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EFFECT OF DHATRI LAUHA IN PANDU ROGA By PARDHV.BALENE. DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF AYURVEDA, UDUPI

EFFECT OF DHATRI LAUHA IN PANDU ROGA By PARDHV.BALENE. DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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  • 1. EFFECT OF DHATRI LAUHA IN PANDU ROGA By PARDHV.BALENE. B.A.M.S Dissertation submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment Of the requirements for the degree of DOCTOR OF MEDICINE (Ay) In KAYA CHIKITSA Under the guidance of Dr.U.N.Prasad, M.D. (Ay) Professor & HOD Co-Guide Dr.Jonah.S, M.D. (Ay) Assistant professor DEPARTMENT OF KAYA CHIKITSA S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI 2005-06 I
  • 2. Rajiv Gandhi University of Health Sciences DECLARATION BY THE CANDIDATEI hereby declare that this dissertation entitled “Effect of Dhatri Lauha inPandu Roga” is a bonafide and genuine research work carried out by me under theguidance of Dr. U.N.Prasad. M.D. (Ayu), Professor, Department of KayaChikitsa and co-guidance of Dr. Jonah.S.M.D. (Ayu), Assistant Professor,Department of Kaya Chikitsa.Date: Signature of the candidateUdupi Pardhv.Balene. II
  • 3. Rajiv Gandhi University of Health Sciences CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “Effect of Dhatri Lauha inPandu roga” is a bonafide research work done by Pardhv Balene. in partialfulfillment of the requirement for the degree of DOCTOR OF MEDICINE(Ayu)Signature of the Co-Guide Signature of the GuideDr.Jonah.S.M.D. (Ayu) Dr.U.N.Prasad. M.D. (Ayu)Asst.Prof, Dept of Kaya chikistsa Professor, Dept.Of Kaya ChikitsaDate:Place: Udupi III
  • 4. Rajiv Gandhi University of Health Sciences ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “Effect of Dhatri Lauha inPandu roga” is a bonafide research work done by Pardhv Balene. under theGuidance of Dr.U.N.Prasad. M.D. (Ayu), Professor, Department of KayaChikitsa and co-guidance of Dr. Jonah.S.M.D. (Ayu), Assistant Professor,Department of Kaya Chikitsa.Signature of the H.O.D Signature of the PrincipalDr.U.N.Prasad Dr.Bala.Krishna.BhatDate: Date:Udupi Udupi IV
  • 5. COPYRIGHT Declaration by the candidateI hereby declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in printor electronic format for academic / research purpose.Date: Signature of the CandidateUdupi: Pardhv Balene. © Rajiv Gandhi University of Health Sciences, Karnataka V
  • 6. I Would Like to Place This Dissertation on the Lotus Feet of My Parents VI
  • 7. ACKNOWLEGEMENTI am ever grateful to my teacher and Guide Dr.U.N.Prasad. Prof & HOD of KayaChikitsa department SDM College of Ayurveda for his support and guidance throughoutthe study.I wish to express my gratitude to my teacher and Co-Guide Dr.Jonah.S.Asst.Prof Dept ofKaya Chikitsa SDMCA for his support and guidance.I wish to express my gratitude to my teacher Dr. Srnivas.Acharya.G.Asst.Prof Dept ofKaya Chikitsa SDMCA for his support.I wish to express my thanks to Prof Dr.Bala Krishna Bhat.Principal & Dr.K.RamachandraRao. Prof & Dean of the PG department SDM College of Ayurveda for their support.I wish to express my gratitude to all the authorities of SDM Educational Society forproviding me all the requisite facilities to carry out this work.I am grateful to Dr.Siddhinandan Mishra manager, Dr.Muralidhar.B and staff of the SDMAyurvedic Pharmacy for providing me the drug compounds of my study to specifications.I am grateful to Mr.Harish Bhat, Librarian for providing me with all the books I needed.Dr.Anil Kumar.G, Dr.Madhusudanan.I.K, Dr.Mithun.M.Bhondre, Dr.Vittal.G.Huddar,Dr.Gajanan Prabhu, Dr.Rajashekar.V.S, Dr.Kuldeep, Dr.Ramesh, Dr.Deepthi.M.S. andDr.Devanathan.R will forever remain in my memories for their tremendous support andhelp. PARDHV.BALENE VII
  • 8. LIST OF ABBREVIATIONSIDA – Iron Deficiency Anaemia.HB% - Haemoglobin percentage.TIBC – Total Iron binding capacity.MCV – Mean cell volume VIII
  • 9. Abstract ABSTRACTBack ground and Objectives: Pandu roga is a common disorder prevalent all over India. If it is not treated, itinterferes with routine activities of a person and neglecting it leads to the development ofvarious upadravas. A formulary, which is effective, cheap and devoid of side effects isneeded to treat this disease. The present study is focused on the literary review & clinicalstudy of the Pandu roga and to evaluate the therapeutic effect of Dhatri Lauha in patientsof Pandu with out alteration in their routine dietary and physical activities.Methods: It is a single blind clinical study with pre test and post test design where in 20patients diagnosed as Pandu roga of either sex were selected. All were administered withDhatri Lauha for a period of 30 days. The relevant investigation HB% was adopted fordiagnosis and to assess the improvement.Results: In this present series majority of patients registered were females at the age groupof 20-50 years. Who were on sedentary life style, Middle class family, and are lowlyeducated. The effect of treatment on the symptoms reordered, that the Dhatri Lauhashowed good effect on Vatakaphaja lakshanas rather on Pittaja lakshana, and slightchanges shown on mean score values of over all body than when compared toHaemoglobin levels.Key words:1. Pandu 2.Rakta 3.Anaemia 4.Dourbalya 5.Varna. IX
  • 10. TABLESSl.No. Table No. Name of the Table Page no.1) 1 Nidana of Pandu roga 182) 2 Proova roopa 213) 3 Samanya Lakshana 244) 4 Vataja Pandu Lakshana 255) 5 Pittaja Pandu Lakshana 266) 6 Kaphaja Pandu Lakshana 277) 7 Tridoshaja Pandu Lakshana 288) 8 Mrutbhakshanajanya Pandu Lakshana 299) 9 Types of Pandu 4410) 10 Upadrava of Pandu roga 5111) 11 Asadhya Lakshana in Pandu roga 5212) 12 Differential Diagnosis of IDA 6713) 13 The similarities between IDA and Pandu 6814) 14 Incidence Acc. to their Age 7715) 15 Incidence Acc. to Sex incidence 7816) 16 Incidence Acc. to religion 7817) 17 Incidence Acc.g to Martial status 7918) 18 Incidence Acc. to occupation 8019) 19 Incidence Acc. to habitat 8020) 20 Incidence Acc. to socio-economic status 8121) 21 Incidence Acc. to Education status 82 XI
  • 11. 22) 22 Incidence Acc. to their Dietary habits 8223) 23 Incidence of Prakruthi 8324) 24 Incidence of Sara 8425) 25 Incidence of Samhanana 8526) 26 Incidence of satva 8527) 27 Incidence of Rasa satmya 8628) 28 Incidence of Agni 8729) 29 Incidence of kosta 8730) 30 Incidence of Bala 8831) 31 Effect of Treatment on Haemoglobin 8932) 32 Effect of Treatment on Pandutwa 9033) 33 Effect of Treatment on Alasya 9034) 34 Effect of Treatment on Shrama 9135) 35 Effect of Treatment on Arohana ayasa 9236) 36 Effect of Treatment on Katiruk 9237) 37 Effect of Treatment on Swetha akshi 9338) 38 Effect of Treatment on Hridrava 9439) 39 Effect of Treatment on Aruchi 9440) 40 Effect of Treatment on Dourbalya 9541) 41 Effect of Treatment on Gaurava 96 XII
  • 12. LIST OF FIGURESSI.No Chart No. Name of the Chart Page No.1) 1 Chart of Samprapti 472) 2 Chart of Mrudbhakshanajanya Pandu 483) 3 Chart of Nidana sevana Samprapthi 494) 4 Chart of Age incidence 775) 5 Chart of Sex incidence 786) 6 Chart of religion incidence 797) 7 Chart of Martial status incidence 798) 8 Chart of occupation incidence 809) 9 Chart of habitat incidence 8110) 10 Chart of socio-economic status incidence 8111) 11 Chart of Qualification incidence 8212) 12 Chart of dietary habit incidence 8313) 13 Incidence of Prakruthi 8314) 14 Incidence of Sara 8415) 15 Incidence of Samhanana 8516) 16 Incidence of Satva 8617) 17 Incidence of Rasa satmya 8618) 18 Incidence of Agni 8719) 19 Incidence of Kosta 8820) 20 Incidence of Bala 8821) 21 Effect of HB% 89 XIII
  • 13. 22) 22 Effect of Pandutwa 9023) 23 Effect of Alasya 9124) 24 Effect of Shrama 9125) 25 Effect of Arohana ayasa 9226) 26 Effect of Kati ruk 9327) 27 Effect of Swetha akshi 9328) 28 Effect of Hridrava 9429) 29 Effect of Aruchi 9530) 30 Effect of Dourbalya 9531) 31 Effect of Gourava 96 XIV
  • 14. Review of Literature Introduction INTRODUCTION The need for the discussion of Pandu roga becomes important due to the gravityof the problem. It is the commonest nutritional disorder all over the world and forms amajor problem of mankind especially in a country like India due to low socio economicstatus, illiteracy and malnutrition in a major part of the population. It affects the physicaland mental health of children, affects school performance and increases susceptibility tovarious infections. Further infants born to anaemic mothers have low Iron reserves andfall prey to Anaemia later in life with its adverse consequences. A survey in Asia byWorld Health Organization showed that approximately 10% of men, more than 20%women (more than 40% during pregnancy); more than 50% of children of all ages and92% of children below the age of two years suffer from Anaemia. In India 20-40% of thepopulation, equally of all ages and either sexes have been suffering from IDA. For itsdiffuse global spread IDA is recognized as a world health problem. The NationalNutritional Anaemic Control Programme launched by Government of India is animportant step in this direction. Therefore such study gains importance. Hence I havetaken this topic for my dissertation work. Pandu roga has been identified as a disease since Vedic Period. Description of Panduroga is available in Rigveda, and Atharvaveda (6000). Pandu has been depicted as`Vilohita` and Halima. The Nomenclature of Pandu roga based on the vaikarika varna i.e., pandutwa.According to Sabdarnava and Sabdhasthoma mahanidhi. The term pandu means swethavarana, Dhoosara, swetabha, swetavabhasata and peetabha and peetavabhasata, andGangadhara explains is as mlana varna. To explain the above varnas the following 1
  • 15. Review of Literature Introductionexamples have been described such as shanka, pakwamadanaphala, keetakadhooli,apakwa parooshaka phala etc. owing to the importance attached to varna in thesamprapthi of pandu roga both prakrita and vikrita varna has been dealt in a separatechapter. The term Vilohitha indicates of Raktalpata a most important clinical condition of panduroga. It is very much appreciated by the sloka in charaka chikitsa sthana stating “saalparakto alpa medasko nissaraha shithilendriyaha”. Mandagni an out come of pachakapitta vikriti at another important defective formation of rasa and there by both qualitativeand quantitatively defective rakta dhatu occurs. Probably that is the reason pandu rogahas been included in rasa pradoshaja vikaras. Dhatu shaithiliyam Nissarata and shithilendriyatwam also result because of shonitanimattaja, based on the above factors it can be stated that rakta dushti and pachaka pittavikriti play a vital role in the samprapthi of pandu roga. Charaka and Vagbhata have mentioned pitta pradhanyata in the vitiation of tridoshasi.e., pitta prakopa is an invariable condition of all the varieties of pandu. Unlike thatpittarabdha katwam that pittara is seen in pittaja pandu roga. Basically pandu roga istridoshaja vyadhi but according to dosha predominance it is named as vataja, piitaja,kaphaja, sannipataja respectively and mrudbhakshana which is a visista vyadhi karanaforms another variety of pandu roga. Keeping rakta dusti and pachaka pitta vikriti in view it can be concluded that pitta animportant part in the causation of pandu roga. Describing the pitta tejasa gunas.Chakrapanidatta says that 2 types of pitta are responsible for the development of panduroga. Owing to its weakness of pachaka pitta rasa forms defectively formation of 2
  • 16. Review of Literature Introductionrakthadhatu occurs. And in the second type pitta owing to its kshapana guna causesdestruction of rakta dhatu. It can be deducted from the above facts that the pahcaka pittadushti in the essential prime factor in causing rakta dushti. Apart from pachaka pitta, Ranjaka pitta plays an important role in the formation ofrakta dhatu, the role of ranjaka pitta in the formation of rakta dhatu has been discussed indetail in a separate chapter. Sadhaka and bhrajaka pitta also go into vaikarika state, whichresults vaivarnya and abhrajishnuta and hridvikaras in severe conditions of pandu rogaalochaka pittavaikriti also occurs and it is evident from the clinical conditions such aspandu sanghatadarsee etc. In pandu roga owing to excessive destruction of snigdha roopa rakta and sneha kshayaof bala varna sneha ojus results. In consequence of the above factors rookshatwam occursin the body and patient appears kanthiheena, because of nissarata and ojokshaya and thenthe complete roopa of pandu roga sets in.To counter act the above pathologic conditions of pandu roga snehana forms the firstprinciple of the treatment. Snehana causes purification of the kosta and facilitates thedoshas to get back into kosta. After having achieved sampoorna snigdhatwa lakshanasshodhana is indicated in pandurogi. Here shodhana implies both oordhwa and adahashodhana. Visista pandu hara oushadas along with oushadas to combat the ill effects ofdosha prakopa. During the treatment pathyavastha is also indicated while advocatingpathyavastha the following points should be observed strictly. 1. Foods that is easy for digestion. 2. Foods that is capable of causing Brimhana. 3
  • 17. Review of Literature IntroductionPrevious work done:1. Clinical evaluation of the effect of Navayasa Churna in different types of pandu roga.By Radha Krishna – Bangalore, 1992.2. A comparative study on the effect of Dhatri Avaleha and kaseesa bhasma in panduroga. By Bhasavaraj.R. Tubaki-Udupi-2002.3. The study of virechana purvaka snehana in pandu roga by Raval K.R.-Jamnagar, 1987. PRESENT STUDY For the present study Tab Dhatri lauha has been selected for clinical trials on Panduroga. The drug has been widely advocated in the treatment of the pandu roga. The abovedrug have been put together to achieve good clinical prognosis in pandu rogi bycounteracting the following pathological conditions of pandu roga. 1. To restore the normal lohamsa which is essential factor to increase the quality and quantity to rakta dhatu. 2. To bring back the vaikaraika pachakapitta to prakritavasatha, this forms as an important causative factor for rakta dushti and for improper development of rasa. 3. To stimulate rakta vaha srothomoola especially yakrit and pleeha to increase the capacity of the production of rakta and also to restore the prakritavastha of ranjaka pitta for the proper ranjana of rasa. 4. To remove the srotoavarodham a vaikarika state which commonly occurs because of the ama condition in the body which is an out come of pachaka pitta vikriti again. By removal of srotoavarodham proper dhatwa pryayanam is possible, so that important pathological conditions such as nissarata, dhatushaithilyam, shithilendriyatwam could be cured effectively. 4
  • 18. Review of Literature Introduction To remove the above causative factors a drug should have the qualities of deepana pachana, pittasamana, pittasarakata, srotas shodhana and which is having abundance of lohamsa in it. To fulfill the above requirements Dhatri lauha have been selected. Dhatri lauha has been given bhavana in Amrutha kwatha for 7 times for 7 days. For the present study the following materials and methods have been taken: 1. Literary Study. 2. Clinical Study. 1. Literary Study: The necessary references regarding the disease and the drug have been compiled and theoretical basis for the clinical trials has been prepared. 2. Clinical Study: Under the clinical material the records and the results of the practical study in the applications of medicines and the clinical data of the patients are included for this purpose 20 patients suffering from pandu roga registered in O.P.D. and I.P.D. have been studied with emphasis on leading symptoms and signs of pandu roga. The following are the silent features of the procedure of the clinical trials with Dhatrilauha on pandu roga. 1. Name of the drug: Dhatri Lauha 2. Dose of the drug: 500mg bid 3. Anupana: Jala 4. Duration: 1 month 5. No. of patients: 20 5
  • 19. Objectives OBJECTIVES• To do a comprehensive conceptual study on Pandu roga.• To evaluate the therapeutic effect of Dhatri Lauha in Pandu roga patients without alteration in their routine, dietary and physical activities. 6
  • 20. Review of Literature Historical Review HISTORICAL REVIEW As one of our aims is to root out the disease in the diseased, accordingly, whileattempting to find a proper management of a disease, it is very much important to studythe disease from its roots. “The function of the historian is neither to love the past nor to emancipate himselffrom the past but to master and understand it as the key to the understanding of thepresent”. E H. Carr. “Those who fail to read history are destined to suffer the repetition of itsmistakes”. “The further back you look, the further forward you can see” - Winston Churchill.The study can be divided into: 1) Vedic – Samhitas, Brahimanas, Upanishad, Kalpasutra (2000-1000BC) 2) Samhita (1000BC – 500 AD). 3) Sangraha Kala (500 AD – 1700 AD). 4) Adhunika Kala (1700 AD onwards).Vedic: Ayurveda is intimately connected with the Vedas. This is evident from the factthat the former is regarded as Upaveda of Rigveda (Kashyapa). Some scholars considerAyurveda as Upaveda of Atharvaveda(1-50; 1-22-4) because of its similarity. Hariman and Harita are the diseases mentioned in Rigveda and Atharvaveda.Hariman is interpreted by Sayana as pallor and yellowishness of the body caused by thedisease. Similar explanation is available in Rigveda(Rig 1-50-11-13) 7
  • 21. Review of Literature Historical Review The author of History of Medicine in India (pg 20) states, “Hariman and Haritalook like synonyms but on careful examination, the former appears to be jaundice whilelatter as pallor. ‘Hr’ in Harita denotes loss of blood (Anaemia). In Rigveda, the Haritacolour of frogs is taken as green by Sayana, but Harita infact is pale. The skin colourationof anaemic patients due to rakta arsha is simulated to the frog`s skin colouration inMadhava nidana. In fact, Charaka has included different skin discolourations in Panduroga.” Prof. P. V. Sharma opines, “Initially it is Harita denoting pallor of skin (Pandu)developing further into Hariman (Kamala, jaundice). In post-vedic texts, the samedescription about Pandu and Kamala is observed. It is interesting to note that they haveretained the Vedic term Hariman in a slightly modified form as Halimaka and havedescribed it as a type of Kamala.” Rig Veda prescribes its treatment with morning sun rays. In Atharvaveda, redcow’s milk and the drug Anjana has been said as Harita Bheshaja. Kaushika Sutraprescribes intake of cooked rice mixed with Haridra and anointing the same over thebody for this disease. In Jaiminiya Brahmana, there is reference regarding Hariman. In the Mahabharata, King Pandu, who was the father of Pandavas, was suffering from Pandutwa.Samhita Kala (1000 BC – 500 AD): This period is considered to be golden era in the Ayurvedic history. Ayurvedaattained its summit both in conceptual and treatment aspects. In this period, it receivedpatronage from both king as well as society. Like other diseases, Pandu roga is also 8
  • 22. Review of Literature Historical Reviewelaborately discussed including its Nidana, Samprapti, Lakshanas, Bheda, Upadrava andChikitsa. It is extensively dealt by Acharyas like Charaka, Sushruta and Vagbhata.Charaka: This Samhita plays main role in wide explanation of pandu roga, in charakasamhita chikitsa sthana 16th chapter pandu roga nidanas, bhedas, lakshanas and chikitsamentioned very clearly. In pandu bhedas mrutbhakshana janya pandu mainly explainedvery particularly.Sushruta: Sushruta explained pandu roga in uttara tantra 44th chapter in detailed along withits nidana, purva roopa, Roopa, sadhya asadhya and treatment. Kamala and other diseasesare maintained as a stage of the pandu roga. Sushruta explained synonyms for the term pandu as kamala, panaki, panduva,kumba kamala, laghavaka and alasam.Vagbhata: Astanga hridayam nidana sthana 13th chapter pandu roga nidana, bhedas,lakshanas and upadravas mentioned very clearly. Over all the brihatrayee the detaildescription of pandu roga is available and which in mostly followed by laghuthrayees inits treatment and other aspects.Madhava nidana & Bhava prakasha: In madhava nidana 8th chapter explained pandu roga nidana, bhedas, lakshanasand upadravas and also sadhaya asadhya. In Bhava prakasha 46th chapter explaines the disease of pandu roga nidana,bhedas, lakshanas and chikitsa very clearly. 9
  • 23. Review of Literature Historical Review The description about pandu roga is also seen in ksayapa samhitha, belasamhitha.Sangraha (500-1700 AD): Chakrapani, Dalhana, Indu, Vijayarakshita, Srikantadatta, Adamalla,Amarasimha, Madhavakara, Sharangadhara, Bhavamishra, Yogaratnakara, Arunadattaand Hemadri have dealt Pandu Roga in detail. They have commented and discussed onthe important previous works. In Garuda Purana, in Nidana, many diseases are describedincluding Pandu and treatment being Loha Churna administered with Takra.Adhunika Kala (1700 AD onwards): Kaviraja Sri Rama Raksha Pathak has devoted a complete book to Pandu Rogagiving elaborate discussion regarding different aspects of Pandu Roga. Rasa Tarangini bySri Sadananda Sharma and Bhaishajya Ratnavali by Sri Govind Das have alsocontributed descriptions regarding Pandu roga during this period. 10
  • 24. Review of Literature Vyutpatti VYUTPATTI The word “Pandu” is formed from the dhatu “Padi Gatou”. Padi means “gati” i.e.parinamana or transformation. The word Padi Gatao (transformation) signifies the formation of Rasa, Rakta andother Dhatus. If the transformation process is hindered or having any aberration then itleads to Pandu. NIRUKTI In Ayurveda, diseases are named after considering certain criteria that are verymuch important. Sometimes they are named after the pre-dominant Dosha and Dushyaviz., Rakta-Pitta, Vata-Rakta; on the basis of similes, eg: Shlipada, Kroshtukasheersha;anatomical structures e.g.: Hridroga, Shiroroga; colouration of the body viz. Pandu,Kamala and based on pain as in Hrutshoola and Parinamashoola and so on. A disease named on the basis of Varna is Pandu roga. • Pandu Varna is a combination of Shweta and Peeta Varna in equal proportions, similar to pollen grains of Ketaki (Harita.S). • Pandu Varna is the combination of Shukla and Peeta (Raja Nighantu). • Pandu Varna is the combination of Shweta and Peeta (Shabdakalpadruma). • Pandu Varna is the combination of Shweta and Peeta Varna (Amarakosha) . By observing the above references, it may be considered that Pandu Varna is thecombination of Shweta and Peeta Varna. The degree of coloration varies according to theseverity of the disease. 11
  • 25. Review of Literature Vyutpatti PARIBHASHA The term Pandu is explained widely in the classics. • The disease in which Pandu bhava is more predominant is called Pandu roga. • The disease in which Pandutva is predominant. • In all the varieties of Pandu roga, Pandu Varna is a predominant feature. • Disease named after Pandutva. • The disease is named Pandu roga wherein Pandu, Harita and Haridra Varna are included. It is evident from the above references that Pandutwa is the predominant featureof Pandu Roga. PARYAYA The synonyms of Pandu are Kamala, Panaki, Kumbhava, Lagharaka, andAlasaka. Though Kamala etc. are considered as synonyms of Pandu; even then, Pandu andKamala are separately explained in terms of Nidana, Lakshana and Chikitsa. Dalhanaclarifies that Acharya Sushruta has considered it as a synonym only on the basis ofKamala being an avastha vishesha of Pandu. Charaka also includes Haridra, Harita andall other skin discolorations under Pandu. 12
  • 26. Review of Literature Nidana NIDANA``Nimitta hetwayatana pratyayothana karnahinnilaka mahuparyaythi````Seti kartavyatako rogotpadaka heturnidanam``Means vividha ahitha ahara vihara which cause vyadhi by vitiating doshas and dhatus.The following are the nidanas of pandu roga1, 2:The causative factors of pandu roga can divided into following three types:1. Ahara2. Vihara3. Nidanartha kara rogas.1).Ahara dravyas causing vataja pandu:A) According to Charaka 1. Adhika katu sevana 8. Kshudhitambhupana 2. Adhika tikta sevana 9. Vishavi sevana 3. Adhika kashaya sevana 10. Meenashana 4. Adhika rooksha sevana 5. Adhika vistambha dravya sevana 6. Adhika Trinadhanya sevana 7. Adhika seta sevanaB) According to Susrutha: 1. Shuskamamsa 2. Udalaka 3. Shyamaka 4. Mridga 13
  • 27. Review of Literature Nidana 5. Adhakee 6. Nishpava 7. Anashana 8. Vishamashana 9. Adhyashana2) Vihara causing Vataja Pandu roga:A) According to Charaka: 1. Vegadharana 2. Virechanadi karma athiyoga 3. Ratrijagarana 4. Pravataseva 5. Atimaituna 6. Ativyayama 7. Ati langhana 8. Atyadhyayana 9. Sahasam 10. BhayaII.Causitive factors Pittaja Pandu:1) Ahara Sambandee:According to Susrutha1. Laghu dravya2. Pinyaka3. Sarshapa 14
  • 28. Review of Literature Nidana4. Matysa5. Ajamamsa6. Amlaphala7. Sura sevanaII.Vihara Sambandhee:1. Shoka2. Bhaya3. Shodhana4. AyasaAccording to Astangha Sangraha:1. Ahara Sambhandee1. Katurasa2. Amlarasa3. Lavana rasa4. Dadhi5. Mastu6. Madhya7. Kshara8. Thaila9. Kulatha10. Maricha11. Dhanyaamla12. Vidhahee dravya 15
  • 29. Review of Literature NidanaII.Vihara Sambandhee:1. Atapa2. Agni3. Krodha4. Ershya5. Ahara vidhakalaIII.Causitive factors of Kaphaja Pandu:1) Ahara Sambhandee1. Madhura dravya2. Amla dravya3. Lavana dravya4. Seetha Dravya5. Snigdha dravya6. Guru dravya7. Abhishyandhi8. Dadhi9. Dugdha10 Payasa11. Masha12. Maha masha13. Vasa14. Visha15.Anoopa mamsa 16
  • 30. Review of Literature NidanaAccording to Astanga Sangraha:1. Ikshurasa2. Kadhalee phala3. Nareekela4. Atyambupana5. Ati santarapanaIV.Causitive factors of Sannitaja Pandu roga:Combination of tridosha dusti karanas produces sannipataja pandu roga.V.Causitive factors of Mrudbhakshana Janya Pandu:Kashaya mrit causes vataja pandu roga.Ooshara mrit causes pittja pandu rogaMadhura mrit causes kaphaja pandu rogaVI.Nidanarthakara Rogas:Due to rakta kshaya the following diseases cause pandu roga:1. Rakta gulma 2.Pleehodara3. Asrugdhara 4.Arshas5. Raktasrava 6.Raktapitta7. Raktapradara 8.Raktaarbuda9. Rakta vahee dhamani vedha 10.Yakrut pleeha vedha 17
  • 31. Review of Literature Nidana TABLE 1: NIDANA Sl. Lakshana C.S. Su. S. A.H. M.N B.P. Dl G.N. No . 1 Kshara sevana + - - - - - - 2 Amla sevana + + + + + + + 3 Lavana rasa sevana + + + + + + + 4 Atyushna bhojana + - - - - - - 5 Asatmya bhojana + - - - - - - 6 Viruddha bhojana + - - - - - - 7 Matsya sevana - - - - - + - 8 Amisha sevana - - - - - + - 9 Ikshu sevana - - - - - + - 10 Pishta sevana - - - - - + - 11 Paya sevana - - - - - + - 12 Pinyak ati sevana + - - - - - - 13 Mashati sevana + + - - - + - 14 Madya sevana - + - + + + + 15 Mrut bhakshana + + - + + + + 16 Teekshna ahara sevana - + + + + + - 17 Maithuna + - - - - - - 18 Vega Vidharana + - - - - - - 19 Pachakarma prati-karma + - - - - - - vaishamya 20 Rutu vaishamya + - - - - - - 21 Kama + - - - - - - 22 Krodha + - - - - - 23 Chinta + - - - - - - 24 Bhaya + - - - - - - 25 Shoka + - - - - - - 26 Divaswapna + + - + + + + 27 Vyayama + + - + + + + 28 Bharaharana - - - - - + - 29 Nishpava sevana + - - - - - - 30 Tilataila sevana + + - - - + + 18
  • 32. Review of Literature Poorva roopa POORVA ROOPA“Sthanasamsraymaha kruddha bhavi vyadhi Prabhodhakam,Doshaha kurvanti yallingam poorvaroopam, Taduchyute”.Doshas which have attained sthana samshravastha show certain symptoms pertaining tofuture disease known as poorva roopa3.According to charaka the following symptoms have been mentioned as poorva roopa(ch.chi.16)4 1. Hridaya spandanadhikya 2. Roukshyam 3. Swedabhava 4. ShramaAcoording to susrutha the following symptoms have been mentioned as poorva roopa ofpandu roga. (su.ut.44)5 1. Twaksphotana 2. Steevana 3. Gatrasada 4. Mrid Bhakshaneccha 5. Prekshana koota shotha 6. Avipaka 7. Vitpeetata 8. Mootra peetata 19
  • 33. Review of Literature Poorva roopaAccording to Astanga Hridayakara the following symptoms have been mentioned aspoorva roopa of pandu roga6. 1. Hridaya spandana 2. Aruchi 3. Alpa vanhita 4. Sada1) Hridaya Spandanadhikya: This is due to the Prakopa of Pitta pradhana tridosha. In the Hridaya, the Chala guna of Vyana vayu coupled with Sara guna of Sadhaka pitta causes Rasa dhatu kshaya and reduced Preenana to the Dhatus. It causes increased functioning of Hridaya, which is its mulasthana, producing Spandanadhikya.2) Twak Roukshya or Twak Sphutana: Twak Roukshya or Twak Sphutana can be produced by: 1) Increased vyana vayu 2) Raktadhatu kshaya 3)Sarahani3) Swedabhavata: Swedabhava can be caused by Srotorodha due to Kapha.4) Shrama: Shrama can be produced by 1) Vyanavayu vriddhi 2) Rasa, Mamsa, Meda, Asthi, Shukra and Ojokshaya5) Shteevana and Hrillasa: Due to Malaroopi kapha vriddhi produced by Rasadhatwagnimandya, Shteevana and Hrillasa are seen in Pandu.6) Gatrasada: Is caused by Vyana vayu prakopa and ojokshaya.7) Mrud-bhakshana Iccha: Is said to be the Prabhava in disease, mainly due to thevitiation of Sadhaka pitta, which disturbs Dhriti and Medha and this disturbed mentalstatus induces the patient to such activities. 20
  • 34. Review of Literature Poorva roopa8) Prekshana Koota shotha: Increased Malaroopi kapha cause Srotorodha, thuscausing Prekshana koota shotha.9) Aruchi, Avipaki, Alpavannita: Increased Pitta (drava rupi) when producesAgnimandya produces Aruchi etc.10) Peetata of Vit and Mootra: Dravyataha vriddhi of pitta due to Nidana and thevicious cycle of Rakta-agnimandya, thus increases Ranjaka pitta and causes increasedcolouration of Vit and Mootra. Table No.2. POORVA RUPASl. Lakshana C. S. A. A. M. B. Vanga H. Y. G. Basa.no S. S. H. S. N. P. S. R. N. 1 Hrudaya + - + + - - - - - - - Spandadhikya 2 Roukshya + - + + - - - - - - - 3 Swedabhava + - + + - - - - - - - 4 Shrama + - + + - - - - - - - 5 Twak Sphotana - + - - + + - + + + + 6 Shteevana - + - - + + - + + + + 7 Gatra Sada - + - - + + - + + + 8 Mrudbhakshana - + - - + + - + + + + Iccha 9 Prekshana Koota - + - - + + - + + + Shotha10 Avipaka - + - - + + - + + +11 Vitpeetata - + - - + + - + + +12. Mootra Peetata - + + + + + - + + + +13. Aruchi - - + + - - - - - - -14. Alpa Vahni - - + + - - - - - - -15 Sada - - + + - - - - - - -16 Pipasa - - - - - - + - - - -17 Hrullasa - - - - - - + - - - -18 Urodaha - - - - - - + - - - -19 Anga gourava - - - - - - + - - - -20 Rakta lochana - - - - - - + - - - -21 Shareera - - - - - - - + - - - pandutwa 21
  • 35. Review of Literature Roopa ROOPA``Tadeva vyaktata yatam roopa mitya bhidheeyatesamsthanam, vyanjanam, lingam, lakshanam, chinnam, akruthi``.The poorva roopa which has attained vyaktavastha known as roopa. The following aresamnya roopa of panduroga.Samanya Lakshana:1) Panduta: It is the Pratyatma lakshana of Pandu. Pandu roga is named on the basis of discolouration of body parts. This is due to Rasa pradosha.2) Alpa Raktata: Includes both qualitative and quantitative decrease. QuantitativelyRakta is 8 Anjalis in body. Normal Rakta is produced by Pachaka pitta, which helps inproper production of Rakta poshaka sara part from Rasadhatu. Ranjaka pitta effectivelyconverts this to Rakta. Alpa raktata causes Shareera vaivarnya, Twacha rukshata.3) Dourbalya: Means reduction in the normal strength (Bala), Normal Bala ismeasured by Vyayama shakthi. In Pandu it is reduced due to Dhatukshaya4) Karshya7: Reduction of various Dhatus in body leads to affliction of Samhananaleading to emaciation of Spik, Udara, Greeva and prominence of Dhamani jala.5) Karna Kshweda: Due to debility in the sense organs, increased Vata produces thissymptom and is one of the Vataja nanatmaja vyadhi.6) Gatra peeda: Different types of pain in the different parts of the body caused byVata vriddhi due to Dhatu kshaya. 22
  • 36. Review of Literature Roopa7) Shoonakshi koota shotha and steevana: Is the continuation of sign fromPoorvaroopa stage. Kapha vriddhi producing Srotorodha produces Shoonakshi kootashotha8) Sheerna lomata8: Asthi dhatu kshaya.9) Hridrava: Means increased Hrit Gati. Involvement of Sadhaka pitta, Vyana vayu,Raktavaha srotodushti causes Hridrava.10) Shwasa: Due to Dhatu kshaya and Dourbalya shwasa is produced. Even debility inthe hridaya can cause Shwasa. Prakopa of Pranavayu can also cause Shwasa. There, itrefers to Arohana Ayasa (exertional dyspnoea). But in Upadrava stage, it is severe stateof Kshudra Shwasa.11) Bhrama: Vata-pitta-rajogunadhikya leading to various Dhatu kshaya like Majja andRakta will produce Bhrama.12) Annadwesha: Charaka mentioned both Annadwesha and Aruchi in Samanyalakshana. Sushruta has mentioned this in Upadrava stage and is caused due to Kaphavriddhi and Agnimandya.13) Gourava: Heavyness of body indicates Kapha and Amavriddhi and is one ofKaphaja nanatmaja vikara.14) Jwara: Indicates Pitta prakopa.15) Harita Varna: Indicates Pitta vriddhi.16) Hata prabhatwa: Pitta prakopa, Oja kshaya cause Prabha hani. 23
  • 37. Review of Literature Roopa Table No.3. SAMANYA LAKSHANA Sl. LAKSHANA C.S. S.S. A.H. A.S. K.S. No. 1. Karna Kshweda + - + + - 2. Hatanala + - + + + 3. Dourbalya + - + + - 4. Sadana + - + + - 5. Bhrama + - + + - 6. Annadwesha + - + + - 7. Shrama + - + + - 8. Gatrashoola + - - - - 9. Jwara + - + + - 10. Shwasa + - + + - 11. Gaurava + - + + - 12. Aruchi + - - - - 13. Gatramarda + - - - - 14. Gatrapeeda + - - - - 15. Gatronmathana + - + + - 16. Shunakshikoota + - + + + 17 Hareeta Varnata + - - - - 18 Sheerna lomata + - + + - 19 Hataprabha + - - - - 20 Kopa + - + + - 21 Shishiradwesha + - + + - 22 Nidralu + - - - - 23 Shtivana + - + + - 24 Alpavak + - + + - 25 Pindikodweshtanam + - - - - 26 Katiruk + - - - - 27 Kati sada + - - - - 28 Padaruk + - - - - 29 Pada sada + - - - - 30 Uru ruk + - - - - 31 Uru sada + - - - - 32 Dhatushaithilya + - + + - 33 Ojo gunakshaya + - + + - 34 Alparaktata + - + + - 35 Alpamedaskata + - + + - 36 Nissarata + - + + - 37 Hridrava + - + + - 38 Shithilendriya + - + + - 39 Shareera Vaivarnya - - - - + 40 Twachi panduta + + - - - 41 Nabhi Shotha - - - - + 24
  • 38. Review of Literature Roopa 42 Shwetha Akshi - - - - + 43 Shwetha Nakha - - - - + 44 Shwetha Vakrata - - - - + 45 Shotha - - - - + 46 Karshya - - - - + 47 Satwahani - - - - + 48 Alasya - - - - + 49 Sanna Saktha - - + + - 50 Nirutsaha - - - - + 51 Rudhira Spriha - - - - +Vishista Lakshana:• Vataja Pandu: Vata vriddhi produces various Vataja manifestations in thepresentation of Pandu roga like Krushnata, Panduta and Arunangata of body parts,various types of Shoola. Table No.4. VATAJA PANDU LAKSHANA Sl. Lakshana C. S. A. A. M. B. Y. G. Basa No. S. S. H. S. N. P. R. N. . 1 Krishna pandutwa + - - - - - - - + 2 Ruksha angata + - + + + + + + - 3 Arunangata + - - - + + + - - 4 Angamarda + - - - - - - - - 5 Raja + - + + - - - - - 6 Toda + - + + + + + + + 7 Kampa + - + + + + + + + 8 Parshwa shoola + - + + - - - - - 9 Shirashoola + - + + - - - - - 10 Varcha shosha + - + + - - - - - 11 Asya vairasya + - + + - - - - - 12 Shopha + - + + - - - - - 13 Anaha + - + + + + + + - 14 Bala kshaya + - - - - - - - - 15 Krushna akshi - + + + - - - + + 16 Krushna Sira - + - - - - - - - Avanaddha 17 Krushna Varnatwa - + - - - - - - + 18 Krushna mala - + + + - - - - - 25
  • 39. Review of Literature Roopa 19 Krusha mootra - + + + - - - + - 20 Krusha nakha - + + + - - - - + 21 Krushna anana - + - - - - - - - 22 Aruna sira - - + + - - - - - 23 Aruna nakha - - + + - - - - + 24 Aruna mala - - + + - - - - - 25 Aruna mootra - - + + - - - + - 26 Aruna akshi - - + + - - - + + 27 Bhrama - - - - - - - + - 28 Vata upadrava - + - - - - - - - 29 Krushna sira - - + + - - - - + 30 Aruna sira - - + + - - - - - 31 Twak krushnabhata - - - - + + + - - 32 Mootra krushnabhata - - - - + + + - - 33 Nayana krushnabhata - - - - + + + - - 34 Twak arunabhata - - - - + + + - - 35 Mootra arunabhata - - - - + + + - - 36 Nayana arunabhata - - - - + + + - - 37 Rakta netra - - - - - - - + + 38 Aruna twak - - - - - - - + -• Pittaja Pandu: Pitta vriddhi produces various Pittaja presentations like Peetabhata,Haritabhata, Jwara.Table No.5. PITTAJA PANDU LAKSHANA Sl. C S. A. A. M. B. Y. G. no. LAKSHANA .S S. H. S. N. P. R. N. . 1 Peetabha + - - - - - - - 2 Haritabha + - + - - - - - 3 Jwara + - + + + + + + 4 Daha + - + + + + + + 5 Trushna + - + + + + + + 6 Moorcha pipasartha + - - - - - - - 7 Peeta mootra + + - - + + + + 8 Peeta shakrut + + - - + + + + 9 Swedana + - - - - - - - 10 Sheeta kamitva + - + + - - - - 11 Na annam abhinandathi + - - - - - - - 12 Katukasya + + + - - - - 26
  • 40. Review of Literature Roopa 13 Anupashaya - - - - - - - - 14 Ushna + - - - - - - - 15 Amla + - - - - - - - 16 Amla udgara + - - - - - - - 17 Vidahata + - - - - - - - 18 Vidagdhata + - - - - - - - 19 Dourgandhya + - + + - - - - 20 Bhinna varcha + - + + + + + + 21 Dourbalya + - - - - - - - 22 Tama + - + + - - - - 23 Peetakshi - + - - + + + + 24 Peeta Sira Avanaddha - + - - - - - - 25 Peeta nakha - + - - - - - - 26 Pittaja upadrava - + - - - - - - 27 Peeta anana - + - - - - - - 28 Moorcha - - + - - - - - 29 Amlata - - + - - - - - 30 Atipeetabha - - - - + + + -• Kaphaja Pandu: Kapha vriddhi produces various Kaphaja manifestations likeShuklavarnata, Gourava and Shwayathu. Table No.6. KAPHAJA PANDU LAKSHANA Sl. LAKSHANA C.S. S. S. A.H. A.S. M.N B.P. Y.R. G.N. no. . 1 Gourava + - - - - - - + 2 Tandra + - + + + + + + 3 Chardhi + - + + - - - - 4 Shewatavabhasata + - - - - - - - 5 Praseka + - - - + + + - 6 Lomaharsha + - + + - - - - 7 Sada + - - - - - - - 8 Moorcha + - - - - - - - 9 Bhrama + - - - - - - - 10 Klama + - - - - - - - 11 Shwasa + - - - - - - - 12 Kasa + - + + - - - 13 Alasya + - - - + + + - 14 Aruchi + - - - - - - - 15 Vatagraha + - - - - - - - 27
  • 41. Review of Literature Roopa 16 Swasa graham + - - - - - - - 17 Shukla motra + - - - + + + - 18 Shukla akshi + - - - + + + - 19 Shukla varcha + - - - - - - - 20 Katu kamatwam + - - - - - - - 21 Ruksha kamatwam + - - - - - - - 22 Ushna kamatwam + - - - - - - - 23 Shwayatu + - - - + + + - 24 Madhurasyatwa + - - - - - - - 25 Shukla sira - + + + - - - - 26 Shukla nakha - + - - - - - - 27 Shukla anana - + - - + + + - 28 Kaphaja upadrava - + - - - - - - 29 Lavanasyata - - + + - - - - 30 Swarakshaya - - + + - - - - 31 Atigourava - - - - + + + - 32 Shukla twacha - - - + + + -• Tridoshaja Pandu: Tridosha prakopa causes presentation of all the Tridoshajalakshanas. Table No.7. TRIDOSHAJA PANDU LAKSHANA Sl.No. Lakshana G.N. H.S. 1 Jwara + + 2 Arochaka + - 3 Hrullasa + + 4 Vamana + + 5 Trushna + + 6 Bhrama + - 7 Tandra - + 8 Alasya - + 9 Shotha - + 10 Kasa - + 11 Shosha - + 12 Vitbandha - + 13 Parushata - + 14 Klama - + 15 Moha - + 28
  • 42. Review of Literature Roopa• Mridbhakshanaja Pandu: Mridbhakshana causes Agnimandya, Roukshyata ofbody, Shotha, Dhatu dourbalya, Indriya-Teja-Bala-Oja-Virya kshaya and Krimi etc.Madhavakara has considered Mridbhakshana as vyadhi hetu. Sushruta has considered thisunder Tridoshaja Pandu as Mridbhakshana produces Tridosha prakopa.Table No.8. MRUDBHAKSHANAJANYA PANDU Sl. LAKSHANA C.S. S.S. A.H. A.S. M.N B.P. Y. G.N. no. . R 1 Indriya bala hani + - - - - + + + 2 Teja hani + - - - - + + + 3 Bala hani + - - - - + + + 4 Ojo hani + - - - - + + + 5 Varna nasha + - - - - + + + 6 Agni nasha + - - - - + + + 7 Shoona ganda + - - - - + + + 8 Shoona akshi koota + - - - - + + + 9 Shoona bhru + - - - - + + + 10 Shoona pada + - + + - + + + 11 Shoona nabhi + - + + - + + + 12 Shoona mehana + - + + - + + + 13 Krumi koshta + - - - - + + + 14 Atisara + - - - - + + + 15 Mala with rakta + - + + - + + + 16 Mala with kapha + - + + - + + + 17 Pandu - - - - - + - - 18 Tandra - - - - - + - - 19 Aruchi - - - - - + - - 20 Alasya - - - - - + - - 21 Kasa - - - - - + - - 22 Swasa - - - - - + - - 23 Shoola - - - - - + - - 24 Sada - - - - - + - - 25 Mala with krimi - - + + - - - - 26 Bhinna Mala - - + + - - - - 29
  • 43. Review of Literature Samprapti SAMPRAPTHI Charaka in chikitsa sthana describing the pandu roga samprapthi states that whenpitta pradhana vatadi dosha gets prakopa avastha in dhatus, cause dhatu shythilyam anddhatu gaurava. Owing to vitiation of shareera by this dushitha dosha dushyas, excessivekshaya of bala varna, snehana and ojus occurs, resulting in alpraktata, alpamedhastaka,nissaratha, shytilendriyatha and vivarnya which is known as pandu roga9,10. Charaka further describing the samprapthi of pandu roga states that when theperson who indulges in kshara, amla, lavana, adhika ushna, asatmya ahara sevana,pinyaka and tilataila sevana. Diwaswapna, ativyayama, atimaituna and vegadharana theperson who is akrantha kama, chinta, bhaya, krodha, hrudhyastha sadhaka pitta attainsvriddha avastha. The balee vayu displaces this sadhaka pitta from hrudaya and spreads throughoutthe body by means of dasha dhamani. Thus when twak, Mamsa madhya asritha pittavitiates kapha, vata, rakta, twacha, mamsa causes pandu, haridra, haritha varna twachawhich is known as pandu roga11, 12. Susrutha describing the samprapthi of pandu roga states that prakopagatatridoshas vitiate rakta cause pandu varna on twacha and the condition is known as panduroga.``NISHEVA MANASYA VIDUSHYARAKTAM KURUVANTHI DOSHA TWACCHIPANDUBHAVAM`` su/ut 44/3.Associating the Nidana and Samprapti: Ahara, vihara and vaidyakruta etiology cause Alparaktata through 30
  • 44. Review of Literature Samprapti • Pitta dosha prakopa, • Agnimandya and • Rasavaha and Raktavaha srotodushti. Further, Alparaktata is due to two causes viz. Raktaposhaka sara bhagaAnutpadana and Raktaposhaka sara bhaga Kshapana due to Pitta. Another aetiologicalconsideration for the Anutpadana and Kshapana are the Aharaja, Viharaja, Oushadha andVyadhi prabhava factors.As a result of Nidanarthakara roga: Nidanarthakara rogas can lead to Pandu by any of thefollowing: 1. Raktaposhaka sara bhaga Anutpadana, 2. Raktaposhaka sara bhaga Kshapana and 3. Alparaktata by Raktasrava. Again, it can be Sadya and Chirottha. This pathogenic pathway holds good also for Aharaja, Viharaja and Vaidyakrutanidanas.Samprapti: Samprapti of the disease Pandu can be studied under two headings - 1. Samanya 2. Vishesha 1) Samanya: It is the general pathogenesis in which the vitiated Doshas affect and vitiate the Dathus and Srotas. This is common to all types of Pandu. 2) Vishesha: It is the specific pathogenesis in which the disease is manifested according to the Samanya samprapti. However a specific aetiology which can 31
  • 45. Review of Literature Samprapti aggravate a specific Dosha, slightly modifies the general Samprapti and produce a specific type of Pandu.Samanya Samprapti: Samprapti can be clearly understood by studying the following aspects ofSamprapti 1) Samprapti ghataka 2) Samprapti bhedaSamprapti ghataka:1) Dosha: Prakopa of all the Tridoshas produces Pandu, the main aggravated Dosha beingPitta.PITTA: Normal physiological understanding of Pitta will give a clear picture of its role inPandu. Like the sun which gives energy and controls the universe, similarly in our bodyPitta is responsible for the energy and governance of metabolic and other activities likeUshma, Kshudha, Trushna including governing of the higher mental functions likeBuddhi, Medha etc13.The predominantly involved Pitta are as follows-Pachaka Pitta: Pachaka pitta helps in Ahara pachana i.e. digests and separates Ahara rasa intoSara and Kitta rasa. As it is seated in Grahani, it gives strength to Grahani as well as to allthe other Pitta. Its function includes Ayu, Varna, Prabha, Bala, Ojas14. 32
  • 46. Review of Literature Samprapti This is the first Pitta, which gets vitiated because of Nidana sevana and causesAgnimandya, Aruchi, Rasa pradosha and further can produce Dhatu shaithilya.Ranjaka pitta: Ranjaka pitta with its Ushma gives Raga to the Rakta poshaka sara bhaga of Rasaand produces Rakta15. When this Ranjaka pitta is vitiated, it produces Rakta that is alteredeither quantitatively or qualitatively. This affliction causes Rakta kshaya, which in turnincreases Mala rupi pitta. Mulasthana of Ranjaka pitta is Yakrut, Pliha16 and Amashaya17. Similarly, studiesin contemporary science have also proved that Liver and Stomach have a significant rolein production and maturation of RBC’s. In 1926, Minot and Murphy showed that liverwas most effective in treating Anaemia in dogs. A factor in liver is essential for thematuration of Erythrocytes and is demonstrated to be associated with non-protein fractionof liver substance that is known as Anti Anaemic or Haematinic principles. (Ricks et. al.1945). In 1929, Castle showed the presence of a substance in gastric tissue responsiblefor formation of Anti-anaemic factor, it being like liver itself, is effective in the treatmentof Pernicious Anaemia18.Sadhaka pitta: Along with Pachaka pitta, the predominant Pitta that is affected is Sadhaka pitta,the one that is located in Rasavaha srotomula (hridaya). Vitiation of this Pitta cause Rasadhatu agnimandya leading to Anutpadana or Kshapana of Rakta poshaka sara bhaga.Sadhaka pitta vitiation produces anger, lessened speech and Mrud-bhakshana in Pandu. 33
  • 47. Review of Literature SampraptiKAPHA: Kapha has also an important role to play in the pathogenesis of Pandu roga Excess intake of Santarpana Karaka regimen has been regarded as a causal factorfor Pandu19. Kaphaja vyadhi produces lakshanas like Pandutwa and Panduta21. Inspite of the Kapha being in its Prakruta avastha, the decreased Vata displaces italong with Pitta to all parts of the body causing Pandu20. Kapha in Twacha produces Shwetavabhasata. Kapha in Rakta produces Pandu22. These cross-references from classics suggest active involvement of Kapha inpathogenesis of Pandu. And the type of Kapha is Avalambaka.VATA: Vayu in Hridaya is responsible for the spread of the vitiated Pitta via the Dashadhamanis to the whole body. This Vayu can be Vyana vayu as it is responsible for all theGati in the body23.2) Dhatu:Rasa dhatu: Pandu is considered as one of the Rasa Pradoshaja Vikara24. Chakrapanicomments that the aggravated Pitta does the Kshapana of the Rakta poshaka rasa and it’sAnutpadana. Affliction of Rasa dhatu is due to affliction of Agni by Pitta; this causesAma roopi rasa disturbing the Dhatu poshana parampara and producing Dhatushaithilya25. 34
  • 48. Review of Literature SampraptiRakta dhatu: In Samprapti it is said that the doshas will vitiate Rakta dhatu (raktam vidushya)and produce Panduta in Twacha26. Both Raktalpata27 and Rakta pradosha28 can causePandu. Ojo guna kshaya means Rakta dhatu roopa oja kshaya, as Rakta dhatu is similarto Ojus29. “Nayati Rudhira Shosham” is the explanation given by Harita to denote Alparaktata30. Excess blood loss and Artava atipravruthi produces Pandu31. There will also bea desire towards intake of blood32 From the above references, we can gather that both Dushti and Kshaya of Raktadhatu are seen in Pandu.Mamsa dhatu: Mamsam Pradushya33.Meda dhatu: Alpa meda34.Ojas: Ojo Guna kshaya is the feature mentioned in the context of Pandu35. Wide rangesof interpretations are attributed to the term Ojas. Ojas is said to be of two types i.e. Paraand Apara ojas. In classics Prakruta Kapha, Rasa, Rakta, Shukra, Sarva dhatu sara andAgni are also referred to as Ojas36. As specific Dhatu kshaya has been mentioned inSamprapti specifically, here Ojo kshaya means Apara Ojas kshaya.Nissara: Refers to decrease in Ashta sara37. 35
  • 49. Review of Literature SampraptiIndriya: Due to affliction to all the Dhatus there will be a decrease in the functioningability of Indriya38, along with other Indriya gata lakshanas like Karna Kshweda, Alpavaktwa.Twacha: Twacha will also be vitiated and this is responsible for different colouration39.Mana: Impact on mind will be via manifestation of Krodha.3) Agni: Agni has a very important role to play in both maintaining health as well as instates of disease. Agni in normalcy is called life, and in deranged state is disease; if itstops functioning is called death40.Agni is of 3 types: 1. Jataragni 2. Dhatwagni 3. BhootagniJataragni: Aetiological factors of Pandu are Pitta kara and Vidahi. These cause increase inDrava guna of Pitta resulting in Jataragnimandya41. This is the first pathologicalderangement, which sets Pandu samprapti rolling. Jataragni mandya causes ama. 36
  • 50. Review of Literature SampraptiDhatwagni and Bhootagni: Jataragni governs the state of functioning of all the Agnis. Its decrease causesDhatwagni and Bhootagni mandya. This leads to impaired absorption of the ingredientsrequired for Poshana of Swadhatu, Upadhatu and in production of Sarabhaga required bythe next Dhatvagni and Bhootagni for its specific Dhatu production. Jataragni mandya produces Sama ahara rasa. When it sets into circulation, thealready debilitated Dhatwagni and Bhootagni produces Samarasa and leads to Raktaposhaka sara bhaga Kshapana and Anutpadana. This vicious chain continues and causesOjo kshaya.4) Ama: Ama is a pathological entity responsible for all diseases; Agnimandya being thekey factor in the causation of any disease.5) Srotas: Important Srotas affected in Pandu are Rasavaha and Raktavaha.Rasavaha srotas:Pandu is a Rasa pradoshaja vikaraIn Pandu due to Agnimandya, Rasa dhatu is first affected, the Prakupita pitta havingsthanasamshraya in Hridaya (mula sthana) spreads all over the body throughDashadhamanis and causes different Rasa vaha srotodushti lakshanas like- • Hridrava42 • Hridaya spandana43 • Shrama43 • Aruchi44 37
  • 51. Review of Literature Samprapti • Agninasha44 • Jwara44 • Angasada44 • Pandutwa44 • Tama44 • Trushna43Thus producing Rasa kshaya and even other Dhatu kshaya, because Preenana karma isaffected.2. Raktavaha srotas:Yakrit and Pliha are the Raktvaha srotomula. Rasaranjana takes places in Yakrit andPliha. The improper formation of Rasa dhatu leads to improper formation of RaktaAlong with Pachaka pitta, Sadhaka and Ranjaka pitta are also affected. These produceRakta kshaya by vitiating Raktavaha srotas.6) Udbhava sthana: Aetiological factors cause vitiation of Dosha and the place through which theysprout is called Udbhava sthana. Pandu being an Amashaya samuttha vyadhi, afterreaching to Hridaya (Srotomula) the Doshas spreads throughout body.7) Sanchara Sthana: After spreading from the Udbhava sthana it all depends on the route throughwhich the Doshas spread. This decides the systemic involvement and the disease inparticular. This is further decided by the Nidana sevana and status of the system. InPandu, Sanchara is through the Dasha dhamanis. 38
  • 52. Review of Literature Samprapti8) Ashraya: In Pandu, the Doshas take Ashraya between Twak and Mamsa thereby causingvitiation of different Dhatus and producing different Varnas.9) Avayava: After the primary localization, the Doshas spread out afflicting the various areasof the body. Here all the Angas are involved.Effect of Dosha Dushya Sammurchana:Dhatu Shaithilya:After the involvement of Agni the disease process affects Rasa and other Dhatus, finallycausing Dhatu kshaya and Ojo kshaya. Kshaya lakshanas of specific Dhatus are:1) Rasa: • Hritspandana (A.S.Su19/10) • Hridrava45 • Shrama462) Rakta: • Twak Roukshya47 • Twak Sphutana48. • Bhrama49. • Trushna50. • Swasa51. • Manda anala52. • Pandutwam53. 39
  • 53. Review of Literature Samprapti • Dhatu kshaya54.3) Mamsa: • Gatra Toda55. • Shrama56. • Gatra Roukshya57. 4) Meda: • Shrama58. • Mamsa Kshaya Lakshanas58. • Gatra Roukshya59. 5) Asthi: • Sheerna Lomata. • Shrama60. • Gatre Rukshata61. 6) Majja: • Bhrama. • Tama. 7) Shukra62: • Pandutwa. • Gatrasada. • Dourbalya. • Shrama. 40
  • 54. Review of Literature Samprapti8) Ojas: • Gatrasada63. • Varna Bheda64. • Gatra Roukshya65. • Dourbalya66. • Shrama67. • Murccha67.Dhatu Gourava:Reduced the functioning ability of Dhatu due to Dhatu Kshaya.Varna Kshaya:Pitta dosha and Rakta dhatu are responsible for Varna prasadana (Agni guna bhuyishta).Pandu is a vyadhi that is named on the basis of discolouration of skin and thisdiscolouration is elaborated in detail.Different discolourations of the body parts in Pandu are -Twak: • Vaivarnya68 • Varnakshaya69 • Varna nasha70 • Pandu71 • Haridra71 • Bahuvidha Varna71 • Krushna Panduta72 41
  • 55. Review of Literature Samprapti • Arunangata72 • Shwetata73 • Shwetavabhasata74 • Pandura75Akshi: • Krushna76 • Peetata77 • Shuklata78 • Arunata79Mukha and Nakha: • Sweta80 • Peeta81 • Krushna • Aruna82Sira: • Sweta83. • Peeta84. • Krushna84. • Aruna86.Pitta involment cause Peetata and other discolourations. When Gambhira dhatus likeMajja are involved, it produces Haridra nakha and netrata87.Prakruta Varna of body is Krushna, Shyama, Shyamavadata, Avadata88 42
  • 56. Review of Literature SampraptiPrakruta Varna of Jihva and oshta is Rakta Varna. Nakha is Rakta and Tamra Varna89. In Pandu roga because of Ojo kshaya, dhatu kshaya and Ashta sara kshaya, therewill be decrease and discolouration of different body parts. Due to Raktalpata the RaktaVarna bhuyishta parts like jihva, oshta and nakha may appear Alpa rakta varnatmaka. Colour of the skin depends not only on Hb level in blood but also on the state ofblood vessels, the amount of fluid in the subcutaneous tissue and the degree of skinpigmentation. Pallor of the palms particularly skin creases are more reliable than pallorelsewhere. Pallor of nail beds, mucous membrane of mouth and conjunctiva are morereliable than pallor of skin.Skin discolourations in Anaemia: • Dead white colour of skin- severe acute blood loss. • Pallor with ashen tint of the skin- Acute Leukaemia. • Lemon or Pale yellow-Advanced Pernicious Anaemia. • Petechiae in Anaemia-Thrombocytopenia. • Ecchymosis - Thrombocytopenia or disturbed coagulation.Samprapti bheda of Pandu:1) Sankhya Samprapti:5 types of Pandu (Charaka, Vagbhata)4 types of Pandu (Sushruta)8 types of Pandu (Tantrantara) 43
  • 57. Review of Literature Samprapti Table No.9. TYPES OF PANDU Sl. C. S. A. A. M. B. Y. Sh. Tantra- G. K. Basa. H.S. No. Types S. S. H. S. N. P. R. S. ntara N. K. 1. Vataja + + + + + + + + + + + + + 2. Pittaja + + + + + + + + + + + + + 3. Kaphaja + + + + + + + + + + + + + 4. Sannipataja + + + + + + + + + + + + + 5. Mrudbhakshanaja + + + + + + + + + + + + +Vidhi Samprapti:Usually Swatantra Pandu is Sadhya whilst Paratantra Pandu is Kashta sadhya.The Chart No 1. explains Vidhi samprapti.Vikalpa Samprapti:The Amshamsha kalpana of the Samprapti of Pandu is separately dealt with under theheading of Samprapti ghataka of Pandu.Pradhanya Samprapti:Pradhana dosha - Pitta pradhana tridosha.Swatantra Pandu is pradhana.Nidanarthakara roga janita Pandu is apradhana.Bala Samprapti:The Bala of Pandu depends on the Nidana, Poorvaroopa, and Roopa are manifestedpartially or completely. When they appear with full strength, the Bala is greater thanwhen they appear partially. Pandu with Upadrava and Asadhya lakshanas are difficult totreat. 44
  • 58. Review of Literature SampraptiKala Samprapti:It is the Samprapti that confirms the role of a particular Dosha in a disease i.e., the Balathat produced the disease or increased its intensity with change in time like Dina, Ratrietc. or in accordance with stages of digestion.Vishesha Samprapti:The role of vata in development of pandu roga: Owing to vata nidana along with pitta prakopakara ahara viharas becomesvatanubandhata causes pandutwam and arunangata in the body the condition is known aspandu vataja roga. In this type of pandu vata and pitta predominanace is there.The role of pitta in development of pandu roga:Owing to pittakara ahara vihara pitta araddhakatwam occurs and causes pittaja panduroga. Pittaja pandu roga causes peetata, haritata in the body.The role of kapha in development of pandu roga:Owing to kaphakara ahara vihara along with pittakara ahara vihara kaphanubandhatadevelops there by resulting in kaphaja pandu. Kaphaja pandu roga causes swethata on thetwak. In kaphaja pandu both kapha and pitta predominance is seen.Sannipataja pandu roga:Owing to indulgence of tridosha prakopaka pandu roga ahara vihara tridosha vitiationoccurs, which results in tridoshaja pandu roga. In tridoshaja pandu roga dhatu shaitilyamand dhatu gauravam are deep set and the patients rakta, bala, varna, sneha gunas go intoteevra ksheenavasta and probably that could be the reason sannipataja pandu has beentermed as asadhyam and achikitsitam. 45
  • 59. Review of Literature SampraptiMrudbhakshana janya pandu:Owing to Kashaya mrittika bhakshana vata gets vitiated. With Ooshara mrittikabhakshana piita gets vitiated and because of Madhura mrittika bhakshana kapha getsvitiated. Hence depending upon dosha vitiation that particular doshaja pandu develops inthe body with mrittika bhakshana. 46
  • 60. Review of Literature Samprapti Illustration no. 1 - Samprapti flow chart Pandu Roga Nidanasevana Aharaja Viharaja Vaidyakruta Nidanaratkara RogaSanchaya Pitta pradhana Agni vikruti Dushya Dusti Khavaigunya in tridosha prakopa Rasa & Rakta Srotas - Rasovaha Raktavaha Through VyanavayuPrakopa Jatharagani mandya Hridaya prapti Circulation through DasadhamaniPrasara Rasavahasrotas Raktavaha srotas Twak mamsantana ashraya Dosha – Dushya samurchana Dhatu – Shaitilya & Dhatu gouravaStanasam-shraya Alpa Raktaka Alpamedoska, ojokshaya, mamsa – twak dushya Bala kshaya, Varna kshaya, Snehakshaya, Nissar, Shithilendriya Poorvaroopa Varnahani (Bahuviddha twaha) Pratyatma lakshana, Samanya laxanas Vyakta Vataja, pittaja Kaphaja Sannipataja, Mrudbhakshanajanya Pandu Bheda Upadrava, Asadhya and Arishta Lakshanas 47
  • 61. Review of Literature SampraptiIllustration no. 2 - Mrudbhakshanajanya Pandu: Mruda 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 48
  • 62. Review of Literature Samprapti Illustration no. 3 - Nidana and Samprapti Samprapti Nidana Sevana Aharatah Viharatah Vaidyakruta Sahaja Nidanartakara Roga Alpa Rakthata- Raktha Srava Pitta Prakopa Alpa Raktha Agini Mandya Sadhya Chirottah Rasavaha Sroto Dusti Rakta Pitta, Arsha Raktaja Gulma Alpa Rakta due to Raktati Pravarthan, Krumi Raktarbuda Yakrut Pleeha VrudhiRakta Poshaka Sara Rakta Poshaka Sarabhaga Bhag Anutpadana Kshapana due to Pitta Ahara – Amla Ahara – Eka rasa satmya Anashana Kshara Ati madya pana Lavana Vishamashana Ushna Virudda bhojana Matsya Asatmya bhojana Tila taila Mrud bhakshana Teekshna Vihara – Ati maithuna Vihara Atapasevana Ati vyayama Oushada – Apatarpana karaka Oushadi – Apatarpana karaka Vyadhi - Raktapitta Oushadi atiyoga Vyadhi - Anna vaha sroto vikara- Grahani Prana vaha sroto vikara- Pittaja Kasa, Pratishyaya Pureshavaha sroto vikara- Arsha Anya sroto vikara 49
  • 63. Review of Literature Upadrava UPADRAVA The following have been mentioned as upadrava of pandu roga90,91: 1. Aruchi 11. Hridaya peedana 2. Pipasa 12. Swasa 3. Jwara 13. Atisara 4. Moorbharaja 14. Trasa 5. Agnisada 15. Shoola 6. Sopha 16. Daha 7. Chardi 17. Avipaka 8. Avalatwam 18. Swarabhedha 9. Moorcha 19. Swarasada 10. Klama 20. Shotha Upadrava may not have a separate samprapthi of their own. But the pain will be deep and severe, and the important character of upadrava is vyadhikalottaraja though the above lakshanas are seen in sadharana and visista lakshanas of pandu roga only differentiating points are upadravas having the qualities of moolatwam, and peedaakaratwam. 50
  • 64. Review of Literature Upadrava Table No.10. UPADRAVA Sl. Lakshana S.S A.H. Bas no. 1 Aruchi + - + 2 Pipasa + - - 3 Chardi + - + 4 Jwara + - - 5 Shiroruja + - - 6 Agnisada + - - 7 Shopha + + + 8 Kanthagata abalatwam + - - 9 Moorcha + - - 10 Klama + - - 11 Hrdayavapeedanam + - - 12 Shwasa + - - 13 Atisara + - + 14 Kasa + - - 15 Daha + - - 16 Avipaka + - - 17 Swarabheda + - - 18 Sada + - - 19 Adhmana - - + 20 Tandra - - + 21 Pandu danta - - + 22 Pandu nakha - - + 23 Pandu netra - - + 24 Pandu sangatha darshi - - + ARISHTA LAKSHANA The lakshanas that indicate the imminent death are called as Arishta lakshanas97. • Pandu varnata in excess. • Ati krushata. • Trushna. • Kupita ucchwasa. • Dambary 51
  • 65. Review of Literature Sadya asadyata ASADHYA PANDU ROGA LAKSHANAS The following conditions which present in rogi, the person is said to be achikitsa theyare92-96: 1. Chirotpanna kharibhuta pandu rogee 2. Kala prakarshcchoona peeta darshee pandu rogee 3. Sa kapha harita baddha alpa vit atisaree pandu rogee 4. Asrik khaya setangee pandu rogee 5. Chardi moorcha tridardita deena swetati digdhanya pandu rogee 6. Anta pradesha shotha and Madhya shareera krisa pandu rogee 7. Antaha pradesha and Madhya shareera shoona pandu rogee 8. Shotha in guda, sephasa and mushka pradesha pandu rogee 9. Jwara atisara peeditha pandu rogee 10. Pandu danta, nakha, netra pandu sanghata darshee pandu rogee. Table No. 11. ASADHYA LAKSHANAS IN PANDU ROGA Sl. Lakshana C. S. S. S. B. P. Y. G. N. no. R. 1 Anteshu shoona parihina madya - + + + + 2 Mlana (Krisha) - + + + + 3 Madya shoona anteshu parihina - + + + + 4 Guda shopha - + + + + 5 Muska (yoni) shopha - + + + + 6 Pratamya (murcha) - + + + + 7 Visamjnatha - + + + + 8 Atisara peeditha - + + + + 9 Jwara peeditha - + + + + 10 Chirothpanna Pandu + - - - + 11 Karibhootha Pandu + - - - + 12 Kala prakarshath shoona + - - - + 13 Peetha darshana + - - - + 14 Bhadda vit + - - - + 15 Alpa vit + - - - + 52
  • 66. Review of Literature Sadya asadyata 16 Sakapha, Haritha Atisaryathe + - - - + 17 Deena + - - - + 18 Shwethatidigdhanga + - - - + 19 Chardhi + - + + + 20 Trit + - + + + 21 Ardhitha + - - - - 22 Swethatha due to adhika rakta kshaya + - - - - 23 Arochaka - - + + + 24 Hrillasa - - + + + 25 Klama - - + + + 26 Ksheena - - + + + 27 Hatendriya - - + + + 28 Pandu danta, naka, netra - - - + + 29 Pandu sanghatha darshi - - - + + 30 Tridoshaja Pandu - - + - + 53
  • 67. Review of Literature Chikitsa CHIKITSAShamana: In Shamana, various single and compound preparations are told whichinclude herbal, mineral and herbomineral preparations. Illustrating a few, 1) Vyoshadya Ghrita98 2) Shuddha Kanta Loha Bhasma99 3) Vidangadi Loha100A point of interest to be noted here is that most mineral preparations contain Loha.LOHA AND LOHA YOGAS: Loha and loha yogas have been considered very important and most specific drugs for panduroga. Nearly about 188 loha yogas have been mentioned. Due to its wide advocation has pandu hara dravya in ayurvedic texts Dhatri lauha has been selected for the present clinical trails on pandu. Apart from loha, suddha kaseesa, swarna makshika, shuddha shilajatu, gairika, gomootra, pravala, mukta, hareetakee, trivrit, yastichoorna, guduchikashyam, draksha or moolika phanta, vardhaman pippalee are some among the very specific drugs for pandu roga treatment.SHODHANA: The terms shodhana denotes oordhwa and adhah shodhana also, some acharyashave contraindicated vamana in pandu roga. But dalhana on the other hand advocatedmridu vamana when ritu, desa, kala, are in favour. For this purpose the following drugshave been mentioned in charaka siddhisthana kota phala indicated for vamana.Dhamargava kalpa, ikshwakukalpa, kritavedhana kalpa, sthana have also been mentionedthe drugs of choice for the vamana karma of pandurogee. 54
  • 68. Review of Literature ChikitsaADAH SHODHANA OR VIRECHANA: For virechana karma the following yogas have been mentioned. 1. Godugdham or gomootra yukta dugdham, may be given for mridukoshta rogee. 2. Dantee phala, Draksha choorna 3. Trivrit choorna in pittaja pandu 4. Aragvadha majja with trikatuchoorna in kaphaja pandu. 5. Gomootra bhajjita hareetakee choorna in kaphaja pandu. Susrutha has advocated preparation of ghritas with virechana dravyas for doingvirechana karma. These types of yogas also available in charaka chikitsasthana such asdadimadya ghrita, katukadhya ghrita, pathya ghrita, dhanti ghrita, drakshadya ghrita,haridradi ghrita, darvyadi ghrita and in susrutha uttarasthana 44th chapter bhrihatyadighrita, kaleyaka ghrita, drakshadya ghrita have been mentioned for the sake of virechanakarma.Mrudbhakshanajanya Pandu Chikitsa101: At the outset, the Balabala of the patient has to be assessed.1) Shodhana: Teekshna shodhana in order to remove the ingested Mruttika.2) Shamana: 1) Medicated Ghrita ie Sarpi for baladana. Eg. Vyoshadya Ghrita 2) Treatment according to the Prakupita Dosha. 3) Krimihara Chikitsa in Udara Krimi. 55
  • 69. Review of Literature Chikitsa3) Nidana Parivarjana: Mruttika given bhavana with Vidanga, Ela, Ativisha, Nimbapatra, Pata, Varthaka, Katurohini, Murva and Kutaja. These • Will produce aversion towards Mrudbhakshana i.e. Dweshartha. • Are Mrudbhakshanajanya dosha nashaka. 56
  • 70. Review of Literature Pathya apathya PATHYAA) Ahara:1) Shuka dhanya varga :Purana yava,Purana godhuma,Jeerna Shali.2) Shami dhanya varga :Mudga,Masura,Adhaki.3) Mamsa varga :Jangala mamsa and Matsya4) Shaka varga: Patola,Jeevanti,Guduchi,Punarnava,Dronapushpi Tanduliyaka, Lashuna, Palandu, Bimbi, Vartaka5) Phala varga : Vriddha Kushmanda, Taruna kadali Amalaki, Haritaki, Pakwa amra6) Ikshu varga : Ikshu rasa7) Gorasa varga :Takra,Ghrita and Navaneeta8) Mootra varga :Gomootra9) Madya varga :Souveeraka and Tushodaka10) Kritanna varga :Yusha11) Anya :Haridra,Chandana,Keshara Yavakshara and Loha bhasmaB) Karma:1) Vamana2) Virechana3) Abhyanga to a) Padasandhis b) 2 angulas below nabhi c) Mastaka d) Stanakakshayormula 57
  • 71. Review of Literature Pathya apathyaPATHYA VYAVASTHA102: Foods that are capable of causing agni deepana and bhrimana should form asimportant principles of pathya-vyavastha of pandu roga. After having achieved kostasuddhi by means of snehana and shodhana pathya vyavastha. For this purpose bakshyaprepared from puranashalidhanyam, purana yava, godhuma, to be given withmridgayosha, jangalamamsa rasa, or ikshu rasa and preparing mantha by adding madhu.Apart from kooshmanda taruna, kadlee jeevantee shaka, gudoochi, punarnava, dronapushpee, vartaka, lashana, bimbee etc. Dugdham, takram, ghritam, navaneetam andtailam are said to be pathya for pandu rogee. APATHYAA) Ahara:1) Rasa: Kshara, Amla, Lavana, Katu2) Anna: Viruddha bhojana, Asatmya bhojana, Vidahi bhojana, Guru bhojana3) Jala : Adhika ambupana, Dushta jala, Jala from rivers of Sahyadri, Vindhya Mountains4) Kritanna varga : Pinyaka5) Shamidhanya varga : Masha, Tila, Kulattha, Nishpava.6) Sneha varga: Tila taila7) Gorasa varga: Dadhi mastu8) Madya varga: Sura9) Aharopayogi dravya: Hingu, Tambula10) Anya dravya: Mrittika 58
  • 72. Review of Literature Pathya apathyaB) Vihara:1) Atapa, Vahni Sevana2) Ayasa, Krodha, Adhwa and MaithunaC) Karma:RaktasrutiDhoomapanaSwedanaVamana vega vidharana.APATHYA103: The drugs which cause rakta hrasa are said to be apathya for pandurogee, such asagni and atapa, atisevana, adhika vyayama, pittala annapana, maithuna, krodham, adhikamargagamana. So the above things must be sacrificed by pandu rogee. By samprapthi we can infer that in panduroga pitta pradhana dosha vitiation. Sogenerally we should have to use such a pandu hara dravya which acts as pitta prasadakaand tridosha hara dravya as well. Apart from this specific pandu hara dravyas are to beused along with respective dosha hara dravyas along with general principle of treatmentin vataja pandu snehabhooyista dravya, in pittaja pandu tikta seetala dravya and inkaphaja pandu katu tikta and ushna dravya yogas should be used respectively. 59
  • 73. Review of Literature Anaemia ANAEMIAHistory: The term Anaemia is an ancient one and can be found in the CarpusHippocraticus. It literally means without blood and is derived from Greek ‘a’ or withoutand ‘haima’ or blood. James Combe, an Edinburgh Physician (1824), first used the term Anaemia inEnglish. Gebrial Andral, a French physician, laid much of the foundation on modernconcepts of Anaemia in 1843. The therapeutic use of Iron was mentioned in Greek mythology in the story ofIphicius. Vanandeus applied the term chlorosis and was described by Jahonnes Lange in1554. In 1830, Hoefer detected hypochromia in blood. In 1832, Pierre described theresponse of chlorosis to his famous pills containing ferrous sulphate and potassiumcarbonate.Classification of Anaemia:Classification of Anemia’s by pathophysiologyI. Blood Lossa) Acute Haemorrhageb) Chronic HaemorrhageII. Decreased Production of Red Blood Cells1. Hameoglobin synthesis- a) Iron deficiency anaemia b) Thalassemia(heriditory) 60
  • 74. Review of Literature Anaemia c) Anaemia of chronic disease2. D.N.A synthesis - Megaloblastic Anaemia3. Stem cell - Aplastic Anaemia4. Bone Marrow infiltration – a) Carcinoma b) Lymphoma5. Pure Red cells AplasiaIII. Increased destruction (Classification of Haemolytic Anaemia)a) Haemolysis (Intrensic) 1) Membrane - i) Heriditary Spherocytosis ii) Eleptocytosis 2) Haemoglobin – i) Sickle cell ii) Unstable Haemoglobin 3) Glycolysis - Pyruvate Kinase 4) Oxidation - G6PD deficiencyb) Haemolysis (Extrinisic) 1) Immune - i) Auto immune ii) Drug toxicity iii) Lympho Preliferative Disease 61
  • 75. Review of Literature Anaemia EtiologyCauses of Iron Deficiency Anaemia (API Medicine)1. Nutritional - 50%2. Malabsorption - 20%3. Parasitic Infestation - 20%4. Chronic blood loss - 5%5. Others - 5%1) Nutritional (commonest cause)a) Poor dietary Intakeb) Poor bioavailability of Iron from cereal based dietc) Increased requirement of Iron2) Malabsorptiona) Any malabsorptive disorder leads to poor iron absorptionb) Geophagia interferes with Iron absorption and aggravates IDD.3) Parasitic Infestationa) Ankylostomiasis4) Chronic blood lossa) GIT bleeding Eg: Peptic Ulcer Disease, Bleeding gum, Ulcerative colitis, Crohnsdisease, Oesophageal varies, MeloryWeiss syndrome.b) Anorectal Disease Eg: Bleeding Pilesc) Genito urinary bleeding Eg: Menorrhagia, Metrorrhagia, Recurrent Haematuria,Haemosideriuria, antipartal post partal, haemorrage etc., 62
  • 76. Review of Literature Anaemia5) OthersRegular blood donation in India where majority of the population has a precarious ironbalance.In many cases IDA is multifactor in origin, with dietary deficiency, poor bioavailabilityand blood loss all contributing to a variant extent. PATHOGENESIS OF IRON DEFICIENCY ANAEMIAThree pathogenic factors are implicated in the Anaemia of iron deficiency. They are asfollows.1) Impaired Haemoglobin Synthesis When transferrin saturation falls below 16% the supply of iron to the marrow isinadequate to meet the basic requirement for haemoglobin production. Each cellproduced contains less haemoglobin resulting in hypochromia. The number of celldivisions and the ultimate erythrocyte size are related to the rate of haemoglobinsynthesis. Haemoglobin enters the nucleus and reacts with nucleohistones, therebycausing nuclear inactivation. In iron deficiency, it takes long to reach the criticalhaemoglobin. Concentration and the generation time is unaffected, hence more celldivisions occur before nuclear inactivation and the resulting cell is microcytic or small insize.2) Generalized defect in Cellular Proliferation In iron deficiency, the cellular proliferation is decreased as evidenced by areduced red blood cell count, reticulocyte count and haemoglobin percentage. Thedegree of erythroid hyperplasia is low in relation to the degree of anemia. In addition 63
  • 77. Review of Literature Anaemiathere is a significant component of ineffective erythropoiesis. A portion of cells in irondeficient subjects are so defective that they are rapidly destroyed.3) Reduced Erythrocyte Survival This is the least important factor involved in the pathogenesis of iron deficiencyanaemia and is found only when the anaemia is severe. Cross transfusion studies havedemonstrated that the shortened survival results from an intra corpuscular defect. Thereis a significant co-relation between the proportion of morphologically abnormal cells onblood smear and the degree of reduction in red cell survival. The reduced erythrocyteviability is associated with decreased membrane deformability. This abnormalityappears to resist it from productive damage to the membrane which in turn may be aconsequence of reduced glutathione peroxidase activity. Several iron proteins are reduced in iron deficiency and some of these proteinsmay be responsible for certain clinical and pathological manifestations of the disease.Iron is a component of haem proteins like cytochromes, myoglobin, catalase andperoxidase, iron sulphur proteins and metalloflavo proteins are important in oxidationreduction reactions, especially those that take place in mitochondria. Iron is a co factorfor certain enzymes and a reduction in tissue enzymes is presumed to be related to theoccurence of epithelial changes in iron deficiency. Impaired resistance to infection iniron deficiency is multifactorial, one important cause being myeloperoxidase deficiency.Stages of Iron Deficiency Anaemia Iron deficiency is usually the end result of a long period of negative iron balanceand develops in sequential stages. These stages include, 64
  • 78. Review of Literature Anaemia1) Stage of Iron Depletion (Pre Latent Iron Deficiency) During this stage, the Iron stores in the hepatocytes and the macrophages of theliver, spleen and bone marrow are exhausted, serum ferritin values are reduced. This isbecause iron stores are mobilized for erythropoiesis.Iron absorption in the gut is usually increased in an attempt to compensate for thenegative iron flow. The RDW (reticulocyte distribution width) is frequently elevated andmay be the first indication of a developing iron deficiency in a non anaemic patient.2) Stage of Iron Deficient Erythropoiesis (Latent Iron Deficiency) In this 2nd stage certain biochemical abnormalities in iron metabolism are usuallydetected. Serum iron is decreased. TIBC is increased and transferrin saturation isdecreased. FEP (free erythrocyte protoporphyrin) levels measured as ZPP (zincprotoporphyrin) are increased. Measurement of ZPP is a sensitive index of this stage ofiron deficiency. Other observation, include sub normal urinary iron excretion afterdesferroxamine injection, decreased tissue cytochrome oxidase levels and absence ofbone marrow sideroblasts and marrow iron is markedly reduced. Few microcytes may be detected on the peripheral smear. But MCV (meancorpuscular volume) remains within normal limits. However Hb level is still normal. Alarge portion of Indian population falls under this group.3) Iron Deficiency Anaemia In the last stage, the blood haemoglobin falls below the lower limit of normal.The most sigificant findings is the classic microcytic hypochromic anaemia. Other ironcontaining enzymes, such as the cytochromes, also reach abnormal levels during this 65
  • 79. Review of Literature Anaemiaperiod. Epithelial manifestations of iron deficiency usually represent a very late phase ofiron depletion. As the negative iron balance continue, serum iron level falls further, TIBCincreases and transferrin saturation falls below 16%. Serum ferritin is reduced. Irondeficient erythropoiesis ensures with the appearance of erythroid precussors with raggedcytoplasmic margins in the marrow. MCV, MCH, MCHC falls down. DIFFERENTIAL DIAGNOSIS OF IDAIn a patient with hypochromic microcytic anaemia, the major diagnostic possibilities are 1. Iron deficiency Anaemia 2. Thalassemia 3. Anaemia of chronic Inflamation 4. Lead poisoning 5. Sideroblastic AnaemiaSeveral laboratory tests are useful in the differential diagnosis Mild Iron deficiency maybe readily confused with b thalassemia trait or with the 2 deletion forms of a thalassemia.In these mild forms of thalassemia, microcytosis is much more marked than hypchromia,accordingly the MCHC is usually normal. The red cell size distribution is more uniformthan that in iron deficiency. Target cells and basophilic stippling are usually moreprominent in thalassemia than in Iron deficiency. HbA2 is elevated in b thalassemia anddecreased in iron deficiency. The level of HbA2 may fall to normal. Serum Iron isnormal or elevated in Thalassemia and decreased in both iron deficiency and the 66
  • 80. Review of Literature AnaemiaAnaemia of chronic disease. However the transferrin level is also decreased in the latercondition.The laboratory tests shown in table are not very helpful in determining whether a patientwith a chronic inflammatory disease such as Rheumatoid arthritis has become irondeficient. The finding of a low serum ferritin level or absent iron stores in a bone marrowaspirate would be diagnostic of Iron deficiency in such patients. A trial of Iron therapymay be necessary to settle the issue. The diagnosis of sideroblastic Anaemia rests on the demonstration of ringedsideroblast in the bone marrow. These often have a population of hypochromic,microcytic red cells, even though the MCHC is usually normal. Table No.12. LABORATORY DIFFERENTIAL DIAGNOSIS OF IRON DEFICIENCY ANAEMIASL. Test Iron Chronic Thalassaemia SiderblasticNO. Deficiency Disorders Anaemia1) MCV, MCH, Reduced Low normal Very low Very low (except MCHC to reduced MCV raised in acquired type)2) Serum Iron Reduced Reduced Normal Raised3) TIBC Raised Reduced Normal Normal4) Serum Ferritin Reduced Raised Normal Raised (complete saturation)5) Marrow Iron Absent Present Present Present stores6) Iron in Absent Absent Present Ring sideroblasts normoblasts7) Hb Normal Normal Abnormal Normal electrophoresis 67
  • 81. Review of Literature AnaemiaTable 13. Showing the Similarities between I.D.A. and Pandu I.D.A Samanya Pandu roga Vataja Pandu Lakshana Lakshana a) Pallor of skin Pandutha of twak, nakha, Krishna varna mishritha mucous membrane ekshana, Anana, Vivarnatha pandutha in these parts. conjunctiva, nails Hataprabha b) Exhertional dyspnoea Arohana, Adhwa ayasa Shrama c) Lassitude, Fatigue Anga sada, Nissaratha, Balakshaya Exhaution Gourava d) Weakness Dourbalya, Bala Hani Asya Vairasya e) Palpitations, Hridrava ---- Tachycardia f) Anorexia, Indigestion Annavit, Aruchi, Hatanala ---- g) Tinnitus Karnakshweda h) Brittle nails, Nakha rukshatha Koilonychia, nail Cracking i) Hypersensitiveto cold Shishira dweshi j) Headache Shiro ruk, Shiro gourava ---- k) Nausea Hrillasa, Praseka Anaha l) Bowel irregularity Vit bandha (vit shosha) m) Insomnia Anidra ---- n) Low grade fever Jwara o) Aches and pains in Gatra mardhana peedanadi Anga marda, toda Various parts of the pindikodwestana, kati, uru, parshwaruk Body pada ruk, gatrashoola, p) Oedema Shoona akshi koota Shopha 68
  • 82. Drug Profile Dhatri lauha DRUG PROFILE OF DHATRI LAUHAIngredients of Dhatri Lauha1041. Amalaki2. Madhuyasti3. Lauha Bhasma4. Guduchi Quatha for Bhavana1. AmalakiFamily : EuphorbiaceaeGana : Vayasthapana, Virechanopaga105, Triphala, Parushakadi106.Latin Name : Embilica officinalis Gaertn.Properties107:Rasa: Amla pradhana, Lavana rahita pancharasaGuna: Guru, SheethaVirya: SheethaVipaka: MadhuraChemical composition108:Fruits contain Galeic acid, Tannic acid, Sugars, Albumin, Cellulose, Calcium and otherminerals and Vit C.Protein 0.5%, Fat 0.1%, Fiber 9.4%, Carbohydrate 14.1%, Minerals 0.7%: Phosphorous0.02%, Calcium 0.05%, Iron 1.2μg, Nicotinic acid 0.2μg - per 100g. 69
  • 83. Drug Profile Dhatri lauhaAyurvedic view:Amlapradhana drugs are Agnidipaka, Brimhana, Indriyadridikaraka, Balavardhaka andhelp in Preenana. It is a Rasayana, Vrishya and Rakta pittahara109Pharmacological Action:Increased acid favours dissolution and reduction of Ferric Iron. Ascorbic acid, which isthe main content of Amalaki, is a reducing substance, which reduces Ferric Iron andforms absorbable complexes. Ascorbic acid is even required for maturation of RBC110.There are many preparations of Amalaki, which are useful in Pandu viz., Dhatri Avaleha,Dhatryarishta etc.2. MadhuyashtiFamily : LeguminoseaeGana : Jeevaniya, Varnya, Snehopaga, Shonitasthapana111, Kakolyadi, Sarivadi, Anjanadi112.Latin name : Glyzyrrhiza glabra Linn.Properties113:Rasa: MadhuraGuna: Guru, SnigdhaVirya: SheethaVipaka: MadhuraChemical composition114:Glycyrrhizin 2.14%, Glucose 3.8%, Sucrose 2.4%-6.5%, Resin 2.4%, steroid Oestrogen –possibly Estriol is also present. Anthoxanthin, a glycoside, Isoliquartin stimulate salivaryglands. 70
  • 84. Drug Profile Dhatri lauhaAyurvedic view:Properties of Madhuyashti bring about Dhatu-vardhana, Pittaghna, Jeevana115 effects andare also a Bala varnakaraka116.Yashtimadhu forms one of the main ingredients in Haridradi ghrita, Madhuyashti yoga117,which are useful in Pandu.Guduchi:Tinospora cordifolia:The stem of Guduchi, which is used for the therapeutic purposes, is said to possess Tikta,Kashaya, and Madhura Rasa as well as Madhura Vipaka. Guru and Snigdha are theproperties. Further, Guduchi is categorized as an Ushna Veerya drug. Principalconstituents of this drug include Tinosporine, Tinosporide, Tinosporaside, Cordifolide,Cordifol, Heptacosanol, Clerodane, Furano diterpene, Diterpenoid furanolactoneTinosporidine, Columbin and ß-sitosterol. Recent researches indicate that, bitterprinciples present in the drug show antiperiodic, antispasmodic, anti-inflammatory andantipyretic properties. It is well known to improve the immune system and the bodysresistance against infections. It is used as an immunomodulator in theimmunosuppression of obstructive jaundice, hepatic fibrosis, peritonitis and sepsis. Ingeneral, Guduchi is beneficial in alleviating the imbalances of all the three Dosha and isalso prescribed as Rasayana.3. Loha Bhasma Properties118:It possesses Madhura Vipaka, Sheetha Veerya and is Netrya, Balya, Vrishya, Medhya,Pandu-Krimi-Kshayahara, and Hridya. It is a Nasa- Garbha shayagata rakta sravasthambhaka, relieves Pandu roga, which is commonly seen in females during puberty. 71
  • 85. Drug Profile Dhatri lauhaAmashaya-Pakwashayagata Kshata vrana, Raktasrava are the other indications whereLoha Bhasma is useful.Method of preparation of Medicines119:Dhatri Lauha:Amalaki choorna - 8 Pala = 384gmsLauha Bhasma - 4 Pala = 192gmsMadhu yasti Fine powder - 2 PalaGuduchi Quatha – Sufficient quantity for Bhavana.Drugs Dhatri, Lauha, Yastimadhu are powdered separately and mixed together and put inAmritha kashaya for Bhavana. After seven days it is taken and dried in the sun. It is thenmixed well.Dosage: 1gm. 72
  • 86. Clinical Study Methodology Materials and MethodsMaterials taken for the study were1. Dhatri Lauha.Collection of drugs: Drugs were collected and prepared by S. D. M. AyurvedicPharmacy, Udupi, Karnataka.Method of administration:1) Dhatri Lauha: Dhatri Lauha was administered 500mg, twice a day, after food, with water.Objectives of the study: • To do a comprehensive conceptual study on Pandu roga. • To evaluate the therapeutic effect of Dhatri Lauha in Pandu roga patients without alteration in their routine, dietary and physical activities.Methods:Source of data: Patients presenting the Pratyatmaka Lakshanas of Pandu roga was selected forthe study from OPD and IPD section of SDM Ayurveda Hospital, kuthpady, Udupi.Method of collection of the data:It is a single blind clinical study with a pre-test and post-test design where minimum of20 patients diagnosed as Pandu roga are selected.A special proforma prepared with all points of physical signs, symptoms and laboratoryinvestigations. 73
  • 87. Clinical Study MethodologyInclusion criteria: 1) Patients with pratyatma lakshana of Pandu 2) Haemoglobin percentage between 5-9 g % 3) Patient’s age in between – 16-60 yrs of both sexes.Exclusion criteria: 1) Patients of disorders like Hepatic cirrhosis, Uraemia, 2) Patients of Malignant disorders. 3) Patients diagnosed as Hemolytic Anaemia. 4) Patients of age below 16 and above 60 years.Assessment parameters before and after treatment: 1. Relief in signs and symptoms of Pandu roga. 2. Changes in Haemoglobin percentage.Grading of the Assessment criteria.Balahani (Weakness): No weakness -0 Weakness not affecting his daily activities -1 Weakness affecting his daily activities -2 Activities reduced due to weakness - 3.Shrama (Fatigue): No Fatigue - 0. Fatigue not affecting his daily activities -1 Fatigue affecting his daily activities -2 Activities reduced due to Fatigue - 3. 74
  • 88. Clinical Study MethodologyArohanaayasa (Exertional Dyspnoea): No Exertional Dyspnoea -0 Mild dyspnoea with normal activities -1 Dyspnoea stops his daily activities intermittently -2 Dyspnoea stops his daily activities frequently -3Hridrava (Palpitation): No Palpitation - 0. Mild Palpitation with normal activities - 1. Palpitation with daily activities -2 Palpitation during rest -3Pandutwa (Pallor): No Pallor - 0. Conjunctiva slightly pale, nail and other mucus membrane not pale -1 Conjunctiva pale, nail and other mucus membrane slightly pale -2. Conjunctiva, mucus membrane and nails pale -3Grading of Severity of disease: 1. Subjective Symptoms- Severity of manifestation >70% -Severe. Severity of manifestation-50-70% -Moderate Severity of manifestation-<50% -Mild.2. Laboratory Criteria- Hbg%- 5-6g% and Hypo chromic Microcytic – Severe. Hbg%-6-8g% and Normochromic Microcytic – Moderate. 75
  • 89. Clinical Study Methodology Hbg%-8-9g% and Normochromic Normocytic – Mild. Between the two grading, the grading of highest severity is considered as gradingof severity of the disease.Duration of treatment: This therapy is continued for 1 month. Hb% is done before and after the treatment. 76
  • 90. Clinical Study Observation ObservationIn the present study, 20 patients suffering from Pandu, fulfilling the inclusion criteriawere registered, Following are the detailed descriptive statistical analysis of the patientsincluded in the study. Total patients registered for the study : 20 Completed : 20 Observations1. Age Incidence: The majority of the patients (50 %) were reported in the age group of20 – 29 years followed by 40% in the age group of 30 - 39 years, 10% in the age group of40 – 49 years (table 14 & chart 4). TABLE 14: SHOWING AGE INCIDENCE OF PATIENTS Age Group No. of Pts No. of pts in % 20-29 10 50 30-39 8 40 40-49 2 10 50-59 0 0 CHART 4: SHOWING AGE INCIDENCE OFPATIENTS Age in years 50 45 40 35 30 25 No of Pts in % 20 15 10 5 0 20-29 30-39 40-49 50-59 77
  • 91. Clinical Study Observation2. Sex Incidence: Total 100% incidence of Pandu was found in females.(Table15 & chart 5) TABLE 15: SHOWING SEX INCIDENCE OF PATIENTS Sex No. of pts No of Pts in % Male 0 0 Female 20 100 CHART 5: SHOWING SEX INCIDENCE OF PATIENTS Sex Incidence 100 90 80 70 60 No of Pts in % 50 40 30 20 10 0 Male Female3. Religion incidence: Maximum number of patient’s i.e. 80% were Hindus, 5% patientswere Christians and 15% patients were Muslims. (Table16 & chart 6) TABLE 16: SHOWING RELIGION INCIDENCE OF PATIENTS Sex No. of pts No of Pts in % Hindu 16 80 Muslim 3 15 Christian 1 5 78
  • 92. Clinical Study Observation CHART 6: SHOWING RELIGION INCIDENCE OF PATIENTS Religion 80 70 60 50 No of Pts in % 40 30 20 10 0 Hindu Muslim Christian4. Marital status incidence: 75% patients were married. 25% was unmarried. (Table17& chart7) TABLE 17: SHOWING MARITAL STATUS OF PATIENTS Marital No.of pts % Status Unmaried 5 25 Married 15 75 CHART 7: SHOWING MARITAL STATUS OF PATIENTS Marital Status 80 70 60 50 No of Pts in % 40 30 20 10 0 Unmaried Married 79
  • 93. Clinical Study Observation5. Occupational Incidence: Most of the patients were housewives i.e. 50%, socialworkers were 35%. While the remaining 25% were students (table18 & chart 8) TABLE 18: SHOWING OCCUPATIONAL INCIDENCE OF PATIENTS Occupation No. of pts No of Pts in % HouseWife 10 50 SocialWorker 7 35 Student 3 15 CHART 5: SHOWING OCCUPATIONAL INCIDENCE OF PATIENTS Occupational incidence 50 45 40 35 30 25 No of Pts in % 20 15 10 5 0 HW SW ST6. Habitat Incidence: Most of the patients wereof rural area i.e., 55% and from urbanarea 45% (Table19 & Graph 9) TABLE 19: SHOWING HABITAT INCIDENCE OF PATIENTS Habitat No. of pts No of Pts in % Urban 9 45 Rural 11 55 80
  • 94. Clinical Study Observation CHART 9: SHOWING HABITAT INCIDENCE OF PATIENTS Habitat incidence 60 50 40 No of Pts in % 30 20 10 0 Urban Rural7. Socio-Economic status incidence: It is observed that maximum patient belongs tomiddle class i.e.50%, followed by higher middle 25%, lower middle 25% (table 20 &chart 10) TABLE 20: SHOWING SOCIOECONOMIC STATUS OF PATIENTS Status No.of pts No of Pts in % MiddleClass 10 50 LowerMiddle 5 25 HigherMiddle 5 25 CHART 10: SHOWING SOCIOECONOMIC STATUS OF PATIENTS Socio-economic status 50 45 40 35 30 25 No of Pts in % 20 15 10 5 0 MC LM HM 81
  • 95. Clinical Study Observation8. Educational status incidence: 10% of the patients were educated up to Post-Graduation. While 10% had completed Graduation. 65% were completed high school.15% were stopped their education to primary school level. (Table 21 & chart11) TABLE 21: SHOWING EDUCATIONAL STATUS OF PATIENTS Education No. of pts No of Pts in % PrimarySchool 3 15 HighSchool 13 65 Graduation 2 10 PostGraduation 2 10 CHART 11: SHOWING EDUCATIONAL STATUS OF PATIENTS Educational status 70 60 50 40 No of Pts in % 30 20 10 0 PS HS G PG9. Incidence of Dietary Habits: 80% of the patients were accustomed to mixed type ofdiet while 20% were Vegetarians (table22 & graph 9). TABLE 22: SHOWING DIETARY HABITS OF PATIENTS Diet No.of pts No of Pts in % Veg 4 20 Mixed 16 80 82
  • 96. Clinical Study Observation CHART 12: SHOWING DIETARY HABITS 0F PATIENTS Dietary habits 80 70 60 50 No of Pts in % 40 30 20 10 0 Veg Mixed10. Incidence of Deha Prakruti: A predominance of Vatakapha prakruti was observedin the patients with 80% followed by Pittakapha 20% (table23 &chart 13). TABLE 23: SHOWING PRAKRUTI OF PATIENTS Prakruti No.of pts No of Pts in % VataPitta 0 0 VataKapha 16 80 PittaKapha 4 20 CHART 13: SHOWING PRAKRUTI OF PATIENTS Prakruti 80 70 60 50 40 No of Pts in % 30 20 10 0 VP VK PK 83
  • 97. Clinical Study Observation11. Incidence of Sara: 55% of the patients were of Mamsa Sara while 25% were ofAsthi Sara,15% were of Medho sara and 5% were of Rakta sara observed(table24 & chart14). TABLE 24: SHOWING SARATAHA OF PATIENTS Sarataha No.of pts No of Pts in % Twak 0 0 Rakta 1 5 Mamsa 11 55 Medo 3 15 Asthi 5 25 Majja 0 0 Sukra 0 0 Sarva 0 0 CHART 14: SHOWING SARATAHA OF PATIENTS Sarataha 60 50 40 30 No of Pts in % 20 10 0 Tk Rt Mm Md At Mj Su Sv12. Incidence in Samhanana: Patients of Madhyama Samhanana were 100% (table25 &chart 15). 84
  • 98. Clinical Study Observation TABLE 25: SHOWING SAMHANANA OF PATIENTS Samhanan No.of pts No of Pts in % Pravara 0 0 Madhyam 20 100 Avara 0 0 CHART 15: SHOWING SAMHANANA OF PATIENTS Samhanana 100 90 80 70 60 50 No of Pts in % 40 30 20 10 0 Pravara Madhyam Avara13. Incidence of Satva: Satva analysis of the patients revealed 100% of Madhyama aSatva, (table 26& chart 16). TABLE 26: SHOWING SATVA OF PATIENTS Satva No.of pts No of Pts in % Pravara 0 0 Madhyam 20 100 Avara 0 0 85
  • 99. Clinical Study Observation CHART 16: SHOWING SATVA OF PATIENTS Satva 100 90 80 70 60 50 No of Pts in % 40 30 20 10 0 Pravara Madhyam Avara14. Incidence of Rasa Satmya: 50% of the patients were Lavana and Madhura rasaSatmya while 30% were Amla Madhura Rasa Satmya and 20% were accustomed toMadhura Rasa (table27 & chart 17). TABLE 27: SHOWING RASA SATMYA OF PATIENTS Rasa No.of pts No of Pts in % Madhura 4 20 AmlaMadhura 6 30 LavanaMadhura 10 50 Katu 0 0 CHART 17: SHOWING RASA SATMYA OF PATIENTS Rasa satmya 50 45 40 35 30 25 No of Pts in % 20 15 10 5 0 M A+M L+M K15. Incidence of Agni: Manda Agni was observed in 100% of the patients (table28 &graph 18). 86
  • 100. Clinical Study Observation TABLE 28: SHOWING INCIDENCE OF AGNI IN PATIENTS Agni No.of pts No of Pts in % Sama 0 0 Vishama 0 0 Manda 20 100 CHART 18: SHOWING INCIDENCE OF AGNI IN PATIENTS Agni 100 90 80 70 60 50 No of Pts in % 40 30 20 10 0 Sama Vishama Manda16. Incidence of Koshta: Madhyama Koshta was observed in 100% of the patients(table29 & graph 19). TABLE 29: SHOWING INCIDENCE OF KOSHTA IN PATIENTS Koshta No.of pts No of Pts in % Mridu 0 0 Madhyama 20 100 Krura 0 0 87
  • 101. Clinical Study Observation CHART 19: SHOWING INCIDENCE OF KOSHTA IN PATIENTS Kosta 100 90 80 70 60 50 No of Pts in % 40 30 20 10 0 Mridu Madhyama Krura17. Incidence of Bala: 100% of the patients were of Madhyama Bala, (table 30 & chart20). TABLE 30: SHOWING BALA OF THE PATIENTS Bala No.of pts No of Pts in % Pravara 0 0 Madhyama 20 100 Avara 0 0 CHART 20:SHOWING BALA OF THE PATIENTS Bala of pts 100 90 80 70 60 50 No of Pts in % 40 30 20 10 0 Pravara Madhyam Avara18. Incidence of Family History: All the patients are not having any family history. 88
  • 102. Clinical Study Results RESULTS1. Effect on Haemoglobin%The mean score of Haemoglobin which was 8.613±0.593 before treatment came down to9.238±0.522 after treatment. Statistical analysis of this data proved to be highlysignificant. (P=<0.001) (Table31).Table 31: Effect on Haemoglobin % Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P8.613+0.593 9.238+0.522 0.625 0.275 0.0615 10.162 <0.001Chart 21: Effect on Haemoglobin % Effect on Haemoglobin% 9.5 BT 9 Mean AT 8.5 82. Effect on Pandutwa The mean Pandutwa which was 1.050±0.686 before treatment reduced to 0.250±444after treatment statistical analysis of data proved to be significant at P<0.001 (table 32). 89
  • 103. Clinical Study ResultsTable 32: Effect on Pandutwa Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P1.050+0.686 0.250+0.444 0.800 0.410 0.0918 8.718 <0.001Chart 22: Effect on Pandutwa Effect on Pandutwa 1.5 BT 1 Mean AT 0.5 03. Effect on AlasyaBefore treatment the mean score of Alasya was 1.350±0.250 and after treatment it was0.489±0.444 indicating that there was a significant improvement. This result is highlysignificant at P<0.001 (table 33).Table 33: Effect on Alasya Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P1.350+0.250 0.489+0.444 1.100 0.308 0.0688 15.983 <0.001 90
  • 104. Clinical Study ResultsChart 23: Effect of Alasya Effect on Alasya 1.5 BT 1 Mean AT 0.5 04. Effect on ShramaImprovement was seen in this symptom with a reduction in the mean score from0.950±0.224 to 0.1000±0.308 which is statistically significant at P<0.001 (table 34).Table 34: Effect on Shrama: Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P0.950+0.224 0.1000+0.308 0.850 0.366 0.0619 10.162 <0.001Chart 24: Effect on Shrama Effect on Shrama 1 BT Mean 0.5 AT 0 91
  • 105. Clinical Study Results5. Effect on Arohana ayasaThere was statistically significant P<0.001 change in the symptomatology with the meanscores being 0.400±0.503 and 0.0500±0.224 pre and post treatment respectively(table35).Table 35: Effect on Arohana ayasa Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P0.400+0.503 0.0500+0.224 0.350 0.489 0.109 3.199 0.005Chart 25: Effect on Arohana ayasa Effect on Arohana ayasa 0.4 BT Mean 0.2 AT 06. Effect on Kati RukThe mean score of Kati ruk before treatment was 1.400±0.503 treatment and this reducedto 0.450±0.510 following the treatment which indicates that the difference is highlysignificant statistically. (P<0.001) (Table 36)Table 36: Effect on Kati ruk Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P1.400+0.503 0.450+0.510 0.950 0.224 0.0500 19.000 <0.001 92
  • 106. Clinical Study ResultsChart 26: Effect on Kati ruk Effect on Kati ruk 1.5 BT 1 Mean AT 0.5 07. Effect of Swetha AkshiThe mean score for Swetha akshi which was 1.250±0.550 before treatment came down to0.300±0.470 after the treatment. This difference is highly significant statistically.(P=<0.001) (Table37).Table 37: Effect on Swetha akshi Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P1.250+0.550 0.300+0.470 0.950 0.224 0.0500 19.000 <0.001Chart 27: Effect on Swetha akshi: Effect on Swetha Akshi 1.5 BT 1 Mean AT 0.5 0 93
  • 107. Clinical Study Results8. Effect on HridravaThe mean score was 0.350±0.489 before treatment and 0.150±0.366 after treatment. Thisis statistically significant at P<0.042 and rules out the possibility of the change havingoccurred by chance (table 38).Table 38: Effect on Hridrava Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P0.350+0.489 0.150+0.366 0.200 0.410 0.0918 2.179 0.042Chart 28: Effect on Hridrava Effect on Hrudrava 0.4 BT Mean 0.2 AT 09. Effect on AruchiThe mean score was 0.950±0.224 before treatment and 0.200±0.410 after treatment. Thisis statistically significant at P<0.001 (table 39)Table 39: Effect on Aruchi Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P0.950+0.224 0.200+0.410 0.750 0.444 0.0993 7.550 <0.001 94
  • 108. Clinical Study ResultsChart 29: Effect on Aruchi Effect on Aruchi 1 BT Mean 0.5 AT 010. Effect on DourbalyaThe mean of Dourbalya score before treatment was 1.050±0.224 and after treatment0.250±0.444 this is statistically highly significant at P<0.001 (table 40).Table 40: Effect on Dourbalya Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P1.050+0.224 0.250+0.444 0.800 0.410 0.0918 8.718 <0.001Chart 30: Effect on Dourbalya Effect on Dourbalya 1.5 BT 1 Mean AT 0.5 0 95
  • 109. Clinical Study Results11. Effect on GauravaThe mean scores of Gaurava was reduced from 0.350±0.489 to 0.150±0.366 followingthe treatment. This result was found to be highly significant at P=<0.042 (table 11) andrules out the possibility of the change having occurred by chance (table 41).Table 41: Effect on Gaurava Difference Mean Paired ‘t’ Test in Means BT AT S.D. S.E.M ‘t’ P0.350+0.489 0.150+0.366 0.200 0.410 0.0918 2.179 0.042Chart 31: Effect on Gaurava Effect on Gourava 0.4 BT AT Mean 0.2 0 96
  • 110. Clinical Study Discussion DISCUSSIONPandu and Iron Deficiency Anaemia: The disease Pandu includes Iron Deficiency Anaemia, told in contemporaryscience. Similarities can be studied under following sub headings, • Aetiology • Pathogenesis • TreatmentAetiology:Pandu has various aetiologies like Asatmyabhojana, Atimadyapana, Kshara, Nishpava,Pinyaka, Krodha, Bhaya that increase Vata and Pitta. These are Apatarpanakaraka. ThisApatarpana may be grossly taken as, the inadequate dietary intake which can causeAnaemia119. However, poor economic status and pregnancy where both anorexia andincreased requirements coexist can cause Iron Deficiency Anaemia. Ativyayama, Atimaithuna, Bharaharana, Panchakarma pratikarma cause excessivekarshana of body, because of which the body requirements increases, which is once againsimilar to the aetiology of Iron Deficiency Anaemia. Excess intake of Paya, Ikshu, Amla, Lavana, Masha, Asatmyabhojana causeAgnimandya and Ama, which can lead to decreased absorption from the Gastro -intestinal tract and cause nutritional deficiency Anaemia. Even certain diseases likeGrahani can cause the same120. Increased blood loss is the direct cause for Anaemia. Even in texts, varioushaemorrhagic conditions are described which cause Pandu like Raktati pravrutti,Raktarbuda, Krimi, Arsha, etc. 97
  • 111. Clinical Study Discussion The aetiologies of Pandu Roga are having similarities with the aetiologies of IronDeficiency Anaemia.Pathogenesis: Among the Dhatu involvement, Pandu chiefly affects the Raktadhatu as it isclearly told by Sushruta, Chakrapanidatta, Charaka and Vagbhata. Iron DeficiencyAnaemia also involves the same phenomenon.Rakta and Lauha: • Rakta is also called Lohita121 • In excessive blood loss, there will be perception of Lauha like odour as in poorvaroopa of Raktapitta122 and in Abhyantara koshtagata Rakta srava123. • In Rakta srava, Sushruta has advised consumption of Yakrut124, which is the chief source of Iron. • Alparaktata produces decrease in its functions i.e. Jeevana, Mamsapushti125, Dhatu poshana and Vardhana126, Bala varnakara127. So also, reduction of blood affects its various functions related to Nutrition, Respiratory, Homeostatic process and defense mechanisms of the body. • Important components required for haemopoietic system are Iron, Vit. B12, and Folic acid, their deficiency leads to anaemia. • In conditions of Alparaktata, texts have advised many Lauha preparations. When there is Apatarpana nimittaja alparaktata, then this should be considered as being caused by deficiency of few of the key components required for production of rakta. Among these, Lauha can be considered as one of the main constituents. 98
  • 112. Clinical Study DiscussionIn Iron Deficiency Anaemia, symptomatologies referred to muscular system are commonlike, tiredness, easy fatiguability and generalized muscular weakness128. Ojakshaya canlead to destruction of body129, Bala and Tejahani130 and it decreases the Vyadhi kshamata. Anemic condition will make any one susceptible to infection. In deficiency state,activity of cytoplasmia enzyme, myclo peroxidase coupled with hydrogen peroxidegenerating system in granulocytes is affected131. This affects phagocytic function andreduces immunity. Iron deficiency lowers antibody production in response to theadministration of bacterial antigens. Cell mediated immunoresponse in Anaemia isimpaired132. Host mechanism against infection is reduced133.Iron has a vital function of sustaining life through essential Iron containing compoundslike Cytochrome catalyse, Peroxidase and Xanthine oxidase134. Pandu affects body partslike Indriya, Mana and Twacha. In Iron Deficiency Anaemia, various Central nervoussystem and gastrointestinal system features reveal the involvement of above body parts.Pandu Roga as a Sahaja vyadhi: Adibala pravrutta (Sushruta), Sanchari (Yagnavalkya), Kulaja (Charaka), Sahaja(Vagbhata) and Prakrutibhava (Bhela), are synonymous with Sahaja vyadhi. Sushrutaopines that, “Kushta arsha prabhrutaha” are Adibala pravrutta vyadhis. Dalhanacommenting on it says that in “Adibala”, there is Doshic vitiation of Shukra Shonitacausing Beeja dushti and “Prabhrutaha” includes other diseases like Meha, Kshaya etc.However, “Adi” also includes other diseases that are due to Bija dushti. Hereditary Anaemia can be included under Pandu Vyadhi. Considering the factthat few of the Anaemia are hereditary, we can give a parallel thinking that Pandu can be 99
  • 113. Clinical Study Discussiona Sahaja Vyadhi though no concrete references regarding Pandu as Sahaja Vyadhi arefound in Ayurvedic texts.Clinical manifestation: Table no. 13 shows the similarity in the manifestation of Pandu and IronDeficiency Anaemia. Thus, we can conclude that the conceptual study of Pandu and IronDeficiency Anaemia reveals later as one of the aetio-pathology of Pandu. Clinical studyrevealed that Iron Deficiency Anaemia mainly presented as Vataja Pandu. Conceptualstudy reveals that Pandu as a whole entity cannot be equated with Iron DeficiencyAnaemia in particular. But the clinical study reveals Vataja Pandu having moreinclination towards Iron Deficiency Anaemia.Regimen:After a thorough clinical and laboratory confirmation of the disease, patients wereregistered for the study. Medication was in accordance with the principles of treatment.Plan of study: After careful examination, 20 patients were registered for the study. They wererandomly divided. Before the medication, thorough laboratory investigations were done.The regimen was started with medication for 1 monthGeneral Description of the patients: 20 patients were registered for the study. Incidence study of all the registeredpatients is as follows:1) Age incidence: Maximum number of patients in the study was in between 20-29 yrs(50%) of age. Contributory factors for women were menstruation, marital tension,lactation and finally dietary inadequacy. 100
  • 114. Clinical Study Discussion2) Sex Incidence: True to the basic feature of the disease i.e. its predominance in females(100%), in this study all females were registered. Menstruating female requires doublethe quantity of dietary Iron supplement than the non-menstruating. This may be the causefor maximum prevalence among females.3) Religion Incidence: Study records larger number of Hindus (80%), when compared toMuslim (15%) and Christian (5%) religions. Data reflects more on the geographicalpredominance of a particular sect, Hindus being dominant in Udupi4) Occupational Incidence: Most of the patients of Pandu were accustomed to mediumwork.5) Habitat Incidence: Patients were more of rural area (55%) than urban (45%)6) Socio-economic Status: Patients belonging to the middle class (50%) were moreaffected by Pandu (Iron Deficiency Anaemia). Lower socio-economic Group (25%)consumes food deficient in Iron and contributing to this, is their heavy labour work,which triggers depletion of Iron stores in body. Patients of upper middle class (25%)were also affected may be due to low dietary Iron intake, poor bio-availability orabsorption of Iron7) Marital Status Incidence: Married patients (75%) were the most sufferers of Panduthan the unmarried patients (25%).8) Educational Status: More patients had completed their education till high school (65%)followed by graduate (10%) and post-graduation (10%), primary school (15%).9) Incidence of Addiction: Most of the patients of Pandu were not addicted to any habits10) Dietary Incidence: Patients of mixed diet (80%) were maximum 101
  • 115. Clinical Study Discussion11) Satwa and Sara Incidence: Most of the patients were of Madhyama Satwa (100%)and Mamsa Sara (55%)12) Incidence of Prakruti: Maximum patients of Pandu were vatakaphaja prakruti(80%),followed by pittakapha (20%).13) State of Agni in patients of Pandu: In most of the patients Agni was Manda(100%)14) Koshta in Pandu Rogi: Most patients had Madhyama Koshta (100%)15) Duration of Illness: Most of the patients had a history of less than 3 months16) Sleep Pattern: Most had normal sleeping habit17) Doshic involvement: Vata Pradhana, Pitta Anubandha Pandu was maximum18) Symptomatology Incidence: Pandutwa, Arohana ayasa, Shrama were present in allthe patients of Pandu (Iron Deficiency Anaemia). Other manifestations like Balahani,Hridrava, Angamarda were also observed. Study showed predominance of Vatajalakshanas. Based on the data, relation can be drawn that in Pandu the predominantpresenting features are Pandutwa, Arohana ayasa and ShramaDiscussion on observations during study:• Aharataha Nidana: Detailed questioning in clinical study elicited few of the Nidanas as told in thetext. But in most of the patients, it was difficult to elicit the specific Nidana due to non-compliance and in few due to Avara Satwa and irritable mental status.80% of patients took mixed diet, mainly comprising of Matsya. Most of the patients wereSatmya to Madhura, Lavana Pradhana Rasa (55%) and Amla, Katu Pradhana Rasa(35%). Patients were in the habit of taking Teekshna and fried foodstuffs. Patients’ food 102
  • 116. Clinical Study Discussioncontained more proportion of Masha. Most of the patients were of lower middle class,dietary history revealed Teekshna Bhojana (60%), Alpamatra Bhojana (40%).• Nidanarthakara roga: Pandu due to other disease were ruled out by proper history,examination and laboratory findings. Laboratory examinations were conducted to aid ourdiagnosis and to exclude associated pathologies.• Poorvaroopa: In the clinical study, patients did not approach during the stage ofPoorvaroopa.• Roopa: Majority of the manifestations in the body had Samanya lakshana of Pandu,such as, o Main features Pandutwa – Pandutwa was seen in skin, nails and eyes of all patients (100%).The family members often noticed it. Shrama – Was the feature that troubled the patients much (100%). Reducedworking capacity was the often the complication of Shrama. Arohana ayasa – was also one of the main symptoms, which was seen in allpatients (100%). Climbing stairs or any slight exertion caused breathlessness forcingthem to stop their work intermittently. o Associated features: Dourbalya (76.19%), Hridrava (57.1%) and Shoola were theother presenting features. Different types of Shoola were observed like Udarashoola andother Vataja lakshanas were 65.6%, Pittaja were 7.7% and Kaphaja were 15.4%• Past illness: Patients with history of similar presentation in the past were not seen.• Family history: No history of Pandu in patient Families. 103
  • 117. Clinical Study Discussion• Treatment history: No history of haematinics was found in patients.Effect of treatment: Effect of treatment was assessed both clinically as well as based on laboratoryparameters. Clinical features were assessed in 30 days with Hb%.Weakness: Weakness was significantly reduced (76.19%) in maximum no. of patients.Fatigue: Marked relief (89.4%) was seen in 30 days of medication.Exert ional Dyspnoea: 87.5% remission was observed in 30 days of medication.Pandutwa: maximum improvement (76.5%) was seen in 30 days of treatmentHridrava: 57.1% relief was observed in 30 days of medication.Haemoglobin Percentage: maximum increase (92.75%) was seen in 30 daysOverall affect of medication on the features of Pandu:After 1 month of medication: Dhatri Lauha is better in the following features of Pandu(Iron Deficiency Anaemia):Features: Weakness, Fatigue,Hridrava, Exertional Dyspnoea, Pandutwa, Haemoglobinpercentage, Kasa, Karna Kshweda, Shoola, Shrama, Tamah pravesha, Alpanidrata.PROBABLE MODE OF ACTION OF MEDICINE Dhatri LauhaIngredients in decreasing order of their proportions in Dhatri lauha are as follows:a) Amalaki 8Phala (384gms)b) Yashtimadhu 2phala (96gms)c) Loha bhasma 4Phala (192gms)d) Guduchi kwatha Sufficient Quantity for bhavana 104
  • 118. Clinical Study Discussion Amalaki is the main ingredient in this Yoga and hence the name Dhatri lauha inBhaishajya Ratnavali. Action of a medicine mainly depends upon its subtle constituentslike Rasa, Guna, Virya, Vipaka, and Prabhava etc. When the Rasadis are equally strong,the Vipaka dominates over Rasa; Virya suppresses the Rasa and Vipaka while Prabhavadominates over all.Rasa: Amalaki is Amla rasa pradhana and can increase Rakta and hence in Raktalpata,Amla preeti is seen. Madhura rasatmaka dravyas like Yashtimadhu, are Preenana,Brimhana, Ksheena dhatu Vardhaka.Guna: Guru, Snigdha guna of Yashtimadhu snigdha,Virya: Amlaki have Sheeta virya.Vipaka: Most of the Dravyas have Madhura vipaka viz. Amalaki, Madhura, Sheetagunaare Balavarnakara, Dhatuvardhaka, Preenana and Jeevana. Thus it can revert back theDhatu shathilya, Gourava, Oja guna kshaya and other Dhatu kshaya.Prabhava: • Amalaki Vrishya, Rasayana, Chakshushya • Yashtimadhu Chakshushya, Shukrala, SwaryaKarma:Dosha karma: • Pittahara: Amalaki, Yashtimadhu, 105
  • 119. Clinical Study Discussion • Vatahara: Yashtimadhu • Kaphahara: Amalaki • Tridoshaghna: Amalaki,Vyadhi karma: • Amalaki Raktapitta, Meha • Yashtimadhu Sadyo kshatasruk harati, Kshaya, ShoshaThese qualities can have an impact on all the entities of the Samprapti like Dosha : Vatapittahara mainly Dushya : Santarpanakaraka, Balya, Dhatuvardhaka, few are Specially effective on Raktaja vikara Srotas : Also acts on Rasavaha srotas (Aruchi, Twak panduta) Raktavaha srotas (Kushta, Raktapitta, Kamala) Agni : Agnivardhaka Ama : AmapachakaMruta loha guna: Rasa : Tikta, Kashaya Guna : Ruksha Virya : Sheeta Karma : Balya, Vrishya, Twak rogahara, Medhya Also helpful in other Alpa rakta conditions like Rakta srava.Lauha Bhasma is an Iron preparation with Iron in the ferrous state. Ferrous Iron can geteasily absorbed in the body. 106
  • 120. Clinical Study Conclusion CONCLUSION1. Pandu Roga mostly affects the females than males.2. Martial status, religion, Social status bear no relation in causation of Pandu Roga.3. Sedentary life style, and fault dietary habits are main contributing factors in theestablishment of the disease. Tendency towards sedentary life style and faulty dietaryhabits, leads to vitiation of Pitta and Rakta leading to Pandu roga.4. Etiological factors here mainly related with Pitta and Rakta vitiation5. The study confirms the dominancy of Pitta Dosha, Rakta Dhatu Dusti, Rasavaha andRakta Srotodushti in the pathogenesis of Pandu roga.6. Pandu Roga is a disease characterized by Pandutva, Swethakshi, Hridaya spandana andRukshtva of the body.7. It can be concluded that on the basis of Nidana, purva rupa and Samprapti of vatajaPandu can be correlated with Iron deficiency anaemia.8. Dhatu apakarshana and Ojo dushti is an invariable manifestation of the disease.9. On the basis of result of the therapy it can be deduced that Dhatri Lauha provided reliefin the chief complaints like Pandutva, swethakshi, Daurbalya.10. It was effective in increasing the Hemoglobin percentage. The mean difference inHb% was 0.607 with P< 0.001 whis is statistically significant.11. The present study was carried on small sample for a limited time with out alterationin their routine dietary and physical activities and it showed encouraging results.However to be more confirmative further study should be conducted on large sample forlonger duration with diet. 107
  • 121. Clinical Study Summary SUMMARY This dissertation entitled “Effect of Dhatri Lauha in Pandu roga” with specialreference to Iron deficiency Anaemia comprises of six chapters namely Historical review,Conceptual study, Drug profile, Clinical study, Discussion, Summary and Conclusion.Historical Review This chapter deals with the historical aspects related to Pandu. Descriptionregarding diseases related to discolouration of body is available in Rigveda andAtharvaveda. Hariman and Harita are two such diseases that appear to be Jaundice andPallor respectively. Along with the identification of the disease, treatment for the samehas also been described. Other books like Jaiminiya Brahmana and Garuda Purana havealso mentioned Hariman. Elaborate description of the disease Pandu is available fromSangrahakala onwards. Charaka, Ashtanga Hridaya and Ashtanga Sangraha, haveelaborately discussed regarding Pandu and accepted 5 types of Pandu whereas Sushrutahas classified it as of 4 types. But few other scholars acknowledge 8 types of Pandu. Themajor contribution during sangraha kala was the addition of different loha preparations inthe treatment of Pandu.Conceptual Study Conceptual study of Pandu and Iron deficiency Anaemia are elaboratelydiscussed in this chapter. Nirukti, Paribhasa, Paryaya, Nidana, Samprapti, Lakshana,Upadrava, Sadhyasadhyata and Arishta of Pandu are discussed in detail. Also includedare Definition, classification, manifestation and treatment of Iron deficiency Anaemia. The Nirukti of Pandu Roga reveals that, the disease is named after varna viz.Pandu. Pandu varna means shweta and peeta mishrita varna. 108
  • 122. Clinical Study Summary Pandu nidana can be broadly classified into Aharaja, Viharaja,Nidanarthakararogaja and Vaidyakruta. Most of the Nidana are Vatapittakara and Vidahi.Nidanarthakara roga can produce Pandu by causing Raktalpata directly by Raktasrava orby Rasadhatu dushti. Panchakarma pratikarma vaishamya can produce Pandu. Samanya and vishesha samprapti of the disease is discussed at length. Lakshana are mainly divided into Samanya and Vishesha. Vishesha includesVataja, Pittaja, Kaphaja, Tridoshaja and Mrudbhakshanajanya Pandu. These have beendealt within relation to different texts. Purvarupa, upadrava, sadhyasadhyata are reviewed according to different authors.Chikitsa is mainly of two types, Shodhana and Shamana. All the patients in this studywere suffering from Vataja Pandu.Drug Profile The chapter on Drug profile includes a detailed study on Dhatri Lauha along withingredients and their probable mode of action in Panduroga.Clinical Study Clinical study describes the registration of patients and details of inclusion andexclusion criteria, diagnostic criteria, assessment criteria and the investigationsconducted. After registration, patients were randomly selected for administration of trialdrug Dhatri Lauha.• Dhatri Lauha was administered in the dosage of 500mg bd.• A total of 20 patients were registered, who are having the Pratyatmaka lakshanas ofPandu roga. 109
  • 123. Clinical Study SummaryObservations: Various observations regarding incidence study like patient’s age, sexetc., clinical findings like satwa, sara, agni, koshta, incidence of clinical features of Panduare tabulated and shown.Results: Results of the clinical trial were assessed on the basis of the grading given forassessment criteria. Observations were subjected to standard statistical analysis, the dataof which have been presented in the chapter.Discussion Here, discussion of the conceptual aspect of disease, its comparison with IronDeficiency Anaemia and the interpretations of the results of the clinical trials has beenincluded. Major emphasis is on the clinical trials. Clinical elicitation of the differentaspects of the disease like nidana, poorvarupa, roopa and upadrava are discussed. Bothobservation and results related to the study are discussed with derivation of possibleinferences.ConclusionAn abstract of the complete dissertation and the conclusions drawn are presented here.• Conclusions are as follows:Conceptual study1) Vyutpatti reveals that the word Pandu is formed from ‘Padi gatou’. Here ‘Gatou’ isrelated to transformation. In this context it is the affliction of the process oftransformation of the dhatus like Rasa, Rakta. 110
  • 124. Clinical Study Summary2) Nirukti and paribhasha reveals that Panduroga is a disease named after differentdiscolourations of the body mainly Pandu varna. Pandu varna refers to shweta and peetamishrita varna.3) Study of the Nidana of Pandu reveals:a) Apatarpana karaka - • Ahara: Tila, Pinyaka, Kshara, Viruddhahara, Asatmya, Pista, Amla, Lavana etc. These are mainly Pitta Rakta Vata vardhaka and Vidahi. • Vihara: Ativyayama, Bharaharana, Atimaithuna, Vegadharana, Krodha. • Vaidyakruta: Panchakarma pratikarma vaishamyab) Santarpana karaka – Amisha, Paya, Ikshu, Yapana basti atiyoga.c) Nidanarthakara roga – They lead to Pandu by causing Alparaktata. This Alpa raktatacan either be directly due to rakta srava or due to rasavaha srotodushti. In the aspect of treatment, texts have given importance to both Vamana andVirechana. But difference of opinion between types of Shodhana is seen betweenCharaka and Sushruta. Charaka suggests Teekshna, Snigdha shodhana while Sushrutarecommends Snigdha shodhana.Clinical study: From the clinical study, following conclusions are being drawn.Observation: Maximum patients belonged to age group of 20-29 years (50%).Predominantly afflicted were of female population (100%). Majority of them belonged toHindu religion (80%) and were from rural area (55%). Most of the patients were educatedtill high school (65%), had no addiction and patients of consumed mixed diet (80%). 111
  • 125. Clinical Study Summary Most of patients were of Madhyama Satwa (100%), were of MadhyamaSamhanana (100%); Bala was Madhyama (100%); predominance of Mamsa Sara wasobserved (55%), Prakriti of most of the patients was Vata-Kapha (80%), most of themwere having Satmya to Lavana, Madhura rasa (50%), status of Agni was Mandagni inmost of the patients (100%) and Koshta was Madhyama (100%). Most patients had soundsleep, most were suffering from the symptoms since 0-3 months. Doshas involved in thepatients of Pandu was Pittanubandha Vataja Pandu, Pitta-kaphanubandha Vataja Pandu,Kaphanubandha Vataja Pandu; Severity of the disease among the patients was moderate,severe and mild.Past history: No history of major disease in family members and no past history ofHaematonics intake.Result:Dhatri Lauha:Weakness: Reduction in weakness (76.19%) was significant. This was assessed after 30days. (P<0.001).Fatigue: There was an improvement in the reduction of Fatigue (89.4%) after 30 days(P<0.001).Exertional Dyspnoea: Reduction in Exertional Dyspnoea was observed (87.5%) after 30days medication (P<0.001). 112
  • 126. Clinical Study SummaryPandutwa: Significant reduction in Pandutwa was observed (76.5%) after 30 days(P<0.001).Hridrava: Improvement in Hridrava was significant (57.1%) after 30 days of medication(P<0.001).Haemoglobin Percentage: Improvement in Haemoglobin Percentage (92.75%) was highlysignificant after 30 days of medication (P<0.001). 113
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  • 137. DEPARTMENT OF KAYA CHIKITSA S. D. M. COLLEGE OF AYURVEDA, UDUPI. CASE PROFORMA FOR CLINICAL STUDY ON PANDU ROGA I. ATURA VIVARA 1. Atura Nama : 10. Serial No. : 2. Linga : M / F 11.O.P.D.No.: 3. Vaya : ___ years. 12. Date 4. Vaivahika Vruttanta : M / UM / W / D 13. Group. : 5. Vrutti : 14.D.O.A : 6. Jati : H / M / C / J / Si 7. Saksharata : UE / PS / MS / HS / GR / PG : 8. Samajika Sthithi : VP / P / LM / M / UM / R 9. Dinanka : II. VEDANA SAMUCHRAYAM A. PRADHANA VEDANA Kala prakarsha Alpa raktata/Alpa medaskata/ Nissarata/Ojo guna kshaya/ Pandutwa/Anya pandu lakshana/ Shitilendriya.III. VEDANA VRUTTANTAIV. POORVA VYADHI VRUTTANTAV. KOUTUMBIKA VRUTTANTA Relative Dead / Alive Health status Treatment history
  • 138. Chikitsa Vruttanta:1) Ayurveda: 1.Shodana 2.Shamana2) Allopathy: 1.Haematinics 2.OthersVI. VYAKTHIGATA VRUTTANTA :1.AHARA : Veg / MixedA) Habits:samashana/vishamanshana/adhyashana/anashana/pratimashana2.Madakari dravya Abyasa: smoking/Alcohol/Tobacco chewing/Tobacco snuff/othersvihara sambandhi vruttantaSleep : ___Hours / day: __Hours / night :sound sleep/inturupted/Delayed/DisturbedExercise: Routine work/occasional/irregular/ regular/morning walkMala : ________ times daily regular / irregularMootra : ________ times daily RAJO SAMBANDHI VRUTTANTA : 1. Menstruating / attained menopause at ________ years of age. 2. Menstrual cycle : 3. History of : Udavartini/Asrugdara/ Shwethapradar / Anya YonigataVikara 4. P ____ G _____ L ____ D ____ 5. History of infertility : primary / secondaryVIII MANASIKA VRUTTANTA:X. GENERAL PHYSICAL EXAMINATION Built and Nourishment : __Wt __ Ht Pallor / Edema / Nail changes / Cyanosis / Icterus / Lymphadenopathy / Neck Nails: Clubbing/koilnychina/onychia/discolouration/haemorrhage Hair:Falling/Thick/premature graying/ Loss of hair/ Lips: Pale/dry/wet/swelling/Fisures/ulcers. Angle of mouth: Pale/dry/wet/swelling/Fisures/ulcers. Tongue:Pale/coated/dry/wet/Fissured/ulcers/tremour/deviation. Palate: ulcer/pigmentation/bleeding.
  • 139. Superficial lymph nodes: Cervical Inguinal Axillary Others Vital-signs: Temperature: Pulse rate: Blood Pressure: Respiratory rate: Cyanosis/Icterus/Pallor:SYSTEMIC EXAMINATIONRespiratory system :Cardiovascular system :Genitourinary system :Central nervous system :Gastro intestinal system :Stomach: organomegaly/hard/smooth/tendernessLiver: organomegaly/hard/smooth/tendernessSpleen: organomegaly/hard/smooth/tendernessKidney: organomegaly/hard/smooth/tendernessSROTO PAREEKSHA :Pranavaha Srotas :Udakavaha Srotas :Annavaha Srotas :Rasavaha Srotas :Raktavaha Srotas :Mamsavaha Srotas :Medavaha Srotas :Astivaha Srotas :Majjavaha Srotas:
  • 140. Shukravaha Srotas:Mootravaha Srotas :Pureeshavaha Srotas:Swedavaha Srotas :Dasha vidha pareeksha:Prakriti V/P/K/VP/VK/KP/VPKSara Twak/rakta/mamsa/meda/asthi/majja/shukra/ssarva sara.Satwa P/M/ASamhanana P/M/APramana P/M/ASatmya P/M/AAharasakti purvakalina P/M/A Adhyatana P/M/AJarana sakti Purvakalina P/M/A Adhyatana P/M/AVaya Bala/Madhyama/Vriddha.VikritiNidana:Ahara Sambandhi: kshara sevana/ amla sevana/ lavana rasa sevana/ atyushna bhojana/asatmya/ viruddha bhojnana/.mathya sevana/ amisha sevana/ ikshu sevana/ pishta sevana/paya sevana/ pinyak ati sevana/ mashati sevana/ Madhya sevana/ mrut bhakshana/teekshana ahara sevana/ maithuna/ vega vidharana/ rutu vaisha,mya/ kama/ krodha/chinta/ bhaya/ shoka/ divaswapna/ vyayama/ bharaharana/ nishapava sevana/ tilatailasevana.Vihara sambandhiShareerika/ atimaithuna/ vegadharana/ divaswapna/ vyayama/ratrijagarana/others.Manogatha karana: kama/ krodha/ chinta/ bhaya/ shoka.Nidanarthakara roga: Rakta ati pravruthi/raktarbuda/antarlohita/raktapitta/raktapradara/raktakshya/ raktasrava/grahani/arshas/pureeshaja krimi/vyavayashotha/ pitaja prathishayaya/pittaja kasa/Prameha others.Poorva roopaHridayaspandhana/twakspootana/swedabhava/shrama/steevana/hrillasa/gatrasada/mrubhakshana
  • 141. Samanya lakshana:Karana kshweda/ hatanal/ dourbalya/ sadana/ bhrama/ anndwesha/shrama/gatrashoola/jwara/shwasa/ gaurava/ aruchi/ gatramanda/gatrapeeda/gatromatra/shunakshikoota/hareetavarnata/sheernalomata/hatprabha/kopa/shishiradwesha/nidralu/steevana/alpavak/pindikodweshtanam/katiruk/katisad/padarauk/padasada/ururuk/dhatushithilyam/ojogunakshaya/ araktata/alpamedeskata/nabhishotha/ alsya/ nirutsaha.Vishista lakshana:Vataja:Krishna Panduta/rukshagaanata/kampa/shoola/varcha shosha.Pittaja: peetabhata/haritabhata/murchapipasartha/ sweda/ sheeta kamatavidhaha/atisara/tamah/murrcha/ushna anupshaya/amla anupaashaya.Kaphaja:tandra/chardhi/shwetavabhasata/lomaharsha/murcha/bhrama/kasa/vakgraha/swaragraha/swarakshaya/kantakamata/rukshakamta/ushnakamata/shoonagandha/shoonakshikoota/krimi kosta/atisara.Mrudbhakshana:SAMPRAPTI GHATAKA DOSHA : DUSHYA : SROTAS : SROTODUSTI LAKSHANA : AGNI : AMA : UDBHAVA STHANA : SANCHARA STHANA : ADHISHTANA : VYAKTA STHANA : ROGA MARGA : UPASHAYA ANUPASHAYA : VYADHI :PRAKARA :SADYASADYATA :CHIKITSA :
  • 142. ASSESSMENT CRITERIA BT ATPandutwaHridravashramaArohana ayasaSwetha akshiDourbalyaJwaraAlpavakSadanaAruchiKatirukShothaAlasya
  • 143. B. ROUTINE BT ATHAEMATOLOGYHb%LymphocytesMonocytesNeutrophilsEosionophilsBasophilsTotal WBC Count(cells/cumm)ESR (in mm/I hour)Stool examinationOva for cystOther investigationsif necessary

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