Comparative study of Nishalauha and Ferrous Sulphate in Iron Deficiency Anaemia

A comparative clinical study to evaluate the effect of
“Nishalauha with Ferrous Sulphate” in the management
of Pandu w.s.r. to Iron Deficiency Anaemia
Co- Guide
Dr. Akhilesh Srivastava
MD (Ayu), PhD
Sr. lecturer
PG Deptt. Of Roga Nidana
Evam Vikriti Vigyana
RGG PG Aurvedic College &
Hospital
Paprola, Distt. Kangra (HP)
Co- Guide
Dr. Seema Shukla
MD (Ayu)
Reader
PG Deptt. Of Prasuti Tantra
Evam Stree Roga
Hospital
Guide
Dr. Rajesh Kumar Manglesh
MD (Ayu)
Reader
PG Deptt. Of Roga Nidana
Evam Vikriti Vigyana
Hospital
Research Scholar
Dr. Ajay kumar
B.A.M.S. (GRAU)

Why Did I Choose
This Topic
Pandu Roga can be clinically correlated
with Anaemia. As in both Pandu Roga and
Anaemia there are similar signs and
symptoms such as pallor, easy fatigability,
decreased appetite, generalized body
aches.
Due to high prevalence in the society and
lack of effective management, the disease
was chosen for study.

1) To evaluate and compare the effect of Nishalauha with Ferrous sulphate
on Pandu (IDA).
2) To explore the literature regarding Pandu in Ayurveda and IDA in modern
literatures.
3) To study the other associated effects of the trial drugs if any.
4) To find the relationship between Deha Prakriti and Pandu Roga.

PLAN OF
STUDY
Historical
Review
Discussion
Conclusion
Disease Review
(Ayurveda & Modern)
Drug Review
Clinical Study

HISTRORICAL REVIEW
 Various references related to Pandu has been mentioned in different
literature as follows:
Veda :
In Rigveda and Athervaveda, threre is description of Pandu and its treatment.
Paurana :
Pandu was mentioned in Garuda purana and Agni Purana.

Samhita :
Charaka Samhita :
Aacharya Charaka has mentioned Pandu Roga in-
 Chikitsasthana 16th Chapter "Pandu Roga Chikitsa."
 Sutrasthana Adhyaya 19, "Ashtodariya Adhyaya“.
 Described Pandu as feature of various other diseases.
Sushruta Samhita :
Uttartantra Adhyaya 44, “Pandu Roga Pratishedhanam Adhyaya”.
Kashyap samhita :
In Sutrasthana 25
th
chapter “Vedana Adhyaya”.
Harita samhita :
Given specific description of Pandu Roga in 8
th
chapter that is “Pandu Roga
Chikitsa Adhyaya” in 3
rd
Sthana.

Sangraha kala :
Vagbhatta :
Nidanasthana 13th Chapter "Pandu Roga- Shopha Visarpa Nidana”.
Chikitsasthana 16th Chapter, "Pandu Roga Chikitsa.“
Madhava Nidana :
8th Chapter "Pandu Roga- Kamla Kumbhkamaladi Nidana“.
Chakradutta :
8
th
chapter as “Pandu Roga Chikitsa Prakaranam”.
Sharangdhar Samhita :
In Purav Khand 7th chapter “Roga Ganana Vishayak Adhyaya”.
Bhava Prakash :
In “Pandu Kamala Halimak Adhikar Adhayaya”.
Bhaisajya Ratnavali :
In the 12
th
chapter as “Pandu Roga Chikitsa Prakaranam”.

Pandu
Etymology of Pandu:
Ikk.MqLrq ihŸkHkkxk/kZ% dsrdh /kfwy lfUuHke%A Vachaspatyam
Part-5
Vachaspatya refers Pandu as mixture of white and yellow colour which
resembles with the pollen grains of Ketaki Flower.
Ikk.Mqq% ihŸka laofyr ”kqDyk%A Amarakosha (Bhanu dixit comm.)
Pu.kha.5/13
gfj.k% ik.Mqj% Ikk.Mqq% bZ’kr~ Ikk.MqLrq /kwlj%A Amarakosha
Pu.kha.1/5/343
According to Amarakosha, Pandu means a white colour mixed with
yellowish Tinge.

ik.Mqgkfjægfjrku~ o.kkZu~ cgqfo/kkaLRofpA l ik.Mjqksx
bR;qä%A Ch.chi.16/11
losZ"kq pSrsf"og ik.MHqkkoks ;rk·sf/kdks·r% [kyq ik.Mqjksx%A
Su utt.44/4
ik.Mqgkfjægfjrku ik.MRqoa rs’kq pkf/kde~A ;rks·r%
ik.MqfjR;qä l jksx%A A.H.ni.13/3-4
ik.MqRouksiyf{krks jksx% ika.Mq jksx%A Ma.Ni.8/1(Madhukosh
Comm.)

nks’kk% fir ç/kkukLrq ;L; dqI;fUr /kkrq’kqA
lks·YijDrks·YiesnLdks fu%lkj%
f”kfFkysfUæ;%A oSo.;Z Hktrs
Ch.chi.16/4-6
Pandu is a clinical condition characterized by whitish yellow discoloration of skin,
eyes, nails etc. The person with this disease suffers from decrease in Rakta Dhatu
amount, strength and complexion. He becomes Nihsara (loss of natural integrity,
tone and strength of Dhatus).

Ikk.Mq ds funku
{kkjkEyyo.kkR;q".kfo:)klkRE;Hkkstukr~A
fu"ikoek"kfi.;kd fryrSyfu’kso.kkr~A
dkefpUrkHk;Øks/k'kksdksigrpsrl%A Ch.chi.16/7-9
O;k;k;eEya yo.kkfu e|a e`na fnokLoIuerho rh{.keA
fu"ksoek.kL; fonw"; jDra dqoZfUr nks"kkLRofp
ik.MHqkkoe~A Su.utt.44/3

Ikk.Mq ds iwoZ:i
rL; fyaxa Hkfo";r%A
ân;LiUnua jkS{;a LosnkÒko% JeLrFkkA
Ch.chi.16/12
Rod~LQksVua "Bhouxk=lknkS e`ö{k.ka
çs{k.kdwV'kksFk%A fo.ew=
ihrRoeFkkfoikdks Hkfo";rL; iqj% ljkf.kA Su.utt
44/5

Ikk.Mq ds
y{k.k
laÒwrs·fLeu~ Hkosr~ loZ%d.kZ{oMh
grkuy%A nqcZy% lnuks∙Uuf}V~
JeHkzefuihfMr%A xk='kwyTojÜokl
xkSjok:fpekéj%A e`fnrSfjo xk=SÜp
ihfMr®UefFkrSfjoA
'wkukf{kdwVks gfjr% ”kh.kZyksek
grçHk%A dksiu% f'kf'kj}s"kh
fuæky%q "Bhouks∙Yiokd~AA
fif.Mdks}ss"VdV;w:ikn:Dlnukfu pAA
ÒoUR;kjksg.kk;klS------------------------

laEizkfIr
 leqnh.kZa ;nk fira ân;s leofLFkre~A
ok;quk cfyuk f{kIra laçkI; /keuhn±'kA
çiUua dsoya nsga
Rod~ekalkUrjekfJre~AA çnw";
dQokrklzd~ Rod~ekalkfu djksfr rr~A
ik.Mqgkfjægfjrku~ o.kkZu~
cgqfo/kkaLRofpA
Ch.chi.16/9-11

Samprapti Ghataka of Pandu :
Dosha : Pitta Pradhanya Tri Dosha
Dushya : Rasa, Rakta, Mamsa and Medas
Agni : Agni Dushti (Jatharagni Mandyata and Rasa Dhatwagni Mandyata)
Ama : Tadjanya
Srotas : Rasavaha, Raktavaha and Mamsavaha
Sroto Dushti Prakara: Sanga
Udbhava Sthana : Amashaya
Sanchara Sthana : Rasayani
Vyakta Sthana : Twak, Netra, Nakha
Adhishtana : Twacha and Mamsa
Rogamarga : Bahya Roga Marga (Shakha)
Vyadhi Swabhava : Chirakari

Ikk.Mq lk/;klk/;rk
ik.MjqksxfÜpjksRiUu% [kjhHkwrks u fl/;frA
dkyçd"kkZPNwuks uk ;”p ihrkfu i';frA c)kYifoVda
ldQa gfjra ;ks∙frlk;ZrsA nhu%
”osrkfrfnX/kkax'NÆnewPNkZr`’kkfnZr%A l
ukLR;l`d~{k;k|Üp ik.M%q ”osrRoekIuq;kr~A
Ch.chi.16/31-32
vUrs’kq ”kwua ifjghue/;a Eykua rFkk∙Urs’kq p
e/;”kwue~A xqns p “ksQL;Fk eq’d”kwua
çrkE;ekua p folaKdYie~A footZ;sr~ ik.Mqfdua
;'kksFkhZ rFkk·frlkjTojihfMra pA
Su.utt.44/43-44

Ikk.Mq fpfdRlk
r= ik.M~~oke;h
fLuX/kLrh{.kS:/okZuqyksfedS%Ala”kks;kse`nqfHk
fLrDrS% dkeyh rq fojspuS%A rkH;ka
la”kq)dks’BkH;kaiF;kU;kUUkfu nki;srA
Ch.chi.16/40-41
lk/;L; pknkS çfrikpua rq fojspua pkL; rrksfo/k;se
ikukfu
pw.kkZU;oygsdkfufojsp;æksxfouk”kkukfuA

“keu fpfdRlk
A. Vanaspatika Yoga
Charaka Samhita Sushruta Samhita Ashtanga Hridaya
Dadimadi Ghrita
Katukadi Ghrita
Pathyadi Ghrita
Danti Ghrita
Drakshadi Ghrita
Haridra Ghrita
Darvyadi Ghrita
Bhruhatyadi Ghrita
Duralabhadi Ghrita

B. Khanija Yoga Lauha alone Lauha in Yoga
Lauha Bhasma
Shuddha Mandoor Bhasma
Tikshna Lauha
Shuddha Kasis Bhasma
Suvarna Makshika
Shuddha Shilajita
Shuddha Gairika
Navayasa Churna
Nisha Lauhadi Vati
Tapyadi Lauha
Mandoor Vataka
Punarrnava Mandoor
Mandooradyavleha
Lauhasava
• Darvyadi Leha (Cha.Chi.16/97)
• Triphaladi Avleha (Y.R.)
• Dhatryavleha (Cha.Chi.16/100-
101)
• Drakshadi Avleha (A.H.16/29-31)
c.
Avaleha
used in
Pandu

D. Asava, Arishta used in Pandu
Charaka Samhita Sushruta Samhita
Gaudakarishta
Bijakarishta
Dhatyarishta
Gomutra Haritaki
Abhayarishta
Madhavasav
Sharkarasava
Yashtimadhu Kashaya
Nyagrodhadi Kashaya

iF;
'kkyhu l;oxks/kweku ;w’klafgrkuA
eqn~xk<dhelwjS'p tkaxySÜp
jlSfgrs%A
Ch.chi.16/41

Pathya Apathaya given by different Aacharya can be
concluded as follows :
1) Pathya
Food Puran Godhum, Shastika, Yava, Shali, Mudga, Aadhki,Masur.
Vegetables Patola, Bimbi, Jeevanti, Guduchi, Punarnava, Haridra.
Non vegetables Aja mans , Jangal mans
Fruits Amala, Aamra, Kharjoor
Roots Shringatak, Kamalkanda, Rasona, Aardrak.
Milk
Products
Go dugdha, Ghee, Navneeta ,Takra
Liquids Gomutra, Laja Manda, Koshna Jala, Laghu Panchamula Siddha Jala.
Madya Varga Sauvira, Tushodaka.
Kshar Varga Yava Kshara.

2) Apathya
Shaka
Varga
Except above
Shimbi
Varga
Matara, Masha, Pinyaka
Drava
Varga
Atyambu Pana, Madhya Pana

DEFINITION
Anaemia is defined as a haemoglobin concentration in blood below the lower
limit of the normal range for the age and sex of the individual.
Deficiency of haemoglobin in the blood is called Anaemia, which can be caused
by either low red blood cells count or low haemoglobin level in the cells. It can
be found in every class of people.
Anaemia can be temporary or long term and can range from mild to severe.

EPIDEMIOLOGY
 About half of the world's anemic women live in the Indian subcontinent, and
88% of them develop anaemia during pregnancy.
 Asia has the highest rates of anaemia in the world.
 In India, Anaemia affects an estimated 50% of the population. In India,
anaemia is considerably high for rural women (54%) than for urban women
(46%).
 Deficiency of iron is the most common cause of anaemia worldwide.

Etiology
Different types of anaemia have different causes. They includes:
Iron deficiency anaemia: Most common type. Due to deficiency of iron.
Vitamin deficiency anaemia: Diet lacking folate and Vit.B12 and other key
nutrients leads to this type of anaemia.
Aplastic anaemia: Due to infection, medication, autoimmune disorder, exposure
to toxic substances body unable to produce RBCs in adequate number.
Hemolytic anaemia: Increase destruction of RBCs.
Sickle cell anaemia: Due to defects in haemoglobin.

Signs and Symptoms of Anaemia
 Weakness
 Easy fatiguability
 Dysponea on exertion
 Tachycardia
 Pallor of skin, mucous membranes and sclerae
 Palpitations
 Unusual dietary cravings such as pica

CLASSIFICATION OF ANAEMIA
 Pathophysiologic classification
 Morphologic features in blood smear.

Pathophysiologic classification
Depending upon
the
pathophysiologic
mechanism,
anaemias are
classified into 3
groups :
i. Anaemia
due to
increased
blood loss
ii. Anaemia
due to
impaired red
cell
production
iii. Anaemia
due to red
cell
destruction
( Haemolytic
anaemias)

Morphologic classification
Based on the red cell
size, haemoglobin
content and red cell
indices, anaemias
are classified into 3
types :
i. Microcytic,
hypochromic –
MCV,MCH, MCHC
are all reduced
i.e. iron
deficiency
anaemia
ii. Normocytic,
normochromic
iii. Macrocytic,
normochromic

Normal Reference Values In Hematology
Men Women
Hemoglobin (g/dl) 14-17.4 12.3-15.3
Hematocrit (%) 42-50% 36-44%
RBC Count (106/mm3) 4.5-5.9 4.1-5.1
Reticulocytes 1.6 +_0.5% 1.4+_0.5%
WBC (cells/mm3) ~4000-11000
MCV (fl) 80-96
MCH (pg) 30.4+_2.8
MCHC (g/dl) 34.4+_1.1
RWD (%) 11.7-14.5

Causes of Iron Deficiency
1. Increased Iron Utilization
 Postnatal Growth
 Adolescent Growth
 Erythropoetin Therapy
2. Physiologic Iron Loss
 Menstruation
 Pregnancy

3. Pathologic Iron Loss
 GIT Bleeding
 Genitourinary Bleeding
 Intravascular Hemolysis
4. Decreased Iron Intake
 Cereal rich diet
 Pica, Malabsorption
 Acute and Chronic Inflammation

Iron Metabolism
 Iron taken in diet is absorbed at all parts of GIT especially duodenal
mucosa.
 Acid medium favours iron absorption.
 Only 10% of the ingested iron is absorbed.
 Normal serum iron level is 50-150 mg/dl.
 Iron absorption is increased in – ferrous state, increase erythropoiesis.

 Iron stored as ferritin and hemosiderin. In men, storage compartment
contains about 1000 mg of iron and in women, it ranges from 0-500
mg.
 Iron is transported after binding with transferrin, contain 3 mg of
iron.
 1 mg elemental iron is lost from shedding of senescent cells of GIT
and Genitourinary tract and desquamation of skin.

Clinical Feature
 Angular stomatitis
 Atrophic Glossitis
 Koilonychia
 Brittle hairs
 Pica
 Menorrhagia
 Plummer Vinson syndrome

Diagnostic features of iron deficiency
Haemoglobin Variably reduced
Mean cell volume Reduced
Erythrocyte count Normal or reduced less than Hb level would suggest
Blood film Hypochromia, microcytosis, oval and elliptical
cells, poikilocytes in more severe cases.
Leucocyte count differential Normal
Platelet count Normal or raised
Bone marrow iron store Empty
Plasma transferrin Raised
Plasma iron Reduced
Serum ferritin Reduced

Differential Diagonosis
 Megaloblastic Anaemia:
Megaloblastic anaemia is characterized by asynchronous nuclear and cytoplasmic
maturation in all myeloid and erythroid cell lines.
It is due to aberrant DNA synthesis as a result of single or combined deficiency of
either Vit.B12 or folate. In deficient state of both these MCV will be <110.
Average daily diet contain 5-30 microgram of Vit.B12 . Daily requirement is about
1 microgram. Source of Vit.B12 is bacteria and animal tissue.
Leafy vegetables, fruits, animal products are rich source of folate. Normal
requirement is 100цg/day. Total body storage capacity is up to 15mg. Serum level
of folate is 5-20 ng/dl. Absorbed mainly in jejunum. Most dietary folate is
present as polyglutamates.

Metabolism of Vit.B12
Ingested
food
Release
Vit.B12 at
gastric pH
& binds
with
carrier R
protein
At
pancreatic
pH Vit.B12
release
from R
protein &
bind with
IF
Vit.B12 +
IF complex
binds to
specific
receptors
in the
terminal
ileum
Vit.B12 is
actively
transported
by
enterocytes
to plasma
From
enterocytes
Vit.B12 is
transported
by
transcobala
min-II to
liver for
tissue
utilization.

Pernicious Anaemia
This is an autoimmune disorder in which the gastric mucosa is atrophic, with loss
of parietal cells causing IF deficiency.
Finding of Anti IF antibody in the context of Vit.B12 defieciency is diagnostic of
pernicious anaemia.
Antiparietal cell antibodies are present in over 90% of cases but are also present
in 20% normal cases.
Schilling test is performed to differential diagnosis the cause of Vit.B12
deficiency.

Finding in Megaloblastic anemia
Haemoglobin often reduced, may be very low
Mean cell volume Usually raised, commonly >120 fl
Erythrocyte count Low for degree of anaemia
Blood film Oval macrocytosis, poikilocytosis, red cell
fragmentation, neutrophil hyper segmentation
Reticulocyte count Low for degree of anaemia
Leucocyte count differential Low or Normal
Platelet count Low or Normal
Bone marrow Increased cellularity, Megaloblastic changes in the
erythroid series, giant metamyelocytes, dysplastic
megakaryocytes, increased iron in stores, pathological
non-ring sideroblasts
Serum ferritin Elevated
Plasma lactate dehydrogenase Elevated often markedly

Anaemia of Chronic disease (ACD)
 Also called as simple anaemia
 This is mild and non progressive anaemia, occurring over a period of 3-4
weeks.
 ACD is most often associated with chronic infection, inflammatory diseases,
trauma and neoplastic diseases.
 Anaemia is normocytic normochromic (most commonly) or microcytic
hypochromic.

Immune Hemolytic Anaemia
 Hemolysis due to immune mechanism occurs when antibody and /or complement
bind to red cell membrane.
 Destruction of RBCs usually occurs by type II (Cytotoxic) hypersensitivity reaction.
 Usually acute, often with jaundice.
 Classified into autoimmune type and drug-induced type.

Special cases of
hemolytic anaemia:
Glucose- Phosphate
Dehydrogenase deficiency –
more common in Mediterranean
and African population. Lack of
RBC enzyme makes cell very
sensitive to oxidative stress.
Sickle cell disease – results due
to a single glutamic acid to valine
substitution at of the beta globin
polypeptide chain. Abnormal
haemoglobin causes change in RBC
shape, resulting in constant RBC
destruction by the spleen.

Thalassemias
Decreased production of normal
haemoglobin polypeptide chains.
Classified according to
haemoglobin chain that is affected
( Alpha, Beta, Gamma, Delta ).
Common, variable severity of
hemolysis.
Characterized by hypochromic
microcytic red cells ( MCV
markedly decreased while MCHC
only slightly decreased )

The drug and its ingredients were tested in the DTL, Jogindernagar RIISM and
drug testing certificate was obtained.

“
”
DRUG
Name Botanical Name Family
Haridra Curcuma longa Zingiberaceae
Daruhari dra Berberis aristata Zingiberaceae
Haritaki Terminalia chebula Combretaceae
Bibhitaki Termanalia bellirica Combretaceae
Amalaki Emblica officinalis Euphorbiaceae
Kutaki Picrorhiza kurroa Scrophulariaceae
Lauha bhasma

Name DRAVYA RASA GUNA VIRYA VIPAKA PRABHAVA
1 Haridra Tikta, Katu Laghu,
Ruksha
Ushana Katu Kaphapittashamak
2 Daruharidra Kashaya, Tikta Laghu,
Ruksha
Ushana Katu Kaphpitta shamk
3 Haritaki Kashaya, Tikta,
Madhur, Katu,
Amala
Laghu,
Ruksha
Ushana Madhura Tridosh shamak
4 Bibhitaki Kashaya Laghu,
Ruksha
Ushana Madhura Tridosh shamak
5 Amalaki Amala, Madhura,
kashaya, Tikta,
Katu
Guru,
Rukhsa,
Sheeta
Sheeta Madhura Tridosh shamak
6 Kutaki Tikta Laghu,
Ruksha
Ushana Katu Kaphpittashamak
7 Lauha bhasma Sheeta
Properties of drugs used in Nishalauha

Inclusion Criteria
Exclusion Criteria
 Patients having Hemoglobin
level 8 to 11 gm%.
 Patients of either sex
between 12 to 60 years.
 Blood picture presenting
either microcytic
hypochromic or normocytic
hypochromic anaemia.
 In pregnancy after 1st
trimester.
 Patients having Hemoglobin level
less than 8 gm% and more than 11
gm%
 IDA resulting from acute or chronic
blood loss.
 Patients showing allergy to the
trial drug .
 Sideroblastic anaemia,
Thalassemia major and minor.
 Anaemia in association with other
systemic disorders which
interferes with the prognosis and
treatment of the case.

GROUPING OF PATIENTS
There were two trial groups with 20 Patients in each trial group .
Dose of formulation / administration
– Group 1- In this group each subject was given 500 mg tab of Nishalauha once
daily.
Group II- In this group each subject was given 200 mg tab of Ferrous Sulphate once
daily.
Anupana
Madhu and Go Ghrita
Total Duration of study-30 days
Follow up- after 15 days

CRITERIA OF ASSESSMENT
CLINICAL ASSESSMENT
SYMPTOM GRADES SCORE
Daurbalyata- Not present 0
After heavy work relieved soon and patient tolerates 1
After moderate work relived later and patient tolerates 2
After little work relived later 3
After little work relieved later but beyond tolerance 4
Daurbalyata even in resting condition 5
Hridspandanam- Not present 0
Hridaspandanam even in resting condition 5

Bhram- Not present 0
Bhrama even in resting condition 5
Rukshata
In Twaka, Nakha, Netrav
artma, Jivha, Hastapada
Not present 0
In any two of these 1
In any three of these 2
In any four of these 3
In all 4

Sramajanya
Shawas-
Not present 0
Shawas even in resting condition 5
Hatanal- Good appetite 0
Patient takes meals 3times/ day with little desire 1
Patient takes meals 2times/day with little desire but not associa
ted with nausea and vomiting
2
Patient takes meals 2times/day with little desire but associated
with nausea and vomiting
3
No desire to take meals 4

Shram-
No feeling of fatigue and weakness on doing any work 0
No feeling of fatigue and weakness on doing accustomed work 1
Feeling of fatigue and weakness on doing accustomed work 2
Feeling of fatigue and weakness on doing less than accustomed
work
3
Feeling of fatigue and weakness even at rest 4
Gatrashoola- Absent 0
Mild and occasional 1
Moderate and often 2
Severe and constant 3

Karana kshweda
(Tinnitus)-
No abnormal sounds in ear 0
Occasional low frequency sound in ears 1
Occasional high frequency sound in ears 2
Constant low frequency sound in ears 3
Constant high frequency sounds in ears 4
Twak Panduta- Not present 0
Mild pallor 1
Moderate pallor 2
Whitish pallor 3

age WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
16-20 21-30 31-40 41-50
Age wise distribution of 40 patients
Series1 Series2
Age in Years No of Patients Total Percentage
Group-I Group-II
16-20 2 4 6 15
21-30 14 12 26 65
31-40 4 4 8 20
41-50 0 0 0 00

sex WISE DISTRIBUTION
0
5
10
15
20
25
GROUP 1 GROUP 2
Sex wise distribution of 40 patients
Male Famale
Sex No of Patients Total Percentage
Group-I Group-II
Male 0 2 2 5
Female 20 18 38 95

religion WISE DISTRIBUTION
0
5
10
15
20
25
GROUP 1 GROUP 2
Religion wise distribution of 40 patients
Hindu Other
Religion No of Patients Total Percentage
Group-I Group-II
Hindu 19 20 39 97.5
Other 01 0 01 2.5

occupation WISE DISTRIBUTION
0
1
2
3
4
5
6
7
8
9
10
Student Private job Govt. Job Housewife
Occupation wise distribution of 40 patients
GROUP 1 GROUP2
Occupation No of Patients Total Percentage
Group-I Group-II
Student 8 5 13 32.5
Private job 4 5 9 22.5
Govt. Job 0 1 1 2.5
Housewife 8 9 17 42.5

marital status WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
GROUP 1 GROUP 2
Marital status wise distribution of 40 patients
Unmarried Married
Marital Status No of Patients Total Percentage
Group-I Group-II
Unmarried 8 6 14 35
Married 12 14 26 65

Edu. qualification WISE DISTRIBUTION
0
2
4
6
8
10
12
Illiterate Under matriculation Matriculation Graduate Post Graduate
Education qualification wise distribution of 40 patients
GROUP 1 GROUP 2
Education No of Patients Total Percentage
Group-I Group-II
Illiterate 0 0 0 0
Under matriculation 3 2 5 12.5
Matriculation 3 7 10 25
Graduate 10 9 19 47.5
Post Graduate 4 2 6 15

socioeconomic status WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
18
High Middle Poor
Socioeconomic status wise distribution of 40 patients
GROUP 1 GROUP2
Socio Ecnomic
Status
No of Patients Total Percentage
Group-I Group-II
High 2 2 4 10
Middle 17 17 34 85
Poor 1 1 2 5

addiction WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
Tea/coffee Smoking Alcohol No addiction Other
Addiction wise distribution of 40 patients
GROUIP 1 GROUP 2
Addiction No of Patients Total Percentage
Group-I Group-II
Tea/coffee 15 13 28 70
Smoking 0 0 0 0
Alcohol 0 0 0 0
No addiction 5 7 12 30
Other 0 0 0 0

dietetic habits WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
18
GROUP 1 GROUP 2
Dietetic habits wise distribution of 40 patients
Vegetarian Mixed
Dietetic habits No of Patients Total Percentage
Group-I Group-II
Vegetarian 3 7 10 25
Mixed 17 13 30 75

jarana Shakti WISE DISTRIBUTION
0
2
4
6
8
10
12
14
Visham Sama Tikshana Mridu
Jarana Shakti wise distribution of 40 patients
No of Patients Group-I No of Patients Group-II
Jarana Shakti No of Patients Total Percentage
Group-I Group-II
Visham 1 1 2 5
Sama 7 6 13 32.5
Tikshana 0 0 0 0
Mridu 12 13 25 62.5

sharirik prakriti WISE DISTRIBUTION
0
2
4
6
8
10
12
Vata-Kaphaj Vata-Pittaj Pitta-Kaphaj Pitta-Vataj Kapha- Pittaj Kapha-Vataj
Sharirik prakriti wise distribution of 40 patients
GROUP1 GROUP2
Sharirika Prakriti No of Patients Total Percentage
Group-I Group-II
Vata-Kaphaj 3 1 4 10
Vata-Pittaj 10 6 16 40
Pitta-Kaphaj 1 2 3 7.5
Pitta-Vataj 1 10 11 27.5
Kapha- Pittaj 4 0 4 10
Kapha-Vataj 1 1 2 5

manasa prakriti WISE DISTRIBUTION
0
2
4
6
8
10
12
14
16
Satavaj Rajasa Tamasa
Manasa prakriti wise distribution of 40 patients
GROUP 1 GROUP2
Manasa Prakriti No of Patients Total Percentage
Group-I Group-II
Satavaj 6 6 12 30
Rajasa 14 13 27 67.5
Tamasa 0 1 1 2.5

signs and symptoms PROFILE
0
5
10
15
20
25
No of Patients Group-I No of Patients Group-II
Clinical feature No of Patients Total Percentage
Group-
I
Group-
II
Daurbalyata
20 17 37 92.5
Hridyaspandan
4 2 6 15
Bhrama
8 5 13 32.5
Rukshata
8 6 14 35
Sramajanya
shawas
18 11 29 72.5
Hatanal
10 8 18 45
Sharam
19 20 39 97.5
Gatrashool
19 17 36 90
Karana kshweda
3 1 4 10
Twakpanduta
14 4 18 45

Effect of therapy on the Symptoms in Group -1 NISHA LAUHA patients (paired t test)
No of Patients : 18
Symptoms Mean % relief SD± SE± ‘t’ P
BT AT Diff. %age
Daurbalyata
2.5 0.278 2.222 88.88% 0.943 0.222 10 <0.001
Hridyaspandan
0.5 0.111 0.389 77.8% 0.778 0.183 2.122 0.049
Bhrama
0.722 0.00 0.722 100% 1.018 0.240 3.010 0.008
Rukshata
0.500 0.389 0.111 22.2% 0.323 0.0762 1.458 0.163
Sramajanya shawas
1.889 0.111 1.778 94.12% 1.003 0.236 7.518 <0.001
Hatanal
0.667 0.00 0.677 100% 0.840 0.198 3.367 0.004
Sharam
2.333 0.0556 2.278 97.64% 0.826 0.195 11.693 <0.001
Gatrashool
1.611 0.278 1.333 82.74% 0.767 0.181 7.376 <0.001
Karana kshweda
0.167 0.00 0.167 100% 0.383 0.0904 1.844 0.083
Twakpanduta
1.111 0.278 0.833 75% 0.786 0.185 4.499 <0.001

Effect of therapy on the Symptoms in Group -2 FERROUS SULPHATE patients
(paired t test)
No of Patients : 18
Symptoms Mean % relief SD± SE± ‘t’ P
BT AT Diff. %age
Daurbalyata
1.833 0.889 0.944 51.5% 0.802 0.189 4.994 <0.001
Hridyaspandan
0.111 0.0556 0.0556 50% 0.236 0.0556 1.00 0.331
Bharma
0.278 0.0556 0.222 79.85% 0.548 0.129 1.719 0.104
Rukshata
0.333 0.333 0.00 0% 0.00 0.00 0.00 1.00
Sramajanya shawas
1.056 0.444 0.611 57.85% 0.778 0.183 3.335 0.004
Hatanal
0.889 0.389 0.500 56.24% 0.786 0.185 2.699 0.015
Sharam
2.222 0.889 1.333 59.99% 0.485 0.114 11.662 <0.001
Gatrashool
1.611 0.667 0.944 58.59% 0.725 0.171 5.524 <0.001
Karana kshweda
0.0556 0.0556 00 0% 0.00 0.00 0.00 1.00
Twakpanduta
0.222 0.0556 0.167 75% 0.383 0.0904 1.844 0.083

INTER GROUP COMPARISION
Symptoms % Relief ‘t’ P Result
Group-I Group-II Diff %age
Daurbalyata
88.88% 51.5% 37.38% 4.379 <0.001 H.S.
Hridyaspandan
77.8% 50% 27.8% 1.741 0.091 Significant
Bharma
100% 79.85% 20.15% 1.844 0.083 Significant
Rukshata
22.2% 00% 22.2% 1.458 0.154 N.S
Sramajanya
shawas
94.12% 57.85% 36.27 % 4.229 <0.001 H.S
Hatanal
100% 56.24% 43.76% 0.615 0.543 N.S
Sharam
97.64% 59.99% 37.65% 4.181 <0.001 H.S
Gatrashool
82.74% 58.59% 24.15% 1.563 0.127 N.S
Karana
kshweda
100% 0% 100% 1.844 0.074 Significant
Twakpanduta 75% 75% 00% 3.234 0.003 H.S

EFFECT OF NISHA LAUHA ON HAEMOGLOBIN
Hb N Mean Score Diff %age
Relief
S.D S.E T P
BT AT
No. of
Patients
18 9.789 11.367 1.578 16.12% 1.057 0.249 6.330 <0.001
GROUP 1
9
9.5
10
10.5
11
11.5
BT AT

EFFECT OF FERROUS SULPHATE ON HAEMOGLOBIN
GROUP 2
Hb N Mean Score Diff %age
Relief
S.D S.E T P
BT AT
No. of
Patients
18 10.267 11.900 1.633 15.90% 0.827 0.195 8.382 <0.001
9
9.5
10
10.5
11
11.5
12
12.5
BT AT

Intergroup comparison of effect of therapy on HAEMOGLOBIN
Group Mean Diff. % age relief SD T P
I 1.578 16.12 1.057 0.176 0.862
II 1.633 15.90 0.827
15.75
15.8
15.85
15.9
15.95
16
16.05
16.1
16.15
GROUP1 GROUP 2

EFFECT OF NISHA LAUHA ON S. FERRITIN
S.
FERRITIN
N Mean Score Diff %age
Relief
S.D S.E T P
BT AT
No. of
Patients
18 52.446 100.879 48.434 92.35 20.713 4.882 9.921 <0.001
0
20
40
60
80
100
120
BT AT

EFFECT OF FERROUS SULPHATE ON S. FERRITIN
S.
FERRITIN
N Mean Score Diff %age
Relief
S.D S.E T P
BT AT
No. of
Patients
18 62.133 98.906 36.772 59.18 20.540 4.841 7.595 <0.001
0
20
40
60
80
100
120
BT AT

Intergroup comparison of effect of therapy on S. FERRITIN
Group Mean Diff. % age relief SD T P
I 48.434 92.35 20.713 1.696 0.099
II 36.772 59.18 20.54
0
10
20
30
40
50
60
70
80
90
100
GROUP 1 GROUP 2

Comparison of Overall Effect of
Therapy in Both Groups
Results Group I (n=18) Group II(n=18)
No. of
Patien
ts
%age No. of
Patients
%age
Markedly
Improved
(76%-100%)
15 83.33% 1 0.05%
Moderately
Improved
(51-75%)
2 11.11% 7 38.88%
Mildly
Improved
(25-50%)
1 0.05% 10 55.55%
No
improveme
nt (<25%)
0 0 0 0
0
2
4
6
8
10
12
14
16
Markedly Improved
(76%-100%)
Moderately
Improved (51-75%)
Mildly Improved
(25-50%)
No improvement
(<25%)
GROUP 1 GROUP2

 Anaemia is very common in India and Iron deficiency anaemia is the most
common deficiency all over the world.
 40 random anaemic patients were taken in this clinical study in which
maximum patients were having the Roop and Poorvroopa which are
mentioned in Ayurvedic classics.
 Among the 40 patients 4 were drop out.
 In remaining 36 patients, 15 were markedly improved in group 1 and 1 was
markedly improved in group 2, 2 were moderately improved in group 1 and 7
were moderately improved in group 2.

 The present clinical study indicates that the herbomineral formulation
“Nishalauha” is an effective, well tolerated, clinically safe and better
alternative for Ferrous Sulphate which is having some adverse effects in the
management of Iron Deficiency Anaemia.
 No major unpredictable effect of therapy was observed during the entire trial
period.
 However, this study was a humble attempt in small number of patients and in
a fixed duration of time thus requires further study on large sample for longer
duration to prove its beneficial effects on patients.

Acknowledgement
At the time of accomplishment, I want to express my sincere and deepest sense of gratitude
and heartfelt regard to my Guide Dr. Rajesh Manglesh and co-guides Dr. Akhilesh
Srivastava , Dr. Seema Shukla and worthy teacher of our depatment Dr Swapnil Saini
for their constant encouragement, vision, motivation and blessings.
My heartiest gratitude to respected principal Prof. Vijay chaudhary sir and all the
respected Teachers of RGGPG Ayurvedic College for their guidance and love.

I am thankful to all my colleagues, seniors and juniors for their valuable support and
love.
Laboratory staffs of RGGPG Ayurvedic Hospitals for their co-operation during the
trial period.
All the officials and working staffs of Charak Ayurvedic Pharmacy.

Comparative study of Nishalauha and Ferrous Sulphate in Iron Deficiency Anaemia

Comparative study of Nishalauha and Ferrous Sulphate in Iron Deficiency Anaemia

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Comparative study of Nishalauha and Ferrous Sulphate in Iron Deficiency Anaemia

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