pandu kc003 kop

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.

Ayurmitra

TAyComprehended

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

Ayurmitra

TAyComprehended



Certificate

This is to certify that the dissertation entitled “Clinical evaluation of


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



Certificate




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



Endorsement




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.

Page : 7

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.

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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


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


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


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


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


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


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


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


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


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


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 + + - -


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 - - - - - - + - -


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 - - - - +


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 - - - - - - - +


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 + - + + - - -


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 - - + + - - - -


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 - -


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

- - - - - - - - - + + + + + + + + + + + + + - - - - - - - -

+ + + + + + + + + - - - - - - - - - - - - - - - - - - - - -

+ + + + + + + + + - - - - - - - - - + + - - + + + + + - - +

+ + + + + + + + + - - - - - - - - - + + - - + + + + + + + -

+ + + + + + + + + + + + + + + + + + + + - - + + + + + + + +


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 &

- -

+ +

- -


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)


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


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


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)


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)


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.


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)


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.


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



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:


Complete relief 0 0



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:


Complete relief 0 0



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:


Complete relief 0 0



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)

&


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)

&


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)

&


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)

&


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)

&


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)

&


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)

&


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

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with Vidyotani Hindi commentary by Satyapala Bhisagacharya Chaukambha

Sanaskrit Sansthan, Varanasi.

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Baidyanath Ayurveda Bhavan Limited Nagpur.

22. Kayadeva; Kayadeva Nighantu (1979), edited & Translated by prof.

Priyavrata Sharma, Dr. Guru Prasad Sharma, I edition, Chaukambha

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23. Kirtikar Lt.col.K.R & Basu; Indian Medicinal Plants (1993), II edition.

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24. Madhavakara; Madhava Nidana, with Madhukosha commentary by

Vijayarakshita &Srikantha Datta, ’Vimala’ Madhukara Hindi commentary by

Dr Brahmananda Tripathi, Chaukamba Surabharati Prakashana, Varanasi.

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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-

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Dr. Indradev Tripathi, Krishnadas Academy, Varanasi.

30. Pathak Kaviraj Ramraksha; Pondu Roga, Central research Institute, Jamnagar.

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Kashinath Shastri. Motilal Banarasidas. Delhi.

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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» ºÁQgÀÄvÉÛÃ£É.)

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



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



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:


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



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:


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.

pandu kc003 kop

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