks, cold food,day sleep and other

Apathya Ahara Vihara mentioned for panduroga.


STUDY DURATION:

Deepana , Pachana – 3 - 5 days

Snehapana – 5-7 days.

Follow up –20days.

Total study duration –30days

INVESTIGATION:

Hb%, TC, DC ESR, RBC and PCV has been indicated. Investigation is carried out on the

patients to rule out other systemic disorders as an optional.

Assessment of clinical Response

Subjective and objective parameters were made out to assess the clinical response in the

total number of patients. All the grades declared for the assessment of subjective and

Objective parameters are clearly mentioned along with the case sheet .

Subjective parameters:

1) Panduta

2) Agnimandya

3) Arohanayasa

4) Bhrama

5) Dourbalya

Objective parameters:

1) Hb %

2) TC, DC

3) ESR

4) TRBC

5) PCV


Investigations

1) Hb %

2) TC, DC

3) ESR

4) TRBC

5) PCV

Assessment Criteria:

Assessment of signs/symptom before and after treatment was main criteria.

Assessment of parameters:

Clinical assessment was made for the severity of the disease and for the clinical

Improvement. Regarding for the severity of individual symptoms assessment was framed

as follows.

GRADING FOR THE SUBJECTIVE PARAMETERS

Panduta

Absent (no pallor) - 0

Mild - 1

Moderate - 2

Severe - 3

Agnimandhya

Absent - 0

Mild - 1

Moderate - 2

Severe - 3

Arohanayasa

No exertional dysponea - 0


Mild dysponea - 1

Dysponea disturbs patient’s daily activities intermittently - 2

Dysponea disturbs patient’s daily activities frequently - 3

Brama

Absent - 0

Occasional - 1

Frequently - 2

Constant - 3

Dourbalya

Absent - 0

Mild - 1

Moderate - 2

Severe - 3

OBJECTIVE PARAMETERS:

Objective parameters will be assessed on the basis of values obtained.

1. Hb% - Male – 14.0 g/dl to 17.4 g/dl.

- Female 12.3 g/dl to 15.3g/dl.

2. Total count. - 4000-1000cells/cumm

3. Differential count

Platelets - 45-65%

Lymphocytes - 20-30%

Esnophils - 01-06%

Monocytes - 00-01%


Basophiles - 00-01%

4. ESR - Male-0-10mm/1st hour

- Female-0-15mm/1st hour

5. RBC count - Male –4.5-6.5million/cumm.

- Female- 4.8-5.5million/cumm.

6. PCV - Male – 40-54% Average – 46%-41%.

- Female 37-47%

OVERALL ASSESSMENT OF CLINICAL RESPONSE

Highly significant improvement in Subjective and Objective parameters.

Significant improvement in Subjective and Objective parameters.

Non significant Improvement in Subjective and Objective parameters.


MASTER CHART Table: 34 Showing Demographical Data

M-Male, F-Female, A-Age, S-Sex H-Hindu, M-Muslim, C-Christian, A-Active, L-Lobour, S-Sedentary , P-Poor, M-Middle class, H-Higher class V-Vegetarian, M-Mixed

SL No:

OPD No:

Age Sex

Religion

Occupation

Economical status

Diet

M F H M C A L S P M H V M

1 29691 42 - + + - - + - - - + - + - 2 32447 27 - + + - - + - - - + - + - 3 7354 22 + - + - - + - - - + - - + 4 7342 22 - + + - - + - - - - + + - 5 7340 22 - + + - - + - - - + - - + 6 7353 35 - + + - - - + - + - - + - 7 7339 22 - + + - - + - - - - + + - 8 7343 22 - + + - - + - - - - + + - 9 7586 38 - + + - - + - - - + - + - 10 7748 22 - + + - - + - - - + - - + 11 7746 22 - + + - - + - - - - + + - 12 8431 28 - + + - - + - - - + - + - 13 9376 42 - + + - - - + - + - - + - 14 7319 26 - + + - - + - - - + - + - 15 10658 26 - + - + - - + - + - - - + 16 10657 20 - + - + - - + - + - - - + 17 14180 25 + - + - - + - - - - + - + 18 16382 26 + - + - - - + - + - - - + 19 16384 30 - + + - - + - - - + - + - 20 17731 38 - + - + - - + - + - - - + 21 18157 24 + - + - - + - - - - + + - 22 23920 22 - + + - - + - - - - + + - 23 23924 22 - + + - - + - - - - + + - 24 25983 23 + - + - - + - - - + - - + 25 25982 22 + - + - - + - - - + - + - 26 27019 23 - + + - - + - - - + - + - 27 29354 30 + - + - - - + - + - - + - 28 25984 23 + - + - - + - - - + - - + 29 32437 34 - + + - - + - - - + - + - 30 34351 21 - + + - - + - - - - + + -


Table no 35 showing pradana vedana Sl No

Vaivarnya

Arohana

yasa Dour balya

Agni mandhya Brama

Aruchi

Nk Nt T V M S

1 2 2 1 1 1 1 + + + + + 2 1 2 2 1 1 1 + + + + + 3 2 2 1 1 1 1 + + + + + 4 2 2 1 1 1 1 + + + + + 5 2 2 1 1 1 1 + + + + + 6 1 2 2 1 1 1 + + + + + 7 2 2 1 1 1 1 + + + + + 8 2 2 1 1 1 1 + + + + + 9 2 2 1 1 1 1 + + + + + 10 2 2 1 1 1 1 + + + + + 11 5 1 1 1 1 1 + + + + + 12 2 2 2 1 1 1 + + + + + 13 2 2 2 1 1 1 + + + + + 14 2 2 2 1 1 1 + + + + + 15 2 2 2 1 1 1 + + + + + 16 2 2 2 1 1 1 + + + + + 17 2 2 2 1 1 1 + + + + + 18 2 2 1 1 1 1 + + + + + 19 2 2 2 1 1 1 + + + + + 20 2 2 1 1 1 1 + + + + + 21 2 2 1 1 1 1 + + + + + 22 2 2 1 1 1 1 + + + + + 23 1 2 2 1 1 1 + + + + + 24 1 2 2 1 1 1 + + + + + 25 2 2 2 1 1 1 + + + + + 26 2 2 2 1 1 1 + + + + + 27 2 2 1 1 1 1 + + + + + 28 1 2 2 1 1 1 + + + + + 29 1 2 2 1 1 1 + + + + + 30 2 2 2 1 1 1 + + + + + Nk-Nakha, Nt –Netra, T-Twak, V-Vit, M-Mootra, S-Sira Prakruta-1,Pandu-2.Krishna-3,Aruna-4,Peeta-5,Shukla-6


Table no 36 showing poorvaroopa:

Sl N

o

Hrit

sp

anda

na

Twak

ro

oksh

ata

Aru

chi

Swed

a ab

hava

A

gni

man

dhya

Sh

ram

a Sh

teev

ana

Gat

rasa

da

Avi

paka

Pe

eta

moo

trata

1 - - + - - - - + - - 2 + + + + + - - - - - 3 + - + - - - - - - + 4 - - + - + - - - - + 5 - + + - + - - - + - 6 + - + - + - - - - - 7 + - - - + - - - + - 8 - + + - + - - - - - 9 + - + - + - - - - - 10 - + + - + - - - + - 11 - - + - + - - - - - 12 - - + - - - - - - - 13 + - + - + - - - - - 14 + - + - - - - - - - 15 - - + - + - + - - - 16 - - - + + - - - - - 17 + + + + + - - - - - 18 + - + - - - + - - - 19 - - + - + - - - - - 20 + - + - + - - - - - 21 - - + - + - - - - - 22 - - + - + - - - + - 23 + - + - + - - - - - 24 - - + - + - - - - - 25 + - + - + - - - - - 26 + - + - + - - - - - 27 - - + - + - - + - - 28 - - + - + - - - - - 29 + - + - + - - - - - 30 - - + - + - - - - -


Table no 37 showing Anubandha Vedana

Sl .N

o

Kar

naks

wed

a

Sada

na

Agn

iman

dhya

Tris

hna

Toda

Ala

sya

Tand

ra

Twak

sput

ana

Shra

ma

Gat

rash

oola

Alp

a m

eda

Jwar

a

Swas

a

kasa

Hat

apra

bha

Hrid

rava

Shira

shoo

la

1 - - - - - + - - - + - - - - - - + 2 - - + - - + - - + + - - - - - - - 3 - - + - - - - + - - - - - - - - - 4 - + + + + + + - - - + - + - - - + 5 - + + + - + - - + - - - - - - - + 6 - - + - - - - - + + - - - - - - + 7 - - + - - - + - - + - - - - + - + 8 - - + + - + + - - + - - + + - - - 9 + - + - + + - - - - - - - - - + 10 - - + + + + - - - - - - - - - - + 11 - - + - - + - - - + - - + + - - + 12 - - + - - + - - - - - - - - - - + 13 - - + - - - + - - + - - + - - - + 14 - - + - - + + - - - - - - - - - - 15 - - + - - + - + - - + - - - - - - 16 - - + - - + - + - - - - - - - - - 17 - - + - - + - + - - + - - - - - - 18 - - + - - - + - - - + - - - - - + 19 - - + - - - + + + - - - - - + - - 20 - - + - - - + - - - - - - - - - + 21 - - + - - + + - - - - - - - - - - 22 - + + + - + - - + - - - - - - - + 23 - - + - - - + + + - + - - + - - - 24 - - + - - + + - - + - - - - + - - 25 - - + - - + + - - - - - - - - - - 26 - - + - - - + - - - - - - - + - + 27 - - + + + + + - + - + - - - - + 28 - - + - - - + - - + - - - - + - + 29 - - + - - - + - - + - - - - + - + 30 - - + - - - + - - + - - - - + - -


Table no 38 Showing Subjective Variables Of Arohana Krama Snehapana

BT –Before treatment, AT- After treatment, AF-After followup Panduta--- Absent - 0,Mild - 1,Moderate - 2,Severe - 3 Agnimandya--- Absent - 0,Mild - 1,Moderate -2,Severe -3 Arohanayasa--- No exertional dysponea - 0,Mild dysponea - 1,Dysponea disturbs patient’s daily activities intermittently - 2, Dysponea disturbs patient’s daily activities frequently - 3 Brama--- Absent - 0,Occasional - 1,Frequently - 2 ,Constant - 3 Dourbalya---- Absent - 0,Mild - 1 ,Moderate – 2,Dourbalya-3

SL NO

OPD NO

Panduta Agnimandhya

Arohanayasa

Bhrama

Dourbalya

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF 1 32447 2 1 0 2 2 1 1 1 0 1 1 0 2 2 1

2 7342 2 2 1 1 1 0 2 2 1 1 1 1 1 0 0

3 7340 2 2 1 2 1 0 0 0 0 1 0 0 2 1 1

4 7339 2 2 1 1 1 0 2 2 1 2 1 0 1 1 1

5 7343 2 2 1 1 1 0 2 2 1 1 1 0 2 1 1

6 7748 2 2 1 2 1 0 2 2 1 1 1 0 2 1 1

7 7746 2 2 1 2 1 0 2 2 1 0 0 0 2 2 1

8 8431 2 2 1 2 2 1 1 1 0 2 1 0 1 0 1

9 9376 2 2 1 1 1 0 2 1 0 3 2 1 3 2 1

10 14180 2 2 1 2 0 0 1 1 0 1 1 0 1 1 1

11 16382 1 1 0 2 2 1 0 0 0 2 1 1 1 1 0

12 23920 1 1 0 2 1 1 1 1 0 2 2 1 1 1 0

13 23924 1 1 0 2 2 0 1 1 1 0 0 0 1 1 1

14 27019 2 2 0 2 1 0 3 1 1 2 1 0 1 0 0

15 29354 2 2 1 1 1 0 2 2 1 2 1 1 1 1 0


Table no 39 Showing Subjective Variables Of Sadaranakrama Sneha Pana

BT –Before treatment, AT- After treatment, AF-After followup Panduta--- Absent - 0,Mild - 1,Moderate - 2,Severe - 3 Agnimandya--- Absent - 0,Mild - 1,Moderate -2,Severe -3 Arohanayasa--- No exertional dysponea - 0,Mild dysponea - 1,Dysponea disturbs patient’s daily activities intermittently - 2, Dysponea disturbs patient’s daily activities frequently - 3 Brama--- Absent - 0,Occasional - 1,Frequently - 2 ,Constant - 3 Dourbalya---- Absent - 0,Mild - 1 ,Moderate – 2,Dourbalya-3

SL NO

OPD NO

Panduta Agnimandhya

Arohanayasa

Bhrama

Dourbalya

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF 1 29691 2 2 2 2 1 1 0 0 0 2 1 1 1 0 1

2 7354 2 2 2 2 1 1 1 1 1 1 0 0 2 1 1

3 7353 2 2 2 2 1 1 2 1 0 1 0 0 2 1 1

4 7586 1 1 0 1 1 1 1 0 1 2 1 1 2 1 1

5 7319 2 1 2 2 0 1 3 2 2 2 1 1 1 1 1

6 10658 2 2 2 3 2 1 2 1 1 0 0 0 2 1 1

7 10657 2 2 2 1 0 1 2 1 1 1 1 0 2 1 2

8 16384 2 2 2 2 1 1 2 1 1 1 1 1 2 1 1

9 17731 2 1 1 2 1 1 3 2 1 3 1 1 2 1 1

10 18157 1 1 1 2 1 2 1 1 0 1 1 0 2 1 1

11 25983 1 1 1 1 0 1 1 0 1 1 0 1 2 1 1

12 25982 2 1 2 2 1 1 1 0 1 1 0 1 1 1 0

13 25984 2 2 2 2 1 0 1 1 1 0 0 0 1 1 1

14 32437 2 2 2 3 2 1 3 2 1 2 2 2 3 2 1

15 34351 2 2 2 2 1 1 2 1 0 1 0 0 2 1 1


Table no 40 showing Manasika nidanas

Sl no

Aharaja Viharaja Manasika

ksha

ra

Am

la

Lava

na

Aty

ushn

a

Atit

eeks

hna

Viru

ddha

Asa

tmya

Mas

ha

Nis

hpav

a

Tila

taila

Piny

aka

Mad

ya

mrit

hika

Div

a sw

apna

Ativ

yaya

ma

Ativ

yava

ya

Veg

a dh

aran

a

Ritu

va

iham

ya

Kam

a

Chi

nta

Bha

ya

Kro

dha

Shok

a

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


Table no 41 showing Manasika nidanas

Sl no

Aharaja

Viharaja Manasika

ksha

ra

Am

la

Lava

na

Aty

ushn

a A

titee

kshn

a

Viru

ddha

Asa

tmya

Mas

ha

Nis

hpav

a

Tila

taila

Piny

aka

Mad

ya

mrit

hika

Div

a sw

apna

A

tivya

yam

a

Ativ

yava

ya

Veg

a dh

aran

a R

itu

vaih

amya

K

ama

Chi

nta

Bha

ya

Kro

dha

Shok

a

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


Tables no 42 showing objective variables in Arohana krama Snehapana

Sl No OPD NO Hb% Total count

Differential count Platelets Lymphocytes Esnophils

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF

1 32447 8.7 9 9.2 6250 6400 6600 55 56 56 42 40 41 3 4 3 2 7342 8.2 8.4 9 5400 5600 5800 60 60 62 36 37 36 4 3 2 3 7340 7.2 7.6 7.8 4800 5000 5100 51 55 60 46 41 38 3 4 2 4 7339 7.6 7.8 8.1 5200 5600 5700 58 62 62 40 36 37 2 2 1 5 7343 9.2 9.6 9.8 7000 7200 7200 52 64 60 40 36 38 8 2

6 7748 7.1 7.4 7.8 5200 5300 5200 49 55 60 45 38 34 6 7 6 7 7746 8.2 8.6 8.8 5600 5680 5820 65 65 65 33 30 32 6 5 3 8 8431 8.8 8.8 9 6000 6200 6300 56 62 58 38 31 38 6 7 4 9 9376 9.1 9.4 9.6 5730 6100 6320 52 58 63 42 39 33 6 3 4 10 14180 11.6 11.6 12 5500 5550 5600 50 52 56 48 46 42 2 2 2 11 16382 11.5 11.7 12 5200 5250 5360 56 58 58 40 36 38 4 6 4

12 23920 9.8 10 11.4 6500 6500 6960 65 64 64 33 34 35 2 2 1 13 23924 8.3 8.6 9.2 7200 7000 6800 57 58 63 40 42 35 3 - 2 14 27019 9 9 10.1 5800 5400 6200 68 64 60 32 36 36 - - 4 15 29354 7.4 7.5 8 6250 5650 5650 58 53 55 38 42 45 4 4 -


Table no 43 showing objective variables in Arohana krama Sneha pana

Sl No OPD NO ESR

Total RBC

PCV (In %)

BT AT AF BT AT AF BT AT AF

1 32447 20 16 14 4.8 5.1 5.2 32 33 33.4 2 7342 9 14 9 4.8 4.8 4.9 31 31.4 33 3 7340 10 12 8 5 5.2 5.4 29 30 30.4 4 7339 8 10 12 4.8 5 5.4 29 29.8 30.2 5 7343 10 12 12 5.2 5.8 6 32 33 33.6 6 7748 15 14 13 4.5 4.5 4.6 29 29.6 30 7 7746 14 13 10 4.9 4.9 5 30.6 30.9 31 8 8431 10 12 10 5 5.1 5.2 30 30.1 31 9 9376 12 14 12 4.9 5.2 5.9 34 34.1 34.5 10 14180 16 12 14 5.4 5.4 5.8 42 42 43.8 11 16382 12 14 14 5.6 5.6 5.8 40 40.3 42 12 23920 8 12 13 3.5 4.2 5 32 33 34.3 13 23924 10 13 32 3.8 3.9 5.2 30 31.9 33 14 27019 22 18 14 5.5 5.6 6.2 33 33 34.1 15 29354 10 8 5 5 3.8 4.01 24 25 26


Table no 44 showing Objective variables in Sadharana krama Snehapana

Sl No OPD NO

Hb% Total count

Differential count Platelets Lymphocytes Esnophils

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF

1 29691 8.2 8.4 9.9 5850 5960 6200 62 66 66 34 30 32 4 4 2

2 7354 9.8 10 10.2 6280 6350 6350 58 60 60 39 36 37 3 4 3 3 7353 8.2 8.6 9 5800 5860 6200 52 54 63 42 40 32 6 6 5

4 7586 9 9.2 9.6 6350 6480 6500 56 58 60 44 40 38 - 2 2 5 7319 8.2 8.6 8.6 5800 5860 6200 52 54 62 42 40 33 6 6 5

6 10658 6.8 7 7.4 4800 4850 4890 58 60 62 36 34 36 6 6 2 7 10657 9.9 9.9 9.9 5800 5900 6200 49 50 50 45 44 44 6 6 6 8 16384 7.6 7.8 8.1 5200 5600 5900 58 62 62 40 36 37 2 2 1 9 17731 8.2 8.6 9.1 5600 5680 5820 65 65 65 33 30 32 2 5 3

10 18157 10.2 10.4 10.4 6200 6400 6300 58 60 62 40 37 36 2 3 2 11 25983 10.2 10.4 10.3 6300 6400 6350 62 66 60 36 31 38 2 3 2

12 25982 9.5 9.8 9.9 5300 5800 6000 63 60 62 36 38 34 1 2 4 13 25984 10.5 10.5 11.2 6200 6300 7200 60 62 64 36 34 34 4 4 2 14 32437 7 7.6 7.7 6100 6300 6400 63 62 60 37 36 38 - 2 2 15 34351 9.1 9.4 9.4 5850 6000 6800 62 66 64 36 32 36 2 2 -


Table no 45 showing Objective variables in Sadharana krama Snehapana

Sl No OPD NO ESR

Total RBC

PCV (In %)

BT AT AF BT AT AF BT AT AF

1 29691 8 10 12 4.8 5 6.1 33 33.2 34.2

2 7354 9 10 10 5.2 5.2 5.4 41 41.5 41.8 3 7353 16 16 14 4.2 4.4 4.5 31 32 32.9

4 7586 8 10 8 4.8 5 5.2 33 33.4 34 5 7319 14 12 12 4.2 4.4 4.5 32 33 33.1

6 10658 12 11 10 4.4 4.6 5 29 29.8 31 7 10657 15 12 12 5.6 5.6 5.8 33 33 33.2 8 16384 8 10 12 4.8 5 5.4 30 31 31.9 9 17731 14 13 10 4.9 4.9 5 32 34 35.2

10 18157 10 10 9 5.1 5.1 5.4 40 40.5 40.4 11 25983 8 9 9 5.2 5.4 5.4 40 41 41.1

12 25982 7 9 14 5.1 5.3 5.4 41 41.2 41.8 13 25984 9 9 9 4.8 4.9 4.9 39 39.5 42 14 32437 19 16 18 4.92 4.90 4.98 28 30 30.8 15 34351 12 14 12 5.2 5.1 5.6 30 31.5 31


OBSERVATION AND RESULTS Total 30 patients underwent treatment who were included randomly

based on inclusion criteria and fulfilled the subjective and objective parameters. All the

patients were examined before and after treatment as per the case sheet Performa. The

datas collected are presented below:

Distribution of patients by Age: Table No 46 Distribution of patients by age

Note :Age Group A, Among 15 patients, 10(66.70%) patients in age group 20 – 25

Years, 4 (26.70%) in age group 26-30 Years, 1(6.60%) in age group 41-45 Years. In

Group B Among 15 patients, 7(46.70%) patients in group 20-25 Years, 3(20%) in group

26 – 30 years, 2 (13.30%) in group 31- 35 Years, 2 (13.30%) in group 36- 40 Years and

1(6.70%) in group 41- 45 Years age group.

Graph No 1 showing distribution of patients by age

010203040506070

20-25 26-30 31-35 36-40 41-45

Group A

%

Group B

%

Age group Group A % Group B % 20-25 10 66.70 7 46.70 26-30 4 26.70 3 20 31-35 0 0 2 13.30 36-40 0 0 2 13.30 41-45 1 6.60 1 6.70


Distribution of patients by Sex Table No 47 Distribution of patients by sex

Note: In group A (Arohana Krama Snehapana), Among 15 patients, 3 (20%) patients

were males and 12(80%) were females. In Group B (Sadharana Krama Snehapana),

Among 15 patients, 5(33.3%) patients were males and10 (66.7%) were females.

Graph No 2 showing distribution of patients by sex

Distribution of patients by Religion Table No 48 Distribution of patients by Religion


were Hindus. In Group B (Sadharana Krama Snehapana), Among 15 patients, 12(80%)

patients were Hindus and 3 (20%) were Muslims.

0102030405060708090

Group A % Group B %

Male

Female

Gender Group A % Group B % Male 3 20 5 33.3 Female 12 80 10 66.7

Religion Group A % Group B % Total % Hindu 15 100 12 80 27 90 Muslim 0 0 3 20 3 10 Christian 0 0 0 0 0 0


Graph No 3 showing distribution of patients by Religion

Distribution of patients by Occupation Table No 49 Distribution of patients by Occupation

Note: In group A, amoung 15 patients, 12 (80%) patients were active group, 3(20%)

were Labourers. In Group B, among 15 patients, 11(73.3%) patients were active and 4

(26.7%) were Labourers.

Graph No 4 showing distribution of patients by Occupation

0

20

40

60

80

100

120

Group A % Group B % Total %

Hindu

Muslim

Christian

01020304050607080


Active

Lobour

Sedentary

Occupation Group A % Group B % Total % Active 12 80 11 73.3 23 76.67 Labour 3 20 4 26.7 7 23.33 Sedentary 0 0 0 0 0 0


Distribution of patients by Economical status Table No 50 Distribution of patients by Economical status


were poor class, 5(33.3%) were middle class and 7(46.7%) belongs to higher class. In

Group B (Sadharana Krama Snehapana), Among 15 patients, 4(26.7%) patients were

poor class, 9(60%) were middle class and 2(13.3%) belongs to higher class group.

Graph No 5 showing distribution of patients by Economical status

Distribution of patients by Mode of onset of disease Table No 51 Distribution of patients by Mode of onset of disease

0102030405060


Poor

Middle class

Higher class

Economical status


Poor 3 20 4 26.7 7 23.3 Middle class 5 33.3 9 60 14 46.7 Higher class 7 46.7 2 13.3 9 30

Mode of onset of disease


Sudden 0 0 0 0 0 0 Gradual 15 100 15 100 30 100 Insidious 0 0 0 0 0 0



had gradual onset of disease. In Group B (Sadharana Krama Snehapana), Among 15

patients, 15 (100%) patients had gradual onset of disease.

Graph No 6 showing distribution of patients by Mode of onset of disease

Distribution of patients by Course of disease Table No 52 Distribution of patients by Course of disease


had course of disease in a gradually progressive way. In Group B (Sadharana Krama

Snehapana), Among 15 patients, 15 (100%) patients had course of disease in a gradually

progressive way.

0

20

40

60

80

100


Sudden

Gradual

Insidious

Course of disease


Gradually progressive

15 100 15 100 30 100

Persistent 0 0 0 0 0 0 Relapsing 0 0 0 0 0 0


Graph No 7 showing distribution of patients by Course of disease

Distribution of patients by Chikitsa vrittanta Table No 53 Distribution of patients by Chikitsa vrittanta

Note: In group A Among 15 patients, 1 (6.67%) patients had taken modern medicine,

6(40%) had taken Ayurvedic treatment and 8(53.33%) had not taken any kind of

treatments. In Group B (,Among 15 patients, 2 (13.33%) patients had taken modern

medicine, 9(60%) had taken Ayurvedic treatment and 4(26.67%) had not taken any kind

of treatments.

0

20

40

60

80

100


Gradually progressive

Persistent

Relapsing

Chikitsa vrittanta


Modern medicine

1 6.67 2 13.33 3 10

Ayurvedic medicine

6 40 9 60 15 50

surgery 0 0 0 0 0 0 No medication

8 53.33 4 26.67 12 40


Graph No 8 showing distribution of patients by Chikitsa vrittanta

Distribution of patients by Kula vrittanta Table No 54 Distribution of patients by Kula vrittanta

Note: In group A among 15 patients, 4 (26.7%) patients had maternal kula vrittanta and

11(73.3%) had no history of maternal or paternal kula vrittanta. In Group B, among 15

patients, 9(60%) patients had maternal kula vrittanta and 6(40%) had no history of

maternal or paternal kula vrittanta.

Graph No 9 showing distribution of patients by Kula vrittanta

010203040506070


Modern medicine

Ayurvedic medicine

surgery

No medication

01020304050607080


Maternal

paternal

Absent

Kula vrittanta


Maternal 4 26.7 9 60 13 43.3 paternal 0 0 0 0 0 0 Absent 11 73.3 6 40 17 56.7


Distribution of patients by Type of diet Table No 55 Distribution of patients by Type of diet

Note: In group A (Arohana Krama Snehapana), Among 15 patients, 11 (73.3%) patients

were vegetarians and 4(26.7%) were mixed diet groups. In Group B (Sadharana Krama

Snehapana), Among 15 patients, 9 (60%) patients were vegetarians and 6(40%) were

mixed diet groups.

Graph No 10 showing distribution of patients by Type of diet

Distribution of patients by Dominant rasa Table No 56 Distribution of patients by Dominant rasa

0

20

40

60

80


Vegetarian

Mixed

Type of diet


Vegetarian 11 73.3 9 60 20 66.7 Mixed 4 26.7 6 40 10 33.3

Dominant rasa


Madhura 10 66.7 6 40 16 53.33 Katu 8 53.3 11 73.33 19 63.33 Amla 12 80 6 40 18 60 Tikta 0 0 0 0 0 0 Lavana 11 73.33 3 20 14 46.66 kashaya 0 0 0 0 0 0


Note: In group A, among 15 patients, 10 (66.7%) patients were taking Madura rasa,

8(53.3%) were taking Katu rasa, 12(80%) were taking Amla rasa, 11(73.33%) were

taking Lavana rasa Ahara . In Group B, among 15 patients, 6(40%) patients were taking

Madura rasa, 11(73.33%) were taking Katu rasa,6(40%) were taking Amla rasa, 3(20%)

were taking lavana rasa Ahara .

Graph No 11showing distribution of patients by Dominant rasa

Distribution of patients by Diet pattern Table No 57 Distribution of patients by Diet pattern

Note: In group A, among 15 patients, 2 (13.3%) patients were Samashana, 1(6.7%) were

Adyashana, 9(60%) were Anashana and 3(20%) are Vishamashana. In Group B, among

15 patients, 2 (13.3%) patients were Samashana, 5(33.3%) were Adyashana, 3(20%) were

Anashana and 5(33.3%) are Vishamashana.

01020304050607080


Madhura

Katu

Amla

Tikta

Lavana

kashaya

Diet pattern Group A % Group B % Total %

Samashana 2 13.3 2 13.4 4 13.3 Adyashana 1 6.7 5 33.3 6 20 Anashana 9 60 3 20 12 40 vishamashana 3 20 5 33.3 8 26.7


Graph No 12showing distribution of patients by Diet pattern

Distribution of patients by Vyayama Table No 58 Distribution of patients by Vyayama


belonged to mild Vyayama group, 7(46.67%) patients belonged to moderate Vyayama

group, 2(13.33%) patients belonged to heavy Vyayama group. In Group B (Sadharana

Krama Snehapana), Among 15 patients, 4 (26.67%) patients belonged to mild Vyayama

group, 8(53.33%) patients belonged to moderate Vyayama group, 3(20%) patients

belonged to heavy Vyayama group.

Graph No 13 showing distribution of patients by Vyayama

0

10

20

30

40

50

60


Samashana

Adyashana

Anashana

vishamashana

Vyayama Group A % Group B % Total %

Mild 6 40 4 26.67 10 33.33 Moderate 7 46.67 8 53.33 15 50 Heavy 2 13.33 3 20 5 16.67


Distribution of patients by Manasika vihara Table No 59 Distribution of patients by Manasika vihara

Note: In group A, among 15 patients, 10(66.67%) patients had Chinta, 6(40%) patients

had Shoka, 4(26.67%) patients had Bhaya and 6(40%) patients had Kroda. In Group B,

among 15 patients, 6(40%) patients had Chinta, 7(46.67%) patients had Shoka,

10(66.67%) patients had Bhaya and 7(46.67%) patients had Kroda.

Graph No 14 showing distribution of patients by Manasika vihara

0

10

20

30

40

50

60


Mild

Moderate

Heavy

0

20

40

60

80


Chinta

Shoka

Bhaya

Krodha

Manasika vihara


Chinta 10 66.67 6 40 16 53.33 Shoka 6 40 7 46.67 13 43.33 Bhaya 4 26.67 10 66.67 14 46.67 Krodha 6 40 7 46.67 13 43.33


Distribution of patients by Vyasana Table No 60 Distribution of patients by Vyasana

Note: In group A (Arohana Krama Snehapana), Among 15 patients, 2(13.33%) patients

were taking tobacco and 13(86.67%) patients were not having any habits. In Group B

(Sadharana Krama Snehapana), Among 15 patients, 1(6.67%) patient were taking

alcohol, 1(6.67%) patient were taking tobacco, 3(20%) patients were smokers and

12(80%) patients were not having any habits.

Graph No 15 showing distribution of patients by Vyasana

0

20

40

60

80

100


Alcohol

Tobacco

Smoking

No habit

Vyasana Group A % Group B % Total % Alcohol 0 0 1 6.67 1 3.33 Tobacco 2 13.33 1 6.67 3 10 Smoking 0 0 3 20 3 10 No habit 13 86.67 12 80 25 83.33


Distribution of patients by Nidra Table No 61 Distribution of patients by Nidra


were having sound sleep and 5(33.33%)were having disturbed sleep. In Group B

(Sadharana Krama Snehapana), Among 15 patients, 9(60%) patients were having sound

sleep, 5(33.33%) were having disturbed sleep and 1(6.67%) patient were having day

sleep,

Graph No 16 showing distribution of patients by Nidra

0

10

20

30

40

50

60

70


Sound

Disturbed

Day sleep

Nidra Group A % Group B % Total %

Sound 10 66.67 9 60 19 63.33 Disturbed 5 33.33 5 33.33 10 33.33 Day sleep 0 0 1 6.67 1 3.34


Distribution of 22 patients by Menstrual history Table No 62 Distribution of patients by Menstrual history

Note: In group A (Arohana Krama Snehapana), Among 12 patients, 12(80%) patients

had regular menstrual history. In Group B (Sadharana Krama Snehapana), Among 10

patients, 7(46.67%) had regular menstrual history, 3(20%) had Irregular menstrual

history,1(6.67%) patients had Menorrhagia,3(20%) patients had Metrorrhagia

and1(6.67%) patients had Leucorrhagia.

Graph No 17 showing distribution of patients by Menstrual history

0

10

20

30

40

50

60

70

80


Regular

Irregular

Menopause

Menorrhagia

Metrorrhagia

Leucorrhagia

Menstrual history


Regular 12 80 7 46.67 19 63.33 Irregular 0 0 3 20 3 10 Menopause 0 0 0 0 0 0 Menorrhagia 0 0 1 6.67 1 3.33 Metrorrhagia 0 0 3 20 3 10 Leucorrhagia 0 0 1 6.67 1 3.33


Distribution of patients by Koshta Table No 63 Distribution of patients by Koshta


had Krura Koshta 11(73.26%) had Madhyama Koshta and 2(13.32%) had Mrudhu

Koshta. In Group B (Sadharana Krama Snehapana), Among 15 patients, 3(19.98%)

patients had Krura Koshta 11(73.26%) had Madhyama Koshta and 1(6.66%) had

Mrudhu Koshta.

Graph No 18 showing distribution of patients by Koshta

Distribution of patients by Prakriti Table No 64 Distribution of patients by Prakriti

0

10

20

30

40

50

60

70

80


Krura

Madhyama

Mrudhu

Koshta Group A % Group B % Total % Krura 2 13.32 3 19.98 5 16.66 Madhyama 11 73.26 11 73.26 22 73.33 Mrudhu 2 13.32 1 6.66 3 10


Note: In group A,among 15 patients, 10(66.67%) patients had Vatapittaja Prakriti,

3(20%) had Kaphavataja Prakriti and 2(13.32%) had Kaphapittaja Prakriti. In Group B

among 15 patients, 9(60%) patients had Vatapittaja Prakriti, 3(20%) had Kaphavataja

Prakriti and 3(20%) had Kaphapittaja Prakriti.

Graph No 19 showing distribution of patients by Prakriti

Distribution of patients by Satwa

Table No 65 Distribution of patients by Satwa

0

10

20

30

40

50

60

70


Vatapittaja

Kaphavataja

Kaphapittaja

Prakriti Group A % Group B % Total %

Vatapittaja 10 66.67 9 60 19 63.33 Kaphavataja 3 20 3 20 6 20 Kaphapittaja 2 13.33 3 20 5 16.67

Satwa Group A % Group B % Total %

Pravara 0 0 0 0 0 0 Madyama 15 100 15 100 30 100 Avara 0 0 0 0 0 0



had Madyama Satwa. In Group B (Sadharana Krama Snehapana), Among 15

patients15(100%) patients had Madyama Satwa.

Graph No 20 showing distribution of patients by Satwa

Distribution of patients by Satmya Table No 66 Distribution of patients by Satmya

Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 2(13.33%) patients

belonged to Sarvarasa Satmya and 13(86.66%) patients belonged to Vyamisra Satmya. In

Group B (Sadharana Krama Snehapana), Among 15 a patient, 1(6.67%) patients

belonged to Sarvarasa Satmya and 14(93.33%) patients belonged to Vyamisra Satmya.

Graph No 21 showing distribution of patients by Satmya

0

20

40

60

80

100


Pravara

Madyama

Avara

Satmya Group A % Group B % Total %

Ekarasa 0 0 0 0 0 0 Sarvarasa 2 13.33 1 6.67 3 10 Vyamisra 13 86.66 14 93.33 27 90


Distribution of patients by Samhanatha Table No 67 Distribution of patients by Samhanatha

Note: In group A, among 15 patients, 15(100%) patients were having Madyama

Samhanatha. In Group B, among 15 patients15(100%) patients were having Madyama

Samhanatha.

Graph No 22 showing distribution of patients by Samhanatha

0

20

40

60

80

100


Ekarasa

Sarvarasa

Vyamisra

0

20

40

60

80

100


Susamhata

Madyama

Asamhata

Samhanatha Group A % Group B % Total %

Susamhata 0 0 0 0 0 0 Madyama 15 100 15 100 30 100 Asamhata 0 0 0 0 0 0


Distribution of patients by Pramana Table No 68 Distribution of patients by Pramana


were having Sama Pramana. In Group B (Sadharana Krama Snehapana), Among 15

patients 15(100%) patients were having Sama Pramana.

Graph No 23 showing distribution of patients by Pramana

Distribution of patients by Abhyavarana shakti Table No 69 Distribution of patients by Abhyavarana shakti

Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 1(6.67%) patient

belonged to Pravara Abhyavarana shakti and 14 (93.33%) patients belonged to Madyama

Abhyavarana shakti. In Group B (Sadharana Krama Snehapana), Among 15 a patient, 14

0

20

40

60

80

100


Sama

Heena

Adhika

Pramana Group A % Group B % Total %

Sama 15 100 15 100 30 100 Heena 0 0 0 0 0 0 Adhika 0 0 0 0 0 0

Abhyavarana shakti


Pravara 1 6.67 0 0 1 3.33 Madyama 14 93.33 14 93.33 28 93.34 Avara 0 0 1 6.67 1 3.33


(93.33%) patients belonged to Madyama Abhyavarana shakti and 1(6.67%) patient

belonged to Avara Abhyavarana shakti.

Graph No 24 showing distribution of patients by Abhyavarana shakti

Distribution of patients by Jarana shakti Table No 70 Distribution of patients by Jarana shakti

Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 14(93.33%) patient

belonged to Madyama Jarana shakti and 1 (6.67%) patient belonged to Avara Jarana

shakti . In Group B (Sadharana Krama Snehapana), Among 15 a patient, 15(100%)

patient belonged to Madyama Jarana shakti .

Graph No 25 showing distribution of patients by Jarana shakti

0

50

100


Pravara

Madyama

Avara

Jarana shakti


Pravara 0 0 0 0 0 0 Madyama 14 93.33 15 100 29 96.67 Avara 1 6.67 0 0 1 3.33


Distribution of patients by Vaya Table No 71 Distribution of patients by Vaya

Note: In group A (Arohana Krama Snehapana), Among 15 patienst, 15(100%) patients

belonged to Yuva. In Group B (Sadharana Krama Snehapana), Among 15 patients

15(100%) patients belonged to Yuva.

Graph No 26 showing distribution of patients by Vaya

Distribution of patients by Vyayama Shakti

0

20

40

60

80

100


Pravara

Madyama

Avara

0

20

40

60

80

100


Bala

Yuva

Vridha

Vaya Group A % Group B % Total %

Bala 0 0 0 0 0 0 Yuva 15 100 15 100 30 100 Vridha 0 0 0 0 0 0


Table No 72 Distribution of patients by Vyayama Shakti

Note: In group A (Arohana Krama Snehapana), Among 15 patienst, 15(100%) patients

belonged to Madyama Vyayama Shakti . In Group B (Sadharana Krama Snehapana),

Among 15 patients 14(93.33%) patients belonged Madyama Vyayama Shakti

and1(6.67%)patient belonged to Avara Vyayama shakti.

Graph No 27 showing distribution of patients by Vyayama Shakti

Distribution of patients by Poorva roopa Table No 73 Distribution of patients by Poorva roopa Poorvaroopa Group A % Group B % Hrit spandana 7 46.66 7 46.66 Twak rookshata 4 26.66 1 6.67 Aruchi 14 93.33 14 93.33 Sweda abhava 1 6.67 2 13.33 Agni mandhya 11 73.33 14 93.33 Shrama 0 0 0 0 Shteevana 1 6.67 2 13.33 Gatrasada 1 6.67 1 6.67 Avipaka 3 20 1 6.67 Peeta mootrata 2 13.33 0 0

0

20

40

60

80

100

120


Pravara

Madyama

Avara

Vyayama Shakti


Pravara 0 0 0 0 0 0 Madyama 15 100 14 93.33 29 96.67 Avara 0 0 1 6.67 1 3.33


Note: In group A among 15 patienst, 7(46.66%) patients had Hrit spandana,4(26.66%)

Twak rookshata, 14(93.33%)Aruchi,1(6.67%)Swedaabhava,11(73.33%)Agni

mandhya,1(6.67%) Shteevana, 1(6.67%) Gatrasada 3(20%) Avipaka and 2(13.33%)Peeta

mootrata. In Group B among 15 patienst,7(46.66%) patients had Hrit spandana,1(6.67%)

Twak rookshata, 14(93.33%)Aruchi, 2(13.33%) Swedaabhava, 14(93.33%) Agni

mandhya ,2(13.33%) Shteevana , 1(6.67%) Gatrasada 1(6.67%)Avipaka .

Graph No 28 showing distribution of patients by Poorva roopa

Distribution of patients by Anubandha vedana Table No 74 Distribution of patients by Anubandha vedana

0

10

20

30

40

50

60

70

80

90

100

Group A

%

Group B

%


Note: In groupA,among 15 patients, 3(20%) patients had sadana,15(100%)

Agnimandhya, 6(40%) Trishna,2(13.33%) Toda,10(66.67%) Alasya,8(53.33%)

Tantra,3(20%) Twaksputana,4(24.67%)srama, 6(40%)gatrashoola, 4(24.67%)alpameda,

1(6.67%) Jwara, 4 (26.67%) swasa, 3(20%) kasa, 5(33.33%) Hataprabha, 1(6.67%)

Hridrava 11(73.33%) Shirashoola. In Group B, among 15 patients, 1(6.67%) had

Karnashweda,14(93.33%) Agnimandhya,8(53.33%)Alasya,4(26.67%) Twaksputana,

2(13.33%)srama, 6(40%) gatrashoola,1(6.67%)alpameda, 5(33.33%) Hataprabha, 6(40%)

having shirashola.

Graph No 29 showing distribution of patients by Anubandha vedana

Anubanda vedana

Group A % Group B %

Karnaksweda 0 0 1 6.67 Sadana 3 20 0 0 Agnimandhya 15 100 14 93.33 Trishna 6 40 0 0 Toda 2 13.33 0 0 Alasya 10 66.67 8 53.33 Tandra 8 53.33 0 0 Twaksputana 3 20 4 26.67 Shrama 4 26.67 2 13.33 Gatrashoola 6 40 6 40 Alpa meda 4 26.67 1 6.67 Jwara 1 6.67 0 0 Swasa 4 26.67 0 0 kasa 3 20 0 0 Hataprabha 5 33.33 5 33.33 Hridrava 1 6.67 0 0 Shirashoola 11 73.33 6 40


Distribution of patients by Pradana vedana Table No 75 Distribution of patients by Pradana vedana

Sl. Lakshana Group A % Group B %

01. Panduta 15 100 15 100

02. Arohana Ayasa 13 86.67 14 93.33

03. Dourbalya 15 100 15 100

04. Bhrama 13 86.67 13 86.67

05. Agnimanndya 15 100 15 100


had Panduta,13(86.67%) Arohana Ayasa, 15(100%) Dourbalya, 13(86.67%) Bhrama

0

10

20

30

40

50

60

70

80

90

100

Karn

aksw

eda

Sada

na

Agni

man

dhya

Trish

na

Toda

Alas

ya

Tand

ra

Twak

sput

ana

Shra

ma

Gat

rash

oola

Alpa

med

a

Jwar

a

Swas

a

kasa

Hata

prab

ha

Hrid

rava

Shira

shoo

la

Group A

Percentage

Group B

Percentage


15(100%) Agnimanndya. In group A Sadharana Krama Snehapana), Among 15 patients,

15(100%) patients had Panduta,14(93.33%) Arohana Ayasa, 15(100%) Dourbalya,

13(86.67%) Bhrama 15(100%) Agnimanndya.

Graph No 30 showing distribution of patients by Pradana vedana

OBSERVATION OF SNEHAPANA LAKSHNAS:

The present study has been undertaken to see the effect of Arohana Snehapana

and Sadharana krama Snehapana in Panduroga .Matra of Sneha taken, time taken for

digestion, onset of Jeeryamana Lakshanas. Samyak snigdha Lakshanas were recorded

in both groups. Out of 30 samples all showed following Snehapana Lakshanas.

Matra of Draksha Ghrita administered:

The matra of Snehapana with Draksha Ghrita in both the groups

0102030405060708090

100

Group A

%

Group B

%


Table No 76 showing Matra of Ghrita administered

Group A (Arohana krama Snehapana): Draksha Ghrita was given in the dose of 30

ml on the first day to all the 15 individuals. The dose was increased by 30 ml every day.

In this group minimum dose was 120 ml and maximum dose was 630 ml.

Group B (Sadharana krama Snehapana): Draksha Ghrita was given in the dose of 40

ml fixed to all the 15 individuals. The same dose was continued up to 7 days. In this

group the total dose was 280 ml.

Sl no

Opd no

Group A Group B 1st day

2nd day

3rd day

4th day

5th day

6th day

Total sneha

Opd no

Snehapana (40 ml Fixed dose)

Total amount of sneha

1 32447 30 60 90 120 - - 300 29691 7X40ml 280 ml 2 7342 30 60 90 120 - - 300 7354 7X40ml 280 ml 3 7340 30 60 90 120 - - 300 7353 7X40ml 280 ml 4 7339 30 60 90 120 - - 300 7586 7X40ml 280 ml 5 7343 30 60 90 120 - - 300 7319 7X40ml 280 ml 6 7748 30 60 90 120 - - 300 10658 7X40ml 280 ml 7 7746 30 60 90 120 150 - 450 10657 7X40ml 280 ml 8 8431 30 60 90 120 150 - 450 16384 7X40ml 280 ml 9 9376 30 60 90 120 - - 300 17731 7X40ml 280 ml 10 14180 30 60 90 120 150 - 450 18157 7X40ml 280 ml 11 16382 30 60 90 120 150 - 450 25983 7X40ml 280 ml 12 23920 30 60 90 120 - - 300 25982 7X40ml 280 ml 13 23924 30 60 90 120 150 - 450 25984 7X40ml 280 ml 14 27019 30 60 90 120 150 - 450 32437 7X40ml 280 ml 15 29354 30 60 90 120 150 180 630 34351 7X40ml 280 ml


Table No 77 showing Snehapana kalavadhi Distribution of patients by Snehapana kalavadhi


took Snehapana up to 4 days. 7(46.67%) took more than 4 days up to 6 days. In group B

(Sadharana Krama Snehapana), Among 15 patients, 15(100%) patients took Snehapana

for 7 days.

Graph No 31 showing distribution of patients by Snehapana kalavadhi

0102030405060708090

100

No of patients in Group A

% No of patients in Group B

%

8

53.33

0 07

46.67

0 00 0

15

100

Up to 4 days

4 to 6 Days

For 7 Days

Sl No

Snehapanakalavadhi No of patient in group A

% No of patient in group B

%

1 Up to 4 days 8 53.33 0 00

2 More than 4 days up to 6 days

7 46.67 0 00

3 Taken for 7 days 0 00 15 100


JEERYAMANYA LAXANAS The mean on set of Jeeryamanya laxanas in Group A Table No 78 showing the mean on set of Jeeryamanya laxanas in Group A

Group A : On the first day after snehapana the mean onset time of Shiroruk, Bhrama,

Lalasrava, Moorcha occurred 80,110,70,160 minutes respectively. On the second day

after snehapana the mean onset time of Shiroruk, Bhrama, Lalasrava, Moorcha occured

120,125,105,120 minutes respectively . On the third day after snehapana the mean onset

time of Shiroruk, Bhrama, Lalasrava, Moorcha and daha occured 235,180,100,170,320

minutes respectively .On the fourth day after snehapana the mean onset time of Shiroruk,

Bhrama, Lalasrava, Moorcha and daha occured 220,285,220,170,315 minutes

respectively. On the fifth day after snehapana the mean onset time of Shiroruk, Bhrama,

Lalasrava, Moorcha occurred 250,230,190,100 minutes respectively. Daha did not occurr

on 1st , 2nd 5th and 6th day.

The mean on set of Jeeryamanya laxanas in Group B Table No 79 showing the mean on set of Jeeryamanya laxanas in Group B

SL.NO

JEERYAMANA LAKSHANAS

MEAN ONSET OF TIME IN MINUTES 1ST DAY

2ND DAY

3RD DAY

4TH DAY

5TH DAY

6TH DAY

7TH DAY

1 Shiroruja 80 120 235 220 250 - - 2 Bhrama 110 125 180 285 230 - - 3 Lalasrava 70 105 100 220 190 - - 4 Moorcha 160 120 170 170 100 - - 5 Daha - - 320 315 - - -

SL.NO JEERYAMANA LAKSHANAS

MEAN ONSET OF TIME IN MINUTES 1ST DAY

2ND DAY

3RD DAY

4TH DAY

5TH DAY

6TH DAY

7TH DAY

1 Shiroruja 90 110 125 150 - - - 2 Bhrama - - - - 90 - - 3 Lalasrava 110 120 160 165 210 - - 4 Moorcha - - - - - - - 5 Klama 105 - - - - - -


Group B : On the first day after snehapana the mean onset time of Shiroruk, Lalasrava,

klama occurred 90,110,105 minutes respectively. On the second day after snehapana the

mean onset time of Shiroruk, Lalasrava, occured 110,160 minutes respectively . On the

third day after snehapana the mean onset time of Shiroruk, Lalasrava, occured 125,160

minutes respectively .On the fourth day after snehapana the mean onset time of Shiroruk,

Lalasrava, occured 150,165 minutes respectively. On the fifth day after snehapana the

mean onset time of Bhrama, Lalasrava occurred 90,210minutes respectively. Klama

occurred only at the first day.moorcha did not occurr in any days.

TIME TAKEN FOR SNEHA JEERNA LAXANAS:

Table no 80 showing mean on set of time in minutes taken for Sneha Jeerna laxanas in group A GROUP A

SL.NO JEERNA LAKSHANAS

MEAN ON SET OF TIME IN MINUTES 1ST DAY 2ND DAY 3RD DAY 4TH DAY 5TH DAY

1 Jeeryamana lakshana prashama

250 300 350 370 470

2 Shareera laghuta 290 350 355 425 480

3 Kshudha pravrutti 255 310 355 470 465

4 Trishna 250 310 345 410 465

5 Udgarashudhi 300 350 360 410 470

Group A : On the first day the the mean onset of time taken for digestion and the

lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,

Trishna, Udgarashudhi occurred on 250,290,255.250,300 minutes respectively. On the

second day the the mean onset of time taken for digestion and the lakshanas like

Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna,


Udgarashudhi occurred on 300,350,310,310,350 minutes respectively. On the third day

the the mean onset of time taken for digestion and the lakshanas like Jeeryamana

lakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurred

on 350,355,355,345,360 minutes respectively. On the fourth day the the mean onset of

time taken for digestion and the lakshanas like Jeeryamana lakshana prashama, Shareera

laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurred on 370,425,470,410,410

minutes respectively. On the fifth day the the mean onset of time taken for digestion and

the lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,

Trishna, Udgarashudhi occurred on 470,480,465,465,470 minutes respectively.

Table No 81 showing mean on set of time in minutes taken for Sneha Jeerna laxanas in group B

Group B: On the first day the the mean onset of time taken for digestion and the

lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,

Trishna, Udgarashudhi occurred on 350,410,360,350,400 minutes respectively. On the

second day the the mean onset of time taken for digestion and the lakshanas like

Sl.no JEERNA LAKSHANAS

MEAN ON SET OF TIME IN MINUTES

1st day 2nd day 3rd day 4th day 5th day 6th day 7th day

1 Jeeryamana lakshana prashama

350 350 340 350 330 298 300

2 Shareera laghuta 410 400 390 350 330 340 340

3 Kshudha pravrutti

360 350 330 330 300 300 280

4 Trishna 350 360 330 330 300 300 290 5 Udgarashudhi 400 390 350 340 330 330 330



Udgarashudhi occurred on 350,400,350,360,390 minutes respectively. On the third day

the the mean onset of time taken for digestion and the lakshanas like Jeeryamana


on 340,390,330,330,350 minutes respectively. On the fourth day the the mean onset of

time taken for digestion and the lakshanas like Jeeryamana lakshana prashama, Shareera

laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurred on 350,350,330,330,390

minutes respectively. On the fifth day the the mean onset of time taken for digestion and

the lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,

Trishna, Udgarashudhi occurred on 330,330,300,300,330 minutes respectively. On the

sixth day the the mean onset of time taken for digestion and the lakshanas like


Udgarashudhi occurred on 298,340,300,300,330 minutes respectively. On the seventh

day the the mean onset of time taken for digestion and the lakshanas like Jeeryamana


on 300,340,280,290,330 minutes respectively.

Distribution of patients by Samyak snigda lakshanas in both groups Table No 82 showing Samyak snigda lakshanas in both groups



got vatanulomana,15(100%) Agnideepti 15(100%) Purisha snigdhata 15(100%)

Asamhata varchas 15(100%) Twak snigdhata 15(100%) Anga laghava 15(100%) Gatra

mardava,13(86.67%) Snehodwega,1(6.67%) Klama. In group B (Sadharana Krama

Snehapana),Among 15 patients,8(53.33%) Vathanulomana,2(13.33%) Agnideepti

5(33.33%) Purisha snigdhata ,8(53.33%) Twak snigdhata 1(6.67%) Anga laghava

8(53.33%) Gatra mardava

Graph No 32 showing Samyak snigda lakshanas in both groups

0

20

40

60

80

100

120

No of patients Group A

No of patients Group B

% Group A

% Group B

Sl no Samyak snigda lakshanas No of patients % Group A Group B Group A Group B

1 Vathanulomana 15 08 100 53.33 2 Agnideepti 15 02 100 13.33 3 Purisha snigdhata 15 05 100 33.33 4 Asamhata varchas 15 00 100 00 5 Twak snigdhata 15 08 100 53.33 6 Anga laghava 15 01 100 6.67 7 Gatra mardava 15 08 100 53.33 8 Snehodwega 13 00 86.67 00 9 Klama 01 00 6.67 00 10 Shaithilya 00 00 00 00


Table no 83 showing mean time (in minutes) taken for Samyak Snigadha laxanas of

both Groups A & B.

Group A : Out of 15 patients, On the First day the mean time taken for Vatanulomana

and Agnideepti was 280, 240 minutes respectively. On the Second day the mean time

taken for Vatanulomana, Agnideepti, Purisha snigdhata, Asamhata varchas , Twak

snigdhata , Anga laghava, , Snehodwega and Klama was 300, 390, 400, 380, 380, 400,

370, 380 minutes respectively.

On the third day the mean time taken for Vatanulomana, Agnideepti, Purisha snigdhata,

Twak snigdhata , Anga laghava,gatra mardava , Snehodwega was 380, 370, 310, 480,

420, 440, 460 minutes respectively. On the fourth day the mean time taken

Vatanulomana, Agnideepti, Purisha snigdhata, Asamhata varchas , Twak snigdhata ,

Samyak snigda lakshanas

1st day mean time

2nd day mean time

3rd day mean time

4th day mean time

5th day mean time

6th day mean time

7th day mean time

A B A B A B A B A B A B A B Vathanulomana

280 240 300 260 380 - 380 - - - - - - -

Agnideepti

240 - 390 - 370 - 430 - 460 - - 240 - 220

Purisha snigdhata

- - 400 - 310 - 410 - 450 - - - - 240

Asamhata varchas

- - 380 - - - 420 - 450 - - - - -

Twak snigdhata - - 380 - 480 - 420 - 460 - - 280 - 260 Anga laghava

- - 400 - 420 - 440 - 500 - - - - 180

Gatra mardava

- - - 440 - 410 - 440 - - 210 - 210

Snehodwega

- - 370 - 460 - 400 - 480 - - - - -

Klama

- - 380 260 - 210 - - 430 - - - - -


Anga laghava, Gatra mardava , Snehodwega 380,430,410,420,420,440,410,400 minutes

respectively. On the fifth day the mean time taken for Agnideepti, Purisha snigdhata,

Asamhata varchas , Twak snigdhata , Anga laghava, Gatra mardava , Snehodwega and

klama 460,450,450,460,500,440,480,430 minutes respectively.

Group B : Out of 15 patients, On the First day the mean time taken for Vatanulomana

was 240 minutes. On the Second day the mean time taken for Vatanulomana, 260minutes

On the second day the mean time taken for klama is 260 minutes. On the third day the

mean time taken for klama is 210 minutes. On the sixth day the mean time taken for

Agnideepti, Twak snigdhata and Gatra mardava is 240,280,210 minutes respectively.

On the seventh day the mean time taken for Agnideepti, Purisha snigdhata, Twak

snigdhata , Anga laghavaand Gatra mardava is 220, 240,260,180,210 minutes

respectively.

SUBJECTIVE AND OBJECTIVE PARAMETERS Analysis of Improvement of All Parameters after Therapy and after Follow up in Both Groups The collected data were analyzed by using SPSS-Software 15 version (Statistical

Software for Social Science).

The analysis shows two of types test, Levene’s test and t-test. The first test assumes

equality of variances and second test assumes un-equality of variances. The Levene’s test

tells us which statistic to consider to analyses the equality of means. It tests the null

hypothesis that the two groups have equal variance. A small value of significance

associated with Levene’s test indicates that the two groups have unequal variances and

the null hypothesis is falls. A small P-Value associated with Levene’s test indicates the


two groups don’t have equal variances. As researcher doesn’t assumed for equality of

variances, the t-test for equality of means is tested.

Effect of Panduta

Table no 84 Group Statistics of Panduta

Group N Mean

Std. Deviation

Std. Error Mean

Panduta Before Treatment

Group A 15 1.80 0.414 0.107 Group B 15 1.80 0.414 0.107

Panduta After Treatment Group A 15 1.73 0.458 0.118 Group B 15 1.60 0.507 0.131

Panduta After Follow-up

Group A 15 0.67 0.488 0.126 Group B 15 1.67 0.617 0.159

In the parameter, Panduta before treatment in group A, Mean was 1.80 with S.D. 0.414 is

reduced to 1.73 with SD 0.458 after treatment and after follow-up is reduced to 0.67 with

S.D. 0.488. Similarly in group B, Mean was 1.80 with S.D. 0.414 is reduced to 1.60 with

SD 0.507 after treatment and after follow-up is increased to 1.67 with S.D. 0.617

Independent Samples Test

The t-test result (with equal variances not assumed) shows t-statistic of 0.00 with 28

degrees of freedom of parameter Panduta before treatment. The corresponding two tailed

value is 1.00 higher than 0.05, which is not significant. The t-test results Panduta after

treatment t-statistic t is 0.75, the corresponding two tailed value is 0.456 which is higher

than 0.05, which is not significant. Similarly, the T-test results after follow-up is 4.922,

the corresponding two tailed value is 0.000 which is less than 0.05, which is significant.


This means the average effects two groups are not significant before and after treatment

and is significant after follow-up.

Paired Samples Correlations for both groups In Group-A, the correlation between Before Treatment After Treatment is 0.829 , which

is significant at 0.00, before and after treatment is 0.707 which is significant at 0.003.and

between after treatment and after follow-up is 0.853 , which is significant at 0.00. which

means there is linear effect between before and after the treatment in Panduata.

In Group-B, the correlation between Before Treatment After Treatment is 0.612 , which

is significant at 0.015., before and after treatment is 0.839 which is significant at 0.00

and between after treatment and after follow-up is 0.685 which is significant at 0.005.

This means there is linear effect before and after the treatment in Panduta

Paired Samples Test Further , the analysis is done by using paired t-test, In group- A, results shows not

significant before and after treatment as P>0.05. and shows more highly significant in

before and after follow-up and after treatment and after follow-up.

In group- B, results shows not significant before treatment and after treatment, before

treatment and after follow-up and after treatment and after follow-up as P>0.05.

In the parameter Panduta group A is more highly significant than group B after

treatment and after follow-up. (By comparing t-values).

Graph No 33 showing mean effect of panduta


Effect of Agnimandhya

Table no 85 Group Statistics of Agnimandhya

In the parameter Agnimandhya before treatment in group A, Mean was 1.67 with S.D.

0.488 is reduced to 1.20 with SD 0.561 after treatment and after follow-up is reduced to

0.27 with S.D. 0.458. Similarly in group B, Mean was 1.93 with S.D. 0.594 is reduced to

0.93 with SD 0.594 after treatment and after follow-up is increased to 1.00 with S.D.

0.378.

Group N Mean

Std. Deviation

Std. Error Mean

Agnimandhya Before Treatment

Group A 15 1.67 0.488 0.126

Group B 15 1.93 0.594 0.153

Agnimandhya After Treatment

Group A 15 1.20 0.561 0.145

Group B 15 0.93 0.594 0.153

Agnimandhya After Follwup

Group A 15 0.27 0.458 0.118

Group B 15 1.00 0.378 0.098

1.8 1.81.731.6

0.67

1.67

00.20.40.60.8

11.21.41.61.8

2

Group A Group B

Mea

n

Group

Mean effect of Panduta

BT

AT

AF


Independent Samples Test The t-test result (with equal variances not assumed) shows t-statistic of 1.344 with

26.989 degrees of freedom of parameter Agnimandhya before treatment. The

corresponding two tailed value is 0.19 higher than 0.05, which is not significant. The t-

test results Agnimandhya after treatment t-statistic t is 1.265. The corresponding two

tailed value is 0.216 which is higher than 0.05, which is not significant. Similarly, the T-

test results after follow-up is 4.785, the corresponding two tailed value is 0.000 which is

less than 0.05, which is significant. This means that the average effects two groups are

not significant before and after treatment and is significant after follow-up.

Paired Samples Correlations

In Group-A, the correlation between Before Treatment, after Treatment is 0.261, which is

significant at 0.347. The correlation between after treatment and after follow-up is 0.612,

which is significant at 0.015, the correlation between before treatment and after follow-up

is 0.4262, which is significant at 0.013, which means there is linear relation before and

after the treatment in Agnimandhya.

In Group-B, the correlation between Before Treatment after Treatment is 0.797, which is

significant at 0.00. The correlation between after treatment and after follow-up and before

treatment and after follow-up is zero. It means there is no relation between after

treatment, after follow-up and before treatment in Agnimandhya.


Paired Samples Test

Further , the analysis is done by using paired t-test, In group- A, results shows not

significant before and after treatment as P>0.05. and shows more highly significant in

after treatment and after follow-up and before treatment and after follow-up as P<0.05.

In group- B, results shows more highly significant before and after treatment , shows not

significant after treatment and after follow-up and highly significant before and after

follow-up as P<0.05.

In parameter Agnimandhya group B is more highly significant than group

A after treatment and group A is highly significant than group B after follow-up (By

comparing t-values).

Graph No 34 showing mean effect of Agnimandhya

1.671.93

1.20.93

0.27

1

0

0.5

1

1.5

2

2.5

Group A Group B

Mea

n

Group

Mean effect of Agnimandhya

BT

AT

AF


Effect of Arohanayasa

Table no 86 Group Statistics of Arohanayasa

Group N Mean Std.

Deviation Std. Error

Mean

Arohanayasa Before Treatment

Group A 15 1.73 0.704 0.182

Group B 15 1.80 0.775 0.200

Arohanayasa After Treatment

Group A 15 1.47 0.516 0.133

Group B 15 1.00 0.655 0.169

Arohanayasa After Follow-up

Group A 15 0.47 0.516 0.133

Group B 15 0.87 0.516 0.133 In the parameter Arohanayasa before treatment in group A, Mean was 1.73 with S.D.

0.704 is reduced to 1.47 with SD 0.516 after treatment and after follow-up is reduced to

0.47 with S.D. 0.516. Similarly in group B, Mean was 1.80 with S.D. 0.775 is reduced

to 1.00 with SD 0.655 after treatment and after follow-up is decreased to 0.87 with

S.D. 0.516.


From 3-B, The t-test result (with equal variances not assumed) shows t-statistic of 0.247

with 27.746 degrees of freedom of parameter Arohanayasa before treatment. The

corresponding two tailed value is 0.807higher than 0.05, which is not significant. The t-

test results Arohanayasa after treatment t-statistic t is 2.168, . The corresponding two

tailed value is 0.039 which is lesser than 0.05, which is significant. Similarly, the T-test

results after follow-up is 2.121, the corresponding two tailed value is 0.043 which is less

than 0.05, which is significant. This means that the average effects two groups are not

significant before and after treatment and is significant after follow-up.



In Group-A, the correlation between Before Treatment After Treatment is 0.563 , which

is significant at 0.029 . The correlation between after treatment and after follow-up is

0.464, which is significant at 0.081, the correlation between before treatment and after

follow-up is 0.367, which is significant at 0.179, which means there is linear relation

before and after the treatment in Arohanayasa.

In Group-B, the correlation between before Treatment after Treatment is 0.845, which is

significant at 0.00. the correlation between after treatment and after follow-up is 0.211

which significant at 0.45 and before treatment and after follow-up is 0.286, which

significant at 0.302.. It means there is linear relation between after treatment and after

follow-up in Arohanayasa.

Paired Samples Test


significant before and after treatment as P>0.05,and shows more highly significant in

after treatment and after follow-up and before treatment and after follow-up as P<0.05.

In group- B, results shows more highly significant before and after treatment , shows not

significant after treatment and after follow-up and highly significant before and after


Group B is more highly significant after treatment and group A is more

highly significant after follow-up (By comparing t-values).

Graph No 35 showing mean effect of Arohanayasa


Effect of Brama

Table no 87 Group Statistics of Brama

In the parameter, Brahma before treatment in group A, Mean was 1.60 with S.D. 0.632is

reduced to 1.00with SD 0.535after treatment and after follow-up is reduced to 0.47 with

S.D. 0.516. Similarly in group B, Mean was1.53 with S.D. 0.743is reduced to 0.67 with

SD 0.617after treatment and after follow-up is increased to 0.80 with S.D. 0.561.

1.73 1.8

1.47

1

0.47

0.87

00.20.40.60.8

11.21.41.61.8

2

Group A Group B

Mea

n

Group

Mean effect of Arohanayasa

BT

AT

AF

Group N Mean

Std. Deviatio

n Std. Error Mean

Brama Before Treatment

Group A 15 1.60 0.632 0.163

Group B 15 1.53 0.743 0.192

Brama After Treatment

Group A 15 1.00 0.535 0.138

Group B 15 0.67 0.617 0.159

Brama After Follow-up

Group A 15 0.47 0.516 0.133

Group B 15 0.80 0.561 0.145



The t-test result (with equal variances not assumed) shows t-statistic of 0.265 with 27.301

degrees of freedom of parameter Brama before treatment. The corresponding two tailed

value is 0.793 higher than 0.05, which is not significant. The t-test results Brama after

treatment t-statistic t is 1.581. The corresponding two tailed value is 0.125 which is

higher than 0.05, which is not significant. Similarly, the T-test results after follow-up is -

1.694, the corresponding two tailed value is 0.101which is more than 0.05, which is not

significant. This means that the average effects two groups are not significant before

treatment, after treatment and after follow-up.


In Group-A, the correlation between Before Treatment After Treatment is 0.634, which is

significant at 0.011, before and after treatment is 0.259which is significant at 0.352.and

between after treatment and after follow-up is 0.394, which is significant at 0.147. This

means there is linear effect between before and after the treatment in Brama.


significant at 0.026, before and after treatment is 0.413which is significant at 0.126and

between after treatment and after follow-up is 0.446which is significant at 0.571. This

means there is linear effect before and after the treatment in Bhrama

Paired Samples Test

Further , the analysis is done by using paired t-test, In group- A, results shows more

highly significant before and after treatment as P<0.05, and shows more highly

significant in before and after follow-up as P<0.05.


In group- B, results shows not significant before treatment and after treatment and after

treatment and after follow-up, but shows highly significant before treatment and after


In the parameter Brama group A is more highly significant than group B

before treatment and after follow-up (By comparing t-values).

Graph No 36 showing mean effect of Brama

Effect of Dourbalya

Table no 88 Group Statistics of Dourbalya

Group N Mean

Std. Deviation

Std. Error Mean

Dourbalya Before Treatment

Group A 15 1.47 0.640 0.165

Group B 15 1.80 0.561 0.145

Dourbalya After Treatment

Group A 15 1.00 0.655 0.169

Group B 15 1.00 0.378 0.098

Dourbalya After Follow-up

Group A 15 0.67 0.488 0.126

Group B 15 0.80 0.414 0.107

1.6 1.53

1

0.670.47

0.8

00.20.40.60.8

11.21.41.61.8

Group A Group B

Mea

n

Group

Mean effect of Bhrama

BT

AT

AF


In the parameter, Dourbalya before treatment in group A, Mean was 1.47with S.D0.640 is

reduced to 1.00 with SD 0.655 after treatment and after follow-up is reduced to 0.67 with

S.D. 0.488. Similarly in group B, Mean was1.80 with S.D. 0.561 is reduced to 1.00 with

SD 0.378 after treatment and after follow-up is increased to 0.80 with S.D. 0.414.


The t-test result (with equal variances not assumed) shows t-statistic of -1.517 with

27.517 degrees of freedom of parameter Dourbalya before treatment. The corresponding

two tailed value is 0.140 higher than 0.05, which is not significant. The t-test results

Dourbalya after treatment t-statistic t is 0.000. The corresponding two tailed value is

1.000 which is higher than 0.05, which is not significant. Similarly, the T-test results

after follow-up is -0.807, the corresponding two tailed value is 0.4267 which is more than

0.05, which is not significant. This means that the average effects two groups are not

significant before treatment after treatment and after follow-up.



significant at 0.005, before and after treatment is 0.447. Which is significant at 0.095 .and


means there is linear effect between before and after the treatment in Dourbalya.


significant at 0.006, before and after treatment is 0.000 which is significant at 1.000 and

between after treatment and after follow-up is 0.739 which is significant at 0.002. This

means there is linear effect before and after the treatment in Dourbalya


Paired Samples Test


significant after treatment and after follow-up as P>0.05, and shows more highly

significant in before treatment and after follow-up as P<0.05.

In group- B, results shows not significant after treatment and after follow-up, and more

highly significant in before treatment and after treatment an after follow-up as P<0.05.

In the parameter Dourbalya group B is more highly significant than

group A after treatment and after follow-up (By comparing t-values).

Graph No 37 showing mean effect of Dourbalya

Effect of Hb% Table no 89 Group Statistics of Hb%

Group N Mean Std. Deviation Std. Error

Mean Hb% Before Treatment

Group A 15 8.780 1.3691 0.3535 Group B 15 8.827 1.1877 0.3067

Hb% After Treatment Group A 15 9.000 1.3229 0.3416 Group B 15 9.080 1.1008 0.2842

Hb% After Follow-up Group A 15 9.453 1.4065 0.3632 Group B 15 9.320 1.0611 0.2740

1.471.8

1 10.67 0.8

0

0.5

1

1.5

2

Group A Group B

Mea

n

Group

Mean effect of Dourbalya

BT

AT

AF


In the parameter, Hb% before treatment in group A, Mean was 8.780 with S.D1.3691 is

reduced to 9.000 with SD 1.3229 after treatment and after follow-up is reduced to 9.453

with S.D. 1.4065 Similarly in group B, Mean was8.827 with S.D. 1.1877 is reduced to

9.080 with SD 1.1008 after treatment and after follow-up is increased to9.320 with S.D.

1.0611


The t-test result (with equal variances not assumed) shows t-statistic of -0.100 with

27.453 degrees of freedom of parameter Hb% before treatment. The corresponding two

tailed value is 0.921 higher than 0.05, which is not significant. The t-test results Hb%

after treatment t-statistic t is -0.180. The corresponding two tailed value is 0.858 which is

higher than 0.05, which is not significant. Similarly, the T-test results after follow-up is

0.293 , the corresponding two tailed value is 0.772 which is more than 0.05, which is not





significant at 0.000., before and after treatment is0.967. Which is significant at 0.000.and


means there is linear effect between before and after the treatment in Hb%.

In Group-B, the correlation between Before Treatment After Treatment is 0.994, which

is significant at 0.000., before and after treatment is 0.974which is significant at 0.000and


means there is linear effect before and after the treatment in Hb%.


Paired Samples Test

Further , the analysis is done by using paired t-test, In group- A, results shows significant

before treatment, after treatment and after follow-up as P<0.05.

In group- B, results shows significant before treatment, after treatment and after follow-

up as P<0.05.

In the parameter Hb% group B is more highly significant than group A after treatment

and group A is better than group B after follow-up (By comparing t-values).

Graph No 38 showing mean effect of Hb%

Effect of Total Count Table no 90 Group Statistics of Total Count

Group N Mean Std.


Mean

Total Count Before Treatment

Group A 15 5842.000 690.9331 178.3982

Group B 15 5828.667 450.0455 116.2012

Total Count After Treatment

Group A 15 5895.333 648.9317 167.5535

Group B 15 5982.667 424.6085 109.6334

Total Count After Follow-up

Group A 15 6040.667 647.7264 167.2422

Group B 15 6220.667 502.0738 129.6349

8.78 8.8279 9.08

9.4539.32

8.48.68.8

99.29.49.6

Group A Group B

Mea

n

Group

Mean effect of Hb%

BT

AT

AF


In the parameter, Total Count before treatment in group A, Mean was 5842.000with S.D.

690.9331is reduced to 5895.333with SD 648.9317after treatment and after follow-up is

reduced to 6040.667with S.D. 647.7264Similarly in group B, Mean was5828.667 with

S.D. 450.0455is reduced to 5982.667with SD 424.6085after treatment and after follow-

up is increased to6220.667with S.D. 502.0738.



degrees of freedom of parameter Total Count before treatment. The corresponding two

tailed value is 0.951 higher than 0.05, which is not significant. The t-test results Total

Count after treatment t-statistic t is -0.436 the corresponding two tailed value is 0.667

which is higher than 0.05, which is not significant. Similarly, the T-test results after

follow-up is -0.851, the corresponding two tailed value is 0.402 which is more than 0.05,

which is not significant. This means that the average effects two groups are not

significant before treatment, after treatment and after follow-up.


In Group-A, the correlation between Before Treatment after Treatment is 0.921, which is

significant at 0.000., before and after treatment is00.934. Which is significant at

0.000.and between after treatment and after follow-up is 0.884, which is significant at

0.000. This means there is linear effect between before and after the treatment in Total

Count.

In Group-B, the correlation between Before Treatment after Treatment is 0.957which is

significant at 0.000before and after treatment is 0.821which is significant at 0.000and


between after treatment and after follow-up 0.790which is significant at 0.000. This

means there is linear effect before and after the treatment in Total Count

Paired Samples Test


significant before and after treatment as P>0.05. And shows more highly significant in

after treatment and before treatment and after follow-up as P<0.05.

In group- B, results shows more significant before treatment, after treatment, and after

follow-up and after treatment P<0.05.

In the parameter Total Count group B is more highly significant than

group A in after treatment and after follow-up (By comparing t-values).

Graph No 39 showing mean effect of Total Count

Effect of Platelets

Table no 91 Group Statistics of Platelets

5842 5828.6675895.333

5982.6676040.667

6220.667

5600

5700

5800

5900

6000

6100

6200

6300

Group A Group B

Mea

n

Group

Mean effect of Total Count

BT

AT

AF


Group N Mean

Std. Deviation

Std. Error Mean

Platelets Before Treatment

Group A 15 56.800 5.7595 1.4871

Group B 15 58.533 4.6578 1.2026

Platelets After Treatment

Group A 15 59.067 4.3006 1.1104

Group B 15 60.333 4.7759 1.2331

Platelets After Follow-up

Group A 15 60.133 3.0675 0.7920

Group B 15 61.467 3.6814 0.9505 In the parameter, Platelets before treatment in group A, Mean was 56.800 with S.D5.7595

is reduced to 59.067 with SD 4.3006 after treatment and after follow-up is reduced to

60.133 with S.D. 3.0675 Similarly in group B, Mean was58.533 with S.D. 4.6578 is

reduced to 60.333 with SD 4.7759 after treatment and after follow-up is increased to

61.467 with S.D. 3.6814.


The t-test result (with equal variances not assumed) shows t-statistic of-0.906with 26.826

degrees of freedom of parameter Platelets before treatment. The corresponding two tailed

value is 0.373 higher than 0.05, which is not significant. The t-test results Platelets after

treatment t-statistic t is 0.763. The corresponding two tailed value is 0.452 which is

higher than 0.05, which is not significant. Similarly, the T-test results after follow-up is -

1.078, the corresponding two tailed value 0.291 which is more than 0.05, which is not





significant at 0.006., before and after treatment is0.638. Which is significant at 0.010.and



means there is linear effect between before and after the treatment in Platelets.


significant at 0.000., before and after treatment is 0.649which is significant at0.009and


means there is linear effect before and after the treatment in Platelets

Paired Samples Test


significant after treatment and after follow-up as P>0.05. And shows highly significant

in before treatment and after follow-up as P<0.05.

In group- B, results shows not significant after treatment and after follow-up, before

treatment and after treatment and after follow-up as P<0.05.

In the parameter Platelets group B is more highly significant than

group A in after treatment and after follow-up (By comparing t-values).

Graph No 40 showing mean effect of Platelet Count

56.8

58.53359.067

60.33360.133

61.467

545556575859606162

Group A Group B

Mea

n

Group

Mean effect of Platelets

BT

AT

AF


Effect of Lymphocytes Table no 92 Group Statistics of Lymphocytes

Group N Mean Std.


Mean

Lymphocytes Before Treatment

Group A 15 39.533 4.7489 1.2262

Group B 15 38.400 3.6410 0.9401

Lymphocytes After Treatment

Group A 15 37.600 4.2561 1.0989

Group B 15 35.867 4.1208 1.0640

Lymphocytes After Follow-up

Group A 15 37.200 3.4682 0.8955

Group B 15 35.800 3.1893 0.8235 In the parameter, Lymphocytes before treatment in group A, Mean was 39.533with S.D.

4.7489 is reduced to 37.600with SD 4.2561after treatment and after follow-up is reduced

to 37.200with S.D. 3.4682. Similarly in group B, Mean was 38.400with S.D. 3.6410is

reduced to 35.867with SD 4.1208after treatment and after follow-up is increased

to35.800 with S.D. 3.1893

Independent Samples Test The t-test result (with equal variances not assumed) shows t-statistic of 0.734 with 26.232

degrees of freedom of parameter Lymphocytes before treatment. The corresponding two

tailed value is 0.470 higher than 0.05, which is not significant. The t-test results

Lymphocytes after treatment t-statistic t is 1.133. The corresponding two tailed value is

0.267 which is higher than 0.05, which is not significant. Similarly, the T-test results

after follow-up is 1.151, the corresponding two tailed value is 0.260which is more than

0.05, which is not significant. Which means that the average effects two groups are not


Paired Samples Correlations In Group-A, the correlation between Before Treatment after Treatment is 0.690, which is

significant at 0.004., before and after treatment is 0.543which is significant at 0.036 .and


between after treatment and after follow-up is 0.327, which is significant at 0.234. Which

means there is linear effect between before and after the treatment in Lymphocytes


significant at 0.000., before and after treatment is 0.443which is significant at 0.098and


means there is linear effect before and after the treatment in Lymphocytes

Paired Samples Test


significant after treatment and after follow-up and before treatment and after follow-up

as P>0.05. And shows significant in before treatment and after treatment as P<0.05.

In group- B, results shows not significant after treatment and after follow-up, and

shows more significant before treatment and after treatment as P>0.05.

In the parameter Lymphocytes group B is more highly significant than

group A after treatment and after follow-up (By comparing t-values)..

Graph No 41showing mean effect of Lymphocyte Count

39.533

38.437.6

35.867

37.2

35.8

3334353637383940

Group A Group B

Mea

n

Group

Mean effect of Lymphocytes

BT

AT

AF


Effect of Esnophils

Table no 93 Group Statistics of Esnophils

Group N Mean

Std. Deviation

Std. Error Mean

Esnophils Before Treatment

Group A 15 3.933 2.1202 0.5474

Group B 15 3.067 2.1536 0.5561

Esnophils After Treatment

Group A 15 3.267 2.3442 0.6053

Group B 15 3.800 1.6562 0.4276

Esnophils After Follow-up

Group A 15 2.667 1.5430 0.3984

Group B 15 2.733 1.6242 0.4194

In the parameter, Esnophils before treatment in group A, Mean was 3.933with S.D.

2.1202is reduced to3.267with SD 2.3442after treatment and after follow-up is reduced to

2.667with S.D. 1.5430. Similarly in group B, Mean was 3.067with S.D2.1536 is reduced

to 3.800with SD 1.6562after treatment and after follow-up is increased to2.733with S.D.

1.6242


The t-test result (with equal variances not assumed) shows t-statistic of 1.111with 27.993

degrees of freedom of parameter Esnophils before treatment. The corresponding two

tailed value is 0.276 higher than 0.05, which is not significant. The t-test results

Esnophils after treatment t-statistic t is -0.720. The corresponding two tailed value is

0.478which is higher than 0.05, which is not significant. Similarly, the T-test results after

follow-up is -0.115, the corresponding two tailed value is 0.909 which is more than 0.05,

which is not significant. Which means that the average effects two groups are not





significant at 0.149., before and after treatment is 0.481which is significant at 0.070.and

between after treatment and after follow-up is 0.298, which is significant at 0.280. which

means there is linear effect between before and after the treatment in Esnophils

In Group-B, the correlation between Before Treatment After Treatment is 0.905, which

is significant at 0.000., before and after treatment is 0.669which is significant at 0.006and


means there is linear effect before and after the treatment in Esnophils.

Paired Samples Test


significant after treatment and after follow-up as P>0.05. And shows significant in

before treatment and after follow-up as P<0.05.

In group- B, results shows not significant before treatment and after follow-up as P>0.05.

And shows significant in before treatment and after treatment and after treatment and

after follow-up as P<0.05.

In the parameter Esnophils group B is more highly significant than group

A after treatment and group A is highly significant than group B after follow-up (By


Graph No 42 showing mean effect of Esnophil Count


Effect of ESR

Table no 94 Group Statistics of ESR

Group N Mean

Std. Deviation Std. Error Mean

ESR Before Treatment Group A 15 12.400 4.2393 1.0946

Group B 15 11.267 3.6345 0.9384

ESR After Treatment Group A 15 12.933 2.3442 0.6053

Group B 15 11.400 2.3845 0.6157

ESR After Follow-up Group A 15 12.800 5.9185 1.5281

Group B 15 11.400 2.5857 0.6676

In the parameter, ESR before treatment in group A, Mean was 12.400with S.D. 4.2393is

reduced to12.933with SD 2.3442after treatment and after follow-up is reduced to

12.800with S.D. 5.9185. Similarly in group B, Mean was 11.267with S.D 3.6345is

reduced to 11.400with SD 2.3845after treatment and after follow-up is increased

to11.400 with S.D. 2.5857.

3.933

3.0673.2673.8

2.667 2.733

00.5

11.5

22.5

33.5

44.5

Group A Group B

Mea

n

Group

Mean effect of Esnophils

BT

AT

AF




degrees of freedom of parameter ESR before treatment. The corresponding two tailed

value is 0.439 higher than 0.05, which is not significant. The t-test results ESR after

treatment t-statistic t is 1.776. The corresponding two tailed value is 0.087which is higher

than 0.05, which is not significant. Similarly, the T-test results after follow-up is 0.840,

the corresponding two tailed value is 0.412 which is more than 0.05, which is not






between after treatment and after follow-up is 0.083, which is significant at 0.768. which

means there is linear effect between before and after the treatment in ESR


significant at 0.000, before and after treatment is 0.656which is significant at 0.008and


means there is linear effect before and after the treatment in ESR

Paired Samples Test


significant before treatment - after treatment, after treatment-after follow-up and before

treatment –after follow-up as P>0.05.


In group- B, results shows not significant before treatment - after treatment, after

treatment-after follow-up and before treatment –after follow-up as P>0.05.

In the parameter ESR both groups shows not significant (By comparing t-

values).

Graph No 43 showing mean effect of ESR

Effect of Total RBC

Table No 95 Group Statistics of Total RBC

Group N Mean

Std. Deviation

Std. Error Mean

Total RBC Before Treatment

Group A 15 4.847 0.5693 0.1470

Group B 15 4.881 0.3878 0.1001

Total RBC After Treatment

Group A 15 4.940 0.6069 0.1567

Group B 15 4.987 0.3357 0.0867

Total RBC After Follow-up

Group A 15 5.307 0.5796 0.1497

Group B 15 5.239 0.4396 0.1135

12.4

11.267

12.933

11.4

12.8

11.4

10

10.5

11

11.5

12

12.5

13

13.5

Group A Group B

Mea

n

Group

Mean effect of ESR

BT

AT

AF


In the parameter, Total RBC before treatment in group A, Mean was 4.847with S.D.

0.5693 is reduced to4.940with SD 0.6069after treatment and after follow-up is reduced to

5.307with S.D. 0.5796. Similarly in group B, Mean was 4.881with S.D 0.3878is reduced

to 4.987with SD 0.3357after treatment and after follow-up is increased to5.239with S.D.

0.4396


The t-test result (with equal variances not assumed) shows t-statistic of -0.195 with 24.69

degrees of freedom of parameter Total RBC before treatment. The corresponding two

tailed value is 0.847 higher than 0.05, which is not significant. The t-test results Total

RBC after treatment t-statistic t is -0.261, the corresponding two tailed value is 0.797

which is higher than 0.05, which is not significant. Similarly, the T-test results after

follow-up is 0.366 the corresponding two tailed value is 0.718 which is more than 0.05,

which is not significant. This means that the average effects two groups are not



In Group-A, the correlation between Before Treatment After Treatment is 0.749which is



means there is linear effect between before and after the treatment in Total RBC.

In Group-B, the correlation between Before Treatment After Treatment is 0.963, which is



means there is linear effect before and after the treatment in Total RBC.


Paired Samples Test


significant before treatment - after treatment as P>0.05. And shows highly significant in

after treatment - after follow-up and before treatment -after follow-up as P<0.05.

In group- B, results shows significant before treatment -after treatment , after treatment

-after follow-up and before treatment - after follow-up as P<0.05.

In the parameter Total RBC group B is more highly significant than group

A after treatment and after follow-up (By comparing t-values).

Graph No 44 showing mean effect of Total RBC

Effect of PCV %

Table no 96 Group Statistics of PCV %

4.847 4.8814.94

4.987

5.3075.239

4.64.74.84.9

55.15.25.35.4

Group A Group B

Mea

n

Group

Mean effect of Total RBC

BT

AT

AF


Group N Mean

Std. Deviation

Std. Error Mean

PCV (%) Before Treatment

Group A 15 31.840 4.3962 1.1351

Group B 15 34.133 4.6884 1.2105

PCV (%) After Treatment

Group A 15 32.473 4.1639 1.0751

Group B 15 34.973 4.4019 1.1366

PCV (%) After Follow-up

Group A 15 33.353 4.4884 1.1589

Group B 15 35.627 4.4252 1.1426

In the parameter, PCV before treatment in group A, Mean was 31.840with S.D. 4.3962is

reduced to32.473with SD 4.1639after treatment and after follow-up is reduced to

33.353with S.D. 4.4884similarly in group B, Mean was 34.133with S.D 4.6884is reduced

to 34.973with SD4.4019after treatment and after follow-up is increased to 35.627 with

S.D. 4.4252

Independent Samples Test The t-test result (with equal variances not assumed) shows t-statistic of -1.382with 28

degrees of freedom of parameter PCV (%) before treatment. The corresponding two

tailed value is 0.178higher than 0.05, which is not significant. The t-test results PCV

(%) after treatment t-statistic t is -1.598The corresponding two tailed value is 0.121which

is higher than 0.05, which is not significant. Similarly, the T-test results after follow-up

is -1.397the corresponding two tailed value is 0.173 which is more than 0.05, which is

not significant. This means that the average effects two groups are not significant before



In Group-A, the correlation between Before Treatment after Treatment is 0.994which is

significant at 0.000., before and after treatment is0.995which is significant at 0.000.and



means there is linear effect between before and after the treatment in PCV (%)

In Group-B, the correlation between Before Treatment After Treatment is 0.993, which is



means there is linear effect before and after the treatment in PCV (%)

Paired Samples Test Further , the analysis is done by using paired t-test, In group- A, results shows significant

before treatment - after treatment , after treatment –after follow-up and before treatment –

after follow-up as P<0.05. In group- B, results shows significant before treatment - after

treatment , after treatment –after follow-up and before treatment –after follow-up as

P<0.05.

In the parameter PCV (%) group B is more highly significant than group

A after treatment and after follow-up group A more highly significant than group B (By


Graph No 45 showing mean effect of PCV (%)

31.84

34.133

32.473

34.973

33.353

35.627

2930313233343536

Group A Group B

Mea

n

Group

Mean effect of PCV

BT

AT

AF


STATISTICAL CONCLUSION

In subjective parameter except Panduta all other parameters are not significant in

before treatment, after treatment and after follow up. It means the mean effects of

two groups are not same in Panduta.

Similarly in objective parameter all parameters are not significant. It means the

mean effects of all the objective parameters are same in both the groups.

While comparing both groups group B is highly significant after treatment and

group A highly significant after follow up.

Further to analysis whether the treatment is differ significantly in both the groups

paired t’ test is used.

In the parameter Panduta group A is more highly significant than group B after

treatment and after follow-up. (By comparing t-values).

In parameter Agnimandhya group B is more highly significant than group A after

treatment and group A is highly significant than group B after follow-up. (By


In parameter Arohanayasa Group B is more highly significant after treatment and

group A is more highly significant after follow-up (By comparing t-values).

In the parameter Brahma group A is more highly significant than group B after

treatment and after follow-up (By comparing t-values).

In the parameter Dourbalya group B is more highly significant than group A after



In the parameter Hb% Group B is more highly significant than group A after

treatment and group A is better than group B after follow-up (By comparing t-

values).

In the parameter Total Count group B is more highly significant than group A in

after treatment and after follow-up (By comparing t-values).

In the parameter Platelets group B is more highly significant than group A in after


In the parameter Lymphocytes group B is more highly significant than group A


In the parameter Esnophils group B is more highly significant than group A after

treatment and group A is highly significant than group B after follow-up (By


In the parameter ESR both groups are not significant (By comparing t-values)..

In the parameter Total RBC group B is more highly significant than group A after


In the parameter PCV (%) group B is more highly significant than group A after

treatment and group A more highly significant than group B after follow-up (By



DISCUSSION

Discussion is the most important part of any research where the observations

are discussed and given reasons by the researcher. Here researcher conveys the

practical experience with special reference to textual explanations. The significant

results and insignificant results will be discussed in the same section with reasons.

Hence it becomes important to discuss the clinical study in detail.

CONCEPTUAL STUDY

Deepana-pachana:

Preceding to administration of Snehapana, the body should have Nirama state

which is attained by Pachana & Agni Vriddhi achieved by Deepana karma. The

reason behind it is that the qualities of Snehana dravyas need a plat form for its action.

It is clearly mentioned in Astanga Sangraha Sutrasthana 25th chapter as before

Snehapana Agni should be at its peak and there must be Koshta laghuta

(Niramavastha).Thus jeeraka choorna used serve the purpose of both nirameekarana

and uttejana of Agni. These drugs which are digestives & carminatives stimulate

enzymatic secretions, Hcl secretions, pancreatic & bile secretions are enhanced; there

by proper assimilation of Snehana can occur. In this present study Deepana Pachana

with Jeeraka choorna given to all the 30 patients for 3-5days or nirama lakshanas are

seen.

Mode of action of Deepana Pachana with Jeeraka Choorna:

Jeeraka is the only ingredient of jeeraka choorna. Jeeraka has katu rasa, ushna

veerya, laghu and teekshna gunas which does amapachana and aging deepana.It is

having Yakrit uttejaka along with Pachana property. In the Samprapti of Panduroga


vitiation of both Jatharagni along with Dhatavagni can be rectified with this jeeraka

choorna as it is indicated in conditions like Agnimandhya and Aruchi. The process of

Deepana is stimulation of agni, where as Pachana is related with digestive and

metabolic properties of Agni. Pachana drugs does pakwata of doshas while Deepana

drugs cause separation of slishtha doshas. A Deepana drug enhances the Agni which

is required for proper Snehana. Sneha Dravya is guru in property so it requires good

state of Agni to digest and to absorb. Modern therapy says that, pancreatic and bile

juice plays important role in digestion and absorption of fat. Deepana drugs are may

be able to secrete those enzymes which are required for digestion and absorption of

Sneha, which perform Snehana process.

Probable mode of action of Snehapana with Ghrita:

Ghrita is best Snehadravya among chatusnehas as explained by Acharya

Charaka. Ghrita is used mainly for abhyantara Snehapana. It is safe even in higher

doses and Suitable for all age group persons. It can be used in all seasons and easily

available. Ghrita is having the properties like Vrishya, Chakshushya, Medha,

Lavanya, Kanti, Oja, Tejavriddhikara, papahara, Rakshoghna, Vayasthapaka, Balya,

Pavitra, Aayushya, Sumangalya, Rasayana, Sugandha, Rochana, Smriti vardhaka,

Rasa, Shukra vardhaka.

Ghrita alleviates pitta and vata but, at the same time does’t aggravates kapha.

From therapeutic point of view Ghrita is having the quality “Samskarasya

anuvartanam” ie., when Ghrita mixed with other dugs it imbibes the property of that

drugs without losing its properties.

Proper acquaintance about the mode of action is necessary to reveal the

scientific basis behind the action of particular therapy. Here, an attempt has been


made to presume the action of Snehapana, Sneha acts as a solvent and it increases

Apyamsha of the body which ultimately leads to Klinnata or Utkleshavastha.

Action as a Solvent Ghee acts as good solvent for many metabolic waste products & it enters the

cells easily because cell wall is made up of phospholipids. Compared to other non-

oily substances, ghee etc. fat materials stays in the body for a stipulated period

without causing any harm & also possesses better permeability property. According

to Susruta, the disease occurs due to dislodgement of vitiated Doshas in the channels

during their circulation in the body (Su.Su.24/1 0). Sneha administered internally

reaches to Srotamsi and acts as a solvent to remove the obstruction by dissolving

Doshas in it, resulting in the removal of Srotorodha, which is one of the important

steps in the Samprapti Vighatana.

Increase in the Apyamsha of the body: This specifies the Vriddhya, Vishyandana and Kledakaraka properties of

Sneha. Sneha has the pedominence of Ap Mahabhuta, which was also corroborated by

the specific qualities ascribed to it by various Acharyas like Charaka and Vagbhaţa.

(Cha.Su.22/15, AH.Su.1/11) Then the fat material comes out of the cell to extra-

cellular fluid by osmosis process. So due to the aqueous properties of Sneha and

liquified Malas brought from the tissues, the levels of fatty acids etc. increases in the

blood resulting in the high plasma volume. To keep up the equilibrium of the normal

plasma level, the extra amount of liquid from it, reaches to the Koshtha for excretion.

This is called as Anu Pravana Bhava.

Draksha Ghrita in Panduroga:

In Charaka Chikitsa sthana for the treatment of Panduroga Snehapana with

Draksha Ghrita is directly indicated. Snehapana plays an important role in the form of


Poorva karma in Shodhana procedure. Here Panduroga is a Pitta and Rakta dhatu

pradoshaja vikara predominantly pitta dosha involvement. Draksha has the following

qualities like Snehopaga and Virechanopaga according to Charaka. Draksha has the

properties like Madhura rasa, Madhura vipaka and Sheeta veerya does both the rakta

and pitta shamana. This Draksha is processed with Ghrita; which is best among the

pitta shamaka. Draksha has the property of Rakta prasadana; so that shuddha rakta is

formed properly which is very essential in Panduroga. Because of it snigdha and

snehopaga property it helps in achieving the samyak snigdha lakshana quickly.

Snehapana in Arohana and Sadharana Krama

Snehapana is practiced since from ancient times as a Poorva karma procedure for

Shodhana Chikitsa. But the practices have been changed in some or other way in the

flow of time period. Also in different regions of India, the procedure varies in the

context of dose, duration and regimen. The cause for this is the dose & duration is

individual Specific. Mainly Agni, Koshtha, Prakriti, Dosha Sthiti, along with Bala,

Satmya, Satva, Vaya, etc. are the points of variables which put the physician in

trouble while deciding the dose & duration for achieving adequate Snehana.

In the Chikitsa sutra of Panduroga, Shodhana Chikitsa is indicated. So for the

purpose of Shodhana, Snehapana as poorva karma is necessary. In this study two

types of Snehapana ie Arohana Krama and Sadharana Krama vidhi is selected to find

out which method is more effective for bringing down the subjective and objective

parameters in Panduroga.

Criteria for making two groups

For better understanding the effect of Snehapana on panduroga, the

subject made into two groups as follows


Arohana Krama Snehapana (Group A)

In this study all the 15 patients were given with Arohana krama Snehapana . The dose

was increased gradually from a fixed dose of 30 ml, in early morning before patients

feels hunger between the time of 6-8 am. It was given in increasing order at a dose of

30 ml every day up to samyak snigdha lakshanas or 7 days. All the patients were

strictly given instruction not to take food until they feel hungry and were advised to

take lukewarm water intermittently. In classics like Vangasena and Kalyanakaraka

mentioned about Arohana krama Snehapana. “kramat vardhayet “ ie the dose should

be increased every day.

Sadharana Krama Snehapana (Group B)

In this study all the 15 patients were given with Sadharana Krama Snehapana.

A fixed dose of 40 ml Ghrita was given to the patients in early morning before

patients feel hunger between the time of 6-8 am, until samyak snigda lakshanas are

seen or up to 7 days. All the patients were strictly given instruction not to take food

until they feel hungry and were advised to take lukewarm water intermittently. In

Sadharana Krama, Snehapana was administered for seven days. It was framed by

considering the opinion of Acharya Charaka that, Snehapana administered more than

seven days it will become satmya to the person. The dose fixation was made under the

opinion of Susruta that the Sneha gets digested within 6 hours as the minimum dose.

Hence two groups were considered to study the effect of Snehapana with

Draksha Ghrita in Arohana Krama and Sadharana Krama in Panduroga.

Panduroga and Anaemia Panduroga is a disease characterized by the colour that it imparts on

the affected individual. It is a pitta pradana vyadhi and is considered under the


heading of santharpanajanya vyadhi by Charaka. Along with the specific colour that

the disease imparts on the various body parts of the patient, the disease is also having

systemic features like alpa raktha, alpa medas, nissaratha and shithilendriyathwa. In

the modern disease review, it is understood that various anemias have similar

presentation to that of Pandu roga with the pallor that it causes to different body parts

and constitutional symptoms like headache, palpitations, dyspnea, and fatigue. Rather

Panduroga can be considered as a spectrum of diseases in which the various types of

anemias can be considered.

Difference in Dosha involvement in Panduroga:

In the conceptual study we have seen that Pandu is a pitha pradhana vyadhi . While

going through the nidanas of Pandu roga it can be seen that most of the nidanas are

pitha prakopaka nidanas especially the factors increase the ushnatwa guna of pitha

dosha. The vitiated pitha pradhana doshas then takes hridaya as ashraya and gets

spread throughout the body with the help of vyana vayu. Eventhough Pandu is a pitha

pradhana vyadhi, individual dosha predominance occur in the disease due to the

peculiarity of the specific nidanas. Preponderance of vatha or pitha or kapha dosha at

one or other stage of the pathogenesis leads to manifestations of the specific dosha

predominant Pandu.

Difference in Types of Panduroga:

Acharya Charaka, Vagbhata, Bavaprakashaa and Yogaratnakara explained its type as

vataja, pittaja, kaphaja, sannipathja and mrudbakhanajanya Pandurogas, where as

Susruta not explained mrudbakhanajanya Panduroga.

Difference in samprapti of Panduroga:

In Pandu roga mainly affected dhathus are rasa dhathu and raktha dhathu followed by

the medo dhathu. If we go through the modern pathology of anemia similar events can


be perceived. Anemia generally signifies decreased amount of hemoglobin in the

blood. We know that the primary function of hemoglobin is oxygen delivery to the

body cells which in turn is required for the metabolic processes. This can be

considered as one of the factor that comes under preenana function. Impaired oxygen

delivery to the cells leads to their nutrition deprivation finally leading to the

symptoms like fatigue. Reduced hemoglobin in the blood leads to pallor of various

body parts. The increased oxygen demand of the cells leads to increased heart rate

which may be the cause for palpitation which again is told as hridayaspandana in the

poorva roopa of Pandu roga. Further progression of the process leads to cardiac

insufficiency and impaired functioning of other vital organs. Hridaya being the moola

of rasa vaha srothas will be the prime organ affected as told in the samprapthi of

Pandu by charaka. The ideology of a Pandu roga culminating in kamala can be very

well established by viewing the pathology of hemolytic anemias. Here excessive

hemolysis leads to the higher level of billirubin (which is one of the end product of

lysis of hemoglobin) resulting in yellowish discoloration of body parts. All these

factors guide us to the conclusion that anemia can be considered under the spectrum

of Pandu roga.

Rasa and Raktha dhathu: In the sequence of dhathu parinama, it is told that the

ranjaka pitha imparts red colour to the rasa dhathu leading to the formation of raktha

dhathu. In the samprapthi of Pandu roga the vitiated pitha dosha causes shoshana of

the rasa dhathu as enumerated by Chakrapani. This shoshana leads to impaired

formation of raktha dhathu and also generally affects the normal functioning of the

rasa dhathu i.e. preenana. This impaired function of rasa dhathu leads to utharothara

dhathu shaithilya finally leading to Oja kshaya.


Medo dhathu: Panduroga is also said to be having the features of alpa medas.

Probably this can be used to explain the pathogenesis of Aplastic anemia. In Susrutha

Samhitha Shareera sthana, while explaining about majja dhathu, he has given that the

majja present in the anu asthis are to be considered as saraktha meda. Also Charaka

has told while explaining the formation of dhathus, that asthi is filled with medas to

form majja dhathu. The impaired functioning of medo dhatu either can be considered

as a result of dhathu shaithilya which is a part of general pathogenesis of Pandu roga

or can be considered as a factor leading to manifestation of Pandu roga

ANAEMIA 54, 55, 56, 57 Anaemia can be defined as a haemoglobin concentration in blood

below the normal range appropriate for the age and sex of the individuals. In adults,

the lower extreme of normal haemoglobin is taken as 14.0g/dl for males and 12.0g/dl

for females.

Although haemoglobin value is employed as the major parameter for

determining whether Anaemia is present or not, Hemoglobin percentage (Hb%), the

red blood cell count (TRBC) and packed cell volume (PCV) provide alternate means

of assessing Anaemia.

Patho-physiology of Anaemia Increased release of oxygen from haemoglobin.

Increased blood flow to the tissues.

Maintenance of the blood volume.

Redistribution of blood flow to maintain the cerebral blood supply.

Tissues with high oxygen requirement such as the Heart, CVS, and the skeletal

muscles during exercise, bear the brunt of clinical effects of Anaemia.


Clinical features of Anaemia The haemoglobin level at which symptoms and signs of Anaemia develop

depends upon following factors

01. The spread of onset of Anaemia – Rapidly progressive Anaemia causes more

symptoms than Anaemia of slow onset, as there is less time for physiological

adaptation.

02. The severity of Anaemia – Mild Anaemia produces no symptoms or signs but

a rapidly developing severe Anaemia may produce significant clinical

features.

03. The age of the patient – The young patients due to good cardiovascular

compensation tolerate Anaemia quite well as compared to the elderly.

Investigations

After obtaining the full medical history pertaining to different general and

specific signs and symptoms in order to confirm the presence of anaemia its type and

its cause the following plan of investigations is generally followed.

A. Haemoglobin estimation – The first and foremost investigation in any

suspected case of Anaemia is to carry out haemoglobin estimation.

B. Peripheral blood film estimation – The haemoglobin estimation in invariably

followed by examination of peripheral blood film for morphologic features

after staining it with Romanowsky dyes (Leishman’s staining).

C. Red cell indices – An alternative method to diagnose and detect the severity of

anaemia is by measuring the red cell indices


D. Leucocytes and platelet count – Measuring of Leucocytes and platelet count

helps to distinguish pure anaemia form pancytopenia in which red cells,

granulocytes and platelet counts are often elevated.

E. Reticulocyte count – Reticulocyte count is done in each case of anaemia to

assess the marrow erythropoietic activity

F. Erythrocyte sedimentation Rate – The ESR is non-specific test used as a

screening test for anaemia.

G. Bone marrow examination – Bone marrow aspiration is done in cases where

the cause for anaemia is not obvious.

H. Total RBC Count:

It is the number of RBC in one cubic millimeter of blood.

Normal values:

In men - 4.5-6.5 millions/mm3.

In women - 3.8-5.8 millions/mm3.

I. Packed Cell Volume or Haematocrit (PCV):

Normal value: 45ml/100ml (45%).

Clinical study:

A total 30 patients suffering from Panduroga fulfilling the inclusion criteria

were studied. The observations and the results as well as statistical analysis of these

are elaborated below.

Number of patients registered in study - 38

Number of patients completed the study – 30


Number of patients discontinued the study – 8

Discussion on clinical findings:

This is an overview of the patients details including age, sex, religion, occupation

socio economic status, personal history and all the details observed during the

examination of the patient.

Discussion on observations (Demographic Data):

AGE:

In this study 10 patients in Group A and 7 patients in group B belongs to age

group of 20-25 who were showing problem in dominance, this shows the people during

these age groups are more anaemic. Presence of more number of patients in both of

these groups is due to the fact that the Panduroga manifests in the early life itself and

the incidence may be because of more iron loss during menstruation, increased demand

of iron during the age group and increased stress and strain, thereby irregularity in diet.

SEX:

The sex wise distribution of patients reveals that Panduroga was observed more

in females12 (80%) in group A and 10 (66.7%) in group B than male 3 (20%) in group

A 5(33.3%) in group B .Higher incidence in female is found because of regular

menstrual blood loss; blood loss during delivery, pregnancy, and lactation requires

more Iron if not compensated results in Anaemia. It may also be due to imbalance,

irregular diet intake, mental and physical stress.

RELIGION:

In this series most of the patients were Hindus 15 (100%) in group A and 12

(80%) in group B and a lesser portion belonged to Muslim community3 (20%). From


this it can be inferred that most of the Hindus are vegetarians and this incidence may be

due to imbalance diet and Prolonged Malnutrition because of lack of awareness

regarding the importance of diet. This shows geographical Predominance of Hindus in

and around GADAG area.

OCCUPATION:

In the present study maximum number of patients were active groups 12

(80%) in group A and 11 (73.3%) in group B. were Labours. In Group A 3(20%) and

4 (26.7%) in group B. This may be due to excessive mental stress, irrelevant,

inadequate and improper diet. In most of these patients, it was observed that

Diwaswapana was common, leading to Agnimandhya, which can cause

Dhatwagnimandya, which is a cause of improper digestion results in Panduroga.

ECONOMICAL STATUS:

In group A (Arohana Krama Snehapana), Among 15 patients, 3 (20%)

patients were poor class, 5(33.3%) were middle class and 7(46.7%) belongs to higher

class. In Group B (Sadharana Krama Snehapana), Among 15 patients, 4(26.7%)

patients were poor class, 9(60%) were middle class and 2(13.3%) belongs to higher

class group.

The study shows the larger numbers of patients belongs to middle class. The patients

form middle class cannot afford expensive nutritious food. As well as they are not

caring for proper diet yet needed time and always worrying for the family

responsibilities, which leads to mental tensions.

MODE OF ONSET OF DISEASE

In Panduroga its mode of onset is also important for the Chikitsa and sadya sadyatha

In this study both of the groups 30(100%) patients were got gradual onset of disease

was observed.


DIET

In group A, 11 (73.3%) patients were vegetarians and 4(26.7%) are mixed

diet groups. In Group B 9 (60%) patients were vegetarians and 6(40%) are mixed diet

groups. So in this study the maximum number of patients belongs to vegetarian diet

According to physiological needs, the food which has consumed should have

a active principles that triggers the production of haem yet times, when it is needed.

As non-vegetarians can consume the liver and bone marrow of animals (Goat), to

supplement the loss of production of haem, where as it is lacked in vegetarian’s diet.

That may be the cause, observed during my study that of vegetarians is more prone to

Panduroga.

NIDANA Aharaja Nidana

Dominent Rasa In group A 10 (66.7%) patients were taking Madura rasa, 8(53.3%) were

taking Katu rasa, 12(80%) were taking Amla rasa, 11(73.33%) were taking Lavana

rasa Ahara . In Group B 6(40%) patients were taking Madura rasa, 11(73.33%) were

taking Katu rasa,6(40%) were taking Amla rasa, 3(20%) were taking lavana rasa

Ahara .It is observed that in this study most of the people takes Katu,Amla, lavana

and Madura rasa which vitiates pitta and leads to Panduroga.

Vihara Nidana

Divaswapna (56.67%), Ativyayama (53.33%) were found maximum. Nidra viparyaya

causes Agnimandya and Ativyayama causing incomplete digestion and production of

Ama, which vitiates rasa and rakta results in Panduroga.

Manasika Vikara

In group A 10(66.67%) patients having Chinta, 6(40%) patients having Shoka,

4(26.67%) patients having Bhaya and 6(40%) patients having Kroda. In Group B


6(40%) patients having Chinta, 7(46.67%) patients having Shoka, 10(66.67%)

patients having Bhaya and 7(46.67%) patients having Kroda.

In the present study chinta and Bhaya were found in 53.33% and 53.33% of

cases respectively. This incidence may be due to the fact that most of the patients

were active groups in this study. The mental stress may cause inadequate

consumption of the diet and improper digestion, thereby resulting in Panduroga.

NIDRA

In group A 10(66.67%) patients having sound sleep and 5(33.33%) having

disturbed sleep. In Group B 15 patients, 9(60%) patients having sound sleep,

5(33.33%) having disturbed sleep and 1(6.67%) patient having day sleep,

Patients reported to have sound sleep 10(66.67%) in Group A and Group B

9(60%) Whereas disturbed sleep in group A 5(33.33%) and group B is 5(33.33%).

Nidra viparyaya causes Agnimandya causing incomplete digestion and production of

Ama, which vitiates rasa and rakta results in Panduroga.

MENSTRUAL HISTORY

In group Among 12 patients, 12(80%) patients having regular menstrual

history. In Group B Among 10 patients, 7(46.67%) having regular menstrual history,

3(20%) having Irregular menstrual history,1(6.67%) patients having

Menorrhagia,3(20%) patients having Metrorrhagia and1(6.67%) patients having

Leucorrhagia.

Among the female patients registered in the study, in group A no one

having irregular menstruation. In group B 20% had irregular menstruation. The

difference was due to the presence of patients of low age group in group B.


KOSHTA

In group A 2(13.32%) patients having Krura Koshta 11(73.26%) having

Madhyama Koshta and 2(13.32%) having Mrudhu Koshta. In Group B 3(19.98%)

patients having Krura Koshta 11(73.26%) having Madhyama Koshta and 1(6.66%)

having Mrudhu Koshta.

In both groups maximum number of patients belongs to Madhyama Kostha

11(73.26%) in each group A and B. It may be due to predominance of kapha dosha,

which place an important role in proper digestion and assimilation of the nutrients. So

that the symptoms like Panduta, Dourbalya, Agnimandya, Bhrama occurs compare to

other category (Koshta ) of the patients.

PRAKRITI

In group A 10(66.67%) patients having Vatapittaja Prakriti, 3(20%) having

Kaphavataja Prakriti and 2(13.32%) having Kaphapittaja Prakriti. In Group B 9(60%)

patients having Vatapittaja Prakriti, 3(20%) having Kaphavataja Prakriti and 3(20%)

having Kaphapittaja Prakriti.

Amoung all the groups maximum number of patients belongs to

vatapittaja prakriti In group A 10(66.67%) and Group B 9(60%) patients. It is

observed that may be due persons have consumed vata and pittaprakopaka Ahara and

vihara results into vata and pitta virddhi and as the person having these kinds of

prakriti are prone to the incidence of the disease Panduroga.

ABHYAVARANA SHAKTI AND JARANA SHAKTI

In group A 1(6.67%) patient belongs to Pravara Abhyavarana shakti and 14

(93.33%) patients belongs to Madyama Abhyavarana shakti. In Group B 14


(93.33%) patients belongs to Madyama Abhyavarana shakti and 1(6.67%) patient

belongs to Avara Abhyavarana shakti.

In group A 14(93.33%) patient belongs to Madyama Jarana shakti and 1

(6.67%) patient belongs to Avara Jarana shakti . In Group B 15(100%) patient

belongs to Madyama Jarana shakti .

It shows maximum number of patients belongs to Madhyama

Abhyavarana shakti and Madhyama jarana shakti. It may be due to predominance of

kapha dosha, which place an important role in proper digestion and assimilation of the

nutrients which leads to Panduroga.

POORVA ROOPA

In group A 7(46.66%) patients having Hrit spandana,4(26.66%) Twak rookshata ,

14(93.33%) Aruchi ,1(6.67%) Sweda abhava , 11(73.33%)Agni mandhya,1(6.67%)

Shteevana , 1(6.67%) Gatrasada 3(20%)avipaka and 2(13.33%)peeta mootrata .In

Group B 7(46.66%) patients having Hrit spandana,1(6.67%) Twak rookshata ,

14(93.33%) Aruchi ,2(13.33%) Sweda abhava , 14(93.33%)agni mandhya ,2(13.33%)

Shteevana , 1(6.67%) Gatrasada 1(6.67%)avipaka .

In this study it is observed that maximum number of patients shows the poorvaroopa

such as Aruchi and Agni mandhya. It shows that classical Poorva roopa are observed

in Panduroga.

ANUBANDA VEDANA

In group A 3(20%) patients having sadana,15(100%)Agnimandhya, 6(40%)Trishna,

2(13.33%) Toda,10(66.67%)Aalasya, 8(53.33%) Tantra, 3(20%) Twaksputana,


4(24.67% ) Srama, 6(40%) Gatrashoola, 4(24.67%) Alpameda, 1(6.67%) Jwara, 4

(26.67%) Swasa, 3(20%) Kasa, 5(33.33%) Hataprabha, 1(6.67%) Hridrava

11(73.33%) Shirashoola, In Group B 1(6.67%) having karnashweda, 14(93.33%)

Agnimandhya, 8(53.33%) alasya, 4(26.67%) twaksputana, 2(13.33%) srama, 6(40%)

gatrashoola,1(6.67%) alpameda, 5(33.33%) Hataprabha, 6(40%) having Shirashola.

In this study it is observed that maximum number of patients shows the Anubanda

vedana such as Agni mandhya, Alasya, Tantra, Shirashoola . It shows that classical

Anubanda vedana are observed in Panduroga.

DISCUSSION ON ROOPA

Most of the patients in this study were observed with clinical symptoms which

are mentioned by the Acharyas.

EFFECT THERAPY ON SUBJECTIVE PARAMETERS

Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%)

patients having Panduta,13(86.67%) Arohana Ayasa, 15(100%) Dourbalya,

13(86.67%) Bhrama 15(100%) Agnimanndya. In group A Sadharana Krama

Snehapana), Among 15 patients, 15(100%) patients having Panduta,14(93.33%)

Arohana Ayasa, 15(100%) Dourbalya, 13(86.67%) Bhrama 15(100%) Agnimanndya.

PANDUTA

In all the 30 patients Panduta was noted, which is pratyatma lakshana of Panduroga. It

may be due to ojakshaya, raktakshaya and vitiation of pittadosha associated with other

doshas.


The improvement calculated after taking data before treatment, after treatment . In the

parameter Panduta group A is more highly significant than group B after treatment

and after follow-up. (By comparing t-values).

AROHANAYASA

Arohanayasa was found in all the patients, it may be due to less oxygen carrying

capacity of blood to the vital organs. So heart has to pump more to provide proper

blood flow. The improvement calculated after taking data before treatment, after

treatment. In parameter Arohanayasa Group B is more highly significant after

treatment and group A is more highly significant after follow-up (By comparing t-

values).

DOURBALYA

Dourbalya were found in 13 patients in group A and 13 patients in group B. Hence, it

can be inferred that these symptoms are also most prominent in this disease. This is

due to Rasa raktadi dhatu kshaya. The improvement calculated after taking data

before treatment, after treatment In the parameter Dourbalya group B is more highly

significant than group A after treatment and after follow-up (By comparing t-values).

BRAMA

Brama were found in all the patients. Hence, it can be inferred that this symptom is

most prominent in this disease. This may be due to pitta vriddhi which leads to

kapha kshaya. The improvement calculated after taking data before treatment, after

treatment. In the parameter Brahma group A is more highly significant than group B



AGNIMANNDYA

Agnimandya was noticed in all the patients, which may be results out of Nidana

sevana, where Pachaka pitta, Samanavata and Ranjaka pitta are mainly involved. The

improvement calculated after taking data before treatment, after treatment . In

parameter Agnimandhya group B is more highly significant than group A after

treatment and group A is highly significant than group B after follow-up. (By


INTER COMPARISON OF ALL SUBJECTIVE PARAMETERS IN BOTH

GROUPS

In both the groups, the Subjective parameters assessed in overall ,the result is

showing that in subjective parameter except Panduta all other parameters are not

significant in before treatment, after treatment and after follow up. It means the mean

effects of two groups are not same in Panduta.

While comparing both groups group B is highly significant after treatment and group

A highly significant after follow up.

EFFECT OF THERAPY ON OBJECTIVE PARAMETERS

HAEMOGLOBIN PERCENTAGE


parameter Hb% Group B is more highly significant than group A after treatment and

group A is better than group B after follow-up (By comparing t-values).

TOTAL COUNT


parameter Total Count group B is more highly significant than group A in after



PLATELETS COUNT


parameter Platelets group B is more highly significant than group A in after treatment

and after follow-up (By comparing t-values).

LYMPHOCYTE COUNT


parameter Lymphocytes group B is more highly significant than group A after


ESNOPHILS COUNT


parameter Esnophils group B is more highly significant than group A after treatment

and group A is highly significant than group B after follow-up (By comparing t-

values).

ESR


parameter ESR both groups are not significant (By comparing t-values)

RBC


parameter Total RBC group B is more highly significant than group A after treatment

and after follow-up (By comparing t-values).

PACKED CELL VOLUME


parameter PCV (%) group B is more highly significant than group A after treatment


and group A more highly significant than group B after follow-up (By comparing t-

values).

INTER COMPARISON OF ALL OBJECTIVE PARAMETERS IN BOTH

GROUPS

In both the groups, the objective parameters assessed in overall after

treatment and after follow up the result is showing that in objective parameter all

parameters are not significant. It means the mean effects of all the objective

parameters are same in both the groups. While comparing both groups group B is

highly significant after treatment and group A highly significant after follow up.

EFFECT OF THE THERAPY

Effect on Deepana and Pachana

Deepana Pachana with Jeeraka choorna was given for 3-5 days or till the appearance

of Nirama lakshanas. As Pandu is santarpanajanya vyadhi where Agnimandhya and

symptoms of Ama can be appreciated. It was observed that all the patients got nirama

lakshanas within 3-5 days. In that 2 patients had complaint of burning sensation and

irritation in the chest region, 10-15 minutes after the intake of the medicine. In such

case dose was reduced and advised to consume with excessive warm water.

OBSERVATION ON SNEHAPANA

Draksha Ghrita was used for Snehapana. In Arohana vidhi Starting with 30 ml

increasing 30 ml every day until gets the samyak snigda lakshanas or up to 7 days,

where in Sadharana vidhi 40 ml fixed for 7 days and was given within 7-8 am in all

the patients. Sukhoshnajala was advice as Anupana, which is kaphahara, deepaka,

amapachana, vatanulomaka, thus helpful in proper digestion of administered Sneha.


The Sneha imparts its qualities to all the dhatus gradually, once all the dhatus

gets saturated with sneha, their qualities like snigdhata and mriduta manifests in the

twak. Snehapana removes the obstruction to the gati of the vata, Vatanulomana takes

place. Hence, individual may feel laghuta and vimalendriyata.

The matra of Snehapana with Draksha Ghrita in both the groups

In Group A Draksha Ghrita was given in the dose of 30 ml on the first day to all the

15 individuals. The dose is increased 30 ml in every day. In this group minimum dose

was 120 m l and maximum dose was 630 ml.

In Group B Draksha Ghrita was given in the dose of 40 ml fixed to all the 15

individuals. The same dose is been continued up to 7 days. In this group the total dose

was 280 ml.

SNEHAPANA KALAVADHI

In this study it shows in group A amoung 15 Patients, 8(53.33%) patients were taken

Snehapana up to 4 days. 7(46.67%) were taken more than 4 days up to 6 days. In

group B 15(100%) patients were taken Snehapana for 7 days.

It shows that in group A among 15 patients 8 patients got samyak snigda lakshanas

within 4 days and 7 patients got samyak snigda lakshanas within 6 days. It gives an

idea about their Kostha and Agni. Where in Sadharana krama Snehapana no one got

samyak snigda lakshanas within the study period.

JEERYAMANA LAXANAS

In Arohana krama Snehapana Shiroruk, Bhrama, Lalasrava, Moorcha were

observed in all the individuals the mean time of onset of all the symptoms was started


middle stage of the digestion of the sneha. These may be due to higher intake of

sneha. Where in Sadharana krama Snehapana symptoms like Shiroruk, and Lalasrava

observed.

SNEHA JEERNA LAXANAS

The individuals showed most of the Jeerna laxanas indicating the digestion of

administered sneha. In Arohana krama Snehapana all symptoms where observed on

the first day in between 250-300 minutes and every day it was increased depends

upon the dose was increased .but in Sadharana Krama Snehapana the first day time

was in between 350-400 minutes and it was almost stable in all seven days.

SAMYAK SNIGDHA LAXANAS

Vatanulamana : It was observed in group A all 15 individuals got vatanulomana

and 8 individuals in group B. Sneha by virtue of its Snigdha, Sara properties

normalizes or brings balance in vitiated vata. By this Vatanulomana will occur.

Agnideepti: In all the 15 persons in group A deeptagni was observed and in group B

only 2 persons got agnideepti.This is due to increased secretion of bile from

cholesterol destruction, as bile is an essential for the digestion of Sneha.

Purisha snigdha and Asamhat varchas : These were observed in 15 persons in

group A and only Purisha snigdha were seen in 5 patients in group B These laxanas

may be due to drava, sara, snigdha and mrudu guna of Sneha. Pureesh becomes drava

and snigdha and person may passes Asamhat and snigdha varchas. This will indicate

for stopping the continuation of Snehapana which is consider as one of the prime

Samyak snigdha laxana.


Twak snigdhata : It was found in 15 and 8 persons in Group A and Group B

respectively. It occurs due to Sneha taken because each and every cell of the body will

be saturated with Sneha that is all the dhatus get saturated gradually one by one and

produces mruduta in skin.

Gatra laghvata : It was observed in 15(100%) and 13(86.58%) persons in Group A

and Group B. Snehapana removes obstruction in the gati of vata which makes

vatanulomana. Due to this person passes asamhat varchas. Hence person may feel

Gatra laghavata.

Snehodwega : It was observed in 13 in Group A and no one in Group B. Due to large

quantity of Sneha in the body will reaches optimum level i.e., body is fully staturated

with excess dose of sneha. Hence individual will showing dislike towards Snehapana.

This is also one of the symptom of Samyak snigdha laxanas.

Klama : It was found in a single person in Group A and no one in Group B, it may

due to restriction of diet regimen and due to properties of Sneha. Person may feel

exhausted or klama on the last day of Snehapana.

All these are different parameters to assess proper Snigdhata of the body.

And in overall Snehapana procedure, It was observed that gradually

increasing the snigdada of the body were noticed it may be due to the absorption of

excessive Sneha in the body from starting to end day. Few patients had nausea

immediately after Snehapana but it did not created any complications this may be due

to the unpleasant smell of Ghrita .Relief in sign & symptoms was observed after 7

days. Due to Deepana and Pachana aushadi the ama got digested, it provided much

mental and physical relaxation to the patients were noticed.


Overall effect of treatment in both groups

All the patients studied in this Snehapana showed different degrees of diminution.

Patients of Panduroga who were treated, Snehapana with Draksha Ghrita shown

Sadharana krama snehapana is highly significant after treatment and Arohana krama

Snehapana highly significant after follow up.

In subjective parameter except Panduta all other parameters are not significant in

before treatment, after treatment and after follow up. It means the mean effects of two

groups are not same in Panduta. Similarly in objective parameter all parameters are

not significant. It means the mean effects of all the objective parameters are same in

both the groups.


CONCLUSION

Panduroga is Pitta pradhana vyadhi, Pitta is responsible for the normal colour of

the body but when it gets vitiated, the Rakta as it happens in Panduroga and thus

loss of complexion or Panduta occurs.

Panduroga is also considered as Santarpanjanya vyadhi, which broadly means

Anabolism, brings about an increase in kapha which in term may cause the

disease by generating Mandagni thus, any diet which may increase kapha or any

disease associated with increase in kapha can cause a change in complexion or

Panduroga.

Though Pitta is pradhana dosha in Panduroga, Vata dosha also plays crucial role

in manifestation of Panduroga, mainly Vyana vayu has a relation with Samprapti

of Panduroga.

Panduroga can be effectively compared with Anemia on the grounds of its similar

signs and symptoms

In the modern medicine, there is good treatment for anemia with considerable

result but that is only for acute deficiency Anaemias. No significant therapy is

there for chronic Anaemias which occurs due to metabolic defects. So Ayurveda

can provide better management of this.

It is obvious that Anaemia is most common among females due to menstruation,

poor general health, improper and inadequate diet which leads to malnutrition

leading to Anaemia.


In conceptual study, importance for Snehapana is highlighted there is direct

reference in Charaka Samhita for treating Panduroga with Draksha Ghrita.

Any patient who is having Panduroga should include symptoms of active disease

and done assessment with necessary objectives like, Hb%, Total count,

Differential count, ESR, RBC and PCV for identification severity of Panduroga.

Observations Maximum patients 56.67% belonged to age group of 20-25,

Maximum of 73.33%% were females.

Maximum of 76.66% were of laborer type.

Majority of the patients belonged to Hindu religion.

All the patients registered with classical symptoms of Panduroga belonged to

rural area of Gadag

Maximum patients with Panduroga were having mandagni.

All the patients registered in the study had the features of involvement

of Rasa and Raktha vaha srothas.

Marked features of Pandu Roga were found only in Patients with Hb %

below 11 gm %.

Results After 4th day of Arohana Snehapana 100% of the patients were observed with

vatanulomana, Agnideepti, Shareera Laghuta and Twak Snigdata, wherein

Sadharana krama Snehapana after 7 days of treatment ,very few patients observed

with vatanulomana, Shareera Laghuta and Twak Snigdata.


Patients ended with Samyak snigdha lakshana in Arohana krama Snehapana but

in Sadharana krama Snehapana nobody had been observed with samyak snigdha

lakshana.

In the present study, subjective parameter except Panduta all other parameters

were not significant in before treatment, after treatment and after follow up.

Similarly in objective parameter all parameters were not significant

While comparing both groups Sadharana krama Snehapana is highly significant

after treatment and Arohana krama Snehapana highly significant after follow up.

Limitations of the study

The Sample size was small.

The Period of Study was limited.

Longer follow up was not done.

Clinical parameters were not considered up to date like use of MCV and MCHC

changes because of non availability at study centre.

Suggestions for the future studies

A similar study can be conducted on large sample.

As Panduroga may be a chronic disease, follow up should be kept for longer

Duration

Maximum Subjective parameters and higher investigations should be incorporated

in the study.

The effect of both Arohana and Sadharana krama Snehapana with Draksha Ghrita

can be studied followed by Virechana karma.

The effect of both Arohana and Sadharana krama Snehapana with Draksha Ghrita

can be studied with standard shamanoushi in Panduroga.


SUMMARY

This dissertation entitled “EVALUATION OF COMPARATIVE EFFICACY OF

AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA”comprises of

seven chapters namely,

Introduction

Objectives

Review of Literature

Methodology

Observation and Results

Discussion

Conclusion and summary

Introduction: This part consists of the general description of health and prelavance of

Pandu and Anaemia. In this part, discussion on Pandu is covered briefly and selection

of Snehapana for this study is discussed. This part also Consists of discussion about

lacuna in current Knowledge and Proposed or formulated hypothesis of this study is

discussed briefly.

Objectives: This part consists of brief description of types of life style and the time

period which causes Pandu, before putting forth the objectives and mainly highlights

the objectives of study and Reasons to Choose Snehapana for Present Study

Review of Literature:

This chapter deals with the historical aspects related to Pandu. Description

regarding diseases related to discolouration of body is available in Rigveda and


Atharvaveda. 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. 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.

Methodology: The materials and methods adapted for the study are described here.

This chapter deals with the

Research approach

Inclusion and exclusion criteria for the patients

Method of administration of Snehapana

Criteria of assessment

Observations and Results:

The observation made on demographic incidence of age, sex, habits etc are presented

in the form of Tables and Graphs. The results of the clinical study are presented with

master charts and statistical analysis in the form of tables with brief narrations.

Discussion: The conceptual part of Snehapana and its effect on Pandu are explained.

Clinical data is discussed in detail. The result obtained in clinical study, as well as

observations in it are discussed.


Conclusion and Summary: The conclusion of whole clinical study is explained in

this chapter. Limitation of study and further scope for study is also discussed briefly.

In summary, the whole thesis is summarized.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga i

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178. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 7-11. 22nd ed. Varanasi:


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186. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi:






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Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 12-14. 28st ed. Varanasi :

Chaukhamba Orientalia; 1998. p.230-231.

Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 14-15, 5st ed.

Varanasi: Chaukhamba Orientalia; 1969. p.102.

Indradev Tripathi Dr. Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 1-

5, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.338.

215. Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 5. Reprinted. Varanasi:


Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 39-41. 22nd ed. Varanasi:


216. Dalhanacharya, Sushruta Smahita Uttartantra, Chapter 44 Shloka 14. 8th ed. Varanasi:




Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xviii

218. Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 35. Reprinted. Varanasi:


Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 117. 22nd ed. Varanasi:


219. Ibid 34 &116.

220. Y. T. Acharya, Astanga Sangraha Chikitsasthana Chapter 18 Chapter 11. 11st ed.


Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 41. 22nd ed. Varanasi:


221. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s

Medical Publishers; 2000.p.334-342.

222. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett,

Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.903.

223. Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco-therapeutics

Chapter 30. 16th ed. Mumbai; Popular Prakashana Publications; 1999. p.453.

224. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s

Medical Publishers; 2000.p.344.

225. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey;

Prentee Hall Inc. Simon and Schuster; 1998.p.877-878.

226. Ibid. 884-885.

227. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi:


228. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi :








Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xix



233. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted. Varanasi :








237. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi:







Prentee Hall Inc. Simon and Schuster; 1998.p.651.



b. Arundutta, Ashtanga Hridaya Shareerasthana Chapter 3 Shloka 8. Reprinted. Varanasi

: Chaukhamba Orientalia; 2000.p.386



243. Ibid.


Prentee Hall Inc. Simon and Schuster; 1998.p.667.

Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett,




Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xx

246. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett,






249. C.C.Chatterjee, Human Physiology, Vol. – I. Chapter 4. Kolkata : Ashutosh Lithographic

Co.; 2004.p.123-124.

250. Agnivesha, Charaka samhita, Sutrasthana, Chapter 20. Shloka20. Edited by Vaidya

Jadavaji Trikamji Acharya,2008 edn. Varanasi,Choukambha subharati prakashan; . p. 115.

251. Agnivesha, Charaka samhita, vimanasthana, Chapter 8. Shloka87. Edited by Vaidya

Jadavaji Trikamji Acharya,2008 edn.Varanasi,Choukambha subharati prakashan; p. 274.

252. Dr.P.V.Sharma edited Dravya guna Vignana, Vol-II.Chapter 5th Reprint edition 2005,

Varanasi: Chaukhambha surabharati academy; Page no.367

253. Agnivesha, Charaka samhita,chikitsasthana, Chapter 16. Shloka 52. Edited by Vaidya

Jadavaji Trikamji Acharya,2008 edn.Varanasi,Choukambha subharati prakashan; .p. 529.

254. Ashtanga Samgraha with the Sashilekha Sanskrit Commentary by Indu, Chapterb 25

edited by Dr.Shivaprasad Sharma,Chaukhamba Sanskrit Series Varanasi, edition 2006,

255. Advanced Text Book on Food & Nutrition, Volume I, By M. Swaminathan, Bappco

publication,Reprint 2006.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxi

SPECIAL CASESHEET FOR PANDUROGA Post Graduate Studies And Research Centre(Panchakarma)

Shri D.G.M.Ayurvedic Medical College,Gadag “Evaluation of comparative efficacy of Arohana and Sadharana krama

Snehapana in Panduroga” Guide : Dr.S.N.Belavadi M.D.(Ayu.) Co – Guide : Dr. Jairaj.P.Basarigidad M.D.(Ayu.) P.G.Scholar: Aneesh Joseph K 01. Name : Sl.No : 02. Father/Husband’s Name: O.P.D. No.: 03. Age : I.P.D.No. : 04. Sex : Bed No. : 05. Religion 06. Occupation 07. Economical Status Date of Initiation Date of Completion 08. Address

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10. Consent: I am fully educated with the disease and treatment; there by I got satisfied

whole-heartedly. I accept for the medicinal trail over me.

Signature of Investigator Signature of Patient

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Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxii

A. Pradhana Vedana :

Vaivarnya Prakruta Pandu Krishna Aruna Peeta Shukla Avadhi Nakha Netra Twak Vit Mootra Sira

Pradhana Vedana Avadhi

Arohanaayasa Dourbalya Agnimandya Brama Aruchi

B. Anubandhi Vedana : Avadhi Avadhi Karnaskweda Alpameda Sadana Jwara Agnimandya Swasa Trishna Kasa Toda Hataprabha Praseka Shishiradweshi Alasya Mridbhakshanaapeksha Tandra Swarakshaya Twak sputana Hridrava Shrama Shirashoola Gatrashoola Shabdaasahishnuta Pindikodvestana Shoonakshikuta C. Vedhana vrittanta :

a. Mode of Onset

b. Course

Sudden Gradual Insidious Sub acute

Gradually progressive Persistent Relapsing Receding

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxiii

D. Poorva Vyadhi Vrittanta :

E. Chikitsa Vrittanta : Modern medicine

Ayurvedic

Surgery

Others

F. Kula Vrittanta : Maternal Paternal

G. Atura charya : a. Ahara :

i. Diet

ii. Dominent Rasa iii. Dietric habits

b. Vihara : i. Vyayama

ii. Manasika Vikara iii.Vyasana iv. Nidra H. Artava Vrittanta :

Menstrual Cycle

Vegetarian Mixed

Madhura Katu Amla Tikta Lavana Kashaya

Samashana Adyashana Anashana Vishamashana

Mild Moderate Heavy

Chinta Shoka Bhaya Krodha Others

None Alcohol Tobacco Smoking Others

Sound Disturbed Day sleep

Regular Irregular

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxiv

Menarche Menopause

I. Garba Vrittanta :

Nature of delivery

Last delivery

J. Samanya Pareeksha :

a.Ashta Sthana Pareeksha :

Nadi Sparsha Mala pravrithi

Jihwa

Mootra pravrithi

Drik

Shabda Akruti b. Vital examination :

c.

Number of days

Inter Menstrual period

Associated of any complaints

Menorrhagia Metrorrhagia Leucorrhoca Dysmenorrhoea Ammenorrhea

Gravida Para

Abortion Miscarriage Still birth

Number of deliveries

Normal Forceps Surgical

Bp mmHg Temp F0 Pulse Rate /min Body Wt Kg Resp.Rate /min Heart Rate /min

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxv

Sroto pareeksha :

Rasavaha Srotas – Observed lakshanas

Asraddha Angamarda Aruchi Jwara

Asyavairasya Tama Hrillasa Pandutwa Gourava Klaibya Tandra Angasada Krishangatha Agninasha

Akaalavali Akaalapalitya

Raktavaha Srotas – Observed lakshanas

Mukhapaka Klama

Akshiroga Lavanasyata

Vaivarnya Swedadhikya

Agnimandya Kampa

Pipasadhikya Swarakshaya

Gurugatrata Tandra

Santapa Nidradhikya

Dourbalya Tamapravesha

Aruchi Kandu

Shirashoola Pidaka

Tiktaamlodhara Pradara

Vidahaannapanasya

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxvi

d.Dasavidha pareeksha :

K.Vikrithaha Pareeksha :

i. Nidana

Ahara Kshara Amla Lavana Atyushna Atiteekshna Viruddha Asatmya Masha Nishpava Tilataila Pinyaka Madya Mrithika

Prakriti Sarataha Satwataha Pravara Madhyama Avara Satmyataha

Ekarasa Sarvarasa Vyamisra

Samhanataha Susamhata Madhyama samhata

Asamhata

Pramanataha Sama Heena Adhika

Aharashakti

Abhyavarana Shakti

Pravara Madhyama Avara

Jarana Shakti Pravara Madhyama Avara

Vyayama Shakti Pravara Madhyama Avara Vaya Bala Yuva Vridha

Vihara Divaswapna Ativyayama Ativyavaya Vegadharana Ritu vaishamya Prati karma

Manasika Kama Chinta Bhaya Krodha Shoka

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxvii

ii. Purvarupa

Hrit spandana Gatrasada Twak rookshata Mridbhakshana iccha Aruchi Akshikotashotha Swedaabhava Avipaka Agnimandhya Peeta mootrata Shrama Peeta purisha Kshtivana

ii. Rupa Karna ksveda Aruchi Hatanila Soonakshikoodatwa Drubala Haritabha Sadana Sheerna roma Srama Hata prabha Brama Kopana Peedana Sisiradweshi Gatra shoola Nidralu Jwara Kshteevana Swasa Alpa vak Gourava Pindikodhweshtana K. Chikitsa :

Deepana Pachana - Jeeraka choorna (3-6 gms). Before food (3 Days)

Anupana - Sukhoshna jala

Snehapana - Draksha ghrita

i. Observation for Snehapana in Arohana Vidhi :

Day / Time I II III IV V VI VII

Sneha Matra 30ml 60ml 90ml 120ml 150ml 180ml 210ml

Pana Kala

Kshudha Pravrutti

Kala

Total time taken for

digestion

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxviii

Observation of jeerymana laxanas Laxanas I Time I

I Tim

e III Time IV Time V Tim

e VI Time VII Time

Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati

Sneha jeerna laxanas

Laxanas I Time

2 Time

3 Time 4 Time

5 Time

6 Time

7 Time

Jeeryamana lakshana Prashama

Shareera Laghuta Kshudha pravrutti Trishna Pravrutti Udgara Shuddhi Anya

ii. Observation for Samyak Snigdha Lakshanas in Arohana vidhi:

Lakshanas Days

I II III IV V VI VII Vatanulomana Agnideepti Purisha snigdhata Asamhata varchas Twak snigdha Anga laghava Gatra mardava Snehodwega Klama Shaithilya

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxix

iii. Observation for Snehapana in Sadharana Vidhi : Day / Time I II III IV V VI VII

Sneha Matra 40ml 40ml 40ml 40ml 40ml 40ml 40ml

Pana Kala

Kshudha Pravrutti Kala

Total time taken for

digestion

Observation of jeerymana laxanas

Laxanas I Time II

Time

III Time IV Time V Time

VI Time VII Time

Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati

Sneha jeerna laxanas

Laxanas I Time

2 Time

3 Time 4 Time

5 Time

6 Time

7 Time

Jeeryamana lakshana Prashama

Shareera Laghuta Kshudha pravrutti Trishna Pravrutti Udgara Shuddhi Anya

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxx

iv. Observation for Lakshanas in Sadharana Vidhi Snehapana :

Lakshanas Days

I II III IV V VI VII

Vatanulomana

Agnideepti

Purisha snigdhata

Asamhata varchas

Twak snigdha

Anga laghava

Gatra mardava

Snehodwega

Klama

Shaithilya

Asamyak snigdha lakshanas

Asnigdha Lakshanas

Ruksha Purisha/ Grathita Purisha/ Apravaguna Vata/ Mrdu Pakta/ Kharatva/ Raukshyata.

Ati Snigdha Lakshana Panduta/ Gaurava/ Jadya/ Tandra/ Aruchi/ Utklesha/ Purishasya Avipakvata. Snehapana vyapat

Tandra/ Utklesha/ Anaha/ Jvara/ Stambha/ Visanmyatha/ Kushta/ Pandu/ Kandu/

Shopha/ Arsha/ Aruchi/ Trishna/ Grahani Dosha/ Staimitya/ Vakyanigraha/ Shula/

Ama Pradosha.

Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxxi

L. Treatment assessment chart: i. Subjective parameters:

Assessment B.T A.T A.F Panduta Agnimandya Arohanayasa Bhrama Dourbalya ii.Objective parameters:

Assessment B.T A.T A.F Hb %

TC DC ESR

TRBC PCV

Advised for follow up treatment: 1. Vishram kala (Abhyanga & Sweda) : 2. Shodhana karma : Signature of the Scholar Signature of the Guide

Documents

Snehapana pandu pk028-gdg