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CLINICAL EVALUATION OF VIRECHANA THERAPY IN THE MANAGEMENT OF PANDUROGA, Shaila Gurappa Borannavar. Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – …

CLINICAL EVALUATION OF VIRECHANA THERAPY IN THE MANAGEMENT OF PANDUROGA, Shaila Gurappa Borannavar. Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.

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  • 1. Clinical Evaluation of Virechana Therapy In The Management of Panduroga By Shaila Gurappa Borannavar. Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. (PANCHAKARMA) In PANCHAKARMA Under the guidance of Dr. Shivaramudu P. M.D. (Ayu) And co-guidance of Dr. Shashidhar.H. Doddamani. M.D. (Ayu) Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  • 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled“Clinical Evaluation Of Virechana Therapy In TheManagement Of Panduroga” is a bonafide and genuineresearch work carried out by me under the guidance ofDr.Shivaramudu P. M.D. (Ayu), Professor, Post-graduate department ofPanchakarma and co-guidance of Dr. Shashidhar. H. Doddamani.M.D.(Ayu) , Assistant Professor, Post graduate department ofPanchakarma.Date: Shaila Gurappa BorannavarPlace: Gadag.
  • 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “ClinicalEvaluation Of Virechana Therapy In The Management OfPanduroga” is a bonafide research work done by Shaila GurappaBorannavar. in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Panchakarma).Date:Place: Gadag Dr. Shivaramudu P. M.D. (Ayu). Professor
  • 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “ClinicalEvaluation Of Virechana Therapy In The Management OfPanduroga” is a bonafide research work done by Shaila GurappaBorannavar. under the guidance of Dr. Shivaramudu P. M.D. (Ayu), Prof.Postgraduate department of Panchakarma and co-guidance ofDr. Shashidhar. H. Doddamani, M.D. (Ayu), Assistant Professor, Post-graduate department of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
  • 5. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “ClinicalEvaluation Of Virechana Therapy In The Management OfPanduroga” is a bonafide research work done by Shaila GurappaBorannavar in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).Place: Gadag. Assistant Professor, Post graduate Department of Panchakarma.
  • 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and dissemi-nate this dissertation / thesis in print or electronic format for academic /research purpose.Date: Shaila Gurappa BorannavarPlace:Gadag.© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 7. I Acknowledgement I deserve my respectful greetings in the lotus feet of Jagadguru Shri. AbhinavaShivanandmahaswamiji to his holiness and divine blessings. I am highly indebted to honorable H.O.D. Dr. G. Purushottamacharyulu M.D.(Ayu), PG Dept. of Panchakarma, for his valuable suggestions in the completion of thiswork. I express my obligation to respectful guide Dr. P. Shivaramudu Prof. Dept. ofPanchakarma P.G.S.&R.S. Gadag for his critical suggestions and expert guidance, whichmade me to complete this work. I am extremely greatful and obliged to my co-guide Dr. Shashidhar H.Doddamani M.D. (Ayu), Dept. of Panchakarma, P.G.S.&R.S., Gadag for his guidanceand encouragement at every step of this work. With profound sense of gratitude I express my sincere thanks to Dr. G.B. Patil,the Principal, D.G.M.A.M.C., Gadag for his timely encouragement as well as providingall necessary facilities for this research work. I am extremely obliged to Dr. Santosh Belawadi M.D. (Ayu) Lecturer, PGDepartment of Panchakarma, for his remarkable suggestions and support throughout thisstudy. I express my sincere gratitude to Dr. V. Varadacharyulu, Dr. M.C. Patil, Dr.Mulgund, Dr. K.S.R. Prasad, Dr. Dilip Kumar, Dr. R.V. Shettar, Dr. Kuber Sankh,Dr. Girish Danappagoudar, Dr. Jagadish Mitti, Dr. Nidagundi for their constantencouragement. My modest gratitude to Dr. S.D.Yerageri, R.M.O. D.G.M.A.M.C.&H, Gadag,Dr. U.V. Purad, Dr. K. S. Paraddi, Dr. S.H. Redder, Dr. S. A. Patil and otherundergraduate teachers for the their support in the clinical work.
  • 8. II My sincere gratitude to Shri. V. M. Mundinmani (Librarian), Shri. Surrebanfor providing book facilities, and to Smt. Belawadi other office and hospital staff fortheir kind support in my study. I am thankful to Dr. P.S. Khona and Shri. B.S Tippanagouda (Lab. Tech.), whoextended their co-operation in the investigations and I also extend my sincere thanks toShri. Nandakumar for statistical analysis of the study. My deep gratitude to all my college and friends Dr. Jairaj, Dr. Hugar, Dr.Kendadmath, Dr. Chandramouleeswaran, Dr. Santosh, Dr. Varsha, Dr. Subin, Dr.Febin, Dr. Sateesh, Dr. Akki, Dr. Vijay, Dr. Biradar, Dr. Hakkandi, Dr. Ashwindev,Dr. Madhushri, Dr. Devendrappa, Dr. Kalmesh, Dr. Shibaprasad, Dr. Prasanna,Dr. Veena, Dr. Bani, Dr. Mangala, Dr. Bhingi, Dr. Sunita, Dr. Sajjanar, Dr.Kalmath, Dr. Venkareddy, Dr. Meenakshi, Dr. Kumbar, Dr. Udaykumar Dr.Ratnakumar, Dr. Shakuntala Dr. Sobagin, Dr. Shivaleela, Dr. Anitha, Dr. Suvarna,Dr. Jayashree, Dr. Ashwini and other PG scholars for their timely help. I extend my gratefulness and sincere obligations to my friends Dr. Pradeep A.,Dr. B. Ganti, Dr. Nikhila and Dr. Seema P., in spite of their busy schedule they havegiven me kind suggestions and support to complete this work. My heartfelt gratitude to all my sisters and their families, especially Shri. B.Mulawad (Lecturer) and Mr. Mahantesh for their constant support and encouragementthroughout my currier. I acknowledge my patients for their constant participation in this clinical trial andI extend my thanks to all persons who ever helped me directly or indirectly withapologies for my inability to identify them individually. Finally, I dedicate this work whole to my respected parents Mr. GurappaBorannavar & Mrs. Ningamma B., for their wholehearted inspiration and support tofulfill this dream.Date : Shaila G. Borannavar.Place : Gadag.
  • 9. III AbbreviationsAh – Ashtanga Hridaya.As – Ashtanga Sangraha.AT – After treatment.AV – After Virechana.BT – Before Treatment.BV – Bhavaprakasha.Ch – Charaka.GIT – Gastrointestinal tract.GR – Good response.Ha – Harita Samhita.IDA – Iron deficiency Anaemia.MN – Madhava Nidana.MR – Moderate Response.NR – Not responded.PR – Poor responded.SS – Sharangadhara Samhita.Su – Sushruta Samhita.Va – Vagbhata.VG – Vyoshadi Gutika.Yr – Yoga Ratnakara.
  • 10. IV AbstractBackground Panchakarma is popular term used for shodhana Chikitsa, which can givesatisfactory results in chronic diseases (Chirakari vyadhis) adopted in bahudoshavastha.Virechana is one among them, which eliminates vitiated doshas through adhomarga i.e.Guda. In this especially ama pakwashayagata doshas are eliminating. Globally, 30% oftotal populations are anaemic and half of these some 600 million people have irondeficiency. Panduroga is a santarpanajanya vyadhi, where pittadosha plays major role inpathogenesis. Hence, Virechana is most appropriate shodhana therapy. Vyoshadi Gutikais upakalpa of Trivrit indicated in Panduroga and can be considered as Sukha Virechaka.Objective The present study was planned with following aims and objectives – 01. To evaluate the effect of Virechana therapy in Panduroga. 02. To evaluate the effect of Virechana karma with Vyoshadi Gutika in Panduroga.Methods It is single group “An observational study” where the patients having symptomsof Panduroga were selected and classical Virechana therapy was administered – The treatment contains the following steps – 01. Deepana pachana with Trikatu churna 3-6 gms thrice daily before food, till the appearance of Nirama lakshanas. 02. Snehapana with “Dadima Ghrita” in arohana vidhi, till the samyak snigdha lakshanas are seen. 03. Abhyanga with murchita tile taila followed by mridu sweda (Ushna jala snana). 04. Virechana with “Vyoshadi Gutika” 35-45 gms along with sheetajala as anupana.
  • 11. V 05. Samsarjana karma was followed for 3-5 days depending upon the shuddhi achieved. 06. Follow up study was done for 15 days. During these period patients were advised to follow the pathya apathya mentioned in Panduroga.Assessment criteriaSubjective parameter – The classical symptoms of Panduroga i.e. “Panduta”, “Arohanayasa”, “Dourbalya”, “Bhrama” and Agnimandya.Objective parameter – Haematological study, i.e. Hb is taken as main criteria, along with that PCV, MCV, MCHC and Smear study was also assessed.Results: As a result of the proper administration of Virechana karma, it was noted that, itgives long-lasting effect, which includes extraneous variable too. This can be appreciatedby comparing both subjective and subjective parameter taken before and after thetreatment. Among 30 patient who were taken for this study 9 patients (30%) wereresponded good, 15 patients (50%) were moderately responded, whereas 6 patients (20%)shown mild response.Interpretation and ConclusionVirechana is the most appropriate shodhana therapy in Panduroga. It alone can showsignificant result if the Pathya apathya is followed properly.Key words – Shodhana karma; Virechana therapy; Panduroga; Anaemia; Iron deficiencyAnaemia; Haemoglobin; Trikatu churna; Dadima Ghrita; Vyoshadi Gutika.
  • 12. VI TABLE OF CONTENTSChapters Page No.1. Introduction 1-32. Objectives 4-53. Review of literature 6-674. Methodology 68-815. Results 82-1146. Discussion 115-1277. Conclusion 128-1298. Summary 130-1319. Bibliography 132-14710. Annexure
  • 13. VIIList of TablesTable No. Table showing the Page No. 01. Virechana yogyas 12 02. Virechana ayogyas 13 03. Samyak snigdha lakshanas 15 04. Virechana matra 16 05. Oushadha jeernajeerana lakshanas 17 06. Virechana vega nirnaya 18 07. Samyak virchana lakshanas 19 08. Virechana ayoga lakshanas 19 09. Virechana atiyoga lakshanas 20 10. Aharaja Nidana of Panduroga 29 11. Viharaja Nidana of Panduroga 30 12. Poorvarupa of Panduroga 31 13. Samanya lakshnas of Panduroga 32 14. Classification of Panduroga 33 15. Lakshanas of vataja Panduroga 33 16. Lakshanas of pittaja Panduroga 34 17. Lakshanas of kaphaja Panduroga 34 18. Lakshanas of Mrit bhakshanajanya Panduroga 36 19. Properties and ingredients of Trikatu churna 69 20. Properties and ingredients of Tila taila 69 21. Properties and ingredients of Dadima ghrita 70 22. Properties and ingredients of Vyoshadi gutika 71-72 23. Status of the patients of present study 82 24. Distribution of patients by age and response 82 25. Distribution of patients by sex and response 84 26. Distribution of patients by religion and response 85 27. Distribution of patients by occupation and response 86 28. Distribution of patients by socio-economical status and response 87 29. Distribution of patients by marital status and response 88 30. Distribution of patients by food habits and response 89 31. Distribution of patients by treatment history and response 90 32. Distribution of patients by prakriti and response 91 33. Distribution of patients by vyasana and response 92 34. Distribution of patients by koshta and response 93 35. Distribution of patients by agni and response 94 36. Distribution of patients by Nidana and response 95 37. Distribution of patients by incidence of lakshanas and response 99 38. Distribution of patients by type of Panduroga and response 100 39. Distribution of patients by snehapana and response 101 40. Distribution of patients by samyak snigdha lakshanas & response 102 41. Distribution of patients by number of Vegas and response 104 42. Distribution of patients by incidence of Maniki and response 105 43. Distribution of patients by incidence of Antaki and response 106
  • 14. VIII 44. Distribution of patients by laingiki shuddhi and response 107 45. Distribution of patients by type of shuddhi and response 108 46. Overall assessment 109 47. The subjective parameters 110 48. The objective parameters 111 49. Distribution of patients by treatment protocol and observations 112-113 50. The statistical results 114List of GraphsGraph No. Graph showing the Page No. 01. Age incidence and response 83 02. Sex incidence and response 84 03. Religion incidence and response 85 04. Occupation incidence and response 86 05. Socio-economical status incidence and response 87 06. Marital status and response 88 07. Food habits and response 89 08. Treatment history and response 90 09. Prakriti and response 91 10. Vyasana and response 92 11. Koshta and response 93 12. Agni and response 94 13. Aharaja Nidana and response 96 14. Viharaja Nidana and response 97 15. Manasika Nidana and response 98 16. Lakshana of Panduroga and response 99 17. Type of Panduroga and response 100 18. Snehapana and response 101 19. Samyak snigdha lakshana and response 103 20. Incidence of vegiki and response 104 21. Incidence of manaki and response 105 22. Incidence of antaki and response 106 23. Incidence of laingiki and response 107 24. Type of shuddhi and response 108 25. Overall assessment 109List of photographsPhoto No. Photographs Showing the Page No.01. Drugs used in the study 6902. Ingredients of Dadima Ghrita 6903. Vyoshadi Gutika and its ingredients 71 List of flow charts.Chart No. Charts Showing the Page No01. Samprapti of Panduroga 3702. Erythropoiesis 62
  • 15. INTRODUCTION Ayurveda the cultural heritage of Indian civilization is not only a medicinal sciencebut also a full-fledged science consisting of social, spiritual, environmental,psychological well-being and allied branches essential to lead healthy and happy life. Ayurveda believes in supreme power (Atma). This concept is essential to knowthe limitations of human efforts and to accept the existence of things beyond theperception of our sence. “Ayu” means life, which is proper combination of Shareera, Indriya, Satwa andAtma. Veda means knowledge. Ayurveda provides not only curative measures but alsopreventive principals for healthy and long life. Restoration of dhosha, dhatu and mala to astate of equilibrium is the main aim of chikitsa in Ayurveda and it also gives equalimportance to Prasanna, Atma, Indriya and Manas i.e. Manasika Swasthya. The brimhana and langhana are the two types of treatment modalities mentionedin the classics1 and this langhana classified into shodhana and shamana, where shodhanacan be considered as Panchakarma therapies2. The procedure by which the vitiated doshas are get eliminated from the body iscalled shodhana3. It is five in number viz. Vamana, Virechana, Vasti, Nasya andRaktamokshana4. This purification may be either transmuscosal or transdermal.Panchakarma can adopt as a part of Chikitsa, prior measures for Rasayana chikitsa andfor Swasthavritta palana as well. Virechana is specially indicated for pitta dosha, pitta dosha associated with kaphadosha and also pitta sthanshrita kapha doshajanita conditions. Along with this virechanais beneficial in vataja and raktaja disorders too. 1 Introduction
  • 16. “Na Tesham Punarudbhavaha” indicates importance of Panchakarma i.e.diseases treated with Panchakarma are having less chances of reoccurrence by prohibitingthe aggravation of doshas5. Panduroga is mentioned in Brihattrayi, Laghutrayi, and other classical texts. Thisis a pitta pradhana tridoshaja vyadhi in which rasa and rakta are mainly affected. Charaka opines that due to excess intake of pitta prakopaka tridosha prakopakaahara, 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. It may occur as primary diseaseor as associated condition with other diseases.Incidence And Prevalence Globally, 30% of the total world population are Anaemic and half these, some 600million people have iron deficiency. Iron deficiency Anaemia (IDA) is most prevalent nutritional problem in the worldtoday. Young children and women of reproductive age group especially pregnant andlactating women are at greatest risk. Though prevalent in all countries, IDA is mostwidespread in developing countries where prevalent of this disease may be as high as 60-70% in pre-school children and 60-80% in pregnant women. 2 Introduction
  • 17. Need for the study The modern management of Anaemia is mainly oral therapy and parental therapyfor correcting iron deficiency. These are inspite 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, febrilenon-hemolytic reactions and allergic reactions. Thus it is important to search to moresafe, cost effective therapy, which could be explored from the Auyrveda. Virechana isone such therapy, which can give wonderful results in many diseases includingPanduroga. As pitta dosha plays a great role in samprapti of Panduroga. Virechana is thebest and most acceptable shodhana therapy. Charaka has praised the importance of Vyoshadi Gutika in Kalpasthana which isindicated in many disorders including Panduroga6 as it is a yoga of Trivirt, it can beconsidered as best for Sukhavirechana. In this study the patient suffering with lakshanas of Panduroga were administeredclassical virechana therapy, with specially indicated Dadima Ghrita7 for Snehapana andVyoshadi Gutika8 for Virechana karma. 3 Introduction
  • 18. OBJECTIVES Even though many research works have been conducted on the effect of someindigenous drugs on “Panduroga.” This study is intended to observe the beneficial effectsof Virechana in Panduroga as Panduroga. Panduroga is pittapradhana tridoshaj vyadhi where rasa and rakta are mainlyaffected. Virechana is main line of treatment for pittadosha and it is not viruddha Chikitsafor kapha and vata dosha, which are associated in this disease. Panduroga issantarpanajanya vyadhi where virechana a kind of apatarpana Chikitsa could givebenefical effects. Veirechana mainly acts on Pittadharakala, as Pittadharakala andMajjadharakala are one and the same according acahrya Dalhana. So Virechana maystimulates triggering points of the production the raktadhatu i.e. Haemopoietic system. Vyoshadi Gutika is a upakalpa of Trivirtt can be considered as Sukhavirechakaand is indicated in Panduroga. Its ingredients are easily available, method of preparationis very easy and it is palatable too. Its ingredients contains properties like Rechaka,Bhedana, Srotoshodhaka, Agnideepaka, Raktashodhaka, Krimighna, Yakrit uttejaka andVatanulomaka, which could be helpful in treating the pathogenesis of Panduroga. So the objective of this study is – 01. To evaluate the effect of Virechana Therapy in Panduroga. 02. To evaluate the effect of Virechana karma with Vyoshadi Gutika. (Charka Kalpasthana) in Panduroga. 4 Objectives
  • 19. Research works done on Panduroga 01. Deshapande Swati S. – Clinical study of Panduroga and its Management with Mandoora bhasma. 02. Pandey Shashi – Effect of Pathya ghrita in cases of Pandu. 03. Kottarshetti Irranna – The effect of Guda Nagaradi Vati in Panduroga. 04. Basavaraj R. – A Comparative study on the effect of Dhattriavaleha and Kaseesa bhasma in Panduroaga w.s.r.t. to Iron deficiency Anaemia. 05. Loba 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. 07. Raka Shital F. – To Study the effect of Rasnapanchaka kashaya in Amavastha of various diseases w.s.r.t. to Pandu. 08. Purani D. A. – A clinical study on the Management of Panduroga with Yogaraja Rasayana. 5 Objectives
  • 20. HISTORICAL REVIEW Ayurveda, the most indigenous system of medicine has propagated treatment formany diseases. The principles of treatment described in our ancient Auyrvedic texts stillhold good since ages. Panduroga is a dreadful disease, which sticks all the age groups. It is thereforeessential to find out effective and harmless treatment of Panduroga and for that it isnecessary to look at ex-post factor where Panduroga has been described in minute details. In a systemic enquire into the state of medical science in India. It may be pointedout that the Brihattrayee’s earliest of medical literatures, which furnish us with detaildescription of the disease Panduroga and Virechana therapy. For the sake of conveniencethe history of Ayurveda can be derived as follows – 01. Vedic Period 02. Pauranika Period 03. Samhita Period 04. Sangraha Period 05. Modern PeriodA. VEDIC PERIOD In Vedic literature especially in Rigveda and “Atharvana veda we found the term“Halima” and “Harita” which are observed to be correlative with Panduroga. Thetreatment of the disease is also mentioned in both Vedas.B. PURANA KALA The word “Pandu” is available in Mahabharata when sage “Vyasa” intercoursewith “Ambilika” the windows of “Vichitra veerya”, she becomes pale with fear. That’swhy her son who born becomes pale (Pandu) colour and named as “Pandu”. 6 Historical review
  • 21. 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.C. SAMHITA PERIOD Charaka Samhita – In Charaka Smahita sutrasthana, it is mentioned aboutVirechana dravya sangraha, Virechana yogas and its procedure9-11. In kalpasthana variousvirechana kalpas have been explained12 where as in Siddhisthana, Virechana samyakyoga, ayoga, atiyoga, Virechana yogyayogya, Virechana vyapat and their respectivetreatment are mentioned.13-15 Panduroga is well elaborated in Charaka samhita Chikitsasthana 16th chapter16. Sushruta Samhita – In sutrasthana different virechana dravyas including thevarious preparations of Trivrit are mentioned17-18. In chikitsasthana, the procedure ofVirechana karma, samyak ayoga, atiyoga, vyapat and their treatment is mentioned19-20. Panduroga is described in Sushruta samhita Uttaratantra 44th chapter.21 Ashtanga Hridaya – In Sutrasthana Virechana vidhi is explained22. InKalpasthana, Virechana yogas and vyapatas are mentioned.23-24 Panduroga Nidana is explained in Ashtanga Hridaya Nidanasthana 13th chapter25and its management in chikitsasthana 16th chapter.26D. SANGRAHA PERIOD Virechana well explained in Ashtanga sangraha Sutrastana27, Kasyapa samhitaSiddisthana,28 Bhavaprakasha Purvakhanda29, Yogaratnakar Virechanaadhikara30 andChakradatta Virechanaadhikara.31 7 Historical review
  • 22. Panduroga is described in Ashtanga sangraha Nidanasthana32 and Chikitsasthana,33Kasyapa samhita Sutrasthana,34 Yogaratnakar Pandurogaadhikara,35 BhavaprakahsaMadyamakhanda,36 Madhavanidana,37 Chakradutta Pandurogaadhikara.38E. MODERN PERIOD Cathartics are used in modern medicine for the treatment. Different types of drugsand their action are mentioned in Satuskar pharmacology.39 In this period so many commentators have discussed about Panduroga and theycorrelated it with Anaemia. The word Anaemia was first appeared for medical use in1824 and in 1849 it began to have specific medical meaning (which is much moresimilarly with Panduroga). 8 Historical review
  • 23. VIRECHANA KARMANIRUKTI AND PARIBHASHA Virechana is described from the root –Rich dhatu, Vi upasarga, Nich and Lout pratyaya are also take part in the derivation. “Visheshena Rechayateeti” 1 It means “Mala Nissarana” i.e. elimination of malas through any of the route inthe body. But in Ayurveda the word virechana is used for indication of only theelimination of malas through adhobhaga i.e. Guda (Anal route). Even in case ofNiruhavasti Malas are eliminating through Guda, but adhobhagaharana type of shodhanais not producing here i.e. elimination of Aama pakwashayagata malas. Certain specificterminology is used in Ayurveda to indicate the elimination of malas other than Guda eg.Vamana, Shirovirechana. “Tatradoshaharanam Adhobhagam Virechanam Sanjnyakam |” 2 The act of expelling vitiated doshas (malas) through adhobhaga is known asvirechana. Here Chakrapani commented adhobhaga means “Guda” 3. “Vireko Mukhapeetam Gudamargenanta: sthetastha | Doshasya Nirasaaranam Pittasya Paramaushadham ||”4 Virechana is the process in which the orally administered drug can bring thevitiated doshas through adhomarga and it is special treatment for pittadosha. “Virechanam Pittaharanam Shreshtam |”5“Pitta Tu Virekam Shleshma Samsrushte Vaa Tatsthanagate Vaa Shleshmaneeti |” 6 9 Virechana Karma
  • 24. Virechana is a specially indicated for pitta dosha, Pitta dosha associated withkapha dosha and kapha dosha which is situated in pittasthana. Mridu Virechana is the line of treatment for avarana vata vyadhies7. As we know“Pittam Tu Swedaraktayo|”8 i.e. Pitta and rakta have got ashraya, ashrayee bhavarelation, thus Virechana can be employed as a treatment in vitiated rakta and its disorders.PARYAYAThe synonyms are9 • Rechana • Praskandana. According to the Sanskrit – English dictionary purgative, cuthartic. Evacuant andApercent are the different meanings of Virechana10.VIRECHANA DRAVYAS Virechana dravyas will have all the properties of vamana dravyas i.e. Ushna,Teekshna, Sukshma, Vyavayi, Vikashi, except Urdhobagahara in case of vamana andAdhobagahar in Virechana. But unlike vamana, the Virechana dravyas consistpredominance of prithvi and jala mahabuthas, which show specific property of removingthe doshas through adhobhaga. i.e. Guda marga11. 10 Virechana Karma
  • 25. TYPES OF ADHOBHAGAHARA KARMA Acharya Sharangadhara has classified according to the action of the virechanadravyas – 01. Anulomana12 – The drugs, which will digest (paka) the apakwa malas and bring them to adhomarga by removing the bandhana. eg. Haritaki. 02. Sramsana13 – The drugs which expel the slishta malas (malas adhere to the lumen of intestines) with out doing the paka. eg. Aragwadha. 03. Bhedana14 – The drugs, which disintegrates the Abaddha or Baddha or Pindita forms of malas and then evacuating through adhomarga. eg Kutaki. 04. Rechana15 – The drugs which eliminates pakwa and apakwa malas by making them in drava form through adhomarga. eg Trivritta. There are certain drugs, which will help, in proper Virechana or which willsynergies the action of Virechana dravyas is known as Virechanopaga. The drugsdisciebed are Draksha, Kashmarya, Parushaka, Abhaya, Amalaki, Vibhitaki, Kuvala,Badara, Karkandhu and Pilu16.VIRECHANA YOGYA AND AYOGYA As a first step in Virechana vidhi, one has to observe whether the patient is fit forVirechana karma or not. For this Virechana yogyas and Virechana ayogya criteria isgiven in the classics. Those who are fit for virechana should only be given withvirechana, otherwise it will leads to complications. 11 Virechana Karma
  • 26. Virechana Yogya 17-19Table No. 01. Showing the indication of Virechana Yogya conditions.Sl. Virechana Ch Su Va Sl. Virechana Yogya Ch Su Va Yogya Pitta pradhana vyadhi Stree Roga01. Jwara + + + 31. Stanya dosha - - +02. Pandu + + + 32. Yoni dosha + + +03. Kamala + - + Shalyapradhana vyadhi04. Halimaka + - + 33. Arbuda + + -05. Asyadaha + + - 34. Bhagandara + + +06. Netradaha + + - 35. Arsha + + +07. Guda & - + - 36. Galaganda + + - Medradaha08. Nasa and - + - 37. Granthi + + + Karnadaha Vata Pradhana vyadhis 38. Bradhna + + -09. Shirashoola + + + 39. Dushta vrina - + +10. Parshwashoola + + + 40. Mutraghata + + +11. Gulma + - + 41. Shastrakshata - + -12. Vatarakta + - + 42. Ksharagni dugdha - + -13. Pakshaghata + + - Shalakya vyadhi14. Pakwashaya ruja - + - 43. Timira + + + Kapha pradhana vyadhi 44. Abhishyanda - + +15. Prameha + + + 45. Kacha - + -16. Netrasrava + - - 46. Akshipaka - + -17. Asyasrava + - - Annavaha Srotas18. Nasasrava + - - 47. Krimikoshta + + +19. Shwasa + - + 48. Garavisha - + +20. Kasa + - + 49. Visuchika + + -21. Kshavathu + + + 50. Alasaka + + - Tridosha vyadhis 51. Udara + - +22. Kushta + + + 52. Arochaka + + -23. Visarpa + + + 53. Avipaka + + -24. Hridroga + + - 54. Vibandha - + + Raktapradhana vyadhis 55. Anaha - + -25. Pleeha + + + Pratimarga Chikitsa26. Vyanga + - + 56. Urdhwaga Raktapitta + + +27. Neelika + - - 57. Udavarta + - -28. Visphotaka + + + 58. Chhardi + + + Manasa roga29. Unmada + - - 30. Apasmara + - - 12 Virechana Karma
  • 27. Virechana Ayogya20-22Table No. 02. Showing the indication of Virechana Ayogya conditions.Sl. Virechana Ayoga Ch Su Va Sl. Virechana Ayoga Ch Su Va Karma Asahanata 21. Bhayabheeta + - -01. Vilambita + - - 22. Chintaprasakta + + -02. Durbala + + + 23. Maithuna prasakta + - -03. Durbalendriya + - - 24. Adhyayana prasakta + - -04. Alpagni + + + 25. Vyayama prasakta + + +05. Kshataksheena + + + 26. Shalyardita + - +06. Shranta + + - Samavastha07. Pipasita + + - 27. Nava pratishyaya - + -08. Kshudita + + + 28. Nava jwara + + +09. Bala + + + Gudagata Vyadhis10. Vriddha + + - 29. Kshataguda + + -11. Karma bhara Adhvahana + - + 30. Muktanala + - -12. Atikrisha + - + Anya Vyadhis13. Atisthula + + - 31 Madatyaya + + -14. Darunakoshtita + + - 32. Adhmana + + -15. Kshama + - + Marga virodhi vyadhi16. Garbhini + + + 33. Adhoga raktapitta + + +17. Navaprasuta - + + 34. Atisara - - +18. Subhaga + - - Some other Conditions19. Atisnighda + + + 20. Atiruksha + 13 Virechana Karma
  • 28. PROCEDURE OF VIRECHANA Procedure of Virechana can be classified under three headings Purvakarma Pradhanakarma PaschatakarmaPurva karma: Sambar sangraha Atura pariksha Atura siddhata Matra vinischaya Sambar sangraha: The medicines and instruments useful for Snehana, Swedana,Virechana and the treatment of Virechana vyapat must be collected prior to theadministration of Virechana therapy. Atura pariksha: Examiniation of the petient for yogya ayogya. Deciding the Virechana matra depending on the Dosha, Atura bala, Bheshaja, Kaala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satwa, Prakriti, Vaya, Saama avastha and Vikara23 Deciding the type of Sneha and Virechana yoga by considering vyadhyanukulata and vyadhyanurupataSpecific drugs for Virechana.24(a)Vata Pradhana - Trivrit + Saidhava + Shunthi + Kanji or MamsarasaPitta Pradhana - Trivrit Choorna + Draksha KwathaKapha Pradhana - Triphala Kwatha, Gomutra, TrikatuChildren between the - Draksha Rasa + Aragvadha Phala Majja 24(b)(Age group of 4-12 years) 14 Virechana Karma
  • 29. Atura siddhata: Prior to Virechana Karma the patients can be administered with Pachana, Snehanaand Swedana procedures as a purvakarma Pachana can be administered in the condition of Ama, till the appearance of Nirama lakshanas Snehapana should be followed in arohana vidhi, till the appearance of samyak snigdha lakshanas, maximum duration will be 3 to 7 days.25Samyak Snigdha Lakshanas26-28Table No. 03. Showing the Samyak Snigdha Lakshanas.Sl. Lakshanas Ch Su Va Sl. Lakshanas Ch Su Va01. Vatanulomana + - + 07. Anga laghavata - + -02. Agnideepti + + + 08. Twak snigdhata - + -03. Purisha snigdhata + + + 09. Adhomarga sneha srava - + -04. Asamhata varcha + + + 10. Klama - + +05. Gatra mardavata + + - 11. Shaithilya - + -06. Gatra snigdhata + + + 12. Snehodvega - - + Snehaat Praskandanam Jantuhu Triratroparata Pibet |29 In case of Virechana, 3 days rest is mentioned after Snehapana. During these daysAbyanga, Swedana and Snigdha, Drava, Ushna bojana, Mamsarasa, Odana, AmlarsaPhala is recommended.30 i.e. the food must not produce kaphavruddhi “Manda Kapha”is the condition described for proper Virechana Karma.31 Matra vinischaya Matra of Virechana drug should be in such a quantity that the desired effect ofShodhana must be achieved with out causing ayoga and atiyoga lakshanas 15 Virechana Karma
  • 30. Table No. 04. Showing the dosage of Virechana according to sharangadhara.32 Kalpana Heena Matra Madhyama Matra Uttama Matra Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna 4 tolas 2 tolas 1 tolas ModakaNature of Koshta and Virechana Mrudvi Matra Mrudu koshte cha madhyama | Krure Tikshana Mata Dravyair Mrudu Madhyama Tikshanakaihi ||Acharya Sharandhra opiens that the dravya matra should be alpa, madhyama, uttama forthe person of Mrudu, Madhyama and Krura Koshta respectively.33 Sushruta also opinsthe same. 34 Pradhana Karma: Pradhana karma starts with administration of virechana dravyas till the stoppageof virechana Vegas i.e. – 01. Virechana yoga sevana. 02. Atura paricharya and Nirikshana. 03. Vega nirnaya. 04. Observation of samyak yoga, ayoga and atiyoga lakshanas. 05. Virechana vyapat and Pratikara.Virechana yoga sevana: Before the administration of virechana yoga the physician must examine thepatients physical and mental health once again. Patient must have digested, the foodtaken on previous day and must got sound sleep on the previous night. 16 Virechana Karma
  • 31. Shleshma kaale Gate Jnyatwa Koshta Samyak Virechayeet |35 According to Vagbhata, the patient has to take virechana karma just aftershlesmakala. It can be understood as the time is so adjusted that the virechana should bestarted during pittakala. The pittakala falls between 10.00 am to 2.00 pm. Hence, the timeand dose of the virechana dravya should be decided depending upon the koshta andagnibalabala of the patient. Ushna or sheeta jala can be used as anupana in accordancewith Virechana yoga.Atura paricharya and Nirikshana: The vaidya must observe the lakshans of Jeernoushadha, Ajeernaoushadha, Hritdosha and vyapat.Aushadha Jeernaajeerna Lakshana36-37Table No. 05. Showing Aushadha jeernaajeerna lakshanas. Sl. Aushadha jeerna lakshana Aushadha ajeerna lakshana 01. Vatanulomana Dourbalya 02. Swasthya Daha 03. Kshut Angasada 04. Pipasa Bhrama 05. Mana prasannata Moorchha 06. Indriya prasannata 07. Shuddha udgar In case of ajeernaoushadha lakshanas, the Virechana drugs should not be givenimmediately, as the drug may produce severe purgation i.e. Atiyoga. But in some cases ifthe drug is digested, and there is no hrit dosha lakshanas, he should be given food, againvirechana oushadhi should be administered on the next day. Even then if the virechanadoes not occur then the patient must be given proper snehana swedana once again andthen Virechana oushadhi can be administered after 10 days38. 17 Virechana Karma
  • 32. Apart form the above lakshanas the hrit dosha lakshanas should also be taken intoconsideration. In proper virechana there will be expulsion of mala, pitta and kapha Vatain sequence, “Kaphantam Virechana” and appearance of daurbalyata and laghutaindicates that doshas have properly eliminated.39 If virechana persists even after manifestation of Hrit dosha lakshanas then vamanashould be performed.40 If the Virechana Vega does not occur then instantaneously theushna jala pana, and swedana must be performed on pani, pada and udara.41Vega Vinirnaya For the purpose of observation of pravara, madhyama and avara shuddhi,Chakrapni has given four types of criteria i.e. Laingiki, Antiki, Vegiki and Maniki, butimportance should be given to Laingiki shuddhi. For vega vinirnaya the physician have toleave the first two-three malayukta Vegas, then counting should be done till kaphantam.Table No. 06. Showing the Virechana vega vinirnaya.42 Sl. Vega vishaya Pravara Madhyama Avara 01. Vegiki 30 Vegas 20 Vegas 10 Vegas 02. Maniki 4 Prastha 3 Prastha 2 Prastha 03. Antaki Kaphantam 04. Laingiki Samyak Virechana Lakshanas 18 Virechana Karma
  • 33. OBSERVATION OF SAMYAK YOGA, AYOGA AND ATIYOGA LAKSHANAS Laingiki shuddhi lakshanas are given in the table. Thereafter the Ayoga andAtiyoga lakshanas mentioned in the classics have been presented in tabular form.Table No. 07. Showing the Samyak Lakshana of Virechana karma.43 Sl. Virechana Samyak Lakshana Ch Su Va 01. Srotovishuddhi + - - 02. Indriya prasada + + - 03. Laghuta + + - 04. Agnideepiti + - - 05. Anamayatwa + - - 06. Kramat Vit, Pitta, Kapha and Vata Nissarana + + - 07. Vatanulomana - + - 08. Absence of Ayoga, Atiyoga lakshanas - - +Virechana Ayoga and Atiyoga LakshanasTable No. 08. Showing the Ayoga lakshanas of Virechana.44 Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va 01. Kapha prakopa + + + 10. Vata pratilomata + - - 02. Pitta prakopa + + + 11. Daha - + + 03. Vata prakopa + - - 12. Hridaya ashuddhi - + + 04. Agnimandya + + - 13. Kukshi ashuddhi - + + 05. Gourava + + - 14. Kandu - + + 06. Pratishyaya + - + 15. Vitsanga - + + 07. Tandra + - - 16. Mutrasanga - + - 08. Chhardi + - - 17. Pidaka - - + 09. Aruchi + + + 19 Virechana Karma
  • 34. Table No. 09. Showing the Atiyoga lakshanas of Virechana.45Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va01. Kapha kshayaja + + - 12. Hikka + - - vikara02. Pittakshayaja + - - 13. Moorchha - - - vikara03. Vata kshayaja + - - 14. Gudabhrimsha - - - vikara04. Supti + - - 15. Shoola - + -05. Angamarda + - - 16. Kapha, Pitta rahita Sweta, - - + lohita udaka nissaranam06. Klama + - - 17. Mamsa dhavanavat - - + Udakasrava07. Vepathu + - - 18. Medakhandavat - - +08. Nidra + - - 19. Trishna - - +09. Dourbalya + - - 20. Bhrama - - +10. Tamapravesh + - - 21. Netra Praveshanam - - +11. Unmad + - - 22. Raktakshayaja vikara + - - Ahridya, durgandhita, adhika matra yukta virechana oushadhi and in kaphotkleshaajeernavastha the administered Virechana oushadha may produce vamana.46Paschat Karma Regimens to be adopted after virechana karma till the patient is able to takenormal diet are known as paschat karma. Soon after the samyak virechana karma the agnibecomes imbalance state. Hence, the patient is not allowed to take normal diet, which cancause further vitiation of agni. Hence, the peyadi samsarjana krama should be followed inorder to bring back the equilibrium in the state of agni.47 20 Virechana Karma
  • 35. Three to seven days samsarjana krama is followed by administrating peya, vilepi, akrita krita yusha and akrita krita mamsarasa depending upon the shuddhi achieved. But in following conditions Tarpana should be administered instead of samsarjana viz.48 – 01. Pitta kapha parisrava. 02. Madatyaya. 03. Vatapitta prakriti. In Tarpna, Swaccha Tarpana, in place of Peya and Ghana Tarpana in place of Vilepi should be used according to Chakrapani.49 VIRECHANA VYAPAT Improper conduction of Virechana leads to vyapats like50 – 01. Adhmana 06. Jeevadana Guda bhramsha 02. Parikartika 07. Vibhrimsha51 Sajnyanasha 03. Parisrava 08. Stambhana Kandu 04. Hridgraha 09. Klama 05. AngagrahaSushruta has given 15 vyapats of virechana52 – 01. Vamana occurs with virechana 08. Atiyoga dravyas (Urdhwagati). 09. Jeevadana 02. Virechana occurs with Vamana 10. Adhmana dravyas(Adhogati) 11. Parikartika 03. Shesha oushadhitwam 12. Parisrava 04. Jeerna oushadhitwam 13. Pravahika 05. Heena dosha apahritatwam 14. Hridyopasarana 06. Vata shoola 15. Vibandha 07. Ayoga 21 Virechana Karma
  • 36. As seen above, acharyas have clearly metioned the ayoga and atiyoga vyapat indetail and their respective treatment.VIRECHANA OUSHADHA KARMUKATA The vamana and virechana dravyas posses similar properties like ushna, teekshna,sukhma, vyavayi and vikashi gunas. Drugs will reach the hridaya by its veerya thereby itenters into dhamanis, sthula and anu srotas of the body. The Vikashi guna is responsiblefor quick absorption, due to ushna guna vishyanadana will be produced. Teekshna gunadoes chhedana of samhata doshas and brings back them to koshta. Form there due toprithwi and jala mahabhoota gunas and adhobhagahara prabhava the doshas geteliminated through gudamarga. Both Virechana and Vaman oushadhas are having thesimiler propereties exept Urdwabhagahara in Vamana, adhobhagahara in case ofVirechana dravyas and it is only because of Prabhava the Virechana drugs producesVirechana karma.53 Sushruta added sara guna along with the ushnadi gunas and this sara guna act asanulomana.54 Acharya charaka says, the drugs act not only due to its prabhava but also due toits dravyatwa prabhava gunatwa prabhava and both dravyatwa and gunatwa prabhava.And the factors mentioned here may change based on the different conditions. The effectproduced is karma. The factor responsible for manifestation of effect is veerya.55 22 Virechana Karma
  • 37. MODERN CONCEPT OF LAXATIVES: 56 Laxatives are act through multiple mechanisms affecting the epithelial transfer,directly or indirectly, leading to decreased sodium absorption and increase in chloridesecretion by intestinal epithelial cells. These drugs are sometimes classified according to intensity of action as mild,moderate or drastic. Laxative effect suggests the elimination of soft-formed stool withoutgripping and without much loss of water. In large doses many laxatives promotecatharsis, which means purgation and passage of more fluid stools. Laxatives can beclassified according to their mechanism of action as follows:I. Stimulant or Irritant Laxatives: Antroquinone group – This acts by stimulation of large bowel and also probably by inhibiting NaCl water absorption in the colon. eg. Cascara sagrada and senna.Pharmacological actions: As these drugs act mainly on large bowel evacuation occurs 6to 8 hours after their ingestion. Stools are usually semisolid in consistency and incidenceof griping is low. Irritant oils – eg. Castor oil. It is fixed oil obtained by expression of the seeds of Ricinus communis Linn.Chemically, it is triglyceride of ricinoleic acid, an unsaturated hydroxy fatty acid. Castoroil itself is nonirritant. When ingested, it is hydrolysed in the intestine by pancreaticlipase to glycerol and ricinoleic acid. Ricinoleic acid acts as an irritant and producespurgation. Pharmacological actions : As ricinoleic acid acts on small intestine, it producescopius liquid stools, with associated fluid loss. Colonic emptying may be so completethat patient may not pass the stool for several days. The action is quicker than that of theanthroquinone and is evident within two to tnree hours. It causes griping. 23 Virechana Karma
  • 38. Miscallaneous – eg. Phenolphthalein bisacodyl, sodium picosufate. Pharmacological actions : Mechanism of action is not known but the drug actsas stimulant mainly on the large bowel after 6 to 8 hours and produces soft, semisolidstools associated with a little griping. An interesting aspect of phenopthaline is that about15% of the dose is absorbed, some of which is re-excreted in the bile. This enterohepaticcirculation of the drug causes prolongation of its laxative effects.II. Osmotic laxatives Certain salts when given orally are not much absorbed and are retained in thegastrointestinal tract. Such preparations exert an osmotic effect and therefore holdconsiderable amount of water, thus increasing the intestinal bulk. This acts as amechanical stimulus causing an increase in the intestinal motor activity and evacuation. Pharmacological actions : these compounds act in the small as well as largeintestines and therefore produces a watery evacuation within 3 to 6 hours. Because oftheir quick onset of action they are given early in the morning before breakfast. They donot cause irritation and there is very little griping. Patients should be instructed to takeplenty of water along with these drugs since administration of hypertonic solution mayproduce dehydration due to water extraction from the circulation.III. Bulk laxatives – eg. Methyl cellulose, Agar agar, Ptantago seeds, Bran. These are various natural or semisynthetic polysaccharides and cellulosederivatives, which when orally are not absorbed and increase the indigestible residue.These agents absorb water and swell up, thus providing the stimulus of mechanicaldistention for evacuation. 24 Virechana Karma
  • 39. Pharmacological actions: These agents act purely because of their physicalproperty. Their action is mild and is usually seen 12 to 36 hours after ingestion. Theyproduce evacuation of solid or semisolid stools without any irritation or griping. Someagents also have lubricating properties. Usually, these drugs are administered at bed time.IV. Emollient laxatives: eg: Liquid paraffin and Dioctyl sodium sulfosuccinate. Liquid paraffin mineral oil most widely used emollient laxative. It consists of amixture of hydrocarbons obtained from petroleum given orally. It is not significantlyabsorbed and exerts a softening and lubricating effect on faeces. Pharmacological actions: It is mild in action and itself does not initiateperistalsis. Because of its lubricant action, the straining during defaecation can beavoided. It is usually given at bed time, but can be taken at any time of the day. 25 Virechana Karma
  • 40. DISEASE REVIEWNIRUKTI AND PARIBHASHA In Ayurveda, different diseases are named on the basis of signs and symptoms,the origin of the disease, location of exhibiting its symptoms. Here the disease Pandu isnamed on the basis of “Varna.” The word “Pandu” is derived form “Padi–Nashne” dhatu by adding “Ku”Pratyaya to it. For Pandu specifically the Nashana will be of the Varna i.e. the colour,which is said by acharya Charaka as “Vaivarnya.”1 Thus the derivation of the word“Pandu” indicates the abnormal colouration of the body. Pandustu Peetabhagardhaha Ketaki Dhuli Sannibham |2 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 | The disease in which, twacha becomes Pandu, Haridra, Harita varna is known asPanduroga.3 Padutwenopalakshitaha Rogaha Pandurogaha | The disease in which Pandubhava, Pandutwa or Panduvarna is more is known asPanduroga.4 26 Disease Review
  • 41. RELATION BETWEEN RAKTA, PITTA AND PANDU. In describing the rupas of Panduroga, acharya charaka has described symptomslike Vaivarnya, Ojogunakshayam, hataprabha, Alparakta nissara. Hence, it is necessary toknow the role of Raktadhatu and Pittadosha which play a predominant role in themaintenance of the complexion of the body. Rakta has been considered as a key factor forthe Jeevana, and Poshanakarma of the body. According to Maharshi Sushruta, Raktam Jeevam Iti Sthiti:|5 But, the proper functions of rakta can be expected only in its pure form as said byacharya charaka. Tadvishuddham Hi Rudhiram Balavarnasukhayusha | Yunakti Pranianam Prana: Shonitam Hyunuvartate ||6 As per the classics, raktadhatu is derived from rasadhatu. Rasa is an aqueousfluid. It is a transparent and colourless substance due to the predominance ofJalamahabhoota and due to predominance of Teja mahabhoota it is reddish in colour. Rasadhatu is sara of Shadrasayukta ahara called Poshya dhatu. When this poshyadhatu undergoes pachana by agni derived from pitta, it transforms into raktadhatu. Due tothe action of ranjaka pitta on rasa, it gets transformed into reddish colour substance i.e.Rakta. Acharya Sushruta has mentioned the main site of rakta is Yakrit and Pleeha.7Ranjaka pitta is located in Yakrit and Pleeha, plays a major role in ranjana karma ofRasadhatu. According to Vagbhata site of Rajaka pitta is amashaya.8 On the bases of above description it can be deducted that rakta depends on pitta,which transforms rasa into rakta, and bala, varna, ayu depends on rakta. 27 Disease Review
  • 42. Pandu is said as Pitta pradhana vyadhi.9 In all types of paittika disordersobviously there will be impairment of pitta i.e. in either vriddhi or kshaya stage. It can be said that pitta plays an important role in the formation of rasaraktadidhatus as agni is represented by pitta in body which brings about good and bad effectsaccording to its normal or abnormal state.10 When pachaka pitta gets vitiated and due to its adverse effect, the digestiveprocess gets disturbed thereby dhatu formation. Ranjaka pitta also plays vital role information of rakta, hence its vitiation also affect the formation of rakta. The vitiation ofsadhaka pitta disturbs the functions of hridaya and rakta parisanchalana. Hence, the sthayidhatus are poorly nourished. As a result, due to rakta kshaya, Bhrajaka and Alochakapitta also becomes durbala in performing their normal functions. Hence, varioussymptoms of pitta are observed in Panduroga. Thus it can be inferred that pitta plays a vital role in manifestation of diseasePandu. 28 Disease Review
  • 43. NIDANA PANCHAKA Disease can be diagnosed by the study of Nidana, Purvaroopa, Roopa, Upashayaand Samprapti.NIDANA11, 12.13 The different authors have explained many nidanas for manifestation of thedisease Pandu. For the sake of convenience it can be categorized under different groups.A. Aharaja NidanaTable No. 10. Showing the Aharaja Nidana of Panduroga.Sl. Nidana Ch Su Va Sl. Nidana Ch Su Va01. Amlarasa sevana + + + 08. Tilataila sevana + + -02. Kshara seavnaa + - - 09. Madya sevana + - -03. Lavana rasa sevana + + + 10. Mrit bhakshana + + -04. Ati ushna bhojana + - - 11. Teeskhnahara sevana - + -05. Viruddha bhojana + - - 12. Atikatu sevana - - +06. Nishapava sevana + - - 13. Ati kashaya sevana - - +07. Masha sevana + + - Charaka mentioned Pandu in Santarpanajanya vyadhi.14 Above said nidanas arecauses for pitta pradhana tridoshas prakopa and Mandagni. Acharya Madhavakar,Bhavaprakash, Yogaratnakar have followed the Susrutha’s version.15 These types ofahara may lead to disturb in digestive and assimilative process, leading to Panduroga. 29 Disease Review
  • 44. B. Viharaja NidanaTable No. 11. Showing the Viharaja Nidana of Panduroga.Sl. Nidana Ch Su Va Sl. Nidana Ch Su Va01. Amlarasa + + + Manasika factors sevana02. Kshara seavnaa + - - 11. Bhaya + - -03. Lavana rasa + + + 12. Krodha + - + sevana04. Ati ushna + - - 13. Kama + - + bhojana05. Viruddha + - - Pratikarma Vaishamya bhojana06. Nishapava + - - 14. Snehatiyoga + - - sevana07. Masha sevana + + - 15. Vegavidharana in vamana + - - karma Manasika factors 16. Amatisara sangaha + + -08. Chinta + - - 17. Dushtaraktanigraha in + - - Raktarsha09. Shoka + - - 18. Snehavibhrama + - - Causes related to vihara deals with both physical and mental activities as well asiatrogenic cause i.e. Pratikarma vaishamya.C. Nidanarthakara Roga Panduroga can manifest as secondary to some other disorders like – Raktarbuda16 Raktarsha20 Asrgdhara17 Pleehodara21 Raktapitta18 Yakrutodara22 Yakrit-pleeha roga19 Pittaja Prameha23 All leads to either rakta kshaya due to bleeding or vikrita doshas which results inPanduroga. 30 Disease Review
  • 45. POORVAROOPA24, 25, 26 The Panduroga manifests with following prodromal signs and symptoms –Table No. 12. Showing the Purvaroopa of Panduroga.Sl. Purvaroopa Ch Su Va Sl. Purvaroopa Ch Su Va lakshana lakshana01. Hritspandana + - + 08. Mritbhakshaneccha - + -02. Rukshya + - + 09. Akshi kuta shotha - + -03. Swedabhava + - + 10. Avipaka - + -04. Shrama + - + 11. Aruchi - - +05. Twacha sphutana - + - 12. Peetamutrata - + +06. Sthivana - + - 13. Peeta purisha - + -07. Gatrasada - + + 14. Alpa vanhita - - + Madhavakara, Bhavaprakasha and Yogaratnakara have followed Sushruta’sversion.27ROOPA The term roopa implies to both the signs and symptoms by which a disease isidentified. These can be classified as – 01. Pratyatma lakshana (Cardinal sign & Symptom) 02. Samanya lakshana (General sign & Symptom) 03. Vishesha lakshana (Distinguisheing features of doshanubandha)Pratyatma Lakshana: Pandurvarna is considered as Pratyatma lakshana of Panduroga. This colour isalmost similar to pollens of Ketaki flower. 31 Disease Review
  • 46. Samanya lakshana: The Samanya lakshanas of Panduroga mentioned in the classics other than Pandutacan be considered as below –Table No. 13. Showing the Samanya lakshanas of Panduroga.28,29 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. Gatramadata + - -Vishishta Rupa The lakshanas which are specifying the involvement of particular doshas andthere by 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 dosha.30 32 Disease Review
  • 47. Classification of Panduroga:31,32,33,34Table No. 14. Showing the classification of Panduroga. Sl. Prakara Ch Su Ah As BP YR MN 01. Vataja + + + + + + + 02. Pittaja + + + + + + + 03. Kaphaja + + + + + + + 04. Tridoshaja + + + + + + + 05. Mridbhakshnanajanya + - + + + + + The description of vishishta rupa according to classification of Panduroga ispresented as follows –Vataja Panduroga Lakshana:35Table No. 15. Showing the Samanya lakshanas of Vataja Panduroga. Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va 01. Krishna angata + - - 09. Toda + - + 02. Krishna nakhatwa - + - 10. Kampa + - + 03. Krishnekshanatwa - + - 11. Parshwaruk + - + 04. Krishna sira - + - 12. Shiroruk + - + 05. Krishna ananatwa - + - 13. Shopha + - + 06. Ruksha netrata - + - 14. Anaha + - + 07. Rukshangata + - - 15. Asya vairasya + - + 08. Angamarda + - - 16. Balakshaya + - + 33 Disease Review
  • 48. Pittaja Panduroga lakshana 36Table No. 16. Showing the Samanya lakshanas of Pittaja Panduroga. Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va 01. Gatra peetata + - + 09. Amlodgara + - - 02. Haritabha + - + 10. Daurbalya + - - 03. Murcha + - + 11. Peeta mutrata + + - 04. Jwara + + + 12. Shosha + - - 05. Daha + - + 13. Peeta vitkata + + - 06. Trishna + - + 14. Bhinna Varchas + - - 07. Sheetakamata + - + 15. Katukasyata + - + 08. Sweda + - + 16. Tama + - +Kaphaja Panduroga lakshana 37Table No. 17. Showing the Samanya lakshanas of Kaphaja Panduroga. Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va 01. Shwetavabhasata + - + 11. Shwayathu + - - 02. Shuklakshita - + + 12. Shukla mutra + + - 03. Shukla nakha - + + 13. Shukla mala + + - 04. Shukla ananatwa - + + 14 Tandra + - + 05. Gaurava + + - 15 Chhardi + - + 06. Sadana - - - 16 Praseka + - - 07. Murchha + - - 17 Lomaharsha + - + 08. Bhrama + - - 18 Klama + - - 09. Shwasa + - - 19 Kasa + - - 10. Alasya + - - 20 Aruchi + - - 34 Disease Review
  • 49. Tridoshasja Panduroga lakshana Vitiation of all the doshas causes severe degree of dhatushaithilya and dhatu gauravata leading to dhatu and Oja kshaya. The features of sannipataja pandu are explained only in Hareeta samhita. All other authors have stated that it manifests due to the vitiation of all the doshas and considered as asadhya type of Panduroga. Hareeta Samhita38 01. Tandra 06. Hrillasa 11. Moha 02. Alasya 07. Shosha 12. Trishna 03. Shotha 08. Vitbheda 13. Klama 04. Vamana 09. Jwara 05. Kasa 10. Kshudartata As per the opinion of Brihattrayee’s the lakshanas of Vataja, Pittaja and KaphajaPanduroga were seen severely in Tridoshaja Panduroga depending on their degree ofvitiation.39Mridbhakshanajanya Pandu – Acharya charaka40 and Vagbhata41 have explained Mridbhakshanajanya pandu.Further, Madhavakara, Yogaratnakara and Bhavaprakashakar have also followed theCharaka’s version.42 But Sushruta has not considered it separately. Here Mridbhakshanais considered as a Nidana for Panduroga rather than an individual type. The person who is addicted to consuming Mrid like Kashaya, Ushara(Ksharanurasa), Madhura rasa will vitiates Vata, Pitta and Kapha dosha respectively. TheMrid moreover, produces srotovarodha without undergoing pachana leading to Indriyabalahani and Teja, Veerya and Ojas kshaya. Thus manifesting Panduroga, which cancause Bala, Varna and Agni nasha. 35 Disease Review
  • 50. Mridbhakshanajanya Panduroga lakshanaTable No. 18. Showing the Samanya lakshanas of Mridbhakshanajanya Panduroga. Sl. Lakshana Ch Va MN BP Yo 01. Shoonaganda + - + + + 02. Shoonakshikoota + - + + + 03. Shoona bhru + - + + + 04. Shoona pada + + + + + 05. Shoona nabhi + + + + + 06. Shoona mehana + + + + + 07. Krimikoshta + - + + + 08. Atisara + + + + + 09. Sasrik Mala Pravritti + + + + + 10. Kaphayukta malapravritti + + + + +SAMPRAPTI The causes of Panduroga that are explained under the heading of Nidana leads tovitiation of Tridosha but however, pitta is dominating dosha irrespective of type ofPandu. Acharya Charaka and Vagbhata mention the detailed Samprapti of Panduroga.The intake of pitta pradhana ahara in excess, pitta situated in hridaya aggravates, it ispropelled by aggravated (balina) vayu through dashadhamani that spreads all over thebody. The vitiated pitta affects in between twak and mamsa leads to vitiation of twak,mamsa, vata, asrik, thereby produces various varna like Pandu, Haridra and Hareeta, dueto Panduvarna pradhanata it is called as “Panduroga”. 43,44 According to acharya Sushruta, indulgence of Nidana leads rakta pradushana thatcauses vitiation in Twak causes the Pandubhava therefore it is called as “Panduroga”.45 36 Disease Review
  • 51. Samprapti of PandurogaDhatu Dourbalya Nidana Sevana AgnidushtiPradushya Raktam Prakopa of Pitta pradhana doshas Agnimandya Hridaya Samvasthita Amavisha Utpatti Vimarga gamana of pitta by vitiated by vayu Twak Mamsantarashrita. Kapha, Vata, Rakta, Twak, Mamsa dushti. Rakta kshaya Bala, varna, oja kshaya. Vaivarnya P a n d u r o g a 37 Disease Revuew
  • 52. UPADRAVA If the patient continues to indulge in ahara and vihara, which are said to be theNidana of Panduroga– the doshas get further aggravation and thus produces upadrava.Only Sushruta has mentioned complication of Panduroga.46. Viz, Aruchi Pipasa Jwara Chhardi Shiro ruja Agnisada Shopha Abalatwa Murchha Klama Hridaya peedana Swarabheda DahaSADHYASADHYATA47 For the prognosis of Panduroga authors have mentioned asadhya Pandurogalakshanas are as follows – Panduroga of long duration with excessive rukshata is not treatable. If the patient has developed shotha after long duration and is having vision of objects in yellow is not treatable. If the patient passes Baddha and Alpamala with kapha and Hareeta varna is not curable. If the patient suffering from Atisara. If the patient is deena, Shwetangayukta (Shwetavarna leepatanga). If the patient is suffering from Chhardi, Moorchha, Trishna. If the patient is having Panduvarna of Danta, Nakha and Netra. Whose anta bhaga i.e, 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. 38 Disease Review
  • 53. CHIKITSA SUTRA The first line of treatment in Panduroga is snehana followed with samshodhana bymeans of teekshna vamana and virechana. After kostha shuddhi the patient shoud beadopted with pathya ahara and vihara.48 According to acharya Sushruta the Chikitsa sutra for Panduroga is snehanafollowed by vamana and virechana. For this acharya Dalhana opines that thoughUrdhwashodhana (vamana) is contra-indicated, Mrudu vamana can be administered inaccordance with Ritu, Desha, Prakruti, Kaala, Shareera.49 Snehairupakramya snigdamatva virechayet | First snehana should be specified with indicated snehas and there after virechanashould be followed.50 For Mrutbhakshanajanya Pandu the line of treatment is précised as Teekshnashodhana in accordance with balabala, followed by snehapana to restore the strength.51 Dosha vishesha Chikitsa in Panduroga52 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. 39 Disease Review
  • 54. SHAMANAUSHADHIS In Pandurogadhikara a variety of Ghrita, Churna, Vati, Kashaya, Avaleha,Asavaarishta Bhasma and other single drug preparations are described for themanagement of all types of Panduroga. Ghrita: Panchagavya ghrita, Kalyanaka ghrita, Mahatiktaka ghrita, Dadimaghrita, Katukadya ghrita, Pathya ghrita, Danti ghrita, Draksha ghrita, Haridradi ghrita,and Vyoshadi ghrita. Churna: Navayasa churna, Tapyadi churna, Trivyushanadi churna, Triphalachurna, and Shunthi churna. Vati: Mandura vataka, Punarnava mandura, Bibitakadi vataka, and Shilajatuvataka. Kashaya: Negrodadivarga kashaya, Triphala kashaya, Vishaladi phanta, Guduchikashaya. 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. 40 Disease Review
  • 55. PATHYAPATHYA53 Pathya Generally for Pana and Bhojana Shali, Yavagu, Yusha, Godhuma, Madya,Mamsarasa, Dugdha, Ghrita, Patola, Shaka, Draksha, Dadima, Kharjura, Amalaki andIkshurasa should be adviced.Specially, for – Vata - Laghupanchamula siddha Jala. Pitta - Hribera, Shunthi sadhita ghrita. Kapha - Arishta, Sidhu, Asava. Tridosha - Takra. Apathya Agni, Aatapa, Aayasa, Pittakaraka annapana, Maithuna, Krodha, Adwa and otherfactors, which are said to be the causes for Panduroga, should be avoided. 41 Disease Review
  • 56. ANAEMIA1,2 Anaemia can be defined as a haemoglobin concentration in blood below thenormal 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 is termed as “Anaemia.”The haemoglobin content of the erythrocytes determines the oxygen carrying capacity.Hence, a reduction in the blood haemoglobin level and in the number of circulatingerythrocytes are 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, the red cell count, haematocrit (PCV) and absolute values of MCV, MCH, andMCHC provide alternate means of assessing Anaemia.Patho-physiology of Anaemia Subnormal level of haemoglobin causes lowered oxygen carrying capacity of theblood. This in turn initiates compensatory physiologic adaptations such as – 01. Increased release of oxygen from haemoglobin. 02. Increased blood flow to the tissues. 03. Maintenance of the blood volume. 04. 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. 42 Disease Review
  • 57. Clinical features of Anaemia The haemoglobin level at which symptoms and signs of anaemia develop dependsupon 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.Symptoms In symptomatic cases of Anaemia, the presenting features are tiredness, easyfatiguability, generealised muscular weakness, lethargy and headache. In older patientsthere may be symptoms of cardiac failure, angina pectoris, intermittent claudication,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 hyperdynamic circulation may be present with tachycardia, collapsing pulse, cardiomegaly, midsystolic flow murmur, dyspnoea on exertion and in case of elderly congestive heart failure. 43 Disease Review
  • 58. 03. Central nervous system – The older patients may develop symptoms like attacks of faintness, giddiness, headache, Tinnitus, drowsiness, numbness and tingling sensation of the hands and feet. 04. Occular manifestations – Retenal haemorrhages may occur if there is associated vascular disease or bleeding diathesis. 05. Reproductive system – Menstrual distribances such as amenorrhoea 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 of the Anaemia subject After obtaining the full medical history pertaining to different general and specificsigns and symptoms in order to confirm the presence of anaemia its type and its cause thefollowing 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 soultionj 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. 44 Disease Review
  • 59. B. Peripheral blood film estimation – The haemoglobin estimation in invariably followed by examination of peripheral blood film for morphologic features after staining it with Romanowsky dyes (Leishman’s Staining). The following abnormalities we can look for in the smear study. a. Variation in size – Microcytosis (Iron deficiency anaemia) Macrocytosis (Megaloblastic Anaemia) Dimophic b. Variation in shape – Poikilocytes. c. Inadequate haemoglobin formulation – Hypochromasia. d. Compensatory erythropoiesis e. Miscellaneous changesC. 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 haemolytic 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 haemorrhage and in haemolysis, the reticulocyte response is indicative of impaired marrow function. 45 Disease Review
  • 60. 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.Classification of Anaemia A. Pathophysiologic I. Anaemia due to impaired red cell production. a. Acute post-haemorrhagic Anaemia. b. Chronic blood loss. II. Anaemia due to impaired red cell production. a. Cytoplasmic maturation defects – i. Deficient haem synthesis – Iron deficiency anaemia. ii. Deficient globin synthesis – Thalassaemic syndromes. b. Nuclear maturation defects – Vitamin B12 or folic acid deficiency and Megaloblastic Anaemia. c. Defect in stem cell proliferation and differentiation – i. Aplastic Anaemia. ii. Pure red cell aplasia. d. Anaemia of chronic disorders. e. Bone marrow infiltration. f. Congenital Anaemia. III. Anaemia due to increased red cell destruction (Haemolytic Anaemia) 46 Disease Review
  • 61. B. 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. The factors responsiblefor iron deficiency in different populations are variable and are best understood in thecontext of normal iron metabolism.Iron metabolism The amount of iron obtained form the diet should replace the losses form skin,bowel and genitourinary tract. These losses together are about 1 mg daily in an adult maleor in non-menstruating female. While in menstruating woman there is an additional ironloss of 0.5-1 mg daily. The iron loss required for haemoglobin synthesis is derived form two primarysources –01. Ingestion of foods containing iron (e.g. Leafy vegetables, Beans, Meats, Liver, etc.)02. Recycling of iron form senescent red cells.Absorption 01. The average western diet contains 10-15 mg of iron out of which only 5-10% is normally absorbed. 02. In pregnancy and in iron deficiency, the proportion of absorption is raised to 20- 30%. 47 Disease Review
  • 62. 03. The iron is absorbed mainly in the duodenum and proximal jejunum. 04. Iron from diet containing haem is better absorbed than non-haem iron. 05. Absorption of non-haem is enhanced by factors such as ascorbic acid (Vitamin C), Citric acids, Sugar, Gastric secretions and Hydrochloric acid. 06. Iron absorption is impaired by factors like medicinal antacids, milk, pancreatic secretions, phytates, phosphates, ethylene diamine tetra acetic acid (EDTA) and tannates contained in tea. 07. Non-haem iron is released as ferrous or ferric form but is absorbed exclusively as ferrous form. The iron balance in the body is maintained largely by regulating the absorptive intake by intestinal mucosal cells, so called Mucosal block. 08. The factors, which determine this mucosal intelligence, are unknown. When the demand for iron is increased there is increased iron absorption, while excessive body stores of iron causes reduced intestinal iron absorption.Distribution In an adult iron is distributed in the body as under – 01. Haemoglobin – Present in the red cells, contains most of the body iron (65%). 02. Myoglobin – Comprises a small amount of iron in the muscles (35%). 03. Haem and Non-haem enzymes – eg. Cytochrome, Cutalase, peroxidase, succinic dehydrogenase and falvoproteins constitute a fraction of total body iron (0.05%). 04. Transferrin bound iron – Circulates in the plasma and constitutes another fraction of total body iron (0.5%). All these forms of iron are in functional forms. 05. Ferritin and haemosiderin – These are the storage forms of excess iron (30%). Thus, are stored in the mononuclear phagocytic cells of the spleen, liver and bone marrow and in the parenchymal cells of the liver. 48 Disease Review
  • 63. Iron transport and utilization After absorption, iron circulates in the blood bound to beta globulin fraction,siderophilin or transferrin. Transferrin is present almost exclusively in the plasma andextra vascular space and serves to transport iron from the site of absorption and storage tothe areas of its utilization. The liver parenchymal cells are the major site of transferrinsynthesis. The labile iron pool (mainly ferritin) is that part of the body iron which is readilyavailable for utilization of haemoglobin synthesis. Iron quickly enters this pool 01. After absorption form the intestines 02. After release form the RBC breakdown 03. Following parental injections. If the amount entering this labile pool is in excess of needs, then it is transferredinto storage pool. The daily iron turnover has been estimated to be approximately 35 mg. The major contribution to this 21 mg comes form the normal red cellsdestruction. About 3 million red cells are destroyed every second. Iron released formdestroyed red cells is thus reutilized. About 11 mg of iron is contributed by that fraction which is not used forhaemoglobin production during its stay in the marrow. While remaining 2-3 mg comesform the storage sites, intestinal absorption and the extra cellular fluid. Form these 35 mg of iron about 32 mg, enters the erthropoietic labile pool, apoorly defined compartment, primarily in the bone, for erythropoiesis. Approximately1mg of iron goes for storage and into extra cellular fluid each and about 1 mg is excreted,mainly in urine and sweat. 49 Disease Review
  • 64. 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 so that state of the following factors – 01. Increased blood loss. 02. Increased requirements. 03. Inadequate dietary intake. 04. Decreased intestinal absorption.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, haemorrhoids, hook worm infestation, cancer of stomach and large bowel oeasophages 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. 50 Disease Review
  • 65. 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 malabsorption such as in coeliac disease.Clinical features Initially, there are usually no clinical abnormalities. But subsequently, inadditionto features of undergoing disorders causing anaemia, the clinical consequences of irondeficiency manifest in two ways – Anaemia itself and Epithelial tissue changes. 01. Anaemia – The onset of iron deficiency anaemia is generally slow. The usual symptoms are of weakness, fatigue, dyspnoea on exertion, palpitations and pallor of the skin. Mucous membranes and sclerae. 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 epithelial tissue causes epithelial tissue changes in some patients. The changes occur in nails (Koilonychia or spoon shaped nails), tongue (Atrophic glossitis), mouth (Angular stomatitis) and oesophagus causing dysphagia form development of thin webs at the postericoid area (Pulmmer – Vinson Syndrome). 51 Disease Review
  • 66. Treatment The management of iron deficiency anaemia consist of 2 essential principles – 01. Correction of disorder causing the anaemia – The underlying cause of iron deficiency is established after thorough 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, but side effects occurs like nausea, abdominal discomfort, diarrhoea. b. Parental therapy – This therapy is indicated in cases who are intolerant to oral iron therapy, in GIT disorders such as malabsorption. This is hazardous and expensive when compared with oral administration. Total dose is calculated by a simple formula multiplying the grams of haemoglobin below normal with 250 mg of elemental iron is required for each gram of deficit haemoglobin. The adverse effects include hypersensitivity reactions, haemolysis, hypertension, circulatory collapse, and vomiting and muscle pain. 52 Disease Review
  • 67. SHAREERAStomach1 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.Regulation of Gastric phase – The CNS, regulated by the short reflexes coordinated in the wall of stomach andregulated by the digestive tract hormones can control the production of acids andenzymes by the gastric mucous.01. The cephahlic phase – Function – Prepare stomach for arrival of food. Duration – short. (minutes) Mechanism – Neural via preganglionic fibers in vagus nerve and synapse insubmucosal plexus (by seeing, smell, taste or thoughts of food) Actions – Primary – Increased volume of gastric juice by stimulatingmucous, enzyme and acid production. Secondary – Stimulation of gastrin release by G cells. 53 Shareera
  • 68. 02. Gastric phase – Enhance secretion started in cephalic phase, homogenizes and acidify the chyme.It initiates the digestion of proteins by pepsin. Duration of the phase is long i.e. 3-4 hours. Mechanism – Neural – Short reflexes triggered by stimulation of stretch receptors as stomach fills. There is also stimulation of chemo-receptors as PH increases. Hormonal – Stimulation of gastrin release by G cells byparasympathetic activity and presence of peptide and amino acids in chyme. Also therelease of histamine by mast cells as stomach fills. As a result there is an increased acidand pepsinogen production, increased motility and initiation of mixing waves. Themixing waves occur several times per minute and they gradually increase in intensity.After an hour, the material with in the stomach is churning like the clothing in thewashing machine.03. Intestinal phase – The main function of this phase is controlled rate of chyme entry into duodenum.The duration of this process is long. i.e. hours. Mechanism – Neural – short reflexes (entero-gastric reflex) triggered by the extension of duodenum. Hormonal – Primary – Stimulation of CCK, GIP, and secretin release by presence of acid, carbohydrate and lipids. 54 Shareera
  • 69. Secondary – Release of gastrin stimulated by presence of undigested proteins andpeptides and finally there is feed back inhibition of gastric acid and pepsinogenproduction, reduction of gastric motility. The intestinal phase of gastric secretion begins when chyme starts to enter thesmall intestine. The intestinal face generally starts after several hours of mixingcontractions, when the wave of contraction begins sweeping down the length of thestomach. Each time the pylorus contracts, a small quantity of chyme squits through thepyloric sphincter. The purpose of intestinal phase is to control the rate of gastricemptying and ensure that the secretary, digestive functions of the small intestine canproceed with reasonable efficacy. The arrival of chyme in the small intestine also triggersother neural and hormonal events that co-ordinate the activities of intestinal tract,pancreas, liver, and gall bladder.Small Intestine2 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. 55 Shareera
  • 70. 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. The stimulation of the parasympathetic system increases the sensitivity of thesemesenteric reflexes and accelerates both local peristalsis and segmentation. Moreelaborate reflexes coordinate activities along the entire length of small intestine. Tworeflexes are triggered by the stimulation of the stretch receptors in the stomach as it fills.The gastro-enteric reflexes stimulates motility and secretion along the entire length of thesmall intestine, the gastro-ilial reflex triggers the relaxation of the iliocecal valve. The netresult is that, the materials pass form small intestine to the large intestine. Thus thegastro-enteric and the gastro-ilial reflexes accelerate movements along with smallintestine, the opposite effect of the entero-gastric reflex. Hormones released by thedigestive tract can enhance or suppress reflex responses. 56 Shareera
  • 71. Large Intestine3 The horseshoe shaped large intestine begins at the end of the ilium and ends at theanus. The large intestine lies inferior to the stomach and liver and almost completelyframes the small intestine. The major functions are – 01.Absorption of water and compactness of intestinal contents into faeces. 02. Absorption of important vitamins liberated by the bacterial action. 03. Storing of fecal material before defecation. It has the following parts – 01. Caecum 02. Colon 03. RectumMovements of large intestine The gastro-ilial and gastro-enteric reflexes move materials into the caecum atmealtime. Movement from the caecum to the transverse colon occurs very slowly,allowing hours for water absorption to convert the already thick material into a sludgypaste. Peristaltic waves move material along the length of colon. Movements from thetransverse colon through the rest of the large intestine results form powerful peristalticcontractions called “Mass movements” which occur a few times each day. The stimulus is distention of the stomach and the duodenum and the commandsare relayed over the intestinal nerve plexus. The contractions force the fecal materialsinto the rectum and produce the conscious urge to defecate. 57 Shareera
  • 72. Defecation The rectal chamber is usually empty except when one of those powerful peristalticcontractions forces fecal material out of the sigmoid colon. Distention of the rectal wallthen triggers the defecation reflex. The defecation reflex involves two positive feed back loops both are triggered bystretch receptor stimulation in the walls of the rectum. The first loop is a shorter reflexthat triggers a series of peristaltic contractions in the rectum that moves the feces towardsthe anus. The second loop is a long reflex coordinated by the sacral parasympatheticsystem. This reflex stimulates mass movements that push the fecal material to the rectumfrom the descending colon and the sigmoid colon. Rectal stretch receptors also trigger two reflexes important to the voluntarycontrol of defecation. 01. Visceral reflex – Mediated by the parasympathetic innervations with in the pelvic nerves. Thisreflex causes the relaxation of the internal anal sphincter, a smooth muscle sphincter thatcontrols the movements of the feces into the anorectal canal. 02. Somatic reflex – That stimulates the immediate contraction of the external anal sphincter. Theelimination of the feces requires that both the internal and external anal sphincter to berelaxed, but these reflexes open the internal sphincter and close the external sphincter.The urge to defecate usually develops when rectal pressure reaches about 15 mm of Hg.When it exceeds 55 mm of Hg external sphincter will relax and the defecation occurs. 58 Shareera
  • 73. When we consider the pathogenesis of Panduroga, we must think of Rasavahasrotas, Raktavaha srotas and twacha which shows the characteristics of this disease i.e.“Panduta”Rasavaha Srotas The rasavaha srotas is the first dhatu to be developed form ahararasa and itnourishes all tissues of the body. Therefore, there is no space in the body, which rasacannot pervade. The ahararasa is produced in annavaha srotas from the completelydigested food and absorbed through the wall of the annavaha srotas. All nutrients jointogether in hridaya (Thorasic heart) qualifying it as rasadhatu and it is the same organwhich 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.4 According to Sushruta,hridaya and rasavahini dhamanis are the moolas.5 Hridaya is stated as the seat of raktaand other fluids which are capable of circulation in the body.6 Since, the preenana and jeevana kriyas are esenetial 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.7 Therefore, hridaya andrasavahini dhamanee’s should be considered as the moolas of rasavaha srotases. 59 Shareera
  • 74. Raktavaha srotas In the process of the dhatu parnamana, raktadhatu is stated to be developed formrasadhatu.8 There are three pittas which participate in the formation of raktadhatu. Viz. – 01. Rasagni. 02. Raktagni 03. Ranjakagni 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 theraktajeevaparamanus is the function of Ranjaka pitta. According to Sushruta, the ranjakapitta is located in yakrit and pleeha.9 Vegbhataconsidered amashaya is the seat of ranjakapitta.10 The above is only rough idea about the production of rakta as explained in ourtext and this formation indicates that the raktadhatu is produced in yakrit and pleeha.Here it is essential to look into the modern science regarding the production of red bloodcells. 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 humeri and tibial, 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. 60 Shareera
  • 75. 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).11 Sushruta bestows importance of rakta equal to the three humours, that the body issupported or maintained by the rakta.12 The most important function of rakta isjeevanakriya i.e. sustains life.13 The word “Prananuvartam” also indicates that it carriesvishishta vayu “Prana”. In panduroga (Anaemia) where there is deficient production of raktadhatu is themain pathological event, all authorities of Ayurveda have invariably prescribed theformulation containing iron. Thereby recognizing the importance of iron in theproduction of raktadhatu. When iron is absorbed form the small intestines, it immediatelycombines with a beta globulin to form transferrin and transported in the blood plasma.About 60% of excess iron is stored in the liver cells, to be released whenever necessary tothe body. There are a few components of vitamin B, which are needed for the formation ofred blood cells. Cyanocobalamin (Vit.B12) is required for the maturation of the red bloodcells. The most common cause of maturation failure is not due to due lack of Vit.B12 inthe diet but failure to absorb Vit.B12 form gastrointestinal tract. The intrinsic factors,which are secreted by the parietal cells of the gastric glands (Amashaya) combines withVit. B12 of the food and makes this vitamin available for absorption. Once Vit. B12 isabsorbed form the gastrointestinal tract, it is stored in large quantities in the liver and thenreleased slowly as needed to the bone marrow. The folic acid also stated in liverresponsible maturation of red blood cells. Even liver can acts as major blood reservoir. Itcan store 200 to 400 ml of blood. 61 Shareera
  • 76. 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.14 Sushrutaadded raktavaha dhamanis.15 Charaka has clearly stated that hridaya (Thoracic heart) andthe ten dhamanees also are to be taken as raktasthana.16 Therefore these also to beconsidered as moola of raktavaha srotas. Since rakta is ashraya for pitta, vitiation of pitta may lead to the vitiation of rakta.The causes of the disease where in the impairment of both functional and structuralintegrity of raktavahasrotas is noticed.Red blood cell formation [Erythropoiesis]17 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.Stages in RBC Maturation During its maturation a red blood cell passes through a series of stages Division of hemocytoblast in bone marrow produce 62 Shareera
  • 77. 1) Myeloid stem cells, which in turn divide to produce red blood cells and several classes of white blood cells and 2) Lymphoid stem cells, which divides to produce the various classes of lymphocytes. The cells destined to become RBCs first differentiate into Proerythroblasts (Day 1) Erythroblasts Basophilic ethroblast (Day 2) Polychromatophilic ethroblast (Day 3) Orthochromatophilic ethroblast (Day 4) Ejection of Nucleus Reticulocyte (Day 5-7) Enters the circulation Mature red blood cell After roughly 4 days of differentiation, the erythroblast, now called a normoblast,sheds its nucleus and becomes a reticulocyte. A reticulocyte contains 80 percent 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. 63 Shareera
  • 78. 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.18a 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.18b The twacha is havingseven layers. At present disease concern the first two layers can be taken intoconsideration.Avabhasini19 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.Lohita20 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.Haemoglobin21 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. 64 Shareera
  • 79. 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. The iron oxygen molecule interactionis very weak; the two can easily be separated with out damaging the heme unit or theoxygen molecule. The binding of an oxygen molecule to the iron in a heme unit istherefore completely reversible.Hemoglobin function There are approximately 280 million Hb molecules in each red blood cell.Because a Hb molecule contains four heme units, each erythrocyte can potentially carrymore 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. Normal activity levels can be sustained only when tissue oxygen levels are keptwith in normal limit. If hematocrit is low or the hemoglobin content of RBCs is reduced,the condition of “Anemia” exists. Anemia produces clinical symptoms because itinterferes with oxygen delivery to peripheral tissues. Every system is affected as organfunction deteriorates due to oxygen starvation. 65 Shareera
  • 80. Functions of Rakta 22 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 modern23 ♦ 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 trough damaged vessels or at other injury sites. ♦ Defense against toxins and pathogens. ♦ Stabilization of body temperature.Shuddha Rakta alakshanas24 The following colours indicate pure blood – 01. Shuddha suvarna 02. Indragopa 03. Looks like padma and Alaktaka. 04. Gunjapahala savarnam.Shuddha rakta purusha lakshanas25 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, Mutra visarjana. 05. Sukhanuvita. 06. Pushti and Bala. 66 Shareera
  • 81. Composition of Blood26 Blood is a highly complex fluid, which is composed of two parts - a liquied,called the plasma and different types of cells that remain suspended in plasma. Thewcells 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 follow. A. Cells – 1) Red blood corpuscles or erythrocytes (RBC) 2) White blood corpuscles or leucocytes (WBC) 3) Platelets or thrombocytes B. Plasma – 1) Water 91 to 92% 2) Solids 8-9 % Inorganic constituents 0.9% (Sodium, Potassium, Calcium, Magnesium,Phosphorus, Iron, Copper). It contains some organic constituents like – i. Proteins 7.5% (Serum albumin, Serum globulin Fibrinogen, Prothrombin) ii. Non-protein Nitrogenous substance [NPN](Urea, Uric acid, Xanthene, Hypoxanthine, Creatine, Creatinin, Ammonia, amino acids) iii. Fats (Natural fats, phaspholipid, cholesterol, choletrides) iv. Carbohydrate (Glucose) v. Other substances (Internal secretions antibodies and various enzymes) vi. Colouring matter (The yellow colour of the plasma is due to small amounts of bilirubin, carotene and xanthophylin). 67 Shareera
  • 82. DRUG REVIEW After describing the details regarding various aspects of virechana karma andPanduroga, it is necessary to go through the details of treatment adopted in the presentstudy. The treatment adopted is virechana karma and prior to Virechana karma thepatient is advised for Deepana Pachana depending on the condition (Amaavastha), laterthe Snehapana in arohana vidhi is given. Later Abyanga and mridu Swedana is adopted.For this purpose the following yogas are used. 01. Deepana-pachana – Trikatu churna.1 02. Snehapana – Dadimadi ghrita.2 03. Abhyanga and Swedana – Moorchhita tila taila3 and Ushna jala snana. 4 04. Virechana – Vyoshadi Gutika.5 The drugs used to prepare the above yoga along with the properties are givenbelow. 68 Methodology
  • 83. Table No. 19. Properties of ingredients of Trikatu churna.Sl Sanskrit Latin Family Rasa Guna Veerya Vipaka Doshaghanata KarmaNo. Name name01. Shunthi6 Zingiber Zingiberacease Katu Laghu, Ushna Madhura Vata and Agnideepana, Pachana, officinale Snigdha Kpaha Bhedana, Vatanulomana02. Maricha7 Piper Piperaceae Katu Ruksha, Ushna Katu Kapha and Deepaka, Pachaka, nigrum Teekshna Vata Krimighna, Uttejala, Vatanulomaka03. Pippali8 Piper Piperaceae Katu Snigdha, Anushna Madhura Vata and Deepaka, Pachaka, longum Lahgu Kapha Vatanulomana, Vrishya, KrimighnaTable No. 20. Properties of ingredients of Tila taila. Sl Sanskrit Latin Family Rasa Guna Veerya Vipaka Doshaghanata KarmaNo. Name name01. Tila12 Sesamum Pedaliaceae Katu, Snigdha, Ushna Katu Pitta and Agnideepana, Pachana, indicum Tikta, Guru, vata Srotoshodhana, Madhura, Grahi Vatanulomana, Mutrajanana, Kashaya Balya, Keshya, Vrinaropaka
  • 84. Table No. 21. Properties of ingredients of Dadima Ghrita.Sl Sanskrit Latin Family Rasa Guna Veerya Vipaka Doshaghanata KarmaNo. Name name01. Dadima9 Punica Puricaceae Madhura, Laghu, Anushna Madhura Tridosha Rochaka, granatum Kashaya Guru, Raktashodhaka, Snighda Hridya, Grahi02. Dhanyaka10 Coriandrum Umbelliferae Kashaya, Snigdha, Ushna Madhura Tridosha Deepaka, sativum Tikta, Laghu Pachaka, Katu Vatanulomaka, Rochaka, Krimighna, Dahashamaka03. Chitraka11 Plumbago Plumbaginaceae Katu Laghu, Ushna Katu Tridosha Deepaka, zeylanica Ruksha Pachaka, Grahi, Uttejaka.04. Shunthi Zingiber Zingiberacease Katu Laghu, Ushna Madhura Vata and Agnideepana, officinale Snigdha Kpaha Pachana, Bhedana, Vatanulomana05. Pippali Piper Piperaceae Katu Snigdha, Anushna Madhura Vata & Kapha Deepaka, longum Lahgu Pachaka, Vatanulomana, Vrishya, Krimighna
  • 85. Table No. 22. Properties of ingredients of Vyoshadi Gutika.Sl. Sanskrit Latin name Family Rasa Guna Veerya Vipaka Doshaghanata KarmaNo Name01. Shunthi Zingiber Zingiberacease Katu Laghu, Ushna Madhura Vata and Agnideepana, officinale Snigdha Kpaha Pachana, Bhedana, Vatanulomana02. Maricha Piper nigrum Piperaceae Katu Ruksha, Ushna Katu Kapha and Deepaka, Teekshna Vata Pachaka, Krimighna, Uttejala, Vatanulomaka03. Pippali Piper longum Piperaceae Katu Snigdha, Anushna Madhura Vata and Deepaka, Lahgu Kapha Pachaka, Vatanulomana, Vrishya, Krimighna04. Twak13 Cinnamomum Lauraceae Tikta, Laghu, Ushna Katu Vata and Deepana, zeylanicum Madhura Ruksha, Pitta Pachana, Teekshna Vatanulomana, Uttejaka, Krimighna.05. Musta14 Cyprus Cyperaceae Katu, Laghu, Sheeta Katu Kapah and Deepana, rotendus Tikta, Ruksha Pitta Pachana, Kashaya Swedajanaka, Krimighna.06. Patra15 Cinnamomu Lauraceae Madhura, Alpa Ushna Katu Kapha and Deepana, tamala Tikta Teekshna, Vata Pachana, Picchila, Vatanulomana, Laghu Uttejaka, Mutrala.07. Ela16 Elettaric Zingiberaceae Katu, Laghu, Sheeta Madhura Vata Deepana, Cardamomum Madhura Ruksha Pachana, Rochaka, Mutrala, Uttejaka, Krimighna, Raktashodhaka
  • 86. 08. Vidanga17 Emblica ribes Myrsinaceae Katu, Teekshna, Ushna Katu Kapha and Deepana, Kashaya Ruksha vata Pachana, Vatanulomana, Raktashodhaka, Krimighna.09. Haritaki18 Terminalia Combretaceae Lavana Ruksha, Ushna Madhura Tridosha Deepana, chebula avrjhit Laghu Rasayana, pancharasa Medhya, Anulomaka.10. Amalaki19 Emblica Euphorbiaceae Pancharasa Mrudu, Sheeta Madhura Tridosha Deepana, officinalis Lavana Ruksha, Pachana, varjit Sheeta Rasayana, Yakrit Uttejaka,11. Danti20 Baliospermum Euphorbiaceae Katu Teekshna, Ushna Katu Kapha and Rechaka, montanum Guru Pitta Shothaghna, Raktashodhaka12. Trivirt21 Operculina _ Madhura, Ruksha, Ushna Katu Tridosha Rechaka, terpenthelum Tikta, Laghu, Bhedana, Katu Teekshna Sukhavirechaka13. Sharkara22 Madhura Sheetala Madhura Madhura Vata and Dahashamaka, Pitta Rakta _ _ viakraghna, Ruchya, Jwaraghna14. Madhu23 Madhura, Laghu, kapha Deepaka, Kashaya Ruksha, Lekhana, _ _ Sukshma, _ _ Srotoshadhaka, Vishada, Varnya, Sheeta Yogavahi, Rakta shodhaka
  • 87. Chemical composition of Virechana drugs 01. Pippali – Peper longum. 29 Part Used – Immature berries (i.e. dried unripe fruits or fruiting spikes) dried inthe sun and stem (roots). Chemical constituent – Resin, volatile oil, starch, gum, fatty oil, inorganic matterand an alkaloids piperine 1-2 p.c. Action – Infusion is stimulant, carminative and alternative tonic more powerfulthan black pepper, also aphrodisiac, diuretic, vermifuge and emmenagogue. Root isstimulant. 02. Maricha – Piper negrum. 30 Part used – Dried unripe fruit – Black pepper. Constituent – A volatile alkaloid piperine 5-9 p.c piperidine 5 p.c. a balsamicvolatile essential oil 1-2 pc fat 7 pc, monsocarp contains chavicin, a balsamic volatile oil,starch, ligin, gum, fat 1 pc protcids 7 pc and ash containing organic matter 5 pc. Action – Black pepper is acrid, pungent, hot, carminative also used asantiperiodic. On the mucous membrane of urethra it acts like cubebs; piperine is mildantipyretic and antiperiodic. 03. Shunti – Zingiber officinale. 31 Part used – Scraped and dried rhizomes as well as the green ones. Constituents – Indian ginger contains an aromatic volatile oil 1 to 5 pc of lightyellow colour having a characteristic odour and containing camphene, phellandrene,zingiberine, cineol and berneol, gingerol a yellow pungent body is an oleoresin“Gingerin” the active principle, other resins and starch. Action – Aromatic, carminative, stimulant to the gastrointestinal tract andstomachic also sialagogue and digestive. 73 Methodology
  • 88. 04. Twak – Cinnamomum zeylanicum. 32 Part used – Dried inner bark of the shoots form trancated stalks (Cinnamomicortex) and essential oil (Oleum cinnamomi B.P.) Constituents – Volatile oil 2 pc Oleum cinnamomum B P is distilled form thecortex and consists chiefly of cinnamic aldehyde oxidizing into resin and cinnamic acid. Action – Bark is carminative, antispasmodic, aromatic, stimulant haemostatic,astringent, antiseptic, stomachic and germicide. 05. Musta – Cyprus rotundus. 33 Part used – Tuber or bulbous root. Constituents – Fat, sugar, gum, carbohydrates, essential oil, albuminous matter,starch, fiber and ash. There are traces of an alkaloid. Action – Stimulant, tonic, demulcent, diuretic, antihelminthis, stomachic,carminative, diaphoretic, astringent and vermifuge. 06. Patra – Cinnamomum tamala. 34 Part used – Leaves, bark and oil. Constituents – The leaves contain an essential oil, eugenol, terpene, and cinnamicaldehydes. Action – Carminative, stimulant, diuretic, diaphoretic, deobstruent andlactogogue. 07. Ela – Elettaria cardamomum. 35 Part used – Dried ripe seeds, oil form fruits. Constituents – Fixed oil, essential oil, volatile oil, volatile oil of the seeds theactive principle 4-8 pc and contains a considerable amount of terpinyl acetate. Action – Powerful aromatic, stimulant, carminative, stomachic and diuretic.These properties are due to the essential oil contained in the seeds. 74 Methodology
  • 89. 08. Vidanga – Embelia ribes. 36 Parts used – Berries (fruit), leaves and root bark. Constituents – Embelic acid a volatile and fixed oil, tannin, christembine. Action – Carminative, anthelmintic, stimulant and alternative pulp is purgative. 09. Haritaki – Terminalia chebula. 37 Parts used – Dried fruits. Constituents – Myrobalans cantina astringent principles tannin 45 pc and largeamount of gallic acid. Action – Myrobalans are a safe and effective purgative astringent and alternative. 10. Amalaki – Emblica officinalis. 38 Part used – Dried fruit. Constituents – Fruits contain tannin acid, albumin, cellulose, calcium, etc. Itcontains Vit. C in large amount. Also contains protein, carbohydrates, red phosphorus,iron and nicotinic acids. Action – Fresh fruit is refrigerant, diuretic and laxative. Dried fruit is sour andastringent. 11. Danti – Baliospermum montanum. 39 Part used – Leaves, seeds and root. Constituents – Root contains resin and starch. Action – Seeds are employed as diuretic purgative. Root is purgative. 12. Trivrit – Operculina turpentum. 40 Part used – Root bark. Constituents – Resin, volatile oil, starch, gum fatty oils, inorganic matter and resinpiperine 1-2%. Also contain resin, albumin, iron, lignanine and some salts. Action – Root bark contains turpethine, which causes purgation. 75 Methodology
  • 90. RESEARCH APPROACH In this work, the aim was to evaluate the efficacy of Virechana karma clinically inPanduroga. After completion of treatment including follow up the results were assessed bycomparing subjective the objective parameters taken before and after the treatment.Source of Data Patients – Patients suffering form Panduroga were selected incidentally from PGOPD and IPD of D.G.M.A.M.C., Gadag by pre set inclusion and exclusion criteria. Literature – Literary aspect of the study was collected from classical Ayurvedicand modern textbooks and medical magazines. Therapy – The materials used for virechana therapy were – 01. Trikatu churna. Sunthi, Maricha, Pippali were taken in equal quantity in the form of fine powder and mixed well. 02. Dadima Ghrita. Ingredients of Dadima Ghrita is as below – Dadima phala twak - 4 Pala. Pippli - 1 Karsha. Dhanyaka - 2 Pala. Ghrita - 20 Pala. Chitraka - 1 Pala. Jala - 4 Prasta. Shunthi - 1 Pala. Ghrita paka should be done with 20 palas of Ghrita by adding 4 Prasta of Jala andkalka of above mentioned drugs. 03. Moorchhita tila taila. It was purchaged from local market. 76 Methodology
  • 91. 04. Vyoshadi Gutika.Ingredients of Vyoshadi Gutika is as below – 01. Pippali 06. Patra 02. Maricha 07. Ela 03. Shunti 08. Vidanga 04. Twak 09. Haritaki 05. Musta 10. AmalakiAll together taken in equal parts – 1 part 11. Danti – 2 parts 12. Trivrit – 8 parts 13. Sharkara – 6 parts 14. Madhu – AvashyanusaraMethod of preparation All the drugs were identified and collected form the local areas. Collected drugswere prepared for the preparation by removing the physical and chemical impurities. Allthe ingredients were made into powder form and mixed well with Madhu thereafterstored in the form of Avaleha.Methods Study design – An observational clinical study. Sample size – A minimum of 30 patients who were fulfilling the inclusion criteriawere selected for the study and subjected to classical Virechana karma. 77 Methodology
  • 92. Inclusion criteria Patients satisfying the following criteria were taken for study they are – 01. Patients of both sexes, between the age of 18-60 years. 02. Patients with classical features of sadya Panduroga and other than that of exclusion criteria are included. 03. Patients who are fit for virechana therapy.Exclusion criteria If any following conditions were noted, such patients were excluded. 01. Patients of age below 18 years and above 60 years. 02. Associated with severe form of systemic disorders like RA, HTN, DM, PT, CA, etc. 03. The clinical signs and symptoms of Panduroga mentioned in the classics were initial criteria for the diagnosis. It is further confirmed by the hematological tests.Intervention Selected patients were given Virechana karma. A. Deepana-Pachana – The patients were administered Trikatu churna 3-6 gm thrice daily before food, till the appearance of Nirama laskhanas. B. Snehapana – After the appearance of nirama lakshanas the patients were administered snehapana with Dadima Ghrita in arohanavidhi. The snehapana was started with hrasayasi matra i.e. 30 ml and gradually increased for 3-4 days. For Panduroga “Na atisnigdhaan Virechayet” has been mentioned in the classics. C. Abhyanga & Mridu Swedana – As swedana is contraindicated in Panduroga, the patients were administered abhyanga with moorchhita tila taila followed by Mridu swedana (ushna jala snana). 78 Methodology
  • 93. D. Virechana karma – On the fourth day the patients were given with Virechana yoga after assessing the Koshta, Agni and Bala of the patient. The medicine used was “Vyoshadi Gutika” Matra – 35-45 gms Anupana – Sheetajala. E. Samsarjana krama – Samsarjana krama is followed for three to five days depending on the type of shuddhi achieved. F. Follow up – Follow up was advised for 15 days. During this period patient was advised to follow the pathyapathya mentioned in the context of Panduroga. G. Result assessment criteria – The following subjective and objective parameters were considered for the result assessment.Subjective parameters The following lakshanas were taken into consideration for assessing the patient – 01. Panduta 02. Arohanayasa 03. Dourbalya 04. Bhrama 05. AgnimandyaObjective Parameters The following investigations were done prior and after the study. 01. Haemoglobin estimation (Hb). 02. Total RBC count. 03. Packed cell volume (PCV) 04. Mean corpuscular volume (MCV) 05. Mean corpuscular haemoglobin concentration (MCHC) 06. Peripheral blood smear examination. 79 Methodology
  • 94. Investigation & their normal values 01. Hb – Male – 14.0 g/dl to 17.4 g/dl. - Female 12.3 g/dl to 15.3g/dl. 02. PCV – Male – 40-54% Average – 46%-41%. - Female 37-47%. 03. RBC count – Male – 5.5+4x1012/L. - Female 4.8+1.0x1012/l. 04. MCV – 77-93 cum Average 90 cum. 05. MCHC – 30-35% Average 33.3%.Score chartA. Panduta (Pallor) 01. Absent (No pallor) –0 02. Mild –1 03. Moderate –2 04. Severe –3B. Arohanayasa (Exertional Dyspnoea) 01. No exertional dyspnoea – 0 02. Mild dyspnoea – 1 03. Dyspnoea distrupts patients daily activities intermittently – 2 04. Dyspnoea distrupts daily activities frequently – 3C. Bhrama 01. Absent – 0 02. Occasional – 1 03. Frequently – 2 04. Regular – 3 05. Constant – 4 80 Methodology
  • 95. F. Agnimandya 01. Present before the treatment – 2 02. Improvement – 1 03. Absent – 0Overall assessment The overall results were declared only the basis of Haemoglobin andimprovement in clinical symptoms is also considered. Following method of overallgrading was used. 01. Good response – Patients with 60% and above results, by considering 0.1 gm improvement in haemoglin as 4%. 02. Moderate response – Patients with 30% to 59% results by considering 0.1 gm improvement in haemoglin as 4%. 03. Poor response – Patients with 1% to 29% of results, by considering 0.1 gm improvement in haemoglin as 4%. 04. No response – Patients with no change after treatment.Statistical Analysis The information gathered on the basis of observation made on the subjective andobjective parameters taken before the treatment, after the virechana and after the followup was subjected to statistical analysis. As this is an observational study, paired “t” testwas used. 81 Methodology
  • 96. In this clinical study, totally 42 cases were reported. Among them 38 cases werecame under the study, 8 patients were discontinued, so 30 patients were completed thetotal study duration. Selected patients were subjected to classical Virechana therapy andassessment was done by considering both subjective and objective parameters. Thechanges were recorded according to the prorforma of the case sheet.Table No. 23. Showing the status of patients of the present study.Sl. Total cases Registered No. of Pt.’s came under study Discontinued Completed01. 42 38 8 30 The data collected was as follows – 01. Demographic data. 02. Data related to disease. 03. Data related to treatment. 04. Data related to parameters.DEMOGRAPHIC DATADistribution of patients age groups.Table No. 24. Showing the age wise distribution and response of the patients. Sl. Age No. of Pt. % G.R. % M.R. % P.R. % Gr. 01. 18-24 14 46.66 2 14.28 8 57.14 4 28.57 02. 24-30 4 13.33 2 50 2 50 0 0 03. 30-36 4 13.33 3 75 1 25 0 0 04. 36-42 5 16.66 1 20 3 60 1 20 05. 42-48 0 0 0 0 0 0 0 0 06. 48-54 2 6.66 1 50 1 50 0 0 07. 54-60 1 3.33 1 100 0 0 0 0 82 Observations & Results
  • 97. Age group of 18-24 contains 14 patients (46%), among them 2 patients (14.28%)responded good, 8 patients (57.14%) were moderately responded and 4 patients (28.57%)had shown poor response. Age group of 24-30 contains 4 patients (46.66%), among them 2 patients (50%)responded good, 2 patients (50%) were moderately responded. Age group of 30-36 contains 4 patients (13.33%), among them 3 patients (75%)responded good, 1 patient (25%) was moderately responded. Age group of 36-42 contains 5 patients (16.66%), among them 1 patient (20%)responded good, 3 patients (60%) were moderately responded and 1 patient (20%) hadshown poor response. Age group of 48-54 contains 2 patients (6.66%), among them 1 patient (50%)responded good, 1 patient (50%) was moderately responded. Age group of 54-60 contains 1 patient (3.33%), among them 1 patient (100%)responded good.Graph No. 01. Showing the distribution of patients by age groups and response. Distribution of Pt.s by Age Groups 16 14 14 12 No. of Pt.s 10 8 8 6 5 4 4 4 4 3 3 2 22 2 2 1 1 1 11 11 0 0 0000 0 00 0 18-24 24-30 30-36 36-42 42-48 48-54 54-60 Age groups No. of Pt. G.R. M.R. P.R. 83 Observations & Results
  • 98. Distribution of patients by Sex.Table No. 25. Showing the Sex distribution and response of the patients. Sl. Sex No. of Pt. % G.R. % M.R. % P.R. % 01. Male 8 26.66 2 25 4 50 2 25 02. Female 22 73.33 7 31.81 11 50 4 18.18 Out of 30 patients 22 patients (73.33%) were female, in which 7 patients(31.81%) shown good response, 11 patients (50%) shown moderate response and 4patients (18.18%) had shown poor response. Remaining 8 patients (26.66%) were male, in which 2 patients (25%) shown goodresponse, 4 patients (50%) shown moderate response and 2 patients (25%) had shownpoor response.Graph No. 02. Distribution of patients by sex and response. Distribution of patients by Sex 25 22 20 No. of Pt.s 15 11 10 8 7 5 4 4 2 2 0 Male Female Sex No. of Pt. G.R. M.R. P.R. 84 Observations & Results
  • 99. Distribution of patients by religion.Table No. 26. Showing the religion distribution and response of the patients. Sl. Religion No. of Pt. % G.R. % M.R. % P.R. % 01. Hindu 25 83.33 8 32 11 44 6 24 02. Muslim 5 16.66 1 20 4 80 0 0 03. Christian 0 0 0 0 0 0 0 0 04. Others 0 0 0 0 0 0 0 0 Out of 30 patients, 25 patients (83.33%) were belonging to Hindu community, inwhich 8 patients (32%) shown good response, 11 patients (44%) responded moderatelyand 6 patients (24%) had shown poor response. Remaining 5 patients (16.66%) were belonging to Muslim community, in which 1patient (20%) shown good response, 4 patients (80%) responded moderately.Graph No. 03. Showing distribution of patients by religion and response. Distribution of Pt.s by Religion 30 25 25 No. of Pt.s 20 15 11 10 8 6 5 4 5 1 0 0 0 0 0 0 0 0 0 0 Hindu Muslim Christian Others No. of Pt. G.R. M.R. P.R. Response 85 Observations & Results
  • 100. Distribution of patients by Occupation.Table No. 27. Showing the occupation distribution and response of the patients.Sl. Occupation No. of Pt. % G.R. % M.R. % P.R. %01. Household 7 23.33 2 28.57 4 57.14 1 14.202. Study 11 36.66 1 9.0 6 54.54 4 36.3603. Service 3 10 1 33.33 2 66.66 0 004. Labour 3 10 0 0 2 66.66 1 33.3305. Sedentary 6 20 5 83.33 1 16.66 0 0 Among 30 patients 7 patients (23.33%) were household, in which 2 patients(28.57%) shown good response, 4 patients (57.14%) were moderately responded and 1patient (14.2%) had shown poor response. 11 patients (36.66%) were students, in which 1 patient (9%) shown goodresponse, 6 patients (54.54%) were moderately responded and 4 patients (36.36%) hadshown poor response. 3 patients (10%) were in service, in which 1 patient (33.33%) shown goodresponse, 2 patients (66.66%) were moderately responded. 3 patients (10%) were labours, in which 2 patients (66.66%) were moderatelyresponded and 1 patient (33.33%) had shown poor response. 6 patients (20%) were in sedentary occupational group, in which 5 patients(83.33%) shown good response, 1 patient (16.66%) was moderately responded.Graph No. 04. Showing the distribution of patients by occupation and response. Distribution of Pt.s by Occupation 12 11 10 No. of Pt.s 8 7 6 6 6 5 4 4 4 3 3 2 2 2 2 1 1 1 1 1 0 0 0 0 HH St Sr Lb Sed No. of Pt. G.R. M.R. P.R. Occupation 86 Observations & Results
  • 101. Distribution of patients by Socioeconomic status.Table No. 28. Showing the Socioeconomic status distribution and response of thepatients.Sl. Socioeconomic No. of % G.R. % M.R. % P.R. % status Pt.01. Poor 5 16.16 1 20 3 60 1 2002. Middle class 16 53.33 7 43.75 5 31.25 4 2503. Upper middle class 9 30 2 22.22 6 66.66 1 11.11 Among 30 patients 5 patients (16.16%) were in poor socio-economical group, inwhich 1 patient (20%) shown good response, 3 patients (60%) were moderatelyresponded and 1 patient (20%) had shown poor response. 16 patients (53.33%) were in middle class socio-economical group, in which 7patient (43.75%) shown good response, 5 patients (31.25%) were moderately respondedand 4 patients (25%) had shown poor response. 9 patients (30%) were in upper middle class socio-economical group, in which 2patient (22.22%) shown good response, 6 patients (66.66%) were moderately respondedand 1 patient (11.11%) had shown poor response.Graph No. 05. Showing the distribution of patients by socio-economical status andresponse. Distribution of Pt.s by Socio-economical status 18 16 16 14 12 10 9 No. of Pt.s 7 8 6 5 5 6 4 4 3 2 2 1 1 1 0 PC MC UMC No. of Pt. G.R. M.R. P.R. Socio-economical Status 87 Observations & Results
  • 102. Distribution of patients by Marital status.Table No. 29. Showing the marital status distribution and response of the patients. Sl. Marital status No. of Pt. % G.R. % M.R. % P.R. % 01. Married 20 66.66 7 35 10 50 3 15 02. Unmarried 10 33.33 2 20 5 50 3 30 Among 30 patients 20 patients (66.66%) were married, in which 7 patients (35%)shown good response, 10 patients (50%) were moderately responded and 3 patients(15%) had shown poor response. 10 patients (33.33%) were unmarried, in which 2 patients (20%) shown goodresponse, 5 patients (50%) were moderately responded and 3 patients (30%) had shownpoor response.Graph No. 06. Showing the distribution of patients by marital status and response. Distribution of Pt.s by Marietal status 25 20 20 No. of Pt.s 15 10 10 10 7 5 5 3 2 3 0 Married Unmarried No. of Pt. G.R. M.R. P.R. Marietal status 88 Observations & Results
  • 103. Distribution of patients in food habits.Table No. 30. Showing the food habits distribution and response of the patients. Sl. Food habits No. of Pt. % G.R. % M.R. % P.R. % 01. Vegetarian 21 70 6 28.57 10 47.61 5 23.80 02. Mixed 9 30 2 22.22 6 66.66 1 11.11 Among 30 patients 21 patients (70%) were vegetarian, in which 6 patients(28.57%) shown good response, 10 patients (47.61%) were moderately responded and 5patients (23.80%) had shown poor response. 9 patients (30%) were mixed type of food habit, in which 2 patients (22.22%)shown good response, 6 patients (66.66%) were moderately responded and 1 patient(11.11%) had shown poor response.Graph No. 07. Showing the distribution of patients by food habits and response. Distribution of Pt.s by Food habits 25 21 20 No. of Pt.s 15 10 9 10 6 5 6 5 2 1 0 Vegetarian Mixed No. of Pt. G.R. M.R. P.R. Food habits 89 Observations & Results
  • 104. Distribution of patients in treatment history.Table No. 31. Showing the distribution of patient’s treatment history and response.Sl. Treatment history No. of Pt. % G.R. % M.R. % P.R. %01. Modern 15 50 6 40 6 40 3 2002. Ayurvedic 2 6.66 1 50 1 50 0 003. Surgery 1 3.33 1 100 0 0 0 004. No History 13 43.33 2 1538 9 69.23 2 15.38 Among 30 patients 15 patients (50%) underwent modern treatment, in which 6patients (40%) shown good response, 6 patients (40%) were moderately responded and 3patients (20%) had shown poor response. 2 patients (6.66%) underwent Ayurvedic treatment, in which 1 patient (50%)shown good response, 1 patient (50%) was moderately responded.Graph No. 08. Showing the distribution of patients by treatment history and response. Distribution of Pt.s by Treatment History 16 15 14 13 12 No. of Pt.s 10 9 8 6 6 6 4 3 2 2 2 2 1 1 1 1 0 0 0 0 Md Ar Sr No No. of Pt. G.R. M.R. P.R. Treatment History 90 Observations & Results
  • 105. Distribution of patients by Prakriti.Table No. 32. Showing the distribution of patient deha prakriti and response.Sl. Prakriti No. of Pt. % G.R. % M.R. % P.R. %01. Vata pitta 8 26.66 2 25 5 62.5 1 12.502. Vata shelshma 6 20 1 16.66 2 33.33 3 5003. Pitta kapha 16 53.33 6 37.5 7 43.75 3 18.75 Among 30 patients 8 patients (26.66%) were of Vata-pittaja prakriti, in which 2patients (25%) shown good response, 5 patients (62.5%) were moderately responded and1 patient (12.5%) had shown poor response. 6 patients (20%) were of Vata-shelshmaja prakriti, in which 1 patient (16.66%)shown good response, 2 patients (33.33%) were moderately responded and 3 patients(50%) had shown poor response. 16 patients (53.33%) were of Pitta-shleshmaja prakriti, in which 6 patients(37.5%) shown good response, 7 patients (43.75%) were moderately responded and 3patients (18.75%) had shown poor response.Graph No. 09. Showing the distribution of patients by deha prakriti and response. Distribution of Pt.s by Dehaprakriti 18 16 16 14 12 10 8 No. of Pt.s 8 7 6 6 6 5 4 3 3 2 2 2 1 1 0 VP VS PK No. of Pt. G.R. M.R. P.R. Deha Prakriti 91 Observations & Results
  • 106. Distribution of patients by Vyasana.Table No. 33. Showing the distribution of patient by Vyasana and response.Sl. Vyasana No. of Pt. % G.R. % M.R. % P.R. %01. Smoking 4 13.33 1 25 2 50 1 2502. Alcohol 1 3.33 0 0 1 100 0 003. Tobacco 6 20 2 33.33 2 33.33 2 33.3304. No Habits 21 70 6 28.57 11 52.38 4 19.05 Among 30 patients, 4 patients (13.33%) were habituated to smoking, in which 1patient (25%) shown good response, 2 patients (50%) were moderately responded and 1patient (25%) had shown poor response. 1 patient (3.33%) was habituated to alcohol, which was shown moderatelyresponded. 6 patients (20%) were habituated to tobacco, in which 2 patients (33.33%) showngood response, 2 patients (33.33%) were moderately responded and 2 patients (33.33%)had shown poor response. 21 patients (70%) were not addicted to habits, in which 6 patients (28.57%)shown good response, 11 patients (52.38%) were moderately responded and 4 patients(19.05%) had shown poor response.Graph No. 10. Showing the distribution of patients by vyasana and response. Distribution of Pt.s by Vyasana 25 21 20 15 11 No of Pt.s 10 6 6 4 4 5 2 2 2 2 1 1 1 1 0 0 0 Sm Alc Tb No Habits No. of Pt. G.R. M.R. P.R. 92 Observations & Results
  • 107. Distribution of patients by Koshta.Table No. 34. Showing the distribution of patient Koshta and response.Sl. Koshta No. of Pt. % G.R. % M.R. % P.R. %01. Mridu 2 6.66 0 0 2 100 0 002. Madhyama 22 73.33 8 36.36 11 50 3 13.6303. Krura 6 20 1 16.66 2 33.33 3 50 Among 30 patients, 2 patients (6.66%) were of Mridu koshta and respondedmoderately. 22 patients (73.33%) were of Madhyama koshta, in which 8 patients (36.36%)shown good response, 11 patients (50%) were moderately responded and 3 patients(13.63%) had shown poor response. 6 patients (20%) were of Krura koshta, in which 1 patient (16.66%) shown goodresponse, 2 patients (33.33%) were moderately responded and 3 patients (50%) hadshown poor response.Graph No. 11. Showing the distribution of patients by nature of Koshta and response. Distribution of Pt.s by Nature of Koshta 25 22 20 No. of Pt.s 15 11 10 8 6 5 3 3 2 2 2 1 0 0 0 Mridu Madhyama Krura No. of Pt. G.R. M.R. P.R. Nature of Koshta 93 Observations & Results
  • 108. Distribution of patients by Agni.Table No. 35. Showing the distribution of patient by Agni and response.Sl. Agni No. of Pt. % G.R. % M.R. % P.R. %01. Manda 22 73.33 8 36.36 11 50 3 13.6302. Vishama 3 10 1 33.33 2 66.66 0 003. Sama 5 16.66 0 0 3 60 2 40 Among 30 patients, 22 patients (73.33%) were having Mandagni, in which 8patients (36.36%) shown good response, 11 patients (50%) were moderately respondedand 3 patients (13.63%) had shown poor response. 3 patients (10%) were having Vishamagni, in which 1 patient (33.33%) showngood response, 2 patients (66.66%) were moderately responded. 5 patients (16.66%) were having Samagni, in which 3 patients (60%) moderatelyresponded and 2 patients (40%) had shown poor response.Graph No. 12. Showing the distribution of patients by nature of agni and response. Distribution of Pt.s by Nature of Agni 25 22 20 No.of Pt.s 15 11 10 8 5 5 3 3 2 3 2 1 0 0 0 Manda Vishama Sama No. of Pt. G.R. M.R. P.R. Nature of Agni 94 Observations & Results
  • 109. DATA RELATED TO DISEASEDistribution of patients by Nidanas and response.Table No. 36. Showing the distribution of patient by Nidana and response.Sl. Nidana No. of Pt. % G.R. % M.R. % P.R. % Aharaja Nidana01. Kshara 26 86.66 7 26.92 15 57.69 4 15.3802. Amla 28 93.33 9 32.14 15 5357 4 14.2803. Lavana 20 66.66 6 30 13 65 1 504. Atiushna 20 66.66 5 25 13 65 2 2005. Ati tikshna 26 86.66 7 26.92 15 57.69 4 15.3806. Virudhha 19 63.33 6 31.58 13 68.42 0 007. Tila 15 50 3 20 11 73.33 1 6.6608. Masha 22 73.33 4 18.18 15 68.18 3 13.6309. Mrit 0 0 0 0 0 0 0 0 Viaharaja Nidanas10. Divaswapna 22 86.66 4 18.18 15 68.18 3 13.6311. Ativyayama 20 66.66 6 30 13 65 1 1512. Ratri jagarana 19 63.33 5 26.31 12 63.15 2 10.5213. Vegadharana 5 16.66 2 40 2 40 1 2014. Atapa sevana 14 46.66 4 28.57 9 64.28 1 7.14 Manasika Nidanas15. Chinta 20 66.66 4 20 14 70 2 1016. Krodha 28 93.33 7 25 15 53.57 6 21.4217. Shoka 15 50 5 33.33 10 66.66 0 018. Bhaya 10 33.33 3 30 5 15 2 20Aharaja Nidana Out of 30 patients, 26 patients (86.66%) were indulging in excess use of ksharatype of foods, in which 7 patients (26.92%) were responded good, 15 patients (57.69%)were moderately responded, 4 patients (15.38%) had shown poor response. 95 Observations & Results
  • 110. 28 patients (93.33%) were indulging in excess use of Amla type of foods, inwhich 9 patients (32.14%) were responded good, 15 patients (53.57%) were moderatelyresponded, 4 patients (14.28%) had shown poor response. 20 patients (66.66%) were indulging in excess use of lavana type of foods, inwhich 6 patients (30%) were responded good, 13 patients (65%) were moderatelyresponded, 1 patient (5%) had shown poor response. 20 patients (66.66%) were indulging in excess use of ushna type of foods, inwhich 5 patients (25%) were responded good, 13 patients (65%) were moderatelyresponded, 2 patients (10%) had shown poor response. 26 patients (86.66%) were indulging in excess use of teekshna type of foods, inwhich 7 patients (26.92%) were responded good, 15 patients (57.69%) were moderatelyresponded, 4 patients (15.38%) had shown poor response. 19 patients (63.66%) were indulging in excess use of viruddha type of foods, inwhich 6 patients (31.58%) were responded good, 13 patients (68.42%) were moderatelyresponded, 1 patient (6.66%) had shown poor response. 15 patients (50%) were indulging in excess use of tila in foods, in which 3patients (20%) were responded good, 11 patients (73.33%) were moderately responded, 4patients (15.38%) had shown poor response. 22 patients (73.33%) were indulging in excess use of masha in foods, in which 4patients (18.18%) were responded good, 15 patients (68.18%) were moderatelyresponded, 3 patients (13.63%) had shown poor response.Graph No. 13. Showing the distribution of Pt.’s by Aharaja Nidana and response. Distribution of Pt.s by Aharaj Nidana sevana wit response 30 28 26 26 25 22 20 20 19 20 No. of Pt.s 15 15 15 15 15 15 13 13 13 11 9 10 7 7 6 5 6 4 4 4 3 4 3 5 2 1 0 1 0000 0 A B C D E F G H I No. of Pt. G.R. M.R. P.R. Aharaj Nidana 96 Observations & Results
  • 111. Viharaja Nidana Out of 30 patients, 22 patients (86.66%) were indulging in excess of divaswapna,in which 4 patients (18.18%) were responded good, 15 patients (68.18%) weremoderately responded, 3 patients (13.63%) had shown poor response. 20 patients (66.66%) were indulging in ativyayama, in which 6 patients (30%)were responded good, 13 patients (65%) were moderately responded, 1 patient (5%) hadshown poor response. 19 patients (63.33%) were indulging in ratrijagarana, in which 5 patients(26.39%) were responded good, 12 patients (63.15%) were moderately responded, 2patients (10.52%) had shown poor response. 5 patients (16.66%) were indulging in vegadharana, in which 2 patients (40%)were responded good, 2 patients (40%) were moderately responded, 1 patient (20%) hadshown poor response. 14 patients (46.66%) were indulging in atapa sevana, in which 4 patients(28.57%) were responded good, 9 patients (64.28%) were moderately responded, 1patient (7.14%) had shown poor response.Graph No. 14. Showing the distribution of pt.’s by Viharaj Nidana and response. Distribution of Pt.s by Viharaja Nidana and response 25 22 20 19 20 15 14 No. of Pt.s 15 13 12 9 10 6 5 5 4 4 5 3 2 2 2 1 1 1 0 J K L M N No. of Pt. G.R. M.R. P.R. Viharaj Nidana 97 Observations & Results
  • 112. Manasika Nidana Out of 30 patients, 20 patients (66.66%) were indulging in excess chinta, in which4 patients (20%) were responded good, 14 patients (70%) were moderately responded, 2patients (10%) had shown poor response. 28 patients (93.33%) were indulging in excess krodha, in which 7 patients (25%)were responded good, 15 patients (53.57%) were moderately responded, 6 patients(21.42%) had shown poor response. 15 patients (50%) were indulging in excess shoka, in which 5 patients (33.33%)were responded good, 10 patients (66.66%) were moderately responded. 10 patients (33.33%) were indulging in excess bhaya, in which 3 patients (30%)were responded good, 5 patients (50%) were moderately responded, 2 patients (20%) hadshown poor response.Graph No. 15. Showing the distribution of patients by Mansika Nidana and response. Distribution of Pt.s by Manasika Nidana & Response 30 28 25 20 No. of Pt.s 20 14 15 15 15 10 10 10 7 6 5 5 4 3 5 2 2 0 0 O L M N Manasika Nidana No. of Pt. G.R. M.R. P.R. 98 Observations & Results
  • 113. Data related to incidence of lakshanas and response.Table No. 37. Distribution of the patients according to incidence of lakshanas andresponse.Sl. Lakshanas No. of Pt. % G.R. % M.R. % P.R. %01. Panduta 30 100 9 30 15 50 6 2002. Arohana Ayasa 24 80 8 33.33 13 54.16 3 12.503. Dourbalya 29 96.66 9 31.03 14 48.27 6 20.6804. Bhrama 29 96.66 9 31.03 14 48.27 6 20.6805. Agnimanndya 20 83.33 9 36 11 44 5 20 Out of 30 patients, all were represented Panduta, in which 9 patients (30%) wereresponded good, 15 patients (50%) were moderately responded, 6 patients (20%) hadshown poor response. 24 patients (80%) were having arohana ayasa, in which 8 patients (33.33%) wereresponded good, 13 patients (54.16%) were moderately responded, 3 patients (12.50%)had shown poor response. 29 patients (96.66%) were having dourbalya and bhrama, in which 9 patients(31.03%) were responded good, 14 patients (48.27%) were moderately responded, 6patients (20.68%) had shown poor response. 25 patients (83.33%) were having agnimandya, in which 9 patients (36%) wereresponded good, 11 patients (44%) were moderately responded, 5 patients (20%) hadshown poor response.Graph No. 16. Showing the distribution of patients by incidence of lakshnas andresponse. Distribution of Pt.s by Lakshanas & Response 35 30 29 29 30 24 25 20 No. of Pt.s 20 15 14 14 13 15 11 9 8 9 9 9 10 6 6 6 5 3 5 0 Pd AA Dl Br Am Lakshanas No. of Pt. G.R. M.R. P.R. 99 Observations & Results
  • 114. Distribution of the patients by type of Panduroga and response.Table No. 38. Showing the types of pandu roga and response.Sl. Types of Pandu No. of Pt. % G.R. % M.R. % P.R. %01. Vataja 6 20 1 16.66 3 50 2 33.3302. Pittaja 14 46.66 6 42.85 7 50 1 7.1403. Kaphaja 10 33.33 2 20 6 60 2 20 Out of 30 patients, 6 patients (20%) were of Vataja Pandu, in which 1 patient(16.66%) were responded good, 3 patients (50%) were moderately responded, 2 patients(33.33%) had shown poor response. 14 patients (46.66%) were of Pittaja Pandu, in which 6 patients (42.85%) wereresponded good, 7 patients (50%) were moderately responded, 1 patient (7.14%) hadshown poor response. 10 patients (33.33%) were of Kaphaja Pandu, in which 2 patients (20%) wereresponded good, 6 patients (60%) were moderately responded, 2 patients (20%) hadshown poor response.Graph No. 17. Showing the distribution of patients by type of Panduroga and treatment. Distribution of Pt.s by types of type of Pandu & Response 14 15 10 No. of Pt.s 10 7 6 6 6 5 3 2 2 2 1 1 0 Vataj Pittaj Kaphaj No. of Pt. G.R. M.R. P.R. Type of Pandu 100 Observations & Results
  • 115. DATA RELATED TO TREATMENTDistribution of patients according to snehapana kalavadhi and response.Table No. 39. Showing the distribution of patient by snehapana kalavadhi and response.Sl. Snehapana kalavadhi No. of Pt. % G.R. % M.R. % P.R. %01. Up to 3 days 20 66.66 4 20 12 60 4 2002. More than 3 days 10 33.33 5 50 3 30 2 20 Out of 30 patients, 20 patients (66.66%) were received snehapana for 3 days, inwhich 4 patients (20%) were responded good, 12 patients (60%) were moderatelyresponded, 4 patients (20%) had shown poor response. 10 patients (33.33%) were received snehapana more than 3 days, in which 5patients (50%) were responded good, 3 patients (30%) were moderately responded, 2patients (20%) had shown poor response.Graph No. 18. Showing the distribution of patients by the snehapana kalavadhi andresponse. Distribution of Pt.s by duration of snehanapana & Response 25 20 20 No. of Pt.s 15 12 10 10 5 4 4 3 5 2 0 Up to 3 days More than 3 days No. of Pt. G.R. M.R. P.R. Duration of Snehapana 101 Observations & Results
  • 116. Distribution of patients according to samyak snigdha lakshana and response.Table No. 40. Showing the distribution of patient by samyak snigdha lakshana andresponse.Sl. Samyak snigdha No. of % G.R. % M.R. % P.R. % lakshana Pt.01. Vatanulomana 27 90 9 33.33 15 55.55 3 11.1102. Agnideepti 30 100 9 30 15 50 6 2003. Purisha snigdhata 30 100 9 30 15 50 6 2004. Asamhata varchas 26 86.66 8 30.76 14 53.84 4 15.3805. Twak snigdhata 28 93.33 9 32.14 15 57.69 4 14.2806. Anga laghava 24 80 8 33.33 15 62.5 1 3.5707. Gatra mardava 24 80 8 33.33 15 62.5 1 3.5708. Snehodwega 20 66.66 9 45 11 55 0 009. Klama 26 86.66 9 34.61 15 57.69 2 7.6910. Shiathilya 12 40 6 50 5 41.66 1 8.33 Out of 30 patients, 27 patients (90%) were reported Vatanulomana, in which 9patients (33.33%) were responded good, 15 patients (55.55%) were moderatelyresponded, 3 patients (11.11%) had shown poor response. All patients were reported Agnideepti and Purisha snigdhata, in which 9 patients(30%) were responded good, 15 patients (50%) were moderately responded, 6 patients(20%) had shown poor response. 26 patients (86.66%) were reported Asamhata varchasa, in which 8 patients(30.76%) were responded good, 14 patients (53.84%) were moderately responded, 4patients (15.38%) had shown poor response. 28 patients (93.33%) were reported Twak snigdhata, in which 9 patients (32.14%)were responded good, 15 patients (57.69%) were moderately responded, 4 patients(14.28%) had shown poor response. 102 Observations & Results
  • 117. 24 patients (80%) were reported Angalaghava and Gatramardavata, in which 8patients (33.33%) were responded good, 15 patients (62.50%) were moderatelyresponded, 1 patient (3.57%) had shown poor response. 20 patients (66.66%) were reported Snehodwega, in which 9 patients (45%) wereresponded good, 11 patients (55%) were moderately responded. 26 patients (86.66%) were reported Klama, in which 9 patients (34.61%) wereresponded good, 15 patients (57.69%) were moderately responded, 2 patients (7.69%)had shown poor response. 12 patients (40%) were reported Shaithilya, in which 6 patients (50%) wereresponded good, 5 patients (41.66%) were moderately responded, 1 patient (8.33%) hadshown poor response.Graph No. 19. Showing the distribution of patients by appearance of Samyak snigdhalakshanas and response. Distribution of Pt.s by appearance of Samyak snigdha Lakshana & Response 35 30 30 30 27 28 26 26 24 24 25 No. of Pt.s 20 20 15 15 15 14 15 15 15 15 15 11 12 9 9 9 8 9 8 8 9 9 10 6 6 65 3 4 4 5 1 1 2 1 0 0 A B C D E F G H I J No. of Pt. G.R. M.R. P.R. Samyak Snigdha Lakshna 103 Observations & Results
  • 118. Distribution of patients according to Vegas attended and response.Table No. 41. Showing the distribution of patient by Vega attended and response.Sl. Vegiki No. of Pt. % G.R. % M.R. % P.R. %01. Below 10 7 23.33 2 28.57 4 57.14 1 14.2802. 10-20 19 63.33 7 36.84 8 42.10 4 21.0503. Above 20 4 13.33 0 0 3 75 1 25 Out of 30 patients, 7 patients (23.33%) attained less than 10 vegas, in which 2patients (28.57%) were responded good, 4 patients (57.14%) were moderately responded,1 patient (14.28%) had shown poor response. 19 patients (63.33%) attained in between 10-20 vegas, in which 7 patients(36.84%) were responded good, 8 patients (42.10%) were moderately responded, 4patients (21.05%) had shown poor response. 4 patients (13.33%) attained more than 20 vegas, in which 3 patients (75%) weremoderately responded, 1 patient (25%) had shown poor response.Graph No. 20. Showing the distribution of the patients by Vegiki and response. Distribution of Pts.s by Vegiki & Response 20 19 18 16 14 No. of Pt.s 12 10 8 8 7 7 6 4 4 4 4 3 2 2 1 1 0 0 Below 10 10 to 20 Above 20 No. of Pt. G.R. M.R. P.R. No. of Vegas attainded 104 Observations & Results
  • 119. Distribution of patients according to Maniki and response.Table No. 42. Showing the distribution of patient by Maniki and response.Sl. Maniki No. of Pt. % G.R. % M.R. % P.R. %01. 2000 ml and above 14 46.66 2 14.28 10 71.42 4 28.5702. Less than 2000 16 53.33 7 43.75 5 31.25 2 12.5 Out of 30 patients, 14 patients (46.66%) possessed 2000 ml and above mala, inwhich 2 patients (14.28%) were responded good, 10 patients (71.42%) were moderatelyresponded, 4 patients (28.57%) had shown poor response. 16 patients (53.33%) possessed less than 2000 ml of mala, in which 7 patients(43.75%) were responded good, 5 patients (31.25%) were moderately responded, 2patient (12.50%) had shown poor response.Graph No. 21. Showing the distribution of patients by Maniki and response. Distribution of Pt.s by Maniki & Respnse 18 16 16 14 14 12 10 No. of Pt.s 10 8 7 6 5 4 4 2 2 2 0 2000 ml and above Less than 2000 No. of Pt. G.R. M.R. P.R. Vega attainded 105 Observations & Results
  • 120. Distribution of patients according to Antaki and response.Table No. 43. Showing the distribution of patient by Antaki by the patient and response.Sl. Anataki No. of Pt. % G.R. % M.R. % P.R. %01. Kaphantam is observed 30 100 9 30 15 50 6 2002. Kaphantam is not observed 0 0 0 0 0 0 0 0 Kaphantam Virechana was observed in all patients, in which 9 patients (30%)were responded good, 15 patients (50%) were moderately responded, 6 patients (20%)had shown poor response.Graph No. 22. Showing the distribution of Patients by Antiki and response. Distribution of Pt.s by Antaki with Response 35 30 30 25 20 15 No. of Pt.s 15 9 10 6 5 0 0 0 0 0 Kaphantam is observed Kaphantam is not observed No. of Pt. G.R. M.R. P.R. Antaki LakshanaDistribution of patients according to Laingiki shuddhi obtained and response.Table No. 44. Showing the distribution of patient by Laingiki shuddhi obtained andresponse.Sl. Laingiki shuddhi No. of Pt. % G.R. % M.R. % P.R. %01. Srotoshuddhi 28 93.33 9 32.14 16 57.14 3 10.7102. Indriya prasadana 25 83.33 8 32 15 60 2 803. Shareera lahuta 26 86.66 6 23.07 16 61.53 4 15.3804. Agni deepti 29 96.66 9 31.03 15 51.72 5 17.2405. Vatanulomana 27 90 9 33.33 15 55.55 3 11.11 106 Observations & Results
  • 121. Out of 30 patients, 28 patients (93.33%) were having Srotoshuddhi, in which 8patients (32%) were responded good, 16 patients (57.14%) were moderately responded, 3patients (10.71%) had shown poor response. 25 patients (83.33%) were having Indriya prasadana, in which 8 patients (32.14%)were responded good, 15 patients (60%) were moderately responded, 2 patients (8%) hadshown poor response. 26 patients (86.66%) were having Sahreera laghuta, in which 6 patients (23.07%)were responded good, 16 patients (61.53%) were moderately responded, 4 patients(15.38%) had shown poor response. 29 patients (96.66%) were having Agnideepti, in which 9 patients (31.03%) wereresponded good, 15 patients (51.72%) were moderately responded, 5 patients (17.24%)had shown poor response. 27 patients (90%) were having Anamayata, in which 8 patients (29.62%) wereresponded good, 15 patients (55.55%) were moderately responded, 4 patients (14.81%)had shown poor response. 27 patients (90%) were having Vatanuloamana, in which 9 patients (33.33%)were responded good, 15 patients (55.55%) were moderately responded, 3 patients(11.11%) had shown poor response.Graph No. 23. Showing the distribution of patients by laingiki shuddhi and response. Distribution of Pt.s by Laingiki shuddhi & Response 35 29 28 27 30 25 26 No. of Pt.s 25 20 16 15 16 15 15 15 9 9 9 8 10 6 5 3 4 3 5 2 0 SS IP SL AD AL No. of Pt. G.R. M.R. P.R. Laingiki Shuddhi Lakshanas 107 Observations & Results
  • 122. Distribution of patients according to type of shuddhi and response.Table No. 45. Showing the distribution of patient type of shuddhi and response.Sl. Type of Shuddhi No. of Pt. % G.R. % M.R. % P.R. %01. Pravara 7 23.33 2 28.57 4 57.17 1 14.2802. Madhyama 19 63.33 7 36.84 8 42.10 4 21.0503. Avara 4 13.33 0 0 3 75 1 25 Pravara, madhyama and avara shuddhi was considered by seeing vegiki response.Hence, <10 vegas is considered as Avara shuddhi, 11-20 vegas are considered asmadhyama shuddhi and 21-30 vegas are considered as Pravra shuddhi. Out of 30 patients, 7 patients (23.33%) were had Pravra shuddhi by Manikicriteria of virechana, in which 2 patients (28.57%) were responded good, 4 patients(57.17%) were moderately responded, 1 patient (14.28%) had shown poor response. 19 patients (63.33%) were had Madhyama shuddhi by Maniki criteria ofvirechana, in which 7 patients (36.84%) were responded good, 8 patients (42.10%) weremoderately responded, 4 patients (21.05%) had shown poor response. 4 patients (13.33%) were had Avara shuddhi by Maniki criteria of virechana, inwhich 3 patients (75%) were moderately responded, 1 patient (25%) had shown poorresponse. Graph No.24. Showing the distribution of patients by type of shuddhi obtainedand response. Distribution of Pt.s by Type of Shuddhi & Response 19 20 15 No. of Pt.s 10 7 7 8 4 4 4 3 5 2 1 0 1 0 Pravara Madhyama Avara No. of Pt. G.R. M.R. P.R. Type of Shuddhi Obtained 108 Observations & Results
  • 123. OVERALL RESULTSTable No. 46. Showing the overall results of the treatment. Sl. Response No. of Pt.’s % 01. Good response 9 30 02. Moderate response 15 50 03. Poor response 6 20 04. No response 0 0 Out of 30 patients, 9 patients (30%) have shown good response, 15 patients (50%)responded moderately and only 6 patients (20%) were shown poor response.Graph No. 25. Showing the overall results of the treatment. Overall Response of the trerapy 0% 20% 30% 50% Good response Moderate response Poor response No response 109 Observations & Results
  • 124. DATA RELATED TO PARAMETERSTable No. 47. Showing the Subjective parameters before and after the treatment.Sl. OPD Panduta Arohanayasa Dourbalya Bhrama AgnimandyaNo. No. BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF01. 5305 2 1 0 1 1 0 2 1 0 2 1 0 2 0 002. 5543 2 2 0 1 1 0 1 1 0 1 1 0 2 1 003. 4465 2 2 1 2 2 1 2 2 1 2 1 1 2 1 104. 5548 2 1 0 1 1 0 2 1 0 2 2 0 0 0 005. 5317 1 1 0 0 0 0 1 0 0 1 0 0 2 0 006. 5489 1 0 0 0 0 0 2 1 0 2 2 0 2 0 007. 697 2 1 0 1 0 0 2 2 0 1 0 0 2 0 108. 2718 3 2 1 3 2 1 3 2 1 3 2 0 2 1 009. 2684 1 1 0 1 0 0 1 1 0 1 1 0 2 0 010. 1148 2 1 0 0 0 0 2 1 0 2 1 1 2 1 011. 1860 2 1 1 1 1 0 1 1 0 1 0 0 0 0 012. 2598 1 0 0 2 2 1 2 2 1 2 1 1 2 1 013. 2342 1 1 0 0 0 0 1 1 0 1 1 0 2 0 014. 2384 1 0 0 1 1 0 2 2 1 2 1 1 2 1 015. 2717 2 2 1 1 1 0 1 1 0 1 0 0 2 0 016. 2719 1 0 0 1 1 0 0 0 0 0 0 0 2 0 017. 2720 1 1 0 1 1 1 1 0 0 1 0 0 0 0 018. 2496 2 1 1 1 1 0 2 2 1 2 1 1 2 0 119. 2721 1 1 0 1 1 0 1 0 0 2 1 0 2 0 020. 2724 3 2 1 2 2 0 3 2 0 3 2 1 2 0 021. 2726 2 2 1 2 1 1 2 2 0 1 0 0 2 1 022. 2716 1 1 0 0 0 0 1 1 0 2 0 0 0 0 023. 2437 1 0 0 1 0 0 1 0 0 1 1 0 2 0 024. 2387 2 2 1 2 2 1 2 1 0 2 2 1 2 1 125. 2722 2 2 1 0 0 0 1 0 0 1 0 0 2 0 026. 2858 1 1 0 1 0 0 1 1 0 1 1 0 2 1 127. 2760 1 0 0 1 1 1 2 1 0 2 1 1 2 0 028. 1143 1 1 0 1 0 0 1 1 0 1 1 0 0 0 029. 5678 1 1 0 1 1 0 1 0 0 1 1 0 2 0 030. 5819 2 1 1 2 1 0 2 2 0 2 1 0 2 0 0BT – Before treatment; AV – After Virechana; AF – After follow up. 110 Observations & Results
  • 125. Table No. 48. Showing the Objective parameters before and after the treatment.Sl. OPD Hb in Gm/dl RBC mil PCV MCV in MCHC in Blood /cumm in% Cumm % smear BT AV AF BT AT BT AT BT AT BT AT BT AT01. 5305 9.82 10.2 11.22 3.59 3.88 29 32 80.7 82 33.7 34 2 102. 5543 10.55 10.7 11.22 3.50 3.81 30 35 83.3 92 34 32 1 103. 4465 9.11 9.3 9.72 3.41 3.68 28 30 82 81.5 32.5 32 1 104. 5548 11.92 11.95 12.6 4.16 4.38 35 37 84 88 34 34 0 005. 5317 11.22 11.5 12.62 4.18 4.52 33 37 79 82 34 34 1 006. 5489 11.22 11.3 11.92 3.98 4.11 32 33 84.4 86 34 34.5 1 007. 697 10.55 10.6 11.22 3.72 3.81 31 33 83.7 86 33 34 1 108. 2718 6.33 7.3 9.11 2.88 3.22 19 28 58 86 21 28 3 109. 2684 10.54 10.55 11.92 3.42 4.22 30 37 87 88 35 35 1 010. 1148 12.62 12.9 13.3 4.42 4.7 38 40 85 85 33 33.5 0 011. 1860 8.44 8.5 9.11 3.22 3.62 27 30 84 84 31 30 2 212. 2598 9.26 10.1 9.26 3.39 3.41 30 29 90 85 31 32 2 213. 2342 11.22 11.22 11.54 4.12 4.21 35 37 85 88 31 32 1 014. 2384 11.22 11.22 12.62 4.09 4.49 36 38 87 88 31 34 1 015. 2717 9.11 9.5 10.5 3.26 3.48 29 31 89 89 31 32 2 116. 2719 10.54 10.57 11.22 3.72 4.11 32 34 86 86.5 32 33 1 117. 2720 9.11 9.20 9.26 3.88 3.41 29 30 85 88 31 31 2 118. 2496 9.82 10.5 9.86 3.66 3.72 30 31 83 84 32 32 1 119. 2721 11.92 11.9 12.24 4.18 4.31 37 38 88 88 32 32 0 020. 2724 7 7 8.44 2.32 3.04 24 27 86 90 29 31 3 221. 2726 8.42 8.5 9.26 3.11 3.52 27 29 87 88.8 31 32 2 222. 2716 11.22 11.2 11.64 3.98 4.28 35 38 89 90 32 31 1 023. 2437 10.556 10.6 11.22 4.0 4.11 32 34 80 83 33 33 1 024. 2387 8.44 8.3 9.86 3.67 3.76 30 30 83 85 30 31 2 225. 2722 12.62 12.68 12.68 4.48 4.63 40 40 88 88 31.5 32 0 026. 2858 10.55 10.6 10.84 3.62 3.96 32 33 88 89 32.8 33 1 127. 2760 11.22 11.3 11.92 4.08 4.21 34 37 85 87 33 33 1 028. 1143 11.22 11.3 11.92 4.12 4.16 34 37 88 88 32 32 1 029. 5678 11.22 11.3 11.92 4.12 4.48 34 36 86 83 31 33 1 030. 5819 9.88 9.0 11.92 3.53 4.18 31 36 86 86 32 33 1 0BT – Before treatment; AV – After Virechana; AF – After follow up. 111 Observations & Results
  • 126. Table No. 49. Showing observation during Virechana therapy.Sl. OPD Deepana Snehapana Virechana karmaNo. No. Pachana 2D 3D 1D 2D 3D 4D T D3 D4 Dose TA IV LV A B C KA M1 M2 30 60 90 120 in in am am pm ml ml ml ml ml gms 01. 5305 - + + + + + 300 - + 40 7 8.30 2 - + - + + - 02. 5543 - + + + + - 180 + - 40 7.30 9 1.30 - + - + - + 03. 4465 + + + + - 180 + - 40 7.30 8.45 1.15 - - - + - + 04. 5548 - + + + + - 180 + - 35 7 8.30 1 - + + + + - 05. 5317 - + + + + + 300 - + 40 7.45 8.45 1.45 - + - + - + 06. 5489 - + + + + - 180 + - 40 7.30 8.45 2 - + - + + - 07. 697 - + + + + - 180 + - 40 7 8.45 2 - + - + + - 08. 2718 - + + + + - 180 + - 40 7 8.35 2 - + - + - + 09. 2684 - + + + + - 180 + - 40 7.30 8.30 2.10 - - + + - + 10. 1148 - + + + + - 180 + - 40 7.30 9 2.35 - + - + + - 11. 1860 - + + + + + 300 + - 45 7 9.15 2.45 - - + + - + 12. 2598 + + + + - 180 + - 35 7 8.45 2.10 - - + + + - 13. 2342 - + + + + + 300 - + 45 7 9 2.30 - - + + + - 14. 2384 - + + + + - 180 + - 40 7.30 8.40 2.45 - + - + - + 15. 2717 - + + + + + 300 - + 45 7 8.30 3 - + - + + -2D – 2 days; 3D – 3 Days; 1D – First Day; 2D – Second day; 3D – Third day; 4D – Fourth day; T – Total dose; D3 – Number ofpatients taken snehapana for 3 days; D4 – Number of patients taken snehapana for 4 days; TA – Time of drug administration, IV –Intiation of first vega; LV – Time of last vega; A – Number of patients who had passed Vegas in between 1 to 10; B – Number ofpatients who had passed Vegas in between 11 to 20; C – Number of patients who had passed Vegas in between 21 to 30; KA –Kaphantam observed; M1 – The Maniki of 2000 ml and below; M2 – The Maniki of 2000 ml and above.
  • 127. Table No. 49. Showing observation during Virechana therapy.Sl. OPD Deepana Snehapana Virechana karmaNo. No. Pachana 2D 3D 1D 2D 3D 4D T D3 D4 Dose TA IV LV A B C KA M1 M2 30 60 90 120 in in am am pm ml ml ml ml ml gms16. 2719 - + + + + - 180 + - 40 7.30 8.45 2.45 + - - + + -17. 2720 + - + + + + 300 - + 45 7 9.20 2.30 - + - + - +18. 2496 - + + + + - 180 + - 40 7 8.30 2.15 - + - + + -19. 2721 - + + + + - 180 + - 40 7.30 8.45 1.45 - + - + + -20. 2724 - + + + + + 300 - + 40 7 8.20 1.45 - + - + - +21. 2726 - + + + + + 300 - + 45 7 8.15 2.50 - + - + - +22. 2716 + - + + + - 180 + - 45 7 9 3 + - - + + -23. 2437 - + + + + + 300 - + 40 7.45 8.35 3 + - - + + -24. 2387 - + + + + - 180 + - 40 7 8.25 2.30 - + - + - +25. 2722 - + + + + - 180 + - 40 7.30 8.45 2.45 - + - + - +26. 2858 - + + + + - 180 + - 40 7.30 8.50 2.10 - + - + + -27. 2760 - + + + + - 180 + - 40 7 9 1.30 -- + - + - +28. 1143 + - + + + - 180 + - 35 7.30 9.45 1.45 + - - + + -29. 5678 - + + + + - 180 + - 40 7 9 2.30 - - + + + -30. 5819 - + + + + + 300 - + 40 7.30 8.45 2.45 - - + + - +2D – 2 days; 3D – 3 Days; 1D – First Day; 2D – Second day; 3D – Third day; 4D – Fourth day; T – Total dose; D3 – Number ofpatients taken snehapana for 3 days; D4 – Number of patients taken snehapana for 4 days; TA – Time of drug administration, IV –Intiation of first vega; LV – Time of last vega; A – Number of patients who had passed Vegas in between 1 to 10; B – Number ofpatients who had passed Vegas in between 11 to 20; C – Number of patients who had passed Vegas in between 21 to 30; KA –Kaphantam observed; M1 – The Maniki of 2000 ml and below; M2 – The Maniki of 2000 ml and above.
  • 128. Table No. 50. Showing statistical results of subjective and objective parameters. Parameter Mean S.D. S.E. t value p value Remarks Panduta 1.233 0.43 0.0785 15.71 <0.001 H.S. Arohanayas 0.833 0.592 0.108 7.71 <0.001 H.S. Dourbalya 1.366 0.614 0.112 12.201 <0.001 H.S. Bhrama 1.266 0.583 0.106 11.94 <0.001 H.S. Agnimandya 1.5 0.776 0.141 10.638 <0.001 H.S. Hb% 0.842 0.598 0.109 7.724 <0.001 H.S. RBC count 0.429 0.672 0.122 3.516 <0.01 H.S. PCV 2.533 1.907 0.348 7.278 <0.001 H.S. MCV 2.823 5.11 0.934 3.022 <0.01 H.S. MCHC 1.083 1.53 0.279 3.881 <0.001 H.S. Blood smear 0.53 0.571 0.104 5.096 <0.001 H.S.STATISTICAL CONCLUSION The analysis is done by using paired t test to know the effect of drug before andafter the treatment. Among subjective parameters the Panduta, Dourbalya, Bhrama, Agnimandyashows more highly significant than Arohana ayasa. Among all the parameters Pandutashows more highly significant than others. (by comparing t and p values). The parameters Agnimandya shows more net mean effect with more variationwhereas the parameters Arohana ayasa shows less net mean effect. The parameterPanduta shows less variation (By comparing mean and SD). Among objective parameters except the parameters RBC count and MCV allother parameter shows more highly significant. (By comparing p value). Again the parameter except Hb and PCV, shows more highly significant thanothers (By comparing t value). The parameter MCV shows more net effect with more variation. The RBC countshows less net mean effect. The parameter blood smear shows less variation. (Bycomparing mean and SD). Among the subjective parameter the Panduta shows uniform effect and amongobjective parameter MCV shows uniform effect after the treatment. (By comparing co-efficient of variation). 114 Observations & Results
  • 129. DISCUSSION ON LITERARY Virechana karma is most commonly used shodhana therapy in general practice. Itmeans elimination of vitiated doshas through adhomarga. Along with ushna, tikshna,vyavayi, vikashi properties, these drugs consists predominance of prithwi and apamahabuta and adhobhagahara prabhava. Virechana is mainly indicated for pitta pradhanavyadhis and also pitta dosha associated with other doshas too. As we know “Pittam TuSweda Raktayoho”, so it can also be indicated for rakta pradoshaja vyadhis. Virechana therapy has three necessary steps to follow, poorvakarma,pradhanakarma and paschyat karma, which are having their own significance. Inpoorvakarma pachana snehapana, swedana are the measures to follow, which arenecessary for vriddhi vishyandana, paka and srotomukha vishodhana. The Panchakarma is mainly indicated in chronic diseases where many toxins(malas) will be present. These toxins are soluble in the fat media, the medicated ghritaused as snehana will reach the cellular level and does shithilata of vitiated doshas (toxins)thereby bring them to koshta for elimination. In pradhanakarma, the given virechana yoga will enters the systemic circulationafter digestion and also brings some remained doshas to koshta. Then it increases theperistalsis thereby eliminates the vitiated doshas (malas). After shodhana, the agni becomes imbalance i.e. it may be unable to digest thenormal consumption of food. Therefore, samsarjana karma should be followed by meansof manda, peya, vilepi, krita-akrita yusha, krita-akrita mamsarasa. Depending on theshuddhi achieved. So that the agni can be brought back to its equilibrium state. 111 Discussion
  • 130. For assessment of Virechana, Vegaki, Manaki, Antaki and Laingiki criteria arementioned in the classics, Laingiki criterion has got more importance than the others.Because, of the fact that, the samyka virakta lakshanas can be observed before achievingthe parameters mentioned for pravara shuddhi in terms of vegiki, manaki and antaki.Once samyak virakta lakshanas are observed, the vega must be stopped by inducingvamana, thereby preventing the possibility of atiyoga. Panduroga is the most common disease, which is explained by all the acharyas. Itis pitta pradhana tridoshas vyadhi, where dhatu parinama (specially rasa to rakta) ismainly affected. Acharya Charaka has mentioned Panduroga in santarpanajanya vyadhis.By term santarpana, we may take it as strengthening and restorative diet. The Nidanasevana may restrain normal process by providing toxic substances and may lead todisturb the digestive and assimilative processes. This may be due to mandagni therebycausing pitta pradhana tridosha prakopa, results in Panduroga. The Anaemia, which results from deficiency of iron and characterized by thereduction of haemoglobin concentration appropriate for age and sex, red cell count,packed cell volume, to below the normal level, is called iron deficiency Anaemia. The alpa rakta causes decrease in the functions of jeevana, mamsapushti,dhatuposhana and vardhana, bala and varna of the body. So also the decrease in bloodaffects its various functions related to nutrition, respiratory, cardiovascular and defencemechanism of the body. Moreover, the signs and symptoms said in Anaemia, like fatigue,weakness, pale skin, rapid heart beat, shortness of breath, dizziness, irritability, numbnessor coldness in hands and feet and headache are same as samanya lakshanas of Panduroga.By considering the above similarities we can come to a conclusion that the Pandurogaexplained in Ayurveda and Anaemia mentioned in modern science are almost similarcondition. 112 Discussion
  • 131. When we look into the Chikitsasutra of Panduroga all the acharyas opines firstsneha should be given with the ghritas indicated in Panduroga, there after shodhana mustbe adopted by means of Vamana and Virechana. According to acharya Dalhana, urdhwashodhana (Vamana) is contraindicated in Panduroga, but mridu vamana can be performedin accordance with ritu, desha, prakriti, kala and Shareera. As pitta is main doshasinvolved in samprapti of Panduroga. Virechana is more suitable shodhana therapy, hence,was chosen for the study.DISCUSSION ON MATERIAL METHODS01. Research design It is an observational study. The efficacy of virechana karma was observed in 30patients, who were selected incidentally form OPD, IPD of D.G.M. Ayurvedic MedicalCollege, Gadag.02. Drugs used for Virechana karmaA) Trikatu churna – The drugs chosen because, it is both agni deepaka and ama pachaka and also ruchikaraka. This churna was given 3-6 gms three times a day before food till the appearance of nirama lakshanas.B) Dadima ghrita – Snehanartha Dadima ghrita is indicated in Pandurogadhikara, hence it was chosen for abhyanatara snehapana. Its ingredients shows the properties like deepaka, pachaka, vatanulomaka, rochaka, krimighna, raktashodhaka. Dadima ghrita is palatable to the patient. It was administered in arohana vidhi. 113 Discussion
  • 132. C) Murchita tila taila and ushna jala – For abhyanaga murchita tila taila was used and for swedana ushna jala snana was performed. In Panduroga swedana is contraindicated, even then, it is mentioned in classics that we can do mridu swedana. Hence, for the purpose of mridu swedana, ushanajala snana was advised. This was performed for 3 days and it can also be considered as vishrama kaala.D) Vyoshadi Gutika – For the purpose virechana Vyoshadi gutika is used because - It is effective Virechana yoga. Its ingredients are easily available. Method of preparation is very simple. It is palatable and is in leha form. It is upakalpa of trivirt, can be considered as sukha virechana, thus safe to use. Dose : - The dose of the Vyoshadi Gutika mentioned in classics is 1 pala i.e. 48gms, can be considered as maximum dose. In the present study according to the koshtaand bala of the patient 35, 40, and 45 gms were used as pravara, madhyama and uttamamatra respectively. In this study 3 patients were given 35 gms, 21 patients were given 40gms and 6 patients 45 gms was given as uttama matra. Anupana : - All the patients were given sheetajala as anupana as mentioned in theclassics. The action of the drugs started within 1-3 hours after its administration. 114 Discussion
  • 133. 03. Inclusion and Exclusion criteria Only mild to moderate (i.e. above 6 gms and below the normal range of Hb) typeof anaemia (Panduroga) cases were taken for the study. Age factor was fixed between 18-60 years. Below 18 years and above 60 yearspatients are unable to withstand the procedure of virechana therapy and bala and vriddhaare contraindicated too. The patients who are fit for virechana, were only selected for the study i.e. eventhough the patient had the lakshanas of Panduroga, if he had the conditions of virechanaayogya was excluded. The patients suffering with severe systemic disorders like Raktarbuda, Asrgdhara,Raktapitta, Yakrit-pleeharoga, Raktarsha, Pleehodara, Pittaja prameha were also excludedto avoid the complications.04. Laboratory investigation Estimation of haemoglobin is first and foremost test in any suspected case ofanaemia. Thus, it was carried out three times in each patient during this study. Blood smear examination was performed for the study of morphological features,thereby assessing the type of Anaemia. An alternative method to diagnose and detect the severity of Anaemia is bymeasuring red cell indices. Thus, PCV, MCV and MCHC were also tested. Leucocytes and platelet count was done to distinguish pure Anaemia formPancytopenia. 115 Discussion
  • 134. Though ESR a non-specific test for Anaemia, it was done as a clue to underlyingorganic disease and urine routine and microscopic tests were also done to rule out othersystemic disorders.05. Study duration 3 days deepana-pachana, 3-5 days for snehapana, 3 days for abhyanga and mriduswedna, 1 day virechana, then 3-5 days samsarjana, includes 13 to 17 days for virechanatherapy. 13 to 17 days follow up was done to observe proper virechana therapy. Hence, the total study duration was 30 days. After the completion of the study ofthe study, the patient was advised for shamanoushadhis.06. Criteria of Assessment As this study mainly deals with the evaluation of efficacy of the virechanatherapy, the subjective and objective parameters were considered for the assessment ofresult. Though various symptoms are present in the Panduroga, for the purpose of theassessment the cardinal symptoms or the symptoms which were found more in this studywere taken for the subjective assessment. They are panduta, arohanayasa, dourbalya,bhrama and agnimandya. For objective assessment Hb%, RBC count, PCV, MCV,MCHC and smear study were taken into consideration.08. Overall assessment The overall assessment was declared only on the basis of improvement inhaemoglobin percentage along with clinical assessment (subjective parameters). No change in Hb – No response. Improvement in Hb – 0.01 – 0.5gms Mild responded. Improvement in Hb – 0.51 – 1 gms Moderate responded. Improvement in Hb – 1.01 gm and above Good responded. 116 Discussion
  • 135. The Panduta after treatment was grade 0 in 20 patients. Among them 5 patients ofgrade 2, 15 were of grade 1 before the treatment. Remaining 10 patients were of grade 1after the treatment, among them 8 patiants were of grade 2 and 2 patients were of grade 3before the treatment. The Arohanayasa was observed in 24 patients. Among them 17 patients were ofgrade 1 before the treatment, of them 15 were of grade 0 after the treatment and 2 werenot responded i.e. grade 1 even after treatment. Among remaining 7 patients 6 were ofgrade 2 and only one patient was of grade 3 before the treatment, of them 5 patients wereof grade 1 and 2 were of grade 0 after the treatment. Dourbalya and Bhrama were found in 29 patients. Among them 2 were of grade 3before the treatment. Among them 1 patient was of grade 0 and 1 patient was of grade 1after the treatment. 13 patients were of grade 2 before the treatment of them 4 patientswere were grade 1 and 9 patients were grade 0 after the treatment. Remaining 14 patientswere of grade 1 before the treatment and were shown grade 0 after the treatment.Agnimandya was found in 25 patients and all the patients were of grade 2 before thetreatment. Among them 5 patients were grade 1 and 20 patients were of grade 0 after thetreatment. 117 Discussion
  • 136. DISCUSSION OF OBSERVATIONS All the cases were taken from OPD & IPD of DGM Ayurvedic Medical College.Postgraduate departments. Special medical camps were also conducted in the college forselecting the patients. Observed features in the patients during the study were recorded inthe case-sheets and the observations were analyzed and tabulated after completion ofclinical study. These observational finding are discussed below.1) Age In the sample of 30 patients, it was observed that the maximum number of patients(46.66%) was from the age group 18-24 years. Among them 11 patients were females and 3were male and also 12 of them were students. The incidence may because of more iron lossduring menstruation, increased demand of iron during the age group and increased stressand strain, thereby irregularity in diet.2) Sex The sex wise distribution of patients reveals that Panduroga was observed more infemales (73.33%) than male (26.66%) approximately 3:1 ratio. Higher incidence in female is found because of regular menstrual blood loss; bloodloss during delivery, pregnancy, and lactation requires more Iron if not compensated resultsin Anaemia. It may also be due to imbalance, irregular diet intake, mental and pshysicalstress.3) Religion In this series most of the patients were Hindus i.e. 83.33% and a lesser portionbelonged to Muslim community. i.e. 16.66%. From this it can be inferred that most of theHindus are vegetarians and this incidence may be due to imbalance diet and ProlongedMalnutrition because of lack of awareness regarding the importance of diet. 118 Discussion
  • 137. 4) Occupation In the present study maximum number of patients were students. (36.66%) and23.33 % were household work. This may be due to excessive mental stress, irrelevant,inadequate and improper diet. In most of these patients, it was observed that Diwaswapanawas common, leading to agnimandya, which can cause Dhatwagnimandya, which is acause of improper digestion results in Panduroga. In the same way Ratrijagarana was foundmaximum which can also be a cause for this disease.5) Socio economic status The larger numbers of patients were from middle class 53.33%, 30% were fromupper middle class & 16.14% were from poor class. The patients form middle class cannot afford expensive nutritious food. However,middle class females due to poor pre and postnatal care are more prone to this disease. Aswell as they are not caring for proper diet yet needed time and always worrying for thefamily responsibilities, which leads to mental tensions. The people of upper middle class,though their diet is adequate, but proper absorption and assimilation is also necessary forits utilization. Thus, lack of supplementation of dhatu at required level, results inPanduroga.6) Food habitIn this clinical study, it was observed that most of them were vegetarians 70% andremaining 30% were mixed type of food habit. According to physiological needs, the food which has consumed should have aactive principles that triggers the production of haem yet times, when it is needed. Asnon-vegetarians can consume the liver and bone marrow of animals (Goat), tosupplement the loss of production of haem, where as it is lacked in vegetarians diet. Thatmay be the cause, observed during my study that 70% of vegetarians are more prone toPanduroga. 119 Discussion
  • 138. 7) Prakriti Majority of cases (53.33%) were having Pitta Shleshmaja prakriti and 26.66%were having Vata Pitta Prakriti It is observed that may be due to these kind of prakriti persons have consumedpittaprakopaka ahara and vihara results into pittavirddhi and as the person having thesekinds of prakriti are prone to the incidence of the disease Panduroga.8) Koshta and Agni In my study it was observed that 22 patients (73.33%) were having the mandagniand madhyama koshta, may be due to predominance of kapha dosha, which place animportant role in proper digestion and assimilation of the nutrients. So that the symptomslike Panduta, Dourbalya, Agnimandya, Bhrama occurs compare to other category (Koshtaand Agni) of the patients.9) Nidana Aharaja About 28 patients (93.33%) had the history of Amla sevana, 26 patients (86.66%)were of kshara and teekshna sevana, 22 patients (73.33%) were of masha sevana andabout 20 patients (66.66%) were of lavana and atiushna sevana and some 15 patients(50%) had the history of tila sevana. Among them most of the patients were vegetarians.It may be due to lack of awareness regarding diet consumption such kind of diet vitiatestridosha, specially pittadosha resulting the disease panduroga. Vihara Divaswapna (86.66%), Ativyayama (66.66%) and Ratrijagarana (63.33%) werefound maximum as most of them were students and households. Nidra viparyaya causesAgnimandya and Ativyayama causing incomplete digestion and production of Ama,which vitiates rasa and rakta results in Panduroga. 120 Discussion
  • 139. Manasika In the present study krodha and chinta were found in 93.33% and 66.66% of casesrespectively. This incidence may be due to the fact that most of the patients were studentsand household in this study. The mental stress may cause inadequate consumption of thediet and improper digestion, thereby resulting in Panduroga.11) Lakshana In all the 30 patients, mild to moderate degree of Panduta was noted, which ispratyatma lakshana of Panduroga. It may be due to ojakshaya, raktakshaya and vitiationof pittadosha associated with other doshas. After treatment it showed the mean effect1.233 and p value <0.001 which is highly significant. Arohanayasa was found in 24 patients, it may be due to less oxygen carryingcapacity of blood to the vital organs. So heart has to pump more to provide proper bloodflow. The mean relief found was 0.833 and p value <0.001 which is highly significant. Dourbalya and Bhrama were found in 29 patients. Hence, it can be inferred thatthese symptoms are also most prominent in this disease. This is due to Rasa raktadi dhatukshaya. The mean effect found after the treatment was 1.366 and 1.266 respectively and pvalue <0.001 which are highly significant. Agnimandya was noticed in 25 patients, which may be results out of Nidanasevana, where Pachaka pitta, Samanavata and Ranjaka pitta are mainly involved. Itsmean effect after the treatment was 1.5 and p value <0.001 which is highly significant.12) Types of Panduroga It shows 45% of cases were pittaja pandu, followed by 35% cases of Kaphajapandu and remaining 20% of cases were of Vataja pandu. Pittaja pandu is the commonesttype of pandu found in the study. The probable cause may be that, most of the patients werepitta-dominating prakriti and involvement of pittaja Nidana was noticed. 121 Discussion
  • 140. DISCUSSION ON TREATMENT Deepana-pachana with Trikatu was given for 2-3 days, 3-6 gms thrice daily tillthe appearance of Nirama lakshanas. As Pandu is santarpanajanya vyadhi whereAgnimandya and symptoms of Ama can be appreciated. It was observed that all thepatients got nirama lakshanas within 2-3 dyas. In that 2 patients had complaint of burningsensation and irritation in the chest region, 10-15 minutes after the intake of the medicine.In such case dose was reduced and advised to consume with excessive warm water. Dadima ghrita was used for Snehapana. Starting with 30 ml and was given within7-8 am in all the patients. Snehapana was continued for 3-4 days in arohana vidhi. Thus,in the present study maximum ghrita given to a patient was 300 ml and minimum was180 ml. It was observed that 30 ml of Dadima ghrita was digested within 180 minutes in27 patients and 3 patients took more than this time i.e. 180-240 minutes. 60 ml of ghritawas digested in between 240-360 minutes, where as time taken to digest 90 ml of ghritawas 360-480 minutes in 28 minutes where as only 2 patients were digested within 360minutes. Sukhoshnajala was adviced as Anupana, which is kaphahara, deepaka,amapachaka, vatanulomaka, thus helpful in proper digestion of administered senha. The sneha imparts its qualities to all the dhatus gradually, once all the dhatus getssaturated with sneha, their qualities like snigdhata and mriduta manifests in the twak.Snehapana removes the obstruction to the gati of the vata, Vatanulomana takes place.Hence, individual may feel laghuta and vimalendriyata. Snehapana itself may act like langhana due to diet restriction during the course ofsnehapana. This may another reason for manifestation of above symptoms. By excessiveamount of sneha, excessive secretion in srotas may takes place and hence producesvishyandana. When snigdhata guna of the body reaches optimum level, invidual will start 122 Discussion
  • 141. showing disliking towards snehapana. Shodhanga snehapana is tedious process ofconsumption of higher dose of sneha, by following restriction in the diet. Thus, glani maybe observed in the individual. Thus, during everyday of snehapana. Samyak snigdhalakshanas were examined thoroughly. According to classics virechana should be administered just after shleshma kala.Keeping this in mind the suitable matra was administered by considering Koshta, Agniand at proper time. Hence, the Virechana yoga was administered around 7-8 am. Beforethe administration observations like pulse, BP, respiration rate were noted to observe thechanges. The parameters like vegiki, maniki, antaki and laingiki were also noted byinterrogation with the patient. In the present study it was noted that, 7 patients had below 10 vegas, 19 patientshad 10-20 vegas and only 4 patients had above 20 vegas. Hence, it can be inferred that,maximum patients has shown madhyama type of shodhana. About 6 patients shown thesymptom of vomiting and nausea during virechana vega kala. It may be due to earlyadministration of virechana yoga, alpa satwa and also due to the properties of virechanadravyas. The quantity of Vegas was measured by asking the patient about the appropriatequantity of single vega. It was observed that 14 patients were passes Vegas of 2000 ml,and above and 16 patiants were less than 2000 ml. Approximately, 2200 ml of maximumamount of drava (vitiated doshas) was measured in a patient who passed 24 vegas and1400 ml was minimum amount found in a patient who passed 7 vegas. All the patients had manifested the features of kaphanta in between 5-30 to 8-30hours after administration of virechana dravyas. It was appropriated by frothy type ofVega pravritti. 123 Discussion
  • 142. Vata, purisha, pitta and kapha kramataha nissarana, Shareera karshya, dourbalya,Shareera laghuta, srotoshuddhi and vatanulomana were observed in all the patients assamyak virakta lakshanas. Shareera kshaya was observed by weight loss after virechanacompared to before the virechana others symptoms were known by interrogation with thepatients. In this study during follow up no shamanoushadhis were administered in order toobserve the long-lasting effect of virechana therapy. It was noticed that the effect ofvirechana is more in long-lasting compare to immediate effect. It may be due to theadditive contribution of the extraneous variables like consumption of pathya ahara andvihara mentioned in the context of Panduroga. When we look into the concept of dhatu parinama, acharya Sushruta opines, rasadevelops from the diet in one day. The circulating rasadhatu, transporting the nutrientsstays in each one of the remaining six dhatus for a period of 3015 kalas (5 days).Therefore, it takes for the rasa, one month to be formed shukra in men and artava inwomen. The total time taken for conversation is 30 days. But according to Charaka, itdepends on the agni status of the person. By considering this the efficacy of virechanawas observed after 15 days of follow up. In the present study, 42 patients were registered. In that 4 patients were notsatisfied the criteria of the study, 5 patients were discontinued the treatment before thevirechana karma, whereas 3 patients were discontinued at the time of follow up. Among30 patients 9 patients (30%) were shown good response, 15 patients (50%) shownmoderate response whereas, 6 patients (20%) were shown poor response. Poor responsemay be either due to not completely adopted follow up or shuddhi of Virechana is not upto the mark. 124 Discussion
  • 143. It is a single group observational study, it showed remarkable changes in signsand symptoms as well as Hb, RBC count, PCV and smear study, which are statisticallysignificant. Among subjective parameters Panduta, Bhrama, Dourbalya showed muchsignificant. The parameter Hb% and Arohana ayasa almost have the same significanteffect. Form this we may conclude that, virechana therapy corrects agni, dhatwagnimandya and srotosanga resulting out of ama, which are the basic causes for Panduroga.Based on the results observed in the present study it can be undoubtedly conclude thatVirechana is effective therapy in Panduroga in which alone can give the mean effect ofHb up to 0.85 gm including extraneous variables.DISCUSSION ON THE EFFECT VIRECHANA THERAPY IN PANDUROGA Samshodhana, samshamana and pathya ahara-vihara are mentioned in the classicsfor the management of Panduroga. Among samshodhana, vamana and virechana areindicated, by considering the opinion of Acharya Dalhana, virechana was chosen for thestudy. The factors, which can influence by the virechana concern to Panduroga are asfollows – 01. Panduroga is a pitta pradhana tridoshaja vyadhi, where rasa and rakta are mainly affected. Virechana is main line of treatment for pitta dosha and it is not viruddha Chikitsa for vata and kapha dosha, which are associated in this disease. 02. Acharya Charaka has mentioned it as Santarpanajanya vyadhi where dhatu parinama is mainly affected. Virechan is apatarpana type of Chikitsa, which could be helpful by eliminating vitiated doshas correcting srotodushti, thereby producing bala and varna. 125 Discussion
  • 144. 03. Virechana acts mainly on pittadhara kala. Acharya Dalhana, in the context of vishavega Chikitsa, it is mentioned that pittadhara kala and majjadhara kala are one and the same. Hence, virechana can also acts on majjadhara kala. Sarakta majja, corresponds to the red bone marrow, which is site of production of RBC’c. 04. When we look into absorption of iron, it is said that, iron is mainly absorbed in the duodenum and the proximal jejunum, which is the site of pittadhara kala. Even in modern it is mentioned that the factors, which determine this mucosal intelligences are unknown, when demand is more there is increase in iron absorption. 05. Transferrin, which serves to transport the iron form the site of absorption is synthesized mainly in the liver parenchymal cells. 06. The main source of iron transport and utilization is the destruction of RBC than that of intestinal absorption and storage. The site of destruction RBC is pleeha (Spleen). 07. Erythropiotin, a haemopiotic growth factor is a glyco-protein produced mainly in the kidney and to a small extent in the liver (Yakrit), in response of cellular hypoxia. 08. The most common cause of maturation failure is not the lack of vitamin B12 in the diet. But, failure of absorbs form the gastrointestinal tract. The intrinsic factor which is secreted by the parietal cells of the gastric glands (Amashaya), combines with the Vitamin B12 of the food and makes this vitamins available for absorption. Its larger quantity is stored in the liver. 09. In Ayurveda, yakrita – pleeha are said as moolas for the raktavaha srotas and ranjaka pitta is situated in yakrit – pleeha and amashaya. The above said factors may be the reason why, the virechana is effective inPanduroga, by correcting the raktadushti. 126 Discussion
  • 145. DISCUSSION ON THE EFFECT OF VYOSHADI GUTIKA IN PANDUROGA Pharmacodynamics in Ayurveda is mainly based on the fundamental doctrines ofPanchamahabhoota and Tridosha, which govern the physiochemical and biologicalphenomena respectively. On assessing the properties of Vyoshadi Gutika, the drugs arehaving following properties – 01. Agnideepaka – Agnimandya specially, dhatwagni mandya is the main cause for the disease Panduroga. 02. Tridoshahara – Panduroga is pitta pradhana, tridoshaja vyadhi. 03. Srotoshodhaka – Sanga type of srotodushti is found in Panduroga, which can affect the dhatu parinamana. 04. Krimighna – Both Ayurveda and modern science accept the involvement of Krimi (Worms) may be cause for Panduroga. 05. Rechaka – Expels both pakwa and apakwa malas present in the pathogenesis of Panduroga. 06. Vatanulomana – Baleena vata is one of the factor involved in the samprapti of this disease. 07. Raktashodhaka – As “Pradushya raktam” is the main condition mentioned in the samprapti of this disease. 08. Yakrit uttejaka – By seeing explanation in Ayurveda and contemporary science, the importance of part played by the yakrit can be revealed. The above said factors may be responsible for the effect of Vyoshadi Gutika inPanduroga used as Virechana yoga. 127 Discussion
  • 146. CONCLUSIONS 01. Panduroga is a disease named after different vaivarnyas of the twak, mainly Pandurvarna, it refers to shweta and Peeta mishrita varna. 02. Panduroga can occur as a main disease, symptoms or as a complication to other diseases. 03. Panduroga is said as Santarpanajanya vyadhi where apatarpana type of treatment like virechana karma is necessary to treat basic pathology. 04. Achary Dalhana opines that the urdwa shodhana is contraindicated in Panduroga and moreover it is pitta pradhana tridoshajanya vaydhi, where pradushya rakta is mainly appreciated. So Virechana therapy was chosen for the study. 05. After the period of observation, it can be said that Virechana therapy has more long lasting effect than that of immediate effect, where extraneous variables are also contributing in the total result. 06. In the present study, individually except RBC and MCV all the parameters show highly significant. 07. In my view as duration of the study is inadequate and Virechana alone is not complete treatment to cure the disease Panduroga, Virechana therapy followed with indicated Sahamanoushadhis and Pathyapathya could give more beneficial effects. 08. In the overall results, 9 patients were responded good, 15 patients were responded moderately whereas 6 patients shown poor response. 128 Conclusion
  • 147. Suggestions for the future studies 01. A similar study can be conducted on large sample. 02. Study on effect of repeated Virechana in Panduroga with longer duration. 03. A comparative study of Vamana and Virechana therapy in Panduroga. 04. A comparative study of Virechana therapy and standard shamanoushi in Panduroga. 05. Study on additive efficacy of Virechana therapy in Panduroga. 129 Conclusion
  • 148. SUMMARY The thesis is entitled with- “Clinical evaluation of Virechana therapy in themanagement of Panduroga”. Panchakarma is a procedure by which vitiated doshas get eliminated from thebody. “Na Tesham Punarudbhavaha” indicates the importance of Panchakarma.Virechana is specially indicated for Pittadosha and Pittadosha associated with otherdoshas. Panduroga is Pittapradhana tridoshaja vyadhi where Rasa and Rakta are mainlyaffected and is Santarpanajanya vyadhi. Thus virechana karma is most appropriate andsuitable procedure which is a variety of Apatarpana Chikitsa. In this study speciallyindicated “Dadima Ghrita” for Snehapana and for Virechana “Vyoshadi Gutika” wasused. The present study covered the following aspects; 1. Introductory part and Objectives. 2. Historical aspect of Virechana and Panduroga. 3. Description about Virechana therapy and Modern Purgatives. 4. Explanation regarding Panduroga, including Nidana panchaka and its Chikitsa. 5. Brief description about Anaemia with special reference to IDA. 6. Anatomical consideration of Virechana therapy and Pathogenesis of Panduroga. 7. Description regarding Materials and Methods of present study including Drug review. 8. Observations of the present study, Results, Discussion, Summary, Conclusion and finally Bibliography. 130 Summery
  • 149. The study was conducted on a single group and all patients received ClassicalVirechana therapy. The disease was diagnosed mainly on the classical signs andsymptoms and was further confirmed with Hematological study. The Drugs selected forstudy were Trikatu Choorna for Deepana Pachana, Dadima Ghrita for Snehapana,Murchita Tila taila for Abhyanga and for Virechana Vyoshadi Gutika which wereexplained in detail in Drug review. Observations were taken before the treatment, after the Virechana karma and afterthe follow up study. Assessment was done on both subjective and objective parameters.The effect of the therapy was statistically assessed by using Paired t-test, which wassignificant. The discussion pertaining to the review of literature, Materials and Methods,observations, treatment and results, hypothesis of the effect of Virechana therapy as wellas Virechana with Vyoshadi Gutika in Panduroga were discussed to draw the logicalconclusion. It was found that Virechana shows long lasting effect if the patients followthe Pathya apathya. Thus the extraneous variables are also contributing in the total effect. 131 Summery
  • 150. INTRODUCTION & HISTORICAL REVIEW 1) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 1-2. 9th ed. Varanasi: Chaukhamba Orientalia; 2002.p.223. Agnivesha, Charaka Samhita Sutrasthana Chapter 22 Shloka 1. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.423. 2) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 4. 9th ed. Varanasi: Chaukhamba Orientalia; 2002.p.223. 3) Vagbhata, Ashatanga Hridaya Sutratshana Chapter 14 Shloka 5. 9th ed. Varanasi: Chaukhamba Orientalia; 2002.p.223. 4) Ibid. 223. Dalhanacharya, Sushruta Smahita Sutrasthana, Chapter 5 Shloka 3. 8th ed. Varanasi: Chaukhamba Orientalia; 2005.p.19. 5) Agnivesha, Charaka Samhita Sutrasthana Chapter 16 Shloka 20. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.321. 6) Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 46-50. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.923. 7) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 44-46. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.494. Arundutta, Ashtanga Hridaya Chikitsathana Chapter 15 Shloka 2-4. 1st ed. Varanasi: Chaukhamba Orientalia; 2000.p.701. 8) Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 46-50. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.923. 9) Agnivesha, Charaka Samhita Sutrasthana Chapter 2 Shloka 9. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.53. 10) Agnivesha, Charaka Samhita Sutrasthana Chapter 2 Shloka 4. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.51. 11) Agnivesha, Charaka Samhita Sutrasthana Chapter 2 Shloka 15. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.54. 12) Agnivesha, Charaka Samhita Kalpasthana Chapter 7-12. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.916-958. 132
  • 151. 13) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 17-19. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.964.14) Agnivesha, Charaka Samhita Siddhisthana Chapter 2 Shloka 11-13. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.980.15) Agnivesha, Charaka Samhita Siddhisthana Chapter 6. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1018-1033.16) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.486-508.17) Sushruta, Sushruta Samhita Sutrasthana Chapter 39 Shloka 4. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.147.18) Sushruta, Sushruta Samhita Sutrasthana Chapter 39 Shloka 4. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.147.19) Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 1-47. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.142-147.20) Sushruta, Sushruta Samhita Chikitsasthana Chapter 34 Shloka 1-22. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.147-152.21) Sushruta, Sushruta Samhita Uttaratantra Chapter 44. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.283.22) Vagbhata, Ashatanga Hridaya Sutrasthana. Chapter 18. 9th ed. Varanasi : Chaukhamba Orientalia; 2002.p.260-270.23) Vagbhata, Ashatanga Hridaya Kalpashana. Chapter 2. 9th ed. Varanasi : Chaukhamba Orientalia; 2002.p.741-748.24) Vagbhata, Ashatanga Hridaya Siddhishana. Chapter 3. 9th ed. Varanasi : Chaukhamba Orientalia; 2002.p.748-753.25) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13. 1st ed. Varanasi : Chaukhamba Orientalia; 2000.p.517-523.26) Arundutta, Ashtanga Hridaya Chikitsasthana. Chapter 13. 1st ed. Varanasi : Chaukhamba Orientalia; 2000.p.701-704.27) Y. T. Acharya, Astanga Sangraha Sutrasthana. Chapter 27. 11st ed. Varanasi : Chaukhamba Orientalia; 1996.p.236-248. 133
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  • 154. 18) Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 32. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.147-145.19) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 8-9. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.261.20) Agnivesha, Charaka Samhita Siddhisthana Chapter 2 Shloka 11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.980.21) . Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 31. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.145.22) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 10-11. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.261-262.23) Agnivesha, Charaka Samhita Sutrasthana Chapter 15 Shloka 5. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.303.24) a. Sharangadhara, Sharangadhara Samhita Uttara khanda Gudartha Depika Vyakya, Chapter 4 Shloka 18-19. Chaukhamba Orientalia; (Jaikrishnadas 53). p.481. b. Agnivesha, Charaka Samhita Kalpasthana Chapter 8 Shloka 13. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.929.25) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 6-7. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.960.26) Agnivesha, Charaka Samhita Sutrasthana Chapter 13 Shloka 47. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.268/27) Sushruta, Sushruta Samhita Chikitsasthana Chapter 31 Shloka 53. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.138.28) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 16 Shloka 30. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.250.29) Chakrapanidutta, Charaka Samhita kalpasthana Chapter 13 Shloka 80. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan;Orientalia; 2004.p.86.30) Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 20. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.144. 136
  • 155. Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 8-9. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.960.31) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 9. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.960-961.32) Sharangadhara, Sharangadhara Samhita Uttara khanda Gudartha Depika Vyakya, Chapter 4 Shloka 16-17. Chaukhamba Orientalia; (Jaikrishnadas 53). p.480-481.33) Sharangadhara, Sharangadhara Samhita Uttara khanda Gudartha Depika Vyakya, Chapter 4 Shloka 13. Chaukhamba Orientalia; (Jaikrishnadas 53). p.479-480.34) Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 21. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.144.35) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 33. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.266.36) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 26. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1023.37) Ibid. 27.38) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 37. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.267.39) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 20. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1021-1022.40) Ibid 21.41) Y. T. Acharya, Astanga Sangraha Sutrasthana Chapter 27 Shloka 40. 11st ed. Varanasi: Chaukhamba Orientalia; 1996.p.494.42) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 13-14. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.962.43) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 17. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.964. Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 27. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.145. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 39. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.267. 137
  • 156. 44) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 18. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.964-965. Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 24. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.144. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 38-39. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.267.45) Agnivesha, Charaka Samhita Siddhisthana Chapter 1 Shloka 19-20. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.965. Sushruta, Sushruta Samhita Chikitsasthana Chapter 33 Shloka 25. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.144. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 40-41. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.267.46) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 32. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1024.47) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 18 Shloka 43-45. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.267-268.48) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 25. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1023.49) Chakrapanidutta, Charaka Samhita kalpasthana Chapter 6 Shloka 25. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan;Orientalia; 2004.p.705.50) Agnivesha, Charaka Samhita Siddhisthana Chapter 6 Shloka 29. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.1023.51) Chakrapanidutta, Charaka Samhita kalpasthana Chapter 6 Shloka 29. Yadavaji Trikamji acharya, reprinted. Varanasi: Chaukhamba Sanskrit Sansthan; 2004.p.705.52) Sushruta, Sushruta Samhita Chikitsasthana Chapter 34 Shloka 3. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.140.53) Agnivesha, Charaka Samhita Sutrasthana Chapter 26 Shloka 67. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.514. 138
  • 157. 54) Sushruta, Sushruta Samhita Sutrasthana Chapter 46 Shloka 259. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.205. 55) Agnivesha, Charaka Samhita Sutrasthana Chapter 26 Shloka 13. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.492. 56) Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco- therapeutics Chapter 38. 16th ed. Mumbai; Popular Prakashana Publications; 1999. p. 580.PANDUROGA 1) Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 16 Shloka 2. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan; 2004.p.526. 2) Radhakant Deva Bahaddur, Shabdakalpadruma, 3rd ed. Varanasi : Chaukhamba Orientalia; 1967.p.104. 3) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 3. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.517. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488. 4) Sushruta, Sushruta Samhita Uttaratantra, Chapter 44 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.285. Madhavakara, Madhava Nidana Part-I Chapter 8 Shloka 2. 28st ed. Varanasi : Chaukhamba Orientalia; 1998. p.221. 5) Sushruta, Sushruta Samhita Sutrasthana Chapter 14 Shloka 44. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.56. 6) Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 4. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.443. 7) Sushruta, Sushruta Samhita Sutrasthana Chapter 14 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.48. 8) Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.194. 9) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.487. 139
  • 158. 10) Agnivesha, Charaka Samhita Sutrasthana Chapter 12 Shloka 11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.251.11) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 7-11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488.12) Sushruta, Sushruta Samhita Uttaratantra, Chapter 44 Shloka 3. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.284.13) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 12 Shloka 1. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.517.14) Agnivesha, Charaka Samhita Sutrasthana Chapter 23 Shloka 5. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.436.15) 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.100.16) Sushruta, Sushruta Samhita Nidanasthana Chapter 11 Shloka 17. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.273.17) Sushruta, Sushruta Samhita Shareerasthana Chapter 2 Shloka 21. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.12.18) Agnivesha, Charaka Samhita Chikitsasthana Chapter 4 Shloka 27. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.285.19) Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi: Chaukhamba Orientalia; 2002.p.71.20) Sushruta, Sushruta Samhita Nidanasthana Chapter 2 Shloka 14. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.238.21) Sushruta, Sushruta Samhita Nidanasthana Chapter 8 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.258.22) Ibid 16.23) Sushruta, Sushruta Samhita Nidanasthana Chapter 6 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.254. 140
  • 159. 24) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 12. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488.25) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 5. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.286.26) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 8-9. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.27) 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.337.28) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 13-16. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.488-489.29) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 4-7. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.30) Gangadhara, Chakrapani, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6, Reprint. Varanasi: Chaukhamba Orientalia; 1991.p.2974.31) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 3. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.486.32) Sushruta, Sushruta Samhita Uttaratantra Chapter 14 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.285.33) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 7. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.34) 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. 141
  • 160. 35) 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.518.36) 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.518.37) 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.518.38) Madatraya Maharshi, Hareetamuni, Samvadarupa Vaidya Granth, Harita Samhita Chapter 8 Shloka 10 Edited by Khemraj Shrikrishnadas; Bombay: Swakiya Venkateshwar Mudranlaya; 1984.p.148.39) 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.518.40) Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 16 Shloka 27-30. Yadavaji Trikamji acharya, reprinted. Varanasi: Chaukhamba Sanskrit Sansthan; 2004.p.528. 142
  • 161. 41) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 13-15. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.518.42) 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.337.43) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 4-6,9-11. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.487-488.44) Arundutta, Ashtanga Hridaya Nidanasthana Chapter 13 Shloka 1-3. Reprinted. Varanasi: Chaukhamba Orientalia; 2000.p.517.45) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 3. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.284.46) Sushruta, Sushruta Samhita Uttaratantra Chapter 44 Shloka 15. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.290.47) 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.338.48) 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.493.49) Dalhanacharya, Sushruta Smahita Uttartantra, Chapter 44 Shloka 14. 8th ed. Varanasi: Chaukhamba Orientalia; 2005.p.730. 143
  • 162. 50) Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 55. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.496. 51) 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. 52) Ibid 34 &116. 53) 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.ANAEMIA 01. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s Medical Publishers; 2000.p.334-342. 02. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.903. 03. Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco- therapeutics Chapter 30. 16th ed. Mumbai; Popular Prakashana Publications; 1999. p.453. 04. Harsh Mohan, Text Book of Pathology; Chapter 12. 4th ed. New Delhi : Japee Brother’s Medical Publishers; 2000.p.344.SHAREERA 01. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.877-878. 02. Ibid. 884-885. 03. Ibid. 898-899. 04. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.711. 05. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.71. 144
  • 163. 06. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan; 2004.p.584.07. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 9. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.70.08. Agnivesha, Charaka Samhita Chikitsasthana Chapter 15 Shloka 16. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.456.09. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 10. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.89.10. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 12 Shloka 13. Reprinted. Varanasi : Chaukhamba Orientalia; 2000.p.194.11. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 13. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.30.12. Sushruta, Sushruta Samhita Sutrasthana Chapter 21 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.87.13. Sushruta, Sushruta Samhita Sutrasthana Chapter 15 Shloka 5. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.56.14. Agnivesha, Charaka Samhita Viamanasthana Chapter 5 Shloka 8. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.711.15. Sushruta, Sushruta Samhita Shareerasthana Chapter 9 Shloka 12. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.71.16. Chakrapanidutta, Charaka Samhita Chikitsasthana Chapter 24 Shloka 35. Yadavaji Trikamji acharya, reprinted. Varanasi : Chaukhamba Sanskrit Sansthan; 2004.p.584.17. Martini F.H., Fundamentals of Anatomy and Physiology. Chapter 24. 4th ed. New Jersey; Prentee Hall Inc. Simon and Schuster; 1998.p.651.18. 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.386 145
  • 164. 19. Sushruta, Sushruta Samhita Shareerasthana Chapter 4 Shloka 4. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.28. 20. Ibid. 21. 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. 22. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 4. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.443. 23. Davidson, Principals and Practice of Medicine. Chapter 19. 19th ed. Christopher Haslett, Edwin R. Chilvers, Boon, Colledge London; Churchill Livingstone;2002.p.897. 24. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 22. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.447. 25. Agnivesha, Charaka Samhita Sutrasthana Chapter 24 Shloka 24. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.449. 26. C.C.Chatterjee, Human Physiology, Vol. – I. Chapter 4. Kolkata : Ashutosh Lithographic Co.; 2004.p.123-124.DRUG REVIEW 01. Arundutta, Ashtanga Hridaya Sutrasthana Chapter 6 Shloka 164. Reprinted. Varanasi : Chaukhamba Orientalia; 2000.p.119. 02. Agnivesha, Charaka Samhita Chikitsasthana Chapter 16 Shloka 44-46. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.494. 03. Govind Das, Bhaishajya Ratnawali. Jwarachikitsa Prakarana. 7th ed. Kaviraj Ambikadutta Shastri Editor. Varanasi; Chaukhamba Orientalia; 1983.p.130. (Kashi Sanskrit Series, 152). 04. Sushruta, Sushruta Samhita Chikitsasthana Chapter 32 Shloka 26. 13th ed. Varanasi : Chaukhamba Orientalia; 2002.p.141. 05. Agnivesha, Charaka Samhita Kalpasthana Chapter 7 Shloka 44-46. 22nd ed. Varanasi: Chaukhamba Orientalia; 1996.p.494. 146
  • 165. 06. Bhavamishra, Bhavaprakasha Poorvakhanda. 5th ed. Varanasi : Chaukhamba Orientalia; 1969. p.13.07. Ibid. 17.08. Ibid. 15.09. Ibid. 582.10. Ibid. 34.11. Ibid. 22.12. Ibid. 651.13. Ibid. 232.14. Ibid. 243.15. Ibid. 228.16. Ibid. 222.17. Ibid. 52.18. Ibid. 5.19. Ibid. 10.20. Ibid. 400.21. Ibid. 398.22. Ibid. 797.23. Ibid. 788.24. Dr. Nadakarni K. M. Indian Materia Medica. Vol. I 3rd ed. Bombay : Popular Prakshana; 1976..965.25. Ibid. 969.26. Ibid. 1308.27. Ibid. 333.28. Ibid. 428.29. Ibid. 333.30. Ibid. 475.31. Ibid. 478.32. Ibid. 1205.33. Ibid. 480.34. Ibid. 116.35. Ibid. 1015. 147
  • 166. POST GRADUATE STUDIES DEPARTMENT OF PANCHAKARMA “ Clinical evaluation of Virechana Therapy in the management of Panduroga - An observational clinical study”Guide : Dr.P.Shivaramudu M.D.(Ayu.)Co – Guide : Dr.S.H.Doddamani M.D.(Ayu.) P.G.Scholar: Shaila.G.Borannavar01. 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. Religion :06. Occupation : Household Student Service Labor Sedentary07. Economical Status : Poor Middle class Higher class08. Diet Vegetarina Mixed Date Of Initiation :09. Address Date Of Completion: Telephone No.:10. Result : Good Responded Moderate Responded Poor Responded Not Responded11. Consent : I am fully educated with the disease and treatment; there by I got satisfied whole-heartedly. I accept for the medicinal trail over me.Signature of Investigator Signature of Patient 1
  • 167. I. HISTORY TAKING:A. Pradhana Vedana: Avadhi01. Vaivarya of Prakruta / Pandu / Krishna / Aruna / Peeta / Shukla. Nakha ( ) Netra ( ) Twak ( ) Vit ( ) Mootra ( ) Sira ( )02. Shonakshikuta ( )03. Arohanaayasa ( )04. Hridrava ( )05. Dourbalya ( )06. Shrama ( )07. Brama ( )08. Sadana ( )09. Shirashoola ( )10. Gatrashoola ( )11. Shabdaasahishnuta ( )12. Pindikodvestana ( )B. Anubandhi Vedana Avadhi AvadhiKarnaskweda ( ) Jwara ( )Aruchi ( ) Swasa ( )Agnimandya ( ) Kasa ( )Trishna ( ) Hataprabha ( )Toda ( ) Shishiradweshi ( )Praseka ( ) Mridbhakshanaapeksha( )Alasya ( ) Swarakshaya ( )Tandra ( ) Twak sputana ( )Alpameda ( ) 2
  • 168. C. Adyathana Vyadhi vrittanta – a. Mode of Onset : Sudden Gradual Insidious Sub acute b. Course : Gradually progressive Persistent Relapsing RecedingD. Poorva Vyadhi Vrittanta :* Bleeding disorders – Vividha abhighata / Krimiroga / Arsha / Raktapitta / Raktarbuda.* Yakrut or Pleeha vikara* Metabolic and other disordes – Prameha / Rajayakshma / Others* Pyogenic diseases – Vruna / ArbudaE. Chikitsa Vrittanta :* Modern medicine -* Ayurvedic -* Surgery (Gastrointestinal) -* Others -F. Kulu Vrittanta :* Hemophilia* Purpura* Leukemia* OthersG. Atura charya : a. Ahara Vegetarian Mixed i. Diet: ii. Dominent rasa Madhura Katu in the food: Amla Tikta Lavana Kashaya Samashana Adyashana iii. Dietric habits: Anashana Vishamashana 3
  • 169. b. Vihara i. Vyayama: Mild Moderate Heavy ii. Vyavaya: iii. Manasika Vikara: Chinta Shoka Bhaya Krodha Others iv. Vyasana: Madhyapana Tobacco Dhomapana Others v. Nidra: Sound Disturbed DivaswapnaH. Gynecological History : Menstrual Cycle Regular Irregular Number of days Inter Menstrual period Associated of any complaints Menarche & Menopause Menorrhagia Metrorrhagia Leucorrhoca Dysmenorrhoea AmmenorrheaI. Obstetrics history : Gravida Para Abortion Miscarriage Still birth Number of deliveries Nature of delivery Normal Forceps Surgical Last delivery 4
  • 170. II. EXAMINATION01. Samanya Pareeksha: Shareera Bhara Ashta Sthana Pareeksha: Nadi Sparsha Mala Jihva Mootra Drink Shabdha Akruti02. Vishesha Pareeksha:SROTO PAREEKSHAI. Rasavaha: Asraddha / Aruchi / Asyavairasya / Arasajnata / Hrillasa / Gourava /Tandra / Sangamardajwara / Tama / Pandutva / Shrotorodha / Klaipya / Sada /Krishnangata / Agninasa / Akaalavali / Akaalapalitya.II. Raktavaha: Mukhapaka / Akshiroga / Vaivarnya / Agnimandya / Pipasadhikya /Gurugatrata / Santapa / Dourbalya / Aruchi / Shirashoola / Tiktaamlodhara /Vidahaannapanasya / Klama / Lavanasyata / Swedadhikya / Kampa / Swarakshaya /Tandra / Nidradhikya / Tamapravesha / Kandu / Pidaka / Pradara / Others.C. Others:II. Pranavaha -III. Udakavaha -IV. Annavaha -V. Mamsavaha -VI. Medovaha -VII. Asthivaha -VIII. Majjavaha -IX. Shukravaha -X. Purishavaha -XI. Mootravaha -XII. Swedavaha - 5
  • 171. 03. Systemic Examination : a. Shiras (Head & Neck) b. Madhyamanga (Uraha pradesh) c. Cardiovascular system (Hridaya) d. Respiratory system (Phuppusa) e. Urinary system (Mutravaha srotas) f. Digestive system (Annavaha srotas) g. Nervous system04. InvestigationsSpecific : Hb R.B.C. PCV MCV MCHC Peripheral Blood SmearRoutine Blood Investigations : WBC – TC DC ESRUrine Routine :AlbuminSugarMicroscopicOthers : If necessary. 6
  • 172. 05. Dashavidha Pareeksha :1. Prakritaha : Pravara Madhyama Avara2. Sara : Pravara Madhyama Avara3. Satwa : Pravara Madhyama Avara4. Satmya : Ekarasa Sarva rasa Vyamishra Rooksha Snigdha5. Samhanana : Susamhata Madhyama samhata Asamhata6. Pramana : Sama Heena Adhika7. Ahara Shakti : Abhyavarana : Pravara Madhyama Avara Jarana Shakti : Pravara Madhyama Avara8. Vyayama Shakti ; Pravara Madhyama Avara.9. Vaya : Bala Yuva Vriddha10. Vikriti Pareeksha : a) Nidana Ahara Vihara Manasika Kshara Divaswapna Kama Amla Ativyayama Chinta Lavana Ativyavaya Bhaya Atyushna Vegadharana Krodha Atiteekshna Ritu vaishamya Shoka Viruddha Prati karma Asatmya Masha Nishpava Tilataila Pinyaka Madya Mrit 7
  • 173. b) Purvapupa Hrit spandana Gatrasada Twak rookshata Mridbhakshaneccha Aruchi Akshikotashotha Swedaabhava Avipaka Agnimandhya Peeta mootrata Shrama Peeta purisha Sthivana c) RupaSl Vataja Pittaja Kaphaja Mridbhakshana janya1. Krishna / Aruna Peetata of – Swetata of – Shotha of – varna Rookshata of – Nakha Netra Nakha Akshikoota Nakha Twacha Netra Bhroo Netra Vit Twacha Ganda Twacha Mootra Vit pradesha Vit Sira Mootra Nabhi Mootra Sira Linga Sira Pada2. Soochivat Vedana Jwara Swetavabhasata Krimikoshta3. Bhrma Daha Gourava Mala –4. Kampana Trishna Moorcha Kaphayukta5. Parshwashoola Chardi Brama Raktayukta6. Shirashoola Sweda Shwasa7. Shopha Amlodgara Alasya8. Asya Vairasya Dourbalya Shwayatu9. Anaha Shosha10 Balakshaya Binna varchashta11 Shopa 8
  • 174. CHIKITSA Virechana KarmaDeepana Pachana: With Trikatu choorna 3- 6 grams two times a day before meals (Half an hour before breakfast and lunchSnehapana with Dadimadi Ghrita in Arohana vidhi with sukhoshna Jala in abhaktavastha till samyak snigdha lakshanas are seen.A. Observation for matra and time of administration of snehadravya.Day / Time I II III IV V VI VIISneha MatraPana KalaKshudha Pravrutti KalaTotal time taken for digestionB. Observation for matra and time of administration of snehadravya. Lakshanas I II III IV V VI VII IVatanulomanaAgnideeptiPurisha snigdhataAsamhata varchasTwaka snigdhaAnga laghavaGatra mardavaSnehodwegaKlamaShaithilya 9
  • 175. Abhyanga : Abyanga with Moorchita tila taila followed with Ushna jala snana (Mridu sweda)for 3 days.Virechana Karma with “Vyoshadi Gutika.” Time / Day Matra Anupana Vega Prarambha Vega ShamanaObservation: Laingiki Vaigiki Antaki Manaki Degree of Virechana Srotoshudhi Indriya Prasadana Shareera Laghuta Agnideepti Anamayatwa VatanulomanaAssessment of virechana:Date/Time Dose Anupana Mala Colour App. Vega BP/Pulse Temp/Resp. pravritti QuantitySamsarjana Krama: Samsarjana karma is advised for 3 to 7 days according to shuddhi followed withplacebo administration. 10
  • 176. RESULT ASSESSMENT* Subjective Parameters :Symptoms before Symptoms after Virechana Symptoms aftertreatment treatmentObjective Parameters : Hb% Before treatment After Virechana After treatment Total RBC Count Before Treatment After Treatment PCV MCH MCHC Blood smearInvestigators Note :Signature of Co-Guide Signature of Guide 11

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