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Snehapana pandu pk028-gdg

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EVALUATION OF COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA” BY Dr. ANEESH JOSEPH KALAYIL Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. …

EVALUATION OF COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA” BY Dr. ANEESH JOSEPH KALAYIL Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.


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  • 1. “EVALUATION OF COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA” BY Dr. ANEESH J OSEPH KALAYIL Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE (AYURVEDA VACHASPATI) IN PANCHAKARMA Under the Guidance of Dr. Santosh.N.Belavadi M.D. (Ayu) Assistant Professor P.G. Dept. of Panchakarma And Co-Guidance of Dr. Jairaj. P. Basrigidad M.D. (Ayu) Lecturer P.G.Dept. of PanchakarmaPOST GRADUATE DEPARTMENT OF PANCHAKARMAD.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2008-2011
  • 2. DECLARATION BY THE CANDITATEI hereby declare that this dissertation / thesis entitled “EVALUATION OFCOMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMASNEHAPANA IN PANDUROGA” is a bonafide and genuine research work carriedout by me under the Guidance of Dr.Santosh. N. Belavadi MD (Ayu), AssistantProfessor and the Co-Guidance of Dr.Jairaj. P. Basrigidad MD (Ayu), Lecturer, PostGraduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,Gadag.Date: Signature of the CandidatePlace: Gadag Aneesh Joseph. K
  • 3. CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “EVALUATION OFCOMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMASNEHAPANA IN PANDUROGA” is a bonafide research work done byANEESH JOSEPH. K in partial fulfillment of the requirement for the degree ofAyurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. Santosh.N.Belavadi M.D. (Ayu) Assistant Professor Department of Panchakarma DGMAMC, PGS & RC, Gadag
  • 4. CERTIFICATE BY THE CO - GUIDEThis is to certify that the dissertation entitled “EVALUATION OFCOMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMASNEHAPANA IN PANDUROGA” is a bonafide research work done byANEESH JOSEPH. K in partial fulfillment of the requirement for the degree ofAyurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co -GuidePlace: Gadag Dr. Jairaj. P. Basrigidad M.D. (Ayu) Lecturer P.G.Dept. of Panchakarma DGMAMC, PGS & RC, Gadag
  • 5. J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTIONThis is to certify that the dissertation entitled “EVALUATION OFCOMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMASNEHAPANA IN PANDUROGA” is a bonafide research work done byANEESH JOSEPH. K under the guidance of DR. SANTOSH.N.BELAVADIMD(Ayu) Assistant Professor, and Co-Guidance of DR. JAIRAJ. P. BASRIGIDADM.D(Ayu) Lecturer Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C,Gadag and contributed good values to the Ayurvedic research.Prof .Dr. P .Sivaramudu Dr. G. B. Patil M.D.(Ayu)M.A.(San)M.A.(Psy) PrincipalProfessor & HOD DGM Ayurvedic Medical College,P.G Department of panchakarma GadagDGM Ayurvedic Medical College,GadagDate:Place: Gadag
  • 6. COPYRIGHT Declaration by the CandidateI hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shallhave the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. ANEESH JOSEPH. K © Rajiv Gandhi University of Health Sciences,
  • 7. ACKNOWLEDGMENTWith a bowed Head to the Almighty,With folded Hands to Revered TeachersAndA warm Heart to Good Friends……….This work is the result of the combined effort of a good number of people whoinclude academicians, colleagues, and above all the patients who cooperated with mein all aspects. Moreover it is only because of Gods’ grace, the work could beaccomplished as per my expectation. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for his divine blessings. I give my respect at this moment to my father K.A Joseph my mother Smt.N .V Mariyam who are the architects of my career. My deep sense of gratification isdue for my parents who are the architects of my career. The culture, discipline andperseverance, which I could imbibe, are solely because of their painstaking nurtureand strong moral support. I thank to my brothers Biju Joseph and Dr Bineesh Josephand their family for affection and continuous encouragement. It is a privilege to convey regards to my wife Dr. Jaya Aneesh and mydaughter Dhyeya Aneesh for their loving and caring support in my difficult times. I am thankful to my in laws K Mohanan Nair and Smt. Snehalatha for theirencouragement, broadmindedness and affection towards me. The inspiring force throughout this research work; was my GuideDr.Santosh N. Belavadi, M.D. (AYU), Assistant Professor, department of Panchakarma,a person whose love and care became a source of light whenever I was in darkness,Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga i
  • 8. who provided necessary fuel for my innovative thoughts. I am deeply indebted for hisguidance. I express my deep sense of gratitude to my HOD Dr. P. Sivaramudu,M.D.(Ayu),M.A(San),MA(Psy), professor and HOD, department of Panchakarma, forhis humble nature, indulgence, and scholarly suggestions during the course of thisresearch work.My deep gratitude to Dr. Jairaj Basarigidad MD (Ayu), Lecturer, Dept of Panchakarma,my Co- Guide whose guidance with accuracy and commitment towards research hashelped me a lot from the very beginning to the end of this work. I express my thankfulness to beloved principal Dr. G. B. Patil, for hisencouragement and support by providing all necessary facilities for this researchwork. I am very much thankful to my teachers Dr. U.V Purad, M.D.(Ayu), Dr. SandeepPatil MD (Ayu) for their timely help and suggestions during this study. I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr.Suresh Babu, Dr. M.C. Patil, Dr. Mulugund, Dr. G. S. Hiremath, Dr. C. S. Hiremath ,Dr. R. V. Shettar, Dr.Girish Danappa Goudar, Dr. Jagadeesh Mitti, Dr. Kuber Sankh, Dr. B. M. Mulkipatiland Dr. M.D. Samudri, Dr. Yasmeen phaniband for their valuable inputs andsuggestions. I extend my immense gratitude to Dr. V. M. Sajjan, Dr.Yarageri, Dr.SuvarnaNidugundi, Dr. Shakuntala and other teaching staff who helped during my study. I express my sincere thanks to Prof. P.M Nandakumar and Dr.Ashok patil,for their help in statistical analysis of results. I take the privilege to thank Sri.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga ii
  • 9. Mundinamani, Librarian. I also extend my thanks to assistant librarians Mr. Shyaviand Mr. Keroor who provided me all the necessary books and time for my literarywork. I am very much thankful to Sri Tippanagowdar (Lab Technician), for his helpduring the study. I extend my thanks to Sri Kulakarni, Sri Nabi, Smt. Sunanda andSmt Renuka and all other hospital for their timely help in trail. I feel extremely thankful to seniors Dr. Ashok M.G, Dr. Prasanna V. Joshi,Dr. Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Sanjeev Chaudary, Dr. Shailej, Dr.Mukta Hiremath, Dr. Sanath Kumar D.G, Dr. Sabareesh , Dr. Rajesh, Dr. Jayasankar,Dr. Deepak and others for their valuable suggestions. I am deeply indebted to my close friends Dr.Joshi George Mattathil , Dr.Bhagyesh .K . Madavu and Dr. Surej Subash Pullarkkat for their rejoicing companyand timely help. I pay sincere regards to my fellow Dr. Renukaraj Medegar , Dr. Biswajith Das,Dr. Sangamesh Iddalgimath , Dr.Vijay Mahantesh, Dr.Vinod Barwal, Dr.Baba Saheb,Dr.Srikanth Patel, Dr.Praveen, Dr. Pushpa, Dr. Triveni, Dr.Satheesh, Dr. Jayakar,Dr.Vijay Chavadi and Dr. Sanjeev Reddy for their truly help and co-operation. I thank my juniors Dr. Raghavendrachar, Dr. Manish, Dr. Paresh, Dr.Jagadeesh, Dr. Shilpa , Dr. Vijay Raj, I thank specially to Miss. Shweta Shirabadagi, Nanda Langotti, Netravathi,Rekha Rani, Manjula Karadi, Priyanka and all UG friends for their help and supports. I am also very much thankful to Mr. Shakthi (Local Guardian), Mr. Salimat,Smt. Lalithamma who made my stay comfort throughout my P.G. carrier.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga iii
  • 10. Lastly I pay my deepest respect for those patients who took part in the studyand I share my success with them. “To err is Human” – certain names, who could be directly or indirectly helpedin this work, might have been missed unintentionally. Thanks are due to all of them.Date : Dr. Aneesh Joseph. KPlace : GadagEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga iv
  • 11. LIST OF ABBREVIATIONS USED A.H – Astanga Hrudaya A.S – Astanga Samgraha B.P – Bhavaprakasha B.S – Bhela Samhita C.S – Charaka Samhita M.N – Madhava Nidana S.S – Sushruta Samhita, V.S – Vangasena Y.R – Yogaratnakara G.N _ Gadanigraha Sh.S _ Sharangadhara SamhitaEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga v
  • 12. ABSTRACT Anemia is a decrease in the normal number of red blood cells (RBCs) orless than the normal quantity of hemoglobin in the blood. However, it can includedecreased oxygen binding ability of each hemoglobin molecule due to deformity orlack in numerical development as in some other types of hemoglobin deficiency.Globally, 30% of the total world populations are Anaemic and half these, some 600million people have iron deficiency. Iron deficiency Anaemia (IDA) is most prevalentnutritional problem in the world today. Young children and women of reproductiveage group especially pregnant and lactating women, are at greatest risk. Panduroga is a pitta pradana tridoshaja vyadhi in which rasa and Rakta aremainly affected. Charaka opines that due to excess intake of Tridosha prakopa Aharaespecially pitta prakopa Ahara viharas the vitiated doshas assumes sthana samshrayain between tawk and mamsa resulting in Pandu, Harita, and Haridra varna to the skin.Hence, the disease is named as Panduroga. By doing the Snehapana it will be beneficial in relieving the pitta vriddiand also helps in Rakta prasadana. Main focus is given for the procedure Snehapanawith Draksha Ghrita which mainly mitigates vata and pitta, enhances the qualities ofbala, varna and also increases the dhatus like rasa, sukra and ojus. The qualities ofGhrita are Vrishya, Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara,Papahara, Rakshoghna, Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya,Rasayana, Sugandha, Rochana, Smriti vardhaka, Rasa, Shukra vardhaka. Byadministrating the Draksha Ghrita Snehapana in both Arohana Krama and SadharanaKrama research is mainly focused on bringing changes in subjective parameters likeEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga vi
  • 13. Panduta, Dourbalya, Arohanayasa, Agnimandhya and increasing of Haemoglobinpercentage is the research point. Here an attempt is made to “Evaluation ofcomparative efficacy of Arohana & Sadharana Krama Snehapana inPanduroga.”Objective of the Study:  To evaluate the efficacy of Draksha Ghrita Arohana Krama Snehapana in Panduroga.  To evaluate the efficacy of Draksha Ghrita Sadharana Krama Snehapana in Panduroga.  To evaluate the comparative efficacy of both the groups.Study Design: It was a Simple randomized comparative clinical study.In this study design 30 patients who were diagnosed to have Panduroga and fulfillingthe criteria of undergoing the process of Snehapana were selected. Patients were given Deepana and Pachana aushadi ie; Jeeraka choorna andwere subjected to Snehapana with Draksha Ghrita in both Arohana and Sadharanakarma for 5-7 days .The assessment criteria were noted before and after treatment andafter follow up. Subjective parameters i.e. Panduta, Dourbalya, Arohanayasa, Brahma,Agnimandhya and Aruchi are the chief complaints of Panduroga and objectiveparameters are Hb%, Total count, Differential count, ESR, Total RBC and Packed cellvolume. Assessments are done before and after the treatment.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga vii
  • 14. Results  In subjective parameters all other parameters except Panduta are not significant before treatment, after treatment and after follow up. It means the mean effects of two groups are not same in Panduta.  Similarly in objective parameter all parameters are not significant. It means the mean effects of all the objective parameters are same in both the groups.  While comparing both groups group B is highly significant after treatment and group A highly significant after follow up.Key wordsArohana Krama Snehapana, Sadharana Krama Snehapana, Draksha GhritaPanduroga, Anaemia.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga viii
  • 15. EVALUATION OF COMPARATIVE EFFICACY OF AROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA TABLE OF CONTENTS SI. No. Contents Page No. 01 Introduction 1 02 Objectives 6 03 Review of Literature 9 04 Drug review 100 05 Methodology 108 06 Observations and Results 128 07 Discussion 194 08 Conclusion 219 09 Summary 222 10 Bibliography i 11 Annexure xxiEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga ix
  • 16. LIST OF TABLESTable Table showing the PageNo. No. 01 The Sneha Guna, Bhoutika Sanghatana & Karmukata Of Sneha 15 Dravys 02 Properties of Ghrita 16 03 Source of Sthavara Sneha according to Charaka 18 04 Sushruta’s Sthavara Sneha classification 18 05 Jangala Sneha & their Ashaya 19 06 Paka Bhedha of Sneha 19 07 Upayoga Bheda 20 08 Opinion about Sneha Matra 21 09 Sneha Matra according to Susruta 22 10 Indications of Sneha Matra 22 11 Opinion of Vangasena regarding dosage of Arohana Snehapana 24 12 Shamana and Brumhana Snehana Yogya 24 13 General Indications of Snehana According to Different 25 Acharyas 14 Deserving Condition for Snehana 26 15 General Contraindications of Snehana 29 16 Sneha Jeeryamana lakshanas 38 17 Samyak snigda lakshanas 39 18 Asnigda lakshanas 40 19 Atisnigda lakshanas 41 20 Aharaja nidanas of panduroga 65 21 Viharaja Nidana of Panduroga. 66 22 Manasika Nidana of Panduroga. 66 23 Poorvaroopa of Panduroga. 68 24 Samanya lakshanas of Panduroga 69 25 Classification of Panduroga. 70 26 Lakshanas of Vataja Panduroga. 70 27 Lakshanas of Pittaja Panduroga. 70 28 Lakshanas of Kaphaja Panduroga. 71 29 Lakshanas of Mridbhakshanajanya Panduroga. 72 30 Complications of Panduroga. 76 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga x
  • 17. 31 Ingredients Of Jeeraka Choorna 101 32 Ingredients Of Draksha Ghrita 103 33 Pharmaco dynamic properties of Ghrita according to Samhitas 106 and Nighantus 34 Demographical Data- master chart 116 35 Pradana vedana-master chart 117 36 Poorvaroopa-master chart 118 37 Anubandha Vedana- master chart 119 38 Subjective Variables Of Arohana Krama Snehapana- master 120 chart 39 Subjective Variables Of Sadaranakrama Sneha Pana- master 121 chart 40 Manasika nidanas- master chart 122 41 Manasika nidanas- master chart 123 42 Objective variables in Arohana krama Snehapana- master chart 124 43 Objective variables in Arohana krama Sneha pana- master chart 125 44 Objective variables in Sadharana krama Snehapana- master 126 chart 45 Objective variables in Sadharana krama Snehapana- master 127 chart 46 Distribution of patients by age 128 47 Distribution of patients by sex 129 48 Distribution of patients by Religion 129 49 Distribution of patients by Occupation 130 50 Distribution of patients by Economical status 131 51 Distribution of patients by Mode of onset of disease 131 52 Distribution of patients by Course of disease 132 53 Distribution of patients by Chikitsa vrittanta 133 54 Distribution of patients by Kula vrittanta 134 55 Distribution of patients by Type of diet 135 56 Distribution of patients by Dominant rasa 135 57 Distribution of patients by Diet pattern 136 58 Distribution of patients by Vyayama 137 59 Distribution of patients by Manasika vihara 138 60 Distribution of patients by Vyasana 139 61 Distribution of patients by Nidra 140 62 Distribution of patients by Menstrual history 141Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xi
  • 18. 63 Distribution of patients by Koshta 142 64 Distribution of patients by Prakriti 143 65 Distribution of patients by Satwa 143 66 Distribution of patients by Satmya 144 67 Distribution of patients by Samhanatha 145 68 Distribution of patients by Pramana 146 69 Distribution of patients by Abhyavarana shakti 146 70 Distribution of patients by Jarana shakti 147 71 Distribution of patients by vaya 148 72 Distribution of patients by Vyayama Shakti 149 73 Distribution of patients by Poorva roopa 149 74 Distribution of patients by Anubandha vedana 151 75 Distribution of patients by Pradana vedana 152 76 Matra of Ghrita administered 154 77 Snehapana kalavadhi 155 78 Mean on set of Jeeryamanya laxanas in Group A 156 79 Mean on set of Jeeryamanya laxanas in Group B 156 80 Mean on set of time in minutes for Sneha Jeerna laxanas in 157 group A 81 Mean on set of time in minutes for Sneha Jeerna laxanas in 158 group B 82 Samyak snigda lakshanas in both groups 160 83 Mean time taken for Samyak Snigadha laxanas of Group A & 161 B. 84 Group Statistics of Panduta 163 85 Group Statistics of Agnimandhya 165 86 Group Statistics of Arohanayasa 168 87 Group Statistics of Brama 170 88 Group Statistics of Dourbalya 172 89 Group Statistics of Hb% 174 90 Group Statistics of Total Count 176 91 Group Statistics of Platelets 179 92 Group Statistics of Lymphocytes 181Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xii
  • 19. 93 Group Statistics of Esnophils 183 94 Group Statistics of ESR 185 95 Group Statistics of Total RBC 187 96 Group Statistics of PCV % 190 LIST OF GRAPHSGraph Graph showing Page No. No. 1 Distribution of patients by age 128 2 Distribution of patients by sex 129 3 Distribution of patients by Religion 130 4 Distribution of patients by Occupation 130 5 Distribution of patients by Economical status 131 6 Distribution of patients by Mode of onset of disease 132 7 Distribution of patients by Course of disease 133 8 Distribution of patients by Chikitsa vrittanta 134 9 Distribution of patients by Kula vrittanta 134 10 Distribution of patients by Type of diet 135 11 Distribution of patients by dominant rasa 136 12 Distribution of patients by Diet pattern 137 13 Distribution of patients by Vyayama 138 14 Distribution of patients by Manasika vihara 138 15 Distribution of patients by Vyasana 139 16 Distribution of patients by Nidra 140 17 Distribution of patients by Menstrual history 141 18 Distribution of patients by Koshta 142 19 Distribution of patients by Prakriti 143 20 Distribution of patients by Satwa 144 21 Distribution of patients by Satmya 145 22 Distribution of patients by Samhanatha 145 23 Distribution of patients by Pramana 146 24 Distribution of patients by Abhyavarana shakti 147 25 Distribution of patients by Jarana shakti 148 26 Distribution of patients by Vaya 148 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xiii
  • 20. 27 Distribution of patients by Vyayama Shakti 149 28 Distribution of patients by Poorva roopa 150 29 Distribution of patients by Anubandha vedana 152 30 Distribution of patients by Pradana vedana 153 31 Distribution of patients by Snehapana kalavadhi 155 32 Samyak snigda lakshanas in both groups 160 33 Mean effect of panduta 165 34 Mean effect of Agnimandhya 167 35 Mean effect of Arohanayasa 170 36 Mean effect of Brama 172 37 Mean effect of Dourbalya 174 38 Mean effect of Hb% 176 39 Mean effect of Total Count 178 40 Mean effect of Platelet Count 180 41 Mean effect of Lymphocyte Count 182 42 Mean effect of Esnophil Count 185 43 Mean effect of ESR 187 44 Mean effect of Total RBC 189 45 Mean effect of PCV (%) 191 LIST OF PHOTOGRAPHSFigure Figures showing the Page No No. 1 Digestion and Absorption of Fat 55 2 Emulsification of Fat 55 3 Micelles 56 4 RBC and Hemoglobin 96 5 Jeeraka choorna 101 6 Draksha 104 7 Ghrita 105 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xiv
  • 21. LIST OF FLOW CHARTSChart Flow charts showing the Page No No. 1 Snehapachana 53 2 Nidana and Samprapti of Panduroga 73 3 Nidana sevana 74 4 Mrudbhakshanajanya Pandu 75 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xv
  • 22. INTRODUCTION Ailment is the inseparable companion of life. Springing up of many ailmentstriggers the effort to heal the same, resulting in the development of Medicine in everycountry whether primitive or advanced. Ayurveda is one of the oldest systems of healthcare dealing with both the preventive and curative aspects of life in a mostcomprehensive way. Ayurveda provides not only curative measures but also preventiveprinciples for healthy and long life. Restoration of dhosha, dhatu and mala to a state ofequilibrium is the main aim of chikitsa in Ayurveda and it also gives equal importance toPrasanna, Atma, Indriya and Manas i.e. Manasika Swasthya. Colour has been one of nature’s subtlest expression of conformities andinfirmities, the former being a poet’s passion and the latter, the object of medicalprofession. Generally we see that the character of an object is proportionate to theintensity of its colour, the more the intensity of the colour, the stronger thecharacter.Paleness has been associated with inadequacy, be it a fruit or man. Pandu is aVarnopalakshita vyadhi wherein paleness is pathogenic. Anaemia is a disease that hassimilar paleness, constitutional symptoms, pathogenesis and etiology.Lacuna in current knowledge: A research has shown that the incidence of anaemia is the highest in females,whereas in males the numbers are lower. Also those women with a poor diet and loweconomic status and living style are more vulnerable to this condition. It is oftencriticized that Ayurvedic science is occult and subjective. But in fact it has derived itsprinciples by logical analysis and intellectual exercises. Although Draksha Gritha has Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 1
  • 23. been described by the Acharyas as an ideal therapy for Panduroga,studies showing itsefficacy in alleviating this disease have not been undertaken on a large scale especially astudy comparing the efficacy of Arohana krama Snehapana and Sadharana kramaSnehapana in Panduroga is unavailable.Incidence and Prevalence Globally, 30% of the total world populations are Anaemic and half these, ie;around 600 million people have iron deficiency. Iron deficiency Anaemia (IDA) is mostprevalent nutritional problem in the world today. Young children and women ofreproductive age group especially pregnant and lactating women are at greatest risk.Though prevalent in all countries, IDA is most widespread in developing countries whereprevalence of this disease may be as high as 60-70% in pre-school children and 60-80%in pregnant women.Purpose of the study The modern management of Anaemia is mainly oral therapy and parentaltherapy for correcting iron deficiency. These in spite of many advantages still remainsunsatisfactory. Oral therapy can cause nausea, abdominal discomfort, diarrhoea, andconstipation as side effects and it almost turns stool black, which is harmless side effect.The adverse effect of parental therapy includes hypersensitive reactions, haemolysis,hypotension, and circulatory collapse, vomiting and muscle pain. Blood transfusion,which is said as emergency treatment, can rise in Hb up to 1gm with a single unit. But itcan also cause some complication like acute intravascular hemolytic reactions, febrile Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 2
  • 24. non-hemolytic reactions and allergic reactions. Thus it is important to search a safer, costeffective therapy, which could be explored from the Ayurveda. Snehapana is one suchtherapy, which can give wonderful results in many diseases including Panduroga. Charaka has praised the importance of Draksha Ghrita in Chikitsa sthanawhich is indicated in many disorders including Panduroga. In this study the patientsuffering having lakshanas of Panduroga were administered Snehapana therapy, withspecially indicated Draksha Ghrita in both Arohana and Sadharana Krama vidhi. Panduroga is mentioned in Brihattrayi, Laghutrayi, and other classical texts.This is a pitta pradhana tridoshaja vyadhi in which rasa and rakta are mainly affected.Charaka opines that due to excess intake of pitta prakopaka ,tridosha prakopaka ahara,viahara the vitiated doshas assumes sthanasamshraya in between tawk and mamsaresulting in pandu, harita, and haridra varna to the skin. Hence, the disease is named asPanduroga. Panduroga can be correlated with “Anaemia” in modern medicine. It refers to astate in which the level of haemoglobin in the blood is below the normal range (M-14.0g/dl F-12.3g/dl) appropriate for the age and sex. Almost all the Acharyas have given the prime importance to Snehana therapyas Poorva karma, Pradhanakarma and Paschat karma according to the need of the personor disease. Acharya Susruta beautifully delineates the importance of Sneha asfollows“Human being is composed of Sneha, prana predominantly contains Sneha.Hence prana can be protected or preserved by Snehana”. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 3
  • 25. By examining the Rogabala, Doshabala and Shareera bala, the proper Snehashould be administered after the complete digestion of food which was taken in theprevious night and Snehas are given in certain specific quantity in the increasing order forspecific number of days or till Samyak Snigdha Laxanas get manifested.Research question Whether internal administration of Draksha Ghrita in the form Arohana andSadharana krama Snehapana is effective in Panduroga or not?Hypothesis:  By administrating the Draksha ghrita snehapana, it will be beneficial in relieving the symptoms of Panduroga.  Research is mainly focused on bringing changes in subjective parameters like Panduta,Dourbalya,Arohanayasa,Agnimandya and increasing of Haemoglobin percentage is the research point.Hence the present work titled as the “evaluation of comparative efficacy of Arohana& Sadharana krama snehapana in panduroga.” is undertaken .This study highlights on both theoretical and clinical aspects related to this disease. Thecontents are divided into the following chapters:  Chapter I Highlights on the historical aspects of both Snehapana and Panduroga. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 4
  • 26.  Chapter IIDeals with conceptual study of both Snehapana and Panduroga It covers all therelevant matters pertaining to the procedure and the disease. Chapter III: Drug profile. Details of all the ingredients and their role in the disease are dealt with. Chapter IV: MethodologyDetails of the clinical trial of Draksha Ghrita Snehapana in Panduroga are furnished. Chapter V: DiscussionDiscussion on both Snehapana and Pandu roga, discussions on the clinical trial withobservation and results have been described. Chapter VI: Summary and ConclusionComplete abstract of the dissertation and the conclusion are enumerated.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 5
  • 27. OBJECTIVES Blood is very essential for life, and nature has devised a very ingenious methodto continuously supply blood to every part of the body, in fact to every cell of the body.Oxygen along with other nutrients is supplied continuously by the circulating blood, withthe heart at the center of this system. Panduroga is a disease characterized by pallor of body which strikinglyresembles with ‘Anaemia’ of modern science,a disease characterized by the reduction innumber of Rbcs per cumm of Blood and quantity of Hb resulting in pallor like othersymptoms. Rakta has been considered as a key factor for the Jeevana, Prinana Dharanaand Poshana karma of the body. Many times it is seen that Rakta gets vitiated by Doshas,mainly by Pitta dosha as Rakta is Pittavargiya and disease like Pandu appear. InAyurveda, Pandu is considered as a specific disease with its own pathogenesis andtreatment.1, 2 Anaemia has a very high global incidence3. It poses serious health problemsbecause it causes general weakness, lethargy, lassitude, sub-optimal work performanceand in certain situations mental retardation, poor intelligence and abnormal immuneresponse.4 The problem of nourishment is worldwide; it has assumed gigantic proportionin the underdeveloped and developing countries. The main cause of Anaemia ismalnutrition. In modern medicine, there is good treatment for Anaemia with considerableresult but that is only for acute deficiencies Anaemias. No significant therapy is availablefor chronic Anaemias which occur due to metabolic defects. Ayurveda can provide bettermanagement in this area. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 6
  • 28. By keeping the above point here an attempt is made to assess the efficacy ofboth Arohana and Sadharana Krama Snehapana and to conclude which kind ofSnehapana is more beneficial in the management of Panduroga.Objectives of the study:  To evaluate the efficacy of Draksha Ghrita Arohana krama Snehapana in Panduroga.  To evaluate the efficacy of Draksha Ghrita Sadharana krama Snehapana in Panduroga.  To evaluate the comparative efficacy of both the groups.Reasons to Choose Following Therapy for Present Study:Snehapana with Draksha Ghrita Panduroga, a disease which is mainly characterized by, Panduta, Dourbalya,Arohana ayasa, Brama, Agni mandya, Aruchi, Rakta heenata etc. in the contemporaryscience anemia is characterized mainly by the decrease of the hemoglobin, which showsymptoms like Pallor, Tiredness, Fatigue, Muscular weakness, Lethargy, Anorexia and inolder patients symptoms of intermittent confusion and visual disturbances. Comparingboth the systems we can reach to conclusion that Panduroga in Ayurveda may becompared with Anemia in the contemporary science. The treatment should target in rectifying the above said problems. Here in thisstudy Snehapana with Draksha Ghrita is selected, since Acharya Charaka has mentionedin his sutra sthana regarding the qualities of the Ghrita. It mainly mitigates vata and pitta, it enhances the qualities of bala,varna and alsoit increases the dhatus like rasa, sukra and ojus5 . The qualities of Ghrita are Vrishya,Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara, Papahara, Rakshoghna, Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 7
  • 29. Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya, Rasayana, Sugandha, Rochana,Smriti vardhaka, Rasa, Shukra vardhaka. Draksha has the following qualities like snehopaga and Virechanopaga accordingto Charaka. Draksha has the properties like Madhura rasa, Madhura vipaka and Sheetaveerya does both the rakta and pitta shamana. This Draksha is processed with Ghrita;which is best among the pitta shamaka. Draksha has the property of Rakta prasadana; sothat shuddha rakta is formed properly which is very essential in this condition. Becauseof it snigdha and snehopaga6 property it helps in achieving the samyak snigdha lakshanaquickly. In Ashtanga Sangraha sutrasthana Ghrita are explained as best for snehana(snehanam uttamam)7 and it is the best pitta shamaka.8Research works done on Panduroga 01. Deshapande Swati S. – Clinical study of Panduroga and its Management with Mandoora bhasma. 02. Pandey Shashi – Effect of Pathya ghrita in cases of Pandu. 03. Kottarshetti Irranna – The effect of Guda Nagaradi Vati in Panduroga. 04. Basavaraj R. – A Comparative study on the effect of Dhattriavaleha and Kaseesa bhasma in Panduroaga w.s.r.t. to Iron deficiency Anaemia. 05. Lobo Zenica – Evaluation of the effect of shuddha Kaseesa and Loha Bhasma in Panduroga w.s.r.t. Iron deficiency Anaemia – A comparative study. 06. Jaiswal Vipal – Efficacy of Ashta Dashanga lepa in the management of Panduroga. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 8
  • 30. HISTORICAL REVIEWSneha karma An up-to-date review of all the references available for Snehakarmafrom Vedic period to the modern period is quite essential in this study.Veda Kala: (4000-6000 BC) Vedas are considered as the oldest recorded credentials, where in liessome of the earliest evidence of the diseases and treatment. Abundance references oftherapeutic use of Sneha can be found in the Atharva Veda. In Atharva Veda Ghritahas been described vividly but there is hardly any information regarding Snehapana.The Materia Medica of Atharvanas contains references regarding the use of plant andanimal products as Snehadravyas like Ghrita, taila. In Rigveda, the word Ghrita isused as a synonym for the nutritious diet. Also capacity of Ghrita to kindle Agni isdescribed. The description of qualities of Ghrita and taila as snehadravyas is alsofound in Rigveda.9Charaka Samhita: (1000 BC)Among the classical literatures of Ayurveda, Charaka Samhita is the oldest, whichcontains ample but scattered matter regarding the Snehana therapy. In the Very firstchapter of sutra Sthana, Mahasneha, and properties of four Sneha are described. Insecond chapter, it is quoted that after Snehana and Svedana, Panchakarma should beadministered in proper dose and at suitable time. Acharya describes in detail aboutShadvidopakramas in Sutra sthana10. The 13th chapter of Sutrasthana in CharakaSamhita explained in detail about Snehana11. He has extensively described about the Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 9
  • 31. properties, sources, indications, and contraindications of Sneha dravyas. Referencesregarding Shodhananga snehana are found in the Siddhisthana12 of Charaka Samhita.Susruta Samhita: (1000-1500 BC)In Susruta Samhita, the description about Panchakarma Chikitsa was started from theSnehopayougika Chikitsa Adhyaya of Chikitsa Sthana. All the information pertainingto all types of Snehana is mentioned here along with the Snehapana Karma in abeautiful manner. He had given prime importance to Sneha by explaining the quote“Sneha saro ayam purushaha” An entire chapter in Chikitsa sthana of Susruta Samhitadeals with the topic of Snehakarma. In this he has described the use of Sneha in theShodhana and Shamana of various diseases including surgical ailments. Thepreparation of Sneha has been described by him in this chapter13. The classification ofSnehana into Shodhana, Shamana and Brumhana on the basis of its Karmukata is alsofound in Susruta Samhita.Astanga Sangraha & Astanga Hrudaya :( 5th cent AD)In Astanga Sangraha sutra sthana, the Snehana is described in elaborative manner14,while in Astanga Hrudaya sutra sthana description is available in verse form. In both,for the first time they have introduced the Hrasiyasi Matra (trial dose) of Sneha whichis very important in the clinical practice.15Kashyapa Samhita (6th cent. BC)Kashyapa has devoted a full chapter for Snehana Karma. All the descriptionpertaining to the all types Sneha is given. The 22nd chapter of Kashyapa’sSutrasthana has references regarding the use of Sneha in the treatment of variousBalarogas16. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 10
  • 32. Bhela Samhita (1000 BC):In the Sutra Sthana 14th chapter, the Snehana therapy is described. The mode ofaction of Snehana as a Poorva Karma is beautifully narrated in a sloka that, “due toSnehana, at the place of Vikriti, there will be an increase in Rasa and Klinnata isgenerated”. Acharya Bhela had given the simile that, as water flows from upper levelto lower level, likewise after Snehana, Doshas came towards Koshta from all thesides of body. The uses of Sneha in the treatment of various diseases have also beenmentioned. 17Kalyaņakaraka (9th cent AD):This is the first text to describe very clearly that, the dose should be given inVardhamana Matra.(Kramad Vardayeth)Vangasena (12th cent AD):Vangasenas Snehapanadhikara is of very much important as he has specified somePractical points regarding the Sneha Pana. The complete dose Schedule of Jaghanya,Madhyama and Uttama Matra is given. He also describe the dose Schedule inascending pattern in an explicit way18.Sharangdhara Samhita (13th cent AD):A separate chapter was devoted to the Snehana Karma in Uttara khanda in whichprocedure, dose, time, indications, contraindications of Sneha, Ayoga, Samyaka Yoga& Ati-yoga symptoms are described. He was the fisrt to mention the Dose of Sneha inNumericals i. e, Pala & Karsha Pramaņa19. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 11
  • 33. Harita Samhita:Qualities of each ghrita and their specific indications have been mentioned in 8thChapter in Harita Samhita. Gunas of purana ghrita also explained in this chapter20.Bhavaprakasa (16th cent AD):In Purvakhanda, a full description of Snehapana vidhi has been made. The days forSnehana and Matra were mentioned on the basis of the Koshţha and Agni.21Chakradatta (11th cent AD):One full chapter on Sneha adhikara has been described, in which all the detailsregarding the sodhana Sneha is narrated22Adhunika KalaThe Kokate’s textbook of Pharmacognocy23 and the Teiz’s text book of clinical Bio-Chemistry24 describes in detail about oils, fats, classification of ghee and properties ofghee. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 12
  • 34. SNEHAPANA KARMA Among the Panchakarmas, Snehanakarma is regarded as the most importantpreparatory measure before Shodhana therapy like Vamana and virechana25. Snehanakarma helps in the alleviation of the vitiated doshas before Shodhana therapy and it 26also imparts strength and unctuousness to the body . As per the literature found inCharaka Samhita, Snehakarma has been included as one of the Shadvidhopakramas 27and can also be considered as treatment . In the treatment regimen, Shodhanatherapies are major procedures or Pradana karma. They are preceded by certainpreparatory procedures known as Poorva Karma and followed by certain recoveryprocedures known as Paschat Karma. The entire Shodhana procedure depends uponthe proper mobilization of Doshas from the channels, which is achieved with the helpof Snehana and Svedana. Out of these two, the Snehana is a major procedure whichleads and decides the whole outcome of Shodhana procedure.NIRUKTI OF SNEHA The word Sneha is Masculine in gender and is derived from ‘Snih’ Dhatuby suffix ‘lyut’Pratyaya. (Vachaspatya ) 28. There are two meanings to the mool wordSnih ie: one implying ‘Snih – Snehane’ to render lubrication and the other --‘Snih -Preetau’ to render affection. But when the present context is considered the first oneholds more meaning. Thus Sneha is a substance which brings oiliness orunctuousness. The literal meaning of word Sneha is oiliness, unctuousness, fattiness,greasiness, lubricity, viscidity, affection, love, kindness and tenderness.(MonierWilliams 1889 & Apte 1970)29. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 13
  • 35. PARIBHASHA OF SNEHA: ‘Snehanam snehavishyand mardavakledakarakam’30 According to Charaka measures adopted to bring about Snigdhata in thebody is known as Snehana. According to him it is a procedure by which Snigdhata,Vishyandana, Mardavata and Kledana can be obtained in the body. As per Charaka Samhita the value of Sneha can be described as“Snehoanilamhanti mrudukarotideham, Malanam vinihantisangam” which meansthat Sneha brings about a balance in the vitiated vata, softens the body and eliminatesthe accumulated malas which have obstructed the srotamsi 31.As per Rajanighantu the word Sneha means the external application of Snehadravyas32SYNONYMS The word Snehana has many synonyms which are Sneha, Snigdhata,Mrtkshana, Mrksha, Abhyanga and Abhyanjana 32.GUNAS OF SNEHA DRAVYAS: 33, 34, 35 The different functions of a drug are due to the various gunas of thedravyas. The various Gunas desirable for Snehadravyas are Sukshma, Sara, Snigdha,Drava, Picchila, Guru, Shita, Manda and Mrdu. But all drugs having these Gunas donot produce Snigdhata. Acharyas have used the word Prayo while describing theproperties of Snehadravyas due to certain variations noted.Table No. 1: Showing the Sneha Guna, Bhoutika Sanghatana & Karmukata of Sneha 36Dravys . Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 14
  • 36. Dominent Mahabhutha Guna Karmukata Prathvi Ap Teja Vayu Akasha Lepana, Jivana, Samghata,Picchila ++++ Sandhana, Balya, Gouravata Sroto Vishodhana, Vivarana,Sukshma ++ ++ +++ Soushiryakara Anulomana, Vyaptisheela,Sara ++ + Preranasheela Snehana, Mardavata,Snigdha + ++++ Kledana Bandhana, Vishyandana, Prakledana, Vilodhana,Drava ++++ Prasari. Brumhana, Malavriddhikara,Guru ++++ ++ Tarpana, Angaglani, Balakara,Shita +++ ++ Sthambhaka, HladanaManda ++ + Shamana Shaithilya of Avayava,Mrdu ++ +++ Mardavata.By the above table it can be concluded that Snehadravyas are predominantlyapyamahabhuta.MAHA SNEHAS OR PRAVARA SNEHA 37, 38, 39 Ghrita, Taila, Vasa and Majja are considered the most important among allthe Snehadravyas due to excellence in Snehana qualities.Sneha Action of Different Snehadravyas on Various Doshas 40 On Pitta Dosha- Ghrita – Pittaghnatama Vasa - Pittaghna Majja - Pittaghnatara On Vata Shleshma- Taila – Vatashleshmaghnatama Majja - Vatashleshmaghna Vasa - Vatashleshmaghnatara Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 15
  • 37. PROPERTIES OF GHRITA 41Table No. 2: Showing Properties of Ghrita Rasa Virya Vipaka Prabhava Guna Madhura seeta Madhura Agnideepaka Snigdha, Mridu, Guru, MandaGhrita Karma 42, 43It mitigates the Pitta & Vata; enhances the Svara, Varna, Teja, Bala ,Rasa, Sukra andOjas; Chakshushya, Medhya, Vayasthapaka, Dahashamaka, Alpa Abhishyandi,Vrashya, best for Kshata Ksheena and Sosha.Seasonal indication: Sharad Rutu.Indications of Ghrita Snehapana 44VataPitta Prakriti, Vata Pitta Vikari.Those desires of longevity, Bala, Varna, Svara, Pushti, Smriti, Medha, Dhee, Agni. Among all the Sneha Dravyas, Ghrita, Taila, Vasa and Majja are the mostimportant Snehas because of their excellence in Snehana qualities. Among these fourSneha, Ghrita is considered as superior Sneha Dravya because of its followingcharacters,(i) Samskarasya Anuvartanam - With its own qualities intact, it has the ability totransform itself so as to imbibe the qualities of the substance added to it. Thisproperty is not so prominent in other Sneha.(ii) Madhuryat - Sweet in taste(iii) Avidahitvat - Not causing Vidaha(iv) Janmadyeva Cha Sheelanat – Being used since birth. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 16
  • 38. Taila also possess the potential of adoptability to some extent. Vasa is said to be themost effective Snehadravya in Vata rogas because it is Dhatu Kshayahara andAvritapathasodhaka. Vasa can be extracted by solvent method extraction or boilingflesh with water. It fills the muscles and is a part of the adipose tissue. It is indicatedin cases of fractures, dislocations, etc. Majja plays an important role in theproduction of sukra. This strengthens bones, softens Krura Koshţha.CLASSIFICATION OF SNEHAClassification of Sneha Dravya according to their origin: All Dravyas are classified under three types according to theirorigins i.e. Parthiva, Jangama and Audbhida or Sthavara. Hence, Snehas are alsohaving the same origin. However, Ayurveda recognizes Sthavara and JangamaSnehas only. They are extensively used in therapeutics. Mineral oils are being used inmodern therapeutics such as Paraffin. (Liquid paraffin is used as laxative, softparaffin is used in ointments and hard paraffin is used in wax bath etc.) AlthoughAyurveda has not separated the mineral oil substances as different Sneha dravyas.Sneha dravyas belonging to Jangama origin are classified as Prakrita’ and Kritrima’.The animal fat has been also classified on the basis of types of animals like Khagaja,Mrigaja and Jalaja. In modern system of medicine, many animal origin oils like codliver oil, shark liver oil etc. is also used. Classification of Sthavara Snehas (fats fromplant kingdom) depends on the parts of the plants from which it is procured. Susrutahas mentioned the classification in Chikitsa Sthana 31st chapter. I. BASED ON YONI (SOURCE) 45,46 Snehadravya is divided into the following based on the source Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 17
  • 39. 1) Sthavara (Vegetable origin) 2) Jangama ( Animal origin) 1) Sthavara (Vegetable origin) Sthavara Snehadravyas are those which are of plant origin. The main sources of Sthavara Snehadravyas are Phala, Sara, Mula, Tvak, Patra & Pushpa.18 Ashayas of Sthavara snehadravyas have been described in Charaka Samhita.Table No. 3 Source of Sthavara Sneha according to Charaka47 Tila Sarshapa Eranda Bibhitaki Priyala Abhishuka Bilva Moolaka Chitra Atasi Madhuka Kusumbha Akshodha Abhaya Karanja Shigru Nikothaka HaritakiThe classification Sthavara Sneha by Sushrutha is according to their actionTable No. 4 Sushruta’s Sthavara Sneha classification48 Action Virechanopayogi Pittasamsrusta Vayu Upayogi Vamanopayogi Krshnikarana Upayogi Shiro Virechanopayogi Pandukarana Upayogi Dushta Vranopayogi Dadru, Kushta, Kitibha Upayogi Maha Vyadhi Upayogi Ashmari Upayogi Mutra Sangopayogi Prameha Upayogi 2)Jangama Sneha (Animal Origin) Jangama Sneha refers to the Snehadravyas which are of animal origin.The common examples are Kshira, Dadhi, Ghrita, Mamsa, Vasa, Majja etc. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 18
  • 40. Table No. 5 Jangala Sneha & their Ashaya: Sneha Ashaya Ghrita Ksheera & Dadhi Taila Phala & Daru Vasa Mamsa Majja Asthi II. PAKA BHEDA Table No. 6 Paka Bhedha of Sneha 49, 50, 51 Snehana Caraka Sushruta Sharangdhara Abhyanga Khara Madhyama Madhyama Pana Madhyama Mrdu Madhyama Nasya Mrdu Madhyama Mrdu Basti Madhyama Khara Madhyama Karnapurana - Khara Madhyama III. SAMYOGA BHEDA 52 Yamaka Sneha: The combination of any two Sneha is known as Yamaka Sneha, for example Sarpi + Vasa and so on. Trivrit Sneha: The combination of any three Sneha is known as Trivrit Sneha, for example Sarpi + Vasa + Majja and so on. Maha Sneha: The combination of all the 4 Sneha is termed as Maha Sneha. These Sneha combinations are used both internally and externally in Samsarga and Sannipatika condition of Dosha. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 19
  • 41. Samyoga Bheda Yamaka Sneha Trivrut Sneha Maha Sneha (Ghrita + Taila ) (Ghrita+Taila+ Vasa ) (Ghrita +Taila +Vasa+ Majja) IV. UPAYOGA BHEDA 53.54,55 Sneha is classified into the following on the basis of their route of administration 1) Abhyantara Snehana (Pana, Basti, Nasya, Bhojana) 2) Bahya Snehana (Abhyanga, Lepa, Udvartana) Table No. 7 Upayoga Bheda Abhyantara Snehana Pana, Basti, Nasya, Bhojana Bahya Snehana Abhyanga, Lepa, Udvartana V. PRAYOGA BHEDA 56,57 Sneha is divided into 2 types on the basis of the method of administration. 1) Accha Peya In this method Sneha is given without mixing with any other dravya. 2) Vicharana Snehana In this method Sneha is mixed with various preparations like Vilepi ,Yavagu etc.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 20
  • 42. VI. ACCORDING TO VISHISTHA SAGNA 58, 59, 60 Vishistha sagna Sadyo Snehana Pancha Prasrta Peya Achapeya VII. MATRA BHEDA 61,62 In this Sneha is classified on the basis of the dosage of the snehadravya. In the classical ayurvedic textbooks the dosage of the Snehadravyas is based on the time taken for its digestion. It is as follows(i) Hrasva Matra - The dose of Sneha that is digested within 6 hours.(ii) Madhyama Matra - The dose of Sneha that is digested within 12 hours.(iii) Uttama Matra - The dose of Sneha that is digested within 24 hours Another matra called Hrasiyasi Matra has also been mentioned by Vagbhatawhich pertains to the quantity of Sneha, which is digested within three hours ofingestion. This is used when the Kostha of the person has not been properlydiagnosed 63. Hrasiyasi Matra is a trail dose, which is administered on the first day ofSnehapana.Table No. 8 Opinion about Sneha Matra 64, 65, 66 Hrasiyasi Madhyama Uttama Author Hrasva Matra Matra Matra Matra 1 Pala, 2 Pala, 4Hemadri - - - Pala, 6 PalaSharangdhara - 2 Tola 3 Tola 4 TolaChakradatta Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 21
  • 43. Table No. 9 Sneha Matra according to Susruta 67 Time required Dose Action Indication for digestionSadharana Matra 3 Hrs. Agnidipti Alpa Dosha Atura(1/4th day)Bruhmana Matra (1/2 Brumhana, 6 Hrs. Madya Dosha Aturaday) VrushyaPrabhala Dosha Matra 9 Hrs. - Bahu Dosha Atura(3/4th day)Shrestha Matra (Full 12 Hrs. - Glani, Murcha, Madaday)Uttama Matra (Day & Kushta, Visha, Unmada, 24 Hrs. -Night) Graha, ApasmaraTable No. 10 Indications of Sneha Matra 68, 69 Criteria for selection of Dose Action Person Disease Uttama Prabhuta Sneha Gulma Shighravikara Shamana Matra nitya Sarpa- Doshanukarshini Kshut–Pipasa Saha damshtra Pervades through all Uttama – Visarpa marga Agnibala Unmatta Balya ShariraBala Mutrakrcchra Rejuvenates-body, Manasa Bala GadhaVarcha sense organs and mindMadhyama Arushka No much complicationMatra Madhyama – Sphota Does not effect strength Sharira bala Pidaka much Manasa bala Kandu Brings Snehana Agnibala Pama comfortably Mrudu Koshta Kushta Used as Shodhanartha Vatarakta SnehanaHrasva Vriddha Chronic BrumhaniyaMatra Bala condition of Snehaniya Sukumara/Sukhocita disease like- Vrushya Mandagni Jvara Balya Durbala/Avara bala Atisara Long lasting benefits Person not able to Kasa Does not cause withstand hunger. Complications Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 22
  • 44. VIII. KARMUKATA BHEDA: This refers to the classification of Sneha on the basis of its action. The3 types of Snehana on the basis of action are Shamana Snehana, Brumhana Snehana and Shodhana Snehana (i) Shamana Snehana:According to Charaka, Shamana Snehana is a procedure by which Madhyama Matraof Accha Sneha is administered during Annakala when one feels hungry withouttaking the meal. 70, 71 According to Hemadri , Shamana Snehana is one whichnormalizes the aggravated doshas without expelling them and disturbing the normaldoshas. 72 (i) Brumhana Snehana:‘Bhrumhana Snehana’ refers to the Sneha which is given for Bhrumhana. As perAstanga Sangraha Brumhana Snehana is the administration of Sneha along withMamsa Rasa, Madya, Ksheera etc.73 Brumhana Snehana if given before food curesAdhobhaga rogas, in the middle of food cures Madhyama bhagarogas, after foodcures Urdhwabhaga rogas and strengthens the body 74. The dosage of Sneha used forBrumhana Snehana should be alpa or even less than quantity of Hrasiyasi Matra 75. (ii) Shodhana Snehana:Shodhana Snehana refers to Uttama Matra of Accha Sneha administered in themorning hours when preceding evening food has been digested but the individual hasshown less hunger70,71,76. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 23
  • 45. Arohana Snehapana:The word Arohana stands for rising or ascending. The oral administration of Sneha inthe periodical increasing dosage is defined as Arohana Snehapana. The concept ofArohana Snehapana has been described in detail by Vangasena.Table No. 11 Opinion of Vangasena regarding dosage of Arohana Snehapana 77Matra DAY(Dosage) 1 2 3 4 5 6 7 Uttama 6 pala 7 pala 8 pala 9 pala 10 pala 11 pala 12 palaMadhyama 6Karsha 7Karsha 8Karsha 9Karsha 10Karsha 11Karsha 12KarshaHrasva 3Karsha 3½Karsha 4Karsha 4½Karsha 5 Karsha 5½Karsha 6 Karsha According to the opinions mentioned by Acharya regarding the Arohana KramaSnehapana it is given until patient gets samyak snigda lakshana or up to 7 days.SNEHANA YOGYAThe general indications of Snehakarma can be found in the classical Ayurvedatextbooks. But the decision regarding the type of Snehana and the implication of thesame appropriately in different conditions depends on the intelligence of thephysician.Table No. 12 Shamana and Brumhana Snehana Yogya 78, 79 Abala Vata Vikari Vyayama – Madya – Stree nitya Bala Chintaka Vriddha Daruna pratibodha Madhyasevita Timira Krsha Abhishyanda Mandagni Ruksha Mrudukostha with alpa doshaShodhana Snehana Yogya: Shodhananga Snehapana is one of the essential Purvakarma for Shodhanaand hence it is indicated in almost all the Shodhana Arha conditions. The Snehawhich is given in Ananna / Akshudha Kala, when the meal of previous night is Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 24
  • 46. completely digested in Medium dose is called as Sodhana Sneha. Snehana used in thePurva Karma of Sodhana is Sodhana Snehana. This is also known as Sodhananga,Sodhanartha or Sodhanapurva SnehanaTable No.13 Showing General Indications of Snehana According to DifferentAcharyas 80, 81, 82 , 83, 84 Snehya C.S A. S A.H S.S K.SI As a Poorva Karma i) Swedya + + + + - ii) Samsodhya + + + + -II Different Stage of Life i) Vruddha - + + + - ii) Bala - + + + -III In Different Conditions i) Rooksha + + + + - ii) Krusha - + + + - iii) Abala - + + - -IV In Different Viharas i) Vyayama nitya + + + + + ii) Madhya nitya + + + + + iii) Stree nitya + + + + + iv) Chintaka + + + + + v) Srama - - - - +VI In Different Diseases i) Vatavikara + + + + - ii) Kshinasra - + + + - iii) Ksheena retasa - + + + - iv) Abhishyanda - + + + - v) Timira - + + + - vi) Daruna practibodha - - - + - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 25
  • 47. Table No. 14 Showing the Deserving Condition for Snehana 85,86,87,88 Ghrita Taila Vasa Majja Vataprakruti Pravruddha Asthiroga Deepthagni shleshma Pittaprakruti Pravruddha medhas Sandhiroga Kleshasaha Vatarogi Sthoola Siraroga Snehasevi Pittarogi Vatharoga Snayuroga Vatarogi Chaksukama Vathaprakriti Marmaroga Krurakoshta Kshataksheena Balarthina Kostangaroga Vruddha Tanuthwarthina Vasasathmya Bala Laghuvarthina Avruthavata Abala Dhardhyarthina Ayuprakasha kama Sthiaryarthina Balarthina For snigdha twak Swararthina For Sleshma twak Pustikama Krimikoshta Soukumaryarthina Krurakoshta Agnideepti Nadeevrana Ojus Smruti Medha Bhuddhi Indriyabala Daha Shastraghata Visha Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 26
  • 48. SnehyaBefore commencing the Snehana Karma proper, one should have to know theconditions, where the Snehana Karma can be administered. The classical indicationsof Snehana are furnished in the chart given belowSNEHA ANARHA: The general contra indications of Snehana karma have beendescribed by various Acharyas. The Table No. 14 shows few of the ShodhanaSnehana Anarha conditions. Few of these conditions are analyzed below i) Rukshana Arha: According to Charaka, Rukshana Anarha persons are generally Abhishyandhya, Bahudosha, Rogas manifested in Marmasthana, Urhusthambha. Snehana administered in such condition, further worsens 89, 90 the condition ii) Dattabasti, Virikta : Agni becomes Manda soon after Basti and Virechana and so Snehapana is contraindicated. iii) Agni Vikruti : Both Tikshnagni and Mandagni are considered in Agnivikriti 91 a) Tikshnagni : Sneha administered in this condition further aggravates Agnibala which in turn leads to many complications such as Trishna etc. b) Mandagni : Sneha administered in Mandagni leads to Sneha Ajirna or Ama. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 27
  • 49. iv) Mada and Murcha : - Although Shodhananga Snehapana is indicted in Mada and Murcha, it is contraindicated during an attack of Mada and Murcha. v) Ksheerapa : The body of the child will have Snigdha Guna in Kshirapa Avastha and so Sneha is contraindicated. vi) Garardita : When Snehapana is administered in Garardita Sneha due to its Vyavayi and Sara property further potentiates and facilitates the spreading of the poison all over the body. Hence Sneha is contradicted in this condition. vii) Durdina : The chances of aggravation of Kapha and Mandagni is high in the days with cloudy atmosphere. Hence Sneha is contraindicated. viii) Ama Pradosha : Snehapana administered in Ama condition further aggravates it because Ama and Sneha have homologues properties and so it is contraindicated. ix) Akala : Untimely administration of Sneha does not give the desired effect.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 28
  • 50. Table No. 15 General Contraindications of Snehana 92 ,93, 94, 95, 96 Asnehya C.S. S.S. A.H. K.S. Sh.S. Rukshanam Samshodhanadrute + Utsanna Kapha medasa + Kapha Prakopa,Dagdha + Abhishyanna anana guda + Nitya Mandagni + + Shleshma Pittopahata antaragni + Tikshnagni + Durbala + + + + Pratanta (Klamayukta) + Shranta + Shramanvita, Akala Prasuta + Garbhini + + Prasuta + Apaprasuta, Urustambha,Udara + Kshirapa, Ativruddha, Jadya, Glani + Madatura, Murcha, Trishna + + Talu Shoshi + Sneha Glani + Garardita + Amajahara + Anna Dvesha + + Arochaka + + Ajirna + + Chardi + + + + + Atisara + Vit Prakopa + Taruna Jvara + + + Sthula + + Gala roga + + Datta Vireka + + Datta Basti + + + + Datta Nasya + + + Akala, Durdina + +Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 29
  • 51. SNEHANA PRAKARSHA KALA :97, 98, 99, 100 Prakarsha kala is defined as the time taken for Snehana procedure. Theprocess of administering Sneha to achieve the desired Doshotkleshana within aspecific number of days is called Shodhananga Snehapana. The minimum andmaximum number of days for Shodhananga Snehapana is 3 to 7 days respectively.i.e. if the person has Mrdu Koshta - 3 days, Madhyama Koshta - 4 to 5 or 6 days andKrura Koshta - 7 days. According to Bhoja persons having Kaphaja, Pittaja and VatajaPrakrti needs 3, 5 and 7 days of Snehapana respectively. According toVagbhata,Shodhananga Snehapana should be continued untill samyak SnigdhaLakshana appears irrespective of any time limit. Considering the different opinions regarding prakarsha kala, it can beconcluded that irrespective of Prakrti or Koshta, the duration of administration ofShodhananga Snehapana should be till the appearance of Samyak Snigdha Lakshana.Sneha Prakarsha Kala in 7 days101, 102, 103 Shodhananga Snehapana does Doshotkleshana in thebody. When Shodhananga Snehapana is continued after 7 days, then Sneha becomesSatmya ie: the individual get accustomed to Sneha just as food article and fail toproduce Doshotkleshana. If the dose of administered Sneha is less, then it will fail toproduce the desired effect in 7 days and in such cases higher dose of Sneha should begiven after some interval. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 30
  • 52. SHODHANANGA SNEHAPANA VIDHI: To understand Snehana process more clearly, the whole procedure can bedivided under three parts namely I. Purvakarma II. Pradhana karma and III. Paschat karma.I. PURVAKARMA: Under Purva Karma, following points are to be necessarily considered (i) Atura Pariksha, (ii) Atura Siddhata, (iii) Sambhara Sangraha i) Atura Pariksha 104 Charaka has described the Dashavidha Pareeksha viz., Prakriti, Vikriti,Sara, Samhanana, Pramana, Satmya, Satva, Ahara Sakti, Vyayama Sakti, and Vayafor knowing the Bala Pramana and Dosha Pramana of the patient. Specificimportance is to be given in fixing the Agnibala and nature of Koshta. AturaPareeksha helps to easily assess the following a. Snehana yogya and Ayogya. b. Understanding Snehapana Prakarsha Kala. c. Selection of appropriate Sneha Dravyas and Shodhananga Snehana method. d. Matra nirnaya and Anupana. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 31
  • 53. 1.PrakritiThe study of Prakriti helps in Selection of type of Sneha. In Pitta and Vata Prakriti,administration of Ghrita is preferred. In Pitta-Vata type constitution also Ghrita isgiven, even though he may be suffering from Kaphaja Vikaras. In the same manner,in Vatika Prakriti Patients, taila is prefered. Moreover Prakriti is to be assessed for theproper diagnosis and prognosis of the disease.2. VikritiVikriti pariksa comprises the study of Hetu, Dosha, Dushya, Prakriti, Desa and Kala.3. Sara 4. Samhanana 5. Pramana 6. Vyayama SaktiAll of these four points are helpful in assessment of Bala of the subject. Bala will helpin selecting Snehana dravya and in fixing the dosage. Some persons will be weak bynature Vagbhata clearly states that Sneha is contraindicated in persons who areextremely weak because they dont have capacity to digest the Sneha. While statingabout the indications of Vasa and Majja persons who’s Dhatus are depleted by Vata,Atap, Adhva etc. has been considered.7. SatvaSatva is of three types, viz. Avara, Madhyama and Pravara. Satva Pareeksha helps usto understand that whether the subject is co-operative to the therapy or not.8. Ahara SaktiThis helps in assessing the Agni of the subject and accordingly the fixation of dose aswell as Vardhamana Krama of Snehana karma.9. SatmyaWhile selecting & deciding the dose of Sneha, history of Satmya is essential.According to some authors, habituated Sneha should be preferred. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 32
  • 54. 10. VayaPersons in the stages like Vriddha, Madhyama and Bala will have to be subjected todifferent types of Snehana, because during Balyavastha, the developing or growingphenomenon will be prominent. In young childrens Sadyaha Sneha itself will besufficient. During Yuvavastha and Madhyamavastha, the sustaining or collectingphenomenon will be prominent in the body. During old age or senility, growingphenomenon completely ceases and degeneration starts. Depending upon these threestages, suitable snehadravya will be used.ii. Atura Siddhata Individual Aturas should be prepared physically and mentally throughfollowing procedures - (a) Deepana – Pachana (b) Diet regimen (c) Manasopacharaa) Deepana – Pachana In disease state, when sodhana Purva Snehana is to be employed, wehave to consider the Samavastha of the disease, and thus Amapachana becomesessential. Deepana - Pachana drugs are Agni and Vayu Mahabhuta dominant. ByDeepana, appetite and quantity of food intake is increased and by Pachana, digestivepower is increased. Pachana Karma is for the digestion of Ama and also detachmentof morbid Doshas from the Dushya and Srotasa. If Snehana is done in AmayuktaDosha then it leads destruction of Sanjna (sensory) perception and even also death. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 33
  • 55. Also Sarvangashrita Ama, the Shodhana, it should not be given without the Pachana,Snehana and Svedana, otherwise destruction of body occurs. Ama is harmful to thebody so it is to be expelled out, from the body. For its elimination, it is to be broughtto Koshtha from Sakha. It is essential to take Deepana and Pachana beforeundergoing Snehana therapy to eliminate Mandagni & Amavastha condition.Deepana:It is the drug which will enhances the state of Jatharagni. It increases appetite 105remarkably and hence increases the better absorption of drug . The usual drugsused for Deepana effect are Deepaniya Gana drugs 106, Guduchyadi Gana drugs107.Pachana:Pachana Dravyas are that which have the capacity of digesting Ama but doesn’tincrease the agni of an individual. Nagakeshara107, Pippalyadi Gana, Musthadigana108Dashamooladi gana etc are used for Amapachana purpose.b) Diet regimen Before starting the Snehana therapy, which type of food should betaken has been described by Acharyas in order to avoid the Agnimndyadi Upadravas.The food to be administered should be Drava, Ushņa and Anabhishyandi, which arenot too Snigdha and Asankeerņa, excessive quantity of liquid, help in the digestion offood and does not remain in the Koshţha for longer period. Ushņa ahara also digestedearly and helps in increasing the taste and Agni. It also helps in Vatanulomana andmitigation of Kapha. The food stuffs should be consumed on the basis of Agni, Kalaetc. and quantity of food varies accordingly. By consuming Asankeerna bhojana thereis less possibility of developing Varieties of diseases. There are different Kinds of Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 34
  • 56. incompatible foods mentioned by Charaka; they are Deaa, Kala, Matra, Satmya,Veerya, Koshţha, Avastha, Krama, Samyoga, etc. Excessive consumption of Snigdhafood stuffs does not get digested timely and aggravate Kapha Dosha, hence excessiveSnigdha articles should not be administered before Snehana therapy.Diet indicated for shodhananga Snehana 109,110,111  Drava – Liquid  Ushna – Warm  Anabhishyandi – not having ‘Abhishyandi’ property  Na Atisnigdha – Not too much Snigdha  Pramanayukta – Regulated quantityc) Manasopachara The complete procedure of Snehapana and Shodhana should be explained tothe individual prior to Snehapana since a large quantity of Sneha is administered andbecause of the non-palatability, discomfortness felt during Sneha Jirna Kala,individual might show aversion to drink the Snehadravya. So the individual should beencouraged to drink Sneha and he should be given confidence for the same.iii. Sambhara Sangraha The required medicaments, first aids and essential materials to treatthe Vyapat should be kept ready 112. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 35
  • 57. II. PRADHANA KARMA After careful management of Purva Karma, the Snehya patients areto be selected for Pradhana Karma.Pradhana karma includes1. Administration of Sneha and Anupana2. Observation of a) Sneha Jiryamana Lakshanas and Sneha Jirna Lakshanas b) Snigdha, Ati Snigdha and Asnigdha Lakshanas1. Administration of Sneha 113 A person with an empty stomach should be made to take Sneha. Sun wouldappear on the summit of the hill at dawn and lighten up the horizon with first shootsof its vermilion tinted golden rays. Rites of benediction should be first done to thesubject before administering the Sneha to him in an adequate dose. After that heshould wash his mouth with warm water and quietly stroll about with his shoes on.Susruta has mentioned first time about Sneha intake time i.e. 15 to 30 minutes beforeSunrise because then only Dosha Utklesha is possible. In Charaka Samhita the time ofSodhana Sneha intake was mentioned as after the digestion of previous night’s meal.For Sodhana Purva Snehana, a large quantity of Sneha is to be given. So the willpower of the subject should be encouraged. Rites of benediction give the mentalserenity to the patient. Due to odor and taste of Sneha, there may be dislike towardsSneha and he may not co-operate. So the suitable methods should be adopted. It is Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 36
  • 58. better to close the eyes of the patient by a cloth, during the administration of Sneha.There may be the Lakshaņas like Hrillhasa, Chardi, Aruchi, Udgara are produced aspatient gets aversion towards Sneha. So to overcome these symptoms, Lemon juice,Hot water may be given along with Sneha.Anupana 114,115,116 Anupana given along with the Snehadravya helps in breakdown,softening, digesting, proper assimilation and instant diffusion of the Sneha taken. Italso helps in refreshing the patient and gives pleasure and energy to the patient. Anupana used for Chaturvidha snehas are: Ushna jala – For Ghrita, Yusha – For Taila, Manda – For Vasa and Majja,Anupana also influences the digestion of Sneha,warm water is used in case of Ghritawhich is seeta veerya, to make it quicker distribution. Taila being Ushņa Veeryadravya is followed by Yusha. Manda being Laghu, Deepana, and Vatanulomana willpromote the quicker digestion of Vasa and Majja which are heavy for digestion. ThusAnupana plays an vital role by its virtues. Salt also behaves as catalyst in bringingabout the results of Sneha rapidly. The dosage of the Anupana may be decided on thebasis of normal digestion capacity or according to the pharmaceutical processinvolved. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 37
  • 59. 2. (a) Observation of Sneha Jiryamana and Jirna Lakshana ‘Sneha Jiryamana Lakshanas’ are certain symptoms produced when theadministered Sneha undergoes various digestive phases. These Lakshanas do not needany sort of therapeutic intervention and subsides after Sneha Jirna. Production of kapha takes place during the first phase of paka avasthawhich has similar qualities to sneha. . Thus production of kapha will be more thanwhich causes lalasrava. Jataragni will increases because of the large amount of snehaadministered and since Jataragni has Agneya quality it causes Trishna, Bhrama,Murcha, and Daha. The completion of Sneha digestion (Sneha Jeerna) is indicated by the onset ofsymptoms like Kshut, Trishna, etc. In cases where the digestion of Sneha is doubtfulhot water should be given to drink to get Shuddha Udgara, Laghuta, and desire forfood. If the Sneha is not digested even after administration of warm water and takesmore time than required it should be eliminated by Vamana .After this cold watersprinkling and applying of Chandna paste on scalp and cold water bath should bedone 117.Table No. 16 Sneha Jiryamana and Jeerna Lakshana 118 Jiryamana Lakshana Jeerna Lakshana Shiroruja Shirorujadi Jiryamana Lakshana Prashamana Bhrama Vatanulomana Nishtiva(Lalasrava) Kshudha pravrtti Murcha Trishna pravrtti Sada Udgarashudhi Arati Laghuta Klama Trishna Daha Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 38
  • 60. 2. (b) Observation of Snigdha–Asnigdha–Ati Snigdha Lakshanas 119,120,121,122,123,124,125 The important laxanas of samyak snigdha, asnigdha and atisnigdhata havebeen described by all acharyas which helps in deciding regarding the furtheradministration of swedana and shodhana therapies. Evaluation of Snehapana based on parameters are likeSamyak Snigdha Lakshanas, Asnigdha Lakshanas and Ati Snigdha Lakshanasi) Samyak Snigdha Lakshanas The most important action of Shodhananga Snehapana is the attainmentof Samyak Snigdha Lakshana. Snehapana has to be stopped after observing theselaxanas.Table No. 17 Samyak Snigdha Lakshanas Lakshanas C.S. S.S. A.H. K.S. Sh.S Ckd Va Se Vatanulomana + + + + + Deeptagni + + + + + + + Snigdha Varcha + + + + + Asamhata Varcha + + + + + + Purisha Mrduta - - - + - - - Adhastat Sneha Darshana - + - - - - - Gatra Mardavata + + + - + - + Gatra Snigdhata + - + - + - + Tvak Snigdhata - + - - - - - Anga Laghava - + + - + - - Klama - - - - - + - Glani - + + - + - - Snehodvega - - + - + - - Vimalendriyata - - - + - - - Medha - - - + - - - Pusthi - - - + - - - Dhrti - - - + - - - Kale Sharira Vrtti - - - + - - - Teja Vrddhi - + + - + + - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 39
  • 61. ii) Asnigdha Lakshanas In individuals who have Asnigdha Lakshanas prior to Snehana therapy ifSnehana therapy is not done properly then these Lakshana persist at the end also. ThePhysician should adjust the matra of snehana according to these Lakshanas .Thefollowing are the Lakshanas observed if Sneha is not carried out properly.Table No. 18 Asnigdha Lakshanas Lakshanas C.S. S.S K.S. Va Se A.H. Grathita Purisha + + + + - Ruksha Purisha + + - - - Shushka Purisha - - + - - Vayu Pratilomana + + + + - Agnimandhya + - + + + Avipaka / Krcchrat Annnam Vipachyate - + - - + Anila Purita Udara - - - - + Gatra Rukshata + - + - + Gatra Kharata + - + + - Urovidahata, Dourbalya - + - - + Dourvarnyata - + - - + Adhrti - - + - -iii) Ati Snigdha Lakshanas If Snehapana is continued even after the appearance of SamyakSnigdha Lakshana, it may lead to increase of Apyamsa in the body and result in themanifestation of Atisnigdha Lakshana. Atisnigdha Lakshanas are as follows Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 40
  • 62. Table No. 19 Ati Snigdha Lakshanas Lakshanas C.S. S.S A.H K.S Sh.S Ckd Va Se Panduta + - - + + + + Gaurava + - - + - - - Jadya + - - + - - + Apakva Purisha + - - + - - + Purisha ati pravrutti - + + - + - - Guda Srava - - - - - + - Ghrana Srava - - - - - + - Mukha Srava - + - - + + - Pravahika - + + - + - - Utklesha + - + + - - + Aruci + - + + - - + Bhakta Dvesha - + - - + - - Adhmana - - - + - - - Tandra + - - + + - + Moha - - + - - - - Angadaha - - + - - - + Gudadaha + + +III. PASCHAT KARMA: Paschat Karma is the post operative procedures which are adopted forbetterment of patient to achieve optimum therapeutic benefits and to avoid anycomplications. As long as Snehana is administered, so long strict regimen should befollowed. Paschat Karma can be divided into two. Paschat Karma on the days of Snehapana. Paschat Karma after attainment of Samyak Snigda Lakshana. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 41
  • 63. Paschat Karma on the days of Snehapana:126 (i) Guru Pravarana - covering body with thick cloth. (ii) Nivata Shayana Sthitaha - residing in a room devoid of breeze. (iii) Jaranantam Pratiksheta-awaiting digestion of Sneha. (iv) Taking little quantity of Ushna Jalapana or any other specified Anupana type of Sneha. (v) When Sneha is digested taking hot water bath, and consuming Yavagu etc. (vi) During snehana the diet should be mrudu which affects in stimulation of digestive power and lightness of abdomen.Paschat Karma after attaining Samyak Snigdha Lakshanas 127,128,129,130 Shodhananga Snehapana is stopped after attainment of Samyak Snigdha Lakshanas and process like Sarvanga Abhyanga, Svedana and Shodhana are advised.Pathya a) Ushna Jalapana - Ushna Jala does Deepana, Pachana and Vatanulomana properties and so helps in Snehapachana process. (b) Bramhacharya - Helps in Snehana process. (c) Kshapashaya - As day sleep and Ratri Jagarana aggravates Kapha and Vata Dosha respectively, only night sleep is advised. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 42
  • 64. Apathya a) Vyayama - Exercise b) Uccha Vachana - Loud speech c) Vega Samrodha - Suppression of Urges d) Shoka, Krodha - Anger, anxiety. e) Hima, Atapa - Mist, Sunlight. f) Pravata - Open breeze g) Atyasana-Sitting at a place for long time. h) Neecha/Uccha Upadhana - Usage of too low or too high pillows. Pathya- Apathya should be followed sincerely for equal number ofdays during the course of Snehana therapy and after therapy also.POST SNEHANA THERAPIES 131,132,133,134,135,136 The period between completion of Shodhananga Snehapana to theday of Virechana or Vamana is known as Vishrama Dina. During this period theindividual will be subjected for Sarvanga Abhyanga, Svedana and provided withappropriate diet.SNEHA VYAPAT 137,138,139 Sneha vyapat results when there is faulty administration of sneha by thevaidya without considering matra, kala, rutu, anupana etc. or if the patient does notfollow the rules during snehana karma. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 43
  • 65. (i) Ashu Utpanna Vyapat: These disorders have acute onset and need immediate management.Examples are (1) Ajeerna (2) Aruchi (3) Amapradosha (4) Shoola (5) Jwara (6) Anaha (7) Trishna (8) Sthambha (9) Utklesha (10) Tundra (11) Samjna Nasha.(ii) Chira Utpanna Vyapat : These disorders manifest in due course of time. Examples are (1) Kandu (2) Kushta (3) Grahani (4) Pandu (5) Arsha (6) Shotha (7) Udara (8) Staimitya (9) Vakgraha.These complications should be treated as explained in the various classical textbooks.Sneha Vyapat Chikitsa 140,141,142 The different therapies to treat Sneha vyapat mentioned in the variousclassical textbooks are1 Upavasa/Trshna: Beneficial in Alpa Dosha Avastha and enhances Agni Bala.2. Ullekhana: In Utklishta Dosha Avastha SadyoVamana is beneficial and is also advised in conditions like Sneha Ajirna, Utklesha, Snehajanya Trshna.3. Svedana : In conditions such as Sthambha, Svedana is beneficial.4. Rukshana: Rukshana therapy is highly beneficial in Sneha Atiyogajanya Vyapat. Rukshana Dravya can be administered in the form of Pana, Anna and Bheshaja. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 44
  • 66. Sneha Ajirna Janya Trishna Chikitsa 143,144,145 If Sneha Ajirna produces severe thirst, the patient’s head and face should besplashed with cold water. . In cases where it does not relieve the thirst, the Pittadominant patient should be given Ruksha Anna and Sheeta Jala and then made tovomit. In case of persons who have predominance of Kapha and Vata or all theDoshas increased in equal proportion, Vamana is induced after giving Ushna Jala.KARMUKATA OF SNEHANA The importance attached to Snehana prior to the administration of Sodhanatherapies can be well understood by the Citation of Charaka. He says prior to theapplication of these depletory therapies first Snehana and Svedana must be done. Theview can be emerged by the study related to the permeability of Sneha dravyas intothe innermost recess of the body. It can be recognized that Kalas which surround theDhatus and Srotamsi are semi permeable. Chakrapani favours this by saying thatevery Dhatus have specific channels pertaining to it and by the channels concernedwith a particular Dhatus, other Dhatus will not be nurtured. Thus Sneha acts as asolvent both for lodged Dosha and Dooshya and as well as unexcreted tissue wasteproducts. When Doshas are present in their vitiated condition, they leave theShakha (periphery) and occupy the Koshta (central place) and their Linatva (latency)withers away and Uthkesha Avastha (Patency) is acquired and it is in this Avasthathat Panchakarmas are indicated when vitiated Doshas have become Utkleshita andwhen they have accumulated in Kostha and are not scattered in remote srotases. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 45
  • 67. 1. Actions of Snehana: The various actions of Snehana results due to the properties ofthe Sneha Dravyas and so a thorough evaluation of the actions of these propertiesSnehana is very necessary.146 a) Drava: The Snehadravyas impart some moisture to the Srotas which removes impediment of doshas, helps in diffusion of Sneha over the body, helps in Dosha Vilayana process and acts as a dissolving media to the Doshas by Alodhana Sandhan Karaka property. b) Sukhshma: The Sukshma property of Sneha helps it to easily enter into the minute channels of body. Sukshma has Sroto Vishodhana property, thus aiding in bringing the Doshas back to Koshta. According to some the capabilities of dilatation of channels was the property which augments the movement of Sneha Dravyas freely even through the minute channels. c) Sara: The spreading of Sneha all over the body is brought about by the ‘Vyaptishilatva’ property i.e., spreading nature of Sara. The Prerana and Vatanulomana action of Sara Guna helps in movement of Doshas back to Koshta. d) Snigdha : Snigdha brings There is a better conveyance of Dosha, Dhatu and Mala due to the softness of Srotas brought about due to the Snigdha property. e) Picchila: Shleshmala property helps the Sneha to come in contact with Doshas for longer duration and thus brings about Dosha Utklesha. Arunadatta has described these as Sandra & Chikkanattva. . The properties attributed to Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 46
  • 68. this are Jeevana, which is shown on Raktadi Dhatus, Balya which imparts strength and Sanghata by the compactness of morbid elements. f) Guru: This property of Sneha is the one responsible for the increase in body dimensions. g) Shita: It keeps the intactness of the body .As a result of this quality it creates satiety and prevents the occurrence of Murcha, Sveda and Daha. h) Mrdu: It brings about Srotomardavata. By generating softness, laxity and loosening the Dosha Sanghata. Although the properties of Guru, Shita and Manda have been describedas those of Sneha, they have more of Shamana or Brumhana value than aiding inShodhana Snehana action. 147 According to Charaka Samhita Siddhisthana when dealing with SnehanaKarya it is described that i) Sneho Anilam Hanti ii) Mrdu Karoti Deham iii) Malanam Vinihanti Sangam. The above said have been described as the functions of Shodhana Snehana by Cakrapani and these actions of Shodhananga Snehana may be analysed as follows .148 i) Sneho Anilam Hanti Sneha has exactly the opposite Guna of Vata Dosha and hence Sneha attains the proper Gati of Vata and helps to bring the Shakhagata Dosha into Koshta. This explains why Vata Nigraha is one of the criteria mentioned Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 47
  • 69. by Charaka to bring Doshas back to Koshta. Vatashamana effect of Snehana can be known by observing Vatanulomana action. ii) Mrdu Karoti Deham Sneha brings softness in Dosha Sanghata, Srotas and Deha by virtue of its Snigdha and Mrdu qualities which in turn brings the Doshas to the Koshta in Utkleshana stage. This Mrdukarana effect of Sneha can be confirmed by observing Gatra Mardavata. iii) Malanam Vinihanti Sangam The Snigdha and Vishyanda properties of Sneha overcomes the Rukshata which causes Mala Sanga and thus the Sanga get relieved.2. Importance of Shodhananga Sneha The importance of Shodhananga Snehana can be substantiated with thehelp of various references available in the classics. As per Charaka Samhita Snehana should be administered first, then 149Swedana and finally followed by Shodhana . The importance of Snehana has beendescribed by Acharya Sushruta as “Sneha saro Ayam Purusha: Pranascha SnehaBhuyistha: Sneha Sadhyascha Bhavati.”150 which means that Sneha is the saravasthaof the human body which believed to be present in all parts of the body and also inthe in prana. The word Prana includes Agni, Soma, Vayu, Satva, Raja, Tama,Panchendriya and Bhootatma. The process of eliminating the impurity of the body with the help ofShodhana measures after deterging Utklesha with Snehana and Svedana can be Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 48
  • 70. compared to the process in which the dirt of the cloth is washed with water afterdeterging (with alkali etc.). The above said version is of extreme importance inexplaining the mode of Action of Snehana and Svedana as Purvakarmas beforeShodhanakarma in bringing Doshotkleshana. Among these two Purvakarmas,Snehana by virtue of its Vishyandana properties, aids in bringing Lina andAnutklishta Doshas to Utklishta Avastha 151. When Snehakarma is administered as a preoperative measure toShodhanakarma the excited doshas are eliminated completely. This can be comparedto a process in which the inner portion of the vessel when it is smeared with ghee andthen is filled with water, the water can be removed completely without leaving asingle drop. When Snehana therapy is used in proportion with the digestive power ofthe individual it gets digested and it oleates only when administered in excess. Thiscan be compared to o process in which a cloth absorbs only a certain amount of waterand oozes out the water in excess. The different ways to bring vitiated Doshas form Shakha to Koshta hasbeen described by Acharya Charaka which are as follows. 152  Vrddhi – By increasing  Vishyandana – By dissolving / by increasing fluidity of Doshas  Paka- By detaching the Dosha from the place of lodgment.  Srotomukha Vishodhanat – By clearing the orifice of Srotas.  Vata Nigrahat – By controlling Vata Dosha . Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 49
  • 71. Hence Sneha acts in every aspect of the above processes to bring the Doshas to the Koshta and bring about Utkleshana of the Doshas.3. Karmukata of Shodhana Poorva Snehapana The inclusion of Snehana as a Purvakarma to various Sodhana procedures can be attributed to the following actions a) It acts as a solvent. b) It increases the Apyamsha of the body. c) It brings the lodged morbid and unexcreted waste products to gastro intestinal tract.Action as solvent As per Sushruta a disease is produced due to the sthana samshraya ofvitiated Doshas through srotases during their circulation in the body 153. When Snehais administered inside the body it reaches the Srotamsi and acts as solvent to removeobstruction by dissolving those morbid factors in it thus resulting in the removal ofSroto vibhandha which is one of the important steps in the Samprapti Vighatana. The study related to the permeability of Dravyas into the innermost recess ofthe body confirms this view and it also can be seen that the Kalas which surround theDhatus and Srotamsi are semi permeable 154. This view is favoured by Chakrapani who opines that every Dhatu will havespecific srotases pertaining to them and by the srotases concerned with a particularDhatu, other Dhatus will not be nourished 155 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 50
  • 72. Therefore in short Sneha acts as a solvent both for lodged morbid factors andfor unexcreted tissue waste products.Increases the Apyamsa of the body 156 Sneha by virtue of its predominance of Apa Mahabhuta liquefiesthe Malas brought from the tissues resulting in the increase in the levels of fatty acids,blood and thereby resulting in high plasma volume. The extra amount of liquid fromthe plasma is reached in the Kostha for excretion to keep up the equilibrium of thenormal plasma level. When Shodhana Karma is administered this increased amountof body fluid is evacuated as a result of which the vitiated Doshas and unexcretedMalas are also expelled out resulting in the cure of the ailmentBrings the lodged morbid and unexcreted waste products to gastro intestinaltract The main purpose of Purvakarma is to promote elimination of theaccumulated malas from Sakas, by bringing them to Kostha which are afterwardsexpelled from the body by Shodhana Karma .According to Acharya Sushruta ,due toSnehana and Svedana, the morbid humor of the disease being instigated, becomeliquefied and are brought to the Kostha for easy elimination by the Sodhana or radicaltherapies 157.DIGESTION AND METABOLISM OF SNEHARole of agni: The concept of Digestion and Metabolism in Ayurveda reflects in theJatharagni, Bhutagni and Dhatavagni Pakas. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 51
  • 73. At the end of Jatharagni Paka, Sanghata Bheda takes place, whereinthe substances acted upon by Jatharagni are broken down into minute fragments. Nowthe substance which is to be subjected to the next Bhutagni Paka is in a uniform liquidstate. From here five types of Bhutagni act upon the respective Mahabhuta moleculespresent in the semi digested food and the resultant is transported to respective Dhatusfor final Dhatwagnipaka. Qualities of Sneha Dravya such as Drava, Sara, Snigdha etcare the qualities of Jala Mahabhuta. So, we can understand the digestion of Sneha Dravya by studying theevents of digestion that takes place at the three Agni levels. Agni digests the fourtypes of Ahara and provides energy for sustaining life. It protects body from wear andtear. Hence Agni performs the functions of digestion and metabolism.Jataragni: The term Jatharagni comprises several factors such for e.g. severalenzymes which participate in the digestion of the different components of food in thesmall intestine. It is mainly concerned with chemical processes involved ingastrointestinal digestion. Reference made by Vagbhata to the organ Grahaniindicates the seat of Pachakagni. According to Charaka, Grahani is so called becauseit receives and retains the food for its digestion.Bhutagni: According to the physiology of Ayurveda, Bhutagni Paka followsJatharagni Paka. The digestion of food by Jatharagni leads to the Sanghatabheda orbreakdown of the former into five distinct physiochemical group’s viz. Parthiva,Apya, Tejas, Vayaviya, and Nabhasa. The Agni moiety present in the substances Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 52
  • 74. belonging to each group is, then stated to digest the substance of that group leading toa radical change in their qualities i.e.,Vailakshanya Guna. Thus food substances arerendered fit for being assimilated for the build up as parts of the correspondingPanchabhuta class.Dhatvagni: The specific Agni corresponding to each Dhatu is called as Dhatvagni.Dhatvagni Paka is stated to metabolise the products of Bhutagni Paka. The nutrientsthat support the body are subjected to Paka by the seven Dhatvagnis, leading to theDhatus through their respective Srotamsi. Flow chart: 1 showing Snehapachana Action of Pachaka Pitta at Pitta S dara kala Jataragni N Bhinnasangata( Break down of E fat in the intestinal digestion ) and production of Amla bhava H A P Digest the Sneha having Bhutagni mainly Apya mahaboota so A increase Apya constituent in the body C H A N Action of all Datwagni in Datwagni general and action of specific A Datwagni in particular Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 53
  • 75. Digestion and absorption of fats Fats consist of a wide group of compounds that are generally soluble inorganic solvents and largely insoluble in water. Fats may be either solid or liquid atroom temperature, depending on their structure and composition. "Lipids" is used torefer to both liquid and solid fats, along with other related substances. Most of the fat in the human diet is in the form of triacylglycerol (TAG),which consists of three fatty acids linked to glycerol. In the digestive tract, TAG ishydrolyzed by the enzyme lipase, to release free fatty acids and monoglycerides.Emulsification and digestion The key issue in the digestion and absorption of fats is one of solubility:lipids are hydrophobic, and thus are poorly soluble in the aqueous environment of thedigestive tract. Digestion is greatly aided by emulsification, the breaking up of fatglobules into much smaller emulsion droplets. Bile salts and phospholipids areamphipathic molecules that are present in the bile. Motility in the small intestinebreaks fat globules apart into small droplets that are coated with bile salts andphospholipids, which prevent the emulsion droplets from re associating. The emulsion droplets are where digestion occurs. Emulsificationgreatly increases the surface area where water-soluble lipase can work to digest TAG.Another factor that helps is colipase, an amphipathic protein that binds and anchorslipase at the surface of the emulsion droplet. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 54
  • 76. Figure: 1 Digestion and Absorption of Fat Figure: 2 Emulsification of FatEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 55
  • 77. Micelles After digestion, monoglycerides and fatty acids associate with bile saltsand phopholipids to form micelles. Micelles are much smaller than emulsion dropletsMicelles are necessary because they transport the poorly soluble monoglycerides andfatty acids to the surface of the enterocyte where they can be absorbed. As well,micelles contain fat soluble vitamins and cholesterol. Micelles are constantlybreaking down and re-forming, feeding a pool of monoglycerides and fatty acids thatare freely dissolved. It is the monoglycerides and fatty acids that are free in solutionthat are absorbed, NOT the micelles. Because of their nonpolar nature,monoglycerides and fatty acids can just diffuse across the plasma membrane of theenterocyte.Figure:3 Micelles Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 56
  • 78. Chylomicrons Once inside the enterocyte, monoglycerides and fatty acids arere-synthesized into TAG. The TAG is packaged, along with cholesterol and fatsoluble vitamins, into chylomicrons. Chylomicrons are lipoproteins, specialparticles that are designed for the transport of lipids in the circulation. Chylomicronsare released by exocytosis at the basolateral surface of the enterocytes. Because theyare particles, they are too large to enter typical capillaries. Instead they enter lacteals,lymphatic capillaries that poke up into the center of each villus. Chylomicrons thenflow into the circulation via lymphatic vessels, which drain into the large veins in theneck. Chylomicrons deliver absorbed TAG to the bodys cells. TAG in chylomicronsand other lipoproteins is hydrolyzed by lipoprotein lipase, an enzyme that is found incapillary endothelial cells. Monoglycerides and fatty acids released from digestion ofTAG then diffuse into cells.Cholesterol absorption Intestinal cholesterol absorption is important because of the clinicalrelevance of cholesterol. Of the total cholesterol that passes through the smallintestine, only half is typically absorbed, and the rest is eliminated in the feces. Thus,cholesterol in the bile is an example of a substance that is targeted for excretion viathe digestive tract. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 57
  • 79. REVIEW OF LITERATURE OF PANDUROGAHISTORICAL REVIEW History is nothing but the record of past events. As one of our aims is to rootout the disease, accordingly, while attempting to find a proper management of a disease,it is very much important to study the disease from its roots.“Those who fail to read history are destined to suffer the repetition of its mistakes”. Ayurveda, the most indigenous system of medicine has propagated treatmentfor many diseases. The principles of treatment described in our ancient Ayurvedic textsstill hold well since ages.The study of the history of Panduroga can be divided into: 1) Vedic period - Samhitas, Brahmanas, Upanishad, Kalpasutra (upto 1000BC) 2) Samhita kala - (1000BC – 500 AD). 3) Sangraha Kala - (500 AD – 1700 AD). 4) Adhunika Kala - (1700 AD onwards).1) Vedic period: Ayurveda is intimately connected with the Vedas. This is evidentfrom the fact that the former is regarded as Upaveda of Rigveda (Kashyapa). Ayurveda isUpanga or Upaveda of Atharvaveda because of its similarity. Thus Ayurveda, which isintimately connected, with Atharva veda should have acquaintance with Puranas. Itwould be logic to say that both Puranas and Ayurveda developed together with postatharvanic period, thus creating an ideal environment for interacting between them. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 58
  • 80. The word “Pandu” is available in Mahabharata when sage “Vyasa” intercoursewith “Ambilika” the widows of “Vichitra veerya”, she becomes pale with fear. That’swhy her son who born with pale (Pandu) colour and named as “Pandu”. In Vedas, we get the reference for the treatment of panduroga with morningsunrays, red cow’s milk and the red anjana which have been said as harita beshaja.Koushiaka sutra prescribes the intake of cooked rice mixed with Haridra and anointingthe same over the body for this disease.Garuda Purana: In Garuda Purana there is a reference that Takra mixed with loha churna wasadvocated in the treatment of Panduroga. Besides the above description, Pandu is alsoavailable in Agnipurana, Valmiki Ramayana and Yogavasistha. Mythological origin of diseases and recitation of stotras like Vishnu sahasranamain jwara chikitsa, Shiva suta aradhana in kushta chikitsa are the direct impact of thepuranas.RigVeda: In Rig veda it is stated ‘I will remove yakshma from various tissues and parts ofbody like taruna asti, antara, yakruth, pleeha, masthiska, jiwha, hrudaya and puppusa’( Rig veda 10/ 163). Hariman and Harita are the diseases mentioned in Rigveda andAtharvaveda. Hariman is interpreted by Sayana as pallor and yellowishness of the bodycaused by the disease. Similar explanation is available in Rigveda . As per the author of History of Medicine in India (pg 20), “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). Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 59
  • 81. 2) Samhitha kala: During this period the scattered information were gathered and arranged in asystematic manner resulting in the genesis of Samhitas. Later it became a living traditionof the community and so it got patronage from both king and the community. Among themany distinguished names in the Hindu medicine during this period Charaka, Susruta,Haritha and Bhela stands out with prominence and all of them have very clearlymentioned about Panduroga by covering all the aspects in detail.Charaka Samhita: Panduroga is explained elaborately in Charaka samhita Chikitsasthana 16thchapter. In this chapter there is a detail description regarding the Nidana, Samprapti andChikitsa sutras of Panduroga been mentioned and considerd this as rasavaha srotovikara.Susruta Samhita: Susruta samhita gives elaborate explanation regarding Panduroga which isdescribed in Uttaratantra 44th chapter158. He has dealt in detail with the Panduroga givingits Nidana, Samprapti, Bedha, Upadrava and Chikitsa considering it as a raktavahasrotovikara.Astanga Hrudaya: Panduroga Nidana is explained in Ashtanga Hridaya Nidanasthana 13th chapter159 and its management in chikitsasthana 16th chapter 160.3) Sangraha kala: It was during this period that the depicted scripture of samhita kala was given aclear interpretation in the form of commentaries to elucidate it. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 60
  • 82. Chakrapani, Indu, Dalhana, Vijayarakshita, Srikantadatta, Adamalla,Amarasimha, Arunadatta, Gangadara all of them have written commentaries on thisdisease given their own interpretations on various aspects of this disease. Panduroga is described in Ashtanga sangraha Nidanasthana161 andChikitsasthana162, Kashyapa Samhita Sutrasthana163 ,Yogaratnakara164Pandurogaadhikara, Bhavaprakahsa Madyamakhanda165, Madhavanidana 166 ,ChakradattaPandurogaadhikara 167.  In Rasaratna Samuchaya author Vagbhata have mentioned the shodana and marana of Loha bhasma and its use pertaining to pandu.  Sharangadhara, in his treatise described the classification of Panduroga and mentioned many kasta aushadis for its cure.  Yogaratnakara was unique in giving equal importance for both kasta and rasa aushadi in the management of Panduroga.3) Adunika kala: Initially due to various foreign invasions and due to high patronage ofwestern medicine, Ayurveda had to face its stagnant state but after independence due tosupportive measures Ayurveda found a sprouting from the stage of dormancy. Kaviraj Rama Rakshak Patak has written a complete book on pandu rogagiving elaborate description on various aspects of panduroga. Various books are writtenon regional languages expectionally in Malayalam like ‘Pandu rogavyum chikitsayum’by Dr. T N K Moosa. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 61
  • 83. Anemia: The term anemia was first found in the Carpus Hippocraticus. It literally meanswith out blood and is derived from Greek word “a” or with out and “haima” or blood. The term anemia was first used in English by James Combe and Edinburgphysician in the year 1824. Gerbrial Andral a French physician laid much of thefoundation on modern concept of anemia. NIRUKTI AND PARIBHASHA In Ayurveda, different diseases are named on the basis of signs andsymptoms, the origin of the disease, location of exhibition of the symptoms. Here thedisease Panduroga is named on the basis of “Varna.” The word “Pandu” is derived from “Padi–Nashne” dhatu by adding “Ku”Pratyaya to it. For Pandu specifically the Nashana will be of the Varna i.e. the colour,which according to Acharya Charaka is “Vaivarnya” 168. Thus the derivation of the word“Pandu” indicates the abnormal colouration of the body. Pandustu Peetabhagardhaha Ketaki Dhuli Sannibham169 Pandu is a mixture of shweta and peeta varna in equal proportions, whichresembles the colour of pollen grains of Ketaki flower. Pandu Haridra haritaan Varnancha Vividham Stwachi Sa Pandurogaha Ityuktaha Pandu Haridra Haritan Pandutwam Tesham Chaadhikam Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 62
  • 84. The disease in which, twacha becomes Pandu, Haridra, Harita varna is known asPanduroga 170. Padutwenopalakshitaha Rogaha Pandurogaha The disease in which Pandubhava, Pandutwa or Panduvarna is more is known asPanduroga. 171RELATION BETWEEN RAKTA, PITTA AND PANDU Acharya Charaka has described symptoms like Vaivarnya, Ojogunakshayam,Hataprabha, Alparaktanissara while describing the roopas of Panduroga. Therefore it isnecessary to know the role of Raktadhatu and Pittadosha which play a predominant rolein the maintenance of the complexion of the body. According to Acharya Sushruta Rakta is considered as a key factor for theJeevana, and Poshanakarma of the body as said in the following sloka Raktam Jeevam Iti Sthiti: 172.But according to Acharya Charaka the proper functions of rakta can be expected only inits pure form Tadvishuddham Hi Rudhiram Balavarnasukhayusha | Yunakti Pranianam Prana: Shonitam Hyunuvartate || 173 As per the classics, Raktadhatu is derived from rasadhatu which is an aqueousfluid. It is a transparent and colourless substance due to the predominance ofJalamahabhoota and reddish in colour due to the predominance of Teja mahabhoota. Rasadhatu is sara of Shadrasayukta ahara called Poshya dhatu. When thisposhya dhatu undergoes pachana by agni derived from pitta, it transforms into raktadhatu. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 63
  • 85. Due to the action of ranjaka pitta on rasa, it gets transformed into reddish coloursubstance i.e. Rakta. According to Acharya Sushruta the main site of rakta is Yakrit and Pleeha 174.Ranjaka pitta, located in Yakrit and Pleeha, plays a major role in ranjana karma ofRasadhatu. As per Vagbhata, Amashaya is the site of Rajaka pitta 175. Based on the above description it can be deducted that rakta depends onpitta, which transforms rasa into rakta, and bala, varna, ayu depends on rakta. Pandu is 176said to be a Pitta pradhana vyadhi . In all types of paittika disorders, there will beimpairment of pitta either in the vriddhi or kshaya stage. Pitta plays an important role in the formation of rasaraktadi dhatus as agniis represented by pitta in body which brings about good and bad effects according to itsnormal or abnormal state 177. When the pachaka pitta gets vitiated, due to its adverse effect, the digestiveprocess gets disturbed which in turn disturbs dhatu formation. Ranjaka pitta also plays avital role in formation of rakta, hence its vitiation also affect the formation of rakta. The vitiation of sadhaka pitta disturbs the functions of hridaya and raktaparisanchalana because of which the sthayi dhatus are poorly nourished. As a result, dueto rakta kshaya, Bhrajaka and Alochaka pitta also becomes durbala in performing theirnormal functions and so various symptoms of pitta are observed in Panduroga. Thereforeit can be concluded that pitta plays a vital role in manifestation of disease Panduroga. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 64
  • 86. NIDANA PANCHAKA Panduroga can be diagnosed by the study of Nidana, Purvaroopa, Roopa,Upashaya and Samprapti.NIDANA 178,179,180 Many nidanas for manifestation of the disease Panduroga have beenexplained by different authors. For the sake of convenience it can be categorized underdifferent groups.A. Aharaja NidanaTable No. 20. Showing the Aharaja Nidana of Panduroga. Sl. Nidana Ch Su Va 01. + + + Amlarasa sevana 02. Kshara seavnaa + - - 03. Lavana rasa sevana + + + 04. Ati ushna bhojana + - - 05. Viruddha bhojana + - - 06. Nishapava sevana + - - 07. Masha sevana + + - 08. Tilataila sevana + + - 09. Madya sevana + - - 10. Mrit bhakshana + + - 11. Teeskhnahara sevana - + - 12. Atikatu sevana - - + 13. Ati kashaya sevana - - + 181 Charaka has mentioned Panduroga in Santarpanajanya vyadhi . Above saidnidanas are causes for Pitta Pradhana Tridoshas Prakopa and Mandagni. Acharya Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 65
  • 87. Madhavakar, Bhavamishra, Yogaratnakara have followed the Susruta’s version182. Thesetypes of ahara may lead to disturbances in the digestive and assimilative process, leadingto Panduroga.B. Viharaja NidanaTable No. 21. Showing the Viharaja Nidana of Panduroga. Sl. Nidana Ch Su Va01. Vegavidharana in vamana karma + - -02. Amatisara sangaha + + -03. Dushtaraktanigraha in Raktarsha + - -04. Snehavibhrama + - -05. Ativyayama and Bharaharana + + -06. Atimaithuna + + -07. + + - Rutu Vaishamya 08 + + + VegadharanaTable No. 22. Showing the Manasika Nidana of Panduroga. Sl. Nidana Ch Su Va 1 Bhaya + - - 2 Krodha + - + 3 Chinta + - - 4 Shoka + - - 5 Kama + - +C. Nidanarthakara Roga Panduroga can also manifest secondary to some other disorders likeRaktarbuda 183Asrgdhara184 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 66
  • 88. Raktapitta 185Yakrit-pleeha roga186Raktarsha 187Pleehodara 188Yakrutodara 189Pittaja Prameha 190 All these lead to either rakta kshaya due to bleeding or vikrita doshas whichresults in Panduroga.POORVAROOPA 191,192,193Puvarupa or Prodoamal symptoms,1). Samanaya Purvarupa2). Vishishta Purvarupa No specific description regarding Vishishta Purvarupa is available in theclassical texts. Although the symptoms of Purvarupavstha and Rupavstha are so muchsimilar with each other that sometimes it becomes difficult to distinguish between them,because most of the symptoms of Purvarupavstha are also found in Rupavstha; but if oneis able to detect them, then to some extent he gets a clue to predict the possibility offuture disease.Classical texts have mentioned the following symptoms and the heading of Purvarupa ofPanduroga. The Panduroga manifests with following prodominal signs and symptoms. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 67
  • 89. Table No 23. Showing the Poorvaroopa of Panduroga.Sl. Poorvaroopa Ch Su Va Sl. Poorvaroopa Ch Su Va lakshana lakshana01. Hritspandana + - + 08. Mritbhakshaneccha - + -02. Rukshya + - + 09. Akshi koota shotha - + -03. Swedabhava + - + 10. Avipaka - + -04. Shrama + - + 11. Aruchi - - +05. Twacha sphutana - + - 12. Peetamutrata - + +06. Shteevana - + - 13. Peeta purisha - + -07. Gatrasada - + + 14. Alpa agni - - + Susruta’s version has been followed by Madhavakara, Bhavamishra andYogaratnakara 194.ROOPA Vyakta Poorvaroopa is known as Roopa. Symptoms play most important rolein proper diagnosis of the disease. Curability and incurability of the disease depends uponthe severity of the presenting symptoms. Roopa appears in the Vyaktavastha i.e., fifthKriyakala of the disease. This is the unique stage of the illness, where it is clearlyrecognizable as all its characteristic signs and symptoms manifest. The term roopa implies to both the signs and symptoms by which a disease isidentified. These can be classified as1) Pratyatma lakshana (Cardinal signs & symptoms)2) Samanya lakshana (General signs & symptoms)3) Vishesha lakshana (Distinguishing features of doshanubandha) Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 68
  • 90. Pratyatma Lakshana The Pratyatma lakshana of Panduroga is Pandurvarna. This colour has been compared to that of the pollens of Ketaki flower.Samanya lakshana The Samanya lakshanas of Panduroga other than Panduta mentioned in theclassics can be considered as belowTable No. 24. Showing the Samanya lakshanas of Panduroga 195,196 Sl. Roopa Ch Su Va Sl. Roopa Ch Su Va 01. Panduta + + + 13. Shwasa + - + 02. Karna kshweda + - + 14. Gaurava + - + 03. Hatanala + - + 15. Gatra peeda + - - 04. Daurbalya + - + 16. Shunakshikuta + - + 05. Sadana + - + 17. Harita varna + - - 06. Annadwesha + - + 18. Hataprabha + - + 07. Shrama + - + 19. Kopanatwa + - - 08. Bhrama + - + 20. Shishira dwesha + - + 09. Gatrashoola + - + 21. Nidralu + - - 10. Jwara + - + 22. Pindikodweshtana + - - 11. Aruchi + - + 23 Sheerna lomata + - - 12. Gatramarda + - -Vishishta Rupa These are the lakshanas which are specifying the involvement of particular doshasand thereby are helpful in differential diagnosis of Panduroga. The classification of Panduroga is made with reference to samanya samprapti.Though the classification is made on the bases of involvement of particular dosha, theprime factor involved is pitta dosha197. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 69
  • 91. Classification of Panduroga 198,199,200,201Table No.25. Showing the classification of Panduroga.Sl. Prakara Ch Su Ah As BP YR MN01. Vataja + + + + + + +02. Pittaja + + + + + + +03. Kaphaja + + + + + + +04. Tridoshaja + + + + + + +05. Mridbhakshnanajanya + - + + + + + The description of vishishta roopa according to classification of Panduroga ispresented as followsVataja Panduroga Lakshana 202Table No. 26. Showing the lakshanas of Vataja Panduroga. Sl. Ch Su Va Sl. Ch Su Va Lakshana Lakshana 01. Krishna angata + - - 09. Toda + - + 02. Krishna nakhatwa - + - 10. Kampa + - + 03. Krishnekshanatwa - + - 11. Parshwaruk + - + 04. Krishna sira - + - 12. Shiroruk + - + 05. Krishna ananatwa - + - 13. Shopha + - + 06. Ruksha netrata - + - 14. Anaha + - + 07. Rukshangata + - - 15. Asya vairasya + - + 08. Angamarda + - - 16. Balakshaya + - +Pittaja Panduroga lakshana 203Table No. 27. Showing the lakshanas of Pittaja Panduroga. Sl. Ch Su Va Sl. Ch Su Va Lakshana Lakshana 01. Gatra peetata + - + 09. Amlodgara + - - 02. Haritabha + - + 10. Daurbalya + - - 03. Murcha + - + 11. Peeta mutrata + + - 04. Jwara + + + 12. Shosha + - - 05. Daha + - + 13. Peeta vitkata + + - 06. Trishna + - + 14. Bhinna Varchas + - - 07. Sheetakamata + - + 15. Katukasyata + - + 08. Sweda + - + 16. Tama + - + Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 70
  • 92. Kaphaja Panduroga lakshana 204Table No. 28. Showing the lakshanas of Kaphaja Panduroga.Sl. Ch Su Va Sl. Ch Su Va Lakshana Lakshana01. Shwetavabhasata + - + 11. Shwayathu + - -02. Shuklakshita - + + 12. Shukla mutra + + -03. Shukla nakha - + + 13. Shukla mala + + -04. Shukla ananatwa - + + 14 Tandra + - +05. Gaurava + + - 15 Chhardi + - +06. Sadana - - - 16 Praseka + - -07. Murchha + - - 17 Lomaharsha + - +08. Bhrama + - - 18 Klama + - -09. Shwasa + - - 19 Kasa + - -10. Alasya + - - 20 Aruchi + - -TridoshajaPandurogaLakshana Vitiation of all the three doshas causes severe degree of dhatushaithilya anddhatu gauravata leading to dhatu and oja kshaya. The features of sannipataja pandu areexplained only in Hareeta samhita. All other authors have stated that it manifests due tothe vitiation of all the doshas and considered as asadhya type of Panduroga.HareetaSamhita205Tandra , Hrillasa, MohaShosha, Shosha, Trishna, Vitbheda, Vitbheda, Klama, JwaraKshudartata and Kshudartata According to Brihattrayees, the lakshanas of Vataja, Pittaja and KaphajaPanduroga were seen severely in Tridoshaja Panduroga depending on their degree ofvitiation 206Mridbhakshanajanya PanduMridbhakshanajanya Pandu has been explained by Acharya Charaka207 and Vagbhata208.Charaka’s version has also been followed by Madhavakara, Yogaratnakara and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 71
  • 93. Bhavamishra209. But Susruta has considered Mridbhakshana as a Nidana for Pandurogarather than an individual type.Mridbhakshanajanya Panduroga lakshanaTable No. 29. Showing the lakshanas of Mridbhakshanajanya Panduroga. Sl. Ch Va MN BP Yo Lakshana 01. Shoonaganda + - + + + 02. Shoonakshikoota + - + + + 03. Shoona bhru + - + + + 04. Shoona pada + + + + + 05. Shoona nabhi + + + + + 06. Shoona mehana + + + + + 07. Krimikoshta + - + + + 08. Atisara + + + + + 09. Sasrik Mala Pravritti + + + + + 10. Kaphayukta malapravritti + + + + +SAMPRAPTI Although the causes of Panduroga that are explained under the heading ofNidanas leads to vitiation of Tridosha but however, Pitta is the dominant doshairrespective of the type of Panduroga. The Samprapti of Panduroga has been explained in detail by AcharyaCharaka and Vagbhata. When there is excess intake of pitta pradhana ahara, pitta situatedin hridaya aggravates and it is propelled by aggravated (balina) vayu throughdashadhamani that spreads all over the body. The vitiated pitta affects in between twakand mamsa and leads to vitiation of twak, mamsa, vata, asrik, thereby produces variousvarna like Pandu, Haridra and Hareeta. Due to Panduvarna pradhanata it is called as“Panduroga”210, 211. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 72
  • 94. Nidana and Samprapti of panduroga Samprapti Nidana Sevana Aharatah Viharatah Vaidyakruta Sahaja Nidanartakara Alpa Rakthata- Raktha Srava Pitta Prakopa Alpa Raktha Agni Mandya Sadhya Chirottah Rasavaha Sroto Dusti Rakta Pitta, Arshas Raktaja Gulma Alpa Rakta due to Krumi Raktarbuda Raktati Pravarthan,Rakta Poshaka Sara Bhag Rakta Poshaka Sarabhaga Ahara – Eka rasa satmya Ahara – Amla Anashana Kshara Ati madya pana Vishamashana Lavana Virudda bhojana Vihara – Ushna Asatmya bhojana Matsya Vihara – Ati maithuna Mrud bhakshana Tila taila Ati vyayama Oushadi – Apatarpana karaka Teekshna Oushada – Apatarpana karaka Oushadi atiyoga Vyadhi - Anna vaha sroto vikara- Grahani Vyadhi - Raktapitta Prana vaha sroto vikara- Pittaja Kasa, Pratishyaya Pureshavaha sroto vikara- Arsha Anya sroto vikara Flow chart: 2 showing Nidana and Samprapti of panduroga Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 73
  • 95. Flow chart: 3 showing Nidanasevana Nidanasevana Aharaja Viharaja Vaidyakruta Nidanaratkara RogaSanchaya Pitta pradhana Agni vikruti Dushya Dusti Khavaigunya in Rasa & Rakta Srotas - RasavahaPrakopa Raktavaha Through Vyanavayu Jatharagani Hridaya prapti mandya Circulation through DasadhamaniPrasara Rasavahasrotas Raktavaha srotas Twak mamsantana ashraya Dosha – Dushya samurchanaStanasam-shraya Dhatu – Shaitilya & Dhatu gourava 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 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 74
  • 96. Flow chart: 4 showing Mrudbhakshanajanya PanduMrudbhakshanajanya Pandu: Mruta Kashaya Ushara Madhura Vata Pitta Kapha Avipakwatha of mruttika causes Agnimandhya & srotorodha Rukshaguna cause Roukshya in Rasadidhatus & shareera Affects the dhatu-poshana Indriya, teja Bala ojus veeryahani Respective dosha Prakopaja Mrud bhakshanajanya - PanduSamprapati GhatakaUdbhava - HrudayaAdhisthana - Rasa dhatuVyakti - TwakSanchara - RasayaniDosha - Sadhaka, Pachaka, Ranjaka Alochaka Pitta Vyana, Samana Vayu Kledaka Kapha.Dushaya - Rasa, Rakta, MamsaSrotas - Rasavaha and Raktavaha Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 75
  • 97. According to Acharya Sushruta, the indulgence of Nidana leads to Rakta pradushana thatcauses vitiation in Twak which in turn causes the Pandubhava therefore it is called as“Panduroga”212UPADRAVA If the patient continues to indulge in ahara and vihara, which are said to bethe Nidana of Panduroga the doshas get further aggravated and thus produces upadrava.The upadravass of Panduroga have been mentioned only by Acharya Sushruta213 whichare,Table No. 30. Showing the complications of Panduroga. Aruchi Pipasa Jwara Chhardi Shiroruja Agnisada Shopha Abalatwa Murchha Klama Hridaya peedana Swarabheda DahaSADHYASADHYATA 214 Asadhya Panduroga lakshanas are as follows  Panduroga of long duration with excessive rukshata.  If the patient has developed shotha after long duration and is having vision of objects in yellow.  If the patient passes Baddha and Alpamala with kapha and Hareeta varna.  If the patient is suffering from Atisara.  If the patient is deena, Shwetangayukta (Shwetavarna leepatanga). Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 76
  • 98.  If the patient is suffering from Chardi, Moorcha, Trishna.  If the patient is having Panduvarna of Danta, Nakha and Netra.  Whose bahu, janga, shira are shothayukta and madhyabhaga is durbala and vice versa.  Patients whose guda, sheeshna and muska are shothayukta.  Patient having recurrent attacks of Sangnya nasha.CHIKITSA SUTRA In Ayurveda, three general principles of treatment have been mentioned byAtreya in Charaka Samhita Sutra Sthana. They areDaivayapashraya. Yuktivyapashraya and Satavawajya. Here we are concerned with Yuktivyapashraya chikitsa with includes thefollowing,1. Nidana parivajana (Planning the treatment so as to avoid aetiological factors)2. Snehana (Olention therapy) and Swedana (Fomentation therapy)3. Shodhana (Eliminating the factors responsible for producing the disease).4. Shamana (Palliative treatment) to correct the deficiency or abnormality and also treatthe allied symptomsSNEHANA In case of Pandu, there is diminution of Rakta, Meda, Oja etc. and the bodybecomes dehydrated, emaciated and deficient in lipid substances which provoke Vatacausing further deterioration in the lipid substances which provokes Vata causing furtherdeterioration in the condition. That is why in the beginning of Shodhana Chikitsa,Snehana is essential because Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 77
  • 99. (i) It protects the gastric mucosa from the irritability of drugs used in Shodhana.(ii) It helps in producing tolerance to the organs for Shodhanakarma.(iii) It alleviates the morbidity of vata and makes the body soft and disintegrates theaccumulation of morbid matter(iv) It helps the organs and tissues to be capable of producing intrinsic factor and also inabsorbing and assimilating extrinsic factor. For performing Snehana Karma, various preparations have been mentionedin Ayurvedic text. For example, Draksha Ghrita Rajni Ghrita, Triphala Ghrita, TailavakaGhrita, Dadhima Ghrita, Danti Ghrita, Panchgavya Ghrita, Mahatikta Ghrita, PanchatiktaGhrita etc. They can be used in various types of Panduroga according to thepredominance of doshas, variation in pathogenesis and in symptoms. After completingthe snehana therapy successfully the signs of which are, the vata becoming regulated, theJatharagni becoming activated, the stool being unctuous and loose, the body becomingsoft and smooth, the next step is Swedana.SWEDANA After Snehana, Swedana karma is done depending upon thepatients conditionso as to bring the doshas into koshtaSHODHANA This is performed to eliminate the factor responsible for producing the disease.In this, out of five Karmas only Vamana and Virechana is essential and even these twoshould be employed when Snehana karma has been successfully completed. Commentingon the performance of vomana Dalhana says that while performing vamana in case ofPanduroga one should always keep in mind about physical condition of the patient. After Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 78
  • 100. 215kostha shuddhi the patient should be adopted with pathya ahara and vihara . TheChikitsa sutra for Panduroga according to Acharya Sushruta is snehana followed byvamana and virechana. Acharya Dalhana opines that though Urdhwashodhana (vamana)is contra-indicated, Mrudu vamana can be administered in accordance with Ritu, Desha,Prakruti, Kaala, Shareera216. Snehairupakramya snigdamatva virechayet | First snehana with indicated snehas should be given and there after virechanashould be followed 217. For Mrutbhakshanajanya Pandu the line of treatment is Teekshna shodhana inaccordance with balabala, followed by snehapana to restore the strength 218 Dosha vishesha Chikitsa in Panduroga 219 1. Vataja pandu – Sneha bhooyistha 2. Pittaja Pandu – Tikta sheetala prayoga. 3. Shleshmaja Pandu – Katu, Tikta, Ushna dravya prayoga. 4. Sannipataja Pandu – Vimishra Chikitsa prayoga. 5. Mritbhakshanajanya Pandu – Nidana parivarjana along with the doshika chikitsa.SHAMANAUSHADHIS A variety of Ghrita, Churna, Vati, Kashaya, Avaleha, Asavaarishta Bhasmaand other single drug preparations are described for the management of all types ofPanduroga in Pandurogadhikara. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 79
  • 101. Ghrita:Panchagavya ghrita, Kalyanaka ghrita, Mahatiktaka ghrita, Dadima ghrita, Katukadyaghrita, Pathya ghrita, Danti ghrita, Draksha Ghrita, Haridradi ghrita, and Vyoshadighrita.Churna:Navayasa churna, Tapyadi churna, Trivyushanadi churna, Triphala churna, and Shunthichurna.Vati:Mandura vataka, Punarnava mandura, Bibitakadi vataka, and Shilajatu vataka.Kashaya:Negrodadivarga kashaya, Triphala kashaya, Vishaladi phanta, Guduchi kashaya.Avaleha:Vidangadyaavaleha, Darvyadileha, Dhatraavaleha, Triphaladyaavaleha, Yogaraj rasa,Pravaladyavaleha, Abhayavaleha and Ayorajovyoshadyavaleha.Asavaarishta:Dhatryarishta, Goudarishta, Beejakarishta, Manduradyorishta, Abhayarishta, Phalarishta,Bibhitakasava, and Lodhrasava.Bhasma:Lohabhasma, Mandurabhasma, and Swarnamakshikabhasma.Others:Suddha kasisa, Shuddha shilajatu, Shuddha gairika, Mandura, Pravala, Mukta, Amalaki,Yashtimadhu, Chitrakamula, Guduchi Daruharidra, Nimba, Swarnakhiri, Ikshu, Goghrita,and Takra. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 80
  • 102. PATHYAPATHYA 220This includes dietic and environmental features which should be regulated according tothe need of the body. Pathya Generally for Pana and Bhojana, Shali, Yavagu, Yusha, Godhuma, Madya,Mamsarasa, Dugdha, Ghrita, Patola, Shaka, Draksha, Dadima, Kharjura, Amalaki andIkshurasa are adviced. Specific pathyas are  Vata - Laghupanchamula siddha Jala.  Pitta - Hribera, Shunthi sadhita ghrita.  Kapha - Arishta, Sidhu, Asava.  Tridosha - TakraApathya Agni, Aatapa, Aayasa, Pittakaraka annapana, Maithuna, Krodha, Adwa and otherfactors, which are said to be the causes for Panduroga, should be avoided.ANAEMIA 221,222,223,224 Anaemia can be defined as a haemoglobin concentration in blood belowthe normal range appropriate for the age and sex of the individuals. In adults, the lowerextreme of normal haemoglobin is taken as 14.0g/dl for males and 12.0g/dl for females. A decrease in the oxygen carrying capacity of the blood can also be termedas “Anaemia.” The haemoglobin content of the erythrocytes determines the oxygen Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 81
  • 103. carrying capacity. Hence, a reduction in the blood haemoglobin level and in the numberof circulating erythrocytes is characteristics of Anaemia, Although haemoglobin value is employed as the major parameter for determiningvalue is employed as the major parameter for determining whether or not Anaemia ispresent, Hemoglobin percentage (Hb%), the red blood cell count (TRBC) and packed cellvolume (PCV) provide alternate means of assessing Anaemia.Clinical features of AnaemiaSymptoms In symptomatic cases of Anaemia, the presenting features are tiredness, easyfatigability, generalized muscular weakness, lethargy and headache. In older patientsthere may be symptoms of cardiac failure, angina pectoris, intermittent claudicating,confusion and visual disturbances.Signs A few general signs common to all types of Anaemia are as follows 01. Pallor – Pallor is the most common and characteristic sign, which may be seen in the mucous membranes, conjunctiva and skin. 02. Cardiovascular System – A hyper dynamic circulation may be present with tachycardia, collapsing pulse, cardiomegaly, miIdsystolic flow murmur, dyspnoea on exertion and in case of elderly congestive heart failure. 03. Central nervous system – The older patients may develop symptoms like attacks of faintness, giddiness, headache, Tinnitus, drowsiness, numbness and tingling sensation of the hands and feet. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 82
  • 104. 04. Occular manifestations – Retinal hemorrhages may occur if there is associated vascular disease or bleeding diathesis. 05. Reproductive system – Menstrual disturbances such as Amenorrhea and Menorrhagia and loss of libido are some of the manifestations involving the reproductive system in Anaemia subjects. 06. Renal System – Mild Proteinuria and impaired concentrating capacity of the kidney may occur in severe Anaemia. 07. Gastrointestinal system – Anorexia, flatulence, nausea, constipation and weight loss may occur.Investigations After obtaining the full medical history pertaining to different general andspecific signs and symptoms in order to confirm the presence of anaemia its type and itscause the following plan of investigations is generally followed. A. Haemoglobin estimation – The first and foremost investigation in any suspected case of Anaemia is to carry out haemoglobin estimation. Several methods are available, but most reliable and accurate is Cyanmethaemoglobin (HiCN) method Drabkin solution and spectrophotometer. If the haemoglobin value is below the lower limit of the normal range for particular age and sex, the patient is said to be anaemic. B. Peripheral blood film estimation – The haemoglobin estimation in invariably followed by examination of peripheral blood film for morphologic features after Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 83
  • 105. staining it with Romanowsky dyes (Leishman’s staining). The following abnormalities we can look for in the smear study. a. Variation in size – Microcytosis (Iron deficiency anaemia) Macrocytosis (Megaloblastic Anaemia) Dimorphic b. Variation in shape – Poikilocytes. c. Inadequate haemoglobin formulation – Hypochromasia. d. Compensatory erythropoiesis e. Miscellaneous changes C. Red cell indices – An alternative method to diagnose and detect the severity of anaemia is by measuring the red cell indices a. In iron deficiency and Thalassaemia MCV, MCH and MCHC are reduced. b. In Anaemia due to acute blood loss and Hemolytic Anaemia MCH, MCV and MCHC are all within normal limits. c. In Megaloblastic Anaemias, MCV is raised above the normal value. D. Leucocytes and platelet count – Measuring of Leucocytes and platelet count helps to distinguish pure anaemia form pancytopenia in which red cells, granulocytes and platelet counts are often elevated. E. Reticulocyte count – Reticulocyte count is done in each case of anaemia to assess the marrow erythropoietic activity. In acute hemorrhage and in haemolysis, the Reticulocyte response is indicative of impaired marrow function.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 84
  • 106. F. Erythrocyte sedimentation Rate – The ESR is non-specific test used as a screening test for anaemia. It usually gives a clue to the underlying organic disease but Anaemia itself may also cause to rise in ESR. G. Bone marrow examination – Bone marrow aspiration is done in cases where the cause for anaemia is not obvious. In addition to these general tests, certain specific tests are done in different types of anaemias. H. Total RBC Count: It is the number of RBC in one cubic millimeter of blood. Normal values: In men - 4.5-6.5 millions/mm3. In women - 3.8-5.8 millions/mm3. I. Packed Cell Volume or Haematocrit (PCV): When blood is mixed with anticoagulants and put in Wintrobe’s Haematocrit Tube, centrifuged for a prolonged time, the formed elements are packed at the bottom and clear supernatant plasma is obtained. Volume of these packed formed elements is called packed cell volume. Normal value: 45ml/100ml (45%).Classification of Anaemia Pathophysiologic I. Anaemia due to impaired red cell production. a. Acute post-hemorrhagic Anaemia. b. Chronic blood loss. II. Anaemia due to impaired red cell production. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 85
  • 107. Cytoplasmic maturation defects i. Deficient haem synthesis – Iron deficiency anaemia. ii. Deficient globin synthesis – Thalassaemic syndromes. Nuclear maturation defects – Vitamin B12 or folic acid deficiency and Megaloblastic Anaemia. Defect in stem cell proliferation and differentiation i. Aplastic Anaemia. ii. Pure red cell aplasia. Anaemia of chronic disorders. Bone marrow infiltration. Congenital Anaemia. III. Anaemia due to increased red cell destruction (Hemolytic Anaemia) Morphologic I. Microcytic, hypochromic. II. Normocytic, Normochromic. III. Macrocytic, Normochromic.Iron deficiency Anaemia The commonest deficiency disorder present throughout the world is irondeficiency, but its prevalence is higher in developing countries.Pathogenesis Iron deficiency anaemia develops when the supply of iron is inadequate for therequirement of haemoglobin synthesis. Initially, the negative iron balance is made goodby mobilization form the tissue stores so as to maintain haemoglobin synthesis. It is onlyafter the tissue stores of iron are exhausted that the supply of iron to the marrow becomesinsufficient for haemoglobin formation. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 86
  • 108. EtiologyI. Increased Blood Loss 01. Uterine - e.g. Excessive menstruation in reproductive years, repeated miscarriage, at onset of menarche, post menopausal uterine bleeding. 02. Gastrointestinal - e.g. Peptic ulcer, hemorrhoids, hook worm infestation, cancer of stomach and large bowel oeasophagel varices, hiatus hernia, chronic aspirin ingestion, uncreative colitis, diverticulosis. 03. Renal tract e.g. Haematuria, haemoglobinuria. 04. Nose e.g. Repeated apitaxis. 05. Lungs e.g. Haemoptysis.II. Increased Requirements 01. Spurts of growth in infancy, childhood and adolescence. 02. Prematurity. 03. Pregnancy and lactation.III. Inadequate Dietary Intake 01. Poor economic status. 02. Anorexia e.g. in pregnancy. 03. Elderly individuals due to poor dentition, apathy and financial constraints.IV. Decreased Absorption 01. Parietal or total gastrectomy. 02. Aschlorhydria. 03. Intestinal mal absorption such as in colic disease. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 87
  • 109. Clinical features 01. Anaemia – The onset of iron deficiency anaemia is generally slow. The usual symptoms are weakness, fatigue, dyspnoea on exertion, palpitations and pallor of the skin, mucous membranes and sclera. Patients may have unusual dietary cravings such as pica. Menorrhagia is a common symptom in iron deficient women. 02. Epithelial tissue changes – Long standing chronic iron deficiency causes changes in nails (Koilonychia or spoon shaped nails), tongue (Atrophic glossitis), mouth (Angular stomatitis) and oesophagus causing dysphagia from development of thin webs at the postcricoid area (Pulmmer – Vinson Syndrome).Treatment The management of iron deficiency anaemia consists of 2 essential principles 01. Correction of disorder causing the anaemia – The underlying cause of iron deficiency is established after careful check-up and investigations. Appropriate medical or preventive and surgical measures are instituted to correct the cause of blood loss. 02. Correction of iron deficiency – This can be compensated by two ways a. Oral Therapy – Administration of oral salts such as ferrous sulfate, tablets containing 60 mg of elements iron is administered thrice daily b. Parental therapy – This therapy is indicated in cases that are intolerant to oral iron therapy, in GIT disorders such as mal absorption. This is hazardous and expensive when compared with oral administration. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 88
  • 110. SHAREERA Shareera which gives information about anatomical and physiological aspects ofstomach and intestine where absorption and digestion of Sneha mainly takes place.Stomach225 The stomach has the shape of an expanded “J”. The stomach performs 4 majorfunctions. Viz. 01. The bulk storage of the ingested food. 02. Disruption of chemical bonds in chemical materials through the action of acids and enzymes. 03. Mechanical breakdown of ingested food. 04. Production of intrinsic factor, a glycoprotein whose presence in the digestive tract is required for the absorption of the vitamin B12.Small Intestine226 The stomach is a holding tank where food is saturated with gastric juices andexposed to stomach acids and the digestive effects of pepsin. These are the primary steps,for most of the digestive and absorption functions occur in the small intestine, where theproducts of digestion are absorbed. The mucosa of the small intestine produces only a few of the enzymes involved.The pancreas provides digestive enzymes as well as buffers that assist in theneutralization of acidic chyme. The liver and the gall bladder provide bile, a solution thatcontains additional buffers and bile salts, compounds that facilitates digestion andabsorption of lipids. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 89
  • 111. The small intestine averages 6 m. in length and has a diameter ranging from 4 cmat the stomach and about 2.5 cm at the junction to the large intestine. It accompanies allabdominal regions except the right and left hypochondriac regions. It has 3 subdivisions.duodenum, jejunum and ileum.Intestinal Movements After chyme has arrived in the duodenum weak peristaltic contractions move itslowly towards the jejunum. These contractions are mesenteric reflexes not under CNScontrol. Their effects are limited to with in a few centimeters of the site of the originalstimulus. These short reflexes are controlled by motor neurons in the submucosal andmesenteric plexus. In addition, some of smooth muscle cells contract periodically evenwithout stimulation, establishing a basic contractile rhythm that then spreads from cell tocell.Digestion and absorbtion of fat Fat contains 8% lower saturated fatty acids which makes it easilydigestible. Due to having 4-5% linoleic acid, an essential fatty acid, it promotes propergrowth of human body. Fat also contains Vit.A, D, E and K. Vit.A and E are antioxidantand are helpful in preventing oxidative injury to the body (A cause of about 80-90%degenerative diseases). Fat is lipophilic and this action of Fat facilitates transportation ofingredients of formulation to target organ and final delivery inside the cell, because cellmembrane also contains lipids. This lipophilic nature of Fat facilitates entry offormulation into the cell and its delivery to mitochondria, microsome and nuclearmembrane. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 90
  • 112. Rasavaha Srotas and Raktavaha srotas When we consider the pathogenesis of Panduroga, we must think ofRasavaha srotas, Raktavaha srotas and twacha which shows the characteristics of thisdisease i.e. “Panduta”Rasavaha Srotas The rasavaha srotas is the first dhatu to be developed form ahararasa and itnourishes all tissues of the body. The ahararasa is produced in annavaha srotas from thecompletely digested food and absorbed through the wall of the annavaha srotas. Allnutrients join together in hridaya (Thorasic heart) qualifying it as rasadhatu and it is thesame organ which ejects the rasa into circulation, triggered by the vyanavata. Since the hridaya is the rasasthana, it is also the moola of rasavaha srotas.Charaka added the ten dhamanees that emits from hridaya.227 According to Sushruta,hridaya and rasavahini dhamanis are the moolas.228Hridaya is stated as the seat of raktaand other fluids which are capable of circulation in the body.229 Since, the preenana and jeevana kriyas are essential for the maintenance of lifeand rakta is the nearest dhatu to rasa they both circulate together. But because of theinability of cellular component (which carries raktamsha) of the raktadhatu to enter allsrotases the rasa proceeds further carrying the nutrients.230Raktavaha srotas In the process of the dhatu parinama, raktadhatu is stated to be developed fromrasadhatu.231 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 91
  • 113. Raktadhatu is cellular in nature and the raktamsha which carries the vishishtavayu known as “Prana”, with the function of jeevanakriya is located in these cells. Theraktamsha impairs colour to the rakta but the introducing this raktamsha into the Raktajeeva paramanus is the function of Ranjaka pitta. According to Sushruta, the ranjakapitta is located in yakrit and pleeha.232Vegbhata considered amashaya is the seat of ranjakapitta.233 Here it is essential to look into the modern science regarding the production of redblood cells. The liver and spleen are responsible for red blood cells production in thegestational age. Then during the latter part of gestation and after birth, red blood cells areproduced exclusively by the bone marrow, of all bones until a person is 5 years old. Afterapproximately the age of 20 years, the marrow of long bones, except for the proximalportion of the humerus and tibia, becomes quite fatty and there is no more production ofred blood cells. Beyond this age most red cells are produced in the marrow of themembranous bones, such as vertebrae, sternum, ribs and iliac bones. Even in these bonesthe marrow becomes less productive as age advances. There is no direct reference in the samhitas to the part played by Majja (Bonemarrow), in the formation of rakta. But, there is a reference in Sushruta samhita statingthat “Sarakta Medas”, corresponding to the red bone marrow. Majja is present inside thesthulasthis (larger bones). The substances present within other bones should beconsidered as Saraktam medas (Medas mixed with the blood).234 Sushruta bestows importance of rakta equal to the three humours, that the body issupported or maintained by the rakta.235 The most important function of rakta is Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 92
  • 114. jeevanakriya i.e. sustains life.236 The word “Prananuvartam” also indicates that it carriesvishishta vayu “Prana”. In panduroga (Anaemia) where the deficient production of raktadhatu is the mainpathological event, all authorities of Ayurveda have invariably prescribed the formulationcontaining iron there by recognizing the importance of iron in the production ofraktadhatu. When iron is absorbed form the small intestines, it immediately combineswith a beta globulin to form transferrin and transported in the blood plasma. About 60%of excess iron is stored in the liver cells, to be released whenever necessary to the body. In normal infant and in adult with fibrosis of bone marrow, red blood cells areproduced in the spleen and the liver (Extra medullary hematopoiesis). The red blood cellsnormally circulate an average of 120 days before being destroyed. Many of the red cellsfragment in spleen. The above stated information clearly indicates the important part played by Yakritpleeha and amashaya in the development of raktadhatu and also in maintaing itscirculating volume. Yakrit and pleeha are stated to be the moolas of raktavaha srotas. 237Sushrutaadded raktavaha dhamanis.238 Charaka has clearly stated that hridaya (Thoracic heart) andthe ten dhamanees also are to be taken as raktasthana.239 Therefore these also to beconsidered as moola of raktavaha srotas.Red blood cell formation [Erythropoiesis] 240 Red blood cell formation in adults occurs in the red bone marrow, or myeloidtissue. Red marrow where active blood cell production occurs is located in portion ofVertebrae, sternum, ribs, skulls, scapulae, pelvis and proximal limb bones. Other marrowareas contain a fatty tissue known as yellow marrow. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 93
  • 115. Stages in RBC Maturation During its maturation a red blood cell passes through a series of stages Division of hemocytoblast in bone marrow produces 1) Myeloid stem cells, which in turn divide to produce red blood cells and several classes of white blood cells and 2) Lymphoid stem cells, which divides to produce the various classes of lymphocytes. The cells destined to become RBCs first differentiate into Proerythroblasts (Day 1) Erythroblasts Basophilic ethroblast (Day 2) Polychromatophilic ethroblast (Day 3) Orthochromatophilic ethroblast (Day 4) Ejection of Nucleus Reticulocyte (Day 5-7) Enters the circulation Mature red blood cell Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 94
  • 116. After roughly 4 days of differentiation, the erythroblast, now called a normoblast,sheds its nucleus and becomes a Reticulocyte. A Reticulocyte contains 80 percent ofhaemoglobin of matured RBC and hemoglobin synthesis continues for 2-3 days. After 2 days in the bone marrow, Reticulocytes enter the circulation. After 24hours in circulation, the reticulocyte completes their maturation and becomesindistinguishable from other mature RBC’s.Twak Vasa and Shat twacha are the upadhatus of mamsa dhatu, which are going todevelop in the process of dhatwagni paka sequential progression of dhatu. 241a The twachashows the characteristic features of Panduroga as the twacha being affected or showingthe disease significance in the skin (Twacha). According to the option of Vagbhata embryological development of the skin isfrom the blood i.e. Rakta as if from boiling milk cream develops. 241b The twacha ishaving seven layers. At present disease concern the first two layers can be taken intoconsideration.Avabhasini242 This is outermost and first layer of the skin. If reflects or show the colour of thesecond layer lohita. As it reflects the colour it is presumed that the colour change in lohitais witness in Avabasini. It is being said at the size of 1/18th of vrihi.Lohita243 Lohita looks like Arunavarna i.e. red in colour and 1/16th of vrihi. It prevents theblood flow form the body. The colour of the blood in the lohita is reflected throughavabhasini. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 95
  • 117. Haemoglobin244 Molecules of hemoglobin (Hb) accounts for over 95% percent of the intracellularproteins, which is specially adopted for gas transport to and from the lungs. It iscomposed of four globin chains each containing an iron- containing porphyrin pigmenttermed haem. Globin chains are a combination of two alpha and two non-alpha chains. The hemoglobin content of whole is reported in terms of grams of Hb per 100 mlof whole blood (g/dl). Normal range are 14 – 18 g/dl in males and 12-16 g/dl in females. Each haem units hold an iron in such away that the iron can interact with anoxygen molecule, forming oxyhemoglobin, HbO2. Figure 4 showing RBC and HemoglobinHemoglobin function There are approximately 280 million Hb molecules in each red blood cell.Because a Hb molecule contains four heme units, each erythrocyte can potentially carry Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 96
  • 118. more than a billion Molecules of oxygen. Roughly 98.5 percent of oxygen carried by theblood travels through the circulation bound to Hb molecules inside red blood cells. The amount of oxygen bound to hemoglobin depends primarily on the oxygencontent of the plasma. When plasma oxygen level are low, hemoglobin releases oxygenunder these conditions, typical of peripheral capillaries, plasma carbon dioxide level areelevated. The alpha and beta chain of hemoglobin then bind carbon dioxide, forming“carbaminohemolobin”. In the capillaries of the lungs, plasma oxygen levels are highand carbon dioxide level are low. Upon reaching these capillaries, RBCs absorb oxygen,which is then bound to hemoglobin, and release carbon dioxide.Functions of Rakta 245 01. Varna prasad – Colour of the skin. 02. Mansapushti – Nourishment to other dhatus like mamsa. 03. Jeevana vyapara – O2 supply. 04. Bala – Strength. 05. Prasannata – Tranquility. 06. Ayu – Life.According to modern246  The transportation of dissolved gases, nutrients, hormones and metabolic wastes  The regulation of pH and electrolyte composition of intestinal fluid throughout the body  The restriction of fluid losses through damaged vessels or at other injury sites.  Defense against toxins and pathogens.  Stabilization of body temperature.Shuddha Rakta lakshanas247 The following colours indicate pure blood 01. Shuddha suvarna Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 97
  • 119. 02. Indragopa 03. Looks like padma and Alaktaka. 04. Gunjapahala savarnam.Shuddha rakta purusha lakshanas248 As long as a person is having pure blood in him, he will have; 01. Prasanna sahreera varna. 02. Swasthyata of Indriya and Indriyartha grahana. 03. Prakrita agni. 04. Normal mala and Mutra visarjana. 05. Sukhanuvita. 06. Pushti and Bala.Composition of Blood249 Blood is a highly complex fluid, which is composed of two parts A liquid, called the plasma and different types of cells that remain suspended inplasma. These cells the called blood corpuscles. The plasma constitutes about 55%, and cells about 45% of the total volume of thehuman blood. General composition of whole blood is as follows A. Cells 1) Red blood corpuscles or erythrocytes (RBC) 2) White blood corpuscles or leucocytes (WBC) 3) Platelets or thrombocytes B. Plasma 1) Water 91 to 92% 2) Solids 8-9 % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 98
  • 120. Inorganic constituents 0.9% (Sodium, Potassium, Calcium, Magnesium,Phosphorus, Iron, Copper). It contains some organic constituents like – i. Proteins 7.5% (Serum albumin, Serum globulin Fibrinogen, Prothrombin) ii. Non-protein Nitrogenous substance [NPN](Urea, Uric acid, Xanthene, Hypoxanthine, Creatine, Creatinin, Ammonia, amino acids) iii. Fats (Natural fats, phaspholipid, cholesterol, choletrides) iv. Carbohydrate (Glucose) v. Other substances (Internal secretions antibodies and various enzymes) vi. Colouring matter (The yellow colour of the plasma is due to small amounts of bilirubin, carotene and xanthophylin). Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 99
  • 121. DRUG REVIEW Health is the supreme foundation of virtue, wealth, enjoyment andsalvation. So in the fight against disease and premature death, drugs have been theweapon used by man. In Ayurveda, drug is defined in broader perspective. It is thatwhich a physician use for restoring the equilibrium of Doshas i.e. relieving the disease.Charaka has said that for the successful management of the disease, it is essential toselect proper medicine250 and examine it in all respects251 in other words correctidentification of the drug becomes the main prerequisite for its use as medicine. Thetreatment without drug would be same as cipher without figures. WHO is defined drug as “Any substance or product that is used or intendedto be used to modify or to explore physiological systems or pathological status for thebenefit of recipient”. Ayurveda advocates using a drug (Dravya) in a whole state i.e. in its naturalintegrity and design. The whole drug being in natural state is friendly for human body.Thus Ayurveda treat the patient through a holistic approach and believes that each andevery substance existing in this universe is Panchabhautic in configuration. Thisknowledge of configuration lead Acharya Charaka to conclude that every substance in theworld has more or less medicinal properties. In this clinical study Jeerka choorna given for deepana pachana and DrakshaGhrita is selected for Snehapana treatment. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 100
  • 122. Drugs used for deepana and pachanaJEERAKA CHOORNAFigure 5 showing jeeraka choornaINGREDIANTS OF JEERAKA CHOORNA252Table No. 31: Showing Ingredients Of Jeeraka ChoornaSan. Latin Family Guna Veerya Doshagnata Karma UsefulName Name Rasa Vipaka partJeeraka Cuminum Umbelli katu Laghu, Ushna Katu Kapha Deepan Seed cyminum ferae rooksha vata pachana shamaka vathanu lomana1) Jeeraka choorna The ingredient of Jeeraka Choorna is jeeraka, which is taken and powdered well, Filtered through cloth and made into fine powder. Jeeraka choorna was prepared in Department of Rasashastra D.G.M.A.M.C, Gadag.Collections of drugs: All the raw drugs were purchased from the local market Gadag.Pharmaco dynamics of ingredients of Jeeraka choornaBotanical Name : Cuminum cyminumFamily : umbelliferae Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 101
  • 123. Synonyms : Jeeraka, Jarana ,Ajaji, Deerkha Jeeraka.Part used : seedPharmacodynamics Rasa : katu Guna : Laghu,rooksha Virya : Ushna Vipaka : Katu Doshaghnata : Kaphavata shamaka Karma : Deepana, pachana and vathanulomanaVernacular names English : Cumin seed. Hindi : Jeera Kannada : JeerigeHabitat: Distribution – Throughout India it is cultivatedPlant description: A small annual herb grows up to 40 cm in height. Leaves alternate,compound, filiform segment, with sheeting bases; flowers small white, found incompound umbels. Fruits greenish, turns grey when ripe, tapering towards both ends,covered with papillose hairs.Pharmacological Activities: Plant pacifies vitiated kapha, vata, dyspepsia, colic, indigestion, worminfestation, flatulence, vomiting, hemorrhoids, calculi, leucorrhoea, skin diseases, fever,asthma, cough, and general debility. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 102
  • 124. Drugs used for Snehapana Draksha Ghrita INGREDIENTS OF DRAKSHA GHRITA253 Table No. 32: Showing Ingredients Of Draksha GhritaSan. Latin Family Rasa Guna Veerya Vipaka Dosha Karma UsefulName Name gnata part RaktaDraksha Vitis Vitaceae Madhura, Guru, Sheeta Madhura Vata prasadana Phala vinifera Amla Snigdha pitta vrushya, samaka balya, jeevaneeya 2) Draksha Ghrita : Draksha Ghrita was be prepared according to the sneha kalpana vidhi mentioned in Sharangadhara samhita madhyama khanda in the Department of Rasa Shastra D.G.M.A.M.C, Gadag. Ingredients of draksha Ghrita are Draksha – ½ prastha (384gm) Ghrita – 1prastha (768ml) Collections of drugs: All the raw drugs were purchased from the local market Gadag. Method of preparation: Ghrita paka should be done with 1 prastha of Ghrita by adding 4 prastha of jala and ½ prastha of draksha kalka. Pharmaco dynamics of ingredients of Draksha Ghrita. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 103
  • 125. DRAKSHABotanical Name : Vitis vinifera Linn.Family : Vitaceae Figure 6 showing DrakshaSynonyms : Draksha, Mrudvika, Gosthana, Svaduphala, Amritaphala, KaraviPart used : PhalaPharmacodynamics Rasa : Madhura, Amla Guna : Guru, Snigdha Virya : Seeta Vipaka : madhura Doshaghnata : Vata pitta shamaka Rogaghnata : Rakta prasadana, vrushya, balya, jeevaneeya Karma : Rakta prasadana Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 104
  • 126. Vernacular names : English : Grape wine, Wine grape. Hindi : Dakh, Drak Kannada : DrakshiHabitat:Distribution: Cultivated in the dry-cold areas of India mainly in Kashmir, Punjab andHimachal Pradesh .Plant description: A perennial, deciduous tendril climber. Tendrils bifid, opposite to leaves.Leaves simple, 3-5 lobed, cordate, toothed; flowers small, green, found in panicledcymes; fruits vary in color from bluish black to green, globes, contain 2-4 seeds withinthe sweet pulp.Pharmacological Activities:Plant pacifies vitiated pitta, burning sensation, constipation, hemorrhoids, anemia, skindiseases, colic, flatulence, jaundice, vomiting, splenomegaly, arthritis, and amenorrhea. GHRITA254 Figure 7 showing Ghrita Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 105
  • 127. Ghrita is best among all the Sneha Dravya.Safe even in higher doses.Suitable to all age group persons.Can be used in all seasonsEasily available.Classical name: Ajaya, Havish, Sarpish, GhritamVernacular name: English - Ghee Hindi - Ghee Kannada - TuppaPharmaco dynamic properties of Ghrita according to Samhitas and NighantusTable No. 33 Showing Pharmaco dynamic properties of Ghrita according toSamhitas and NighantusSamhitas Rasa Guna Virya Vipaka DoshaghnataandNighantusCh. S. Madhura - Sheeta Madhura VatapittaharaSu.S Madhura - Sheeta Madhura VatapittaharaA.S - - Sheeta Madhura VatapittaharaA.H - - Sheeta - -K.S Madhura - - - -D.N Madhura - Sheeta Madhura -M.N Madhura Guru Sheeta - VatapittaharaK.N - - - Madhura VatapittaharaR .N - - - - TridoshaharaB.P.N Madhura Guru Sheeta Madhura TridoshaharaSh.N Madhura - Sheeta Madhura TridoshaharaSamanya Karma:Vrishya, Chakshushya, Medha, Lavanya, Kanti, Oja, Tejavriddhikara, papahara,Rakshoghna, Vayasthapaka, Balya, Pavitra, Aayushya, Sumangalya, Rasayana,Sugandha, Rochana, Smriti vardhaka, Rasa, Shukra vardhaka Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 106
  • 128. Rogaghnata:Visha, Unmada, Shosa, Jvara, Mada, Apasmara, Murchcha, Yoni shoola, Karna shoola,Shira shoola.Chemical Constituents: Fatty acids, Phospholipids, Sterols, Sterols esters, Fat soluble Vitamins (Vit.A, D,K) Hydrocarbons, Carotenoids, Casein, Traces of iron Phosphorus, copper, Tracesof iron Phosphorus, Copper, β carotene.Chemical composition of Ghrita255:Triglycerides : 97.98%Diglycerides : 0.25 -1.5%Monoglycerides : 0.16 - 0.038%Ketoacid glycerides : 0.015 - 0.018%Glycerylesters : 0.011 - 0.015%Free fatty acid : 0.1 - 0.44%Phospholipids : 0.2 -1%Sterols : 0.22 - 0.4%Pharmacological effects: Like any clarified butter, ghee is composed almost entirely of saturatedfat. Ghee contains 8% lower saturated fatty acids which makes it easily digestible. Itsdigestibility coefficient or rate of absorption is 96% which is highest of all oils and fats.Ghee is lipophilic and this action of ghee facilitates transportation of ingredients offormulation to a target organ and final delivery, inside the cell, up to the mitochondria,microsome and nuclear membrane, because cell membrane also contains lipid. Due to thePalatability of Ghee even at higher dose, relative to oil it is most acceptable to theinternal environment of the body. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 107
  • 129. METHODOLOGY“The man of Science has learned to believe in justification not by faith, but byverification” Clinical study is the essence of any research work. It reveals the promisesand short comings of any hypothesis. It further rectifies the hypothesis and improves itspractical applicability. Ayurveda has its own dictum and principles which have stayedagainst the test of time. Still if we can support them by findings of modern pathologythen they would be more acceptable to the whole world. The classification of diseases inAyurveda is done on the basis of their dosha predominance and the symptoms varyaccordingly. Interpretation of laboratory investigations is very much significant in thepresent scenario of Ayurvedic practice. This study is a humble effort to derive a possible hypothesis regarding the roleof Snehapana in Panduroga by giving Arohana and Sadharana . So here the diseasePanduroga is being selected for the study due to its predominance in the community andthe difference in its lakshanas according to specific dosha predominance. The classicalreferences state that Raktha dhathu is affected in the pathogenesis of Panduroga alongwith Rasadhathu. Objective study of Raktha dhathu is possible by laboratory parameters.Anemia is a disorder where there is an abnormality in the elements of blood andclinically most of the symptoms of anemia come under the description of Panduroga. Soselected blood parameters to assess anaemia is subjected here for the study.Research approach:The main aim of this study is the Evaluation of comparative efficacy of arohana &sadharana krama snehapana in panduroga. After the completion of the full treatment, the Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 108
  • 130. outcome were assessed by comparing the before treatment data with the after treatmentdata.MATERIALS: The materials taken for the clinical study were 1. Jeeraka choorna (Depana pachana) 2. Draksha ghritha (Arohanakrama snehapana and sadaranakrama snehapana)1) Jeeraka Choorna: The ingredient of Jeeraka Choorna is jeeraka, which is taken and powderedwell, Filtered through cloth and made into fine powder. Jeeraka choorna was prepared inDepartment of Rasashastra D.G.M.A.M.C, Gadag.2) Draksha Ghrita : Draksha Ghrita was being prepared according to the Sneha kalpana vidhimentioned in Sharangdhara Samhita Madhyama khanda in the Department of RasaShastra D.G.M.A.M.C, Gadag.Ingredients of Draksha Ghrita are Draksha – ½ Prastha (384gm) Ghrita – 1Prastha (768ml)Collections of drugs: All the raw drugs were purchased from the local market Gadag.Method of preparation: Ghrita paka should be done with 1 prastha of Ghrita by adding 4 prastha of jalaand ½ prastha of Draksha kalka. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 109
  • 131. Research Design:Simple randomized comparative clinical study.Sample Size:A total number of 30 Patients will be selected randomly and assigned in two groups.Group A: 15 patients will receive Draksha ghrita Arohana krama snehapana.Group B: 15 patients will receive Draksha ghrita Sadharana krama snehapana.Source of Data:Patients: Patients of Panduroga will be selected from O.P.D. and I.P.D, Dept ofPanchakarma, P.G.studies and Research Centre, Shri D.G.M.A.M.C. and Hospital,Gadag.Literary: Literary aspect of the study will be collected from classical Ayurvedic andmodern text with updated recent medical journals.Criteria for diagnosis: The clinical features of Panduroga mentioned as per Ayurvedic texts like, Panduta Arohanayasa Dourbalya Agnimandya Brama These will be the basis for diagnosis and further confirmed by the hematologicaltests.Selection criteria:The cases selected strictly as per the signs and symptoms mentioned as per classics. Inclusion criteria: 1) Patients with classical features like panduta, raktalpata, dourbalya, annadwesaha etc of sadhya Panduroga and other than that of exclusion criteria are included. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 110
  • 132. 2) Patients of both sex, between the age of 18 to 60 years. 3) Patients who are fit for Snehanapana.Exclusion Criteria: 1) Patients of age below 18 years and more than 60 years. 2) Pregnancy and lactating mothers. 3) Associated with severe systemic disorders like Hypertension, Diabetes mellitus, etc.Administration of therapy: 1) Deepana - Pachana with Jeeraka choorna 3-6 gms,with sukhoshna jala asAnupana three times a day before food for 3-5 days or till the appearance of niramalakshana 2) Snehapana with Draksha Ghrita in Arohana vidhi starting with 30mlincreasing 30 ml every day for 5-7 days or till samyak snigdha lakshanas are seen for 15patients. 3) Snehapana with Draksha ghrita in sadharana vidhi 40ml (each day) for 7 daysfor 15 patients.Pathya:All the patients were advised to take drava, ushna, anabhishyandi and Luke warm waterand Some Pathya Ahara Vihara mentioned for panduroga.Apathya:All the patients were advised not to take cold drinks, cold food,day sleep and otherApathya Ahara Vihara mentioned for panduroga. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 111
  • 133. STUDY DURATION: Deepana , Pachana – 3 - 5 days Snehapana – 5-7 days. Follow up –20days. Total study duration –30daysINVESTIGATION:Hb%, TC, DC ESR, RBC and PCV has been indicated. Investigation is carried out on thepatients to rule out other systemic disorders as an optional.Assessment of clinical ResponseSubjective and objective parameters were made out to assess the clinical response in thetotal number of patients. All the grades declared for the assessment of subjective andObjective parameters are clearly mentioned along with the case sheet .Subjective parameters:1) Panduta2) Agnimandya3) Arohanayasa4) Bhrama5) DourbalyaObjective parameters:1) Hb %2) TC, DC3) ESR4) TRBC5) PCV Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 112
  • 134. Investigations1) Hb %2) TC, DC3) ESR4) TRBC5) PCVAssessment Criteria: Assessment of signs/symptom before and after treatment was main criteria.Assessment of parameters: Clinical assessment was made for the severity of the disease and for the clinicalImprovement. Regarding for the severity of individual symptoms assessment was framedas follows.GRADING FOR THE SUBJECTIVE PARAMETERSPandutaAbsent (no pallor) -0Mild -1Moderate -2Severe -3AgnimandhyaAbsent -0Mild -1Moderate -2Severe -3ArohanayasaNo exertional dysponea -0 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 113
  • 135. Mild dysponea -1Dysponea disturbs patient’s daily activities intermittently -2Dysponea disturbs patient’s daily activities frequently -3BramaAbsent -0Occasional -1Frequently -2Constant -3DourbalyaAbsent -0Mild -1Moderate -2Severe -3OBJECTIVE PARAMETERS:Objective parameters will be assessed on the basis of values obtained. 1. Hb% - Male – 14.0 g/dl to 17.4 g/dl. - Female 12.3 g/dl to 15.3g/dl. 2. Total count. - 4000-1000cells/cumm 3. Differential count Platelets - 45-65% Lymphocytes - 20-30% Esnophils - 01-06% Monocytes - 00-01% Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 114
  • 136. Basophiles - 00-01% 4. ESR - Male-0-10mm/1st hour - Female-0-15mm/1st hour 5. RBC count - Male –4.5-6.5million/cumm. - Female- 4.8-5.5million/cumm. 6. PCV - Male – 40-54% Average – 46%-41%. - Female 37-47%OVERALL ASSESSMENT OF CLINICAL RESPONSEHighly significant improvement in Subjective and Objective parameters.Significant improvement in Subjective and Objective parameters.Non significant Improvement in Subjective and Objective parameters. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 115
  • 137. MASTER CHARTTable: 34 Showing Demographical DataSL OPD Age Sex Religion Occupation Economical DietNo: No: status M F H M C A L S P M H V M1 29691 42 - + + - - + - - - + - + -2 32447 27 - + + - - + - - - + - + -3 7354 22 + - + - - + - - - + - - +4 7342 22 - + + - - + - - - - + + -5 7340 22 - + + - - + - - - + - - +6 7353 35 - + + - - - + - + - - + -7 7339 22 - + + - - + - - - - + + -8 7343 22 - + + - - + - - - - + + -9 7586 38 - + + - - + - - - + - + -10 7748 22 - + + - - + - - - + - - +11 7746 22 - + + - - + - - - - + + -12 8431 28 - + + - - + - - - + - + -13 9376 42 - + + - - - + - + - - + -14 7319 26 - + + - - + - - - + - + -15 10658 26 - + - + - - + - + - - - +16 10657 20 - + - + - - + - + - - - +17 14180 25 + - + - - + - - - - + - +18 16382 26 + - + - - - + - + - - - +19 16384 30 - + + - - + - - - + - + -20 17731 38 - + - + - - + - + - - - +21 18157 24 + - + - - + - - - - + + -22 23920 22 - + + - - + - - - - + + -23 23924 22 - + + - - + - - - - + + -24 25983 23 + - + - - + - - - + - - +25 25982 22 + - + - - + - - - + - + -26 27019 23 - + + - - + - - - + - + -27 29354 30 + - + - - - + - + - - + -28 25984 23 + - + - - + - - - + - - +29 32437 34 - + + - - + - - - + - + -30 34351 21 - + + - - + - - - - + + -M-Male, F-Female, A-Age, S-Sex H-Hindu, M-Muslim, C-Christian, A-Active, L-Lobour, S-Sedentary , P-Poor, M-Middle class, H-Higher class V-Vegetarian, M-Mixed Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 116
  • 138. Table no 35 showing pradana vedanaSl Vaivarnya ArohanaN Dour Agni Brama Aruchio yasa balya mandhya Nk Nt T V M S1 2 2 1 1 1 1 + + + + +2 1 2 2 1 1 1 + + + + +3 2 2 1 1 1 1 + + + + +4 2 2 1 1 1 1 + + + + +5 2 2 1 1 1 1 + + + + +6 1 2 2 1 1 1 + + + + +7 2 2 1 1 1 1 + + + + +8 2 2 1 1 1 1 + + + + +9 2 2 1 1 1 1 + + + + +10 2 2 1 1 1 1 + + + + +11 5 1 1 1 1 1 + + + + +12 2 2 2 1 1 1 + + + + +13 2 2 2 1 1 1 + + + + +14 2 2 2 1 1 1 + + + + +15 2 2 2 1 1 1 + + + + +16 2 2 2 1 1 1 + + + + +17 2 2 2 1 1 1 + + + + +18 2 2 1 1 1 1 + + + + +19 2 2 2 1 1 1 + + + + +20 2 2 1 1 1 1 + + + + +21 2 2 1 1 1 1 + + + + +22 2 2 1 1 1 1 + + + + +23 1 2 2 1 1 1 + + + + +24 1 2 2 1 1 1 + + + + +25 2 2 2 1 1 1 + + + + +26 2 2 2 1 1 1 + + + + +27 2 2 1 1 1 1 + + + + +28 1 2 2 1 1 1 + + + + +29 1 2 2 1 1 1 + + + + +30 2 2 2 1 1 1 + + + + +Nk-Nakha, Nt –Netra, T-Twak, V-Vit, M-Mootra, S-SiraPrakruta-1,Pandu-2.Krishna-3,Aruna-4,Peeta-5,Shukla-6 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 117
  • 139. Table no 36 showing poorvaroopa: Shteevana Gatrasada rookshata spandana mandhya mootrata Avipaka Shrama abhava Aruchi SwedaSl No Twak Peeta Agni Hrit1 - - + - - - - + - -2 + + + + + - - - - -3 + - + - - - - - - +4 - - + - + - - - - +5 - + + - + - - - + -6 + - + - + - - - - -7 + - - - + - - - + -8 - + + - + - - - - -9 + - + - + - - - - -10 - + + - + - - - + -11 - - + - + - - - - -12 - - + - - - - - - -13 + - + - + - - - - -14 + - + - - - - - - -15 - - + - + - + - - -16 - - - + + - - - - -17 + + + + + - - - - -18 + - + - - - + - - -19 - - + - + - - - - -20 + - + - + - - - - -21 - - + - + - - - - -22 - - + - + - - - + -23 + - + - + - - - - -24 - - + - + - - - - -25 + - + - + - - - - -26 + - + - + - - - - -27 - - + - + - - + - -28 - - + - + - - - - -29 + - + - + - - - - -30 - - + - + - - - - - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 118
  • 140. Table no 37 showing Anubandha Vedana Agnimandhya Karnaksweda Twaksputana Gatrashoola Shirashoola Hataprabha Alpa meda Hridrava Shrama Trishna Sadana Tandra AlasyaSl .No Swasa Jwara Toda kasa1 - - - - - + - - - + - - - - - - +2 - - + - - + - - + + - - - - - - -3 - - + - - - - + - - - - - - - - -4 - + + + + + + - - - + - + - - - +5 - + + + - + - - + - - - - - - - +6 - - + - - - - - + + - - - - - - +7 - - + - - - + - - + - - - - + - +8 - - + + - + + - - + - - + + - - -9 + - + - + + - - - - - - - - - +10 - - + + + + - - - - - - - - - - +11 - - + - - + - - - + - - + + - - +12 - - + - - + - - - - - - - - - - +13 - - + - - - + - - + - - + - - - +14 - - + - - + + - - - - - - - - - -15 - - + - - + - + - - + - - - - - -16 - - + - - + - + - - - - - - - - -17 - - + - - + - + - - + - - - - - -18 - - + - - - + - - - + - - - - - +19 - - + - - - + + + - - - - - + - -20 - - + - - - + - - - - - - - - - +21 - - + - - + + - - - - - - - - - -22 - + + + - + - - + - - - - - - - +23 - - + - - - + + + - + - - + - - -24 - - + - - + + - - + - - - - + - -25 - - + - - + + - - - - - - - - - -26 - - + - - - + - - - - - - - + - +27 - - + + + + + - + - + - - - - +28 - - + - - - + - - + - - - - + - +29 - - + - - - + - - + - - - - + - +30 - - + - - - + - - + - - - - + - - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 119
  • 141. Table no 38 Showing Subjective Variables Of Arohana Krama SnehapanaSL OPD Panduta Agnimandhya Arohanayasa Bhrama DourbalyaNO NO BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 32447 2 1 0 2 2 1 1 1 0 1 1 0 2 2 12 7342 2 2 1 1 1 0 2 2 1 1 1 1 1 0 03 7340 2 2 1 2 1 0 0 0 0 1 0 0 2 1 14 7339 2 2 1 1 1 0 2 2 1 2 1 0 1 1 15 7343 2 2 1 1 1 0 2 2 1 1 1 0 2 1 16 7748 2 2 1 2 1 0 2 2 1 1 1 0 2 1 17 7746 2 2 1 2 1 0 2 2 1 0 0 0 2 2 18 8431 2 2 1 2 2 1 1 1 0 2 1 0 1 0 19 9376 2 2 1 1 1 0 2 1 0 3 2 1 3 2 110 14180 2 2 1 2 0 0 1 1 0 1 1 0 1 1 111 16382 1 1 0 2 2 1 0 0 0 2 1 1 1 1 012 23920 1 1 0 2 1 1 1 1 0 2 2 1 1 1 013 23924 1 1 0 2 2 0 1 1 1 0 0 0 1 1 114 27019 2 2 0 2 1 0 3 1 1 2 1 0 1 0 015 29354 2 2 1 1 1 0 2 2 1 2 1 1 1 1 0BT –Before treatment, AT- After treatment, AF-After followupPanduta--- Absent - 0,Mild - 1,Moderate - 2,Severe - 3Agnimandya--- Absent - 0,Mild - 1,Moderate -2,Severe -3Arohanayasa--- No exertional dysponea - 0,Mild dysponea - 1,Dysponea disturbspatient’s daily activities intermittently - 2, Dysponea disturbs patient’s daily activitiesfrequently - 3Brama--- Absent - 0,Occasional - 1,Frequently - 2 ,Constant - 3Dourbalya---- Absent - 0,Mild - 1 ,Moderate – 2,Dourbalya-3 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 120
  • 142. Table no 39 Showing Subjective Variables Of Sadaranakrama Sneha PanaSL OPD Panduta Agnimandhya Arohanayasa Bhrama DourbalyaNO NO BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 29691 2 2 2 2 1 1 0 0 0 2 1 1 1 0 12 7354 2 2 2 2 1 1 1 1 1 1 0 0 2 1 13 7353 2 2 2 2 1 1 2 1 0 1 0 0 2 1 14 7586 1 1 0 1 1 1 1 0 1 2 1 1 2 1 15 7319 2 1 2 2 0 1 3 2 2 2 1 1 1 1 16 10658 2 2 2 3 2 1 2 1 1 0 0 0 2 1 17 10657 2 2 2 1 0 1 2 1 1 1 1 0 2 1 28 16384 2 2 2 2 1 1 2 1 1 1 1 1 2 1 19 17731 2 1 1 2 1 1 3 2 1 3 1 1 2 1 110 18157 1 1 1 2 1 2 1 1 0 1 1 0 2 1 111 25983 1 1 1 1 0 1 1 0 1 1 0 1 2 1 112 25982 2 1 2 2 1 1 1 0 1 1 0 1 1 1 013 25984 2 2 2 2 1 0 1 1 1 0 0 0 1 1 114 32437 2 2 2 3 2 1 3 2 1 2 2 2 3 2 115 34351 2 2 2 2 1 1 2 1 0 1 0 0 2 1 1BT –Before treatment, AT- After treatment, AF-After followupPanduta--- Absent - 0,Mild - 1,Moderate - 2,Severe - 3Agnimandya--- Absent - 0,Mild - 1,Moderate -2,Severe -3Arohanayasa--- No exertional dysponea - 0,Mild dysponea - 1,Dysponea disturbspatient’s daily activities intermittently - 2, Dysponea disturbs patient’s daily activitiesfrequently - 3Brama--- Absent - 0,Occasional - 1,Frequently - 2 ,Constant - 3Dourbalya---- Absent - 0,Mild - 1 ,Moderate – 2,Dourbalya-3 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 121
  • 143. Table no 40 showing Manasika nidanasSl Aharaja Viharajano Manasika Ativyayama Atiteekshna Ativyavaya vaihamya Atyushna Viruddha Nishpava Asatmya mrithika Tilataila Pinyaka dharana Krodha swapna Lavana Madya Chinta Masha kshara Bhaya Shoka Kama Amla Vega Diva Ritu1 - - - - - + + - - - - - - - - + + - - + + - +2 - + - + - + - - - - - - - - - + + - - - - - +3 - - - - + + + - - - - - - - - - + - - - - + -4 - + + - - - - - - - - - - + - - + - - + + + +5 - - + + - + + - - + - - - + - - + - - + + - -6 - + - - - + + - - + - - - - - + + - - + - + +7 - + + - - - + - - - - - - + - - - - - + - + -8 - + + - - - - - - - - - - + - - - + - + + - -9 + + - + - + - - - - - - - - - - + - - + - - +10 - + + - - + - - - + - - - + - - - - - + + - -11 - + + - - - - - - + - - - + - - - - - + - + -12 - - - - - + - - - + - - - - - - + - - - - - +13 - + - - + + - + - - - - - - - - + + - + + - +14 - - - - - + + - - - - - - + - - + - - - + + -15 - - - + - + - - - + - - - - - - + - - - - + - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 122
  • 144. Table no 41 showing Manasika nidanasSl Aharaja Viharajano Manasika Ativyayama Atiteekshna Ativyavaya vaihamya Atyushna Viruddha Nishpava Asatmya mrithika Tilataila Pinyaka dharana Krodha swapna Lavana Madya Chinta Masha kshara Bhaya Shoka Kama Amla Vega Diva Ritu16 - - - - + + + - - + - - - - - - + - - - + + -17 - + + - - - - - - - - - - - - - + - - - - - +18 - + + - - + - - - - - - - + + + - + + - + -19 - + + - - + - - - + - - - - - - + + - + + - -20 - - - + + - - - - - - - - - - - + - - + + - -21 - - - + + + - - - - - + - - - - + - - + + - -22 - + + + - + - - - - - - - + - - - - - - - + -23 - + + - - - + - - - - - - - - - - - - - - + -24 - - - + + + - - - - - - - - - - + - - + - - -25 - - - - + + - - - - - - - - - - + - - - + + -26 - + + - + + - - - - - - - - - - + - - + - - +27 + + + - - + + - - - - - - + + - + - - + - - -28 - + - - + + - - - - - - - - - - + - - - - + -29 - + + - + + - - - + - - - - - - + - - + + - +30 - + + - - + - - - - - - - - - - + - - + + + + Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 123
  • 145. Tables no 42 showing objective variables in Arohana krama SnehapanaSl No OPD NO Hb% Total count Differential count Platelets Lymphocytes Esnophils BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 32447 8.7 9 9.2 6250 6400 6600 55 56 56 42 40 41 3 4 32 7342 8.2 8.4 9 5400 5600 5800 60 60 62 36 37 36 4 3 23 7340 7.2 7.6 7.8 4800 5000 5100 51 55 60 46 41 38 3 4 24 7339 7.6 7.8 8.1 5200 5600 5700 58 62 62 40 36 37 2 2 15 7343 9.2 9.6 9.8 7000 7200 7200 52 64 60 40 36 38 8 26 7748 7.1 7.4 7.8 5200 5300 5200 49 55 60 45 38 34 6 7 67 7746 8.2 8.6 8.8 5600 5680 5820 65 65 65 33 30 32 6 5 38 8431 8.8 8.8 9 6000 6200 6300 56 62 58 38 31 38 6 7 49 9376 9.1 9.4 9.6 5730 6100 6320 52 58 63 42 39 33 6 3 410 14180 11.6 11.6 12 5500 5550 5600 50 52 56 48 46 42 2 2 211 16382 11.5 11.7 12 5200 5250 5360 56 58 58 40 36 38 4 6 412 23920 9.8 10 11.4 6500 6500 6960 65 64 64 33 34 35 2 2 113 23924 8.3 8.6 9.2 7200 7000 6800 57 58 63 40 42 35 3 - 214 27019 9 9 10.1 5800 5400 6200 68 64 60 32 36 36 - - 415 29354 7.4 7.5 8 6250 5650 5650 58 53 55 38 42 45 4 4 - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 124
  • 146. Table no 43 showing objective variables in Arohana krama Sneha panaSl No OPD NO ESR Total RBC PCV (In %) BT AT AF BT AT AF BT AT AF1 32447 20 16 14 4.8 5.1 5.2 32 33 33.42 7342 9 14 9 4.8 4.8 4.9 31 31.4 333 7340 10 12 8 5 5.2 5.4 29 30 30.44 7339 8 10 12 4.8 5 5.4 29 29.8 30.25 7343 10 12 12 5.2 5.8 6 32 33 33.66 7748 15 14 13 4.5 4.5 4.6 29 29.6 307 7746 14 13 10 4.9 4.9 5 30.6 30.9 318 8431 10 12 10 5 5.1 5.2 30 30.1 319 9376 12 14 12 4.9 5.2 5.9 34 34.1 34.510 14180 16 12 14 5.4 5.4 5.8 42 42 43.811 16382 12 14 14 5.6 5.6 5.8 40 40.3 4212 23920 8 12 13 3.5 4.2 5 32 33 34.313 23924 10 13 32 3.8 3.9 5.2 30 31.9 3314 27019 22 18 14 5.5 5.6 6.2 33 33 34.115 29354 10 8 5 5 3.8 4.01 24 25 26 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 125
  • 147. Table no 44 showing Objective variables in Sadharana krama SnehapanaSl No OPD Hb% Total count Differential count NO Platelets Lymphocytes Esnophils BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 29691 8.2 8.4 9.9 5850 5960 6200 62 66 66 34 30 32 4 4 22 7354 9.8 10 10.2 6280 6350 6350 58 60 60 39 36 37 3 4 33 7353 8.2 8.6 9 5800 5860 6200 52 54 63 42 40 32 6 6 54 7586 9 9.2 9.6 6350 6480 6500 56 58 60 44 40 38 - 2 25 7319 8.2 8.6 8.6 5800 5860 6200 52 54 62 42 40 33 6 6 56 10658 6.8 7 7.4 4800 4850 4890 58 60 62 36 34 36 6 6 27 10657 9.9 9.9 9.9 5800 5900 6200 49 50 50 45 44 44 6 6 68 16384 7.6 7.8 8.1 5200 5600 5900 58 62 62 40 36 37 2 2 19 17731 8.2 8.6 9.1 5600 5680 5820 65 65 65 33 30 32 2 5 310 18157 10.2 10.4 10.4 6200 6400 6300 58 60 62 40 37 36 2 3 211 25983 10.2 10.4 10.3 6300 6400 6350 62 66 60 36 31 38 2 3 212 25982 9.5 9.8 9.9 5300 5800 6000 63 60 62 36 38 34 1 2 413 25984 10.5 10.5 11.2 6200 6300 7200 60 62 64 36 34 34 4 4 214 32437 7 7.6 7.7 6100 6300 6400 63 62 60 37 36 38 - 2 215 34351 9.1 9.4 9.4 5850 6000 6800 62 66 64 36 32 36 2 2 - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 126
  • 148. Table no 45 showing Objective variables in Sadharana krama Snehapana Sl No OPD NO ESR Total RBC PCV (In %) BT AT AF BT AT AF BT AT AF 1 29691 8 10 12 4.8 5 6.1 33 33.2 34.2 2 7354 9 10 10 5.2 5.2 5.4 41 41.5 41.8 3 7353 16 16 14 4.2 4.4 4.5 31 32 32.9 4 7586 8 10 8 4.8 5 5.2 33 33.4 34 5 7319 14 12 12 4.2 4.4 4.5 32 33 33.1 6 10658 12 11 10 4.4 4.6 5 29 29.8 31 7 10657 15 12 12 5.6 5.6 5.8 33 33 33.2 8 16384 8 10 12 4.8 5 5.4 30 31 31.9 9 17731 14 13 10 4.9 4.9 5 32 34 35.2 10 18157 10 10 9 5.1 5.1 5.4 40 40.5 40.4 11 25983 8 9 9 5.2 5.4 5.4 40 41 41.1 12 25982 7 9 14 5.1 5.3 5.4 41 41.2 41.8 13 25984 9 9 9 4.8 4.9 4.9 39 39.5 42 14 32437 19 16 18 4.92 4.90 4.98 28 30 30.8 15 34351 12 14 12 5.2 5.1 5.6 30 31.5 31 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 127
  • 149. OBSERVATION AND RESULTS Total 30 patients underwent treatment who were included randomlybased on inclusion criteria and fulfilled the subjective and objective parameters. All thepatients were examined before and after treatment as per the case sheet Performa. Thedatas collected are presented below:Distribution of patients by Age:Table No 46 Distribution of patients by age Age group Group A % Group B % 20-25 10 66.70 7 46.70 26-30 4 26.70 3 20 31-35 0 0 2 13.30 36-40 0 0 2 13.30 41-45 1 6.60 1 6.70Note :Age Group A, Among 15 patients, 10(66.70%) patients in age group 20 – 25Years, 4 (26.70%) in age group 26-30 Years, 1(6.60%) in age group 41-45 Years. InGroup B Among 15 patients, 7(46.70%) patients in group 20-25 Years, 3(20%) in group26 – 30 years, 2 (13.30%) in group 31- 35 Years, 2 (13.30%) in group 36- 40 Years and1(6.70%) in group 41- 45 Years age group.Graph No 1 showing distribution of patients by age 70 60 50 Group A 40 % 30 20 Group B 10 % 0 20-25 26-30 31-35 36-40 41-45 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 128
  • 150. Distribution of patients by SexTable No 47 Distribution of patients by sex Gender Group A % Group B % Male 3 20 5 33.3 Female 12 80 10 66.7Note: In group A (Arohana Krama Snehapana), Among 15 patients, 3 (20%) patientswere males and 12(80%) were females. In Group B (Sadharana Krama Snehapana),Among 15 patients, 5(33.3%) patients were males and10 (66.7%) were females.Graph No 2 showing distribution of patients by sex 90 80 70 60 50 40 Male 30 Female 20 10 0 Group A % Group B %Distribution of patients by ReligionTable No 48 Distribution of patients by Religion Religion Group A % Group B % Total % Hindu 15 100 12 80 27 90 Muslim 0 0 3 20 3 10 Christian 0 0 0 0 0 0Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15 (100%) patientswere Hindus. In Group B (Sadharana Krama Snehapana), Among 15 patients, 12(80%)patients were Hindus and 3 (20%) were Muslims. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 129
  • 151. Graph No 3 showing distribution of patients by Religion 120 100 80 Hindu 60 Muslim 40 Christian 20 0 Group A % Group B % Total %Distribution of patients by OccupationTable No 49 Distribution of patients by Occupation Occupation Group A % Group B % Total % Active 12 80 11 73.3 23 76.67 Labour 3 20 4 26.7 7 23.33 Sedentary 0 0 0 0 0 0Note: In group A, amoung 15 patients, 12 (80%) patients were active group, 3(20%)were Labourers. In Group B, among 15 patients, 11(73.3%) patients were active and 4(26.7%) were Labourers.Graph No 4 showing distribution of patients by Occupation 80 70 60 50 Active 40 Lobour 30 20 Sedentary 10 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 130
  • 152. Distribution of patients by Economical statusTable No 50 Distribution of patients by Economical status Economical Group A % Group B % Total % status Poor 3 20 4 26.7 7 23.3 Middle class 5 33.3 9 60 14 46.7 Higher class 7 46.7 2 13.3 9 30Note: In group A (Arohana Krama Snehapana), Among 15 patients, 3 (20%) patientswere poor class, 5(33.3%) were middle class and 7(46.7%) belongs to higher class. InGroup B (Sadharana Krama Snehapana), Among 15 patients, 4(26.7%) patients werepoor class, 9(60%) were middle class and 2(13.3%) belongs to higher class group.Graph No 5 showing distribution of patients by Economical status 60 50 40 Poor 30 Middle class 20 Higher class 10 0 Group A % Group B % Total %Distribution of patients by Mode of onset of diseaseTable No 51 Distribution of patients by Mode of onset of diseaseMode of Group A % Group B % Total %onset ofdiseaseSudden 0 0 0 0 0 0Gradual 15 100 15 100 30 100Insidious 0 0 0 0 0 0 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 131
  • 153. Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15 (100%) patientshad gradual onset of disease. In Group B (Sadharana Krama Snehapana), Among 15patients, 15 (100%) patients had gradual onset of disease.Graph No 6 showing distribution of patients by Mode of onset of disease 100 80 60 Sudden 40 Gradual Insidious 20 0 Group A % Group B % Total %Distribution of patients by Course of diseaseTable No 52 Distribution of patients by Course of disease Course of Group A % Group B % Total % disease Gradually 15 100 15 100 30 100 progressive Persistent 0 0 0 0 0 0 Relapsing 0 0 0 0 0 0Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15 (100%) patientshad course of disease in a gradually progressive way. In Group B (Sadharana KramaSnehapana), Among 15 patients, 15 (100%) patients had course of disease in a graduallyprogressive way. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 132
  • 154. Graph No 7 showing distribution of patients by Course of disease 100 80 60 Gradually progressive 40 Persistent Relapsing 20 0 Group A % Group B % Total %Distribution of patients by Chikitsa vrittantaTable No 53 Distribution of patients by Chikitsa vrittanta Chikitsa Group A % Group B % Total % vrittanta Modern 1 6.67 2 13.33 3 10 medicine Ayurvedic 6 40 9 60 15 50 medicine surgery 0 0 0 0 0 0 No 8 53.33 4 26.67 12 40 medicationNote: In group A Among 15 patients, 1 (6.67%) patients had taken modern medicine,6(40%) had taken Ayurvedic treatment and 8(53.33%) had not taken any kind oftreatments. In Group B (,Among 15 patients, 2 (13.33%) patients had taken modernmedicine, 9(60%) had taken Ayurvedic treatment and 4(26.67%) had not taken any kindof treatments. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 133
  • 155. Graph No 8 showing distribution of patients by Chikitsa vrittanta 70 60 50 Modern medicine 40 Ayurvedic medicine 30 20 surgery 10 No medication 0 Group A % Group B % Total %Distribution of patients by Kula vrittantaTable No 54 Distribution of patients by Kula vrittanta Kula Group A % Group B % Total % vrittanta Maternal 4 26.7 9 60 13 43.3 paternal 0 0 0 0 0 0 Absent 11 73.3 6 40 17 56.7Note: In group A among 15 patients, 4 (26.7%) patients had maternal kula vrittanta and11(73.3%) had no history of maternal or paternal kula vrittanta. In Group B, among 15patients, 9(60%) patients had maternal kula vrittanta and 6(40%) had no history ofmaternal or paternal kula vrittanta.Graph No 9 showing distribution of patients by Kula vrittanta 80 70 60 50 Maternal 40 paternal 30 20 Absent 10 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 134
  • 156. Distribution of patients by Type of dietTable No 55 Distribution of patients by Type of diet Type of Group A % Group B % Total % diet Vegetarian 11 73.3 9 60 20 66.7 Mixed 4 26.7 6 40 10 33.3Note: In group A (Arohana Krama Snehapana), Among 15 patients, 11 (73.3%) patientswere vegetarians and 4(26.7%) were mixed diet groups. In Group B (Sadharana KramaSnehapana), Among 15 patients, 9 (60%) patients were vegetarians and 6(40%) weremixed diet groups.Graph No 10 showing distribution of patients by Type of diet 80 60 40 Vegetarian Mixed 20 0 Group A % Group B % Total %Distribution of patients by Dominant rasaTable No 56 Distribution of patients by Dominant rasa Dominant Group A % Group B % Total % rasa Madhura 10 66.7 6 40 16 53.33 Katu 8 53.3 11 73.33 19 63.33 Amla 12 80 6 40 18 60 Tikta 0 0 0 0 0 0 Lavana 11 73.33 3 20 14 46.66 kashaya 0 0 0 0 0 0 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 135
  • 157. Note: In group A, among 15 patients, 10 (66.7%) patients were taking Madura rasa,8(53.3%) were taking Katu rasa, 12(80%) were taking Amla rasa, 11(73.33%) weretaking Lavana rasa Ahara . In Group B, among 15 patients, 6(40%) patients were takingMadura rasa, 11(73.33%) were taking Katu rasa,6(40%) were taking Amla rasa, 3(20%)were taking lavana rasa Ahara .Graph No 11showing distribution of patients by Dominant rasa 80 70 Madhura 60 Katu 50 40 Amla 30 Tikta 20 Lavana 10 0 kashaya Group A % Group B % Total %Distribution of patients by Diet patternTable No 57 Distribution of patients by Diet pattern Diet pattern Group A % Group B % Total % Samashana 2 13.3 2 13.4 4 13.3 Adyashana 1 6.7 5 33.3 6 20 Anashana 9 60 3 20 12 40 vishamashana 3 20 5 33.3 8 26.7Note: In group A, among 15 patients, 2 (13.3%) patients were Samashana, 1(6.7%) wereAdyashana, 9(60%) were Anashana and 3(20%) are Vishamashana. In Group B, among15 patients, 2 (13.3%) patients were Samashana, 5(33.3%) were Adyashana, 3(20%) wereAnashana and 5(33.3%) are Vishamashana. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 136
  • 158. Graph No 12showing distribution of patients by Diet pattern 60 50 40 Samashana 30 Adyashana 20 Anashana 10 vishamashana 0 Group A % Group B % Total %Distribution of patients by VyayamaTable No 58 Distribution of patients by VyayamaVyayama Group A % Group B % Total %Mild 6 40 4 26.67 10 33.33Moderate 7 46.67 8 53.33 15 50Heavy 2 13.33 3 20 5 16.67Note: In group A (Arohana Krama Snehapana), Among 15 patients, 6 (40%) patientsbelonged to mild Vyayama group, 7(46.67%) patients belonged to moderate Vyayamagroup, 2(13.33%) patients belonged to heavy Vyayama group. In Group B (SadharanaKrama Snehapana), Among 15 patients, 4 (26.67%) patients belonged to mild Vyayamagroup, 8(53.33%) patients belonged to moderate Vyayama group, 3(20%) patientsbelonged to heavy Vyayama group.Graph No 13 showing distribution of patients by Vyayama Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 137
  • 159. 60 50 40 Mild 30 Moderate 20 Heavy 10 0 Group A % Group B % Total %Distribution of patients by Manasika viharaTable No 59 Distribution of patients by Manasika viharaManasika Group A % Group B % Total %viharaChinta 10 66.67 6 40 16 53.33Shoka 6 40 7 46.67 13 43.33Bhaya 4 26.67 10 66.67 14 46.67Krodha 6 40 7 46.67 13 43.33Note: In group A, among 15 patients, 10(66.67%) patients had Chinta, 6(40%) patientshad Shoka, 4(26.67%) patients had Bhaya and 6(40%) patients had Kroda. In Group B,among 15 patients, 6(40%) patients had Chinta, 7(46.67%) patients had Shoka,10(66.67%) patients had Bhaya and 7(46.67%) patients had Kroda.Graph No 14 showing distribution of patients by Manasika vihara 80 60 Chinta 40 Shoka 20 Bhaya Krodha 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 138
  • 160. Distribution of patients by VyasanaTable No 60 Distribution of patients by Vyasana Vyasana Group A % Group B % Total % Alcohol 0 0 1 6.67 1 3.33 Tobacco 2 13.33 1 6.67 3 10 Smoking 0 0 3 20 3 10 No habit 13 86.67 12 80 25 83.33Note: In group A (Arohana Krama Snehapana), Among 15 patients, 2(13.33%) patientswere taking tobacco and 13(86.67%) patients were not having any habits. In Group B(Sadharana Krama Snehapana), Among 15 patients, 1(6.67%) patient were takingalcohol, 1(6.67%) patient were taking tobacco, 3(20%) patients were smokers and12(80%) patients were not having any habits.Graph No 15 showing distribution of patients by Vyasana 100 80 60 40 Alcohol 20 Tobacco 0 Smoking Group A % Group B % Total % No habit Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 139
  • 161. Distribution of patients by NidraTable No 61 Distribution of patients by Nidra Nidra Group A % Group B % Total % Sound 10 66.67 9 60 19 63.33 Disturbed 5 33.33 5 33.33 10 33.33 Day sleep 0 0 1 6.67 1 3.34Note: In group A (Arohana Krama Snehapana), Among 15 patients, 10(66.67%) patientswere having sound sleep and 5(33.33%)were having disturbed sleep. In Group B(Sadharana Krama Snehapana), Among 15 patients, 9(60%) patients were having soundsleep, 5(33.33%) were having disturbed sleep and 1(6.67%) patient were having daysleep,Graph No 16 showing distribution of patients by Nidra 70 60 50 40 Sound Disturbed 30 Day sleep 20 10 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 140
  • 162. Distribution of 22 patients by Menstrual historyTable No 62 Distribution of patients by Menstrual history Menstrual Group A % Group B % Total % history Regular 12 80 7 46.67 19 63.33 Irregular 0 0 3 20 3 10 Menopause 0 0 0 0 0 0 Menorrhagia 0 0 1 6.67 1 3.33 Metrorrhagia 0 0 3 20 3 10 Leucorrhagia 0 0 1 6.67 1 3.33Note: In group A (Arohana Krama Snehapana), Among 12 patients, 12(80%) patientshad regular menstrual history. In Group B (Sadharana Krama Snehapana), Among 10patients, 7(46.67%) had regular menstrual history, 3(20%) had Irregular menstrualhistory,1(6.67%) patients had Menorrhagia,3(20%) patients had Metrorrhagiaand1(6.67%) patients had Leucorrhagia.Graph No 17 showing distribution of patients by Menstrual history 80 70 60 Regular 50 Irregular 40 Menopause Menorrhagia 30 Metrorrhagia 20 Leucorrhagia 10 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 141
  • 163. Distribution of patients by KoshtaTable No 63 Distribution of patients by Koshta Koshta Group A % Group B % Total % Krura 2 13.32 3 19.98 5 16.66 Madhyama 11 73.26 11 73.26 22 73.33 Mrudhu 2 13.32 1 6.66 3 10Note: In group A (Arohana Krama Snehapana), Among 15 patients, 2(13.32%) patientshad Krura Koshta 11(73.26%) had Madhyama Koshta and 2(13.32%) had MrudhuKoshta. In Group B (Sadharana Krama Snehapana), Among 15 patients, 3(19.98%)patients had Krura Koshta 11(73.26%) had Madhyama Koshta and 1(6.66%) hadMrudhu Koshta.Graph No 18 showing distribution of patients by Koshta 80 70 60 50 Krura 40 Madhyama 30 Mrudhu 20 10 0 Group A % Group B % Total %Distribution of patients by PrakritiTable No 64 Distribution of patients by Prakriti Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 142
  • 164. Prakriti Group A % Group B % Total % Vatapittaja 10 66.67 9 60 19 63.33 Kaphavataja 3 20 3 20 6 20 Kaphapittaja 2 13.33 3 20 5 16.67Note: In group A,among 15 patients, 10(66.67%) patients had Vatapittaja Prakriti,3(20%) had Kaphavataja Prakriti and 2(13.32%) had Kaphapittaja Prakriti. In Group Bamong 15 patients, 9(60%) patients had Vatapittaja Prakriti, 3(20%) had KaphavatajaPrakriti and 3(20%) had Kaphapittaja Prakriti.Graph No 19 showing distribution of patients by Prakriti 70 60 50 40 Vatapittaja 30 Kaphavataja 20 Kaphapittaja 10 0 Group A % Group B % Total %Distribution of patients by SatwaTable No 65 Distribution of patients by Satwa Satwa Group A % Group B % Total % Pravara 0 0 0 0 0 0 Madyama 15 100 15 100 30 100 Avara 0 0 0 0 0 0 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 143
  • 165. Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%) patientshad Madyama Satwa. In Group B (Sadharana Krama Snehapana), Among 15patients15(100%) patients had Madyama Satwa.Graph No 20 showing distribution of patients by Satwa 100 80 60 Pravara Madyama 40 Avara 20 0 Group A % Group B % Total %Distribution of patients by SatmyaTable No 66 Distribution of patients by Satmya Satmya Group A % Group B % Total % Ekarasa 0 0 0 0 0 0 Sarvarasa 2 13.33 1 6.67 3 10 Vyamisra 13 86.66 14 93.33 27 90Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 2(13.33%) patientsbelonged to Sarvarasa Satmya and 13(86.66%) patients belonged to Vyamisra Satmya. InGroup B (Sadharana Krama Snehapana), Among 15 a patient, 1(6.67%) patientsbelonged to Sarvarasa Satmya and 14(93.33%) patients belonged to Vyamisra Satmya.Graph No 21 showing distribution of patients by Satmya Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 144
  • 166. 100 80 60 Ekarasa 40 Sarvarasa Vyamisra 20 0 Group A % Group B % Total %Distribution of patients by SamhanathaTable No 67 Distribution of patients by SamhanathaSamhanatha Group A % Group B % Total %Susamhata 0 0 0 0 0 0Madyama 15 100 15 100 30 100Asamhata 0 0 0 0 0 0Note: In group A, among 15 patients, 15(100%) patients were having MadyamaSamhanatha. In Group B, among 15 patients15(100%) patients were having MadyamaSamhanatha.Graph No 22 showing distribution of patients by Samhanatha 100 80 60 Susamhata 40 Madyama Asamhata 20 0 Group A % Group B % Total % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 145
  • 167. Distribution of patients by PramanaTable No 68 Distribution of patients by Pramana Pramana Group A % Group B % Total % Sama 15 100 15 100 30 100 Heena 0 0 0 0 0 0 Adhika 0 0 0 0 0 0Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%) patientswere having Sama Pramana. In Group B (Sadharana Krama Snehapana), Among 15patients 15(100%) patients were having Sama Pramana.Graph No 23 showing distribution of patients by Pramana 100 80 60 Sama 40 Heena Adhika 20 0 Group A % Group B % Total %Distribution of patients by Abhyavarana shaktiTable No 69 Distribution of patients by Abhyavarana shakti Abhyavarana Group A % Group B % Total % shakti Pravara 1 6.67 0 0 1 3.33 Madyama 14 93.33 14 93.33 28 93.34 Avara 0 0 1 6.67 1 3.33Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 1(6.67%) patientbelonged to Pravara Abhyavarana shakti and 14 (93.33%) patients belonged to MadyamaAbhyavarana shakti. In Group B (Sadharana Krama Snehapana), Among 15 a patient, 14 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 146
  • 168. (93.33%) patients belonged to Madyama Abhyavarana shakti and 1(6.67%) patientbelonged to Avara Abhyavarana shakti.Graph No 24 showing distribution of patients by Abhyavarana shakti 100 50 Pravara Madyama 0 Avara Group A % Group B % Total %Distribution of patients by Jarana shaktiTable No 70 Distribution of patients by Jarana shakti Jarana Group A % Group B % Total % shakti Pravara 0 0 0 0 0 0 Madyama 14 93.33 15 100 29 96.67 Avara 1 6.67 0 0 1 3.33Note: In group A (Arohana Krama Snehapana), Among 15 a patient, 14(93.33%) patientbelonged to Madyama Jarana shakti and 1 (6.67%) patient belonged to Avara Jaranashakti . In Group B (Sadharana Krama Snehapana), Among 15 a patient, 15(100%)patient belonged to Madyama Jarana shakti .Graph No 25 showing distribution of patients by Jarana shakti Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 147
  • 169. 100 80 60 Pravara 40 Madyama Avara 20 0 Group A % Group B % Total %Distribution of patients by VayaTable No 71 Distribution of patients by Vaya Vaya Group A % Group B % Total % Bala 0 0 0 0 0 0 Yuva 15 100 15 100 30 100 Vridha 0 0 0 0 0 0Note: In group A (Arohana Krama Snehapana), Among 15 patienst, 15(100%) patientsbelonged to Yuva. In Group B (Sadharana Krama Snehapana), Among 15 patients15(100%) patients belonged to Yuva.Graph No 26 showing distribution of patients by Vaya 100 80 60 Bala 40 Yuva Vridha 20 0 Group A % Group B % Total %Distribution of patients by Vyayama Shakti Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 148
  • 170. Table No 72 Distribution of patients by Vyayama Shakti Vyayama Group A % Group B % Total % Shakti Pravara 0 0 0 0 0 0 Madyama 15 100 14 93.33 29 96.67 Avara 0 0 1 6.67 1 3.33Note: In group A (Arohana Krama Snehapana), Among 15 patienst, 15(100%) patientsbelonged to Madyama Vyayama Shakti . In Group B (Sadharana Krama Snehapana),Among 15 patients 14(93.33%) patients belonged Madyama Vyayama Shaktiand1(6.67%)patient belonged to Avara Vyayama shakti.Graph No 27 showing distribution of patients by Vyayama Shakti 120 100 80 Pravara 60 Madyama 40 Avara 20 0 Group A % Group B % Total %Distribution of patients by Poorva roopaTable No 73 Distribution of patients by Poorva roopaPoorvaroopa Group A % Group B %Hrit spandana 7 46.66 7 46.66Twak rookshata 4 26.66 1 6.67Aruchi 14 93.33 14 93.33Sweda abhava 1 6.67 2 13.33Agni mandhya 11 73.33 14 93.33Shrama 0 0 0 0Shteevana 1 6.67 2 13.33Gatrasada 1 6.67 1 6.67Avipaka 3 20 1 6.67Peeta mootrata 2 13.33 0 0 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 149
  • 171. Note: In group A among 15 patienst, 7(46.66%) patients had Hrit spandana,4(26.66%)Twak rookshata, 14(93.33%)Aruchi,1(6.67%)Swedaabhava,11(73.33%)Agnimandhya,1(6.67%) Shteevana, 1(6.67%) Gatrasada 3(20%) Avipaka and 2(13.33%)Peetamootrata. In Group B among 15 patienst,7(46.66%) patients had Hrit spandana,1(6.67%)Twak rookshata, 14(93.33%)Aruchi, 2(13.33%) Swedaabhava, 14(93.33%) Agnimandhya ,2(13.33%) Shteevana , 1(6.67%) Gatrasada 1(6.67%)Avipaka .Graph No 28 showing distribution of patients by Poorva roopa 100 90 80 70 60 50 Group A 40 % 30 Group B 20 % 10 0Distribution of patients by Anubandha vedanaTable No 74 Distribution of patients by Anubandha vedana Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 150
  • 172. Anubanda Group A % Group B % vedana Karnaksweda 0 0 1 6.67 Sadana 3 20 0 0 Agnimandhya 15 100 14 93.33 Trishna 6 40 0 0 Toda 2 13.33 0 0 Alasya 10 66.67 8 53.33 Tandra 8 53.33 0 0 Twaksputana 3 20 4 26.67 Shrama 4 26.67 2 13.33 Gatrashoola 6 40 6 40 Alpa meda 4 26.67 1 6.67 Jwara 1 6.67 0 0 Swasa 4 26.67 0 0 kasa 3 20 0 0 Hataprabha 5 33.33 5 33.33 Hridrava 1 6.67 0 0 Shirashoola 11 73.33 6 40Note: In groupA,among 15 patients, 3(20%) patients had sadana,15(100%)Agnimandhya, 6(40%) Trishna,2(13.33%) Toda,10(66.67%) Alasya,8(53.33%)Tantra,3(20%) Twaksputana,4(24.67%)srama, 6(40%)gatrashoola, 4(24.67%)alpameda,1(6.67%) Jwara, 4 (26.67%) swasa, 3(20%) kasa, 5(33.33%) Hataprabha, 1(6.67%)Hridrava 11(73.33%) Shirashoola. In Group B, among 15 patients, 1(6.67%) hadKarnashweda,14(93.33%) Agnimandhya,8(53.33%)Alasya,4(26.67%) Twaksputana,2(13.33%)srama, 6(40%) gatrashoola,1(6.67%)alpameda, 5(33.33%) Hataprabha, 6(40%)having shirashola.Graph No 29 showing distribution of patients by Anubandha vedana Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 151
  • 173. 100 90 80 70 60 50 Group A 40 Percentage 30 Group B Percentage 20 10 0 Agnimandhya Shrama Gatrashoola Shirashoola Twaksputana Hataprabha Karnaksweda Sadana Trishna Toda Alasya Tandra Alpa meda Jwara Hridrava Swasa kasaDistribution of patients by Pradana vedanaTable No 75 Distribution of patients by Pradana vedana Sl. Lakshana Group A % Group B % 01. Panduta 15 100 15 100 02. Arohana Ayasa 13 86.67 14 93.33 03. Dourbalya 15 100 15 100 04. Bhrama 13 86.67 13 86.67 05. Agnimanndya 15 100 15 100Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%) patientshad Panduta,13(86.67%) Arohana Ayasa, 15(100%) Dourbalya, 13(86.67%) Bhrama Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 152
  • 174. 15(100%) Agnimanndya. In group A Sadharana Krama Snehapana), Among 15 patients,15(100%) patients had Panduta,14(93.33%) Arohana Ayasa, 15(100%) Dourbalya,13(86.67%) Bhrama 15(100%) Agnimanndya.Graph No 30 showing distribution of patients by Pradana vedana 100 90 80 70 60 50 Group A 40 % 30 Group B 20 10 % 0OBSERVATION OF SNEHAPANA LAKSHNAS: The present study has been undertaken to see the effect of Arohana Snehapanaand Sadharana krama Snehapana in Panduroga .Matra of Sneha taken, time taken fordigestion, onset of Jeeryamana Lakshanas. Samyak snigdha Lakshanas were recordedin both groups. Out of 30 samples all showed following Snehapana Lakshanas.Matra of Draksha Ghrita administered:The matra of Snehapana with Draksha Ghrita in both the groups Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 153
  • 175. Table No 76 showing Matra of Ghrita administeredSl Opd no Group A Group B st nd rdno 1 2 3 4th 5th 6 th Total Opd no Snehapan Total day da da day day day sneha a amount y y (40 ml of sneha Fixed dose)1 32447 30 60 90 120 - - 300 29691 7X40ml 280 ml2 7342 30 60 90 120 - - 300 7354 7X40ml 280 ml3 7340 30 60 90 120 - - 300 7353 7X40ml 280 ml4 7339 30 60 90 120 - - 300 7586 7X40ml 280 ml5 7343 30 60 90 120 - - 300 7319 7X40ml 280 ml6 7748 30 60 90 120 - - 300 10658 7X40ml 280 ml7 7746 30 60 90 120 150 - 450 10657 7X40ml 280 ml8 8431 30 60 90 120 150 - 450 16384 7X40ml 280 ml9 9376 30 60 90 120 - - 300 17731 7X40ml 280 ml10 14180 30 60 90 120 150 - 450 18157 7X40ml 280 ml11 16382 30 60 90 120 150 - 450 25983 7X40ml 280 ml12 23920 30 60 90 120 - - 300 25982 7X40ml 280 ml13 23924 30 60 90 120 150 - 450 25984 7X40ml 280 ml14 27019 30 60 90 120 150 - 450 32437 7X40ml 280 ml15 29354 30 60 90 120 150 180 630 34351 7X40ml 280 mlGroup A (Arohana krama Snehapana): Draksha Ghrita was given in the dose of 30ml on the first day to all the 15 individuals. The dose was increased by 30 ml every day.In this group minimum dose was 120 ml and maximum dose was 630 ml.Group B (Sadharana krama Snehapana): Draksha Ghrita was given in the dose of 40ml fixed to all the 15 individuals. The same dose was continued up to 7 days. In thisgroup the total dose was 280 ml. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 154
  • 176. Table No 77 showing Snehapana kalavadhiDistribution of patients by Snehapana kalavadhi Sl Snehapanakalavadhi No of patient in % No of patient % No group A in group B 1 Up to 4 days 8 53.33 0 00 2 More than 4 days up 7 46.67 0 00 to 6 days 3 Taken for 7 days 0 00 15 100Note: In group A (Arohana Krama Snehapana), Among 15 patients, 8(53.33%) patientstook Snehapana up to 4 days. 7(46.67%) took more than 4 days up to 6 days. In group B(Sadharana Krama Snehapana), Among 15 patients, 15(100%) patients took Snehapanafor 7 days.Graph No 31 showing distribution of patients by Snehapana kalavadhi 100 100 90 80 70 60 53.33 46.67 Up to 4 days 50 40 4 to 6 Days 30 For 7 Days 15 20 8 7 10 0 0 0 0 0 0 0 No of patients % No of patients % in Group A in Group B Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 155
  • 177. JEERYAMANYA LAXANASThe mean on set of Jeeryamanya laxanas in Group ATable No 78 showing the mean on set of Jeeryamanya laxanas in Group ASL.N JEERYAMANA MEAN ONSET OF TIME IN MINUTESO LAKSHANAS 1ST 2ND 3RD 4TH 5TH 6TH 7TH DAY DAY DAY DAY DAY DAY DAY1 Shiroruja 80 120 235 220 250 - -2 Bhrama 110 125 180 285 230 - -3 Lalasrava 70 105 100 220 190 - -4 Moorcha 160 120 170 170 100 - -5 Daha - - 320 315 - - -Group A : On the first day after snehapana the mean onset time of Shiroruk, Bhrama,Lalasrava, Moorcha occurred 80,110,70,160 minutes respectively. On the second dayafter snehapana the mean onset time of Shiroruk, Bhrama, Lalasrava, Moorcha occured120,125,105,120 minutes respectively . On the third day after snehapana the mean onsettime of Shiroruk, Bhrama, Lalasrava, Moorcha and daha occured 235,180,100,170,320minutes respectively .On the fourth day after snehapana the mean onset time of Shiroruk,Bhrama, Lalasrava, Moorcha and daha occured 220,285,220,170,315 minutesrespectively. On the fifth day after snehapana the mean onset time of Shiroruk, Bhrama,Lalasrava, Moorcha occurred 250,230,190,100 minutes respectively. Daha did not occurron 1st , 2nd 5th and 6th day.The mean on set of Jeeryamanya laxanas in Group BTable No 79 showing the mean on set of Jeeryamanya laxanas in Group B SL.NO JEERYAMANA MEAN ONSET OF TIME IN MINUTES LAKSHANAS 1ST 2ND 3RD 4TH 5TH 6TH 7TH DAY DAY DAY DAY DAY DAY DA Y 1 Shiroruja 90 110 125 150 - - - 2 Bhrama - - - - 90 - - 3 Lalasrava 110 120 160 165 210 - - 4 Moorcha - - - - - - - 5 Klama 105 - - - - - - Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 156
  • 178. Group B : On the first day after snehapana the mean onset time of Shiroruk, Lalasrava,klama occurred 90,110,105 minutes respectively. On the second day after snehapana themean onset time of Shiroruk, Lalasrava, occured 110,160 minutes respectively . On thethird day after snehapana the mean onset time of Shiroruk, Lalasrava, occured 125,160minutes respectively .On the fourth day after snehapana the mean onset time of Shiroruk,Lalasrava, occured 150,165 minutes respectively. On the fifth day after snehapana themean onset time of Bhrama, Lalasrava occurred 90,210minutes respectively. Klamaoccurred only at the first day.moorcha did not occurr in any days.TIME TAKEN FOR SNEHA JEERNA LAXANAS:Table no 80 showing mean on set of time in minutes taken for Sneha Jeerna laxanasin group AGROUP A SL.NO JEERNA MEAN ON SET OF TIME IN MINUTES LAKSHANAS 1ST DAY 2ND DAY 3RD DAY 4TH DAY 5TH DAY 1 Jeeryamana 250 300 350 370 470 lakshana prashama 2 Shareera laghuta 290 350 355 425 480 3 Kshudha pravrutti 255 310 355 470 465 4 Trishna 250 310 345 410 465 5 Udgarashudhi 300 350 360 410 470Group A : On the first day the the mean onset of time taken for digestion and thelakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,Trishna, Udgarashudhi occurred on 250,290,255.250,300 minutes respectively. On thesecond day the the mean onset of time taken for digestion and the lakshanas likeJeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna, Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 157
  • 179. Udgarashudhi occurred on 300,350,310,310,350 minutes respectively. On the third daythe the mean onset of time taken for digestion and the lakshanas like Jeeryamanalakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurredon 350,355,355,345,360 minutes respectively. On the fourth day the the mean onset oftime taken for digestion and the lakshanas like Jeeryamana lakshana prashama, Shareeralaghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurred on 370,425,470,410,410minutes respectively. On the fifth day the the mean onset of time taken for digestion andthe lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,Trishna, Udgarashudhi occurred on 470,480,465,465,470 minutes respectively.Table No 81 showing mean on set of time in minutes taken for Sneha Jeerna laxanasin group BSl.no JEERNA MEAN ON SET OF TIME IN LAKSHANAS MINUTES 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day1 Jeeryamana 350 350 340 350 330 298 300 lakshana prashama2 Shareera laghuta 410 400 390 350 330 340 3403 Kshudha 360 350 330 330 300 300 280 pravrutti4 Trishna 350 360 330 330 300 300 2905 Udgarashudhi 400 390 350 340 330 330 330Group B: On the first day the the mean onset of time taken for digestion and thelakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,Trishna, Udgarashudhi occurred on 350,410,360,350,400 minutes respectively. On thesecond day the the mean onset of time taken for digestion and the lakshanas like Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 158
  • 180. Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna,Udgarashudhi occurred on 350,400,350,360,390 minutes respectively. On the third daythe the mean onset of time taken for digestion and the lakshanas like Jeeryamanalakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurredon 340,390,330,330,350 minutes respectively. On the fourth day the the mean onset oftime taken for digestion and the lakshanas like Jeeryamana lakshana prashama, Shareeralaghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurred on 350,350,330,330,390minutes respectively. On the fifth day the the mean onset of time taken for digestion andthe lakshanas like Jeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti,Trishna, Udgarashudhi occurred on 330,330,300,300,330 minutes respectively. On thesixth day the the mean onset of time taken for digestion and the lakshanas likeJeeryamana lakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna,Udgarashudhi occurred on 298,340,300,300,330 minutes respectively. On the seventhday the the mean onset of time taken for digestion and the lakshanas like Jeeryamanalakshana prashama, Shareera laghuta, Kshudha pravrutti, Trishna, Udgarashudhi occurredon 300,340,280,290,330 minutes respectively.Distribution of patients by Samyak snigda lakshanas in both groupsTable No 82 showing Samyak snigda lakshanas in both groups Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 159
  • 181. Sl no Samyak snigda lakshanas No of patients % Group A Group B Group A Group B1 Vathanulomana 15 08 100 53.332 Agnideepti 15 02 100 13.333 Purisha snigdhata 15 05 100 33.334 Asamhata varchas 15 00 100 005 Twak snigdhata 15 08 100 53.336 Anga laghava 15 01 100 6.677 Gatra mardava 15 08 100 53.338 Snehodwega 13 00 86.67 009 Klama 01 00 6.67 0010 Shaithilya 00 00 00 00Note: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%) patientsgot vatanulomana,15(100%) Agnideepti 15(100%) Purisha snigdhata 15(100%)Asamhata varchas 15(100%) Twak snigdhata 15(100%) Anga laghava 15(100%) Gatramardava,13(86.67%) Snehodwega,1(6.67%) Klama. In group B (Sadharana KramaSnehapana),Among 15 patients,8(53.33%) Vathanulomana,2(13.33%) Agnideepti5(33.33%) Purisha snigdhata ,8(53.33%) Twak snigdhata 1(6.67%) Anga laghava8(53.33%) Gatra mardavaGraph No 32 showing Samyak snigda lakshanas in both groups 120 100 80 60 No of patients Group A 40 No of patients Group B 20 % Group A 0 % Group B Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 160
  • 182. Table no 83 showing mean time (in minutes) taken for Samyak Snigadha laxanas ofboth Groups A & B.Samyak snigda 1st day 2nd day 3rd day 4th day 5th day 6th day 7th daylakshanas mean mean mean mean mean mean mean time time time time time time time A B A B A B A B A B A B A BVathanulomana 280 240 300 260 380 - 380 - - - - - - -Agnideepti 240 - 390 - 370 - 430 - 460 - - 240 - 220Purisha - - 400 - 310 - 410 - 450 - - - - 240snigdhataAsamhata - - 380 - - - 420 - 450 - - - - -varchasTwak snigdhata - - 380 - 480 - 420 - 460 - - 280 - 260Anga laghava - - 400 - 420 - 440 - 500 - - - - 180Gatra mardava - - - 440 - 410 - 440 - - 210 - 210Snehodwega - - 370 - 460 - 400 - 480 - - - - -Klama - - 380 260 - 210 - - 430 - - - - -Group A : Out of 15 patients, On the First day the mean time taken for Vatanulomanaand Agnideepti was 280, 240 minutes respectively. On the Second day the mean timetaken for Vatanulomana, Agnideepti, Purisha snigdhata, Asamhata varchas , Twaksnigdhata , Anga laghava, , Snehodwega and Klama was 300, 390, 400, 380, 380, 400,370, 380 minutes respectively.On the third day the mean time taken for Vatanulomana, Agnideepti, Purisha snigdhata,Twak snigdhata , Anga laghava,gatra mardava , Snehodwega was 380, 370, 310, 480,420, 440, 460 minutes respectively. On the fourth day the mean time takenVatanulomana, Agnideepti, Purisha snigdhata, Asamhata varchas , Twak snigdhata , Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 161
  • 183. Anga laghava, Gatra mardava , Snehodwega 380,430,410,420,420,440,410,400 minutesrespectively. On the fifth day the mean time taken for Agnideepti, Purisha snigdhata,Asamhata varchas , Twak snigdhata , Anga laghava, Gatra mardava , Snehodwega andklama 460,450,450,460,500,440,480,430 minutes respectively.Group B : Out of 15 patients, On the First day the mean time taken for Vatanulomanawas 240 minutes. On the Second day the mean time taken for Vatanulomana, 260minutesOn the second day the mean time taken for klama is 260 minutes. On the third day themean time taken for klama is 210 minutes. On the sixth day the mean time taken forAgnideepti, Twak snigdhata and Gatra mardava is 240,280,210 minutes respectively.On the seventh day the mean time taken for Agnideepti, Purisha snigdhata, Twaksnigdhata , Anga laghavaand Gatra mardava is 220, 240,260,180,210 minutesrespectively.SUBJECTIVE AND OBJECTIVE PARAMETERSAnalysis of Improvement of All Parameters after Therapy and after Follow up inBoth GroupsThe collected data were analyzed by using SPSS-Software 15 version (StatisticalSoftware for Social Science).The analysis shows two of types test, Levene’s test and t-test. The first test assumesequality of variances and second test assumes un-equality of variances. The Levene’s testtells us which statistic to consider to analyses the equality of means. It tests the nullhypothesis that the two groups have equal variance. A small value of significanceassociated with Levene’s test indicates that the two groups have unequal variances andthe null hypothesis is falls. A small P-Value associated with Levene’s test indicates the Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 162
  • 184. two groups don’t have equal variances. As researcher doesn’t assumed for equality ofvariances, the t-test for equality of means is tested.Effect of PandutaTable no 84 Group Statistics of Panduta Std. Std. Error Group N Mean Deviation MeanPanduta Before Group A 15 1.80 0.414 0.107Treatment Group B 15 1.80 0.414 0.107Panduta After Treatment Group A 15 1.73 0.458 0.118 Group B 15 1.60 0.507 0.131Panduta After Follow- Group A 15 0.67 0.488 0.126up Group B 15 1.67 0.617 0.159In the parameter, Panduta before treatment in group A, Mean was 1.80 with S.D. 0.414 isreduced to 1.73 with SD 0.458 after treatment and after follow-up is reduced to 0.67 withS.D. 0.488. Similarly in group B, Mean was 1.80 with S.D. 0.414 is reduced to 1.60 withSD 0.507 after treatment and after follow-up is increased to 1.67 with S.D. 0.617Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 0.00 with 28degrees of freedom of parameter Panduta before treatment. The corresponding two tailedvalue is 1.00 higher than 0.05, which is not significant. The t-test results Panduta aftertreatment t-statistic t is 0.75, the corresponding two tailed value is 0.456 which is higherthan 0.05, which is not significant. Similarly, the T-test results after follow-up is 4.922,the corresponding two tailed value is 0.000 which is less than 0.05, which is significant. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 163
  • 185. This means the average effects two groups are not significant before and after treatmentand is significant after follow-up.Paired Samples Correlations for both groupsIn Group-A, the correlation between Before Treatment After Treatment is 0.829 , whichis significant at 0.00, before and after treatment is 0.707 which is significant at 0.003.andbetween after treatment and after follow-up is 0.853 , which is significant at 0.00. whichmeans there is linear effect between before and after the treatment in Panduata.In Group-B, the correlation between Before Treatment After Treatment is 0.612 , whichis significant at 0.015., before and after treatment is 0.839 which is significant at 0.00and between after treatment and after follow-up is 0.685 which is significant at 0.005.This means there is linear effect before and after the treatment in PandutaPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before and after treatment as P>0.05. and shows more highly significant inbefore and after follow-up and after treatment and after follow-up.In group- B, results shows not significant before treatment and after treatment, beforetreatment and after follow-up and after treatment and after follow-up as P>0.05. In the parameter Panduta group A is more highly significant than group B aftertreatment and after follow-up. (By comparing t-values).Graph No 33 showing mean effect of panduta Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 164
  • 186. Mean effect of Panduta 2 1.8 1.8 1.73 1.67 1.8 1.6 1.6 1.4 1.2 Mean 1 BT 0.8 0.67 0.6 AT 0.4 AF 0.2 0 Group A Group B GroupEffect of AgnimandhyaTable no 85 Group Statistics of Agnimandhya Std. Std. Error Group N Mean Deviation MeanAgnimandhya Before Group A 15 1.67 0.488 0.126Treatment Group B 15 1.93 0.594 0.153Agnimandhya After Group A 15 1.20 0.561 0.145Treatment Group B 15 0.93 0.594 0.153Agnimandhya After Group A 15 0.27 0.458 0.118Follwup Group B 15 1.00 0.378 0.098In the parameter Agnimandhya before treatment in group A, Mean was 1.67 with S.D.0.488 is reduced to 1.20 with SD 0.561 after treatment and after follow-up is reduced to0.27 with S.D. 0.458. Similarly in group B, Mean was 1.93 with S.D. 0.594 is reduced to0.93 with SD 0.594 after treatment and after follow-up is increased to 1.00 with S.D.0.378. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 165
  • 187. Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 1.344 with26.989 degrees of freedom of parameter Agnimandhya before treatment. Thecorresponding two tailed value is 0.19 higher than 0.05, which is not significant. The t-test results Agnimandhya after treatment t-statistic t is 1.265. The corresponding twotailed value is 0.216 which is higher than 0.05, which is not significant. Similarly, the T-test results after follow-up is 4.785, the corresponding two tailed value is 0.000 which isless than 0.05, which is significant. This means that the average effects two groups arenot significant before and after treatment and is significant after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment, after Treatment is 0.261, which issignificant at 0.347. The correlation between after treatment and after follow-up is 0.612,which is significant at 0.015, the correlation between before treatment and after follow-upis 0.4262, which is significant at 0.013, which means there is linear relation before andafter the treatment in Agnimandhya.In Group-B, the correlation between Before Treatment after Treatment is 0.797, which issignificant at 0.00. The correlation between after treatment and after follow-up and beforetreatment and after follow-up is zero. It means there is no relation between aftertreatment, after follow-up and before treatment in Agnimandhya. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 166
  • 188. Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before and after treatment as P>0.05. and shows more highly significant inafter treatment and after follow-up and before treatment and after follow-up as P<0.05.In group- B, results shows more highly significant before and after treatment , shows notsignificant after treatment and after follow-up and highly significant before and afterfollow-up as P<0.05. In parameter Agnimandhya group B is more highly significant than groupA after treatment and group A is highly significant than group B after follow-up (Bycomparing t-values).Graph No 34 showing mean effect of Agnimandhya Mean effect of Agnimandhya 2.5 1.93 2 1.67 1.5 Mean 1.2 0.93 1 BT 1 AT 0.5 0.27 AF 0 Group A Group B Group Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 167
  • 189. Effect of ArohanayasaTable no 86 Group Statistics of Arohanayasa Std. Std. Error Group N Mean Deviation MeanArohanayasa Before Group A 15 1.73 0.704 0.182Treatment Group B 15 1.80 0.775 0.200Arohanayasa After Group A 15 1.47 0.516 0.133Treatment Group B 15 1.00 0.655 0.169Arohanayasa After Group A 15 0.47 0.516 0.133Follow-up Group B 15 0.87 0.516 0.133In the parameter Arohanayasa before treatment in group A, Mean was 1.73 with S.D.0.704 is reduced to 1.47 with SD 0.516 after treatment and after follow-up is reduced to0.47 with S.D. 0.516. Similarly in group B, Mean was 1.80 with S.D. 0.775 is reducedto 1.00 with SD 0.655 after treatment and after follow-up is decreased to 0.87 withS.D. 0.516.Independent Samples TestFrom 3-B, The t-test result (with equal variances not assumed) shows t-statistic of 0.247with 27.746 degrees of freedom of parameter Arohanayasa before treatment. Thecorresponding two tailed value is 0.807higher than 0.05, which is not significant. The t-test results Arohanayasa after treatment t-statistic t is 2.168, . The corresponding twotailed value is 0.039 which is lesser than 0.05, which is significant. Similarly, the T-testresults after follow-up is 2.121, the corresponding two tailed value is 0.043 which is lessthan 0.05, which is significant. This means that the average effects two groups are notsignificant before and after treatment and is significant after follow-up. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 168
  • 190. Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.563 , whichis significant at 0.029 . The correlation between after treatment and after follow-up is0.464, which is significant at 0.081, the correlation between before treatment and afterfollow-up is 0.367, which is significant at 0.179, which means there is linear relationbefore and after the treatment in Arohanayasa.In Group-B, the correlation between before Treatment after Treatment is 0.845, which issignificant at 0.00. the correlation between after treatment and after follow-up is 0.211which significant at 0.45 and before treatment and after follow-up is 0.286, whichsignificant at 0.302.. It means there is linear relation between after treatment and afterfollow-up in Arohanayasa.Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before and after treatment as P>0.05,and shows more highly significant inafter treatment and after follow-up and before treatment and after follow-up as P<0.05.In group- B, results shows more highly significant before and after treatment , shows notsignificant after treatment and after follow-up and highly significant before and afterfollow-up as P<0.05. Group B is more highly significant after treatment and group A is morehighly significant after follow-up (By comparing t-values).Graph No 35 showing mean effect of Arohanayasa Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 169
  • 191. Mean effect of Arohanayasa 2 1.8 1.73 1.8 1.6 1.47 1.4 1.2 1 Mean 1 0.87 BT 0.8 0.6 0.47 AT 0.4 AF 0.2 0 Group A Group B GroupEffect of BramaTable no 87 Group Statistics of Brama Std. Deviatio Group N Mean n Std. Error MeanBrama Before Group A 15 1.60 0.632 0.163Treatment Group B 15 1.53 0.743 0.192Brama After Group A 15 1.00 0.535 0.138Treatment Group B 15 0.67 0.617 0.159Brama After Group A 15 0.47 0.516 0.133Follow-up Group B 15 0.80 0.561 0.145In the parameter, Brahma before treatment in group A, Mean was 1.60 with S.D. 0.632isreduced to 1.00with SD 0.535after treatment and after follow-up is reduced to 0.47 withS.D. 0.516. Similarly in group B, Mean was1.53 with S.D. 0.743is reduced to 0.67 withSD 0.617after treatment and after follow-up is increased to 0.80 with S.D. 0.561. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 170
  • 192. Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 0.265 with 27.301degrees of freedom of parameter Brama before treatment. The corresponding two tailedvalue is 0.793 higher than 0.05, which is not significant. The t-test results Brama aftertreatment t-statistic t is 1.581. The corresponding two tailed value is 0.125 which ishigher than 0.05, which is not significant. Similarly, the T-test results after follow-up is -1.694, the corresponding two tailed value is 0.101which is more than 0.05, which is notsignificant. This means that the average effects two groups are not significant beforetreatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.634, which issignificant at 0.011, before and after treatment is 0.259which is significant at 0.352.andbetween after treatment and after follow-up is 0.394, which is significant at 0.147. Thismeans there is linear effect between before and after the treatment in Brama.In Group-B, the correlation between Before Treatment after Treatment is 0.096, which issignificant at 0.026, before and after treatment is 0.413which is significant at 0.126andbetween after treatment and after follow-up is 0.446which is significant at 0.571. Thismeans there is linear effect before and after the treatment in BhramaPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows morehighly significant before and after treatment as P<0.05, and shows more highlysignificant in before and after follow-up as P<0.05. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 171
  • 193. In group- B, results shows not significant before treatment and after treatment and aftertreatment and after follow-up, but shows highly significant before treatment and afterfollow-up as P<0.05. In the parameter Brama group A is more highly significant than group Bbefore treatment and after follow-up (By comparing t-values).Graph No 36 showing mean effect of Brama Mean effect of Bhrama 1.8 1.6 1.53 1.6 1.4 1.2 1 Mean 1 0.8 0.8 0.67 BT 0.6 0.47 AT 0.4 AF 0.2 0 Group A Group B GroupEffect of DourbalyaTable no 88 Group Statistics of Dourbalya Std. Std. Error Group N Mean Deviation MeanDourbalya Before Group A 15 1.47 0.640 0.165Treatment Group B 15 1.80 0.561 0.145Dourbalya After Group A 15 1.00 0.655 0.169Treatment Group B 15 1.00 0.378 0.098Dourbalya After Group A 15 0.67 0.488 0.126Follow-up Group B 15 0.80 0.414 0.107 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 172
  • 194. In the parameter, Dourbalya before treatment in group A, Mean was 1.47with S.D0.640 isreduced to 1.00 with SD 0.655 after treatment and after follow-up is reduced to 0.67 withS.D. 0.488. Similarly in group B, Mean was1.80 with S.D. 0.561 is reduced to 1.00 withSD 0.378 after treatment and after follow-up is increased to 0.80 with S.D. 0.414.Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of -1.517 with27.517 degrees of freedom of parameter Dourbalya before treatment. The correspondingtwo tailed value is 0.140 higher than 0.05, which is not significant. The t-test resultsDourbalya after treatment t-statistic t is 0.000. The corresponding two tailed value is1.000 which is higher than 0.05, which is not significant. Similarly, the T-test resultsafter follow-up is -0.807, the corresponding two tailed value is 0.4267 which is more than0.05, which is not significant. This means that the average effects two groups are notsignificant before treatment after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.682, which issignificant at 0.005, before and after treatment is 0.447. Which is significant at 0.095 .andbetween after treatment and after follow-up is 0.534, which is significant at 0.040. Thismeans there is linear effect between before and after the treatment in Dourbalya.In Group-B, the correlation between Before Treatment after Treatment is 0.674, which issignificant at 0.006, before and after treatment is 0.000 which is significant at 1.000 andbetween after treatment and after follow-up is 0.739 which is significant at 0.002. Thismeans there is linear effect before and after the treatment in Dourbalya Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 173
  • 195. Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant after treatment and after follow-up as P>0.05, and shows more highlysignificant in before treatment and after follow-up as P<0.05.In group- B, results shows not significant after treatment and after follow-up, and morehighly significant in before treatment and after treatment an after follow-up as P<0.05. In the parameter Dourbalya group B is more highly significant thangroup A after treatment and after follow-up (By comparing t-values).Graph No 37 showing mean effect of Dourbalya Mean effect of Dourbalya 2 1.8 1.47 1.5 1 1 Mean 1 0.8 BT 0.67 0.5 AT 0 AF Group A Group B GroupEffect of Hb%Table no 89 Group Statistics of Hb% Std. Error Group N Mean Std. Deviation MeanHb% Before Group A 15 8.780 1.3691 0.3535Treatment Group B 15 8.827 1.1877 0.3067Hb% After Treatment Group A 15 9.000 1.3229 0.3416 Group B 15 9.080 1.1008 0.2842Hb% After Follow-up Group A 15 9.453 1.4065 0.3632 Group B 15 9.320 1.0611 0.2740 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 174
  • 196. In the parameter, Hb% before treatment in group A, Mean was 8.780 with S.D1.3691 isreduced to 9.000 with SD 1.3229 after treatment and after follow-up is reduced to 9.453with S.D. 1.4065 Similarly in group B, Mean was8.827 with S.D. 1.1877 is reduced to9.080 with SD 1.1008 after treatment and after follow-up is increased to9.320 with S.D.1.0611Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of -0.100 with27.453 degrees of freedom of parameter Hb% before treatment. The corresponding twotailed value is 0.921 higher than 0.05, which is not significant. The t-test results Hb%after treatment t-statistic t is -0.180. The corresponding two tailed value is 0.858 which ishigher than 0.05, which is not significant. Similarly, the T-test results after follow-up is0.293 , the corresponding two tailed value is 0.772 which is more than 0.05, which is notsignificant. This means that the average effects two groups are not significant beforetreatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.995, which issignificant at 0.000., before and after treatment is0.967. Which is significant at 0.000.andbetween after treatment and after follow-up is 0.972, which is significant at 0.000. Thismeans there is linear effect between before and after the treatment in Hb%.In Group-B, the correlation between Before Treatment After Treatment is 0.994, whichis significant at 0.000., before and after treatment is 0.974which is significant at 0.000andbetween after treatment and after follow-up is 0.978which is significant at 0.000. Thismeans there is linear effect before and after the treatment in Hb%. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 175
  • 197. Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows significantbefore treatment, after treatment and after follow-up as P<0.05.In group- B, results shows significant before treatment, after treatment and after follow-up as P<0.05.In the parameter Hb% group B is more highly significant than group A after treatmentand group A is better than group B after follow-up (By comparing t-values).Graph No 38 showing mean effect of Hb% Mean effect of Hb% 9.6 9.453 9.32 9.4 9.2 9 9.08 Mean 9 8.78 8.827 BT 8.8 8.6 AT 8.4 AF Group A Group B GroupEffect of Total CountTable no 90 Group Statistics of Total Count Std. Std. Error Group N Mean Deviation MeanTotal Count Before Group A 15 5842.000 690.9331 178.3982Treatment Group B 15 5828.667 450.0455 116.2012Total Count After Group A 15 5895.333 648.9317 167.5535Treatment Group B 15 5982.667 424.6085 109.6334Total Count After Group A 15 6040.667 647.7264 167.2422Follow-up Group B 15 6220.667 502.0738 129.6349 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 176
  • 198. In the parameter, Total Count before treatment in group A, Mean was 5842.000with S.D.690.9331is reduced to 5895.333with SD 648.9317after treatment and after follow-up isreduced to 6040.667with S.D. 647.7264Similarly in group B, Mean was5828.667 withS.D. 450.0455is reduced to 5982.667with SD 424.6085after treatment and after follow-up is increased to6220.667with S.D. 502.0738.Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 0.063 with 24.067degrees of freedom of parameter Total Count before treatment. The corresponding twotailed value is 0.951 higher than 0.05, which is not significant. The t-test results TotalCount after treatment t-statistic t is -0.436 the corresponding two tailed value is 0.667which is higher than 0.05, which is not significant. Similarly, the T-test results afterfollow-up is -0.851, the corresponding two tailed value is 0.402 which is more than 0.05,which is not significant. This means that the average effects two groups are notsignificant before treatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment after Treatment is 0.921, which issignificant at 0.000., before and after treatment is00.934. Which is significant at0.000.and between after treatment and after follow-up is 0.884, which is significant at0.000. This means there is linear effect between before and after the treatment in TotalCount.In Group-B, the correlation between Before Treatment after Treatment is 0.957which issignificant at 0.000before and after treatment is 0.821which is significant at 0.000and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 177
  • 199. between after treatment and after follow-up 0.790which is significant at 0.000. Thismeans there is linear effect before and after the treatment in Total CountPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before and after treatment as P>0.05. And shows more highly significant inafter treatment and before treatment and after follow-up as P<0.05.In group- B, results shows more significant before treatment, after treatment, and afterfollow-up and after treatment P<0.05. In the parameter Total Count group B is more highly significant thangroup A in after treatment and after follow-up (By comparing t-values).Graph No 39 showing mean effect of Total Count Mean effect of Total Count 6300 6220.667 6200 6100 6040.667 5982.667 6000 Mean 5895.333 BT 5900 5842 5828.667 5800 AT 5700 AF 5600 Group A Group B GroupEffect of PlateletsTable no 91 Group Statistics of Platelets Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 178
  • 200. Std. Std. Error Group N Mean Deviation MeanPlatelets Before Group A 15 56.800 5.7595 1.4871Treatment Group B 15 58.533 4.6578 1.2026Platelets After Group A 15 59.067 4.3006 1.1104Treatment Group B 15 60.333 4.7759 1.2331Platelets After Follow- Group A 15 60.133 3.0675 0.7920up Group B 15 61.467 3.6814 0.9505In the parameter, Platelets before treatment in group A, Mean was 56.800 with S.D5.7595is reduced to 59.067 with SD 4.3006 after treatment and after follow-up is reduced to60.133 with S.D. 3.0675 Similarly in group B, Mean was58.533 with S.D. 4.6578 isreduced to 60.333 with SD 4.7759 after treatment and after follow-up is increased to61.467 with S.D. 3.6814.Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of-0.906with 26.826degrees of freedom of parameter Platelets before treatment. The corresponding two tailedvalue is 0.373 higher than 0.05, which is not significant. The t-test results Platelets aftertreatment t-statistic t is 0.763. The corresponding two tailed value is 0.452 which ishigher than 0.05, which is not significant. Similarly, the T-test results after follow-up is -1.078, the corresponding two tailed value 0.291 which is more than 0.05, which is notsignificant. This means that the average effects two groups are not significant beforetreatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment after Treatment is 0.670, which issignificant at 0.006., before and after treatment is0.638. Which is significant at 0.010.and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 179
  • 201. between after treatment and after follow-up is 0.406, which is significant at 0.133. Thismeans there is linear effect between before and after the treatment in Platelets.In Group-B, the correlation between Before Treatment after Treatment is 0.913, which issignificant at 0.000., before and after treatment is 0.649which is significant at0.009andbetween after treatment and after follow-up is 0.588which is significant at 0.021. Thismeans there is linear effect before and after the treatment in PlateletsPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant after treatment and after follow-up as P>0.05. And shows highly significantin before treatment and after follow-up as P<0.05.In group- B, results shows not significant after treatment and after follow-up, beforetreatment and after treatment and after follow-up as P<0.05. In the parameter Platelets group B is more highly significant thangroup A in after treatment and after follow-up (By comparing t-values).Graph No 40 showing mean effect of Platelet Count Mean effect of Platelets 62 61.467 61 60.133 60.333 60 59.067 59 58.533 Mean 58 BT 56.8 57 56 AT 55 AF 54 Group A Group B Group Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 180
  • 202. Effect of LymphocytesTable no 92 Group Statistics of Lymphocytes Std. Std. Error Group N Mean Deviation MeanLymphocytes Before Group A 15 39.533 4.7489 1.2262Treatment Group B 15 38.400 3.6410 0.9401Lymphocytes After Group A 15 37.600 4.2561 1.0989Treatment Group B 15 35.867 4.1208 1.0640Lymphocytes After Group A 15 37.200 3.4682 0.8955Follow-up Group B 15 35.800 3.1893 0.8235In the parameter, Lymphocytes before treatment in group A, Mean was 39.533with S.D.4.7489 is reduced to 37.600with SD 4.2561after treatment and after follow-up is reducedto 37.200with S.D. 3.4682. Similarly in group B, Mean was 38.400with S.D. 3.6410isreduced to 35.867with SD 4.1208after treatment and after follow-up is increasedto35.800 with S.D. 3.1893Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 0.734 with 26.232degrees of freedom of parameter Lymphocytes before treatment. The corresponding twotailed value is 0.470 higher than 0.05, which is not significant. The t-test resultsLymphocytes after treatment t-statistic t is 1.133. The corresponding two tailed value is0.267 which is higher than 0.05, which is not significant. Similarly, the T-test resultsafter follow-up is 1.151, the corresponding two tailed value is 0.260which is more than0.05, which is not significant. Which means that the average effects two groups are notsignificant before treatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment after Treatment is 0.690, which issignificant at 0.004., before and after treatment is 0.543which is significant at 0.036 .and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 181
  • 203. between after treatment and after follow-up is 0.327, which is significant at 0.234. Whichmeans there is linear effect between before and after the treatment in LymphocytesIn Group-B, the correlation between Before Treatment after Treatment is 0.908, which issignificant at 0.000., before and after treatment is 0.443which is significant at 0.098andbetween after treatment and after follow-up is 0.506which is significant at 0.055. Thismeans there is linear effect before and after the treatment in LymphocytesPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant after treatment and after follow-up and before treatment and after follow-upas P>0.05. And shows significant in before treatment and after treatment as P<0.05.In group- B, results shows not significant after treatment and after follow-up, andshows more significant before treatment and after treatment as P>0.05. In the parameter Lymphocytes group B is more highly significant thangroup A after treatment and after follow-up (By comparing t-values)..Graph No 41showing mean effect of Lymphocyte Count Mean effect of Lymphocytes 40 39.533 39 38.4 38 37.6 37.2 37 Mean 35.867 35.8 BT 36 35 AT 34 AF 33 Group A Group B Group Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 182
  • 204. Effect of EsnophilsTable no 93 Group Statistics of Esnophils Std. Std. Error Group N Mean Deviation MeanEsnophils Before Group A 15 3.933 2.1202 0.5474Treatment Group B 15 3.067 2.1536 0.5561Esnophils After Group A 15 3.267 2.3442 0.6053Treatment Group B 15 3.800 1.6562 0.4276Esnophils After Group A 15 2.667 1.5430 0.3984Follow-up Group B 15 2.733 1.6242 0.4194In the parameter, Esnophils before treatment in group A, Mean was 3.933with S.D.2.1202is reduced to3.267with SD 2.3442after treatment and after follow-up is reduced to2.667with S.D. 1.5430. Similarly in group B, Mean was 3.067with S.D2.1536 is reducedto 3.800with SD 1.6562after treatment and after follow-up is increased to2.733with S.D.1.6242Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 1.111with 27.993degrees of freedom of parameter Esnophils before treatment. The corresponding twotailed value is 0.276 higher than 0.05, which is not significant. The t-test resultsEsnophils after treatment t-statistic t is -0.720. The corresponding two tailed value is0.478which is higher than 0.05, which is not significant. Similarly, the T-test results afterfollow-up is -0.115, the corresponding two tailed value is 0.909 which is more than 0.05,which is not significant. Which means that the average effects two groups are notsignificant before treatment, after treatment and after follow-up. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 183
  • 205. Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.392, which issignificant at 0.149., before and after treatment is 0.481which is significant at 0.070.andbetween after treatment and after follow-up is 0.298, which is significant at 0.280. whichmeans there is linear effect between before and after the treatment in EsnophilsIn Group-B, the correlation between Before Treatment After Treatment is 0.905, whichis significant at 0.000., before and after treatment is 0.669which is significant at 0.006andbetween after treatment and after follow-up is 0.557which is significant at 0.031. Thismeans there is linear effect before and after the treatment in Esnophils.Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant after treatment and after follow-up as P>0.05. And shows significant inbefore treatment and after follow-up as P<0.05.In group- B, results shows not significant before treatment and after follow-up as P>0.05.And shows significant in before treatment and after treatment and after treatment andafter follow-up as P<0.05. In the parameter Esnophils group B is more highly significant than groupA after treatment and group A is highly significant than group B after follow-up (Bycomparing t-values).Graph No 42 showing mean effect of Esnophil Count Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 184
  • 206. Mean effect of Esnophils 4.5 3.933 3.8 4 3.5 3.267 3.067 3 2.667 2.733 Mean 2.5 2 BT 1.5 AT 1 0.5 AF 0 Group A Group B GroupEffect of ESRTable no 94 Group Statistics of ESR Std. Group N Mean Deviation Std. Error MeanESR Before Treatment Group A 15 12.400 4.2393 1.0946 Group B 15 11.267 3.6345 0.9384ESR After Treatment Group A 15 12.933 2.3442 0.6053 Group B 15 11.400 2.3845 0.6157ESR After Follow-up Group A 15 12.800 5.9185 1.5281 Group B 15 11.400 2.5857 0.6676In the parameter, ESR before treatment in group A, Mean was 12.400with S.D. 4.2393isreduced to12.933with SD 2.3442after treatment and after follow-up is reduced to12.800with S.D. 5.9185. Similarly in group B, Mean was 11.267with S.D 3.6345isreduced to 11.400with SD 2.3845after treatment and after follow-up is increasedto11.400 with S.D. 2.5857. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 185
  • 207. Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of 0.786 with 27.362degrees of freedom of parameter ESR before treatment. The corresponding two tailedvalue is 0.439 higher than 0.05, which is not significant. The t-test results ESR aftertreatment t-statistic t is 1.776. The corresponding two tailed value is 0.087which is higherthan 0.05, which is not significant. Similarly, the T-test results after follow-up is 0.840,the corresponding two tailed value is 0.412 which is more than 0.05, which is notsignificant. This means that the average effects two groups are not significant beforetreatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment after Treatment is 0.736, which issignificant at 0.002., before and after treatment is 0.282which is significant at 0.308.andbetween after treatment and after follow-up is 0.083, which is significant at 0.768. whichmeans there is linear effect between before and after the treatment in ESRIn Group-B, the correlation between Before Treatment after Treatment is 0.902, which issignificant at 0.000, before and after treatment is 0.656which is significant at 0.008andbetween after treatment and after follow-up is 0.596which is significant at 0.019. Thismeans there is linear effect before and after the treatment in ESRPaired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before treatment - after treatment, after treatment-after follow-up and beforetreatment –after follow-up as P>0.05. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 186
  • 208. In group- B, results shows not significant before treatment - after treatment, aftertreatment-after follow-up and before treatment –after follow-up as P>0.05. In the parameter ESR both groups shows not significant (By comparing t-values).Graph No 43 showing mean effect of ESR Mean effect of ESR 13.5 12.933 12.8 13 12.4 12.5 12 Mean 11.267 11.4 11.4 BT 11.5 11 AT 10.5 AF 10 Group A Group B GroupEffect of Total RBCTable No 95 Group Statistics of Total RBC Std. Std. Error Group N Mean Deviation MeanTotal RBC Before Group A 15 4.847 0.5693 0.1470Treatment Group B 15 4.881 0.3878 0.1001Total RBC After Group A 15 4.940 0.6069 0.1567Treatment Group B 15 4.987 0.3357 0.0867Total RBC After Group A 15 5.307 0.5796 0.1497Follow-up Group B 15 5.239 0.4396 0.1135 Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 187
  • 209. In the parameter, Total RBC before treatment in group A, Mean was 4.847with S.D.0.5693 is reduced to4.940with SD 0.6069after treatment and after follow-up is reduced to5.307with S.D. 0.5796. Similarly in group B, Mean was 4.881with S.D 0.3878is reducedto 4.987with SD 0.3357after treatment and after follow-up is increased to5.239with S.D.0.4396Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of -0.195 with 24.69degrees of freedom of parameter Total RBC before treatment. The corresponding twotailed value is 0.847 higher than 0.05, which is not significant. The t-test results TotalRBC after treatment t-statistic t is -0.261, the corresponding two tailed value is 0.797which is higher than 0.05, which is not significant. Similarly, the T-test results afterfollow-up is 0.366 the corresponding two tailed value is 0.718 which is more than 0.05,which is not significant. This means that the average effects two groups are notsignificant before treatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment After Treatment is 0.749which issignificant at 0.001., before and after treatment is 0.829which is significant at 0.000.andbetween after treatment and after follow-up is 0.450, which is significant at 0.093. Thismeans there is linear effect between before and after the treatment in Total RBC.In Group-B, the correlation between Before Treatment After Treatment is 0.963, which issignificant at 0.000., before and after treatment is 0.774which is significant at 0.001andbetween after treatment and after follow-up is 0.732which is significant at 0.002. Thismeans there is linear effect before and after the treatment in Total RBC. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 188
  • 210. Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows notsignificant before treatment - after treatment as P>0.05. And shows highly significant inafter treatment - after follow-up and before treatment -after follow-up as P<0.05.In group- B, results shows significant before treatment -after treatment , after treatment-after follow-up and before treatment - after follow-up as P<0.05. In the parameter Total RBC group B is more highly significant than groupA after treatment and after follow-up (By comparing t-values).Graph No 44 showing mean effect of Total RBC Mean effect of Total RBC 5.4 5.307 5.3 5.239 5.2 5.1 4.987 Mean 5 4.94 BT 4.847 4.881 4.9 AT 4.8 4.7 AF 4.6 Group A Group B GroupEffect of PCV %Table no 96 Group Statistics of PCV % Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 189
  • 211. Std. Std. Error Group N Mean Deviation MeanPCV (%) Before Group A 15 31.840 4.3962 1.1351Treatment Group B 15 34.133 4.6884 1.2105PCV (%) After Group A 15 32.473 4.1639 1.0751Treatment Group B 15 34.973 4.4019 1.1366PCV (%) After Follow- Group A 15 33.353 4.4884 1.1589up Group B 15 35.627 4.4252 1.1426In the parameter, PCV before treatment in group A, Mean was 31.840with S.D. 4.3962isreduced to32.473with SD 4.1639after treatment and after follow-up is reduced to33.353with S.D. 4.4884similarly in group B, Mean was 34.133with S.D 4.6884is reducedto 34.973with SD4.4019after treatment and after follow-up is increased to 35.627 withS.D. 4.4252Independent Samples TestThe t-test result (with equal variances not assumed) shows t-statistic of -1.382with 28degrees of freedom of parameter PCV (%) before treatment. The corresponding twotailed value is 0.178higher than 0.05, which is not significant. The t-test results PCV(%) after treatment t-statistic t is -1.598The corresponding two tailed value is 0.121whichis higher than 0.05, which is not significant. Similarly, the T-test results after follow-upis -1.397the corresponding two tailed value is 0.173 which is more than 0.05, which isnot significant. This means that the average effects two groups are not significant beforetreatment, after treatment and after follow-up.Paired Samples CorrelationsIn Group-A, the correlation between Before Treatment after Treatment is 0.994which issignificant at 0.000., before and after treatment is0.995which is significant at 0.000.and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 190
  • 212. between after treatment and after follow-up is 0.988, which is significant at 0.000. Thismeans there is linear effect between before and after the treatment in PCV (%)In Group-B, the correlation between Before Treatment After Treatment is 0.993, which issignificant at 0.000., before and after treatment is 0.987which is significant at 0.000andbetween after treatment and after follow-up is 0.981which is significant at 0.000. Thismeans there is linear effect before and after the treatment in PCV (%)Paired Samples TestFurther , the analysis is done by using paired t-test, In group- A, results shows significantbefore treatment - after treatment , after treatment –after follow-up and before treatment –after follow-up as P<0.05. In group- B, results shows significant before treatment - aftertreatment , after treatment –after follow-up and before treatment –after follow-up asP<0.05. In the parameter PCV (%) group B is more highly significant than groupA after treatment and after follow-up group A more highly significant than group B (Bycomparing t-values).Graph No 45 showing mean effect of PCV (%) Mean effect of PCV 35.627 36 34.973 35 34.133 34 33.353 32.473 Mean 33 31.84 BT 32 31 AT 30 AF 29 Group A Group B Group Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 191
  • 213. STATISTICAL CONCLUSION In subjective parameter except Panduta all other parameters are not significant in before treatment, after treatment and after follow up. It means the mean effects of two groups are not same in Panduta. Similarly in objective parameter all parameters are not significant. It means the mean effects of all the objective parameters are same in both the groups. While comparing both groups group B is highly significant after treatment and group A highly significant after follow up. Further to analysis whether the treatment is differ significantly in both the groups paired t’ test is used. In the parameter Panduta group A is more highly significant than group B after treatment and after follow-up. (By comparing t-values). In parameter Agnimandhya group B is more highly significant than group A after treatment and group A is highly significant than group B after follow-up. (By comparing t-values). In parameter Arohanayasa Group B is more highly significant after treatment and group A is more highly significant after follow-up (By comparing t-values). In the parameter Brahma group A is more highly significant than group B after treatment and after follow-up (By comparing t-values). In the parameter Dourbalya group B is more highly significant than group A after treatment and after follow-up (By comparing t-values). Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 192
  • 214.  In the parameter Hb% Group B is more highly significant than group A after treatment and group A is better than group B after follow-up (By comparing t- values). In the parameter Total Count group B is more highly significant than group A in after treatment and after follow-up (By comparing t-values). In the parameter Platelets group B is more highly significant than group A in after treatment and after follow-up (By comparing t-values). In the parameter Lymphocytes group B is more highly significant than group A after treatment and after follow-up (By comparing t-values). In the parameter Esnophils group B is more highly significant than group A after treatment and group A is highly significant than group B after follow-up (By comparing t-values). In the parameter ESR both groups are not significant (By comparing t-values).. In the parameter Total RBC group B is more highly significant than group A after treatment and after follow-up (By comparing t-values). In the parameter PCV (%) group B is more highly significant than group A after treatment and group A more highly significant than group B after follow-up (By comparing t-values). Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 193
  • 215. DISCUSSION Discussion is the most important part of any research where the observationsare discussed and given reasons by the researcher. Here researcher conveys thepractical experience with special reference to textual explanations. The significantresults and insignificant results will be discussed in the same section with reasons.Hence it becomes important to discuss the clinical study in detail.CONCEPTUAL STUDYDeepana-pachana: Preceding to administration of Snehapana, the body should have Nirama statewhich is attained by Pachana & Agni Vriddhi achieved by Deepana karma. Thereason behind it is that the qualities of Snehana dravyas need a plat form for its action.It is clearly mentioned in Astanga Sangraha Sutrasthana 25th chapter as beforeSnehapana Agni should be at its peak and there must be Koshta laghuta(Niramavastha).Thus jeeraka choorna used serve the purpose of both nirameekaranaand uttejana of Agni. These drugs which are digestives & carminatives stimulateenzymatic secretions, Hcl secretions, pancreatic & bile secretions are enhanced; thereby proper assimilation of Snehana can occur. In this present study Deepana Pachanawith Jeeraka choorna given to all the 30 patients for 3-5days or nirama lakshanas areseen.Mode of action of Deepana Pachana with Jeeraka Choorna: Jeeraka is the only ingredient of jeeraka choorna. Jeeraka has katu rasa, ushnaveerya, laghu and teekshna gunas which does amapachana and aging deepana.It ishaving Yakrit uttejaka along with Pachana property. In the Samprapti of PandurogaEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 194
  • 216. vitiation of both Jatharagni along with Dhatavagni can be rectified with this jeerakachoorna as it is indicated in conditions like Agnimandhya and Aruchi. The process ofDeepana is stimulation of agni, where as Pachana is related with digestive andmetabolic properties of Agni. Pachana drugs does pakwata of doshas while Deepanadrugs cause separation of slishtha doshas. A Deepana drug enhances the Agni whichis required for proper Snehana. Sneha Dravya is guru in property so it requires goodstate of Agni to digest and to absorb. Modern therapy says that, pancreatic and bilejuice plays important role in digestion and absorption of fat. Deepana drugs are maybe able to secrete those enzymes which are required for digestion and absorption ofSneha, which perform Snehana process.Probable mode of action of Snehapana with Ghrita: Ghrita is best Snehadravya among chatusnehas as explained by AcharyaCharaka. Ghrita is used mainly for abhyantara Snehapana. It is safe even in higherdoses and Suitable for all age group persons. It can be used in all seasons and easilyavailable. Ghrita is having the properties like Vrishya, Chakshushya, Medha,Lavanya, Kanti, Oja, Tejavriddhikara, papahara, Rakshoghna, Vayasthapaka, Balya,Pavitra, Aayushya, Sumangalya, Rasayana, Sugandha, Rochana, Smriti vardhaka,Rasa, Shukra vardhaka. Ghrita alleviates pitta and vata but, at the same time does’t aggravates kapha.From therapeutic point of view Ghrita is having the quality “Samskarasyaanuvartanam” ie., when Ghrita mixed with other dugs it imbibes the property of thatdrugs without losing its properties. Proper acquaintance about the mode of action is necessary to reveal thescientific basis behind the action of particular therapy. Here, an attempt has beenEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 195
  • 217. made to presume the action of Snehapana, Sneha acts as a solvent and it increasesApyamsha of the body which ultimately leads to Klinnata or Utkleshavastha.Action as a Solvent Ghee acts as good solvent for many metabolic waste products & it enters thecells easily because cell wall is made up of phospholipids. Compared to other non-oily substances, ghee etc. fat materials stays in the body for a stipulated periodwithout causing any harm & also possesses better permeability property. Accordingto Susruta, the disease occurs due to dislodgement of vitiated Doshas in the channelsduring their circulation in the body (Su.Su.24/1 0). Sneha administered internallyreaches to Srotamsi and acts as a solvent to remove the obstruction by dissolvingDoshas in it, resulting in the removal of Srotorodha, which is one of the importantsteps in the Samprapti Vighatana.Increase in the Apyamsha of the body: This specifies the Vriddhya, Vishyandana and Kledakaraka properties ofSneha. Sneha has the pedominence of Ap Mahabhuta, which was also corroborated bythe specific qualities ascribed to it by various Acharyas like Charaka and Vagbhaţa.(Cha.Su.22/15, AH.Su.1/11) Then the fat material comes out of the cell to extra-cellular fluid by osmosis process. So due to the aqueous properties of Sneha andliquified Malas brought from the tissues, the levels of fatty acids etc. increases in theblood resulting in the high plasma volume. To keep up the equilibrium of the normalplasma level, the extra amount of liquid from it, reaches to the Koshtha for excretion.This is called as Anu Pravana Bhava.Draksha Ghrita in Panduroga: In Charaka Chikitsa sthana for the treatment of Panduroga Snehapana withDraksha Ghrita is directly indicated. Snehapana plays an important role in the form ofEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 196
  • 218. Poorva karma in Shodhana procedure. Here Panduroga is a Pitta and Rakta dhatupradoshaja vikara predominantly pitta dosha involvement. Draksha has the followingqualities like Snehopaga and Virechanopaga according to Charaka. Draksha has theproperties like Madhura rasa, Madhura vipaka and Sheeta veerya does both the raktaand pitta shamana. This Draksha is processed with Ghrita; which is best among thepitta shamaka. Draksha has the property of Rakta prasadana; so that shuddha rakta isformed properly which is very essential in Panduroga. Because of it snigdha andsnehopaga property it helps in achieving the samyak snigdha lakshana quickly.Snehapana in Arohana and Sadharana KramaSnehapana is practiced since from ancient times as a Poorva karma procedure forShodhana Chikitsa. But the practices have been changed in some or other way in theflow of time period. Also in different regions of India, the procedure varies in thecontext of dose, duration and regimen. The cause for this is the dose & duration isindividual Specific. Mainly Agni, Koshtha, Prakriti, Dosha Sthiti, along with Bala,Satmya, Satva, Vaya, etc. are the points of variables which put the physician introuble while deciding the dose & duration for achieving adequate Snehana. In the Chikitsa sutra of Panduroga, Shodhana Chikitsa is indicated. So for thepurpose of Shodhana, Snehapana as poorva karma is necessary. In this study twotypes of Snehapana ie Arohana Krama and Sadharana Krama vidhi is selected to findout which method is more effective for bringing down the subjective and objectiveparameters in Panduroga.Criteria for making two groups For better understanding the effect of Snehapana on panduroga, thesubject made into two groups as followsEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 197
  • 219. Arohana Krama Snehapana (Group A)In this study all the 15 patients were given with Arohana krama Snehapana . The dosewas increased gradually from a fixed dose of 30 ml, in early morning before patientsfeels hunger between the time of 6-8 am. It was given in increasing order at a dose of30 ml every day up to samyak snigdha lakshanas or 7 days. All the patients werestrictly given instruction not to take food until they feel hungry and were advised totake lukewarm water intermittently. In classics like Vangasena and Kalyanakarakamentioned about Arohana krama Snehapana. “kramat vardhayet “ ie the dose shouldbe increased every day.Sadharana Krama Snehapana (Group B) In this study all the 15 patients were given with Sadharana Krama Snehapana.A fixed dose of 40 ml Ghrita was given to the patients in early morning beforepatients feel hunger between the time of 6-8 am, until samyak snigda lakshanas areseen or up to 7 days. All the patients were strictly given instruction not to take fooduntil they feel hungry and were advised to take lukewarm water intermittently. InSadharana Krama, Snehapana was administered for seven days. It was framed byconsidering the opinion of Acharya Charaka that, Snehapana administered more thanseven days it will become satmya to the person. The dose fixation was made under theopinion of Susruta that the Sneha gets digested within 6 hours as the minimum dose. Hence two groups were considered to study the effect of Snehapana withDraksha Ghrita in Arohana Krama and Sadharana Krama in Panduroga.Panduroga and Anaemia Panduroga is a disease characterized by the colour that it imparts onthe affected individual. It is a pitta pradana vyadhi and is considered under theEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 198
  • 220. heading of santharpanajanya vyadhi by Charaka. Along with the specific colour thatthe disease imparts on the various body parts of the patient, the disease is also havingsystemic features like alpa raktha, alpa medas, nissaratha and shithilendriyathwa. Inthe modern disease review, it is understood that various anemias have similarpresentation to that of Pandu roga with the pallor that it causes to different body partsand constitutional symptoms like headache, palpitations, dyspnea, and fatigue. RatherPanduroga can be considered as a spectrum of diseases in which the various types ofanemias can be considered.Difference in Dosha involvement in Panduroga:In the conceptual study we have seen that Pandu is a pitha pradhana vyadhi . Whilegoing through the nidanas of Pandu roga it can be seen that most of the nidanas arepitha prakopaka nidanas especially the factors increase the ushnatwa guna of pithadosha. The vitiated pitha pradhana doshas then takes hridaya as ashraya and getsspread throughout the body with the help of vyana vayu. Eventhough Pandu is a pithapradhana vyadhi, individual dosha predominance occur in the disease due to thepeculiarity of the specific nidanas. Preponderance of vatha or pitha or kapha dosha atone or other stage of the pathogenesis leads to manifestations of the specific doshapredominant Pandu.Difference in Types of Panduroga:Acharya Charaka, Vagbhata, Bavaprakashaa and Yogaratnakara explained its type asvataja, pittaja, kaphaja, sannipathja and mrudbakhanajanya Pandurogas, where asSusruta not explained mrudbakhanajanya Panduroga.Difference in samprapti of Panduroga:In Pandu roga mainly affected dhathus are rasa dhathu and raktha dhathu followed bythe medo dhathu. If we go through the modern pathology of anemia similar events canEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 199
  • 221. be perceived. Anemia generally signifies decreased amount of hemoglobin in theblood. We know that the primary function of hemoglobin is oxygen delivery to thebody cells which in turn is required for the metabolic processes. This can beconsidered as one of the factor that comes under preenana function. Impaired oxygendelivery to the cells leads to their nutrition deprivation finally leading to thesymptoms like fatigue. Reduced hemoglobin in the blood leads to pallor of variousbody parts. The increased oxygen demand of the cells leads to increased heart ratewhich may be the cause for palpitation which again is told as hridayaspandana in thepoorva roopa of Pandu roga. Further progression of the process leads to cardiacinsufficiency and impaired functioning of other vital organs. Hridaya being the moolaof rasa vaha srothas will be the prime organ affected as told in the samprapthi ofPandu by charaka. The ideology of a Pandu roga culminating in kamala can be verywell established by viewing the pathology of hemolytic anemias. Here excessivehemolysis leads to the higher level of billirubin (which is one of the end product oflysis of hemoglobin) resulting in yellowish discoloration of body parts. All thesefactors guide us to the conclusion that anemia can be considered under the spectrumof Pandu roga.Rasa and Raktha dhathu: In the sequence of dhathu parinama, it is told that theranjaka pitha imparts red colour to the rasa dhathu leading to the formation of rakthadhathu. In the samprapthi of Pandu roga the vitiated pitha dosha causes shoshana ofthe rasa dhathu as enumerated by Chakrapani. This shoshana leads to impairedformation of raktha dhathu and also generally affects the normal functioning of therasa dhathu i.e. preenana. This impaired function of rasa dhathu leads to utharotharadhathu shaithilya finally leading to Oja kshaya.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 200
  • 222. Medo dhathu: Panduroga is also said to be having the features of alpa medas.Probably this can be used to explain the pathogenesis of Aplastic anemia. In SusruthaSamhitha Shareera sthana, while explaining about majja dhathu, he has given that themajja present in the anu asthis are to be considered as saraktha meda. Also Charakahas told while explaining the formation of dhathus, that asthi is filled with medas toform majja dhathu. The impaired functioning of medo dhatu either can be consideredas a result of dhathu shaithilya which is a part of general pathogenesis of Pandu rogaor can be considered as a factor leading to manifestation of Pandu rogaANAEMIA 54, 55, 56, 57 Anaemia can be defined as a haemoglobin concentration in bloodbelow the normal range appropriate for the age and sex of the individuals. In adults,the lower extreme of normal haemoglobin is taken as 14.0g/dl for males and 12.0g/dlfor females. Although haemoglobin value is employed as the major parameter fordetermining whether Anaemia is present or not, Hemoglobin percentage (Hb%), thered blood cell count (TRBC) and packed cell volume (PCV) provide alternate meansof assessing Anaemia.Patho-physiology of Anaemia  Increased release of oxygen from haemoglobin.  Increased blood flow to the tissues.  Maintenance of the blood volume.  Redistribution of blood flow to maintain the cerebral blood supply. Tissues with high oxygen requirement such as the Heart, CVS, and the skeletalmuscles during exercise, bear the brunt of clinical effects of Anaemia.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 201
  • 223. Clinical features of Anaemia The haemoglobin level at which symptoms and signs of Anaemia developdepends upon following factors 01. The spread of onset of Anaemia – Rapidly progressive Anaemia causes more symptoms than Anaemia of slow onset, as there is less time for physiological adaptation. 02. The severity of Anaemia – Mild Anaemia produces no symptoms or signs but a rapidly developing severe Anaemia may produce significant clinical features. 03. The age of the patient – The young patients due to good cardiovascular compensation tolerate Anaemia quite well as compared to the elderly.Investigations After obtaining the full medical history pertaining to different general andspecific signs and symptoms in order to confirm the presence of anaemia its type andits cause the following plan of investigations is generally followed. A. Haemoglobin estimation – The first and foremost investigation in any suspected case of Anaemia is to carry out haemoglobin estimation. B. Peripheral blood film estimation – The haemoglobin estimation in invariably followed by examination of peripheral blood film for morphologic features after staining it with Romanowsky dyes (Leishman’s staining). C. Red cell indices – An alternative method to diagnose and detect the severity of anaemia is by measuring the red cell indicesEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 202
  • 224. D. Leucocytes and platelet count – Measuring of Leucocytes and platelet count helps to distinguish pure anaemia form pancytopenia in which red cells, granulocytes and platelet counts are often elevated. E. Reticulocyte count – Reticulocyte count is done in each case of anaemia to assess the marrow erythropoietic activity F. Erythrocyte sedimentation Rate – The ESR is non-specific test used as a screening test for anaemia. G. Bone marrow examination – Bone marrow aspiration is done in cases where the cause for anaemia is not obvious. H. Total RBC Count: It is the number of RBC in one cubic millimeter of blood. Normal values: In men - 4.5-6.5 millions/mm3. In women - 3.8-5.8 millions/mm3. I. Packed Cell Volume or Haematocrit (PCV): Normal value: 45ml/100ml (45%).Clinical study: A total 30 patients suffering from Panduroga fulfilling the inclusion criteriawere studied. The observations and the results as well as statistical analysis of theseare elaborated below. Number of patients registered in study - 38 Number of patients completed the study – 30Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 203
  • 225. Number of patients discontinued the study – 8 Discussion on clinical findings: This is an overview of the patients details including age, sex, religion, occupation socio economic status, personal history and all the details observed during the examination of the patient. Discussion on observations (Demographic Data): AGE: In this study 10 patients in Group A and 7 patients in group B belongs to agegroup of 20-25 who were showing problem in dominance, this shows the people duringthese age groups are more anaemic. Presence of more number of patients in both ofthese groups is due to the fact that the Panduroga manifests in the early life itself andthe incidence may be because of more iron loss during menstruation, increased demandof iron during the age group and increased stress and strain, thereby irregularity in diet. SEX: The sex wise distribution of patients reveals that Panduroga was observed morein females12 (80%) in group A and 10 (66.7%) in group B than male 3 (20%) in groupA 5(33.3%) in group B .Higher incidence in female is found because of regularmenstrual blood loss; blood loss during delivery, pregnancy, and lactation requiresmore Iron if not compensated results in Anaemia. It may also be due to imbalance,irregular diet intake, mental and physical stress. RELIGION: In this series most of the patients were Hindus 15 (100%) in group A and 12(80%) in group B and a lesser portion belonged to Muslim community3 (20%). From Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 204
  • 226. this it can be inferred that most of the Hindus are vegetarians and this incidence may bedue to imbalance diet and Prolonged Malnutrition because of lack of awarenessregarding the importance of diet. This shows geographical Predominance of Hindus inand around GADAG area.OCCUPATION: In the present study maximum number of patients were active groups 12(80%) in group A and 11 (73.3%) in group B. were Labours. In Group A 3(20%) and4 (26.7%) in group B. This may be due to excessive mental stress, irrelevant,inadequate and improper diet. In most of these patients, it was observed thatDiwaswapana was common, leading to Agnimandhya, which can causeDhatwagnimandya, which is a cause of improper digestion results in Panduroga.ECONOMICAL STATUS: In group A (Arohana Krama Snehapana), Among 15 patients, 3 (20%)patients were poor class, 5(33.3%) were middle class and 7(46.7%) belongs to higherclass. In Group B (Sadharana Krama Snehapana), Among 15 patients, 4(26.7%)patients were poor class, 9(60%) were middle class and 2(13.3%) belongs to higherclass group. The study shows the larger numbers of patients belongs to middle class. The patientsform middle class cannot afford expensive nutritious food. As well as they are notcaring for proper diet yet needed time and always worrying for the familyresponsibilities, which leads to mental tensions.MODE OF ONSET OF DISEASEIn Panduroga its mode of onset is also important for the Chikitsa and sadya sadyathaIn this study both of the groups 30(100%) patients were got gradual onset of diseasewas observed.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 205
  • 227. DIET In group A, 11 (73.3%) patients were vegetarians and 4(26.7%) are mixeddiet groups. In Group B 9 (60%) patients were vegetarians and 6(40%) are mixed dietgroups. So in this study the maximum number of patients belongs to vegetarian diet According to physiological needs, the food which has consumed should havea active principles that triggers the production of haem yet times, when it is needed.As non-vegetarians can consume the liver and bone marrow of animals (Goat), tosupplement the loss of production of haem, where as it is lacked in vegetarian’s diet.That may be the cause, observed during my study that of vegetarians is more prone toPanduroga.NIDANAAharaja NidanaDominent Rasa In group A 10 (66.7%) patients were taking Madura rasa, 8(53.3%) weretaking Katu rasa, 12(80%) were taking Amla rasa, 11(73.33%) were taking Lavanarasa Ahara . In Group B 6(40%) patients were taking Madura rasa, 11(73.33%) weretaking Katu rasa,6(40%) were taking Amla rasa, 3(20%) were taking lavana rasaAhara .It is observed that in this study most of the people takes Katu,Amla, lavanaand Madura rasa which vitiates pitta and leads to Panduroga.Vihara NidanaDivaswapna (56.67%), Ativyayama (53.33%) were found maximum. Nidra viparyayacauses Agnimandya and Ativyayama causing incomplete digestion and production ofAma, which vitiates rasa and rakta results in Panduroga.Manasika VikaraIn group A 10(66.67%) patients having Chinta, 6(40%) patients having Shoka,4(26.67%) patients having Bhaya and 6(40%) patients having Kroda. In Group BEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 206
  • 228. 6(40%) patients having Chinta, 7(46.67%) patients having Shoka, 10(66.67%)patients having Bhaya and 7(46.67%) patients having Kroda. In the present study chinta and Bhaya were found in 53.33% and 53.33% ofcases respectively. This incidence may be due to the fact that most of the patientswere active groups in this study. The mental stress may cause inadequateconsumption of the diet and improper digestion, thereby resulting in Panduroga.NIDRA In group A 10(66.67%) patients having sound sleep and 5(33.33%) havingdisturbed sleep. In Group B 15 patients, 9(60%) patients having sound sleep,5(33.33%) having disturbed sleep and 1(6.67%) patient having day sleep, Patients reported to have sound sleep 10(66.67%) in Group A and Group B9(60%) Whereas disturbed sleep in group A 5(33.33%) and group B is 5(33.33%).Nidra viparyaya causes Agnimandya causing incomplete digestion and production ofAma, which vitiates rasa and rakta results in Panduroga.MENSTRUAL HISTORY In group Among 12 patients, 12(80%) patients having regular menstrualhistory. In Group B Among 10 patients, 7(46.67%) having regular menstrual history,3(20%) having Irregular menstrual history,1(6.67%) patients havingMenorrhagia,3(20%) patients having Metrorrhagia and1(6.67%) patients havingLeucorrhagia. Among the female patients registered in the study, in group A no onehaving irregular menstruation. In group B 20% had irregular menstruation. Thedifference was due to the presence of patients of low age group in group B.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 207
  • 229. KOSHTA In group A 2(13.32%) patients having Krura Koshta 11(73.26%) havingMadhyama Koshta and 2(13.32%) having Mrudhu Koshta. In Group B 3(19.98%)patients having Krura Koshta 11(73.26%) having Madhyama Koshta and 1(6.66%)having Mrudhu Koshta. In both groups maximum number of patients belongs to Madhyama Kostha11(73.26%) in each group A and B. It may be due to predominance of kapha dosha,which place an important role in proper digestion and assimilation of the nutrients. Sothat the symptoms like Panduta, Dourbalya, Agnimandya, Bhrama occurs compare toother category (Koshta ) of the patients.PRAKRITI In group A 10(66.67%) patients having Vatapittaja Prakriti, 3(20%) havingKaphavataja Prakriti and 2(13.32%) having Kaphapittaja Prakriti. In Group B 9(60%)patients having Vatapittaja Prakriti, 3(20%) having Kaphavataja Prakriti and 3(20%)having Kaphapittaja Prakriti. Amoung all the groups maximum number of patients belongs tovatapittaja prakriti In group A 10(66.67%) and Group B 9(60%) patients. It isobserved that may be due persons have consumed vata and pittaprakopaka Ahara andvihara results into vata and pitta virddhi and as the person having these kinds ofprakriti are prone to the incidence of the disease Panduroga.ABHYAVARANA SHAKTI AND JARANA SHAKTI In group A 1(6.67%) patient belongs to Pravara Abhyavarana shakti and 14(93.33%) patients belongs to Madyama Abhyavarana shakti. In Group B 14Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 208
  • 230. (93.33%) patients belongs to Madyama Abhyavarana shakti and 1(6.67%) patientbelongs to Avara Abhyavarana shakti. In group A 14(93.33%) patient belongs to Madyama Jarana shakti and 1(6.67%) patient belongs to Avara Jarana shakti . In Group B 15(100%) patientbelongs to Madyama Jarana shakti . It shows maximum number of patients belongs to MadhyamaAbhyavarana shakti and Madhyama jarana shakti. It may be due to predominance ofkapha dosha, which place an important role in proper digestion and assimilation of thenutrients which leads to Panduroga.POORVA ROOPAIn group A 7(46.66%) patients having Hrit spandana,4(26.66%) Twak rookshata ,14(93.33%) Aruchi ,1(6.67%) Sweda abhava , 11(73.33%)Agni mandhya,1(6.67%)Shteevana , 1(6.67%) Gatrasada 3(20%)avipaka and 2(13.33%)peeta mootrata .InGroup B 7(46.66%) patients having Hrit spandana,1(6.67%) Twak rookshata ,14(93.33%) Aruchi ,2(13.33%) Sweda abhava , 14(93.33%)agni mandhya ,2(13.33%)Shteevana , 1(6.67%) Gatrasada 1(6.67%)avipaka .In this study it is observed that maximum number of patients shows the poorvaroopasuch as Aruchi and Agni mandhya. It shows that classical Poorva roopa are observedin Panduroga.ANUBANDA VEDANAIn group A 3(20%) patients having sadana,15(100%)Agnimandhya, 6(40%)Trishna,2(13.33%) Toda,10(66.67%)Aalasya, 8(53.33%) Tantra, 3(20%) Twaksputana,Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 209
  • 231. 4(24.67% ) Srama, 6(40%) Gatrashoola, 4(24.67%) Alpameda, 1(6.67%) Jwara, 4(26.67%) Swasa, 3(20%) Kasa, 5(33.33%) Hataprabha, 1(6.67%) Hridrava11(73.33%) Shirashoola, In Group B 1(6.67%) having karnashweda, 14(93.33%)Agnimandhya, 8(53.33%) alasya, 4(26.67%) twaksputana, 2(13.33%) srama, 6(40%)gatrashoola,1(6.67%) alpameda, 5(33.33%) Hataprabha, 6(40%) having Shirashola.In this study it is observed that maximum number of patients shows the Anubandavedana such as Agni mandhya, Alasya, Tantra, Shirashoola . It shows that classicalAnubanda vedana are observed in Panduroga.DISCUSSION ON ROOPA Most of the patients in this study were observed with clinical symptoms whichare mentioned by the Acharyas.EFFECT THERAPY ON SUBJECTIVE PARAMETERSNote: In group A (Arohana Krama Snehapana), Among 15 patients, 15(100%)patients having Panduta,13(86.67%) Arohana Ayasa, 15(100%) Dourbalya,13(86.67%) Bhrama 15(100%) Agnimanndya. In group A Sadharana KramaSnehapana), Among 15 patients, 15(100%) patients having Panduta,14(93.33%)Arohana Ayasa, 15(100%) Dourbalya, 13(86.67%) Bhrama 15(100%) Agnimanndya.PANDUTAIn all the 30 patients Panduta was noted, which is pratyatma lakshana of Panduroga. Itmay be due to ojakshaya, raktakshaya and vitiation of pittadosha associated with otherdoshas.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 210
  • 232. The improvement calculated after taking data before treatment, after treatment . In theparameter Panduta group A is more highly significant than group B after treatmentand after follow-up. (By comparing t-values).AROHANAYASAArohanayasa was found in all the patients, it may be due to less oxygen carryingcapacity of blood to the vital organs. So heart has to pump more to provide properblood flow. The improvement calculated after taking data before treatment, aftertreatment. In parameter Arohanayasa Group B is more highly significant aftertreatment and group A is more highly significant after follow-up (By comparing t-values).DOURBALYADourbalya were found in 13 patients in group A and 13 patients in group B. Hence, itcan be inferred that these symptoms are also most prominent in this disease. This isdue to Rasa raktadi dhatu kshaya. The improvement calculated after taking databefore treatment, after treatment In the parameter Dourbalya group B is more highlysignificant than group A after treatment and after follow-up (By comparing t-values).BRAMABrama were found in all the patients. Hence, it can be inferred that this symptom ismost prominent in this disease. This may be due to pitta vriddhi which leads tokapha kshaya. The improvement calculated after taking data before treatment, aftertreatment. In the parameter Brahma group A is more highly significant than group Bafter treatment and after follow-up (By comparing t-values).Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 211
  • 233. AGNIMANNDYAAgnimandya was noticed in all the patients, which may be results out of Nidanasevana, where Pachaka pitta, Samanavata and Ranjaka pitta are mainly involved. Theimprovement calculated after taking data before treatment, after treatment . Inparameter Agnimandhya group B is more highly significant than group A aftertreatment and group A is highly significant than group B after follow-up. (Bycomparing t-values).INTER COMPARISON OF ALL SUBJECTIVE PARAMETERS IN BOTHGROUPSIn both the groups, the Subjective parameters assessed in overall ,the result isshowing that in subjective parameter except Panduta all other parameters are notsignificant in before treatment, after treatment and after follow up. It means the meaneffects of two groups are not same in Panduta.While comparing both groups group B is highly significant after treatment and groupA highly significant after follow up.EFFECT OF THERAPY ON OBJECTIVE PARAMETERSHAEMOGLOBIN PERCENTAGEThe improvement calculated after taking data before treatment, after treatment . In theparameter Hb% Group B is more highly significant than group A after treatment andgroup A is better than group B after follow-up (By comparing t-values).TOTAL COUNTThe improvement calculated after taking data before treatment, after treatment . In theparameter Total Count group B is more highly significant than group A in aftertreatment and after follow-up (By comparing t-values).Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 212
  • 234. PLATELETS COUNTThe improvement calculated after taking data before treatment, after treatment . In theparameter Platelets group B is more highly significant than group A in after treatmentand after follow-up (By comparing t-values).LYMPHOCYTE COUNTThe improvement calculated after taking data before treatment, after treatment . In theparameter Lymphocytes group B is more highly significant than group A aftertreatment and after follow-up (By comparing t-values).ESNOPHILS COUNTThe improvement calculated after taking data before treatment, after treatment . In theparameter Esnophils group B is more highly significant than group A after treatmentand group A is highly significant than group B after follow-up (By comparing t-values).ESRThe improvement calculated after taking data before treatment, after treatment . In theparameter ESR both groups are not significant (By comparing t-values)RBCThe improvement calculated after taking data before treatment, after treatment . In theparameter Total RBC group B is more highly significant than group A after treatmentand after follow-up (By comparing t-values).PACKED CELL VOLUMEThe improvement calculated after taking data before treatment, after treatment . In theparameter PCV (%) group B is more highly significant than group A after treatmentEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 213
  • 235. and group A more highly significant than group B after follow-up (By comparing t-values).INTER COMPARISON OF ALL OBJECTIVE PARAMETERS IN BOTHGROUPS In both the groups, the objective parameters assessed in overall aftertreatment and after follow up the result is showing that in objective parameter allparameters are not significant. It means the mean effects of all the objectiveparameters are same in both the groups. While comparing both groups group B ishighly significant after treatment and group A highly significant after follow up.EFFECT OF THE THERAPYEffect on Deepana and PachanaDeepana Pachana with Jeeraka choorna was given for 3-5 days or till the appearanceof Nirama lakshanas. As Pandu is santarpanajanya vyadhi where Agnimandhya andsymptoms of Ama can be appreciated. It was observed that all the patients got niramalakshanas within 3-5 days. In that 2 patients had complaint of burning sensation andirritation in the chest region, 10-15 minutes after the intake of the medicine. In suchcase dose was reduced and advised to consume with excessive warm water.OBSERVATION ON SNEHAPANADraksha Ghrita was used for Snehapana. In Arohana vidhi Starting with 30 mlincreasing 30 ml every day until gets the samyak snigda lakshanas or up to 7 days,where in Sadharana vidhi 40 ml fixed for 7 days and was given within 7-8 am in allthe patients. Sukhoshnajala was advice as Anupana, which is kaphahara, deepaka,amapachana, vatanulomaka, thus helpful in proper digestion of administered Sneha.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 214
  • 236. The Sneha imparts its qualities to all the dhatus gradually, once all the dhatusgets saturated with sneha, their qualities like snigdhata and mriduta manifests in thetwak. Snehapana removes the obstruction to the gati of the vata, Vatanulomana takesplace. Hence, individual may feel laghuta and vimalendriyata.The matra of Snehapana with Draksha Ghrita in both the groupsIn Group A Draksha Ghrita was given in the dose of 30 ml on the first day to all the15 individuals. The dose is increased 30 ml in every day. In this group minimum dosewas 120 m l and maximum dose was 630 ml.In Group B Draksha Ghrita was given in the dose of 40 ml fixed to all the 15individuals. The same dose is been continued up to 7 days. In this group the total dosewas 280 ml.SNEHAPANA KALAVADHIIn this study it shows in group A amoung 15 Patients, 8(53.33%) patients were takenSnehapana up to 4 days. 7(46.67%) were taken more than 4 days up to 6 days. Ingroup B 15(100%) patients were taken Snehapana for 7 days.It shows that in group A among 15 patients 8 patients got samyak snigda lakshanaswithin 4 days and 7 patients got samyak snigda lakshanas within 6 days. It gives anidea about their Kostha and Agni. Where in Sadharana krama Snehapana no one gotsamyak snigda lakshanas within the study period.JEERYAMANA LAXANAS In Arohana krama Snehapana Shiroruk, Bhrama, Lalasrava, Moorcha wereobserved in all the individuals the mean time of onset of all the symptoms was startedEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 215
  • 237. middle stage of the digestion of the sneha. These may be due to higher intake ofsneha. Where in Sadharana krama Snehapana symptoms like Shiroruk, and Lalasravaobserved.SNEHA JEERNA LAXANAS The individuals showed most of the Jeerna laxanas indicating the digestion ofadministered sneha. In Arohana krama Snehapana all symptoms where observed onthe first day in between 250-300 minutes and every day it was increased dependsupon the dose was increased .but in Sadharana Krama Snehapana the first day timewas in between 350-400 minutes and it was almost stable in all seven days.SAMYAK SNIGDHA LAXANASVatanulamana : It was observed in group A all 15 individuals got vatanulomanaand 8 individuals in group B. Sneha by virtue of its Snigdha, Sara propertiesnormalizes or brings balance in vitiated vata. By this Vatanulomana will occur.Agnideepti: In all the 15 persons in group A deeptagni was observed and in group Bonly 2 persons got agnideepti.This is due to increased secretion of bile fromcholesterol destruction, as bile is an essential for the digestion of Sneha.Purisha snigdha and Asamhat varchas : These were observed in 15 persons ingroup A and only Purisha snigdha were seen in 5 patients in group B These laxanasmay be due to drava, sara, snigdha and mrudu guna of Sneha. Pureesh becomes dravaand snigdha and person may passes Asamhat and snigdha varchas. This will indicatefor stopping the continuation of Snehapana which is consider as one of the primeSamyak snigdha laxana.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 216
  • 238. Twak snigdhata : It was found in 15 and 8 persons in Group A and Group Brespectively. It occurs due to Sneha taken because each and every cell of the body willbe saturated with Sneha that is all the dhatus get saturated gradually one by one andproduces mruduta in skin.Gatra laghvata : It was observed in 15(100%) and 13(86.58%) persons in Group Aand Group B. Snehapana removes obstruction in the gati of vata which makesvatanulomana. Due to this person passes asamhat varchas. Hence person may feelGatra laghavata.Snehodwega : It was observed in 13 in Group A and no one in Group B. Due to largequantity of Sneha in the body will reaches optimum level i.e., body is fully staturatedwith excess dose of sneha. Hence individual will showing dislike towards Snehapana.This is also one of the symptom of Samyak snigdha laxanas.Klama : It was found in a single person in Group A and no one in Group B, it maydue to restriction of diet regimen and due to properties of Sneha. Person may feelexhausted or klama on the last day of Snehapana. All these are different parameters to assess proper Snigdhata of the body. And in overall Snehapana procedure, It was observed that graduallyincreasing the snigdada of the body were noticed it may be due to the absorption ofexcessive Sneha in the body from starting to end day. Few patients had nauseaimmediately after Snehapana but it did not created any complications this may be dueto the unpleasant smell of Ghrita .Relief in sign & symptoms was observed after 7days. Due to Deepana and Pachana aushadi the ama got digested, it provided muchmental and physical relaxation to the patients were noticed.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 217
  • 239. Overall effect of treatment in both groupsAll the patients studied in this Snehapana showed different degrees of diminution.Patients of Panduroga who were treated, Snehapana with Draksha Ghrita shownSadharana krama snehapana is highly significant after treatment and Arohana kramaSnehapana highly significant after follow up.In subjective parameter except Panduta all other parameters are not significant inbefore treatment, after treatment and after follow up. It means the mean effects of twogroups are not same in Panduta. Similarly in objective parameter all parameters arenot significant. It means the mean effects of all the objective parameters are same inboth the groups.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 218
  • 240. CONCLUSION Panduroga is Pitta pradhana vyadhi, Pitta is responsible for the normal colour of the body but when it gets vitiated, the Rakta as it happens in Panduroga and thus loss of complexion or Panduta occurs. Panduroga is also considered as Santarpanjanya vyadhi, which broadly means Anabolism, brings about an increase in kapha which in term may cause the disease by generating Mandagni thus, any diet which may increase kapha or any disease associated with increase in kapha can cause a change in complexion or Panduroga. Though Pitta is pradhana dosha in Panduroga, Vata dosha also plays crucial role in manifestation of Panduroga, mainly Vyana vayu has a relation with Samprapti of Panduroga. Panduroga can be effectively compared with Anemia on the grounds of its similar signs and symptoms In the modern medicine, there is good treatment for anemia with considerable result but that is only for acute deficiency Anaemias. No significant therapy is there for chronic Anaemias which occurs due to metabolic defects. So Ayurveda can provide better management of this. It is obvious that Anaemia is most common among females due to menstruation, poor general health, improper and inadequate diet which leads to malnutrition leading to Anaemia.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 219
  • 241.  In conceptual study, importance for Snehapana is highlighted there is direct reference in Charaka Samhita for treating Panduroga with Draksha Ghrita.  Any patient who is having Panduroga should include symptoms of active disease and done assessment with necessary objectives like, Hb%, Total count, Differential count, ESR, RBC and PCV for identification severity of Panduroga.Observations  Maximum patients 56.67% belonged to age group of 20-25,  Maximum of 73.33%% were females.  Maximum of 76.66% were of laborer type.  Majority of the patients belonged to Hindu religion.  All the patients registered with classical symptoms of Panduroga belonged to rural area of Gadag  Maximum patients with Panduroga were having mandagni.  All the patients registered in the study had the features of involvement of Rasa and Raktha vaha srothas.  Marked features of Pandu Roga were found only in Patients with Hb % below 11 gm %.Results  After 4th day of Arohana Snehapana 100% of the patients were observed with vatanulomana, Agnideepti, Shareera Laghuta and Twak Snigdata, wherein Sadharana krama Snehapana after 7 days of treatment ,very few patients observed with vatanulomana, Shareera Laghuta and Twak Snigdata. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 220
  • 242.  Patients ended with Samyak snigdha lakshana in Arohana krama Snehapana but in Sadharana krama Snehapana nobody had been observed with samyak snigdha lakshana.  In the present study, subjective parameter except Panduta all other parameters were not significant in before treatment, after treatment and after follow up.  Similarly in objective parameter all parameters were not significant  While comparing both groups Sadharana krama Snehapana is highly significant after treatment and Arohana krama Snehapana highly significant after follow up. Limitations of the study  The Sample size was small.  The Period of Study was limited.  Longer follow up was not done.  Clinical parameters were not considered up to date like use of MCV and MCHC changes because of non availability at study centre.Suggestions for the future studies  A similar study can be conducted on large sample.  As Panduroga may be a chronic disease, follow up should be kept for longer Duration  Maximum Subjective parameters and higher investigations should be incorporated in the study.  The effect of both Arohana and Sadharana krama Snehapana with Draksha Ghrita can be studied followed by Virechana karma.  The effect of both Arohana and Sadharana krama Snehapana with Draksha Ghrita can be studied with standard shamanoushi in Panduroga. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 221
  • 243. SUMMARYThis dissertation entitled “EVALUATION OF COMPARATIVE EFFICACY OFAROHANA & SADHARANA KRAMA SNEHAPANA IN PANDUROGA”comprises ofseven chapters namely,  Introduction  Objectives  Review of Literature  Methodology  Observation and Results  Discussion  Conclusion and summaryIntroduction: This part consists of the general description of health and prelavance ofPandu and Anaemia. In this part, discussion on Pandu is covered briefly and selectionof Snehapana for this study is discussed. This part also Consists of discussion aboutlacuna in current Knowledge and Proposed or formulated hypothesis of this study isdiscussed briefly.Objectives: This part consists of brief description of types of life style and the timeperiod which causes Pandu, before putting forth the objectives and mainly highlightsthe objectives of study and Reasons to Choose Snehapana for Present StudyReview of Literature: This chapter deals with the historical aspects related to Pandu. Descriptionregarding diseases related to discolouration of body is available in Rigveda and Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 222
  • 244. Atharvaveda. Along with the identification of the disease, treatment for the same hasalso 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. Sushruta hasclassified it as of 4 types. But few other scholars acknowledge 8 types of Pandu. Themajor contribution during Sangraha kala was the addition of different Lohapreparations in the treatment of Pandu.Methodology: The materials and methods adapted for the study are described here.This chapter deals with the  Research approach  Inclusion and exclusion criteria for the patients  Method of administration of Snehapana  Criteria of assessmentObservations and Results:The observation made on demographic incidence of age, sex, habits etc are presentedin the form of Tables and Graphs. The results of the clinical study are presented withmaster charts and statistical analysis in the form of tables with brief narrations.Discussion: The conceptual part of Snehapana and its effect on Pandu are explained.Clinical data is discussed in detail. The result obtained in clinical study, as well asobservations in it are discussed. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 223
  • 245. Conclusion and Summary: The conclusion of whole clinical study is explained inthis chapter. Limitation of study and further scope for study is also discussed briefly.In summary, the whole thesis is summarized. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga 224
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  • 259. 177. Agnivesha, Charaka Samhita Sutrasthana Chapter 12 Shloka 11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.251.178. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 7-11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488.179. Sushruta, Sushruta Samhita Uttaratantra, Chapter 44 Shloka 3. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.284.180. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 12 Shloka 1. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.517.181. Agnivesha, Charaka Samhita Sutrasthana Chapter 23 Shloka 5. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.436.182. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 2. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.245. Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 2, 1st ed. Varanasi : Chaukhamba Orientalia; 1998. p.336. Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 2. 5st ed. Varanasi: Chaukhamba Orientalia; 1969. p.100.183. Sushruta, Sushruta Samhita Nidanasthana Chapter 11 Shloka 17. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.273.184. Sushruta, Sushruta Samhita Shareerasthana Chapter 2 Shloka 21. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.12.185. Agnivesha, Charaka Samhita Chikitsasthana Chapter 4 Shloka 27. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.285.186. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.71.187. Sushruta, Sushruta Samhita Nidanasthana Chapter 2 Shloka 14. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.238.188. Sushruta, Sushruta Samhita Nidanasthana Chapter 8 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.258.189. Ibid 16.190. Sushruta, Sushruta Samhita Nidanasthana Chapter 6 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.254. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xiv
  • 260. 191. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 12. 22 nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488.192. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 5. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.286.193. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 8-9. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.194. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 3. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.225. Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 3, 5st ed. Varanasi: Chaukhamba Orientalia; 1969. p.100. Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 3, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.337.195. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 13-16. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488-489.196. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 4-7. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518197. Gangadhara, Chakrapani, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6, Reprint. Varanasi: Chaukhamba Orientalia; 1991.p.2974.198. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 3. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.486.199. Sushruta, Sushruta Samhita Uttaratantra Chapter 14 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.285.200. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 7. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.201. Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 1, 5st ed. Varanasi: Chaukhamba Orientalia; 1969. p.98. Indradev Tripathi Dr, Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 1, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.336. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 1. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.220. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xv
  • 261. 202. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 17-18. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.489. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 7. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.286. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 9-10. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.203. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 19-22. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.489. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 8. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.286. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 10-11. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.204. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 23-25. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.489. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 9. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.287. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 11-12. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.205. Madatraya Maharshi, Hareetamuni, Samvadarupa Vaidya Granth, Harita Samhita Chapter 8 Shloka 10 Edited by Khemraj Shrikrishnadas; Bombay: Swakiya Venkateshwar Mudranlaya; 1984.p.148.206. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 26. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.489-490. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 10. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.287. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 12. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.207. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 16 Shloka 27-30. Yadavaji Trikamji acharya, reprinted. Varanasi: Chaukhamba Sanskrit Sansthan; 2004.p.528.208. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 13-15. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xvi
  • 262. 209. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 9-11. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.229. Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 8-10, 5st ed. Varanasi: Chaukhamba Orientalia; 1969. p.101. Indradev Tripathi Dr. Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 1- 3, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.337.210. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6,9-11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.487-488.211. Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 1-3. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.517.212. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 3. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.284.213. Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.290.214. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 31-33. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.490-491. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 12-14. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.230-231. Bhavamishra, Bhavaprakasha Madhyamakhanda Chapter 8 Shloka 14-15, 5st ed. Varanasi: Chaukhamba Orientalia; 1969. p.102. Indradev Tripathi Dr. Daya Shankar Tripathi Yogaratnakar Pandurogaadhikar, Shloka 1- 5, 1st ed. Varanasi: Chaukhamba Orientalia; 1998. p.338.215. Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 5. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.701. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 39-41. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.493.216. Dalhanacharya, Sushruta Smahita Uttartantra, Chapter 44 Shloka 14. 8th ed. Varanasi: Chaukhamba Orientalia; 2005.p.730.217. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 55. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.496. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xvii
  • 263. 218. Arundutta, Ashtanga Hridaya Chikitsasthana Chapter 16 Shloka 35. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.703. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 117. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.504.219. Ibid 34 &116.220. Y. T. Acharya, Astanga Sangraha Chikitsasthana Chapter 18 Chapter 11. 11st ed. Varanasi: Chaukhamba Orientalia; 1996.p.475. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 41. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.493.221. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s Medical Publishers; 2000.p.334-342.222. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.903.223. Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco-therapeutics Chapter 30. 16th ed. Mumbai; Popular Prakashana Publications; 1999. p.453.224. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s Medical Publishers; 2000.p.344.225. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.877-878.226. Ibid. 884-885.227. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.711.228. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.71.229. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan; 2004.p.584.230. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 9. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.70.231. Agnivesha, Charaka Samhita Chikitsasthana Chapter 15 Shloka 16. 22 nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.456. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xviii
  • 264. 232. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 10. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.89.233. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted. Varanasi : Chaukhamba Orientalia; 2000.p.194.234. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 13. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.30.235. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.87.236. Sushruta, Sushruta Samhita Sutrasthana Chapter 15 Shloka 5. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.56.237. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.711.238. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.71.239. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan; 2004.p.584.240. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.651.241. Agnivesha, Charaka Samhita Chikitsasthana Chapter 15 Shloka 16. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.456. b. Arundutta, Ashtanga Hridaya Shareerasthana Chapter 3 Shloka 8. Reprinted. Varanasi : Chaukhamba Orientalia; 2000.p.386242. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.28.243. Ibid.244. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.667. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.895.245. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 4. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.443. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xix
  • 265. 246. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.897.247. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 22. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.447.248. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 24. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.449.249. C.C.Chatterjee, Human Physiology, Vol. – I. Chapter 4. Kolkata : Ashutosh Lithographic Co.; 2004.p.123-124.250. Agnivesha, Charaka samhita, Sutrasthana, Chapter 20. Shloka20. Edited by Vaidya Jadavaji Trikamji Acharya,2008 edn. Varanasi,Choukambha subharati prakashan; . p. 115.251. Agnivesha, Charaka samhita, vimanasthana, Chapter 8. Shloka87. Edited by Vaidya Jadavaji Trikamji Acharya,2008 edn.Varanasi,Choukambha subharati prakashan; p. 274.252. Dr.P.V.Sharma edited Dravya guna Vignana, Vol-II.Chapter 5th Reprint edition 2005, Varanasi: Chaukhambha surabharati academy; Page no.367253. Agnivesha, Charaka samhita,chikitsasthana, Chapter 16. Shloka 52. Edited by Vaidya Jadavaji Trikamji Acharya,2008 edn.Varanasi,Choukambha subharati prakashan; .p. 529.254. Ashtanga Samgraha with the Sashilekha Sanskrit Commentary by Indu, Chapterb 25 edited by Dr.Shivaprasad Sharma,Chaukhamba Sanskrit Series Varanasi, edition 2006,255. Advanced Text Book on Food & Nutrition, Volume I, By M. Swaminathan, Bappco publication,Reprint 2006. Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xx
  • 266. SPECIAL CASESHEET FOR PANDUROGA Post Graduate Studies And Research Centre(Panchakarma) Shri D.G.M.Ayurvedic Medical College,Gadag “Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga”Guide : Dr.S.N.Belavadi M.D.(Ayu.)Co – Guide : Dr. Jairaj.P.Basarigidad M.D.(Ayu.) P.G.Scholar: Aneesh Joseph K01. Name : Sl.No :02. Father/Husband’s Name: O.P.D. No.:03. Age : I.P.D.No. :04. Sex : Bed No. : Hindu Muslim Christian Others05. Religion06. Occupation Active Labour Sedentary Others07. Economical Status Poor Middle class Higher class Date of Initiation Date of Completion08. Address Telephone No.:09. Result Good Responded Moderate Responded Poor Responded Not Responded10. Consent: I am fully educated with the disease and treatment; there by I got satisfiedwhole-heartedly. I accept for the medicinal trail over me.Signature of Investigator Signature of PatientEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxi
  • 267. A. Pradhana Vedana :Vaivarnya Prakruta Pandu Krishna Aruna Peeta Shukla AvadhiNakhaNetraTwakVitMootraSira Pradhana Vedana Avadhi Arohanaayasa Dourbalya Agnimandya Brama AruchiB. Anubandhi Vedana : Avadhi AvadhiKarnaskweda AlpamedaSadana JwaraAgnimandya SwasaTrishna KasaToda HataprabhaPraseka ShishiradweshiAlasya MridbhakshanaapekshaTandra SwarakshayaTwak sputana HridravaShrama ShirashoolaGatrashoola ShabdaasahishnutaPindikodvestana ShoonakshikutaC. Vedhana vrittanta : a. Mode of Onset Sudden Gradual Insidious Sub acute b. Gradually progressive Persistent Relapsing RecedingCourseEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxii
  • 268. D. Poorva Vyadhi Vrittanta :E. Chikitsa Vrittanta :Modern medicineAyurvedicSurgeryOthersF. Kula Vrittanta :MaternalPaternalG. Atura charya : a. Ahara : Vegetarian Mixed i. Diet ii. Dominent Rasa Madhura Katu Amla Tikta Lavana Kashaya Samashana Adyashana iii. Dietric habits Anashana Vishamashana b. Vihara : i. Vyayama Mild Moderate Heavy ii. Manasika Vikara Chinta Shoka Bhaya Krodha Others iii.Vyasana None Alcohol Tobacco Smoking Others iv. Nidra Sound Disturbed Day sleepH. Artava Vrittanta : Menstrual Cycle Regular IrregularEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxiii
  • 269. Number of days Inter Menstrual period Associated of any complaints Menarche Menopause Menorrhagia Metrorrhagia Leucorrhoca Dysmenorrhoea AmmenorrheaI. Garba Vrittanta : Gravida Para Abortion Miscarriage Still birth Number of deliveries Nature of delivery Normal Forceps Surgical Last deliveryJ. Samanya Pareeksha : a.Ashta Sthana Pareeksha : Nadi Sparsha Mala Jihwa pravrithi Mootra Drik pravrithi Shabda Akruti b. Vital examination : Bp mmHg Temp F0 Pulse Rate /min Body Wt Kg Resp.Rate /min Heart Rate /min c.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxiv
  • 270. Sroto pareeksha : Rasavaha Srotas – Observed lakshanasAsraddha AngamardaAruchi JwaraAsyavairasya TamaHrillasa PandutwaGourava KlaibyaTandra AngasadaKrishangatha AgninashaAkaalavali Akaalapalitya Raktavaha Srotas – Observed lakshanasMukhapaka KlamaAkshiroga LavanasyataVaivarnya SwedadhikyaAgnimandya KampaPipasadhikya SwarakshayaGurugatrata TandraSantapa NidradhikyaDourbalya TamapraveshaAruchi KanduShirashoola PidakaTiktaamlodhara PradaraVidahaannapanasyaEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxv
  • 271. d.Dasavidha pareeksha : Prakriti Sarataha Satwataha Pravara Madhyama Avara Ekarasa Satmyataha Sarvarasa Vyamisra Samhanataha Susamhata Madhyama Asamhata samhata Pramanataha Sama Heena Adhika Aharashakti Abhyavarana Pravara Madhyama Avara Shakti Jarana Shakti Pravara Madhyama Avara Vyayama Shakti Pravara Madhyama Avara Vaya Bala Yuva VridhaK.Vikrithaha Pareeksha : i. Nidana Ahara Vihara Kshara Divaswapna Amla Ativyayama Lavana Ativyavaya Atyushna Vegadharana Atiteekshna Ritu vaishamya Viruddha Prati karma Asatmya Masha Manasika Nishpava Kama Tilataila Chinta Pinyaka Bhaya Madya Krodha Mrithika Shoka Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxvi
  • 272. ii. Purvarupa Hrit spandana Gatrasada Twak rookshata Mridbhakshana iccha Aruchi Akshikotashotha Swedaabhava Avipaka Agnimandhya Peeta mootrata Shrama Peeta purisha Kshtivanaii. RupaKarna ksveda AruchiHatanila SoonakshikoodatwaDrubala HaritabhaSadana Sheerna romaSrama Hata prabhaBrama KopanaPeedana SisiradweshiGatra shoola NidraluJwara KshteevanaSwasa Alpa vakGourava PindikodhweshtanaK. Chikitsa : Deepana Pachana - Jeeraka choorna (3-6 gms). Before food (3 Days) Anupana - Sukhoshna jala Snehapana - Draksha ghritai. Observation for Snehapana in Arohana Vidhi :Day / Time I II III IV V VI VIISneha Matra 30ml 60ml 90ml 120ml 150ml 180ml 210mlPana KalaKshudha PravruttiKalaTotal time taken fordigestionEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxvii
  • 273. Observation of jeerymana laxanas Laxanas I Time I Tim III Time IV Time V Tim VI Time VII Time I e e Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati Sneha jeerna laxanasLaxanas I Tim 2 Tim 3 Time 4 Tim 5 Tim 6 7 Tim e e e e Time eJeeryamana lakshanaPrashamaShareera LaghutaKshudha pravruttiTrishna PravruttiUdgara Shuddhi Anya ii. Observation for Samyak Snigdha Lakshanas in Arohana vidhi: Lakshanas Days I II III IV V VI VII Vatanulomana Agnideepti Purisha snigdhata Asamhata varchas Twak snigdha Anga laghava Gatra mardava Snehodwega Klama Shaithilya Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxviii
  • 274. iii. Observation for Snehapana in Sadharana Vidhi : Day / Time I II III IV V VI VII Sneha Matra 40ml 40ml 40ml 40ml 40ml 40ml 40ml Pana Kala Kshudha Pravrutti Kala Total time taken for digestion Observation of jeerymana laxanas Laxanas I Time I Tim III Time IV Time V Tim VI Time VII Time I e e Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati Sneha jeerna laxanasLaxanas I Tim 2 Tim 3 Time 4 Tim 5 Tim 6 7 Tim e e e e Time eJeeryamana lakshanaPrashamaShareera LaghutaKshudha pravruttiTrishna PravruttiUdgara Shuddhi Anya Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxix
  • 275. iv. Observation for Lakshanas in Sadharana Vidhi Snehapana : Days Lakshanas I II III IV V VI VIIVatanulomanaAgnideeptiPurisha snigdhataAsamhata varchasTwak snigdhaAnga laghavaGatra mardavaSnehodwegaKlamaShaithilyaAsamyak snigdha lakshanasAsnigdha LakshanasRuksha Purisha/ Grathita Purisha/ Apravaguna Vata/ Mrdu Pakta/ Kharatva/ Raukshyata.Ati Snigdha LakshanaPanduta/ Gaurava/ Jadya/ Tandra/ Aruchi/ Utklesha/ Purishasya Avipakvata.Snehapana vyapatTandra/ Utklesha/ Anaha/ Jvara/ Stambha/ Visanmyatha/ Kushta/ Pandu/ Kandu/Shopha/ Arsha/ Aruchi/ Trishna/ Grahani Dosha/ Staimitya/ Vakyanigraha/ Shula/Ama Pradosha.Evaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxx
  • 276. L. Treatment assessment chart: i. Subjective parameters: Assessment B.T A.T A.FPandutaAgnimandyaArohanayasaBhramaDourbalya ii.Objective parameters: Assessment B.T A.T A.F Hb % TC DC ESR TRBC PCVAdvised for follow up treatment:1. Vishram kala (Abhyanga & Sweda) :2. Shodhana karma :Signature of the Scholar Signature of the GuideEvaluation of comparative efficacy of Arohana and Sadharana krama Snehapana in Panduroga xxxi

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