Pandu kc008 gdg


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Evaluation of the effect ofGudanagaradi Vati in Pandu , Iranna B. Kotturshetti Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

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Pandu kc008 gdg

  1. 1. “Evaluation of the effect of Gudanagaradi Vati in Pandu”. Thesis submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of regulations for the Award of the degree of DOCTOR OF MEDICINE (AYURVEDA VACHASPATHI) By Iranna B. Kotturshetti Guide Dr. Ch. Ranga Rao. M.D. (Ayu) Professor and Head of the Department Post Graduate and Research Center D. G. M. Ayurvedic Medical College, Gadag. Co-Guide Dr. Siva Rama Prasad Ketamakka. M.D. (Ayu) Reader in Kayachikitsa Post Graduate and Research Center D.G.M. Ayurvedic Medical College, Gadag. POST GRADUATE AND RESEARCH CENTRE (KAYACHIKITSA) D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG. 2001
  2. 2. This is to certify that Iranna B. Kotturshetti (M.D. (Ayurveda)Kayachikitsa) has worked for his thesis on the topic entitled “Evaluation of theeffect of Gudanagaradi Vati in Pandu”. Clinical trials are done under my supervision andguidance. This thesis makes a distinct advance on scientific linesin the above subject and the findings are highly significant at thestatistical evaluation and have considerably contributed to thepresent knowledge of the subject. I am fully satisfied with his original work and hereby forwardthe thesis for the evaluation of adjudicators. Co-Guide Dr. Siva Rama Prasad Kethamakka M.D. (Ayu) (Osm) Reader in Kayachikitsa Postgraduate and Research Center (Kayachikitsa) D.G.M. Ayurvedic Medical College, Gadag.
  3. 3. This is to certify that the contents of this thesis entitled “Evaluationof the effect of Gudanagaradi Vati in Pandu”, has been worked out byIranna B. Kotturshetti under my supervision and close guidance and coguidance of Dr. Siva Rama Prasad Kethamakka, M.D. (Ayu) (Osm). This disease, Pandu was brought to light in Ayurvedic texts, theetiology, pathogenesis etc., as advanced and explained by Iranna B.Kotturshetti is solitary, scientific, and methodical and will definitely help inexplaining the disease in Ayurvedic parlance and further planning themanagement. This work is applied, scientific and an original contribution in the field ofresearch in Ayurveda. I am fully satisfied with the work and recommend the thesis to be putbefore the adjudication. Guide Dr.Ch.Ranga Rao M.D. (Ayu) (Osm) Professor and head of the department Post graduation and research center Kayachikitsa D.G.M. Ayurvedic Medical College, Gadag.
  4. 4. IndexSection I Introduction 1 -2Section II Literary review 3 - 70 Historical Shareera Nidana Contemporary Science ChikitsaSection III Material and methods 71 - 110 Drug review Methods ObservationsSection IV Discussion and conclusion 111 - 122 Future Prospective 123 Summary 124 References Bibliography
  5. 5. List of ChartsChart number 1- Demographic Data of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 2A-1- Chief Complaints of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 2A-2 – Chief Complaints of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 2B – Chief Complaints of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 3 – Associated Complaints of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 4 – Nidana (etiology) of “Evaluation of the effect of Gudanagaradi Vati in Pandu”.Chart number 5a – Vatajadi lakshana of “Evaluation of the effect of Gudanagaradi Vati in Pandu”Chart number 5b – Vatajadi lakshana of “Evaluation of the effect of Gudanagaradi Vati in Pandu”Chart number 6 – Assessment of “Evaluation of the effect of Gudanagaradi Vati in Pandu”Chart number 7 Statistical assessment for the
  6. 6. “Evaluation of the effect of Gudanagaradi Vati in Pandu” List of GraphsGraph number - 1 Age incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"Graph number - 2 Sex incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"Graph number - 3 Occupational incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"Graph number - 4 Economical status incidence in “Evaluation of the effect of Gudanagaradi Vati in PanduGraph number – 5 Diet incidence in “Evaluation of the effect of Gudanagaradi Vati in Pandu"Graph number – 6 Objective parameters at mean values in regular intervals Heamoglobin and RBC countGraph number – 7 Objective parameters at mean values in regular intervals PCV and Serum IronGraph number 8 Result of the “Evaluation of the effect of Gudanagaradi Vati in Pandu"
  7. 7. List of PhotographsPhotograph - 1 GudaPhotograph - 2 NagaraPhotograph - 3 ManduraPhotograph - 4 TilaPhotograph - 5 Pippali
  8. 8. ACKNOWLEDEMENT I express my deep sense of gratitude to my respected guide Prof. Dr. Ch.Ranga Rao M.D (Ayu) Head of department of Kayachikitsa, D.G.M Ayurvedicmedical college and post graduate and research center, Gadag. He has been verykind to guide me in the preparation of thesis and for whose extraordinary efforts,tremendous encouragement and most valuable thoughts provoking advice made meto complete this work. I am also grateful to my respected co-guide Dr. Siva Rama PrasadKethamakka, M.D (Ayu) (Osm), Reader in Kayachikitsa, PGARC, D.G.M Ayurvedicmedical college, Gadag, for patiently going through the draft of thesis and correctingwith precious remarks which have been very useful. I am extremely thankful to Dr. G.B. Patil principal D.G.M Ayurvedic medicalcollege and post graduate and research center Gadag, for providing all necessaryfacilities for this research work. It gives me pleasure to expresses my gratitude to Dr. A.K. Panda, M.D (Ayu)Lecturer, P.G. Department, D.G.M. Ayurvedic Medical College, Gadag. For beingkind and affectionate through his valuable suggestions and advisees as and whenapproach.
  9. 9. I am very much grateful to Dr. M.C Patil, M.D. (Ayu), P.G. Lecturer, for hisvaluable suggestions on the important subjects. I wish to convey thanks to my respected lecturers, Dr. G.S. Hiremath, Dr. U.V.Purad, Dr. C.M. Sarangamath, Dr. S.A. Patil, Dr. R.K. Gachchinamath, Dr. G.S.Jukthihiremath, Dr. B.S. Patil, Dr. C.S. Hiremath, Dr. K.S. Paraddi, and otherlecturers of D.G.M Ayurvedic Medical College, for their help and suggestions duringmy post graduation studies. I sincerely thank my beloved classmates Dr. S.S. Hiremath, Dr. A.S Patil,Dr.(Smt) Yashoda Mudigoudar, Dr. S.T Hombal, for their deep co operation andinvolvement in the P.G study. I am also thankful to all my post graduate colleagues Dr. B.M Mulkipatil, Dr.R.Y.Shettar, Dr. J.I Hiremath, Dr. Suresh R.D, Dr. S.K Tiwari, Dr. C.V. Rajashekar,Dr.Shyal kumar, Dr. Jayaprakash, Dr. Anil Kumar Bacha, Dr. V.N. Kulkarni and Dr. D.Sitarama prasad, for their constant cooperation and help. I am ever thankful to Prof. S.V. Sankanur for his constant moral support,encouragement and help throughout my carrier. I wise to convey my thanks to beloved Dr. Shashidhar Doddamani, M.D (Ayu)and Dr. S.R. Hiremath, for their constant help and rational suggestions at thisresearch work. I wish to convey my thanks to beloved Dr. Mallikarjuna A.S, Dr. M.S.Hiremath, Dr. A.M Adi, Dr. D.G. Kolume for their cooperation. I am ever grateful to respected Dr. S.B. Lakkol, Sri R.P Huilgol, Dr. R.N Patil,Sri S.V. Kori and Prof. Siddu yapalparavi, for their encouragement and helpthroughout my carrier.
  10. 10. I wish to convey my thanks to beloved shri V.M Mundinamani and Mr.S.B.Sureban for supplying me essential references in the study. I m thankful to Mr. B.S.Tippanagoudar, Lab technician, who extended his co-operation in investigations. I thanks to Mr. P.M. Nanda kumar for his help in the statistical evaluate. I am highly indebted to my beloved parents Smt. & Sri BasavanneppaKotturshetti, Sisters Lalitha, Akamahadevi, Sumangala, Ratna, and beloved brotherShiva for their love and affection rendered throughout my carrier. Thanks to all lecturers, physicians, house-surgeons, hospital staff, nurses andnon teaching staff for their timely assistance in completion of this work. Let me express my thanks to all patients, those are on the trial for theirconsent for enrolling in this clinical study and obedience to advises. This list is incomplete with out remembering my beloved wife, Dr. Veena, whohelped in all respects to complete this valuable dissertation work. Lastly I pay my deep homage and tribute to my former teacher late Prof. Dr.V.V.S. Sastri for his selection of this valuable project. Iranna B. Kotturshetti
  11. 11. Ayurveda is an ancient Indian medical science reminded by lord Brahma1.The main aim of this Ayurvedic medical science is to protect the human beings fromvarious diseases following by rules and regulations of Swasthavritta and to havedisease free human beings to have healthy society2. Disease is nothing but, life under altered conditions. These altered conditionsin fact manifest themselves through the agency of doshas, Dhatus and mala in thebody. The present day unwholesome food habits are influencing deficiencies of vitalnutrients and leads to nutritional disorders. The disease Panduroga that is dealt in allAyurvedic texts with its treatment which is very much similar to Anaemia in later 1 Introduction
  12. 12. period. The Panduroga has very much similarity with Anaemia in later period. Theword Anaemia first appeared for medical use in 1824 and in 1849 it began to have aspecific medical meaning. It is one of the common clinical conditions both in thedeveloped and developing countries like India. The W.H.O has recognized as a worldhealth problem, which is much common in our country. The disease Panduroga is explained in all most all Ayurvedic classics with itsetiopathogenesis and treatment elaborately. Ayurveda advocate the treatment ofPandu with many herbal and herbo-mineral combinations. Charaka (C.Chi 16/72)and Vagbhata ( A.H.Chi 16/25) have highlighted the combination of Guda, Nagara,Mandura, Tila and Pippali, as an effective recipe in Panduroga that is named as "Gudanagaradivati " in the present study. The ingredients of Gudanagaradivati are easily available and chief from theirqualities and this prospective the study is being conducted to evaluate the effect of itas a combination in Panduroga. In this clinical study 25 patients were incidentally selected and subjected inone group. The duration of treatment was 21 days. The clinical and hematological assessment was made before and after thestudy. In this study it was observed and analyzed the effect of Gudanagaradivati wasstatistically significant. The hemoglobin concentration raised significantly andresponse of clinical features of Pandu to the drug was good. 2 Introduction
  13. 13. 1 Astanga Hridaya Sutra 1/32 Susruta Sutra 1/6 3 Introduction
  14. 14. Unlike the history of any other subjects the "History of medicine" is medicine itself such a history at hand will serve as a golden key to the understanding of manyaspects of medicine in both academic and practical ways. The history of Ayurvedicliterature reveals more information regarding Panduroga. In a systemic enquire into the state of medical science in India, it may bepointed out that the Brihatrayi, were the earliest of the medical literatures. Whichfurnish us with detail description of the disease Pandu, for the sake of conveniencethe history of Ayurveda can be divided as follows. 1. Vedic period 2. Pauranika (Purana) period 3. Samhita period 4. Sangraha period 5. Modern period1. Vedic period: In Vedic literature especially in Rigveda3 and Atharvaveda4, we found theterms "Halima" and "Harita" which are observed to be correlative with Panduroga.The treatment of the said disease also mentioned in both the Vedas. 3 Review of literature
  15. 15. 2. Purana kala: The word "Pandu" is available in Mahabharata when sage "Vyasa"intercourse with "Ambilika" the widow of Vichitravirya; she became quite pale (PanduVarna) with fear. Thats why her son who born became pales (Pandu) coloured andnamed as "Pandu". In Garuda purana there is a reference that takra mixed with lauha churna wasadvocated in the treatment of Pandu patient. Besides the above the description ofPandu is also available in Agnipurana, Valmiki Ramayana, and Yogavasistha.3. Samhita period: The main Samhita like Charaka and Susruta have clearly described aboutPanduroga. In Charaka Samhita Chikitsa sthana 16th chapter and in Susruta SamhitaUttaratantra 44th chapter we can find about the description of Panduroga.4. Sangraha period: In this period - Astanga Sangraha, Astanga Hridaya, Madhava Nidana waswritten and elaborated about Panduroga.5. Modern period: In modern period so many commentators discussed about Panduroga andthey co-relate it with Anaemia. The word Anaemia first appeared for medical use in1824 and in 1849 it began to have specific medical meaning (which is much moresimilarity with Panduroga). 4 Review of literature
  16. 16. Naming of the disease - " PANDU ROGA" According to Ayurveda diseases are innumerable (aparisankhyeya) asdescribed by Charaka5. But they may be classified on the basis of rupa (maincomplaints), Varna (alteration in colors), samuthana (according to etiology) sthana(according to seat or location) and samsthana (according to clinical features of thedisease) and so on. There fore the Panduroga is such a disease rather clinicalcondition characterized by alteration in colour of skin and mucous membrane.Panduroga its definition and literature meaning: When there is decreasing of Rakta (blood), Meda (fat), Ojas (body immunity),diminished of body activities and discoloration of body occurs, at that time it is knownas Panduroga6. When Ranjakapitta mixed with the first Dhatu i.e., Rasadhatu, it producesRakta Dhatu (blood), but when this process vitiated the vikara takes place andultimately Panduroga occurs7. The word Pandu is a relative term to indicate some colour. With this purposeCharaka had quoted in 24 places, Susruta in 29 places and Vagbhata in 14 placeshave used the words like Pandu, Pandutwa, Panduta, Pandubhava, Panduvarna, 5 Review of literature
  17. 17. Pandura, Pandugatra, Panduvadan etc. in their classical text. Chakrapani, Dalhanaand Arunadutta, commentator of above Brihatrayee of Ayurveda had explained itsmeaning as sweta, dhushara swetavabhasa and peetavabhasa. Acharya Gangadhara has defined a Pandu Varna as Mlana Varna to explainthe colour. Different colorful objectives like Shankha, Madanphala (ripe), Katakidhuli,Parushakphala (unripe) etc. have been quoted. Monier William in his Sanskrit -English dictionary has defined Pandu as pallor.In Ayurvedic classic Pandu has been taken in three forms i.e., Pandu as a disease Pandu as a sings symptoms (clinical features) Pandu as a complicationBut maximum part it considers as a disease due to change of the natural body colourinto abnormal colour and "Raktalpata" occurs. The word Pandu is derived padi nashane dhatu by adding ku pratyaya in it.The meaning of which is always taken in the sense of "nasham" and as Pandu hasbeen kept under the group which is classified and named according to the change incolour. Therefore the nashana will be in the Varna or colour, which is further,approved by Charaka with the word " vaivarna". Thus Pandu is a disease in whichthere is mainly vaivarna or change in colour of the body takes place. 6 Review of literature
  18. 18. From various dictionaries, the term "Pandu" is defined as - Pandu pittasamvalitah suklah - (Amarakosh) Pandustu pitabhagardhah ketakidhuli sannibha - (Vachaspatyam) Panduh sretavarna, ketakidhuli sannibha, pitabhagardha varna vedascha - (sabdastommahanidhi) Pandu - pale white, whitish, pale, yellowish. The pale white or yellowish white colour (the students sanskrit English dictionary by Vaman Shivram Apte.)From the above derivatives it could be concluded that Pandu denotes some specificcolour. "Roga " derived from (ruja + ghang) or "ruja karoti roga" - it means whichgives some pain is known as Roga. As per students Sanskrit English dictionary; Roga means - a disease, malady, sickness etc. So from above discussion wecould say that Panduroga = the disease with pallor of the body. 7 Review of literature
  19. 19. 3 Rigveda 10-50-114 Atharvaveda 4-9-3 & 1-22-25 Charaka Samhita Sutra 18/436 Charaka Samhita Chikitsa 16/67 Susruta Samhita Sutra 14/ 8 Review of literature
  20. 20. In the process of genesis of Pandu pathology it is necessary to consider theorgans in concern. Specifically skin and blood, an admixture of plasma and bloodcorpuscles has to be studied in detail. Lung, Liver, Spleen, and bone marrow alsohave its impact on the genesis of pathology in Pandu. Here a stretch has been giventowards blood, as it is the specific cause of showing decreased haem and also totalblood cell (RBC) count along with Skin a covering and protective agent of the entirebody as it reflects the deficiency of blood in the body.I. Twak Vasa and shattwacha are the upadhatu of Mamsa Dhatu8, which are going todevelop in the process of dhatwagni paka of sequential progression of Dhatus theMamsa is said to be making the covering of the body9 and responsible for gati. Theskin (Upadhatu of Mamsa) is developed from Mamsa, show the characteristicfeatures in Panduroga as the twacha is being affected or showing the diseasesignificance in the skin, its importance is to be elucidated. According to the opinion of Vagbhata embryological development of the skinis from the blood i.e., Rakta as if from the boiling milk cream develops10. The skin ishaving seven layers. At the present disease concern the first layer Avabhasini orotherwise Udakadhara referred by Shalya and Kayachikitsa faculties respectively.The shat twacha are as follows 11- 8 Literary review - Shareera
  21. 21. 1. Avabhasini or Udakadhara 2. Lohita or Asrigdhara 3. Swetha or Sidhmakilasa sambhava 4. Tamra or Dadru Kusta sambhava 5. Vedini or Alaji vidradhi sambhavadhistana 6. Rohini 7. MamsadharaAvabhacini This is the outer most and first layer of the skin. It reflects or shows thecolour of the second layer Lohita. As it reflects the colour it is presumed that thecolour change in Lohita is witnessed in Avabhasini. It is being said at the size of1/18th of vrhee.Lohita Lohita looks in arunavarna i.e., red in colour and 1/16th of vrhee. It preventsthe blood flow to outside from the body. The colour of the blood in the lohita isreflected through Avabhasini.II. Rakta Rakta i.e. blood is a liquid connective tissue, which is made of cells andplasma and in further it is described as liquid intercellular substance. When freshlyshed, blood is a red, thick, opaque and slightly alkaline fluid. Out of its normal 9 Literary review - Shareera
  22. 22. functions as regular transportation, maintenance of Iron balance and acid basebalance are said to be specific.Formation of Rakta The essence of Ahara after being subjected to paka by Ranjakapitta attainsred colour and becomes Rakta Dhatu12. Susruta further says that the rasa is formedfrom the Ahara rasa after reaching Yakrit and Pleha from the Kosta. Now, coming to the point as to what the Rakta Dhatu may be in terms ofmodern physiology, it can be said that the cellular portion of the blood is as RaktaDhatu and liquid part of blood is considered as Rasa Dhatu. Therefore, bloodincludes both Rasa and Rakta Dhatu and for the convenience of description bloodcan be referred to as Rasa Rakta.Blood cells The cellular portion of rasa Rakta comprises 45%. The blood cells are of 3 types. 1. Erythrocytes or R.B.C.s 2. Leukocytes or W.B.C.s and 3. Thrombocytes or platelets. R.B.C.s number about 5-6 millions/ diameter 7.7 microns andThickness of 2.2 microns. R.B.Cs do not contain nuclei while they are in circulation.These cells enter the blood at bone marrow as and how they are produced and 10 Literary review - Shareera
  23. 23. matured in the red bone marrow. The rate of production of R.B.Cs by the bonemorrow is about 7 millions/second and the R.E. cells of the circulation will destroyapproximately the same number of cells. The red bone morrow gets stimulation forthe synthesis of materials required for the R.B.C production from the haemopoiticfactors present in the stomach, Brunners glands of duodenum, liver, spleen andR.E.F (Renal erythropoitic factor) of juxta glomerular apparatus. Apart from theseinternal factors iron (Fe) copper (Cu), B12, folic acid and proteins of food serve asextrinsic factors. By the influence of the above said factors hemoglobin issynthesized in the body, and gets fixed to the R.B.C s. if the hemoglobin is notsynthesized well, the red bone marrow sends only premature R.B.Cs devoid ofhemoglobin.Hemoglobin The red colour of R.B.C s is due to the hemoglobin. This pigment iscomposed of 2 substances viz. Heam and globulin heam contains prophyrin and Fe(iron). Therefore the main component of hemoglobin is iron. This compound (Hb) cancombine with oxygen 60 times more than what the water can i.e., we are able to geton with 6 liters of blood only due to the presence of this hemoglobin. If there hadbeen water instead of blood we would require 360 liters. Another advantages with Hbare it can readily combine with O2 in the lungs and CO2 in the tissues and form theunstable compounds, carboxy and oxy hemoglobin, and thus serving the oxygenneeds of the body with maximum quickness. Quantity = 16 grams/100c.c. of blood in adults. 11 Literary review - Shareera
  24. 24. The life of R.B.C s is about 120 days. After this period since the R.B.C becomesold and incapable to carry its functions, the R.E. cells of liver and spleen will destroysuch cells. The iron content of hemoglobin of these destroyed cells is mostly usedagain for the synthesis of hemoglobin and part of it is spent for the production of bilejuice. If the destruction of R.B.Cs is increased more than normal, more of bilirubin willbe produced. And accumulates in the circulation resulting in jaundice (Kamala) thehemolytic jaundice) the jaundice may also be caused by the damage of liver(infective or hepatic jaundice) or by the obstruction of bile ducts (obstructive jaundice- Avaruddha kamala). Thus the main functions of hemoglobin are. 1. To impart O2 carrying capacity to blood. 2. To impart colour to the body through blood. 3. To help again for the manufacture of Hb, and 4. To contribute some constituents required for the production of bile juice.Functions of Rakta131 Varna prasada Colour of the skin2 Mamsapusti Nourishment to other Dhatus like Mamsa3 Jeevana vyapara O2 supply4 Bala Strength5 Sukha Health and happiness6 Prasannata Tranquility7 Ayuh Life 12 Literary review - Shareera
  25. 25. Suddha rakta purusha lakshanas14(Characteristics of the person endowed with pure blood)As long as a person is having pure blood in him - His colour and complexion are very attractive. His Indriyas and Indriyardhas are perfectly normal His digestive power is perfect. Will be quite healthy and happy. His Dhatupusti and Bala are perfectly normal.Suddha Rakta lakshanas15The following colors indicate of pure blood. Pure blood looks like a bright indra gopa Like pure gold Looks like Padma (lotus flower) and Alaktaka (lacca) and Gunjaphala savarnam i.e. brightly red like Gunja seedPANCHABOUTIKATA OF BLOOD16 The following qualities of blood represent the presence of their respectiveMahabhutas and thus establish the fact that the blood is Panchaboutika its. 1. Visrata = Fleshy odour indicates pruthvi bhuta 2. Dravata = Fluidity of out indicates jala bhuta. 3. Raga = Redness odour indicates agni bhuta 4. Spandana = Movement odour indicates vayu bhuta, and 5. Laghuta = Lightness odour indicates akasha bhuta. 13 Literary review - Shareera
  26. 26. Role of Phupphusa, Yakrit and Pleeha in Rakta Shodhana:(Role of lungs, liver and spleen in the purification of blood) Blood reaches the lungs through pulmonary artery from the right ventricle andis distributed all around the pulmonary alveoli in lungs through the single cell walledcapillary net work. The alveolar wall also is extremely thin to facilitate the freeexchange of gases between the blood and air. Blood thus oxygenated in the lungspasses on to the left atrium through pulmonary veins. Thus, the lungs are responsiblefor the oxygenation of blood. Here, the CO2 of blood brought from the right side of theheart gets eliminated through lungs during expiration and the O2 is taken in side bythe blood after inspiration.SPLEEN: The reticulo endothelial cells of the spleen destroy the old RBCs of the blood.Bilirubin is formed out of the hemoglobin of the destroyed RBCs, spleen also helps inthe storage of blood.LIVER: Conjugation of bile pigments to form bile juice takes place in the liver.Destruction of old RBCs takes place to some extent in the liver also by the Kupfferscells of liver. Moreover, as already described, the harmful substances like toxins,bacteria, absorbed drugs etc., circulating in the blood are destroyed by the liver cellsand excreted through bile juice. The liver maintains the composition of blood. 14 Literary review - Shareera
  27. 27. COMPOSTION OF BLOODCellular portion 45% 1 RBC"s 5 to 6 millions per 2 WBC"s 6000 to 8000 per and 3 Platelets 2 to 3 lakhs per RBC, WBCm ratio: 1000: 1 RBC, platelets ratio: 20:1 Platelets WBC ratio: 50:1 Plasma 55% Water = 92% proteins = 7% Na, K, Ca, Mg, P, Fe, C etc. 0.9%Non-protein nitrogenous substances - Such as uric acid, Creatine, NH3 amino acid, neutral fat, = tracesThe plasma proteins are Serum albumin = 4.7% Serum globulin = 0.4% Fibrinogen = 2.2%RAKTA KSHAYA LAKSHANAS17 1. Amla sishira preeti = desire for acrid and cold substances 2. Sirashaithilyata = collapse of blood vessels, and 3. Rookshata = dryness of skin 15 Literary review - Shareera
  28. 28. RASA VAHA AND RAKTA VAHA SROTASES18 The origin of Rakta vaha srotases is Yakrit (liver) and Pleha (spleen). Theabove descriptions state that, the nutrients required for plasma and the storage ofblood take place in Raktavaha srotomoolas i.e., liver and spleen whereas thepumping station for blood which as a basic nutrient supplier for all the Dhatus isHridaya along with its 10 dhamanis. These ten dhamanis cannot correctly bedescribed according to modern physiology. To correlate the number (10) we have totake the important arteries like 1. Right and 2. Left coronary arteries 3. Inanimate artery 4. Subclavian artery and so on.RAKTA SARA PURUSHA LAKSHANAS19 A person having fully developed Rakta Dhatu from the birth onwards is knownas Raktasarapurusha. His/her Karna (ears), Netra (eyes), Mukha (face), Jihva(tongue), Nasa (nose), Oshtha (lips), Panitala (palms), Padatala (soles of the foot),Nakha (nails), Lalata (fore head), Medhra (penis) etc., look brightly red glistening andattractive. 16 Literary review - Shareera
  29. 29. 8 Charaka Samhita Chikitsa 15/179 Astanga Hridaya Sutra 11/410 Astanga Hridaya Shareera 3/811 Susruta Samhita Shareera 4/3; Charaka SamhitaShareera 7/512 Charaka Samhita Chikitsa 15/2713 Charaka Samhita Sutra 24/3 Susruta Samhita Sutra 5/614 Charaka Samhita Sutra 24/2315 Charaka Samhita Sutra 24/2116 Susruta Samhita Sutra 14/917 Astanga Hridaya Sutra 11/1718 Charaka Samhita Vimana 5/919 Charaka Samhita Vimana 8/114 17 Literary review - Shareera
  30. 30. Factors, which are responsible for production of Pandu Roga, are clearlymentioned by our Ayurvedic classics.According to Charaka20 Intake of Kshara (alkali), Amla (acid) Lavana (salt), Ati Ushnata, virudhaAhara, asatmya Ahara, Nishpava, Masha, Pinyaka, Tilataila, day sleep, excessiveexercise, Atimaithuna (excessive indulgence in the sexual acts), immediate alterationof daily routine life, suppression of the natural urges (vegadadharan). Human having excessive sexual willing, thought, fear, anxieties, anger,person after taking the above etiological factors; his/her Pitta (Sadhakapitta which isat heart) got aggravated and it mixed with vayu (Vyanavata) (which is more powerfulamong the Tridosha). Than it makes "sthana sanshraya" within skin and muscle andpolluted Kapha, Vata, Rakta, Twacha (skin) Mamsa and create Pandu Roga.According to Susruta21 Excess exercise, acidic and salty diet, madya (alcohol), mrit (soil), day sleep,etc. - All these factors create Panduroga. Certain disease which act as causativefactor in the production of Panduroga (Nidanarthakar Roga) are -1. Bleeding tendency diseases like - vividha abhighata, krimi roga (helminthic manifestation), Arsha (piles), Rakta pitta, Rakta pradara etc. 17 Literary review - Nidana
  31. 31. 2. Diseases of liver and spleen - Yakritdalyodar, Pleehodara, (hepatospleenomegaly) Jalodar (ascities), Grahani (sprue).3. Metabolic and other diseases like - Prameha, Raj-yakshma, Atimaithuna janya Vyadhi (diseases because of excessive indulgence in sexual act), Visama jwara (malarial fever), etc.4. Pyogenic diseases like - Vrana, Arbuda (malignancy tumor).5. Panduroga is also due to nidanarthakar roga - when some disease produce another diseases are known as nidanarthakar roga. With this understanding many diseases are found in Ayurvedic literatures, that precipitated Pandu, possibly due to loss of blood from the human system. Examples are - Raktarbuda22 Raktapradara23 Raktapitta24 Katika-taruna marmavedha 25 Raktakshaya26 Yakrit Pleha vedha27 etc,. Various Ayurvedic Samhita describes the causative factors of Panduroga asfollows - 1. Ahara Hetu (Dietary factors) 2. Vihara Hetu (physical factors) 3. Manasika Hetu (factors affecting mind) 18 Literary review - Nidana
  32. 32. Samhita Ahara Vihara ManasikaCharaka28 Rasa Kshara Diwaswpna Kama Amla Vyayama Lavana Ativyavaya Guna Atiushna Prati Karma Chinta Dravya Nishpav Ritu vaishamya Bhaya Masha Vegadharana Krodha Tila taila Shoka Prinyaka 29Susruta Rasa: Amla DiwaswpnaMadhava Nidana Lavana AtivyayamaYogaratnakara Guna Atiteekshna Dravya Madhya Mrit 19 Literary review - Nidana
  33. 33. Purvarupa of panduroga The sign and symptoms, which give the earlier idea about disease, which areto be developed further, are called Poorvarupa that is prodromal symptoms of thedisease30. Acharya Susruta has described six stages of Kriyakala out of which theforth stage of Kriyakala is sthanasamshraya represents the prodromal phase orPoorvarupa of the disease. In this stage the virgin doshas or dushyas are vitiated to the place in the bodywhere they suited place in khavaigunya and development of disease takes place atthat site. 20 Literary review - Nidana
  34. 34. Poorvarupa described by Brihatrai31S.No Signs/Symptoms Charaka Susruta Vagbhata1 Hrit Spandhana (palpitation) + - +2 Rooksha (dryness) + - +3 Swedabhava (No sweating) + - +4 Shrama (Fatigue) + - +5 Twak Sputana (cracking of skin) - + +6 Hrillasa (Nausea) - + +7 Pada gourava (Heaviness in lower limbs) - + +8 Mridbhakshaneccha - + +9 Akshi Koota shota (puffiness around eyes) - + +10 Avipaka (Indigestion) - + +11 Peeta mutrata (yellow urine) - + +12 Peeta Purisha (yellow stool) - + +13 Aruchi (loss of appetite) - - +Purva rupa described by laghrutrayi Harita Samihita Vangasena32Twak spotona Akshikuta shotha PipasaSthevana Shwayathu AruchiGatrashoola Shareera panduta HrillasaMridbhaksanechcha Peta mutrata UrodahaPrekshan kuta shoota Twak pradeeryata Anga gouravaPurisha petata RaktalochanataMutra petataAvipaka 21 Literary review - Nidana
  35. 35. Lakshana (Roopa) of Pandu The term roopa implies both the signs and symptoms through which a disease isidentified. In addition to the cardinal signs and symptoms, a number of constitutionalsymptoms will also manifest in Pandu. Few of the symptoms aid in distinguishing thetypes on the basis of doshanubandha. In the advanced stage with deterioration of thegeneral condition, a number of other symptoms will develop. Accordingly the signsand symptoms can be classified as follows. 1) Pratyatma lakshanas (cardinal signs and symptoms) 2) Samanye lakshanas (general signs and symptoms) 3) Vishishta lakshanas (distinguishing features of doshanubanda)1. Pratyatma Niyata lakshanas It is the invariable feature present in a disease Pandu Varna of the twacha isconsidered as the pratyatma Niyata lakshanas of Panduroga. This is an abnormalcolour imparted to the skin due to rasa and Rakta kshaya in the body. This is almostlike colour of pollens of kethaki flower. In addition to the above in vathaja Pandu krishna or arunavarna is associatedwith Panduroga. In pittaja pandu peetha, haritha, haridra, likewise in kaphaja pandushwetha varna is associated with pandu varma and changes the normal colour of theskin like krishna, shyama, avadatha, shymavedata to krishna pandutha, haridrapandutha, shwetha pandutha etc. 22 Literary review - Nidana
  36. 36. 2. Samanya lakshanas A number of constitutional symptoms will manifest in varying degrees, whichare considered as general symptoms. • Alparaktha • Dourbalya • Hridrava • Shwasa • Bhrama • Kati uru and parshwaruk • Karna kshewada • Mandagni • Sadana • Gourava • Shoonkshi koota • Shotha This is an important lakshana that can be observed in Panduroga. Thequantity of Rakta in whole body is stated to be about ashtanjali (eight anjali) andRakta Varna in its colour. Here guru and ushna gunas are on account of prithvidravatha due to Ap mahabutha. Rakthata is an account of tejo mahabhuta. Hencethis Rakta is attributed as Jeeva Rakta. Rakta imparts colour and complexion to theskin and hence causes Pandu Varna. 23 Literary review - Nidana
  37. 37. Alpa Raktata Alap raktata or Raktalpatha can also occur due to the kshaya of Rasadhatuand Panduroga is grouped under rasapradoshaja vikaras. The kshaya of Rasadhatucan be mainly due to two reasons, first being scarce availability of Ahara dravyas,which are considered as basic requirements for the rasa prapthi. Any scarcity eitherquantitative or qualitative results in rasaabhava owing to under nutrition andmalnutrition respectively. The second reason, which can result in rasaabhava, is the vikruti ofPachakapitta. Any vikruti in Pachakapitta results in the improper production ofRasadhatu and in turn in the production of Rakta Dhatu depends on its previousDhatu the rasa. Sometimes even though the production of Rasadhatu is proper any vikruti ofRanjakapitta can also result in rakthalpatha as the process of rasaranjana isimpaired. Along with Pachakapitta and Ranjakapitta the aganthu reasons like abhighatacan also result in rakthalpatha and in turn it may leads to Panduroga. The conditions like Arshas, Pleehodara, Jeernavishama - Jwara, Raktharbudha,Yakshma, Rakthapitta which result in Rakta nasha is also responsible for theoccurrence of Pandu. The disease Pandu that is resulted out of rasa andraktakshaya can exhibit the following lakshanas. 24 Literary review - Nidana
  38. 38. 1) Hridrava 12) Pandutha2) Trishna 13) Twak spotana3) Roukshya 14) Dhatukshaya4) Shrama 15) Dourbalya5) Shosha 16) Gatrasada6) Glani 17) Gurugatrata7) Daha 18) Varnabeda8) Sheeta pradhana 19) Nidralutva9) Krusha 20) Tandra10) Shwasa 21) Shopha11) MandanalaDourbalya The extent of dourbalya in Pandu can be measured in relation to his normalbala. The degree of rakthalpatha can also help in estimating whether dourbalya ismrudu, madya or dharuna.Karshya Karshya in Pandu is related to the body of the individual in his healthy state.Anyway the kshaya of poshaka dhatu such as Rasa, Rakta, Mamsa etc., can causethe shushkta of the spik, greeva and udara. Dhamanijala will be prominent andsthoolaparva may be present. The lakshanas appear as the vitiated Vata finds itsplace in Raktadhatu. 25 Literary review - Nidana
  39. 39. Hridrava Rasa kshaya and rakthakshaya result in Vata vriddhi cause Hridayaspandana there will be an extra load on Hridaya as the hridayagati increases in orderto reach Raktadhatu to all parts of the body. This may ultimately result in Hridayavisthara.Shwasa Shwasa in Pandu referred to the increases in the number of shwasa gathi thisis a common manifestation of dourbalya and many times indicated as Hridayadourbalya resulted out of extra load on Hridaya. This shramaja shwasa suggests theprakopa of vayu and Kapha in general and prakopa of Pranavata in particular.Bhrama Any increase in rajoguna along with the prakopa of Vata and Pitta isresponsible for Bhrama. The vitiated Vata influencing Rakta, Mamsa and Medascauses Bhrama. Pittavrutavata, ksheena kapha, ksheena majja, can also causeBhrama. Bhrama occurs due to the involvement of all these factors in Panduroga.Kati, uru and pada ruk The vrudha Vata of Panduroga is responsible for the pain in the aboveregions. 26 Literary review - Nidana
  40. 40. Karnakshweda It is a nanatmaja vikara of Vata. Due to Rakta Pitta the shravanendriya is notnourished properly and due to alpamedaskatha, the snehanakriya does not takesplace, resulting in sthanika rooksha guna vriddi and vitiated vayu takes shelter inkarna to lead to karnakashweda.Mandagni Mandagni is due to rakthalpata. This is due to the vitiated Pitta, Kapha andalso due to the influence of vayu over koshtagni.Sadana Avayavasadana is a nanatmaja vikara of Pitta dosha, Mamsa Dhatuksheenatha and ojoksheenatha are mainly responsible for causing sadana in thebody so we can say sadana in Pandu is due to Dhatu kshaya and ojokshaya.Gourava It is due to the increased Kapha dosha and Ama dosha in the body. InPanduroga this occurs due to Agnimandya which results in the formation of Ama thatcauses the Dhatu shaithilyatha in the body.Shoonakshikoota Occurrence of shotha in akshikoota is due to rakthalpata in Panduroga. Thisis again due to the increase in Amadosha. 27 Literary review - Nidana
  41. 41. Sheernalomatha This is due to increase of Vata and Pitta in the body. Due to rakthalpata otherDhatus will be undernourished due to which sheernalomatha occurs.Hathaprabha This is due to the causes like raktalpatha and Pitta prakopa. Rakta Dhatu andPitta prakopa are responsible for imparting colour and complexion to the body. Theperson of Panduroga suffers from the loss of complexion due to ojokshaya in thebody.Shwetaakshitwa This is explained by kashyapa under the heading of samanya lakshanas ofPanduroga. This is due to increased vayu and majjagatha Kapha vikruthi.Shwethanakhatwa This is due to the rakthalpata and vitiated Kapha in the body.Satwahani The word satwa denotes bala so satwahani means balahani. Dhatu shaitilyaand agnimandya leads to mal nourishment and satwahani. Satwa also signifiesManas, so the involvement of Manas in Pandu is also significant. The satwa amshaof Manas is deteriorated due to Ojokshaya in the body. 28 Literary review - Nidana
  42. 42. Tabular form of Pandu LakshanaS.No Lakshana Charaka Susruta Vagbhata1 Karnakseweda + - +2 Hatanala + - +3 Dourbalya + - +4 Sadana + - -5 Annadwesha + - +6 Shrama + - +7 Bhrama + - +8 Gatrashoola + - -9 Jwara + - +10 Swasha + - -11 Gourava + - +12 Aruchi + - +13 Gatramardata + - +14 Gatrapeeda + - -15 Gatronmatana + - -16 Soonakshikoota + - +17 Harita varna + - Panduvarna18 Sheerna lomata + - +19 Hata prabha + - -20 Kopanata + - +21 Shishira dweshi + - +22 Nidraluta + - -23 Pindikodweshtana + - -24 Katiruk + - -25 Pada ruk + - -26 Pada sada + - -27 Ururuk + - -28 Kati sada + - -29 Uru sada + - -30 Dhatu saithilya + - +31 Ojo guna kshaya + - +32 Alpa raktata + Raktadusti +33 Alpamedaskata + - +34 Nissarata + - +35 Hridrava + - +36 Sithilendriyata + - +37 Twacha panduta + + +38 Swetakshitwa - - -39 Sweta nakhatwa - - -40 Swetha vakrata - - - 29 Literary review - Nidana
  43. 43. 3. Vishista roopas The lakshanas specified to doshic virulence is also an important part of theirstudy, for the early diagnosis and for the purpose of prognosis. The differentclassification of Panduroga is mentioned with reference to samanya Samprapti.Classification of Panduroga According to sankya Samprapti the classification of Panduroga described indifferent Samhita granthas in different views. Charaka, Vagbhata, Madhava,Sharangandhara, Yogaratnakara and Kashyapa all mentioned 5 types of Panduroga.They are as follows33. 1.Vataja 2.pittaja 3.kaphaja 4.sannipataja 5.mritbhakshanajanyaSusruta has claimed that there are only 4 types of Panduroga34 1.vataja 2.pittaja 3.kaphaja 4.sannipataja According to Susruta different types of mrit produces particulardoshavaishamya or doshaprakopa and afterwards gets converted into doshajaPandu. Hence he has not included the mritbhakshanajanya Pandu as 5th type ofPanduroga. 30 Literary review - Nidana
  44. 44. Taking in to consideration all these opinions we can say that there are 5 typesof Panduroga as described by Acharya Charaka and Vagbhata.Vathaja Panduroga As said earlier the prevalence of vathaja Panduroga is in those who are ofvathaja tendency. Hence in this the colours like krishna and aruna are associatedwith Panduroga. Due to the vitiation of Vata the person suffers from kampa, parshwashoola,shirogourava etc., apart from the above features we can also note some otherfeatures in vathaja Panduroga like nakhachippitathe, nakhabhangrurathe etc.,Pittaja Pandu: Pittaja Panduroga occurs to those who are usually of pittaja tendency wheresevere aggravation of Pitta is present.Kaphaja Pandu lakshana Kaphaja Panduroga usually occurs in those persons who are usually ofkaphaja tendency. Here Kapha will be severely associated with Pitta dosha resultingin the causation of Panduroga Kapha will be aggravated in Dhatus and vitiatesmainly rasa and Rakta resulting in Dhatu shaitilyatha. This further leads to conditionslike balakshaya, sneha kshaya, Varna kshaya and ojokshaya. 31 Literary review - Nidana
  45. 45. Showing the lakshana of vataja Pandu35S.No Lakshana Charaka Susruta Vagbhata1 Krishna panduta + - -2 Krishna nakatwa - + -3 Aruna nakatwa - + -4 Krishana Akshitwa - + -5 Krishna siratwa - + -6 Shrama + - +7 Rookshangata + - -8 Arunangata + - -9 Rukshanetrata - + -10 Angatoda + - +11 Angamarda + - -12 Kampa + - +13 Parshwaruk + - +14 Shiroruk + - +15 Asyavairasya + - +16 Shofa + - +17 Balakshaya + - + 32 Literary review - Nidana
  46. 46. Showing the lakshana of Pittaja Pandu36S.No Lakshana Charaka Susruta Vagbhata1 Gatrapeetata + - +2 Harita + - +3 Peeta sira - + +4 Jwara + + +5 Daha + - +6 Trishna + - +7 Chardi + - -8 Sweda + - +9 Amlodgara + -10 Dourabalya + -11 Peetomutrata + +12 Shosha + -13 Peeta vitkata + +14 Binna varchastva + -15 Shopa - - 33 Literary review - Nidana
  47. 47. Showing the lakshana of Kaphaja Pandu37S.No Lakshana Charaka Susruta Vagbhata1 Shwethavabasatha + -2 Shuklakshita - + +3 Shuklanakataha - + +4 Shuklananathva - + +5 Gourava + + +6 Moorcha + - -7 Bramaha + - -8 Shwasa + - -9 Alasya + - -10 Shwayathu + - -11 Shuklamootratva + + -12 Shuklavarchaskatha + + - 34 Literary review - Nidana
  48. 48. Sannipathaja lakshana If the vitiation of all the dosha is equally severe then it may be resulting intridoshajnya Panduroga. This causes severe degree of Dhatu shaitilyatha anddhatugourava from which deterioration of Dhatu and Ojas occurs very rapidly. Wecan find the features of sannipataja Panduroga in Harita Samhita only. Others havesated the manifestation due to the degree of variations In the doshic imbalance, thisPanduroga considered as Asadhaya. Tridoshajanya Panduroga lakshanas as stated by Harita38 -1) Tandra 8) Vitbadha2) Alasya 9) Parusha3) Shotha 10) Jwara4) Vamana 11) Kshudarta5) Kasa 12) Moha6) Hrullasa 13) Trushna7) Shosha 14) KlamaMritbhakshanajanya pandu lakshana39 A separate or a unique explanation of this condition is seen in CharakaSamhita. Susruta has included this condition is sannipathaja Panduroga only.Mritbhakshana or consumption of mud or soil is a peculiar condition in which itcauses Panduroga only. That is why Vijayarakshitha has quoted this instance ofoccurrence of Panduroga due to mud eating and here soil eating is to be consideredas Vyadhi karana. Consumption of soil vitiates all the three doshas in the body. If thesoil is kashayarasa, then the increase of Vata can be observed. Like wise if it iskaturasa then of Pitta or if it in madura rasa then the increase of Kapha can beobserved in the Panduroga. 35 Literary review - Nidana
  49. 49. 1) swatantra Panduroga. Where the condition has appeared as a specific disease entity, and 2) paratantra Panduroga where the Pandu appears as a clinical feature or complication of other disease like pittija pratisyaya, pittija kosha, pittarsha, pittija promeha, grahani krimi roga, sosha, etc. Table for classification of Pandu in different Name of the Pandu CS SS AH AS BP VS MN HS1 Vataja + + + + + + + +2 Pittaja + + + + + + + +3 Slesmika + + + + + + + +4 Sannipataja + + + + + + + +5 Mridvakshanaja + - + + + + + - (CS = Charaka Samhita, SS = Susruta Samhita, AH = Astanga Hridaya, AS = Astanga Sangraha, BP = Bhava Prakasha, VS = Vanga sena MN = Madhava Nidana, HS = Harita Samhita) 36 Literary review - Nidana
  50. 50. Samprapti of Pandu and its co-relations Ayurveda believes in the doshika theory for creation of any type of diseaseaccording to our classics there is three dhosas namely Vata, Pitta and Kapha in ourbody. As long as these doshas (humors) are in complete harmony, body is in normalcondition and as soon as they imbalance, any kind of disease is produced40. Thisimbalance state is usually because of the vitiation of a particular dosha or incombination of other, leads to the production of disease, is known as Samprapti. According to Vagbhata Samprapti is the process of the disease, which dealswith the process of vitiation of doshas, which spread all over the body and with themanifestation of the sign and symptoms of a disease. Thus the study of the entirechanges taking place in the body under the influence of the etiological factors leadingto production of disease is known as "Samprapti"41. It deals with the body changesboth in the clinical as well as sub clinical stages of the disease. According to Charaka, due to intake of Pitta prdhana tridosha prakopak Aharaand Vihara, the Pitta (Sadhakapitta) which is situated in the heart is excited and thisexcited Pitta throws away from the heart via ten dhamanis with the help of vitiatedvayu. Then it wanders through out the whole body and finally takes(sthanasamsraya) in the space between skin and muscle and theyre by vitiatingKapha, Vata, Rakta, Twak and Mamsa and producing Pandu varna (pale coloration),haridra varna (deep yellow colour), Harita varna (greenish colour), etc. the skin42. 37 Literary review - Nidana
  51. 51. Samprapti according to Charaka in summarized form43 Pitta pradhan tridosha prakopak nidan sevan Agni vikar and rasa dusti Dosha prakopa (mainly Sadhakapitta inside heart) Prasara via srotas by vayu Dhatu dusti (vikriti) Dhatu kshaya (raktalpata) Panduta (discoloration of skin) Susruta has distinctly subdivided the entire process of the production of diseasein to six stages and has termed as " shat Kriyakala". These stages have importancefrom both diagnostic and treatment point of view. These six stages of progression ofpathology are44 - sanchaya (accumulation) prakopa (excitation) prasara (spread) sthana samsraya (localization) vyakti (manifestation) veda (complication) 38 Literary review - Nidana
  52. 52. Sanchaya: In Panduroga due to excessive intake of paittika Ahara - Vihara, the Pittadosha will be vitiated which accumulates in its chief site i.e., Amashaya. Here thisperson may develop mild symptoms in the form of ichha and dwesha, which means,he may like the sheeta and madhura dravyas and dislikes ushna and tikshnadravyas. If person recognizes these instincts (likes and dislikes) and acts accordinglythe dosha will come back to their normal condition, on the other hand if they are notrecognized and the patient continue to indulge in Pitta vardhak Nidana; the doshasincrease again.Prakopa: In Panduroga due to continuous indulgence of paittika Ahara - Vihara, thePitta dosha increase further and spread to many of their own sites like Yakrit, Pleha,twaka, drika etc. and produce its own specific symptoms in all places. These aremoderate in nature, the person feels that he is not well but goes about his dailyroutine. He can easily get over this abnormality by suitable adjustment in foods,activities and simple drugs and remedial measures by consulting physicians.Negligence in appropriate action leads to the next stage of abnormality.Prasara: In Panduroga excited Pitta dosha enter in to the Hridaya (Hridayasamvasthitam) by leaving its original sites i.e. Yakrit, Pleha, twak etc. after reachingHridaya, this excited Pitta dosha spread to all over the body through dhamanies withthe help of vayu. Here the person develops some powerful symptoms. If effective 39 Literary review - Nidana
  53. 53. treatment become available the doshas will come back to normal. If the personcontinues to indulge the same etiology, or if treatment is ineffective, the abnormalitycontinues further to the inset of the fourth stage.Sthanasamshraya The fourth stage of Kriyakala is also as Sthanasamshraya. At this stagedosha - doosya samorchhana occurs. The increase doshas, which were higher totravelling all over, the body mixed with the circulating rasa Dhatu. Now tend tolocalize in the particular tissue, organ or system because of early symptoms of thespecific disease start manifestingVyakti: This is the stage of full manifestation of specific disease with all itscharacteristic of specific disease with its entire characteristic sign and symptoms. Incase of Panduroga, after the localization of vitiated Pitta dosha in between twak andMamsa, the specific sign and symptoms of Pandu like pale yellow and greenish anddifferent types of discoloration of skin develops.Bheda: In this stage the body forces may arrest the pathological process and diseasemay subside or it may be passed to sub acute or chronic stage or stage ofcomplication may begin. 40 Literary review - Nidana
  54. 54. Co-relation:Vatika Pandu: Although Pitta plays main role in the development of Pandu but Vata dosha isalso vitiated in the process of pathogenesis. It acts along with Pitta on the RaktaDhatu, so that they absorb fluid portion of the cell and as a result cell assumessmaller size. Thus the vatika Pandu may be correlated with the microcytic anemiaand other anemias having disorders in the shape of RBC like sickle cell anemia.Paittika Pandu: In this type of Pandu, there is a disturbed metabolic activity of theerythrocytes due to increased metabolic activity. So there is no proper formation ofblood and on the other hand there is accumulation of waste products (malaSanchaya). Thus in patient of paittika Pandu, there is increased haemolysis due tobreak down of R.B.C. as Pitta is predominantly acting on the Rakta so there is moreand more haemolysis. Hence the size of red cell and hemoglobin concentration issame but the number of red blood corpuscles remains low. So the paittika Pandumay be correlated with normocytic anemia.Kaphaja Pandu: Kapha and Pitta are antagonistic to each other, one being of sheeta gunaother of ushna guna. Thus the sheeta quality of Kapha is neutrialized by ushna gunaof Pitta. In Kapha fluid portion is more, hence more and more fluid is absorbed by thecell and assumes large size. Therefore kaphaja Pandu may be correlated withmacrocytic anemia. 41 Literary review - Nidana
  55. 55. Sannipataja Pandu: When all doshas are involved and act together, naturally it will producedifferent types of cells. When there will be more activity of Kapha, the cells assumelarge size and when Pitta activity is more, the cells remain normal and when Vataactivity is more, it assumes smaller size. So there will be anisocytosis andpolikilocytosis. This type of pandu may be correlated with mixed type of anemiahaving dimorphic picture.Mrid bhakshana janya pandu : In this condition any of the three doshas may be vitiated according to natureof the clay and doshas when vitiated will produce corresponding types of Pandu. Ayurveda Nidana Chikitsa ka sidhanta by prof. R.H. Singh, it is clearlymentioned that after eating of Mrit (soil) the worms are created in side abdomen andhamper the absorption of the nutritions and ultimately iron deficiency anemia.Modern medical science also believe that pica (i.e. eating of clay) is the one of themajor factor for iron deficiency anemia45. 42 Literary review - Nidana
  56. 56. Factors of SampraptiI. Doshaa. Pitta dosha - Pitta is the chief factor responsible for Panduroga. Before explaining thepathological process of the doshas it is ideal to briefly know its physiological functionin the body. Generally Pitta dosha is responsible for various functions like vision(darshana), digestion and metabolism (pakti rushma), appetite (kshut), thirst(thrishna), unctuousness (deha mardava), complexion (prabha), intellectuality (meda)etc., Pitta dosha, which is situated in the Amashaya, is responsible for nourishingand regulating the subsidiaries like Sadhakapitta, Ranjakapitta, and Alochakapittaand Bhrajakapitta. These varieties have their definite and specific actions in the body. In Panduroga Pitta dosha attain morbidity due to Nidana sevana. There atfirst the Pachakapitta is the target of morbidity and this morbid and increased Pittatransforms the poshaka rasa into the state of amavastha and circulates all over thebody along with it, in this process it vitiates other Pitta and other doshas etc. The Pachakapitta which itself is excited and morbid fails in its own functionsand also in the nourishment of other Pitta in the body. The process of digestion is 43 Literary review - Nidana
  57. 57. suffered and metabolism is impaired. The desire for the food is lost, the thirstincreased, the complexion is changed and the intelligence interfered. It may not be out of place here to mention that the modern medicinepostulates the importance of castle intrinsic factor in the absorption of vitamin B12 (anextrinsic factor). Which is essential for the synthesis of erythrocytes that is from theproerythroblastic phase. This intrinsic factor is present in the gastric mucosa and inthe normal gastric juice. This is an enzyme like unidentified substance secreted bystomach. The factors responsible for the erosion of gastric mucosa and for the alteredpH of gastric juice may lead to the absence of intrinsic factor leading to perniciousanemia. In Ayurveda the highest importance is given for the maintenance ofJatharagni which in other words can also be called as Pachakapitta. If this Pitta isnormal then the digestion and metabolism of the food material is proper. If thispaktirushma is disturbed due to various extrinsic factors like consumption of madya,katu, rooksha, teekshana aharas leads to the khavaigunya in the Amashaya. Due tothe above cause the walls of Amashaya (gastric, mucosa) is impaired due tokhavaigunya in the Amashaya, the Ahara rasa will not be digested and absorbedbecause it attains Ama roopa. In this context we can quote the reference ofchakrapani who mentions "raktaposhaka sarabhaga anutpadana" or the non- 44 Literary review - Nidana
  58. 58. production of Rakta poshaka rasabhaga in the Amashaya is one of the chief cause ofPanduroga. As explained earlier the remaining Pitta like Sadhaka, Ranjaka, Brajaka getinvolved in the causation of Panduroga. The Ranjakapitta, which is situated in Yakritand Pleha, is responsible for the coloration of Rasadhatu. The Yakrit and Pleha arethe seats of Raktavaha Srotas vitiation of Ranjakapitta leads to the impairedcoloration of Rakta Dhatu. The modern physiology says that the bile pigments and the chlorophyll arenecessary for the hemoglobin formation. The two chief constituents of bile pigmentsare billirubin and biliverdin, which is present in bile. The old and worn out RBCsdisintegrated and they are removed from the circulation through the cells of reticuleendothelial system. The bone marrow appears to be the most active site.Hemoglobin is released by the degradation and is broken into amino acid, whichenters the general amino acid pool In the formation of new hemoglobin. The rest ofthe haem is converted into yellow pigment. The deficiency of bile pigment and chlorophyll leads to the loss of hemoglobinformation and therefore leads to hypo chromic anemia. As said earlier the mala of Rakta is known to be Pitta. Though it is verydifficult to establish this malaroopa Pitta as bile itself, yet basing on the availablereferences we can say that bile is one of the chief constituents of Rakta Dhatu 45 Literary review - Nidana
  59. 59. (RBCs) which are old and damaged. These are disintegrated in Yakrit and Pleha andare broken down. If the Pitta is provoked in Yakrit and Pleha then again themalaroopa Pitta is increased and these may ultimately interfere in the formation ofRakta through rasa ranjana, where bile pigments are affected and ultimately causePandu or hypo chromic anemia. After the vitiation of Pachakapitta and Ranjakapitta the next target is thehridistita Sadhakapitta. Due to alpa raktata the Hridaya which is responsible for thecirculation is strained and the cardiac effort will be increased. Due to this theSadhakapitta is influenced by the vitiated Rakta and is circulated all over the bodyand locates in vitiated twacha and Mamsa, when Sadhakapitta is vitiated and locatedbetween twak and Mamsa is further influenced on Bhrajakapitta of twacha. TheBhrajakapitta, which is already, affected from the lack of nourishment (due toPachakapitta vitiation) its functions like prabha and Varna are interfered leading toPandutha of the skin.b. Vata dosha The vayu is the chief factor in the body for initiation of all the activities.Vitiated vayu is responsible of the expulsion of Sadhakapitta from Hridaya to dashadhamanies. Here vayu is responsible for manifestation of various signs andsymptoms due to Dhatu kshaya and margavarodha. In the pathogenic processSamanavata may play an important role in the vitiation of Pachakapitta likewise dueto rakthalpata Vyanavata may be increased in the body and this further increases the 46 Literary review - Nidana
  60. 60. cardiac effect and the function of Hridaya impaired. On the causation of vathajaPandu Charaka mentions the person who consumes the food materials whichprovoke Vata may suffer from vataja Pandu by manifesting the signs and symptomslike rookshatha, angamarda, kampa, parshwaruk, shotha, balakshaya and krishnapandutwa. The prevalence of vathaja Pandu is seen in those who are known to be ofvathaja tendency.c. Kapha dosha The role of Kapha in Panduroga is again to be discussed on the basis of theassociation in this disease, Kledakakapha and Avalambakakapha are the chieffactors for the causation of Panduroga. Incase of kaphaja Panduroga Charaka mentions some of the importantfeatures like shwasa, kasa, aruchi, vakgraha, brama, klama, moorcha. Theprevalence of kaphaja Pandu is more in those persons of kaphaja tendency.II. DOOSHYASa. Rasa It is interesting to know the involvement of Rasadhatu in the occurrence ofPanduroga. Physiologically the function of Rasadhatu is attributed to nourishment(preenanam) and also helps nourishment. If this Dhatu is efficient then it is not onlynourishes itself, but also helps to nourish the other Dhatus of the body. And itsupadhatus like twacha and Lasika. In case of Panduroga rasa Dhatu is basically 47 Literary review - Nidana
  61. 61. influenced by the vitiated Pitta dosha and attains the amaroopa due to coming incontact with the amaroopa poshaka rasa. In this stage instead of its normal functionsof Rasadhatu results in the form of Dhatu shaitilya, from which the integrity in thefunctions of rasa Dhatu and other Dhatus will be lost and later results in Shareeragourava. This ultimately fails in the nourishment of twacha and may result inrookshatha and vaivarnya.b. Rakta Dhatu In fact the Dhatu that has direct bearing with Panduroga though in the earlierreference it is mentioned that Rasadhatu is involved. The function of rasa ranjana isinterfered in the raktavaha srothamoola i.e., Yakrit and Pleha. The result of theinterference is alparakata, nissarata, vaivarnyata, indriya shaitilyatha in the body. TheRakta alpata either may be directly due to the involvement of Yakrit and Pleha orindirectly it is affected due to the failure mechanism of Jatharagni. At this juncture theimportance of Pleha in its subtle control over the bone marrow in the RBC formationis to be noted.III. The role of Agni The independent study of Agni is equally essential for the study of Panduroga. Itis of 4 types - 1. Doshagni 2. Jatharagni 3. Dhatwagni 4. Panchabhootagni 48 Literary review - Nidana
  62. 62. 1. Dhoshagni The Pitta doshagni is responsible for complexion digestion and metabolism inthe body at different levels. The Agni constituent of Pitta dosha is severely impaireddue to which the doshas is impaired in the body leading to increased amaroopi doshain the body.2. Jatharagni This is basically, impaired in the body resulting in the formation of Ama. Thisis directly responsible for Pandu due to khavaigunya in Amashaya and has indirectinfluence on other Agnis to cause Pandu due to Ranjakapitta dushti.3. Dhatwagni The dhatwagni especially rasa dhatwagni and Rakta dhatwagni are impaireddue to amaroopi poshakarasa. Hence the twacha loses its integral functions. Rakta isdeteriorated in its functions in the body.4. Panchabhootagni The tejamsha of the tejo mahabhoota is interfered in Pandu and the ap-bhutagni is associated with it. As the tejoagni is impaired the digestion andmetabolism, the complexion of the body is impaired. In the due course the ap-bhootagni is associated due to which the person may suffer from shotha. 49 Literary review - Nidana
  63. 63. IV. Ama The non-homologous undigested substance can be called as Ama. InPanduroga, the Ama may be formed due to the impairment of Jatharagni, doshagniand dhatwagni etc.V. Srotas The important srotas, which are involved in panduroga, are - 1) Rasavaha srothas 2) Rakthavaha srothas1. Rasavaha srotas Here the Hridaya is involved along with dasha damanies and the functions ofthis is impaired leading to various signs and symptoms.2. Raktavaha srotas The Yakrit and Pleha are the chief organs involved in Panduroga whereRanjakapitta is vitiated.VI. Pandu as Rasa pradoshaja vikara Both Charaka and Susruta considered pandutwa and Panduroga inrasapradoshajavikara. Before explaining the rasapradoshaja vikaras, Charaka hastold that the vikaras are caused by the vitiated doshas, which affects the rasadidhatus. Apart from this in the context of graham while explaining amothpatti he hastold that when rasadhi dhatus are affected by Ama dosha it leads to rasaprdoshaja 50 Literary review - Nidana
  64. 64. Vyadhi while commentating on the word rasadoshaja told by Susruta, Dalhana saysthat - "rasadoshaja iti doshadushitha rasajathna"It means the disease produced by the vitiated doshas that affects rasa. So the disease Pandu is included in rasa pradoshaja Vyadhi because it ismanifested due to the vitiation of rasa Dhatu by vitiated vatadi doshas and Amadosha. The Panduroga lakshanas explained in the classics are almost similar withthat of dhatukshaya lakshanas. By this it is evident dhatukshaya leads to Panduroga,because through rasa dhatu other dhatus are nourished. Here in Pandurogadhatukshaya may occur after the manifestation of the disease not only directly Raktaand its srotases involves in this diseases but also other srotases such as rasa,medhas, etc., when they are under diminished condition gives rise twak roushyata,etc., 51 Literary review - Nidana
  65. 65. Upadravas of Panduroga46 Roga arambhaka dosha prokopajanya vikara is known as Upadrava of thatparticular disease. Any factor which is early part causes development of disease, ifthe same factor is later part produces any other severe manifestation then it is calledas Upadravas (complications), in Ayurvedic classics the various complications areavailable. These are aruchi (anorexia), jwara (pyrexia), pipasa (thirst), agnisada(maldigestion), moordha jura, chhardi (vomiting), murchha (fainting), abalatwa(weakness), shotha (oedema) klama (nuresthenia), hridayawapidanam (pre-cardialpain), kasa (cough), shoola (pain), avipaka (improper digestion), atisara (diarrohea),daha (burning sensation) swarabheda (obstruction of speech), shwas (dyspnoea). The symptoms are described above when aggravated require specialmanagement but few of them usually may be more important and require moreattention.Moordha ruja - It is due to increased Kapha and Vata. When there is lack of bloodformation due to dysaemopoiesis. It is like sub acute combined degeneration asobtained in pernicious Anaemia.Murchha - It is due to increased activity of Pitta. There is more and more blooddestruction and in turn fainting (murcha) may develop.Hridayawapidanam - It is due to excessive loss of rasa and Rakta. Heart has toperform more activity for the compensation of the blood supply of the whole body. If 52 Literary review - Nidana
  66. 66. this condition is continued for long time, the heart may be dilated and this maydevelop the symptoms of precordial pain.Shotha - Due to loss of blood, there is hypoproteinaemia which in turn may produceshotha (oedema).Kasa - It is due to the loss of blood and increased activity of Kapha, because of itkasa may develop.Atisara - It is due to aruchi (anorexia) and avipaka (improper digestion) atisara maydevelop.Swasa - Due to severe loss of blood, there is anoxia, which simulates the respiratorycenter, and breathing is increased.Daha (burning sensation) - It is due to diminution of rasa and Rakta and increasedactivity of Pitta, symptoms of daha may develop.Prognosis of Pandu (sadhyasadhyata) The disease Pandu leads to balakshaya and person becomes nihsar. So thebody immunity of the person is reduced. If the disease is severe and untreated it maybe fatal. 53 Literary review - Nidana
  67. 67. Sadhya - Asadhyata of Panduroga47Sadhya lakshana1. Diseases which are caused with less causative factors2. Which are created with unequaled in nature in dosha and dushya, dosha and prakruthi, dosha and kala, dosha and dushya.3. Which is situated in any one out of shaakha, marma asthi sandi and koshta.4. Which is new and without any complication5. Which arises from one dosha6. The patients body which is capable of taking all kinds of medicine.The above features are considered to be sadhya for the management of Panduroga.Asadya lakshanas1. A chronic Shotha in a due course in whom the eyes are looking peethabha.2. A chronic and deteriorated person3. The person who is suffering from Atisara or who is passing stools with Kapha and is haritha in its colour.4. The person who is suffering from severe degree of pallor due to Rakta kshaya.5. The person who is suffering from Chardi, Moorcha6. Occurrence of Shotha in the dependent parts7. Occurrence of Shotha in the abdomen 54 Literary review - Nidana
  68. 68. 20 Charaka Samhita Chikitsa 16/7-821 Susruta Samhita Uttara 44/322 Susruta Samhita Nidana 11/1723 Susruta Samhita Shareera 2/2124 Charaka Samhita Chikitsa 2/2725 Susruta Samhita Shareera 6/2726 Harita Samhita 3-9-3927 Susruta Samhita Shareera 9/1228 Charaka Samhita Chikitsa 16/7-1129 Susruta Samhita Uttara 44/330 Astanga Hridaya Nidana 1/3-431 Charaka Samhita Chikitsa 16/12 Susruta Samhita Uttara 44/5 Astanga Hridaya Nidana 13/8 Astanga Sangraha Nidana 13/9 Madhava Nidana 8/332 HaritaSamhita 3/8 Vangasena Panduroga /233 Charaka Samhita Chikitsa 16/17-30 Astanga Hridayam Nidana 13/7 Madhava Nidana 8/1 Yogaratnakara Panduroga Nidana /134 Susruta Samhita Uttara 44/435 Charaka Samhita Chikitsa 16/17-18 Astanga Hridayam Nidana 13/8-10 Susruta Samhita Uttara 44/736 Charaka Samhita Chikitsa 16/19-22 Astanga Hridayam Nidana 13/10-11 Susruta Samhita Uttara 44/837 Charaka Samhita Chikitsa 16/23-25 Astanga Hridayam Nidana 13/11-12 Susruta Samhita Uttara 44/938 Harita Samhita Panduroga Chikitsa 8/1039 Charaka Samhita Chikitsa 16/27-30 Astanga Hridayam Nidana 13/13-1440 Charaka Samhita sutra 3/341 Astanga Hridaya Nidana 1/842 Charaka Samhita Chikitsa 16/9-1143 Ibid 16/4, 9-1144 Susruta Samhita Sutra 21/3645 Auartely medical review. Vol. 47 no-2 april, 199646 Susruta Samhita Uttara 44/1347 Charaka Samhita Chikitsa 16/31-33 Susruta Samhita Sutra 33/23 Madhava Nidana 8/12-15 55 Literary review - Nidana
  69. 69. The most important function of the red cell is the transport of hemoglobin,again important function of hemoglobin is to supply of essential oxygen to all cellstissues of the body and to maintain normal colour of skin and mucous membrane.The most common and important disorder associated with the disease of the red cellis Anaemia, which defined as qualitative and quantitative deficiency of R.B.C countand or hemoglobin percentage in relation of standard age and sex. There are endless causes of Anaemia. But iron deficiency is the commonestcause of Anaemia. It is also the commonest nutritional disorder in humans and widelyprevalent almost all over the world although more common in the developingcountries like ours.Classification of Anaemia Anaemia can be classified in different way but the etiological andmorphological classification is most important.Etiological classification of Anaemia From etiological point of view Anaemia can be classified into three sub groups1. Anaemia due to deficient supply of nutrients or pre modular causes - these includes deficiency of high protein diet, iron, Vitamin B12, folic acid, vit. C etc.2. Decreased production of red cell or medullar cause - it includes leukemia, Aplasia, chronic infection, rheumatoid arthritis etc. 55 Literary review - Contemporary science
  70. 70. 3. Anaemia due to blood loss and or break down of R.B.C i.e., post medullar causes. It includes acute blood loss, chronic blood loss, congenital or acquired haemolysis etc. Classification of Anaemia based on etiological factors Premedullary Medullary Post medullary1. Deficiency of high 1. Leukaemia Acute protein diet 2. Multiple Myeloma Chronic Fe++ 3. Metastasis Mg++ 4. Apalstic Anaemia2. Minerals Zn Cobalt Primary Secondary (Known cause)3. Vitamins (Unknown cause) drugs like Chloramphenical, • Vit B12 Gold, Anticonvulsent, Anti • Folic acid 5. Chronic Infection Cancer repeated exposure to • Vit. C 6. R.A. Radio active therapyHaemolysis (break down of RBC) Haemorrhage (extravassation of Blood)Intra corpuscular Extra corpuscular defect Acute Chronicdefect (congenital) (acquired) haemorrohagic Iron deficiency• Thalassaemia • Misma D blood shock Anaemia• Sickle cell transfusion Anaemia • Snake venom (Viper)• spherocytosis • Immunological disorders Corpuscular defect • G6 PD deficiency • Pk deficiency • Eleptocyposis 56 Literary review - Contemporary science
  71. 71. Morphological classification Anaemia can be classified in terms of the appearance of the red cells. There arethree major types of Anaemia: 1. Hypochromic microcytic with a low mean corpuscular volume ( M.C.V.). 2. Normochromic normocytic with a normal ( M.C.V.). 3. Macrocytic with a high ( M.C.V.). Summary of iron balance (in our body)The iron balance may be summarized (In adult) as follows: Input Body Iron OutputMale Average : 1mg/day Total 3 to 6 gms. Average 1mg/dayderived from foods a) functional Iron in Skin desquamationa) animal muscle haemoglobin and miscellaneousb) Vegetables - the myoglobin 80% at least secretion average diet contains enzyme systems 10 to 20 mg Iron of transferrin Menstruation which about 10% is This extra loss of absorbed. b) storage Iron in Liver, about 0.5 to 1 mgN.B. for Female it is about Spleen, Bone marrow 20% requires extra input2mg. as Ferrritin and or less in the females HemosedarinIron deficiency Anaemia results when this delicate balance is upset in one of threemain ways, described below:1. In creased output: this almost always occurred by blood loss - often small in amount and chronic (1 ml blood loss = .5mg iron). In the female uterine bleeding is a common cause and in both sexes bleeding from the alimentary tract is important. 57 Literary review - Contemporary science
  72. 72. 2. Decreased input: A) Poor diet (including diets containing substances antagonistic to iron absorption e.g., phytates pbhosphates). B) malabsorcption - due to bowel disease or post surgical.3. Increased body requirement: a) During rapid growth in childhood. b) In pregnancy Usually Anaemia develops slowly (except in case of serious hemorrhage) Iron of deficiency Metabolisation of reserves (First hemosedarin then feratin) Exhaustion of reserves Increased absorption of available in diet may postpone Deficient synthesis of hemoglobin AnaemiaIron deficiency Anaemia Anaemia due to deficient of iron in the body is known as iron deficiencyAnaemia. The exact prevalence of iron deficiency Anaemia is difficult to define.Morphologically it belongs to hypochromic microcytic group. 58 Literary review - Contemporary science
  73. 73. Hypochronic microcytic Anaemia Due to Iron deficiency Other than Iron deficiencySideroblastic Anaemia Thalassaemia Anaemia of chronic disordersCauses of iron deficiency: Iron deficiency Anaemia develops when there is an inadequate amount of iron forhemoglobin synthesis. A normal level of hemoglobin is maintained for as long aspossible until all the iron stores are depleted; during this time latent iron deficiency issaid to be present - Poor intake Decreased absorption Increased demands Blood loss Most iron deficiency occurs from blood loss. Pre menopausal women arealways in a state of precious iron balance owing to menstruation. Nutritional irondeficiency is rare in developed countries. In UK, it is sometimes see in vegetarian.Asian women eating chapatis containing phytate. The commonest cause of irondeficiency worldwide is blood loss from gastrointestinal tract due to hook workinfestation. 59 Literary review - Contemporary science
  74. 74. The causes vary with the age and sex of the patients. Careful consideration ofthe clinical features, especially of the history, will establish the causes in many cases,but further investigation is often necessary.Major etiological factors in iron deficiency:1) Females in the reproductive period of life • Menstruation • Pregnancy • Lactation • Pathological blood loss • Deficient diet2) Adult males and post menopausal females • Pathological blood loss • Deficient diet3) Infant and children • Deficient diet • Diminished iron stores at birth.4) chronic gastrointestinal blood loss due to • peptic ulcer • haemorrhoids • hiatus hernia • carcinoma of the stomach • carcinoma of the colon • chronic aspirin ingestion • oesophageal varics • ulcerative colitis • hook worm infestation 60 Literary review - Contemporary science