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Clinical evaluation of Virechana and Nisha loha in the management of Pandu roga , James Chacko, PG Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G. Centre, Koppa.
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BY Dr. James Chacko
B.A.M.S. (R.G.U.H.S, Bangalore)
Dissertation submitted to
Rajiv Gandhi University of Health sciences, Karnataka, Bangalore in partial fulfillment
of the requirements for the degree of “Ayurveda Vachaspati” [M.D.]
in
KAYACHIKITSA
GUIDE CO-GUIDE Dr. Tarani Kanta Mohanta M.D, Ph.D (Ayu) Jamnagar Professor, Dept. of Kayachikitsa
DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA A.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE KOPPA
CHIKMAGALUR DISTRICT, KARNATAKA, INDIA - 577126
MARCH - 2006
Dr. Neelakant.J M.B.B.S, M.D (Medicine) Physician, Govt. Hospital, Koppa.
A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur
Department of Post Graduate Studies in KAYACHIKITSA
Declaration
I here by declare that this dissertation entitled “Clinical evaluation of
Virechana and Nisha loha in the management of Pandu roga” with special
reference to iron deficiency anemia, is a bonafide and genuine research work carried
out by me under the guidance of Dr.Taranikanta Mohanta Department of Post
Graduate Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College
and P. G. Centre, Koppa.
Date:
Place: Koppa
Dr.James Chacko P.G.Scholar,
Dept. of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur
Department of Post Graduate Studies in KAYACHIKITSA
Certificate
This is to certify that the dissertation entitled “Clinical evaluation of
Virechana and Nisha loha in the management of Pandu roga” with special
reference to iron deficiency anemia is a bonafide research work done by
Dr. James Chacko in partial fulfillment of the requirement for the degree
of Ayurveda Vachaspati (M.D.) in Kayachikitsa, of Rajiv Gandhi University of
Health Sciences, Bangalore, Karnataka.
Date:
Place: Koppa
Guide:Dr. Tarani Kanta Mohanta
M.D. Ph. D (Ayu) Jamnagar Professor, P.G. Studies in Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur
Department of Post Graduate Studies in KAYACHIKITSA
Certificate
This is to certify that the dissertation entitled “Clinical evaluation of
Virechana and Nisha loha in the management of Pandu roga” with special
reference to iron deficiency anemia is a bonafide research work done by
Dr. James Chacko in partial fulfillment of the requirement for the degree of
Ayurveda Vachaspati (M.D.) in Kayachikitsa of Rajiv Gandhi University of
Health Sciences, Bangalore, Karnataka.
Date:
Place: Koppa
Co-Guide:Dr. Neelakant.J
M.B.B.S, M.D (Medicine) Physician, Govt. Hospital Koppa
A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur
Department of Post Graduate Studies in KAYACHIKITSA
Endorsement
This is to certify that the dissertation entitled “Clinical evaluation of
Virechana and Nisha loha in the management of Pandu roga” with special
reference to iron deficiency anemia is a bonafide research work done by
Dr. James Chacko under the guidance of Dr. Taranikanta Mohanta,
Department of Post Graduate Studies in Kayachikitsa, A.L.N. Rao Memorial
Ayurvedic Medical College and P.G. Centre, Koppa.
Date:
Place: Koppa
Dr.Jagadeesh Kunjal M.D. (Ayu)
Principal, A.L.N.Rao Memorial Ayurvedic Medical College, Koppa –577126, Dist: Chikmagalur
COPYRIGHT
I here by declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this
dissertation in print or electronic format for academic/research purpose.
Date:
Place: Koppa
Dr. James Chacko
P.G.Scholar, Dept. of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
© Rajiv Gandhi University of Health Sciences, Karnataka
INDEX Page No.
INRODUCTION 1-3
Chapter - I OBJECTIVES 4
HISTORICAL REVIEW 5-8
Chapter - II REVIEW OF LITERATURE
A) Disease review 9-52
Nirukti, Paribhasha, Paryaya 9
Nidana 11
Poorvaroopa 18
Samprapti 20
Classification of Pandu 30
Roopa 32
Upadrava, Sadhyaasadyata 34
Arishta 35
Pathya apathya 36
Chikitsa vivechana 38
Concept of Virechana 40
Iron deficiency anaemia 53-63
B) Drug Review 64-74
Chapter - III METHODOLOGY 75-93
Materials and Methods
Observations
Chapter - IV RESULTS 94-111
Chapter - V DISCUSSION 112-125
Chapter - VI CONCLUSION 126-127
SUMMARY 128-129
REFERENCES
BIBLIOGRAPHY
ANNEXURES
List of Tables Sl. No.
Topic Page No.
1. Nidana with effect on dosa – dushya 16 2. Poorva roopa with amsha amsha kalpana 19 3. Classification of Pandu 31 4. Dose of virechana drugs according to sharingdhara 42 5. Matra according to kosta 43 6. Complication of treatment 47 7. Samsajana krama 51 8. Age wise distribution of 50 patients of Pandu 81 9. Sex wise distribution of 50 patients of Pandu. 82 10. Religion wise distribution of 50 patients of Pandu 83 11. Occupation wise distribution of 50 patients of Pandu 84 12. Socio economic status wise distribution of 50 patients of Pandu 85 13. Dietary Pattern wise distribution of 50 patients of Pandu 86 14. Martial Status wise distribution of 50 patients of Pandu 87 15. Family history wise distribution of 50 patients of Pandu 88 16. Hygienic condition wise distribution of 50 patients of Pandu 89 17. Main symptom observed in 50 patients of Pandu roga 90 18. Associated symptom observed in 50 patients of Pandu roga 91 19. Sroto dusti observed in 50 patients of Pandu roga 92 20. Hb % observed in 50 patients of Pandu roga 93 21. Effect of shamana on main symptoms of 25 patients of Pandu after
45 days of treatment . 94
22. Effect of shamana on main symptoms of 25 patients of Pandu after follow up.
95
23. Effect of shamana on associated symptoms of 25 patients of Pandu after treatment.
96
24. Effect of shamana on associated symptoms of 25 patients of Pandu after follow up.
96
25. Effect of shamana on sroto dusti in 25 patients of Pandu after treatment.
97
26. Effect of shamana on sroto dusti in 25 patients of Pandu after follow up.
98
27. Effect of shamana on management of decreased Hb % in 25 patients of Pandu after treatment.
98
28. Effect of shamana on management of decreased Hb % in 25 patients of Pandu after follow up.
99
29. Effect of combine therapy in the management of main symptoms on 25 patients of Pandu after treatment
99
30. Effect of combine therapy in the management of main symptoms on 25 patients of Pandu follow up.
100
31. Effect of combine therapy in the management of associated symptoms on 25 patients of Pandu after treatment.
101
32. Effect of combine therapy in the management of associated symptoms on 25 patients of Pandu after follow up.
101
33. Effect of combine therapy in the management of sroto dusti on 25 patients of Pandu after treatment.
102
34. Effect of combine therapy in the management of sroto dusti on 25 patients of Pandu after follow up.
102
35. Effect of combine therapy in the management of lowered Hb % on 25 patients of Pandu after treatment.
103
36. Effect of combine therapy in the management of lowered Hb % on 25 patients of Pandu after follow up.
103
37. Total effect of shamana therapy on 25 patients of Pandu after treatment.
104
38. Total effect of shamana therapy on 25 patients of Pandu after follow up.
104
39. Total effect of combine therapy in 25 patients of Pandu after treatment.
105
40. Total effects of combine therapy in 25 patients of Pandu after follow up.
105
41. Comparative effect of therapies in the management of main symptoms of 50 patients of Pandu
107
42. Comparative effect of therapies in the management of associated symptoms of 50 patients of Pandu
108
43. Comparative effect of therapies in the management of sroto drusti on 50 patients of Pandu
109
44. Comparative effect of therapies in the management of lowered Hb % on 50 patients of Pandu
110
45. Comparative effect of overall therapy. 111
List of Charts/Graphs
Sl.
No. Topics Page No.
1. Schematic Representation of samprapthi of Pandu 23
2. Schematic Representation of samprapthi of mrut bhakshana janya
Pandu
24
3. Schematic Representation of mode of action of virechana 52
4. Age wise distribution of 50 patients of Pandu. 81
5. Sex wise distribution of 50 patients of Pandu. 82
6. Religion wise distribution of 50 patients of Pandu 83
7. Occupation wise distribution of 50 patients of Pandu 84
8. Socio economic status wise distribution of 50 patients of Pandu 85
9. Dietary Pattern wise distribution of 50 patients of Pandu 86
10. Martial Status wise distribution of 50 patients of Pandu 87
11. Family history wise distribution of 50 patients of Pandu 88
12. Hygienic condition wise distribution of 50 patients of Pandu 89
13. Main symptom observed in 50 patients of Pandu roga 90
14. Associated symptom observed in 50 patients of Pandu roga 91
15. Sroto dusti observed in 50 patients of Pandu roga 92
16. Comparative effect of therapies in the management of main
symptoms of 50 Pandu patients
107
17. Comparative effect of therapies in the management of associated
symptoms of 50 Pandu patients.
108
18. Comparative effect of therapies in the management of Sroto dusti
in 50 Pandu patients
109
19. Comparative effect of therapies in the management of lowed Hb
% in 50 Pandu patients
110
20. Comparative effect of overall therapies. 111
LIST OF ABBREVIATIONS
1. A.H : Astanga Hridaya
2. A.K : Amarakosha
3. A.S : Astanga Sangraha
4. B.P : Bhava Prakasha
5. B.R : Bhaishajya Rathnavali
6. Basa : Basavarajeeyam
7. C.D : Chakra Datta
8. C.M.P : Concise Medical Physiology
9. C.S : Charaka Samhita A
10. Ckr : Chakrapani.
11. D.G : Dravya Guna Vijnana
12. D.G.V : Dravya Guna Vijnaniyam
13. D.N : Dhanvantari Nighantu
14. D.P.P.M : Davidson’s Practice and Principles of Medicine.
15. Dl : Dalhana
16. E.M.P : Essentials Of Medical Pharmacology
17. G.N : Gada Nigraha
18. H.P.I.M : Harrison’s Principle Of Internal Medicine
19. H.S : Harita Samhita.
20. K.S : Kashyapa Samhita
21. M.N : Madhava Nidana
22. Madhu : Madhukosha
23. N.L : Nisha Loha (Shamana group)
24. R.N : Raja Nighantu
25. R.P.B.D : Robbin’s Pathologic Basis Of Disease
26. R.R.S : Rasa Ratna Samucchaya
27. S.K.D : Shabda Kalpa Druma
28. S.S : Sushruta Samhita
29. Sh.S : Sharangadhara Samhita
30. T.B.P : Text Book Of Pathology By HarshMohan
31. V.N.L : Virechana Nisha Loha (Shodana group)
32. Vag : Vagbhata
33. Vang : Vangasena
34. W.I : The Wealth Of India
35. Y.R : Yogaratnakara
ABBREVIATIONS OF STHANAS OF SAMHITA
1. Chi : Chikitsa sthana
2. Ind : Indriya sthana
3. Ka : Kalpa sthana
4. Ma.Kha : Madhyama Khanda
5. Ni : Nidana sthana
6. Po.Kha : Poorva Khanda
7. Sha : Shareera sthana
8. Si : Siddhi sthana
9. Su : Sutra sthana
10. Ut : Uttara tantra
11. Vi : Vimana sthana
ABSTRACT
INTRODUCTION
Pandu roga is a multi factorial disease involving multiple facet, different
srotus, dhatus and ojas. The cardinal feature of Pandu is Pandutha, which causes for
the impairment of the colour and the complexion of the person. Pancha Pandu have
ben described in our classic and mrit bhakshanajanya is considered as different as
samprapti, nidana and chikitsa are different. The present study is done to understand
disease principle in Ayurveda about Pandu roga, Iron deficiency anaemia in the
contemporary sciences, and evaluate the efficacy of shodhana and shamana drug.
Objectives of the study:
The study is based on the following aims and objectives.
I. To assess the efficacy of Nisha loha in the management of Pandu roga.
II. To evaluate the efficacy of Dadimadi sneha panoktha virechana and Nisha
loha as a combined therapy in the management of Pandu roga.
III. To evaluate the combined therapy results on Iron deficiency anaemia.
IV. To evaluate the effect of Nisha loha in the management of Iron deficiency
anaemia.
V. Detail study of the drug Nisha loha, Sneha pana and virechana
procedures.
VI. Detail study of the disease covering classical and modern literature.
METHODOLOGY
Total 50 patients who fulfilled the inclusion criteria were randomly selected
for the study. These patients were grouped into two i.e combined therapy group and
shamana therapy group.
The V.N.L (Virechana & Nisha loha) group patients were given Dadimadi ghrutha
sneha pana for 3–7 days depending upon the kosta followed by two days of vishrama
kala and virechana with Trivrit churna, followed by 45 days of shamana therapy by
Nisha loha.
The N.L (Nisha loha) group patients were given Nisha loha with a anupana of madhu
for 45 days.
During this duration, various subjective and objective parameters were observed and
recorded in a special proforma made for this purpose.
INTERPRETATION OF RESULTS
At the end of the treatment schedule of 45 days the results were collected and
statistically analysed. It was found that combined therapy gave highly significant
relief (p<0.001) in curing symptoms like Pandutha, arohana ayasa, bhrama, hriddrava
after follow up with good improvement in Hb% and brought about change in size and
colouration of the cells to the normal.
The shamana group gave only moderate (p<0.010) relief after follow up in
managing in symptoms like Panduta, hriddrava, but sustained long lasting results
could not be found.
CONCLUSION
Combined therapy provided significant relief in the management of symptoms like
hriddrava, Pandutha, bhrama with sustained long-standing effect when compared to
shamana group.
Combined therapy is very effective in management of Pandu as it reduces the
srotho dushti and dathu kshaya.
Combined therapy gave good significant result in changing the size and
colouration of the cells to normal.
ACKNOWLEDGEMENT
I am obliged to my beloved parents and family members for their
constant efforts, encouragements and inspirations through out the work.
On the completion of this thesis work, I extend my sincere gratitude to
my revered Guide Dr. Tarani Kanta Mohanta, M.D, PhD (Ayu), who was the
vital and kinetic force of this thesis, with out his initiation this piece of work
would not have been accomplished in stipulated time.
I owe my sincere regards and boundless gratitude to Dr. Neelkant J.
MBBS, M.D(Med); my Co-guide and Physician of Govt. Hospital, Koppa for
his constant encouragement and valuable suggestions which kindled my
inner enthusiasm and his vast treasure of knowledge which always
fascinated me.
I am grateful to Sri. Aroor Ramesh Rao, President, A.L.N. Rao
Memorial Ayurvedic Medical College, Koppa. for giving me an opportunity
to do my post-graduate studies.
My immense thanks to Dr. Jagadeesh Kunjal, M.D (Ayu), Principal,
A.L.N Rao Memorial Ayurvedic Medical College, Koppa, for his help and
support in completing this work
I am sincerely grateful to Dr. Lucas M.D(Ayu), FRAS(Lon), Dept. of
Dravya guna for his motivational inspiration and support.
My sincere gratitude to all my respected teachers in the Dept. of
Kayachikitsa; HOD Prof. P.K Mishra, MD(Ayu), Dr. Narayana Sharma,
M.D(Ayu), Dr. R.R Mishra, M.D (Ayu) and Dr. C.B Singh, M.D(Ayu).
I remain grateful forever to Dr.Shyamalan PhD and my senior
Dr.Christy J.T for their complete guidance in the statistical work.
I am obliged to the respected teachers of Dept. of Rasa shastra and
Bhaishajya kalpana; Dr. D.K Mishra, M.D (Ayu) and Dr. Galib, M.D (Ayu)
for their guidance in the preparation of medicine.
My earnest gratitude to the respected teachers of the faculty of
Dravya guna; Dr. Sanjaya K.S, M.D (Ayu) and Dr. Sreedhar, M.D (Ayu) for
their extensive help in the drug review along with Dr. H.R Pradeep,
M.D(Ayu) and Dr. Sathish Sringeri, M.D(Ayu).
I am glad to express my sincere thanks to Dr. Rajesh Kumar,
M.D(Ayu) from the Dept. of Shalakya.
I will always treasure the guidance and support given by Dr.
Ramohan, Dr.Ramesh N.V, Dr. Lalitha Bhasker, and Dr. Sreenivas;
Consultant Physicians of Ayurvedic college hospital for their support during
various stages of my work.
I am ever grateful to my friend Dr. Abhinetri Hegde RMO, for her
continuous motivation, patient hearing of my queries and valuable
suggestions through out the course of my work.
My special thanks to Dr. John K George, Dr. Basavaraj and Dr.
Madhu for their support.
I remain grateful for ever to Dr. Banmali Das, M.D(Ayu), Dept. of
Roga nidana for his valuable guidance in the laboratory investigative
procedures.
It will be reprehensible if I do not extend my gratitude to my seniors
Dr. Pradeep K.V, Dr. Prashant Bhat, Dr. Anil P Varkey, Dr. Indu, Dr.
Clarence, Dr.Rakesh, and Dr. Shivakumar.
With amicable gratitude, I thank Dr. Purushotham K.G and Dr.
Harvin George. N, for providing me the technical support.
I will be failing in my duties if I do not express my immense gratitude
to my classmates Dr. Vijayendra, Dr. Prathibha Hullur, Dr. Binu A, Dr.
Roshy, Dr.Vishwanath, Dr. Krishnakishore, Dr. Sanjeev, Dr. Suja, Dr.
Kavitha, and Dr.Pankaj.
With immense pleasure, I extend my heart full thanks to my good
friends; Dr.Prashanth B.K, Dr. Dayanand R.D, Dr. Ratheesh, Dr. Guru, and
Dr. Harihara Prasad with out whose support this thesis work would not
have been complete.
My heart full thanks to Dr. Prabeesh. K; Prabakara Ayurveda
Pharmacy, Kozhikode. for preparing and providing me the medicine for the
study.
I am grateful to all the patients who were included in the study.
My thanks to Dr. Raghuram, Dr. Susheel Shetty for their moral
support.
I would like to express my gratitude to Miss.Amrutha, Mrs.Jyothsna
and Mrs.Mary for their sincere support in lab investigations.
My thanks to Mrs.Triveni and Miss.Manjula (Librarians) and other
office staffs and hospital staffs.
My special thanks to PG juniors, House surgeons, UG friends Mariya,
Susha and others for their constant support.
Finally, thanks to all who helped me directly or indirectly, to complete
this work.
Last but not the least I will always cherish the love and consideration
extended by my dear roommates Ravi, Sarat, Partha, Pradeep, Sandesh,
Gururaj, Sreejith, Naveen and Leeladhar.
Date :
Place : Koppa Dr. James Chacko
Introduction
INTRODUCTION
“Bhadram karanebhihi rinuyamaha devaha
Bhadram pashyema akshbhirya jatraha
Sthire angaihi suduvan sthanubihi kshemaha” (Rig veda)
This is the main motto of every vedanti i.e. we should have a long life and
till that time anga, pratyanga and indriyas should be completely filled with energy.
According to Shankaracharya -
“Jeevame sharataha shatam paschati vividhani pushpani tu”
(Shankaracharya Brahmasutra)
When we live for 100 years, our eyes should be able to see different
colorful flowers suggesting that color is the spice of life and color has been
assigned the role of nature’s subtlest expressions of conformities and infirmities.
It is generally seen that character of an object is proportionate to the
intensity of its color, the more the intensity of the color, the stronger the character
or in other words healthy skin color is an integral part of robust health. They are
closely interlocked like flower and fragrance.
Colors were used as symbols of worship and were used to denote
personalities. In ‘Atharvaveda’, Ganapathi Atharva Sheersha it is said
“Rakta gandhanuliptangam raktapushpe supujitam”
Ganesha who is the adhipathi of vayu likes rakta varna and should be prayed with
rakta chandana and rakta pushpas.
Page : 1
Introduction
Kaviratna Kalidasa who is considered sreshta in ‘kavyalankara’ as
propounded by Chanakya as “Khavyeshu magha Kavi Kalidasa” in ‘Abhijnana
Shaakuntalam’ talks about the skin fairness of Shakuntala during the pregnancy as
“Navaketaki pushpa sannibham”. This clearly indicates anemia in pregnancy.
Paleness is always associated with inadequacy. It is said that the color of
Pandu patient is equivalent to ‘Peetardha ketaki dhooli sannibham’ but this does
not makes it a rule that for roga vinischaya it is pratyatmaka lakshana as sushka
Pandu mentioned in ‘Bhasavarajeeyam’ has no Pandu varnata but patient may go
krisha day by day. Pandu is a varnopa lakshita vyadhi where paleness is path
gnomonic, Iron deficiency anemia is a disease that has similar paleness,
constitutional symptoms pathogenesis and etiology.
Iron deficiency anemia is the most common nutritional disorder prevalent
all over the world with an estimated 4.5 billion people effected accounting for 60-
80% of the worlds population with 9 out of 10 sufferers living in the developing
countries. This compelled the W.H.O to declare it as a world health problem. The
high incidence of iron deficiency anemia has a direct influence on productivity of
the whole nation by 20% since it reduces the working capacity of the populace.
Even after 300 years of research in this field complete treatment of anemia
without complications like constipation and metallic taste in the mouth with
allopath system is inevitable. Thus, my humble attempt is to understand this
disease according to the Ayurvedic perspective and to adopt shodhana therapy in
the form of Dadimadi snehapanokta virechana and shamana in the form of Nisha
loha .
Page : 2
Introduction
Again, from the core of my heart I bow to Lord Shiva, who is the
varnadhipathi to show me the path.
“Tanme manaha Shiva sankalpamastu”
This study highlights on both conceptual and clinical aspect related to the disease
of Pandu. The contents are sub divided into the following chapters -
Chapter I- Objectives.
It highlights on the main aims and objectives of the present study
Chapter II- Review of literature
It deals with the conceptual study of both Pandu roga and iron deficiency
anemia. It covers all the relevant matters related to the disease.
Chapter III- Methodology
Details of the clinical trial of Dhadimadi snehapanokta virechana and
Nisha loha combined and individually in Pandu are furnished along with
observations during the study are explained.
Chapter IV- Results
The results of the entire study have been explained with appropriate graphs
for easy understanding.
Chapter V- Discussion
Discussion on both Pandu and iron deficiency anemia, discussion on
clinical trial with observations and results have been described.
Chapter VI- Summary and Conclusion
Complete abstract of the dissertation and the conclusion are enumerated.
Page : 3
Objectives
OBJECTIVES
The study is based on the following aims and objectives:
I. To assess the efficacy of Nisha loha in the management of Pandu roga.
II. To assess the role of Dadimadi sneha pana and Trivrit churna virechana in
the management of Pandu roga.
III. To compare the efficacy of combined therapy (shamana and shodhana) with
respect to shamana therapy.
IV. Detailed study of the Nisha loha and concepts of snehapana and virechana by
evaluating its merits and demerits.
V. Detail study of the disease covering classical and modern literature.
HYPOTHESIS:
I. Null hypothesis – Nisha loha and Dadimadi sneha panokta virechana does
not have any effect in the management of patients suffering from Pandu roga.
II. Alternate hypothesis - Nisha loha and Dadimadi snehapanokta virechana
have effect in the management of patients suffering from Pandu roga.
Page : 4
Historical Review
HISTORICAL REVIEW
History is nothing but the record of past events arranged chronologically. In
medicine it contributes to the review of accomplishments, errors, false theories, mis-
information and mistaken interpretations since it is derived to a very great degree
from the intuitive and observational prepositions and cumulative experiences
gleaned from others; so one should master and understand it, as a key to
understanding of the present.
“The further back you look the further forward you can see”
Winston Churchil.
The study can be sub divided in to 1) Vedic period (up to 1000 BC)
2) Samhitha kala (1000 BC -500 AD)
3) Sangraha kala (500 AD-1700 AD)
4) Adunika kala (1700 AD onwards)
1) Vedic kala:
From the above literature, it is found that Ayurveda, which is intimately
connected, with Atharva veda should have acquaintance with puranas. It would be
logic to say that both puranas and Ayurveda developed together with post atharanic
period, thus creating an ideal environment for interacting between them.
Mythological origin of diseases and recitation of stotras like Vishnu
sahasranama in jwara chikitsa, Shiva Shiva suta aradhana in kushta chikitsa are the
direct impact of the puranas.
Page : 5
Historical Review
Rig veda it is stated ‘I will remove yakshma from various tissues and parts
of body like taruna asti, antra, yakruth, pleeha, masthiska, jihwa, hrudaya and
puppusa’ Rig veda 10/ 163
Hariman and Harita are the diseases mentioned in Rig-veda and Atharva
veda, Hariman is interpreted by Sayana as pallor and yellowishness of the body
caused by the diseases.
In Vedas, we get the reference for its treatment with morning sunrays, red
cow’s milk and the red anjana has been said as harita bheshaja. Caushiaka sutra
prescribe intake of cooked rice mixed with Haridra and anointing the same over the
body for this disease. In Mahabaratha also we get reference regarding the
manifestation of this diseases as the King Pandu, the father of Pandavas were
suffering from Panduta.
2) Samhitha kala:
During this period the scattered information were gathered and
arranged in a systematic manner resulting in the genesis of samhitas. Later it became
a living tradition of the community and so it got patronage from both king and the
community. Among the many distinguished names in the Hindu, medicine during
this period Charaka, Susrutha, Haritha and Bhela stands out with prominence and all
of them have very clearly mentioned Pandu covering all the aspects in detail.
Page : 6
Historical Review
Charaka:
Agnivesa tantra was a detailed record of exposition which flowed
from the benevolent lips of maharshi Atreya. This text has been redacted by Charaka
who has given a detail description regarding the nidana, samprapti, chikitsa sutras
and chikitsa considering this as rasa vaha sroto vikara.
Susrutha:
Susrutha samhita written by Vriddha Susrutha gives elaborate
explanation regarding this disease. It contains the teachings of Lord Dhanvantari and
has stressed importance for the surgicial aspects. He has dealt with the vyadhi
Pandu in detail giving its nidana, samprapti, bedha, upadrava and chikitsa
considering it as a rakta vaha sroto vikara.
3) Sangraha kala:
It was during this period that the depicted scripture of samhita kala
was given a clear interpretation in the form of commentaries to elucidate it.
Chakradatta, Indu, Dalhana, Vijayarakshita, Srikantadatta, Adamalla,
Amarasimha, Arunadatta, Gangadara all of them have written commentaries on this
disease given their own interpretations on various aspects of this disease.
• In Rasaratna samuchaya author Vagbata have mentioned the marana and
shodhana of Loha bhasma and its use pertaining to Pandu.
• Sharangadhara (1300 AD), in his treatise described the classification of
Pandu roga and mentioned many kasta aushadis for its cure.
• Yogaratnakara was unique in giving equal importance for both kasta and rasa
aushadi in the management of Pandu.
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Historical Review
4) Adunika kala:
Initially due to various foreign invasions and due to high patronage of
western medicine, Ayurveda had to face its stagnant state but after independence due
to supportive measures by government and non-government, organizations
Ayurveda found a sprouting from the stage of dormacy.
Kaviraj Ramarakshak Patak has written a complete book on Pandu roga
giving elaborate description on various aspects of Pandu roga. Various books are
written on regional languages expectionally in Malayalam like ‘Pandu rogavyum
chikitsayum’ by Dr. T N K Moosa.
5) Anemia:
The term anemia was first sound in the Carpus Hippocraticus. It literally
means with out blood and is derived from Greek word “a” or with out and “haima”
or blood.
The term anemia was first used in English by James Combe and Edinburg
physician in the year 1824. Gerbrial Andral a French physician laid much of the
foundation on modern concept of anemia.
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Disease Review
DISEASE REVIEW
VYUTPATTI & PARIBHASHA:
The word Pandu is formed from the root dhatu “PADI GATOU” means Gati1
i.e parinama or transformation. This signifies the transformation of various dhatus
from ahara rasa.
• The disease Pandu is named after the Varna, as it is a mixture of shweta and
peeta varna2.
• Pandu varna is the combination of shewta and peeta varna in equal
proportion, similar to pollen grains of Ketaki (Harita samhita).
• In Shabdakalpadruma Pandu varna is mentioned as combination of shweta
and peetha.
• In Raja nighantu Pandu varna is the combination of shukla and peetha varna.
In Ayurvedic classics, different definitions has been given, stating -
• The disease in which Pandu bhava is more predominent is called Pandu
roga3.
• The disease in which Panduthwa is predominant4.
• Predominant features in all Pandu bhedha are Pandu varna5.
• Disease named after Panduthwa6.
It is evident that the colour is being used as main criteria for diagnosing and
differentiating the vyadhi Pandu from other diseases.
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Disease Review
Paryaya
Various paryaya are mentioned for Pandu roga which are mainly based on the
colour7. They include
Pandu
Kamala
Panaki
Kumbhava
Lagharaka
Alasakshya
Haridra
Haritha
Though Kamala8, Kumbha kamala has been mentioned as paryaya even then
separate nidana, lakshana and chikitsa are mentioned. Dalhana clarifies that
Susrhutha has considered it as synonyms only based on Kamala being one of the
avasta vishesha of Pandu.
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Disease Review
NIDANA
Nidana in ayurvedic classics have two different meanings
1) Vyadhi bhodaka hetu 2) Vyadhi janaka hetu.
That which points out those factors, which help us to know clearly about the
disease, is vyadhi bhodaka hetu and that which points out those factors that produces
the disease is called as vyadhi janaka hetu. Here nidana is used, as vyadhi janaka
hetu and the knowledge of these are very important for the proper understanding of
samprapti, sadyaasadyata, upadrava and chikitsa. The nidana parivarjana forms the
first line of treatment. The factor, which supports the formation of the disease, is
summerised under four major headings so that it could be studied elaborately.
1) Aharaja nidana
2) Viharaja nidana
3) Chikitsa apacharaja nidana
4) Nidanaarthakara roga
AHARAJA NIDANA
Improper diet and dietic practices are the prime factors responsible for the
disease manifestation particularly when taken in excess. Such etiological factors
related to food are9,
1) Rasa – Amla, lavana, kshara.
2) Guna – Ruksha, ushna, tikshna.
3) Veerya – Ushna.
4) Dravya – Vidagdha anna, nishpava, pinnyaka, matsya, amisha, pista, paya,
tila taila, masha atisevana, Madhya.
IMPROPER DIETIC PRACTICES
1) Concept of virudha ahara.
2) Improper practice of ahara sevana vidhi like adhyasana, vishama ashana.
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Disease Review
VIHARATAHA
• Ratri jagarana
• Ati nidra
• Divaswapna
• Vegadharana10
• Ativyayama
• Avyayama
• Ativyavaya
• Ritu vaishamya
According to the modern view, food also plays a major role in producing the
disease anaemia especially iron deficiency anaemia. Usually malnutrition,
particularly food deficient in folic acid, vit B-12 and iron are the cause of anaemia of
different variety.
MANISIKA KARANAS
Acharya Charaka has given some of the manasika karanas which could pre-
dispose a person towards the disease Pandu. They include11,
• Kama
• Krodha
• Chinta
• Bhaya
• Shoka
CHIKITSA APACHARAJA
• Panchakarma vaishamya12
• Vamana virechana vyapat, i.e parisrava can cause Panduta13.
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Disease Review
• Snehapana vibrama can cause Pandu14.
• Grahi oushadi prayoga in ama atisara15.
• Akala sneha prayoga16.
• Chardi nigrahana17.
• Ati yoga of yapana vasti18.
NIDANA ARTAKA ROGA
They can be classified into two depending up on the karanas for the vyadhi.
Nija karanas for the roga Angantu karanas for rogas
Rakta arbudha20 Katika taruna marma vedha19
Antarlohita21 Raktavahi dhamani vedha45
Raktapita upadrava22 Revati graham46
Rakta pradra23 Mamsa marma abhighata47
Rakta kshaya24 Rajiman sarpa damsha48
Raktha srava25 Udarastha visha49
Punaravartaka jwara26 Mushaka damshtra50
Grahani27 Antarmruta shishu51
Arsha poorva roopa28
Pureeshaja krimi29
Rakta pitta30
Asrugdhara31
Kaphaja yoni vyapath32
Pleehodara33
Yakrudalyudra34
Pittaja pratishaya35
Vyavaya shosha36
Pittaja kasa37
Shukra kshaya38
Beejopaghatha klaibya39
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Disease Review
Pittadusta stanya40
Paittika prameha upadrava41
Kaphaja shopha42
Raktaja gulma43
Rasa pradosaja vikara44
RASA
“Kashaya tikta maduraha pittamanye tu kurvate” these rasas amla, lavana
kshara have the quality to increase the pitta dosa. Due to the predominance of Agni
maha bhoota in them, they are pitta vardaka, dathu shoshaka, ojo kshaya karaka and
rakta dusti karaka. In rasabhediya adhyaya of Astanga samgraha ati yoga of these
rasa produces,
Amalati yoga Lavanati yoga Ksharati yoga
Kapha vilayaka Moorcha janaka Pumsopagtaka
Trishna janaka Trishana janaka Kalithya janaka
Pitta vardaka Kusta karaka Palithya janaka
Mamsa shoshaka Pumsopagataka Hridayopa gataka
Dourbhyala janaka Indriyopa gataka Akshi upagataka
Daha janaka Raktha prakopaka Raktha dusthi
GUNA
Ruksha, ushna and tikshna are pitta vardaka due to the agni maha bhoota in
them and also cause shoshana of dhatus. They are rakta and pitta dushti karaka,
produces snehamsha ksheenata, ap dhatu shosha and ojo kshaya karaka.
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Disease Review
DRAVYAS
1) Vidagda anna
2) Madya ati sevana52 – Madhya gunas and visha gunas are almost similar and
the amla rasa and katu vipaka ushna tikshna, vidahi guna of the Madhya will
produce ojo kshaya, pitta vridhi and rakta dusti. Its guna directly have the
action on the soumya dhatus of shareera producing daha.
3) Paya and ikshu53 – paya and ikshu are kapha vardaka and having similar
qualities of ojas but excess intake is said to be kleda karaka and agni nashaka
and also sroto avarodaka and ama karaka.
4) Tila54 – the taila extracted from the tila is kusta karaka when taken internally,
it is ushna veerya, with madhura tikshna and kashaya rasa. It is vata and
kapha hara and rakta pitta dusti karaka.
5) Ruksha ahara sevana –
6) Mrit sevana55 – a specific type of Pandu is produced by in take of mrit.
Depending up on the predominance of rasa in mrit i.e kashaya – vata, ushara
– pitta, madhura – kapha are increased and produces rukshata in shareera and
the mrit taken does the sroto avarodhana.
7) Pinyaka56 – it is kapha vatahara and pitta rakta avarodhaka. It is said to be
glani karaka and guru paki.
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Disease Review
Table No. 1 Nidana with effect on dosha-dushya:
Dravya Guna Effect on dosa - dushya
1. Nishpava Ruksha guna, amla
vipaka
Kaphahara,Glanikaraka,
Sukranashaka, Vidahi,
Pitta vata vardaka
2. Masha57 Madura rasa, Guru
vipaka
Kapha prakopaka Kledakaraka
Klaibyakaraka
3. Pinyaka Ruksha guna, guru
paki, Ushna veerya
Kaphagna, Vidahi
Vata pitta vardaka, Sukra
nasaka,Rakthapitta
prakopaka
4. Tila taila Madhura kashaya
rasa, Ushna veerya
Vata kapha hara, Raktha pitta
prakopaka
5. Tila pishta Ushna & Guru Pitta karaka,Raktha prakopaka
6. Paya sevana Madhura rasa, sheeta
veerya,Guru snigdha
Kapha vardaka ,Kleda karaka
7.Matsya58
(Samudra)
Ushna veerya Kapha-pitta vardaka,Raktha
prakopaka
8.Amisha59
(mamsa)
Ruksha & sheeta Vata-pitta prakopaka,Rasa
raktha dusti karaka
9Ikshu sevana60 Madhura rasa,
Sheeta veerya
Snigdha, sara guna
Kapha prakopaka,Ama karaka,
Abishyandaka
10.Ruksha, ati
sevana
Katu, ushna Vata prakopaka,Rakta dusti
karaka,Kapha soshaka
11.Mruth
sevana61
Kashaya- vata
Katu- pitta
Madhura - kapha
Tridosha prakopaka
Sroto avarodhaka,
Krimi janaka
12. Madya Amala rasa
Katu vipaka
Ushna, vidahi
Pitta prakopaka - Ojo nashaka
Kapha shoshaka- Raktha dusti
karaka
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Disease Review
ETIOLOGY OF IRON DEFECIENCY ANAEMIA (IDA):
IDA has been classified based on etiology62.
Classification:
a) Increased blood loss:
1. Uterine – e.g. excessive menstruation in reproductive years, repeated
miscarriages, at onset of menarche, post – menopausal uterine bleeding.
2. Gastrointestinal – e.g. peptic ulcer, haemorrhoids, hookworm infestation,
cancer of stomach and large intestine, chronic aspirin ingestion.
3. Renal tract – e.g. haematuria, haemoglobinuria.
4. Nose – e.g. repeated epistaxis.
5. Lungs – e.g. haemoptysis.
b) Inadequacy due to increased requirements:
1. Spurts of growth in infancy, childhood and adolescence,
2. Prematurity,
3. Pregnancy and lactation.
c) Inadequate dietary intake:
1. Poor economic status,
2. Anorexia e.g. pregnancy.
3. Elderly individuals due to poor dentition, apathy and financial constraints.
d) Decreased absorption:
1. Partial or total gastrectomy
2. Achlorhydria
3. Intestinal malabsorption diseases.
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Disease Review
Dietary lack of Iron is a rare cause of Iron Deficiency Anaemia in
industrialised countries, where 2/3rd of dietary Iron is in readily assimilable “heme”
form; the situation is different in developing countries where food is less abundant
and diet is predominantly vegetarian containing poorly absorbable inorganic Iron128.
Chronic blood loss is the most important cause of Iron Defiency Anaemia in
the western world128. Recurrent blood loss during menstruation is the important
cause for higher incidence of Iron deficiency in women.
POORVA ROOPA
These features develop before the actual onset of disease they give clues
about the forth-coming disease and are called Prodromal symptoms or
Poorvaroopa63.
These are produced during the stage of Sthana samshraya of vitiated doshas.
Poorvaroopa will give us the information regarding the forthcoming disease; if
treated at this stage, progress or severity of disease can be checked.
Poorvaroopa may continue to exist in the actual state of disease as Roopa;
some may disappear. Some times poorvaroopas contradictory to roopas may also
appear, like vibandha before atisara.
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Disease Review
Table No: 2
Poorva roopas with their amshamsha kalpana according to “Samprapti laxanyoho sambandha” by Sadashiva Shaarma:
Sl. No Lakshana Dosha Gunathaha Amsamsa kalpana
1. Hridaya spanadana
Vyana vata
Sadaka pitta
Chala gunataha
Sara gunataha
-
2. Twachi rukshata
Vyana vata Ruksha gunataha
-
3. Sweda abhava Kapha Medo mala vridhi
Srotho avarodhaka
4. Srama Vata/Vyana vata
- Rasa kshaya
5. Twak spotam Vata Ruksha gunataha
-
6. Steevena Kapha - Rasa/ Ama
7. Gatra sada Vata - Ojo kshaya
8. Mrid bakshana Tridosha - Prabhava
9. Prekshana koota shotha
Kapha vridhi - Srotho rodha
10. Vin mootra peetata
Pitta Roopata vridhi -
11. Avipaka Pitta Drava roopa vridhi
-
12. Aruchi Pitta Drava roopatha vridhi
-
13. Rakthalochana Pitta vridha - -
14. Pippasa Vata pitta vridhi
Udaka kshaya
-
15. Alpa vannita Pitta vridhi Drava roopatha vridhi
-
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Disease Review
SAMPRAPTHI
The manner of dosha vitiation right from contact with the nidanas and the
course they follow culminating in the development of specific clinical manifestation
is known by the name samprapthi. Every factor connected with the process of
disease at various stages is considered in detail in samprapthi. It gives a clear idea of
the disease process helping management of the condition
Charaka considers Pandu to be a santharpanaja rasa vaha srotho vikara and
susrutha says it to be rakthavaha sroto vikara and clearly projects pitta dosha as the
major factor behind the whole pathogenesis in Pandu. Due to the involvement of
rasa, raktha and ojas the main presenting symptom is Panduta, indriya-bala-
varnahani and the nidanas for Pandu is pittaja nidanas.
Samprapthi of Pandu can be explained and understood based on
shadkriyakala-sanchaya, prakopa, prasara, sthanasamsraya, vyaktha and bheda.
Sanchaya
This is the initial stage of the disease, where in the doshas is accumulated
and stagnated in its own sthanas. Chayavastha is characterised by vague and ill-
defined symptomatology though some symptoms may indicate the underlying
doshic involvement such as dullness and fullness by vata, laziness and heaviness of
limbs by kapha. There may be aversion towards contraries. Here since there is
accumulation of pitta dosha the person may feel an aversion towards those factors,
which are similar to that of pitta. If it is neglected or due to negligence in treatment
it may enter in to prakopa.
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Disease Review
Prakopa
The liquifaction of the accumulated dosha in previous stage as well, as if the
person is continuously indulging in the dosha aggravating factors, it leads to
prakopaavastha. In the present, contest the pittakara nidanas like teekshna, amla,
kshara etc leads to further aggravation and excitation of pitta dosha providing
perfect base for the manifestation of Panduroga. This stage may give rise to
symptoms characteristic of doshas like abdominal pain, thirst, burning sensation,
disinclination for food, nausea etc.Neglecting this stage result in the next stage, i.e.
praasara.
Prasaravastha
The term prasara means to spread. In this stage the increased and excited
dosha spread over to other parts, which is the sthana of other dosha. It is to be noted
that Vayu which posses the power of locomotion is responsible for this stage and the
prakupitadoshas especially pitta produces symptoms like burning sensation in
various parts of the body, painful sucking sensation impaired digestion may be seen.
The accumulated pitta dosha from hridaya spread to various parts of body
through dasadamanis in this stage. In the above three stage of kriyakala a vague
manifestation of symptom will be seen which is not sufficient for diagnosis of
Pandu. If it is detected in the stage, the progression of the disease may be arrested by
timely intervention.
Sthanasamsrayavastha
The vitiated dosha relocate them in the site of other doshas vitiating the
dushyas present there and mark the beginning of specific diseases pertaining to the
site. Obviously, this stage represents the prodromal phase or the stage of
poorvaroopa and disease is yet to manifest fully.
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Disease Review
The Doshas thus spread through the dasha dhamanies relocate themselves in
the srothas of rasa, raktha and medovaha producing kha vaigunya and get asraya in
twak mamsa and vitiate doshas and dushyas like asruk, twak, mamsa resulting in
various type of discolouration in the body and manifestation of prodromal symptoms
like hridayaspandanadhikya, roukshya,sweda abhava,srama are seen.
Vykthavastha
This stage in which the disease manifest completely with its symptoms in a
fully developed form. This stage is marked by presence of cardinal features like
Panduta, hridrava, aruchi arohana-ayasa, shishira dweshi.
Bhedavastha
The disease when neglected in vyakthavasta turns into bhedavasta.This stage
can make the condition worse by manifestation of kamala and enters into deep
dhatus. The disease proceeds into more severe form due to extensive dhathukshaya
and finally attains the asadhyaavastha.
Samprapthi of Panduroga64:
A disease has been deliberated due to the result of dosha dushya
sammurchana. Due to the nidana, sevana in the form of mithya ahara and vihara,
there will be pitta prdhana trdosha prakopa and Vagbhata says that there is an
increase in snigdhatha and the dusthi of pitta is in the form of dravyatha vrudhi,
gunata and karmata kshaya. This vitiated dosha is carried to hridhaya, vyana vayu
throws this through the dasha dhamani to the sarva shareera, and get stana samsraya
between twak and mamsa resulting in discolouration of the skin such as paleness and
yellowish discolouration of which Panduta being the predominant colour. There will
be indriya and ojohani, which will produce Varna bala kshaya and indriya saithilya
and produce five types of Pandu with specific character.
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Disease Review
Illustration No: I
Nidana Samprapti Flow chart:
Sanchaya
Hridaya prapti
Agni vikruti Pitta pradhana tridosha prakopa
Through Vyana vayu
Prakopa
Circulation through Dasadhamani
Twak mamsa antra asrya
Rasa vaha srotus, rakta vaha sroto dusti
Prasara
Dosha dushya sammurchana
Stana
Samshraya
Upadrava, Asadhya, Arista
Alpa rakta, Alpa medaska, Ojo kshaya, Mamsa twak dushya
Poorva rupa
Bala kshaya,Varna kshaya, Nissara, Shithilendriya
Pancha Pandu
Dhatu shaitilya & Dhatu Gourava
Vyakta
Bheda
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Disease Review
Illustration No: II
Mruth bhakashanajanya Pandu:
Mrut
Kashaya Ushara
Vata Pitta
Rukshaguna cause Roukshya in Rasadidhatus & shareera
Agnimandhya & srotorodha
Avipakwatha of mruttika causes
Kapha
Madhura
Indriya, teja Bala ojus veeryahani
Affects the dhatu-poshana
Respective dosha Prakopaja Mrud bhakshanajanya - Pandu
Vyadhi ghatakas
Vyadhi ghatakas have been described with relation to the disease process and
nidana is said to cause vyadhi by deranging the samprpthi ghatakas.Here an effort is
made in narrating the role of these in producing the vyadhi Pandu.
1) Dosha65- Pitta pradhana tridosha
2) Dooshya66- Rasa, Rakta, Medha
3) Agni- Agni dusthi(mandagni)
4) Ama- Amaja vyadhi
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Disease Review
5) Srotas- Rasa vaha srotas
Raktavaha srotas
Medovaha srotas
6) Udbhava sthana – Amashaya
7) Vyakta sthana – Sarva shareera
8) Sanchara sthana- Dashadhamanis and Sarvashareera
9) Ashraya- Twak and Mamsa
PITTA
Pitta is the prime dosha involved for the manifestation of disease Pandu and
the normal physiological understanding of pitta bhedas gives its importance in
the vyadhi.
i) Pachaka pitta- The main karma of pachaka pitta is to digest the ahara and
sara kitta vibhajana. This bheda of pitta gets vitiated by nidana sevana and cause
agnimandya and leads to formation of improper adyadhatu, ama and
dhatushaithilya.
ii) Ranjaka pitta- Its sthana is yakrit and pleeha and is responsible for the rasa
ranjana. Sushruta says that amashaya is the ranjaka pitta sthana and when there
is a vitiation of Ranjaka pitta, there is improper conversion of rasa into rakta.
Sarangadhara says that hridaya is the sthana of ranjaka pitta.
In the contemporary sciences, it has been proved that liver has a significant
role in the formation and maturation of R.B.C.
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Disease Review
In 1929, Castle showed the presence of a substance in gastric tissue
responsible for formation of anti anemic factor.
iii) Alochaka pitta- It is present in the eyes and is responsible for
roopalochana.In Pandu due to the indriyasthitilyata proper drishti does not occur.
iv) Sadaka pitta- It is present in the hridaya, helps for dhee, dhriti, dhairya,
abhiprekshata sadhana and these functions are hindered, and manas gets
involved.
v) Bhrajaka pitta- The seat of this variety of pitta is twak, it gives color to the
skin, vitiation of the bhrajaka pitta produces alteration of the normal color and
brings about Panduta of twak.
KAPHA
Kapha also has an important role to play in the pathogenesis of Pandu roga.
Avalambaka kapha is responsible for uru palana, in case of Pandu, due to the
kapha vriddhi the sthana is vitiated and that leads into hriddrava, arohana ayasa.
Bhodaka kapha is responsible for ruchi grahanam, which is destroyed in Pandu.
Shleshaka kapha, which is responsible for sandhi samsleshana, gets vitiated and
leads to parvashoola.
Kapha situated in the twak produces shwetaavabhasata.
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Disease Review
VATA
The role of vata is very important in the manifestation of the disease because
the vitiated dosha enters the hridaya and it is carried from the hridaya to the
sarva shareera through the dasha dhamanis by vyana vayu and gets displaced
between twak and mamsa.
DOOSHYA
i) Rasa dhatu- Acharya Charaka mentions it as a rasa pradoshaja vikara and
Chakrapani comments that the aggravated pitta dosha does the kshapana
of rakta poshaka rasa and its anutpadana due to the impairment of the
agni resulting in dhatu shaithilya.
ii) Rakta dhatu- Raktalpata is mentioned by Charaka as pradhana lakshana
and pitta being the pradhana dosha there will be the involvement of the
rakta dhatu.
iii) Medhas- Alpa medhata is due to the improper uttarothara dhatu
formation.
AGNI
There is a gross vitiation of jataragni, bhoothagni and dhatwagni. The nidana
sevana will cause increase in the Drava guna of pitta resulting in jataragni
mandhya. This jataragni governs the state of functioning of all the agnis. This
leads to the production of sama ahara rasa and impaired conversion to
subsequent dhatus. So poshana of dhatus and upadhatus does not occur properly.
This leads to ojokshaya.
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Disease Review
AMA
Agnimandhya being one of the key factors for the Pandu, the role of ama
cannot be ruled out.
SROTAS
Important srotas affected in Pandu is rasa and raktavaha.
I) Pandu is a rasa pradoshaja vikara. In Pandu due to agnimandya rasa dhatu is
first affected and prakupita pitta having sthana samshraya in hridaya which is the
moola sthana for rasavaha srotas and many rasa kshaya lakshana and dushti
lakshanas are seen in Pandu.
II) Pitta dosha and rakta dhatu are responsible for varna prasadana i.e. agni guna
bhuyishta. There is also alparaktata and some symptoms of raktavaha sroto
dushti like bhrama, trishna, Panduta are seen.
SAMPRAPTI BHEDA OF PANDU
1) Sankhya samprapti:
5 types of Pandu (Charaka and Vaghbata)
4 types of Pandu (Sushruta)
8 types of Pandu (Harita)
2) Vidhi samprapti:
The method in which the dosha is kupita leading into dosha dushya
sammurchana and vyadhi sanghatana is caused as vidhi samprapti, which is
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Disease Review
mentioned above. The swatantra Pandu is sadhya and paratantra Pandu is
kashta sadhya.
3) Vikalpa samprapti:
The amshamsha kalpana of the samprapti of Pandu is seperately dealt under
the heading of samprapti ghatakas of Pandu.
4) Pradhanya samprapti:
Pradhana dosha – pitta pradhana tridosha
Swatantra Pandu is pradhana
Nidanarthakara roga janita Pandu is apradhana
Anubandhya Pandu is apradhana
5) Bala samprpati:
The bala or strength of Pandu depends on whether the nidana, poorvaroopa
and roopa are manifested partially or completely.
6) Kala samprapti:
It is the samprapti that confirms the role of a particular dosha in a
disease i.e. the bala that produce the disease or increase its intensity with
change in time like dina, ratri etc. or in accordance with the stage of
digestion.
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Disease Review
Vishesha samprapti:
1) Vataja Pandu- Etiological factors, which mainly increase vata along with
pittadi doshas, lead to the production of Pandu roga with vata anubandha
producing vataja Pandu.
2) Pittaja Pandu- Etiological factors, which mainly increase pitta along with
other doshas, leads to the production of pittaja Pandu.
3) Kaphaja Pandu- Etiological factors, which mainly increase kapha along with
pittadi dosha, leads to production of Pandu roga with kapha anubandha thus
producing kaphaja Pandu.
4) Tridoshaja Pandu- Etiological factors, which mainly increase all the tridosha
simultaneously, lead to production of tridoshaja Pandu.
5) Mrit bhakshanajanya Pandu67- Habitual intelligence in eating mrit aggravates
one of the tridoshas. If the mrit is of kashaya rasa, then it aggravates vayu. If
it is ushara, then pitta gets aggravated, if it is madhura kapha. Because of its
ruksha, guna the mrit causes rukshata in the rasa then the undigested mrit
produces avarodha of srotas and causes indriya bala hani, agnimandya and
thus producing Pandu..
Classification of Pandu
Charaka has classified Pandu roga into five68, i.e Vataja, Pittaja, Kaphaja,
Sannipataja and Mruhbakshanaja. Sushrutha mentions only four types of Pandu and
says- Mrutbhakshana is one of the causes for Pandu roga. The vitiation of dosha
varies according to the rasa of the mrut taken. The intake of kashaya rasa mrut
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Disease Review
vitiates vata and produces vataja Pandu and ushara, madhura rasa pradhana mrut
produces pittaja and kaphaja Pandu respectively, and hence he says
mrutbakshanajanya Pandu is not a separate entity but is only one among the general
cause for Pandu roga.
Vijayaraksita the commentator of Madhavanidana supports the opinion of
Charaka and says that signs and symptoms as well as treatment of
mrutbakshanajanya Pandu are entirely different than the general course of Pandu
roga hence it should be considered as separate one.
Harita have included Kamala, Kumbhakamala and Haleemaka as Pandu
bhedhas and described the disease kamala as later stage of Pandu roga only.
Table No: 3
Classification of Pandu:
Sl.
No
Charaka Susrutha69 Vagbhata7
0
Madhava71 Yogaratna
kara72
Harita
1. Vataja Vataja Vataja Vataja Vataja Vataja
2. Pittaja Pittaja Pittaja Pittaja Pittaja Pittaja
3. Kaphaja Kaphaja Kaphaja Kaphaja Kaphaja Kaphaja
4. Sannipataja Sannipataja Sannipataja Sannipataja Sannipata
ja
Sannipat
a ja
5. Mrutbhaksha
naja
Mrutbhaks
hanaja
Mrutbhaks
hanaja
Mrutbhaks
hanaja
Mrutbha
k
shanaja
6. Kamala
7. Kumba
Kamala
8. Haleema
ka
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Disease Review
ROOPA
The term roopa implies to both signs and symptoms through which a disease
is identified. In addition to the cardinal signs and symptoms, a number of
constitutional symptoms also manifest in Pandu roga. A few of the symptom aid in
distinguishing the type based on dosha anubandhata. Accordingly that can be
classified into
i) Pratyatma lakshanas (cardinal signs & symptoms)
ii) Samanya lakshana (general signs & symptoms).
iii) Vishista lakshana (distinguishing features of dosa anubandhata)
i) Pratyatma lakshanas: The vyadhi Pandu is distinguished by the unique paleness
of skin. Panduta of twak can be considered as the pratyatma lakshna of
Pandu roga. This impairment of skin is due to rasa and rakta kshaya and the
colour is almost like the pollen grains of Ketaki flower. Charaka says that
arohanaayasa is specifically seen in all the variety of Pandu roga due to the
rakta kshaya and vyana vata vridhi. “Visheshat arohana ayasam” specific
colour of the skin depends on the specificity of doshic predominance.
ii) Samanaya lakshana: A number of constitutional symptoms manifest in varying
degree, which are considered as general symptoms. They are as follows; alpa
rakthata, dourbalya, hriddrava, swasa, bhrama, kati- uru -parshva ruk, shotha,
shoonakshi koota, gourava, sadana, mandagni, karna ksheweda, hata prabha,
shweta akshitwa, satwa hani, shweta nakha.
iii) Vishista roopa: The signs and symptoms specified to virulence of dosa are an
important part of our study for early diagnosis and purpose of treatment.
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Disease Review
a) Vataja Pandu73: vata vridhi produces various vataja manifestations in the
presentation of Pandu roga like krushnata of nakha, angamarda, ruja, toda,
shiroruja, varchashosha etc.
b) Pittaja Pandu74 pitta vridhi produces various pittja presentations like peeta
avabhasa, jwara, trishna, pipasa, murcha.
c) Kaphaja Pandu75: kapha vridhi produces various kaphaja manifestations
like shukala varnata, gourava, shwayathu, aruchi, praseka.
d) Tridosaja Pandu76: vitiation of all the dosa causes severe degree of dhatu
shaithilya and dhatu gourava from which detoriation of dhatus and ojas
occur rapidly and are considered ashadhya. Harita has clearly explained the
sannipata Pandu lakshana; thandra, alasya, vit bheda, hrullasa, kasa,
shotha, jwara, moha, trishna.
e) Mrit bhakshana janya Pandu77: it causes agni mandhya and roukshata to
shareera, shotha, dhatu dourbhalya, indriya-teja-bala-virya kshaya and also
may produce krimi.
- Madhavakara has considered it as a vyadhi hetu.
- Susruta has considered it upper tridosaja Pandu as in take of mrit
causes tridosaja prakopa.
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Disease Review
SADHYA- ASADHYATA78
The prognosis of a disease can be established only after consideration of the
sadhyaasadhyata. The signs and symptoms indicationg the incurablity of the disease
are as follows,
i) When the disease is chirakari.
ii) When there is varna kshaya due to rukshata.
iii) Due to the chronicity of vyadhi when shotha has appeared.
iv) Baddhata or alpata of vit pravruthi.
v) When patient view every thing as yellow.
vi) When there is harita and sakapha mala pravarti.
vii) Deenata.
viii) When patient is affected with chardi, murcha and trishna.
ix) When there is Panduta shwetabhasa due to asrik kshaya.
x) When shotha is seen in extremities or in the trunk and emaciation of body
parts.
xi) Tama praveshya.
xii) Samjna hani.
xiii) Pandu associated with jwara and atisara.
xiv) Shotha in guda pradesa, shepha and mushka.
xv) Panduta of danta, nakha, netra and Pandu darshi.
xvi) Tridosaja Pandu is asadhya for chikitsa.
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Disease Review
UPADRAVA
Upadravas are those ailments that are rogashrita and are manifested after the
manifestation of main disease. These are nothing but the supervening symptoms that
occur along with the disease or as a sequel. These generally subside when the main
disease subsides or some times indicate the fatality of the disease. Some times
samanya lakshana may itself may be converted into upadrava by increasing their
severity. Susruta has explained the upadrava.
ARISTA LAKSHANA79
The signs and symptoms indicating the occurrence of death in the near future
are referred to as arista lakshanas. There is no death with out the evolution of the
aristalakshana. The aristas have been classified into sthayi and asthayi by Acharya
Vagbhata and have stated that stahyi arista definitely kill the patient. Some of the
arista lakshanas pertaining to Pandu are;
• Excess Pandu varnata.
• Ati krisha.
• Excessive trishna.
• Kupitha ucchwasa.
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Disease Review
PATHYAPATHYA80
Pathya :
A. Ahara:
1. Suka dhanya varga - Purana Shali
Purana Yava
Godhuma
2. Shami dhanya varga - Mudga
3. Mamsa varga - Jangala Mamsa, Matsya.
4. Shaka varga - Patola, Kushmanda, Jeevanti, Bimbi,
Punarnava, Nagakesara,
Guduchi, Dronapushpi.
5. Phala varga - Kadali phala , Abhaya ,Dhatri.
6. Ikshu varga - Ikshu Rasa
7. Gorasa varga - Takra , Ghrita , Navaneeta.
8. Mootra varga - Gomutra
9. Madya varga- Souviraka, Tushodaka.
10. Kritanna Varga- Yusha.
11. Anya dravya- Haridra, Chandana,
Yavakshara, Loha bhasma.
B.Karma:
i. Vamana.
ii. Virechana.
iii. Abhyanga.
Apathya:
A. Ahara: 1. Rasa- Kshara, Amla, Katu, Lavana.
2.Anna- Viruddha bhojana, Asatmya bhojana.
3. Jala- Adhikambupana, Dushita jalapana.
4.Kritanna varga- Pinyaka.
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Disease Review
5. Shamidhanya varga- Masha, Tila, Kulatha, Nishpava.
6. Sneha varga - Tila taila.
7. Gorasa varga- Dadhi masthu.
8. Madya varga- Saktu.
9. Ahara varga- Hingu, Tambula, Teekshnapadartha
like Maricha, Vidahi padartha,
Atyushna padartha.
10. Anya dravya- Mruttika.
B. Vihara:
- Agni, Atapa atisevana,
- Adhika vyayama.
- Adhika vyavaya.
- Krodha.
- Adhika marga gamana.
C.Karma:
1. Rakta Sruti.
2. Dhoomapana.
3. Swedana.
4. Vamana vega dharana.
Food rich in iron:
The inadequate diet results in iron deficiency and the best source of iron is red meat
because haem can be absorbed as such.
Vegetable have variable amount of absorbable iron, soybean is rich source.
Iron rich foods include red meat, liver, green leafy vegetables, fruits like
apple, apricot, spinach, egg yolk and fishes.
Milk particularly cow milk is well known for its iron deficiency.
Non-green vegetables are deficient in iron content.
Rice and bread are rich in phytates and prevent iron absorbation.
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Disease Review
TREATMENT OF PANDU ROGA
Treatment given in Pandu can be divided in to81 1) Shodhana
2) Shamana
1) Shodhana: Shodhana is done by Snigdha, Teekshna Vamana and Virechana.
Prior to Shodhana,
a) Snehana is done as
i) Body’s Sneha quality is greatly reduced in Pandu.
ii) Alpa raktata, Alpa medaskata and Ojo kshaya cause predominance of
Rukshata in the body.
iii) To bring back the Shakhashrita dosha to Koshta
Eg. Kalyanaka Ghrita, Panchagavyaghrita
b) Swedana has been contradicted in Pandu82. However, Mridu swedana can be
performed.
c) Shodhana is done for
1) Koshta shuddhi
2) To combat the Dosha bahulyata.
Brihatrayees accept both Urdhwa and Adho shodhana keeping in accordance
with the condition.
Shodhana is followed by Shamana oushadha and Pathya.
2) Shamana: In Shamana, various single and compound preparations are told
which include herbal, mineral and herbomineral preparations. Illustrating a few,
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Disease Review
1) Vyoshadya Ghrita
2) Shuddha Kanta Loha Bhasma83
3) Vidangadi Loha 84
A point of interest to be noted here is that most mineral preparations contain
Loha.
Mrudbhakshanajanya Pandu Chikitsa85:
At the outset, the Balabala of the patient has to be assessed.
1) Shodhana:
Teekshna shodhana in order to remove the ingested Mruttika.
2) Shamana:
1) Medicated Ghrita ie Sarpi for baladana. Eg. Kalyanaka Ghrita
2) Treatment according to the Prakupita Dosha.
3) Krimihara Chikitsa in Udara Krimi.
3) Nidana Parivarjana:
Mruttika, given bhavana with Vidanga, Ela, Ativisha, Nimbapatra, Pata,
Varthaka, Katurohini, Murva and Kutaja86. These
• Will produce aversion towards Mrudbhakshana i.e. Dweshartha.
• Mrudbhakshanajanya dosha nashaka.
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Disease Review
CONCEPT OF VIRECHANA
Virechana karma is one of the most important therapeutic measures used for
the elimination of vitiated dosas from the body.
The word virechana VI + RICH, PLUT -
Maladeha nissaranam means to expel dosa – malas from the body.
The term verechana is widely used in the sense of expulsion of secretory or
excretory matter from the body.
Virechana karma is indicated in the conditions of 87
1. Pitta predominance.
2. Kapha in combination with Pitta.
3. Kapha migrated to Pitta stana.
In addition, it brings out the normalcy of dosa by
1. Expelling the dusta pitta and kapha dosa.
2. Vata dosa anulomana.
3. Sroto shodhana.
4. Jataragni vardhana.
The dravyas used for virechana are 1) Snigdha virechana, 2) Ruksha virechana.
The snigdha virechana is indicated in vata pitta or vataja vikara and it is indicated if
samyak snigdha lakshana does not occur properly. Rukshana viechana is indicated
where atisneha pana lakshanas are seen.
According to the drug used, they are classified in to88 –
1. Sukha virechaka – Trivruth.
2. Mrudhu virechaka – Aragwadha.
3. Teekshna virechaka – Snuhi ksheera.
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Disease Review
According to the mechanism of action virechana drugs89 are –
1. Anulomaka – the virechana dravya, which digests the undigested mala,
breaks down the adhesion and relieves vibandha are called as anulomana
dravyas.
2. Sramsaka – the one, which break the adhesion irrespective of pakwata or
apakwata of mala and leads to adhobagahara, are called as sramsaka dravya.
3. Bhedana – the one, which breaks the adhesion accumulation and hard stools
and expelled them out, called bhedaka dravyas.
4. Rechana – The one, which liquidify the mala irrespective of pakwa or
apawkata and expels them out, is called rechaka dravya.
Virechana karma:
For the proper conduct of virechana the procedure is divided into three stages
1. Purva karma
2. Pradhana karma
3. Paschat karma
Purva karma:
Those pre-requisite procedures done to attain utklesha of dosas and bring
them back to kosta for their expulsion from the body.
1. Sambhara samgraha – collection of materials required.
2. Atura pareeksha – selection of patients.
3. Atura sidhata – preparing the patient.
4. Matra vinischaya – selection of matra.
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Disease Review
1) Sambhara samgrha:
Various materials are collected for the proper conduct of sneha pana,
abhyanga and virechana.
2) Atura pareeksha:
Selections of patients are based on the criteria of selection depending upon
the dosa, desa, bala, kala, shareera, ahara, satmya, satwa, prakriti and vaya.
3) Atura sidhata:
Preparing the patient for virechana by subjecting him for proper oleation and
sudation therapy
4) Matra vinischaya:
The virechana matra is selected based on vaya, agni and kosta and is
administere with a proper saha pana. Matra mentioned in the classics are as
follows90
Table No.4
Doses of Virechana drugs according to Sharangdhara:
Kalpana Hina Matra Madhyama Matra Uttama Matra
Kvatha ½ Pala (2 tola) 1 Pala ( 4 tola) 2 Pala (8 tola)
Curna
Kalka etc. 1 tola 2 tola 4 tola
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Disease Review
Table No.5
Matra according Koshta;
Authors Mrdu Koshta Madhyama Koshta Krura
Koshta
Sushruta ( Su.Ci.
33/21) Mrdu Matra Madhyama Matra
Tikshna
Matra
Vangasena 1 tola 2 tola 3 tola
Snehana & Swedana:
The prerequisite for every shodhana procedure is snehana and swedana. The
usage of medicated and non-medicated snehas used internally is called sneha pana.
Depending upon the nature of administration snehana is classified into91
1) Accha pana
2) Vicharana sneha
1) Accha pana:
The ingestion of snehas without the mixing food materials taken in the empty
stomach is termed as Acha sneha pana. This type of administration has more
efficacy as it produces sneha karma in the body very quickly. Hence,
Charaka and Vagbata consider this as the best among all varieties of snehana.
2) Vicharana:
The administration of medicated or non-medicated snehas along with various
food stuffs or when used as abhyangha, nasya, karnapurana, vasti etc. is
known as vicharana. When sneha is used along with food as it is having 63
types of rasa combinations (rasa bheda). There are 63 types of vicharana and
Charaka mentioned 24 types of Pravicharana.
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Disease Review
Sneha pana:
1.Purva karma.
2. Pardhana karma.
3. Paschat karma.
1. Purva karma:
Pre operative procedure, which include
i) Atura pareeksha( Examination of the patient) it is done to select
the patients for the sneha pana by attaining the proper knowledge about the
disease, strength of the patient, apetite, agni, bala of dosa and ama .
ii) Fixation of dosage and course of sneha – fixation of dosage of
sneha mainly depends up on the digestive capacity of the individual.
f) Hrasiyasi matra – digested in one yama (3 hrs).
g) Hruswa matra – digested in two yama (6 hrs).
h) Madhyama matra – digested in 4 yama (12 hrs).
i) Uttama matra – digested in 8 yama (24 hrs).
Hrasayasi matra should be administered prior to sneha pana in order to asses the
digestive capacitive of the individual.
Type of sneha is given for 3, 5 & 7 days respectively for mridhu madhyama and
krura kosta.
All Acharyas of the opinion that the course of sneha pana should be fixed
for the individual in between 3 to 7 days. If it exceeds 7, days it becomes satmee
bhava (accustom ness). Bhoja states that Kapha prakriti person needs 3 days, Pitta
5 days and Vata 7 days to attain samyak snigdha. Jejjata, the commentator of
Madhava nidana advice 1 to 9 days course depending upon the tara and tama
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Disease Review
bhava of koshta. If the patient does not get samyak snidha by 7 days then a gap of
one day is given and again started from first.
Pathya kalpana / dietary arrangements:
The recommended diet during the time of sneha pana is to be given. The
dietary restrictions start from a day prior to sneha pana. The food that is
administered should be hot easily digestible, semi solid in consistency. It should
be wholesome diet and the quality of food suits the individual’s digestive capacity.
Collection of drugs:
The drugs should be collected which are necessary during the time of sneha pana.
Pradhana karma:
• The sneha pana is advised to be given in the morning hours, in the empty
stomach, after performing prayers, it is advised to sit facing to east. A brief
idea should be given to the patient about the process to avoid fear and
anxiety. The face of the patient is covered with piece of cloth and the patient
has to close his nostril with his own hands to prevent the development of
aversion towards the sneha dravya.
• Sneha is given to the patient and asked to drink.
• A little quantity of hot water or shunti kashaya is given for drinking soon
after sneha pana, which help to clean the mouth and throat of the patient.
• Patient is advised to take ushana jala or shunti jala frequently.
• Patient is carefully observed during the procedure of sneha pana and after
attaining sneha jeerna lakshana the patient can go for laghu ahara after
attaining proper appetite.
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Disease Review
Sneha jeeryamana lakshana92:
1. Siroruja. 2. Bhrama. 3. Lalasrava. 4. Murcha. 5. Sada.
6. Klama 7. Trishana. 8. Daha. 9. Arati.
Sneha jeerna lakshana93:
1. Disappearance of all jeeryamana lakshana.
2. Shareera laghutwa.
3. Vata anulomana.
4. Prakruta kshudha.
5. Prakruta trishna.
6. Udgara shudhi.
Samyak snidha lakshana94:
1. Agni deepthi. 2. Snehodvega.
3. Asamhat varcha. 4. Anga lagavata.
5. Gatra mardava. 6. Gatra snidhata.
7. Purusha snigdhata. 8. Twak snigdhata.
9. Vata anulomana. 10. Klama.
11. Shaithilya.
Asnigdha lakshna95 Ati snigdha lakshana95
Grathitha purishatwa Pandutha
Ruksha purishatwa Gaurava
Agnimandhya Jadya
Vayu pratilomana Purisha apakwata
Gatra rukshata Tandra
Uro vidaha Aruchi
Dourbalya Utklesha
Dourvarnya Pravahika
Krichrat anna vipachyate Guda srava
Su-snigdha lakshana viparyaya Guda daha
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Disease Review
Complication of the treatment97:
Complication occurs due to the administration of the sneha dravya in
improper time and improper matra. The complications can be acute or chronic in
nature.
Table No.6
Complication of treatment;
Acute complications Chronic complication
Ajeerna Kushta
Trishna Kamala
Samjhna nasha Pandu
Utklesha Shopha
Amadosa Udara roga
Jwara Grahani
Stambha Arsha
Aruchi Sthaimithya
Tandra Vak samga
The acute complication require only short term treatment in which hot water
is the best and simple since it digests the ama and sneha and does the vata
anulomana. Administration of specific kashayas like Sunti kashaya, Triphala, some
aristas is also indicated. The chronic sneha vyapat require specific treatment.
Sneha pana guna98:
• It increases the digestive capacity.
• It evacuates the bowel and clears the kosta.
• Rejuvenate the dhatus of the body.
• Improves the colour and strength.
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Disease Review
• Improves the functions of the sense organs.
• Increase the longevity of life99.
• It corrects the jataragni there by improves the health.
• Pacify the vitiated vayu.
• Softens the body.
• Utklesha of dosa and drag it to the kosta.
Pharmacological action of sneha:
Susruta says – whole body is snehamayi on which prana is depended and
they obtain optimum potentiality after sneha pana. When sneha pana is done for
shodhana karma it produces kledhana and sravana of dosas deposited in the deeper
dhatus. It also imparts strength to the dhatus to withstand the possible vitiation of
vayu because of shodhana karma. It also gives druddatha and bala to sareera agni
and indriyas.
Pradhana karma100 ( Shodhana):
It is main procedure, which includes –
i) Administration of virechana dravya.
ii) Vega nireekshana.
iii) Vyapath nirharana.
1. Virechana dravya prayoga:
In the morning when it becomes pitta kala, three days after abhyanga and
swedana virechana dravyas are administrated in appropriate dose with or
with out sahapana in empty stomach.
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Disease Review
2. Vega nireekshana
After administration of virechana dravya patient develop vegas after one
to one and half hours. The first few vegas containing mala are excluded
and then observed for the corresponding vegas for pitta and kapha101.
Observation for sudhi lakshana:
When the virechana dravyas administered one has to observe for type of
sudhi, i.e samyak sudhi, asamyak sudhi or atiyoga.
Samyak sudhi:
Samyak sudhi lakshanas are considered when dosas are expelled in order of
mala, pitta, oushadha and kapha, i.e kapahante virechana. It also called as antiki
sudhi lakshana.
Lakshaniki sudhi lakshana102:
1. Sroto vishodhata.
2. Indriya prasannata.
3. Laghuta.
4. Agni deepti.
5. Relief of symptoms of vyadhi.
Shudhi prakara103:
Based on the number of vegas and quantity of expelled dosas sudhi is
classified into –
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Disease Review
1. Pravara - 30 Vegas - 4 Prastha
2. Madhyama - 20 Vegas - 3 Prastha
3. Avara - 10 Vegas - 2 Prastha
Management of Ayoga & Atiyoga:
In case of ayoga lakshana and atiyoga lakshana when observed immediate
action has to be taken for relieving the atiyoga and ayoga. Elabrote explanation is
got about vyapat of virechana in Charaka Siddhi sthana 6th chapter.
Paschat karma:
They are the procedures adopted after attainment of samyak lakshana till the
patient attains normal state of health. It comprises of –
- Samsarjana karma
- Samana chikitsa
- Parihara vishaya
Samsarjana karma104:
These are the specific dietic regimens which are indicated in bringing back
the agni to the normalcy. Peya, Vilepi, Akruta-kruta yusa and mamsa rasa have been
used in 3, 2 &1 anna kala respectively in case of Pravara, Madhyama and Avara
suddhi.
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Disease Review
Table No. 7
Day Annakala Pravara Madhyma Avara
1 Morning - - - 1
2 Evening Peya Peya Peya
3 Morning Peya Peya Vilepi 2
4 Evening Peya Vilepi Kruta yusha
5 Morning Vilepi Vilepi Kruta mamsaras 3
6 Evening Vilepi Akruta yusha Prakruta bhojana
7 Morning Vilepi Kruta yusha - 4
8 Evening Akruta yusha Akruta mamsaras -
9 Morning Kruta yusha Kruta mamsaras - 5
10 Evening Kruta yusha Prakruta bhojana -
11 Morning Akruta mamsa rasa - - 6
12 Evening Kruta mamsaras - -
13 Morning Kruta mamsaras - - 7
14 Evening Prakruta bhojana - -
Samana chikitsa:
After samsarjana, karma in order to pacify the residual dosas samana
oushadhis is indicated.
Pariharya vishayas:
After the shodana therapy certain pariharya vishayas have been mentioned to
get maximum benefit of shodhana karma.
Page: 51
Disease Review
ILLUSTRATING VIRECHANA DRAVYA KARMUKATHA SCHEMATICALLY
Vyavayi vikashi veerya
Enters the hrudaya
Through Dhamani circulats all over the
body
Virechana yoga
(Aushadha)
Due to Sookshma guna enters sthula
& Sookshma srotas
VIRECHANA
Atura
nireekshna
Shareera &
Lalata pradesha
Sweda utpathi
Roma harsha
Hrillasa, Udara
admana
Due to Anupravana Bhava Dushitha
Dosha ati sookshma rupa not
adheres to any region
Due to Tikshna & Ushana guna Dosha Chedana & Bhedana
Due to Agneya guna Dosha
vilayana in Srotus
Dosha amashaya pravesha
Apana vayu
Jala, prithvi maha bootha predominant
Page: 52
Disease Review - IDA
IRON DEFICIENCY ANEMIA
Anemia is defined as hemoglobin concentration in blood below the lower
limit of normal range for the age and sex of the individual106. In adult, the lower
extreme of the normal hemoglobin is taken as13.0 gm/dl for males and 11.5 gm/dl
for females. Newborn infants have higher hemoglobin level and there fore 15gm/dl
is taken as the lower limit at birth.
Anaemia resulting from the deficiency of iron is known as iron deficiency
Anaemia107.
Patho-physiology of anemia:
Subnormal level of hemoglobin causes lowered oxygen carrying capacity of
the blood. This in turn imitates the compensatory physiological adaptation108 such as
Increased release of oxygen form Hb.
Increased blood flow to the tissues.
Maintenance of the blood volumes.
Redistribution of the blood flow to maintain the cerebral blood supply.
To maintain the homeostatic condition of the body, the rate of catabolism
should match the rate of anabolism. In iron metabolism the rate of loss should be
less than or equal to the rate of ingestion. Any alteration in this metabolism lead to
the decrease in all the physiological functions related to iron. Chiefly it affects the
haematopoesis where iron is the chief component of hemoglobin synthesis. Source
of iron for the synthesis of RBC are –
a) Ingestion of food containing iron.
b) Recycling of the iron from the destructed R.B.Cs.
Page : 53
Disease Review - IDA
Diet contains two types109 of iron- haem and non haem-iron. Haem irons are
abundant in non-vegetarian diets and are easily absorbed (35%). And non-haem
irons is abundant in in vegetarian diet and are poorly absorbed because it is ferric
iron (Fe+++) for the absorption it has to become soluble and ferrous iron (Fe++). The
gastric HCl makes the iron soluble and Vit-C act as a strong reducing agent convert
ferric into ferrous form.
Absorption of iron110:
Iron food is absorbed from the upper small intestine mainly in the ferrous
form but can also be absorbed as haem from red meat. Much of the iron in the food
is un-absorbable because it is irreversibly bound to the other substance, for instance
phytates and phosphates, and iron readily takes a ferric form in which it cannot be
absorbed.
• The low pH of stomach contents helps to preserve the iron in the ferrous
form and that process is assisted by binding of iron to sugar and amino
acid which protects it from conversion to the ferric form.
Iron loss:
In adult male it is about 1mg per day. In non pregnant non lactating women of
reproductive age is about 1.5-2 mg / day.
Storage:
Iron is stored in cells in two forms –
1) Ferritin- from which iron is fairly readily available
2) Haemosiderin- which is more stable form and constituent the bulk of iron store.
Page : 54
Disease Review - IDA
Iron deficiency anemia develops when the supply of iron is inadequate for
the requirement of hemoglobin synthesis. Initially the negative iron balance is made
good by mobilization from the tissue stores so as to maintain the hemoglobin
synthesis. It is only after tissue store of the iron is exhausted that the supply of the
iron to the marrow becomes in sufficient for the hemoglobin formation such that the
state iron deficiency anemia develops. The tissue hypoxia causes impaired function
of the affected tissues and degree of impairment depends on oxygen requirement of
the tissue. So only the heart, central nervous system and skeletal muscles which
experience wear and tear everyday bear brunt of clinical affects of anemia.
Iron deficiency anemia produces various manifestations related to different
systems. Long standing chronic iron deficiency anemia causes epithelial tissue
damage like –
a. Nails – Koilonychia
b. Tongue – Atrophic glossitis
c. Mouth – Angular stomatitis
d. Esophagus – Plummer Vinson syndrome
Clinical features:111
The hemoglobin level at which symptoms and signs of anemia develop depends up
on four main factors
1. Speed of onset of anemia – rapidly progressive anemia cause more
symptoms than anemia of slow onset as there is less time for physiological
adaptation.
Page : 55
Disease Review - IDA
2. The severity of anemia – mild anemia produces no symptoms or signs but a
rapidly developing severe anemia (Hb < 6gm %) may produce significant
clinical features.
3. Age of the patient – the young patients due to good cardiovascular
compensation tolerance anemia quiet well as compared to elders. The elderly
patients develop cardiac and cerebral symptoms more prominently due to
associated cardiovascular disease.
4. The hemoglobin dissociation curve – in anemia the affinity of Hb for oxygen
is depressed as 2,3 BPG in the red cell increases as a result the oxy-
hemoglobin is dissociated more rapidly to release free oxygen for cellular
use causing a shift in the oxy-hemoglobin dissociation curve.
Symptoms:
In symptomatic cases of anemia the presenting complaints are tiredness,
early fatiguabity, generalized muscular weakness, lethargy and head ache. In older
patients there may be symptoms of cardiac failure, angina pectoris, intermittent
claudication, confusion and visual disturbances.
Pallor – It is the most common and characteristic sign which may be seen in the
mucus membrane, conjunctiva and skin.
Dyspnoea on exertion is common symptom, which occur with exertion or with
emotion.
Tiredness- Due to deficient oxygen carrying capacity, cells are deprived from vital
oxygen producing hypoxia of the brain and other cells.
Giddiness- Deficient oxygen to the brain cells produces giddiness.
Palpitation
Page : 56
Disease Review - IDA
Hematological Features:
If the symptoms of anemia are the presenting complaints, the blood
hemoglobin is usually 8gm % lower. The MCV, MCH and MCHC are all reduced in
the usual patients.
Differential Diagnosis:
Thalassaemias:
Alpha and Beta Thalassaemias are associated with microcytosis,
hypochromia and anemia of varying severity. The racial background and family
history of patient may be a clue to the Thalassaemia. To exclude the globin
production defect involvement, full laboratory assessment is required.
Morphological clues like presence of target cells, normal red cell distribution
width indicating a uniform microcytosis and microcytosis /hypochromia out of
proportion to the severity of the Anaemia. In Thalassaemia minor, patients can
demonstrate microcytosis at haemoglobin levels of 13-14 mg/dl. But is not so in Iron
deficiency Anaemia. Iron supply studies are normal in Thalassaemia.
Chronic Disorders:
Chronic Disorders cause inflammatory block in Iron delivery from reticulo-
endothelial system to the erythroid progenitor SI and TIBC are reduced. Marrow
aspiration shows normal to increased Iron stores with hypo proliferative marrow
morphology. Transferrin receptors levels tend to increase with inflammation as
compared to two to four fold increase seen with true Iron deficiency.
Page : 57
Disease Review - IDA
Sideroblastic Anaemia:
Hereditary Sideroblastic anemia is a rare condition that present in childhood
either as a X-linked or autosomally inherited condition. RBC morphology is
typically dimorphic.
Iron supply studies distinguish it from Iron deficiency anemia. Acquired
ringed Sideroblastic anemia typically exhibits excessive Iron accumulation.
Lead poisoning in children causes inhibition of mitochondrial haem
synthesis by lead resulting in very high red cell protoporpherin levels.
Diagnosis of Iron Deficiency Anemia
By definition, a patient has anemia whenever hemoglobin level in the
number of circulatory R.B.Cs is significantly reduced. From laboratory stand point,
the diagnosis of presence and severity of anemia is easy. From a clinical perspective,
diagnosis of anemia is more complex.
Diagnosis of Iron Deficiency anemia ultimately rests on laboratory studies.
Laboratory findings of Iron deficiency Anaemia are shown in Table no. 14
Investigations of the Anemic Subjects111:
I. Hemoglobin Estimation:
Hemoglobin is estimated in terms of its concentration i.e. amount of
Hemoglobin in grams per 100ml of whole blood.
II. Peripheral Blood Film Examination:
Peripheral blood film examination for morphologic features after staining it
with the Romanowsky Dyes (Eg. Leishmann’s stain)
Page : 58
Disease Review - IDA
The blood smear is evaluated neither in an area where there is neither
Rouleaux formation nor so thin as to cause red cell distortion. Such an area is
usually found at the tail of the film, but not actually at the tail.
Following abnormalities in erythroid series are particularly looked for:
i. Variation in size (Anisocytosis):
Normal variation in diameter of the red cell is 6.7-7.7micrometer. Increased
variation in the size of the red cell is termed as Anisocytosis
Anisocytosis may be
1) Macrocytosis (larger than normal cells)
2) Microcytosis (smaller than normal cells)
1) Macrocytes - are found in Megaloblastic Anaemia, Aplastic Anaemia etc.
2) Microcytes - are seen in Iron deficiency Anaemia, Thalassaemia and
Spherocytosis.
ii. Variation in shape (Poikilocytosis):
Increased variation in the shape of the red cells is termed Poikilocytosis. Eg.
Megaloblastic anemia, Iron deficiency anemia.
iii. Inadequate hemoglobin formation (Hypochromasia):
Normally, the intensity of pink staining of hemoglobin in a Romanowsky
stained blood smear gradually decreases from the periphery to the centre of the cell.
Increased centre pallor is Hypochromasia. It may be due to
a) Lowered hemoglobin content (Eg. Iron deficiency Anaemia)
b) Thinness of the red cells (Eg. Thalassaemia)
Page : 59
Disease Review - IDA
Hyperchromasia is seen in Megaloblastic Anaemia.
iv. Compensatory Erythropoiesis:
A number of changes are associated with compensatory increase in
erythropoietic activity. These are
a) Polychromasia:
Red cells having more than one type of colour. They generally represent
Reticulocytosis and they correlate well with the reticulocyte count.
b) Normoblastaemia:
Presence of nucleated red cells in the peripheral blood film is mainly seen in
haemolytic disease of the newborn.
v. Miscellaneous changes:
Other abnormal red cells may also be seen like
a) Schistocytosis: Is identified by fragmentation of erythrocytes; is seen in
Thalassaemia, Iron deficiency Anaemia etc.
b) Leptocytosis: Is the presence of unusually thin red cells. Leptocytes are seen
in severe Iron deficiency Anaemia and Thalassaemia.
c) Target cells: Are a form of leptocytes in which there is a central round stained
area and a peripheral rim of hemoglobin; is seen in Iron deficiency Anaemia,
Thalassaemia etc.
III. Red Cell Indices:
An alternate method to diagnose and detect the severity of Anaemia is by
measuring the Red cell indices.
Page : 60
Disease Review - IDA
In Iron deficiency Anaemia and Thalassaemia, MCV, MCH and MCHC are
reduced.
IV. Leucocyte and Platelet Count:
These help to distinguish pure Anaemia from others.
Leucocytes and platelets are raised in hemorrhage, haemolysis, infection and
leukaemia and reduced in pancytopenia.
V. Reticulocyte Count: (Normal 0.5-2.5%)
Is done to assess the Marrow erythropoietic activity. In acute hemorrhage
and haemolysis, the reticulocyte response is an indication of impaired marrow
function.
VI. Erythrocyte Sedimentation Rate:
Maybe raised due to underlying organic disease or Anaemia itself may cause
raise in ESR.
Explanation of the terms:
1. Packed Cell Volume or Haematocrit (PCV):
When blood is mixed with anticoagulants and put in Wintrobe’s Haematocrit
Tube, centrifuged for a prolonged time, the formed elements are packed at the
bottom and clear supernatant plasma is obtained. Volume of these packed formed
elements is called Packed cell volume.
Normal value: 45ml/100ml (45%).
2. Mean Corpuscular Volume (MCV): Is the volume of an average R.B.C.
Page : 61
Disease Review - IDA
MCV=PCVx10/ No. of RBC in millions /cubic mm, expressed in cubic μ.
Normal value: 80-90μ3.
3. Mean Corpuscular Hemoglobin (MCH):
Is the amount of Hemoglobin present in an “average RBC”. Weight is
expressed in picograms (pg), which is equivalent to 10-12 g.
MCH = Hb (g/dl) x 10/ RBC count in millions.
Normal value: 27-32pg%.
4. Mean Corpuscular Hemoglobin Concentration (MCHC):
Refers to the amount of Hemoglobin present in 100ml of RBC. Hence is
expressed in g/dl, which is same as percentage.
MCHC=MCH/MCV x 100 or MCHC = Hb in g%/PCV
Normal value: 31-35 gm %.
5. Total RBC Count: It is the number of RBC in one cubic millimeter of blood.
Normal values: In men - 4.5-6.5 millions/mm3.
In women- 3.8-5.8 millions/mm3.
Treatment of Iron Deficiency Anaemia
It consists of 2 principles
1) Correction of the disorder causing Anaemia
2) Correction of Iron deficiency
Page : 62
Disease Review - IDA
Correction of the disorder:
After a thorough check-up and investigations, evaluation is done and
accordingly surgical or medical measures are taken.
Correction of Iron deficiency:
a) Oral therapy:
Iron deficiency responds very effectively to Oral Iron salts like Ferrous
sulphate in the dosage of 60mg, thrice daily.
b) Parenteral therapy:
This is indicated in intolerance to oral Iron therapy, GIT disorders like oral
mal-absorption or when rapid replenishment of Iron store is desired like in women
before the expected date of delivery.
Page : 63
Disease Review - Tables
TABLES
NIDANA
Sl. no
Lakshana C.S. Su. S. A.H. M.N.
1 Kshara sevana + - - - 2 Amla sevana + + + + 3 Lavana rasa sevana + + + + 4 Atyushna bhojana + - - - 5 Asatmya bhojana + - - - 6 Viruddha bhojana + - - - 7 Matsya sevana - - - - 8 Amisha sevana - - - - 9 Ikshu sevana - - - -
10 Pishta sevana - - - - 11 Paya sevana - - - - 12 Pinyak ati sevana + - - - 13 Mashati sevana + + - - 14 Madya sevana - + - + 15 Mrut bhakshana + + - + 16 Teekshna ahara sevana - + + + 17 Maithuna + - - - 18 Vega Vidharana + - - - 19 Pachakarmapratikarmavaishamya + - - - 20 Rutu vaishamya + - - - 21 Kama + - - - 22 Krodha + - - 23 Chinta + - - - 24 Bhaya + - - - 25 Shoka + - - - 26 Divaswapna + + - + 27 Vyayama + + - + 28 Bharaharana - - - - 29 Nishpava sevana + - - - 30 Tilataila sevana + + - -
Disease Review - Tables
TYPES OF PANDU
Sl. No.
Types C.S.
S. S.
A. H.
A.S.
M.N.
B.P.
Y.R.
Sh.S.
Tantra-ntara*
G.N.
K.K.
H.S.
1.
Vataja + + + + + + + + + + + +
2.
Pittaja + + + + + + + + + + + +
3.
Kaphaja + + + + + + + + + + + +
4.
Sannipataja + + + + + + + + + + + +
5.
Mrudbhakshanaja + + + + + + + + + + + +
6.
Shakhashrita Kamala
- - - - - - - - + - - -
7.
Koshthashrita Kamala
- - - - - - - - + - - -
8.
Halimaka - - - - - - - - + - - -
*Dalhan-Su.Ut.44/4
POORVA RUPA
Sl. no
Lakshana C. S.
S. S.
A.H.
A.S.
M.N.
B.P.
H.S.
Y.R.
G.N.
1 Hrudaya Spandadhikya
+ - + + - - - - -
2 Roukshya + - + + - - - - - 3 Swedabhava + - + + - - - - - 4 Shrama + - + + - - - - - 5 Twak Sphotana - + - - + + + + + 6 Shteevana - + - - + + + + + 7 Gatra Sada - + - - + + + + + 8 Mrudbhakshana
Iccha - + - - + + + + +
9 Prekshana Koota Shotha
- + - - + + + + +
10 Avipaka - + - - + + + + 11 Vitpeetata - + - - + + + + 12. Mootra Peetata - + + + + + + + + 13. Aruchi - - + + - - - - - 14. Alpa Vahni - - + + - - - - - 15 Sada - - + + - - - - - 16 Pipasa - - - - - - - - - 17 Hrullasa - - - - - - - - - 18 Urodaha - - - - - - - - - 19 Anga gourava - - - - - - - - - 20 Rakta lochana - - - - - - - - - 21 Shareera
Pandutwa - - - - - - + - -
Disease Review - Tables
SAMANYA LAKSHANA
Sl. No. LAKSHANA C.S. S.S. A.H. A.S. K.S. 1. Karna Kshweda + - + + - 2. Hatanala + - + + + 3. Dourbalya + - + + - 4. Sadana + - + + - 5. Bhrama + - + + - 6. Annadwesha + - + + - 7. Shrama + - + + - 8. Gatrashoola + - - - - 9. Jwara + - + + -
10. Shwasa + - + + - 11. Gaurava + - + + - 12. Aruchi + - - - - 13. Gatramarda + - - - - 14. Gatrapeeda + - - - - 15. Gatronmathana + - + + - 16. Shunakshikoota + - + + + 17 Hareeta Varnata + - - - - 18 Sheerna lomata + - + + - 19 Hataprabha + - - - - 20 Kopa + - + + - 21 Shishiradwesha + - + + - 22 Nidralu + - - - - 23 Shtivana + - + + - 24 Alpavak + - + + - 25 Pindikodweshtanam + - - - - 26 Katiruk + - - - - 27 Kati sada + - - - - 28 Padaruk + - - - - 29 Pada sada + - - - - 30 Uru ruk + - - - - 31 Uru sada + - - - - 32 Dhatushaithilya + - + + - 33 Ojo gunakshaya + - + + - 34 Alparaktata + - + + - 35 Alpamedaskata + - + + - 36 Nissarata + - + + - 37 Hridrava + - + + - 38 Shithilendriya + - + + - 39 Shareera Vaivarnya - - - - + 40 Twachi Panduta + + - - - 41 Nabhi Shotha - - - - + 42 Shwetha Akshi - - - - + 43 Shwetha Nakha - - - - + 44 Shwetha Vakrata - - - - + 45 Shotha - - - - + 46 Karshya - - - - + 47 Satwahani - - - - + 48 Alasya - - - - + 49 Sanna Saktha - - + + - 50 Nirutsaha - - - - +
Disease Review - Tables
VATAJA PANDU LAKSHANA
Sl. No.
Lakshana C.S.
S. S.
A.H.
A.S.
M.N.
B.P. Y.R. G.N.
1 Krishna Pandutwa + - - - - - - - 2 Ruksha angata + - + + + + + + 3 Arunangata + - - - + + + - 4 Angamarda + - - - - - - - 5 Raja + - + + - - - - 6 Toda + - + + + + + + 7 Kampa + - + + + + + + 8 Parshwa shoola + - + + - - - - 9 Shirashoola + - + + - - - - 10 Varcha shosha + - + + - - - - 11 Asya vairasya + - + + - - - - 12 Shopha + - + + - - - - 13 Anaha + - + + + + + + 14 Bala kshaya + - - - - - - - 15 Krushna akshi - + + + - - - + 16 Krushna Sira
Avanaddha - + - - - - - -
17 Krushna Varnatwa - + - - - - - - 18 Krushna mala - + + + - - - - 19 Krusha mootra - + + + - - - + 20 Krusha nakha - + + + - - - - 21 Krushna anana - + - - - - - - 22 Aruna sira - - + + - - - - 23 Aruna nakha - - + + - - - - 24 Aruna mala - - + + - - - - 25 Aruna mootra - - + + - - - + 26 Aruna akshi - - + + - - - + 27 Bhrama - - - - - - - + 28 Vata upadrava - + - - - - - - 29 Krushna sira - - + + - - - - 30 Aruna sira - - + + - - - - 31 Twak krushnabhata - - - - + + + -
32 Mootra krushnabhata - - - - + + + - 33 Nayana krushnabhata - - - - + + + - 34 Twak arunabhata - - - - + + + - 35 Mootra arunabhata - - - - + + + - 36 Nayana arunabhata - - - - + + + - 37 Rakta netra - - - - - - - + 38 Aruna twak - - - - - - - +
Disease Review - Tables
PITTAJA PANDU LAKSHANA
Sl. no.
LAKSHANA C.S.
S. S.
A.H.
A.S.
M.N.
B.P.
Y.R.
G.N.
1 Peetabha + - - - - - - - 2 Haritabha + - + - - - - - 3 Jwara + - + + + + + + 4 Daha + - + + + + + + 5 Trushna + - + + + + + + 6 Moorcha pipasartha + - - - - - - - 7 Peeta mootra + + - - + + + + 8 Peeta shakrut + + - - + + + + 9 Swedana + - - - - - - -
10 Sheeta kamitva + - + + - - - - 11 Na annam abhinandathi + - - - - - - - 12 Katukasya + + + - - - - 13 Anupashaya - - - - - - - - 14 Ushna + - - - - - - - 15 Amla + - - - - - - - 16 Amla udgara + - - - - - - - 17 Vidahata + - - - - - - - 18 Vidagdhata + - - - - - - - 19 Dourgandhya + - + + - - - - 20 Bhinna varcha + - + + + + + + 21 Dourbalya + - - - - - - - 22 Tama + - + + - - - - 23 Peetakshi - + - - + + + + 24 Peeta Sira Avanaddha - + - - - - - - 25 Peeta nakha - + - - - - - - 26 Pittaja upadrava - + - - - - - - 27 Peeta anana - + - - - - - - 28 Moorcha - - + - - - - - 29 Amlata - - + - - - - - 30 Atipeetabha - - - - + + + -
KAPHAJA PANDU LAKSHANA
Sl. no.
LAKSHANA C.S.
S. S. A.H. A.S. M.N. B.P. Y.R. G.N.
1 Gourava + - - - - - - + 2 Tandra + - + + + + + + 3 Chardhi + - + + - - - - 4 Shewatavabhasata + - - - - - - - 5 Praseka + - - - + + + - 6 Lomaharsha + - + + - - - - 7 Sada + - - - - - - - 8 Moorcha + - - - - - - - 9 Bhrama + - - - - - - -
10 Klama + - - - - - - - 11 Shwasa + - - - - - - - 12 Kasa + - + + - - -
Disease Review - Tables
13 Alasya + - - - + + + - 14 Aruchi + - - - - - - - 15 Vatagraha + - - - - - - - 16 Swasa graha + - - - - - - - 17 Shukla motra + - - - + + + - 18 Shukla akshi + - - - + + + - 19 Shukla varcha + - - - - - - - 20 Katu kamatwam + - - - - - - - 21 Ruksha kamatwam + - - - - - - - 22 Ushna kamatwam + - - - - - - - 23 Shwayatu + - - - + + + - 24 Madhurasyatwa + - - - - - - - 25 Shukla sira - + + + - - - - 26 Shukla nakha - + - - - - - - 27 Shukla anana - + - - + + + - 28 Kaphaja upadrava - + - - - - - - 29 Lavanasyata - - + + - - - - 30 Swarakshaya - - + + - - - - 31 Atigourava - - - - + + + - 32 Shukla twacha - - - + + + -
MRUDBHAKSHANAJANYA PANDU
Sl. no.
LAKSHANA C.S. S.S.
A.H. A.S. M.N.
B.P. Y.R G.N.
1 Indriya bala hani + - - - - + + + 2 Teja hani + - - - - + + + 3 Bala hani + - - - - + + + 4 Ojo hani + - - - - + + + 5 Varna nasha + - - - - + + + 6 Agni nasha + - - - - + + + 7 Shoona ganda + - - - - + + + 8 Shoona akshi koota + - - - - + + + 9 Shoona bhru + - - - - + + +
10 Shoona pada + - + + - + + + 11 Shoona nabhi + - + + - + + + 12 Shoona mehana + - + + - + + + 13 Krumi koshta + - - - - + + + 14 Atisara + - - - - + + + 15 Mala with rakta + - + + - + + + 16 Mala with kapha + - + + - + + + 17 Pandu - - - - - + - - 18 Tandra - - - - - + - - 19 Aruchi - - - - - + - - 20 Alasya - - - - - + - - 21 Kasa - - - - - + - - 22 Swasa - - - - - + - - 23 Shoola - - - - - + - - 24 Sada - - - - - + - - 25 Mala with krimi - - + + - - - - 26 Bhinna Mala - - + + - - - -
Disease Review - Tables
TRIDOSHAJA PANDU LAKSHANA
Sl.No. Lakshana G.N. H.S.1 Jwara + + 2 Arochaka + - 3 Hrullasa + + 4 Vamana + + 5 Trushna + + 6 Bhrama + - 7 Tandra - + 8 Alasya - + 9 Shotha - + 10 Kasa - + 11 Shosha - + 12 Vitbandha - + 13 Parushata - + 14 Klama - + 15 Moha - +
UPADRAVA
Sl. no.
Lakshana S.S A.H.
1 Aruchi + - 2 Pipasa + - 3 Chardi + - 4 Jwara + - 5 Shiroruja + - 6 Agnisada + - 7 Shopha + + 8 Kanthagata abalatwam + - 9 Moorcha + -
10 Klama + - 11 Hrdayavapeedanam + - 12 Shwasa + - 13 Atisara + - 14 Kasa + - 15 Daha + - 16 Avipaka + - 17 Swarabheda + - 18 Sada + - 19 Adhmana - - 20 Tandra - - 21 Pandu danta - - 22 Pandu nakha - - 23 Pandu netra - - 24 Pandu sangatha darshi - -
Disease Review - Tables
ASADHYA LAKSHANAS IN PANDU ROGA
Sl. no.
Lakshana C. S. S. S. B. P. Y. R. G. N.
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Anteshu shoona parihina madya Mlana (Krisha) Madya shoona anteshu parihina Guda shopha Muska (yoni) shopha Pratamya (murcha) Visamjnatha Atisara peeditha Jwara peeditha Chirothpanna Pandu Karibhootha Pandu Kala prakarshath shoona Peetha darshana Bhadda vit Alpa vit Sakapha, Haritha Atisaryathe Deena Shwethatidigdhanga Chardhi Trit Ardhitha Swethatha due to adhika rakta kshaya Arochaka Hrillasa Klama Ksheena Hatendriya Pandu danta, naka, netra Pandu sanghatha darshi Tridoshaja Pandu
- - - - - - - - - + + + + + + + + + + + + + - - - - - - - -
+ + + + + + + + + - - - - - - - - - - - - - - - - - - - - -
+ + + + + + + + + - - - - - - - - - + + - - + + + + + - - +
+ + + + + + + + + - - - - - - - - - + + - - + + + + + + + -
+ + + + + + + + + + + + + + + + + + + + - - + + + + + + + +
Disease Review - Tables
CLINICAL FEATURES OF IRON DEFICIENCY ANAEMIA
SL. No.
Symptoms Davidson’s P.P. of Medicine
Harrison’s Internal Medicine
Robin’s Pathologic Basis
of Diseases 1 2 3
4 5 6 7 8
9 10 11 12
13 14
15
16 17 18
19
20 21 22 23 24
25
26
Lassitude Fatigue Breathlessness on exertion Headache Palpitation Dizziness Angina Angular Stomatitis Glossitis Pika Tinnitus Dimness of vision Insomnia Paraesthesia in fingures & toes Hypersensitivity to cold Anorexia Nausea Bowel irregularity Abnormal menstruation Amenorrhoea and menorrhoea Loss of Libido Dysphagia Low grade fever Alopecia Lack of concentration Night cramps Aches and pains in various parts of body Throbbing in heart and ears
+ +
+ + + + +
+ + + +
+ + - - - - - - - + - - - -
+
+ +
+ + + + -
+ + + + - - -
+ + +
+ - - - - - - - -
+ +
+ + - - + - - - -
+ - - - - - - - + - - + - - -
27 28 29
Indigestion Impotence Pallor of skin, mucous membrane, palms &
- -
+ +
- -
Disease Review - Tables
30 31 32
33 34 35 36
37 38
39
40
conjuncitiva Koilonychia Brittle fingers Cardiac dilatation Oedema Splenomegaly Nail cracking Venous hum of neck vessels Wide pulse pressure Tachycardia Systolic flow murmur Hyperdynamic Precordium
+ + +
+ + + + - -
+
+ -
+ + - - - - -
+ + - -
+
+ + + - - + + - - - - -
LABORATORY DIFFERENTIAL DIAGNOSIS OF HYPOCHROMIC
ANAEMIA (IRON DEFICIENCY ANEMIA)
SL. NO.
Test Iron Deficiency
Chronic Disorders
Thalassaemia Siderblastic Anaemia
1)
2) 3) 4) 5)
6)
7)
MCV, MCH, MCHC Serum Iron TIBC Serum Ferritin Marrow Iron stores Iron in normoblasts Hb electrophoresis
Reduced Reduced Raised Reduced Absent Absent Normal
Low normal to reduced Reduced Reduced Raised Present Absent Normal
Very low Normal Normal Normal Present Present Abnormal
Very low (except MCV raised in acquired type) Raised Normal Raised (complete saturation) Present Ring sideroblasts Normal
DIAGNOSTIC FEATURES OF IDA
Sl. No.
Blood parameters Findings
1. Haemoglobin Falls up to a variable degree. 2. Erythrocyte count Below normal but not proportional to haemoglobin. 3. Blood film Hypochromia precedes microcytosis, Anisocytosis,
Poikilocytosis, target cells, elliptical forms poly chromatic cells are often seen.
4. Reticulocyte count Normal or reduced 5. Absolute value
MCV MCH MCHC
Diminished (< 50 fl) Diminished (< 15 pg) Diminished (< 20 g/dl)
Disease Review - Tables
6. Leukocyte & differential count
Normal
7. Platelet count Normal or raised 8. ESR Less elevated than degree of anemia might suggest 9. Bone marrow findings
Marrow cellularity Serum Iron TIBC (Total Iron Binding capacity) Serum Iron Red cell protoporphyrin
Increased due to erythroid hyperplasia Reduced < 50 μg/dl Rises Very low Very low
REFERENCES REGARDING PANDU IN CHARAKA SAMHITA
Sl. No.
Context
Ref:
Sutra Sthana 1. Dhoomapana is indicated in Panduta of Mukha 5/29 2. Snehapana in Kapha Pradhana Purusha in Sheetakala produces Panduroga 13/21 3. • Ati Snigdha Lakshana – Panduta 13/59 4. • Pandu as snehavyapad 13/75 5. SamshodhanaYogya or Adhika doshayukta purusha lakshana - Panduta 16/13 6. Vrudda Pitta and Kapha and Ksheena Vayu produce Panduta as a
lakshana 17/54
7. • Pandu as a Shukra Kshaya Lakshana 17/69 8. In Kaphaja Shotha- Pandu is one of the lakshanas. 18/13 9. Pandu Roga and its 5 types 19/4 10. Pandu is one of the Santarpanajanya Roga 23/5 11. Rakta vitiated by Kaphadi dosha is Ishat Pandu Varna 24/21 12. • Slaishmika Mada lakshana 24/32
Nidana Sthana 13. Pand as Raktapitta Upadrava 2/7 14. • Madhumeha- Pandu Mootrata 4/44
Chikitsa Sthana 15. Lakshana of Punaravartaka Jwara is Panduta 3/336 16. Pandu varna of Rakta in case of Kaphaja Raktapitta 4/12 17. Pandu varna Shwitra as a Sadhya vyadhi. 7/176 18. Patient sees Pandura varnayukta materials in Kaphaja Apasmara 10/11 19. Kaphaja Arshas patient also has Pandu Roga. 14/17 20. As a Poorvaroopa of Arshas . 14/22 21. Early occlusion of Raktasrava in Arshas leads to Panduroga 14/178 22. Pandu is nidana for Hikka and Swasa roga. 17/13 23. Sangrahana oushadha in Amatisara produces Pandu. 15/16 24. It is advisable to drink little water and then excess of water in Pandu 22/54 25. Pakwashayagata visha produces Pandu. 23/115 26. Kaphaja Yoni lakshana.- Pandu varnata of shareera and Pandu-Picchila
artava 30/14
27. Consumption of Pittaprakopaka ahara by the mother produces durgandhata of stanya leading to Pandu roga in balaka.
30/245
Disease Review - Tables
Siddhi Sthana 28. • Pandu rogi as Vamana Yogya 2/10 29. • Virechana Yogya 2/13 30. • Anuvasana Ayogya 2/17 31. Anuvasana Basti in Pandu Rogi produces Udara Roga 2/18 32. • Virechana Anarha 6/8 33. Vamana virechana vyapath- Parisrava can cause Panduta 6/69
Chikitsa Sthana 34. Pandu varna as Kaphaja vrana lakshana . 25/15 35. Kaphaja Shotha presents with Pandu varna 12/14
Siddhi Sthana 36. Divaswapna produces Pandu roga 12/7 37. Atiyoga of Yapana Basti produces Pandu roga 12/30
Indriya Sthana 38. Pandura is one of the 7 types of Prabha 7/14
YOGAS FROM CHARAKA SAMHITA USEFUL IN THE TREATMENT OF
PANDU
(other than Pandu Adhyaya)
Sl No. Yoga Reference
1. Mutra Guna Ch. Su. 1/98 2. • Kshira Guna Cha. Su. 1/110 3. Vyoshadhya Saktu Cha. Su. 23/23 4. • Arishta Guna Cha. Su. 27/182 5. Gouda (Madhya from Guda) Cha. Su. 27/186 6. Souviraka and Tushodhaka Cha. Su. 27/191 7. • Takra Guna Cha. Su. 27/229 8. • Yavakshara Cha. Su. 27/305 9. • Haritaki Cha. Chi. 1/32 10. Pippali Rasayana Cha. Chi. 1-3/34 11. • Hingwadi Churna Gutika Cha. Chi. 5/83 12. Shatyadi Churna Cha. Chi. 5/90 13. Nilinyadhya Ghritha Cha. Chi. 5/109 14. Bhallatakadhya Ghritha Cha. Chi. 5/146 15. Danti Haritaki Cha. Chi. 5/159 16. Ksheera shatphalaka ghritha Cha. Chi. 5/148 17. Madhwasava Cha. Chi. 6/41 18. Mustadi Churna Cha. Chi. 7/67 19. Siddartaka Snana Cha. Chi. 7/92 20. Tikta Shatphalaka Ghritha Cha. Chi. 7/143 21. Maha Tiktaka Ghritha Cha. Chi. 7/148 22. Talisadi Churna Cha. Chi. 8/146 23. Lashunadhya Ghritha Cha. Chi. 9/55 24. • Maha Pandu Gavya Ghritha Cha. Chi. 10/23 25. Punarnavadhyarista Cha. Chi. 12/37
Disease Review - Tables
26. Triphaladhyarista Cha. Chi. 12/40 27. Kshara Gutika Cha. Chi. 12/46 28. Kamsa Haritaki Cha. Chi. 12/52 29. Rohitaka Ghritha Cha. Chi. 13/58 30. Patola muladhya Churna Cha. Chi. 13/123 31. Narayana Churna Cha. Chi. 13/137 32. Abhayarista Cha. Chi. 14/143 33. Dantyarista Cha. Chi. 14/147 34. Phalarista Cha. Chi. 14/152 35. Dwitiya Phalarista Cha. Chi. 14/157 36. Kanakarista Cha. Chi. 14/167 37. Hriveradi Ghritha Cha. Chi. 14/233 38. 4 Amladi Dravya Prayoga Cha. Chi. 15/111 39. • Bhunimbadi Churna Cha. Chi. 15/133 40. Kiratadhya Churna Cha. Chi. 15/139 41. Duralabhasava Cha. Chi. 15/155
42. Mulasava Cha. Chi. 15/159 43. • Madhwarista Cha. Chi. 15/167 44. • Bhallataka Kshara Cha. Chi. 15/177 45. Chaturtha Kshara Cha. Chi. 15/187 46. Panchaka Kshara Cha. Chi. 15/192 47. Ksharaguda Cha. Chi. 23/102 48. Amrita Ghritha Cha. Chi. 23/248 49. Trayushanadi Ghritha Cha. Chi. 26/87 50. Jeevaneeya Ghritha Cha. Chi. 26/169 51. Shatapaka Madhuparni Taila Cha. Chi. 29/118 52. Jeemutaka Suramanda Cha. Ka. 2/8 53. Jeemutaka phala with Dadhi Mastu or
with Takra after paka along withd Madhu and Saindhava
Cha. Ka. 2/10
54. • Krutha vedhana Cha. Ka. 6/4 55. Kalyanaka Guda Cha. Ka. 7/44 56. Vyoshadi Gutika Cha. Ka. 7/49 57. Trivritharista Cha. Ka. 7/71 58. Snuhi Cha. Ka. 10/6 59. Dantyadi Yoga Cha. Ka. 12/26 60. Chitra Dantyadi Modaka Cha. Ka. 12/29 61. Dantimula and Mrudwika Kwatha as
Virechanartha Cha. Ka. 12/30
62. Shyama Dantyadyarista Cha. Ka. 12/32 63. Panchamuladi Basti Cha. Si. 3/59 64. • Dhamargava phala Cha. Si. 10/12 65. Dwi Panchamuladi Basti Cha. Si. 12/18
Drug Review
DRUG REVIEW
The trial drug Nisha loha is been evaluated for its clinical efficacy with and
without virechana. Prior to virechana sneha pana is given with Dadimadi gritha113
and virechana was done with Trivrut choorna.
- The trail drug Nisha loha114 is mentioned in the Bhaishajya ratnavali in the
Pandu roga prakarana.
- Dadimadi grita is mentioned in the Pandu roga adhyaya of Charaka Samhita
chikitsasthana.
This drug review is discussed under two sub-headings
1) Compound drug study.
2) Individual drug study.
NISHA LOHA
Ingredients
i) Haridra 1 part 80 gms.
ii) Daruharidra 1 part 80 gms.
iii) Amalaki 1 part 80 gms.
iv) Vibetaki 1 part 80 gms.
v) Haritaki 1 part 80 gms
vi) Katukarohini 1 part 80 gms.
vii) Loha bhasma 6 parts 480 gms.
Page : 64
Drug Review
COMPOUND DRUG STUDY:
This formulated churna with the above ingredients when taken orally with
madhu as sahapana in a dose of 2-4 ratti will cure Pandu and kamala.
INDIVIDUVAL DRUG STUDY:
i) Haridra115:
Botanical name : Curcuma longa.
Family : Zingiberaceae.
Gana : Kustghna, lekhaniya, kantughna, vishaghna, tikta
skanda (Charaka).
Haridradi, mustadi, sleshma samshamana (Sushruta).
Chemical composition: Curcumene, Curcumenone,Curcone, Camphor,
Camphene, Curcumins.
Rasa panchakas:
Rasa : Tikta, katu.
Guna : Ruksha, laghu
Veerya : Ushna
Vipaka : Katu
Karma : Kapha vata hara, lekhna, vishagna, varnya.
Indication : Pandu, kamala, prameha, kandhu, kusta, vrna.
ii) Daruharidra116:
Botanical name : Berberis aristata.
Family : Berberidaceae.
Gana : Arshoghna, kandukhna, lekhneya (Charaka)
Haridradi, Mustadi, Lakshadi (Sushrutha)
Page : 65
Drug Review
Chemical composition: Berberin, Karachine, Taxilamine, Palmatine,
Oxycanthine.
Rasa panchaka :
Rasa : Tikta, kashaya
Guna : Laghu, ruksha
Veerya : Ushna
Vipaka : Katu
Karma : Kapha pitta hara, chedhana
Indication : Kusta, kamala, vrna, visarpa, premeha.
iii) Amalaki117:
Botanical name : Emblica officinalis
Family : Euphorbiaceae.
Gana :Jwaraghna, kasaghna, virechanopaga, kustaghna,
vayasthapana (Charaka)
Amalakiyadi, parushakadi, triphaladi (Sushrutha)
Chemical composition:
Fruit :Vit.C, linolic acid, terchebin, phyllemblin.
Rasa panchaka:
Rasa : Amala pradhana pancha rasa
Veerya : Sheeta
Guna : Laghu ruksha
Vipaka : Madhura
Karma : Tridosa hara, chakshushya, rasayana, vayastapana,vrishya
Indication : Premeha, raktapitta, kusta, arshas, somaroga
Page : 66
Drug Review
iv) Vibheetaki118:
Botanical name : Terminalia bellarica
Family : Combretaceae.
Guna : Jwaraghna, kasahara, virechanopaga (Charaka)
Mustadi, triphala (Sushrutha)
Chemical composition:
Fruit : Fructose, glactose, glucose, beta-sitasterol
Rasa panchaka:
Rasa :kashaya
Guna : Laghu, ruksha
Veerya :Ushna
Vipaka: Madhura
Karma : Kapha pitta hara, chakshushya, bedhana
Indication : Swasa, kasa, atisara, jwara,ashmari, chardi.
v) Haritaki119:
Botanical name : Terminelia chebula
Family : Combretaceae
Gana :Jwaraghna, arshoghna, kasaghna,kustaghna,
Prajasthapana (Charaka)
Amalakadi, tripahala, parushakadi (Sushrutha)
Chemical composition:
Fruits :Chebulinic acid, tannic acid, vit.C
Fruit kernel :Oleic acid, palmitic acid, arachidic acid
Page : 67
Drug Review
Rasa panchaka:
Rasa : Lavana vargita pancha rasa
Guna :Laghu, rukaha
Veerya :Ushna
Vipaka :Madhura
Karma :Tridoshahara, anulomana, rasayana, hridya,
lekhana,prajasthapana, Chakshushya
Indication :Kusta, prameha, vrna, hridroga, chardi, ashmari,
vatarakta, amlapitta.
vi) Katukarohini120:
Botanical name : Pichrorhiza kurroa
Family : Scropularaceae
Gana : Bhedaniya, lekhaniya, stanya shodana, tikta skanta
(Charaka)
Pattoladi, pippallyadi, mustadi (Sushrutha)
Chemical composition: Phenol glucosides, kutkin,
kutkiol,kutkisterol,apocyanine, pichorrhine
Rasa panchaka:
Rasa : Tikta
Guna : Ruksha, laghu
Veerya : Sheetha
Vipaka :Katu
Karma :Kapha pitta hara, bedhana, hridya, lekhana, deepana
Indication :Rakta vikara, kusta, vishama jwara, prameha,
arochaka
Page : 68
Drug Review
DADIMADI GHRUTA
This formulated ghruta with the below mentioned ingredients when taken
orally will enhance the jataragni thus eliminating the root cause and cures Pandu
roga, gulma, arshas, pleeha, hridroga and vatakaphaja roga. It relives swasa, kasa,
mootavata, highly beneficial for pregnant women bearing difficulty during labour
and helps in infertility.
Method of preparation:
Ingredients Quantity
i) Dadima 1900 gms.
ii) Dhanyaka 950 gms.
iii) Chitraka 475 gms.
iv) Sringavera 475 gms.
v) Pippali 230 gms
vi) Jala 30 ltrs.
vii) Ghruta 10 kg.
Method of preparation:
i) Dadima, dhanyaka, chitraka moola, sunti, pippali are taken and made
into yavakuta churna and made into kalka form by adding sufficient
water.
ii) Ghruta is taken, heated slightly over mandagni, kalka and jala is added
along with it.
iii) Continuous stir is needed to prevent the carbonization of kalka dravya.
iv) Paka is done till samyak Ghruta paka lakshana is observed (4- 5 days).
v) Ghruta is filtered with a fine cloth and stored in air tight container.
Page : 69
Drug Review
INDIVIDUVAL DRUG STUDY
i) Dadima121:
Botanical name : Punica granatum
Family : Punicaceae
Gana : Hridhya, chardinigrahana (Charaka)
Parukshakadi (Sushrutha)
Chemical composition:
Fruits peel :Tannins
Seed : Estrone, punicic acid
Rasa panchaka:
Rasa : Kashaya, madhura, amla
Guna : Laghu, snigdha
Veerya :Ushna
Vipaka : Madhura amla
Karma :Tridosahara, hridya, lekhana, sukla, grahi
Indication : Jwara, raktaatisara, rakta arsa, rakta pitta.
ii) Dhanyaka122
Botanical name : Coriandrum sativum
Family : Umbelliferae
Gana : Sheetha prashamana, trishna nigrahana (Charaka)
Guduchiyadi (Sushrutha)
Chemical composition: Carotene cugenol, bergaptene, coriandrinol,
coriandrun, citranellol
Page : 70
Drug Review
Rasa panchaka:
Rasa : Kashaya, tikta
Guna : Laghu, snigdha
Veerya : Ushna
Vipaka : Madhura
Karma : Tridosahara, dipana, pachana, grahi.
Indication : Chardi, kasa,jwara.
iii) Chitraka123
Botanical name : Plumbago zeylanica
Family : Plumbaginaceae
Gana :Dipaneeya, shoolaprashamana, arshoghana,
Lekhaneeya (Charaka)
Pipalliyadi, amalakyadi, aragwadadi (Sushrutha)
Chemical composition: Chirananone, plumbagine, plumbagic acid, beta-
sitsterol, 3-choloro plumbgune, isozeylinone.
Rasa panchaka:
Rasa : Katu
Guna : Laghu, ushna, teekshna
Veerya : Ushna
Vipaka : Katu
Karma :Vata kapha hara
Indication : Pandu, kasa, krimi, grahani, udara
Page : 71
Drug Review
iv) Sringavera124
Botanical name : Zingiber officinalis
Family : Zinziberaceae
Gana : Arshoghna, triptighna, dipaniya,
shoolaprashamaniya, trishna nigrahaniya( Charaka)
Pippaliyadi, trikatu (Suhrutha)
Chemical composition: Alpha-curcumine, citral, citronellol, geraniol,
gingiberol, gingerone, gingerdiol.
Rasa panchaka:
Rasa : Katu
Guna : Guru, ruksha, teekshna
Veerya : Ushna
Vipaka : Madhura
Karma : Deepana, bhedana
Indication: Pandu, rakta pitta, vrna, kusta, agnimandhya, jwara, atisara.
v) Pippali125
Botanical name : Piper longum
Family : Piperaceae
Gana : Dipaneeya, kasa hara, vamana, sirovireechanopaga,
seethaprasamana, , hikka nigrahana, (Charaka)
Pippaliyadi, urdwabagahara,trishna, amalakyadi,
Sirovirechana (Sushrutha)
Chemical composition: Caryophyllene, piperine, piplartine, sesamin, beta-
sitosterol,pipernonaline.
Page : 72
Drug Review
Rasa panchaka:
Rasa : Katu
Guna : Laghu, snigdha, teekshna
Veerya : Ushna
Vipaka : Madhura
Karma : Vata kapha hara, dipana, vrishya, rasayana.
Indication : Pleeha roga, jwara, kusta, prameha, arshas.
vi) Grutha:
Chemical composition: Linoleic acid, arachidonic acid
Rasa panchaka:
Rasa : Madhura
Veerya : Sheetha
Vipaka : Madhura
Guna : Laghu
Karma : Pitta anila hara, mrdukaram, vatapittahara, svara
varna prasadana, smriti budhi agni sukra oja
kapha meda vivardhanam.
Indication : Shosha, jwara, madha, apasmara, murcha, unmada,
visha, yoni karnasiro shoola (jeerna grutha)
Page : 73
Drug Review
TRIVRUTH CHOORNA
The drug trivrut churna is known as the best purgative i.e. sukha virechaka.
Method of preparation:
One kilogram of Trivruth is taken and boiled in one liter of milk until the
milk is evaporated completely. Take this and dry it under the sun. After proper
drying it is powdered and stored in glass bottles.
TRIVRUTH126:
Botanical name : Operculina turpethum
Family : Convolvulaceae
Guna : Bhedaniya (Charaka)
Shyamadi, adhobaghahara ( Sushrutha)
Chemical composition: Alpha & beta turpethins, seotoletin, turpethinic acid,
turpethin
Rasa panchaka:
Rasa : Tikta, katu
Guna : Laghu, ruksha, teekshana
Veerya : Ushna
Vipaka : Katu
Karma : Kapha pitta hara, rechana
Indications : Pandu, kamala, pleeha roga, jwara.
Page : 74
Methodology
METHODOLOGY
1. MATERIALS & METHODS 1. Source of data:
Patients of either sex diagnosed as Pandu roga is selected from the
O.P.D and I.P.D of A.L. N Rao Memorial Ayurvedic Medical College &
Hospital, Koppa for the study. Out of 64 selected patients, 14 patients were
dropped out in the initial stages of the study and 50 patients completed the
course of treatments. The dropouts were not included as the total numbers of
patients in the study were 50.
2. Criteria for selection of patients:
The patients presenting with the signs and symptoms of
Pandu roga according to Ayurvedic texts were selected for the present study.
Patients of both sexes in the age group of 16 – 60 years were taken. The main
criteria for diagnosis was the presence of clinical symptoms of Pandu roga
i.e., Panduta, Arohana ayasa, Hriddrava, Bhrama and Shotha. The symptoms
of srotho dushti were also assessed along with the main symptoms for the
selection of the patients.
a) Inclusion criteria:
1) The patients diagnosed as Pandu roga on the bases of
classical signs and symptoms will be selected for the study.
2) Patients of both sexes with in the age group of 16 – 60
years.
3) Hemoglobin % below 10gm% and above 6gm% will be
included in the study.
Page: 75
Methodology
b) Exclusion criteria:
1) Mrithbhakshana janya Pandu will be excluded.
2) Pittaja and Sannipataja Pandu will be excluded from the
study.
3) Pregnancy and lactating women will be excluded.
4) Pandu roga associated with complication like heart diseases,
tuberculosis, diabetes mellitus, or any type of chronic
systemic disorder will be excluded.
c) Laboratory investigations:
The modern laboratory investigations included for the clinical
study are,
a) Blood - Hb%, TC, DC, ESR, peripheral smear, MCH, MCV, PCV,
Complete haemogram.
b) Urine - Sugar, Albumin, Microscopic.
3) Study design:
Randomized standard single blind comparative clinical study with pre
test and post test design is adopted.
4) Treatment schedule:
Group A
Shodana - Virechana.
Abyantara sneha - Dadima ghrita (Ref. Charaka Samhita).
Virechana yoga - Trivrith Choorna (Dosage depending on
koshtha).
Shamana - Nisha loha.
Dosage - 250- 500 mg bd.
Page: 76
Methodology
Anupana - Madhu.
Duration - 45 days.
Group B
No shodana given.
Shamana - Nisha loha.
Dosage - 250- 500 mg bd.
Anupana - Madhu.
Duration - 45 days.
5) Criteria for the assessment of symptoms:
The improvements of patients were assessed on the basis of relief in
the signs and symptoms of diseases. To analyse the efficacy of the drug,
statistically marks were given to each symptoms. According to severity of
the symptoms the grading were given as below;
6) Score of specific symptoms:
I) Main symptoms:
1) Bhrama
No Bhrama 0
Occasional Bhrama 1
Frequent Bhrama 2
Always Bhrama 3
2) Panduta
No Pandutha 0
Pale pink 1
Pale 2
White 3
Page: 77
Methodology
3) Arohana ayasa
No arohana ayasa 0
Walking for 20 min with difficulty 1
Walking for 10 min with difficulty 2
Walking for 5 min with difficulty 3
4) Hriddrava
No Hriddrava 0
After heavy work 1
After light work 2
Always present 3
5) Shotha
No Shotha 0
Mild Shotha 1
Moderate Shotha 2
Severe Shotha 3
II) Associated complaint:
1) Karna shweda
None 0
Occasionally 1
Frequently 2
Always 3
2) Aruchi
Equal emitting towards all food substance 0
Willing towards some specific taste 1
Willing towards only one taste 2
Willing towards only liking food 3
Page: 78
Methodology
3) Srama
No Srama 0
After heavy work 1
After light work 2
Always present 3
III) Srotho dusti
No symptoms 0
One symptom present 1
Two symptoms present 2
Three or more symptoms present 3
IV) Modern parameter
10 gm% and above 0
9 – 10gm% 1
8 – 9gm% 2
6 – 8gm% 3
The improvement is documented through statistical significance. The
subjective and objective parameters are assessed by means of interrogation and by
ascertaining the signs and symptoms before and after the treatment.
The clinical study is based on the comparative study of the trail groups.
The response of the drug is assessed weekly through interrogation, signs and
symptoms. The trail Shamana drug was given for a period of 45 days,
7) Statistical Analysis:
For assessing the improvement of symptomatic relief and to analyse
statistically the observations were recorded before, after the treatment and after
follow- up. The mean, percentage, S.D, S.E, and t-value (paired t-test) were
Page: 79
Methodology
calculated from the observation recorded. The total result including the overall effect
of therapy is given in tables for three groups.
8) Criteria for assessment of overall effect of therapy:
i) Complete relief:
100% relief in the complaints of patients along with Hb% above 14gm%.
ii) Marked improvement:
More than 75% relief in the complaints as well as Hb% increased up to
10 gm%.
iii) Moderate improvement:
More than 50% relief in the complaints along Hb% increased up to
8 gm%.
iv) Improvement:
25% to 50% relief in the complaints and light improvement in the Hb%.
v) Unchanged:
Less than 25% relief in the complaints and Hb% unchanged.
Page: 80
Methodology
2. OBSERVATIONS
Table No: 8
Age wise distribution of 50 patients of Pandu roga:
Age group Shodhana Shamana Total Percentage
16 – 30 5 6 11 22
30 - 40 8 7 15 30
40 - 50 6 8 14 28
50 - 60 6 4 10 20
Shodhana = V.N.L Group = Combined therapy
Maximum numbers of patients were obtained in the age group of 30 – 40 years,
i.e 30%. In the age group of 40 – 50 years 28% of patients were obtained, and
minimum numbers of patients were got from the age group 50 – 60 years i.e 20%. In
the age group of 16 – 30 years 22% of patients were got.
Chart No: 4
Age wise distribution of 50 patients of Pandu roga:
0
10
20
30
40
16-30 30-40 40-50 50-60
Page: 81
Methodology
Table No: 9
Sex wise distribution of 50 patients of Pandu roga:
Sex Shodhana Shamana Total Percentage
Male 10 11 21 42
Female 15 14 29 58
Male patients were 42%, and females were 58%.
Chart No: 5
Sex wise distribution of 50 patients of Pandu roga:
010203040506070
Male Female
Page: 82
Methodology
Table No: 10
Religion wise distribution of 50 patients of Pandu roga:
Religion Shodhana Shamana Total Percentage
Hindus 10 12 22 44
Muslim 9 9 18 36
Christian 6 4 10 20
Among the 50 patients 36% were Muslims, 44% were Hindus and 20% were
Christians.
Chart no: 6
Religion wise distribution of 50 patients of Pandu roga:
05
1015202530354045
Hindu Muslim Christian
Page: 83
Methodology
Table No: 11
Occupation wise distribution of 50 patients of Pandu roga:
Occupation Shodhana Shamana Total Percentage
House wife 5 7 12 24
Unemployed 6 8 14 28
Labour 10 7 17 34
Student 3 1 4 8
Business 1 2 3 6
Maximum numbers of patients were Labors (34%), Unemployed were 28%, House
wives were 24%, Students were 8% and business people were 6%.
Chart No: 7
Occupation wise distribution of 50 patients of Pandu roga:
0
5
10
15
20
25
30
35
House wife Unemployed Labour Student Business
Page: 84
Methodology
Table No: 12
Socio-economical status wise distribution of 50 patients of Pandu roga:
Socio economical status
Shodhana Shamana Total Percentage
Lower 11 12 23 46
Middle 9 9 18 36
Upper 5 4 9 18
46% of patients belong to Lower class, 36% patients were in Middle class and 18%
of patients were in Upper class.
Chart No:8
Socio-economical status wise distribution of 50 patients of Pandu roga:
0
10
20
30
40
50
Upper Middle Lower
Table No: 13
Page: 85
Methodology
Dietary pattern wise distribution of 50 patients of Pandu roga:
Dietary pattern Shodhana Shamana Total Percentage
Vegetarian 14 13 27 54
Non-veg 11 12 23 46
Vegetarians were 54% and Non-vegetarians were 46%.
Chart No: 9
Dietary pattern wise distribution of 50 patients of Pandu roga:
0
10
20
30
40
50
60
Veg Non-veg
Page: 86
Methodology
Table No: 14
Marital status wise distribution of 50 patients of Pandu roga:
Marital status Shodhana Shamana Total Percentage
Married 13 12 25 50
Un-married 9 10 19 38
Widow 3 3 6 12
50% of patients were married, 38% were un-married and 12% were widow.
Chart No: 10
Marital status wise distribution of 50 patients of Pandu roga:
0
10
20
30
40
50
60
Married Un-married Widow
Page: 87
Methodology
Table No: 15
Family history of 50 patients of Pandu roga:
Family history Shodhana Shamana Total Percentage
Positive 14 10 24 48
Negative 11 15 26 52
52% of patients did not had any family history where as 48% of patients had related
family history.
Chart No: 11
Family history of 50 patients of Pandu roga:
0
10
20
30
40
50
60
+ve -ve
Table No: 16
Page: 88
Methodology
Hygienic condition of 50 patients of Pandu roga:
Hygienic condition Shodhana Shamana Total Percentage
Poor 14 12 26 52
Moderate 9 10 19 38
Good 2 3 5 10
52% of patients were living under poor hygienic conditions, 38% were moderate and
10% were under good hygienic conditions.
Chart No: 12
Hygienic condition of 50 patients of Pandu roga:
0
10
20
30
40
50
60
Poor Moderate Good
Table No: 17
Page: 89
Methodology
Main symptoms observed in 50 Pandu Patients:
Main symptoms Shodhana Shamana Total Percentage
Pandutha 25 25 50 100
Arohana ayasa 25 25 50 100
Hruthdrava 20 20 40 80
Brahma 20 20 40 80
Shotha 10 10 20 40
Pandutha and Arohana ayasa were found in 100% of patients, Where as Hruthdrava
and Brahma were found in 80% of patients. Shotha in 40% of patients.
Chart No: 13
Main symptoms observed in 50 Pandu Patients:
0
20
40
60
80
100
Pandutha Arohanaayasa
Hruthdrava Brahma Shotha
Table No: 18
Page: 90
Methodology
Associated Symptom observed in 50 Pandu Patients:
Associated symptom Shodhana Shamana Total Percentage
Srama 25 25 50 100
Aruchi 20 20 40 80
Karna kshweda 10 10 20 40
100% of patients were found with Srama, 80% with Aruchi and 40% with Karna
kshweda.
Chart No: 14
Associated Symptom observed in 50 Pandu Patients:
0
20
40
60
80
100
Srama Aruchi KarnaKshweda
Table No: 19
Page: 91
Methodology
Srothodusti observed in 50 patients of Pandu roga:
Stothus Shodhana Shamana Total Percentage
Rasa vaha 25 25 50 100
Raktha vaha 25 25 50 100
Annna vaha 2 20 40 80
100% of the patients had dusti in the Rasa and Raktha vaha sothus and 80% of
patients had the dusti of Anna vaha srothus.
Chart no: 15
Srothodusti observed in 50 patients of Pandu roga:
0
20
40
60
80
100
Rasa vaha Raktha vaha Anna vaha
Page: 92
Methodology
Table No: 20
Hb% observed in 50 patients of Pandu roga:
Investigation Shodhana Shamana Total Percentage
Hb% 25 25 50 100
100% of the patients were below the normal Hb% level.
Hb% observed in 50 patients of Pandu roga:
0
5
10
15
20
25
Shodhana Shamana
Page: 93
Results
RESULTS
THERAPEUTIC EFFECT OF SHAMANA IN PANDU ROGA
Table No: 21
Effect of Shamana on Main symptoms of Pandu roga in 25 patients after 45 days
of treatment:
Mean score Sl.
No
Main
Symptom BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Bhrama 1.30 0.85 0.45 45 0.510 0.114 3.942 <0.001
2 Panduta 1.40 0.76 0.64 64 0.700 0.143 4.570 <0.001
3 Arohana
ayasa
1.48 0.88 0.60 60 0.645 0.129 4.647 <0.001
4 Hruddrava 1.40 1.05 0.35 35 0.489 0.109 3.198 <0.010
5 Shotha 1.40 0.80 0.60 60 0.516 0.163 3.674 <0.010
Shamana therapy provided highly significant relief (p<0.001) in the management of
Bhrama, Pandutha and Arohana ayasa by 45%, 64%, 60% respectively. It provided
moderate significant (p<0.010) in the management of Hruddrava and Shotha by 35%
and 60% respectively.
Page : 94
Results
Table No: 22
Effect of Shamana on Main symptoms of Pandu roga in 25 patients after follow
up:
Mean score Sl.
No
Main
Symptom BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Bhrama 1.30 0.85 0.45 45 0.604 0.135 3.327 <0.010
2 Panduta 1.40 0.92 0.48 48 0.585 0.117 4.095 <0.001
3 Arohana
ayasa
1.48 1.04 0.44 44 0.650 0.150 3.812 <0.001
4 Hruddrava 1.40 1.10 0.30 30 0.470 0.105 2.853 <0.050
5 Shotha 1.40 1.00 0.40 40 0.516 0.163 2.449 <0.050
It provided highly significant relief (p<0.001) in the management of Panduta and
Arohana ayasa by 48% and 44% respectively. It provided moderate significant relief
(p<0.010) in the management of Bhrama by 45% where as it provided mild significant
relief (p<0.050) in the management of Hruddrava and Shotha by 30% and 40%
respectively.
Page : 95
Results
Table No: 23
Effect of Shamana on Associated symptoms of Pandu roga in 25 patients after 45
days of treatment:
Mean score Sl.
No
Associated
Symptom BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Karna
shweda
1.375 0.625 0.75 75 0.462 0.16
3
4.582 <0.010
2 Aruchi 1.20 0.70 0.50 50 0.512 0.11
4
4.35 <0.010
3 Srama 1.28 0.84 0.44 44 0.650 0.13
0
3.812 <0.010
It provided moderate significant relief (p<0.010) in all associated symptom by 75%,
50% and 44% for Karnashweda, Aruchi and Srama respectively.
Table No:24
Effect of Shamana on Associated symptoms of Pandu roga in 25 patients after
follow up:
Mean score Sl.
No
Associated
Symptom BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Karna
shweda
1.375 1.125 0.25 25 0.462 0.163 1.527 >0.100
2 Aruchi 1.20 0.85 0.35 35 0.489 0.109 3.198 <0.010
3 Srama 1.28 1.00 0.28 28 0.458 0.091 3.055 <0.010
Page : 96
Results
It provided moderate significant relief (p<0.010) in the management of Aruchi and
Srama by35%, 28% respectively, where as it provided insignificant relief (p>0.100) in
the management of Karnashweda by 25%.
Table No:25
Effect of Shamana therapy in Sroto dusti in 25 patients of Pandu roga after 45
days of treatment:
Mean score Sl.
No
Srotas
BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Anna vaha 1.40 0.85 0.55 55 0.604 0.135 4.066 <0.001
2 Rasa vaha 1.56 1.08 0.48 48 0.585 0.117 4.095 <0.001
3 Raktha
vaha
1.48 0.84 0.64 64 0.700 0.143 4.570 <0.001
It provided highly significant relief (p<0.001) in the management of all Sroto dusti by
55%, 48% and 64% respectively for Annavaha, Rasa vaha and Rakhta vaha srotas.
Page : 97
Results
Table No: 26
Effect of Shamana therapy in Sroto dusti in 25 patients of Pandu roga after
follow up:
Mean score Sl.
No
Stotas
BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Anna vaha 1.40 0.95 0.45 45 0.604 0.135 3.327 <0.010
2 Rasa vaha 1.56 1.24 0.32 32 0.556 0.111 2.873 <0.010
3 Raktha
vaha
1.48 1.20 0.28 28 0.458 0.091 3.055 <0.010
It provided moderate significant relief (p<0.010) in all Sroto dusti by 45%,32% and
28% for Anna vaha, Rasa vaha and Raktha vaha respectively.
Table No: 27
Effect of Shamana therapy in management of decreased Hb% in 25 patients of
Pandu roga after 45 days of treatment:
Mean score Sl.
No
Objective
symptoms BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Hb% 1.32 0.84 0.48 48 0.509 0.101 4.706 <0.001
It provided highly significant relief (p<0.001) in the management of the lowered Hb%
by 48%.
Page : 98
Results
Table No: 28
Effect of Shamana therapy in management of decreased Hb% in 25 patients of
Pandu roga after follow up:
Mean score Sl.
No
Objective
symptoms BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Hb% 1.32 0.96 0.36 36 0.568 0.113 3.165 <0.010
It provided moderate significant relief (p<0.010) in the management of lowered Hb%
by 36%.
THERAPEUTIC EFFECT OF COMBINED THERAPY IN THE
MANAGEMENT OF PANDU ROGA
Table No: 29
Effect of Combined therapy (V.N.L) in the management of Main symptoms of
Pandu roga in 25 patients after treatment:
Mean score Sl.
No
Main
Symptom BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Bhrama 1.35 0.95 0.40 40 0.502 0.112 3.559 <0.010
2 Panduta 1.44 0.96 0.48 48 0.509 0.101 4.706 <0.001
3 Arohana
ayasa
1.40 0.96 0.44 44 0.650 0.130 3.812 <0.001
4 Hruddrava 1.30 0.85 0.45 45 0.510 0.114 3.942 <0.001
5 Shotha 1.25 0.92 0.33 33 0.492 0.142 3.342 <0.010
Page : 99
Results
It provided highly significant relief (p<0.001) in the management of Pandutha ,
Hruddrava and arohana ayasa by 40% , 45%and44% respectively. It provided
moderate significant relief (p<0.010) in the management of Bhrama and shotha by
40% and 33% respectively.
Table No: 30
Effect of Combined therapy (V.N.L) in the management of Main symptoms of
Pandu roga in 25 patients after follow up:
Mean score Sl.
No
Main
Symptom BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Bhrama 1.35 0.80 0.55 55 0.604 0.135 4.066 <0.001
2 Pandutha 1.44 0.92 0.52 52 0.509 0.101 5.099 <0.001
3 Arohana
ayasa
1.40 0.88 0.52 52 0.584 0.17 4.437 <0.001
4 Hruthdrava 1.30 0.80 0.50 50 0.512 0.114 4.35 <0.001
5 Shotha 1.25 0.59 0.66 66 0.492 0.142 4.693 <0.001
After follow up mixed combined therapy provided highly significant relief (p<0.001)
in the entire main symptom by 55%, 52%, 52%, 50% and 66% for Brahma, Pandutha,
Arohanaayasa, Hruthdrava and Shotha respectively.
Page : 100
Results
Table No: 31
Effect of Combined therapy in the management of associated symptoms of
Pandu roga in 25 patients after treatment:
Mean score Sl.
No
Associated
Symptom BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Karna
shweda
1.40 0.90 0.50 50 0.527 0.166 3.00 <0.010
2 Aruchi 1.35 0.90 0.45 45 0.604 0.135 3.327 <0.010
3 Srama 1.44 1.16 0.28 28 0.458 0.091 3.055 <0.010
It provided moderate significant relief (p<0.010) in the management of all associated
symptoms by 50%, 45% and 28% in the management of Karnashweda, Aruchi and
Srama respectively.
Table No: 32
Effect of Combined therapy in the management of associated symptoms of
Pandu roga in 25 patients after follow up:
Mean score Sl.
No
Associated
Symptom BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Karna
shweda
1.40 0.70 0.70 70 0.483 0.152 4.582 <0.001
2 Aruchi 1.35 0.80 0.55 55 0.604 0.135 4.066 <0.001
3 Srama 1.44 0.996 0.48 48 0.509 0.101 4.706 <0.001
After follow up, combined therapy provided highly significant relief (p<0.001) in the
management of all associated symptoms by 70%, 55% and 48% respectively for
Karnashweda, Aruchi and Srama.
Page : 101
Results
Table No: 33
Effect of Combined therapy in the management of Sroto dusti in 25 patients of
Pandu roga after treatment:
Mean score Sl.
No
Srotas
BT AT BT-
AT
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Anna vaha 1.45 1.01 0.35 35 0.489 0.109 3.198 <0.010
2 Rasa vaha 1.44 1.00 0.44 44 0.650 0.130 3.812 <0.010
3 Raktha
vaha
1.36 0.96 0.40 40 0.50 0.10 4.00 <0001
Combined therapy provided highly significant relief (p<0.001) in the management of
Raktha vaha srotus by 40%, it provided moderate significant relief in the management
of Anna vaha srotas and Rasa vaha sroto dusti by 35%and 44% respectively.
Table No: 34
Effect of Combined therapy in the management of Sroto dusti in 25 patients of
Pandu roga after follow up:
Mean score Sl.
No
Srotas
BT AFU BT-
AFU
% S.D
(+-)
S.E
(+-)
t
value
p
value
1 Anna vaha 1.45 0.95 0.50 50 0.512 0.114 4.35 <0.001
2 Rasa vaha 1.44 0.84 0.60 60 0.645 0.129 4.647 <0.001
3 Raktha
vaha
1.36 0.84 0.52 52 0.585 0.117 4.437 <0.001
Page : 102
Results
Combined therapy provided highly significant relief (p<0.001) in the management of
all sroto dusti by 50%, 60% and 52% for Anna vaha, Rasa vaha and Raktha vaha
respectively.
Table No: 35
Effect of Combined therapy in the management of lowered Hb% in 25 patients
of Pandu roga after treatment:
Mean score Sl.No
Objective symptom
BT AT BT-AT
% S.D (+-)
S.E (+-)
t value
p value
1 Hb% 1.36 0.84 0.52 52 0.585 0.117 4.437 <0.001
It provided highly significant relief (p<0.001) in the management of lowered Hb% by
52% after treatment.
Table No: 36
Effect of Combined therapy in the management of lowered Hb% in 25 patients
of Pandu roga after follow up:
Mean score Sl.No
Objective symptom
BT AFU BT-AFU
% S.D (+-)
S.E (+-)
t value
p value
1 Hb% 1.36 0.84 0.52 52 0.509 0.101 5.099 <0.001
After follow up, highly significant relief (p<0.001) were observed in the management
of lowered Hb% by 52%.
Page : 103
Results
TOTAL EFFECT OF SHAMANA
Table No: 37
Total effect of Shamana therapy on 25 patients of Pandu roga after treatment:
Results No: of patients (%)
Complete relief 0 0
Marked improvement 3 12
Moderate improvement 12 48
Improved 8 32
Unchanged 2 8
In this group 48% of patients were assessed under moderate improvement,.32%
patients were assessed under improvement. Only 12% showed marked improvement.
8% were under unchanged category, where as nobody included under complete relief.
Table No: 38
Total effect of Shamana therapy on 25 patients of Pandu roga after follow up:
Results No: of patients (%)
Complete relief 0 0
Marked improvement 2 8
Moderate improvement 11 44
Improved 9 36
Unchanged 3 12
After follow up 44% of patients had moderate improvement and 36% of patients came
under improved section. 8% of patients had marked improvement, 12% of patients
were unchanged. None of them had complete relief.
Page : 104
Results
TOTAL EFFECT OF SHODANA
Table No: 39
Total effect of Shodana therapy on 25 patients of Pandu roga after treatment:
Results No: of patients (%)
Complete relief 0 0
Marked improvement 3 12
Moderate improvement 11 44
Improved 9 36
Unchanged 2 8
In this group 44% of patients were assessed under moderate improved category. 36%
patients were assessed under improved category. Only 12% showed marked
improvement. 8% were under unchanged category, where as nobody included under
complete relief.
Table No: 40
Total effect of Shodana therapy on 25 patients of Pandu roga after follow up:
Results No: of patients (%)
Complete relief 0 0
Marked improvement 5 20
Moderate improvement 11 44
Improved 9 36
Unchanged 0 0
Page : 105
Results
After follow up 44% of patients had moderate improvement and 36% of patients came
under improved section. 20% of patients had marked improvement. No patients were
unchanged. None of them had complete relief.
COMPARATIVE ANALAYSIS OF THE THEARAPIES
Table No: 41
Comparative effect of therapies in the management of Main symptoms of 50
Pandu roga patients:
Groups Bhrama Panduta Arohana
ayasa
Hruddrava Shotha
Group A 45 48 44 30 40
Group B 55 52 52 50 66
Group A – Shamana(N.L) ; Group B - Combined therapy(V.N.L)
While comparing the effect of therapies on main symptoms it was found that N.L
group showed 45%,48%,44%,30%and 40% relief in managing symptoms like
bhrama, panduta, arohana ayasa, hruddrava and shotha where as high improvement
rate was found in V.N.L group by 55%,52%,52%,50% and 66% respectively.
Page : 106
Results
Graph No: 17
Combined effect of therapies in the management of Main symptoms of 50 Pandu
roga patients:
0
20
40
60
80
100
Brahma Pandutha Arohanaayasa
Hruthdrava Shotha
N.L V.N.L
Table No:42
Comparative effect of therapies in the management of Associated symptoms of
50 Pandu roga patients:
Groups Karnashweda Aruchi Srama
Group A 25 35 28
Group B 70 55 48
• Group A – Shamana (N.L) ; Group B - Combined therapy(V.N.L)
On the comparative effect of therapies in the management of associated
symp;toms N.L group showed 25%, 35% relief in Karnashweda respectively
where as shodana group ( VNL group) showed very good relief by about 70%,
55%,and 40% relief in karnashweda, aruchi and srama.
Page : 107
Results
Graph No: 18
Comparative effect of therapies in the management of Associated symptoms of
50 Pandu roga patients:
0
20
40
60
80
100
Karnashweda Aruchi Srama
N.L V.N.L
Table No: 43
Comparative effect of therapies in the management of Sroto dusti in 50 patients
of Pandu roga:
Groups Anna vaha Rasa vaha Raktha vaha
Group A 45 32 28
Group B 50 60 52
• Group A – Shamana (N.L) ; Group B - Combined therapy (V.NL).
Page : 108
Results
While comparing the therapies on srothodushti N .L group gave 45%,32%,28% in the
improvement of annavaha, rasavaha, rakthavaha, respectively. Whereas VNL group
gave high improvemnent in srothodushti by 50%, 60%,52% respectively.
Graph No: 19
Comparative effect of therapies in the management of Sroto dusti in 50 patients
of Pandu roga:
0
20
40
60
80
100
Anna vaha Rasa vaha Raktha vaha
N.L V.N.L
Page : 109
Results
Table No: 44
Comparative effect of therapies in the management of lowered Hb% in 50
patients of Pandu roga:
Groups Hb%
Group A 36
Group B 52
• Group A – Shamana (N.L) ; Group B - Combined therapy (V.NL).
Graph No: 20
Comparative effect of therapies in the management of lowered Hb% in 50
patients of Pandu roga:
0
20
40
60
Hb%
N.L V.N.L
Page : 110
Results
COMPARATIVE EFFECT OF OVERALL OF THERAPY
Table No: 45
Comparative effect of over all therapy:
Groups Complete
relief
Marked
improvement
Moderate
improvement
Improved Unchanged
Group A 0 8 42 34 16
Group B 0 16 46 38 0
While comparing overall effect of therapies it was found that N.L group gave 8%,
marked improvement, 42% moderate improvement, 34% improvement and 16%
unchanged and complete relief was found in none. Where as in VNL group 16%had
marked improvement, 46% moderate improvement, 48% improvement and none had
complete relief.
Graph No: 21
Comparative effect of over all therapy:
0
10
20
30
40
50
Complete relief Markedimprovement
Moderateimprovement
Improved Unchanged
N.L V.N.L
Page : 111
Discussion
DISCUSSION
This disease is pertaining to the loss of color and complexion. The iron
deficiency anemia told in the contemporary science may be included in Pandu roga
as it has similarity in the etymology, pathology and treatment. The prevalence of this
disease is very high in the developing countries like India, Pakistan and Sri Lanka
due to the poverty, malnutrition, recurrent pregnancy and poor antenatal care. Rakta
is vital for various physiological activities like nutrition transport, waste removal,
oxygen carrying, thermoregulation etc. The diseases of blood effect organs likes
heart, kidneys, and lungs, brain in particular and entire body in general.
Acharyas have mentioned the involvement of rakta dushti or raktasrava for
the manifestation of Pandu roga. Even in iron deficiency anemia, pathology lies in
the blood or at the site of production of cells due to various factors responsible for
its production. The entire work is discussed under various headings and is
mentioned below.
Etiology:
Improper diet and dietic regime in the form of excessive intake of amla,
lavana, katu and kshara which are pitta prakopaka, rakta dushtikaraka and ojo
kshayakaraka and the intake of specific food materials like pinyaka, amisha, paya,
tilapishtaa will however vitiate the rakta dhatu and produces Pandu. These types of
food materials hamper the normal process of absorption and assimilation. In the
contemporary science, it is a proven fact that intake of unwholesome diet, both
quantitatively and qualitatively will produce sequential changes in the process of
digestion and absorption.
Page : 112
Discussion
Improper dietic practices in the form of viruddha ahara, asatmya bhojana
interferes in the physiology of digestion that gives way to improper byproducts and
altered dhatu parinama.
The mental health always contributes for the physical well-being. A healthy
mental composure is needed as it indirectly influences to bring up physical health. A
proper diet taken will not undergo digestion if the mind is influenced by chinta,
shoka, krodha and other disturbances, which will hamper both the jataragni and
dhatwagni. In present era, the studies have shown that anxiety, stress, nervousness
and mental disturbances reflect on body mechanism and impair the outcome of body
functions.
The vyadhi Pandu exists as pradhana, anubandhya or as upadrava to other vyadhi
and sometime it may appear as chikitsa apacharja mainly due to the improper
conduct of panchakarma. It is mentioned as one of the vamana- virechana vyapat
and sneha vibrama also produces Pandu.
Pandu can also manifest as secondary to some other disease like raktasrava,
jeernajwara, raktarshas. Chronic and acute blood loss can lead to anemia.
Discussion on samprapti of Pandu and I.D.A
While describing the samprapti of the disease it is stated that alpata of raktha
dhatu and its vitiation are responsible for incapacitating raktha dhatu to perform its
normal functions. Pitta plays a very important role.
Page : 113
Discussion
Pachaka pitta gets vitiated resulting in mandagni ama and dhatu shaitilya
Even the ranjana of raktha does not occur due to the vitiation of Ranchaka
pitta situated in yakrut and pleeha.
In the contemporary science, it has been proved that liver has a significant
role in the formation and maturation of RBC, and gastric juice helps in
formation of anti anemic factor.
Vata especially vyana vata carries the dosa to the twak and displaces it
between twak and mamsa.
Kapha as well as ojo kshaya occur due to rukshata and teekshnata of vata and
pitta respectively.
Rasa and raktha vaha srotus get involved and sroto dusti prakara is sangha
so the nutritive part does not reach the subsequent dhathus and there is alpata
of raktha and medhas.
Patho-physiology of Anemia:
The main function of hemoglobin is to transport oxygen from lungs to the
tissues. Anemia, by reducing the oxygen capacity of the blood reduces amount of
oxygen available to the tissue resulting in tissue hypoxia. The hypoxia causes
impairment of functions of body tissue and symptoms and signs of anemia are there
for referred to many system. The degree and functional impairment of individual
tissue depends largely on their normal oxygen requirement.
Poorva roopa is discussed under the chapter with tables showing the opinion
of different authors.
Page : 114
Discussion
Discussion on plan of study:
The present study has been carried out on 50 patients treated in two groups
selected from the OPD and IPD of A.L.N.Rao Memorial Ayurvedic College &
Hospital, Koppa. The criteria of selection of patients were based upon the classical
signs and symptoms and decreased Hb% below 10gm% and above 6gm%. Anaemia
due to systemic disorder, infective causes, anemia in pregnant and lactation, due to
acute and chronic blood loss are excluded from the study.
25 patients of Pandu roga were selected for Shodhana treatment and were
given Sneha pana with Dadimadi ghruta. Prior to sneha pana, deepana pachana was
done with Vaiswanara choorna. Sneha pana was given in Arohana krama and done
till samyak sneha is obtained, followed by two days of visrama kala. On these days
abhyanga is done with Dhanwanthara taila followed by bashpa sweda.
Virechana is given with Trivruth choorna. After attaining samyak virechana
samsarjana krama is done depending upon the sudhi.
Samana oushadhi is given for 45 days.
25 patients were selected for second group and only samana oushadhi i.e,
Nisha loha 250 to 500 mg twice daily was given for a period of 45 days.
The improvements in the symptoms of disease and sroto dusti after the
treatment as well as Hb% were the main criteria of assessment. The total effects of
the therapy were also assessed in terms of complete relief, marked improvement,
moderate improvement and improvement and unchanged.
Page : 115
Discussion
Discussion on observations during study:
62 patients were registered for the study, 12 patients were dropped out in the due
course. Incidence studies of all the registered patients are as follows –
1. Age incidence: maximum number of patients in the study was in between the
age 30 to 40 years; in this age group, contributory factors for women were
menstruation, repeated pregnancy, mental tension, lactation and malnutrition.
In men, it could be due to constant hard labour work and mental tension.
2. Sex incidence: maximum patients were females nearly about 58%,
menstruating females require double the quantity of dietary iron supplement
than the non menstruating. This may be the probable cause for maximum
prevalence among the females.
3. Religion incidence: 45% of the selected patients for the study were Hindus as
the area of study was Hindu dominated and followed by 36% of Muslims.
4. Occupational incidence: maximum patients were labourers about 34%
followed by unemployed about 28%, probably due to hard physical works
and tough working conditions.
5. Socio-economical incidence: patients belonging to lower class were more
affected by Pandu roga. The lower socio-economical group will have
deficient nutrition diet, hard labour work and poor financial conditions.
6. Marital incidence: 62% of married patients were suffering from Pandu roga,
probably due to recurrent pregnancy and lactation. 38% of unmarried were
also sufferers.
7. Educational incidence: maximum patients were illiterates and had a family
history of same signs and symptoms.
Page : 116
Discussion
8. Treatment incidence: 50% of patients were on haematonics when approached
for the treatment.
9. State of Agni in Pandu roga: In most of cases studied, the patients had
mandagni and vishamagni.
10. Kosta in Pandu roga: maximum patients had constipation probably because
the maximum case got for the study was vataja type of Pandu.
11. Doshic involvement: vataja Pandu and pittaja Pandu were more for the study.
12. Dietary incidence: detailed questioning was done during the clinical study
and was observed that patients suffered from Pandu roga were vegetarians.
Their food mainly comprised of less calorie vegetables and patients had the
habit of taking amla, katu pradana rasas. Most patients had habit of taking
fried food items and were from the lower class, less hygienic and less
nutritious diet which could probably be a significant cause.
13. Symptomatological incidence: majority of the cases had the samanya
lakshana of Pandu mentioned in Charaka samhita.
i) Panduta – it is a symptom seen in all the patients taken for the
study and was seen in the skin, nails and eyes.
ii) Shrama – was the symptom, which troubled all the patients
reducing the work capacity of the patients.
iii) Arohana ayasa – it was main symptom, which precipitated on
veery small work, heavy physical work produceing severe
exertion and breathlessness.
iv) Balahani, Dourbalya, Hriddrava, Shota, Bhrama, Karnakshweda,
Aruchi were the other presenting features.
v) Vataja lakshanas were predominantly seen in maximum cases.
Page : 117
Discussion
Effect of treatment:
Effect of treatment was assessed both clinically as well as based on
laboratory parameters. Clinical features were assessed once in every fifteen days.
Laboratory parameters like Hb% peripheral smear study, PCV, total RBC count and
the shape of the cells were noted before and after the study.
Every signs and symptoms of Pandu showed good response to the drug. The
side effect reported during the study period was nil. The relief obtained in the 50
patients in subjective and objective symptomatology is as follows –
Effect of therapies on main symptoms:
a) After therapy – Combined therapy group ( V.N.L)
&
Shamana therapy group (N.L)
Combined therapy group provided highly significant relief (p<0.001) in the
management of Panduta, hriddrava and arohana ayasa by 48%, 45% and 44%
respectively, moderate significant relief (p<0.010) in the management of bhrama and
shotha by 40% and 33%. Shamana group showed highly significant relief (p<0.001)
in the management of bhrama, Panduta and arohana ayasa by 45%, 64% and 60%
respectively, moderate significance in the management of hriddrava and shotha by
35% and 60%.
Page : 118
Discussion
b) After follow up – Combined therapy group (V.N.L)
&
Shamana therapy group (N.L)
Combined therapy gave highly significant relief (p<0.001) in the
management of symptoms like bhrama, Panduta, arohanayasa, hriddrava and shotha
by 55%, 52%, 52%, 50% and 60% respectively. In the long run, they gave a
sustained and constant relief of the symptoms of Pandu.
Shamana group showed moderate significance (p<0.010) in the cure of
lakshnas like bhrama, Pandutha, and arohana ayasa by 45%, 47% and 44% where as
mild significance (p<0.050) relief was found in cure of hridrva and shotha by 30%
and 40%.
Effect of therapies on associated symptoms:
a) After therapy – Combined therapy group (V.N.L)
&
Shamana therapy group (N.L)
Combined therapy gave moderate significant relief (p<0.010) in the
management of associated symptoms like karna kshweda, aruchi and srama by 50%,
45% and 28% respectively.
Shamana group provided moderate significant relief (p<0.01) in relieving karna
kshweda, aruchi and srama by 75%, 50% and 45% respectively.
b) After follow up – Combined therapy group (V.N.L)
&
Shamana therapy group (N.L)
Combined therapy showed very high significance (p<0.001) in the cure of
associated signs like karna ksheweda, aruchi, and srama by 70%, 55% and 48%
respectively.
Page : 119
Discussion
Shamana group showed insignificant relief (p>0.100) in cure of karna
ksheweda by 25% and moderate significance (p<0.010) in the cure of aruchi and
srama by 35% and 28%.
Effect of therapies on srotho dusti:
a) After therapy – Combined therapy group(V.N.L)
&
Shamana therapy group (N.L)
Combined therapy showed highly significant results (p<0.001) in cure of
raktha vaha sroto dusti by 40% and moderate significance (p<0.010) in the
management of anna vaha and rasa vaha srotho dusti by 35% and 45% respectively.
Shamana group showed a highly significant relief (p<0.001) in the
management of rasa, rktha and anna vaha srotho dusti by 48%, 64% and 55%
respectively.
b) After follow up – Combined therapy group(V.N.L)
&
Shamana therapy group (N.L)
Follow up study of combined therapy group showed high significance
(p<0.001) in the management of anna vaha rasa vaha and raktha vaha srotho dusti by
50%, 60% and 62%.
Shamana group provided moderate significance (p<0.010) in the
management of annavaha rasavaha and raktha vaha srotho dushti by 45%, 32% and
28% respectively and it could not maintain a long standing relief.
Page : 120
Discussion
Effect of therapies on Hb%:
a) After therapy – Combined therapy group(V.N.L)
&
Shamana therapy group (N.L)
Increase Hb% was significant in both the group but improvement was
gradual. Combined therapy group showed a highly significant change (p<0.001) in
increasing the Hb% by about 52%.
Shamana group provided good significant relief (p<0.001) in increasing the Hb by
48%.
b) After follow up – Combined therapy group(V.N.L)
&
Shamana therapy group (N.L)
Combined therapy group gave a high significant relief (p<0.001) in
increasing Hb% by 52% where as shamana therapy showed moderate significance in
increasing the Hb% by 36%
Size and chromasia of RBC:
There was significant increase in the size and coloration of the RBC in the
combined therapy group only. Very mild changes were seen during the course of
therapies but radical change was seen in the follow up period nearly about 50-80
days of observation.
Page : 121
Discussion
Hematological factors:
There was a rise in PCV, MCV, MCH after the combined therapy to a great
extend which was gradual and sustained, and where as shamana group showed only
a slight amplified changes in the hematological values.
Overall effect of medications on features of Pandu roga:
During the course of study (15 days) some relief was found in symptoms in
both the groups. After one month of treatment shamana group showed good
significant relief in relieving the symptoms like Panduta, arohana ayasa, bhrama in
the initial stages of study but later this group could not give sustained and long-
standing effect, Hb increase was very slow with the use of shamana oushadhis.
There was only little change on the chromatia and size of the cells, the other
hematological values showed a little improvement.
Combined therapy i.e sneha pana for 3-7 days followed by virechana and
shamana oushadhis showed a good relief of symptoms. Just after the virechana and
start of Nisha loha there was a drastic change in the Pandu lakshanas like Panduta
and hriddrava. After follow up there was a highly significant results seen in all
symptoms like bhrama, Pandu. Arohanayasa, hriddrava, shotha, aruchi, srama,
increase in Hb%, MCV, PCV and change in chromatia and size of RBC.
Overall picture of the results obtained in both groups suggests that:-
Combined therapy showed better results in controlling the severity of
manifestation, effective in significantly reducing all the manifestations, better
improvement in the hematological findings and brought about long-standing relief.
After a period of observations, the hematological reading was found satisfactory
after the course of medication in combined therapy with regards to symptoms, Hb%
and other objective hematological symptoms.
Page : 122
Discussion
Probable mode of action of Nisha loha:
Drugs mainly act through four streams to break down the pathological
process, i.e i) Activator, ii) Potentiator, iii) Bio active enhancer, iv) Anti-dotes. Our
Acharayas have formulated various compound drugs keeping the above points in
view. When the drug Nisha loha is administered to combat the disease process in
Pandu, the major ingredient is Loha bhasma, which assigns the role of activator. Iron
being a major component of hemoglobin and its loss leading to the disease is
compensated by supplement of Loha bhasma and for the absorption of Iron it has to
be made into absorbable form which is obtained by the gastric HCl and vitamin C.
Amalaki, which is rich source of vitamin C (660mg /100gms) also assigns a
role of activator. In context of raktha dathu kshaya it is said that the person will have
carving for amla rasa pradhana dravya as a compensatory mechanism in the body to
make up the deficit of raktha. The amla rasa profoundly found in amalaki makes up
the above loss. Further on analysis of above facts it can be interpreted that pancha
bhautikata of amla rasa and raktha dhatu are similar (jala & agni).
Haridra, Daruharidra and Katukarohini, which are established yakrut
uttejaka drugs takes role of the potentiator. These drugs have tikta rasa and have
raktha shodaka properties, which is attained probably by expulsion of metabolic
waste from the body. Ranjaka pitta, which does the rasa ranjana, has its moola in
yakrut and pleeha and above mentioned drugs acts on the moola (yakrut & pleeha)
to achieve this specification there by overcoming the pathology.
Haritaki, Vibetaki and Amalaki take up bio enhancer property by virtue of
their anulomana and pitta saraka property.
Page : 123
Discussion
Haridra and Triphala are universal antidotes, which acts against any
untoward effects caused by the above combinations.
In brief, this compound drug by its synergic action brings about the desired
effect by curing Pandu roga.
Probable mode of action of Snehapana:
Shodhana treatment is mentioned to be complete by itself as the vitiated
dosha are totally expelled from the body to attain normalcy. Snehapana is done as a
pre therapeutic procedure for virechana. Here the main intention of snehapana is to
facilitate movement of dosha, which has spread through the body to koshta from
where it will be expelled out.
Dadimadi ghrita is used to attain the above-mentioned objectives. Snehapana
has its significance in increasing the digestive capacity, evacuation of the bowels
and thereby clearing the koshta, rejuvenation of the dhatus in the body, improving
color, strength and functioning of the sense organs. Dadimadi ghrita by virtue of its
ingredients attain the above qualities to its very near perfection. Further Sushruta
says the whole body is snehamayi on which the prana is dependent and it attains
optimum potentiality after snehapana.
Probable mode of action of virechana:
Even though virechana drugs are panchaboutika, it is mentioned that these
dravyas are predominant of jala and prithvi mahabhuta. Commenting on this
Chakrapani says predominance of these mahabhuta accelerate downward movement
of the doshas. The qualities mentioned for virechana dravyas act by its veerya,
vipaka and prabhava and Charaka opines that action of vamana- virechana dravyas
is only by prabhava. The trivrit churna used for virchana posses these qualities and
considered as sukha virechaka and hridya virechaka.
Page : 124
Discussion
MODERN EXPLANATION OF POSSIBLE ACTION OF
VIRECHANA KARMA:
In modern sciences while explaining laxatives said that they probably induce
limited low-grade inflammation in the small and lower bowel to promote
accumulation of water and electrolytes and stimulate intestinal motility. From the
above view, we can say that Ayurvedic shodhana are mild irritant to the stomach and
the intestinal mucosa respectively, to cause inflammation. Due to this, the
permeability of the membrane changes and those substances come out due to the
changed permeability, which cannot come out in normal condition.
This medically produced mild inflammation facilitates quick absorption of
the active principles (Veerya) of the drug in initial stage. Later on it facilitate the
excretion of the morbid matters, which generally are not supposed to be excreted out
through the mucosa of gut. It is possible only because inflammation increases the
permeability of the capillaries, which in turn allow the absorption, as well as
excretion of such substances, which are not allowed in normal condition
(Gurdip Singh, 2003).
Page : 125
Conclusion
CONCLUSION
From the scrutiny of the observations and the clinical study the following
conclusion can be drawn-
Pandu affects invariably patients of any age with more incidents in females than in
males in the age group of 30-40 years.
Strength of patient decreases with the chronicity of the disease Pandu.
Pandu is a multi-factorial disorder involving almost all the srotus, dhatus and the
ojas.
Pathologically there are 5 types of Pandu and Mrit bhakshanajanya Pandu was not
included under the Pandu bheda by Sushruta as it is one of the nidana for Pandu
roga.
Nidana parivarjana has a very important role incurring specific variety of Pandu ,
i.e. Mrit bhakshanajanya Pandu.
Some poorvaroopa are continued in roopa avastha also, which includes Pandutha,
hriddrava, trishna.
The drug Nisha loha gave significant relief of symptoms initially but long lasting
effect was not obtained.
The Shamana drug (Nisha Loha) could not bring about any change in chromasia
and size of the cells.
The combined therapy initially gave moderate significant relief, but high
significant relief was found after follow up and there was a sustained long-
standing effect on relieving symptoms.
Page : 126
Conclusion
Combined therapy brought some change in size and chromasia of the cells
probably would be the reason for long standing sustained effect.
This study has given a new perspective in the management of Pandu roga with
special reference to Iron deficiency anemia.
Limitations:
The sizes of the sample were small to draw a generalized conclusion.
Drug palatability was less.
The sneha pana and virechana was long standing procedure, which need
admission in hospital and specialized care.
Only one virechana dravya (Trivrut churna) could be used for all prakriti patients.
This study was confined to Pandu roga with special reference to Iron deficiency
Anaemia.
Recommendation for further study:
The study is advised on large samples.
Change in the formulations in the capsule form for better palatability and easy
administration.
Various Virechana dravyas like Eranda taila, Trivrut lehya etc. should be used
depending upon the deha prakriti and asses the results.
The study should be held to evaluate its efficacy in other varieties of Anemia like
Sickle cell anemia, Megaloblastic anemia etc.
Page : 127
Summary
SUMMARY
The dissertation entitled “Clinical evaluation of virechana and Nisha loha
in the management of Pandu roga with special reference to Iron deficiency
Anaemia” has been carried to find out the clinical efficacy of Nisha loha and role of
Virechana on the patients of Pandu. This study comprises of different topics and is
discussed under various headings.
1. Introduction: Gives the historical glimpses with regard to the disease Pandu
roga and traces the various developments right from the vedic period to the
present era. Importance to the disease by various Samhitakaras has been
mentioned in Samgraha kala, when the different loha preparations was in
wide use has been discussed, also gives a glimpse of disease Anaemia, its
historical importance, first use of the word.
2. Objectives: The main aim and objectives of the study has been mentioned
along with the hypothesis under this heading.
3. Review of literature: This chapter comprises of exhaustive collection of
data wise, about Etymology, Definition, Classification, Nidana, Poorva
roopa, Roopa, Samprapti, Sadhya-asadhyata, Upadrava, Arista lakshana and
Chikitsa along with Pathya-apathya of the disease. Some modern aspects of
Iron Deficiency Anaemia have been dealt.
4. Methodology:
• Clinical study – Under this heading detailed description of the
clinical study with specific reference to patients, grouping, selection,
inclusion and exclusion criteria, protocol, criteria for assessment of
signs and symptoms, dose, duration of the study is mentioned.
• Observational study – Here a detailed explanation is given on the
distribution of the patients according to age, sex, economical status,
Page : 128
Summary
diet, habits, marital status, hygienic conditions, educational status are
represented along with tables and charts.
• Preparation of the drug- Here a detailed explanation regarding the
preparation of the compound drug has been mentioned in detail.
5. Results: A total of 25 patients in each group were selected for the present
study which was according to the inclusion and exclusion criteria of the
study.
• Result of clinical study – The results obtained after completion of 45
days of treatment is discussed under this heading. The scoring of
important feature of Pandu before and after the treatment is tabulated
and percentage of improvement is taken. The improvement grading is
done and this is analyzed statistically with student paired t- test. The
total relief obtained after the treatment schedule was recorded as i)
Complete relief, ii) Marked improvement, iii) Moderate improvement
iv)Improved, v) Unchanged. In the present study no side effects was
reported.
6. Discussion: Under this heading, Nidanatmaka study and results obtained
from this study have been described. The probable mode of action of the trial
drug that is Nisha loha as a yoga and role of individual drugs in the
management of Pandu roga is discussed, the role of Dadimadi ghrita and
Virechana in the management of Pandu has been discussed.
7. Conclusion: In this chapter the conclusion of the above study is done by
highlighting the outcome of the study along with limitation of study and the
scope of further improvement.
Page : 129
References
REFERANCE Vyuthpathy and Paribasha
1. S.K.D. 2. A.K. Khanda, 5th varga 3. S.S. Ut. 44/4 4. A.H. Ni 13/3-4 5. Dl on S.S. Ut 44/3 6. M.N Madhu 8
Paryaya
7. S.S. Ut. 44/6 8. Dl on S.S. Ut 44/6
Nidana
9. C.S. Ch 16/3 10. C.S. Su 7/14 11. C.S. Ch 16/18 12. C.S. Ch 16/7-8 13. C.S. Si 6/69 14. C.S. Su 3/75 15. C.S. Ch 9/16 16. C.S. Su 13/21 17. C.S. Su 7/14 18. C.S. Si 12/30 19. S.S. Sa 6/27 20. S.S. Ni 11/17 21. S.S Ch 2/51 22. C.S. Ch 2/27 23. S.S. Sh 2/20 24. H.S. 3/9/19 25. Sh.S Ut 40/177 26. C.S. Ch 3/337 27. S.S. Ut 40/177 28. C.S. Ch 14 29. A.H. Ni 15/56 30. C.S. Ni 2/7 31. S.S. Sh 2/19 32. C.S Ch 30/13 33. A.H. Ni 12/26 34. S.S Ni 7
References
35. S.S Ut 24/8 36. S.S Ut 41 37. S.S. Ut 12/9 38. C.S Su 17/69 39. C.S Ch 30/161 40. C.S. Ch 30 41. S.S Ni 6 42. A.H Ni 13 43. C.S Ch 23 44. C.S Su 28/9 45. S.S. Sa 9 46. K.S. Ch Balagraha 47. S.S. Su 25 48. A.S. Ut 41 49. K.S. Kila 9 50. S.S Ka 7/11 51. S.S Ni 8/14 52. B.P Sandhana varga 17 53. C.S. Su 1/107 54. B.P Taila varga 2/6 55. C.S. Ch 16/27 56. A.S. Su 7/53 57. C.S. Su 27/87 58. B.P Mamsa varga 40 59. C.S. Su 27/74 60. S.S. Su 45 61. C.S Ch 16 62. R.P.B.D.
H.P.I.M T.B.P D.P.P.M
Poorva roopa
63. A.H Ni 13/8 C.S. Ch 16 S.S. Ut 44
Samprapthi
64. C.S Ch 16/4 65. C.S. Ch 16/10 66. C.S. Ch 16 67. M.N 8
References
Pandu bheda
68. C.S. Ch 16/33 69. S.S Ut 44/4 70. A.H Ni 13/7 71. M.N 8/11 72. Y.R. Panduroga
Roopa
73. A.H. Ni 13/9 74. A.H. Ni 13/10 75. A.H. Ni 13/11 76. A.H. Ni 13/12 77. A.H. Ni 13/13
Sadhya Asadhyatha
78. C.S. Ch 16/31 M.N. 8/11 Y.R Pandu 13-14 S.S Ut 44/39
Arishta Laxana
79. C.S. Ind 6/19 Pathya Apathya
80. B.R. Pandu 12 Chikitsa
81. C.S Ch 16/14 82. S.S. Ch 32 83. R.R.S 5/139 84. B.R. Pandu 32 85. C.S. Ch 16/17 86. C.S. Ch 16/123
References
Virechana 87. A.S. Su 27/5 88. C.S. Su 25/40 89. Sh.S. 4/4 90. Sh.S Ut 4/16 91. C.S. Su 13/26 92. A.S. Su 24 93. A.S. Su 24 94. C.S. Su 13 95. C.S. Su 13/58 96. C.S. Su 13/59 97. C.S. Su 16/75 98. C.S. Si 1 99. S.S. Ch 31/56
100. C.S. Su 15/18 101. C.S. Si 1/8 102. C.S. Si 1/7 103. C.S. Si 1/5 104. C.S. Si 1/11 105. C.S. Ka 1
Iron Deficiency Anemia 106. D.P.P.M 107. Mehta BC 1998 108. T.B.P 109. C.M.P Sec 2 110. C.M.P Sec 2 111. T.B.P 112. C.M.P Sec 2
Drug Review 113. C.S. Ch 16/45 114. B.R. Pandu roga 115. D.G.V. Page No.162 116. D.G.V. Page No.537 117. D.G.V. Page No.758 118. D.G.V. Page No.239 119. D.G.V. Page No.753 120. D.G.V. Page No.441 121. D.G.V. Page No.340 122. D.G.V. Page No.322 123. D.G.V. Page No.359 124. D.G.V. Page No.331 125. D.G.V. Page No.275 126. D.G.V. Page No.420
Bibliography
BIBLIOGRAPHY
1. Agnivesha; Charaka Samhita, Rev by Charaka and Dradabala, Ayurveda
Dipika Commentry by Chakrapanidatta with Vidyotani Hindi Commentry by
Pandith Kasinath Shastri, 1997, Published by Chaukambha Saskrit Samsthan
Varanasi.
2. Agnivesha; Charaka Samhita, Rev by Charaka and Dradabala commentary by
Chakrapani, 2001, Chaukambha Sanskrit Samsthan, Varanasi.
3. Amarasinha, Amarakosh; with Ramasrani commentary of Bhanuji Diksita,
edited with the easy maniprabha hindi commentary by Haragovinda Shastri, 3rd
edition, 1997, Chaukambha Sanskrit Samsthan, Varanasi
4. Anonymous, Yogaratnakara: Vidyotini Hindi commentary by Vaidya
Laksmipathi Sastri, 7th edtn 1999, Chaukambha Sanskrit Sansthan, Varanasi.
5. Basavaraj, Basava Rajeeyam:,edited by Goverdan Sharma,published by
Gorakshanantralaya Nagpur, Also Chaukambha Sanskrit orientalia, Varanasi.
6. Bhavamishra; Bhavaprakash Nighantu, commentary by Dr.K.C Chunekar,
edited by Dr.G.S.Pondey, 1998, Chaukambha Bharati Academy, Varanasi.
7. Bhavaprakash; Bhavamishra, Vidyotini Hindi Commentry by Brahmasankara
misra & Rupalalji Vaisya, Chaukmbha Sanskrit Sansthan, Varanasi.
8. Boyd, William; Boyd’s Textbook of Pathology: ed A.C Ritchie, 9th
edition1990, Lea & Febiger, Philadelphia, London.
9. Chakrapanidatta, Chakradatta with Vaidayaprabha Hindi commentary by Dr.
Indradeva Tripathi, 1997, Chaukambha Sanskrit Sansthan, Varanasi
10. Chaudhari, Sujit.K.; Concise Medical Physiology, 1998, II edition, New
Central Book Agency(p) Ltd, Calcutta.
Bibliography
11. Davidson, Sir Stanley; Davidson’s Principles and practice of medicine:Ed
C.R.W. Edwards et al,17th International Student edition 1995, Reprinted
1998,Churchil Livinstone, Edinburgh
12. Deva Raja Radhakant; The Shabdakalpadruma, 1988, Nag publishers, Delhi.
13. French, Herbert; French’s Index of Differential Diagnosis, 13th Edition, Ed Ian.
A.D. Bouchiers, Harolld Ellis, Peler R, Fleming.Butterwoth Heinemann, a
division on Reed educational and Proffessional Publishing Ltd.
14. G. N. Shakunthala; Clinical Study on the effect of Dhatriloha in pandu (IDA)
(Unpublished doctoral dissertation, University of Mysore, Mysore).
15. Govind Das; Bhaisajyaratnavali, Vidyotini Hindi Commentry By Ambikadatta
Shastri, Ed Rajeshwaradatta Shastri,2001, Chaukmbha Sanskrit Sansthan,
Varanasi.
16. Guyton Arthur. C; Hall Jhon. E. Text Book of Medical Phisiology:,9th edition
Harcourt Brace & company Asia pte Ltd Singapore.
17. Harrison.T.R.; et.al, Harrison’s principle’s of Internal medicine. vol I &II, 14th
International Ediion 1998,Published by McGraw-Hill book Co, Singapore.
18. Harsh Mohan; Text Book of Pathology (1998), 4th edition, Jaypee Brothers
Medical publishers (p) Ltd., New Delhi.
19. Joshi Venimadhavashastri, Narayan Edt; Ayurvedeeya Shabdhakosha: ‘Hari
Joshi publishers’, Department of culture & Literature (sahitya) Government of
Maharasthra, Mumbai.
20. Kashyapa, Maricha; Kashyapa Samhita (1998), Vruddha Jeevaka Rev Vatsya
with Vidyotani Hindi commentary by Satyapala Bhisagacharya Chaukambha
Sanaskrit Sansthan, Varanasi.
Bibliography
21. Kasthuri Haridas Shridara; Ayurvediya Panchakarma Vijnana: Shree
Baidyanath Ayurveda Bhavan Limited Nagpur.
22. Kayadeva; Kayadeva Nighantu (1979), edited & Translated by prof.
Priyavrata Sharma, Dr. Guru Prasad Sharma, I edition, Chaukambha
Orientalia, Varanasi.
23. Kirtikar Lt.col.K.R & Basu; Indian Medicinal Plants (1993), II edition.
Periodical Experts Book Agency. Delhi.
24. Madhavakara; Madhava Nidana, with Madhukosha commentary by
Vijayarakshita &Srikantha Datta, ’Vimala’ Madhukara Hindi commentary by
Dr Brahmananda Tripathi, Chaukamba Surabharati Prakashana, Varanasi.
25. Mahajan, B.K.; Methods in Biostatistics, 6th Edition, Jaypee Brothers, Mumbai,
Maharashtra
26. Mahakavi Kaalidas; Malavika Agnimitram, Edited with, the Prakash, Sanskrit
Hindi commentaries by Shri Ramachandra Mishra, 1965. The Chowkamba
Sanskrita Series Office. Varanasi.
27. Mukharjee Kanai.L. Medical Laboratary Technology (1978) . Tata Mcgrow-
Hill publishing company limited, New Delhi.
28. Mukhopadhyaya Girindranath; History of Indian medicine, II edition, 1974,
Oriental Books Represent Corporation, New Delhi.
29. Narahari; Rajanighantu (1998), Dravyaguna prakasika Hindi commentary by
Dr. Indradev Tripathi, Krishnadas Academy, Varanasi.
30. Pathak Kaviraj Ramraksha; Pondu Roga, Central research Institute, Jamnagar.
Bibliography
31. Rasavaidya Shaha Nageenadas Changanlal (collected by): Bharat Bhaishajya
Ratnakar, (1985) commented by Gopinath Gupta edited by Nivarachandra
Bhattacharya, Motilal Banarasidas, Delhi.Jamnagar.
32. Robbin’s pathologic basis of Disease(1994):Ramzi S Cutran, Vinay Kumar,
Stanley L Robbin, W.B.Saunders Company, Harcourt Brace & Company
33. Sharangadharacharya; Sharangadhar Samhita, Dipika Hindi Commentry by Dr
Brahmanand Tripathi, Chaukhambha Surabharathi Prakashan, Varanasi.
34. Sharma Dr Guruprasad; Dhanavantari Nighantuh (1998), by edited by
Priyavrita Sharma, Chaukambha Orientalia, Varanasi.
35. Sharma, K. Sadashiva:Samprapthi lakshanayoho sambandhaha,Ayurveda
Snatakottar Shikikshana Kendram,1961,Jamnagar,Gujarat.
36. Sharma Priyavrat; History of Medicine in India, edition I print 1992.India
National Science Academy, New Delhi.
37. Sharma Prof P.V.; Dravya Guna Vijnana, 1998, Chaukambha Amarabharati
prakashana, Varanasi.
38. Sharma Shri Sadananda; Rasatarangini (1998), Hindi commentary by Pt
Kashinath Shastri. Motilal Banarasidas. Delhi.
39. Shukla Vidyadar; Kayachikista (1995); by Chaukambha Surabharati
Prakashana, Varanasi.
40. Sodhala Sri Vaidya, Gada Nigraha: (1997), Vidyotini Hindi commentary by
Sri Indradeva Tripathi edited by Sri Ganga Sahaya Pondeya II edition,
Chaukambha Sanskrit Sansthan, Varanasi.
41. Sood, Dr. Ramnik; Hematology for students & practitioners, 3rd edition,
1984,Jaypee Brothers Medical publishers(p) Ltd, New Delhi
Bibliography
42. Sushruta, Sushruta Samhita, Rev Dhalanacharya and the Nyayachandrika
panjika of Sri Gayadasacharya on Nidanashana.1997
43. Taber’s cyclopedia Medical Dictionary (1990) 16th edition, Jaypee Brothers,
Delhi.
44. The Ayurvedic Formulary of India, part- I, Government of India, Ministry of
Health & Family Planning, Department of Health.
45. Vagbhata, Astangahridayam, with commentaries Sarvangasundara of
Arunadatta and Ayurveda Rasayana of Hemadri, Ed by Pandit Bhishak
Acharya, Hari Shastri paradkar Akola 8th ed 2000,Chaukambha Orientalia,
Varanasi(U.P).
46. Vaghbhata, Astanga Sangraha: with Hindi commentary by Kaviraj Atrideva
Gupta, Reprinted edtn, 1993, Krishnadas Academy, Varanasi.
47. Vagbhatacharya, Rasa Ratna Samuchaya (1995): Suratnojjvala Hindi
commentary by Ambikadatta shastri, Chaukambha Amarabharati prakashana,
Varanasi.
48. Vaishya Sri Saligrama, Shaligrama Nighantu Bhusanam :1999 ,I edition
Kaviraj Shri Krisnadas prakashan Mumbai.
49. Vidyadhar Shukla, Ayurveda Vikriti Vijnana, Chaukambha Sanskrit
Pratisthan. Delhi..
50. Williams Sir Monier, A Sanskrit English Dictionary (1999): 1st edition Motilal
Banarasidas publishers Pvt. Ltd, Delhi.
Case Proforma
CLINICAL PROFORMA DEPARTMENT OF KAYACHIKITSA
A.L.N.R.M.A.COLLEGE, KOPPA-577 126 PROFORMA FOR CLINICAL STUDY ON PANDU ROGA
Part-A – Examination P.G. Scholar: Dr. James Chacko Guide: Dr. T.K. Mohantha, M.D., Ph.D. (Ayu) Co-Guide : Dr. Neelkant J, M.B.B.S. MD(Med)
Patient Name: Group:
Age/Sex: ..............yrs M/F Sl.No.:
Religion: H/M/CH/J OPD/IPD:
Education: UE/P/M/HS/GR/ Ward/Bed No:
Marital Status: M/UM/W/D D.O.A :
Social status: VP/P/LM/M/UM/R D.O.D:
Occupation: HW/W/B/S/E Diagnosis:
Postal Address: Result:
Chief Complaints Duration BT AT I II III
1. Bhrama
2. Hridrava
3. Arohana ayasa
4. Pandutha
5. Aruchi
6. Karnakshwedi
7. Srama
8. Durbalatha
9. Padashotha BT AT
Associated Complaints Present / Absent 1. Hatanala
2. Annavit
3. Gathrasula
4. Jwara
Case Proforma
5. Gourava
6. Shoonaakshikootashotha
7. Nidralu
8. Shtivana
9. Sandhisoola
II. History of Present illness:
III. History of past illness:
IV. Drug History:
V. Family History:
VI. Personal History:
1. Diet:
Nature : Veg/Mix
Habits: Samasana/Visamasana/Adhyasana/Anasana/Pramitasana
Rasapradhana: M/A/L/K/T/KS/Sarva rasa
Supplementary diet: Tea/Coffee/Milk/Cold drink
Water intake: Every morning, during or after lunch &dinner
2. Vyasana: Alcohol/smoking/tobacco chewing/others/Nil
Vyayama: Regular/Irregular/occasional/only routine work.
3. Nidra: Sound/Irregular/Disturbed/Delayed
Night:................Hrs Day............Hrs.
4. Malapravrutti: Regular/Irregular/constipation/Loose/Soft/Hard
No. Of frequency ...........
Case Proforma
5. Mootrapravrutti: Regular/Irregular...........times/day..........times/night
Colour: .............
6. Agni: Samagni/Mandagni/Vishamagni
VII. Occupational History: Sedenatary/moderate/Heavy
Nature of Work: Physical/mental
Time of work: Day/Night/Day & Night.........Hrs.
VIII. Socio Economic History:
Hygienic condition of residence: Poor/Moderate/Good
Economically. Poor / Moderate / Upper
IX. Gynaecological/Obstetrics History:
Part - B
I. Atura Bala Pariksha:
1. Prakriti :
Sharira : V/P/K/VP/VK/PK/VPK
Manas : S/R/T/
2. Sara : T/R/M/Md/A/MT/S/Sv
: P/M/A
3. Samhana : P/M/A
4. Satva : P/M/A
5. Satmya : P/M/A
6. Pramana : Height.........ft.
: Weight......Kg:(BT).....Kg:(AT)
7. Ahara Shakti :
Abhyavaharan shakti : P/M/A/(BT) P/M/A(AT)
Jarana shakti : P/M/A/(BT) P/M/A (AT)
Agni : Sama/Visama/Manda/Tikshna (BT)...........(AT)
Kostha : Mridu/Madhyama/Krura (BT) ..............(AT)
8. Vyayama shakti : P/M/A (BT) P/M/A (AT)
Case Proforma
9. Vaya : Bala/Madhyama/Vridda
10. Desha : A/J/S
11. Vikrititaha : P/M/A
II. General Examination: BT AT 1) 2) 3) Pulse rate:
Respiration rate:
Temp:
BP:
Pallor:
Icterous:
Cyanosis:
Clubbing:
Pedal oedema/Puffiness:
Lymphadenopathy:
III. Systemic Examination.
RS:
CVS:
CNS:
GIT:
I. Inspection:
Mouth : Stomatitis/Other/Normal
Shape : Distended/Scaphoid/Bulging of flanks/Normal
Umbilicus : Inverted/Everted/Normal
Surface : Smooth/Glossy/scar/wrinkles/Pigmentation/striae
Asymetrial Bulging : Epigastric/Hypogastric/Umbilical/lumbar/
Hypocondriac/illiac/None
Movement : Symetrical/Asymetrical
Pulsation : Visible/Invisible
P/A
Case Proforma
II. Palpation : Superficial-Region of tenderness............
Hyperaesthesia: Present/Absent/Site...........
Musle guard: Regid/Normal
Liver : Palpable/Tender/Normal
Spleem : Palpable/Tender/Normal
Kidney : Palpable/Tender/Normal
Colon : Palpable/Tender/Normal
Any other Mass Present/Absent
III. Percussion :
IV. Srotas Examination:
Annavaha Srotas : Aruchi/Avipaka/Chardi/Anannabhilasha/Prakrita
Rasavaha Srotas : Angasad/Prasek/Alasya/Gaurava/Bhrama
Krusha/Tantra/Hrullasa/Aruchi/Jwara/Glani/Pandu/
Asraddha/Asyavairasya Arasagnata/Prakrita
Rakthavaha Srotas : Bhrama/Peedaka/Gudhapaka/Medrapaka/Asyapaka/
Pleha/Neelika/Mandala
Other Srotas : Prakrita/Vaikrita
V. Investigation: B.T. A.T.
1. Haematological Investigation: HB%
TC
DC
ESR
Heamogram
Peripheral smear
Case Proforma
2. Routine Urine Investigation: Micro / Macro
3. Others
Scoring Chart A) Main Complaints:
Score Bhrama Pandutha Arohana ayasa Hrudrava Shotha 0 No Bhrama No Pandatha No Arohana ayasa No Hrudrava No Shotha 1 Occasional Pale pink Walking for
20min. with difficulty
After heavy work
Mild Shotha
2 Frequently Pale Walking for 10min. with difficulty
After light work
Moderate
3 Always White Walking for 5min. with difficulty
Always Present
Severe
B) Associate Complaint:
Score Karnashweda Aruchi Srama 0 None Equal emitting towards all
food substance No srama
1 Occasionally Willing towards some specific tastes
After heavy work
2 Frequently Willing towards only one taste
After light work
3 Always Willing towards only liking food
Always Present
VI. Provisional Diagnosis: VII. Final Diagnosis:
Case Proforma
Part – C
I. Treatment Schedule :
1. Virechana Procedure : Snehapana: 1 day 2 day 3 day 4 day 5 day 6 day 7 day
Anupana : Any Complications : Swedhana Karma : 1 day 2 day 3 day Complication Virechana Yoga : ……………………………… Dose : Type of Shuddhi : Samsarjana Krama:
II. Treatment Schedule (Group –II)
Trial Drug Dosage : Duration : Anupana :
PART D
Pathya Apathya : Signature of the Researcher Signature of the Guide
Case Proforma
POST GRADUATE STUDIES AND RESEARCH CENTRE
DEPARTEMENT OF KAYACHIKITSA
A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE
KOPPA-CHIKMAGALUR
PATIENT CONSENT FORM I __________________________________________ exercising my free power of
choice, hereby give you my complete consent to be included as a subject in the Clinical
trial on “CLINICAL EVALUATION OF VIRECHANA AND NISHA LOHA IN THE
MANEGEMENT OE PANDU ROGA WITH SPECIAL REFERENCE TO IRON DEFICIENCY
ANAEMIA”. I have been informed to my satisfaction by the attending Doctor, the purpose
of the Clinical Trial and the nature of drug treatment, therapeutic procedures, follow-up
and probable complications. I am also ready to undergo necessary Laboratory
Investigations to monitor and safeguard my body functions.
I am also aware of my right to opt out of the trial at any time during the course of
the trial without having to give the reasons for doing so.
Signature of the Doctor Signature of the Patient/ Guardian
(£Á£ÀÄ N¢/ N¢¹ CxÀð ªÀiÁrPÉÆAqÀÄ
¸À» ºÁQgÀÄvÉÛãÉ.)
MASTER CHART - SHODANA
Associated symptoms I II III
Sl.No Name Age Sex Religion Occupation Economical status
Diet Hygiene
BT AT BT AT BT AT
1. VIB 32 F H Hw U V Md + + + + + +
2. SAT 20 M H St U V Md A A + + ++ + 3. SRA 31 F Mu Ue L Mx P A A + - + +
4. RMP 47 M H Lb Mi V P + + + + + + 5. CTY 26 M C St Mi Mx Md A A ++ - + +
6. SRA 42 F H Lb L V P A A + + + + 7. SUR 49 F Mu Ue Mi V Md + + + - + +
8. VHU 33 M H Lb U V P A A + + + +
9. VEN 24 F C St L Mx G A A A A + - 10. BAK 50 F Mu Lb Mi V P A A + + ++ +
11. BTA 33 F C Ue Mi Mx Md + + ++ + ++ ++ 12. ADL 42 M Mu Lb L V P A A + + + -
13. VIH 37 F H Ue Mi V Md A A A A + + 14. SAK 40 F Mu Hw Mi V P + - + + + +
15. SUK 28 M Mu Bs Mi Mx Md A A ++ + + - 16. MAL 55 M Mu Lb L Mx P + + + + + +
17. ANM 58 F C Hw Mi Mx G A A A A + + 18. RDA 47 F H Lb L V P ++ + + - + +
19. KRU 38 F C Ue U Mx Md A A + + + + 20. AMD 60 M Mu Lb Mi Mx P ++ + A A + +
21. SRD 23 F H Hw L V P A A + + ++ ++ 22. FUK 56 M Mu Lb L Mx P + - + - ++ + 23. MAT 35 F H Ue U V Md A A A A + + 24. MAD 44 M Mu Lb L Mx P ++ + ++ + ++ + 25. PLV 34 F H Hw L V P A A ++ + + +
I-Karnakshweda, II-Aruchi, III-Srama; M-Male, F-Female; H-Hindu, C-Christian, Mu-Muslim; Lb-Labor, Hw-House wife, Se-Service, Bs-Business, Ue–Unemployed, St–Student; L-Lower Class, Mi- Middle Class, U-Upper Class; V-Vegetarian, Mx- Mixed diet; Md-Moderate, P-Poor, G- Good; +- 1 score, ++- 2 scores, -ve- 0 score; BT- Before Treatment, AT-After Treatment; A –Absent.
Shodana – After treatment Main complaints Srotho dusti
Sl. No:
I II III IV V A B C Hb%
BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 + + + + + + + + + + + + ++ - ++ ++ + +
2 + + + + + + + + A A + + ++ - ++ + ++ ++ 3 + + + + + + + + + + + + + - ++ ++ ++ - 4 + + + + + + + + A A A A + - + + + - 5 + + + + ++ - + + + + A A + - + - ++ ++ 6 ++ ++ + + + + + + A A A A + - + - + - 7 ++ ++ ++ ++ + + + + + + + + ++ + + - + - 8 A A ++ ++ ++ - + + + + + + + - ++ ++ ++ + 9 + - ++ ++ + + + + + + + + ++ + + + + +
10 ++ + ++ ++ ++ + A A A A ++ ++ + + + + + + 11 + - + - + + A A A A ++ ++ + + + + + + 12 ++ + + - ++ ++ A A A A ++ ++ + + + + + + 13 + - + - + + A A A A ++ ++ + + + + ++ ++ 14 ++ + ++ ++ + + ++ + A A ++ ++ ++ ++ ++ ++ + - 15 + - ++ ++ ++ + ++ + A A A A ++ ++ + + ++ + 16 + - + + ++ + + + A A A A ++ ++ ++ ++ + + 17 A A + - ++ + ++ + A A + + ++ ++ + + ++ + 18 A A ++ + + + ++ + A A ++ + + + + + + + 19 A A ++ + ++ + + - A A + + + + + + + - 20 A A ++ + + + + - ++ + ++ + ++ ++ + - + + 21 + + + - ++ + + - ++ + + - ++ ++ + - + + 22 ++ ++ + - + + + - + - + - + + ++ + + + 23 + + + - + + A A ++ + + - + + ++ + ++ + 24 + + ++ + ++ + ++ ++ + + ++ + + + + - + - 25 ++ ++ ++ + + + + + + + ++ + ++ ++ + - ++ +
I – Brama, II – Pandutha, III – Arohanayasa, IV – Hridrava, V – Shotha; A – Anna vaha srothus, B – Rasa vaha, C – Raktha vaha; ; + - 1 score, ++ - 2 scores, -ve - 0 score; BT- Before Treatment, AT – After Treatment; A - Absent.
MASTER CHART – SHODANA AFTER FOLLOW UP
Associated symptoms I II III
Sl.No Name Age Sex Religion Occupation Economical status
Diet Hygiene
BT AFU BT AFU BT AFU 1. VIB 32 F H Hw U V Md + + + + + + 2. SAT 20 M H St U V Md A A + - ++ + 3. SRA 31 F Mu Ue L Mx P A A + - + + 4. RMP 47 M H Lb Mi V P + + + + + + 5. CTY 26 M C St Mi Mx Md A A ++ + + - 6. SRA 42 F H Lb L V P A A + + + + 7. SUR 49 F Mu Ue Mi V Md + + + + + + 8. VHU 33 M H Lb U V P A A + - + + 9. VEN 24 F C St L Mx G A A A A + +
10. BAK 50 F Mu Lb Mi V P A A + + ++ ++ 11. BTA 33 F C Ue Mi Mx Md + - ++ ++ ++ - 12. ADL 42 M Mu Lb L V P A A + - + + 13. VIH 37 F H Ue Mi V Md A A A A + + 14. SAK 40 F Mu Hw Mi V P + - + + + + 15. SUK 28 M Mu Bs Mi Mx Md A A ++ + + + 16. MAL 55 M Mu Lb L Mx P + + + + + - 17. ANM 58 F C Hw Mi Mx G A A A A + + 18. RDA 47 F H Lb L V P ++ + + - + - 19. KRU 38 F C Ue U Mx Md A A + - + - 20. AMD 60 M Mu Lb Mi Mx P ++ + A A + + 21. SRD 23 F H Hw L V P A A + + ++ + 22. FUK 56 M Mu Lb L Mx P + - + + ++ ++ 23. MAT 35 F H Ue U V Md A A A A + - 24. MAD 44 M Mu Lb L Mx P ++ + ++ - ++ + 25. PLV 34 F H Hw L V P A A ++ ++ + +
I-Karnakshweda, II-Aruchi, III-Srama; M-Male, F-Female; H-Hindu, C-Christian, Mu-Muslim; Lb-Labor, Hw-House wife, Se-Service, Bs-Business, Ue–Unemployed, St–Student; L-Lower Class, Mi- Middle Class, U-Upper Class; V-Vegetarian, Mx- Mixed diet; Md-Moderate, P-Poor, G- Good; +- 1 score, ++- 2 scores, -ve- 0 score; BT- Before Treatment, AFU -After follow up, A - Absent.
Shodana – After follow up
Main complaints Srotho dusti I II III IV V A B C Hb% Sl.
No: BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU 1 + + + + + + + + + + + + ++ + ++ + + +
2 + + + + + - + + A A + + ++ - ++ + ++ ++ 3 + + + + + - + + + + + + + + ++ ++ ++ ++ 4 + + + + + - + - A A A A + - + + + + 5 + + + + ++ ++ + - + + A A + + + - ++ + 6 ++ + + - + + + - A A A A + - + + + + 7 ++ + ++ - + + + - + + + + ++ - + + + + 8 A A ++ - ++ + + + + + + - + - ++ ++ ++ - 9 + + ++ - + - + - + + + + ++ - + + + -
10 ++ - ++ + ++ + A A A A ++ + + - + + + - 11 + + + + + - A A A A ++ + + + + + + + 12 ++ - + + ++ + A A A A ++ + + + + + + + 13 + + + - + + A A A A ++ + + + + + ++ + 14 ++ + ++ - + + ++ + A A ++ + ++ ++ ++ + + + 15 + + ++ + ++ + ++ + A A A A ++ ++ + + ++ + 16 + + + + ++ + + + A A A A ++ ++ ++ - + - 17 A A + + ++ + ++ - A A + - ++ + + + ++ - 18 A A ++ + + + ++ + A A ++ - + - + - + - 19 A A ++ ++ ++ + + + A A + - + - + - + + 20 A A ++ ++ + + + + ++ - ++ ++ ++ - + - + - 21 + + + + ++ - + + ++ - + + ++ ++ + + + - 22 ++ + + + + + + + + - + + + + ++ - + + 23 + - + ++ + + A A ++ - + + + + ++ - ++ + 24 + - ++ + ++ - ++ + + - ++ + + + + + + + 25 ++ - ++ + + - + + + + ++ + ++ + + - ++ +
I – Brama, II – Pandutha, III – Arohanayasa, IV – Hridrava, V – Shotha; A – Anna vaha srothus, B – Rasa vaha, C – Raktha vaha; ; + - 1 score, ++ - 2 scores, -ve - 0 score; BT- Before Treatment, AFU – After follow up; A - Absent.
MASTER CHART - SHAMANA
Associated symptoms I II III
Sl.No Name Age Sex Religion Occupation Economical status
Diet Hygiene
BT AT BT AT BT AT
1. VSK 20 M H Lb Mi V G + + + + + + 2. SKL 41 F Mu Hw L Mx P A A ++ + ++ - 3. RAP 24 M H Lb Mi V G A A ++ + + + 4. SYM 31 F H Hw L V P + - + + + - 5. HRS 48 F H Ue Mi Mx G A A + - + + 6. SVT 26 F H Hw Mi V Md A A + - + - 7. KRH 58 M H Ue L V P A A + + + + 8. SVB 37 F Mu Ue U Mx G A A + - ++ + 9. STM 22 F H Lb L V P A A + - + +
10. KOR 47 M H Lb L Mx P + - + + + + 11. RLM 30 F H Hw Mi V Md A A A A + + 12. ABD 40 M Mu Bs U Mx G A A ++ + ++ ++ 13. SJV 28 F Mu Hw L V P A A + + + + 14. NDN 36 M H St Mi Mx Md ++ + ++ + + - 15. SEL 42 F H Ue L V P A A + - + + 16. CRT 32 M Mu Hw L V P + + + - ++ + 17. BSR 42 M C Bs U Mx Md A A + + + + 18. VSU 60 M Mu Ue U Mx Md A A A A + + 19. SMN 39 F H Ue L V P + - + + ++ + 20. LUS 38 F Mu Hw Mi V Md A A A A + + 21. RAM 21 M C Ue L Mx P ++ + A A ++ - 22. SYD 52 M H Lb Mi V Md A A + + + + 23. HSN 37 F Mu Lb L Mx P A A A A + + 24. PIS 55 M C Ue L Mx P ++ + + + ++ - 25. RKN 30 M H Lb Mi Mx Md A A + + + +
I-Karnakshweda, II-Aruchi, III-Srama; M-Male, F-Female; H-Hindu, C-Christian, Mu-Muslim; Lb-Labor, Hw-House wife, Se-Service, Bs-Business, Ue–Unemployed, St–Student; L-Lower Class, Mi- Middle Class, U-Upper Class; V-Vegetarian, Mx- Mixed diet; Md-Moderate, P-Poor, G- Good; +- 1 score, ++- 2 scores, -ve- 0 score; BT- Before Treatment, AT-After Treatment; A –Absent.
Shamana – After treatment Main complaints Srotho dusti
Sl. No:
I II III IV V A B C Hb%
BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 + + + + ++ ++ + + + + + + + + + + + +
2 A A + + + + A A A A + + + + + + ++ ++ 3 + + + + + + + + + + + + + + + + + + 4 A A ++ - ++ + + + A A A A + + ++ - + + 5 + + ++ ++ ++ + A A A A + + + + ++ - + + 6 ++ ++ ++ - + - + + + + A A ++ ++ ++ + + + 7 A A + + ++ + + + A A ++ ++ ++ ++ ++ + + + 8 + + ++ ++ + - ++ ++ + + A A ++ - + - + + 9 + + + + ++ + A A A A + + ++ ++ + - + +
10 + + ++ + ++ ++ + + A A A A + + + - + - 11 + + + - ++ + ++ ++ + - + + + - ++ + + - 12 + + ++ + + + + + A A A A + - ++ + + - 13 A A + - + - + + ++ + + + ++ ++ ++ + + - 14 ++ + + - + + ++ ++ A A ++ - ++ ++ ++ + ++ + 15 ++ ++ + - ++ + A A ++ + + + + + ++ + + + 16 A A ++ ++ + + + - A A + + + + ++ - + - 17 ++ + + - + - A A ++ + ++ + + + + + + - 18 + - + + + + ++ - A A + - ++ + + + ++ + 19 ++ + + - ++ + ++ + ++ + ++ + ++ + ++ ++ ++ + 20 + - + + + + + - A A ++ + ++ + ++ ++ + - 21 + - + - ++ - + - + - ++ + ++ + + + ++ + 22 ++ + + - ++ ++ ++ + A A + - ++ + + + + - 23 + - ++ ++ ++ - ++ ++ A A ++ + ++ + + + ++ ++ 24 + - ++ - + + + - A A + - ++ + + + ++ ++ 25 + + ++ ++ + + ++ ++ A A ++ + ++ + + + ++ ++
I – Brama, II – Pandutha, III – Arohanayasa, IV – Hridrava, V – Shotha; A – Anna vaha srothus, B – Rasa vaha, C – Raktha vaha; ; + - 1 score, ++ - 2 scores, -ve - 0 score; BT- Before Treatment, AT – After Treatment; A - Absent.
MASTER CHART – SHAMANA AFTER FOLLOW UP
Associated symptoms I II III
Sl.No Name Age Sex Religion Occupation Economical status
Diet Hygiene
BT AFU BT AFU BT AFU
1. VSK 20 M H Lb Mi V G + + + + + + 2. SKL 41 F Mu Hw L Mx P A A ++ ++ ++ ++ 3. RAP 24 M H Lb Mi V G A A ++ ++ + + 4. SYM 31 F H Hw L V P + + + + + - 5. HRS 48 F H Ue Mi Mx G A A + - + - 6. SVT 26 F H Hw Mi V Md A A + + + - 7. KRH 58 M H Ue L V P A A + - + + 8. SVB 37 F Mu Ue U Mx G A A + + ++ ++ 9. STM 22 F H Lb L V P A A + + + -
10. KOR 47 M H Lb L Mx P + - + - + + 11. RLM 30 F H Hw Mi V Md A A A A + + 12. ABD 40 M Mu Bs U Mx G A A ++ ++ ++ - 13. SJV 28 F Mu Hw L V P A A + + + + 14. NDN 36 M H St Mi Mx Md ++ + ++ - + + 15. SEL 42 F H Ue L V P A A + + + - 16. CRT 32 M Mu Hw L V P + + + - ++ ++ 17. BSR 42 M C Bs U Mx Md A A + - + + 18. VSU 60 M Mu Ue U Mx Md A A A A + - 19. SMN 39 F H Ue L V P + + + + ++ ++ 20. LUS 38 F Mu Hw Mi V Md A A A A + + 21. RAM 21 M C Ue L Mx P ++ ++ A A ++ ++ 22. SYD 52 M H Lb Mi V Md A A + + + + 23. HSN 37 F Mu Lb L Mx P A A A A + + 24. PIS 55 M C Ue L Mx P ++ ++ + - ++ ++ 25. RKN 30 M H Lb Mi Mx Md A A + + + +
I-Karnakshweda, II-Aruchi, III-Srama; M-Male, F-Female; H-Hindu, C-Christian, Mu-Muslim; Lb-Labor, Hw-House wife, Se-Service, Bs-Business, Ue–Unemployed, St–Student; L-Lower Class, Mi- Middle Class, U-Upper Class; V-Vegetarian, Mx- Mixed diet; Md-Moderate, P-Poor, G- Good; +- 1 score, ++- 2 scores, -ve- 0 score; BT- Before Treatment, AFU-After follow up; A –Absent.
Shamana – After follow up Main complaints Srotho dusti
Sl. No:
I II III IV V A B C Hb%
BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU 1 + + + - ++ + + + + + + + + + + + + -
2 A A + + + + A A A A + + + + + + ++ + 3 + + + + + + + + + + + + + + + + + + 4 A A ++ - ++ ++ + - A A A A + + ++ + + + 5 + + ++ ++ ++ ++ A A A A + - + + ++ + + - 6 ++ ++ ++ ++ + - + + + + A A ++ + ++ ++ + + 7 A A + + ++ + + + A A ++ ++ ++ + ++ ++ + + 8 + + ++ ++ + + ++ ++ + + A A ++ + + - + + 9 + + + - ++ ++ A A A A + - ++ + + + + +
10 + + ++ ++ ++ ++ + + A A A A + + + + + - 11 + + + + ++ - ++ ++ + - + + + + ++ ++ + + 12 + + ++ ++ + + + + A A A A + + ++ ++ + + 13 A A + - + - + + ++ ++ + + ++ ++ ++ ++ + - 14 ++ + + - + - ++ + A A ++ ++ ++ ++ ++ - ++ ++ 15 ++ ++ + - ++ - A A ++ + + + + - ++ ++ + + 16 A A ++ ++ + + + + A A + + + + ++ ++ + - 17 ++ + + + + + A A ++ + ++ + + + + + + + 18 + - + - + - ++ ++ A A + + ++ ++ + + ++ + 19 ++ + + - ++ ++ ++ + ++ + ++ ++ ++ ++ ++ + ++ ++ 20 + - + + + + + + A A ++ - ++ ++ ++ ++ + + 21 + - + - ++ ++ + + + + ++ + ++ ++ + + ++ ++ 22 ++ + + - ++ ++ ++ + A A + + ++ ++ + - + - 23 + - ++ ++ ++ ++ ++ + A A ++ + ++ - + - ++ ++ 24 + - ++ + + - + + A A + + ++ + + + ++ ++ 25 + + ++ + + + ++ + A A ++ + ++ ++ + + ++ ++
I – Brama, II – Pandutha, III – Arohanayasa, IV – Hridrava, V – Shotha; A – Anna vaha srothus, B – Rasa vaha, C – Raktha vaha; ; + - 1 score, ++ - 2 scores, -ve - 0 score; BT- Before Treatment, AFU – After follow A – Abesnt.